Does adding clinical data to administrative data improve agreement among hospital quality measures?

Background: Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system.

Methods: We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA).

Using Harm-Based Weights for the AHRQ Patient Safety for Selected Indicators Composite (PSI-90): Does It Affect Assessment of Hospital Performance and Financial Penalties in Veterans Health Administration Hospitals?

Objective: To assess whether hospital profiles for public reporting and pay-for-performance, measured by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety for Selected Indicators (PSI-90) composite measure, were affected by using the recently developed harm-based weights.

Data Sources/study Setting: Retrospective analysis of 2012-2014 data from the Veterans Health Administration (VA).

Study Design: The AHRQ PSI software (v5.

A Systematic Review of Patient Safety Measures in Adult Primary Care.

Safety measure development has focused on inpatient care despite outpatient visits far outnumbering inpatient admissions. Some measures are clearly identified as outpatient safety measures when published, yet outcomes from quality improvement studies also may be useful measures. The authors conducted a systematic review of the literature to identify published articles detailing safety measures applicable to adult primary care.

Universal Health Care Identifiers: The Challenge of Linking Medical Records.

Many patients have a primary care physician and an assortment of specialists they might see regularly or even just once. Patients' use of multiple clinicians and clinical organizations increases the need to share health information among providers to reduce the probability of medical errors, improve quality in general, and eliminate unnecessary costs. An obstacle to sharing records is the absence of a common identifier used by all of a patient's providers.

Classification of patients with incident non-specific low back pain: implications for research.

Background Context: Comparing research studies of low back pain is difficult because of heterogeneity. There is no consensus among researchers on inclusion criteria or the definition of an episode.

Purpose: This study aimed to determine pattern(s) of recurrent non-specific low back pain from data collected over 27 months.

The Economics of Reproducibility in Preclinical Research.

Low reproducibility rates within life science research undermine cumulative knowledge production and contribute to both delays and costs of therapeutic drug development. An analysis of past studies indicates that the cumulative (total) prevalence of irreproducible preclinical research exceeds 50%, resulting in approximately US$28,000,000,000 (US$28B)/year spent on preclinical research that is not reproducible-in the United States alone. We outline a framework for solutions and a plan for long-term improvements in reproducibility rates that will help to accelerate the discovery of life-saving therapies and cures.

Cost-utility of cognitive behavioral therapy for low back pain from the commercial payer perspective.

Study Design: Markov cost-utility model.

Objective: To evaluate the cost-utility of cognitive behavioral therapy (CBT) for the treatment of persistent nonspecific low back pain (LBP) from the perspective of US commercial payers.

Summary Of Background Data: CBT is widely deemed clinically effective for LBP treatment.

Emergency Department Use in the US-Mexico Border Region and Violence in Mexico: Is There a Relationship?

Purpose: This study assessed the association between homicide rates in northern Mexico and potentially avoidable use of emergency departments (ED) in the US-Mexico border region. The border region is largely rural and underserved, making the identification and correction of potential barriers to access crucial.

Methods: We used secondary data from state inpatient and ED discharge databases for California and Arizona for 2005-2010.

The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.

Background: Substantial proportions of US residents in the USA-Mexico border region cross into Mexico for health care; increases in violence in northern Mexico may have affected this access. We quantified associations between violence in Mexico and decreases in access to care for border county residents. We also examined associations between border county residence and access.

Partnering With VA Stakeholders to Develop a Comprehensive Patient Safety Data Display: Lessons Learned From the Field.

Health care systems are increasingly burdened by the large numbers of safety measures currently being reported. Within the Veterans Administration (VA), most safety reporting occurs within organizational silos, with little involvement by the frontline users of these measures. To provide a more integrated picture of patient safety, the study team partnered with multiple VA stakeholders and engaged potential frontline users at 2 hospitals to develop a Guiding Patient Safety (GPS) tool.

Building the case for quality improvement in the health care industry: a focus on goals and training.

Health care organizations are under intense pressure to improve the efficiency and effectiveness of care delivery and, increasingly, they are using quality improvement teams to identify and target projects to improve performance outcomes. This raises the question of what factors actually drive the performance of these projects in a health care environment. Using data from a survey of health care professionals acting as informants for 244 patient care, clinical-administrative, and nonclinical administrative quality improvement project types in 93 health care organizations, we focus on 2 factors--goal setting and quality training--as potential drivers of quality improvement project performance.

Exploring the Association of Homicides in Northern Mexico and Healthcare Access for US Residents.

Many legal residents in the United States (US)-Mexico border region cross from the US into Mexico for medical treatment and pharmaceuticals. We analyzed whether recent increases in homicides in Mexico are associated with reduced healthcare access for US border residents. We used data on healthcare access, legal entries to the US from Mexico, and Mexican homicide rates (2002-2010).

Advanced diagnostic imaging in privately insured patients: recent trends in utilization and payments.

Recent studies have reported that the rate of growth in utilization of noninvasive diagnostic imaging has slowed, with a concomitant reduction in total payments to providers in the Medicare Part B fee-for-service population. Utilization and payment growth trends in commercially insured populations, however, are not as well understood. We used the Truven Health Analytics MarketScan® Commercial Claims and Encounters database containing more than 29 million individuals to investigate commercially insured population trends in utilization of and payments for CT, MRI, PET, and ultrasound procedures in the years 2007-2011.

Impact of provider coordination on nurse and physician perceptions of patient care quality.

The objective of this study was to assess the role of provider coordination on nurse manager and physician perceptions of care quality, while controlling for organizational factors. Findings indicated that nurse-nurse coordination was positively associated with nurse manager perceptions of care quality; neither physician-physician nor physician-nurse coordination was associated with physician perceptions. Organizational factors associated with positive perceptions of care quality included facility support of education for nurses and physicians, and the use of multidisciplinary rounding.

The effects of health information technology on the costs and quality of medical care.

Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998 to 2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals' adoption statuses over time, analyzing 2.

Organizational predictors of coordination in inpatient medicine.

Background: As the care of hospitalized patients becomes more complex, intraprofessional coordination among nurses and among physicians, and interprofessional coordination between these groups are likely to play an increasingly important role in the provision of hospital care.

Purpose: The purpose of this study was to identify the independent effects of organizational factors on provider ratings of overall coordination in inpatient medicine (OCIM).

Methodology/approach: This was an exploratory cross-sectional, descriptive study.

Medical and surgical readmissions in the Veterans Health Administration: what proportion are related to the index hospitalization?

Background: Readmissions are an attractive quality measure because they offer a broad view of quality beyond the index hospitalization. However, the extent to which medical or surgical readmissions reflect quality of care is largely unknown, because of the complexity of factors related to readmission. Identifying those readmissions that are clinically related to the index hospitalization is an important first step in closing this knowledge gap.

Distinct communication patterns during genetic counseling for late-onset Alzheimer's risk assessment.

Objective: To identify and characterize patient-provider communication patterns during disclosure of Alzheimer's disease genetic susceptibility test results and to assess whether these patterns reflect differing models of genetic counseling.

Methods: 262 genetic counseling session audio-recordings were coded using the Roter Interactional Analysis System. Cluster analysis was used to distinguish communication patterns.

Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicator Rates Among Veteran Dual Users.

This study compares rates of 11 Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) among 266 203 veteran dual users (ie, those with hospitalizations in both the Veterans Health Administration [VA] and the private sector through Medicare fee-for-service coverage) during 2002 to 2007. PSI risk-adjusted rates were calculated using the PSI software (version 3.1a).

Open questions concerning influences on clinical decision making.

Efforts to influence utilization of services to bring down spending and to improve quality of care have largely failed. A critical reason is that most attention has focused on dysfunctional financial incentives without considering other factors that also influence physicians' utilization decisions. In this article, after providing a framework for ideal physician-patient interactions, questions are also raised about other influences, including physicians' impulse to help patients, professional codes of ethics, the threat of malpractice claims, and the leadership of health care organizations.

Fiscal strategy in an era of reform.

In a reform environment, hospitals and health systems should be able to control-rather than simply understand-their costs. Senior managers and line managers throughout a healthcare organization should be solidly behind-and deeply involved in-the organization's cost-control efforts. Physicians also should be heavily engaged in cost control, as they are the only ones who can both establish clinical pathways and monitor their colleagues' use of them.