Gabriel J Escobar
Biographic Data
| ID | 1742386 |
|---|---|
| NAME | Gabriel J Escobar |
| GIVEN NAMES | Gabriel J |
| FAMILY NAME | Escobar |
| SIGNATURE | ESCOBAR G J |
| AFFILIATIONS | Kaiser Permanente |
| ORCID | 0000-0003-2540-3327 |
| VERIFIED | Yes |
| TOTAL WORKS | 13 |
| TOTAL CITATIONS | 21 |
| AUTHOR COUNT | 13 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1983 |
| LATEST PUBLICATION YEAR | 2021 |
| H-INDEX | 2 |
Evaluation of Vaccination Strategies to Compare Efficient and Equitable Vaccine Allocation by Race and Ethnicity Across Time
In this simulation modeling study of adults from a large integrated health care delivery system, risk-based strategies were associated with the largest estimated reductions in COVID-19 hospitalizations, deaths, and household transmissions compared with the CDC proxy and age-based strategies, with a higher proportion of Hispanic and Black patients were estimated to be vaccinated early in the process compared with the CDC strategy
Hospital-specific Template Matching for Benchmarking Performance in a Diverse Multihospital System
BACKGROUND: Hospital-specific template matching is a newer method of hospital performance measurement that may be fairer than regression-based benchmarking. However, it has been tested in only limited research settings. OBJECTIVE: The objective of this study was to test the feasibility of hospital-specific template matching assessments in the Veterans Affairs (VA) health care system and determine power to detect greater-than-expected 30-day morta…
The Impact of Pharmacy-specific Predictors on the Performance of 30-Day Readmission Risk Prediction Models
RESEARCH OBJECTIVE: Pharmacists are an expensive and limited resource in the hospital and outpatient setting. A pharmacist can spend up to 25% of their day planning. Time spent planning is time not spent delivering an intervention. A readmission risk adjustment model has potential to be used as a universal outcome-based prioritization tool to help pharmacists plan their interventions more efficiently. Pharmacy-specific predictors have not been us…
Incorporating Longitudinal Comorbidity and Acute Physiology Data in Template Matching for Assessing Hospital Quality
OBJECTIVE: We sought to build on the template-matching methodology by incorporating longitudinal comorbidities and acute physiology to audit hospital quality. STUDY SETTING: Patients admitted for sepsis and pneumonia, congestive heart failure, hip fracture, and cancer between January 2010 and November 2011 at 18 Kaiser Permanente Northern California hospitals. STUDY DESIGN: We generated a representative template of 250 patients in 4 diagnosis gro…
Nonelective Rehospitalizations and Postdischarge Mortality
BACKGROUND: Hospital discharge planning has been hampered by the lack of predictive models. OBJECTIVE: To develop predictive models for nonelective rehospitalization and postdischarge mortality suitable for use in commercially available electronic medical records (EMRs). DESIGN: Retrospective cohort study using split validation. SETTING: Integrated health care delivery system serving 3.9 million members. PARTICIPANTS: A total of 360,036 surviving…
Accuracy of Hospital Standardized Mortality Rates
BACKGROUND: Risk-adjusted mortality rates are commonly used in quality report cards to compare hospital performance. The risk adjustment depends on models that are assessed for goodness-of-fit using various discrimination and calibration measures. However, the relationship between model fit and the accuracy of hospital comparisons is not well characterized. OBJECTIVES: To evaluate the impact of imperfect model calibration (miscalibration) on the …
Risk-adjusting Hospital Mortality Using a Comprehensive Electronic Record in an Integrated Health Care Delivery System
OBJECTIVE: Using a comprehensive inpatient electronic medical record, we sought to develop a risk-adjustment methodology applicable to all hospitalized patients. Further, we assessed the impact of specific data elements on model discrimination, explanatory power, calibration, integrated discrimination improvement, net reclassification improvement, performance across different hospital units, and hospital rankings. DESIGN: Retrospective cohort stu…
Interpersonal Processes of Care and Cesarean Delivery in Two Health Care Settings
Objectives. We examined whether interpersonal processes of care (IPC) were associated with cesarean delivery. Methods. We performed a cross-sectional study of 1308 postpartum women at Kaiser Permanente Medical Center in Walnut Creek, CA (KP-WC), and San Francisco General Hospital (SFGH) from 2004 to 2006. Using interview and medical record data, logistic regression analyses estimated the odds of cesarean delivery as a function of IPC domains. Res…
Derivation and Validation of a Model to Predict Daily Risk of Death in Hospital
BACKGROUND: As electronic patient data from automated hospital databases become increasingly available, it is important to explore the ways in which these data could be used for the purposes other than patient care, such as quality assurance and improvement. OBJECTIVE: To determine if information from automated patient databases can be used to derive a model that can predict patients' daily risk of death in hospital. Such a model could be used to…
Effect of Choice of Estimation Method on Inter-Hospital Mortality Rate Comparisons
OBJECTIVE: To evaluate and compare the use of 6 different methods for calculating expected mortality rates and standardized mortality ratios (SMRs) when performing interhospital mortality rate comparisons. DESIGN: Retrospective cohort study using actual and simulated hospitalization data to evaluate the use of (1) fixed-effects, (2) Generalized Linear Mixed Model, and (3) Bayesian (Markov Chain Monte Carlo-based) random-effects models on both agg…
Length of Stay Predictions
BACKGROUND: Length of stay (LOS) is a common measure of hospital resource utilization. Most methods for risk-adjusting LOS are limited by the use of only administrative data. Recent studies suggest that adding automated clinical data to these models improves performance. OBJECTIVES: To evaluate the utility of adding "point of admission" automated laboratory and comorbidity measures-the Laboratory Acute Physiology Score (LAPS) and Comorbidity Poin…
Risk-Adjusting Hospital Inpatient Mortality Using Automated Inpatient, Outpatient, and Laboratory Databases
OBJECTIVES: To develop a risk-adjustment methodology that maximizes the use of automated physiology and diagnosis data from the time period preceding hospitalization. DESIGN: : Retrospective cohort study using split-validation and logistic regression. SETTING: Seventeen hospitals in a large integrated health care delivery system. SUBJECTS: Patients (n = 259,699) hospitalized between January 2002 and June 2005. MAIN OUTCOME MEASURES: Inpatient and…
Beliefs regarding the etiology and treatment of infantile diarrhea in Lima, Peru
Beliefs regarding the etiology and treatment of infantile diarrhea in Lima, Peru
Interpersonal Processes of Care and Cesarean Delivery in Two Health Care Settings
Objectives. We examined whether interpersonal processes of care (IPC) were associated with cesarean delivery. Methods. We performed a cross-sectional study of 1308 postpartum women at Kaiser Permanente Medical Center in Walnut Creek, CA (KP-WC), and San Francisco General Hospital (SFGH) from 2004 to 2006. Using interview and medical record data, logistic regression analyses estimated the odds of cesarean delivery as a function of IPC domains. Res…
Beliefs regarding the etiology and treatment of infantile diarrhea in Lima, Peru
Risk-Adjusting Hospital Inpatient Mortality Using Automated Inpatient, Outpatient, and Laboratory Databases
OBJECTIVES: To develop a risk-adjustment methodology that maximizes the use of automated physiology and diagnosis data from the time period preceding hospitalization. DESIGN: : Retrospective cohort study using split-validation and logistic regression. SETTING: Seventeen hospitals in a large integrated health care delivery system. SUBJECTS: Patients (n = 259,699) hospitalized between January 2002 and June 2005. MAIN OUTCOME MEASURES: Inpatient and…
Effect of Choice of Estimation Method on Inter-Hospital Mortality Rate Comparisons
OBJECTIVE: To evaluate and compare the use of 6 different methods for calculating expected mortality rates and standardized mortality ratios (SMRs) when performing interhospital mortality rate comparisons. DESIGN: Retrospective cohort study using actual and simulated hospitalization data to evaluate the use of (1) fixed-effects, (2) Generalized Linear Mixed Model, and (3) Bayesian (Markov Chain Monte Carlo-based) random-effects models on both agg…
Length of Stay Predictions
BACKGROUND: Length of stay (LOS) is a common measure of hospital resource utilization. Most methods for risk-adjusting LOS are limited by the use of only administrative data. Recent studies suggest that adding automated clinical data to these models improves performance. OBJECTIVES: To evaluate the utility of adding "point of admission" automated laboratory and comorbidity measures-the Laboratory Acute Physiology Score (LAPS) and Comorbidity Poin…
Derivation and Validation of a Model to Predict Daily Risk of Death in Hospital
BACKGROUND: As electronic patient data from automated hospital databases become increasingly available, it is important to explore the ways in which these data could be used for the purposes other than patient care, such as quality assurance and improvement. OBJECTIVE: To determine if information from automated patient databases can be used to derive a model that can predict patients' daily risk of death in hospital. Such a model could be used to…
Interpersonal Processes of Care and Cesarean Delivery in Two Health Care Settings
Objectives. We examined whether interpersonal processes of care (IPC) were associated with cesarean delivery. Methods. We performed a cross-sectional study of 1308 postpartum women at Kaiser Permanente Medical Center in Walnut Creek, CA (KP-WC), and San Francisco General Hospital (SFGH) from 2004 to 2006. Using interview and medical record data, logistic regression analyses estimated the odds of cesarean delivery as a function of IPC domains. Res…
Risk-adjusting Hospital Mortality Using a Comprehensive Electronic Record in an Integrated Health Care Delivery System
OBJECTIVE: Using a comprehensive inpatient electronic medical record, we sought to develop a risk-adjustment methodology applicable to all hospitalized patients. Further, we assessed the impact of specific data elements on model discrimination, explanatory power, calibration, integrated discrimination improvement, net reclassification improvement, performance across different hospital units, and hospital rankings. DESIGN: Retrospective cohort stu…
Accuracy of Hospital Standardized Mortality Rates
BACKGROUND: Risk-adjusted mortality rates are commonly used in quality report cards to compare hospital performance. The risk adjustment depends on models that are assessed for goodness-of-fit using various discrimination and calibration measures. However, the relationship between model fit and the accuracy of hospital comparisons is not well characterized. OBJECTIVES: To evaluate the impact of imperfect model calibration (miscalibration) on the …
Nonelective Rehospitalizations and Postdischarge Mortality
BACKGROUND: Hospital discharge planning has been hampered by the lack of predictive models. OBJECTIVE: To develop predictive models for nonelective rehospitalization and postdischarge mortality suitable for use in commercially available electronic medical records (EMRs). DESIGN: Retrospective cohort study using split validation. SETTING: Integrated health care delivery system serving 3.9 million members. PARTICIPANTS: A total of 360,036 surviving…
Incorporating Longitudinal Comorbidity and Acute Physiology Data in Template Matching for Assessing Hospital Quality
OBJECTIVE: We sought to build on the template-matching methodology by incorporating longitudinal comorbidities and acute physiology to audit hospital quality. STUDY SETTING: Patients admitted for sepsis and pneumonia, congestive heart failure, hip fracture, and cancer between January 2010 and November 2011 at 18 Kaiser Permanente Northern California hospitals. STUDY DESIGN: We generated a representative template of 250 patients in 4 diagnosis gro…
The Impact of Pharmacy-specific Predictors on the Performance of 30-Day Readmission Risk Prediction Models
RESEARCH OBJECTIVE: Pharmacists are an expensive and limited resource in the hospital and outpatient setting. A pharmacist can spend up to 25% of their day planning. Time spent planning is time not spent delivering an intervention. A readmission risk adjustment model has potential to be used as a universal outcome-based prioritization tool to help pharmacists plan their interventions more efficiently. Pharmacy-specific predictors have not been us…
Evaluation of Vaccination Strategies to Compare Efficient and Equitable Vaccine Allocation by Race and Ethnicity Across Time
In this simulation modeling study of adults from a large integrated health care delivery system, risk-based strategies were associated with the largest estimated reductions in COVID-19 hospitalizations, deaths, and household transmissions compared with the CDC proxy and age-based strategies, with a higher proportion of Hispanic and Black patients were estimated to be vaccinated early in the process compared with the CDC strategy
Hospital-specific Template Matching for Benchmarking Performance in a Diverse Multihospital System
BACKGROUND: Hospital-specific template matching is a newer method of hospital performance measurement that may be fairer than regression-based benchmarking. However, it has been tested in only limited research settings. OBJECTIVE: The objective of this study was to test the feasibility of hospital-specific template matching assessments in the Veterans Affairs (VA) health care system and determine power to detect greater-than-expected 30-day morta…
Medicine (12 works) · Internal Medicine (9 works) · Sepsis Diagnosis and Treatment (9 works) · Internal Medicine (8 works) · Emergency Medicine (7 works) · Emergency Medicine (7 works) · Statistics (7 works) · Retrospective cohort study (6 works) · Comorbidity (5 works) · Health care (4 works)