Trends in the Inpatient Quality Indicators
The Veterans Health Administration Experience
Bibliographic Data
| ID | 9097589 |
|---|---|
| Authors | Ann M Borzecki (0000-0003-1894-1274, Boston University, corresponding author), Cindy L Christiansen (Boston University, corresponding author), Susan Loveland (Boston University), Priscilla Chew (Edith Nourse Rogers Memorial Veterans Hospital, corresponding author), Amy K Rosen (0000-0002-7539-7749, Boston University) |
| Year | 2010 |
| Volume | 48 |
| Issue | 8 |
| Pages | 694-702 |
| Publication date | 2010-08-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0b013e3181e419e3 |
| PMID | 20613657 |
| OpenAlex | W2088798286 |
| Language | EN |
| References cited | 26 |
BACKGROUND: The Agency for Healthcare Research and Quality Inpatient Quality Indicators (IQIs), which include in-hospital mortality and utilization rates, have received little attention in the Veterans Health Administration (VA), despite extensive private sector use for quality improvement. OBJECTIVES: We examined the following: the feasibility of applying the IQIs to VA data; temporal trends in national VA IQI rates; temporal and regional IQI trends in geographic areas defined by Veterans Integrated Service Networks' (VISNs); and VA versus non-VA (Nationwide Inpatient Sample) temporal trends. METHODS: We derived VA- and VISN-level IQI observed rates, risk-adjusted rates, and observed to expected ratios (O/Es), using VA inpatient data (2004-2007). We examined the trends in VA- and VISN-level rates using weighted linear regression, variation in VISN-level O/Es, and compared VA to non-VA trends. RESULTS: VA in-hospital mortality rates from selected medical conditions (stroke, hip fracture, pneumonia) decreased significantly over time; procedure-related mortality rates were unchanged. Laparoscopic cholecystectomy rates increased significantly. A few VISNs were consistently high or low outliers for the medical-related mortality IQIs. Within any given year, utilization indicators, especially cardiac catheterization and cholecystectomy, showed the most inter-VISN variation. Compared with the non-VA, VA medical-related mortality rates for the above-mentioned conditions decreased more rapidly, whereas laparascopic cholecystectomy rates rose more steeply. CONCLUSIONS: The IQIs are easily applied to VA administrative data. They can be useful to tracks rate trends over time, reveal variation between sites, and for trend comparisons with other healthcare systems. By identifying potential quality events related to mortality and utilization, they may complement existing VA quality improvement initiatives
Health care · Inpatient care · Mortality rate · Demography · Emergency Medicine · Healthcare Operations and Scheduling Optimization · Healthcare Policy and Management · Internal Medicine · Medicine · Primary Care and Health Outcomes
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| Highly cited | No |
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