Screening Inpatient Quality Using Post-Discharge Events

Bibliographic Data

ID9099819
AuthorsLisa I Iezzoni (0000-0002-1416-5039, Beth Israel Deaconess Medical Center, corresponding author), Yevgenia D Mackiernan (Harvard University, corresponding author), Michael J Cahalane (Beth Israel Deaconess Medical Center), Richard S Phillips (0000-0002-7281-7154, Harvard University, corresponding author), RUSSELL S PHILLIPS, Roger B Davis (0000-0003-3330-3123, Harvard University, corresponding author), Kristin Miller (0000-0001-7820-989X, Beth Israel Deaconess Medical Center, corresponding author)
Year1999
Volume37
Issue4
Pages384-398
Publication date1999-04-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-199904000-00008
PMID10213019
OpenAlexW2074471778
LanguageEN
Citations received5
References cited33

BACKGROUND: Decreasing hospital lengths of stay (LOS) hamper efforts to detect and to definitively treat complications of care. Patients leave before some complications are identified. OBJECTIVES: To develop a computerized method to screen for hospital complications using readily available administrative data from outpatient and nonacute care within 90 days of discharge. DESIGN: We developed the Complications Screening Program for Outpatient data (CSP-O) by using diagnosis and procedure codes from Medicare Part A and B claims to define 50 complication screens. Seventeen apply to specific procedural cases, and 33 apply to all adult, acute, medical, or surgical hospitalizations. The CSP-O algorithm examined outpatient, physician office, home health agency, and hospice claims within 90 days following discharge. SUBJECTS: Seven hundred thirty nine thousand, two hundred and forty eight discharges of Medicare beneficiaries (age range, > or = 65 years) were admitted to 515 hospitals nationwide in 1994. RESULTS: Complete 90-day, post-discharge windows were present for 62.8% of all and 68.5% of procedural cases. The 33 general screens flagged 13.6% of all cases; only 1.8% of procedural cases were flagged by the 17 procedural screens. When we allowed the CSP-O algorithm to scan information from acute hospital readmissions, flag rates rose to 32.8% for general and 8.7% for procedural complications. Controlling for patient and hospital characteristics, flag rates were considerably higher among the very old and at small and for-profit institutions. CONCLUSIONS: Whereas several CSP-O findings have construct validity, limitations of claims raise concerns. Regardless of the CSPO's ultimate utility, examining post-discharge experiences to identify inpatient complications remains important as LOSs fall

Ambulatory · Current Procedural Terminology · Diagnosis-related group · Health care · Hospital discharge · Intensive care medicine · Medical emergency · MEDLINE · Operations management · Outpatient surgery · Patient discharge · Quality management · Emergency Medicine · Heart Failure Treatment and Management · Hospital Admissions and Outcomes · Medicine · Sepsis Diagnosis and Treatment · Surgery

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