Linking Clinical Data to Administrative Data - AHRQ Contract with MHA
Linking Clinical Data to Administrative Data - AHRQ Contract with MHA
Potential Benefits to Participants in the Project
Michael Pine, M.D., M.B.A.
Michael Pine and Associates, Inc.
President
January 15, 2008
Potential Benefits to Participants
- Evaluation and improvement of data quality
- Evaluation of comparative performance as a guide to quality improvement
- Optional opportunity to explore value of enhanced coding of symptoms and clinical findings
Importance of Data Quality
- Distinction between conditions present on admission (comorbidities) and hospital-acquired complications will become increasingly important in quality assessment and in hospital reimbursement
- Underreporting or improper designation of hospital-acquired complications may result in distorted performance profiles and in financial penalties
Evaluation of Data Quality (1)
- Rates chronic conditions are not reported as POA
- Comparison of rates chronic conditions and associated combination codes are reported as POA
- Comparison of rates of reported hospital-acquired complications in high-risk patients discharged dead and discharged alive
Evaluation of Data Quality (2)
- Rates conditions reported as POA are associated with normal diagnostic admission laboratory data
- Rates cases with prolonged risk-adjusted lengths of stay do not have at least one reported hospital-acquired complication
Evaluation of Comparative Performance
- Evaluation of measured post-operative complication rates with and without validation using POA code and associated laboratory data
- Evaluation of hospital’s comparative risks of death and post-operative complications and its risk-adjusted outcome rates with and without enhancement of its analytic database
Risk-Adjusted Mortality - CABG Surgery
Chart of risk-adjusted mortality in percent for CABG surgery
Chart shows confidence interval, predicted percent risk-adjusted mortality, observed percent risk-adjusted mortality, and p-value of predicted to observed percent risk-adjusted mortality for CABG surgery by hospital.
Chart does not include data values, so range of values are estimated.
| Hospital Number |
Confidence Limit (Lower) |
Confidence Limit (Upper) |
Predicted percent risk-adjusted mortality |
Observed percent risk-adjusted mortality |
P-value of predicted to observed percent mortality |
| Hospital 6 |
1.5% to 2.0% |
4.5% to 5.0% |
3.0% to 3.5% |
1.5% to 2.0% |
p = 0.001 to 0.01 |
| Hospital 7 |
2.0% to 2.5% |
4.0% to 4.5% |
3.0% to 3.5% |
2.0% to 2.5% |
p = 0.01 to 0.05 |
| Hospital 18 |
1.0% to 1.5% |
7.5% to 8.0% |
4.0% to 4.5% |
2.0% to 2.5% |
p = 0.01 to 0.05 |
| Hospital 13 |
1.5% to 2.0% |
5.0% to 5.5% |
3.5% to 4.0% |
2.5% to 3.0% |
p is greater than 0.05 |
| Hospital 1 |
0.5% to 1.0% |
5.0% to 5.5% |
3.0% to 3.5% |
1.5% to 2.0% |
p is greater than 0.05 |
| Hospital 10 |
0.0% |
4.0% to 4.5% |
2.0% to 2.5% |
1.0% to 1.5% |
p is greater than 0.05 |
| Hospital 14 |
0.5% to 1.0% |
4.5% to 5.0% |
2.5% to 3.0% |
2.0% to 2.5% |
p is greater than 0.05 |
| Hospital 5 |
1.0% to 1.5% |
6.5% to 7.0% |
3.5% to 4.0% |
3.0% to 3.5% |
p is greater than 0.05 |
| Hospital 3 |
0.0% to 0.5% |
4.5% to 5.0% |
2.5% to 3.0% |
2.0% to 2.5% |
p is greater than 0.05 |
| Hospital 12 |
0.0% |
3.5% to 4.0% |
1.5% to 2.0% |
1.5% to 2.0% |
p is greater than 0.05 |
| Hospital 11 |
0.0% to 0.5% |
4.5% to 5.0% |
2.5% to 3.0% |
2.5% to 3.0% |
p is greater than 0.05 |
| Hospital 17 |
0.5% to 1.0% |
4.0% to 4.5% |
2.5% to 3.0% |
2.5% to 3.0% |
p is greater than 0.05 |
| Hospital 16 |
0.5% to 1.0% |
5.0% to 5.5% |
2.5% to 3.0% |
3.0% to 3.5% |
p is greater than 0.05 |
| Hospital 15 |
0.0% |
3.0% to 3.5% |
1.0% to 1.5% |
2.0% to 2.5% |
p is greater than 0.05 |
| Hospital 9 |
1.5% to 2.0% |
4.0% to 4.5% |
2.5% to 3.0% |
3.0% to 3.5% |
p is greater than 0.05 |
| Hospital 8 |
1.0% to 1.5% |
3.5% to 4.0% |
2.0% to 2.5% |
2.5% to 3.0% |
p is greater than 0.05 |
| Hospital 2 |
1.0% to 1.5% |
4.5% to 5.0% |
3.0% to 3.5% |
3.5% to 4.0% |
p is greater than 0.05 |
| Hospital 4 |
0.5% to 1.0% |
5.5% to 6.0% |
3.0% to 3.5% |
4.5% to 5.0% |
p = 0.01 to 0.05 |
Risk-Adjusted Mortality Rates
- Acute Myocardial Infarction
- Congestive Heart Failure
- Acute Cerebrovascular Accident
- Gastrointestinal Hemorrhage
- Pneumonia
- Coronary Artery Bypass Graft Surgery
- Percutaneous Transluminal Coronary Angioplasty
Risk-Adjusted Post-Op Complications
- Respiratory Failure
- Pulmonary Embolism / Deep Vein Thrombosis
- Sepsis
- Acute Myocardial Infarction
Enhanced Coding of Clinical Findings
- Some ICD-9-CM codes for important symptoms and clinical findings often are underreported, in many cases because coding regulations preclude their use in conjunction with many diagnostic codes
- Examples are: coma (780.01), severe malnutrition (260, 261, 262), tachycardia (785.0), tachypnea (786.06), fever (780.6), hypotension (458.9), pleural effusion (511.9)
Collection of Supplementary Codes
- Permits evaluation of additional improvement in risk-adjustment of clinical outcomes
- Prepares facility for future enhancements to billing databases with revisions of coding standards and analytic practices
- Collection of supplementary codes is not required for participation in this project
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