Case‐Mix Adjusting Performance Measures in a Veteran Population: Pharmacy‐ and Diagnosis‐Based Approaches

Health Services Research - Tập 38 Số 5 - Trang 1319-1338 - 2003
Chuan‐Fen Liu1, Anne Sales1, NANCY SHARP1, Paul Fishman2,1, Kevin L. Sloan1, Jeff Todd-Stenberg3, W. Paul Nichol1, Amy K. Rosen4,5, Susan Loveland4,5
1University of Washington
2Group Health Cooperative
3VA Puget Sound Health Care System
4Boston University
5VA Medical Center

Tóm tắt

Objective. To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy‐ and diagnosis‐based case‐mix adjustment measures.Data Sources/Study Setting. The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse.Study Design. We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care.Principal Findings. Rankings of predicted utilization measures across facilities vary by case‐mix adjustment measure. There is greater consistency within the diagnosis‐based models than between the diagnosis‐ and pharmacy‐based models. The eight facilities were ranked differently by the diagnosis‐ and pharmacy‐based models.Conclusions. Choice of case‐mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility.

Từ khóa


Tài liệu tham khảo

Ash A. S., 2000, Using Diagnoses to Describe Populations and Predict Costs, Health Care Financing Review, 21, 7

10.1097/00005650-199806000-00003

10.1097/00005650-200108000-00013

10.1097/00005650-199806000-00015

10.1017/CBO9780511814365

Chang W., 1996, Applying Case Mix Adjustment in Profiling Primary Care Physician Performance, Journal of Health Care Finance, 22, 1

Ciesco E. andM.Greenblatt.1999. “Implementing a Performance Measurement System at the Veterans Health Administration.” Paper presented at the International Quality and Productivity Center Ninth National Performance Measure Conference September 14 Arlington VA.

10.1097/00005650-199508000-00004

10.2307/1391852

10.2307/1391711

10.1097/00005650-199010000-00003

Ellis R. P., 1995, Refinements to the Diagnostic Cost Group (DCG) Model, Inquiry, 32, 418

Ellis R. P., 1996, Diagnosis‐Based Risk Adjustment for Medicare Capitation Payments, Health Care Financing Review, 17, 101

Fishman P. A., 2003, Risk Adjustment Using Automated Pharmacy Data, Medical Care, 41, 84, 10.1097/00005650-200301000-00011

10.1097/00005650-199909000-00004

10.1046/j.1525-1497.2000.04079.x

10.1097/00005650-200111000-00006

Hornbrook M. C., 1991, Health Plan Case Mix, Advances in Health Economics and Health Services Research, 12, 111

Hughes J. S., 1997, Risk Adjustment for Measuring Healthcare Outcomes, 263

10.1016/0895-4356(94)90106-6

Judge G. G., 1985, The Theory and Practice of Econometrics

Kanji G. K., 1993, 100 Statistical Tests

10.1097/00005650-199809000-00005

10.1177/106286069901400105

Kizer K. W., 1996, Prescription for Change

Kizer K. W., 2000, Reinventing VA Health Care, Medical Care, 38, I 7

Kronick R., 2000, Improving Health‐Based Payment for Medicaid beneficiaries, Health Care Financing Review, 21, 29

10.1097/00005650-199908000-00012

10.1097/00004479-199610000-00008

Parente S. T., 1996, Profiling Resource Use by Primary‐Care Practices, Health Care Financing Review, 17, 23

Phibbs C. S., 1997, Does Case Mix Matter for Substance Abuse Treatment?, Health Services Research, 31, 755

Pietz K. M.Byrne andN.Petersen.2000. Results of Profiling Methodology Working Group.” Paper presented at the CHIPS Annual Meeting August Seattle Wash.

Pope G. C., 2000, The Principal Inpatient Diagnostic Cost Group Model for Medicare Risk Adjustment, Health Care Financing Review, 21, 93

Roblin D. W., 1994, Patient Case Mix Measurement Using Outpatient Drug Dispense Data, Managed Care Quarterly, 2, 38

10.1097/00004479-199810000-00006

Rosen A. K. A.Ash J.Rothendler andS.Loveland.1999. “Implementing Ambulatory Care Case‐Mix Measures in the VA: from Theory to Practice.” Paper presented at the VA HSR&D annual meeting Washington DC February.

10.1097/00005650-200107000-00006

Salem‐Schatz S., 1994, The Case for Case‐Mix Adjustment in Practice Profiling, Journal of the American Medical Association, 272, 871, 10.1001/jama.1994.03520110051028

Sales A. E., 2003, Predicting Costs of Care Using a Pharmacy‐Based Measure, Medical Care, 41, 753, 10.1097/01.MLR.0000069502.75914.DD

10.1097/00005650-200203000-00007

Sloan K. L., 2003, Construction and Characteristics of the RxRisk‐V, Medical Care, 41, 761, 10.1097/01.MLR.0000064641.84967.B7

Starfield B., 1991, Ambulatory Care Groups, Health Services Research, 26, 53

10.1097/00005650-198808000-00007

Szeto H. andM.Goldstein.1999. “Accuracy of Computer Identified Diagnoses in a VA General Medicine Clinic.” Unpublished paper.

Veterans Health Administration. Office of Quality and Performance., 2000, FY2001 VA Performance Measurement System Technical Manual

10.1016/0895-4356(92)90016-G

10.1097/00005650-199105000-00006

10.1377/hlthaff.16.4.200

Thông tin
Thông tin xuất bản

Health Services Research

Tập 38 Số 5

1319-1338

Thông tin tác giả