Goldman L Elizabeth, Chu Philip W, Bacchetti Peter, Kruger Jenna, Bindman Andrew
Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA.
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
Health Serv Res. 2015 Jun;50(3):922-38. doi: 10.1111/1475-6773.12239. Epub 2014 Oct 6.
To evaluate how the accuracy of present-on-admission (POA) reporting affects hospital 30-day acute myocardial infarction (AMI) mortality assessments.
A total of 2005 California patient discharge data (PDD) and vital statistics death files.
We compared hospital performance rankings using an established model assessing hospital performance for AMI with (1) a model incorporating POA indicators of whether a secondary condition was a comorbidity or a complication of care, and (2) a simulation analysis that factored POA indicator accuracy into the hospital performance assessment. For each simulation, we changed POA indicators for six major acute risk factors of AMI mortality. The probability of POA being changed depended on patient and hospital characteristics.
Comparing the performance rankings of 268 hospitals using the established model with that using the POA indicator, 67 hospitals' (25 percent) rank differed by ≥10 percent. POA reporting inaccuracy due to overreporting and underreporting had little additional impact; POA overreporting contributed to 4 percent of hospitals' difference in rank compared to the POA model and POA underreporting contributed to <1 percent difference.
Incorporating POA indicators into risk-adjusted models of AMI care has a substantial impact on hospital rankings of performance that is not primarily attributable to inaccuracy in POA hospital reporting.
评估入院时存在情况（POA）报告的准确性如何影响医院30天急性心肌梗死（AMI）死亡率评估。
总共2005份加利福尼亚州患者出院数据（PDD）和生命统计死亡档案。
我们使用一个既定模型比较医院绩效排名，该模型评估AMI的医院绩效，（1）一个纳入次要病症是合并症还是护理并发症的POA指标的模型，以及（2）一个将POA指标准确性纳入医院绩效评估的模拟分析。对于每次模拟，我们改变了AMI死亡率的六个主要急性风险因素的POA指标。POA被改变的概率取决于患者和医院特征。
将使用既定模型的268家医院的绩效排名与使用POA指标的排名进行比较，67家医院（25%）的排名差异≥10%。由于报告过多和报告不足导致的POA报告不准确几乎没有额外影响；与POA模型相比，POA报告过多导致4%的医院排名差异，POA报告不足导致的差异<1%。
将POA指标纳入AMI护理的风险调整模型对医院绩效排名有重大影响，这主要不是由于POA医院报告不准确造成的。
