Meehan T P, Hennen J, Radford M J, Petrillo M K, Elstein P, Ballard D J
Connecticut Peer Review Organization, Middletown, USA.
Ann Intern Med. 1995 Jun 15;122(12):928-36. doi: 10.7326/0003-4819-122-12-199506150-00007.
To evaluate the feasibility of linking claims-based pattern analysis with medical record review in the assessment of quality of hospital care among Medicare beneficiaries with acute myocardial infarction.
An analysis of risk-adjusted mortality after hospital admission for acute myocardial infarction using the regression model from the Health Care Financing Administration for predicting mortality rates. Hospital records for 300 patients admitted for myocardial infarction were abstracted to evaluate the accuracy of diagnostic coding and the adequacy of claims data-based risk adjustment and to assess process measures of quality care.
Six Connecticut hospitals in the pilot study of the Medicare Hospital Information Project.
Medicare beneficiaries 65 years of age or older who were hospitalized with a primary diagnosis of acute myocardial infarction from 1989 to 1991.
Principal diagnosis code verification rates for acute myocardial infarction; observed mortality rates at 30 and 365 days; 30-day standardized mortality ratios; and utilization rates for thrombolytic agents, aspirin, and beta-blockers.
The coding of acute myocardial infarction diagnosis had an overall accuracy of 96%. Little change was noted in relative mortality ratio hospital rank order after the exclusion of 13 patients who did not fulfill criteria for acute myocardial infarction and after additional risk adjustment with Killip class data. Utilization rates for therapies among eligible patients were as follows: aspirin, 73%; beta-blockers, 41%; and thrombolytic agents, 43%. The use of thrombolytic agents was associated with a lower 30-day mortality; the use of thrombolytic agents, aspirin, and beta-blockers was related to lower mortality rates at 1 year after discharge; and the use of these three therapies was lower in the two hospitals with the highest risk-adjusted mortality.
Medicare principal diagnosis codes for acute myocardial infarction were accurate in the six study hospitals. Therapies that have been endorsed by clinicians in Connecticut were underused in elderly patients. Pattern analysis of Medicare claims data can be useful as a quality-of-care screening tool; however, additional clinical information is required to stimulate quality improvement efforts within hospitals.
评估在评估急性心肌梗死医疗保险受益人的医院护理质量时，将基于索赔的模式分析与病历审查相结合的可行性。
使用医疗保健财务管理局的回归模型对急性心肌梗死后住院的风险调整死亡率进行分析，以预测死亡率。提取300例因心肌梗死入院患者的医院记录，以评估诊断编码的准确性、基于索赔数据的风险调整的充分性，并评估质量护理的过程指标。
康涅狄格州的六家医院参与医疗保险医院信息项目的试点研究。
1989年至1991年因急性心肌梗死作为主要诊断住院的65岁及以上医疗保险受益人。
急性心肌梗死的主要诊断编码验证率；30天和365天的观察死亡率；30天标准化死亡率；以及溶栓剂、阿司匹林和β受体阻滞剂的使用率。
急性心肌梗死诊断编码的总体准确率为96%。在排除13例不符合急性心肌梗死标准的患者并使用Killip分级数据进行额外风险调整后，相对死亡率医院排名顺序变化不大。符合条件患者的治疗使用率如下：阿司匹林73%；β受体阻滞剂41%；溶栓剂43%。使用溶栓剂与较低的30天死亡率相关；使用溶栓剂、阿司匹林和β受体阻滞剂与出院后1年较低的死亡率相关；在风险调整死亡率最高的两家医院中，这三种疗法的使用较低。
在六家研究医院中，医疗保险急性心肌梗死的主要诊断编码是准确的。康涅狄格州临床医生认可的疗法在老年患者中使用不足。医疗保险索赔数据的模式分析可作为护理质量筛查工具；然而，需要额外的临床信息来推动医院内的质量改进工作。
