Accuracy of Medicaid Payer Coding in Hospital Patient Discharge Data

Medical Care ◽  
2005 ◽  
Vol 43 (6) ◽  
pp. 586-591 ◽  
Author(s):  
Arpita Chattopadhyay ◽  
Andrew B. Bindman
Keyword(s):  
Patient Discharge ◽  
Hospital Patient ◽  
Discharge Data

Abstract 164: Treatment Differences in Acute Stroke By Mode of Transport

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Prasanthi Govindarajan ◽  
Anisha Chandra ◽  
David Ghilarducci ◽  
Steve Shiboski ◽  
Barbara Grimes ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Demographic Data ◽  
Patient Discharge ◽  
Cross Sectional Study ◽  
Primary Diagnosis ◽  
Cross Sectional ◽  
Discharge Data ◽  
Patient Demographic Data ◽  
Mode Of Transport ◽  
Time Of Admission

Background: EMS (Emergency Medical Services) is an important component of the stroke chain of survival. While in hospital stroke time targets have shown to be better when prehospital providers provide advance notification, population-wide studies on thrombolysis rates (IV t-PA) for those who arrive by EMS is sparse. Objective: To examine differences in treatment rates for acute stroke by mode of transport. Methods: This is a cross-sectional study of all patients who were transported to hospitals in two Northern California counties by providers of a single EMS agency during a three year period. Patient demographic data, prehospital provider clinical assessment was obtained from the computerized prehospital transport records and patient location, hospital demographics, physician diagnosis and treatment rates were obtained from statewide administrative patient discharge data. The data sources were linked using probabilistic linkage methodology. Patients ≥18 years of age with validated ICD- 9 code for stroke were included. We excluded inter-facility transports and direct admissions. Results: Of 10,456 patients who had a hospital based discharge diagnosis of stroke, 3787 (36%) were transported by EMS. Mean age at the time of admission was 75 years (+/- 14); 55% (2093) were females, 65% (2471) were whites and 86% (3247) were Hispanics. Most of the patients had Medicare (72%, 2737) and 92% (3471) were transported from home. Majority of the patients were treated at stroke centers [n=3014, (80%)]) and at community hospitals [n=3664, (97%)]. Of 3757 patients with a primary diagnosis of stroke, 4% (150) were treated with IV t-PA. After controlling for covariates, patients transported by EMS had higher odds of treatment with IV t-PA (OR 2.6, 95 CI 1.9-3.3). Treatment at stroke centers (OR 1.5, 95 CI 1-2.2) and academic centers were independently associated with treatment rates (OR 2.4, 95 CI 1.6-3.6). Conclusions: Arrival by EMS to emergency department is associated with higher treatment rates with thrombolytics for acute stroke patients and efforts should be targeted to improve use of EMS for stroke.

Determining the Effects of Patient Casemix on Length of Hospital Stay: A Proportional Hazards Frailty Model Approach

2001 ◽  
Vol 40 (04) ◽  
pp. 288-292 ◽  
Author(s):  
K. K. W. Yau ◽  
A. H. Lee
Keyword(s):  
Proportional Hazards ◽  
Diagnosis Related Groups ◽  
Insurance Coverage ◽  
Length Of Hospital Stay ◽  
Patient Discharge ◽  
Frailty Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Data ◽  
Prolonged Hospitalization

Summary Objectives: To identify factors associated with hospital length of stay (LOS) and to model variations in LOS within Diagnosis Related Groups (DRGs). Methods: A proportional hazards frailty modelling approach is proposed that accounts for patient transfers and the inherent correlation of patients clustered within hospitals. The investigation is based on patient discharge data extracted for a group of obstetrical DRGs. Results: Application of the frailty approach has highlighted several significant factors after adjustment for patient casemix and random hospital effects. In particular, patients admitted for childbirth with private medical insurance coverage have higher risk of prolonged hospitalization compared to public patients. Conclusions: The determination of pertinent factors provides important information to hospital management and clinicians in assessing the risk of prolonged hospitalization. The analysis also enables the comparison of inter-hospital variations across adjacent DRGs.

scholarly journals Examining the relationship between poverty and length of stay: a repeated cross-sectional study of paediatric hospitalisations in Chile

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e034512
Author(s):  
Florencia Borrescio-Higa ◽  
Dominiquo Santistevan
Keyword(s):  
Length Of Stay ◽  
Fixed Effects ◽  
Patient Discharge ◽  
Cross Sectional Study ◽  
Poverty Rate ◽  
Sectional Study ◽  
Cross Sectional ◽  
Discharge Data ◽  
Individual Level ◽  
The Relationship

ObjectiveTo measure poverty-based disparities in inpatient length of stay for paediatric hospitalisations. In particular, this paper examines the relationship between municipality level poverty rates and length of stay, accounting for individual level characteristics.DesignWe use patient discharge data to conduct a repeated cross-sectional study of the totality of paediatric hospitalisations in 15 regions of Chile, in the years 2011, 2013, 2015 and 2017.SettingAll hospital discharges in 15 regions of Chile.Participants1 033 222 discharges for children under the age of 15, between 2011 and 2017.Outcome measuresLength of stay (LOS); LOS by type of insurance and type of hospital; hospitalisation rates; municipality-level average LOS.ResultsWe find that municipality level poverty rates are a significant predictor of LOS, even after controlling for individual and area level characteristics, including type of insurance. Children from municipalities in the poorest quintile have a LOS that is 14% shorter as compared with children from municipalities in the richest quintile. This relationship is stronger for publicly insured children: the decrease in LOS associated with the same poverty change is of 22%.ConclusionsThis paper shows that there is an association between municipality-level poverty rates and length of stay for paediatric hospitalisations in Chile. For the vast majority of the sample, and after controlling for individual level characteristics, an increase in the municipality level poverty rate is associated with a decrease in the length of stay. Further, there is a non-linearity in the relationship, where at the highest poverty rates, poverty and LOS are positively associated. These findings are robust after controlling for type of hospital (public vs private), type of insurance (public vs private), type of diagnosis, as well as year and region fixed effects.

Abstract 154: Acute Stroke Recognition by Paramedics after Regionalization of Stroke Care: Outcomes Based Study

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Prasanthi Govindarajan ◽  
David Ghilarducci ◽  
Steve Shiboski ◽  
Barbara Grimes ◽  
Larry Cook ◽  
...  
Keyword(s):  
Demographic Data ◽  
Patient Discharge ◽  
Stroke Care ◽  
Primary Diagnosis ◽  
Cross Sectional ◽  
Discharge Data ◽  
Predictive Values ◽  
Implementation Phase ◽  
Before And After ◽  
Sensitivity Specificity

Background: Early evidence supports preferential transport of patients with stroke symptoms to primary stroke centers. While validated stroke tools exist for screening of stroke symptoms in the prehospital setting, system wide triage performance of prehospital providers in a regionalized system has not been reported. The objective of this study is to assess the diagnostic ability of prehospital providers, before and after regionalization of care, using outcomes based approach. Methods: This is a cross-sectional study of all patients who were transported to hospitals in two Northern California counties by providers of a single EMS agency during a three year period. One county remained non-regionalized (NR) during the study period and the other initiated and completed regionalization(R) of the system during the study period. Patient demographic data, prehospital provider clinical assessment was obtained from the computerized prehospital transport records and physician diagnosis was obtained from statewide administrative patient discharge data. The data sources were linked using probabilistic linkage methodology. Patients ≥18 years of age with validated ICD- 9 code for stroke were included. We excluded inter-facility transports and direct admissions. Sensitivity, specificity and predictive values for were determined before and after implementation of regionalization. Data analysis was performed using SAS version 9.2. Results: The total number of medical related EMS transports for 3 years was 310,731 and the number of patient discharges with a primary diagnosis of stroke was 10,298. We were able to link 3736 stroke records which indicate EMS use by 36% (3736/10,298) stroke patients. The sensitivity, specificity, PPV and NPV in the pre-regionalization phase was 28%, 80%, 53%, 58% and during the implementation phase of regionalization was 39% 78%,57% and 63% (p <0.05). The performance in the NR County during the entire period was 23%, 76%, 40% and 58%. Conclusions: Diagnostic accuracy remained low although improved prehospital provider performance was observed after regionalization of stroke care.

scholarly journals Hospital patient discharge process: an evaluation

2016 ◽  
Vol 24 (5) ◽  
pp. 278-282 ◽  
Author(s):  
Sally Bullock ◽  
Charles W Morecroft ◽  
Rachel Mullen ◽  
Alison B Ewing
Keyword(s):  
Patient Discharge ◽  
Discharge Process ◽  
Hospital Patient

scholarly journals Determinants of length of stay:implications on differential funding for rural and metropolitan hospitals

2000 ◽  
Vol 23 (4) ◽  
pp. 126 ◽  
Author(s):  
Andy H Lee ◽  
Jim Codde
Keyword(s):  
Length Of Stay ◽  
State Government ◽  
Western Australia ◽  
Diagnosis Related Groups ◽  
Patient Discharge ◽  
Inpatient Stay ◽  
Discharge Data ◽  
Patient Transfers ◽  
Adjustment Strategy ◽  
Government Perspective

This study analysed and compared the determinants of length of inpatient stay between the rural and metropolitanpublic hospitals. The investigation was based on the 1998/99 Western Australia patient discharge data. A Coxregression model was used due to the high proportion of patient transfers in the rural hospitals. It was found thatseveral variables were associated with length of stay (LOS) variations within Diagnosis Related Groups (DRG). Themethod provides additional insights to hospital management and clinicians in assessing the risk of prolongedhospitalisation. From a state government perspective, a DRG payment adjustment strategy may be developed fordifferent categories of admitted patient episodes. The analysis has implications on the formulation of differentialfunding rates between rural and metropolitan hospitals.

GP and Hospital Doctor Perspectives on the Hospital Patient Discharge Process

2011 ◽  
Vol 93 (1) ◽  
pp. 1-4
Author(s):  
M Wills ◽  
L Hyland ◽  
T Chearman ◽  
F Cross ◽  
K Verrier-Jones
Keyword(s):  
Patient Discharge ◽  
Discharge Process ◽  
Hospital Patient ◽  
Hospital Doctor
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