Association of Hospital Characteristics With Early SEP-1 Performance

2019 ◽  
Vol 35 (2) ◽  
pp. 110-116 ◽  
Author(s):  
Jeff Liao ◽  
Emily Aaronson ◽  
Jungyeon Kim ◽  
Xiu Liu ◽  
Colleen Snydeman ◽  
...  
Keyword(s):  
Case Mix ◽  
Linear Modeling ◽  
For Profit ◽  
Case Mix Index ◽  
Teaching Status ◽  
Acute Hospitals ◽  
Patient Complexity ◽  
Hospital Compare ◽  
Teaching Intensity ◽  
Hospital Characteristics

A variety of hospital characteristics, including teaching status, ownership, location, and size, have been shown to be associated with quality measure performance. The association of hospital characteristics, including teaching intensity, with performance on the Centers for Medicare & Medicaid Services (CMS) SEP-1 sepsis measure has not been well studied. Utilizing a statewide, all-payer database and the CMS Hospital Compare database, this study investigated the association of various hospital characteristics with early SEP-1 performance in 48 acute hospitals in Massachusetts. Hospital teaching intensity and Magnet designation did not have a statistically significant association with SEP-1 performance in multivariable linear modeling. However, SEP-1 performance was higher in smaller, for-profit hospitals with higher case mix index. This finding suggests that emergency department activity, hospital ownership, and patient complexity should be studied further across a larger geographic spectrum and longitudinally as hospitals implement efforts to reduce morbidity associated with sepsis.

Is the CMS Hospital-Acquired Condition Reduction Program a Valid Measure of Hospital Performance?

2016 ◽  
Vol 32 (3) ◽  
pp. 254-260 ◽  
Author(s):  
Richard L. Fuller ◽  
Norbert I. Goldfield ◽  
Richard F. Averill ◽  
John S. Hughes
Keyword(s):  
Risk Adjustment ◽  
Hospital Performance ◽  
Case Mix ◽  
Valid Measure ◽  
Hospital Case ◽  
Case Mix Index ◽  
Alternative Method ◽  
Reduction Program ◽  
Hospital Acquired ◽  
Hospital Characteristics

In October 2014, the Centers for Medicare & Medicaid Services began reducing Medicare payments by 1% for the bottom performing quartile of hospitals under the Hospital-Acquired Condition Reduction Program (HACRP). A tight clustering of HACRP scores around the penalty threshold was observed resulting in 13.2% of hospitals being susceptible to a shift in penalty status related to single decile changes in the ranking of any one of the complication or infection measures used to compute the HACRP score. The HACRP score also was found to be significantly correlated with several hospital characteristics including hospital case mix index. This correlation was not confirmed when an alternative method of measuring hospital complication performance was used. The sensitivity of the HACRP penalties to small changes in performance and correlation of the HACRP score with hospital characteristics call into question the validity of the HACRP measure and method of risk adjustment.

Abstract 9152: Incidence of Cardiac Arrest Among Medicare Beneficiaries

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Tyler P Rasmussen ◽  
Danielle Riley ◽  
Mary Vaughan-Sarazzin ◽  
Paul Chan ◽  
Saket Girotra
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Nurse Staffing ◽  
Incidence Rates ◽  
Case Mix ◽  
Medicare Beneficiaries ◽  
Case Mix Index ◽  
Hospital Variation ◽  
Number Of Patients ◽  
Teaching Status

Introduction: Although survival for in-hospital cardiac arrest (IHCA) has improved substantially over the last two decades, survival rates have plateaued in recent years. Our understanding of incidence of IHCA remains limited. We measured incidence of IHCA among Medicare beneficiaries and evaluated hospital variation in incidence of IHCA. Methods: We used an observational cohort study using data from 2014-2017 Get with the Guidelines-Resuscitation (GWTG-R) data linked with Medicare inpatient data summarized by hospital. Hospital incidence of IHCA among Medicare beneficiaries was calculated as the total number of patients 65 years and older with an IHCA divided by the total number of Medicare admissions. Multivariable hierarchical regression models were used to adjust hospital incidence rates for differences in case-mix across study hospitals and evaluate its the association with hospital variables. Results: Among a total of 4.5 million admissions at 170 hospitals, 38,630 patients experienced an IHCA. The median risk-adjusted IHCA incidence was 8.3 per-1000 admissions. Even after adjusting for differences in case-mix index, IHCA incidence varied markedly across hospitals (Figure 1) ranging from 2.1 per-1000 admissions to 24.7 per-1000 admissions (interquartile range: 6.5-11.4; median odds ratio: 1.52; 95% credible interval 1.45-1.59). Among hospital variables, a higher case-mix index, higher nurse staffing and teaching status were associated with a lower hospital incidence of IHCA. Conclusions: Incidence of IHCA varies markedly across hospitals, even after adjustment for differences in patient case-mix. Hospital variables including case-mix severity, nurse staffing and teaching status were significantly associated with incidence rates. Future studies are needed to better understand processes of care at hospitals with exceptionally low IHCA incidence to identify best practices for cardiac arrest prevention.

scholarly journals Schockraum- und Schwerverletztenversorgung als „Verlustgeschäft“

2020 ◽  
Author(s):  
Thomas Gross ◽  
Felix Amsler
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Diagnosis Related Groups ◽  
Case Mix ◽  
Multivariate Analyse ◽  
New Injury Severity Score ◽  
Case Mix Index

Zusammenfassung Hintergrund Es galt herauszufinden, wie kostendeckend die Versorgung potenziell Schwerverletzter in einem Schweizer Traumazentrum ist, und inwieweit Spitalgewinne bzw. -verluste mit patientenbezogenen Unfall‑, Behandlungs- oder Outcome-Daten korrelieren. Methodik Analyse aller 2018 im Schockraum (SR) bzw. mit Verletzungsschwere New Injury Severity Score (NISS) ≥8 notfallmäßig stationär behandelter Patienten eines Schwerverletztenzentrums der Schweiz (uni- und multivariate Analyse; p < 0,05). Ergebnisse Für das Studienkollektiv (n = 513; Ø NISS = 18) resultierte gemäß Spitalkostenträgerrechnung ein Defizit von 1,8 Mio. CHF. Bei einem Gesamtdeckungsgrad von 86 % waren 66 % aller Fälle defizitär (71 % der Allgemein- vs. 42 % der Zusatzversicherten; p < 0,001). Im Mittel betrug das Defizit 3493.- pro Patient (allg. Versicherte, Verlust 4545.-, Zusatzversicherte, Gewinn 1318.-; p < 0,001). Auch „in“- und „underlier“ waren in 63 % defizitär. SR-Fälle machten häufiger Verlust als Nicht-SR-Fälle (73 vs. 58 %; p = 0,002) wie auch Traumatologie- vs. Neurochirurgiefälle (72 vs. 55 %; p < 0,001). In der multivariaten Analyse ließen sich 43 % der Varianz erhaltener Erlöse mit den untersuchten Variablen erklären. Hingegen war der ermittelte Deckungsgrad nur zu 11 % (korr. R2) durch die Variablen SR, chirurgisches Fachgebiet, Intensivaufenthalt, Thoraxverletzungsstärke und Spitalletalität zu beschreiben. Case-Mix-Index gemäß aktuellen Diagnosis Related Groups (DRG) und Versicherungsklasse addierten weitere 13 % zu insgesamt 24 % erklärter Varianz. Diskussion Die notfallmäßige Versorgung potenziell Schwerverletzter an einem Schweizer Traumazentrum erweist sich nur in einem Drittel der Fälle als zumindest kostendeckend, dies v. a. bei Zusatzversicherten, Patienten mit einem hohen Case-Mix-Index oder einer IPS- bzw. kombinierten Polytrauma- und Schädel-Hirn-Trauma-DRG-Abrechnungsmöglichkeit.

Association of hospital characteristics with outcomes for pediatric neurosurgical accidental trauma patients

2021 ◽  
pp. 1-6
Author(s):  
Shenae Samuels ◽  
Rebekah Kimball ◽  
Vivian Hagerty ◽  
Tamar Levene ◽  
Howard B. Levene ◽  
...  
Keyword(s):  
General Hospital ◽  
Inpatient Mortality ◽  
Hospital Ownership ◽  
Ownership Type ◽  
Accidental Trauma ◽  
For Profit ◽  
Discharge Disposition ◽  
Not For Profit ◽  
Children’S Hospitals ◽  
Hospital Characteristics

OBJECTIVE In the pediatric population, few studies have examined outcomes for neurosurgical accidental trauma care based on hospital characteristics. The purpose of this study was to explore the relationship between hospital ownership type and children's hospital designation with primary outcomes. METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2006, 2009, and 2012 Kids’ Inpatient Database. Primary outcomes, including inpatient mortality, length of stay (LOS), and favorable discharge disposition, were assessed for all pediatric neurosurgery patients who underwent a neurosurgical procedure and were discharged with a primary diagnosis of accidental traumatic brain injury. RESULTS Private, not-for-profit hospitals (OR 2.08, p = 0.034) and freestanding children's hospitals (OR 2.88, p = 0.004) were predictors of favorable discharge disposition. Private, not-for-profit hospitals were also associated with reduced inpatient mortality (OR 0.34, p = 0.005). A children's unit in a general hospital was associated with a reduction in hospital LOS by almost 2 days (p = 0.004). CONCLUSIONS Management at freestanding children's hospitals correlated with more favorable discharge dispositions for pediatric patients with accidental trauma who underwent neurosurgical procedures. Management within a children's unit in a general hospital was also associated with reduced LOS. By hospital ownership type, private, not-for-profit hospitals were associated with decreased inpatient mortality and more favorable discharge dispositions.

Case Mix Index

1996 ◽  
Vol 27 (9) ◽  
pp. 31???32 ◽  
Author(s):  
TIMOTHY P. ADAMS
Keyword(s):  
Case Mix ◽  
Case Mix Index

Alberta's Acute Care Funding Plan: Update to December 1994

1995 ◽  
Vol 8 (2) ◽  
pp. 17-22 ◽  
Author(s):  
Philip Jacobs ◽  
Edward M. Hall ◽  
Richard H.M. Plain
Keyword(s):  
Acute Care ◽  
Hospital Performance ◽  
Case Mix ◽  
Patient Classification ◽  
The Core ◽  
Case Mix Index ◽  
Adjustment Factors ◽  
Formula Method ◽  
Alberta Health ◽  
New System

From 1990 until 1994 Alberta Health adjusted the acute care portion of hospital budgets based on a case mix index, initially called the Hospital Performance Index (HPI). The HPI formula method was a temporary measure; in November 1993, Alberta Health announced that, commencing in 1994, hospitals would be funded on a prospective basis, although they would still use the core of the HPI in the setting of funding rates. The creation of 17 health regions in June 1994 created the need for a new system of funding which would supplant the modified prospective system. In this paper we review the evolution of the HPI plan and its individual components — patient data, patient classification, funding weights, inpatient costs and adjustment factors.

Ökonomische Aspekte der interdisziplinären Plastischen Chirurgie – Veränderung der diagnosebezogenen Fallgruppen (DRG) durch Eingriffe der rekonstruktiven Mikrochirurgie

2020 ◽  
Vol 52 (06) ◽  
pp. 464-472
Author(s):  
Riccardo E. Giunta ◽  
Denis Ehrl ◽  
Nikolaus Wachtel ◽  
Paul S. Wiggenhauser ◽  
Nura Ahmad
Keyword(s):  
Case Mix ◽  
Sich Eine ◽  
Ökonomische Aspekte ◽  
Case Mix Index

Zusammenfassung Hintergrund Die Etablierung der Mikrochirurgie hat in den letzten Jahrzehnten eine enorme Verbesserung der operativen Versorgung von interdisziplinären Fällen ermöglicht. Gleichzeitig steigt hierdurch aber auch der Ressourcenaufwand der mitbehandelnden plastischen Chirurgie. Ziel der vorliegenden Arbeit war es daher, den Zusammenhang zwischen Erlössteigerung und Ressourcenaufwand der rekonstruktiven Mikrochirurgie an einem Universitätsklinikum der Maximalversorgung in der interdisziplinären Zusammenarbeit darzustellen. Methoden An einem Standort einer plastisch-chirurgischen Abteilung einer Universitätsklinik wurden in den Jahren 2018 und 2019 alle Fälle der interdisziplinären Zusammenarbeit fallbegleitend verfolgt. Aus dem Gesamtkollektiv wurden die interdisziplinären chirurgischen Fälle identifiziert und prospektiv mit Hinblick auf die stationären Behandlungstage, operativen Ressourcenaufwand und die ökonomische Entwicklung (DRG-Erlöse vor und nach mikrochirurgischer Rekonstruktion) ausgewertet. Ergebnisse In den Jahren 2018 und 2019 wurden insgesamt 68 freie mikrochirurgische Lappenplastiken in 64 interdisziplinären Fällen durchgeführt. 62 der Fälle erfüllten die Kriterien einer interdisziplinären chirurgischen Behandlung. Bei Betrachtung des Beitrages der Plastischen Chirurgie an der ökonomischen Entwicklung und dem damit verbundenen Resourcenaufwand zeigt sich eine signifikante Zunahme in allen erhobenen Parametern (p < 0,0001). So stieg der Case Mix Index (CMI) um 20,2 %, die stationären Behandlungstage um 79,1 %, die Anzahl der operativen Eingriffe um 62,4 %, die kumulative Schnitt-Naht-Zeit um 131,4 % und die OP-Arztstunden um 75,4 %. Schlussfolgerung Die rekonstruktive Mikrochirurgie führt bei interdisziplinären chirurgischen Fällen, durch Veränderung der DRG, zu einem signifikanten Anstieg des Erlöses. Allerdings lässt sich auch ein deutlicher Anstieg des Ressourcenverbrauches beobachten. Zudem sind diese zusätzlichen Kosten nicht immer adäquat in der DRG abgebildet. Dies betrifft vor allem DRGs mit hoher initialer Bewertungsrelation, die durch Eingriffe der rekonstruktiven Mikrochirurgie zum Teil nicht aufgewertet wurden. Zur Sicherstellung einer zeitgemäßen, individuellen, patientenorientierten und leitliniengerechten Patientenversorgung besteht daher dringender Bedarf an einer Anpassung des (G-)DRG-Systems an den Mehraufwand. Zudem muss bei interdisziplinären chirurgischen Fällen eine klare interne Leistungsverrechnung, gemäß dem chirurgischen Ressourcenaufwand, erfolgen.

Sign in / Sign up

Export Citation Format

Share Document