Use of Administrative Claims Models to Assess 30-Day Mortality Among Veterans Health Administration Hospitals
- 1 July 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Medical Care
- Vol. 48 (7), 652-658
- https://doi.org/10.1097/mlr.0b013e3181dbe35d
Abstract
Background: The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital-specific risk-standardized, 30-day, all-cause, mortality rates (RSMRs) for all hospitalizations among fee-for-service Medicare beneficiaries for acute myocardial infarction (AMI), heart failure (HF), and pneumonia at non-Federal hospitals. Objective: To examine the performance of the statistical models used by CMS among veterans at least 65 years of age hospitalized for AMI, HF, and pneumonia in Veterans Health Administration (VHA) hospitals. Research Design: Cross-sectional analysis of VHA administrative claims data between October 1, 2006 and September 30, 2009. Subjects: Thirteen thousand forty-six veterans hospitalized for AMI among 123 VHA hospitals; 26,379 veterans hospitalized for HF among 124 VHA hospitals; and 31,126 veterans hospitalized for pneumonia among 124 VHA hospitals. Measures: Hospital-specific RSMR for AMI, HF, and pneumonia hospitalizations calculated using hierarchical generalized linear models. Results: Median number of AMI hospitalizations per VHA hospital was 87. Average AMI RSMR was 14.3% [95% confidence interval (CI), 13.9%–14.6%] with modest heterogeneity among VHA hospitals (RSMR range: 8.4%–20.3%). The c-statistic for the AMI RSMR statistical model was 0.79. Median number of HF hospitalizations was 188. Average HF RSMR was 10.1% (95% CI, 9.9%–10.4%) with modest heterogeneity (RSMR range: 6.1%–14.9%). The c-statistic for the HF RSMR statistical model was 0.73. Median number of pneumonia hospitalizations was 221.5. Average pneumonia RSMR was 13.0% (95% CI, 12.7%–13.3%) with modest heterogeneity (RSMR range: 9.0%–18.4%). The c-statistic for the pneumonia RSMR statistical model was 0.72. Conclusions: The statistical models used by CMS to estimate RSMRs for AMI, HF, and pneumonia hospitalizations at non-Federal hospitals demonstrate similar discrimination when applied to VHA hospitals.Keywords
This publication has 18 references indexed in Scilit:
- Declining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care SystemBMC Cardiovascular Disorders, 2009
- Veterans Affairs intensive care unit risk adjustment model: Validation, updating, recalibration*Critical Care Medicine, 2008
- An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With an Acute Myocardial InfarctionCirculation, 2006
- An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With Heart FailureCirculation, 2006
- Benchmarking Veterans Affairs Medical Centers in the Delivery of Preventive Health ServicesMedical Care, 2002
- Sample size considerations in observational health care quality studiesStatistics in Medicine, 2002
- Reinventing VA Health CareMedical Care, 2000
- The Quality Enhancement Research Initiative (QUERI)Medical Care, 2000
- Quality Enhancement Research Initiative (QUERI)Medical Care, 2000
- The "New VA": A National Laboratory for Health Care Quality ManagementAmerican Journal of Medical Quality, 1999