Risk adjustment for measuring health care outcomes:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Chicago, Ill.
Health Administration Press
2003
|
| Ausgabe: | 3. ed. |
| Schlagworte: | |
| Online-Zugang: | Table of contents Inhaltsverzeichnis |
| Beschreibung: | Includes bibliographical references (p. 411-478) and index |
| Beschreibung: | XX, 508 S. Ill., graph. Darst. |
| ISBN: | 156793207X |
Internformat
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| 245 | 1 | 0 | |a Risk adjustment for measuring health care outcomes |c ed. by Lisa I. Iezzoni |
| 250 | |a 3. ed. | ||
| 264 | 1 | |a Chicago, Ill. |b Health Administration Press |c 2003 | |
| 300 | |a XX, 508 S. |b Ill., graph. Darst. | ||
| 336 | |b txt |2 rdacontent | ||
| 337 | |b n |2 rdamedia | ||
| 338 | |b nc |2 rdacarrier | ||
| 500 | |a Includes bibliographical references (p. 411-478) and index | ||
| 650 | 7 | |a Gezondheid |2 gtt | |
| 650 | 7 | |a Protocollen (zorgsector) |2 gtt | |
| 650 | 7 | |a Risk management |2 gtt | |
| 650 | 7 | |a Vergelijkend onderzoek |2 gtt | |
| 650 | 4 | |a Decision Support Techniques | |
| 650 | 4 | |a Delivery of Health Care |x organization & administration | |
| 650 | 4 | |a Health risk assessment | |
| 650 | 4 | |a Models, Statistical | |
| 650 | 4 | |a Outcome Assessment (Health Care) |x methods | |
| 650 | 4 | |a Outcome assessment (Medical care) | |
| 650 | 4 | |a Risk Adjustment |x methods | |
| 650 | 4 | |a Risk Factors | |
| 650 | 0 | 7 | |a Medizinische Versorgung |0 (DE-588)4038270-9 |2 gnd |9 rswk-swf |
| 650 | 0 | 7 | |a Risikoanalyse |0 (DE-588)4137042-9 |2 gnd |9 rswk-swf |
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| 700 | 1 | |a Iezzoni, Lisa I. |e Sonstige |4 oth | |
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| 999 | |a oai:aleph.bib-bvb.de:BVB01-010269153 | ||
Datensatz im Suchindex
| _version_ | 1804129918298095616 |
|---|---|
| adam_text | CONTENTS IN BRIEF
Preface xvii
1 Reasons for Risk Adjustment, Lisa I. Iezzoni 1
2 Getting Started and Denning Terms, Lisa I. Iezzoni 17
3 Range of Risk Factors, Lisa I. Iezzoni 33
4 Windows of Observation, Amy K. Rosen 71
5 Coded Data from Administrative Sources, Lisa I. Iezzoni 83
6 Clinical Data from Medical Records or Providers,
Lisa I. Iezzoni 139
7 Data from Surveys or Asking Patients, Lisa I. Iezzoni 163
8 Conceptual and Practical Issues in Developing
Risk Adjustment Methods, Jennifer Daley, Lisa I.
Iezzoni, and Michael Shwartz 179
9 Validity and Reliability of Risk Adjusters, Jennifer
Daley, Arlene S. Ash, and Lisa I. Iezzoni 207
10 Evaluating Risk Adjustment Models Empirically,
Michael Shwartz and Arlene S. Ash 231
11 Estimating the Effect of an Intervention from
Observational Data, Michael Shwartz and Arlene S. Ash 275
12 Comparing Outcomes Across Providers, Arlene S. Ash,
Michael Shwartz, and Erol A. Pekoz 297
i
13 Risk Adjustment in Pediatric Populations, Karen
Kuhlthau and Timothy G. Ferris 335
14 Risk Adjustment for Mental Health Care, Richard C.
Hermann 349
15 Risk Adjustment for Studying Health Care Outcomes
of People with Disabilities, Lisa I. Iezzoni 363
16 Risk Adjustment for Studying Long Term Care, Dan
Berlowitz and Amy K. Rosen 383
17 Final Observations, Lisa I. Iezzoni 401
References 411
Glossary of Acronyms 479
Index 483
About the Contributors 505
Detailed Contents
Preface xvii
1 Reasons for Risk Adjustment, Lisa I. Iezzoni 1
Purpose of Risk Adjustment 3
Purpose of this Book and Updates 5
Historical Precedents 9
Improving and Monitoring Outcomes 10
Focusing on End Results 12
Conclusions 15
Notes 15
2 Getting Started and Denning Terms, Lisa I. Iezzoni 17
Risk of What? 18
Over What Time Frame? 22
For What Population? 23
For What Purpose? 25
Additional Considerations 27
Notes 29
3 Range of Risk Factors, Lisa I. Iezzoni 33
Age 34
Sex and Gender 38
Race and Ethnicity 40
Acute Clinical Stability 43
Principal Diagnosis 46
Defining and Delineating Diseases and Diagnoses 46
Severity or Extent of Principal Diagnosis 48
Extent and Severity of Comorbiditdes 49
Functional Status 52
Psychological, Cognitive, and Psychosocial Functioning 56
Health Behavior, Sociocultural, and Environmental
Attributes 58
Overall Health Status and Health Related Quality of Life 60
Patients Attitudes and Preferences for Outcomes 65
Additional Issues 67
Role of Processes of Care 67
Nature of the Intervention 67
Random Chance 68
Notes 68
4 Windows of Observation, Amy K. Rosen 71
Conceptual Framework 71
Acute Care Hospitalization 73
Fixed, Longer Term Windows 75
Episodes of Care 77
Implementing Episode Algorithms 78
An Episode Approach for Asthma Patients 79
Conclusions 81
Note 82
5 Coded Data from Administrative Sources, Lisa I. Iezzoni 83
Overview of Administrative Databases in the United States 84
Sources of Administrative Data 86
Medicare 88
The VA 90
Medicaid 92
Private Insurance 94
Diagnosis Codes 95
Origins of ICD 9 CM 96
Organization and Format of ICD 9 CM 97
Clinical Content of ICD 9 CM Codes 99
Context of ICD 9 CM Diagnostic Coding and Sources of
Error 102
Steps in Coding 103
Coding Certainty and Specificity 105
The Accuracy and Reliability of Coded Data 107
Studies of Coding Accuracy 109
Limitations of Coding Slots and Potential Undercoding 111
Retrospective Nature of Discharge Diagnoses 114
Coding Differences Across Hospitals 120
Information About Procedures 121
Procedural Nomenclatures 121
Quality of Procedure Coding 122
Pharmacy Data 123
Structural Attributes of Administrative Data 124
Merging Administrative Data with Other Data Sources 126
Examples of Administrative Data from Other Countries 129
Future Issues 130
Privacy 130
Setting Standards for Data Content and Electronic
Transmission 132
ICD 10 and Other New Code Sets 133
Notes 135
6 Clinical Data from Medical Records or Providers,
Lisa I. Iezzoni 139
History of Medical Records 140
Reliability of Clinical Information 142
Quality of Medical Records and Other Risk Factor
Documentation 145
Potential Biases in Quality of Medical Records 146
Effects of Published Performance Reports on Data Quality 148
Missing Records 150
Privacy and Obtaining Clinical Records for Research 150
History of Privacy Concerns 151
HIPAA and Privacy 153
How Much Clinical Information Is Enough? 154
Information Technologies and the Future 156
Notes 160
7 Data from Surveys or Asking Patients, Lisa I. Iezzoni 163
Risk Factors and Patient Reported Outcomes 164
Accuracy of Patient Reported Risk Factor Data 167
Logistics and Feasibility 170
Using Survey Data for Risk Adjustment 173
Using Functional Status to Set Capitation Payments 174
CAHPS 175
Notes 177
8 Conceptual and Practical Issues in Developing
Risk Adjustment Methods, Jennifer Daley, Lisa I.
Iezzoni, and Michael Shwartz 179
Getting Started 181
Identifying Risk Factors 185
Timing of Risk Factors 189
Other Feasibility Considerations 190
Building the Risk Adjustment Model 191
Assembling an Analytic Data Set 192
Treatment of Missing Values 193
Structure of Continuous Independent Variables 196
Need for Data Reduction 198
Multivariable Modeling Techniques 200
Conclusions 203
Notes 203
9 Validity and Reliability of Risk Adjusters, Jennifer
Daley, Arlene S. Ash, and Lisa I. Iezzoni 207
Dimensions of Validity 208
Face Validity 208
Content Validity 210
Criterion and Construct Validity 211
Predictive Validity 212
Attributional Validity 213
Examples of Validation Studies 215
Examining Hospital Based Severity Measures 215
NSQIP and Attributional Validity 219
Reliability 221
Reliability and the Data Source 221
Sources of Variability 222
Assessing Reliability 224
Cohen s Kappa 225
Weighted Kappa 225
Other Measures of Reliability 226
Other Issues in Assessing Reliability 227
Notes 229
10 Evaluating Risk Adjustment Models Empirically,
Michael Shwartz and Arlene S. Ash 231
Translating Risk Scores into Predicted Outcomes 231
Model Performance in Development and Validation Data
Sets 233
Measuring Model Performance when die Outcome Is
Continuous 235
Grouped R2 238
Handling Extreme Values of the Outcome Variable 242
Interpreting R2 245
Importance of the Form of the Risk Score for Interpreting R2 248
Measures of Model Performance for Dichotomous
Outcomes 249
Models to Predict Dichotomous Outcomes 251
Model Calibration and Discrimination 252
The c Statistic to Measure Model Discrimination 253
Methods for Measuring Model Calibration 258
Model Performance Within Subgroups 260
R2 and Dichotomous Outcomes 262
Model Validation 265
Conclusions 270
Notes 271
11 Estimating the Effect of an Intervention from
Observational Data, Michael Shwartz and Arlene S. Ash 275
Multivariable Models for Estimating the Effects of
Interventions 276
Propensity Scores 279
Hypothetical Example 280
Propensity Score Approach 281
Examples from the Literature Using Propensity Scores 283
Instrumental Variables 286
Hypothetical Example 287
Examples of IV Analyses in the Literature 290
Conclusions 293
Notes 294
12 Comparing Outcomes Across Providers, Arlene S. Ash,
Michael Shwartz, and Erol A. Pekoz 297
The Effect of Randomness on Comparing Patient
Outcomes 298
Comparing Observed and Expected Outcomes 303
Failure of O to i; Comparisons to Adjust Fully for Risks 306
Random Variation in Comparing O to £ Outcomes 308
Presenting Comparisons of O to £ Outcomes 310
Bayesian Models 318
The Bayesian Approach 319
Empirical Bayes Analysis 321
Hierarchical Bayesian Models 323
An Example Using Bayes Estimation 326
Comparing Outcomes over Time 329
Notes 331
13 Risk Adjustment in Pediatric Populations, Karen
Kuhlthau and Timothy G. Ferris 335
What Is Special About Children? 335
Epidemiology 336
Risk Factors 336
Processes of Care 337
Care Settings 338
External Factors 338
Risk Adjusting Pediatric Costs 339
Risk Adjusting Pediatric Quality Outcomes 340
NICU Outcomes 340
PICU Outcomes 342
Congenital Heart Disease and Other Pediatric Hospital
Admissions 342
Conclusions 344
Notes 346
14 Risk Adjustment for Mental Health Care,
Richard C. Hermann 349
Outcomes of Mental Health Care 350
Risk Factors in Mental Illness 352
Diagnoses and Illness Severity 352
Other Risk Factors 354
Examples of Risk Adjustment in Mental Health Care 355
Resource Consumption for Inpatient Care 355
Capitation and Comprehensive Services 357
Clinical Outcomes 358
Conclusions 359
Notes 361
15 Risk Adjustment for Studying Health Care Outcomes
of People with Disabilities, Lisa I. Iezzoni 363
Defining Disability 364
Risk Factors for Assessing Functional Outcomes 367
Demographic Characteristics 367
Physiological Status and Medical Diagnoses 368
Cognitive Ability, Mental Heakh, and Sensory Functioning 369
Sociocultural Factors, Preferences, and the Physical
Environment 371
Functional Status, Disability, and Overall Health 372
Administrative Data and Disability Related Outcomes
Research 373
Enrollment and Eligibility 373
Claims or Encounter Records 375
Diagnosis Codes 376
Procedure Codes, DME, and Outpatient Pharmacy 378
Conclusions 379
Notes 379
16 Risk Adjustment for Studying Long Term Care,
Dan Berlowitz and Amy K. Rosen 383
Impetus for Long Term Care Risk Adjustment 383
Data for Risk Adjustment in Long Term Care 386
Regulatory Monitoring and Reimbursement 387
Clinical Management, Quality Assessment, and Improvement 388
Outcome Measures 390
Risk Factors for Long Term Care Outcomes 392
Time Frame 394
Examples of Risk Adjustment in Long Term Care 396
Medicare Nursing Home Quality Assessment 396
Medicare Home Care Quality Assessment 398
Conclusions 398
Notes 399
17 Final Observations, Lisa I. Iezzoni 401
Risk Adjustment as a Common Thread 402
Epilogue: Nightingale, Farr, and Hospital Death Rates 406
References 411
Glossary of Acronyms 479
Index 483
About the Contributors 505
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| spelling | Risk adjustment for measuring health care outcomes ed. by Lisa I. Iezzoni 3. ed. Chicago, Ill. Health Administration Press 2003 XX, 508 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Includes bibliographical references (p. 411-478) and index Gezondheid gtt Protocollen (zorgsector) gtt Risk management gtt Vergelijkend onderzoek gtt Decision Support Techniques Delivery of Health Care organization & administration Health risk assessment Models, Statistical Outcome Assessment (Health Care) methods Outcome assessment (Medical care) Risk Adjustment methods Risk Factors Medizinische Versorgung (DE-588)4038270-9 gnd rswk-swf Risikoanalyse (DE-588)4137042-9 gnd rswk-swf Medizinische Versorgung (DE-588)4038270-9 s Risikoanalyse (DE-588)4137042-9 s DE-604 Iezzoni, Lisa I. Sonstige oth http://www.loc.gov/catdir/toc/fy043/2003045292.html Table of contents HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=010269153&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Risk adjustment for measuring health care outcomes Gezondheid gtt Protocollen (zorgsector) gtt Risk management gtt Vergelijkend onderzoek gtt Decision Support Techniques Delivery of Health Care organization & administration Health risk assessment Models, Statistical Outcome Assessment (Health Care) methods Outcome assessment (Medical care) Risk Adjustment methods Risk Factors Medizinische Versorgung (DE-588)4038270-9 gnd Risikoanalyse (DE-588)4137042-9 gnd |
| subject_GND | (DE-588)4038270-9 (DE-588)4137042-9 |
| title | Risk adjustment for measuring health care outcomes |
| title_auth | Risk adjustment for measuring health care outcomes |
| title_exact_search | Risk adjustment for measuring health care outcomes |
| title_full | Risk adjustment for measuring health care outcomes ed. by Lisa I. Iezzoni |
| title_fullStr | Risk adjustment for measuring health care outcomes ed. by Lisa I. Iezzoni |
| title_full_unstemmed | Risk adjustment for measuring health care outcomes ed. by Lisa I. Iezzoni |
| title_short | Risk adjustment for measuring health care outcomes |
| title_sort | risk adjustment for measuring health care outcomes |
| topic | Gezondheid gtt Protocollen (zorgsector) gtt Risk management gtt Vergelijkend onderzoek gtt Decision Support Techniques Delivery of Health Care organization & administration Health risk assessment Models, Statistical Outcome Assessment (Health Care) methods Outcome assessment (Medical care) Risk Adjustment methods Risk Factors Medizinische Versorgung (DE-588)4038270-9 gnd Risikoanalyse (DE-588)4137042-9 gnd |
| topic_facet | Gezondheid Protocollen (zorgsector) Risk management Vergelijkend onderzoek Decision Support Techniques Delivery of Health Care organization & administration Health risk assessment Models, Statistical Outcome Assessment (Health Care) methods Outcome assessment (Medical care) Risk Adjustment methods Risk Factors Medizinische Versorgung Risikoanalyse |
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