Assessing the Impacts of Misclassified Case-Mix Factors on Health Care Provider Profiling: Performance of Dialysis Facilities.

Quantitative metrics are used to develop profiles of health care institutions, including hospitals, nursing homes, and dialysis clinics. These profiles serve as measures of quality of care, which are used to compare institutions and determine reimbursement, as a part of a national effort led by the...

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Publicado en:Inquiry (00469580) Vol. 57; pp. 1 - 10
Autores principales: Mu, Yi, Chin, Andrew I., Kshirsagar, Abhijit V., Bang, Heejung
Formato: equations & formulas research tables/charts Journal Article
Publicado: Sage Publications Inc. 6/1/2020
Acceso en línea:Ver este registro en EBSCOhost
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        atl: Assessing the Impacts of Misclassified Case-Mix Factors on Health Care Provider Profiling: Performance of Dialysis Facilities.
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        au:
          Mu, Yi
          Chin, Andrew I.
          Kshirsagar, Abhijit V.
          Bang, Heejung
        affil: Actelion Pharmaceuticals US, Inc., South San Francisco, CA, USA
      sug:
        subj:
          Diagnosis-Related Groups
          Health Care Delivery
          Dialysis Centers Administration
          Insurance, Health, Reimbursement
          Human
          United States
          Readmission
          Comorbidity
          Multiple Regression
          Correlation Coefficient
          Patient Record Systems
          United States Centers for Medicare and Medicaid Services
          Data Analysis Software
          Aged
          Aged, 80 and Over
          Descriptive Statistics
          Male
          Funding Source
          Aged: 65+ years
          Aged, 80 & over
          Male
      ab: Quantitative metrics are used to develop profiles of health care institutions, including hospitals, nursing homes, and dialysis clinics. These profiles serve as measures of quality of care, which are used to compare institutions and determine reimbursement, as a part of a national effort led by the Center for Medicare and Medicaid Services in the United States. However, there is some concern about how misclassification in case-mix factors, which are typically accounted for in profiling, impacts results. We evaluated the potential effect of misclassification on profiling results, using 20 744 patients from 2740 dialysis facilities in the US Renal Data System. In this case study, we compared 30-day readmission as the profiling outcome measure, using comorbidity data from either the Center for Medicare and Medicaid Services Medical Evidence Report (error-prone) or Medicare claims (more accurate). Although the regression coefficient of the error-prone covariate demonstrated notable bias in simulation, the outcome measure—standardized readmission ratio—and profiling results were quite robust; for example, correlation coefficient of 0.99 in standardized readmission ratio estimates. Thus, we conclude that misclassification on case-mix did not meaningfully impact overall profiling results. We also identified both extreme degree of case-mix factor misclassification and magnitude of between-provider variability as 2 factors that can potentially exert enough influence on profile status to move a clinic from one performance category to another (eg, normal to worse performer).
      pubtype: Academic Journal
      doctype:
        equations & formulas
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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