ABSTRACT
The Episode Treatment Group (ETG) methodology is a patented case-mix adjustment and episode-building system that uses routinely collected inpatient and ambulatory claims data. The resulting clinically homogenous groups, of which there are approximately 600, adjust for severity by the presence of complicating conditions, comorbidities, and other characteristics of a patient's condition that affect resource utilization.
Subject(s)
Abstracting and Indexing/methods , Diagnosis-Related Groups/classification , Episode of Care , Forms and Records Control/methods , Medical Records/classification , Outcome Assessment, Health Care/methods , Humans , Inpatients/classification , Outpatients/classification , Risk Adjustment , United StatesABSTRACT
This article describes a risk-adjusted approach for profiling hospitals and physicians on clinical quality indicators using readily available administrative data. By comparing risk-adjusted rates of mortality, complications, and readmissions to peers, national norms, and benchmarks, this approach enables purchasers and providers to identify both favorable and adverse outcomes performance.
Subject(s)
Outcome Assessment, Health Care/methods , Quality Indicators, Health Care , Risk Adjustment , Benchmarking/standards , Diagnosis-Related Groups , Female , Hospital Mortality , Humans , Models, Statistical , Patient Readmission , Postoperative Complications/epidemiology , Pregnancy , Pregnancy Complications/epidemiology , Risk Assessment , Risk Factors , United States/epidemiologySubject(s)
Hospitals/standards , Outcome Assessment, Health Care/standards , Quality of Health Care/standards , Hospital Mortality , Humans , Information Services , Models, Organizational , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology , Risk Factors , United States/epidemiologyABSTRACT
Central to the success of clinical improvement programs is the degree to which hospitals and physicians can work together to achieve mutually beneficial goals. The purpose of this article is to provide a clear understanding of what is ultimately required for hospitals and physicians to form constructive relationships that deliver greater value to the marketplace.
Subject(s)
Hospital Administrators , Hospital-Physician Relations , Institutional Management Teams , Medical Staff, Hospital , Hospital Administrators/psychology , Hospital-Physician Joint Ventures/standards , Humans , Medical Staff, Hospital/psychology , Practice Patterns, Physicians'/economics , Systems Analysis , Total Quality Management/organization & administration , United StatesABSTRACT
Measuring severity of illness within diagnosis-related groups (DRGs) has become increasingly important because of the growing need to compare outcomes across providers. In response to these needs, the Health Care Financing Administration (HCFA) has developed a DRG-based severity system as a refinement to its current Medicare DRG structure. As a result of this recent HCFA research, all-payer severity-adjusted DRGs (APS-DRGs) have been developed to provide a uniform approach for severity classification that is also applicable to the all-payer population.
Subject(s)
Diagnosis-Related Groups/classification , Severity of Illness Index , Centers for Medicare and Medicaid Services, U.S. , Diagnosis-Related Groups/economics , Health Services Research , Humans , Medicare , Models, Theoretical , New York , Patient Discharge , Pilot Projects , Prospective Payment System , United StatesABSTRACT
This article describes a risk-adjusted approach for profiling hospitals and physicians on quality outcomes using readily available administrative data. By comparing risk-adjusted rates of mortality, complications, and readmissions to rates for peers, national norms, and benchmarks, this approach enables purchasers and providers to compare the performance of providers in terms of both favorable and adverse outcomes.
Subject(s)
Hospitals/standards , Outcome Assessment, Health Care/standards , Physicians/standards , Centers for Medicare and Medicaid Services, U.S. , Databases, Factual/statistics & numerical data , Diagnosis-Related Groups/classification , Female , Hospital Mortality , Hospitals/classification , Humans , Models, Statistical , Patient Readmission/statistics & numerical data , Physicians/classification , Postoperative Complications/classification , Postoperative Complications/epidemiology , Pregnancy , Pregnancy Complications/classification , Pregnancy Complications/epidemiology , Risk Assessment , United States/epidemiologyABSTRACT
The presumed stellar characteristics of clinical pathways have grown in unearthly proportions to the extent that our expectations of pathway utilization are unrealistic and unfounded. Therefore, before expectations go unmet and dissatisfaction with clinical pathway outcomes becomes prevalent, we must objectively analyze the clinical pathway phenomenon and understand the origins, elements, and purpose of this clinical improvement technique.
Subject(s)
Critical Pathways/organization & administration , Total Quality Management/methods , Humans , Organizational Culture , Organizational Innovation , Outcome and Process Assessment, Health Care , United StatesABSTRACT
This article illustrates a process by which hospitals can assess their outcomes performance on rate-related complications and mortality using readily available administrative data. This approach allows hospitals to demonstrate the value of their clinical services to managed care organizations and further investigate services that may be experiencing adverse outcomes. The analysis compares outcome performance to national norms and benchmarks, as well as to local competitors.
