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Case‐Mix Adjusting Performance Measures in a Veteran Population: Pharmacy‐ and Diagnosis‐Based Approaches

To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy‐ and diagnosis‐based case‐mix adjustment measures. The study included veterans who used inpatient or outpatient service... Full description

Journal Title: Health Services Research October 2003, Vol.38(5), pp.1319-1338
Main Author: Liu, Chuan‐Fen
Other Authors: Sales, Anne E. , Sharp, Nancy D. , Fishman, Paul , Sloan, Kevin L. , Todd‐Stenberg, Jeff , Paul Nichol, W. , Rosen, Amy K. , Loveland, Susan
Format: Electronic Article Electronic Article
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ID: ISSN: 0017-9124 ; E-ISSN: 1475-6773 ; DOI: 10.1111/1475-6773.00179
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recordid: wj10.1111/1475-6773.00179
title: Case‐Mix Adjusting Performance Measures in a Veteran Population: Pharmacy‐ and Diagnosis‐Based Approaches
format: Article
creator:
  • Liu, Chuan‐Fen
  • Sales, Anne E.
  • Sharp, Nancy D.
  • Fishman, Paul
  • Sloan, Kevin L.
  • Todd‐Stenberg, Jeff
  • Paul Nichol, W.
  • Rosen, Amy K.
  • Loveland, Susan
subjects:
  • Case‐Mix Adjustment
  • Pharmacy Data
  • Profiling
ispartof: Health Services Research, October 2003, Vol.38(5), pp.1319-1338
description: To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy‐ and diagnosis‐based case‐mix adjustment measures. The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; =126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Rankings of predicted utilization measures across facilities vary by case‐mix adjustment measure. There is greater consistency within the diagnosis‐based models than between the diagnosis‐ and pharmacy‐based models. The eight facilities were ranked differently by the diagnosis‐ and pharmacy‐based models. Choice of case‐mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility.
language:
source:
identifier: ISSN: 0017-9124 ; E-ISSN: 1475-6773 ; DOI: 10.1111/1475-6773.00179
fulltext: fulltext
issn:
  • 0017-9124
  • 00179124
  • 1475-6773
  • 14756773
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titleCase‐Mix Adjusting Performance Measures in a Veteran Population: Pharmacy‐ and Diagnosis‐Based Approaches
creatorLiu, Chuan‐Fen ; Sales, Anne E. ; Sharp, Nancy D. ; Fishman, Paul ; Sloan, Kevin L. ; Todd‐Stenberg, Jeff ; Paul Nichol, W. ; Rosen, Amy K. ; Loveland, Susan
ispartofHealth Services Research, October 2003, Vol.38(5), pp.1319-1338
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subjectCase‐Mix Adjustment ; Pharmacy Data ; Profiling
descriptionTo compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy‐ and diagnosis‐based case‐mix adjustment measures. The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; =126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Rankings of predicted utilization measures across facilities vary by case‐mix adjustment measure. There is greater consistency within the diagnosis‐based models than between the diagnosis‐ and pharmacy‐based models. The eight facilities were ranked differently by the diagnosis‐ and pharmacy‐based models. Choice of case‐mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility.
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titleCase‐Mix Adjusting Performance Measures in a Veteran Population: Pharmacy‐ and Diagnosis‐Based Approaches
descriptionTo compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy‐ and diagnosis‐based case‐mix adjustment measures. The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; =126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Rankings of predicted utilization measures across facilities vary by case‐mix adjustment measure. There is greater consistency within the diagnosis‐based models than between the diagnosis‐ and pharmacy‐based models. The eight facilities were ranked differently by the diagnosis‐ and pharmacy‐based models. Choice of case‐mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility.
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abstractTo compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy‐ and diagnosis‐based case‐mix adjustment measures. The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; =126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Rankings of predicted utilization measures across facilities vary by case‐mix adjustment measure. There is greater consistency within the diagnosis‐based models than between the diagnosis‐ and pharmacy‐based models. The eight facilities were ranked differently by the diagnosis‐ and pharmacy‐based models. Choice of case‐mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility.
copOxford, UK
pubBlackwell Publishing
doi10.1111/1475-6773.00179
pages1319-13137
date2003-10