An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With an Acute Myocardial Infarction

Abstract

Background-A model using administrative claims data that is suitable for profiling hospital performance for acute myocardial infarction would be useful in quality assessment and improvement efforts. We sought to develop a hierarchical regression model using Medicare claims data that produces hospital risk-standardized 30-day mortality rates and to validate the hospital estimates against those derived from a medical record model. Methods and Results-For hospital estimates derived from claims data, we developed a derivation model using 140 120 cases discharged from 4664 hospitals in 1998. For the comparison of models from claims data and medical record data, we used the Cooperative Cardiovascular Project database. To determine the stability of the model over time, we used annual Medicare cohorts discharged in 1995, 1997, and 1999 -2001. The final model included 27 variables and had an area under the receiver operating characteristic curve of 0.71. In a comparison of the risk-standardized hospital mortality rates from the claims model with those of the medical record model, the correlation coefficient was 0.90 (SEϭ0.003).The slope of the weighted regression line was 0.95 (SEϭ0.007), and the intercept was 0.008 (SEϭ0.001), both indicating strong agreement of the hospital estimates between the 2 data sources. The median difference between the claims-based hospital risk-standardized mortality rates and the chart-based rates was Ͻ0.001 (25th and 75th percentiles, Ϫ0.003 and 0.003). The performance of the model was stable over time. Conclusions-This administrative claims-based model for profiling hospitals performs consistently over several years and produces estimates of risk-standardized mortality that are good surrogates for estimates from a medical record model.

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

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Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014

“…We identified comorbidities included in the Centers for Medicare & Medicaid Services 30‐day mortality and readmission measures for acute myocardial infarction and heart failure,17, 18 including cardiovascular risk factors (hypertension, diabetes mellitus, atherosclerotic disease, unstable angina, previous myocardial infarction, previous heart failure, peripheral vascular disease, stroke, and other cerebrovascular diseases), geriatric conditions (dementia, functional disability, and malnutrition), and other conditions (renal failure, chronic obstructive pulmonary disease, pneumonia, respiratory failure, liver disease, cancer, major psychiatric disorders, depression, and trauma). We determined comorbidities from a combination of secondary diagnosis codes for the index hospitalization and principal and secondary diagnosis codes for all hospitalizations over 12 months preceding the index hospitalization.…”

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