Comparison Between Clinical Registry and Medicare Claims Data on the Classification of Hospital Quality of Surgical Care

Lawson, Elise H.; Zingmond, David S.; Hall, Bruce L.; Louie, Rachel; Brook, Robert H.; Ko, Clifford Y.

doi:10.1097/sla.0000000000000707

Cited by 70 publications

(62 citation statements)

References 21 publications

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“…15 There are significant implications for hospital reimbursements and public reporting based on the source of data evaluated. 4 If improving patient care and healthcare delivery are truly valued, obtaining valid and reliable…”

Section: Discussionmentioning

confidence: 99%

“…4 These findings have also been reinforced when comparing assessment of SSI using NSQIP and the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) in colon surgery. 5 Not only are postoperative complications difficult to identify given variability in definitions and documentation, they can be exceedingly difficult to compare given the need for risk-adjustment.…”

Section: A N U S C R I P Tmentioning

confidence: 90%

“…Additionally, the primary use of billing claims data to generate hospital reimbursement may confound the validity of the data. 4 In the changing reimbursement landscape where complications result in financial penalties, documentation practices will continue to have significant implications on the assessment of SSI. Additionally, while ICD-10 provides additional granularity (e.g.…”

Section: A N U S C R I P Tmentioning

confidence: 99%

“…This source of data is generally considered to be more accurate and reliable, but is more labor intensive and many require a large financial investment for participation in the registry. 4 Not only do these measures differ in quality, but they also result in different estimates of attributable costs in adults. 8 Little is known about the measurement and surveillance of SSI in children.…”

mentioning

confidence: 99%

“…[1][2][3][4][5] However, in order for these clinical outcome parameters to validly assess quality in healthcare delivery, it is important that they accurately and reliably measure the outcome of interest. A number of different mechanisms exist to measure SSI, including administrative or billing claims data (International Classification of Disease, 9 th revision [ICD-9] derived), active electronic surveillance, and clinical registries.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Measuring Surgical Site Infections in Children: Comparing Clinical, Electronic, and Administrative Data

Kulaylat

Engbrecht

Rocourt

et al. 2016

Journal of the American College of Surgeons

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Section: Discussionmentioning

confidence: 99%

Section: A N U S C R I P Tmentioning

confidence: 90%

Section: A N U S C R I P Tmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Measuring Surgical Site Infections in Children: Comparing Clinical, Electronic, and Administrative Data

Kulaylat

Engbrecht

Rocourt

et al. 2016

Journal of the American College of Surgeons

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Comparison of Hospitals Affiliated With PPS-Exempt Cancer Centers, Other Hospitals Affiliated With NCI-Designated Cancer Centers, and Other Hospitals That Provide Cancer Care

et al. 2019

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IMPORTANCE Congress has exempted 11 specialized cancer centers in the United States from the Prospective Payment System (PPS). These centers are also exempt from reporting many of the process-of-care and outcome measures to the Centers for Medicare & Medicaid Services that are required for hospitals in the PPS. It is not known how hospitals affiliated with PPS-exempt cancer centers differ from other hospitals affiliated with National Cancer Institute cancer centers (NCI-CCs) or other US hospitals that provide cancer care. OBJECTIVE To examine differences between hospitals affiliated with PPS-exempt cancer centers, other hospitals affiliated with NCI-CCs, and other hospitals that provide cancer care on metrics that could be used in public reporting. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study compared hospital characteristics and cancer-related services using data from the American Hospital Association Annual Survey and US News Best Hospitals rankings. With a 100% sample of Medicare beneficiaries who underwent 1 of 9 cancer operations (brain tumor resection, colorectal resection, cystectomy, esophagectomy, gastrectomy, liver resection, lung resection, pancreatic resection, prostatectomy) from January 1, 2011, to May 31, 2015, we used hierarchical logistic regression methods to compare differences in 18 postoperative outcomes. Data analysis was conducted from February 2018 to August 2018. MAIN OUTCOMES AND MEASURES This study evaluated hospital characteristics, including cancer-specific services, patient comorbidity burden, and cancer surgery postoperative outcomes, from PPS-exempt cancer centers, NCI-affiliated cancer centers, and other US hospitals that provide cancer care. RESULTS Hospitals affiliated with PPS-exempt cancer centers (n = 15) and NCI-CCs (n = 54) were similar in hospital characteristics, basic cancer-related services, and patient comorbidity burden. Compared with NCI-CCs, PPS-exempt cancer centers had significantly higher US News reputation scores (mean [SD], 17.5 [24.0] vs 2.6 [4.8]; P < .001) but no differences in oncology patient volume, patient safety ratings, comorbidity burden, nurse staffing, US News total cancer scores, or US News survival scores. Hospitals affiliated with PPS-exempt cancer centers and NCI-CCs had similar adjusted postoperative outcomes for 15 of 18 measures, including mortality, readmission, and surgical site infections. Compared with hospitals affiliated with PPS-exempt cancer centers, patients treated at NCI-CCs were more likely to have postoperative sepsis (3.1% vs 1.7%; P = .002), acute renal failure (6.2% vs 3.9%; P = .01), and urinary tract infection (6.4% vs 4.0%; P = .002). Compared with the other hospitals that provide cancer care (n = 3578), PPS-exempt cancer center status was associated with improved outcomes for 7 of 18 measures, including mortality, sepsis, acute renal failure, pulmonary failure, and failure to rescue. CONCLUSIONS AND RELEVANCE Hospitals affiliated with PPS-exempt cancer centers and NCI-CCs had generally similar hospital...

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Distinction of Risk Factors for Superficial vs Organ-Space Surgical Site Infections After Pancreatic Surgery

et al. 2017

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Preoperative biliary stenting and coriticosteroid use increase superficial SSI, even in patients receiving perioperative piperacillin-tazobactam. Additional measures, including extended broad-spectrum perioperative antibiotic treatment, should be considered in these patients. Organ/space SSIs appear to be related to pancreatic fistulae, which are not modifiable. Reporting these different subtypes as a single, overall rate may be misleading.

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Comparison Between Clinical Registry and Medicare Claims Data on the Classification of Hospital Quality of Surgical Care

Abstract: Despite using the same statistical methodology with each data source, classification of hospital outlier status as better or worse performance than expected for postoperative complications differed substantially between ACS-NSQIP and Medicare claims.

Cited by 70 publications

References 21 publications

Measuring Surgical Site Infections in Children: Comparing Clinical, Electronic, and Administrative Data

Measuring Surgical Site Infections in Children: Comparing Clinical, Electronic, and Administrative Data

Comparison of Hospitals Affiliated With PPS-Exempt Cancer Centers, Other Hospitals Affiliated With NCI-Designated Cancer Centers, and Other Hospitals That Provide Cancer Care

Distinction of Risk Factors for Superficial vs Organ-Space Surgical Site Infections After Pancreatic Surgery

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