The Adequacy of Individual Hospital Data to Identify High Utilizers and Assess Community Health

Abstract

procedures and the subanalysis contained 91 907 GI procedures and 1440 unique physicians. Patient characteristics are described in the Table. The Figure shows that the predicted probability of being coded as having a high risk of anesthesia more than doubled for all conditions from 2005 to 2013, indicating potential upcoding. The probability for patients with sleep apnea, for example, increased from 8.8% in 2005 to 21.5% in 2011 and remained at 20.8% in 2013. A similar pattern was also found among patients without any chronic conditions. In the subanalysis, the odds of patients with similar characteristics being coded as being at high risk in 2011 were approximately twice those in 2010, more than 3 times those in 2012, and about 5 times those in 2013, with all year-to-year changes found to be statistically significant.

Factors Associated With Emergency Department Use by Patients With and Without Mental Health Diagnoses

“…We used nonpublic data from January 1, 2012, through December 31, 2014, from California’s Office of Statewide Health Planning and Development (OSHPD), which provides detailed information on all ED visits at licensed hospitals in the state. Importantly, the data set is a census of all nonfederal hospitals in California and all payers, not just a subset of hospitals or payers; such an approach is critical to accurately and comprehensively capture ED use among patients who may visit multiple EDs and change insurance status frequently . Hospitals report data to OSHPD and perform routine accuracy checks using OSHPD’s Medical Information Reporting for California online system to reduce the likelihood of potential reporting errors and missing data .…”

“…Importantly, the data set is a census of all nonfederal hospitals in California and all payers, not just a subset of hospitals or payers; such an approach is critical to accurately and comprehensively capture ED use among patients who may visit multiple EDs and change insurance status frequently. 15 Hospitals report data to OSHPD and perform routine accuracy checks using OSHPD's Medical Information Reporting for California online system to reduce the likelihood of potential reporting errors and missing data. 16 For each patient, the first ED visit in 2013 was considered his or her index visit.…”

Comparing Statewide and Single‐center Data to Predict High‐frequency Emergency Department Utilization Among Patients With Asthma Exacerbation

“…As expected, in both the adult and the pediatric populations, fewer patients were categorized as high‐utilizers in the model that used single‐center visits. A study of patients with high ED utilization in Maryland found that 18% of the individuals with more than five ED visits visited more than three hospitals, and only 59% made more than five visits to any one hospital, suggesting that the rest would be underidentified by single‐center studies . Using HCUP data, Duseja et al .…”

Variation in outpatient emergency department utilization in Texas Medicaid: a state-level framework for finding “superutilizers”

“…State-level, population-based efforts to address the health needs of these high utilizers start with a robust characterization of these beneficiaries from statewide data sources [ 12 , 13 ]. In Maryland, Horrocks et al reported that, in the absence of state data, analyses limited to a single hospital would fail to identify two out of five high utilizers (≥ 5 ED visits) [ 14 ].…”