Skip to main content
PMC home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1989 Apr;79(4):430–436. doi: 10.2105/ajph.79.4.430

A methodology for targeting hospital cases for quality of care record reviews.

E L Hannan 1, H R Bernard 1, J F O'Donnell 1, H Kilburn Jr 1
PMCID: PMC1349969  PMID: 2494893

Abstract

We tested the efficacy of selected case characteristics in targeting quality of care problems for medical record review. The case characteristics, all of which apply to patients who die in a hospital, consist primarily of procedures and DRGs (diagnosis-related groups) for which death rarely occurs, and a set of complications of surgical care. All characteristics are obtainable from combinations of the principal and secondary diagnoses and procedures in the case, and are available from discharge abstracts. The presence of a quality of care problem is confirmed through a review of the medical record by a nurse and two or more physicians. A logistic regression model that controls for various patient and hospital variables is used as a measure of each of the proposed case characteristics. The results indicate that most of the characteristics are associated with higher percentages of quality of care problems than cases chosen at random, and that the methodology has promise as a tool for targeting cases for medical record review.

Full text

PDF
434

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brewster A. C., Karlin B. G., Hyde L. A., Jacobs C. M., Bradbury R. C., Chae Y. M. MEDISGRPS: a clinically based approach to classifying hospital patients at admission. Inquiry. 1985 Winter;22(4):377–387. [PubMed] [Google Scholar]
  2. Dubois R. W., Brook R. H., Rogers W. H. Adjusted hospital death rates: a potential screen for quality of medical care. Am J Public Health. 1987 Sep;77(9):1162–1166. doi: 10.2105/ajph.77.9.1162. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dubois R. W., Rogers W. H., Moxley J. H., 3rd, Draper D., Brook R. H. Hospital inpatient mortality. Is it a predictor of quality? N Engl J Med. 1987 Dec 24;317(26):1674–1680. doi: 10.1056/NEJM198712243172626. [DOI] [PubMed] [Google Scholar]
  4. Flood A. B., Scott W. R., Ewy W. Does practice make perfect? Part II: The relation between volume and outcomes and other hospital characteristics. Med Care. 1984 Feb;22(2):115–125. [PubMed] [Google Scholar]
  5. Horn S. D., Bulkley G., Sharkey P. D., Chambers A. F., Horn R. A., Schramm C. J. Interhospital differences in severity of illness. Problems for prospective payment based on diagnosis-related groups (DRGs). N Engl J Med. 1985 Jul 4;313(1):20–24. doi: 10.1056/NEJM198507043130105. [DOI] [PubMed] [Google Scholar]
  6. Hughes R. G., Hunt S. S., Luft H. S. Effects of surgeon volume and hospital volume on quality of care in hospitals. Med Care. 1987 Jun;25(6):489–503. doi: 10.1097/00005650-198706000-00004. [DOI] [PubMed] [Google Scholar]
  7. Kelly J. V., Hellinger F. J. Physician and hospital factors associated with mortality of surgical patients. Med Care. 1986 Sep;24(9):785–800. doi: 10.1097/00005650-198609000-00001. [DOI] [PubMed] [Google Scholar]
  8. Luft H. S., Bunker J. P., Enthoven A. C. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979 Dec 20;301(25):1364–1369. doi: 10.1056/NEJM197912203012503. [DOI] [PubMed] [Google Scholar]
  9. Rutstein D. D., Berenberg W., Chalmers T. C., Child C. G., 3rd, Fishman A. P., Perrin E. B. Measuring the quality of medical care. A clinical method. N Engl J Med. 1976 Mar 11;294(11):582–588. doi: 10.1056/NEJM197603112941104. [DOI] [PubMed] [Google Scholar]
  10. Wennberg J. E., Gittelsohn A., Shapiro N. Health care delivery in Maine, III: evaluating the level of hospital performance. J Maine Med Assoc. 1975 Nov;66(11):298–306. [PubMed] [Google Scholar]
  11. Wennberg J. E., McPherson K., Caper P. Will payment based on diagnosis-related groups control hospital costs? N Engl J Med. 1984 Aug 2;311(5):295–300. doi: 10.1056/NEJM198408023110505. [DOI] [PubMed] [Google Scholar]
  12. Wennberg J., Gittelsohn Small area variations in health care delivery. Science. 1973 Dec 14;182(4117):1102–1108. doi: 10.1126/science.182.4117.1102. [DOI] [PubMed] [Google Scholar]
  13. Wennberg J. Which rate is right? N Engl J Med. 1986 Jan 30;314(5):310–311. doi: 10.1056/NEJM198601303140509. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES