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S T Fleming

Publications and source records attributed to S T Fleming.

25 records · Page 2Linked to original sources
PubMed1988

The Risk-Adjusted Mortality Index. A new measure of hospital performance.

The Commission on Professional and Hospital Activities (CPHA) developed the Risk-Adjusted Mortality Index (RAMI), a method for comparing hospital death rates using existing abstract or billing data. The method is comprehensive insofar as it includes all payers and all types of cases except neonates. RAMI was designed to differentiate among admissions on the basis of the patient characteristics that increase or reduce the risk of dying in the hospital. Using a large national data base, risk factors were determined empirically within each of 310 clusters based on diagnosis-related groups (DRGs). The model was very effective at predicting risk-adjusted outcomes, with a correlation of 0.98 between actual and predicted deaths in a sample of 300 hospitals. RAMI appears to be a powerful tool for using existing data to monitor changes over time in hospital death rates.

Adult↗
PubMed1987

The effect of PPS on hospital product and productivity.

The results suggest that Prospective Payment System (PPS) prompted a reduction in the proportion of Medicare patients that were discharged, for whom the hospital considered the episode of care to be completed. The results also show a reduction in the proportion of patients discharged dead. When controlling for patient type, the results support the findings, but the magnitude of the change that might be attributed to PPS is somewhat smaller. Proportional changes in the input measures for all patients were next considered. The results indicate that fewer diagnostic tests, fewer laboratory tests, and fewer x-rays were used in 1984. Laboratory tests showed the most dramatic decrease. LOS decreased, but the drug input remained fairly constant. A productivity index that reflects the change in the input measure while controlling for patient type was developed. The results provide strong evidence of a productivity increase in all products for Medicare patients. The drug input did not contribute to the productivity increase. The 50 most frequent DRGs for Medicare patients were examined separately for productivity changes by product. The results further support the findings of an increase in productivity.

Commission on Professional and Hospital Activities↗
PubMed1985

A multidimensional analysis of the impact of high-cost hospitalization.

In this update of a study of high-cost illness, we analyzed data on 1,455,766 discharges from 167 short-term general hospitals that participated in the Professional Activity Study of the Commission on Professional and Hospital Activities. Our results suggest that high-cost hospitalization can be characterized broadly by two groups: the single costly hospital episode and the multiple-admission pattern. We propose a theoretical framework to analyze high-cost hospitalization in terms of three dimensions: the magnitude of expenditures, the scope of high-cost illness within the cohort, and the scale of high-cost hospitalization within the population at large.

Age Factors↗
PubMedDate not supplied

Multiple sclerosis as a comorbidity: a study of resource utilization and outcomes of care.

The purpose of this paper is to compare the resource utilization and outcomes of care of elderly hospitalized patients with multiple sclerosis (MS) as a comorbidity to a comparison group without multiple sclerosis, matched by age, gender, and diagnosis related group (DRG) using the 1989 Quality Care (QC) MEDPAR file. The results of this paper demonstrate some differences in resource use. MS discharges incur lower average charges ($8698 for MS discharges, $8977 for controls), although the results are not statistically significant. Proportionately fewer MS discharges use intensive or coronary care services (14.7% versus 18.5%, P < .05). MS patients had a lower, but not statistically significant, 30-day mortality rate than the comparison group matched by age, sex, and DRG (7.6% versus 8.8%), a lower rate of readmission (13.9% versus 16.7%, P < .05), and a lower rate of complications (2.6% versus 4.7%, P < .05), although the results are not consistent across DRGs. Charges, length of stay, and intensive/coronary care utilization were lower, as expected, for a subset of less comorbid MS discharges and controls with, at most, four diagnoses. In this subset, MS discharges and controls were not statistically different, with the exception of overall complication rates (1.0% for MS versus 4.1% for controls, P < .05) and surgical complication rates (2.1% for MS versus 10.0% for controls, P < .05). It is unclear whether these results are due to differences in disease severity, case-mix within DRG, surgical risk, patient surveillance, or quality of care.

Aged↗
PubMedDate not supplied

Complications, adverse events, and iatrogenesis: classifications and quality of care measurement issues.

Accountability in the healthcare system demands the development of valid and reliable measures of quality, particularly outcome measures that have been risk-adjusted for factors that increase the probability of a poor outcome. Although the literature documents the existence of complications, adverse events, and iatrogenic illness, these concepts have not been compared and discussed thoroughly. This article ponders complications as a measure of quality of care by proposing a three-level classification scheme and by examining the incidence, consequence, and determinants of these events.

Clinical Competence↗
PubMedDate not supplied

Linking claims and cancer registry data: is it worth the effort?

Insurance claims and cancer registries represent different sources of data, each with advantages and limitations insofar as describing severity of illness, cost, utilization, and outcome of care for cancer patients. Although registries typically are able to identify stage of disease and initial course of treatment, claims-based data include more detailed information on the cost and utilization of medical-care services. Moreover, claims data can provide critical information about the use and location of medical services prior to diagnosis of cancer. The purpose of this paper is to argue the advantages of merging claims with registry data by considering evidence and insights from the literature. We discuss the advantages and disadvantages of claims data, describe studies that compare claims and registry data, and highlight the advantages of linking both sources of data. The latter is accomplished by considering a major advantage of each source of data. Registry data contain useful measures of severity of illness (cancer stage, tumor size, and sites of metastasis), whereas claims data include a detailed history of the cost of medical service.

Cost of Illness↗