Medical care
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Clinically plausible risk-adjustment methods are needed to implement pay-for-performance protocols. Because billing data lacks clinical precision, may be gamed, and chart abstraction is costly, we sought to develop predictive models for mortality that maximally used automated laboratory data and intentionally minimized the use of administrative data (Laboratory Models). We also evaluated the additional value of vital signs and altered mental status (Full Models). ⋯ Mortality can be well predicted using models that maximize reliance on objective pathophysiologic variables whereas minimizing input from billing data. Such models should be less susceptible to the vagaries of billing information and inexpensive to implement.
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System approaches, such as improving working conditions, have been advocated to improve patient safety. However, the independent effect of many working condition variables on patient outcomes is unknown. ⋯ Nurse working conditions were associated with all outcomes measured. Improving working conditions will most likely promote patient safety. Future researchers and policymakers should consider a broad set of working condition variables.
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Hospitals are under pressure to increase revenue and lower costs, and at the same time, they face dramatic variation in clinical demand. ⋯ Hospitals that operate at or over capacity may experience heightened rates of patient safety events and might consider re-engineering the structures of care to respond better during periods of high stress.
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Comparative Study
Differences among the elderly in the treatment costs of colorectal cancer: how important is race?
Medical expenditures adjusted for price differences are a barometer of total resources devoted to patient care and thus may reflect treatment differentials. ⋯ African American CRC patients cost more than their white counterparts, but adjusted differences were nonsignificant and trivial. Several nonracial cost differences were considerably larger (but not all statistically significant), and suggest that future research pay more attention to these characteristics.