Medical care
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Hospitalizations represent a significant portion of the annual expenditures for the US health care system. Understanding recent changes in the sources of unscheduled admissions may provide opportunities to improve the quality and cost of inpatient care. ⋯ Sources of unscheduled hospitalization in the United States have evolved, mostly resulting from care for a variety of clinical conditions now originating in the ED. This trend does not seem to be harming patients or worsening LOS.
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The Electronic Data Methods (EDM) Forum, with support from the Agency for Healthcare Research and Quality, exists to advance knowledge and practice on the use of electronic clinical data (ECD) for comparative effectiveness research, patient-centered outcomes research, and quality improvement (QI). The EDM Forum facilitates collaboration between the Prospective Outcome Systems using Patient-specific Electronic data to Compare Tests and therapies, Scalable Distributed Research Network, and Enhanced registry projects funded by Agency for Healthcare Research and Quality. ⋯ The papers in this supplement provide lessons learned based on experiences building transparent, scalable, reusable networks for research and QI. Through these papers, and a new open access e-journal, eGEMs, the EDM Forum is working to advance the science of health research and QI using ECD to improve patient outcomes.
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Comparative Study
Comparing 2 methods of assessing 30-day readmissions: what is the impact on hospital profiling in the veterans health administration?
The Centers for Medicare and Medicaid Services' (CMS) all-cause readmission measure and the 3M Health Information System Division Potentially Preventable Readmissions (PPR) measure are both used for public reporting. These 2 methods have not been directly compared in terms of how they identify high-performing and low-performing hospitals. ⋯ Despite uncertainty over which readmission measure is superior in evaluating hospital performance, we confirmed that there are differences in CMS-generated and PPR-generated hospital profiles for reporting and pay-for-performance, because of methodological differences and the PPR's preventability component.
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Interest in comparing hospital surgical quality continues to increase, particularly with respect to examining certain hospital designations such as National Cancer Institute-designated Cancer Centers (NCI-CC). Our objectives were to compare patients, surgical complexity, and risk-adjusted 30-day outcomes following major cancer surgery at NCI-CC versus non-NCI centers. ⋯ NCI-CCs treated younger, healthier patients, but performed more complex procedures. Patients treated at NCI-CCs had a lower risk of mortality for colorectal resection, but morbidity was similar to non-NCI centers. Comparison of cancer surgery hospital quality is feasible and should adjust for differences in patient demographics, comorbidities, and surgical complexity.
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Proposed changes to financing of teaching hospitals and new quality-based performance incentives may differentially impact the financial health of teaching and safety-net institutions. Few data have examined the potential impact of these financial changes on teaching institutions. ⋯ In this nationally representative evaluation, we found significant variation in performance on risk-adjusted mortality and readmission rates, and differences in readmission rates based on safety-net status. Our findings suggest that high teaching intensity and safety-net institutions may be disproportionately affected by upcoming changes in hospital payment models.