Medical care
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Multicenter Study
How valid is the ICD-9-CM based AHRQ patient safety indicator for postoperative venous thromboembolism?
Hospital administrative data are being used to identify patients with postoperative venous thromboembolism (VTE), either pulmonary embolism (PE) or deep-vein thrombosis (DVT). However, few studies have evaluated the accuracy of these ICD-9-CM codes across multiple hospitals. ⋯ Current PSI 12 criteria do not accurately identify patients with acute postoperative lower extremity DVT or PE. Modification of the ICD-9-CM codes and implementation of "present on admission" flags should improve the predictive value for clinically important VTE events.
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Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care. ⋯ Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.
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Multicenter Study
Development of an algorithm to identify preoperative medical consultations using administrative data.
Preoperative consultation by internal medicine specialists may help improve the care of patients undergoing major surgery. Population-based administrative data are an efficient approach for studying these consultations at a population-level. However, administrative data in many jurisdictions lack specific codes to identify preoperative medical consultations, as opposed to consultations for nonoperative indications. ⋯ A simple claims-based algorithm can accurately identify preoperative medical consultations before major elective noncardiac surgery. This algorithm may help enhance population-based evaluations of preoperative care, provided that the requisite linked administrative healthcare data are present.
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Alzheimer disease and related dementias (ADRD) have become a major concern for Medicare because of the increasing prevalence rate and the associated high cost of care. ⋯ The results of our study highlight the challenges to reducing expenditure growth and persistence for high-cost ADRD beneficiaries with prominent comorbidities. It will be important to examine whether better care coordination and disease management tailored to high-cost beneficiaries with ADRD can effectively contain costs.