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The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes.

Publication ,  Journal Article
O'Brien, EC; Li, S; Thomas, L; Wang, TY; Roe, MT; Peterson, ED
Published in: Clin Cardiol
September 2018

BACKGROUND: Comorbid condition and hospital risk-adjusted outcomes prevalence were compared based on clinical registry vs administrative claims data. HYPOTHESIS: Risk-adjusted outcomes will vary depending on the source of comorbidity data used. METHODS: Clinical data from hospitalized Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines (CRUSADE) non-ST-segment elevation myocardial infarction (NSTEMI) patients ≥65 years was linked to Medicare claims. Eight common comorbid conditions were coded and compared between registry data (derived from medical record review) and claims data; hospital-level observed vs expected ratios and outlier status for 30-day readmission and mortality were calculated using logistic generalized estimating equations for clinical vs claims data. RESULTS: Of 68 199 NSTEMI patients, 48.1% were female, 86.9% were white, and median age was 78. Degree of agreement between data sources for comorbid condition prevalence was 67.8% for myocardial infarction and 89.3% for diabetes. Overall, multivariable model performance was similar: Medicare mortality c-statistics is 0.69 vs CRUSADE is 0.71; readmission c-statistics is 0.59 for both. Hospital ratings were similar regardless of data source (mortality, R2 = 0.97863; readmission, R2 = 0.97858). Eighty-two hospitals were mortality outliers in claims-based models; of these, 70 were outliers in registry-based models. Forty-five hospitals were readmission outliers in claims-based models; of these, 39 were outliers in registry-based models. CONCLUSIONS: There were significant differences in individual comorbid condition prevalence when derived from registries vs claims, but hospital-level outcomes were comparable.

Duke Scholars

Published In

Clin Cardiol

DOI

EISSN

1932-8737

Publication Date

September 2018

Volume

41

Issue

9

Start / End Page

1225 / 1231

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • Risk Assessment
  • Registries
  • Medicare
  • Male
  • Humans
  • Hospitals
  • Hospitalization
 

Citation

APA
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MLA
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O’Brien, E. C., Li, S., Thomas, L., Wang, T. Y., Roe, M. T., & Peterson, E. D. (2018). The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes. Clin Cardiol, 41(9), 1225–1231. https://doi.org/10.1002/clc.23059
O’Brien, Emily C., Shuang Li, Laine Thomas, Tracy Y. Wang, Matthew T. Roe, and Eric D. Peterson. “The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes.Clin Cardiol 41, no. 9 (September 2018): 1225–31. https://doi.org/10.1002/clc.23059.
O’Brien EC, Li S, Thomas L, Wang TY, Roe MT, Peterson ED. The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes. Clin Cardiol. 2018 Sep;41(9):1225–31.
O’Brien, Emily C., et al. “The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes.Clin Cardiol, vol. 41, no. 9, Sept. 2018, pp. 1225–31. Pubmed, doi:10.1002/clc.23059.
O’Brien EC, Li S, Thomas L, Wang TY, Roe MT, Peterson ED. The impact of clinical vs administrative claims coding on hospital risk-adjusted outcomes. Clin Cardiol. 2018 Sep;41(9):1225–1231.
Journal cover image

Published In

Clin Cardiol

DOI

EISSN

1932-8737

Publication Date

September 2018

Volume

41

Issue

9

Start / End Page

1225 / 1231

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • Risk Assessment
  • Registries
  • Medicare
  • Male
  • Humans
  • Hospitals
  • Hospitalization