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Does adding clinical data to administrative data improve agreement among hospital quality measures?

机译：将临床数据添加到行政数据是否改善了医院质量措施之间的协议？

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Background: Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. Methods: We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. Results: For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume -remained poor. Conclusions: Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. Interpretation: Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality.
机译：背景：基于患者死亡率和入院的医院绩效措施表明了适度的一致性率。如果将临床数据与行政数据的实验室测试和生命标志相结合，我们会审查了与行政数据的重要迹象相互改进，并在全国最大的综合保健系统中达成协议。方法：从退伍军人健康管理局（VA），我们使用患者级别的行政和临床资质数据，以及关于质量指标的医院级数据，2007 - 2010年。对于患有急性心肌梗死（AMI）的患者，心力衰竭（HF）和肺炎，我们在30-D死亡率和30-D入院率的情况下检查了医院性能的变化，因为将临床数据添加到行政数据。我们评估了这一增强是否基于与其他医院质量指标的一致性产生了改善的医院质量措施。结果：对于30-D死亡率，数据增强改善了模型性能，显着改变了医院性能概况;对于30-D人入住，影响适度。增强措施之间的一致性，以及其他医院质量措施 - 包括联合委员会的过程措施，VA外科质量改善计划（VASQIP）死亡率和发病率，以及案件的贫困性。结论：加入实验室检验和生命体征来衡量医院对死亡率和入院的表现，并未提高VA中医院质量指标的达成差的协议率。解释：应持续改善风险调整模型的努力;但是，验证证据应在其用途之前作为可靠的质量措施。

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