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Screening inpatient quality using post-discharge events.

L I Iezzoni1, Y D Mackiernan, M J Cahalane

  • 1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. liezzoni@bidmc.harvard.edu

Medical Care
|April 23, 1999
PubMed
Summary
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A new computerized method, the Complications Screening Program for Outpatient data (CSP-O), identifies hospital complications using post-discharge claims. This approach is vital as shorter hospital lengths of stay (LOS) limit in-patient complication detection.

Area of Science:

  • Health Services Research
  • Medical Informatics
  • Patient Safety

Background:

  • Declining hospital lengths of stay (LOS) impede the timely detection and treatment of patient care complications.
  • Patients are discharged before certain complications can be identified, posing a risk to their health outcomes.

Purpose of the Study:

  • To develop and evaluate a computerized system for screening hospital-acquired complications.
  • Utilize readily available administrative data from outpatient and nonacute care settings within 90 days post-discharge.

Main Methods:

  • Developed the Complications Screening Program for Outpatient data (CSP-O) using Medicare Part A and B claims (diagnosis and procedure codes).
  • Created 50 complication screens: 17 for specific procedures and 33 for general adult hospitalizations.

Related Experiment Videos

  • The CSP-O algorithm analyzed claims from outpatient, physician offices, home health, and hospice within 90 days of discharge.

    • Main Results:

    • Complete 90-day post-discharge data were available for 62.8% of all cases.
    • General screens flagged 13.6% of cases; procedural screens flagged 1.8%.
    • Including acute readmissions increased flag rates to 32.8% (general) and 8.7% (procedural); rates were higher for older patients and at for-profit facilities.

    Conclusions:

    • The Complications Screening Program for Outpatient data (CSP-O) shows promise but has limitations due to claims data.
    • Further examination of post-discharge patient experiences is crucial for identifying inpatient complications, especially with decreasing hospital LOS.