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D L Ordin

Publications and source records attributed to D L Ordin.

10 recordsLinked to original sources
PubMed2000

Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels.

CONTEXT: Despite condition-specific and managed care-specific reports, no systematic program has been developed for monitoring the quality of medical care provided to Medicare beneficiaries. OBJECTIVE: To create a monitoring system for a range of measures of clinical performance that supports quality improvement and provides repeated, reliable estimates at the national and state levels for fee-for-service (FFS) Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTS: National study of repeated, cross-sectional observational data collected in 1997-1999 on all Medicare FFS beneficiaries or on a representative sample of beneficiaries with a particular condition. Data were collected using medical record abstraction for inpatient care, analysis of Medicare claims for some ambulatory services, and surveys for immunization rates. Separate samples were drawn for each topic for each state. MAIN OUTCOME MEASURES: Beneficiary patients' receipt of 24 process-of-care measures related to primary prevention, secondary prevention, or treatment of 6 medical conditions (acute myocardial infarction, breast cancer, diabetes mellitus, heart failure, pneumonia, and stroke) for which there is strong scientific evidence and professional consensus that the process of care either directly improves outcomes or is a necessary step in a chain of care that does so. RESULTS: Across all states for all measures, the percentage of patients receiving appropriate care in the median state ranged from a high of 95% (avoidance of sublingual nifedipine for patients with acute stroke) to a low of 11% (patients with pneumonia screened for pneumococcal immunization status before discharge). The median performance on an indicator is 69% (patients discharged with heart failure diagnosis who received angiotensin-converting enzyme inhibitors; diabetic patients having an eye examination in the last 2 years). Some states (particularly less populous states and those in the Northeast) consistently ranked high in relative performance while others (particularly more populous states and those in the Southeast) consistently ranked low. CONCLUSIONS: It is possible to assemble information on a diverse set of clinical performance measures that represent performance on the range of services in a health insurance program. These findings indicate substantial opportunities to improve the care delivered to Medicare beneficiaries and urgently invite a partnership among practitioners, hospitals, health plans, and purchasers to achieve that improvement. JAMA. 2000;284:1670-1676.

Breast Neoplasms↗
PubMed1996

Closing the surveillance gap.

Since 1986 there has been substantial progress in developing surveillance systems for occupational disease and injury that meet the goals of surveillance: identification or new diseases and causes of injury; estimation of the magnitude and trend of injuries and illnesses; identification of epidemic clusters; and identification of sentinel cases representing failures of prevention. A quiltwork of surveillance systems for occupational diseases and injury has been implemented by several federal agencies; surveillance systems for many more disease and injuries are being developed by the states. The conceptual basis for "closing the surveillance gap" has been developed; national implementation is the next challenge.

Carpal Tunnel Syndrome↗
PubMedDate not supplied

Medicare initiatives to improve heart failure care: an introduction.

Purchasers of health care, patients, physicians, and other health care professionals are increasingly seeking to evaluate quality of health care. Scattered reports have suggested that there is currently marked variation in evaluation and treatment of heart failure and substantial gaps between guideline recommendations and care delivered to heart failure patients. Heart failure is the most common discharge diagnosis for Medicare beneficiaries and yet, until recently, relatively little national information was available to describe the quality of care and to identify opportunities to improve practice. To address the need to evaluate care of patients with heart failure and support national, state, and local efforts to improve care and outcomes, the Health Care Financing Administration has initiated three programs that stretch across much of the continuum of care: the National Heart Failure Quality Improvement Project, focusing on inpatient care; the Heart Failure Practice Improvement Effort (HF PIE), a pilot outpatient effort in 11 states; and the 2001 requirement for Medicare+Choice Organizations to initiate quality improvement efforts for their heart failure patients. This paper is the first in a series that will provide information about these programs. We hope that this series will stimulate discussion on how clinicians can join these national efforts to improve the care and outcomes of patients with heart failure. (c)2000 by CHF, Inc.

Journal Article↗
PubMedDate not supplied

The National Heart Failure Project: a health care financing administration initiative to improve the care of Medicare beneficiaries with heart failure.

This is the second in a series describing Health Care Financing Administration (HCFA) initiatives to improve care for Medicare beneficiaries with heart failure. The first article outlined the history of HCFA quality-improvement projects and current initiatives to improve care in six priority areas: heart failure, acute myocardial infarction, stroke, pneumonia, diabetes, and breast cancer. This article details the objectives and design of the Medicare National Heart Failure Quality Improvement Project (NHF), which has as its goal the improvement of inpatient heart failure care. (c)2000 by CHF, Inc.

Journal Article↗
PubMedDate not supplied

Heart failure practice improvement effort in the outpatient setting: a health care financing administration initiative to improve the care of medicare beneficiaries with heart failure.

This column is the fourth in a series describing Health Care Financing Administration initiatives to improve care for Medicare beneficiaries with heart failure. The first three papers addressed the background, design, and baseline results of the Health Care Financing Administration national initiative to improve quality of inpatient care for heart failure through the activities of each state's Health Care Financing Administration contractor Peer Review Organization. This paper describes a smaller-scale but equally important endeavor: the Heart Failure Practice Improvement Effort, a pilot project to test the feasibility of assessing and improving heart failure care in the outpatient setting. (c)2001 by CHF, Inc.

Journal Article↗
PubMedDate not supplied

Profiles of quality improvements in heart failure care.

The Health Care Financing Administration, with its National Heart Failure project, has made heart failure care one of its targets for quality improvement. Previous columns have highlighted the clinical and epidemiologic background for the National Heart Failure project. This column provides "real-world" examples of hospitals improving care for their heart failure patients. (c)2001 by CHF, Inc.

Journal Article↗
PubMedDate not supplied

Improving heart failure care in the office setting.

This column is the sixth in a series describing Health Care Financing Administration (HCFA) initiatives to improve care for Medicare beneficiaries with heart failure. The fourth column addressed the Heart Failure Practice Improvement Effort, HCFA's pilot project to test the feasibility of assessing and improving heart failure care in the outpatient setting through the activities of HCFA-contracted peer review organizations in eight states. This column is dedicated to illustrating the progress of the Heart Failure Practice Improvement Effort project at an individual state and practice level, focusing on the quality improvement activities in outpatient heart failure care conducted by the Colorado peer review organization. (c)2001 CHF, Inc.

Journal Article↗
PubMedDate not supplied

Lessons learned from the national heart failure project: a center for medicare and medicaid services initiative to improve the care of medicare beneficiaries with heart failure.

This column is the seventh in a series reporting on the efforts of the Center for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration, to improve care for Medicare beneficiaries with heart failure. In previous columns we have described the overall structure of Medicare quality improvement efforts, detailed the structure of the national inpatient fee-for-service program known as the National Heart Failure project, and discussed the baseline quality indicator rates for the project, which are focused on rates of ejection fraction documentation and angiotensin-converting enzyme inhibitor prescription. In more recent columns, we reported on quality improvement projects from several participating hospitals, and on a pilot project exploring quality improvement efforts for heart failure based in physicians' offices. This column will focus on ways in which systematic examination of data, such as those from the National Heart Failure project, might shape future quality improvement and research efforts. The National Heart Failure project's quality indicator data are collected primarily to guide and evaluate the efforts of the CMS contractor peer-review organizations to facilitate quality improvement efforts in hospitals throughout the United States. (c)2001 CHF, Inc.

Journal Article↗
PubMedDate not supplied

Baseline quality indicator rates from the National Heart Failure Project: a HCFA initiative to improve the care of medicare beneficiaries with heart failure.

This column is the third in a series reporting on Health Care Financing Administration (HCFA) initiatives to improve care for Medicare beneficiaries with heart failure. The first paper outlined the history of HCFA quality improvement projects and current initiatives to improve care in six priority areas: heart failure, acute myocardial infarction, stroke, pneumonia, diabetes, and breast cancer. The second reported in more detail the structure of the national inpatient fee-for-service heart failure initiative, known as the National Heart Failure project. It described the development of the quality indicators, the sampling strategy for selecting charts to be reviewed, and the types of local efforts spurred by the project through the activities of each state's HCFA contractor peer review organization. This article discusses baseline quality indicator rates from the National Heart Failure project. (c)2001 by CHF, Inc.

Journal Article↗