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Biomedical subjects

E D Huff

Publications and source records attributed to E D Huff.

11 recordsLinked to original sources
PubMed2000

Outpatient utilization patterns and quality outcomes after first acute episode of mental health hospitalization. Is some better than none, and is more service associated with better outcomes?

Access to outpatient services within the first 30 days after an inpatient mental health episode may influence relapse risk. A retrospective cohort of 3,755 adult Medicaid mental health inpatients discharged from their first managed care acute episode of care from July 1, 1996, through May 20, 1998, were studied. Results showed patients' utilization of any psychotherapy (OR = .43), medication management (OR = .41), or diagnostic evaluation services (OR = .61), relative to no utilization, was associated with significantly lower 30-day readmission rates, and longer times in remission. However, patients receiving above the median total number of ambulatory services, or having contact with more providers showed significantly greater likelihood of 30-day readmission, and shorter time in remission. Findings heighten the need for the availability of timely risk-reducing mental health outpatient services, the continuity and risk of fragmentation of therapeutic relationships, as well as crisis planning before an inpatient discharge.

Adult↗
PubMed1997

Comprehensive reliability assessment and comparison of quality indicators and their components.

To test whether conventional data reliability assessment overestimates reliability, an assessment and a comparison of the reliability of complex quality indicators and their simpler components were conducted. Medical records of 1078 Medicare cases with principal diagnoses of initial episodes of acute myocardial infarction (AMI) were independently reabstracted at two national Clinical Data Abstraction Centers (CDACs). The inter-rater agreement beyond chance (kappa) of reabstracted and original quality indicators and key components were computed and compared. Results showed excellent agreement (kappas ranging from 0.88 to 0.95) for simple determinations of whether standard medical therapies were provided. Repeatability of eligibility status and the more complex determinations of whether "ideal" candidates were not treated showed moderate to excellent kappa values ranging from 0.41 to 0.79. A planned comparison of five similar quality indicators and their key components showed that the simpler treatment components, as a group, had significantly higher kappas than the more complexly derived eligibility components and composite indicators (Fisher's exact, p < 0.02). Reliability assessment of quality indicators should be based upon the repeatability of the whole indicator, accounting for both data and logic, and not just one simple element.

Humans↗
PubMedDate not supplied

Discontinuity in the Health Care Financing Administration's published standardized mortality ratios due to underestimation bias across multiple admissions case selection methods.

Case counts below 50 can compromise the careful use of disease- or procedure-specific standardized mortality ratio comparisons across small hospitals in predominantly rural areas. Linking data series where data are of the same quality and are continuous across the series is one way of handling the problem of small case sizes. Examination of three different annual reports of Health Care Financing Administration (HCFA) mortality findings for 1987 of one state's providers showed significantly lower actual and predicted mortality rates reported in 1989, compared with the same mortality rates reported about 1987 published in 1988 and 1987. One hypothesis for the downward trend is the change in case selection method used for constructing the mortality model from last discharge (used in 1987 and 1988 reports) to random selection of cases with multiple admissions (initiated in 1989). A test of both case selection methods is presented and shows the consequences of mortality model changes that create discontinuities with previously reported findings, changes that limit or at least need to be taken into account when linking current HCFA mortality data series with historic series.

Bias↗
PubMedDate not supplied

Developing quality of acute care indicators through claims data augmentation.

OBJECTIVE: To demonstrate the use of quality indicators developed through claims data augmentation. METHOD: A retrospective examination of field-tested acute care quality indicators and methods used in developing them to identify opportunities for quality improvement was used. The settings were 46 acute care hospitals and physician staffs serving Medicare beneficiaries in Vermont and New Hampshire, with more than 60,000 Medicare inpatient admissions per year. The objective was to measure hospital and provider initiatives in quality improvement projects. RESULT: More than 100 projects have been developed from hospital-specific comparative analyses and presentations about peer group profiles on indicator and outcome variables. Successfully completed projects have resulted in significant improvements in patient out comes, including reduced acute myocardial infarction mortality, reduced rates of discharges against medical advice, and increased use of pressure sore prevention and prophylactic antibiotics guidelines. CONCLUSION: Certain essential enabling data elements permit construction of a credible claims-based acute care quality indicator dataset. Unique individual patient identifiers and validated deaths are essential for conducting readmission and mortality analyses, respectively. Risk adjustment is necessary for making provider comparisons on indicators influenced by patient severity of illness. Cross-validation of outcome patterns with multiple indicators, and project successes have built provider interest and confidence in the use of such a data base.

Health Services Research↗