Biomedical subjects

Todd R Huschka

Publications and source records attributed to Todd R Huschka.

3 recordsLinked to original sources

PubMed2005

Recollection of previous colon cancer screening in Minnesota adults.

Regularly scheduled screening of patients has been shown to be effective for decreasing morbidity and mortality from colorectal cancer. We used a questionnaire to assess patients' ability to accurately recall the date and type of their most recent colorectal cancer screening. The study included 200 consecutive patients whose records indicated they had undergone previous colorectal cancer screening (8 patients were later excluded because they had been screened more than 5 years earlier). Overall, 32.3% of patients could not recall the date of their last colorectal cancer screening, 34.3% recalled the date inaccurately, and 33.3% recalled the date accurately within 1 month. The results suggest that recall alone is not sufficient to determine the date and type of previous colorectal cancer screening, especially if the screening was performed more than a year earlier.

Aged↗

PubMed2004

Do complication screening programs detect complications present at admission?

BACKGROUND: A study was undertaken to verify the accuracy of computer algorithms on administrative data to identify hospital complications. The assessment was based on a medical records indicator that differentiated hospital-acquired conditions from preexisting comorbidities. METHODS: The indicators for identifying potential hospital complications were applied to all secondary diagnoses to distinguish hospital-acquired from preexisting conditions for all 1997-1998 discharges. RESULTS: Of the 95 defined complication types, cases were found with secondary diagnoses that met the criteria for 71 different complications. Sixty-nine of these complications had one or more cases with the trigger diagnosis coded as an acquired condition. Thirty-five complications had at least 30 cases with acquired conditions. Hospital complications add greatly to costs; for example, postoperative septicemia increased the hospital bill by more $25,000, added 13 hospital days to the stay, and increased hospital mortality by 16.6%. CONCLUSIONS: Current complication algorithms identify many cases where the condition was actually present on hospital admission. This fact, coupled with the known variability in coding between institutions, makes comparisons between hospitals on many of the complications problematic. Collection of the present-on-admission flag significantly reduces the noise in monitoring complication rates.

Algorithms↗

PubMed2004

Distinguishing hospital complications of care from pre-existing conditions.

OBJECTIVE: To compare cases identified through the Complications Screening Program (CSP) as complications with cases using the same ICD-9 secondary diagnosis codes, where the identifying diagnosis is also indicated as not present at admission. DESIGN: Observational study comparing two sources of potential hospital complications: published computer algorithms applied to coded diagnosis data versus a secondary diagnosis indicator, which distinguishes pre-existing from hospital-developed conditions. SETTING: All patients discharged from Mayo Clinic Rochester hospitals during 1998 and 1999. The Mayo Clinic is a large integrated delivery system in southeastern Minnesota, USA, providing services ranging from local, primary care to tertiary care for referral patients. Approximately 35% of Mayo patients travel >200 km for medical care. STUDY PARTICIPANTS: Hospital patients (total = 84 436). The numbers of cases with complications ranged from 0 to 2444 per algorithm. MAIN OUTCOME MEASURES: Percent of algorithm complication cases indicated as developing in the hospital, and percent of acquired conditions of that type detected by the computer algorithms. Incremental hospital charges, length of stay (LOS) and mortality associated with acquired complications. RESULTS: The percent of cases identified through the computer algorithm that were also coded as acquired varied from 8.8% to 100%. The ability of the computer algorithms to detect acquired conditions of that type also varied greatly, from 2% to 99%. Incremental charges and LOS were significant for patients with acquired complications except for hip fracture/falls. Many acquired complications also increased hospital mortality. CONCLUSIONS: Complication rates based strictly on standard discharge abstracts have limited use for inter-hospital comparisons due to large variability in coding across hospitals and the insensitivity of existing computer algorithms to exclude conditions present on admission from true complications. However, complications do carry high costs, including extended stays and increased hospital mortality. Enhancing secondary diagnoses with a simple indicator identifying which diagnoses were present on admission greatly increases the accurate identification of complications for internal quality and patient safety improvements.

Algorithms↗