Use of administrative claims models to assess 30-day mortality among Veterans Health Administration hospitals.
BACKGROUND
The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital-specific risk-standardized, 30-day, all-cause, mortality rates (RSMRs) for all hospitalizations among fee-for-service Medicare beneficiaries for acute myocardial infarction (AMI), heart failure (HF), and pneumonia at non-Federal hospitals.


OBJECTIVE
To examine the performance of the statistical models used by CMS among veterans at least 65 years of age hospitalized for AMI, HF, and pneumonia in Veterans Health Administration (VHA) hospitals.


METHODS
Cross-sectional analysis of VHA administrative claims data between October 1, 2006 and September 30, 2009.


METHODS
Thirteen thousand forty-six veterans hospitalized for AMI among 123 VHA hospitals; 26,379 veterans hospitalized for HF among 124 VHA hospitals; and 31,126 veterans hospitalized for pneumonia among 124 VHA hospitals.


METHODS
Hospital-specific RSMR for AMI, HF, and pneumonia hospitalizations calculated using hierarchical generalized linear models.


RESULTS
Median number of AMI hospitalizations per VHA hospital was 87. Average AMI RSMR was 14.3% [95% confidence interval (CI), 13.9%-14.6%] with modest heterogeneity among VHA hospitals (RSMR range: 8.4%-20.3%). The c-statistic for the AMI RSMR statistical model was 0.79. Median number of HF hospitalizations was 188. Average HF RSMR was 10.1% (95% CI, 9.9%-10.4%) with modest heterogeneity (RSMR range: 6.1%-14.9%). The c-statistic for the HF RSMR statistical model was 0.73. Median number of pneumonia hospitalizations was 221.5. Average pneumonia RSMR was 13.0% (95% CI, 12.7%-13.3%) with modest heterogeneity (RSMR range: 9.0%-18.4%). The c-statistic for the pneumonia RSMR statistical model was 0.72.


CONCLUSIONS
The statistical models used by CMS to estimate RSMRs for AMI, HF, and pneumonia hospitalizations at non-Federal hospitals demonstrate similar discrimination when applied to VHA hospitals.
Ross
Joseph S
JS
HSR&D Research Enhancement Award Program and Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, NY 10468, USA. joseph.ross@mssm.edu
Maynard
Charles
C
Krumholz
Harlan M
HM
Sun
Haili
H
Rumsfeld
John S
JS
Normand
Sharon-Lise T
SL
Wang
Yun
Y
Fihn
Stephan D
SD
D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality; D016017:Odds Ratio; D011014:Pneumonia / Q000401:mortality; D011787:Quality of Health Care