title: Determining population based mortality risk in the Department of Veterans Affairs.
abstract: We develop a patient level hierarchical regression model using administrative claims data to assess mortality outcomes for a national VA population. This model, which complements more traditional process driven performance measures, includes demographic variables and disease specific measures of risk classified by Diagnostic Cost Groups (DCGs). Results indicate some ability to discriminate survivors and non-survivors with an area under the Receiver Operating Characteristic Curve (C-statistic) of .86. Observed to expected mortality ranges from .86 to 1.12 across predicted mortality deciles while Risk Standardized Mortality Rates (RSMRs) range from .76 to 1.29 across 145 VA hospitals. Further research is necessary to understand mortality variation which persists even after adjusting for case mix differences. Future work is also necessary to examine the role of personal behaviors on patient outcomes and the potential impact on population survival rates from changes in treatment policy and infrastructure investment.
authors.affiliation: Department of Veterans Affairs, Office of Productivity, Efficiency and Staffing, Bedford, MA, USA. theodore.stefos@va.gov
authors.forename: Theodore
authors.initials: T
authors.lastname: Stefos
authors.forename: Laura
authors.initials: L
authors.lastname: Lehner
authors.forename: Marta
authors.initials: M
authors.lastname: Render
authors.forename: Eileen
authors.initials: E
authors.lastname: Moran
authors.forename: Peter
authors.initials: P
authors.lastname: Almenoff
mesh_terms: D000367:Age Factors; D002908:Chronic Disease; D003953:Diagnosis-Related Groups; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data