title: A cross-hospital cost and quality assessment system by extracting frequent physician order set from a nationwide Health Insurance Research Database.
abstract: OBJECTIVE
  Clinical pathways fall under the process perspective of health care quality. For care providers, clinical pathways can be compared to improve health care quality. The objective of this study was to design a convenient physician order set comparison system based on claim records from the National Health Insurance Research Database (NHIRD) of Taiwan.
  
  
  METHODS
  Data were retrieved from the NHIRD for the period of 2003-2007 for frequent physician order sets found in hospital surgical hernia repair inpatient claim records. The derived frequent physician order sets were divided into five frequency thresholds: 80%, 85%, 90%, 95% and 100%. A consistency index was defined and calculated to understand each care providers' adherence to clinical pathways. In addition, the average count of physician orders, average amount of cost, Charlson comorbidity index, and recurrence rate were calculated; these variables were considered in frequent physician order sets comparison.
  
  
  RESULTS
  Records for 3262 patients from 257 hospitals were retrieved. The frequent physician order sets of various frequency thresholds, Charlson comorbidities, and recurrence rates were extracted and computed for comparison among hospitals. A recurrence rate threshold of 2% was established to separate low and high quality of herniorrhaphy at each hospital. Univariable analysis showed that low recurrence rate was associated with high consistency index (70.99±23.88 vs. 52.60±20.30; P<.001), few surgeons at each hospital (3.50±4.41 vs. 7.09±6.57; P<.001), and non-medical center facility type (P=.042). A multivariable Cox regression analysis indicated an association of low recurrence rates with consistency index only (one percentage increased: OR=0.973; CI: 0.957-0.990; P=.002).
  
  
  CONCLUSIONS
  The proposed system leveraged the claim records to generate frequent physician order sets at hospitals, thus solving the difficulty in obtaining clinical pathway data. This allows medical professionals and management to conveniently and effectively compare and query similarities and differences in clinical pathways among hospitals.
authors.affiliation: Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Kuo-Hsin
authors.initials: KH
authors.lastname: Chen
authors.affiliation: Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taiwan; Department of Surgery, National Taiwan University Hospital, Taiwan.
authors.forename: Jin-Ming
authors.initials: JM
authors.lastname: Wu
authors.affiliation: Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taiwan.
authors.forename: Te-Wei
authors.initials: TW
authors.lastname: Ho
authors.affiliation: Department of Computer Science and Information Engineering, National Taiwan University, Taiwan.
authors.forename: Hwan-Jeu
authors.initials: HJ
authors.lastname: Yu
authors.affiliation: Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taiwan; Department of Computer Science and Information Engineering, National Taiwan University, Taiwan; Department of Electrical Engineering, National Taiwan University, Taiwan.
authors.forename: Feipei
authors.initials: F
authors.lastname: Lai
mesh_terms: D000465:Algorithms; D003628:Database Management Systems; D017721:Hospital Costs; D009313:National Health Programs; D010820:Physicians; D011785:Quality Assurance, Health Care; D013624:Taiwan
keywords: Clinical pathways; Database; Hernia; Physician order; Quality of health care