title: Adding Laboratory Data to Hospital Claims Data to Improve Risk Adjustment of Inpatient/30-Day Postdischarge Outcomes.
abstract: Numerical laboratory data at admission have been proposed for enhancement of inpatient predictive modeling from administrative claims. In this study, predictive models for inpatient/30-day postdischarge mortality and for risk-adjusted prolonged length of stay, as a surrogate for severe inpatient complications of care, were designed with administrative data only and with administrative data plus numerical laboratory variables. A comparison of resulting inpatient models for acute myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous cardiac interventions demonstrated improved discrimination and calibration with administrative data plus laboratory values compared to administrative data only for both mortality and prolonged length of stay. Improved goodness of fit was most apparent in acute myocardial infarction and percutaneous cardiac intervention. The emergence of electronic medical records should make the addition of laboratory variables to administrative data an efficient and practical method to clinically enhance predictive modeling of inpatient outcomes of care.
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Pine
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.affiliation: 2 The Mayo Clinic, Rochester, MN.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.affiliation: 3 University at Albany-State University of New York, Albany, NY.
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Kay
authors.initials: K
authors.lastname: Whitman
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Agnes
authors.initials: A
authors.lastname: Reband
authors.affiliation: 2 The Mayo Clinic, Rochester, MN.
authors.forename: Feng
authors.initials: F
authors.lastname: Qian
authors.affiliation: 4 Minnesota Hospital Association, St Paul, MN.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schindler
authors.affiliation: 4 Minnesota Hospital Association, St Paul, MN.
authors.forename: Mark
authors.initials: M
authors.lastname: Sonneborn
authors.affiliation: 4 Minnesota Hospital Association, St Paul, MN.
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Roland
authors.affiliation: 1 MPA Healthcare Solutions, Inc., Chicago, IL.
authors.forename: Linda
authors.initials: L
authors.lastname: Hyde
authors.affiliation: 5 New York State Department of Health, Albany, NY.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Dennison
mesh_terms: D000067575:Administrative Claims, Healthcare; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D006333:Heart Failure / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007755:Laboratories, Hospital / Q000706:statistics & numerical data*; D007902:Length of Stay; D009203:Myocardial Infarction / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D020379:Risk Adjustment / Q000379:methods*; D016896:Treatment Outcome
keywords: cardiovascular disease; clinically enhanced claims data; patient outcomes; patient safety (measurement); quality of care; risk adjustment