title: Does adding clinical data to administrative data improve agreement among hospital quality measures?
abstract: BACKGROUND
  Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system.
  
  
  METHODS
  We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators.
  
  
  RESULTS
  For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor.
  
  
  CONCLUSIONS
  Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA.
  
  
  CONCLUSIONS
  Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality.
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA; Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA. Electronic address: hanchate@bu.edu.
authors.forename: Amresh D
authors.initials: AD
authors.lastname: Hanchate
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stolzmann
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA; Department of Surgery, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.affiliation: Professor Emeritus of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Fink
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA; Department of Operations and Technology Management, Boston University School of Management, Boston, MA 02215, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Ash
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA.
authors.forename: Hassen
authors.initials: H
authors.lastname: Abdulkerim
authors.affiliation: South Texas Veterans Health Care System, San Antonio, TX 78229, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX 78229, USA.
authors.forename: Mary Jo V
authors.initials: MJV
authors.lastname: Pugh
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA 02130, USA.
authors.forename: Priti
authors.initials: P
authors.lastname: Shokeen
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VAMC, Bedford, MA 01730, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Borzecki
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000639:trends; D004282:Documentation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D008297:Male; D008490:Medical Informatics / Q000379:methods / Q000639:trends; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality; D019984:Quality Indicators, Health Care / Q000639:trends*; D011787:Quality of Health Care / Q000592:standards*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data
keywords: 30-d mortality; 30-d readmission; Clinical data; Hospital compare; Hospital quality