Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
Currently Skimming:
16 The Uniform Clinical Data Set
16 The Uniform Clinical Data Set
Pages 120-136
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 120... ...
PROs exert considerable influence on the practice of medicine through the financial and disciplinary actions at their disposal. They are authorized to: · deny reimbursement for inappropriate admissions, · deny reimbursement for substandard care, · initiate sanctions by the Inspector General, and correct aberrant patterns of medical care.
|
From page 121... ...
develop and uniformly apply objective standards that would permit the physician reviewer to ascertain with a high level of probability that a deficiency in care did occur. The best guide in these matters is actual experience.
|
From page 122... ...
THE UNIFORM CLINICAL DATA SET AND PRO NEEDS The Uniform Clinical Data Set occupies a specific niche in this process. It is a tool for extracting data from medical records to permit effective risk adjustment in assessing the treatment of a given patient.
|
From page 123... ...
Admission status Admission medication history History permanent anatomic changes History and physical Laboratory: chemistry/blood gases Laboratory: hematology/urinalysis Laboratory: microbiology J Laboratory: cytologylhistology K
|
From page 124... ...
TABLE 4 Excerpt from the Uniform Clinical Data Set Computer Screen: Peer Reviews Screens History and Physical A Chronic necrologic disease History of necrologic surgery Current neuroloic exam findings Chronic cardiac disease Chronic vascular disease History of cardiovascular surgery Current cardiovascular exam findings I Chronic pulmonary disease History of pulmonary surgery K
|
From page 125... ...
COLLECTION OF PRIMARY DATA 125 TABLE 5 Excerpt from the Uniform Clinical Data Set Computer Screen: Cardiovascular Examination Findings Enter item letter on 1st line to change or enter T or F beside item ENTER ITEM LETTER: CHANGE ITEM ENTER = ITEM BY ITEM, F10 = LEAVE PRESS "+" FOR OTHER CV EXAM FINDINGS Item Description Value A B C D E F G H I K L M N o p Normal Shock Pulmonary edema Peripheral edema Jugular venous distension T Tachycardia Bradycardia Murmur Arrhythmia Cardiomegaly Gallop rhythm Peripheral pallor Bruit Thrill Friction rub Pulse Deficit-peripheral F F F F F F F F F F F Current CV exam Findings Enter item letter on 1st line to change or enter T or F beside item ENTER ITEM LETTER: CHANGE ITEM ENTER = ITEM BY ITEM, F10 = LEAVE PRESS "+" FOR OTHER CV EXAM FINDINGS Item Description Value A Ischemic ulcers F B Stasis ulcers F C Venous/varicose ulcer F D Gangrene F E Dependent rubor F F Delayed capillary fill F G Chest pain (steady) F H Other findings F
|
From page 126... ...
Table 6 illustrates the kinds of information being collected about treatment, such as nonsurgical procedures and drugs administered during the hospitalization. The medications data sought include route of administra tion (self-administrable, thus not requiring specific skills, or invasive, requiring specific skills for administration)
|
From page 127... ...
OK FLAG DPO1 OK OP09 Central nervous system MO A CASE REQUIRES MONITORING FOR SEVERITY OF ILLNESS DS01 Discharge status/disposition MO N17 Surgical patient with final hemoglobin missing or result less than admission result with difference >= 3 and < 4 grams per deciliter, discharge pulse > 110 DS01 Discharge status/disposition N29 No creatinines MO aExample for actual hospitalization
|
From page 128... ...
This is a problem that, in the current environment of medical uncertainty, will dog the application of any expert system to the evaluation of medical practices. The other application of the data acquisition system, the development of an epidemiological data base, has as its ultimate purpose the reduction of that uncertainty so that case-finding rules and judgments rendered by PRO physician advisors might be more more objective and substantial.
|
From page 129... ...
It indicates that in about 90 percent of pairs of patients, one of whom died and one of whom did not, the patient who died had the higher predicted probability of death. I am not expert in these matters, but I am TABLE X Evaluation of Goodness-of-Fit of Regression Models of the Probability of Death of Individual Patients Variables in Model Demographic only Demographic and hospital Core Core and hospital Core and MedisGroups ASGb Core, MedisGroups ASG, and hospital Core and clinical findings Core, clinical findings, and hospital Proportion of Concordant Pairsa Rank Correlation of Observed and Predicted Deaths 0.640 0.689 0.838 0.852 0.883 0.890 0.896 0.902 0.279 0.378 0.675 0.704 0.767 0.781 0.792 0.804 aConcordant pairs: in pairs consisting of one patient who did and one who did not die, those pairs in which the patient who died had the higher predicted probability of dying.
|
From page 130... ...
A more compelling application of detailed clinical data is to the estimation of the influence of patient risk factors and of treatments on outcomes, illustrated in Table 9. It presents a very useful example because of its 2 ~1 =)
|
From page 131... ...
no History of congestive heart failure, yes vs. no History of myocardial infarction Comorbidities (by ICD-9-CM codes)
|
From page 132... ...
no History of congestive heart failure, yes vs. no History of chronic obstructive pulmonary disease, yes vs.
|
From page 133... ...
The initial intent was to provide PROs with more effective tools for the review and evaluation of patient care. Clearly, the information generated in this process has broader applications, the most important being to assist clinicians in the treatment of patients by providing assessments of the relative merits of treatment strategies overall and for patients with specific risk factors.
|
From page 135... ...
Previously, we could determine outcomes only in terms of whether a patient was alive or dead or by using some kind of medical test. We had very limited knowledge about what effect various medical interventions had on patients.
|
From page 136... ...
136 EFFECTIVENESS AND OUTCOMES IN HEALTH CARE and recent research efforts in the development and use of outcome measures. The presentation highlights the use of patient self-reports.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.