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Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
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11 Claims Data and Effectiveness: Acute Myocardial Infarction and Other Examples
Pages 65-70

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From page 65...
... It is important to note, however, that since these data have begun to be used for prospective payment, their accuracy has improved considerably. I think we can expect improvements of similar magnitude once these data are used to a greater extent for research on effectiveness and outcomes, particularly as they relate to medical technology.
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From page 66...
... Currently, they allow us to measure mortality rates and readmission rates; however, it is not always possible to determine whether a readmission is related to the prior admission, is a consequence of suboptimal care, or is an unrelated event. Because much of medical care is designed to reduce morbidity rather than mortality, omission of data on postdischarge functioning of the patient and on alleviation of the symptoms that generated the hospitalization limits the usefulness of current outcomes data to research.
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From page 67...
... The study supports the conclusion that previous hospital discharge data on acute myocardial infarction lack sufficient validity in themselves to define an inception cohort for effectiveness and outcomes research. As coding rules change over the next year, however, to minimize some of the above-mentioned problems, identification of an inception cohort from the discharge codes will become more accurate.
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From page 68...
... some of the above problems can be alleviated. In any case, the limitations described above regarding inpatient data have prompted the National Cancer Institute to conduct a major prospective study of the effectiveness of diagnostic imaging procedures in patients with one of five types of cancer.
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From page 69...
... This was mentioned under general limitations, but I repeat it here because of its particular importance for evaluation of therapies. Elliot Fisher and John Wennberg emphasize this in their discussion of the claims analyses of transurethral prostatectomies (41.
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From page 70...
... Pp. 94-104 in Effectiveness and Outcomes in Health Care.
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Key Terms

  • acute myocardial
  • myocardial infarction
  • inception cohort
  • diagnostic devices
  • medicare claims

  • diagnostic procedures
  • mortality rates
  • sicker patients
  • ill patients
  • infarction code

  • outcomes data
  • socioeconomic status
  • medicare beneficiaries
  • patients usually
  • principal diagnoses

  • expected results
  • coding guidelines
  • care financing
  • technically permitting
  • acute event

  • coded diagnostic
  • diagnostic imaging
  • cardiac condition
  • prospective study
  • clinical trials

  • postdischarge functioning
  • allow identification
  • artery bypass
  • five types
  • inpatient data


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