Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy-and Diagnosis-Based Approaches

Health Services Research

Volumn 38, Issue 5, 2003, Pages 1319-1338

  Liu, Chuan Fen ^a,b   Sales, Anne E ^a,b   Sharp, Nancy D ^a,b   Fishman, Paul ^b,c   Sloan, Kevin L ^a,d   Todd Stenberg, Jeff ^a   Nichol, W Paul ^a,b   Rosen, Amy K ^e,f   Loveland, Susan ^e,f  

^a VA PUGET SOUND HEALTH CARE SYSTEM   (United States)

^b UNIVERSITY OF WASHINGTON   (United States)

^c CENTER FOR HEALTH STUDIES   (United States)

^d UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE   (United States)

^e VETERANS AFFAIRS MEDICAL CENTER   (United States)

^f BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

Case mix adjustment; Pharmacy data; Profiling

Indexed keywords

ADULT; AGED; AMBULATORY CARE; ARTICLE; COMPARATIVE STUDY; CONTROLLED STUDY; FEMALE; HEALTH CARE DELIVERY; HEALTH CARE SYSTEM; HEALTH CARE UTILIZATION; HOSPITAL PATIENT; HUMAN; INFORMATION PROCESSING; LENGTH OF STAY; MAJOR CLINICAL STUDY; MALE; MODEL; OUTPATIENT; PHARMACY; REGRESSION ANALYSIS; RISK ASSESSMENT; SOLDIER;

EID: 0142057528     PISSN: 00179124     EISSN: None     Source Type: Journal    
DOI: 10.1111/1475-6773.00179     Document Type: Article

References (48)

1. Ash, A. S., R. P. Ellis, G. C. Pope, J. Z. Ayanian, D. W. Bates, H. Burstin, L. I. Iezzoni, E. MacKay, and W. Yu. 2000. "Using Diagnoses to Describe Populations and Predict Costs." Health Care Financing Review 21 (3): 7-28.
2. Ashton, C. M., N. J. Petersen, N. P. Wray, and H. J. Yu. 1998. "The Veterans Affairs Medical Care System: Hospital and Clinic Utilization Statistics for." Medical Care 36 (6): 793-803.
3. Au, H. A., M. B. McDonell, D. C. Martin, and S. D. Fihn. 2001. "Regional Variations in Health Status." Medical Care 39 (8): 879-88.
4. Berlowitz, D. R., A. S. Ash, E. C. Hickey, B. Kader, R. Friedman, and M. A. Moskowitz. 1998. "Profiling Outcomes of Ambulatory Care: Casemix Affects Perceived Performance." Medical Care 36 (6): 928-33.
5. Cameron, A. C., and P. K. Trivedi. 1998. Regression Analysis of Count Data. New York: Cambridge University Press.
6. Chang, W., and S. B. McCracken. 1996. "Applying Case Mix Adjustment in Profiling Primary Care Physician Performance." Journal of Health Care Finance 22 (4): 1-9.
7. Ciesco, E., and M. Greenblatt. 1999. "Implementing a Performance Measurement System at the Veterans Health Administration." Paper presented at the International Quality and Productivity Center Ninth National Performance Measure Conference, September 14, Arlington, VA.
8. Clark, D. O., M. Von Korff, K. Saunders, W. M. Baluch, and G. E. Simon. 1995. "A Chronic Disease Score with Empirically Derived Weights." Medical Care 33 (8): 783-95.
9. Duan, N., W. Manning, C. Morris, and J. Newhouse. 1983. "A Comparison of Alternative Models for the Demand for Medical Care." Journal of Business and Economics Statistics 1 (2): 115-26.
10. -. 1984. "Choosing between the Sample Selection Model and the Multi-part Model." Journal of Business and Economics Statistics 2 (4): 283-9.
11. Elixhauser, A., S. A. Eisen, J. C. Romeis, and S. M. Homan. 1990. "The Effects of Monitoring and Feedback on Compliance." Medical Care 28 (10): 882-93.
12. Ellis, R. P., and A. Ash. 1995. "Refinements to the Diagnostic Cost Group (DCG) Model." Inquiry 32 (4): 418-29.
13. Ellis, R. P., G. C. Pope, L. Iezzoni, J. Z. Ayanian, D. W. Bates, H. Burstin, and A. S. Ash. 1996. "Diagnosis-Based Risk Adjustment for Medicare Capitation Payments." Health Care Financing Review 17 (3): 101-28.
14. Fishman, P. A., M. Goodman, M. Hombrook, R. Meenan, D. Bachman, and M. O'Keefe Rossetti. 2003. "Risk Adjustment Using Automated Pharmacy Data: The RxRisk Model." Medical Care 41 (1): 84-99.
15. Fishman, P. A., and D. K. Shay. 1999. "Development and Estimation of a Pediatric Chronic Disease Score Using Automated Pharmacy Data." Medical Care 37 (9): 874-83.
16. Franks, P., G. C. Williams, J. Zwanziger, C. Mooney, and M. Sorbero. 2000. "Why Do Physicians Vary So Widely in Their Referral Rates?" Journal of General Internal Medicine 15 (3): 163-8.
17. Gilmer, T., R. Kronick, P. Fishman, and T. G. Ganiats. 2001. "The Medicaid Rx Model: Pharmacy-Based Risk Adjustment for Public Programs." Medical Care 39 (11): 1188-202.
18. Hombrook, M. C., and M. J. Goodman. 1991. "Health Plan Case Mix: Definition, Measurement, and Use." Advances in Health Economics and Health Services Research 12: 111-48.
19. Hughes, J. S., and A. S. Ash. 1997. "Reliability of Risk-Adjustment Models." In Risk Adjustment for Measuring Healthcare Outcomes, edited by L. Iezzoni, pp. 263-86. Chicago: Health Administration Press.
20. Johnson, R. E., M. C. Hornbrook, and G. A. Nichols. 1994. "Replicating the Chronic Disease Score (CDS) from Automated Pharmacy Data." Journal of Clinical Epidemiology 47 (10): 1191-9.
21. Judge, G. G., W. E. Griffiths, R. C. Hill, H. Lutkephol, and T.-C. Lee. 1985. The Theory and Practice of Econometrics. new York: Wiley.
22. Kanji, G. K. 1993. 100 Statistical Tests, new edition. London: Sage.
23. Kashner, T. M. 1998. "Agreement between Administrative Files and Written Medical Records: A Case of the Department of Veterans Affairs." Medical Care 36 (9): 1324-36.
24. Kazis, L. E., X. S. Ren, A. Lee, K. Skinner, W. Rogers, J. Clark, and D. R. Miller. 1999. "Health Status in VA Patients: Results from the Veterans Health Study." American Journal of Medical Quality 14 (1): 28-38.
25. Kizer, K. W. 1996. Prescription for Change. Washington, DC: Department of Veterans Affairs, Veterans Health Administration.
26. Kizer, K. W., J. G. Demakis, and J. R. Feussner. 2000. "Reinventing VA Health Care: Systematizing Quality Improvement and Quality Innovation." Medical Care 38 (6, Supplement 1): I 7-16.
27. Kronick, R., T. Gilmer, T. Dreyfus, and L. Lee. 2000. "Improving Health-Based Payment for Medicaid beneficiaries: CDPS." Health Care Financing Review 21 (3): 29-64.
28. Lamers, L. M. 1999. "Pharmacy Costs Groups: A Risk-Adjuster for Capitation Payments Based on the Use of Prescribed Drugs." Medical Care 37 (8): 824-30.
29. Newman, C., S. White, and D. Burman. 1996. "Physician Profiling: Applications for the Robert Wood Johnson Profiling Project Database." Journal of Ambulatory Care Management 19 (4): 49-57.
30. Parente, S. T., J. P. Weiner, D. W. Garnick, J. Fowles, A. G. Lawthers, and R. H. Palmer. 1996. "Profiling Resource Use by Primary-Care Practices: Managed Medicare Implications." Health Care Financing Review 17 (4): 23-42.
31. Phibbs, C. S., R. W. Swindle, and B. Recine. 1997. "Does Case Mix Matter for Substance Abuse Treatment?" Health Services Research 31 (6): 755-71.
32. Pietz, K., M. Byrne, and N. Petersen. 2000. Results of Profiling Methodology Working Group." Paper presented at the CHIPS Annual Meeting, August, Seattle, Wash.
33. Pope, G. C., R. C. Ellis, A. S. Ash, C. F. Liu, J. Z. Ayanian, D. W. Bates, H. Burstin, L. I. Iezzoni, and M. J. Ingber. 2000. "The Principal Inpatient Diagnostic Cost Group Model for Medicare Risk Adjustment." Health Care Financing Review 21 (3): 93-118.
34. Roblin, D. W. 1994. "Patient Case Mix Measurement Using Outpatient Drug Dispense Data." Managed Care Quarterly 2 (2): 38-47.
35. -. 1998. "Physician Profiling Using Outpatient Pharmacy Data as a Source for Case Mix Measurement and Risk Adjustment." Journal of Ambulatory Care Management 21 (4): 68-84.
36. Rosen, A. K., A. Ash, J. Rothendler, and S. Loveland. 1999. "Implementing Ambulatory Care Case-Mix Measures in the VA: from Theory to Practice." Paper presented at the VA HSR&D annual meeting, Washington, DC, February.
37. Rosen, A. K., S. Loveland, J. J. Anderson, J. A. Rothendler, C. S. Hankin, C. C. Rakovski, M. A. Moskowitz, and D. R. Berlowitz. 2001. "Evaluating Diagnosis-Based Case-Mix Measures: How Well Do They Apply to the VA Population?" Medical Care 39 (7): 692-704.
38. Salem-Schatz, S., G. Moore, M. Rucker, and S. D. Pearson. 1994. "The Case for Case-Mix Adjustment in Practice Profiling: When Good Apples Look Bad." Journal of the American Medical Association 272 (11): 871-4.
39. Sales, A. E., C. F. Liu, K. L. Sloan, J. Malkin, P. Fishman, A. K. Rosen, S. Loveland, W. P. Nichol, N. T. Suzuki, E. Perrin, N. D. Sharp, and J. Todd-Stenberg. 2003. "Predicting Costs of Care Using a Pharmacy-Based Measure: Risk Adjustment in a Veteran Population." Medical Care 41 (6): 753-60.
40. Selim, A., D. Berlowitz, G. Fincke, A. K. Rosen, X. Ren, C. Christiansen, Z. Cong, A. Lee, and L. Kazis. 2002. "Risk-Adjusted Mortality Rates as a Potential Outcome Indicator for Outpatient Quality Assessments." Medical Care 40 (3): 237-45.
41. Sloan, K. L., A. E. Sales, C. F. Liu, P. Fishman, W. P. Nichol, N. T. Suzuki, and N. D. Sharp. 2003. "Construction and Characteristics of the RxRisk-V: A VA-Adapted Pharmacy-Based Case-Mix Instrument." Medical Care 41 (6): 761-74.
42. Starfield, B., and L. Mumford. 1991. "Ambulatory Care Groups: A Categorization of Diagnoses for Research an Management." Health Services Research 26 (1): 53-74.
43. Steiner, J. F., T. D. Koepsell, S. D. Fihn, and T. S. Inui. 1988. "A General Method of Compliance Assessment Using Centralized Pharmacy Records: Description and Validation." Medical Care 26 (8): 814-23.
44. Szeto, H., and M. Goldstein. 1999. "Accuracy of Computer Identified Diagnoses in a VA General Medicine Clinic." Unpublished paper
45. Veterans Health Administration. Office of Quality and Performance. 2000. FY2001 VA Performance Measurement System Technical Manual. Washington, DC: Department of Veterans Affairs, Veterans Health Administration.
46. Von Korff, M., E. H. Wagner, and K. Saunders. 1992. "A Chronic Disease Score from Automated Pharmacy Data." Journal of Clinical Epidemiology 45 (2): 197-203.
47. Weiner, J. P., B. H. Starfield, D. M. Steinwachs, and L. M. Mumford. 1991. "Development and Application of a Population-Oriented Measure of Ambulatory Care Case-Mix." Medical Care 29 (5): 452-72.
48. Wilson, N. J., and K. W. Kizer. 1997. "The VA Health Care System: An Unrecognized National Safety Net." Health Affairs 16 (4): 200-4.