PMID: 9630133Jun 18, 1998Paper

Profiling outcomes of ambulatory care: casemix affects perceived performance

Medical Care
D R BerlowitzM A Moskowitz

Abstract

The authors explored the role of casemix adjustment when profiling outcomes of ambulatory care. The authors reviewed the medical records of 656 patients with hypertension, diabetes, or chronic obstructive pulmonary disease (COPD) receiving care at one of three Department of Veterans Affairs medical centers. Outcomes included measures of physiological control for hypertension and diabetes, and of exacerbations for COPD. Predictors of poor outcomes, including physical examination findings, symptoms, and comorbidities, were identified and entered into regression models. Observed minus expected performance was described for each site, both before and after casemix adjustment. Risk-adjustment models were developed that were clinically plausible and had good performance properties. Differences existed among the three sites in the severity of the patients being cared for. For example, the percentage of patients expected to have poor blood pressure control were 35% at site 1, 37% at site 2, and 44% at site 3 (P < 0.01). Casemix-adjusted measures of performance were different from unadjusted measures. Sites that were outliers (P < 0.05) with one approach had observed performance no different from expected with another approach. Casemix ...Continue Reading

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Citations

Jul 23, 2002·Journal of General Internal Medicine·Kenneth J MukamalTom Delbanco
Dec 31, 1998·The New England Journal of Medicine·D R BerlowitzM A Moskowitz
Dec 6, 2007·Journal of General Internal Medicine·Pramod MeduruUsha Sambamoorthi
Nov 5, 2016·The Journal of Clinical Hypertension·Dan R Berlowitz
Oct 11, 2005·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Alfredo J SelimLewis E Kazis
Jun 24, 2004·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Vijay N JoishM Jane Mohler
Nov 6, 2007·The Journal of Clinical Hypertension·George A Mensah

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