viernes, 7 de mayo de 2010

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0BAHRQ Quality Indicators
1BEstimating Risk-Adjustment Models
2BIncorporating Data on Present on Admission


Overview
4BThis document describes the current AHRQ Quality Indicator (AHRQ QI) risk-adjustment methodology incorporating data on Present on Admission (POA). After a summary of the POA data element, the document discusses how POA has been used in the past in the development and implementation of the AHRQ QI, and how that approach has been critiqued in the literature.

The document then discusses the general intent of the current approach and provides a general overview of the methodology.

Appendix-A presents the statistical methods used and how the approach is implemented in the AHRQ QI software. Appendix-B presents a table of AHRQ QIs that use POA. Finally, Appendix-C provides an example of the methodology for the Patient Safety Indicator Post-Operative Sepsis (PSI #13).

Present on admission
12BPresent on Admission (POA) was added as a data element to the UB-04 in fiscal year 2008 (effective March 1, 2007). Prior to adoption in the uniform bill there were earlier state-specific data elements for diagnosis codes present on admission in California and New York. The POA data element applies to each principal and secondary diagnosis code and provides a means of distinguishing pre-existing co-morbidities from complications that occur during the hospitalization of interest. POA is defined as “present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, are considered as present on admission.

”F125BThe Deficit Reduction Act of 2005 (DRA) required an adjustment in Medicare Diagnosis Related Group (DRG) payments for certain hospital-acquired conditions. In order to implement the provisions of the DRA, hospitals were required by law to submit POA information on diagnoses for inpatient discharges on or after January 1, 2008 (unless otherwise exempt from the requirement)

F226BIn addition, several states have adopted POA in the hospital discharge data submitted by hospitals to either the state department of health or the state hospital association. Nine (9) states provide this data element for the 2007 State Inpatient Databases (SID) created by AHRQ under the Healthcare Cost and Utilization (HCUP) project (HUhttp://hcup-us.ahrq.govU).

27BPrior uses of POA for the AHRQ QI13BThe concept of POA has informed both the development and implementation of the AHRQ QI.

For example, cases where the outcome of interest is more likely than not to be POA are excluded...

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http://www.qualityindicators.ahrq.gov/downloads/webinars/Using%20Present%20on%20Admission.pdf

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