5 results on '"Zhenqiu Lin"'
Search Results
2. Changes in outcomes for internal medicine inpatients after work-hour regulations
- Author
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Harlan M. Krumholz, Zhenqiu Lin, Mikhail Kosiborod, and Leora I. Horwitz
- Subjects
Male ,medicine.medical_specialty ,MEDLINE ,Graduate medical education ,Personnel Staffing and Scheduling ,law.invention ,law ,Internal medicine ,Health care ,Outcome Assessment, Health Care ,Internal Medicine ,Medicine ,Humans ,Hospitals, Teaching ,Aged ,Retrospective Studies ,Aged, 80 and over ,Inpatients ,business.industry ,Internship and Residency ,Retrospective cohort study ,General Medicine ,Middle Aged ,Intensive care unit ,United States ,Hospitalists ,Family medicine ,Emergency medicine ,Observational study ,Female ,Patient Care ,business ,Health care quality ,Cohort study - Abstract
Limits on resident work hours are intended to reduce fatigue-related errors, but may raise risk by increasing transfers of responsibility for patients.To examine changes in outcomes for internal medicine patients after the implementation of work-hour regulations.Retrospective cohort study.Urban, academic medical center.14,260 consecutive patients discharged from the teaching (housestaff) service and 6664 consecutive patients discharged from the nonteaching (hospitalist) service between 1 July 2002 and 30 June 2004.Outcomes included intensive care unit utilization, length of stay, discharge disposition, 30-day readmission rate to the study institution, pharmacist interventions to prevent error, drug-drug interactions and in-hospital death.The teaching service had net improvements in 3 outcomes. Relative to changes experienced by the nonteaching service, the rate of intensive care unit utilization decreased by 2.1% (95% CI, -3.3% to -0.7%; P = 0.002), the rate of discharge to home or rehabilitation facility versus elsewhere improved by 5.3% (CI, 2.6% to 7.6%; P0.001), and pharmacist interventions to prevent error were reduced by 1.92 interventions per 100 patient-days (CI, -2.74 to -1.03 interventions per 100 patient-days; P0.001). Teaching and nonteaching services had similar changes over time in length of stay, 30-day readmission rate, and adverse drug-drug interactions. In-hospital death was uncommon in both groups, and change over time was similar in the 2 groups.The study was a retrospective, nonrandomized design that assessed a limited number of outcomes. Teaching and nonteaching cohorts may not have been affected similarly by secular trends in patient care.After the implementation of work-hour regulations, 3 of 7 outcomes improved for patients in the teaching service relative to those in the nonteaching service. The authors found no evidence of adverse unintended consequences after the institution of work-hour regulations.
- Published
- 2007
3. Development and Use of an Administrative Claims Measure for Profiling Hospital-wide Performance on 30-Day Unplanned Readmission
- Author
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Julia Montague, Mitchell M. Conover, Leora I. Horwitz, Chohreh Partovian, Lisa G. Suter, Harlan M. Krumholz, Joseph S. Ross, Jeph Herrin, Susannah M. Bernheim, Kathleen Bartczak, Jacqueline N. Grady, Elizabeth E. Drye, Zhenqiu Lin, and Chloe Dillaway
- Subjects
Male ,medicine.medical_specialty ,Quality management ,MEDLINE ,Insurance Claim Review ,Medicare ,Patient Readmission ,Article ,Internal Medicine ,Unplanned readmission ,Humans ,Medicine ,Profiling (information science) ,Hospital Mortality ,Aged ,business.industry ,Mortality rate ,Fee-for-Service Plans ,General Medicine ,Quality Improvement ,Hospitals ,United States ,Administrative claims ,Family medicine ,Emergency medicine ,Female ,Risk Adjustment ,business ,Health care quality - Abstract
Existing publicly reported readmission measures are condition-specific, representing less than 20% of adult hospitalizations. An all-condition measure may better measure quality and promote innovation.To develop an all-condition, hospital-wide readmission measure.Measure development study.4821 U.S. hospitals.Medicare fee-for-service beneficiaries aged 65 years or older.Hospital-level, risk-standardized unplanned readmissions within 30 days of discharge. The measure uses Medicare fee-for-service claims and is a composite of 5 specialty-based, risk-standardized rates for medicine, surgery/gynecology, cardiorespiratory, cardiovascular, and neurology cohorts. The 2007-2008 admissions were randomly split for development and validation. Models were adjusted for age, principal diagnosis, and comorbid conditions. Calibration in Medicare and all-payer data was examined, and hospital rankings in the development and validation samples were compared.The development data set contained 8 018 949 admissions associated with 1 276 165 unplanned readmissions (15.9%). The median hospital risk-standardized unplanned readmission rate was 15.8 (range, 11.6 to 21.9). The 5 specialty cohort models accurately predicted readmission risk in both Medicare and all-payer data sets for average-risk patients but slightly overestimated readmission risk at the extremes. Overall hospital risk-standardized readmission rates did not differ statistically in the split samples (P = 0.71 for difference in rank), and 76% of hospitals' validation-set rankings were within 2 deciles of the development rank (24% were more than 2 deciles). Of hospitals ranking in the top or bottom deciles, 90% remained within 2 deciles (10% were more than 2 deciles) and 82% remained within 1 decile (18% were more than 1 decile).Risk adjustment was limited to that available in claims data.A claims-based, hospital-wide unplanned readmission measure for profiling hospitals produced reasonably consistent results in different data sets and was similarly calibrated in both Medicare and all-payer data.Centers for MedicareMedicaid Services.
- Published
- 2014
4. Development and Use of an Administrative Claims Measure for Profiling Hospital-wide Performance on 30-Day Unplanned Readmission.
- Author
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Horwitz, Leora I., Partovian, Chohreh, Zhenqiu Lin, Grady, Jacqueline N., Herrin, Jeph, Conover, Mitchell, Montague, Julia, Dillaway, Chloe, Bartczak, Kathleen, Suter, Lisa G., Ross, Joseph S., Bernheim, Susannah M., Krumholz, Harlan M., and Drye, Elizabeth E.
- Subjects
FEE for service (Medical fees) ,HOSPITAL care ,HEALTH promotion ,PATIENT readmissions ,PERFORMANCE evaluation ,HEALTH risk assessment ,MEDICAL protocols - Abstract
BACKGROUND: Existing publicly reported readmission measures are condition-specific, representing less than 20% of adult hospitalizations. An all-condition measure may better measure quality and promote innovation. OBJECTIVE: To develop an all-condition, hospital-wide readmission measure. DESIGN: Measure development study. SETTING: 4821 U.S. hospitals. PATIENTS: Medicare fee-for-service beneficiaries aged 65 years or older. MEASUREMENTS: Hospital-level, risk-standardized unplanned readmissions within 30 days of discharge. The measure uses Medicare fee-for-service claims and is a composite of 5 specialty-based, risk-standardized rates for medicine, surgery/gynecology, cardiorespiratory, cardiovascular, and neurology cohorts. The 2007-2008 admissions were randomly split for development and validation. Models were adjusted for age, principal diagnosis, and comorbid conditions. Calibration in Medicare and all-payer data was examined, and hospital rankings in the development and validation samples were compared. RESULTS: The development data set contained 8 018 949 admissions associated with 1 276 165 unplanned readmissions (15.9%). The median hospital risk-standardized unplanned readmission rate was 15.8 (range, 11.6 to 21.9). The 5 specialty cohort models accurately predicted readmission risk in both Medicare and all-payer data sets for average-risk patients but slightly overestimated readmission risk at the extremes. Overall hospital risk-standardized readmission rates did not differ statistically in the split samples (P = 0.71 for difference in rank), and 76% of hospitals' validation-set rankings were within 2 deciles of the development rank (24% were more than 2 deciles). Of hospitals ranking in the top or bottom deciles, 90% remained within 2 deciles (10% were more than 2 deciles) and 82% remained within 1 decile (18% were more than 1 decile). LIMITATION: Risk adjustment was limited to that available in claims data. CONCLUSION: A claims-based, hospital-wide unplanned readmission measure for profiling hospitals produced reasonably consistent results in different data sets and was similarly calibrated in both Medicare and all-payer data. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
5. Changes in Outcomes for Internal Medicine Inpatients after Work-Hour Regulations.
- Author
-
Horwitz, Leora I., Kosiborod, Mikhail, Zhenqiu Lin, and Krumholz, Harlan M.
- Subjects
HOSPITAL patients ,DEATH rate ,SEXUALLY transmitted disease treatment ,HOSPITAL care ,INTERNAL medicine - Abstract
Background: Limits on resident work hours are intended to reduce fatigue-related errors, but may raise risk by increasing transfers of responsibility for patients. Objective: To examine changes in outcomes for internal medicine patients after the implementation of work-hour regulations. Design: Retrospective cohort study. Setting: Urban, academic medical center. Patients: 14 260 consecutive patients discharged from the teaching (housestaff) service and 6664 consecutive patients discharged from the nonteaching (hospitalist) service between 1 July 2002 and 30 June 2004. Measurements: Outcomes included intensive care unit utilization, length of stay, discharge disposition, 30-day readmission rate to the study institution, pharmacist interventions to prevent error, drug—drug interactions and in-hospital death. Results: The teaching service had net improvements in 3 outcomes. Relative to changes experienced by the nonteaching service, the rate of intensive care unit utilization decreased by 2.1% (95% CI, -3.3% to -0.7%; P = 0.002), the rate of discharge to home or rehabilitation facility versus elsewhere improved by 5.3% (CI, 2.6% to 7.6%; P < 0.001), and pharmacist interventions to prevent error were reduced by 1.92 interventions per 100 patient-days (CI, -2.74 to -1.03 interventions per 100 patient-days; P < 0.001). Teaching and nonteaching services had similar changes over time in length of stay, 30-day readmission rate, and adverse drug-drug interactions. In-hospital death was uncommon in both groups, and change over time was similar in the 2 groups. Limitations: The study was a retrospective, nonrandomized design that assessed a limited number of outcomes. Teaching and non-teaching cohorts may not have been affected similarly by secular trends in patient care. Conclusions: After the implementation of work-hour regulations, 3 of 7 outcomes improved for patients in the teaching service relative to those in the nonteaching service. The authors found no evidence of adverse unintended consequences after the institution of workhour regulations. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
- View/download PDF
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