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The following terms are frequently used in the world of QCMetrix
and healthcare quality improvement:
Benchmarking
Benchmarking is the continuous process of measuring an organization's
performance against the results of industry leaders. The ACS NSQIP
makes benchmarking available through the ACS NSQIP.org website
for the purpose of allowing a hospital to compare its performance
to other hospitals and to motivate its quality improvement
efforts where they may be required.
CPT
Physicians’ Current Procedural Terminology (CPT®),
Fourth Edition, is a listing of descriptive terms and identifying
codes for reporting medical services and procedures. The purpose
of CPT is to provide a uniform language that accurately describes
medical, surgical, and diagnostic services, and thereby serves
as an effective means for reliable nationwide communication
among physicians, patients, and third parties.
Data Extraction from Legacy Systems in Heterogeneous Environments
U.S. hospitals have a wide variety of information systems environments: some are fully electronic; some are fully paper-based; and all shades in between. Most hospitals do use electronic information systems, assembled from a wide variety of architectures, vendors, decades, and applications. It is not an exaggeration to say that each hospital’s information systems environment is unique. And there are thousands of hospitals in the U.S.
As experts in the use and application of advanced standards-based software tools to transfer data between a variety of systems and applications, the technical staff at QCMetrix are (working with your staff) able to access all enterprise legacy data sources including relational, networked, indexed, hierarchical, object-oriented, and flat-file systems. QCMetrix has successfully worked with sites to:
- Shorten development projects using standards-based connectivity
- Seamlessly access enterprise data from any business application, reporting and ETL tools
- Aggregate data from disparate databases
- Maintain data integrity
- Simplify data access and control
High-Outlier and Low-Outlier Hospitals in the ACS NSQIP
High-outlier hospitals have mortality or morbidity rates that
are significantly higher than what is expected based on the
severity of illness of their respective patient populations,
while low-outlier hospitals have mortality or morbidity rates
that are significantly lower than what is expected based on
the severity of the patients’ pre-operative risk factors.
(Khuri, et. al. Arch Surg Vol 137, Jan 2002)
HIPAA
To improve the efficiency and effectiveness of the health
care system, the Health Insurance Portability and Accountability
Act (HIPAA) of 1996, Public Law 104-191, included “Administrative
Simplification” provisions that required Health and
Human Services (HHS) to adopt national standards for electronic
health care transactions. At the same time, Congress recognized
that advances in electronic technology could erode the privacy
of health information. Consequently, Congress incorporated
into HIPAA provisions that mandated the adoption of Federal
privacy protections for individually identifiable health information.
ICD9
The ICD9 coding system is an international classification
system which groups related disease entities and procedures
for the purpose of reporting statistical information. Like
the CPT the purpose of the ICD9 is to provide a uniform language
and thereby serve as an effective means for reliable nationwide
communication among physicians, patients, and third parties.
Inter-Rater Reliability (IRR)
QCMetrix performs Inter-Rater Reliability (IRR) audits to
test for consistent case handling across the Surgical clinical
Nurse Reviewers (SCNRs). Approximately six months after the
initial training of the SCNR, the National ACS NSQIP Nurse Coordinator
performs an IRR Audit. The purpose of this audit is to assess
the quality of the data collected at each site and to educate
the site SCNR in any area that may be identified as a weakness.
These audits also serve to provide feedback to the Executive
Committee about data definitions that may be found to be problematic
for all sites. QCMetrix, in accordance with the guidelines
defined by the ACS NSQIP Executive Committee, randomly selects
cases for the audit and provides written reports to all sites
about the results.
In addition to site audits, inter-rater reliability is monitored
through regularly scheduled online testing, using case studies
to assess the SCNRs' understanding and application of the
ACS NSQIP data definitions.
Java
Developed by Sun Microsystems, Java is a high-level object-oriented
technology generating code that can run on the Web as well
as most operating systems. Because it is both a programming
language and a selection of specialized platforms, Java allows
QCMetrix to readily harness the power of networks across a
diverse spectrum of hospital IT environments. Java technology
standardizes the development and deployment of the kind of
secure, portable, reliable, and scalable applications required
by ACS NSQIP participants and hospitals working on quality improvement.
O/E Ratio
An observed vs. expected ratio is a statistical calculation
that allows for the calculation of a population-specific expected
outcome that reflects the severity of illness of that population
and compares it to the observed outcome. The risk-adjusted
outcome that is calculated by the ACS NSQIP is expressed as the
O/E ratio, where O represents the total number of observed
events (death or complications) and E, the number of events
that is expected on the basis of the compendium of the preoperative
risk factors prevalent in that population. The ACS NSQIP calculates
separate morbidity and mortality O/E ratios for each participating
site on at least an annual basis. (Khuri, et. al. Arch Surg
Vol 137, Jan 2002)
Outcomes
Outcomes are those changes, either favorable or adverse, in
the actual or potential health status of persons, groups,
or communities that can be attributed to prior or concurrent
care. What is included in the category of “outcomes”
depends, therefore, on how narrowly or broadly one defines
“health” and the corresponding responsibilities
of…practitioners or the health care system as a whole.
(Donabedian 1985, 256)
Examples of Outcomes (Iezonni 1997, 2):
- Longevity, mortality
- Acute physiologic stability
- Chronic disease and morbidity
- Complications, of disease or of medical care
- Physical functional status
- Psychosocial functioning
- Quality of life
- Costs of care
- Use of specified services
- Satisfaction with care, experiences with care
RBRVS
In 1992, Medicare significantly changed the way it pays for
physicians’ services. Instead of basing payments on
charges, the federal government established a standardized
physician payment schedule based on a resource-based relative
value scale (RBRVS). In the RBRVS system, payments for services
are determined by the resource costs needed to provide them.
The cost of providing each service is divided into three components:
physician work, practice expense and professional liability
insurance.
The physician work component accounts, on average, for 55%
of the total relative value for each service. The initial
physician work relative values were based on the results of
a Harvard University study. The factors used to determine
physician work include the time it takes to perform the service;
the technical skill and physical effort; the required mental
effort and judgment; and stress due to the potential risk
to the patient. The physician work relative values are updated
each year to account for changes in medical practice. Also,
the legislation enacting the RBRVS requires the Centers for
Medicare and Medicaid Services (CMS) to review the whole scale
at least every five years.
The ACS NSQIP uses the RBRVS physician work component to weight
the complexity of procedures in the O/E statistical models.
Risk
The definition of “risk” for surgical outcomes
is focused primarily on the effect of a particular disease
or co-morbidities on the physiologic integrity of the patient,
asking such questions as, "Is a patient more likely to
die, become disabled, or experience long-run sequelae than
other patients?"
Examples of Dimensions of Risk (Iezzoni 1997,45)
- Age
- Sex
- Race and ethnicity
- Acute clinical stability
- Principal diagnosis (“case mix)
- Severity of principal diagnosis
- Extent and severity of comorbidities
- Physical functional status
- Psychological, cognitive, and psychosocial functioning
- Cultural and socioeconomic attributes and behaviors
- Health Status and quality of life
- Patient attitudes and preferences for outcomes
Risk Adjustment
Meaningful comparison of patients’ outcomes requires
adjustment for those patients' risk factors. Risk adjustment
“levels the playing field,” accounting for factors
that patients bring to the healthcare encounters (e.g. surgery)
that could affect their outcomes. Risk adjustment facilitates
comparisons of “apples to apples,” sorting patients
by similar characteristics so that like is compared to like.
Controlling for patients’ risk factors is essential
for drawing useful inferences from observed healthcare outcomes
about the treatment effectiveness, provider performance, or
quality of care. (Iezzoni 1997, xiii)
XML
XML, short for Extensible Markup Language, was designed to
improve the functionality of the Web by providing more flexible
and adaptable information identification and exchange. Using
XML, developers can create their own customized "tags"
that enable the definition, transmission, validation, and
interpretation of data between applications and entities.
XML is a subset of the Standard Generalized Markup Language
(SGML), the international standard metalanguage for text markup
systems.
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