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Landrum, M.B., Bronskill, S.E., and Normand, S-L. T. (2000, January). "Analytic methods for constructing cross-sectional profiles of health care providers." (AHRQ grant HS08071). Health Services & Outcomes Research Methodology 1(1), pp. 23-47.
National efforts are currently underway to develop and disseminate comparative information about both the outcomes and processes of care for health care providers. However, many different performance measures may be used to assess quality for a particular provider, and this information can often be contradictory and overwhelming. Thus, there is a need for measures that summarize quality at a provider level. This article proposes the use of latent variable models for comparing health care providers in the cross-sectional setting, when each provider is measured on more than one dimension of care. This may produce a composite measure of quality with more statistical power to detect differences among providers.
Longenecker, J.C., Coresh, J., Klag, M.J., and others. (2000, March). "Validation of comorbid conditions on the end-stage renal disease medical evidence report: The CHOICE study." (AHRQ grant HS08365). Journal of the American Society of Nephrology 11, pp. 520-529.
The Health Care Financing Administration's medical evidence report for end-stage renal disease (ESRD), known as Form 2728, documents a patient's need for renal replacement therapy and provides important baseline data upon patient entry into the ESRD program. High mortality rates among dialysis patients, along with other concerns, prompted the addition of a section on 20 coexisting medical conditions in 1995. Since that time, Form 2728 has been used nationally to collect information on comorbid conditions. To date, these data have not been validated. These researchers conducted a national cross-sectional study of 1,005 dialysis patients enrolled between 1995 and 1998 using clinical data to validate 17 comorbid conditions on the form. Sensitivity was fairly high for HIV infection, diabetes, and hypertension and intermediate for other conditions. The specificity was very good for hypertension and excellent for the other 16 conditions. Given the underreporting of comorbid conditions, the authors suggest improving Form 2728 coding if it is to provide accurate estimates of total disease burden in ESRD.
Walston, S.L., Burns, L.R., and Kimberly, J.R. (2000, February). "Does reengineering really work? An examination of the context and outcomes of hospital reengineering initiatives." (AHRQ grant HS09581). Health Services Research 34(6), pp. 1363-1388.
The authors explore the direct effects of hospital reengineering on the competitive cost position of hospitals and the modifying effects of implementation factors. Reengineering is the radical redesign of business processes to achieve dramatic improvements in critical measures of performance, such as cost, quality, and service. The researchers used data from a 1996-1997 national survey of hospital chief executive officers (CEOs) on restructuring and reengineering, and combined it with data from another annual hospital survey. Results suggest that reengineering without integrative and coordinated efforts may damage an organization's competitive position. Organizations attempting to improve their cost competitiveness must consider the way in which change is implemented. The authors point out that the process of change may be as important as the change instrument.
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Current as of April 2000
AHRQ Publication No. 00-0027