ArticleBMJ open2021
Elucidating the association between regional variation in diagnostic frequency with risk-adjusted mortality through analysis of claims data of medicare inpatients: a cross-sectional study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Hospital-Wide Quality Assessment Using All-Condition Versus Summed-Condition Risk Adjustment.Health services research · 2026Article
- Article
- The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA).Emergency radiology · 2023Article
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Authors and funding
6 authors.
Funding
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Abstract
objectiveThe validity of risk-adjustment methods based on administrative data has been questioned because hospital referral regions with higher diagnosis frequencies report lower case-fatality rates, implying that diagnoses do not track the underlying health risk. The objective of this study is to test the hypothesis that regional variation of diagnostic frequency in inpatient records is not associated with different coding practices but a reflection of the underlying health risks.
designWe applied two stratification methods to Medicare Analysis and Provider Review data from 2009 through 2014: (1) the number of chronic conditions; and, (2) quartiles of Risk Stratification Index (RSI)-defined risk. After sorting hospital referral regions into quintiles of diagnostic frequency, we examined all-cause mortality.
settingMedicare Analysis and Provider Review administrative database.
participants18 126 301 hospitalised Medicare fee-for-service beneficiaries aged 65 or older who had at least one hospital-based procedure between 2009 and 2014. EXPOSURE: Coding frequency and baseline regional population risk factors by hospital referral region. PRIMARY AND SECONDARY OUTCOMES AND MEASURES: One year all-cause mortality in patients having the same number of chronic conditions or within the same RSI score quartile across US health referral regions, grouped by diagnostic frequency.
resultsNo consistent relationship between diagnostic frequency and mortality in the risk stratum defined by number of chronic conditions was detected. In the strata defined by RSI quartile, there was no decrease in mortality as a function of diagnostic frequency. Instead, adjusted mortality was positively correlated with socioeconomic risk factors.
conclusionsUsing present-on-admission codes only, diagnostic frequency among inpatients with at least one hospital-based procedure appears to be consequent to differences in baseline population health status, rather than diagnostic coding practices. In this population, claims-based risk-adjustment using RSI appears to be useful for assessing hospital outcomes and performance.
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