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Comparison of RatesLet us take on the real challenges in healthcare. The life and death issues. The persistent errors and the big frustrations. Have you ever had a loved one go to the hospital for a minor problem and die? Ever wondered why healthcare does not work smoothly, why wrong side surgeries occur, or why medication errors occur; this week you get to see the data for yourself. This week we learn how to examine changes in mortality, infection and other rates of other adverse events across time, and we continue to download real data from hospital compare site. P-chart and risk-adjusted p-chart are used to analyze the data. We will look at the assumptions of these charts, and gain hands-on experience in analyzing real data. After this week, you should be able to go to any hospital and examine if they are getting fewer sentinel adverse events. Well you do not even need to go to the hospital, you can take their data from the Hospital Compare site and analyze it. Assigned Reading
Presentations
Examples
AssignmentsInstruction for Submission of Assignments: Assignments should be submitted directly on Blackboard. In rare situations assignments can be sent directly by email to the instructor. Submission should follow these rules:
Question 1: This exercise allows you to examine how the quality of hospital care is evaluated through data obtained from electronic health records. In practice, the need to analyze these types of data arises in improvement teams, where managers, clinicians, and patients work together to systematically improve healthcare processes. In this assignment, you are asked to examine hospital compliance with severe sepsis and septic shock treatment protocols. Instead of providing you with the data directly, we ask that you download it from the web so that you learn more about the source of the data and its specific organizational structure. Hospital Compare provides information on many quality indicators. In this assignment, you will focus on timely clinical interventions. The Centers for Medicare & Medicaid Services (CMS) provides the following rationale for why this measure of quality is helpful: "Sepsis is a medical emergency. Early identification and appropriate intervention within hours of presentation are critical for improving patient survival. The severe sepsis and septic shock early management bundle (SEP_1) measures whether a hospital provided the most effective, evidence-based interventions within 3 hours and 6 hours of the diagnosis. Tracking this measure helps hospitals systematically improve clinical workflows and ensure life-saving care is delivered reliably." To complete this assignment, execute the following tasks:
Resources for Question 1:
Question 2: Nursing home and hospital administrators implement many initiatives to reduce falls. This problem shows how these initiatives can be measured and evaluated. Prepare a risk-adjusted control chart for data on falls in a nursing home.
Question 3: Following data were obtained on post surgical infection rates. Are we having more infections than expected from the patients' conditions?
Question 4: Download Hospital Compare data for the year 2015 and 2016. Start from 1/1/2015 till the most recent available database. Since the data on AMI payments does not change in the files, you can save time and read only the following 3 files into a new database:
In these files the denominator indicates the number of patients. Whether the hospital had above average payments are reported in different fields: [Compared to National], [Category], and [Payment Category] Select data that meet the following conditions:
Construct a control chart showing probability of change over time.
Question 5: On average 1 in 10 patients have some sort of medication error in our facility; what is the probability that out of 10 patients none will have medication errors? See page 176 of the required textbook for how a similar question was answered.
Question 6: The probability of a patient recovering from a heart operation is 0.9. Assuming that heart operations are not related to each other, what is the probability that exactly 4 out of 8 next patients will survive the operation? See page 176 of the required book for a similar example.
Question 7An insurance salesperson is about to sell life insurance policies to 7 unrelated women, all of whom are of the same age, belong to the same race, and are in good health. According to independent actuarial estimates, the probability of a woman of this age, race, and health status being alive 20 years from now is 80%. What is the probability that in 20 years all 3 women are alive?
Question 8: Healthcare organizations are often interested in assessing the impact of screening efforts in generating new referrals. Patients may return to many different clinics and not just to the original screening clinic. They may also return to a clinic months later and not immediately. The attached data shows visits from pregnant mothers who received ultrasound tests. Data are presented on date of visits and clinics that were visited. Re-organize the data to count the number of referrals per month to neurology. Note that you will need to use Excel or SQL text processing commands to identify when the mother has returned to the neurology department. Construct a p- chart for the probability of a subsequent neurological visits in mothers who had an ultrasound screening.
Question 9: Examine percentage of healthcare workers given influenza vaccination for preventive care. This is a patient safety measure for timely and effective care. The needed data are at hospital compare data provided by Centers for Medicare and Medicaid. The IMM-3-FAC-ADHPCT measure is defined as percentage of healthcare workers given influenza vaccination. Read the rationale behind this measure.
Construct a control chart showing percentage of health care professional's vaccination over time in "Brookdale Hospital Medical Center" in New York; this is provider ID "330233". Estimate the control limits based on the "Presbyterian Hospital" in New York; this is provider ID "330101". These two hospitals were selected based on a July 2020 article by the NY Times that described Brookdale Hospital Medical Center as a “struggling independent hospital, located in Brooklyn”. In the same article, New York – Presbyterian Hospital was described as “Manhattan’s largest private hospital network”. The article claimed that surviving COVID-19 virus might have depended on which hospital admits you
Question 10 Part of Semester Long Case Study: Please attach the copy of your second email in the case study. The overall purpose of the case study is to get you engaged in networking with the industry. You should proceed with your contact, even if they have not answered your first email. You should continue contacts unless you have a bounced email. The 2nd email should focus the analysis by selecting the following: (1) A type of patient that the analysis focuses on (2) The measures that describe the quality of care for these patients, and (3) competitors selected for the hospital. Case Study►
Resources for this assignment:
MoreThis page is part of the course on Statistical Process Control, the lecture on Comparison of Rates. This presentation was based on Alemi F, Rom W, Eisenstein E. Risk adjusted control charts for health care assessment. Annals of Operations Research, 1996. Created on Tuesday, September 17, 1996. Most recent revision 10/08/26. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
