The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

Understanding “Proxy” Measurements

By Brent A. Metfessel MD, MS, CMP™ (Hon)

Medical claims data has clear limitations for outcomes analysis and quality reportage.

Such data only deals with the process of care and does not have information directly pertaining to outcomes except where specified in the ICD-9 codes. 

Thus, one must rely in many cases on proxy measures for outcomes. Proxy measures are process of care metrics that can imply certain outcomes, such as length of an illness episode.

The following are some ways to ascertain outcomes of care using claims data:

·         Complications of care:  The ICD-9 codes directly contain language for denoting outcomes.  There exist codes for wound infection and dehiscence, miscarriage in pregnancy, and general surgical complications.  The coding of a major infection in a cancer patient on chemotherapy is another example of complications-based outcomes obtainable through claims data.

·         Procedure re-performances:  Two coronary artery stent procedures within a six month to a year period may imply failure of the first stent.  However, a medical record check may ultimately be needed since it could also be a stent placed in a new vessel.  Returns to the operating room within a few days of a surgical operation, or an outpatient procedure that turns into an inpatient stay within a few days also implies poor outcomes.

·         Readmission rates:  Two or more hospitalizations for the same episode of care within 30 to 60 days also imply poor outcomes.

·         Episode length analysis:  The length that an episode of care lasts can be compared between providers.  Shorter episodes for acute illnesses imply better outcomes unless it is due to the expiration of a patient or poor access to care.

·         Medication prescribing patterns:  In some conditions the drugs prescribed may imply certain outcomes.  A rheumatoid arthritis patient that needs Remicade® probably has a more severe form of the illness.  Frequent antibiotic switching for an infectious disease such as pneumonia either implies a resistant organism or difficulties in quality of care.

·       Emergency room and hospital utilization:  Frequent ER use or hospitalizations for chronic conditions such as asthma or congestive heart failure imply a poor outcome from outpatient treatment.

Assessment

How reliable are these proxy measures in evaluating medical outcomes?  

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

• PRACTICES: www.BusinessofMedicalPractice.com
• HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
• CLINICS: http://www.crcpress.com/product/isbn/9781439879900
• ADVISORS: www.CertifiedMedicalPlanner.org
• FINANCE: Financial Planning for Physicians and Advisors
• INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
• Dictionary of Health Economics and Finance
• Dictionary of Health Information Technology and Security
• Dictionary of Health Insurance and Managed Care

***

Filed under: Quality Initiatives | 1 Comment »