Literature Tables for Utilization and ACSC Indicators

Sheryl M Davies; Jeffrey Geppert; Mark McClellan; Kathryn M McDonald; Patrick S Romano; Kaveh G Shojania

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Davies SM, Geppert J, McClellan M, et al. Refinement of the HCUP Quality Indicators. Rockville (MD): Agency for Healthcare Research and Quality (US); 2001 May. (Technical Reviews, No. 4.)

Refinement of the HCUP Quality Indicators.

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APPENDIX 8Literature Tables for Utilization and ACSC Indicators

This appendix summarizes the literature reviews for area utilization and ACSC indicators in table format.

Table 1A. Studies of appropriateness of specific procedures. This table summarizes the studies used to identify area utilization indicators.

Tables 2A-6A. These tables summarize studies of ACSC indicators. Table 2A identifies the studies and designs. Table 3A lists the ACS conditions examined in each study. Tables 4A-6A list pediatric avoidable hospitalizations, infant discretionary hospitalizations, and late hospitalization indicators examined by each study.

Table 3A focuses on conditions for which the risk of hospitalization can be reduced, either through better outpatient management of chronic diseases (e.g., asthma, CHF, diabetes) or through more timely diagnosis and effective treatment of acute conditions (e.g., pneumonia, UTI, cellulitis). This is the best validated of the 4 constructs, and is the basis for all of our selected indicators.

Table 4A includes "conditions for which evidence exists that specific ambulatory care modalities reduce hospitalization rates." This category differs from #1 in that it is more sharply focused on defects in ambulatory care, such as a lack of prior outpatient visits or antibiotic prescriptions. There is some overlap between this list and #1 (e.g., asthma, gastroenteritis, DKA, severe ENT infections, PID), although the definitions often differ slightly. Some of these indicators cannot be implemented without linked outpatient claims.

Table 5A focuses on conditions "for which the decision to admit involves a substantial amount of physician judgment...have a wide range in severity and are often managed at home." This concept seems somewhat less relevant to discussions about quality of care.

Table 6A focuses on conditions "whose advanced stages are presumed to have a greater likelihood of reflecting untimely hospital admissions" (because earlier admission would have prevented progression to the advanced stage). This concept relates to the timeliness of hospitalization and the appropriateness of inpatient care, more than to the timeliness and effectiveness of outpatient care.

Table 1A. Studies of appropriateness of specific procedures

Table 2A. Studies of ACSC indicators

Table 3A. Studies of ACSC indicators

Table 4A. Studies of ACSC Indicators- Pediatric Avoidable Hospitalizations

Table 5A. Studies of ACSC Indicators-Discretionary Hospitalization of Infants

Table 6A. Studies of ACSC Indicators- Late Hospitalization

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2.: Matchar DB, et al Influence of projected complication rates on estimated appropriate use rates for carotid endarterectomy HSR. 199732(3):325–342. [PMC free article: PMC1070194] [PubMed: 9240284]
3.: Chassin MR, et al Does inappropriate use explain geographic variations in the use of health care services: A study of three procedures. JAMA. . 1987;258:2533–2537. [PubMed: 3312655]
4.: Leape LL, et al Does inappropriate use explain small -- area variations in the use of health care services? JAMA. . 1990;236:669–672. [PubMed: 2404147]
5.: Tobacman JK, et al Assessment of appropriateness of cataract surgery at ten academic medical centers in 1990. Ophthalmology. . 1996;103:207–215. [PubMed: 8594503]
6.: Pilpel D, Fraser GM, Kosecoff J, Weitzman S, Brook RH Regional differences in appropriateness of cholecystectomy prepaid health insurance system. Public Health Rev. . 1992/93;20:61–74. [PubMed: 1305979]
7.: Froehlich F, et al Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: A prospective study. Gastrointest Endosc. . 1998;48:128–36. [PubMed: 9717777]
8.: Noonan SJ, et al Relationship of anatomic disease to appropriateness ratings of coronary angiography. Arch Intern Med . 1995;155:1209–1213. [PubMed: 7763127]
9.: Gray D, Hampton JR, Bernstein SJ, Kosecoff J, Brook RH Audit of coronary angiography and bypass surgery. Lancet. . 1990;335:1317–1320. [PubMed: 1971385]
10.: McGlynn EA, et al Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State. JAMA. . 1994;272:934–940. [PubMed: 8084060]
11.: Bernstein SJ, et al The appropriateness of use of coronary angiography in New York State. JAMA. . 1993;269:766–769. [PubMed: 8423658]
12.: Leape LL, et al Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures. Am Heart J. . 2000;139:106–113. [PubMed: 10618570]
13.: Leape LL, et al The appropriateness of Coronary Artery Bypass Graft surgery in academic medical centers. Ann Intern Med. . 1996;125:8–18. [PubMed: 8644996]
14.: Leape LL, et al The appropriateness of use of Coronary Artery Bypass Graft surgery in New York state. JAMA. . 1993;269:753–760. [PubMed: 8423656]
15.: Ziskind AA, Lauer MA, Bishop G, Vogel A Assessing the appropriateness of coronary revascularization: The University of Maryland Revascularization Appropriateness Score (RAS) and its comparison to RAND expert panel ratings and American College of Cardiology/American Heart Association guidelines with regard to assigned appropriateness rating and ability to predict outcome. Clin Cardiol. . 1999;22:67–76. [PMC free article: PMC6655816] [PubMed: 10068842]
16.: Bernstein SJ, Brorsson B, Aberg T, Emanuelsson H, Brook RH, Werko L Appropriateness of referral of coronary angiography patients in Sweden. Heart. . 1999;81:470–477. [PMC free article: PMC1729044] [PubMed: 10212163]
17.: Carlisle DM, et al Underuse and overuse of diagnostic testing for coronary artery disease in patients presenting with new-onset chest pain. Am J Med. . 1999;106:391–398. [PubMed: 10225240]
18.: Bernstein SJ, et al The appropriateness of hysterectomy: A comparison of care in seven health plans. JAMA. . 1993;269:2398–2402. [PubMed: 8479066]
19.: Porchet F, Vader JP, Larequi-Lauber T, Costanza MC, Burnand B, Dubois RW The assessment of appropriate indications for laminectomy. J Bone Joint Surg [Br] . 1999;81-B:234–239. [PubMed: 10204927]
20.: Larequi-Lauber T, et al Appropriateness of indications for surgery of Lumbar Disc Hernia and Spinal Stenosis. Spine. . 1997;22:203–209. [PubMed: 9122803]
21.: Van Walraven C, et al Appropriateness of primary total hip and knee replacements in regions of Ontario with high and low utilization rates. [PMC free article: PMC1335222] [PubMed: 8823215]
22.: Karp HR, Flanders WD, Shipp CC, Taylor B, Martin D Carotid Endarterectomy among Medicare beneficiaries: A statewide evaluation of appropriateness and outcome. Stroke. . 1998;29:46–52. [PubMed: 9445327]
23.: Broder MS, Kanouse DE, Mittman BS, Bernstein SJ The appropriateness of recommendations for hysterectomy. Obstet Gynecol. . 2000;95:199–205. [PubMed: 10674580]
24.: Wong JH, Lubkey TB, Auarez-Almazor ME, Findlay JM Improving the appropriateness of Carotid Endarterectomy: Results of a prospective city-wide study. Stoke. . 199;30:12–15. [PubMed: 9880381]
25.: Quintana JM, Azkarate J, Goenaga JI, Ar?stegui I, Beldarrain I, Villar JM Evaluation of the appropriateness of hip joint replacement techniques. Intl J Tech Assessment in Health Care. . 2000;16:165–177. [PubMed: 10815362]
26.: Ferguson JA, Adams TA, Weinberger M Racial differences in cardiac catheterization use and appropriateness. Am J Med Sci. . 1998;315:302–306. [PubMed: 9587086]

References

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Davies SM, Geppert J, McClellan M, et al. Refinement of the HCUP Quality Indicators. Rockville (MD): Agency for Healthcare Research and Quality (US); 2001 May. (Technical Reviews, No. 4.) APPENDIX 8, Literature Tables for Utilization and ACSC Indicators.