Abstract
The purpose of this study was to characterize quality of care problems among Medicare and Medicaid inpatients in New York State. The patients selected for this study comprised 1991 and 1992 Medicare and all 1992 Medicaid inpatients in whom quality of care problems with actual or potential adverse effects were found. The patients in this study were drawn from public, proprietary, voluntary and teaching hospitals.
A total of 1000 quality of care problems with either actual or potential adverse effects were found in 706 Medicare patients. Two hundred and seventy-five (275) quality of care problems with actual or potential adverse effects were found in 154 Medicaid patients. Premature death occurred in 53 (7.4%) of the 706 Medicare and in 42 (27.2%) of the 154 Medicaid patients. Treatment problems and monitoring failures accounted for the majority of quality of care problems with actual or potential adverse effects for both Medicare (63.0%) and Medicaid (75.7%) patients. Among Medicare patients, the treatment of infections and antibiotic use, fluid and electrolyte management, and inappropriate drug use were among the leading causes of quality of care problems. Attending physicians were associated with the majority of Medicare quality of care problems while house staff and attending physicians were associated with the majority of those among Medicaid patients.
The results of this study indicate that there are several leading causes of quality of care problems among Medicare and Medicaid patients. Treatment problems and monitoring failures together comprise the majority of such problems. Among Medicare patients, it was found that most quality of care problems were associated with the treatment of infections and antibiotic use, fluid and electrolyte management, and inappropriate drug use. Most quality of care problems among Medicaid patients were associated with these categories as well as with labor and delivery problems, and poor discharge planning.
The results of this study reflect the peer-review process in which providers are given an opportunity to respond to physicianreviewer decisions about the presence of actual or potential adverse effects. Such a process, which permits the presentation of additional data and information by providers, produces fewer final adverse outcome determinations than a process uniquely based on chart review.
The quality of care problems observed in this study are amenable to focused educational interventions. Such remedial interventions could yield significant improvements in the quality of care for all patients.
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References
Rubenstein, LV, Kahn, KL, Reinisch, EJ, Sherwood, MJ, Rogers, WH, Kamberg, C, et al. Changes in quality of care for five diseases measured by implicit review, 1981 to 1986.JAMA 1990;264:1974–1979.
Davis, PE, Weiner, JP, Otter, VE. Peer review organizations: promises and potential pitfalls.New Engl J Medicine 1985; 313:1331–1337.
Haywood, RA, McMahon, LF, Bernard, AM. Evaluating the care of general medicine in inpatients: how good is implicit review?Ann. Int. Med. 1993; 118:550–556.
Brook, RH, Lohr, XN. Monitoring quality of care in the Medicare program. Two proposed systems.JAMA 1987; 258:3138–3141.
Brennan, JA, Leape, LL, Laird, NM et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Practice Study I.New Engl J Medicine 1991; 324:377–384.
Leape, LL, Brennan, TA, Laird, N et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II.New Engl J Medicine 1991; 324:377–384.
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Nenner, R.P., Imperato, P.J., Silver, A.L. et al. Quality of care problems among medicare and medicaid patients. J Community Health 19, 307–318 (1994). https://doi.org/10.1007/BF02260401
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DOI: https://doi.org/10.1007/BF02260401