Screening inpatient quality using post-discharge events

Med Care. 1999 Apr;37(4):384-98. doi: 10.1097/00005650-199904000-00008.


Background: Decreasing hospital lengths of stay (LOS) hamper efforts to detect and to definitively treat complications of care. Patients leave before some complications are identified.

Objectives: To develop a computerized method to screen for hospital complications using readily available administrative data from outpatient and nonacute care within 90 days of discharge.

Design: We developed the Complications Screening Program for Outpatient data (CSP-O) by using diagnosis and procedure codes from Medicare Part A and B claims to define 50 complication screens. Seventeen apply to specific procedural cases, and 33 apply to all adult, acute, medical, or surgical hospitalizations. The CSP-O algorithm examined outpatient, physician office, home health agency, and hospice claims within 90 days following discharge.

Subjects: Seven hundred thirty nine thousand, two hundred and forty eight discharges of Medicare beneficiaries (age range, > or = 65 years) were admitted to 515 hospitals nationwide in 1994.

Results: Complete 90-day, post-discharge windows were present for 62.8% of all and 68.5% of procedural cases. The 33 general screens flagged 13.6% of all cases; only 1.8% of procedural cases were flagged by the 17 procedural screens. When we allowed the CSP-O algorithm to scan information from acute hospital readmissions, flag rates rose to 32.8% for general and 8.7% for procedural complications. Controlling for patient and hospital characteristics, flag rates were considerably higher among the very old and at small and for-profit institutions.

Conclusions: Whereas several CSP-O findings have construct validity, limitations of claims raise concerns. Regardless of the CSPO's ultimate utility, examining post-discharge experiences to identify inpatient complications remains important as LOSs fall.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aftercare / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Cross Infection / epidemiology
  • Female
  • Hospitals / standards*
  • Humans
  • Iatrogenic Disease / epidemiology*
  • Length of Stay
  • Male
  • Mass Screening*
  • Multivariate Analysis
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Patient Discharge*
  • Postoperative Complications / epidemiology
  • Time Factors