Borzecki AM (Center for Health Quality, Outcomes and Economic Research (CHQOER)), Chew P
(CHQOER), Loveland S
(CHQOER), Loya S
(CHQOER), Rosen AK
VA’s commitment to improving care of special veteran populations is evidenced by initiatives including tracking of selected national performance measures in groups such as spinal cord injured (SCI) patients. Additional quality measures, such as AHRQ’s Inpatient Quality Indicators (IQIs), may be useful in these populations. IQIs screen for potential inpatient quality problems using administrative data by measuring: a) mortality rates from specific procedures and conditions where high mortality may be associated with poorer care, and b)utilization rates of procedures where concerns exist about over-/under-, or misuse. As part of a larger IQI study, we identified high-priority special populations and determined their IQI rates.
We convened a panel of key VA stakeholders who helped prioritize both IQIs and special populations for further study. We then derived rates (risk-adjusted for age, gender, comorbidities and illness severity using APR-DRGs) for the selected populations: diabetes, seriously mentally ill (SMI), SCI, HIV, and stroke patients, using FY04-07 National Patient Care Database inpatient files and AHRQ IQI software (v3.1). Rates were compared to the remaining VA population.
Of 2.3 million admissions, the subpopulation breakdown was as follows: diabetes 34%, SMI 13%, SCI 2%, HIV 1%, and stroke 6%. Diabetes and stroke patients were older than the remaining VA population (65.5+/-11.6 and 69.0+/-11.5 vs 61.7+/-14.3 years; p < 0.05); SMI, SCI and HIV subjects were younger (respective mean ages 57.5+/-13.8, 59.3+/-12.9, 51.4+/-8.8; p < 0.05). SMI patients had higher mortality rates from several medical conditions, including acute myocardial infarction (AMI), heart failure, stroke, and pneumonia than the non-SMI population (e.g., for AMI, risk-adjusted rates were 9.7+/-2.4 vs 7.4+/-2.8, per 100 AMI admissions; p < 0.05). There was a trend toward higher mortality for SCI subjects across the same conditions, but differences weren’t significant presumably due to low numbers. No consistent trends were seen amongst the other cohorts, or with respect to procedure-related mortality or utilization indicators.
SMI patients are at higher mortality risk from various medical conditions compared to the general VA population. This risk persisted despite adjustment for comorbidities.
National clinical performance measures should be targeted at the SMI population, since this group may be receiving poorer quality of medical care compared to others.