TY - JOUR
T1 - Estimating Anesthesia time using the medicare claim
T2 - A validation study
AU - Silber, Jeffrey H.
AU - Rosenbaum, Paul R.
AU - Even-Shoshan, Orit
AU - Mi, Lanyu
AU - Kyle, Fabienne A.
AU - Teng, Yun
AU - Bratzler, Dale W.
AU - Fleisher, Lee A.
N1 - Funding Information:
The authors thank the following persons for their assistance in collecting data for this study. Kenneth J. Abrams, M.D., M.B.A. Senior Vice President, Clinical Operations Chief Quality Officer Associate Chief Medical Officer North Shore Long Island Jewish Health System Great Neck, New York David Amar, M.D. Professor of Anesthesiology Director of Thoracic Anesthesia Memorial Sloan-Kettering Cancer Center New York, New York Jane Byrnes, R.N. Department of Clinical Quality and Effectiveness NYU Langone Medical Center New York, New York Karen Carroll, R.N., M.S., A.P.R.N.-B.C. Quality Certification Coordinator Quality Management Blessing Hospital Quincy, Illinois Janet Cottrell, R.N., M.S. Director, Outcomes Management St. Joseph Regional Health System Bryan, Texas Barbara J. Dalton, R.N., B.S.N. Nursing Case Manager, Case Management Good Sheppard Medical Center Longview, Texas Kristin Duncan, R.N., B.S.N., M.B.A. Director, Quality Management Texas Health Harris Methodist Hospital Hurst-Euless-Bedford Bedford, Texas Neil Fleming, Ph.D., C.Q.E. Vice-President, Health Care Research Director of the Center for Health Care Research Institute of Health Care Research and Improvement Baylor Health Care System Dallas, Texas Nancy Franklin, L.V.N. Clinical Data Abstractor Outcomes Management St. Joseph Regional Health Center Bryan, Texas Lisa Galati Burke, P.A.C. Physician's Assistant Quality Assurance Coordinator Department of Surgery New York Hospital Queens Flushing, New York Lisa Gayre, R.H.I.A. Director, Clinical Decision Support Baptist Health System San Antonio, Texas Melissa Green, R.N., C.B.N. Bariatric Program Coordinator Bariatric Surgery Providence Health Center Waco, Texas Geraldine Koster, R.N. Director of Operations Institute for Clinical Excellence & Quality North Shore-Long Lisland Jewish Health System Great Neck, New York Susann F. Land, M.D., M.B.A. Vice President, Chief Quality Officer Harris Methodist HEB Bedford, Texas Jill Lapaglia, R.N., M.N.Sc. Senior Director of Quality/Risk/Infection Prevention/Regulatory Southwest Texas Methodist San Antonio, Texas Lori Loya, R.N., B.S.N. QI Specialist Quality Management Covenant Health System Lubbock, Texas Rachel Magsalin, M.D. Research Institute Carle Foundation Hospital Urbana, Illinois Paige Metz, R.N. Quality Improvement Coordinator Harris Methodist HEB Bedford, Texas Susan Mitchell, B.S.N., C.P.H.Q. Director, Quality Management Covenant Health System Lubbock, Texas Reed Panos, M.D. Clinical Assistant Professor of Surgery, University of Illinois College of Medicine Department of Surgery Carle Foundation Hospital Urbana, Illinois Martha J. Radford, M.D., F.A.C.C., F.A.H.A. Chief Quality Officer Professor of Medicine (Cardiology) NYU School of Medicine NYU Langone Medical Center New York, New York Jane Redmond, R.N. Infection Control Peterson Regional Medical Center Kerrville, Texas Scott Robins, M.D. Chief Medical Officer Covenant Health System Lubbock, Texas Joye Poole, R.N., O.N.C. Charge RN, Nursing Pool Good Sheppard Medical Center Longview, Texas Judith Rosenblum, R.N. Clinical Research Associate Department of Surgery Advocate Lutheran General Hospital Park Ridge, Illinois Meri Beth Schwendeman, R.N. Quality Nurse Auditor Quality Risk Management Peterson Regional Medical Center Kerrville, Texas Laura A. Sheppard, R.N., B.S.N., C.C.S. Quality Resource Coordinator Rockford Memorial Rockford, Illnois Ljuba Stojiljkovic, M.D., Ph.D. Associate Professor of Anesthesiology Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital Chicago, Illnois John V. White, M.D. Attending Vascular Surgeon Chairman, Department of Surgery Advocate Lutheran General Hospital Park Ridge, Illnois
PY - 2011/8
Y1 - 2011/8
N2 - Introduction: Procedure length is a fundamental variable associated with quality of care, though seldom studied on a large scale. The authors sought to estimate procedure length through information obtained in the anesthesia claim submitted to Medicare to validate this method for future studies. Methods: The Obesity and Surgical Outcomes Study enlisted 47 hospitals located across New York, Texas, and Illinois to study patients undergoing hip, knee, colon, and thoracotomy procedures. A total of 15,914 charts were abstracted to determine body mass index and initial patient physiology. Included in this abstraction were induction, cut, close, and recovery room times. This chart information was merged to Medicare claims that included anesthesia Part B billing information. Correlations between chart times and claim times were analyzed, models developed, and median absolute differences in minutes calculated. Results: Of the 15,914 eligible patients, there were 14,369 for whom both chart and claim times were available for analysis. For these 14,369, the Spearman correlation between chart and claim time was 0.94 (95% CI 0.94, 0.95), and the median absolute difference between chart and claim time was only 5 min (95% CI: 5.0, 5.5). The anesthesia claim can also be used to estimate surgical procedure length, with only a modest increase in error. Conclusion: The anesthesia bill found in Medicare claims provides an excellent source of information for studying surgery time on a vast scale throughout the United States. However, errors in both chart abstraction and anesthesia claims can occur. Care must be taken in the handling of outliers in these data.
AB - Introduction: Procedure length is a fundamental variable associated with quality of care, though seldom studied on a large scale. The authors sought to estimate procedure length through information obtained in the anesthesia claim submitted to Medicare to validate this method for future studies. Methods: The Obesity and Surgical Outcomes Study enlisted 47 hospitals located across New York, Texas, and Illinois to study patients undergoing hip, knee, colon, and thoracotomy procedures. A total of 15,914 charts were abstracted to determine body mass index and initial patient physiology. Included in this abstraction were induction, cut, close, and recovery room times. This chart information was merged to Medicare claims that included anesthesia Part B billing information. Correlations between chart times and claim times were analyzed, models developed, and median absolute differences in minutes calculated. Results: Of the 15,914 eligible patients, there were 14,369 for whom both chart and claim times were available for analysis. For these 14,369, the Spearman correlation between chart and claim time was 0.94 (95% CI 0.94, 0.95), and the median absolute difference between chart and claim time was only 5 min (95% CI: 5.0, 5.5). The anesthesia claim can also be used to estimate surgical procedure length, with only a modest increase in error. Conclusion: The anesthesia bill found in Medicare claims provides an excellent source of information for studying surgery time on a vast scale throughout the United States. However, errors in both chart abstraction and anesthesia claims can occur. Care must be taken in the handling of outliers in these data.
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U2 - 10.1097/ALN.0b013e31821d6c81
DO - 10.1097/ALN.0b013e31821d6c81
M3 - Article
C2 - 21720242
AN - SCOPUS:79961020735
SN - 0003-3022
VL - 115
SP - 322
EP - 333
JO - Anesthesiology
JF - Anesthesiology
IS - 2
ER -