2016
Rethinking Medicare Payment Adjustments for Quality
Averill RF, Fuller RL, McCullough EC, Hughes JS. Rethinking Medicare Payment Adjustments for Quality. Journal Of Ambulatory Care Management 2016, 39: 98-107. PMID: 26945288, PMCID: PMC4870963, DOI: 10.1097/jac.0000000000000137.Peer-Reviewed Original Research
2013
Postadmission Sepsis as a Screen for Quality Problems
Hughes JS, Eisenhandler J, Goldfield N, Weinberg PG, Averill R. Postadmission Sepsis as a Screen for Quality Problems. American Journal Of Medical Quality 2013, 29: 499-507. PMID: 24226649, DOI: 10.1177/1062860613509002.Peer-Reviewed Original ResearchConceptsDiagnosis codesNew York State hospitalsHospital-acquired sepsisPeripheral intravenous cathetersCentral venous cathetersHospital discharge abstractsCase-control studyHospital complicationsSepsis casesSurgical patientsVenous cathetersCare guidelinesMedical patientsUrethral catheterIntravenous cathetersDischarge abstractsSepsisAdmission indicatorsState HospitalCare problemsPatientsCatheterComplicationsSubsequent developmentHospital
2011
Challenges and Benefits of Adding Laboratory Data to a Mortality Risk Adjustment Method
McCullough E, Sullivan C, Banning P, Goldfield N, Hughes J. Challenges and Benefits of Adding Laboratory Data to a Mortality Risk Adjustment Method. Quality Management In Health Care 2011, 20: 253-262. PMID: 21971023, DOI: 10.1097/qmh.0b013e318231cf4f.Peer-Reviewed Original ResearchPaying for Outcomes, Not Performance: Lessons from the Medicare Inpatient Prospective Payment System
Averill RF, Goldfield N, Hughes J. Paying for Outcomes, Not Performance: Lessons from the Medicare Inpatient Prospective Payment System. The Joint Commission Journal On Quality And Patient Safety 2011, 37: 184-192. PMID: 21500719, DOI: 10.1016/s1553-7250(11)37023-7.Peer-Reviewed Original Research
2009
Hospital Complications: Linking Payment Reduction to Preventability
Averill R, Goldfield N, Hughes J, McCullough EC. Hospital Complications: Linking Payment Reduction to Preventability. The Joint Commission Journal On Quality And Patient Safety 2009, 35: 283-285. PMID: 19480383, DOI: 10.1016/s1553-7250(09)35040-0.Peer-Reviewed Original Research
2008
Identifying potentially preventable readmissions.
Goldfield NI, McCullough EC, Hughes JS, Tang AM, Eastman B, Rawlins LK, Averill RF. Identifying potentially preventable readmissions. Medicare & Medicaid Research Review 2008, 30: 75-91. PMID: 19040175, PMCID: PMC4195042.Peer-Reviewed Original Research
2006
Identifying potentially preventable complications using a present on admission indicator.
Hughes JS, Averill RF, Goldfield NI, Gay JC, Muldoon J, McCullough E, Xiang J. Identifying potentially preventable complications using a present on admission indicator. Medicare & Medicaid Research Review 2006, 27: 63-82. PMID: 17290649, PMCID: PMC4194950.Peer-Reviewed Original ResearchConceptsSeverity of illnessPreventable complicationsComplication rateAdmission indicatorsRisk-adjusted complication ratesHospital complication ratesFrequency of complicationsHigher hospital chargesHospital complicationsHospital chargesSecondary diagnosisPOA indicatorComplicationsCalifornia hospitalsLonger lengthAdmissionStayHospitalIllness
2004
Clinical Risk Groups (CRGs)
Hughes JS, Averill RF, Eisenhandler J, Goldfield NI, Muldoon J, Neff JM, Gay JC. Clinical Risk Groups (CRGs). Medical Care 2004, 42: 81-90. PMID: 14713742, DOI: 10.1097/01.mlr.0000102367.93252.70.Peer-Reviewed Original ResearchMeSH KeywordsCapitation FeeChronic DiseaseConcurrent ReviewDiagnosis-Related GroupsForecastingHealth Services Needs and DemandHealth Services ResearchHumansInsurance Claim ReviewInsurance, HealthMedicaidMedicareProgram DevelopmentReimbursement MechanismsRisk AdjustmentSeverity of Illness IndexUnited States
1999
The Prospective Risk Adjustment System
Goldfield N, Averill R, Eisenhandler J, Hughes J, Muldoon J, Steinbeck B, Bagadia F. The Prospective Risk Adjustment System. Journal Of Ambulatory Care Management 1999, 22: 41-52. PMID: 10387584, DOI: 10.1097/00004479-199904000-00005.Peer-Reviewed Original ResearchConceptsRisk of mortalityEpisodes of illnessEpisode of careHealth care costsHealth care servicesPatient characteristicsFuture health care costsClinical episodesMedical historyDuration of serviceCare costsCare servicesClassification systemProvider profilingRisk adjustment systemSpecific diseasesEpisodesRisk adjustersIllnessMortalityDiseaseSeverityCare