PMID- 33567101
OWN - NLM
STAT- MEDLINE
DCOM- 20210603
LR  - 20210603
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Linking)
VI  - 131
IP  - 6
DP  - 2021 Jun
TI  - Improving Mortality Attribution in Otolaryngology - Head and Neck Surgery.
PG  - E1805-E1810
LID - 10.1002/lary.29418 [doi]
AB  - OBJECTIVE/HYPOTHESIS: Mortality attribution can have significant implications for 
      reimbursement, hospital/department rankings, and perceptions of safety. This work 
      seeks to compare the accuracy of externally assigned diagnosis-related group 
      (DRG)-based service line mortality attribution in otolaryngology to an internal 
      review process that assigns mortality to the teams that cared for a patient 
      during hospitalization. STUDY DESIGN: Retrospective case series. METHODS: 
      Mortality events at Vanderbilt University Medical Center (VUMC) from 2012 to 2018 
      were compared. Included events were assigned to the otolaryngology service line 
      (OSL) via the following methods: an external agency (Vizient) using DRG, 
      utilization management assignment based on the service that provided care at 
      admission (admission service), discharge (discharge service), or throughout 
      hospitalization (major service line), or through the internal VUMC mortality 
      review committee. Internal review was considered the standard for comparison. 
      RESULTS: Of the 28 mortality events assigned to OSL by the DRG-based external 
      method, nine (32%) were actually attributable to OSL. Of the 23 total mortality 
      events attributable to OSL at our institution, external DRG-based review captured 
      nine (39%). The designation of major service during hospitalization was correct 
      95% of the time and captured 87% of mortality events. Differences between 
      external and internal attribution methods were statistically significant 
      (P < .001). CONCLUSIONS: DRG-based models are frequently utilized but can be 
      inaccurate when attributing mortality for an individual otolaryngology 
      department. Otolaryngology mortalities appear to be captured and assigned more 
      accurately by assigning deaths to the service that renders the majority of care 
      during hospitalization. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1805-E1810, 2021.
CI  - (c) 2021 The American Laryngological, Rhinological and Otological Society, Inc.
FAU - Freeman, Michael H
AU  - Freeman MH
AUID- ORCID: 0000-0002-5232-8695
AD  - Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical 
      Center, Nashville, Tennessee, U.S.A.
FAU - Slayton, Jennifer M
AU  - Slayton JM
AD  - Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University 
      Medical Center, Nashville, Tennessee, U.S.A.
FAU - Woods, Marcella C
AU  - Woods MC
AD  - Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University 
      Medical Center, Nashville, Tennessee, U.S.A.
FAU - Martin, Barbara J
AU  - Martin BJ
AD  - Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University 
      Medical Center, Nashville, Tennessee, U.S.A.
FAU - Eavey, Roland D
AU  - Eavey RD
AD  - Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical 
      Center, Nashville, Tennessee, U.S.A.
FAU - Langerman, Alexander J
AU  - Langerman AJ
AUID- ORCID: 0000-0003-0866-463X
AD  - Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical 
      Center, Nashville, Tennessee, U.S.A.
FAU - Bennett, Marc L
AU  - Bennett ML
AD  - Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical 
      Center, Nashville, Tennessee, U.S.A.
AD  - Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University 
      Medical Center, Nashville, Tennessee, U.S.A.
AD  - The Otology Group, Vanderbilt University Medical Center, Nashville, Tennessee, 
      U.S.A.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210210
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - *Diagnosis-Related Groups
MH  - *Hospital Mortality
MH  - Humans
MH  - Otolaryngology/*standards
MH  - Otorhinolaryngologic Diseases/*mortality
MH  - *Outcome Assessment, Health Care
MH  - Patient Care Team/*standards
MH  - Retrospective Studies
MH  - Tennessee
OTO - NOTNLM
OT  - Mortality attribution
OT  - diagnosis related groups
OT  - risk assessment
EDAT- 2021/02/11 06:00
MHDA- 2021/06/04 06:00
CRDT- 2021/02/10 17:14
PHST- 2020/12/19 00:00 [revised]
PHST- 2020/10/20 00:00 [received]
PHST- 2021/01/08 00:00 [accepted]
PHST- 2021/02/11 06:00 [pubmed]
PHST- 2021/06/04 06:00 [medline]
PHST- 2021/02/10 17:14 [entrez]
AID - 10.1002/lary.29418 [doi]
PST - ppublish
SO  - Laryngoscope. 2021 Jun;131(6):E1805-E1810. doi: 10.1002/lary.29418. Epub 2021 Feb 
      10.