Please see the attached file and answer these questions:1.Provide an example from your work...

Question

Please see the attached file and answer these questions:

1.Provide an example from your work experience that involved an exercise in identifying variation in processes or performance (e.g., across physicians, patient types, clinics, etc.). What were the main outcomes on which you focused?

2.What additional information would you want to extract from the hospital’s EMR to understand variability in performance?

3.How is the hospital performing relative to the Medicare benchmarks? What types of additional benchmarking analyses might the hospital want to consider?

4.How might the hospital think about prioritizing which DRGs on which to focus? How might it think about the dimensions of variation vs. volume vs. payments?

5.Which DRGs exhibit the greatest relative variability with respect to payments? Length of stay?

Reading

Veney, Kros, and Rosenthal (VKR): Ch. 1, 2, 3.1-3.3, 4.1, 4.3, Ch. 4 appendix

What is the difference between categorical, ordinal and interval variables?

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Musculoskeletal Major Diagnostic Category: 5 DRGs on which to Focus General Hospital is examining its performance related to five musculoskeletal diagnosis related groups (DRG). It is concerned about how much variation there is in length of stay (LOS) and payments across patients that have the same DRG. Below is a chart summarizing total payments (vertical axis) and total volume (horizontal axis). The circle represents the relative amount of variability in individual patients’ payments by DRG (circle width is proportional to the coefficient of variation for payments). The DRG number is listed next to each point. Summary Statistics: Here are the data corresponding to the chart. I’ve also included Medicare’s mean LOS to give you a benchmark to think about. drgNamepaymentsvolumeaverage paymentsSDpaymentsCVpayments460spinal fusion except cervical w/out mcc$3,896,16264$60,877.53125$21,645.871090.355564207473cervical spine fusion w/out cc/mcc$1,725,97065$26,553.38477$7,291.7836910.274608433481hip and femur procedures except major joint w cc$901,76132$28,180.03125$10,251.890630.36379984494lower extreme$447,18531$14,425.32227$8,221.9707030.569967926552medical back problems w/out mcc$464,58155$8,446.927734$6,134.9780270.726296961 drgNameALOSSD-LOSCV-LOSMedicare arithmetic mean LOS460spinal fusion except cervical w/out mcc3.906251.4770060.3781136273.8473cervical spine fusion w/out cc/mcc1.584615351.5400110.9718518261.8481hip and femur procedures except major joint w cc4.751.5862310.3339433975.4494lower extreme1.8709677460.9216630.4926128693.1552medical back problems w/out mcc3.2000000482.0312380.6347617513.9

005_t25lapo-wob4fmus.docx 005_ww9lapo-uc2acx0p.docx

David · Accepted Answer

1) When we talk about variation or variability in process ,experiment or performance we 
need to understand that there are two types of variability in an performance or experiment  
i) Variation due to random causes or due to nature of data such variation cannot be 
separated or removed. So we can say that we cannot remove variability of data 
100%. 
ii) Variation due to assignable cause or due to fault in performance or experiment. 
Such variation can be separated and controlled.  
Even the workings of a hospital are not untouched from this variability. From the 
very basic of filling out of forms to results of top doctors’ procedures we can see 
variation.  
One such example can be of number of readmission after a surgery.  Even for a 
single procedure number of readmission vary from one doctor to another. Main 
outcomes to look for are average number of admissions for procedure and 
variance for each procedure.  
2) Hospital EMR form contains many important information regarding health status of 
patients. One such important detail is demographic information of patients such as age, 
gender, job profile etc. this information can further give details on if variability is due to 
difference in age group or there might be difference due to nature of duties of one’s job. 
Those who keep sitting on desk will have different type of injuries than those who work 
at a farm or factory. 
3) We consider following table no- 1 to compare hospital’s performance with the given 
benchmark of LOS of Medicare. 
Table no-1 
drg Name ALOS SD-LOS CV-LOS 
Medicare arithmetic  
mean LOS 
460 
spinal fusion except  
cervical w/out mcc 
3.90625 1.477006 0.378113627 3.8 
473 
cervical spine fusion  
w/out cc/mcc 
1.58461535 1.540011 0.971851826 1.8 
481 
hip and femur procedures  
except major joint w cc 
4.

Please see the attached file and answer these questions: 1.Provide an example from your work experience that involved an exercise in identifying variation in processes or performance (e.g., across...

Answer To: Please see the attached file and answer these questions: 1.Provide an example from your work...

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