As expected, the explained variation was higher in the medical record model (R2 = 0.20) than in the administrative model.
The estimates from this model agree strongly with the estimates from a medical record model with a higher C-statistic.
For the purposes of profiling outcomes, the claims model was a very good surrogate for the medical record model, and the model was very stable over time.
We computed measures of model fit and discrimination for the medical record model similar to those computed for the claims-based models.
An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model.
We developed an administrative claims-based model for profiling hospitals for pneumonia mortality that is a good proxy for results from a medical record model.
To assess the validity of the administrative data model, we calculated state-specific RSMR using the procedures described above and compared these rates with state-specific RSMRs obtained from the medical record model.
We have demonstrated that an administrative claims-based model for calculating 30-day pneumonia mortality rates for Medicare fee-for-service patients results in risk-standardized estimates at the state level that are highly correlated with the estimates obtained from a medical record model.
Medical records in the participating practices are based on the problem-oriented medical record model as proposed by Weed (1968) [ 10] in which the patient's history, physical findings, laboratory results, etc. are organized around patient's problems.
The results also highlight potential limitations of using hypothetical case scenarios or reviews of medical records as models for evaluating the psychometric properties of the ASA-PS scale.
Estimated state-specific RSMRs derived from the medical record and administrative models are displayed in Figure 3.
