Stephen F. Jencks

University of Baltimore

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Edward F. Ellerbeck

University of Kansas Medical Center

Honora Englander

Oregon Health & Science University

Devan Kansagara

Oregon Health & Science University

David Kagen

Oregon Health & Science University

Makalapua Motu’apuaka

VA Portland Health Care System

Michele Freeman

University of California, San Diego

Joseph Chiovaro

Portland VA Medical Center

Karli Kondo

Oregon Health & Science University

Harlan M. Krumholz

Yale University

Rose Relevo

American Cancer Society

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Centers for Medicare and Medicaid Services

Harvard University

Johns Hopkins University

University of Pennsylvania

National Bureau of Economic Research

University of Washington

Oregon Health & Science University

Boston University

University of California, San Francisco

National Institutes of Health

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Measuring quality of care under Medicare and Medicaid.

PubMed (1995)

Stephen F. Jencks

The Health Care Financing Administration's (HCFA) approach to measuring quality of care uses an accepted definition of quality, explicit domains of measurement, and a formal validation procedure that includes face validity, construct validity, reliability, clinical validation, and tests for usefulness. The indicators of quality for Medicare and Medicaid patients span the range of service types, medical conditions, and payment systems and rest on a variety of data systems. Some have already been incorporated into operational systems while others are scheduled for incorporation over the next 3 years.

Health care financing

Face validity

Health Care Quality

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Citations (36)

FIGURE 2, TRANSITIONAL CARE MAP

Devan Kansagara Joseph Chiovaro David Kagen Stephen F. Jencks Kerry Rhyne

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Can Large-Scale Interventions Improve Care?

JAMA (1997)

Stephen F. Jencks

The burgeoning outcomes measurement industry has generated growing attention to steps that governments and organizations can take to promote better outcomes. In an era of growing belief in market forces and disquiet with regulation, publishing information for consumers and providing technical assistance to providers have special appeal. A leader in the former has been New York State, which has published statewide information on mortality rates of coronary artery bypass graft (CABG) centers and surgeons. Three years ago, Hannan and colleagues¹reported that publication of performance had been followed by a 41% decrease in risk-adjusted CABG mortality rates in New York between 1987 and 1993. They argued that publication played a significant role in the decline. Last year, O'Connor and colleagues²reported a 24% decrease in risk-adjusted mortality between 1987 and 1993 in the Northern New England Cardiovascular Disease Study Group, which is a voluntary quality improvement consortium of

10.1001/jama.1997.03540290071034

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Are Clinical Trials Cost-effective?

JAMA (1990)

Stephen F. Jencks

To the Editor.—

Dr Detsky¹provides a carefully designed analysis of how we might evaluate the cost-effectiveness of clinical trials in improving health. He argues, and Dr Fletcher²seems to concur, that the evidence of cost-effectiveness is so overwhelming that policymakers would provide more money for research if they understood the evidence. As Dr Fletcher points out, Dr Detsky substantially overstates the cost-effectiveness of trials because he does not include the cost of providing the tested treatment. A more serious problem, however, is that neither considers the extent to which the results of the trials actually change medical outcomes. The impact of a clinical trial on outcomes tends to be limited by at least five factors: (1) physicians remain unaware of the results, (2) not all physicians agree as to what the trial "really" proved or whether the results are generalizable, (3) many physicians believe that changes in

10.1001/jama.1990.03440110053015

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Citations (1)

Quality improvement organizations and hospital care [1] (multiple letters)

JAMA (2005)

Stephen F. Jencks Dale W. Bratzler Jonathan R. Sugarman Greg A. Baumgardner Jay A Gold

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Refining Case-Mix Adjustment

New England Journal of Medicine (1987)

Stephen F. Jencks Allen Dobson

Abstract We review case-mix adjustment, which is the process of adjusting for differences in the cases treated in different hospitals so that their costs or outcomes can be compared. We examine the Medicare payment system, which rests on case-mix adjustment, and identify areas, including outlier payments, in which payment accuracy might be improved without better measurement of the severity of illness. There is no available measure of severity of illness that would produce a large improvement in the accuracy of Medicare payments if used to supplement or replace the system of diagnosis-related groups. Evidence regarding whether better measurement of severity would substantially change the distribution of payments across hospitals is mixed. Considerable evidence suggests that the intensity of medically appropriate treatment for patients in the same diagnosis-related group varies substantially for reasons other than the severity of illness. Despite great demand for measures of the quality of care, important technical problems must be solved before we can be confident that differences in case-mix-adjusted outcomes reflect differences in the quality of care. (N Engl J Med 1987;317:679–86.)

Case mix index

Diagnosis-related group

Prospective payment system

10.1056/nejm198709103171106

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Citations (121)

Health Care Leader Action Guide to Reduce Avoidable Readmissions

Anne‐Marie J. Audet Stephen F. Jencks

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Containing U.S. health care costs: what bullet to bite?

PubMed (1991)

Stephen F. Jencks George Schieber

In this article, the authors provide an overview of the problem of health care cost containment. Both the growth of health care spending and its underlying causes are discussed. Further, the authors define cost containment, provide a framework for describing cost-containment strategies, and describe the major cost-containment strategies. Finally, the role of research in choosing such a strategy for the United States is examined.

Containment (computer programming)

Health care cost

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JAMA (1989)

Stephen F. Jencks Deborah K. Williams Terrence L. Kay

In Reply.—

Dr Wagner argues that it would be more appropriate to observe hospital-associated mortality during a period from admission to 30 days after discharge rather than from admission to 30 days after admission. He observes that in states such as New York, with very long stays for certain patients with certain conditions (such as stroke), taking a period of 30 days after admission omits a substantial number of inpatient deaths; he also is concerned that physicians can delay inpatient deaths so that they fall after the 30-day observation period and artificially improve the performance of the hospital. The problem Dr Wagner identifies in data from New York is largely that New York hospitals are serving as skilled nursing facilities for a number of terminally ill patients, a situation that is much less frequent in other states. The statistic he proposes would charge New York hospitals with deaths that would

Hospital admission

Statistic

10.1001/jama.261.16.2331

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Do frail, disabled, poor, and very old Medicare beneficiaries have higher hospital charges?

JAMA (1987)

Stephen F. Jencks

To determine whether basing payments on diagnosis related groups (DRGs) results in mispayment for certain classes of patients, we examined the relation between total Medicare charges per hospitalization and eight beneficiary characteristics (including admission from a nursing home, extreme age, Medicaid enrollment, and disability). We controlled for the hospital in which care was given and the DRG to which the discharge was assigned. The largest effects were that average charges were 6.7% higher for beneficiaries who were disabled before the age of 65 years, and 6.2% higher for patients admitted from a nursing home; charges were 1.5% lower for Medicare beneficiaries who were also enrolled in Medicaid, 3.8% higher for those older than 80 years, and 1.3% lower for those older than 85 years compared with those aged from 80 to 84 years. Because these differences are very small compared with the average variation within DRGs, we conclude that using these beneficiary characteristics in the DRG classification system would only slightly improve DRGs. Medicare's DRG-based payments seem to be substantially equitable with regard to these beneficiary characteristics. (JAMA1987;257:198-202)

Beneficiary

Skilled Nursing Facility

10.1001/jama.257.2.198

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Citations (6)