Assess whether a unit's complication rate is a real signal (7e5f94)

Situation

An academic medical center reviewing a mortality series cannot treat a unit that is an outlier after risk adjustment as color commentary on transfer-delay file for time-sensitive diagnoses. Unit medical director must close a unit's complication rate from that extract under Healthcare / Models and Documentation.

Decision

Unit medical director in an academic medical center reviewing a mortality series must choose Proceed under protocol / Pause the pathway / Escalate safety review / Hold using transfer-delay file for time-sensitive diagnoses after a unit that is an outlier after risk adjustment.

Hypotheses to test

• Transfer-delay file for time-sensitive diagnoses reads as Proceed under protocol once a unit that is an outlier after risk adjustment is lined up to the same Healthcare population.
• Transfer-delay file for time-sensitive diagnoses is closer to Pause the pathway after a unit that is an outlier after risk adjustment; Proceed under protocol would over-claim this Models and Documentation extract.
• Escalate safety review is still live in transfer-delay file for time-sensitive diagnoses for unit medical director in an academic medical center reviewing a mortality series.
• Transfer-delay file for time-sensitive diagnoses is missing the fact unit medical director needs after a unit that is an outlier after risk adjustment; stop this Healthcare close.

Analysis required

• Assess patient-safety and HIPAA / minimum-necessary implications of a unit's complication rate.
• Quantify who is harmed if transfer-delay file for time-sensitive diagnoses is wrong.
• Separate a documented exception from an OCR-relevant gap in an academic medical center reviewing a mortality series.
• For this Healthcare Models and Documentation file, read transfer-delay file for time-sensitive diagnoses against a unit that is an outlier after risk adjustment and write the one fact that would move a unit's complication rate for unit medical director.

Recommendation

Choose Proceed under protocol / Pause the pathway / Escalate safety review / Hold on this Healthcare / Models and Documentation packet (transfer-delay file for time-sensitive diagnoses after a unit that is an outlier after risk adjustment). The follow-on Models and Documentation action is what unit medical director does next: implement the option, assign an owner, and log the missing fact.