D R Harris

Bio: D R Harris is an academic researcher from Westat. The author has contributed to research in topics: Comorbidity & Severity of illness. The author has an hindex of 2, co-authored 2 publications receiving 6869 citations.

Comorbidity measures for use with administrative data.

Abstract: Objectives.This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.Methods.The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other

Racial and gender differences in use of procedures for black and white hospitalized adults.

Abstract: A number of studies have found that blacks and females with coronary heart disease are less likely to undergo major diagnostic and therapeutic procedures than whites and males, even after controlling for severity of illness and other indicators of physical condition. This investigation examined 78 conditions treated in acute care hospitals to identify possible variations in medical treatment by race and gender among blacks and whites. The study is unique in examining such a wide range of conditions and in using an all-payer national sample. The study examines over 1.7 million inpatient discharge abstracts from the Hospital Cost and Utilization Project, a national sample of about 500 hospitals in the United States. Logistic regression modeling was used to describe the influence of race and gender among blacks and whites on the likelihood of having a major therapeutic or major diagnostic procedure, controlling for patient age, disease severity, health insurance and hospital-level characteristics. The study found that blacks were less likely than whites to receive major therapeutic procedures in 37 of 77 (48%) conditions, and females were less likely than males to receive major therapeutic procedures for 32 of 62 (52%) conditions. The proportion of conditions in which blacks and females were less likely to receive a major diagnostic procedure (without a major therapeutic procedure) was 21% and 26%, respectively. This study identified a number of conditions with apparent variations in medical treatment by race or gender among blacks and whites that should be targeted for more detailed investigations.

Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.

Abstract: Objectives:Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data. Recognizing this, we conducted a multistep process to develop ICD-10 coding algorithms to define C

Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data From 6 Countries

Abstract: With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson comorbidity index to mortality is likely to have changed since development of the index in 1984. The authors reevaluated the Charlson index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data.

The Agency for Healthcare Research and Quality

Abstract: The mission of the Agency for Healthcare Research and Quality is “to improve the quality, safety, efficiency, and effectiveness of health care for all Americans”. The organization and selected major activities of the Agency are briefly described.

Prevalence, expenditures, and complications of multiple chronic conditions in the elderly

Abstract: Methods: A cross-sectional analysis was conducted on a nationally random sample of 1217103 Medicare feefor-service beneficiaries aged 65 and older living in the United States and enrolled in both Medicare Part A and Medicare Part B during 1999. Multiple logistic regression was used to analyze the influence of age, sex, and number of types of chronic conditions on the risk of incurring inpatient hospitalizations for ambulatory care sensitive conditions and hospitalizations with preventable complications among aged Medicare beneficiaries. Results: In 1999, 82% of aged Medicare beneficiaries had 1 or more chronic conditions, and 65% had multiple chronic conditions. Inpatient admissions for ambulatory care sensitive conditions and hospitalizations with preventable complications increased with the number of chronic conditions. For example, Medicare beneficiaries with 4 or more chronic conditions were 99 times more likely than a beneficiary without any chronic conditions to have an admission for an ambulatory care sensitive condition (95% confidence interval, 86-113). Per capita Medicare expenditures increased with the number of types of chronic conditions from $211 among beneficiaries without a chronic condition to $13973 among beneficiaries with 4 or more types of chronic conditions. Conclusions: The risk of an avoidable inpatient admission or a preventable complication in an inpatient setting increases dramatically with the number of chronic conditions. Better primary care, especially coordination of care, could reduce avoidable hospitalization rates, especially for individuals with multiple chronic conditions.

Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

Abstract: OBJECTIVES: Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. METHODS: The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. RESULTS: Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. CONCLUSIONS: Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.