Risk Assessment

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Risk Assessment

• Farrokh Alemi, Ph.D.

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Session Objectives

1. Discuss the role of risk assessment in the TQM
   process.
2. Describe the five severity indices presented in
   the course.
3. Compare and contrast the indices based on the
   sources of data used, scores produced, and
   accuracy of predictions.

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Why measure severity?

• One way to measure quality of health care is to
  compare outcomes for a group of patients to
  outcomes observed for other patients with similar
  severity of illness.
• When we want to do so, it is important to
  separate the influence of the patients' severity
  of illness from the quality of care.

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What is severity?

• What is severity?
• Severity is the progression of the disease when
  left untreated.
• Severity is prognosis under ideal levels of care.
  
• Some patients are further along in their illness
  than others.

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How to measure severity?

• Statistical analysis of outcomes of care
• Sample may not be relevant
• Expert opinions
• Expert consensus maybe false
• Patients self insight
• Only felt symptoms affect self insight

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Sources of Data

• ICD9 codes
• Readily available
• Maybe gamed
• Reflect whole visit
• Key clinical findings
• Requires chart review
• Maybe masked by treatment
• Reflects condition on admission

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Disease Staging

1. Stage 1 includes conditions with no complications
   and minimal risk for the patient.
2. Stage 2 includes problems which are contained in
   one organ or system.
3. Stage 3 includes problems in multiple sites and
   general systemic problems.
4. Stage 4 is death

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APACHE

• Deviations from norm on 12 physiological
  variables like heart rate, blood oxygen level, or
  respiratory rate.
• Age of the patient.
• Chronic illness include coma.

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Medisgroup

• At level 0, there are no clinical findings.
• At level 1, there are minimal abnormal findings.
• At level 2, there are either acute findings or
  findings with an unclear potential for organ
  failure.
• At level 3, there are clinical findings with high
  potential for imminent organ failure.
• At level 4, organ failure is indicated.

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Computerized Severity Index

• ICD9 codes
• Key clinical findings

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Best Approach

• Ease of use
• Cost of gathering information
• Accuracy
• Face validity

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Differences Among Indices
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Accuracy of Predictions
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What to do?

• Rely on a combination
• Rely on known indicators of prognosis
• Rely on consensus of experts

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Risk of Fall

• The ability to ambulate
• Steadiness of gait
• Presence of certain chronic medical conditions
• Number of medications
• Mental status
• History of falls

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Analyze Data

• At different time periods the risk for fall can
  be calculated for each patient
• Now we can analyze whether the number of falls
  exceeds what could be expected from patient
  conditions
• See example data at following address
  http//gunston.gmu.edu/708/RiskPChart.htm

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Take Home Lesson

• It is best to use multiple methods of measuring
  severity