Assess whether a unit's complication rate is a real signal (bb889e)

Situation

In a rural hospital with long transfer times, 30-day readmission cohort with social-risk flags is the evidence after a unit that is an outlier after risk adjustment. Mortality-and-morbidity reviewer has to pick Proceed under protocol or Pause the pathway for this Healthcare Outcomes Review close using 30-day readmission cohort with social-risk flags.

Decision

Mortality-and-morbidity reviewer in a rural hospital with long transfer times must choose Proceed under protocol / Pause the pathway / Escalate safety review / Hold using 30-day readmission cohort with social-risk flags after a unit that is an outlier after risk adjustment.

Hypotheses to test

• Authorize Proceed under protocol now; 30-day readmission cohort with social-risk flags already has the discriminator after a unit that is an outlier after risk adjustment.
• Keep Pause the pathway in force until 30-day readmission cohort with social-risk flags is completed after a unit that is an outlier after risk adjustment for mortality-and-morbidity reviewer.
• Treat 30-day readmission cohort with social-risk flags as Escalate safety review because both readings appear after a unit that is an outlier after risk adjustment.
• Refuse a Healthcare close: mortality-and-morbidity reviewer does not have the page a unit's complication rate turns on in 30-day readmission cohort with social-risk flags.

Analysis required

• Quantify who is harmed if 30-day readmission cohort with social-risk flags is wrong.
• Separate a documented exception from an OCR-relevant gap in a rural hospital with long transfer times.
• Validate clinical-outcome evidence and protocol steps in 30-day readmission cohort with social-risk flags after a unit that is an outlier after risk adjustment.
• For this Healthcare Outcomes Review file, read 30-day readmission cohort with social-risk flags against a unit that is an outlier after risk adjustment and write the one fact that would move a unit's complication rate for mortality-and-morbidity reviewer.

Recommendation

Choose Proceed under protocol / Pause the pathway / Escalate safety review / Hold on this Healthcare / Outcomes Review packet (30-day readmission cohort with social-risk flags after a unit that is an outlier after risk adjustment). If 30-day readmission cohort with social-risk flags cannot force a Healthcare label under Outcomes Review, stop. If 30-day readmission cohort with social-risk flags after a unit that is an outlier after risk adjustment cannot support Proceed under protocol versus Pause the pathway on this Healthcare Outcomes Review close, mortality-and-morbidity reviewer must state the unresolved clinical or safety evidence requirement explicitly.