Surgeon Involvement in the Care of Patients Deemed to Have “Preventable” Conditions
Bibliographic record
Abstract
BACKGROUND: As of October 1, 2008, the Centers for Medicare and Medicaid Services stopped payment for 8 "preventable" conditions: retained foreign body, air embolism, blood incompatibility, catheter-associated urinary tract infection, pressure ulcer, vascular catheter-associated infection, mediastinitis, and hospital fall. Our hypothesis was that surgeons are frequently involved in the care of patients deemed to have "preventable" conditions. STUDY DESIGN: This is a retrospective cohort of patients with "preventable" conditions identified from 2004 California and New York discharge data. The proportion of patients who required a surgical procedure during the index hospital stay was then determined. RESULTS: "Preventable" conditions were identified in 286,509 (4%) of 6,618,637 total patient discharges, of which 224,073 (78.2%) were insured by Medicare or Medicaid. A surgical procedure was performed in 168,886 (59.5%) patients. In the subset that developed a "preventable" condition during the index hospital stay, 1 or more surgical procedures were performed in 100% of patients with mediastinitis; 96% of patients with retained foreign bodies; 96% of patients with air embolism; 92% of patients with vascular catheter-associated infections; 79% of patients with blood incompatibility; 70% of patients with catheter-associated urinary tract infections; and 65% of patients with pressure ulcers. The most common surgical procedures were cardiovascular, gastrointestinal, and respiratory. CONCLUSIONS: A large number of patients are coded as having "preventable" conditions, and surgeons are frequently involved in their care. Nonpayment for "preventable" conditions may lead hospitals and surgeons to avoid complex procedures, refuse care to high-risk patients, or both.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".