A hybrid Centers for Medicaid and Medicare service mortality model in 3 diagnoses.

INTRODUCTION: Reliance on administrative data sources and a cohort with restricted age range (Medicare 65 y and above) may limit conclusions drawn from public reporting of 30-day mortality rates in 3 diagnoses [acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia (PNA)] from Center for Medicaid and Medicare Services. METHODS: We categorized patients with diagnostic codes for AMI, CHF, and PNA admitted to 138 Veterans Administration hospitals (2006-2009) into 2 groups (less than 65 y or ALL), then applied 3 different models that predicted 30-day mortality [Center for Medicaid and Medicare Services administrative (ADM), ADM+laboratory data (PLUS), and clinical (CLIN)] to each age/diagnosis group. C statistic (CSTAT) and Hosmer Lemeshow Goodness of Fit measured discrimination and calibration. Pearson correlation coefficient (r) compared relationship between the hospitals' risk-standardized mortality rates (RSMRs) calculated with different models. Hospitals were rated as significantly different (SD) when confidence intervals (bootstrapping) omitted National RSMR. RESULTS: The ≥ 65-year models included 57%-67% of all patients (78%-82% deaths). The PLUS models improved discrimination and calibration across diagnoses and age groups (CSTAT-CHF/65 y and above: 0.67 vs. 0. 773 vs. 0.761; ADM/PLUS/CLIN; Hosmer Lemeshow Goodness of Fit significant 4/6 ADM vs. 2/6 PLUS). Correlation of RSMR was good between ADM and PLUS (r-AMI 0.859; CHF 0.821; PNA 0.750), and 65 years and above and ALL (r>0.90). SD ratings changed in 1%-12% of hospitals (greatest change in PNA). CONCLUSIONS: Performance measurement systems should include laboratory data, which improve model performance. Changes in SD ratings suggest caution in using a single metric to label hospital performance.

Flavoring exposure in food manufacturing.

Flavorings are substances that alter or enhance the taste of food. Workers in the food-manufacturing industry, where flavorings are added to many products, may be exposed to any number of flavoring compounds. Although thousands of flavoring substances are in use, little is known about most of these in terms of worker health effects, and few have occupational exposure guidelines. Exposure assessment surveys were conducted at nine food production facilities and one flavor manufacturer where a total of 105 area and 74 personal samples were collected for 13 flavoring compounds including five ketones, five aldehydes, and three acids. The majority of the samples were below the limit of detection (LOD) for most compounds. Diacetyl had eight area and four personal samples above the LOD, whereas 2,3-pentanedione had three area samples above the LOD. The detectable values ranged from 25-3124 ppb and 15-172 ppb for diacetyl and 2,3-pentanedione respectively. These values exceed the proposed National Institute for Occupational Safety and Health (NIOSH) recommended exposure limit for these compounds. The aldehydes had the most detectable samples, with each of them having >50% of the samples above the LOD. Acetaldehyde had all but two samples above the LOD, however, these samples were below the OSHA PEL. It appears that in the food-manufacturing facilities surveyed here, exposure to the ketones occurs infrequently, however levels above the proposed NIOSH REL were found. Conversely, aldehyde exposure appears to be ubiquitous.