7 results on '"Han, Lein F."'
Search Results
2. National Performance on Door-In to Door-Out Time Among Patients Transferred for Primary Percutaneous Coronary Intervention.
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Herrin, Jeph, Miller, Lauren E., Turkmani, Dima F., Nsa, Wato, Drye, Elizabeth E., Bernheim, Susannah M., Ling, Shari M., Rapp, Michael T., Han, Lein F., Bratzler, Dale W., Bradley, Elizabeth H., Nallamothu, Brahmajee K., Ting, Henry H., and Krumholz, Harlan M.
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HOSPITAL patients , *PERCUTANEOUS balloon valvuloplasty , *HEART valve surgery , *CARDIAC patients - Abstract
The article discusses the results of a study which used a system developed by the U.S. Centers for Medicare & Medicaid Services to examine the national performance in door-in to door-out (DIDO) time. The study examined the association of the national median DIDO time with patient and hospital characteristics. The study concluded that rarely does the DIDO time met the recommended 30 minutes among patients requiring transfer to another facility for percutaneous coronary intervention.
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- 2011
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3. Improvements in Door-to-Balloon Time in the United States, 2005 to 2010.
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Krumholz, Harlan M., Herrin, Jeph, Miller, Lauren E., Drye, Elizabeth E., Ling, Shari M., Han, Lein F., Rapp, Michael T., Bradley, Elizabeth H., Nallamothu, Brahmajee K., Nsa, Wato, Bratzler, Dale W., and Curtis, Jeptha P.
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MEDICAL care of cardiac patients , *MYOCARDIAL infarction treatment , *HEART beat , *HOSPITAL administration - Abstract
Background-Registry studies have suggested improvements in door-to-balloon times, but a national assessment of the trends in door-to-balloon times is lacking. Moreover, we do not know whether improvements in door-to-balloon times were shared equally among patient and hospital groups. Methods and Results-This analysis includes all patients reported by hospitals to the Centers for Medicare & Medicaid Services for inclusion in the time to percutaneous coronary intervention (acute myocardial infarction-8) inpatient measure from January 1, 2005, through September 30, 2010. For each calendar year, we summarized the characteristics of patients reported for the measure, including the number and percentage in each group, the median time to primary percutaneous coronary intervention, and the percentage with time to primary percutaneous coronary intervention within 75 minutes and within 90 minutes. Door-to-balloon time declined from a median of 96 minutes in the year ending December 31, 2005, to a median of 64 minutes in the 3 quarters ending September 30, 2010. There were corresponding increases in the percentage of patients who had times <90 minutes (44.2% to 91.4%) and <75 minutes (27.3% to 70.4%). The declines in median times were greatest among groups that had the highest median times during the first period: patients >75 years of age (median decline, 38 minutes), women (35 minutes), and blacks (42 minutes). Conclusion-National progress has been achieved in the timeliness of treatment of patients with ST-segment-elevation myocardial infarction who undergo primary percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]
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- 2011
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4. An Administrative Claims Model for Profiling Hospital 30- Day Mortality Rates for Pneumonia Patients.
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Bratzler, Dale W., Normand, Sharon-Lise T., Yun Wang, O'Donnell, Walter J., Metersky, Mark, Han, Lein F., Rapp, Michael T., and Krumholz, Harlan M.
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PNEUMONIA , *LUNG diseases , *MEDICAL care , *DIAGNOSIS , *HOSPITAL admission & discharge , *MEDICAL records , *HEALTH insurance reimbursement - Abstract
Background: Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings: Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998-2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998-2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25th, 50th, and 75th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived riskstandardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). Conclusions/Significance: An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model. [ABSTRACT FROM AUTHOR]
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- 2011
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5. Reduction in Acute Myocardial Infarction Mortality in the United States.
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Krumholz, Harlan M., Yun Wang, Chen, Jersey, Drye, Elizabeth E., Spertus, John A., Ross, Joseph S., Curtis, Jeptha P., Nallamothu, Brahmajee K., Lichtman, Judith H., Havranek, Edward P., Masoudi, Frederick A., Radford, Martha J., Han, Lein F., Rapp, Michael T., Straube, Barry M., and Normand, Sharon-Lise T.
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MORTALITY , *CORONARY disease , *HOSPITAL admission & discharge , *MEDICARE , *PATIENTS ,MYOCARDIAL infarction-related mortality - Abstract
The article focuses on an observational study which estimated hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with acute myocardial infarction (AMI). Administrative data and a validated risk model were used to evaluate 3,195,672 discharges in 2,755,370 patients discharged from nonfederal acute care hospitals in the U.S. between January 1, 1995 to December 31, 2006. A significant decrease was observed in the risk-standardized hospital mortality rate for Medicare patients discharged with AMI, as well as between-hospital variation.
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- 2009
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6. Trends in Care Practices and Outcomes Among Medicare Beneficiaries with Diabetes
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Kuo, Sylvia, Fleming, Barbara B., Gittings, Neil S., Han, Lein F., Geiss, Linda S., Engelgau, Michael M., and Roman, Sheila H.
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MEDICARE , *DIABETES complications , *MEDICAL care for older people - Abstract
Background: While diabetes is a major issue for the aging U.S. population, few studies have described the recent trends in both preventive care practices and complications among the Medicare population with diabetes. Using the Medicare Quality Monitoring System (MQMS), this 2004 study describes these trends from 1992 to 2001 and how these rates vary across demographic subgroups. Methods: Outcomes include age- and gender-adjusted rates of 15 indicators associated with diabetes care from 1992 to 2001, the absolute change in rates from 1992 to 2001, and 2001 rates by demographic subgroups. The data were cross-sectional samples of Medicare beneficiaries with diabetes from 1992 to 2001 from the Medicare 5% Standard Analytic Files. Results: Use of preventive care practices rose from 1992 to 2001: 45 percentage points for HbA1c tests, 51 for lipid tests, 8 for eye exams, and 38 for self-monitoring of glucose levels (all p<0.05). Rates for short-term and some long-term complications of diabetes (e.g., lower-extremity amputations and cardiovascular conditions) fell from 1992 to 2001 (p<0.05). However, rates of other long-term complications such as nephropathy, blindness, and retinopathy rose during the period (p<0.05). Nonwhites and beneficiaries aged <65 and >85 exhibited consistently higher complication rates and lower use of preventive services. Conclusions: The Medicare program has seen some significant improvement in preventive care practices and significant declines in lower-limb amputations and cardiovascular conditions. However, rates for other long-term complications have increased, with evidence of subgroup disparities. The MQMS results provide an early warning for policymakers to focus on the diabetes care provided to some vulnerable subgroups. [Copyright &y& Elsevier]
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- 2005
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7. Skilled Nursing Facility Referral and Hospital Readmission Rates after Heart Failure or Myocardial Infarction
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Chen, Jersey, Ross, Joseph S., Carlson, Melissa D.A., Lin, Zhenqiu, Normand, Sharon-Lise T., Bernheim, Susannah M., Drye, Elizabeth E., Ling, Shari M., Han, Lein F., Rapp, Michael T., and Krumholz, Harlan M.
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HEART failure risk factors , *NURSING care facilities , *PATIENT readmissions , *MEDICAL referrals , *HOSPITAL care , *REGRESSION analysis - Abstract
Abstract: Background: Substantial hospital-level variation in the risk of readmission after hospitalization for heart failure (HF) or acute myocardial infarction (AMI) has been reported. Prior studies have documented considerable state-level variation in rates of discharge to skilled nursing facilities (SNFs), but evaluation of hospital-level variation in SNF rates and its relationship to hospital-level readmission rates is limited. Methods: Hospital-level 30-day all-cause risk-standardized readmission rates (RSRRs) were calculated using claims data for fee-for-service Medicare patients hospitalized with a principal diagnosis of HF or AMI from 2006-2008. Medicare claims were used to calculate rates of discharge to SNF following HF-specific or AMI-specific admissions in hospitals with ≥25 HF or AMI patients, respectively. Weighted regression was used to quantify the relationship between RSRRs and SNF rates for each condition. Results: Mean RSRR following HF admission among 4101 hospitals was 24.7%, and mean RSRR after AMI admission among 2453 hospitals was 19.9%. Hospital-level SNF rates ranged from 0% to 83.8% for HF and from 0% to 77.8% for AMI. No significant relationship between RSRR after HF and SNF rate was found in adjusted regression models (P =.15). RSRR after AMI increased by 0.03 percentage point for each 1 absolute percentage point increase in SNF rate in adjusted regression models (P =.001). Overall, HF and AMI SNF rates explained <1% and 4% of the variation for their respective RSRRs. Conclusion: SNF rates after HF or AMI hospitalization vary considerably across hospitals, but explain little of the variation in 30-day all-cause readmission rates for these conditions. [Copyright &y& Elsevier]
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- 2012
- Full Text
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