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11. Volume-based referral for cardiovascular procedures in the United States: a cross-sectional regression analysis

Author

Krumholz Harlan M, Rathore Saif S, Epstein Andrew J, and Volpp Kevin GM

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background We sought to estimate the numbers of patients affected and deaths avoided by adopting the Leapfrog Group's recommended hospital procedure volume minimums for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). In addition to hospital risk-adjusted mortality standards, the Leapfrog Group recommends annual hospital procedure minimums of 450 for CABG and 400 for PCI to reduce procedure-associated mortality. Methods We conducted a retrospective analysis of a national hospital discharge database to evaluate in-hospital mortality among patients who underwent PCI (n = 2,500,796) or CABG (n = 1,496,937) between 1998 and 2001. We calculated the number of patients treated at low volume hospitals and simulated the number of deaths potentially averted by moving all patients to high volume hospitals under best-case conditions (i.e., assuming the full volume-associated reduction in mortality and the capacity to move all patients to high volume hospitals with no related harms). Results Multivariate adjusted odds of in-hospital mortality were higher for patients treated in low volume hospitals compared with high volume hospitals for CABG (OR 1.16, 95% CI 1.10–1.24) and PCI (OR 1.12, 95% CI 1.05–1.20). A policy of hospital volume minimums would have required moving 143,687 patients for CABG and 87,661 patients for PCI from low volume to high volume hospitals annually and prevented an estimated 619 CABG deaths and 109 PCI deaths. Thus, preventing a single death would have required moving 232 CABG patients or 805 PCI patients from low volume to high volume hospitals. Conclusion Recommended hospital CABG and PCI volume minimums would prevent 728 deaths annually in the United States, fewer than previously estimated. It is unclear whether a policy requiring the movement of large numbers of patients to avoid relatively few deaths is feasible or effective.

Published
2005
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12. Differences, Disparities, and Biases: Clarifying Racial Variations in Health Care Use

Author

Rathore, Saif S., Rathore, Saif S., Krumholz, Harlan M., Rathore, Saif S., Rathore, Saif S., and Krumholz, Harlan M.

Abstract

Studies documenting racial differences in health care use are common in the medical literature. However, observational studies of racial differences in health care use lack a framework for interpreting reports of variations in health care use, leading to various terms, ranging from "variations" to "bias," that suggest different causes, consequences, and, ultimately, remedies for such variations in treatment. We propose criteria to assess racial differences in health care use by using a clinical equity (equal treatment based on equal clinical need) framework. This framework differentiates between initial reports of racial differences and subsequent classifications of their findings as racial disparities or racial bias in health care use. Racial variations in health care use may be considered disparities after demonstrating that racial differences are not attributable to treatment eligibility, clinical contraindications, patient preferences, or confounding by other clinical factors and are associated with adverse consequences. Racial bias with adverse consequences in health care may be inferred if a racial variation in treatment that has been characterized as a disparity persists after accounting for health care system factors (for example, type of hospital at which the patient was treated). We apply this framework to published reports of racial differences in treatment to determine which studies provide evidence of differences, disparities, and bias. We discuss the use of such a framework in directing policy interventions for alleviating inappropriate racial variations in health care use.

Published
2004

17. Abstract 4: Acute, Hospital-Acquired Anemia is Associated With Increased Mortality and Worse Health Status in Patients With Acute Myocardial Infarction

Author

Salisbury, Adam C, primary, Alexander, Karen P, additional, Reid, Kimberly J, additional, Spertus, John A, additional, Masoudi, Frederick A, additional, Rathore, Saif S, additional, Wang, Tracy Y, additional, Bach, Richard G, additional, Marso, Steven P, additional, Charlap, Esti, additional, and Kosiborod, Mikhail, additional

Published
2011
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18. Abstract P141: Health Care Insurance, Financial Concerns in Accessing Care, and Nonelective Readmissions Following Acute Myocardial Infarction

Author

Smolderen, Kim G, primary, Spertus, John A, additional, Nallamothu, Brahmajee K, additional, Krumholz, Harlan M, additional, Tang, Fengming, additional, Xiang, Ying, additional, Wang, Tracy, additional, Ross, Joseph S, additional, Ting, Henry H, additional, Rathore, Saif S, additional, and Chan, Paul S, additional

Published
2011
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19. Abstract P161: Relationship Between Clinical Availability of Hemoglobin A1c and Glucose Therapy Intensification in Patients With Diabetes Hospitalized for Acute Myocardial Infarction

Author

Stolker, Joshua M, primary, Spertus, John A, additional, McGuire, Darren K, additional, Inzucchi, Silvio E, additional, Rathore, Saif S, additional, Maddox, Thomas M, additional, Masoudi, Frederick A, additional, Tang, Fengming, additional, Jones, Philip G, additional, and Kosiborod, Mikhail, additional

Published
2011
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24. IN-HOSPITAL HEMOGLOBIN A1C TESTING AND ITS RELATION TO INITIATION OF GLUCOSE LOWERING THERAPY IN HYPERGLYCEMIC PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Author

Stolker, Joshua, primary, Spertus, John A., additional, McGuire, Darren K., additional, Inzucchi, Silvio E., additional, Rathore, Saif S., additional, Maddox, Thomas M., additional, Masoudi, Frederick A., additional, Tang, Fengming, additional, Jones, Philip G., additional, and Kosiborod, Mikhail, additional

Published
2010
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30. Standards for Statistical Models Used for Public Reporting of Health Outcomes

Author

Krumholz, Harlan M., primary, Brindis, Ralph G., additional, Brush, John E., additional, Cohen, David J., additional, Epstein, Andrew J., additional, Furie, Karen, additional, Howard, George, additional, Peterson, Eric D., additional, Rathore, Saif S., additional, Smith, Sidney C., additional, Spertus, John A., additional, Wang, Yun, additional, and Normand, Sharon-Lise T., additional

Published
2006
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36. Race and Renal Impairment in Heart Failure

Author

Smith, Grace L., primary, Shlipak, Michael G., additional, Havranek, Edward P., additional, Masoudi, Frederick A., additional, McClellan, William M., additional, Foody, JoAnne M., additional, Rathore, Saif S., additional, and Krumholz, Harlan M., additional

Published
2005
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