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51. Association Between Medicare Expenditures and Adverse Events for Patients With Acute Myocardial Infarction, Heart Failure, or Pneumonia in the United States

Author

Wang, Yun, primary, Eldridge, Noel, additional, Metersky, Mark L., additional, Sonnenfeld, Nancy, additional, Rodrick, David, additional, Fine, Jonathan M., additional, Eckenrode, Sheila, additional, Galusha, Deron H., additional, Tasimi, Anila, additional, Hunt, David R., additional, Bernheim, Susannah M., additional, Normand, Sharon-Lise T., additional, and Krumholz, Harlan M., additional

Published
2020
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61. Post-discharge Acute Care and Outcomes in the Era of Readmission Reduction: A National Retrospective Cohort Study of Medicare Beneficiaries in the United States

Author

Khera, Rohan, Wang, Yongfei, Bernheim, Susannah M, Lin, Zhenqiu, and Krumholz, Harlan

Abstract

Background: With incentives to reduce readmission rates in the United States, there are concerns that patients who need hospitalization after a recent hospital discharge may be denied access, which would increase their risk of mortality. Objective: We determined whether patients with hospitalizations for conditions covered by national readmission programs who received care in emergency department (ED) or observation units but were not hospitalized within 30 days had an increased risk of death. We also evaluated temporal trends in post-discharge acute care utilization in inpatient units, emergency department (ED) and observation units for these patients. Design, Setting, and Participants: In this observational study of national Medicare claims data for 2008-2016, we identified patients 65 years of age and older hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia, conditions included in the HRRP. Main Outcomes and Measures: Post-discharge 30-day mortality according to patients 30-day acute care utilization. Acute care utilization in inpatient and observation units, and the ED during the 30-day and 31-90-day post-discharge period. Results: There were 3,772,924 hospitalizations for HF, 1,570,113 for AMI, and 3,131,162 for pneumonia. The overall post-discharge 30-day mortality was 8.7% for HF, 7.3% for AMI, and 8.4% for pneumonia. Risk-adjusted mortality increased annually by 0.05% (95% CI, 0.02% to 0.08%) for HF, decreased by 0.06% (95% CI, -0.09% to -0.04%) for AMI, and did not significantly change for pneumonia. Specifically, mortality increased for HF patients who did not utilize any post-discharge acute care, increasing at a rate of 0.08% per year (95% CI, 0.05% to 0.12%), exceeding the overall absolute annual increase in post-discharge mortality in heart failure, without an increase in mortality in observation units or the ED. Concurrent with a reduction in 30-day readmission rates, 30-day observation stays and visits to the ED increased across all 3 conditions during and beyond the post-discharge 30-day period. There was no significant change in overall 30-day post-acute care utilization. Conclusions: The only condition with an increasing mortality through the study period was HF; the increase preceded the policy and was not present among those received ED or observation unit care without hospitalization. Overall, during this period, there was not a significant change in the overall 30-day post-discharge acute care utilization.

Published
2019
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65. Development and Testing of Improved Models to Predict Payment Using Centers for Medicare & Medicaid Services Claims Data

Author

Krumholz, Harlan M., primary, Warner, Frederick, additional, Coppi, Andreas, additional, Triche, Elizabeth W., additional, Li, Shu-Xia, additional, Mahajan, Shiwani, additional, Li, Yixin, additional, Bernheim, Susannah M., additional, Grady, Jacqueline, additional, Dorsey, Karen, additional, Desai, Nihar R., additional, Lin, Zhenqiu, additional, and Normand, Sharon-Lise T., additional

Published
2019
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66. Comparative Effectiveness of New Approaches to Improve Mortality Risk Models From Medicare Claims Data

Author

Krumholz, Harlan M., primary, Coppi, Andreas C., additional, Warner, Frederick, additional, Triche, Elizabeth W., additional, Li, Shu-Xia, additional, Mahajan, Shiwani, additional, Li, Yixin, additional, Bernheim, Susannah M., additional, Grady, Jacqueline, additional, Dorsey, Karen, additional, Lin, Zhenqiu, additional, and Normand, Sharon-Lise T., additional

Published
2019
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68. Variation in and Hospital Characteristics Associated With the Value of Care for Medicare Beneficiaries With Acute Myocardial Infarction, Heart Failure, and Pneumonia

Author

Desai, Nihar R., primary, Ott, Lesli S., additional, George, Elizabeth J., additional, Xu, Xiao, additional, Kim, Nancy, additional, Zhou, Shengfan, additional, Hsieh, Angela, additional, Nuti, Sudhakar V., additional, Lin, Zhenqiu, additional, Bernheim, Susannah M., additional, and Krumholz, Harlan M., additional

Published
2018
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69. Administrative Claims Measure for Profiling Hospital Performance Based on 90-Day All-Cause Mortality Following Coronary Artery Bypass Graft Surgery.

Author

Makoto Mori, Nasir, Khurram, Haikun Bao, Jimenez, Andreina, Legore, Shani S., Yongfei Wang, Grady, Jacqueline, Lama, Sonam D., Brandi, Nina, Zhenqiu Lin, Kurlansky, Paul, Geirsson, Arnar, Bernheim, Susannah M., Krumholz, Harlan M., Suter, Lisa G., Mori, Makoto, Bao, Haikun, Wang, Yongfei, and Lin, Zhenqiu

Subjects
HOSPITALS, RESEARCH, CORONARY artery bypass, RESEARCH methodology, PATIENT readmissions, MEDICAL cooperation, EVALUATION research, HOSPITAL mortality, COMPARATIVE studies, MEDICARE
Abstract

Background: Coronary artery bypass graft (CABG) surgery is a focus of bundled and alternate payment models that capture outcomes up to 90 days postsurgery. While clinical registry risk models perform well, measures encompassing mortality beyond 30 days do not currently exist. We aimed to develop a risk-adjusted hospital-level 90-day all-cause mortality measure intended for assessing hospital performance in payment models of CABG surgery using administrative data.Methods: Building upon Centers for Medicare and Medicaid Services hospital-level 30-day all-cause CABG mortality measure specifications, we extended the mortality timeframe to 90 days after surgery and developed a new hierarchical logistic regression model to calculate hospital risk-standardized 90-day all-cause mortality rates for patients hospitalized for isolated CABG. The model was derived from Medicare claims data for a 3-year cohort between July 2014 to June 2017. The data set was randomly split into 50:50 development and validation samples. The model performance was evaluated with C statistics, overfitting indices, and calibration plot. The empirical validity of the measure result at the hospital level was evaluated against the Society of Thoracic Surgeons composite star rating.Results: Among 137 819 CABG procedures performed in 1183 hospitals, the unadjusted mortality rate within 30 and 90 days were 3.1% and 4.7%, respectively. The final model included 27 variables. Hospital-level 90-day risk-standardized mortality rates ranged between 2.04% and 11.26%, with a median of 4.67%. C statistics in the development and validation samples were 0.766 and 0.772, respectively. We identified a strong positive correlation between 30- and 90-day risk-standardized mortality rates, with a regression slope of 1.09. Risk-standardized mortality rates also showed a stepwise trend of lower 90-day mortality with higher Society of Thoracic Surgeons composite star ratings.Conclusions: We present a measure of hospital-level 90-day risk-standardized mortality rates following isolated CABG. This measure complements Centers for Medicare and Medicaid Services' existing 30-day CABG mortality measure by providing greater insight into the postacute recovery period. It offers a balancing measure to ensure efforts to reduce costs associated with CABG recovery and rehabilitation do not result in unintended consequences. [ABSTRACT FROM AUTHOR]

Published
2021
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70. Readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia among young and middle-aged adults: a retrospective observational cohort study

Author

Ranasinghe, Isuru, Wang, Yongfei, Dharmarajan, Kumar, Hsieh, Angela F., Bernheim, Susannah M., and Krumholz, Harlan M.

Subjects
Heart attack -- Care and treatment, Bacterial pneumonia -- Care and treatment, Hospital care -- Comparative analysis, Pneumonia -- Care and treatment, Heart failure -- Research -- Comparative analysis -- Care and treatment, Biological sciences
Abstract

Background: Patients aged ≥ 65 years are vulnerable to readmissions due to a transient period of generalized risk after hospitalization. However, whether young and middle-aged adults share a similar risk pattern is uncertain. We compared the rate, timing, and readmission diagnoses following hospitalization for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among patients aged 18-64 years with patients aged ≥ 65 years. Methods and Findings: We used an all-payer administrative dataset from California consisting of all hospitalizations for HF (n = 206,141), AMI (n = 107,256), and pneumonia (n = 199,620) from 2007-2009. The primary outcomes were unplanned 30- day readmission rate, timing of readmission, and readmission diagnoses. Our findings show that the readmission rate among patients aged 18-64 years exceeded the readmission rate in patients aged ≥ 65 years in the HF cohort (23.4% vs. 22.0%, p < 0.001), but was lower in the AMI (11.2% vs. 17.5%, p < 0.001) and pneumonia (14.4% vs. 17.3%, p < 0.001) cohorts. When adjusted for sex, race, comorbidities, and payer status, the 30-day readmission risk in patients aged 18-64 years was similar to patients ≥ 65 years in the HF (HR 0.99; 95%CI 0.97-1.02) and pneumonia (HR 0.97; 95%CI 0.94- 1.01) cohorts and was marginally lower in the AMI cohort (HR 0.92; 95%CI 0.87-0.96). For all cohorts, the timing of readmission was similar; readmission risks were highest between days 2 and 5 and declined thereafter across all age groups. Diagnoses other than the index admission diagnosis accounted for a substantial proportion of readmissions among age groups < 65 years; a non-cardiac diagnosis represented 39-44% of readmissions in the HF cohort and 37-45% of readmissions in the AMI cohort, while a non-pulmonary diagnosis represented 61-64% of patients in the pneumonia cohort. Conclusion: When adjusted for differences in patient characteristics, young and middle-aged adults have 30-day readmission rates that are similar to elderly patients for HF, AMI, and pneumonia. A generalized risk after hospitalization is present regardless of age., Introduction Reducing readmissions is a key focus of current health policy initiatives in the United States (US). The scope of the problem among elderly individuals is well established--one in five [...]

Published
2014
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73. Association of Racial and Socioeconomic Disparities With Outcomes Among Patients Hospitalized With Acute Myocardial Infarction, Heart Failure, and Pneumonia

Author

Downing, Nicholas S., primary, Wang, Changqin, additional, Gupta, Aakriti, additional, Wang, Yongfei, additional, Nuti, Sudhakar V., additional, Ross, Joseph S., additional, Bernheim, Susannah M., additional, Lin, Zhenqiu, additional, Normand, Sharon-Lise T., additional, and Krumholz, Harlan M., additional

Published
2018
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78. Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015

Author

Salerno, Amy M, primary, Horwitz, Leora I, additional, Kwon, Ji Young, additional, Herrin, Jeph, additional, Grady, Jacqueline N, additional, Lin, Zhenqiu, additional, Ross, Joseph S, additional, and Bernheim, Susannah M, additional

Published
2017
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83. Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time

Author

Dharmarajan, Kumar, primary, Qin, Li, additional, Lin, Zhenqiu, additional, Horwitz, Leora I., additional, Ross, Joseph S., additional, Drye, Elizabeth E., additional, Keshawarz, Amena, additional, Altaf, Faseeha, additional, Normand, Sharon-Lise T., additional, Krumholz, Harlan M., additional, and Bernheim, Susannah M., additional

Published
2016
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84. Mortality and Readmission at Safety Net and Non-Safety Net Hospitals for Three Common Medical Conditions

Author

Ross, Joseph S., Bernheim, Susannah M., Lin, Zhenqiu, Drye, Elizabeth E., Chen, Jersey, Normand, Sharon-Lise T., and Krumholz, Harlan M.

Subjects
Heart Failure, Medically Uninsured, Myocardial Infarction, Fee-for-Service Plans, Pneumonia, Medicare, Patient Readmission, Article, Health Services Accessibility, United States, Hospitals, Urban, Humans, Hospital Mortality, Aged, Quality Indicators, Health Care, Quality of Health Care
Abstract

Safety-net hospitals, which include urban hospitals serving large numbers of low-income, uninsured, and otherwise vulnerable populations, have historically faced greater financial strains than hospitals that serve more affluent populations. These strains can affect hospitals' quality of care, perhaps resulting in worse outcomes that are commonly used as indicators of care quality-mortality and readmission rates. We compared risk-standardized rates of both of these clinical outcomes among fee-for-service Medicare beneficiaries admitted for acute myocardial infarction, heart failure, or pneumonia. These beneficiaries were admitted to urban hospitals within Metropolitan Statistical Areas that contained at least one safety-net and at least one non-safety-net hospital. We found that outcomes varied across the urban areas for both safety-net and non-safety-net hospitals for all three conditions. However, mortality and readmission rates were broadly similar, with non-safety-net hospitals outperforming safety-net hospitals on average by less than one percentage point across most conditions. For heart failure mortality, there was no difference between safety-net and non-safety-net hospitals. These findings suggest that safety-net hospitals are performing better than many would have expected.

Published
2012

87. Place of Residence and Outcomes of Patients With Heart Failure

Author

Bikdeli, Behnood, primary, Wayda, Brian, additional, Bao, Haikun, additional, Ross, Joseph S., additional, Xu, Xiao, additional, Chaudhry, Sarwat I., additional, Spertus, John A., additional, Bernheim, Susannah M., additional, Lindenauer, Peter K., additional, and Krumholz, Harlan M., additional

Published
2014
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93. Abstract 13: Risks of Death and Hospital Readmission by Time Following Hospitalization for Heart Failure and Acute Myocardial Infarction

Author

Dharmarajan, Kumar, primary, Hsieh, Angela F, additional, Lin, Zhenqiu, additional, Kim, Nancy, additional, Ross, Joseph S, additional, Horwitz, Leora I, additional, Kulkarni, Vivek, additional, Suter, Lisa G, additional, Bernheim, Susannah M, additional, Drye, Elizabeth E, additional, Normand, Sharon-Lise, additional, and Krumholz, Harlan M, additional

Published
2013
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