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Exploring the Healthcare Value of Percutaneous Coronary Intervention: Appropriateness, Outcomes, and Costs in Michigan Hospitals.
- Source :
-
Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2018 Jun; Vol. 11 (6), pp. e004328. - Publication Year :
- 2018
-
Abstract
- Background: Assessments of healthcare value have largely focused on measuring outcomes of care at a given level of cost with less attention paid to appropriateness. However, understanding how appropriateness relates to outcomes and costs is essential to determining healthcare value.<br />Methods and Results: In a retrospective cohort study design, administrative data from fee-for-service Medicare patients undergoing percutaneous coronary intervention (PCI) in Michigan hospitals between June 30, 2010, and December 31, 2014, were linked with clinical data from a statewide PCI registry to calculate hospital-level measures of (1) appropriate use criteria scores, (2) 90-day risk-standardized readmission and mortality rates, and (3) 90-day risk-standardized episode costs. We then used Spearman correlation coefficients to assess the relationship between these measures. A total of 29 839 PCIs were performed at 33 PCI hospitals during the study period. A total of 13.3% were for ST-segment-elevation myocardial infarction, 25.0% for non-ST-segment-elevation myocardial infarction, 47.1% for unstable angina, 9.8% for stable angina, and 4.7% for other. The overall hospital-level mean appropriate use criteria score was 8.4±0.2. Ninety-day risk-standardized readmission occurred in 23.7%±3.7% of cases, 90-day risk-standardized mortality in 4.3%±0.6%, and mean risk-standardized episode costs were $26 159±$1074. Hospital-level appropriate use criteria scores did not correlate with 90-day readmission, mortality, or episode costs.<br />Conclusions: Among Medicare patients undergoing PCI in Michigan, we found hospital-level appropriate use criteria scores did not correlate with 90-day readmission, mortality, or episode costs. This finding suggests that a comprehensive understanding of healthcare value requires multidimensional consideration of appropriateness, outcomes, and costs.<br /> (© 2018 American Heart Association, Inc.)
- Subjects :
- Administrative Claims, Healthcare
Aged
Aged, 80 and over
Clinical Decision-Making
Cost-Benefit Analysis
Databases, Factual
Decision Support Techniques
Female
Humans
Male
Medicare economics
Michigan
Middle Aged
Models, Economic
Patient Readmission economics
Patient Selection
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Registries
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
United States
Fee-for-Service Plans economics
Hospital Costs
Outcome and Process Assessment, Health Care economics
Percutaneous Coronary Intervention economics
Practice Patterns, Physicians' economics
Quality Indicators, Health Care economics
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7705
- Volume :
- 11
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular quality and outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 29853465
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.117.004328