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Exploring the Healthcare Value of Percutaneous Coronary Intervention: Appropriateness, Outcomes, and Costs in Michigan Hospitals.
- Source :
- Circulation: Cardiovascular Quality & Outcomes; Jun2018, Vol. 11 Issue 6, pe004328-e004328, 1p
- Publication Year :
- 2018
-
Abstract
- <bold>Background: </bold>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.<bold>Methods and Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- ECONOMIC impact
MEDICARE
MEDICAL economics
FEE for service (Medical fees)
EVALUATION of medical care
DATABASES
RESEARCH
KEY performance indicators (Management)
PATIENT selection
TIME
RESEARCH methodology
HOSPITAL costs
MEDICAL care
ACQUISITION of data
PATIENT readmissions
RETROSPECTIVE studies
EVALUATION research
MEDICAL cooperation
MULTIDIMENSIONAL Health Locus of Control scales
CARDIOVASCULAR system
TREATMENT effectiveness
COMPARATIVE studies
CLINICAL medicine
COST effectiveness
DECISION making
RESEARCH funding
STATISTICAL models
ECONOMICS
Subjects
Details
- Language :
- English
- ISSN :
- 19417713
- Volume :
- 11
- Issue :
- 6
- Database :
- Supplemental Index
- Journal :
- Circulation: Cardiovascular Quality & Outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 130239470
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.117.004328