2021
Incorporating Present-on-Admission Indicators in Medicare Claims to Inform Hospital Quality Measure Risk Adjustment Models
Triche EW, Xin X, Stackland S, Purvis D, Harris A, Yu H, Grady JN, Li SX, Bernheim SM, Krumholz HM, Poyer J, Dorsey K. Incorporating Present-on-Admission Indicators in Medicare Claims to Inform Hospital Quality Measure Risk Adjustment Models. JAMA Network Open 2021, 4: e218512. PMID: 33978722, PMCID: PMC8116982, DOI: 10.1001/jamanetworkopen.2021.8512.Peer-Reviewed Original ResearchConceptsPOA indicatorRisk factorsOutcome measuresQuality outcome measuresRisk-adjustment modelsClaims dataAdmission indicatorsPatient risk factorsAcute myocardial infarctionPatient-level outcomesAdministrative claims dataQuality improvement studyClaims-based measuresComparative effectiveness studiesPatient claims dataInternational Statistical ClassificationMortality outcome measuresRelated Health ProblemsHospital quality measuresRisk model performanceHospital stayIndex admissionCare algorithmHeart failureMortality outcomesApparent Increase in Chronic Obstructive Pulmonary Disease Mortality Is Likely an Artifact of Changes in Documentation and Coding
Lindenauer PK, Yu H, Grady J, Dorsey K, Triche EW. Apparent Increase in Chronic Obstructive Pulmonary Disease Mortality Is Likely an Artifact of Changes in Documentation and Coding. American Journal Of Respiratory And Critical Care Medicine 2021, 203: 647-649. PMID: 33166177, PMCID: PMC7924577, DOI: 10.1164/rccm.202009-3697le.Peer-Reviewed Original ResearchAdministrative Claims Measure for Profiling Hospital Performance Based on 90-Day All-Cause Mortality Following Coronary Artery Bypass Graft Surgery
Mori M, Nasir K, Bao H, Jimenez A, Legore SS, Wang Y, Grady J, Lama SD, Brandi N, Lin Z, Kurlansky P, Geirsson A, Bernheim SM, Krumholz HM, Suter LG. Administrative Claims Measure for Profiling Hospital Performance Based on 90-Day All-Cause Mortality Following Coronary Artery Bypass Graft Surgery. Circulation Cardiovascular Quality And Outcomes 2021, 14: e006644. PMID: 33535776, DOI: 10.1161/circoutcomes.120.006644.Peer-Reviewed Original ResearchMeSH KeywordsAgedCoronary Artery BypassHospital MortalityHospitalsHumansMedicarePatient ReadmissionUnited StatesConceptsRisk-standardized mortality ratesCoronary artery bypass graft surgeryArtery bypass graft surgeryBypass graft surgeryMortality rateGraft surgeryC-statisticMedicaid ServicesAdministrative Claims MeasureCause mortality ratesMortality measuresUnadjusted mortality ratesProfiling Hospital PerformanceHierarchical logistic regression modelsAlternate payment modelsHospital performanceLogistic regression modelsCABG recoveryPayment modelsCABG surgeryCause mortalityCABG proceduresDays postsurgeryHospital levelSurgery
2020
Quality Measure Public Reporting Is Associated with Improved Outcomes Following Hip and Knee Replacement.
Bozic K, Yu H, Zywiel MG, Li L, Lin Z, Simoes JL, Dorsey Sheares K, Grady J, Bernheim SM, Suter LG. Quality Measure Public Reporting Is Associated with Improved Outcomes Following Hip and Knee Replacement. Journal Of Bone And Joint Surgery 2020, 102: 1799-1806. PMID: 33086347, DOI: 10.2106/jbjs.19.00964.Peer-Reviewed Original ResearchConceptsRisk-standardized readmission ratesTotal hip arthroplastyReadmission ratesPublic reportingFiscal year 2010Hospital-level outcomesPrognostic Level IIIHospital-level ratesFiscal year 2016Hospital-level performanceHospital coding practicesHospital-level risk-standardized readmission ratesTKA patientsComplication rateClinical outcomesReadmission modelsImproved outcomesHip arthroplastyKnee replacementMedicare beneficiariesLevel IIIComplicationsReplacement proceduresInterquartile rangeOutcomesImpact of left ventricular assist devices and heart transplants on acute myocardial infarction and heart failure mortality and readmission measures
Brandt EJ, Ross JS, Grady JN, Ahmad T, Pawar S, Bernheim SM, Desai NR. Impact of left ventricular assist devices and heart transplants on acute myocardial infarction and heart failure mortality and readmission measures. PLOS ONE 2020, 15: e0230734. PMID: 32214363, PMCID: PMC7098556, DOI: 10.1371/journal.pone.0230734.Peer-Reviewed Original ResearchMeSH KeywordsAgedDatabases, FactualFemaleHeart FailureHeart TransplantationHeart-Assist DevicesHumansMaleMyocardial InfarctionPatient ReadmissionRiskConceptsLeft ventricular assist deviceHeart transplantation patientsRisk-standardized mortalityHeart transplantationTransplantation patientsAMI cohortReadmission cohortHF cohortVentricular assist deviceAMI mortalityAssist deviceHeart failure mortalityAcute myocardial infarctionHF mortalityLVAD indicationHF patientsLVAD patientsReadmission ratesHeart transplantMyocardial infarctionPrimary diagnosisReadmission measuresMedicare feeChronic supportPatients
2019
Development and Testing of Improved Models to Predict Payment Using Centers for Medicare & Medicaid Services Claims Data
Krumholz HM, Warner F, Coppi A, Triche EW, Li SX, Mahajan S, Li Y, Bernheim SM, Grady J, Dorsey K, Desai NR, Lin Z, Normand ST. Development and Testing of Improved Models to Predict Payment Using Centers for Medicare & Medicaid Services Claims Data. JAMA Network Open 2019, 2: e198406. PMID: 31411709, PMCID: PMC6694388, DOI: 10.1001/jamanetworkopen.2019.8406.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHeart failurePopulation-based programsPOA codesSingle diagnostic codeDiagnostic codesComparative effectiveness research studyPublic reportingIndex admission diagnosisDays of hospitalizationClinical Modification codesService claims dataAcute care hospitalsMultiple care settingsPatient-level modelsAdmission diagnosisTotal hospitalizationsCare hospitalPrevious diagnosisNinth RevisionMyocardial infarctionCandidate variablesCare settingsClaims dataMAIN OUTCOMETrends in Hospital Readmission of Medicare-Covered Patients With Heart Failure
Blecker S, Herrin J, Li L, Yu H, Grady JN, Horwitz LI. Trends in Hospital Readmission of Medicare-Covered Patients With Heart Failure. Journal Of The American College Of Cardiology 2019, 73: 1004-1012. PMID: 30846093, PMCID: PMC7011858, DOI: 10.1016/j.jacc.2018.12.040.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramSecondary heart failureReadmission ratesHeart failureReadmissions Reduction ProgramHF hospitalizationAffordable Care ActMedicare's Hospital Readmissions Reduction ProgramRisk-adjusted readmission ratesCause readmission rateHigher readmission ratesAcute myocardial infarctionCare ActReduction programsLinear spline regression modelsPneumonia hospitalizationsHospital readmissionMedicare hospitalizationsRetrospective studySecondary diagnosisMyocardial infarctionPrincipal diagnosisHospitalizationSpline regression modelsPatients
2018
Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization
Horwitz LI, Wang Y, Altaf FK, Wang C, Lin Z, Liu S, Grady J, Bernheim SM, Desai NR, Venkatesh AK, Herrin J. Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization. Medical Care 2018, 56: 281-289. PMID: 29462075, PMCID: PMC6170884, DOI: 10.1097/mlr.0000000000000882.Peer-Reviewed Original ResearchMeSH KeywordsCross-Sectional StudiesEmergency Service, HospitalFee-for-Service PlansHeart FailureHospital AdministrationHospitals, PublicHumansMedicareMyocardial InfarctionNursing Staff, HospitalOwnershipPatient ReadmissionPneumoniaResidence CharacteristicsRetrospective StudiesSafety-net ProvidersUnited StatesConceptsAcute care utilizationAcute myocardial infarctionHeart failureCare utilizationAcute careMyocardial infarctionHospital characteristicsNet hospitalExcess daysPublic hospitalsNonsafety net hospitalsHigher readmission ratesEmergency department utilizationProportion of hospitalsAcute care hospitalsSafety-net hospitalService Medicare beneficiariesLarge urban hospitalMajor teaching hospitalType of hospitalCross-sectional analysisPostdischarge utilizationHospital dischargeHospital factorsReadmission ratesSeasonal Variation in Readmission Risk for Patients Hospitalized with Cardiopulmonary Conditions
Blecker S, Kwon JY, Herrin J, Grady JN, Horwitz LI. Seasonal Variation in Readmission Risk for Patients Hospitalized with Cardiopulmonary Conditions. Journal Of General Internal Medicine 2018, 33: 599-601. PMID: 29464475, PMCID: PMC5910346, DOI: 10.1007/s11606-017-4299-0.Peer-Reviewed Original ResearchEffect of Hospital Readmission Reduction on Patients at Low, Medium, and High Risk of Readmission in the Medicare Population
Blecker S, Herrin J, Kwon JY, Grady JN, Jones S, Horwitz LI. Effect of Hospital Readmission Reduction on Patients at Low, Medium, and High Risk of Readmission in the Medicare Population. Journal Of Hospital Medicine 2018, 13: 537-543. PMID: 29455229, PMCID: PMC6063766, DOI: 10.12788/jhm.2936.Peer-Reviewed Original ResearchMeSH KeywordsAgedFee-for-Service PlansFemaleHospitalizationHumansMaleMedicarePatient ReadmissionRetrospective StudiesUnited StatesVariation in the Diagnosis of Aspiration Pneumonia and Association with Hospital Pneumonia Outcomes
Lindenauer PK, Strait KM, Grady JN, Ngo CK, Parisi ML, Metersky M, Ross JS, Bernheim SM, Dorsey K. Variation in the Diagnosis of Aspiration Pneumonia and Association with Hospital Pneumonia Outcomes. Annals Of The American Thoracic Society 2018, 15: 562-569. PMID: 29298090, DOI: 10.1513/annalsats.201709-728oc.Peer-Reviewed Original ResearchConceptsAspiration pneumoniaHospital mortalityHospital patientsMortality rateLower risk-standardized mortality ratesRisk-standardized mortality ratesRisk-standardized ratesPatients 65 yearsHospital readmission ratesNational mortality ratesPneumonia cohortPneumonia outcomesHospital outcomesReadmission ratesHospital differencesPrincipal diagnosisOutcome measuresReadmission measuresHospital codingMedicare feePneumoniaService claimsPatientsMedian proportionMortality
2017
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
Salerno AM, Horwitz LI, Kwon JY, Herrin J, Grady JN, Lin Z, Ross JS, Bernheim SM. 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. BMJ Open 2017, 7: e016149. PMID: 28710221, PMCID: PMC5541519, DOI: 10.1136/bmjopen-2017-016149.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramNon-safety net hospitalsSafety-net hospitalMedicare administrative claims dataReadmission ratesAdministrative claims dataNet hospitalReadmissions Reduction ProgramRetrospective time series analysisSafety netClaims dataTime series analysisSocioeconomic statusUnplanned readmission ratePrincipal discharge diagnosisLow socioeconomic statusInterrupted time seriesReduction programsFive-digit zip codeSeries analysisHRRP penaltiesIndex admissionHospital proportionDischarge diagnosisService patientsHospital Characteristics Associated With Risk-standardized Readmission Rates
Horwitz LI, Bernheim SM, Ross JS, Herrin J, Grady JN, Krumholz HM, Drye EE, Lin Z. Hospital Characteristics Associated With Risk-standardized Readmission Rates. Medical Care 2017, 55: 528-534. PMID: 28319580, PMCID: PMC5426655, DOI: 10.1097/mlr.0000000000000713.Peer-Reviewed Original Research
2016
Hospital Use of Observation Stays
Venkatesh AK, Wang C, Ross JS, Altaf FK, Suter LG, Vellanky S, Grady JN, Bernheim SM. Hospital Use of Observation Stays. Medical Care 2016, 54: 1070-1077. PMID: 27579906, PMCID: PMC5850934, DOI: 10.1097/mlr.0000000000000601.Peer-Reviewed Original ResearchMeSH KeywordsCross-Sectional StudiesHeart FailureHospitalizationHospitalsHumansLength of StayMyocardial InfarctionPatient ReadmissionPneumoniaWatchful WaitingConceptsRisk-standardized readmission ratesAcute myocardial infarctionObservation staysHeart failureReadmission measuresHospital useHospital risk-standardized readmission ratesCross-sectional analysisModest inverse correlationPostdischarge periodReadmission ratesHospital observationMyocardial infarctionMedicare feeStayPneumoniaService beneficiariesMeasures of qualityMedicaid ServicesHospitalInverse correlationModest correlationReadmissionPublic reportingFailure
2015
Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data
Horwitz LI, Grady JN, Cohen DB, Lin Z, Volpe M, Ngo CK, Masica AL, Long T, Wang J, Keenan M, Montague J, Suter LG, Ross JS, Drye EE, Krumholz HM, Bernheim SM. Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data. Journal Of Hospital Medicine 2015, 10: 670-677. PMID: 26149225, PMCID: PMC5459369, DOI: 10.1002/jhm.2416.Peer-Reviewed Original ResearchConceptsSame-hospital readmissionsNegative predictive valuePositive predictive valuePredictive valueReadmission measuresHospital-wide readmission measureGold standard chart reviewAdministrative claims-based algorithmDiagnostic cardiac catheterizationClaims-based algorithmLarge teaching centersAcute care hospitalsSmall community hospitalUnplanned readmissionChart reviewCardiac catheterizationScheduled careSpecificity 96.5Community hospitalReadmissionClaims dataCardiac devicesHealth systemTeaching centerPublic reporting
2014
Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission.
Horwitz LI, Partovian C, Lin Z, Grady JN, Herrin J, Conover M, Montague J, Dillaway C, Bartczak K, Suter LG, Ross JS, Bernheim SM, Krumholz HM, Drye EE. Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission. Annals Of Internal Medicine 2014, 161: s66-75. PMID: 25402406, PMCID: PMC4235629, DOI: 10.7326/m13-3000.Peer-Reviewed Original ResearchConceptsUnplanned readmissionReadmission measuresReadmission ratesReadmission riskMedicare feeHospital-wide readmission measureRisk-standardized readmission ratesPayer dataAdministrative Claims MeasureRisk-standardized ratesAverage-risk patientsUnplanned readmission rateDays of dischargeHospital risk-standardized readmission ratesAdult hospitalizationsComorbid conditionsPrincipal diagnosisClaims dataService claimsService beneficiariesReadmissionMeasure development studiesMedicaid ServicesRisk adjustmentHospitalNational Patterns of Risk-Standardized Mortality and Readmission After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia: Update on Publicly Reported Outcomes Measures Based on the 2013 Release
Suter LG, Li SX, Grady JN, Lin Z, Wang Y, Bhat KR, Turkmani D, Spivack SB, Lindenauer PK, Merrill AR, Drye EE, Krumholz HM, Bernheim SM. National Patterns of Risk-Standardized Mortality and Readmission After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia: Update on Publicly Reported Outcomes Measures Based on the 2013 Release. Journal Of General Internal Medicine 2014, 29: 1333-1340. PMID: 24825244, PMCID: PMC4175654, DOI: 10.1007/s11606-014-2862-5.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesAcute myocardial infarctionHeart failurePneumonia mortalityMyocardial infarctionMedian risk-standardized mortality rateHospital-level mortalityUnplanned readmission ratePrincipal discharge diagnosisHospital performanceRisk-Standardized MortalityHF mortalityReadmission resultsReadmission ratesDischarge diagnosisOutcome measuresAMI mortalityReadmission measuresPneumoniaMortality rateService MedicareHierarchical logistic modelsMortalityMedicaid ServicesReadmission
2010
National Patterns of Risk-Standardized Mortality and Readmission for Acute Myocardial Infarction and Heart Failure
Bernheim SM, Grady JN, Lin Z, Wang Y, Wang Y, Savage SV, Bhat KR, Ross JS, Desai MM, Merrill AR, Han LF, Rapp MT, Drye EE, Normand SL, Krumholz HM. National Patterns of Risk-Standardized Mortality and Readmission for Acute Myocardial Infarction and Heart Failure. Circulation Cardiovascular Quality And Outcomes 2010, 3: 459-467. PMID: 20736442, PMCID: PMC3027304, DOI: 10.1161/circoutcomes.110.957613.Peer-Reviewed Original ResearchThe performance of US hospitals as reflected in risk‐standardized 30‐day mortality and readmission rates for medicare beneficiaries with pneumonia
Lindenauer PK, Bernheim SM, Grady JN, Lin Z, Wang Y, Wang Y, Merrill AR, Han LF, Rapp MT, Drye EE, Normand S, Krumholz HM. The performance of US hospitals as reflected in risk‐standardized 30‐day mortality and readmission rates for medicare beneficiaries with pneumonia. Journal Of Hospital Medicine 2010, 5: e12-e18. PMID: 20665626, DOI: 10.1002/jhm.822.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesReadmission ratesHospital referral regionsReferral regionsMedicare beneficiariesMortality rateRisk-standardized readmission ratesNonfederal acute care hospitalsNational quality improvement effortsPattern of hospitalAcute care hospitalsCross-sectional studyService Medicare beneficiariesQuality improvement effortsMedian hospitalHospital dischargeElderly patientsHospital admissionCare hospitalReadmission analysisOutpatient MedicareLeading causePrincipal diagnosisPneumoniaPatients