2024
Incorporating Medicare Advantage Admissions Into the CMS Hospital-Wide Readmission Measure
Kyanko K, Sahay K, Wang Y, Li S, Schreiber M, Hager M, Myers R, Johnson W, Zhang J, Krumholz H, Suter L, Triche E. Incorporating Medicare Advantage Admissions Into the CMS Hospital-Wide Readmission Measure. JAMA Network Open 2024, 7: e2414431. PMID: 38829614, PMCID: PMC11148674, DOI: 10.1001/jamanetworkopen.2024.14431.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Cohort StudiesFee-for-Service PlansFemaleHospitalsHumansMaleMedicare Part CPatient ReadmissionReproducibility of ResultsUnited StatesConceptsCenters for Medicare & Medicaid ServicesSpecialty subgroupsPerformance quintileMedicare AdvantageReadmission ratesRisk-standardized readmission ratesHospital-wide readmission measureHospital outcome measuresTest-retest reliabilityRisk-adjustment variablesMeasurement reliabilityAdministrative claims dataReadmission measuresImprove measurement reliabilityIntegrated data repositoryMA beneficiariesQuintile rankingsMedicare beneficiariesMedicaid ServicesAll-causePublic reportingStudy assessed differencesClaims dataOutcome measuresMA cohort
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 ResearchMeSH KeywordsAgedAged, 80 and overBenchmarkingCenters for Medicare and Medicaid Services, U.S.Fee-for-Service PlansFemaleHeart FailureHospitalsHumansInsurance Claim ReviewMaleMedicareMyocardial InfarctionPatient ReadmissionPneumoniaQuality Indicators, Health CareRisk AdjustmentUnited StatesConceptsPOA 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 outcomes
2020
Association Between Medicare Expenditures and Adverse Events for Patients With Acute Myocardial Infarction, Heart Failure, or Pneumonia in the United States
Wang Y, Eldridge N, Metersky ML, Sonnenfeld N, Rodrick D, Fine JM, Eckenrode S, Galusha DH, Tasimi A, Hunt DR, Bernheim SM, Normand ST, Krumholz HM. Association Between Medicare Expenditures and Adverse Events for Patients With Acute Myocardial Infarction, Heart Failure, or Pneumonia in the United States. JAMA Network Open 2020, 3: e202142. PMID: 32259263, PMCID: PMC7139276, DOI: 10.1001/jamanetworkopen.2020.2142.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Cross-Sectional StudiesFee-for-Service PlansFemaleHealth ExpendituresHeart FailureHospitalizationHospitalsHumansMaleMedicareMyocardial InfarctionPatient DischargePatient SafetyPneumoniaUnited StatesConceptsAcute myocardial infarctionMedicare Patient Safety Monitoring SystemAdverse event ratesAdverse eventsHeart failureMedicare expendituresService patientsMyocardial infarctionMedicare feeEvent ratesHigher adverse event ratesCare expendituresRisk-standardized ratesPatients 65 yearsAdverse event dataAcute care hospitalsCross-sectional studyFinal study sampleInpatient care expendituresRate of occurrenceDates of analysisPatient characteristicsCare hospitalMean ageInpatient care
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 ResearchMeSH KeywordsAdultAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.FemaleForecastingHeart FailureHumansMaleMedicaidMedicareMiddle AgedModels, TheoreticalMyocardial InfarctionPatient ReadmissionPneumoniaUnited StatesConceptsAcute 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 OUTCOMEPersistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016
Wang Y, Zhang Q, Spatz ES, Gao Y, Eckenrode S, Johnson F, Ho SY, Hu S, Xing C, Krumholz HM. Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016. BMC Geriatrics 2019, 19: 103. PMID: 30975076, PMCID: PMC6460800, DOI: 10.1186/s12877-019-1117-z.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.FemaleHealth Services AccessibilityHomes for the AgedHumansMaleMedicaidMedicareNursing HomesQuality of Health CareRetrospective StudiesSkilled Nursing FacilitiesUnited States
2017
Describing the performance of U.S. hospitals by applying big data analytics
Downing NS, Cloninger A, Venkatesh AK, Hsieh A, Drye EE, Coifman RR, Krumholz HM. Describing the performance of U.S. hospitals by applying big data analytics. PLOS ONE 2017, 12: e0179603. PMID: 28662045, PMCID: PMC5491053, DOI: 10.1371/journal.pone.0179603.Peer-Reviewed Original ResearchPrime Time for Shared Decision Making
Spatz ES, Krumholz HM, Moulton BW. Prime Time for Shared Decision Making. JAMA 2017, 317: 1309-1310. PMID: 28384834, DOI: 10.1001/jama.2017.0616.Peer-Reviewed Original ResearchCenters for Medicare and Medicaid Services, U.S.Decision MakingDecision Support TechniquesHumansInformed ConsentPhysician-Patient RelationsRiskUnited StatesWashington
2016
Accounting For Patients’ Socioeconomic Status Does Not Change Hospital Readmission Rates
Bernheim SM, Parzynski CS, Horwitz L, Lin Z, Araas MJ, Ross JS, Drye EE, Suter LG, Normand SL, Krumholz HM. Accounting For Patients’ Socioeconomic Status Does Not Change Hospital Readmission Rates. Health Affairs 2016, 35: 1461-1470. PMID: 27503972, PMCID: PMC7664840, DOI: 10.1377/hlthaff.2015.0394.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Databases, FactualFemaleHealth ExpendituresHospitals, RuralHospitals, UrbanHumansInsurance CoverageMalePatient DischargePatient ReadmissionRetrospective StudiesSocioeconomic FactorsUnited StatesConceptsHospital Readmissions Reduction ProgramPatients' socioeconomic statusMedicare's Hospital Readmissions Reduction ProgramLow socioeconomic statusReadmission ratesSocioeconomic statusRisk-standardized readmission ratesHospital readmission ratesReadmissions Reduction ProgramMedicaid Services methodologyReadmission measuresHospital resultsPatientsHospitalSuch hospitalsPayment penaltiesReduction programsStatusCurrent CentersLower proportionLarge proportionPercentAdjustmentProportionDeclining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time
Dharmarajan K, Qin L, Lin Z, Horwitz LI, Ross JS, Drye EE, Keshawarz A, Altaf F, Normand SL, Krumholz HM, Bernheim SM. Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Health Affairs 2016, 35: 1294-1302. PMID: 27385247, DOI: 10.1377/hlthaff.2015.1614.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Chronic DiseaseDatabases, FactualDisease ProgressionFemaleGeriatric AssessmentHospital MortalityHumansIncidenceLength of StayMaleOutcome Assessment, Health CarePatient AdmissionPatient ReadmissionRetrospective StudiesRisk AssessmentSeverity of Illness IndexTime FactorsUnited StatesAssociation Between Hospital Performance on Patient Safety and 30‐Day Mortality and Unplanned Readmission for Medicare Fee‐for‐Service Patients With Acute Myocardial Infarction
Wang Y, Eldridge N, Metersky ML, Sonnenfeld N, Fine JM, Pandolfi MM, Eckenrode S, Bakullari A, Galusha DH, Jaser L, Verzier NR, Nuti SV, Hunt D, Normand S, Krumholz HM. Association Between Hospital Performance on Patient Safety and 30‐Day Mortality and Unplanned Readmission for Medicare Fee‐for‐Service Patients With Acute Myocardial Infarction. Journal Of The American Heart Association 2016, 5: e003731. PMID: 27405808, PMCID: PMC5015406, DOI: 10.1161/jaha.116.003731.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCause of DeathCenters for Medicare and Medicaid Services, U.S.Fee-for-Service PlansFemaleHospitalsHospitals, RuralHospitals, VoluntaryHumansMaleMedicareMortalityMyocardial InfarctionPatient ReadmissionPatient SafetyPrognosisUnited StatesUnited States Agency for Healthcare Research and QualityConceptsAcute myocardial infarctionUnplanned readmission rateMedicare Patient Safety Monitoring SystemRisk-standardized mortalityAdverse eventsReadmission ratesService patientsMedicare feeUnplanned readmissionMyocardial infarctionMedicare patientsPatient safetyHospital performanceMore adverse eventsAdverse event ratesAcute care hospitalsPatient safety dataHospital mortalityAdverse event measuresCause mortalityOccurrence rateCare hospitalHospital characteristicsReadmission dataPatient safety performance
2015
Development of a Hospital Outcome Measure Intended for Use With Electronic Health Records
McNamara RL, Wang Y, Partovian C, Montague J, Mody P, Eddy E, Krumholz HM, Bernheim SM. Development of a Hospital Outcome Measure Intended for Use With Electronic Health Records. Medical Care 2015, 53: 818-826. PMID: 26225445, DOI: 10.1097/mlr.0000000000000402.Peer-Reviewed Original ResearchMeSH KeywordsAgedCenters for Medicare and Medicaid Services, U.S.Electronic Health RecordsFemaleHospital MortalityHospitalsHumansInsurance Claim ReviewMaleModels, StatisticalMyocardial InfarctionOutcome Assessment, Health CareQuality ImprovementRegistriesRisk AssessmentUnited StatesConceptsElectronic health recordsOutcome measuresClinical dataMortality rateClinical practiceFuture quality improvement measuresRisk-standardized mortality ratesHospital risk-standardized mortality ratesLow-mortality hospitalsHealth recordsSystolic blood pressureOdds of mortalityClinical registry dataAcute myocardial infarctionHigh-mortality hospitalsHospital outcome measuresEHR dataFinal risk modelCurrent clinical practiceStandard clinical practiceFirst outcome measureNational Quality ForumCurrent electronic health recordsQuality improvement measuresChart abstractionAn Administrative Claims Measure of Payments Made for Medicare Patients for a 30-Day Episode of Care for Acute Myocardial Infarction
Kim N, Bernheim SM, Ott LS, Han L, Spivack SB, Xu X, Volpe M, Liu A, Krumholz HM. An Administrative Claims Measure of Payments Made for Medicare Patients for a 30-Day Episode of Care for Acute Myocardial Infarction. Medical Care 2015, 53: 542-549. PMID: 25970575, DOI: 10.1097/mlr.0000000000000361.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Episode of CareFemaleHospital AdministrationHumansInsurance Claim ReviewMaleMedicareMyocardial InfarctionRisk AdjustmentUnited StatesConceptsAcute myocardial infarctionMyocardial infarctionICD-9 codes 410Administrative Claims MeasurePatients 65 yearsDate of admissionClaims-based measuresIntraclass correlation coefficient scoreIntraclass correlation coefficientValue of careHigh-value careClinical variablesDischarge diagnosisMedicare patientsMedicare claimsClinical careAMI episodeAMI hospitalizationCare costsCode 410HospitalizationMedicaid ServicesHospitalClaims measuresCareImprovements in the Distribution of Hospital Performance for the Care of Patients With Acute Myocardial Infarction, Heart Failure, and Pneumonia, 2006–2011
Nuti SV, Wang Y, Masoudi FA, Bratzler DW, Bernheim SM, Murugiah K, Krumholz HM. Improvements in the Distribution of Hospital Performance for the Care of Patients With Acute Myocardial Infarction, Heart Failure, and Pneumonia, 2006–2011. Medical Care 2015, 53: 485-491. PMID: 25906012, PMCID: PMC8635168, DOI: 10.1097/mlr.0000000000000358.Peer-Reviewed Original Research
2011
National Performance on Door-In to Door-Out Time Among Patients Transferred for Primary Percutaneous Coronary Intervention
Herrin J, Miller LE, Turkmani DF, Nsa W, Drye EE, Bernheim SM, Ling SM, Rapp MT, Han LF, Bratzler DW, Bradley EH, Nallamothu BK, Ting HH, Krumholz HM. National Performance on Door-In to Door-Out Time Among Patients Transferred for Primary Percutaneous Coronary Intervention. JAMA Internal Medicine 2011, 171: 1879-1886. PMID: 22123793, PMCID: PMC4312661, DOI: 10.1001/archinternmed.2011.481.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAngioplasty, Balloon, CoronaryCenters for Medicare and Medicaid Services, U.S.FemaleHospitalsHumansMaleMiddle AgedMyocardial InfarctionRetrospective StudiesTime and Motion StudiesTime FactorsTransportation of PatientsUnited StatesYoung AdultConceptsPercutaneous coronary interventionDIDO timeCoronary interventionST-segment elevation acute myocardial infarctionMixed-effects multivariable modelElevation acute myocardial infarctionPrimary percutaneous coronary interventionMedian DIDO timeAcute myocardial infarctionFibrinolytic therapyPatient characteristicsMultivariable analysisEmergency departmentMyocardial infarctionHospital characteristicsMultivariable modelPatientsRural hospitalsHospitalMedicaid ServicesAge categoriesInterventionAfrican AmericansMinutesTreatment timeOperator Experience and Carotid Stenting Outcomes in Medicare Beneficiaries
Nallamothu BK, Gurm HS, Ting HH, Goodney PP, Rogers MA, Curtis JP, Dimick JB, Bates ER, Krumholz HM, Birkmeyer JD. Operator Experience and Carotid Stenting Outcomes in Medicare Beneficiaries. JAMA 2011, 306: 1338-1343. PMID: 21954477, PMCID: PMC3208144, DOI: 10.1001/jama.2011.1357.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overAtherosclerosisCarotid StenosisCenters for Medicare and Medicaid Services, U.S.Clinical CompetenceFee-for-Service PlansFemaleHospital MortalityHumansInsurance CoverageMaleMedicarePhysiciansQuality of Health CareRetrospective StudiesStentsStrokeTime FactorsTreatment OutcomeUnited StatesConceptsAnnual operator volumeCarotid stentingOperator volumeMedicare beneficiariesNational coverage decisionHigh riskOperator experienceStudy periodThirty-day mortalityEmbolic protection devicesHigh-volume operatorsLow-volume operatorsService Medicare beneficiariesLow annual volumeMultivariable adjustmentOlder patientsRate of failureClinical trialsCoverage decisionsObservational studyMAIN OUTCOMEPatientsClinical practiceStentingMore procedures
2010
Is Same-Hospital Readmission Rate a Good Surrogate for All-Hospital Readmission Rate?
Nasir K, Lin Z, Bueno H, Normand SL, Drye EE, Keenan PS, Krumholz HM. Is Same-Hospital Readmission Rate a Good Surrogate for All-Hospital Readmission Rate? Medical Care 2010, 48: 477-481. PMID: 20393366, DOI: 10.1097/mlr.0b013e3181d5fb24.Peer-Reviewed Original ResearchMeSH KeywordsCenters for Medicare and Medicaid Services, U.S.Heart FailureHumansInsurance Claim ReviewPatient ReadmissionQuality Indicators, Health CareUnited StatesConceptsRisk-standardized readmission ratesHospital readmission ratesSame-hospital readmissionsSame-hospital readmission ratesDays of dischargeReadmission ratesHeart failureUS acute care hospitalsThirty-day readmissionStandard Analytic FilesAcute care hospitalsHierarchical logistic regression modelsLogistic regression modelsCause readmissionHF readmissionIndex hospitalizationCare hospitalHospital readmissionAnalytic FilesMedicare inpatientReadmissionStudy populationHospital measuresReadmission measuresHospitalization
2009
Reduction in Acute Myocardial Infarction Mortality in the United States: Risk-Standardized Mortality Rates From 1995-2006
Krumholz HM, Wang Y, Chen J, Drye EE, Spertus JA, Ross JS, Curtis JP, Nallamothu BK, Lichtman JH, Havranek EP, Masoudi FA, Radford MJ, Han LF, Rapp MT, Straube BM, Normand SL. Reduction in Acute Myocardial Infarction Mortality in the United States: Risk-Standardized Mortality Rates From 1995-2006. JAMA 2009, 302: 767-773. PMID: 19690309, PMCID: PMC3349070, DOI: 10.1001/jama.2009.1178.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.FemaleHospital MortalityHumansLength of StayMaleMyocardial InfarctionRiskUnited StatesConceptsRisk-standardized mortality ratesAcute myocardial infarctionShort-term mortality rateMortality rateHospital variationNonfederal acute care hospitalsAcute myocardial infarction mortalityHospital mortality rateDay of admissionRisk standardized mortality ratesAcute care hospitalsMyocardial infarction mortalityHealth care professionalsIndex hospitalizationCare hospitalMyocardial infarctionNational averagePatient levelMedicare patientsObservational studyMedical adviceHospital varianceMAIN OUTCOMECare professionalsPatients
2007
Measuring Performance For Treating Heart Attacks And Heart Failure: The Case For Outcomes Measurement
Krumholz HM, Normand SL, Spertus JA, Shahian DM, Bradley EH. Measuring Performance For Treating Heart Attacks And Heart Failure: The Case For Outcomes Measurement. Health Affairs 2007, 26: 75-85. PMID: 17211016, DOI: 10.1377/hlthaff.26.1.75.Peer-Reviewed Original ResearchMeSH KeywordsCardiology Service, HospitalCenters for Medicare and Medicaid Services, U.S.DisclosureGuideline AdherenceHeart FailureHumansMyocardial InfarctionOutcome and Process Assessment, Health CarePractice Guidelines as TopicQuality Indicators, Health CareRisk AdjustmentUnited States
2006
Hospital Quality for Acute Myocardial Infarction: Correlation Among Process Measures and Relationship With Short-term Mortality
Bradley EH, Herrin J, Elbel B, McNamara RL, Magid DJ, Nallamothu BK, Wang Y, Normand SL, Spertus JA, Krumholz HM. Hospital Quality for Acute Myocardial Infarction: Correlation Among Process Measures and Relationship With Short-term Mortality. JAMA 2006, 296: 72-78. PMID: 16820549, DOI: 10.1001/jama.296.1.72.Peer-Reviewed Original ResearchMeSH KeywordsAgedCenters for Medicare and Medicaid Services, U.S.Cross-Sectional StudiesHospital MortalityHospitalsHumansJoint Commission on Accreditation of Healthcare OrganizationsMedicareMyocardial InfarctionOutcome and Process Assessment, Health CareQuality Indicators, Health CareRegistriesRisk AssessmentUnited StatesConceptsAcute myocardial infarctionMortality rateMyocardial infarctionProcess measuresAngiotensin-converting enzyme inhibitor useRisk-standardized mortality ratesShort-term mortality rateBeta-blocker useEnzyme inhibitor useHospital performanceHospital-level variationShort-term mortalityQuality process measuresAspirin useCessation counselingHospital outcomesInhibitor useAMI patientsNational registryMedication measuresTherapy measuresHospital qualityInfarctionMedicaid ServicesJoint Commission
2005
From Adversary to Partner: Have Quality Improvement Organizations Made the Transition?
Bradley EH, Carlson MD, Gallo WT, Scinto J, Campbell MK, Krumholz HM. From Adversary to Partner: Have Quality Improvement Organizations Made the Transition? Health Services Research 2005, 40: 459-476. PMID: 15762902, PMCID: PMC1361151, DOI: 10.1111/j.1475-6773.2005.0y368.x.Peer-Reviewed Original ResearchMeSH KeywordsAttitude of Health PersonnelBenchmarkingCenters for Medicare and Medicaid Services, U.S.Cross-Sectional StudiesHealth PromotionHospital AdministratorsHospitalsHumansMyocardial InfarctionOrganizational InnovationPhysician ExecutivesProfessional Review OrganizationsQuality Indicators, Health CareTotal Quality ManagementUnited StatesConceptsQuality Improvement OrganizationQuality of careAcute myocardial infarctionImprovement organizationsPeer review organizationsMyocardial infarctionHospital performance dataTarget physiciansNational random sampleSpecific interventionsHospitalHospital administrationQuality improvement directorsInterventionCareReview organizationsPhysiciansRandom sampleAdministrationOne-quarterManagement directorsInfarctionEducational materialsPatientsRespondents