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 outcomes
2020
The Promise of Big Data and Digital Solutions in Building a Cardiovascular Learning System: Opportunities and Barriers.
Mori M, Khera R, Lin Z, Ross JS, Schulz W, Krumholz HM. The Promise of Big Data and Digital Solutions in Building a Cardiovascular Learning System: Opportunities and Barriers. Methodist DeBakey Cardiovascular Journal 2020, 16: 212-219. PMID: 33133357, PMCID: PMC7587314, DOI: 10.14797/mdcj-16-3-212.Commentaries, Editorials and LettersConceptsLearning health systemLearning systemCommon data modelDynamic learning systemAdvanced analyticsBig dataData assetsData modelDigital solutionsCustomer interactionContinuous learningKnowledge generationEffective useConceptual modelAnalyticsSystemGoogleHealth systemLearningComparable scaleModelDataCompanies
2019
Trends in Performance and Opportunities for Improvement on a Composite Measure of Acute Myocardial Infarction Care
Desai NR, Udell JA, Wang Y, Spatz ES, Dharmarajan K, Ahmad T, Julien HM, Annapureddy A, Goyal A, de Lemos JA, Masoudi FA, Bhatt DL, Minges KE, Krumholz HM, Curtis JP. Trends in Performance and Opportunities for Improvement on a Composite Measure of Acute Myocardial Infarction Care. Circulation Cardiovascular Quality And Outcomes 2019, 12: e004983. PMID: 30871375, DOI: 10.1161/circoutcomes.118.004983.Peer-Reviewed Original ResearchMeSH KeywordsAgedCardiology Service, HospitalFemaleGuideline AdherenceHealthcare DisparitiesHumansMaleMiddle AgedMyocardial InfarctionOutcome and Process Assessment, Health CarePractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareRacial GroupsRegistriesSex FactorsSocioeconomic FactorsTreatment OutcomeUnited StatesConceptsProportion of patientsAcute myocardial infarctionDefect-free careHispanic patientsAMI careOlder patientsCare measuresNational Cardiovascular Data Registry Acute Coronary TreatmentIntervention Outcomes Network RegistryAcute myocardial infarction careGuideline-recommended pharmacotherapyMedicaid insurance coverageSociodemographic groupsMyocardial infarction careSafety-net statusGreatest absolute improvementComposite measureQuality of careHospital-level performanceCessation counselingEvidence-based processReperfusion therapyCardiac rehabilitationCoronary TreatmentVentricular functionAssociation Between Hospital Recognition for Resuscitation Guideline Adherence and Rates of Survival for In-Hospital Cardiac Arrest
Khera R, Tang Y, Link MS, Krumholz HM, Girotra S, Chan PS. Association Between Hospital Recognition for Resuscitation Guideline Adherence and Rates of Survival for In-Hospital Cardiac Arrest. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005429. PMID: 30871337, PMCID: PMC6592630, DOI: 10.1161/circoutcomes.118.005429.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAwards and PrizesFemaleGuideline AdherenceHeart ArrestHospital MortalityHospitalsHumansInpatientsMaleMiddle AgedOutcome and Process Assessment, Health CarePatient DischargePractice Guidelines as TopicPractice Patterns, Physicians'Quality Indicators, Health CareRegistriesResuscitationTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesYoung AdultConceptsHospital cardiac arrestCardiac arrestRate of survivalSpontaneous circulationIn-Hospital Cardiac ArrestGuidelines-Resuscitation registryCardiac arrest survivalEndotracheal tube placementHigh rateHospital performanceBest tertileGuidelines-ResuscitationNational GetGuideline adherenceOverall survivalBackground HospitalTube placementNational registryChest compressionsResuscitation qualityHospitalHospital recognitionAward statusSurvivalWeak association
2018
Effects of the Hospital Readmissions Reduction Program
Khera R, Krumholz HM. Effects of the Hospital Readmissions Reduction Program. Circulation Cardiovascular Quality And Outcomes 2018, 11: e005083. PMID: 30562071, DOI: 10.1161/circoutcomes.118.005083.Peer-Reviewed Original ResearchDefining Multiple Chronic Conditions for Quality Measurement
Drye EE, Altaf FK, Lipska KJ, Spatz ES, Montague JA, Bao H, Parzynski CS, Ross JS, Bernheim SM, Krumholz HM, Lin Z. Defining Multiple Chronic Conditions for Quality Measurement. Medical Care 2018, 56: 193-201. PMID: 29271820, DOI: 10.1097/mlr.0000000000000853.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCohort StudiesFemaleHumansMaleMedicareMiddle AgedMultiple Chronic ConditionsOutcome Assessment, Health CarePatient ReadmissionQuality Indicators, Health CareUnited StatesConceptsMultiple chronic conditionsChronic conditionsMedicare feeService beneficiariesMedicare Chronic Conditions WarehouseMCC cohortBroad cohortChronic Conditions WarehouseRisk-standardized ratesNational quality measuresUnplanned admissionsFinal cohortTotal admissionsAdmission riskAccountable care organizationsAdmission ratesOutcome measuresAdmissionCohortCohort conditionCare organizationsPatientsStakeholder inputNarrow cohortBeneficiaries
2017
Home Health Agency Performance in the United States: 2011–15
Wang Y, Spatz ES, Tariq M, Angraal S, Krumholz HM. Home Health Agency Performance in the United States: 2011–15. Journal Of The American Geriatrics Society 2017, 65: 2572-2579. PMID: 28960228, PMCID: PMC5729079, DOI: 10.1111/jgs.14987.Peer-Reviewed Original ResearchHospital-Readmission Risk — Isolating Hospital Effects from Patient Effects
Krumholz HM, Wang K, Lin Z, Dharmarajan K, Horwitz LI, Ross JS, Drye EE, Bernheim SM, Normand ST. Hospital-Readmission Risk — Isolating Hospital Effects from Patient Effects. New England Journal Of Medicine 2017, 377: 1055-1064. PMID: 28902587, PMCID: PMC5671772, DOI: 10.1056/nejmsa1702321.Peer-Reviewed Original ResearchMeSH KeywordsAgedHospitalsHumansOutcome Assessment, Health CarePatient ReadmissionQuality Indicators, Health CareRisk AdjustmentUnited StatesConceptsRisk-standardized readmission ratesReadmission ratesObserved readmission ratesSimilar diagnosesHospital effectsDifferent hospitalsHospital readmission performanceRate of readmissionHospital readmission ratesLower readmission ratesStudy sampleYears of ageSignificant differencesMultiple admissionsReadmission outcomesOnly significant differencePatient effectsSame patientMedicare recipientsPatientsReadmission performanceRisk-standardized hospital readmission ratesHospitalHospital qualityQuartileQuality of Care in Chinese Hospitals: Processes and Outcomes After ST‐segment Elevation Myocardial Infarction
Downing NS, Wang Y, Dharmarajan K, Nuti SV, Murugiah K, Du X, Zheng X, Li X, Li J, Masoudi FA, Spertus JA, Jiang L, Krumholz HM. Quality of Care in Chinese Hospitals: Processes and Outcomes After ST‐segment Elevation Myocardial Infarction. Journal Of The American Heart Association 2017, 6: e005040. PMID: 28645937, PMCID: PMC5669155, DOI: 10.1161/jaha.116.005040.Peer-Reviewed Original ResearchConceptsST-elevation myocardial infarctionRisk-standardized mortality ratesQuality of careGuideline-recommended careGuideline-recommended treatmentMyocardial infarctionMortality rateST-segment elevation myocardial infarctionChina PEACE-Retrospective AMI StudyComposite rateMedian risk-standardized mortality rateProportion of patientsElevation myocardial infarctionQuality improvement initiativesProportion of opportunitiesDefect-free rateHospital levelInfarctionHospitalChinese hospitalsPatientsCareAMI studyImprovement initiativesHigh rateComparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States
Zheng Z, Zhang H, Yuan X, Rao C, Zhao Y, Wang Y, Normand SL, Krumholz HM, Hu S. Comparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003327. PMID: 28611187, PMCID: PMC5482563, DOI: 10.1161/circoutcomes.116.003327.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedChinaCoronary Artery BypassCoronary Artery DiseaseFemaleHealthcare DisparitiesHospital Bed CapacityHospital MortalityHospitals, High-VolumeHospitals, TeachingHospitals, UrbanHumansLength of StayMaleMiddle AgedOdds RatioPrevalenceProcess Assessment, Health CarePropensity ScoreQuality Indicators, Health CareRegistriesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeUnited StatesYoung AdultConceptsIsolated CABG surgeryCoronary artery bypassUrban hospitalHospital mortalityArtery bypassCABG surgeryChinese Cardiac Surgery RegistryTotal hospital stayCardiac Surgery RegistryCoronary artery diseaseNational Inpatient SampleLarge teachingLength of staySignificant mortality differenceHospital staySecondary outcomesArtery diseasePrimary outcomeMedian lengthComparing outcomesInpatient SampleMortality differencesHigher ageHigh mortalityHospitalHospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures
Chui PW, Parzynski CS, Nallamothu BK, Masoudi FA, Krumholz HM, Curtis JP. Hospital Performance on Percutaneous Coronary Intervention Process and Outcomes Measures. Journal Of The American Heart Association 2017, 6: e004276. PMID: 28446493, PMCID: PMC5524055, DOI: 10.1161/jaha.116.004276.Peer-Reviewed Original ResearchMeSH KeywordsCardiac RehabilitationCoronary DiseaseCross-Sectional StudiesHealthcare DisparitiesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMedicarePatient DischargePatient ReadmissionPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsProcess Assessment, Health CareQuality ImprovementQuality Indicators, Health CareReferral and ConsultationRegistriesRisk FactorsTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsProcess measuresReadmission ratesOutcome measuresNational Cardiovascular Data Registry CathPCI RegistryHospital performancePercutaneous coronary interventionSpecific process measuresRisk-standardized mortalityPCI patientsCathPCI RegistryCoronary interventionHospital variationOutcome ratesHospital qualityPhysician ConsortiumMortalitySmall percentageWeak correlationAssociationIntervention processPatientsPatient–Provider Communication and Health Outcomes Among Individuals With Atherosclerotic Cardiovascular Disease in the United States
Okunrintemi V, Spatz ES, Di Capua P, Salami JA, Valero-Elizondo J, Warraich H, Virani SS, Blaha MJ, Blankstein R, Butt AA, Borden WB, Dharmarajan K, Ting H, Krumholz HM, Nasir K. Patient–Provider Communication and Health Outcomes Among Individuals With Atherosclerotic Cardiovascular Disease in the United States. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003635. PMID: 28373270, DOI: 10.1161/circoutcomes.117.003635.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAspirinAtherosclerosisCommunicationEmergency Service, HospitalFemaleHealth Care CostsHealth Care SurveysHealth ExpendituresHealth StatusHumansHydroxymethylglutaryl-CoA Reductase InhibitorsLength of StayMaleMental HealthMiddle AgedOdds RatioPatient Reported Outcome MeasuresPatient-Centered CarePhysician-Patient RelationsPlatelet Aggregation InhibitorsQuality Indicators, Health CareRisk FactorsUnited StatesYoung AdultConceptsAtherosclerotic cardiovascular diseasePatient-provider communicationHealthcare resource utilizationPatient-reported outcomesCardiovascular diseaseHealth Plans SurveyMedical Expenditure Panel Survey cohortHigher annual healthcare expendituresRepresentative US adult populationHealthcare expendituresAtherosclerotic cardiovascular disease (ASCVD) patientsConsumer AssessmentEmergency room visitsEvidence-based therapiesAnnual healthcare expendituresCardiovascular disease patientsUS adult populationPlans SurveyMental health statusPatient-centered careOutcomes of interestASA useHospital stayRoom visitsPoor outcome
2016
Practice‐Level Variation in Outpatient Cardiac Care and Association With Outcomes
Clough JD, Rajkumar R, Crim MT, Ott LS, Desai NR, Conway PH, Maresh S, Kahvecioglu DC, Krumholz HM. Practice‐Level Variation in Outpatient Cardiac Care and Association With Outcomes. Journal Of The American Heart Association 2016, 5: e002594. PMID: 26908402, PMCID: PMC4802452, DOI: 10.1161/jaha.115.002594.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAmbulatory CareCardiologyFemaleHealth Care CostsHealthcare DisparitiesHeart DiseasesHospitalizationHumansMaleMedicareMiddle AgedOffice VisitsPractice Patterns, Physicians'Process Assessment, Health CareQuality Indicators, Health CareTime FactorsTreatment OutcomeUnited StatesConceptsOutpatient cardiac careCardiac careCardiac servicesPractice-level variationMyocardial perfusion imagingNoncardiac hospitalizationsMedical hospitalizationCardiac catheterizationOffice visitsClinical endpointsOutpatient careLowest quartileOdds ratioCardiology practiceMedicare populationMedicare beneficiariesHospitalizationPerfusion imagingDevice proceduresEfficient carePhysician practicesQuartileCarePractice levelMean payment
2015
Differences in Colonoscopy Quality Among Facilities: Development of a Post-Colonoscopy Risk-Standardized Rate of Unplanned Hospital Visits
Ranasinghe I, Parzynski CS, Searfoss R, Montague J, Lin Z, Allen J, Vender R, Bhat K, Ross JS, Bernheim S, Krumholz HM, Drye EE. Differences in Colonoscopy Quality Among Facilities: Development of a Post-Colonoscopy Risk-Standardized Rate of Unplanned Hospital Visits. Gastroenterology 2015, 150: 103-113. PMID: 26404952, DOI: 10.1053/j.gastro.2015.09.009.Peer-Reviewed Original ResearchConceptsUnplanned hospital visitsDay of colonoscopyHospital visitsOutpatient facilitiesColonoscopy qualityHealthcare costsRisk-standardized ratesHospital outpatient departmentsUtilization Project dataAmbulatory surgery centersLogistic regression modelsHierarchical logistic regressionQuality improvement effortsPrior arrhythmiaAbdominal painElectrolyte imbalanceOutpatient departmentSurgery centersCommon causeHospital careOutcome measuresPsychiatric disordersColonoscopyUtilization ProjectPatient choiceStandardized Data Collection Practices and the Racial/Ethnic Distribution of Hospitalized Patients
Chakkalakal RJ, Green JC, Krumholz HM, Nallamothu BK. Standardized Data Collection Practices and the Racial/Ethnic Distribution of Hospitalized Patients. Medical Care 2015, 53: 666-672. PMID: 26147864, PMCID: PMC4503513, DOI: 10.1097/mlr.0000000000000392.Peer-Reviewed Original ResearchMeSH KeywordsEthnicityHealth Services AccessibilityHealthcare DisparitiesHospitalizationHumansInpatientsMinority GroupsNew JerseyNew YorkQuality Indicators, Health CareRacial GroupsSocioeconomic FactorsNational Quality Assessment of Early Clopidogrel Therapy in Chinese Patients With Acute Myocardial Infarction (AMI) in 2006 and 2011: Insights From the China Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE)–Retrospective AMI Study
Zhang L, Desai NR, Li J, Hu S, Wang Q, Li X, Masoudi FA, Spertus JA, Nuti SV, Wang S, Krumholz HM, Jiang L, Group T. National Quality Assessment of Early Clopidogrel Therapy in Chinese Patients With Acute Myocardial Infarction (AMI) in 2006 and 2011: Insights From the China Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE)–Retrospective AMI Study. Journal Of The American Heart Association 2015, 4: e001906. PMID: 26163041, PMCID: PMC4608074, DOI: 10.1161/jaha.115.001906.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsian PeopleChinaClopidogrelDrug Administration ScheduleFemaleHealthcare DisparitiesHumansMaleMiddle AgedMyocardial InfarctionNational Health ProgramsPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareResidence CharacteristicsRetrospective StudiesRisk FactorsRural Health ServicesTiclopidineTime FactorsTreatment OutcomeUrban Health ServicesConceptsAcute myocardial infarctionEarly clopidogrel useClopidogrel therapyClopidogrel useRural hospitalsMyocardial infarctionQuality improvement initiativesEligible patientsClopidogrel administrationReperfusion therapyCardiac eventsHospital admissionAMI patientsChina PatientChinese patientsPatterns of useUrban hospitalPatientsClopidogrelChinese trialsHospitalTherapyEarly useAMI studyImprovement initiativesImprovements 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 ResearchHospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation
Al-Damluji MS, Dzara K, Hodshon B, Punnanithinont N, Krumholz HM, Chaudhry SI, Horwitz LI. Hospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation. Circulation Cardiovascular Quality And Outcomes 2015, 8: 77-86. PMID: 25587091, PMCID: PMC4303507, DOI: 10.1161/circoutcomes.114.001227.Peer-Reviewed Original ResearchConceptsDays of dischargeDischarge summary qualityDischarge summariesHeart failureHeart Failure Outcome StudyHeart failure exacerbationHospital-level variationHospital-level performanceSingle-site studyMedian hospitalHospital courseDischarge weightHospital variationVolume statusAdverse outcomesOutcome studiesConsensus conferencePatientsHospitalCare toolsPhysiciansInadequate qualityDaysExacerbationSummaryAssociation of Discharge Summary Quality With Readmission Risk for Patients Hospitalized With Heart Failure Exacerbation
Salim Al-Damluji M, Dzara K, Hodshon B, Punnanithinont N, Krumholz HM, Chaudhry SI, Horwitz LI. Association of Discharge Summary Quality With Readmission Risk for Patients Hospitalized With Heart Failure Exacerbation. Circulation Cardiovascular Quality And Outcomes 2015, 8: 109-111. PMID: 25587092, PMCID: PMC4303529, DOI: 10.1161/circoutcomes.114.001476.Peer-Reviewed Original Research
2014
Strategies to reduce hospital 30-day risk-standardized mortality rates for patients with acute myocardial infarction: a cross-sectional and longitudinal survey
Bradley EH, Sipsma H, Brewster AL, Krumholz HM, Curry L. Strategies to reduce hospital 30-day risk-standardized mortality rates for patients with acute myocardial infarction: a cross-sectional and longitudinal survey. BMC Cardiovascular Disorders 2014, 14: 126. PMID: 25252826, PMCID: PMC4182840, DOI: 10.1186/1471-2261-14-126.Peer-Reviewed Original ResearchMeSH KeywordsCooperative BehaviorCross-Sectional StudiesEmergency Medical ServicesEmergency Medical TechniciansHealth Care SurveysHospital MortalityHospitalsHumansInservice TrainingInterdisciplinary CommunicationLongitudinal StudiesMedical Order Entry SystemsMyocardial InfarctionOrganizational CulturePatient Care TeamQuality ImprovementQuality Indicators, Health CareTime FactorsUnited StatesConceptsAcute myocardial infarctionAMI mortality ratesPercentage of hospitalsMortality rateMyocardial infarctionAMI mortalityHospital AMI mortality ratesRisk-standardized mortality ratesEmergency medical services (EMS) providersHospital strategiesCross-sectional surveyPhysician order entryBackgroundSurvival ratesAMI careMedical service providersResultsBetween 2010HospitalU.S. hospitalsOrder entryRegular trainingInfarctionLongitudinal analysisHospital performanceMortalityCurrent use