2019
Association of Hospital Payment Profiles With Variation in 30-Day Medicare Cost for Inpatients With Heart Failure or Pneumonia
Krumholz HM, Wang Y, Wang K, Lin Z, Bernheim SM, Xu X, Desai NR, Normand ST. Association of Hospital Payment Profiles With Variation in 30-Day Medicare Cost for Inpatients With Heart Failure or Pneumonia. JAMA Network Open 2019, 2: e1915604. PMID: 31730185, PMCID: PMC6902811, DOI: 10.1001/jamanetworkopen.2019.15604.Peer-Reviewed Original ResearchConceptsHeart failureSame patientSame diagnosisMortality rateRisk-standardized mortality ratesHighest quartile hospitalsObservational cohort studyMedian hospitalQuartile hospitalsIndex hospitalizationCohort studyCritical access hospitalsPatient characteristicsHospital variationAcute careEpisode paymentsPrincipal diagnosisMAIN OUTCOMEMedicare feePneumoniaMedicare beneficiariesPatientsCase mixService Part ADifferent hospitalsHospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14
Cooper Z, Craig S, Gaynor M, Harish NJ, Krumholz HM, Van Reenen J. Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14. Health Affairs 2019, 38: 184-189. PMID: 30715987, DOI: 10.1377/hlthaff.2018.05424.Peer-Reviewed Original ResearchConceptsPhysician pricesHospital pricesHospital-based outpatient careHealth care spendingCare spendingTypes of pricesPrice growthHospital-based outpatient servicesProvider pricesReference pricingAntitrust enforcementPricesPolicy makersPricingSpendingOutpatient careRange of optionsGrowth rateGrowthPaymentsInpatient careOutpatient servicesInsurersMakersPercent
2017
Burden of Catastrophic Health Expenditures for Acute Myocardial Infarction and Stroke Among Uninsured in the United States
Khera R, Hong JC, Saxena A, Arrieta A, Virani SS, Blankstein R, de Lemos JA, Krumholz HM, Nasir K. Burden of Catastrophic Health Expenditures for Acute Myocardial Infarction and Stroke Among Uninsured in the United States. Circulation 2017, 137: 408-410. PMID: 29133601, PMCID: PMC5780190, DOI: 10.1161/circulationaha.117.030128.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultFemaleHealth Care CostsHealth ExpendituresHealth Services AccessibilityHospital ChargesHospital CostsHumansIncomeMaleMedically UninsuredMiddle AgedMyocardial InfarctionPatient Protection and Affordable Care ActProcess Assessment, Health CareStrokeTime FactorsUnited StatesYoung Adult
2016
Hospital Phenotypes in the Management of Patients Admitted for Acute Myocardial Infarction
Xu X, Li SX, Lin H, Normand SL, Lagu T, Desai N, Duan M, Kroch EA, Krumholz HM. Hospital Phenotypes in the Management of Patients Admitted for Acute Myocardial Infarction. Medical Care 2016, 54: 929-936. PMID: 27261637, PMCID: PMC5305177, DOI: 10.1097/mlr.0000000000000571.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPercutaneous coronary interventionICU admission rateICU admissionMyocardial infarctionAdmission ratesProcedure ratesIntensive care unit admissionHigher ICU admissionLower ICU admissionCare unit admissionCoronary artery bypassPatients' clinical characteristicsManagement of patientsOpen heart surgeryRisk-standardized mortalityArtery bypassUnit admissionClinical characteristicsCoronary interventionReadmission ratesGroup of hospitalsHospital costsPractice patternsCABG
2015
Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth
Xu X, Gariepy A, Lundsberg LS, Sheth SS, Pettker CM, Krumholz HM, Illuzzi JL. Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth. Health Affairs 2015, 34: 1212-1219. PMID: 26153317, DOI: 10.1377/hlthaff.2014.1088.Peer-Reviewed Original ResearchConceptsCesarean deliveryHospital costsMaternity staysSerious maternal morbidityNationwide Inpatient SampleCoordination of careValue of careMaternal morbidityHospital admissionInpatient SampleDelivery system reformRural hospitalsUS hospitalsHospital practiceSafe reductionHospitalChildbirthStayLong stayHigh rateCareLower proportionUnited StatesFacility costsOpportunities and challenges for reducing hospital revisits.
Dharmarajan K, Krumholz HM. Opportunities and challenges for reducing hospital revisits. Annals Of Internal Medicine 2015, 162: 793-4. PMID: 26030636, DOI: 10.7326/m15-0878.Peer-Reviewed Original Research
2014
Readmission Rates and Long-Term Hospital Costs Among Survivors of an In-Hospital Cardiac Arrest
Chan PS, Nallamothu BK, Krumholz HM, Curtis LH, Li Y, Hammill BG, Spertus JA. Readmission Rates and Long-Term Hospital Costs Among Survivors of an In-Hospital Cardiac Arrest. Circulation Cardiovascular Quality And Outcomes 2014, 7: 889-895. PMID: 25351479, PMCID: PMC4241155, DOI: 10.1161/circoutcomes.114.000925.Peer-Reviewed Original ResearchConceptsHospital cardiac arrestCardiac arrestInpatient costsMean inpatient costsLarge national registryInpatient resource useNeurological statusReadmission patternsHospital dispositionPatient demographicsReadmission ratesMean ageInpatient useNational registryYounger ageReadmissionArrestAgeYearsDaysPatientsRegistryResource useSurvivors
2013
For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery
Sen S, Soulos PR, Herrin J, Roberts KB, Yu JB, Lesnikoski BA, Ross JS, Krumholz HM, Gross CP. For-profit hospital ownership status and use of brachytherapy after breast-conserving surgery. Surgery 2013, 155: 776-788. PMID: 24787104, PMCID: PMC4008843, DOI: 10.1016/j.surg.2013.12.009.Peer-Reviewed Original ResearchConceptsHospital ownership statusBreast-conserving operationsBreast-conserving surgeryUse of brachytherapyRadiation therapyOperative careBreast cancerMedicare beneficiariesOverall useReceipt of brachytherapyAdjuvant radiation therapyInvasive breast cancerFemale Medicare beneficiariesGreater overall useYears of ageShort life expectancyRetrospective studyRT modalityProfit hospitalsExpensive modalityOlder womenBrachytherapy useBreast brachytherapyHospitalBrachytherapyA High Risk of Hospitalization Following Release From Correctional Facilities in Medicare Beneficiaries: A Retrospective Matched Cohort Study, 2002 to 2010
Wang EA, Wang Y, Krumholz HM. A High Risk of Hospitalization Following Release From Correctional Facilities in Medicare Beneficiaries: A Retrospective Matched Cohort Study, 2002 to 2010. JAMA Internal Medicine 2013, 173: 1621-1628. PMID: 23877707, PMCID: PMC4069256, DOI: 10.1001/jamainternmed.2013.9008.Peer-Reviewed Original ResearchSpending more, doing more, or both? An alternative method for quantifying utilization during hospitalizations
Lagu T, Krumholz HM, Dharmarajan K, Partovian C, Kim N, Mody PS, Li S, Strait KM, Lindenauer PK. Spending more, doing more, or both? An alternative method for quantifying utilization during hospitalizations. Journal Of Hospital Medicine 2013, 8: 373-379. PMID: 23757115, PMCID: PMC4014449, DOI: 10.1002/jhm.2046.Peer-Reviewed Original Research
2012
Procedure Intensity and the Cost of Care
Chen SI, Dharmarajan K, Kim N, Strait KM, Li SX, Safavi KC, Lindenauer PK, Krumholz HM, Lagu T. Procedure Intensity and the Cost of Care. Circulation Cardiovascular Quality And Outcomes 2012, 5: 308-313. PMID: 22576844, PMCID: PMC3415230, DOI: 10.1161/circoutcomes.112.966069.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCosts and Cost AnalysisCross-Sectional StudiesFemaleHeart FailureHospital Bed CapacityHospital CostsHospital MortalityHospitalizationHospitals, RuralHospitals, TeachingHospitals, UrbanHumansLength of StayLinear ModelsMaleMiddle AgedModels, EconomicOutcome and Process Assessment, Health CareResidence CharacteristicsRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeUnited StatesYoung AdultConceptsHF hospitalizationHeart failureInvasive proceduresHospital groupRisk-standardized mortality ratesProportion of patientsLength of stayCost of careWilcoxon rank sum testHigher procedure ratesRank sum testPatient demographicsPerspective databaseMedian lengthSurgical proceduresProcedure ratesHospitalizationOutcome differencesMortality rateHospitalPatientsPractice styleProcedure useSum testOverall use
2005
The Complexity and Cost of Drug Regimens of Older Patients Hospitalized With Heart Failure in the United States, 1998-2001
Masoudi FA, Baillie CA, Wang Y, Bradford WD, Steiner JF, Havranek EP, Foody JM, Krumholz HM. The Complexity and Cost of Drug Regimens of Older Patients Hospitalized With Heart Failure in the United States, 1998-2001. JAMA Internal Medicine 2005, 165: 2069-2076. PMID: 16216996, DOI: 10.1001/archinte.165.18.2069.Peer-Reviewed Original ResearchMeSH KeywordsAgedCohort StudiesComorbidityDrug CostsHeart FailureHospital CostsHospitalizationHumansRetrospective StudiesUnited StatesConceptsHeart failureOlder patientsNumber of drugsDrug regimensComplex drug regimensPatients 65 yearsChronic lung diseaseNumber of dosesPrior revascularizationConcurrent prescriptionsMultiple comorbiditiesChronic medicationsElderly patientsHospital dischargeMultiple medicationsMedical therapyLung diseaseMultivariable modelDrug treatmentWhite raceMore drugsPatientsYounger ageDrugsUtilization measuresPharmacologic prophylaxis for postoperative atrial tachyarrhythmia in general thoracic surgery: Evidence from randomized clinical trials
Sedrakyan A, Treasure T, Browne J, Krumholz H, Sharpin C, van der Meulen J. Pharmacologic prophylaxis for postoperative atrial tachyarrhythmia in general thoracic surgery: Evidence from randomized clinical trials. Journal Of Thoracic And Cardiovascular Surgery 2005, 129: 997-1005. PMID: 15867772, DOI: 10.1016/j.jtcvs.2004.07.042.Peer-Reviewed Original ResearchMeSH KeywordsAdrenergic beta-AntagonistsAgedAmiodaroneAnti-Arrhythmia AgentsAtrial FibrillationAtrial FlutterCalcium Channel BlockersDigitalis GlycosidesEvidence-Based MedicineFemaleFlecainideHospital CostsHumansLength of StayMagnesiumMaleMiddle AgedMorbidityPostoperative ComplicationsPremedicationPreoperative CareRandomized Controlled Trials as TopicTachycardia, SupraventricularThoracic Surgical ProceduresTreatment OutcomeConceptsPostoperative atrial tachyarrhythmiasGeneral thoracic surgeryAtrial tachyarrhythmiasCalcium channel blockersRandomized clinical trialsThoracic surgeryClinical trialsSingle small trialLonger hospital stayUse of digitalisPossible adverse eventsFixed-effects modelAntiarrhythmic medicationsPharmacologic prophylaxisHospital stayProphylactic regimenAdverse eventsCommon complicationPulmonary edemaSignificant morbidityUnblinded trialCochrane DatabaseProphylactic useSmall trialsPlacebo control
2002
Randomized trial of an education and support intervention to preventreadmission of patients with heart failure
Krumholz HM, Amatruda J, Smith GL, Mattera JA, Roumanis SA, Radford MJ, Crombie P, Vaccarino V. Randomized trial of an education and support intervention to preventreadmission of patients with heart failure. Journal Of The American College Of Cardiology 2002, 39: 83-89. PMID: 11755291, DOI: 10.1016/s0735-1097(01)01699-0.Peer-Reviewed Original ResearchConceptsHeart failureSupport interventionsIntervention groupControl groupHospital readmission costsOne-year readmissionRate of readmissionAdverse clinical outcomesCost of careDisease management programsReadmission costsClinical outcomesHospital costsReadmissionLower riskPatientsOne-yearDemographic characteristicsInterventionTrialsGroupFormal educationTotal numberMedical componentsFailure
2001
Predictors of costs of caring for elderly patients discharged with heart failure
Wexler D, Chen J, Smith G, Radford M, Yaari S, Bradford W, Krumholz H. Predictors of costs of caring for elderly patients discharged with heart failure. American Heart Journal 2001, 142: 350-357. PMID: 11479477, DOI: 10.1067/mhj.2001.116476.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overConnecticutFemaleHealth Services for the AgedHeart FailureHospital CostsHumansLength of StayMaleMedical RecordsMedicareModels, EconomicOutcome Assessment, Health CarePatient DischargePatient ReadmissionPredictive Value of TestsRetrospective StudiesRisk AssessmentRisk FactorsConceptsHeart failureIndependent correlatesHeart failure-related admissionsHeart failure-related readmissionsSubstantial hospital costsHeart failure admissionsHistory of strokeSubset of patientsPrincipal discharge diagnosisSignificant independent correlatesOutcomes 6 monthsPredictors of costsMedicare administrative databasesCause readmissionClinical characteristicsElderly patientsAverage admissionDischarge diagnosisKidney failureCause costsCorrelates of costsMedical recordsRisk factorsAdministrative databasesConnecticut hospitals
1999
Performance of the '100 top hospitals': what does the report card report?
Chen J, Radford MJ, Wang Y, Marciniak TA, Krumholz HM. Performance of the '100 top hospitals': what does the report card report? Health Affairs 1999, 18: 53-68. PMID: 10425843, DOI: 10.1377/hlthaff.18.4.53.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionElderly AMI patientsThirty-day mortalityUse of aspirinLower readmission ratesHospital peer groupsTop hospitalsReadmission ratesAMI patientsSuperior clinical performanceHospital studyMyocardial infarctionHospital costsMedicare patientsBetter outcomesHospitalBetter carePatientsClinical performanceLower lengthReperfusionInfarctionAspirinStayMortalityVariations in and correlates of length of stay in academic hospitals among patients with heart failure resulting from systolic dysfunction.
Krumholz HM, Chen YT, Bradford WD, Cerese J. Variations in and correlates of length of stay in academic hospitals among patients with heart failure resulting from systolic dysfunction. The American Journal Of Managed Care 1999, 5: 715-23. PMID: 10538451.Peer-Reviewed Original ResearchConceptsLength of stayCongestive heart failureHeart failureSystolic dysfunctionPatient characteristicsAcademic hospitalCollaborative quality improvement projectIndividual hospitalsAdmission clinical characteristicsRetrospective cohort studyPrincipal discharge diagnosisNumber of patientsQuality improvement projectUniversity HealthSystem ConsortiumCorrelates of lengthHospital stayPeripheral edemaClinical characteristicsCohort studyRenal failureClinical factorsMajor complicationsHospital eventsRegression modelsAtrial fibrillationEconomics, health-related quality of life, and cost-effectiveness methods for the TACTICS (Treat Angina with Aggrastat® [tirofiban] and Determine Cost of Therapy with Invasive or Conservative Strategy)–TIMI 18 trial
Weintraub W, Culler S, Kosinski A, Becker E, Mahoney E, Burnette J, Spertus J, Feeny D, Cohen D, Krumholz H, Ellis S, Demopoulos L, Robertson D, Boccuzzi S, Barr E, Cannon C. Economics, health-related quality of life, and cost-effectiveness methods for the TACTICS (Treat Angina with Aggrastat® [tirofiban] and Determine Cost of Therapy with Invasive or Conservative Strategy)–TIMI 18 trial. The American Journal Of Cardiology 1999, 83: 317-322. PMID: 10072215, DOI: 10.1016/s0002-9149(98)00860-1.Peer-Reviewed Original ResearchConceptsQuality-adjusted life yearsHealth Utilities IndexLife yearsHealth-related qualityCost-effectiveness methodsNon-Q-wave myocardial infarctionUtility indexCost-effectiveness analysisDetermine CostImpact of invasiveEconomic formsUB92 formulationHealth care costsUnstable anginaRelative value scaleMedicare conversion factorMyocardial infarctionMedicare fee scheduleDepartmental costsEconomicsExpensive formFee scheduleTACTICS-TIMI 18Care costsOutcomes of patients
1998
Trends in costs of percutaneous transluminal coronary angioplasty.
Heiat A, Mattera JA, Henry GA, Chen YT, Krumholz HM. Trends in costs of percutaneous transluminal coronary angioplasty. The American Journal Of Managed Care 1998, 4: 1667-74. PMID: 10339099.Peer-Reviewed Original ResearchConceptsPercutaneous transluminal coronary angioplastyTransluminal coronary angioplastyCoronary angioplastyClinical outcomesElective percutaneous transluminal coronary angioplastyYale-New Haven HospitalCatheterization laboratory costsMedical chart reviewGroup of patientsTotal hospital costsLength of stayHospital cost accounting systemChart reviewClinical characteristicsConsecutive patientsAngiographic featuresHospital recordsContrast volumeRetrospective studyPatient populationHospital costsLesion characteristicsStent useCatheterization laboratoryPatient profilesClinical correlates of in-hospital costs for acute myocardial infarction in patients 65 years of age and older
Krumholz H, Chen J, Murillo J, Cohen D, Radford M. Clinical correlates of in-hospital costs for acute myocardial infarction in patients 65 years of age and older. American Heart Journal 1998, 135: 523-531. PMID: 9506340, DOI: 10.1016/s0002-8703(98)70331-x.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionPatients 65 yearsHospital costsMyocardial infarctionAcute myocardial infarction hospitalizationsActual clinical practiceMyocardial infarction hospitalizationsClinical characteristicsAdverse outcomesClinical correlatesMedical recordsClinical practiceHospital proceduresRoom costsInfarctionStudy sampleTotal meanRelative paucityAgeLarge proportionCorrelatesHospitalizationPatientsHospitalYears