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
Timely estimation of National Admission, readmission, and observation-stay rates in medicare patients with acute myocardial infarction, heart failure, or pneumonia using near real-time claims data
Li SX, Wang Y, Lama SD, Schwartz J, Herrin J, Mei H, Lin Z, Bernheim SM, Spivack S, Krumholz HM, Suter LG. Timely estimation of National Admission, readmission, and observation-stay rates in medicare patients with acute myocardial infarction, heart failure, or pneumonia using near real-time claims data. BMC Health Services Research 2020, 20: 733. PMID: 32778098, PMCID: PMC7416804, DOI: 10.1186/s12913-020-05611-w.Peer-Reviewed Original ResearchPost-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States
Khera R, Wang Y, Bernheim SM, Lin Z, Krumholz HM. Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States. The BMJ 2020, 368: l6831. PMID: 31941686, PMCID: PMC7190056, DOI: 10.1136/bmj.l6831.Peer-Reviewed Original ResearchConceptsAcute care utilizationAcute myocardial infarctionRetrospective cohort studyHeart failureCare utilizationPost-discharge periodEmergency departmentMyocardial infarctionDay mortalityCohort studyHospital admissionObservation unitAcute careNational retrospective cohort studyPost-acute care utilizationHospital Readmissions Reduction ProgramObservation unit carePost-discharge mortalityDay readmission rateRisk of deathReadmissions Reduction ProgramReadmission reduction initiativesReadmission ratesUnit careInpatient unit
2019
Hospital 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 ResearchMeSH KeywordsAdultCommerceEconomic CompetitionFemaleHospital CostsHumansInsurance CarriersInsurance Claim ReviewMaleMiddle AgedPhysiciansPrivate SectorUnited StatesConceptsPhysician 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
Blockchain Technology
Angraal S, Krumholz HM, Schulz WL. Blockchain Technology. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003800. PMID: 28912202, DOI: 10.1161/circoutcomes.117.003800.Peer-Reviewed Original Research
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 ResearchConceptsElectronic 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 abstractionDevelopment 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 ResearchMeSH KeywordsAgedAlgorithmsFee-for-Service PlansHospitals, VoluntaryHumansInsurance Claim ReviewMedicarePatient ReadmissionSensitivity and SpecificityUnited StatesConceptsSame-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 reportingAn 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 ResearchConceptsAcute 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 measuresCare
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 adjustmentHospital
2013
Diagnoses and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia
Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, Barreto-Filho JA, Kim N, Bernheim SM, Suter LG, Drye EE, Krumholz HM. Diagnoses and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. JAMA 2013, 309: 355-363. PMID: 23340637, PMCID: PMC3688083, DOI: 10.1001/jama.2012.216476.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionCommon readmission diagnosesAcute MI hospitalizationReadmission diagnosesDays of hospitalizationPatient demographic characteristicsHeart failureMyocardial infarctionHF hospitalizationReadmission timingPneumonia hospitalizationsMedian timeMI hospitalizationMedicare feeIndex HF hospitalizationIndex pneumonia hospitalizationProportion of patientsDemographic characteristicsService claims dataMI cohortPneumonia cohortHF cohortCondition categoriesHospitalizationReadmission
2012
Regional Associations Between Medicare Advantage Penetration and Administrative Claims-based Measures of Hospital Outcomes
Kulkarni VT, Shah SJ, Bernheim SM, Wang Y, Normand SL, Han LF, Rapp MT, Drye EE, Krumholz HM. Regional Associations Between Medicare Advantage Penetration and Administrative Claims-based Measures of Hospital Outcomes. Medical Care 2012, 50: 406-409. PMID: 22456113, PMCID: PMC5459365, DOI: 10.1097/mlr.0b013e318245a0f9.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesAcute myocardial infarctionRisk-standardized readmission ratesHospital outcomesReadmission ratesHeart failureMyocardial infarctionPopulation riskOutcome measuresMortality rateMedicare Advantage patientsHospital referral region levelHospital outcome measuresClaims-based measuresMedicaid Services measuresFFS patientsAdvantage patientsRetrospective studyService patientsMedicare feeMedicare Advantage penetrationPatientsMedicaid ServicesInfarctionPneumonia
2011
An Administrative Claims Measure Suitable for Profiling Hospital Performance Based on 30-Day All-Cause Readmission Rates Among Patients With Acute Myocardial Infarction
Krumholz HM, Lin Z, Drye EE, Desai MM, Han LF, Rapp MT, Mattera JA, Normand SL. An Administrative Claims Measure Suitable for Profiling Hospital Performance Based on 30-Day All-Cause Readmission Rates Among Patients With Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2011, 4: 243-252. PMID: 21406673, PMCID: PMC3350811, DOI: 10.1161/circoutcomes.110.957498.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCohort StudiesFemaleHumansInsurance Claim ReviewLogistic ModelsMaleMedicareModels, StatisticalMyocardial InfarctionOutcome and Process Assessment, Health CareOutcome Assessment, Health CarePatient ReadmissionQuality of Health CareReproducibility of ResultsRisk FactorsTime FactorsUnited States
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
2008
An Administrative Claims Measure Suitable for Profiling Hospital Performance on the Basis of 30-Day All-Cause Readmission Rates Among Patients With Heart Failure
Keenan PS, Normand SL, Lin Z, Drye EE, Bhat KR, Ross JS, Schuur JD, Stauffer BD, Bernheim SM, Epstein AJ, Wang Y, Herrin J, Chen J, Federer JJ, Mattera JA, Wang Y, Krumholz HM. An Administrative Claims Measure Suitable for Profiling Hospital Performance on the Basis of 30-Day All-Cause Readmission Rates Among Patients With Heart Failure. Circulation Cardiovascular Quality And Outcomes 2008, 1: 29-37. PMID: 20031785, DOI: 10.1161/circoutcomes.108.802686.Peer-Reviewed Original ResearchConceptsRisk-standardized readmission ratesCause readmission rateReadmission ratesHeart failureHospital-level readmission ratesAdjusted readmission ratesAdministrative Claims MeasureUnadjusted readmission ratesHeart failure patientsHospital risk-standardized readmission ratesMedical record dataProfiling Hospital PerformanceHierarchical logistic regression modelsUse of MedicareMedical record modelNational Quality ForumLogistic regression modelsCause readmissionClaims-based modelsHospital dischargeFailure patientsC-statisticPreventable eventsPatientsQuality Forum
2006
An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With Heart Failure
Krumholz HM, Wang Y, Mattera JA, Wang Y, Han LF, Ingber MJ, Roman S, Normand SL. An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With Heart Failure. Circulation 2006, 113: 1693-1701. PMID: 16549636, DOI: 10.1161/circulationaha.105.611194.Peer-Reviewed Original ResearchAn Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With an Acute Myocardial Infarction
Krumholz HM, Wang Y, Mattera JA, Wang Y, Han LF, Ingber MJ, Roman S, Normand SL. An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With an Acute Myocardial Infarction. Circulation 2006, 113: 1683-1692. PMID: 16549637, DOI: 10.1161/circulationaha.105.611186.Peer-Reviewed Original Research