2024
Hospital Variation in Delivery of Skilled Rehabilitation to Mechanically Ventilated Older Adults With Acute Respiratory Failure
Jimenez Ceja J, Zhang L, Lin Z, Walkey A, Krumholz H, Jain S. Hospital Variation in Delivery of Skilled Rehabilitation to Mechanically Ventilated Older Adults With Acute Respiratory Failure. 2024, a1096-a1096. DOI: 10.1164/ajrccm-conference.2024.209.1_meetingabstracts.a1096.Peer-Reviewed Original Research
2023
Race and Ethnicity and Emergency Department Discharge Against Medical Advice
Tsai J, Janke A, Krumholz H, Khidir H, Venkatesh A. Race and Ethnicity and Emergency Department Discharge Against Medical Advice. JAMA Network Open 2023, 6: e2345437. PMID: 38015503, PMCID: PMC10685883, DOI: 10.1001/jamanetworkopen.2023.45437.Peer-Reviewed Original ResearchConceptsWhite patientsHispanic patientsEmergency departmentCross-sectional studyED visitsBlack patientsDAMA rateMedical adviceMAIN OUTCOMEEthnic disparitiesNationwide Emergency Department SampleNational cross-sectional studyHospital ED visitsEmergency department dischargeHospital-level variationEmergency Department SampleMetropolitan teaching hospitalHealth care resourcesMedian ageGreater morbidityHospital variationUnadjusted analysesTeaching hospitalAdditional adjustmentLower odds
2022
Hospital Variation of Spironolactone Use in Patients Hospitalized for Heart Failure in China—The China PEACE Retrospective Heart Failure Study
Yu Y, Guan W, Masoudi FA, Wang B, He G, Spertus JA, Lu Y, Krumholz HM, Li J. Hospital Variation of Spironolactone Use in Patients Hospitalized for Heart Failure in China—The China PEACE Retrospective Heart Failure Study. Journal Of The American Heart Association 2022, 11: e026300. PMID: 36172964, PMCID: PMC9673705, DOI: 10.1161/jaha.122.026300.Peer-Reviewed Original ResearchConceptsSpironolactone prescriptionSpironolactone useHeart failureMedian odds ratioIdeal patientAldosterone antagonistsHospital variationMedian rateReduced ejection fractionUse of spironolactoneMultivariable linear regression modelsHeart Failure StudyEjection fractionHospital characteristicsOdds ratioRepresentative cohortPatientsHospitalChinese hospitalsInappropriate usePrescriptionSpironolactoneSelect individualsAntagonistHigh rate
2020
Revascularization Practices and Outcomes in Patients With Multivessel Coronary Artery Disease Who Presented With Acute Myocardial Infarction and Cardiogenic Shock in the US, 2009-2018
Khera R, Secemsky EA, Wang Y, Desai NR, Krumholz HM, Maddox TM, Shunk KA, Virani SS, Bhatt DL, Curtis J, Yeh RW. Revascularization Practices and Outcomes in Patients With Multivessel Coronary Artery Disease Who Presented With Acute Myocardial Infarction and Cardiogenic Shock in the US, 2009-2018. JAMA Internal Medicine 2020, 180: 1317-1327. PMID: 32833024, PMCID: PMC9377424, DOI: 10.1001/jamainternmed.2020.3276.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedCohort StudiesCoronary VesselsFemaleFollow-Up StudiesHospital MortalityHumansMaleMiddle AgedMyocardial InfarctionPatient DischargePercutaneous Coronary InterventionRisk AssessmentRisk FactorsShock, CardiogenicST Elevation Myocardial InfarctionTime FactorsTreatment OutcomeUnited StatesConceptsST-segment elevation myocardial infarctionMultivessel percutaneous coronary interventionMultivessel coronary artery diseasePercutaneous coronary interventionAcute myocardial infarctionCoronary artery diseaseCulprit vessel percutaneous coronary interventionCardiogenic shockHospital mortalityArtery diseaseMyocardial infarctionCohort studyPrimary outcomeHospital variationPCI strategyMedicare beneficiariesUnderwent multivessel PCISignificant hospital variationElevation myocardial infarctionSubset of patientsHigh-risk populationRecent evidenceHospital complicationsPCI useRevascularization practice
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 hospitals
2018
Variation in and Hospital Characteristics Associated With the Value of Care for Medicare Beneficiaries With Acute Myocardial Infarction, Heart Failure, and Pneumonia
Desai NR, Ott LS, George EJ, Xu X, Kim N, Zhou S, Hsieh A, Nuti SV, Lin Z, Bernheim SM, Krumholz HM. Variation in and Hospital Characteristics Associated With the Value of Care for Medicare Beneficiaries With Acute Myocardial Infarction, Heart Failure, and Pneumonia. JAMA Network Open 2018, 1: e183519. PMID: 30646247, PMCID: PMC6324438, DOI: 10.1001/jamanetworkopen.2018.3519.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesAcute myocardial infarctionHeart failureHigh-value careHospital characteristicsValue of careMyocardial infarctionNational cross-sectional studyHospital risk-standardized mortality ratesMedian risk-standardized mortality rateProportion of patientsSafety-net statusAcute care hospitalsCross-sectional studyLow socioeconomic statusCharacteristics of hospitalsValue-based payment modelsWeak inverse correlationCare hospitalHospital variationHospital typeHospitalizationMAIN OUTCOMEPneumoniaMedicare beneficiaries
2017
Hospital 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 processPatients
2015
Hospital Variation in Outcomes for Transcatheter Aortic Valve Replacement Among Medicare Beneficiaries, 2011 to 2013
Murugiah K, Wang Y, Desai NR, Nuti SV, Krumholz HM. Hospital Variation in Outcomes for Transcatheter Aortic Valve Replacement Among Medicare Beneficiaries, 2011 to 2013. Journal Of The American College Of Cardiology 2015, 66: 2678-2679. PMID: 26670069, PMCID: PMC5459372, DOI: 10.1016/j.jacc.2015.10.008.Peer-Reviewed Original ResearchHospital variation in admission to intensive care units for patients with acute myocardial infarction
Chen R, Strait KM, Dharmarajan K, Li SX, Ranasinghe I, Martin J, Fazel R, Masoudi FA, Cooke CR, Nallamothu BK, Krumholz HM. Hospital variation in admission to intensive care units for patients with acute myocardial infarction. American Heart Journal 2015, 170: 1161-1169. PMID: 26678638, PMCID: PMC5459386, DOI: 10.1016/j.ahj.2015.09.003.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAnterior Wall Myocardial InfarctionCoronary Care UnitsHealth Care RationingHospital MortalityHumansLength of StayMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionQuality ImprovementRetrospective StudiesRisk AssessmentTriageUnited StatesConceptsAcute myocardial infarctionIntensive care unitCritical care therapiesRisk-standardized mortality ratesHospital risk-standardized mortality ratesICU admissionResource-intensive settingsCare therapyAMI patientsCare unitMyocardial infarctionMortality rateAdult hospitalizationsHospital variationNinth RevisionClinical ModificationICU triageInternational ClassificationBetter outcomesPatientsHospitalAdmissionPremier databaseTherapyAppropriate useHospital 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 qualityDaysExacerbationSummary
2014
Hospital Variation in the Use of Noninvasive Cardiac Imaging and Its Association With Downstream Testing, Interventions, and Outcomes
Safavi KC, Li SX, Dharmarajan K, Venkatesh AK, Strait KM, Lin H, Lowe TJ, Fazel R, Nallamothu BK, Krumholz HM. Hospital Variation in the Use of Noninvasive Cardiac Imaging and Its Association With Downstream Testing, Interventions, and Outcomes. JAMA Internal Medicine 2014, 174: 546-553. PMID: 24515551, PMCID: PMC5459406, DOI: 10.1001/jamainternmed.2013.14407.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionNoninvasive cardiac imagingDownstream testingReadmission ratesRevascularization proceduresCardiac imagingHospital variationCardiac ischemiaProportion of patientsNoninvasive imagingLower readmission ratesPrincipal discharge diagnosisCross-sectional studyCardiac biomarker testsQ4 hospitalsChest discomfortCoronary angiographyCoronary diseaseDischarge diagnosisCoronary angiogramEmergency departmentMyocardial infarctionSame hospitalCurrent guidelinesInpatient wardsHospital variation in risk-standardized hospital admission rates from US EDs among adults
Capp R, Ross JS, Fox JP, Wang Y, Desai MM, Venkatesh AK, Krumholz HM. Hospital variation in risk-standardized hospital admission rates from US EDs among adults. The American Journal Of Emergency Medicine 2014, 32: 837-843. PMID: 24881514, DOI: 10.1016/j.ajem.2014.03.033.Peer-Reviewed Original ResearchConceptsHospital admission ratesEmergency departmentAdmission ratesClinical characteristicsED visitsHospital factorsClinical factorsAdult ED visitsUS emergency departmentsHospital teaching statusCross-sectional analysisPatient characteristicsHospital admissionHospital variationPatientsTeaching statusHospitalED dataVisitsRepresentative sampleAdultsRural locationsAdmissionFactorsNational variationsHospital Variation in Noninvasive Positive Pressure Ventilation for Acute Decompensated Heart Failure
Kulkarni VT, Kim N, Dai Y, Dharmarajan K, Safavi KC, Bikdeli B, Lindenauer PK, Testani J, Dries DL, Krumholz HM. Hospital Variation in Noninvasive Positive Pressure Ventilation for Acute Decompensated Heart Failure. Circulation Heart Failure 2014, 7: 427-433. PMID: 24633829, PMCID: PMC4386575, DOI: 10.1161/circheartfailure.113.000698.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureNoninvasive positive pressure ventilationDecompensated heart failureRisk-standardized mortality ratesPositive pressure ventilationHeart failureIntubation rateMortality ratePressure ventilationUse of NPPVHospital risk-standardized mortality ratesHigher intubation rateHospital practice patternsHospital-level outcomesCross-sectional studyHierarchical logistic regression modelsLogistic regression modelsNIPPV useHospital variationSuch hospitalizationsPractice patternsHospitalizationHospitalQuartileBottom quartileHospital Variation in Intravenous Inotrope Use for Patients Hospitalized With Heart Failure
Allen LA, Fonarow GC, Grau-Sepulveda MV, Hernandez AF, Peterson PN, Partovian C, Li SX, Heidenreich PA, Bhatt DL, Peterson ED, Krumholz HM. Hospital Variation in Intravenous Inotrope Use for Patients Hospitalized With Heart Failure. Circulation Heart Failure 2014, 7: 251-260. PMID: 24488983, PMCID: PMC5459367, DOI: 10.1161/circheartfailure.113.000761.Peer-Reviewed Original ResearchMeSH KeywordsAgedCardiotonic AgentsCross-Sectional StudiesDose-Response Relationship, DrugFemaleFollow-Up StudiesGuideline AdherenceHeart FailureHospital MortalityHospitalsHumansInfusions, IntravenousInpatientsLength of StayMaleOutcome Assessment, Health CarePractice Patterns, Physicians'RegistriesRetrospective StudiesSurvival RateUnited StatesConceptsInotrope useHeart failureInotropic therapyInotropic agentsGuidelines-Heart Failure registryIntravenous inotropic agentsIntravenous inotropic therapyRisk-standardized ratesUse of inotropesHeart failure hospitalizationHospital-level ratesRandom hospital effectsFailure hospitalizationClinical characteristicsHospital factorsInpatient mortalityClinical factorsClinical outcomesHospital variationHospital characteristicsHospital effectsPatientsUS hospitalsHospitalStudy period
2012
Hospital Patterns of Use of Positive Inotropic Agents in Patients With Heart Failure
Partovian C, Gleim SR, Mody PS, Li SX, Wang H, Strait KM, Allen LA, Lagu T, Normand SL, Krumholz HM. Hospital Patterns of Use of Positive Inotropic Agents in Patients With Heart Failure. Journal Of The American College Of Cardiology 2012, 60: 1402-1409. PMID: 22981548, PMCID: PMC3636773, DOI: 10.1016/j.jacc.2012.07.011.Peer-Reviewed Original ResearchConceptsPositive inotropic agentsRisk-standardized ratesInotropic agentsHeart failureInotrope useHospital patternsMortality rateRisk-standardized mortality ratesHospital mortality rateHeart failure patientsLittle clinical evidenceLength of stayPatient case mixHierarchical logistic regression modelsLogistic regression modelsIntraclass correlation coefficientFailure patientsHospital variationClinical evidenceInterhospital variationClinical guidelinesIndividual hospital effectsHospital ratesHospital effectsPatterns of use
2011
Use and Effectiveness of Intra-Aortic Balloon Pumps Among Patients Undergoing High Risk Percutaneous Coronary Intervention
Curtis JP, Rathore SS, Wang Y, Chen J, Nallamothu BK, Krumholz HM. Use and Effectiveness of Intra-Aortic Balloon Pumps Among Patients Undergoing High Risk Percutaneous Coronary Intervention. Circulation Cardiovascular Quality And Outcomes 2011, 5: 21-30. PMID: 22147887, PMCID: PMC3801197, DOI: 10.1161/circoutcomes.110.960385.Peer-Reviewed Original ResearchConceptsHigh-risk percutaneous coronary interventionIntra-aortic balloon pumpPercutaneous coronary interventionHospital quartilesHospital mortalityIABP useCoronary interventionBalloon pumpHospital characteristicsST-segment elevation myocardial infarctionDepressed left ventricular functionHigh-risk PCI patientsSegment elevation myocardial infarctionElevation myocardial infarctionLeft ventricular functionHierarchical logistic regression modelsLogistic regression modelsIABP usageCardiogenic shockPCI patientsCathPCI RegistryHemodynamic supportVentricular functionHospital variationMultivariable analysis
2009
Recent National Trends in Readmission Rates After Heart Failure Hospitalization
Ross JS, Chen J, Lin Z, Bueno H, Curtis JP, Keenan PS, Normand SL, Schreiner G, Spertus JA, Vidán MT, Wang Y, Wang Y, Krumholz HM. Recent National Trends in Readmission Rates After Heart Failure Hospitalization. Circulation Heart Failure 2009, 3: 97-103. PMID: 19903931, PMCID: PMC2830811, DOI: 10.1161/circheartfailure.109.885210.Peer-Reviewed Original ResearchConceptsCause readmission rateReadmission ratesHeart failureRecent national trendsHospital variationService beneficiariesAcute-care nonfederal hospitalsUS acute care hospitalsHeart failure hospitalizationHospital readmission ratesAcute care hospitalsNational trendsNational Quality ForumMedicare administrative dataDistinct hospitalizationsFailure hospitalizationMultiple comorbiditiesCare hospitalNonfederal hospitalsMedicare beneficiariesHospitalizationHospitalQuality ForumStudy periodAdministrative dataReduction 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 ResearchConceptsRisk-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 professionalsPatientsHospital Variation in Time to Defibrillation After In-Hospital Cardiac Arrest
Chan PS, Nichol G, Krumholz HM, Spertus JA, Nallamothu BK. Hospital Variation in Time to Defibrillation After In-Hospital Cardiac Arrest. JAMA Internal Medicine 2009, 169: 1265-1273. PMID: 19636027, DOI: 10.1001/archinternmed.2009.196.Peer-Reviewed Original ResearchConceptsCardiac arrestHospital factorsHospital variationIn-Hospital Cardiac ArrestHospital-level effectsHospital cardiac arrestWorse survivalImproved survivalPatient factorsAdult inpatientsHospital predictorsNational registryHospital ratesCardiopulmonary resuscitationGreater oddsIdentical covariatesDefibrillation delaysHospitalDefibrillationDefibrillation timeSurvivalArrestWide variationPatientsInpatients
2000
Variations among hospitals in the quality of care for heart failure.
Luthi JC, McClellan WM, Fitzgerald D, Herrin J, Delaney RJ, Krumholz HM, Bratzler DW, Elward K, Cangialose CB, Ballard DJ. Variations among hospitals in the quality of care for heart failure. Effective Clinical Practice : ECP 2000, 3: 69-77. PMID: 10915326.Peer-Reviewed Original ResearchConceptsQuality of careCongestive heart failureLeft ventricular functionHeart failureVentricular functionEnzyme inhibitorsLeft ventricular systolic dysfunctionAngiotensin-converting enzyme inhibitorDaily weight monitoringPercent of patientsVentricular systolic dysfunctionProportion of patientsHospital medical recordsLow sodium dietQuality Improvement ProgramSubstantial hospitalSystolic dysfunctionDischarge medicationsHospital variationDischarge instructionsMedical recordsPractice patternsPatientsTarget doseWeight monitoring