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 Research
2019
Substantial Differences Between Cohorts of Patients Hospitalized With Heart Failure in Canada and the United States
Lin Z, Li SX. Substantial Differences Between Cohorts of Patients Hospitalized With Heart Failure in Canada and the United States. JAMA Cardiology 2019, 4: 1178-1179. PMID: 31532467, DOI: 10.1001/jamacardio.2019.3314.Peer-Reviewed Original ResearchDevelopment 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 ResearchConceptsAcute 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 OUTCOMEComparative Effectiveness of New Approaches to Improve Mortality Risk Models From Medicare Claims Data
Krumholz HM, Coppi AC, Warner F, Triche EW, Li SX, Mahajan S, Li Y, Bernheim SM, Grady J, Dorsey K, Lin Z, Normand ST. Comparative Effectiveness of New Approaches to Improve Mortality Risk Models From Medicare Claims Data. JAMA Network Open 2019, 2: e197314. PMID: 31314120, PMCID: PMC6647547, DOI: 10.1001/jamanetworkopen.2019.7314.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionICD-9-CM codesMortality risk modelHeart failureHospital admissionC-statisticMAIN OUTCOMEMortality rateRisk-standardized mortality ratesHospital risk-standardized mortality ratesIndex admission diagnosisPatients 65 yearsDays of hospitalizationComparative effectiveness studiesClaims-based dataHospital-level performance measuresMedicare claims dataPatient-level modelsCMS modelRisk-adjustment modelsRisk modelHospital performance measuresAdmission diagnosisNinth RevisionMyocardial infarction
2018
Quantifying the utilization of medical devices necessary to detect postmarket safety differences: A case study of implantable cardioverter defibrillators
Bates J, Parzynski CS, Dhruva SS, Coppi A, Kuntz R, Li S, Marinac‐Dabic D, Masoudi FA, Shaw RE, Warner F, Krumholz HM, Ross JS. Quantifying the utilization of medical devices necessary to detect postmarket safety differences: A case study of implantable cardioverter defibrillators. Pharmacoepidemiology And Drug Safety 2018, 27: 848-856. PMID: 29896873, PMCID: PMC6436550, DOI: 10.1002/pds.4565.Peer-Reviewed Original ResearchConceptsAdverse event ratesSafety differencesEvent ratesMedical device utilizationICD utilizationRate ratioNational Cardiovascular Data RegistryICD modelsImplantable cardioverter defibrillatorEvent rate ratioMost patientsCardioverter defibrillatorProportion of individualsAmerican CollegeData registryRoutine surveillanceSample size estimatesAverage event rateDevice utilizationSignificance levelDifferencesPatientsRegistryDefibrillatorICD
2016
Analysis of Machine Learning Techniques for Heart Failure Readmissions
Mortazavi BJ, Downing NS, Bucholz EM, Dharmarajan K, Manhapra A, Li SX, Negahban SN, Krumholz HM. Analysis of Machine Learning Techniques for Heart Failure Readmissions. Circulation Cardiovascular Quality And Outcomes 2016, 9: 629-640. PMID: 28263938, PMCID: PMC5459389, DOI: 10.1161/circoutcomes.116.003039.Peer-Reviewed Original ResearchTreatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure
Dharmarajan K, Strait KM, Tinetti ME, Lagu T, Lindenauer PK, Lynn J, Krukas MR, Ernst FR, Li SX, Krumholz HM. Treatment for Multiple Acute Cardiopulmonary Conditions in Older Adults Hospitalized with Pneumonia, Chronic Obstructive Pulmonary Disease, or Heart Failure. Journal Of The American Geriatrics Society 2016, 64: 1574-1582. PMID: 27448329, PMCID: PMC4988873, DOI: 10.1111/jgs.14303.Peer-Reviewed Original ResearchMeSH KeywordsAdrenal Cortex HormonesAgedAged, 80 and overAnti-Bacterial AgentsCardiotonic AgentsCohort StudiesComorbidityCross-Sectional StudiesDiureticsDrug Therapy, CombinationFemaleHeart FailureHospitalizationHumansMalePneumoniaPulmonary Disease, Chronic ObstructiveRetrospective StudiesUnited StatesVasodilator AgentsConceptsChronic obstructive pulmonary diseaseAcute cardiopulmonary conditionsObstructive pulmonary diseaseHeart failureCardiopulmonary conditionsOlder adultsPulmonary diseasePremier Research DatabaseEpisodes of pneumoniaRetrospective cohort studyReal-world treatmentHF hospitalizationCohort studyHospital daysPneumonia hospitalizationsCOPD hospitalizationsClinical syndromeAcute conditionsPneumoniaDiagnostic uncertaintyResearch DatabaseHospitalizationDiagnostic categoriesU.S. hospitalsAdults
2015
Intravenous Fluids in Acute Decompensated Heart Failure
Bikdeli B, Strait KM, Dharmarajan K, Li SX, Mody P, Partovian C, Coca SG, Kim N, Horwitz LI, Testani JM, Krumholz HM. Intravenous Fluids in Acute Decompensated Heart Failure. JACC Heart Failure 2015, 3: 127-133. PMID: 25660836, PMCID: PMC4438991, DOI: 10.1016/j.jchf.2014.09.007.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCohort StudiesDatabases, FactualFemaleFluid TherapyHeart FailureHospital MortalityHospitalizationHumansInfusions, IntravenousIntensive Care UnitsIntubation, IntratrachealIsotonic SolutionsMaleMiddle AgedRenal Replacement TherapyRetrospective StudiesRinger's SolutionSaline Solution, HypertonicSodium Potassium Chloride Symporter InhibitorsUnited StatesYoung AdultConceptsAcute decompensated heart failureDecompensated heart failureHeart failureIntravenous fluidsRetrospective cohort studyCritical care admissionRenal replacement therapyDays of hospitalizationProportion of hospitalizationsHalf-normal salineWarrants further investigationOnly diureticsCare admissionHospital deathHospital outcomesCohort studyLoop diureticsPatient groupReplacement therapyWorse outcomesNormal salineInpatient careMedian volumePatientsHospitalization
2014
“Phenotyping” Hospital Value of Care for Patients with Heart Failure
Xu X, Li S, Lin H, Normand S, Kim N, Ott LS, Lagu T, Duan M, Kroch EA, Krumholz HM. “Phenotyping” Hospital Value of Care for Patients with Heart Failure. Health Services Research 2014, 49: 2000-2016. PMID: 24974769, PMCID: PMC4254136, DOI: 10.1111/1475-6773.12197.Peer-Reviewed Original ResearchConceptsLower mortalityHeart failureHeart failure hospitalizationHospital mortality rateLonger hospital stayIntensive care unitDistinct joint trajectoriesValue of careFailure hospitalizationHospital stayCare unitClinical outcomesGroup of hospitalsHospital characteristicsHospital careHospital patternsSurgical proceduresMultinomial logistic regressionMortality rateHigh mortalityHospitalHospitalizationMortalityLogistic regressionHospital ValueNational Patterns of Risk-Standardized Mortality and Readmission After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia: Update on Publicly Reported Outcomes Measures Based on the 2013 Release
Suter LG, Li SX, Grady JN, Lin Z, Wang Y, Bhat KR, Turkmani D, Spivack SB, Lindenauer PK, Merrill AR, Drye EE, Krumholz HM, Bernheim SM. National Patterns of Risk-Standardized Mortality and Readmission After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia: Update on Publicly Reported Outcomes Measures Based on the 2013 Release. Journal Of General Internal Medicine 2014, 29: 1333-1340. PMID: 24825244, PMCID: PMC4175654, DOI: 10.1007/s11606-014-2862-5.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesAcute myocardial infarctionHeart failurePneumonia mortalityMyocardial infarctionMedian risk-standardized mortality rateHospital-level mortalityUnplanned readmission ratePrincipal discharge diagnosisHospital performanceRisk-Standardized MortalityHF mortalityReadmission resultsReadmission ratesDischarge diagnosisOutcome measuresAMI mortalityReadmission measuresPneumoniaMortality rateService MedicareHierarchical logistic modelsMortalityMedicaid ServicesReadmissionHospital 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
2013
Acute Decompensated Heart Failure Is Routinely Treated as a Cardiopulmonary Syndrome
Dharmarajan K, Strait KM, Lagu T, Lindenauer PK, Tinetti ME, Lynn J, Li SX, Krumholz HM. Acute Decompensated Heart Failure Is Routinely Treated as a Cardiopulmonary Syndrome. PLOS ONE 2013, 8: e78222. PMID: 24250751, PMCID: PMC3824040, DOI: 10.1371/journal.pone.0078222.Peer-Reviewed Original ResearchConceptsDecompensated heart failureHeart failureRespiratory therapyHospital daysCardiopulmonary syndromeAcute decompensated heart failureAcute heart failure treatmentChronic obstructive pulmonary diseaseReceipt of medicationHeart failure hospitalizationHigh-dose corticosteroidsHospital day 2Hospital day 3Half of patientsChronic lung diseaseDays of hospitalizationHeart failure treatmentObstructive pulmonary diseaseShortness of breathIntensive care unitPrincipal discharge diagnosisLate intubationAcute asthmaFailure hospitalizationHospital deathContraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure
Dharmarajan K, Masoudi FA, Spertus JA, Li SX, Krumholz HM. Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure. JAMA Internal Medicine 2013, 173: 1547-1549. PMID: 23797379, PMCID: PMC4043342, DOI: 10.1001/jamainternmed.2013.7717.Peer-Reviewed Original ResearchPatterns of Change in Nesiritide Use in Patients With Heart Failure How Hospitals React to New Information
Partovian C, Li SX, Xu X, Lin H, Strait KM, Hwa J, Krumholz HM. Patterns of Change in Nesiritide Use in Patients With Heart Failure How Hospitals React to New Information. JACC Heart Failure 2013, 1: 318-324. PMID: 24621935, PMCID: PMC5322944, DOI: 10.1016/j.jchf.2013.04.005.Peer-Reviewed Original ResearchConceptsHeart failureNesiritide useHospital characteristicsHospital groupDecompensated heart failureProportion of hospitalizationsPatterns of changeMultivariate regression analysisPatient characteristicsEarly reliefHospital patternsHospitalTeaching statusPremier databaseMedical evidenceHospitalizationPatientsRegression analysisSafety concernsLow usersUse ratesGroupFailureFurther researchDyspneaSpending 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 ResearchDominance of Furosemide for Loop Diuretic Therapy in Heart Failure Time to Revisit the Alternatives?
Bikdeli B, Strait KM, Dharmarajan K, Partovian C, Coca SG, Kim N, Li SX, Testani JM, Khan U, Krumholz HM. Dominance of Furosemide for Loop Diuretic Therapy in Heart Failure Time to Revisit the Alternatives? Journal Of The American College Of Cardiology 2013, 61: 1549-1550. PMID: 23500272, PMCID: PMC4038646, DOI: 10.1016/j.jacc.2012.12.043.Peer-Reviewed Original ResearchVariation Exists in Rates of Admission to Intensive Care Units for Heart Failure Patients Across Hospitals in the United States
Safavi KC, Dharmarajan K, Kim N, Strait KM, Li SX, Chen SI, Lagu T, Krumholz HM. Variation Exists in Rates of Admission to Intensive Care Units for Heart Failure Patients Across Hospitals in the United States. Circulation 2013, 127: 923-929. PMID: 23355624, PMCID: PMC3688061, DOI: 10.1161/circulationaha.112.001088.Peer-Reviewed Original ResearchConceptsIntensive care unitHeart failureRisk-standardized mortalityICU admissionICU useCare unitPatient outcomesCoronary intensive care unitMedical intensive care unitNoninvasive positive pressure ventilationSurgical intensive care unitTop quartileGreater ICU useOverall heart failureTop quartile hospitalsICU admission ratePercent of patientsPremier Perspective databaseHeart failure patientsPositive pressure ventilationRate of admissionHigh-cost settingsQuality of careHF admissionsICU days
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 useProcedure 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