2019
Modeling defibrillation benefit for survival among cardiac resynchronization therapy defibrillator recipients
Bilchick KC, Wang Y, Curtis JP, Cheng A, Dharmarajan K, Shadman R, Dardas TF, Anand I, Lund LH, Dahlström U, Sartipy U, Maggioni A, O'Connor C, Levy WC. Modeling defibrillation benefit for survival among cardiac resynchronization therapy defibrillator recipients. American Heart Journal 2019, 222: 93-104. PMID: 32032927, PMCID: PMC7814502, DOI: 10.1016/j.ahj.2019.12.017.Peer-Reviewed Original ResearchConceptsCRT-D patientsImplantable cardioverter defibrillatorSurvival benefitCRT-DsCardiac resynchronization therapy defibrillator recipientsCardiac resynchronization therapy candidatesSeattle Heart Failure ModelSeattle Proportional Risk ModelCox proportional hazards regressionNational Cardiovascular Data RegistryHeart Failure TrialHeart failure patientsProportional hazards regressionHeart failure modelProportional risk modelFailure patientsCRT candidatesHeart failureCRT pacemakerFailure TrialArrhythmic deathHazards regressionDefibrillator recipientsCRT deviceCardioverter defibrillatorThirty-Day Hospital Readmission After Acute Myocardial Infarction in China
Li J, Dharmarajan K, Bai X, Masoudi FA, Spertus JA, Li X, Zheng X, Zhang H, Yan X, Dreyer RP, Krumholz HM, Group F. Thirty-Day Hospital Readmission After Acute Myocardial Infarction in China. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005628. PMID: 31092023, DOI: 10.1161/circoutcomes.119.005628.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionUnplanned cardiovascular readmissionsDays of dischargeMyocardial infarctionCardiovascular readmissionCause readmissionMost readmissionsLower riskFit Cox proportional hazards modelsST-segment elevation myocardial infarctionAcute Coronary Events (GRACE) scoreThirty-day hospital readmissionsDisease-specific health statusCox proportional hazards modelVentricular ejection fractionProportional hazards modelLow social supportBackground ReadmissionRecurrent anginaCardiovascular eventsHospital complicationsUnplanned readmissionIndex hospitalizationClinical factorsConsecutive patients
2018
Admission diagnoses among patients with heart failure: Variation by ACO performance on a measure of risk-standardized acute admission rates
Benchetrit L, Zimmerman C, Bao H, Dharmarajan K, Altaf F, Herrin J, Lin Z, Krumholz HM, Drye EE, Lipska KJ, Spatz ES. Admission diagnoses among patients with heart failure: Variation by ACO performance on a measure of risk-standardized acute admission rates. American Heart Journal 2018, 207: 19-26. PMID: 30404047, DOI: 10.1016/j.ahj.2018.09.006.Peer-Reviewed Original ResearchMeSH KeywordsAccountable Care OrganizationsAgedAlgorithmsAnalysis of VarianceCardiovascular DiseasesComorbidityFemaleHeart FailureHospitalizationHumansInternational Classification of DiseasesMaleMedicare Part AMedicare Part BPatient AdmissionPatient DischargePatient-Centered CareSex DistributionTime FactorsUnited StatesConceptsHeart failureAccountable care organizationsMean admission rateAdmission ratesAdmission typeAcute admission ratesNoncardiovascular conditionsAdmission diagnosisCause admission ratesMedicare Shared Savings Program Accountable Care OrganizationsRate of hospitalizationPrincipal discharge diagnosisProportion of admissionsType of admissionNoncardiovascular causesHF admissionsHF patientsPerson yearsDischarge diagnosisPatient populationPatientsAdmissionKey quality metricDiagnosisSubstantial proportion
2017
Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease
Lindenauer PK, Dharmarajan K, Qin L, Lin Z, Gershon AS, Krumholz HM. Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease. American Journal Of Respiratory And Critical Care Medicine 2017, 197: 1009-1017. PMID: 29206052, PMCID: PMC5909167, DOI: 10.1164/rccm.201709-1852oc.Peer-Reviewed Original ResearchConceptsChronic obstructive pulmonary diseaseSame respective groupsObstructive pulmonary diseaseVentilator supportPulmonary diseaseRisk of readmissionRisk of hospitalizationGeneral elderly populationGeneral Medicare populationRisk of deathDaily riskRespective groupsReadmission ratesHospital readmissionAbsolute riskMedicare populationReadmissionElderly populationMedicare beneficiariesHospitalizationClinical servicesFirst monthProlonged riskDeathLongitudinal outcomesLength of Stay From the Hospital Perspective
Rosen JE, Salazar MC, Dharmarajan K, Kim AW, Detterbeck FC, Boffa DJ. Length of Stay From the Hospital Perspective. Annals Of Surgery 2017, 266: 383-388. PMID: 27564681, DOI: 10.1097/sla.0000000000001971.Peer-Reviewed Original ResearchConceptsMedian LOSLength of stayEarly discharge practicesDischarge practicesReadmission ratesEarly dischargeCancer-accredited hospitalsNational Cancer DatabaseLung cancer surgeryRisk of readmissionHospital discharge practicesHierarchical logistic regression modelsLack of effectLogistic regression modelsMore readmissionsUnplanned readmissionThoracotomy approachCancer surgeryReadmission riskLung cancerCancer DatabaseInclusion criteriaReadmissionHospital perspectivePatientsQuality 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 rateOutcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study
Dharmarajan K, Qin L, Bierlein M, Choi JES, Lin Z, Desai NR, Spatz ES, Krumholz HM, Venkatesh AK. Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study. The BMJ 2017, 357: j2616. PMID: 28634181, PMCID: PMC5476173, DOI: 10.1136/bmj.j2616.Peer-Reviewed Original ResearchSeattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators
Bilchick KC, Wang Y, Cheng A, Curtis JP, Dharmarajan K, Stukenborg GJ, Shadman R, Anand I, Lund LH, Dahlström U, Sartipy U, Maggioni A, Swedberg K, O’Conner C, Levy WC. Seattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators. Journal Of The American College Of Cardiology 2017, 69: 2606-2618. PMID: 28545633, PMCID: PMC5502749, DOI: 10.1016/j.jacc.2017.03.568.Peer-Reviewed Original ResearchConceptsSeattle Heart Failure ModelSeattle Proportional Risk ModelNational Cardiovascular Data RegistryPrimary prevention ICDsHeart failureSudden deathCause mortalitySurvival benefitMultivariable Cox proportional hazards regressionCox proportional hazards regressionProportional riskProportional hazards regressionRecent clinical trialsHeart failure modelProportional risk modelControl patientsOverall survivalVentricular arrhythmiasHazards regressionICD benefitClinical trialsCardioverter defibrillatorLarge cohortHigh riskData registry
2016
Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions
Desai NR, Ross JS, Kwon JY, Herrin J, Dharmarajan K, Bernheim SM, Krumholz HM, Horwitz LI. Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions. JAMA 2016, 316: 2647-2656. PMID: 28027367, PMCID: PMC5599851, DOI: 10.1001/jama.2016.18533.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramAcute myocardial infarctionReadmission ratesReadmissions Reduction ProgramHeart failurePenalty statusNontarget conditionsMedicare feeMean readmission rateThirty-day riskRetrospective cohort studyUnplanned readmission rateReduction programsHRRP announcementHRRP implementationPenalized hospitalsCohort studyService patientsMyocardial infarctionMAIN OUTCOMEExcess readmissionsMedicare beneficiariesService beneficiariesHospitalPatientsAnalysis 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 ResearchTrajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia
Krumholz HM, Hsieh A, Dreyer RP, Welsh J, Desai NR, Dharmarajan K. Trajectories of Risk for Specific Readmission Diagnoses after Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. PLOS ONE 2016, 11: e0160492. PMID: 27716841, PMCID: PMC5055318, DOI: 10.1371/journal.pone.0160492.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionRisk of readmissionHeart failureReadmission diagnosesHospital dischargeReadmission riskTiming of riskMyocardial infarctionImmediate post-discharge periodDiagnostic categoriesPhysiologic systemsRisk of rehospitalizationGeneral elderly populationRisk of deathPost-discharge periodPost-discharge interventionsTrauma/injuryHospitalization riskHospitalizationTrajectories of riskElderly populationMedicare feePneumoniaRehospitalizationService beneficiariesDeclining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time
Dharmarajan K, Qin L, Lin Z, Horwitz LI, Ross JS, Drye EE, Keshawarz A, Altaf F, Normand SL, Krumholz HM, Bernheim SM. Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time. Health Affairs 2016, 35: 1294-1302. PMID: 27385247, DOI: 10.1377/hlthaff.2015.1614.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCenters for Medicare and Medicaid Services, U.S.Chronic DiseaseDatabases, FactualDisease ProgressionFemaleGeriatric AssessmentHospital MortalityHumansIncidenceLength of StayMaleOutcome Assessment, Health CarePatient AdmissionPatient ReadmissionRetrospective StudiesRisk AssessmentSeverity of Illness IndexTime FactorsUnited States
2015
Sex Differences in the Rate, Timing, and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction
Dreyer RP, Ranasinghe I, Wang Y, Dharmarajan K, Murugiah K, Nuti SV, Hsieh AF, Spertus JA, Krumholz HM. Sex Differences in the Rate, Timing, and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction. Circulation 2015, 132: 158-166. PMID: 26085455, PMCID: PMC5322973, DOI: 10.1161/circulationaha.114.014776.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionPrincipal diagnosisYounger patientsHigh riskUtilization Project State Inpatient DatabasesYoung womenCause readmission rateGreater mortality riskSex differencesNoncardiac diagnosesReadmission diagnosesReadmission timingReadmission ratesInpatient DatabaseReadmission riskFemale sexCondition categoriesReadmissionMortality riskHealthcare costsDay 2InfarctionPatientsDiagnosis
2014
Trends in Hospitalizations Among Medicare Survivors of Aortic Valve Replacement in the United States From 1999 to 2010
Murugiah K, Wang Y, Dodson JA, Nuti SV, Dharmarajan K, Ranasinghe I, Cooper Z, Krumholz HM. Trends in Hospitalizations Among Medicare Survivors of Aortic Valve Replacement in the United States From 1999 to 2010. The Annals Of Thoracic Surgery 2014, 99: 509-517. PMID: 25527425, PMCID: PMC4454375, DOI: 10.1016/j.athoracsur.2014.08.045.Peer-Reviewed Original ResearchConceptsAortic valve replacementValve replacementHospitalization ratesAnnual Medicare paymentsPrincipal diagnosisOne-year hospitalization rateCommon principal diagnosisRisk of hospitalizationMean lengthGeneral Medicare populationMedicare paymentsPostoperative complicationsHeart failureBlack patientsMedicare patientsHospitalizationMedicare populationMedicare beneficiariesMortality ratePatientsStayCumulative daysCumulative lengthCertain subgroupsSurvivorsNational Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010
Chaudhry SI, Khan RF, Chen J, Dharmarajan K, Dodson JA, Masoudi FA, Wang Y, Krumholz HM. National Trends in Recurrent AMI Hospitalizations 1 Year After Acute Myocardial Infarction in Medicare Beneficiaries: 1999–2010. Journal Of The American Heart Association 2014, 3: e001197. PMID: 25249298, PMCID: PMC4323804, DOI: 10.1161/jaha.114.001197.Peer-Reviewed Original Research
2013
Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions
Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI, Barreto-Filho JA, Kim N, Suter LG, Bernheim SM, Drye EE, Krumholz HM. Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions. The BMJ 2013, 347: f6571. PMID: 24259033, PMCID: PMC3898430, DOI: 10.1136/bmj.f6571.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionRetrospective cohort studyReadmission diagnosesReadmission ratesHeart failureMyocardial infarctionCohort studySpecific diagnosisReadmission performanceHospital readmission performancePatterns of readmissionDay readmission rateRisk-standardized readmission ratesLow performing hospitalsHospital performanceHigh performing hospitalsReadmission timingDay readmissionHospital stayIndex admissionHospital dischargeReadmission patternsHospital admissionCommon diagnosisMedian timeDiagnoses 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
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