2019
Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition
Venkatesh AK, Chou SC, Li SX, Choi J, Ross JS, D’Onofrio G, Krumholz HM, Dharmarajan K. Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition. JAMA Internal Medicine 2019, 179: 686-693. PMID: 30933243, PMCID: PMC6503571, DOI: 10.1001/jamainternmed.2019.0037.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAsthmaCritical CareCross-Sectional StudiesDatabases, FactualEmergency Service, HospitalFemaleHealth Services AccessibilityHospitalizationHumansInsurance CoverageInsurance, HealthLung DiseasesMaleMedicaidMedically UninsuredMiddle AgedPatient DischargePatient TransferPneumoniaPulmonary Disease, Chronic ObstructiveUnited StatesConceptsNational Emergency Department SampleEmergency Department SampleCommon medical conditionsUninsured patientsCritical care capabilitiesED dischargeED visitsED transfersPulmonary diseaseCare capabilitiesInsurance statusHigher oddsMedicaid beneficiariesMedical conditionsChronic obstructive pulmonary diseaseAcute pulmonary diseaseEmergency department transfersAdult ED visitsHospital admission ratesObstructive pulmonary diseaseEmergency department dispositionPatient insurance statusPatient case mixHospital ownership statusIntensive care capabilities
2016
Treatment 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
2014
Use of Intravenous Diuretics on Day of Discharge in Adults Hospitalized for Heart Failure
Fazel R, Strait KM, Bikdeli B, Dharmarajan K, Krumholz HM. Use of Intravenous Diuretics on Day of Discharge in Adults Hospitalized for Heart Failure. Journal Of Cardiac Failure 2014, 20: 706-707. PMID: 24951932, PMCID: PMC4427892, DOI: 10.1016/j.cardfail.2014.06.354.Peer-Reviewed Original ResearchHospital 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 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 quartile
2013
Spending 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 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 ResearchMeSH KeywordsCohort StudiesCross-Sectional StudiesDatabases, FactualFemaleHeart FailureHospital MortalityHospitalsHumansIntensive Care UnitsMalePatient AdmissionUnited StatesConceptsIntensive 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
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