2019
Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization
Weerahandi H, Bao H, Herrin J, Dharmarajan K, Ross JS, Jones S, Horwitz LI. Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization. Journal Of The American Geriatrics Society 2019, 68: 96-102. PMID: 31603248, PMCID: PMC6964248, DOI: 10.1111/jgs.16179.Peer-Reviewed Original ResearchConceptsSkilled nursing facilitiesHF hospitalizationReadmission ratesReadmission riskHeart failure readmission ratesDays of dischargeHeart failure hospitalizationRetrospective cohort studyHospital discharge practicesMore functional impairmentHome health careFailure hospitalizationHF patientsUnplanned readmissionCohort studyHospital dischargePrimary outcomeRestorative therapySNF stayFunctional impairmentHome healthcare servicesService Medicare dataAdjusted modelCox modelNursing facilitiesThirty-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 patientsRisk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study
Weerahandi H, Li L, Bao H, Herrin J, Dharmarajan K, Ross JS, Kim KL, Jones S, Horwitz LI. Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study. Journal Of The American Medical Directors Association 2019, 20: 432-437. PMID: 30954133, PMCID: PMC6486375, DOI: 10.1016/j.jamda.2019.01.135.Peer-Reviewed Original ResearchConceptsSkilled nursing facilitiesSNF dischargeRetrospective cohort studySNF lengthHeart failureHF hospitalizationComposite outcomeCohort studyNursing facilitiesService beneficiaries 65Heart failure hospitalizationRisk of readmissionHazard rate ratiosFailure hospitalizationUnplanned readmissionHF diagnosisHospital dischargePostdischarge outcomesSNF stayMedicare patientsMedicare feeHome transitionPatientsReadmissionDay 3Relationship Between Patient-Reported Hospital Experience and 30-Day Mortality and Readmission Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia
Dong N, Eisenberg JD, Dharmarajan K, Spatz ES, Desai NR. Relationship Between Patient-Reported Hospital Experience and 30-Day Mortality and Readmission Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia. Journal Of General Internal Medicine 2019, 34: 526-528. PMID: 30746641, PMCID: PMC6446004, DOI: 10.1007/s11606-018-4746-6.Peer-Reviewed Original Research
2018
Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act
Angraal S, Khera R, Zhou S, Wang Y, Lin Z, Dharmarajan K, Desai NR, Bernheim SM, Drye EE, Nasir K, Horwitz LI, Krumholz HM. Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act. The American Journal Of Medicine 2018, 131: 1324-1331.e14. PMID: 30016636, PMCID: PMC6380174, DOI: 10.1016/j.amjmed.2018.06.013.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overFemaleHumansMaleMedicareOdds RatioPatient Protection and Affordable Care ActPatient ReadmissionRisk FactorsUnited StatesConceptsHospital Readmissions Reduction ProgramReadmission ratesAcute myocardial infarctionHeart failurePatient groupMyocardial infarctionCause readmission rateNationwide Readmissions DatabaseReadmissions Reduction ProgramNon-Medicare patientsNon-target conditionsLower readmissionAffordable Care ActMedicare beneficiariesAge groupsPrivate insuranceCare ActPneumoniaInfarctionPatientsReduction programsMedicareGroupReadmissionFailureAssociation of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia
Khera R, Dharmarajan K, Wang Y, Lin Z, Bernheim SM, Wang Y, Normand ST, Krumholz HM. Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia. JAMA Network Open 2018, 1: e182777. PMID: 30646181, PMCID: PMC6324473, DOI: 10.1001/jamanetworkopen.2018.2777.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramAcute myocardial infarctionPostdischarge mortalityHeart failureHRRP announcementReadmissions Reduction ProgramMedicare beneficiariesRisk-adjusted ratesMyocardial infarctionService Medicare beneficiariesReduction programsInterrupted time series frameworkHospital mortalityReduced readmissionsCohort studyPneumonia hospitalizationsReadmission ratesMAIN OUTCOMEPneumoniaMedicare dataHospitalizationHospitalMortalityReadmissionConcomitant harmRising Mortality in Patients With Heart Failure in the United States Facts Versus Fiction
Khera R, Dharmarajan K, Krumholz HM. Rising Mortality in Patients With Heart Failure in the United States Facts Versus Fiction. JACC Heart Failure 2018, 6: 610-612. PMID: 29914774, DOI: 10.1016/j.jchf.2018.02.011.Commentaries, Editorials and LettersIs Posthospital Syndrome a Result of Hospitalization-Induced Allostatic Overload?
Goldwater DS, Dharmarajan K, McEwan BS, Krumholz HM. Is Posthospital Syndrome a Result of Hospitalization-Induced Allostatic Overload? Journal Of Hospital Medicine 2018, 13 PMID: 29813141, DOI: 10.12788/jhm.2986.Peer-Reviewed Original ResearchConceptsPosthospital syndromeAllostatic overloadAutonomic nervous systemMultiple organ systemsHospital dischargeInflammatory markersAdverse eventsHospital readmissionAdrenal axisAdverse outcomesPlausible etiologyPathophysiologic consequencesElevated riskNervous systemNarrative reviewOrgan systemsEnhanced vulnerabilityElevated levelsHospital environmentTraditional hospital environmentSyndromeMaladaptive statesOverloadOutcomesPossible mechanismReply to Soo Hoo and Esquinas: Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease: Don’t Shortchange Noninvasive Ventilation
Lindenauer PK, Dharmarajan K, Krumholz HM. Reply to Soo Hoo and Esquinas: Risk Trajectories of Readmission and Death in the First Year after Hospitalization for Chronic Obstructive Pulmonary Disease: Don’t Shortchange Noninvasive Ventilation. American Journal Of Respiratory And Critical Care Medicine 2018, 198: 283-284. PMID: 29566340, PMCID: PMC6058983, DOI: 10.1164/rccm.201803-0426le.Peer-Reviewed Original ResearchEvaluating Readmission—Need for More Clarity on Methods
Krumholz HM, Dharmarajan K, Normand ST. Evaluating Readmission—Need for More Clarity on Methods. JAMA Cardiology 2018, 3: 265. PMID: 29450464, DOI: 10.1001/jamacardio.2017.5321.Peer-Reviewed Original Research
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 outcomesConsequences of Reductions in Hospital Readmissions—Reply
Dharmarajan K, Krumholz HM. Consequences of Reductions in Hospital Readmissions—Reply. JAMA 2017, 318: 1934-1934. PMID: 29164250, DOI: 10.1001/jama.2017.14799.Peer-Reviewed Original ResearchHumansPatient ReadmissionHospital-Readmission Risk — Isolating Hospital Effects from Patient Effects
Krumholz HM, Wang K, Lin Z, Dharmarajan K, Horwitz LI, Ross JS, Drye EE, Bernheim SM, Normand ST. Hospital-Readmission Risk — Isolating Hospital Effects from Patient Effects. New England Journal Of Medicine 2017, 377: 1055-1064. PMID: 28902587, PMCID: PMC5671772, DOI: 10.1056/nejmsa1702321.Peer-Reviewed Original ResearchMeSH KeywordsAgedHospitalsHumansOutcome Assessment, Health CarePatient ReadmissionQuality Indicators, Health CareRisk AdjustmentUnited StatesConceptsRisk-standardized readmission ratesReadmission ratesObserved readmission ratesSimilar diagnosesHospital effectsDifferent hospitalsHospital readmission performanceRate of readmissionHospital readmission ratesLower readmission ratesStudy sampleYears of ageSignificant differencesMultiple admissionsReadmission outcomesOnly significant differencePatient effectsSame patientMedicare recipientsPatientsReadmission performanceRisk-standardized hospital readmission ratesHospitalHospital qualityQuartileLength 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 perspectivePatientsRegional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling
Bottle A, Ventura CM, Dharmarajan K, Aylin P, Ieva F, Paganoni AM. Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling. Health Care Management Science 2017, 21: 292-304. PMID: 28755175, DOI: 10.1007/s10729-017-9410-x.Peer-Reviewed Original ResearchConceptsHeart failureClinical practice differencesMedium-term mortalityHospital administrative databaseSerious chronic conditionsNon-hospital settingsSet of patientsHF admissionsCommon comorbiditiesFirst admissionLondon patientsDeath RegisterHigh morbidityChronic conditionsAdministrative databasesDisease progressionPatientsLower mortalityMortalityAdmissionPractice differencesShort stayLong stayHealthcare systemHospitalisationReductions in Readmission Rates Are Associated With Modest Improvements in Patient-reported Health Gains Following Hip and Knee Replacement in England
Friebel R, Dharmarajan K, Krumholz HM, Steventon A. Reductions in Readmission Rates Are Associated With Modest Improvements in Patient-reported Health Gains Following Hip and Knee Replacement in England. Medical Care 2017, 55: 834-840. PMID: 28742545, PMCID: PMC5555974, DOI: 10.1097/mlr.0000000000000779.Peer-Reviewed Original ResearchConceptsRisk-adjusted readmission ratesReadmission ratesEQ-VASHealth gainsEQ-5DKnee replacementHip replacementOxford Hip ScoreOxford Knee ScorePatient-reported healthPatient-reported outcomesVisual analog scaleKnee replacement surgeryReadmission reduction initiativesHealth care systemAdditional health gainsHip scoreKnee scoreAnalog scalePresurgical assessmentReplacement surgeryPatients' senseHospital groupModest ImprovementPatient healthAssociation of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge
Dharmarajan K, Wang Y, Lin Z, Normand ST, Ross JS, Horwitz LI, Desai NR, Suter LG, Drye EE, Bernheim SM, Krumholz HM. Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge. JAMA 2017, 318: 270-278. PMID: 28719692, PMCID: PMC5817448, DOI: 10.1001/jama.2017.8444.Peer-Reviewed Original ResearchConceptsRisk-adjusted readmission ratesRisk-adjusted mortality ratesAcute myocardial infarctionHeart failureReadmission ratesMortality rateMyocardial infarctionMedicare feeService beneficiariesHospital readmission ratesMean hospitalHospital mortalityPostdischarge mortalityHospital dischargeHospital readmissionRetrospective studyAffordable Care ActReadmission reductionMAIN OUTCOMEPneumoniaHospitalSecondary analysisWeighted Pearson correlation coefficientMortalityCare ActOutcomes 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 ResearchSex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia
Dreyer RP, Dharmarajan K, Hsieh AF, Welsh J, Qin L, Krumholz HM. Sex Differences in Trajectories of Risk After Rehospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003271. PMID: 28506980, PMCID: PMC5650228, DOI: 10.1161/circoutcomes.116.003271.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionMyocardial infarctionHeart failureReadmission riskDaily riskImmediate postdischarge periodRisk of rehospitalizationSex differencesDeath 1 yearPrincipal discharge diagnosisHospitalization of patientsAssociation of sexRehospitalization riskPostdischarge periodDischarge diagnosisMedicare patientsHigh riskMortality riskMedicare feeTrajectories of riskRehospitalizationInfarctionService beneficiariesHospitalizationPneumoniaSex Differences in 1-Year All-Cause Rehospitalization in Patients After Acute Myocardial Infarction
Dreyer RP, Dharmarajan K, Kennedy KF, Jones PG, Vaccarino V, Murugiah K, Nuti SV, Smolderen KG, Buchanan DM, Spertus JA, Krumholz HM. Sex Differences in 1-Year All-Cause Rehospitalization in Patients After Acute Myocardial Infarction. Circulation 2017, 135: 521-531. PMID: 28153989, PMCID: PMC5312975, DOI: 10.1161/circulationaha.116.024993.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseFemaleHumansMaleMiddle AgedMyocardial InfarctionPatient ReadmissionProspective StudiesSex FactorsConceptsAcute myocardial infarctionAge-sex interactionHigh riskRehospitalization ratesClinical factorsMyocardial infarctionCox proportional hazards modelSignificant age-sex interactionCause rehospitalization rateSex differencesMedical record abstractionProportional hazards modelYears of ageFirst yearTRIUMPH studyCause rehospitalizationRecord abstractionPatient interviewsRehospitalizationUS CentersHazards modelPsychosocial factorsPhysician panelHealth statusPsychosocial state