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
2019
Comparative 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
Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization
Horwitz LI, Wang Y, Altaf FK, Wang C, Lin Z, Liu S, Grady J, Bernheim SM, Desai NR, Venkatesh AK, Herrin J. Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization. Medical Care 2018, 56: 281-289. PMID: 29462075, PMCID: PMC6170884, DOI: 10.1097/mlr.0000000000000882.Peer-Reviewed Original ResearchMeSH KeywordsCross-Sectional StudiesEmergency Service, HospitalFee-for-Service PlansHeart FailureHospital AdministrationHospitals, PublicHumansMedicareMyocardial InfarctionNursing Staff, HospitalOwnershipPatient ReadmissionPneumoniaResidence CharacteristicsRetrospective StudiesSafety-net ProvidersUnited StatesConceptsAcute care utilizationAcute myocardial infarctionHeart failureCare utilizationAcute careMyocardial infarctionHospital characteristicsNet hospitalExcess daysPublic hospitalsNonsafety net hospitalsHigher readmission ratesEmergency department utilizationProportion of hospitalsAcute care hospitalsSafety-net hospitalService Medicare beneficiariesLarge urban hospitalMajor teaching hospitalType of hospitalCross-sectional analysisPostdischarge utilizationHospital dischargeHospital factorsReadmission ratesEffect of Hospital Readmission Reduction on Patients at Low, Medium, and High Risk of Readmission in the Medicare Population
Blecker S, Herrin J, Kwon JY, Grady JN, Jones S, Horwitz LI. Effect of Hospital Readmission Reduction on Patients at Low, Medium, and High Risk of Readmission in the Medicare Population. Journal Of Hospital Medicine 2018, 13: 537-543. PMID: 29455229, PMCID: PMC6063766, DOI: 10.12788/jhm.2936.Peer-Reviewed Original ResearchMeSH KeywordsAgedFee-for-Service PlansFemaleHospitalizationHumansMaleMedicarePatient ReadmissionRetrospective StudiesUnited States
2017
Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015
Salerno AM, Horwitz LI, Kwon JY, Herrin J, Grady JN, Lin Z, Ross JS, Bernheim SM. Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015. BMJ Open 2017, 7: e016149. PMID: 28710221, PMCID: PMC5541519, DOI: 10.1136/bmjopen-2017-016149.Peer-Reviewed Original ResearchConceptsHospital Readmissions Reduction ProgramNon-safety net hospitalsSafety-net hospitalMedicare administrative claims dataReadmission ratesAdministrative claims dataNet hospitalReadmissions Reduction ProgramRetrospective time series analysisSafety netClaims dataTime series analysisSocioeconomic statusUnplanned readmission ratePrincipal discharge diagnosisLow socioeconomic statusInterrupted time seriesReduction programsFive-digit zip codeSeries analysisHRRP penaltiesIndex admissionHospital proportionDischarge diagnosisService patientsHospital Characteristics Associated With Risk-standardized Readmission Rates
Horwitz LI, Bernheim SM, Ross JS, Herrin J, Grady JN, Krumholz HM, Drye EE, Lin Z. Hospital Characteristics Associated With Risk-standardized Readmission Rates. Medical Care 2017, 55: 528-534. PMID: 28319580, PMCID: PMC5426655, DOI: 10.1097/mlr.0000000000000713.Peer-Reviewed Original Research
2015
Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data
Horwitz LI, Grady JN, Cohen DB, Lin Z, Volpe M, Ngo CK, Masica AL, Long T, Wang J, Keenan M, Montague J, Suter LG, Ross JS, Drye EE, Krumholz HM, Bernheim SM. Development and Validation of an Algorithm to Identify Planned Readmissions From Claims Data. Journal Of Hospital Medicine 2015, 10: 670-677. PMID: 26149225, PMCID: PMC5459369, DOI: 10.1002/jhm.2416.Peer-Reviewed Original ResearchMeSH KeywordsAgedAlgorithmsFee-for-Service PlansHospitals, VoluntaryHumansInsurance Claim ReviewMedicarePatient ReadmissionSensitivity and SpecificityUnited StatesConceptsSame-hospital readmissionsNegative predictive valuePositive predictive valuePredictive valueReadmission measuresHospital-wide readmission measureGold standard chart reviewAdministrative claims-based algorithmDiagnostic cardiac catheterizationClaims-based algorithmLarge teaching centersAcute care hospitalsSmall community hospitalUnplanned readmissionChart reviewCardiac catheterizationScheduled careSpecificity 96.5Community hospitalReadmissionClaims dataCardiac devicesHealth systemTeaching centerPublic reporting
2014
Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission.
Horwitz LI, Partovian C, Lin Z, Grady JN, Herrin J, Conover M, Montague J, Dillaway C, Bartczak K, Suter LG, Ross JS, Bernheim SM, Krumholz HM, Drye EE. Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission. Annals Of Internal Medicine 2014, 161: s66-75. PMID: 25402406, PMCID: PMC4235629, DOI: 10.7326/m13-3000.Peer-Reviewed Original ResearchConceptsUnplanned readmissionReadmission measuresReadmission ratesReadmission riskMedicare feeHospital-wide readmission measureRisk-standardized readmission ratesPayer dataAdministrative Claims MeasureRisk-standardized ratesAverage-risk patientsUnplanned readmission rateDays of dischargeHospital risk-standardized readmission ratesAdult hospitalizationsComorbid conditionsPrincipal diagnosisClaims dataService claimsService beneficiariesReadmissionMeasure development studiesMedicaid ServicesRisk adjustmentHospital
2010
The performance of US hospitals as reflected in risk‐standardized 30‐day mortality and readmission rates for medicare beneficiaries with pneumonia
Lindenauer PK, Bernheim SM, Grady JN, Lin Z, Wang Y, Wang Y, Merrill AR, Han LF, Rapp MT, Drye EE, Normand S, Krumholz HM. The performance of US hospitals as reflected in risk‐standardized 30‐day mortality and readmission rates for medicare beneficiaries with pneumonia. Journal Of Hospital Medicine 2010, 5: e12-e18. PMID: 20665626, DOI: 10.1002/jhm.822.Peer-Reviewed Original ResearchConceptsRisk-standardized mortality ratesReadmission ratesHospital referral regionsReferral regionsMedicare beneficiariesMortality rateRisk-standardized readmission ratesNonfederal acute care hospitalsNational quality improvement effortsPattern of hospitalAcute care hospitalsCross-sectional studyService Medicare beneficiariesQuality improvement effortsMedian hospitalHospital dischargeElderly patientsHospital admissionCare hospitalReadmission analysisOutpatient MedicareLeading causePrincipal diagnosisPneumoniaPatients