Association Between Preventive Dental Care and Healthcare Cost for Enrollees With Diabetes or Coronary Artery Disease: 5-Year Experience.

Background: Evidence of preventive dental care impacting healthcare costs among diabetes or coronary artery disease (CAD) patients is sparse.

Methods: This study examined the association between healthcare costs and adherence with preventive dental care protocols among diabetes and CAD patients in a dental plan affiliated with a large commercial health plan in Arkansas. These patients were auto-enrolled in a program with additional benefits at no cost, and support from medical and dental care management teams was evaluated.

Impact of advance care planning consults on advance directives completion.

Objectives: Advance care planning (ACP) consults have been credited with increasing the likelihood that patients will receive desired care at the end of life, including reduced hospitalization and spending. We aimed to investigate whether implementation of ACP consults leads to improved advance directive (AD) completion rates.

Study Design: Retrospective case-control evaluation.

REadmission PREvention in SepSis: Development and Validation of a Prediction Model.

Hospital 30-day readmissions remain a major quality and cost indicator. Traditional readmission risk scores, such as LACE (length of stay, acuity of admission, Charlson comorbidity index, and emergency department visits), may be suboptimal in special patient populations, such as those with sepsis. As sepsis survivorship improves, there is a need to determine which variables might be associated with a decrease in 30-day readmission.

Do all outpatient spine surgeries cost the same? Comparison of economic outcomes data from a state-level database for outpatient lumbar decompression performed in an ambulatory surgery center or hospital outpatient setting.

Objective: Spinal procedures are increasingly conducted as outpatient procedures, with a growing proportion conducted in ambulatory surgery centers (ASCs). To date, studies reporting outcomes and cost analyses for outpatient spinal procedures in the US have not distinguished the various outpatient settings from each other. In this study, the authors used a state-level administrative database to compare rates of overnight stays and nonroutine discharges as well as index admission charges and cumulative 7-, 30-, and 90-day charges for patients undergoing outpatient lumbar decompression in freestanding ASCs and hospital outpatient (HO) settings.

Incidence and risk factors for prolonged postoperative opioid use following lumbar spine surgery: a cohort study.

Objective: Sustained postoperative opioid use after elective surgery is a matter of growing concern. Herein, the authors investigated incidence and predictors of long-term opioid use among patients undergoing elective lumbar spine surgery, especially as a function of opioid prescribing practices at postoperative discharge (dose in morphine milligram equivalents [MMEs] and type of opioid).

Methods: The OptumLabs Data Warehouse (OLDW) was queried for postdischarge opioid prescriptions for patients undergoing elective lumbar decompression and discectomy (LDD) or posterior lumbar fusion (PLF) for degenerative spine disease.

Variations in Postoperative Opioid Prescription Practices and Impact on Refill Prescriptions Following Lumbar Spine Surgery.

Objective: Understanding postsurgical prescribing patterns and their impact on persistent opioid use is important for establishing reasonable opioid prescribing protocols. We aimed to determine national variation in postoperative opioid prescription practices following elective lumbar spine surgery and their impact on short-term refill prescriptions.

Methods: The OptumLabs Data Warehouse was queried from 2016 to 2017 for adults undergoing anterior lumbar fusion, posterior lumbar fusion, circumferential lumbar fusion, and lumbar decompression/discectomy for degenerative spine disease.

Can AM-PAC "6-Clicks" Inpatient Functional Assessment Scores Strengthen Hospital 30-Day Readmission Prevention Strategies?

Background Prevention of unplanned hospital readmissions remains a priority in the US healthcare sector. Patient functional status has evolved as an important factor in identifying patients at risk for unplanned readmissions and poor predischarge functional performance has been shown to be predictive of increased readmission risk. Yet, patient functional status appears to be underutilized in readmission prediction models.

Outcomes of a Nursing Home-to-Community Care Transition Program.

Objectives: Most transitional care initiatives to reduce rehospitalization have focused on the transition that occurs between a patient's hospital discharge and return home. However, many patients are discharged from a skilled nursing facility (SNF) to their homes. The goal was to evaluate the effectiveness of the Mayo Clinic Care Transitions (MCCT) program (hereafter called program) among patients discharged from SNFs to their homes.

Using machine learning to improve the accuracy of patient deterioration predictions: Mayo Clinic Early Warning Score (MC-EWS).

Objective: We aimed to develop a model for accurate prediction of general care inpatient deterioration.

Materials And Methods: Training and internal validation datasets were built using 2-year data from a quaternary hospital in the Midwest. Model training used gradient boosting and feature engineering (clinically relevant interactions, time-series information) to predict general care inpatient deterioration (resuscitation call, intensive care unit transfer, or rapid response team call) in 24 hours.

Functional Outcomes and Health-Related Quality of Life Before and After Primary Total Knee Replacement for Patients From Diverse Geographic Regions.

Background: The purpose of this study was to investigate whether patient-reported knee function and health status before and after primary total knee replacement (TKR) at an academic medical center differs among patients from diverse geographic regions.

Methods: We assessed patient-reported outcomes (PROs) as measured by the Oxford Knee Score (OKS) and EuroQoL-5D (EQ-5D) in 2855 TKR patients at preprimary and one year postprimary TKR procedure between January 1, 2012 and June 30, 2014. We compared the demographic characteristics, response rates, and changes in OKS, EQ-5D, and EQ visual analog scale among local, regional, and national patient groups.

Screening for Diabetic Retinopathy with a Nonmydriatic Ultra-Wide-Field Retina Camera by Family Medicine Physicians.

Purpose: Diabetic retinopathy (DR) is the leading cause of blindness among working-aged adults aged 20 to 74 years. Despite professional association guidelines that recommend yearly screening for DR, only about 60% of Americans with diabetes mellitus (DM) receive annual examinations. The purpose of this 2-phase study was to determine the ability of family medicine (FM) physicians to accurately interpret retinal images of patients with DM.

Use of a Computerized Algorithm to Evaluate the Proportion and Causes of Potentially Preventable Readmissions Among Patients Discharged to Skilled Nursing Facilities.

Objectives: Older patients discharged to skilled nursing facilities (SNFs) for post-acute care are at high risk for hospital readmission. Yet, as in the community setting, some readmissions may be preventable with optimal transitional care. This study examined the proportion of 30-day hospital readmissions from SNFs that could be considered potentially preventable readmissions (PPRs) and evaluated the reasons for these readmissions.

Do safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome?

Introduction: Safety-net hospitals provide care to a substantial share of disadvantaged patient populations. Whether disparities exist between safety-net hospitals and their counterparts in performing emergent neurosurgical procedures has not yet been examined.

Objective: We used the Nationwide Inpatient Sample (NIS), a national all-payer inpatient healthcare database, to determine whether safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome (CES).

Disparities in inpatient costs and outcomes after elective anterior cervical discectomy and fusion at safety-net hospitals.

Introduction: Characterizing disparities that exist at safety-net hospitals is crucial for crafting national healthcare reform policies. Healthcare disparities in performing elective neurosurgical procedures like anterior cervical discectomy and fusion (ACDF) at safety-net hospitals have not yet been examined.

Objective: We use the National Inpatient Sample (NIS), a national all-payer healthcare database of inpatient admissions, to determine whether safety-net hospitals can provide equitable care after elective ACDF.

Hospital robotic use for colorectal cancer care.

The use of robotic surgery for colorectal cancer continues to increase. However, not all organizations offer patients the option of robotic intervention. This study seeks to understand organizational characteristics associated with the utilization of robotic surgery for colorectal cancer.

Impact of a Program to Improve Venous Thromboembolism Prophylaxis on Incidence of Thromboembolism and Bleeding Rates in Hospitalized Patients During Implementation of Programs to Improve Venous Thromboembolism Prophylaxis.

Objective: To study the impact of multiphase quality improvement efforts to enhance appropriate use of chemical and mechanical venous thromboembolism (VTE) prophylaxis (VTEP) on the rate of hospital-acquired VTE and determine whether efforts have been associated with increased bleeding complications.

Patients And Methods: All adult inpatients discharged between January 1, 2005, and December 31, 2015, were included in the study. Retrospective interrupted time series analysis compared VTEP performance, VTE outcomes, and unintended consequences (derived from linked administrative and clinical data) across 5 improvement phases: baseline (January 1, 2005-December 31, 2006), paper order set phase (January 1, 2007-February 9, 2009), electronic order set phase (February 10, 2009-December 16, 2009), active reminder phase (December 17, 2009-May 31, 2012), and maintenance phase (June 1, 2012-September 30, 2015).

Neuro R score: Predicting high-risk neurologic readmissions within 30 days.

Objective: To evaluate clinical and demographic factors of patients with neurologic disorders to determine which patient characteristics are significant for predicting 30-day hospital readmissions to develop a readmission risk predictor specific to patients with neurologic disorders.

Methods: We performed a retrospective single-center chart review for all patients admitted to the Department of Neurology or neurologic intensive care unit from January 1, 2013, to December 31, 2017. Clinical and demographic factors were analyzed to determine the association with readmission.

Impact of Patient Stage and Disease Characteristics on the proposed Radiation Oncology Alternative Payment Model (RO-APM).

Purpose: The proposed Radiation Oncology Alternative Payment Model (RO-APM) released on July 10, 2019, represents a dramatic shift from fee-for-service (FFS) reimbursement in radiation therapy (RT). This study compares historical revenue at Mayo Clinic to the RO-APM and quantifies the effect that disease characteristics may have on reimbursement.

Methods And Materials: FFS Medicare reimbursements were determined for patients undergoing RT at Mayo Clinic from 2015 to 2016.

An Investigation of Healthcare Worker Perception of Their Workplace Safety and Incidence of Injury.

Managing the safety climate in health care is a promising tool for improving employee and patient safety in the health care work environment. Gaps in the theoretical and conceptual underpinnings of safety climate, as well as the evidence base for its practical application in health care remain. The purpose of this study was to evaluate the number of work injuries occurring in health care work units and associated safety climate beliefs.

Impact of Psychiatric Comorbidities on Health Care Costs Among Patients With Cancer.

Background: Psychiatric disorders are common in cancer patients and impact outcomes. Impact on cancer care cost needs study to develop business case for psychosocial interventions.

Objective: To evaluate the impact of preexisting psychiatric comorbidities on total cost of care during 6 months after cancer diagnosis.

Detection of Surgical Site Infection Utilizing Automated Feature Generation in Clinical Notes.

Postsurgical complications (PSCs) are known as a deviation from the normal postsurgical course and categorized by severity and treatment requirements. Surgical site infection (SSI) is one of major PSCs and the most common healthcare-associated infection, resulting in increased length of hospital stay and cost. In this work, we proposed an automated way to generate keyword features using sublanguage analysis with heuristics to detect SSI from cohort in clinical notes and evaluated these keywords with medical experts.

Deep learning and alternative learning strategies for retrospective real-world clinical data.

In recent years, there is increasing enthusiasm in the healthcare research community for artificial intelligence to provide big data analytics and augment decision making. One of the prime reasons for this is the enormous impact of deep learning for utilization of complex healthcare big data. Although deep learning is a powerful analytic tool for the complex data contained in electronic health records (EHRs), there are also limitations which can make the choice of deep learning inferior in some healthcare applications.

Identifying the Most Costly Patients in Radiation Oncology and Predicting the Top Spenders.

Purpose: Quality payment programs aim to adjust payments on the basis of quality and cost; however, few quality metrics exist in radiation oncology. This study evaluates and predicts the top spenders (TS) after radiation therapy (RT).

Materials And Methods: Patient characteristics, cancer details, treatments, toxicity, and survival data were collected for patients treated with RT at Mayo Clinic from 2007 to 2016.

Factors Associated With Minimally Invasive Surgery for Colorectal Cancer in Emergency Settings.

Background: Minimally invasive surgery (MIS) is associated with improved colorectal cancer (CRC) outcomes, but it is used less frequently in emergency settings. We aimed to assess patient-level factors associated with emergency presentation for CRC and the use of MIS in emergency versus elective settings.

Methods: This retrospective study examined the clinical data of patients who underwent emergency and elective resections for CRC from 2013 to 2015 using the Florida Inpatient Discharge Dataset.