Associations between published quality ratings of skilled nursing facilities and outcomes of medicare beneficiaries with heart failure.

Introduction: Nursing Home Compare quality ratings are designed to allow patients, families, and clinicians to compare facilities based on quality, but associations of the current measures with important clinical outcomes are not known. Our study examined associations between ratings and readmission and mortality among Medicare beneficiaries admitted to a skilled nursing facility with a primary diagnosis of heart failure.

Methods: We conducted a retrospective cohort study of 164,672 Medicare beneficiaries discharged to skilled nursing facilities after hospitalization for heart failure in 2006-2007.

Bladder augmentation versus urinary diversion in patients with spina bifida in the United States.

Purpose: Augmentation cystoplasty has replaced urinary diversion as the cornerstone of surgical management of refractory neurogenic bladder in patients with spina bifida. Other than single institution series little is known about practice patterns of bladder augmentation vs diversion. Therefore, we characterized the use of bladder augmentation and urinary diversion in patients with spina bifida in a nationally representative, all payer, all ages data set.

Practice variation in the surgical management of urinary lithiasis.

Purpose: Shock wave lithotripsy and ureteroscopy are highly effective treatments for urinary lithiasis. While stone size and location are primary determinants of therapy, little is known about other factors associated with treatment. We identified patient, provider and practice setting characteristics associated with the selection of ureteroscopy or shock wave lithotripsy.

Do heart failure disease management programs make financial sense under a bundled payment system?

Background: Policy makers have proposed bundling payments for all heart failure (HF) care within 30 days of an HF hospitalization in an effort to reduce costs. Disease management (DM) programs can reduce costly HF readmissions but have not been economically attractive for caregivers under existing fee-for-service payment. Whether a bundled payment approach can address the negative financial impact of DM programs is unknown.

Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure.

Background: Heart failure (HF) is the leading cause of hospitalization among older Americans. Subsequent discharge to skilled nursing facilities (SNF) is not well described.

Methods And Results: We performed an observational analysis of Medicare beneficiaries ≥65 years of age, discharged alive to SNF or home after ≥3-day hospitalization for HF in 2005 and 2006 within the Get With The Guidelines-HF Program.

Non-evidence-based ICD implantations in the United States.

Context: Practice guidelines do not recommend use of an implantable cardioverter-defibrillator (ICD) for primary prevention in patients recovering from a myocardial infarction or coronary artery bypass graft surgery and those with severe heart failure symptoms or a recent diagnosis of heart failure.

Objective: To determine the number, characteristics, and in-hospital outcomes of patients who receive a non-evidence-based ICD and examine the distribution of these implants by site, physician specialty, and year of procedure.

Design, Setting, And Patients: Retrospective cohort study of cases submitted to the National Cardiovascular Data Registry-ICD Registry between January 1, 2006, and June 30, 2009.

Incremental value of clinical data beyond claims data in predicting 30-day outcomes after heart failure hospitalization.

Background: Administrative claims data are used routinely for risk adjustment and hospital profiling for heart failure outcomes. As clinical data become more readily available, the incremental value of adding clinical data to claims-based models of mortality and readmission is unclear.

Methods And Results: We linked heart failure hospitalizations from the Get With The Guidelines-Heart Failure registry with Medicare claims data for patients discharged between January 1, 2004, and December 31, 2006.

Assessment of left ventricular function in older Medicare beneficiaries with newly diagnosed heart failure.

Background: Assessment of left ventricular function is a recommended performance measure for the care of patients with newly diagnosed heart failure. Little is known about the extent to which left ventricular function is assessed in real-world settings.

Methods And Results: We analyzed a 5% national sample of data from the Centers for Medicare and Medicaid Services from 1991 through 2008.

Generalizability and longitudinal outcomes of a national heart failure clinical registry: Comparison of Acute Decompensated Heart Failure National Registry (ADHERE) and non-ADHERE Medicare beneficiaries.

Background: Clinical registries are used increasingly to analyze quality and outcomes, but the generalizability of findings from registries is unclear.

Methods: We linked data from the Acute Decompensated Heart Failure National Registry (ADHERE) to 100% fee-for-service Medicare claims data. We compared patient characteristics and inpatient mortality of linked and unlinked ADHERE hospitalizations; patient characteristics, readmission, and postdischarge mortality of linked ADHERE patients to a random 20% sample of Medicare beneficiaries hospitalized for heart failure; and characteristics of Medicare sites participating and not participating in ADHERE.

Geographic variation and trends in carotid imaging among medicare beneficiaries, 2001 to 2006.

Background: Diagnostic imaging among Medicare beneficiaries is an important contributor to rising health care costs. We examined temporal trends and geographic variation in the use of carotid ultrasound, carotid magnetic resonance angiography (MRA), and carotid x-ray angiography.

Methods And Results: Analysis of a 5% national sample of claims from the Centers for Medicare and Medicaid Services for 1999 through 2006.

Risks of mortality, myocardial infarction, bleeding, and stroke associated with therapies for age-related macular degeneration.

Objective: To examine associations between therapies for age-related macular degeneration and risks of all-cause mortality, incident myocardial infarction, bleeding, and incident stroke.

Methods: We conducted a retrospective cohort study of 146,942 Medicare beneficiaries 65 years or older with a claim for age-related macular degeneration between January 1, 2005, and December 31, 2006. On the basis of claims for the initial treatment, we assigned beneficiaries to 1 of 4 groups.

Resource use in the last 6 months of life among patients with heart failure in Canada.

Background: Heart failure (HF) is a debilitating and chronic condition associated with significant morbidity and mortality. However, much less is known about end-of-life (EOL) costs among patients with HF.

Methods: To examine trends in resource use and costs during the last 6 months of life among elderly patients with HF, we evaluated data regarding all patients 65 years or older with HF who died between January 1, 2000, to December 31, 2006, in Alberta, Canada, and examined costs associated with all-cause hospitalizations, intensive care, emergency department visits, outpatient visits, physician office visits, and outpatient drugs in the 180 days before death.

Resource use in the last 6 months of life among medicare beneficiaries with heart failure, 2000-2007.

Background: Heart failure is a common cause of death among Medicare beneficiaries, but little is known about health care resource use at the end of life.

Methods: In a retrospective cohort study of 229,543 Medicare beneficiaries with heart failure who died between January 1, 2000, and December 31, 2007, we examined resource use in the last 180 days of life, including all-cause hospitalizations, intensive care unit days, skilled nursing facility stays, home health, hospice, durable medical equipment, outpatient physician visits, and cardiac procedures. We calculated overall costs to Medicare and predictors of costs.

Successful linking of the Society of Thoracic Surgeons adult cardiac surgery database to Centers for Medicare and Medicaid Services Medicare data.

Background: The Centers for Medicare and Medicaid Services (CMS) Medicare database complements The Society of Thoracic Surgeons (STS) database by providing information about long-term outcomes and cost. This study demonstrates the feasibility of linking STS data to CMS data and examines the penetration, completeness, and representativeness of the STS database.

Methods: Using variables common to both STS and CMS databases, STS operations were linked to CMS data for all CMS coronary artery bypass graft surgery (CABG) hospitalizations discharged between 2000 and 2007, inclusive.

Geographic variation in carotid revascularization among Medicare beneficiaries, 2003-2006.

Background: Little is known about patterns in the use of carotid revascularization since a 2004 Medicare national coverage decision supporting carotid artery stenting. We examined geographic variation in and predictors of carotid endarterectomy and carotid stenting.

Methods: Analysis of claims from the Centers for Medicare & Medicaid Services from January 1, 2003, through December 31, 2006.

Use of guideline-recommended therapies for heart failure in the Medicare population.

Background: Most information about the use of guideline-recommended therapies for heart failure reflects what occurred at discharge after an inpatient stay.

Hypothesis: Using a nationally representative, community-dwelling sample of elderly Medicare beneficiaries, we examined how the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and beta-blockers has changed and factors associated with their use.

Methods: Using data from the Medicare Current Beneficiary Survey cost and use files matched with Medicare claims data, we identified beneficiaries for whom a diagnosis of heart failure was reported between January 1, 2000, and December 31, 2004.

Associations between worsening renal function and 30-day outcomes among Medicare beneficiaries hospitalized with heart failure.

Background: Kidney disease is common among patients with heart failure, but relationships between worsening renal function (WRF) and outcomes after hospitalization for heart failure are poorly understood, especially among patients with preserved systolic function. We examined associations between WRF and 30-day readmission, mortality, and costs among Medicare beneficiaries hospitalized with heart failure.

Methods: We linked data from a clinical heart failure registry to Medicare inpatient claims for patients >or=65 years old hospitalized with heart failure.

Long-term outcomes of medicare beneficiaries with worsening renal function during hospitalization for heart failure.

We examined whether worsening renal function (RF) was associated with long-term mortality, readmission, and inpatient costs in Medicare beneficiaries hospitalized with heart failure (HF). Baseline renal insufficiency in patients hospitalized for HF is associated with increased risk of morbidity and mortality. However, the relation between worsening RF and long-term clinical outcomes is unclear.

Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure.

Context: Readmission after hospitalization for heart failure is common. Early outpatient follow-up after hospitalization has been proposed as a means of reducing readmission rates. However, there are limited data describing patterns of follow-up after heart failure hospitalization and its association with readmission rates.

Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999-2006.

Context: Emerging technologies, changing diagnostic and treatment patterns, and changes in Medicare reimbursement are contributing to increasing use of imaging in cancer. Imaging is the fastest growing expense for Medicare but has not been examined among beneficiaries with cancer.

Objective: To examine changes in the use of imaging and how those changes contribute to the overall cost of cancer care.

Clopidogrel use and clinical events after drug-eluting stent implantation: findings from the HealthCore Integrated Research Database.

Background: Relationships between long-term use and level of dual antiplatelet therapy and outcomes after drug-eluting stent implantation are not well established.

Methods: This is a retrospective cohort study of 9,256 patients receiving drug-eluting stents between January 2003 and August 2006. We classified patients according to tertiles of clopidogrel use during the 12 months after stent implantation.

Relationships between emerging measures of heart failure processes of care and clinical outcomes.

Background: Previous studies have not confirmed associations between some current performance measures for inpatient heart failure processes of care and postdischarge outcomes. It is unknown if alternative measures are associated with outcomes.

Methods: Using data for 20,441 Medicare beneficiaries in OPTIMIZE-HF from March 2003 through December 2004, which we linked to Medicare claims data, we examined associations between hospital-level processes of care and patient outcomes.

Process of care performance measures and long-term outcomes in patients hospitalized with heart failure.

Background: Recent efforts to improve care for patients hospitalized with heart failure have focused on process-based performance measures. Data supporting the link between current process measures and patient outcomes are sparse.

Objective: To examine the relationship between adherence to hospital-level process measures and long-term patient-level mortality and readmission.

Costs of inpatient care among Medicare beneficiaries with heart failure, 2001 to 2004.

Background: Inpatient care is the primary driver of costs for patients with heart failure. It is unclear whether recent advances in heart failure care have reduced the costs to Medicare for the care of inpatients with heart failure.

Methods And Results: In a retrospective cohort study of 1 363 977 elderly Medicare beneficiaries hospitalized with heart failure between January 1, 2001, and December 31, 2004, we examined costs to Medicare for all inpatient care, inpatient cardiovascular care, and inpatient heart failure care and the adjusted relationships between patient characteristics and costs.