Risk Adjustment of ICD-10-CM Coded Potential Inpatient Complications Using Administrative Data.

Objective: To risk-adjust the Potential Inpatient Complication (PIC) measure set and propose a method to identify large deviations between observed and expected PIC counts.

Data Sources: Acute inpatient stays from the Premier Healthcare Database from January 1, 2019 to December 31, 2021.

Study Design: In 2014, the PIC list was developed to identify a broader set of potential complications that can occur as a result of care decisions.

Neuro-Ophthalmological Manifestations of Craniosynostosis: Current Perspectives.

Craniosynostosis, a premature fusion of cranial sutures that can be isolated or syndromic, is a congenital defect with a broad, multisystem clinical spectrum. The visual pathway is prone to derangements in patients with craniosynostosis, particularly in syndromic cases, and there is a risk for permanent vision loss when ocular disease complications are not identified and properly treated early in life. Extensive advancements have been made in our understanding of the etiologies underlying vision loss in craniosynostosis over the last 20 years.

A 26-Year-old Woman With Dysuria and Hematuria.

In this case, we present imaging findings characteristic of chronic genitourinary schistosomiasis. Schistosoma haematobium, a blood fluke endemic to Africa and the Middle East, is a prominent cause of hematuria and bladder cancer in regions lacking adequate water sanitation. Luminal calcifications of the genitourinary tract, that is, of the bladder and/or ureters, from deposition of fluke eggs are a classic sign of chronic S.

The plant pathogen enzyme AldC is a long-chain aliphatic aldehyde dehydrogenase.

Aldehyde dehydrogenases are versatile enzymes that serve a range of biochemical functions. Although traditionally considered metabolic housekeeping enzymes because of their ability to detoxify reactive aldehydes, like those generated from lipid peroxidation damage, the contributions of these enzymes to other biological processes are widespread. For example, the plant pathogen strain DC3000 uses an indole-3-acetaldehyde dehydrogenase to synthesize the phytohormone indole-3-acetic acid to elude host responses.

Association of in-hospital resource utilization with post-acute spending in Medicare beneficiaries hospitalized for acute myocardial infarction: a cross-sectional study.

Background: Efforts to decrease hospitalization costs could increase post-acute care costs. This effect could undermine initiatives to reduce overall episode costs and have implications for the design of health care under alternative payment models.

Methods: Among Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with acute myocardial infarction (AMI) between July 2010 and June 2013 in the Premier Healthcare Database, we studied the association of in-hospital and post-acute care resource utilization and outcomes by in-hospital cost tertiles.

The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis.

Purpose: The purpose of the study is to determine the effectiveness of semi-active and active robotic hip and knee arthroplasty on post-operative patient-reported outcomes of function, pain, quality of life and satisfaction with surgery.

Methods: PubMed, Medline, Embase and CENTRAL were searched. Included were comparative studies investigating the effectiveness of semi-active or active robotic hip or knee arthroplasty compared to any other surgical intervention on function, pain, quality of life and satisfaction with surgery.

Hospital Phenotypes in the Management of Patients Admitted for Acute Myocardial Infarction.

Objectives: To characterize hospital phenotypes by their combined utilization pattern of percutaneous coronary interventions (PCI), coronary artery bypass grafting (CABG) procedures, and intensive care unit (ICU) admissions for patients hospitalized for acute myocardial infarction (AMI).

Research Design: Using the Premier Analytical Database, we identified 129,138 hospitalizations for AMI from 246 hospitals with the capacity for performing open-heart surgery during 2010-2013. We calculated year-specific, risk-standardized estimates of PCI procedure rates, CABG procedure rates, and ICU admission rates for each hospital, adjusting for patient clinical characteristics and within-hospital correlation of patients.

Patient Factors Predictive of Hospital Readmissions Within 30 Days.

Background: Under the Affordable Care Act, the Congress has mandated that the Centers for Medicare and Medicaid Services reduce payments to hospitals subject to their Inpatient Prospective Payment System that exhibits excess readmissions. Using hospital-coded discharge abstracts, we constructed a readmission measure that accounts for cross-hospital variation that enables hospitals to monitor their entire inpatient populations and evaluate their readmission rates relative to national benchmarks.

Methods: Multivariate logistic regressions are applied to determine which patient factors increase the odds of a readmission within 30 days and by how much.

The effectiveness of a multicenter quality improvement collaborative in reducing inpatient mortality.

Motivation And Background: This study examines the evidence that a particular quality improvement collaborative that focused on Quality, Efficiency, Safety and Transparency (QUEST) was able to improve hospital performance.

Setting: The collaborative included a range of improvement vehicles, such as sharing customized comparative reports, conducting online best practices forums, using 90-day rapid-cycle initiatives to test specific interventions, and conducting face-to-face meetings and quarterly one-on-one coaching sessions to elucidate opportunities.

Methods: With these kinds of activities in mind, the objective was to test for the presence of an overall "QUEST effect" via statistical analysis of mortality results that spanned 6 years (2006-2011) for more than 600 acute care hospitals from the Premier alliance.

"Phenotyping" hospital value of care for patients with heart failure.

Objective: To characterize hospitals based on patterns of their combined financial and clinical outcomes for heart failure hospitalizations longitudinally.

Data Source: Detailed cost and administrative data on hospitalizations for heart failure from 424 hospitals in the 2005-2011 Premier database.

Study Design: Using a mixture modeling approach, we identified groups of hospitals with distinct joint trajectories of risk-standardized cost (RSC) per hospitalization and risk-standardized in-hospital mortality rate (RSMR), and assessed hospital characteristics associated with the distinct patterns using multinomial logistic regression.

Identifying hospital-wide harm: a set of ICD-9-CM-coded conditions associated with increased cost, length of stay, and risk of mortality.

This study identifies an expanded set of hospital-acquired conditions (HACs), using the Present-On-Admission (POA) indicator and secondary diagnoses present on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded discharge abstracts and evaluates their association with mortality, length of stay (LOS), and cost. A sample of 500 000 de-identified ICD-9-CM-coded discharge abstracts was randomly drawn from a data set of 11 million. A total of 138 secondary condition clusters were identified as potential inpatient complications (PICs).

Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte.

Objective: To assess the association of 0.9% saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery.

Background: 0.

Apples and oranges: comparison of ACS-NSQIP observed outcomes with premier's quality manager-predicted outcomes.

The National Surgical Quality Improvement Program (NSQIP) is used by the American College of Surgeons to measure and report surgical quality and outcomes. Premier's Quality Manager (QM) generates expected outcomes from patient charts. The authors compared observed NSQIP morbidity and mortality outcomes with those predicted by QM.

Making hospital mortality measurement more meaningful: incorporating advance directives and palliative care designations.

Accounting for patients admitted to hospitals at the end of a terminal disease process is key to signaling care quality and identifying opportunities for improvement. This study evaluates the benefits and caveats of incorporating care-limiting orders, such as do not resuscitate (DNR) and palliative care (PC) information, in a general multivariate model of mortality risk, wherein the unit of observation is the patient hospital encounter. In a model of the mortality gap (observed - expected from the baseline model), DNR explains 8% to 24% of the gap variation.