Publications by authors named "ZhenQiu Lin"
Background: Isolated subsegmental pulmonary embolism (issPE) is a commonly encountered diagnosis. Although the International Classification of Diseases (ICD)-10 codes are used for research, their validity for identifying issPE is unknown. Moreover, issPE diagnosis is challenging, and the findings from radiology reports may conflict with those from expert radiologists.
View Article and Find Full Text PDFAims: Alcohol consumption along with negative sequelae from excess alcohol intake increased during the COVID-19 pandemic. We evaluated the association between binge alcohol use and long-term functional outcomes among COVID-19-positive individuals.
Methods: Using a prospective, longitudinal, multisite cohort study design, we evaluated the association between binge alcohol use and mental and physical functional outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS)-29 scores three and six months postinfection.
Background: Elective primary total hip and total knee arthroplasty (collectively, total joint arthroplasties [TJAs]) are commonly performed procedures that can reduce pain and improve function. TJAs are generally safe, but complications can occur. Although historically performed as inpatient procedures, TJAs are increasingly being performed in the outpatient setting.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates sex differences in treatment approaches for pulmonary embolism (PE) among older adults, revealing that existing evidence on disparities is limited and often inconclusive due to small sample sizes and inadequate methods.
- Analysis of data from a European PE registry and US Medicare beneficiaries shows no significant overall sex differences in the use of anticoagulation or advanced therapies, although fewer women received fibrinolytic therapy compared to men with intermediate-risk PE.
- The authors suggest that future research should explore whether the observed sex disparities in treatment correlate with different clinical outcomes, especially regarding fibrinolytic therapy and advanced treatment utilization in older adults in the US.
Background: Many research investigations for pulmonary embolism (PE) rely on the International Classification of Diseases 10th Revision (ICD-10) codes for analyses of electronic databases. The validity of ICD-10 codes in identifying PE remains uncertain.
Objectives: The objective of this study was to validate an algorithm to efficiently identify pulmonary embolism using ICD-10 codes.
Background: Digital remote patient monitoring (RPM) enables longitudinal care outside traditional healthcare settings, especially in the vulnerable period after hospitalizations, with broad coverage of the service by payers. We sought to evaluate patterns of RPM service availability at US hospitals and the association of these services with 30-day readmissions for two key cardiovascular conditions, heart failure (HF) and acute myocardial infarction (AMI).
Methods: We used contemporary national data from the American Hospital Association (AHA) Annual Survey to ascertain US hospitals offering RPM services for post-discharge or chronic care and used census-based county-level data to define the characteristics of the communities they serve.
Background: The lack of automated tools for measuring care quality limits the implementation of a national program to assess guideline-directed care in heart failure with reduced ejection fraction (HFrEF).
Objectives: The authors aimed to automate the identification of patients with HFrEF at hospital discharge, an opportunity to evaluate and improve the quality of care.
Methods: The authors developed a novel deep-learning language model for identifying patients with HFrEF from discharge summaries of hospitalizations with heart failure at Yale New Haven Hospital during 2015 to 2019.
Background/objective: The Centers for Medicare & Medicaid Services (CMS) Overall Hospital Quality Star Rating, established in 2016, is a summary of publicly available quality information for acute care hospitals. In July 2023, Veterans Health Administration (VHA) hospitals became eligible to receive a CMS Overall Hospital Quality Star Rating for the first time. Our objective was to compare performance in quality ratings among VHA and non-VHA hospitals.
View Article and Find Full Text PDFArticle Synopsis
- The research highlights significant racial and ethnic disparities in excess mortality during the COVID-19 pandemic, revealing a concerning trend concerning minoritized populations who faced greater mortality rates compared to pre-pandemic disparities.!* -
- A comprehensive analysis of over 10.6 million death certificates from March 2020 to May 2023 indicated that more than 1.38 million excess deaths occurred, representing around 23 million years of potential life lost.!* -
- The findings emphasize the need for further investigation into the age-specific impact of COVID-19 on various racial and ethnic groups to better understand and address these health disparities moving forward.!*
Race, Ethnicity, and Gender Differences in Patient Reported Well-Being and Cognitive Functioning Within 3 Months of Symptomatic Illness During COVID-19 Pandemic.
J Racial Ethn Health Disparities
August 2024
Article Synopsis
- This study investigates how race, ethnicity, and gender affect long-term health-related quality of life in individuals who tested positive for COVID-19, focusing on changes in well-being over a three-month period.
- Among COVID-19 positive participants, Black individuals showed better cognitive function and reduced fatigue compared to non-Hispanic Whites, while females and gender diverse groups reported worse overall well-being and less improvement in fatigue.
- The findings suggest that social constructs, such as race, ethnicity, and gender, play a significant role in COVID-19 health outcomes, highlighting the need for further research in this area.
Article Synopsis
- This study analyzed data from the National Cardiovascular Data Registry to evaluate how the volume of atrial fibrillation (AF) ablation procedures performed by hospitals and physicians affects procedural success and major adverse events (MAEs).
- Results showed that hospitals and physicians with higher procedural volumes had better success rates (98.5% success) and lower rates of complications (1.0% MAE), indicating that experience matters in these medical procedures.
- Specifically, lower volume hospitals (Q1) had a significantly reduced likelihood of success and an increased risk of complications, suggesting that a minimum annual volume of about 190 for hospitals and 60 for physicians is important for optimal patient outcomes.
Procedure Volume and Outcomes With WATCHMAN Left Atrial Appendage Occlusion.
Circ Cardiovasc Interv
June 2024
Article Synopsis
- Higher hospital and physician volumes of WATCHMAN left atrial appendage occlusion procedures correlate with better procedural success, indicating that experience may influence outcomes.
- An analysis of over 87,000 patients revealed a 94.2% success rate overall, with lower success rates seen in lower-volume hospitals and physicians.
- The newer WATCHMAN FLX device showed improved success rates and reduced variability in outcomes across different volume categories compared to earlier models.
Importance: The Centers for Medicare & Medicaid Services (CMS) Overall Star Rating is widely used by patients and consumers, and there is continued stakeholder curiosity surrounding the inclusion of a peer grouping step, implemented to the 2021 Overall Star Rating methods.
Objective: To calculate hospital star rating scores with and without the peer grouping step, with the former approach stratifying hospitals into 3-, 4-, and 5-measure group peer groups based on the number of measure groups with at least 3 reported measures.
Design, Setting, And Participants: This cross-sectional study used Care Compare website data from January 2023 for 3076 hospitals that received a star rating in 2023.
Article Synopsis
- The study aimed to investigate whether the quality of hospitals before the pandemic influenced the survival rates of Medicare patients hospitalized with COVID-19.
- Researchers analyzed in-hospital and 30-day mortality rates in relation to pre-pandemic hospital quality, finding that better-rated hospitals had significantly lower mortality rates.
- Results showed that patients in lower-rated hospitals, specifically those with one star, faced much higher odds of dying either during their hospital stay or within 30 days of discharge compared to those in five-star hospitals.
Importance: Equity is an essential domain of health care quality. The Centers for Medicare & Medicaid Services (CMS) developed 2 Disparity Methods that together assess equity in clinical outcomes.
Objectives: To define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value).
Article Synopsis
- Patient-reported outcome-based performance measures (PRO-PMs) can improve assessments of healthcare performance but face several implementation challenges.
- In May 2023, a review revealed that there are currently 54 active PRO-PM instances in CMS programs, indicating some level of utilization.
- The study identified five key principles (clinical relevance, adequate sample size, performance variance, equity, and risk adjustment) that must be prioritized to enhance the development and use of PRO-PMs in alternative payment models.
Article Synopsis
- The study addresses the challenge of assessing care quality for heart failure patients, specifically those with reduced ejection fraction (HFrEF), due to a lack of automated measurement tools at hospital discharge.
- Researchers developed a deep learning language model that identifies HFrEF patients from discharge summaries using a semi-supervised approach, validated with hospital data from Yale New Haven Hospital and external institutions.
- The model demonstrated high performance, achieving AUROC values of up to 0.97 in detecting HFrEF, effectively improving the identification of these patients and potentially enhancing care quality.
Article Synopsis
- Selected treatments for type 2 diabetes, specifically GLP-1 receptor agonists and SGLT-2 inhibitors, offer heart protection but require regular usage to be effective.
- A study of over 587,000 patients showed that only about 13.6% and 11.5% were prescribed GLP-1RAs and SGLT-2is, with only around 52.5% of these patients maintaining consistent use over the first year.
- Patients with commercial insurance were more likely to fill prescriptions consistently compared to those on Medicare Advantage, highlighting disparities in medication adherence and the need for improved access.
Article Synopsis
- The study explores the controversial issue of adjusting quality measures for social risk factors in pay-for-performance healthcare programs, specifically focusing on acute admissions for patients with multiple chronic conditions (MCCs).
- Utilizing Medicare claims data and community surveys from 2013-2019, the research analyzed a large cohort of Medicare beneficiaries aged 65 and older with at least two chronic conditions.
- Findings revealed a median risk-standardized measure score related to acute hospital admissions, emphasizing the impact of social risk factors such as low socioeconomic status, limited access to specialists, and dual Medicare-Medicaid eligibility on healthcare outcomes.
Background: Contemporary pulmonary embolism (PE) research, in many cases, relies on data from electronic health records (EHRs) and administrative databases that use International Classification of Diseases (ICD) codes. Natural language processing (NLP) tools can be used for automated chart review and patient identification. However, there remains uncertainty with the validity of ICD-10 codes or NLP algorithms for patient identification.
View Article and Find Full Text PDFSevere Fatigue and Persistent Symptoms at 3 Months Following Severe Acute Respiratory Syndrome Coronavirus 2 Infections During the Pre-Delta, Delta, and Omicron Time Periods: A Multicenter Prospective Cohort Study.
Clin Infect Dis
June 2023
Article Synopsis
- A study examined the prevalence of prolonged symptoms in COVID-19 patients three months after infection, focusing on three variant periods: pre-Delta, Delta, and Omicron.
- Almost 20% of COVID-positive participants experienced prolonged symptoms, with those infected pre-Delta showing the most severe fatigue and symptoms compared to Delta and Omicron cohorts.
- However, when considering vaccination status, the significant differences in symptoms across variant periods diminished, indicating vaccination may play a protective role against long-term effects.
Importance: Long-term sequelae after symptomatic SARS-CoV-2 infection may impact well-being, yet existing data primarily focus on discrete symptoms and/or health care use.
Objective: To compare patient-reported outcomes of physical, mental, and social well-being among adults with symptomatic illness who received a positive vs negative test result for SARS-CoV-2 infection.
Design, Setting, And Participants: This cohort study was a planned interim analysis of an ongoing multicenter prospective longitudinal registry study (the Innovative Support for Patients With SARS-CoV-2 Infections Registry [INSPIRE]).
Background: Procedural complications limit the clinical benefit of transcatheter left atrial appendage occlusion (LAAO). Next-generation devices incorporate design modifications intended to improve procedural safety, but their clinical impact has not been described.
Objectives: The aim of this study was to compare in-hospital outcomes for the Watchman FLX with the predicate Watchman 2.
Article Synopsis
- The study aims to introduce a new way to measure disparities at the hospital level by focusing on continuous polysocial risk factors and their impact on patient outcomes.
- It analyzed Medicare data for patients aged 65 and older, focusing on hospital readmissions for common conditions, using methods that improve upon traditional measurements of social risk.
- The results suggest that this novel approach provides a more nuanced understanding of disparities across hospitals and helps identify provider-level outcomes that better reflect social risk profiles.