Assessment of HF Outcomes Using a Claims-Based Frailty Index

Shashikumar, Sukruth A; Luke, Alina A.; Johnston, Kenton J.; Maddox, Karen E. Joynt

doi:10.1016/j.jchf.2019.12.012

Cited by 13 publications

(18 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other designs included mixed, cross-sectional, and qualitative methods. Among the studies that developed, used, or studied outcome measure sets, 20 studies validated these outcomes in clinical practice [ 39 – 41 , 43 , 44 , 46 – 54 , 60 , 63 , 65 – 67 , 69 ].…”

Section: Resultsmentioning

confidence: 99%

“…As Quality of Life (QoL) is evaluated and reported by patients and includes measures that are relatively visible, their inclusion in the outcome sets of VBHC was very common, particularly in this theme ( n = 24) [ 40 , 41 , 43 , 44 , 46 , 52 , 53 , 56 – 59 , 61 – 66 , 70 – 76 ]. To ensure the inclusion of outcomes that the patients value most, the studies used a combination of generic and disease/condition-specific tools to measure QoL that covered multiple domains such as mental, functional, social, physical, and other aspects of health status.…”

Section: Resultsmentioning

confidence: 99%

“…The reported case-mix variables can be clustered into three main groups: demographics (e.g., age, sex, race/ethnicity, educational level), baseline clinical factors, and comorbidities (e.g., body mass index, family history, medical conditions, diabetes mellitus, hypertension, renal failure) as well as treatment variables (e.g., medications, surgeries, interventions). Measuring these variables at baseline (i.e., first clinical encounter) was used in all studies that measured them [ 39 , 41 – 44 , 46 – 51 , 54 , 57 – 66 , 68 , 70 – 72 , 74 , 75 ]. Another two studies recommended including frailty score and stroke severity in risk adjustment for heart failure and acute ischemic stroke patients, respectively [ 41 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…Measuring these variables at baseline (i.e., first clinical encounter) was used in all studies that measured them [ 39 , 41 – 44 , 46 – 51 , 54 , 57 – 66 , 68 , 70 – 72 , 74 , 75 ]. Another two studies recommended including frailty score and stroke severity in risk adjustment for heart failure and acute ischemic stroke patients, respectively [ 41 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…In our review, it was found that administrative data were the least frequently used source for outcome measurement, and they were limited to measures such as survival and mortality [ 40 , 41 , 43 , 45 , 50 , 52 , 56 – 61 , 64 – 66 , 69 – 72 , 75 , 76 ]. Data reported by clinicians and patients were more frequently used in the studies reviewed.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Quality measurement for cardiovascular diseases and cancer in hospital value-based healthcare: a systematic review of the literature

Abdalla

Pavlova

Hussein

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

Background This systematic literature review identifies hospital value-based healthcare quality measures, measurement practices, and tools, as well as potential strategies for improving cardiovascular diseases and cancer care. Methods A systematic search was carried out in the PubMed, Embase, CINAHL, and MEDLINE (OvidSP) databases. We included studies on quality measures in hospital value-based healthcare for cardiovascular diseases and cancer. Two reviewers independently screened titles and abstracts, conducted a full-text review of potentially relevant articles, assessed the quality of included studies, and extracted data thematically. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and four validated tools were used for methodological quality assessment. Results The search yielded 2860 publications. After screening the titles and abstracts, 60 articles were retrieved for full-text review. A total of 37 studies met our inclusion criteria. We found that standardized outcome sets with patient involvement were developed for some cardiovascular diseases and cancer. Despite the heterogeneity in outcome measures, there was consensus to include clinical outcomes on survival rate and disease control, disutility of care, and patient-reported outcome measures such as long-term quality of life. Conclusion Hospitals that developed value-based healthcare or are planning to do so can choose whether they prefer to implement the standardized outcomes step-by-step, collect additional measures, or develop their own set of measures. However, they need to ensure that their performance can be consistently compared to that of their peers and that they measure what prioritizes and maximizes value for their patients. Trial registration PROSPERO ID: CRD42021229763.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Quality measurement for cardiovascular diseases and cancer in hospital value-based healthcare: a systematic review of the literature

Abdalla

Pavlova

Hussein

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

Association of Hospital Participation in Bundled Payments for Care Improvement Advanced With Medicare Spending and Hospital Incentive Payments

Shashikumar

Gulseren

Berlin

et al. 2022

JAMA

Self Cite

View full text Add to dashboard Cite

ImportanceBundled Payments for Care Improvement Advanced (BPCI-A) is a Centers for Medicare &amp; Medicaid Services (CMS) initiative that aims to produce financial savings by incentivizing decreases in clinical spending. Incentives consist of financial bonuses from CMS to hospitals or penalties paid by hospitals to CMS.ObjectiveTo investigate the association of hospital participation in BPCI-A with spending, and to characterize hospitals receiving financial bonuses vs penalties.Design, Setting, and ParticipantsDifference-in-differences and cross-sectional analyses of 4 754 139 patient episodes using 2013-2019 US Medicare claims at 694 participating and 2852 nonparticipating hospitals merged with hospital and market characteristics.ExposuresBPCI-A model years 1 and 2 (October 1, 2018, through December 31, 2019).Main Outcomes and MeasuresHospitals’ per-episode spending, CMS gross and net spending, and the incentive allocated to each hospital.ResultsThe study identified 694 participating hospitals. The analysis observed a −$175 change in mean per-episode spending (95% CI, −$378 to $28) and an aggregate spending change of −$75.1 million (95% CI, −$162.1 million to $12.0 million) across the 428 670 episodes in BPCI-A model years 1 and 2. However, CMS disbursed $354.3 million (95% CI, $212.0 million to $496.0 million) more in bonuses than it received in penalties. Hospital participation in BPCI-A was associated with a net loss to CMS of $279.2 million (95% CI, $135.0 million to $423.0 million). Hospitals in the lowest quartile of Medicaid days received a mean penalty of $0.41 million; (95% CI, $0.09 million to $0.72 million), while those in the highest quartile received a mean bonus of $1.57 million; (95% CI, $1.09 million to $2.08 million). Similar patterns were observed for hospitals across increasing quartiles of Disproportionate Share Hospital percentage and of patients from racial and ethnic minority groups.Conclusions and RelevanceAmong US hospitals measured between 2013 and 2019, participation in BPCI-A was significantly associated with an increase in net CMS spending. Bonuses accrued disproportionately to hospitals providing care for marginalized communities.

show abstract

Outcomes Following Surgical and Nonsurgical Treatment for Uncomplicated Appendicitis in Older Adults

Ashbrook,

McGing,

Cheng

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceThe optimal treatment of acute uncomplicated appendicitis in older adults with frailty is not defined.ObjectiveTo examine outcomes associated with treatment strategies for acute uncomplicated appendicitis in older adults with or without frailty.Design, Setting, and ParticipantsThis retrospective cohort study used National Inpatient Sample data from adults 65 years or older with a diagnosis of uncomplicated appendicitis from January 1, 2016, to December 31, 2018. Data were analyzed from July to November 2023. The National Inpatient Sample database approximates a 20% stratified sample of all inpatient hospital discharges in the US.ExposuresStudy patients were categorized into 3 groups: nonoperative management, immediate operation, and delayed operation.Main Outcomes and MeasuresClinical outcomes, including hospital complications and in-hospital mortality, were assessed among older adults with and without frailty, identified using an adapted claims-based frailty index.ResultsA total of 24 320 patients were identified (median [IQR] age, 72 [68-79] years; 50.9% female). Of those, 7290 (30.0%) were categorized as having frailty. Overall, in-hospital mortality was 1.4%, and the incidence of complications was 37.3%. In patients with frailty, multivariable analysis showed both nonoperative management (odds ratio [OR], 2.89; 95% CI, 1.40-5.98; P &lt; .001) and delayed appendectomy (OR, 3.80; 95% CI, 1.72-8.43; P &lt; .001) were associated with increased in-hospital mortality compared with immediate appendectomy. In patients without frailty, immediate appendectomy was associated with increased hospital complications compared with nonoperative management (OR, 0.77; 95% CI, 0.64-0.94; P = .009) and lower hospital complications compared with delayed appendectomy (OR, 2.05; 95% CI, 1.41-3.00; P &lt; .001).Conclusions and RelevanceIn this cohort study of older adults with uncomplicated appendicitis, outcomes differed among management strategies based on frailty status. Routine frailty assessments incorporated in the care of older adult patients may help guide discussions for shared decision-making.

show abstract

Assessment of HF Outcomes Using a Claims-Based Frailty Index

Cited by 13 publications

References 22 publications

Quality measurement for cardiovascular diseases and cancer in hospital value-based healthcare: a systematic review of the literature

Quality measurement for cardiovascular diseases and cancer in hospital value-based healthcare: a systematic review of the literature

Association of Hospital Participation in Bundled Payments for Care Improvement Advanced With Medicare Spending and Hospital Incentive Payments

Outcomes Following Surgical and Nonsurgical Treatment for Uncomplicated Appendicitis in Older Adults

Contact Info

Product

Resources

About