Association Between Spending and Survival of Chronic Heart Failure Across Veterans Affairs Medical Centers

Groeneveld, Peter W.; Medvedeva, Elina; Walker, Lorrie; Segal, Andrea G.; Menno, Diane; Epstein, Andrew J.

doi:10.1001/jamanetworkopen.2019.7238

Cited by 10 publications

(9 citation statements)

References 24 publications

(34 reference statements)

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“…We assigned each patient to a primary facility, defined as the hospital where they received the majority of their VA care, which was quantified as number of outpatient clinic visits within 1 year of the index date . Facility-level factors included complexity, total number of patients with cirrhosis seen at a facility during the cohort accrual period, whether the facility was a VA liver transplant center, and whether it was in a rural or urban setting.…”

Section: Methodsmentioning

confidence: 99%

Factors Associated With Access to and Receipt of Liver Transplantation in Veterans With End-stage Liver Disease

et al. 2021

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IMPORTANCEOrgan scarcity means few patients with advanced liver disease undergo a transplant, making equitable distribution all the more crucial. Disparities may arise at any stage in the complex process leading up to this curative therapy.OBJECTIVE To examine the rate of and factors associated with referral, wait-listing, and receipt of liver allografts. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used linked data from comprehensive electronic medical records and the United Network of Organ Sharing. Adult patients with cirrhosis and a Model for End-Stage Liver Disease with addition of sodium score of at least 15 points between October 1, 2011, and December 31, 2017, were included in the study. Patients were from 129 hospitals in the integrated, US Department of Veterans Affairs health care system and were followed up through December 31, 2018. Statistical analyses were performed from April 28, 2020, to January 31, 2021. EXPOSURES Sociodemographic (eg, age, insurance, income), clinical (eg, liver disease etiology, severity, comorbidity), and health care facility (eg, complexity, rural or urban, presence of a liver transplant program) factors were evaluated. MAIN OUTCOMES AND MEASURES Referral, wait-listing, and liver transplantation. RESULTS Of the 34 494 patients with cirrhosis (mean [SD] age, 62 [7.7] years; 33 560 men [97.29%]; 22 509 White patients [65.25%]), 1534 (4.45%) were referred, 1035 (3.00%) were wait-listed, and 549 (1.59%) underwent a liver transplant within 3 years of meeting clinical criteria for transplantation. Patient age of 70 years or older was associated with lower rates of referral (hazard ratio [HR], 0.09; 95% CI, 0.06-0.13), wait-listing (HR, 0.07; 95% CI, 0.04-0.12), and transplant (HR, 0.08; 95% CI, 0.04-0.16). Alcohol etiology for liver cirrhosis was associated with lower rates of referral (HR, 0.38; 95% CI, 0.33-0.44), wait-listing (HR, 0.32; 95% CI, 0.27-0.38), and transplant (HR, 0.30; 95% CI, 0.23-0.37). In addition, comorbidity (none vs >1 comorbidity) was associated with lower rates of referral (HR, 0.47; 95% CI, 0.40-0.56), wait-listing (HR, 0.38; 95% CI, 0.31-0.46), and transplant (HR, 0.28; 95% CI, 0.21-0.38). African American patients were less likely to be referred (HR, 0.82; 95% CI, 0.70-0.95) and wait-listed (HR, 0.73; 95% CI, 0.61-0.88). Patients with lower annual income and those seen in facilities in the West were less likely to be referred (HR, 0.70; 95% CI, 0.53-0.93), wait-listed (HR, 0.48; 95% CI, 0.36-0.64), or undergo a transplant (HR, 0.50; 95% CI, 0.34-0.74). In a review of the medical records for 333 patients who had limited comorbidity but were not referred, organ transplant was considered as a potential option in 176 (52.85%). When documented, medical and psychosocial barriers explained most of the deficits in referral. CONCLUSIONS AND RELEVANCEIn this cohort study, few patients with advanced liver disease received referrals, were wait-listed, or underwent a transplant. The greatest deficits occurred at the referral step. Although health ...

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Section: Methodsmentioning

confidence: 99%

Factors Associated With Access to and Receipt of Liver Transplantation in Veterans With End-stage Liver Disease

et al. 2021

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“…The most common reason for HF-related hospitalizations is symptom exacerbations. Engaging in self-care [ 10 ]—self-monitoring of physiologic changes and symptom recognition—is among the most critical preventative efforts to decrease HF readmission rates among patients, as early detection of potentially serious symptoms enables patients and their caregivers to intervene before hospitalization is needed [ 11 ]. HF prevention efforts, therefore, ideally target improving patients’ ability to identify and attribute meaning to early symptoms [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis

et al. 2022

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Background Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans. Objective The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF. Methods Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data. Results Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language. Conclusions We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features.

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“…Furthermore, the costs of HF-related hospitalization (67.3%) were two-fold the costs of outpatient care (32.7%). Some studies have reported that inpatient costs are not associated with patient prognosis, but rather with physicians decisions and an indication of high-cost procedures, which are not necessarily related to improved patient outcomes [ 18 , 20 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have reported the substantial economic burden of HF [17][18][19]. A previous study from Japan reported that 44% of the overall hospitalization costs in acute major cardiovascular disease were attributable to hospitalizations for HF, and the cost of a one-time hospitalization is US$8284 [20,21].…”

Section: Introductionmentioning

confidence: 99%

Burden of Repeated Hospitalizations on Patients with Heart Failure: An Analysis of Administrative and Claims Data in Japan

Eguchi

Morita

Mitani

et al. 2022

Drugs - Real World Outcomes

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Background Repeated hospitalization is a predictor of outcomes in heart failure, indicating the presence of symptoms, a deteriorated condition at pre-admission, and worsened prognosis. Objectives The current database study aimed to understand the clinical and economic burden of repeated hospitalizations among patients with heart failure in Japan. The effect of repeated hospitalizations on the subsequent in-hospital mortality was the primary objective; economic burden of heart failure after discharge was investigated as a secondary outcome. Methods Between 2013 and 2018, administrative claims and discharge summary data of patients aged ≥ 20 years and diagnosed with heart failure were obtained from a Diagnosis Procedure Combination database maintained by Medical Data Vision. Hospitalization, mortality, and economic burden data were analyzed. Results This study included 49,094 patients. The mean length of the first hospital stay was 22.9 days. The in-hospital mortality rate was approximately 10%, with one to five repeated hospitalizations. The time interval between repeated hospitalizations for heart failure decreased with an increasing number of hospitalizations. In-hospital mortality did not increase even with an increasing number of hospitalizations. The mean heart failure-related healthcare cost per patient was ¥564,281 ± 990,447 (US$5178 ± 9,088), 67.3% of which was hospitalization costs. Among hospitalization costs, other costs were high, mainly for basic hospitalization fees (71.7%; ¥233,146/person-year). Conclusions Repeated hospitalization did not increase in-hospital mortality; however, it may shorten the intervals between heart failure-related hospitalizations, potentially caused by deterioration of the patient's condition, and increase the clinical and economic burden on patients. Key PointsRepeated hospitalization was shown to be an important predictor of outcomes in patients with heart failure.The 2013-18 data showed that there was a 10% in-hospital mortality rate among patients who underwent one to five repeated hospitalizations.In-hospital mortality did not increase with the number of hospitalizations.

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Association Between Spending and Survival of Chronic Heart Failure Across Veterans Affairs Medical Centers

Cited by 10 publications

References 24 publications

Factors Associated With Access to and Receipt of Liver Transplantation in Veterans With End-stage Liver Disease

Factors Associated With Access to and Receipt of Liver Transplantation in Veterans With End-stage Liver Disease

Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis

Burden of Repeated Hospitalizations on Patients with Heart Failure: An Analysis of Administrative and Claims Data in Japan

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