Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-1999 to 2000-2001

Jencks, Stephen F.; Huff, Edwin D.; Cuerdon, Timothy

doi:10.1001/jama.289.3.305

Cited by 457 publications

(124 citation statements)

References 9 publications

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“…Regional studies have examined antithrombotic medication use in persons with cerebrovascular events, but the studies did not exclude persons with a history of cardiac events [10, 12]. A large US study examined prescription of antithrombotic medications for persons with cerebrovascular events at hospital discharge [13]. Although this is an important quality indicator of inpatient care, it is probably higher than antithrombotic medication use in community-dwelling samples [14].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Secondary Prevention Care after Myocardial Infarction and Stroke

et al. 2006

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Background: Whether secondary prevention of atherosclerosis is performed as frequently after cerebrovascular events (stroke or transient ischemic attack) as after cardiac events (myocardial infarction or angina) is unknown. Methods: We compared the receipt of six secondary preventive care processes among 943 persons with a prior cardiac event to that among 523 persons with a prior cerebrovascular event using a representative sample of the US population. Results: The cardiac event group had higher rates for three care processes: antithrombotic medication use in the past year (83–77%, p = 0.01), ever advised to exercise more (66–52%, p < 0.001), and ever advised to eat fewer high-fat or high-cholesterol foods (70–54%, p < 0.001). Conclusions: Compared to the cardiac event group, the quality of care of the cerebrovascular event group is lower and should be improved.

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Section: Discussionmentioning

confidence: 99%

Comparison of Secondary Prevention Care after Myocardial Infarction and Stroke

et al. 2006

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“…At present, only annual rates are reported in most care settings, and the longitudinal nature of hemoglobin A1C testing is not emphasized 16, 32, 33. The direct association between higher‐consistency testing and fewer deaths, myocardial infarctions, strokes, and amputations—all outcomes of significant importance to patients—makes this an important opportunity.…”

Section: Discussionmentioning

confidence: 99%

Consistency of Hemoglobin A1c Testing and Cardiovascular Outcomes in Medicare Patients With Diabetes

Goodney

Newhall

Bekelis

et al. 2016

JAHA

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BackgroundAnnual hemoglobin A1c testing is recommended for patients with diabetes mellitus. However, it is unknown how consistently patients with diabetes mellitus receive hemoglobin A1c testing over time, or whether testing consistency is associated with adverse cardiovascular outcomes.Methods and ResultsWe identified 1 574 415 Medicare patients (2002–2012) with diabetes mellitus over the age of 65. We followed each patient for a minimum of 3 years to determine their consistency in hemoglobin A1C testing, using 3 categories: low (testing in 0 or 1 of 3 years), medium (testing in 2 of 3 years), and high (testing in all 3 years). In unweighted and inverse propensity‐weighted cohorts, we examined associations between testing consistency and major adverse cardiovascular events, defined as death, myocardial infarction, stroke, amputation, or the need for leg revascularization. Overall, 70.2% of patients received high‐consistency testing, 17.6% of patients received medium‐consistency testing, and 12.2% of patients received low‐consistency testing. When compared to high‐consistency testing, low‐consistency testing was associated with a higher risk of adverse cardiovascular events or death in unweighted analyses (hazard ratio [HR]=1.21; 95% CI, 1.20–1.23; P<0.001), inverse propensity‐weighted analyses (HR=1.16; 95% CI, 1.15–1.17; P<0.001), and weighted analyses limited to patients who had at least 4 physician visits annually (HR=1.15; 95% CI, 1.15–1.16; P<0.001). Less‐consistent testing was associated with worse results for each cardiovascular outcome and in analyses using all years as the exposure.ConclusionsConsistent annual hemoglobin A1c testing is associated with fewer adverse cardiovascular outcomes in this observational cohort of Medicare patients of diabetes mellitus.

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“…The National Institutes of Health Stroke Scale (NIH-SS) is a 42-point score assessing 11 impairment domains and it is commonly used in clinical trials, routine care settings, and has been validated for retrospective use [4,7]. The National Stroke Project (NSP) was a retrospective cohort study of Medicare beneficiaries hospitalized with stroke or transient ischemic attack (TIA) between 1998 and 2001 that was authorized by the US Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) as part of an effort to improve the quality of care for patients with stroke or TIA [9,10,11]. Recent studies have used NSP data [12].…”

Section: Introductionmentioning

confidence: 99%

Concerns for the Reliability and Validity of the National Stroke Project Stroke Severity Scale

Husseini

Shea²,

Goldstein

2011

Cerebrovasc Dis

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Background: The National Stroke Project (NSP) was a retrospective cohort study of US Medicare beneficiaries hospitalized with stroke or transient ischemic attack (TIA). The NSP included a simple assessment of stroke severity (NSP-Stroke Scale, NSP-SS). Used for risk adjustment in outcome studies, the reliability and validity of the NSP-SS have not been assessed. We determined the reliability, concurrent and construct validity of theNSP-SS. Methods: The initial neurologic examinations of 100 consecutive patients hospitalized with ischemic stroke/TIA in a single academic medical center were reviewed. The NSP-SS was retrospectively scored twice by the same rater and independently by a second rater to assess reliability. The National Institutes of Health Stroke Scale (NIH-SS) was also scored retrospectively and used as the criterion standard for concurrent validity. Construct validity was based on discharge status. Results: The NSP-SS had moderate-substantial inter-rater (weighted kappa, ĸ_w = 0.66, 95% CI 0.55–0.77) and intra-rater (ĸ_w = 0.63, 95% CI 0.52–0.75) reliability. Correlation between NSP-SS and NIH-SS scores was moderate (Spearman r = 0.65, 95% CI 0.52–0.75, p < 0.0001) but some categorizations in the NSP-SS seemed inappropriate reflecting poor content validity. Each NSP-SS point was associated with a greater likelihood of poor outcome (OR = 2.1, 95% CI 1.1–3.7, p = 0.016). Based on dichotomized scores (NSP 0–2 and NIH-SS <6; mild deficits), the NSP-SS sensitivity was 70.9% (95% CI 57.9–81.2%), specificity 82.2% (95% CI 68.7–90.7%), likelihood ratio for severe stroke 4.0 (95% CI 2.1–7.6) and likelihood ratio for mild stroke 0.3 (95% CI 0.20–0.5). The dichotomized NSP-SS and NIH-SS similarly predicted poor outcome (NSP-SS >2, OR = 4.7, 95% CI 1.7–13.0, p = 0.003 vs. NIH-SS ≧6, OR = 4.4, 95% CI 1.5–13.0, p = 0.006) with excellent discrimination (C = 0.827 and 0.826, respectively). Conclusion: The NSP-SS has moderate-substantial reliability but poor content validity and poor to moderate concurrent validity as compared with the NIH-SS. In addition, it is not clear that the NSP-SS is easier to extract from medical records than the NIH-SS. Given this, and its other limitations, the utility of this scale for risk adjustment in future stroke outcome studies is questionable.

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Change in the Quality of Care Delivered to Medicare Beneficiaries, 1998-1999 to 2000-2001

Cited by 457 publications

References 9 publications

Comparison of Secondary Prevention Care after Myocardial Infarction and Stroke

Comparison of Secondary Prevention Care after Myocardial Infarction and Stroke

Consistency of Hemoglobin A1c Testing and Cardiovascular Outcomes in Medicare Patients With Diabetes

Concerns for the Reliability and Validity of the National Stroke Project Stroke Severity Scale

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