Insurance Status Influences the Rates of Reportable Quality Metrics in Brain Tumor Patients

Hooten, Kristopher G.; Neal, Dan; Lovatón-Espadín, Rolando; Gil, Jorge; Azari, Hassan; Rahman, Maryam

doi:10.1227/neu.0000000000000594

Cited by 22 publications

(27 citation statements)

References 26 publications

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“…The authors estimated the national incidence of a brain tumor patient experiencing one or more PSI or HAC as 16.3% and 2.8%, respectively. [10] Similarly, Fargen et al identified 54,589 admissions for unruptured cerebral aneurysm and reported that the national incidence of one or more PSI among this patient population was 14.6% (95% CI 13.9%–15.4%) if the patient underwent surgical clipping and 10.5% (95% CI 9.9%–11.1%) if the patient underwent endovascular coiling. [39] Differences in acuity of care for patients admitted with brain tumors or cerebral aneurysms compared to patients undergoing cervical fusion likely explain the differences in the incidence of adverse quality outcomes among these populations.…”

Section: Discussionmentioning

confidence: 99%

“…[10] Each covariate was included in our models because we felt that that the association between insurance status and PSI and HAC incidence may be confounded by patient-and hospital-level characteristics. This list of covariates is an exhaustive list of patient-and hospital-level characteristics included in the NIS.…”

Section: Methodsmentioning

confidence: 99%

“…Accordingly, comparisons between these cohorts permit identification of the independent effect of insured status upon reportable quality measures. This approach is identical to the analytical framework used by Hooten et al[10] A Bonferroni correction was used to account for multiple comparisons: our threshold for statistical significance was p <0.001.…”

Section: Methodsmentioning

confidence: 99%

“…This study uses a nationally representative, all-payer database to determine the association of insurance status with adverse quality outcomes in patients undergoing cervical spine fusion. Based on the results of prior studies in other patient populations,[10, 21, 22] we hypothesize that the incidence of HAC and PSI will be significantly higher among Medicaid or self-pay patients undergoing cervical fusion relative to patients with private insurance.…”

Section: Introductionmentioning

confidence: 99%

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Insurance status and reportable quality metrics in the cervical spine fusion population

et al. 2017

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BACKGROUND CONTEXT The incidence of adverse care quality events among patients undergoing cervical fusion surgery is unknown using the definition of care quality employed by the Centers for Medicare and Medicaid Services (CMS). The effect of insurance status on the incidence of these adverse quality events is also unknown. PURPOSE This study determined the incidence of hospital acquired conditions (HAC) and patient safety indicators (PSI) in cervical spine fusion patients and analyzed the association between primary payer status and these adverse events. STUDY DESIGN Retrospective cohort design PATIENT SAMPLE All patients in the Nationwide Inpatient Sample (NIS) aged eighteen and older that underwent cervical spine fusion from 1998–2011 were included. OUTCOME MEASURES Incidence of HAC and PSI from 1998–2011. METHODS We queried the NIS for all hospitalizations that included a cervical fusion during the inpatient episode from 1998–2011. All comparisons were made between privately insured patients and Medicaid/self-pay patients because Medicare enrollment is confounded with age. Incidence of non-traumatic HAC and PSI were determined using publicly available lists of ICD-9-CM diagnosis codes. We built logistic regression models to determine the effect of primary payer status on PSI and non-traumatic HAC. RESULTS We identified 419,424 hospitalizations with cervical fusion performed during an inpatient episode. The estimated national incidences of non-traumatic HAC and PSI were 0.35% and 1.6%, respectively. After adjusting for patient demographics and hospital characteristics, Medicaid/self-pay patients had significantly greater odds of experiencing one or more HAC (OR 1.51 95% CI 1.23–1.84) or PSI (OR 1.52 95% CI 1.37–1.70) relative to the privately-insured cohort. CONCLUSION Among patients undergoing inpatient cervical fusion, primary payer status predicts PSI and HAC (both indicators of adverse healthcare quality used to determine hospital reimbursement by CMS). As the U.S. healthcare system transitions to a value-based payment model, the cause of these disparities must be studied to improve the quality of care delivered to vulnerable patient populations.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Insurance status and reportable quality metrics in the cervical spine fusion population

et al. 2017

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“…More favorable outcomes have been reported in patients with active health insurance status 3 and fewer comorbid conditions. 4 Hospital-related positive predictors of improved outcomes include a hospital infrastructure geared towards high-volume neurosurgical procedures 5 and high socioeconomic status of the patient population served by the hospital. 6 In addition, racial and ethnic disparities in access to high-volume neuro-oncologic care and final health outcomes have been reported to disproportionately affect the African American and Hispanic patient population in the United States.…”

Section: Introductionmentioning

confidence: 99%

Surgery for CNS Tumors in the Brazilian National Health Care System

Pontes

Shafaee

Haaland

et al. 2017

JGO

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PurposeResource limitations in low- and middle-income countries make the management of CNS tumors challenging, particularly in Brazil, a country with major disparities in socioeconomic status and access to health care. We aimed to evaluate cancer-related neurosurgical procedures in the public health care system.MethodsOn the basis of Brazil’s public health system database, we collected data for neurosurgical procedures related to CNS tumors performed between January 2008 and November 2013. Information about the number of procedures, costs, length of stay, and number of inpatient deaths were analyzed for each state and then correlated to the state-specific population, gross domestic product per capita, and number of procedures.ResultsIn all, 57,361 procedures were performed, the majority of them in the Southeast region. The mean length of hospital stay was 14.4 days, but longer hospital stay was reported for patients treated in the North. The inpatient mortality rate was 7.11%. Mortality rates decreased as the number of procedures (P < .001), gross domestic product per capita (P < .001), or state population increased (P < .001). On multivariate analysis, only the number of procedures (odds ratio, 0.93; 95% CI, 0.91 to 0.96; P < .001) and state population (odds ratio, 1.25; 95% CI, 1.13 to 1.38; P < .001) had an independent association with mortality.ConclusionTo the best of our knowledge, this is the first study to evaluate disparities in CNS tumor surgery in a middle-income country, confirming that regional disparities exist and that clinical and economic outcomes correlate with income level, number of procedures, and state population.

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Outcome prediction in brain tumor surgery: a literature review on the influence of nonmedical factors

et al. 2020

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Insurance Status Influences the Rates of Reportable Quality Metrics in Brain Tumor Patients

Cited by 22 publications

References 26 publications

Insurance status and reportable quality metrics in the cervical spine fusion population

Insurance status and reportable quality metrics in the cervical spine fusion population

Surgery for CNS Tumors in the Brazilian National Health Care System

Outcome prediction in brain tumor surgery: a literature review on the influence of nonmedical factors

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