Readmission Rates and Diagnoses Following Total Hip Replacement in Relation to Insurance Payer Status, Race and Ethnicity, and Income Status

White, Robert S.; Sastow, Dahniel; Gaber-Baylis, Licia K.; Tangel, Virginia; Fisher, Andrew D; Turnbull, Zachary A.

doi:10.1007/s40615-018-0467-0

Cited by 45 publications

(37 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study, using data from strict screening and regular follow-up of CHF patients, confirms the significance of some demographic characteristics for prognosis; the results are consistent with those from other studies. [28][29][30][31] In our prediction model, anxiety showed the greatest effect on the risk of readmission, followed by paranoia, health care, independence, income, support and appetite-sleep, while the smallest contributors were gender and depression.…”

Section: Discussionmentioning

confidence: 99%

A Nomogram based on a Patient-reported Outcomes Measure: Predicting the Risk of Readmission for Patients with Chronic Heart Failure

Han

Tian

Yang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Health-related quality of life, evaluated by a patient-reported outcomes measure, is an important prognostic marker in patients with chronic heart failure. This study aimed to use PROM to establish an effective readmission nomogram for chronic heart failure.Methods Using patient-reported outcomes measure as a measurement tool, we conducted a readmission nomogram for chronic heart failure on a prospective observational study comprising 454 patients with chronic heart failure hospitalized between May 2017 to January 2020. Concordance index and calibration curve were used to evaluate the discriminative ability and predictive accuracy of the nomogram. A bootstrap resampling method was used for internal validation of results. ResultsThe median follow-up period in the study was 197 days. After a final COX regression analysis, the computed gender, income, health care, appetite-sleep, anxiety, depression, paranoia, support, and independence were identified and included in the nomogram. The nomogram showed moderate discrimination, with concordance index of 0.737 (95% CI 0.673-0.800). The calibration curves for the probability of readmission for patients with chronic heart failure showed high consistency between the probability, as predicted, and the actual probability.Conclusions This model offers a platform to assess the risk of readmission for different populations with CHF and can assist clinicians with personalized treatment recommendations.

show abstract

Section: Discussionmentioning

confidence: 99%

A Nomogram based on a Patient-reported Outcomes Measure: Predicting the Risk of Readmission for Patients with Chronic Heart Failure

Han

Tian

Yang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Bundled payments are a common form of value based payment 123. Several countries, including the United States, Germany, Sweden, and the Netherlands, have developed bundled payments programmes, in which healthcare organizations receive a fixed payment for services provided in discrete care episodes and are held financially accountable for spending on those episodes 456.…”

Section: Introductionmentioning

confidence: 99%

Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

Rolnick

Liao

Emanuel

et al. 2020

BMJ

View full text Add to dashboard Cite

ObjectiveTo evaluate whether longer term participation in the bundled payments for care initiative (BPCI) for medical conditions in the United States, which held hospitals financially accountable for all spending during an episode of care from hospital admission to 90 days after discharge, was associated with changes in spending, mortality, or health service use.DesignQuasi-experimental difference-in-differences analysis.SettingUS hospitals participating in bundled payments for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease (COPD), or pneumonia, and propensity score matched to non-participating hospitals.Participants238 hospitals participating in the Bundled Payments for Care Improvement initiative (BPCI) and 1415 non-BPCI hospitals. 226 BPCI hospitals were matched to 700 non-BPCI hospitals.Main outcome measuresPrimary outcomes were total spending on episodes and death 90 days after discharge. Secondary outcomes included spending and use by type of post-acute care. BPCI and non-BPCI hospitals were compared by patient, hospital, and hospital market characteristics. Market characteristics included population size, competitiveness, and post-acute bed supply.ResultsIn the 226 BPCI hospitals, episodes of care totaled 261 163 in the baseline period and 93 562 in the treatment period compared with 211 208 and 78 643 in the 700 matched non-BPCI hospitals, respectively, with small differences in hospital and market characteristics after matching. Differing trends were seen for some patient characteristics (eg, mean age change −0.3 years at BPCI hospitals v non- BPCI hospitals, P<0.001). In the adjusted analysis, participation in BPCI was associated with a decrease in total episode spending (−1.2%, 95% confidence interval −2.3% to −0.2%). Spending on care at skilled nursing facilities decreased (−6.3%, −10.0% to −2.5%) owing to a reduced number of facility days (−6.2%, −9.8% to −2.6%), and home health spending increased (4.4%, 1.4% to 7.5%). Mortality at 90 days did not change (−0.1 percentage points, 95% confidence interval −0.5 to 0.2 percentage points).ConclusionsIn this longer term evaluation of a large national programme on medical bundled payments in the US, participation in bundles for four common medical conditions was associated with savings at three years. The savings were generated by practice changes that decreased use of high intensity care after hospital discharge without affecting quality, which also suggests that bundles for medical conditions could require multiple years before changes in savings and practice emerge.

show abstract

“…Xu et al 7 showed that Medicaid (as compared with private insurance) THA patients had higher odds of postoperative in-hospital mortality, increased complications, LOS and readmissions. White et al 15 showed that THA patients with Medicaid/Medicare, who are blacks, live in poorer neighborhoods and are treated at hospitals with a low surgical volume, have higher odds of readmission. Elsharydah et al found that a propensity matched cohort of black patients had higher rates of 30 day complications for lower extremity arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…6 Evidence supports the association between THA outcomes and multifactorial patient-level, provider-level and hospital-level racial and socioeconomic disparities. [7][8][9][10][11][12][13][14][15][16] Hospital safety net burden is defined as the proportion of cases at an individual hospital with the primary insurance payer being Medicaid or uninsured; safety net hospitals operate with a mandate or adopted mission to deliver care to patients regardless of their ability to pay. 17 18 Research shows higher rates of mortality, hospitalacquired infection, perioperative complications and poorer markers of surgical quality (timeliness, patient centeredness and equity of treatment) at high safety net burden hospitals.…”

Section: Introductionmentioning

confidence: 99%

Hospital safety net burden is associated with increased inpatient mortality and postoperative morbidity after total hip arthroplasty: a retrospective multistate review, 2007–2014

Tangel

Gupta

et al. 2019

Reg Anesth Pain Med

Self Cite

View full text Add to dashboard Cite

BackgroundTotal hip arthroplasty (THA) is one of the most widely performed surgical procedures in the USA. Safety net hospitals, defined as hospitals with a high proportion of cases billed to Medicaid or without insurance, deliver a significant portion of their care to vulnerable populations, but little is known about the effects of a hospital’s safety net burden and its role in healthcare disparities and outcomes following THA. We quantified safety net burden and examined its impact on in-hospital mortality, complications and length of stay (LOS) in patients who underwent THA.MethodsWe analyzed 500 189 patient discharge records for inpatient primary THA using data from the Healthcare Cost and Utilization Project’s State Inpatient Databases for California, Florida, New York, Maryland and Kentucky from 2007 to 2014. We compared patient demographics, present-on-admission comorbidities and hospital characteristics by hospital safety net burden status. We estimated mixed-effect generalized linear models to assess hospital safety burden status’ effect on in-hospital mortality, patient complications and LOS.ResultsPatients undergoing THA at a hospital with a high or medium safety net burden were 38% and 30% more likely, respectively, to die in-hospital compared with those in a low safety net burden hospital (high adjusted OR: 1.38, 95% CI 1.10 to 1.73; medium adjusted OR: 1.30, 95% CI 1.07 to 1.57). Compared with patients treated in hospitals with a low safety net burden, patients treated in high safety net hospitals were more likely to develop a postoperative complication (adjusted OR: 1.11, 95% CI 1.00 to 1.24) and require a longer LOS (adjusted IRR: 1.06, 95% CI 1.05, 1.07).ConclusionsOur study supports our hypothesis that patients who underwent THA at hospitals with higher safety net burden have poorer outcomes than patients at hospitals with lower safety net burden.

show abstract

Readmission Rates and Diagnoses Following Total Hip Replacement in Relation to Insurance Payer Status, Race and Ethnicity, and Income Status

Cited by 45 publications

References 51 publications

A Nomogram based on a Patient-reported Outcomes Measure: Predicting the Risk of Readmission for Patients with Chronic Heart Failure

A Nomogram based on a Patient-reported Outcomes Measure: Predicting the Risk of Readmission for Patients with Chronic Heart Failure

Spending and quality after three years of Medicare’s bundled payments for medical conditions: quasi-experimental difference-in-differences study

Hospital safety net burden is associated with increased inpatient mortality and postoperative morbidity after total hip arthroplasty: a retrospective multistate review, 2007–2014

Contact Info

Product

Resources

About