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Pradhan P, Chatterjee P, Stevens H, Marmon A, Medrano-Trochez C, Jimenez A, Kippner L, Li Y, Savage E, Gaul D, Fernández F, Gibson G, Kurtzberg J, Kotanchek T, Yeago C, Roy K. Multiomic analysis and computational modeling to identify critical quality attributes for immunomodulatory potency of mesenchymal stromal cells. Cytotherapy 2021. [DOI: 10.1016/s1465324921002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
IMPORTANCE Safety-net hospitals (SNHs) operate under limited financial resources and have had challenges providing high-quality care. Medicaid expansion under the Affordable Care Act led to improvements in hospital finances, but whether this was associated with better hospital quality, particularly among SNHs given their baseline financial constraints, remains unknown. OBJECTIVE To compare changes in quality from 2012 to 2018 between SNHs in states that expanded Medicaid vs those in states that did not. DESIGN, SETTING, AND PARTICIPANTS Using a difference-in-differences analysis in a cohort study, performance on quality measures was compared between SNHs, defined as those in the highest quartile of uncompensated care in the pre-Medicaid expansion period, in expansion vs nonexpansion states, before and after the implementation of Medicaid expansion. A total of 811 SNHs were included in the analysis, with 316 in nonexpansion states and 495 in expansion states. The study was conducted from January to November 2020. EXPOSURES Time-varying indicators for Medicaid expansion status. MAIN OUTCOMES AND MEASURES The primary outcome was hospital quality measured by patient-reported experience (Hospital Consumer Assessment of Healthcare Providers and Systems Survey), health care-associated infections (central line-associated bloodstream infections, catheter-associated urinary tract infections, and surgical site infections following colon surgery) and patient outcomes (30-day mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia). Secondary outcomes included hospital financial measures (uncompensated care and operating margins), adoption of electronic health records, provision of safety-net services (enabling, linguistic/translation, and transportation services), or safety-net service lines (trauma, burn, obstetrics, neonatal intensive, and psychiatric care). RESULTS In this difference-in-differences analysis of a cohort of 811 SNHs, no differential changes in patient-reported experience, health care-associated infections, readmissions, or mortality were noted, regardless of Medicaid expansion status after the Affordable Care Act. There were modest differential increases between 2012 and 2016 in the adoption of electronic health records (mean [SD]: nonexpansion states, 99.4 [7.4] vs 99.9 [3.8]; expansion states, 94.6 [22.6] vs 100.0 [2.2]; 1.7 percentage points; P = .02) and between 2012 and 2018 in the number of inpatient psychiatric beds (mean [SD]: nonexpansion states, 24.7 [36.0] vs 23.6 [39.0]; expansion states: 29.3 [42.8] vs 31.4 [44.3]; 1.4 beds; P = .02) among SNHs in expansion states, although they were not statistically significant at a threshold adjusted for multiple comparisons. In subgroup analyses comparing SNHs with higher vs lower baseline operating margins, an isolated differential improvement was noted in heart failure readmissions among SNHs with lower baseline operating margins in expansion states (mean [SD], 22.8 [2.1]; -0.53 percentage points; P = .001). CONCLUSIONS AND RELEVANCE This difference-in-differences cohort study found that despite reductions in uncompensated care and improvements in operating margins, there appears to be little evidence of quality improvement among SNHs in states that expanded Medicaid compared with those in states that did not.
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Chatterjee P, Qi M, Werner R. Relative contributions of hospital versus skilled nursing facility quality on patient outcomes. BMJ Qual Saf 2021; 30:195-201. [PMID: 32229627 PMCID: PMC7770560 DOI: 10.1136/bmjqs-2019-010660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hospitals and health systems worldwide have adopted value-based payment to improve quality and reduce costs. In the USA, skilled nursing facilities (SNFs) are now financially penalised for higher-than-expected readmission rates. However, the extent to which SNFs contribute to, and should thus be held accountable for, readmission rates is unknown. To compare the relative contributions of hospital and SNF quality on readmission rates while controlling for unobserved patient characteristics. METHODS Retrospective cohort study of Medicare beneficiaries, 2010-2016. Acute care hospitals and SNFs in the USA. Medicare beneficiaries with two hospitalisations followed by SNF admissions, divided into two groups: (1) patients who went to different hospitals but were discharged to the same SNF after both hospitalisations and (2) patients who went to the same hospital but were discharged to different SNFs. Hospital-level and SNF-level quality, using a lagged measure of 30-day risk-standardised readmission rates (RSRRs). Readmission within 30 days of hospital discharge. RESULTS There were 140 583 patients who changed hospitals but not SNFs, and 183 232 who changed SNFs but not hospitals. Patients who went to the lowest-performing hospitals (highest RSRR) had a 0.9% higher likelihood of readmission (p=0.005) compared with patients who went to the highest-performing hospitals (lowest RSRR). In contrast, patients who went to the lowest-performing SNFs had a 2% higher likelihood of readmission (p<0.001) compared with patients to went to the highest-performing SNFs. CONCLUSIONS The association between SNF quality and patient outcomes was larger than the association between hospital quality and patient outcomes among postacute care patients. Holding postacute care providers accountable for their quality may be an effective strategy to improve SNF quality.
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Chatterjee P, Warner LN, Basil MC, Christopher M, Manning K, Fisher HN, Rexrode KM, Solomon SR, Kakoza RM, Yialamas MA. "Make the Implicit Explicit": Measuring Perceptions of Gender Bias and Creating a Gender Bias Curriculum for Internal Medicine Residents. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:49-52. [PMID: 33488136 PMCID: PMC7814655 DOI: 10.2147/amep.s292166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/28/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Gender bias in clinical training has been well established; however, little is known about how perceptions differ between men and women. Furthermore, few curricular options have been developed to discuss gender bias. OBJECTIVE To measure the prevalence of gender bias, examine qualitative differences between men and women, and create a gender bias curriculum for internal medicine residents. METHODS We surveyed 114 residents (response rate of 53.5%) to identify the prevalence and types of gender bias experienced in training. We compared estimates between genders and organized qualitative results into shared themes. We then developed a curriculum to promote and normalize discussions of gender bias. RESULTS Among surveyed residents, 61% reported personal experiences of gender bias during training, with 98% of women and 19% of men reporting experiences when stratified by gender. We identified two domains in which gender bias manifested: role misidentification and a difficult working environment. Residents identified action items that led to the development of a gender bias curriculum. The curriculum includes didactic conferences and training sessions, a microaggression response toolkit, dinners for men and women residents, participation in a WhatsApp support group, and participation in academic projects related to gender bias in training. CONCLUSION We confirmed a wide prevalence of gender bias and developed a scalable curriculum for gender bias training. Future work should explore the long-term impacts of these interventions.
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Chatterjee P, Sommers BD, Joynt Maddox KE. Essential but Undefined - Reimagining How Policymakers Identify Safety-Net Hospitals. N Engl J Med 2020; 383:2593-2595. [PMID: 33369352 DOI: 10.1056/nejmp2030228] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Anastos-Wallen R, Werner RM, Chatterjee P. Prevalence of Informal Caregiving in States Participating in the US Patient Protection and Affordable Care Act Balancing Incentive Program, 2011-2018. JAMA Netw Open 2020; 3:e2025833. [PMID: 33320262 PMCID: PMC7739120 DOI: 10.1001/jamanetworkopen.2020.25833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/20/2020] [Indexed: 11/14/2022] Open
Abstract
Importance The Balancing Incentives Program (BIP), established under the 2010 Patient Protection and Affordable Care Act provided federal funding for states to shift long-term care out of institutional settings and into the home. However, the association of its implementation with informal caregiving is not known. Objective To evaluate the association between BIP participation and the prevalence and frequency of informal caregiving and socioeconomic disparities among caregivers. Design, Setting, and Participants The cohort study included respondents to the 2011-2018 American Time Use Survey in BIP-adopting states and non-BIP-adopting states. Exposure Living in a state that had implemented the BIP after program implementation had begun (April 2012 to April 2018). Main Outcomes and Measures Prevalence of caregiving among all respondents, frequency of caregiving, and minutes of daily sleep, a marker of well-being. Differences-in-differences (DID) regression analysis was used to compare these outcomes between BIP-adopting states and non-BIP-adopting states. Results The study included 38 343 respondents in BIP-adopting states (median age, 47 years [interquartile range (IQR), 31-61 years]; 51.9% women), of whom 7428 were caregivers (median age, 51 years [IQR, 37-61 years]; 55.6% women), and 26 437 respondents in non-BIP-adopting states (median age, 48 years [IQR, 32-62 years]; 52.7% women), of whom 5527 were caregivers (median age, 52 years [IQR, 38-62 years]; 57.9% women). There was no change in the prevalence of caregiving between BIP-adopting and non-BIP-adopting states after program implementation (DID, 0.00%; 95% CI, -0.01% to 0.01%). Caregivers in BIP-adopting states were more likely to provide daily care after implementation (DID, 3.2%; 95% CI, 0.3%-6.0%; P = .03) and report increased time sleeping (DID, 15.6 minutes; 95% CI, 4.9-26.2 minutes; P = .005) compared with caregivers in non-BIP-adopting states. This association was more pronounced among caregivers with more education (DID, 25.1 minutes; 95% CI, 6.5-43.8 minutes; P = .01) and higher annual family income (DID, 16.9 minutes; 95% CI, 5.9-27.9 minutes; P = .004) compared with caregivers in non-BIP-adopting states who had the same education and income levels, respectively. Conclusions and Relevance In this cohort study, the BIP was associated with increased daily caregiving and improved caregiver well-being. However, it may have disproportionately benefited caregivers of higher socioeconomic status, potentially exacerbating disparities in caregiver stress. Future policies should aim to mitigate this unintended consequence.
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Sarkar B, Munshi A, Shahid T, Ganesh T, Mohanti B, Bansal K, Rastogi K, Chaudhari B, Manikandan A, Biswal S, Bhattacharya J, Ghosh T, De A, Roy Chowdhury S, Mandal S, George K, Mukherjee M, Gazi M, Chauhan R, Chatterjee P. Challenges Faced by Woman Radiation Oncologists (WRO) in South Asia. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chatterjee P, Kelly S, Qi M, Werner RM. Characteristics and Quality of US Nursing Homes Reporting Cases of Coronavirus Disease 2019 (COVID-19). JAMA Netw Open 2020; 3:e2016930. [PMID: 32725243 PMCID: PMC8310566 DOI: 10.1001/jamanetworkopen.2020.16930] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nathan AS, Blebea C, Chatterjee P, Thomasson A, Diamond JM, Groeneveld PW, Giri J, Goldberg HJ, Courtwright AM. Mortality trends around the one‐year survival mark after heart, liver, and lung transplantation in the United States. Clin Transplant 2020; 34:e13852. [DOI: 10.1111/ctr.13852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 01/19/2023]
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Chatterjee P, Werner RM. The hospital readmission reduction program and social risk. Health Serv Res 2020; 54:324-326. [PMID: 30848490 DOI: 10.1111/1475-6773.13131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Chatterjee P, Joynt Maddox KE. US National Trends in Mortality From Acute Myocardial Infarction and Heart Failure: Policy Success or Failure? JAMA Cardiol 2019. [PMID: 29541764 DOI: 10.1001/jamacardio.2018.0218] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Hospitals in the United States have been subject to mandatory public reporting of mortality rates for acute myocardial infarction (AMI) and heart failure (HF) since 2007 and to value-based payment programs for these conditions since 2011. However, whether hospitals with initially poor baseline performance have improved relative to other hospitals under these programs, and whether patterns of improvement differ by condition, is unknown. Understanding trends within public reporting and value-based payment can inform future efforts in these areas. Objective To examine patterns in 30-day mortality from AMI and HF and determine whether they differ for baseline poor performers (worst quartile in 2009 and 2010 in public reporting, prior to value-based payment) compared with other hospitals. Design, Setting, and Participants Retrospective cross-sectional study at US acute care hospitals from 2009 to 2015 that included 2751 and 3796 hospitals with publicly reported mortality data for AMI and HF, respectively. Exposures Public reporting and value-based purchasing. Main Outcomes and Measures Hospital-level risk-adjusted 30-day mortality rates. Results We identified 422 and 600 baseline poor-performing hospitals for AMI and HF, respectively. Baseline poor performers for AMI were more often public and for-profit and less often teaching hospitals. Baseline poor performers for HF were less often large hospitals. For AMI, 30-day mortality among baseline poor performers was higher at baseline but improved more over time compared with other hospitals (18.6% in 2009 to 14.6% in 2015; -0.74% per year; P < .001 vs 15.7% in 2009 to 14.0% in 2015; -0.26% per year; P < .001; P for interaction <.001). In contrast, for HF, baseline poor performers improved over time (13.5%-13.0%; -0.12% per year; P < .001), but mean mortality among all other HF hospitals increased during the study period (10.9%-12.0%; 0.17% per year; P < .001; P for interaction, <.001). Conclusions and Relevance Despite being subject to identical policy pressures, mortality trends for AMI and HF differed markedly between 2009 and 2015.
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Chatterjee P, Qi M, Coe NB, Konetzka RT, Werner RM. Association Between High Discharge Rates of Vulnerable Patients and Skilled Nursing Facility Copayments. JAMA Intern Med 2019; 179:1296-1298. [PMID: 31135825 PMCID: PMC6547066 DOI: 10.1001/jamainternmed.2019.1209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses data from the Centers for Medicare and Medicaid Services to investigate the association between Medicare copayment policies and discharge rates of vulnerable patients from skilled nursing facilities.
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Polsky D, Candon MK, Chatterjee P, Chen X. Scope Of Primary Care Physicians' Participation In The Health Insurance Marketplaces. Health Aff (Millwood) 2019; 37:1252-1256. [PMID: 30080470 DOI: 10.1377/hlthaff.2018.0179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Millions of Americans have purchased health insurance through the Marketplaces, but their access to care is not well understood. Using an audit study, we compared the scope of primary care physicians' participation in Marketplace plans to that in other insurance types in 2016. Across ten diverse states, rates of participation in Marketplace plans were higher than those in Medicaid, but lower than those in employer-sponsored insurance.
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Bhattacharya J, Mukherjee M, Kumar K V, Rajan R, Shahid T, Goswami S, Naha Biswas L, Chatterjee P, Saha S. EP-1180 Re-radiation in head and neck malignancies: experience from a tertiary care centre in eastern india. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nathan AS, Shah RM, Khatana SA, Dayoub E, Chatterjee P, Desai ND, Waldo SW, Yeh RW, Groeneveld PW, Giri J. Effect of Public Reporting on the Utilization of Coronary Angiography After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2019; 12:e007564. [PMID: 30998398 PMCID: PMC9123930 DOI: 10.1161/circinterventions.118.007564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Public reporting of cardiovascular outcomes has been associated with risk aversion for potentially lifesaving procedures and may have spillover effects on nonreported but related procedures. METHODS AND RESULTS A cross-sectional analysis of the utilization of coronary angiography among patients presenting with out-of-hospital cardiac arrest between 2005 and 2011 in states with public reporting of percutaneous coronary intervention outcomes (New York and Massachusetts) versus neighboring states without public reporting of percutaneous coronary intervention outcomes (Delaware, Connecticut, Maine, Vermont, Maryland, and Rhode Island) was performed using the Nationwide Inpatient Sample. We analyzed 50 125 admission records with out-of-hospital cardiac arrest between 2005 and 2011. The unadjusted rate of coronary angiography for patients presenting with out-of-hospital cardiac arrest in states with public reporting versus without public reporting was not different (20.8% versus 22.8%, P=0.35). We found no statistically significant difference in the adjusted likelihood of coronary angiography in states with public reporting, though the point estimate suggested decreased utilization (odds ratio, 0.84; 95% CI, 0.66-1.06; P=0.14). There was no difference in the adjusted likelihood of in-hospital mortality for patients presenting with out-of-hospital cardiac arrest in states with public reporting compared to states without public reporting (odds ratio, 0.98; 95% CI, 0.78-1.23; P=0.88). CONCLUSIONS Public reporting of percutaneous coronary intervention outcomes was associated with a nonstatistically significant reduction in the utilization of diagnostic coronary angiography, a nonreported but related procedure, for patients with out-of-hospital cardiac arrest.
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Prakash A, Jaiswal A, Mittal S, Chatterjee P, Kotalwar S, Datta B. Barber′s neck manipulation causing bilateral diaphragmatic paralysis and type-2 respiratory failure. Lung India 2019. [DOI: 10.4103/0970-2113.257713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Venkataramani AS, Chatterjee P. Early Medicaid Expansions and Drug Overdose Mortality in the USA: a Quasi-experimental Analysis. J Gen Intern Med 2019; 34:23-25. [PMID: 30238403 PMCID: PMC6318168 DOI: 10.1007/s11606-018-4664-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Chatterjee P, Joynt Maddox K. Patterns of performance and improvement in US Medicare's Hospital Star Ratings, 2016-2017. BMJ Qual Saf 2018; 28:486-494. [PMID: 30530807 DOI: 10.1136/bmjqs-2018-008384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Publicly reported quality data can help consumers make informed choices about where to seek medical care. The Centers for Medicare and Medicaid Services developed a composite Hospital Compare Overall Star Rating for US acute-care hospitals in 2016. However, patterns of performance and improvement have not been previously described. OBJECTIVE To characterise high-quality and low-quality hospitals as assessed by Star Ratings. DESIGN We performed a retrospective cross-sectional study of 3429 US acute-care hospitals assigned Overall Star Ratings in both 2016 and 2017. We used multivariable logistic regression models to identify characteristics associated with receiving 4 or 5 stars. RESULTS Small hospitals were more likely to receive 4 or 5 stars in 2016 (33% of small hospitals, 26% of medium hospitals and 21% of large hospitals, OR for medium 0.78, p=0.02, and for large, 0.61, p=0.003). Non-profit status (OR 1.37, p=0.01), midwest region (OR=2.30, p<0.001), west region (OR 1.30 in 2016, p=0.06) and system membership (OR 1.33, p=0.003) were associated with higher odds of achieving a higher Star Rating. Hospitals with the most Medicaid patients were markedly less likely to receive 4 or 5 stars (OR for highest quartile=0.32, p<0.001), and hospitals with the highest proportion of Medicare patients were somewhat less likely to do so (OR for highest quartile=0.68, p=0.01). These associations remained largely consistent over the first two years of reporting and were also associated with the highest likelihood of improvement. CONCLUSIONS Small hospitals with fewer Medicaid patients had the highest odds of performing well on Star Ratings. Further monitoring of these trends is needed as patients, clinicians and policymakers strive to use this information to promote high-quality care.
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Goozee K, Chatterjee P, James I, Shen K, Sohrabi HR, Asih PR, Dave P, ManYan C, Taddei K, Ayton SJ, Garg ML, Kwok JB, Bush AI, Chung R, Magnussen JS, Martins RN. Elevated plasma ferritin in elderly individuals with high neocortical amyloid-β load. Mol Psychiatry 2018; 23:1807-1812. [PMID: 28696433 DOI: 10.1038/mp.2017.146] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/14/2017] [Accepted: 05/26/2017] [Indexed: 12/14/2022]
Abstract
Ferritin, an iron storage and regulation protein, has been associated with Alzheimer's disease (AD); however, it has not been investigated in preclinical AD, detected by neocortical amyloid-β load (NAL), before cognitive impairment. Cross-sectional analyses were carried out for plasma and serum ferritin in participants in the Kerr Anglican Retirement Village Initiative in Aging Health cohort. Subjects were aged 65-90 years and were categorized into high and low NAL groups via positron emission tomography using a standard uptake value ratio cutoff=1.35. Ferritin was significantly elevated in participants with high NAL compared with those with low NAL, adjusted for covariates age, sex, apolipoprotein E ɛ4 carriage and levels of C-reactive protein (an inflammation marker). Ferritin was also observed to correlate positively with NAL. A receiver operating characteristic curve based on a logistic regression of the same covariates, the base model, distinguished high from low NAL (area under the curve (AUC)=0.766), but was outperformed when plasma ferritin was added to the base model (AUC=0.810), such that at 75% sensitivity, the specificity increased from 62 to 71% on adding ferritin to the base model, indicating that ferritin is a statistically significant additional predictor of NAL over and above the base model. However, ferritin's contribution alone is relatively minor compared with the base model. The current findings suggest that impaired iron mobilization is an early event in AD pathogenesis. Observations from the present study highlight ferritin's potential to contribute to a blood biomarker panel for preclinical AD.
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Prakash AK, Datta B, Tripathy JP, Kumar N, Chatterjee P, Jaiswal A. The clinical utility of cycle of threshold value of GeneXpert MTB/RIF (CBNAAT) and its diagnostic accuracy in pulmonary and extra-pulmonary samples at a tertiary care center in India. Indian J Tuberc 2018; 65:296-302. [PMID: 30522616 DOI: 10.1016/j.ijtb.2018.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are knowledge gaps in the in-depth analysis of the most promising and robust diagnostic tool, GeneXpert MTB/RIF (CBNAAT). The cycle of threshold (CT) value of the CBNAAT test and its clinical implications has not been explored much. AIMS AND OBJECTIVES The study aimed at (a) estimating the diagnostic accuracy and incremental yield of Xpert MTB/RIF in various specimens (b) establishing the association between CT value category (high, medium, low, very low) and culture time-to-positivity (TTP). METHODS A total of 1000 samples, both pulmonary and extra-pulmonary were collected from presumptive TB cases in a large tertiary care hospital. Sensitivity and specificity of CBNAAT was calculated with culture as the gold standard. The association of CT value with culture TTP was also studied. RESULTS The overall sensitivity of CBNAAT was 88.5%, with bronchial washing specimen being the most sensitive (92.3%) and pleural fluid being the least (66.7%). In smear negative individuals, the sensitivity of CBNAAT was 80.9%. The additional yield of CBNAAT over smear microscopy was 10.9%. It was observed that as we move from high to very low CT category, culture positivity decreases significantly (p<0.001), whereas time taken for culture growth increases (p<0.001). CONCLUSION CBNAAT is a robust test for accurate diagnosis of tuberculosis both pulmonary and extra-pulmonary, smear negative as well, especially in resource-limited settings. The correlation between CT value and culture TTP has potential in predicting bacillary load, though further studies are required.
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Navathe AS, Liao JM, Shah Y, Lyon Z, Chatterjee P, Polsky D, Emanuel EJ. Characteristics of Hospitals Earning Savings in the First Year of Mandatory Bundled Payment for Hip and Knee Surgery. JAMA 2018; 319:930-932. [PMID: 29509857 PMCID: PMC5885897 DOI: 10.1001/jama.2018.0678] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses Medicare data to compare the characteristics of hospitals that did vs did not realize episodes savings under the Centers for Medicare & Medicaid Services’ Comprehensive Care for Joint Replacement program, which bundled payments for hip and knee surgery and paid bonuses to hospitals that exceeded quality and cost benchmarks.
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Akpoveso OO, Olivier G, Chatterjee P, Olajide O, Tumbas Šaponjac V. Investigation of potential anti-diabetic effect of Mucuna pruriens (L) DC (Fabaceae) aqueous leaf extract. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Singh H, Chatterjee P, Narang R, Dey A. GERIATRIC SYNDROMES WITH HEART FAILURE, CROSS-SECTIONAL STUDY WITH IMPLICATION IN CLINICAL PRACTICE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prem N, Chatterjee P, Chakrawarty A, Dey A. URINARY INCONTINENCE AMONG OLDER INDIANS: ASSESSMENT AND IMPACT ON QUALITY OF LIFE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Subramanian M, Chatterjee P, Chakrawarty A, Dey A. A STUDY OF GAIT AND FALLS IN OLDER INDIANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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