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Mabotuwana T, Hall CS, Flacke S, Thomas S, Wald C. Inpatient Complexity in Radiology-a Practical Application of the Case Mix Index Metric. J Digit Imaging 2018; 30:301-308. [PMID: 28083829 DOI: 10.1007/s10278-017-9944-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
With ongoing healthcare payment reforms in the USA, radiology is moving from its current state of a revenue generating department to a new reality of a cost-center. Under bundled payment methods, radiology does not get reimbursed for each and every inpatient procedure, but rather, the hospital gets reimbursed for the entire hospital stay under an applicable diagnosis-related group code. The hospital case mix index (CMI) metric, as defined by the Centers for Medicare and Medicaid Services, has a significant impact on how much hospitals get reimbursed for an inpatient stay. Oftentimes, patients with the highest disease acuity are treated in tertiary care radiology departments. Therefore, the average hospital CMI based on the entire inpatient population may not be adequate to determine department-level resource utilization, such as the number of technologists and nurses, as case length and staffing intensity gets quite high for sicker patients. In this study, we determine CMI for the overall radiology department in a tertiary care setting based on inpatients undergoing radiology procedures. Between April and September 2015, CMI for radiology was 1.93. With an average of 2.81, interventional neuroradiology had the highest CMI out of the ten radiology sections. CMI was consistently higher across seven of the radiology sections than the average hospital CMI of 1.81. Our results suggest that inpatients undergoing radiology procedures were on average more complex in this hospital setting during the time period considered. This finding is relevant for accurate calculation of labor analytics and other predictive resource utilization tools.
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Affiliation(s)
- Thusitha Mabotuwana
- Radiology Solutions, Philips Healthcare, 3000 Minuteman Rd, Andover, MA, 01810, USA.
| | - Christopher S Hall
- Radiology Solutions, Philips Healthcare, 3000 Minuteman Rd, Andover, MA, 01810, USA
| | - Sebastian Flacke
- Department of Radiology, Lahey Hospital & Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Shiby Thomas
- Enterprise Information Technology Department, Lahey Health, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Christoph Wald
- Department of Radiology, Lahey Hospital & Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
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Boriani G, Berti E, Belotti LMB, Biffi M, De Palma R, Malavasi VL, Bottoni N, Rossi L, De Maria E, Mantovan R, Zardini M, Casali E, Marconi M, Bandini A, Tomasi C, Boggian G, Barbato G, Toselli T, Zennaro M, Sassone B. Cardiac device therapy in patients with left ventricular dysfunction and heart failure: ‘real‐world’ data on long‐term outcomes (mortality, hospitalizations, days alive and out of hospital). Eur J Heart Fail 2016; 18:693-702. [DOI: 10.1002/ejhf.509] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/05/2015] [Accepted: 12/26/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, University of Bologna Azienda Ospedaliera S. Orsola‐Malpighi Bologna Italy
- Division of Cardiology, Modena University Hospital University of Modena and Reggio Emilia Modena Italy
| | - Elena Berti
- Agency for Health and Social Care of Emilia‐Romagna Bologna Italy
| | | | - Mauro Biffi
- Institute of Cardiology, University of Bologna Azienda Ospedaliera S. Orsola‐Malpighi Bologna Italy
| | - Rossana De Palma
- Agency for Health and Social Care of Emilia‐Romagna Bologna Italy
| | - Vincenzo L. Malavasi
- Division of Cardiology, Modena University Hospital University of Modena and Reggio Emilia Modena Italy
| | - Nicola Bottoni
- Division of Cardiology S. Maria Nuova Hospital Reggio Emilia Italy
| | - Luca Rossi
- Division of Cardiology G. da Saliceto Hospital Piacenza Italy
| | | | | | - Marco Zardini
- Division of Cardiology Parma University Hospital Parma Italy
| | - Edoardo Casali
- Division of Cardiology, Modena University Hospital University of Modena and Reggio Emilia Modena Italy
| | - Marco Marconi
- Division of Cardiology, Local Health Unit Rimini Italy
| | - Alberto Bandini
- Division of Cardiologia G.B. Morgagni‐L. Pierantoni Hospital Forlì Italy
| | - Corrado Tomasi
- Division of Cardiology S. Maria delle Croci Hospital Ravenna Italy
| | - Giulio Boggian
- Division of Cardiology Hospital of Bentivoglio Bologna Italy
| | | | - Tiziano Toselli
- Division of Cardiology Ferrara University Hospital Ferrara Italy
| | - Mauro Zennaro
- Division of Cardiology Baggiovara Hospital Modena Italy
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Lindvall C, Chatterjee NA, Chang Y, Chernack B, Jackson VA, Singh JP, Metlay JP. National Trends in the Use of Cardiac Resynchronization Therapy With or Without Implantable Cardioverter-Defibrillator. Circulation 2016; 133:273-81. [PMID: 26635400 PMCID: PMC5259807 DOI: 10.1161/circulationaha.115.018830] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Candidates for cardiac resynchronization therapy (CRT) receive either a biventricular pacemaker or a biventricular pacemaker with an implantable cardioverter-defibrillator (CRT-D). Optimal device selection remains challenging because the benefit of implantable cardioverter-defibrillator therapy may not be uniform, particularly in patients at competing risk of nonsudden death. METHODS AND RESULTS In this serial cross-sectional study using the National Inpatient Sample database, we identified 311,086 admissions associated with CRT implant between 2006 to 2012. CRT-D was the most common device type (86.1%), including in patients ≥ 75 years of age with ≥ 5 Elixhauser comorbidities (75.5%). Multivariate predictors of CRT-D implant included demographic, clinical, and geographic factors: prior ventricular arrhythmia (rate ratio [RR], 1.14; 95% CI, 1.13-1.14), ischemic heart disease (RR, 1.11; 95% CI, 1.10-1.11), male sex (RR, 1.10; 95% CI, 1.09-1.10), black race (RR, 1.06; 95% CI: 1.04-1.07), and Northeast geographic region (RR, 1.06; 95% CI, 1.04-1.09). There was significant interhospital variation in the use of CRT-D (10-90 percentile range, 72.9%-98.0% CRT-D). CONCLUSIONS The majority of patients in this contemporary US cohort underwent implantation of CRT-D. Predictors of CRT-D implant included demographic, clinical, and geographic factors. In patient subgroups predicted to have an attenuated benefit from implantable cardioverter-defibrillator therapy (older adults with multiple comorbidities), CRT-D remained the dominant device type. An improved understanding of the determinants of device selection may aid in decision making and ultimately better align patient risk with device benefit at the time of CRT implantation.
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Affiliation(s)
- Charlotta Lindvall
- From Divisions of Palliative Care (C.L., V.A.J.), General Internal Medicine (C.L., Y.C., J.P.M.), and Cardiology (N.A.C., J.P.S.), Department of Medicine, Massachusetts General Hospital, Boston, MA and Harvard Medical School (C.L., Y.C., B.C., V.A.J., J.P.S., J.P.M.), Boston, MA.
| | - Neal A Chatterjee
- From Divisions of Palliative Care (C.L., V.A.J.), General Internal Medicine (C.L., Y.C., J.P.M.), and Cardiology (N.A.C., J.P.S.), Department of Medicine, Massachusetts General Hospital, Boston, MA and Harvard Medical School (C.L., Y.C., B.C., V.A.J., J.P.S., J.P.M.), Boston, MA
| | - Yuchiao Chang
- From Divisions of Palliative Care (C.L., V.A.J.), General Internal Medicine (C.L., Y.C., J.P.M.), and Cardiology (N.A.C., J.P.S.), Department of Medicine, Massachusetts General Hospital, Boston, MA and Harvard Medical School (C.L., Y.C., B.C., V.A.J., J.P.S., J.P.M.), Boston, MA
| | - Betty Chernack
- From Divisions of Palliative Care (C.L., V.A.J.), General Internal Medicine (C.L., Y.C., J.P.M.), and Cardiology (N.A.C., J.P.S.), Department of Medicine, Massachusetts General Hospital, Boston, MA and Harvard Medical School (C.L., Y.C., B.C., V.A.J., J.P.S., J.P.M.), Boston, MA
| | - Vicki A Jackson
- From Divisions of Palliative Care (C.L., V.A.J.), General Internal Medicine (C.L., Y.C., J.P.M.), and Cardiology (N.A.C., J.P.S.), Department of Medicine, Massachusetts General Hospital, Boston, MA and Harvard Medical School (C.L., Y.C., B.C., V.A.J., J.P.S., J.P.M.), Boston, MA
| | - Jagmeet P Singh
- From Divisions of Palliative Care (C.L., V.A.J.), General Internal Medicine (C.L., Y.C., J.P.M.), and Cardiology (N.A.C., J.P.S.), Department of Medicine, Massachusetts General Hospital, Boston, MA and Harvard Medical School (C.L., Y.C., B.C., V.A.J., J.P.S., J.P.M.), Boston, MA
| | - Joshua P Metlay
- From Divisions of Palliative Care (C.L., V.A.J.), General Internal Medicine (C.L., Y.C., J.P.M.), and Cardiology (N.A.C., J.P.S.), Department of Medicine, Massachusetts General Hospital, Boston, MA and Harvard Medical School (C.L., Y.C., B.C., V.A.J., J.P.S., J.P.M.), Boston, MA
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Wang NC, Piccini JP, Fonarow GC, Knight BP, Harinstein ME, Butler J, Lahiri MK, Metra M, Vaduganathan M, Gheorghiade M. The potential role of nonpharmacologic electrophysiology-based interventions in improving outcomes in patients hospitalized for heart failure. Heart Fail Clin 2013; 9:331-43, vi-vii. [PMID: 23809419 DOI: 10.1016/j.hfc.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hospitalization for heart failure (HHF) is commonly associated with symptomatic improvement in response to standard medical therapy, yet there remains a substantial risk of rehospitalization and death. Clinically stable outpatients and decompensated inpatients represent two types of patients with chronic heart failure. In the former, treatment of common heart rhythm disorders with nonpharmacologic electrophysiology-based interventions is of substantial benefit in select patients. The potential benefits of these interventions in the hospitalized setting are not well studied. In this review, current knowledge is discussed and future research directions are suggested with nonpharmacologic electrophysiology-based interventions to reduce the morbidity and mortality associated with patients with HHF.
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Affiliation(s)
- Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Mantziari L, Guha K, Senguttuvan NB, Sharma R. Cardiac resynchronization therapy for critically ill patients with left ventricular systolic dysfunction. Int J Cardiol 2011; 163:141-5. [PMID: 21664704 DOI: 10.1016/j.ijcard.2011.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/02/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The experience of cardiac resynchronization therapy (CRT) in critically ill patients with cardiogenic shock or advanced heart failure is limited and inadequately described in literature. METHODS CRT implants performed in patients on the cardiothoracic intensive care unit (ICU) at a tertiary cardiac centre during 2007-2010 were retrospectively studied. RESULTS We identified 24 patients, 17 male, of median age 76 years (IQR 11) treated with a CRT pacemaker (n=10) or CRT defibrillator (n=14). Prior to implantation median left ventricular ejection fraction (LVEF) was 26% (IQR 13) and median QRS duration 146 ms (IQR 29). Eleven (46%) patients were post elective cardiac surgery and 8 (33%) post emergency cardiac surgery or intervention with high prevalence of co-morbidities. Nineteen patients required inotropic support pre-implantation, 8 patients were on mechanical circulatory support and 18 were on mechanical ventilation. Post CRT LVEF improved from 26% to 39% (p=0.027) and the estimated glomerular filtration rate increased from 42 ml/min/1.73 m(2) (IQR 26) to 63 ml/min/1.73 m(2) (IQR 48, p=0.001). All but one patient were successfully weaned from inotropic support within a median of 4 days (IQR 5) post CRT and 22/24 (92%) survived to hospital discharge. After a median follow up of 392 days (IQR 538), 7 (33%) patients died. In-hospital and one year mortality rates were 8.3% and 29.4% respectively. Ten out of 12 patients (83%) were alive at long-term (22 ± 9 months) follow up. CONCLUSIONS CRT may assist weaning from circulatory and respiratory support in critically ill patients with left ventricular systolic dysfunction.
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