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Ludmir J, Suero-Abreu GA, Gonzalez de la Nuez A, Robles M, Wood MJ, Del Carmen MG, Wasfy JH. Building a post-myocardial infarction discharge intervention program for Hispanic patients. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2024; 12:100730. [PMID: 38087744 DOI: 10.1016/j.hjdsi.2023.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/08/2023] [Accepted: 12/03/2023] [Indexed: 03/12/2024]
Abstract
Hispanic patients disproportionally suffer from disparities in care delivery in the setting of acute myocardial infarction (AMI). More specifically, Hispanic patients have higher 30-day readmission rates post-AMI and are less likely to be referred to cardiac rehab. Because of the challenges Hispanic patients face with post-AMI care, the Hispanic Acute Myocardial Infarction Discharge Intervention Study (HAMIDI) was launched to provide a culturally sensitive discharge framework to improve readmission and mortality rates in this population. Patients enrolled in this study participate in a comprehensive post-discharge program involving follow-up with a Spanish-speaking cardiologist, a two-part educational virtual group visit program, and access to support throughout the study. During the initial year of the study, 35 patients enrolled and successfully participated in the program. This case study reviews the implementation process, initial outcomes, challenges, and future plans of the program.
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Affiliation(s)
- Jonathan Ludmir
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, USA.
| | - Giselle A Suero-Abreu
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, USA
| | | | - Martin Robles
- Department of Internal Medicine, University of California, San Francisco, Fresno, USA
| | - Malissa J Wood
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, USA
| | - Marcela G Del Carmen
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Jason H Wasfy
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, USA
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Impact of HRRP Policy on 30-day and 90-day Readmissions in Patients with Acute Myocardial Infarction: A Ten-Year Trend from the National readmissions database. Curr Probl Cardiol 2023; 48:101696. [PMID: 36921652 DOI: 10.1016/j.cpcardiol.2023.101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Hospital readmissions following acute myocardial infarction (AMI) pose a significant economic burden on health care utilization. The hospital readmission reduction program (HRRP) enacted in 2012 focused on reducing readmissions by penalizing CMS Medicare hospitals. We aim to assess the trend of readmissions after AMI hospitalization between 2010-2019 and assess the impact of HRRP. METHODS The NRD was queried to identify AMI hospitalizations between 2010 and 2019. In the primary analysis, trends of 30-day and 90-day all-cause and AMI specific readmissions were assessed from 2010-2019. In the secondary analysis, trend of readmission mean length of stay (LOS) and mean adjusted total cost were calculated. RESULTS There were a total of 592,015 30-day readmissions and 787,008 90-day readmissions after an index hospitalization for AMI between 2010-2019. The rates of 30-day and 90-day all-cause readmissions decreased significantly from 12.8% to 11.6%, (p=0.0001) and 20.6 to 18.8, p(=0.0001) respectively in the decade under study. With regards to HRRP policy intervals, the pre-HRRP period from 2010-2012 showed a downward trend in all-cause readmission (12.8% to 11.6%) and similarly a downward trend was also seen in the post HRRP period (2013-2015:11.0%-8.2%, 2016-2019-12.3-11.7%). Secondary analysis showed a trend towards increase in mean LOS (4.54 to 4.96 days, P=0.0001) and adjusted total cost ($13,449 to $16,938) in 30-day all-cause readmission for AMI in the decade under review. CONCLUSION In our NRD-based analysis of patients readmitted to hospitals within 30-days and 90-days after AMI, the rate of all-cause readmissions down trended from 2010 to 2019.
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Abstract
PURPOSE OF REVIEW The past decade has brought increased efforts to better understand causes for ACS readmissions and strategies to minimize them. This review seeks to provide a critical appraisal of this rapidly growing body of literature. RECENT FINDINGS Prior to 2010, readmission rates for patients suffering from ACS remained relatively constant. More recently, several strategies have been implemented to mitigate this including improved risk assessment models, transition care bundles, and development of targeted programs by federal organizations and professional societies. These strategies have been associated with a significant reduction in ACS readmission rates in more recent years. With this, improvements in 30-day post-discharge mortality rates are also being appreciated. As we continue to expand our knowledge on independent risk factors for ACS readmissions, further strategies targeting at-risk populations may further decrease the rate of readmissions. Efforts to understand and reduce 30-day ACS readmission rates have resulted in overall improved quality of care for patients.
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McCarthy CP, Kolte D, Kennedy KF, Pandey A, Raber I, Oseran A, Wadhera RK, Vaduganathan M, Januzzi JL, Wasfy JH. Hospitalizations and Outcomes of T1MI Observed Before and After the Introduction of MI Subtype Codes. J Am Coll Cardiol 2021; 78:1242-1253. [PMID: 34531025 DOI: 10.1016/j.jacc.2021.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND International Classification of Disease (ICD)-10 coding of type 1 myocardial infarction (MI) is used for reimbursement, value-based programs, and clinical research. OBJECTIVES This study sought to determine whether the introduction of ICD-10 codes for type 2 and types 3-5 MI was associated with changes in hospitalizations for ICD-10 codes now attributed to type 1 MI. METHODS Using the Nationwide Readmissions Database, we identified patients with ICD-10 codes now attributed to type 1 MI between January 2016 and December 2018. Patients were stratified according to the timing of their event in relation to the introduction of the type 2 and types 3-5 MI codes on October 1, 2017. RESULTS There were 2,680,323 hospitalizations for ICD-10 codes now attributed to type 1 MI; after adjustment for seasonality, there was a 13.7% decline in hospitalizations after the introduction of the new subtype codes. Patients with ICD-10 codes now attributed to type 1 MI after the coding change were less likely to be female, had lower prevalence of several cardiovascular and noncardiovascular comorbidities, and had higher rates of coronary angiography and revascularization. After introduction of the new codes, there was a positive deflection in the slope of risk-adjusted in-hospital mortality (0.007%; P <0.001) and a negative deflection in risk-adjusted 30-day readmission (-0.002%; P = 0.05) for patients with ICD-10 codes now attributed to type 1 MI. CONCLUSIONS The introduction of ICD-10 codes for type 2 and types 3-5 MI was associated with a decrease in hospitalizations for ICD-10 codes now attributed to type 1 MI and changes in the observed characteristics and treatment patterns of these patients.
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Affiliation(s)
- Cian P McCarthy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dhaval Kolte
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin F Kennedy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Inbar Raber
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Oseran
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rishi K Wadhera
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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5
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Levy AE, Hammes A, Anoff DL, Raines JD, Beck NM, Rudofker EW, Marshall KJ, Nensel JD, Messenger JC, Masoudi FA, Pierce RG, Allen LA, Ream KS, Ho PM. Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System. Circ Cardiovasc Qual Outcomes 2021; 14:e006570. [PMID: 33653116 PMCID: PMC8127730 DOI: 10.1161/circoutcomes.120.006570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among Medicare value-based payment programs for acute myocardial infarction (AMI), the Hospital Readmissions Reduction Program uses International Classification of Diseases, Tenth Revision (ICD-10) codes to identify the program denominator, while the Bundled Payments for Care Improvement Advanced program uses diagnosis-related groups (DRGs). The extent to which these programs target similar patients, whether they target the intended population (type 1 myocardial infarction), and whether outcomes are comparable between cohorts is not known. METHODS In a retrospective study of 2176 patients hospitalized in an integrated health system, a cohort of patients assigned a principal ICD-10 diagnosis of AMI and a cohort of patients assigned an AMI DRG were compared according to patient-level agreement and outcomes such as mortality and readmission. RESULTS One thousand nine hundred thirty-five patients were included in the ICD-10 cohort compared with 662 patients in the DRG cohort. Only 421 patients were included in both AMI cohorts (19.3% agreement). DRG cohort patients were older (70 versus 65 years, P<0.001), more often female (48% versus 30%, P<0.001), and had higher rates of heart failure (52% versus 33%, P<0.001) and kidney disease (42% versus 25%, P<0.001). Comparing outcomes, the DRG cohort had significantly higher unadjusted rates of 30-day mortality (6.6% versus 2.5%, P<0.001), 1-year mortality (21% versus 8%, P<0.001), and 90-day readmission (26% versus 19%, P=0.006) than the ICD-10 cohort. Two observations help explain these differences: 61% of ICD-10 cohort patients were assigned procedural DRGs for revascularization instead of an AMI DRG, and type 1 myocardial infarction patients made up a smaller proportion of the DRG cohort (34%) than the ICD-10 cohort (78%). CONCLUSIONS The method used to identify denominators for value-based payment programs has important implications for the patient characteristics and outcomes of the populations. As national and local quality initiatives mature, an emphasis on ICD-10 codes to define AMI cohorts would better represent type 1 myocardial infarction patients.
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Affiliation(s)
- Andrew E. Levy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Cardiology, Denver Health and Hospital Authority, Denver, CO
| | - Andrew Hammes
- Division of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Debra L. Anoff
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Joshua D. Raines
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Natalie M. Beck
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Eric W. Rudofker
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kimberly J. Marshall
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jessica D. Nensel
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - John C. Messenger
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Frederick A. Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Larry A. Allen
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Karen S. Ream
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - P. Michael Ho
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Cardiovascular Medicine, VA Eastern Colorado Healthcare System, Denver, CO
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6
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Siddiqui MU, Ahmed A, Siddiqui MD, Pasha AK. Myocardial Infarction Type 2: Avoiding Pitfalls and Preventing Adverse Outcomes. Clin Med Res 2020; 18:117-119. [PMID: 33060112 PMCID: PMC7735451 DOI: 10.3121/cmr.2020.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/21/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022]
Abstract
Myocardial infarction type 2 (MI type 2) is an elevation of cardiac biomarkers in a physiologically stressful state leading to demand-supply mismatch of oxygen. This type of myocardial infarction is commonly seen in hospitalized patients. Since the introduction of clear definition, diagnostic criteria and International Classification of Disease (ICD) codes, the diagnosis has become increasingly common. There still remains plenty to learn about MI type 2 especially prevention and treatment strategies. Studies have shown that there is increased mortality and morbidity associated with MI type 2 when compared to MI type 1, and there may be benefit in having a multi-disciplinary approach including cardiology when treating such patients. Secondary prevention therapies may also play a role in decreasing adverse events from MI type 2. However, randomized control trials are insufficient, and results of studies are cautiously interpreted. In this article we have assessed the current evidence on MI type 2 and the gap in literature that will potentially be the focus of future analyses.
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Affiliation(s)
- Muhammad Umer Siddiqui
- Hospital Medicine/Internal Medicine, Marshfield Clinic Medical Center, Rice Lake, Wisconsin USA
| | - Adnan Ahmed
- Internal Medicine, Mayo Clinic, Mankato, Minnesota USA
| | | | - Ahmed K Pasha
- Internal Medicine, University of South Dakota, Sioux Falls, South Dakota USA
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Hilliard AL, Winchester DE, Russell TD, Hilliard RD. Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities. Clin Cardiol 2020; 43:1076-1083. [PMID: 32779762 PMCID: PMC7533960 DOI: 10.1002/clc.23431] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022] Open
Abstract
Heart disease continues to be the leading cause of death in the United States, with approximately 805 000 cumulative deaths from myocardial infarctions (MI) from 2005 to 2014. Gender and racial/ethnic disparities in MI diagnoses are becoming more evident in quality review audits. Although recent changes in diagnostic codes provided an improved framework, clinically distinguishing types of MI remains a challenge. MI misdiagnoses and health disparities contribute to adverse outcomes in cardiac medicine. We conducted a literature review of relevant biomedical sources related to the classification of MI and disparities in cardiovascular care and outcomes. From the studies analyzed, African Americans and women have higher rates of mortality from MI, are more probably to be younger and present with other comorbidities and are less probably to receive novel therapies with respect to type of MI. As high‐sensitivity troponin assays are adopted in the United States, implementation should account for how race and sex differences have been demonstrated in the reference range and diagnostic threshold of the newer assays. More research is needed to assess how the complexity of health disparities contributes to adverse cardiovascular outcomes. Creating dedicated medical quality teams (physicians, nurses, clinical documentation improvement specialists, and medical coders) and incorporating a plan‐do‐check‐adjust quality improvement model are strategies that could potentially help better define and diagnose MI, reduce financial burdens due to MI misdiagnoses, reduce cardiovascular‐related health disparities, and ultimately improve and save lives.
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Affiliation(s)
- Aaron L Hilliard
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, Florida, USA
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.,Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Tanya D Russell
- Center for Advanced Professional Excellence, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rosland D Hilliard
- Health Matters Environmental, Medical, Pharmaceutical and Toxicology, Jacksonville, Florida, USA
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McCarthy C, Murphy S, Cohen JA, Rehman S, Jones-O'Connor M, Olshan DS, Singh A, Vaduganathan M, Januzzi JL, Wasfy JH. Misclassification of Myocardial Injury as Myocardial Infarction: Implications for Assessing Outcomes in Value-Based Programs. JAMA Cardiol 2020; 4:460-464. [PMID: 30879022 DOI: 10.1001/jamacardio.2019.0716] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Similar to other patients with acute myocardial infarction, patients with type 2 myocardial infarction (T2MI) are included in several value-based programs, including the Hospital Readmissions Reduction Program and the Hospital Value-Based Purchasing Program. To our knowledge, whether nonischemic myocardial injury is being misclassified as T2MI is unknown and may have implications for these programs. Objective To determine whether patients with nonischemic myocardial injury are being miscoded as having T2MI and if this has implications for 30-day readmission and mortality rates. Design, Settings, and Participants Using the new International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code, we identified patients who were coded as having T2MI between October 2017 and May 2018 at Massachusetts General Hospital. Strict adjudication using the fourth universal definition of MI was then applied. Main outcome and Measures Clinical adjudication of T2MI and 30-day readmission and mortality rates as a function of T2MI or nonischemic myocardial injury. Results Of 633 patients, 369 (58.3%) were men and 514 (81.2%) were white. After strict adjudication, 359 (56.7%) had T2MI, 265 (41.9%) had myocardial injury, 6 (0.9%) had type 1 MI, and 3 (0.5%) had unstable angina. Patients with T2MI had a higher prevalence of cardiovascular comorbidities than those with myocardial injury. Patients with T2MI and myocardial injury had high in-hospital mortality rates (10.6% and 8.7%, respectively; P = .50). Of those discharged alive (563 [88.9%]), 30-day readmission rates (22.7% vs 21.1%; P = .68) and mortality rates (4.4% vs 7.4%; P = .14) were comparable among patients with T2MI and myocardial injury. Conclusions and Relevance A substantial percentage of patients coded as having T2MI actually have myocardial injury. Both conditions have high 30-day readmission and mortality rates. Including patients with high-risk myocardial injury may have substantial implications for value-based programs.
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Affiliation(s)
- Cian McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Sean Murphy
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Joshua A Cohen
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Saad Rehman
- Department of Medicine, Massachusetts General Hospital, Boston
| | | | - David S Olshan
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Avinainder Singh
- Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jason H Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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9
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Wasfy JH, Hidrue MK, Ngo J, Tanguturi VK, Cafiero-Fonseca ET, Thompson RW, Johnson N, McDermott ST, Singh JP, Del Carmen MG, Ferris TG. Association of an Acute Myocardial Infarction Readmission-Reduction Program With Mortality and Readmission. Circ Cardiovasc Qual Outcomes 2020; 13:e006043. [PMID: 32393130 DOI: 10.1161/circoutcomes.119.006043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reducing hospital readmission after acute myocardial infarction (AMI) has the potential to both improve quality and reduce costs. As such, readmission after AMI has been a target of financial penalties through Medicare. However, substantial concern exists about potential adverse effects and efficacious readmission-reduction strategies are not well validated. METHODS AND RESULTS We started an AMI readmissions reduction program in November 2017. Between July 2016 and February 2019, hospital billing data were queried to detect all inpatient hospitalizations at the Massachusetts General Hospital for AMI. Thirty-day readmission was identified through hospital billing data, and mortality was extracted from our electronic health record. The data set was merged with claims data for patients in accountable care organizations to detect readmission at other hospitals. We performed segmented linear regression, adjusting for secular trend and case mix, to assess the independent association of our program on both outcome variables. After inclusion and exclusion criteria were applied, the study population included 2020 patients. The overall 30-day readmission rate was higher before the intervention than after the intervention (15.5% versus 10.7%, P=0.002). The overall 30-day mortality rate was similar in both time periods (1.8% versus 1.4%, P=0.457). The program was associated with initial reduction in 30-day readmission (-9.8%, P=0.0002) and 30-day mortality (-2.6%, P=0.041). The program did not change trend in 30-day readmission (+0.19% readmissions/mo, P=0.554) and trend in 30-day mortality (-0.21% deaths/mo, P=0.119). CONCLUSIONS An AMI readmissions reduction program that increases outpatient and emergency department (ED) access to cardiology care is associated with reduced 30-day readmission and 30-day mortality. Similar statistical techniques can be used to conduct a rigorous, mechanistic program evaluation of other quality improvement initiatives.
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Affiliation(s)
- Jason H Wasfy
- Cardiology Division, Department of Medicine (J.H.W., V.K.T., S.T.M., J.P.S.), Massachusetts General Hospital, Harvard Medical School, Boston.,Massachusetts General Physicians Organization, Boston (J.H.W., M.K.H., J.N., M.G.d.C., T.G.F.)
| | - Michael K Hidrue
- Massachusetts General Physicians Organization, Boston (J.H.W., M.K.H., J.N., M.G.d.C., T.G.F.)
| | - Jacqueline Ngo
- Massachusetts General Physicians Organization, Boston (J.H.W., M.K.H., J.N., M.G.d.C., T.G.F.).,Performance Analysis and Improvement Unit, Massachusetts General Hospital, Boston (J.N., E.T.C.-F., N.J.)
| | - Varsha K Tanguturi
- Cardiology Division, Department of Medicine (J.H.W., V.K.T., S.T.M., J.P.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | | | - Ryan W Thompson
- Department of Medicine (T.G.F., R.W.T.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Natalie Johnson
- Performance Analysis and Improvement Unit, Massachusetts General Hospital, Boston (J.N., E.T.C.-F., N.J.)
| | - Susan T McDermott
- Cardiology Division, Department of Medicine (J.H.W., V.K.T., S.T.M., J.P.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jagmeet P Singh
- Cardiology Division, Department of Medicine (J.H.W., V.K.T., S.T.M., J.P.S.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (M.G.d.C.), Massachusetts General Hospital, Harvard Medical School, Boston.,Massachusetts General Physicians Organization, Boston (J.H.W., M.K.H., J.N., M.G.d.C., T.G.F.)
| | - Timothy G Ferris
- Department of Medicine (T.G.F., R.W.T.), Massachusetts General Hospital, Harvard Medical School, Boston.,Massachusetts General Physicians Organization, Boston (J.H.W., M.K.H., J.N., M.G.d.C., T.G.F.)
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10
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Wasfy JH, Murphy SP. Editorial: Misclassification of Type 2 Myocardial Infarction: Implications for Value-Based Programs and Quality Metrics. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:180-181. [DOI: 10.1016/j.carrev.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/29/2022]
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11
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Culler SD, Kugelmass AD, Cohen DJ, Reynolds MR, Katz MR, Brown PP, Schlosser ML, Simon AW. Understanding Readmissions in Medicare Beneficiaries During the 90-Day Follow-Up Period of an Acute Myocardial Infarction Admission. J Am Heart Assoc 2019; 8:e013513. [PMID: 31663436 PMCID: PMC6898831 DOI: 10.1161/jaha.119.013513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Medicare has a voluntary episodic payment model for Medicare beneficiaries that bundles payment for the index acute myocardial infarction (AMI) hospitalization and all post‐discharge services for a 90‐day follow‐up period. The purpose of this study is to report on the types and frequency of readmissions and identify demographic and clinical factors associated with readmission of Medicare beneficiaries that survived their AMI hospitalization. Methods and Results This retrospective study used the Inpatient Standard Analytical File for 2014. There were 143 286 Medicare beneficiaries with AMI who were discharged alive from 3619 hospitals. All readmissions occurring in any hospital within 90 days of the index AMI discharge date were identified. Of 143 286 Medicare beneficiaries discharged alive from their index AMI hospitalization, 28% (40 145) experienced at least 1 readmission within 90 days and 8% (11 477) had >1 readmission. Readmission rates were higher among Medicare beneficiaries who did not undergo a percutaneous coronary intervention in their index AMI admission (34%) compared with those that underwent a percutaneous coronary intervention (20.2%). Using all Medicare beneficiary's index AMI, 27 comorbid conditions were significantly associated with the likelihood of a Medicare beneficiary having a readmission during the follow‐up period. The strongest clinical characteristics associated with readmissions were dialysis dependence, type 1 diabetes mellitus, and heart failure. Conclusions This study provides benchmark information on the types of hospital readmissions Medicare beneficiaries experience during a 90‐day AMI bundle. This paper also suggests that interventions are needed to alleviate the need for readmissions in high‐risk populations, such as, those managed medically and those at risk of heart failure.
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Affiliation(s)
| | | | - David J Cohen
- Saint Luke's Mid America Heart Institute Kansas City MO
| | | | - Marc R Katz
- Medical University of South Carolina Charleston SC
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12
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McCarthy CP, McWalters ST, Wasfy JH. ICD- 10 Coding of Type 2 Myocardial Infarction and Myocardial Injury as It Relates to US Centers for Medicare & Medicaid Services Value-Based Payment Programs—Reply. JAMA Cardiol 2019; 4:1051-1052. [DOI: 10.1001/jamacardio.2019.2821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Cian P. McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sean T. McWalters
- Center for Quality and Safety, Quality Incentives and Rankings, Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston
| | - Jason H. Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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