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de Havenon A, Skolarus LE, Mac Grory B, Bangad A, Sheth KN, Burke JF, Creutzfeldt CJ. National- and State-Level Trends in Medicare Hospice Beneficiaries for Stroke During 2013 to 2019 in the United States. Stroke 2024; 55:131-138. [PMID: 38063013 PMCID: PMC10752263 DOI: 10.1161/strokeaha.123.045021] [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: 08/29/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Stroke is the fifth leading cause of death in the United States, one of the leading contributors to Medicare cost, including through Medicare hospice benefits, and the rate of stroke mortality has been increasing since 2013. We hypothesized that hospice utilization among Medicare beneficiaries with stroke has increased over time and that the increase is associated with trends in stroke death rate. METHODS Using Medicare Part A claims data and Centers for Disease Control mortality data at a national and state level from 2013 to 2019, we report the proportion and count of Medicare hospice beneficiaries with stroke as well as the stroke death rate (per 100 000) in Medicare-eligible individuals aged ≥65 years. RESULTS From 2013 to 2019, the number of Medicare hospice beneficiaries with stroke as their primary diagnosis increased 104.1% from 78 812 to 160 884. The number of stroke deaths in the United States in individuals aged ≥65 years also increased from 109 602 in 2013 to 129 193 in 2019 (17.9% increase). In 2013, stroke was the sixth most common primary diagnosis for Medicare hospice, while in 2019 it was the third most common, surpassed only by cancer and dementia. The correlation between the change from 2013 to 2019 in state-level Medicare hospice for stroke and stroke death rate for Medicare-eligible adults was significant (Spearman ρ=0.5; P<0.001). In a mixed-effects model, the variance in the state-level proportion of Medicare hospice for stroke explained by the state-level stroke death rate was 48.2%. CONCLUSIONS From 2013 to 2019, the number of Medicare hospice beneficiaries with a primary diagnosis of stroke more than doubled and stroke jumped from the sixth most common indication for hospice to the third most common. While increases in stroke mortality in the Medicare-eligible population accounts for some of the increase of Medicare hospice beneficiaries, over half the variance remains unexplained and requires additional research.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, Center for Brain & Mind Health, Yale University, New Haven, CT (A.d.H., A.B., K.N.S.)
| | - Lesli E Skolarus
- Department of Neurology, Northwestern University, Chicago, IL (L.E.S.)
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, NC (B.M.G.)
| | - Aaron Bangad
- Department of Neurology, Center for Brain & Mind Health, Yale University, New Haven, CT (A.d.H., A.B., K.N.S.)
| | - Kevin N Sheth
- Department of Neurology, Center for Brain & Mind Health, Yale University, New Haven, CT (A.d.H., A.B., K.N.S.)
| | - James F Burke
- Department of Neurology, Ohio State University, Columbus (J.F.B.)
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Etges APBDS, de Souza AC, Jones P, Liu H, Zhang X, Marcolino M, Polanczyk CA, Martins SO, Sampaio G, Lioutas VA. Variation in Ischemic Stroke Payments in the USA: A Medicare Beneficiary Study. Cerebrovasc Dis 2023; 53:298-306. [PMID: 37717574 DOI: 10.1159/000533513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION The growing cost of stroke care has created the need for outcome-oriented and cost-saving payment models. Identifying imbalances in the current reimbursement model is an essential step toward designing impactful value-based reimbursement strategies. This study describes the variation in reimbursement fees for ischemic stroke management across the USA. METHODS This Medicare Fee-For-Service claims study examines USA beneficiaries who suffered an ischemic stroke from 2021Q1 to 2022Q2 identified using the Medicare-Severity Diagnosis-Related Groups (MS-DRGs). Demographic national and regional US data were extracted from the Census Bureau. The MS-DRG codes were grouped into four categories according to treatment modality and clinical complexity. Our primary outcome of interest was payments made across individual USA and US geographic regions, assessed by computing the mean incremental payment in cases of comparable complexity. Differences between states for each MS-DRG were statistically evaluated using a linear regression model of the logarithmic transformed payments. RESULTS 227,273 ischemic stroke cases were included in our analysis. Significant variations were observed among all DRGs defined by medical complexity, treatment modality, and states (p < 0.001). Differences in mean payment per case with the same MS-DRG vary by as high as 500% among individual states. Although higher payment rates were observed in MS-DRG codes with major comorbidities or complexity (MCC), the variation was more expressive for codes without MCC. It was not possible to identify a standard mean incremental fee at a state level. At a regional level, the Northeast registered the highest fees, followed by the West, Midwest, and South, which correlate with poverty rates and median household income in the regions. CONCLUSIONS The payment variability observed across USA suggests that the current reimbursement system needs to be aligned with stroke treatment costs. Future studies may go one step further to evaluate accurate stroke management costs to guide policymakers in introducing health policies that promote better care for stroke patients.
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Affiliation(s)
- Ana Paula Beck da Silva Etges
- Avant-garde Health, Boston, Massachusetts, USA,
- National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil (Project: 465518/2014-1), Porto Alegre, Brazil,
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,
| | | | | | - Harry Liu
- Avant-garde Health, Boston, Massachusetts, USA
| | | | - Miriam Marcolino
- National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil (Project: 465518/2014-1), Porto Alegre, Brazil
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carisi Anne Polanczyk
- National Institute of Science and Technology for Health Technology Assessment (IATS) - CNPq/Brazil (Project: 465518/2014-1), Porto Alegre, Brazil
- Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sheila Ouriques Martins
- Hospital Moinhos de Vento, Porto Alegre, Brazil
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gisele Sampaio
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vasileios Arsenios Lioutas
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Simmonds KP, Burke J, Kozlowski AJ, Andary M, Luo Z, Reeves MJ. Emulating Three Clinical Trials that Compare Stroke Rehabilitation at Inpatient Rehabilitation Facilities to Skilled Nursing Facilities. Arch Phys Med Rehabil 2022; 103:1311-1319. [PMID: 35245481 DOI: 10.1016/j.apmr.2021.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To inform the design of a potential future randomized controlled trial, we emulated three trials where patient-level outcomes were compared following stroke rehabilitation at Inpatient Rehabilitation Facilities (IRFs) to Skilled Nursing Facilities (SNFs). DESIGN Trials were emulated using a 1:1 matched propensity score analysis. The three trials differed as facilities from rehabilitation networks with different case-volumes were compared. Rehabilitation network case-volumes were based on the number of stroke patients that each hospital discharged to each specific IRF or SNF. Trial 1 included 60,529 patients from all networks, trial 2 included 34,444 patients from networks with medium- and large case-volumes (i.e., ≥5 patients), trial 3 included 19,161 patients from networks with large case-volumes (i.e., ≥10 patients). E-values were calculated to estimate the minimum strength that an unmeasured confounder would need to be to nullify the results. SETTING A national sample of IRFs and SNFs from across the United States. PARTICIPANTS Acute Fee-for-service Medicare stroke patients who received IRF or SNF based rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) 1-year successful community discharge (home for >30 consecutive days) and all-cause mortality. RESULTS Overall, 29,500, 15,156, and 7,450 patients were matched for trials 1, 2 and 3. For 1-year successful community discharge, absolute risk differences for IRF patients were 0.21 (95% CI: 0.20, 0.22), 0.17 (95% CI: 0.16, 0.19), and 0.12 (95% CI: 0.10, 0.14) in trials 1, 2 and 3, respectively. For 1-year all-cause mortality, corresponding risk differences were -0.11 (95% CI: -0.12, -0.11), -0.11 (95% CI: -0.12, -0.09), and -0.08 (95% CI: -0.10, -0.06). E-values indicated that a moderately sized unmeasured confounder, with a relative risk of 1.6 to 2.0 would nullify differences in successful community discharge. CONCLUSION(S) IRF patients had superior outcomes, but differences were attenuated when IRFs and SNFs from larger rehabilitation networks were compared. The vulnerability of the findings to unmeasured confounding supports the need for an RCT.
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Affiliation(s)
- Kent P Simmonds
- Department of Epidemiology and Biostatistics, Michigan State University - College of Human Medicine
| | - James Burke
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor, Mi
| | - Allan J Kozlowski
- Department of Epidemiology and Biostatistics, Michigan State University - College of Human Medicine; John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital
| | - Michael Andary
- Department of Physical Medicine & Rehabilitation, Michigan State University - College of Osteopathic Medicine
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, Michigan State University - College of Human Medicine
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University - College of Human Medicine.
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Stein LK, Mocco J, Fifi J, Jette N, Tuhrim S, Dhamoon MS. Correlations Between Physician and Hospital Stroke Thrombectomy Volumes and Outcomes: A Nationwide Analysis. Stroke 2021; 52:2858-2865. [PMID: 34092122 DOI: 10.1161/strokeaha.120.033312] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Laura K Stein
- Department of Neurology (L.K.S., J.F., N.J., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, NY
| | - J Mocco
- Department of Neurosurgery (J.M., J.F.), Icahn School of Medicine at Mount Sinai, NY
| | - Johanna Fifi
- Department of Neurology (L.K.S., J.F., N.J., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, NY.,Department of Neurosurgery (J.M., J.F.), Icahn School of Medicine at Mount Sinai, NY
| | - Nathalie Jette
- Department of Neurology (L.K.S., J.F., N.J., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, NY.,Department of Population Health Science and Policy (N.J.), Icahn School of Medicine at Mount Sinai, NY
| | - Stanley Tuhrim
- Department of Neurology (L.K.S., J.F., N.J., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, NY
| | - Mandip S Dhamoon
- Department of Neurology (L.K.S., J.F., N.J., S.T., M.S.D.), Icahn School of Medicine at Mount Sinai, NY
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Stein LK, Tuhrim S, Jette N, Fifi J, Mocco J, Dhamoon MS. Nationwide Analysis of Endovascular Thrombectomy Provider Specialization for Acute Stroke. Stroke 2020; 51:3651-3657. [DOI: 10.1161/strokeaha.120.029989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Purpose:
Determine the extent of cerebrovascular expertise among the specialties of proceduralists providing endovascular thrombectomy (ET) for emergent large vessel occlusion stroke in the modern era of acute stroke among Medicare beneficiaries
Methods:
Retrospective cohort study using validated
International Classification of Diseases, Tenth Revision
, Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ET. We identified proceduralist specialty by linking the National Provider Identifier provided by Medicare to the specialty listed in the National Provider Identifier database, grouping into radiology, neurology, neurosurgery, other surgical, and internal medicine. We calculated the number of proceduralists and hospitals who performed ET, ET team specialty composition by hospital, and number of proceduralists who performed ET at multiple hospitals.
Results:
Forty-two percent (n=5612) of ET were performed by radiology-background proceduralists, with unclear knowledge of how many were cerebrovascular specialists. Neurosurgery- and neurology-background interventionalists performed fewer but substantial numbers of cases, accounting for 24% (n=3217) and 23% (n=3124) of total cases, respectively. ET teams included a neurology- or neurosurgery-background proceduralist at 65% (n=407) of hospitals that performed ET and included both in 26% (n=160) of teams.
Conclusions:
Almost two-thirds of ET teams nationwide include a neurology- or neurosurgery-background proceduralist and higher volume centers in urban areas were more likely to have neurology- or neurosurgery-background proceduralists with cerebrovascular expertise on their team. It is unclear how many radiology-background interventionalists are cerebrovascular specialists versus generalists. Significant work remains to be done to understand the impact of proceduralist specialty, training, and cerebrovascular expertise on ET outcomes.
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Affiliation(s)
- Laura K. Stein
- Department of Neurology (L.K.S., S.T., N.J., J.F., M.S.D.), Icahn School of Medicine at Mount Sinai, NY
| | - Stanley Tuhrim
- Department of Neurology (L.K.S., S.T., N.J., J.F., M.S.D.), Icahn School of Medicine at Mount Sinai, NY
| | - Nathalie Jette
- Department of Neurology (L.K.S., S.T., N.J., J.F., M.S.D.), Icahn School of Medicine at Mount Sinai, NY
| | - Johanna Fifi
- Department of Neurology (L.K.S., S.T., N.J., J.F., M.S.D.), Icahn School of Medicine at Mount Sinai, NY
- Department of Neurosurgery (J.F., J.M.), Icahn School of Medicine at Mount Sinai, NY
| | - J Mocco
- Department of Neurosurgery (J.F., J.M.), Icahn School of Medicine at Mount Sinai, NY
| | - Mandip S. Dhamoon
- Department of Neurology (L.K.S., S.T., N.J., J.F., M.S.D.), Icahn School of Medicine at Mount Sinai, NY
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Wittbrodt E, Bhalla N, Andersson Sundell K, Gao Q, Dong L, Cavender MA, Hunt P, Wong ND, Mellström C. Assessment of the high risk and unmet need in patients with CAD and type 2 diabetes (ATHENA): US healthcare resource utilization, cost and burden of illness in the Diabetes Collaborative Registry. Endocrinol Diabetes Metab 2020; 3:e00133. [PMID: 32704557 PMCID: PMC7375123 DOI: 10.1002/edm2.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND THEMIS (NCT01991795) showed that in patients with type 2 diabetes (T2D) and stable coronary artery disease (CAD) but with no prior myocardial infarction (MI) or stroke, ticagrelor plus acetylsalicylic acid (ASA) decreased the incidence of ischaemic cardiovascular events compared with placebo plus ASA. To complement these findings, we assessed disease burden and healthcare resource utilization (HRU) in US patients with CAD and T2D, but without a prior MI or stroke. METHODS This observational study used 2013-2014 data from the Diabetes Collaborative Registry linked to Medicare administrative claims. Two cohorts of patients with T2D were studied: patients at high cardiovascular risk (THEMIS-like cohort; N = 56 040) and patients at high cardiovascular risk or taking P2Y12 inhibitors (CAD-T2D cohort; N = 69 790). Outcomes included the composite of all-cause death, MI and stroke; the individual events from the composite endpoint; HRU; and costs. RESULTS Median age was 73.0 years, and median follow-up was 1.3 years in both cohorts. Event rates of the composite outcome were 16.34 (95% confidence interval: 16.31-16.37) and 17.64 (17.61-17.67) per 100 person-years for the THEMIS-like and CAD-T2D cohorts, respectively. The incidence rate of bleeding events was 0.13 events per 100 person-years in both cohorts. Healthcare costs per patient-year were USD 8741 and USD 9150 in the THEMIS-like and CAD-T2D cohorts, respectively. CONCLUSIONS Patients in the THEMIS-like cohort and the broader CAD-T2D population had similarly substantial cardiovascular event rates and healthcare costs, indicating that patients with CAD and T2D similar to the THEMIS population are at an increased cardiovascular risk.
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Affiliation(s)
| | | | | | - Qi Gao
- Baim Institute for Clinical ResearchBostonMAUSA
| | - Liyan Dong
- Baim Institute for Clinical ResearchBostonMAUSA
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Olivera P, Danese S, Jay N, Natoli G, Peyrin-Biroulet L. Big data in IBD: a look into the future. Nat Rev Gastroenterol Hepatol 2019; 16:312-321. [PMID: 30659247 DOI: 10.1038/s41575-019-0102-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Big data methodologies, made possible with the increasing generation and availability of digital data and enhanced analytical capabilities, have produced new insights to improve outcomes in many disciplines. Application of big data in the health-care sector is in its early stages, although the potential for leveraging underutilized data to gain a better understanding of disease and improve quality of care is enormous. Owing to the intrinsic characteristics of inflammatory bowel disease (IBD) and the management dilemmas that it imposes, the implementation of big data research strategies not only can complement current research efforts but also could represent the only way to disentangle the complexity of the disease. In this Review, we explore important potential applications of big data in IBD research, including predictive models of disease course and response to therapy, characterization of disease heterogeneity, drug safety and development, precision medicine and cost-effectiveness of care. We also discuss the strengths and limitations of potential data sources that big data analytics could draw from in the field of IBD, including electronic health records, clinical trial data, e-health applications and genomic, transcriptomic, proteomic, metabolomic and microbiomic data.
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Affiliation(s)
- Pablo Olivera
- Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.,Humanitas Clinical Research Hospital, Rozzano, Milan, Italy
| | - Nicolas Jay
- Orpailleur and Department of Medical Information, LORIA and Nancy University Hospital, Vandoeuvre-lès-Nancy, Nancy, France
| | | | - Laurent Peyrin-Biroulet
- INSERM U954 and Department of Hepatogastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre-lès-Nancy, Nancy, France.
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8
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Lichtman JH, Leifheit EC, Wang Y, Goldstein LB. Hospital Quality Metrics: “America's Best Hospitals” and Outcomes After Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 28:430-434. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/03/2018] [Accepted: 10/13/2018] [Indexed: 11/27/2022] Open
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Ammann EM, Leira EC, Winiecki SK, Nagaraja N, Dandapat S, Carnahan RM, Schweizer ML, Torner JC, Fuller CC, Leonard CE, Garcia C, Pimentel M, Chrischilles EA. Chart validation of inpatient ICD-9-CM administrative diagnosis codes for ischemic stroke among IGIV users in the Sentinel Distributed Database. Medicine (Baltimore) 2017; 96:e9440. [PMID: 29384925 PMCID: PMC6392785 DOI: 10.1097/md.0000000000009440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/08/2017] [Accepted: 12/01/2017] [Indexed: 01/25/2023] Open
Abstract
The Sentinel Distributed Database (SDD) is a large database of patient-level medical and prescription records, primarily derived from insurance claims and electronic health records, and is sponsored by the U.S. Food and Drug Administration for drug safety assessments. In this chart validation study, we report on the positive predictive value (PPV) of inpatient ICD-9-CM acute ischemic stroke (AIS) administrative diagnosis codes (433.x1, 434.xx, and 436) in the SDD.As part of an assessment of the risk of thromboembolic adverse events following treatment with intravenous immune globulin (IGIV), charts were obtained for 131 potential post-IGIV AIS cases. Charts were abstracted by trained nurses and then adjudicated by stroke experts using pre-specified diagnostic criteria.Case status could be determined for 128 potential AIS cases, of which 34 were confirmed. The PPVs for the inpatient AIS diagnoses recorded in the SDD were 27% overall [95% confidence interval (95% CI): 19-35], 60% (95% CI: 32-84) for principal-position diagnoses, 42% (95% CI: 28-57) for secondary diagnoses, and 6% (95% CI: 2-15) for position-unspecified diagnoses (which in the SDD generally originate from separate physician claims associated with an inpatient stay).Position-unspecified diagnoses were unlikely to represent true AIS cases. PPVs for principal and secondary inpatient diagnosis codes were higher, but still meaningfully lower than estimates from prior chart validation studies. The low PPVs may be specific to the IGIV user study population. Additional research is needed to assess the validity of AIS administrative diagnosis codes in other study populations within the SDD.
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Affiliation(s)
- Eric M. Ammann
- College of Public Health, University of Iowa, Iowa City, IA
| | - Enrique C. Leira
- College of Public Health, University of Iowa, Iowa City, IA
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Scott K. Winiecki
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | | | | | | | - Marin L. Schweizer
- Carver College of Medicine, University of Iowa, Iowa City, IA
- Iowa City VA Health Care System, Iowa City, IA
| | | | - Candace C. Fuller
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Charles E. Leonard
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Crystal Garcia
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Madelyn Pimentel
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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Karhade AV, Larsen AMG, Cote DJ, Dubois HM, Smith TR. National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations. Neurosurgery 2017; 83:333-344. [DOI: 10.1093/neuros/nyx408] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/21/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
- Aditya V Karhade
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra M G Larsen
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Cote
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heloise M Dubois
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Hung LC, Sung SF, Hsieh CY, Hu YH, Lin HJ, Chen YW, Yang YHK, Lin SJ. Validation of a novel claims-based stroke severity index in patients with intracerebral hemorrhage. J Epidemiol 2016; 27:24-29. [PMID: 28135194 PMCID: PMC5328736 DOI: 10.1016/j.je.2016.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Stroke severity is an important outcome predictor for intracerebral hemorrhage (ICH) but is typically unavailable in administrative claims data. We validated a claims-based stroke severity index (SSI) in patients with ICH in Taiwan. METHODS Consecutive ICH patients from hospital-based stroke registries were linked with a nationwide claims database. Stroke severity, assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes, assessed using the modified Rankin Scale (mRS), were obtained from the registries. The SSI was calculated based on billing codes in each patient's claims. We assessed two types of criterion-related validity (concurrent validity and predictive validity) by correlating the SSI with the NIHSS and the mRS. Logistic regression models with or without stroke severity as a continuous covariate were fitted to predict mortality at 3, 6, and 12 months. RESULTS The concurrent validity of the SSI was established by its significant correlation with the admission NIHSS (r = 0.731; 95% confidence interval [CI], 0.705-0.755), and the predictive validity was verified by its significant correlations with the 3-month (r = 0.696; 95% CI, 0.665-0.724), 6-month (r = 0.685; 95% CI, 0.653-0.715) and 1-year (r = 0.664; 95% CI, 0.622-0.702) mRS. Mortality models with NIHSS had the highest area under the receiver operating characteristic curve, followed by models with SSI and models without any marker of stroke severity. CONCLUSIONS The SSI appears to be a valid proxy for the NIHSS and an effective adjustment for stroke severity in studies of ICH outcome with administrative claims data.
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Affiliation(s)
- Ling-Chien Hung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
| | - Ya-Han Hu
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Wei Chen
- Department of Neurology, Landseed Hospital, Tao-Yuan County, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yea-Huei Kao Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sue-Jane Lin
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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Roth DL, Sheehan OC, Huang J, Rhodes JD, Judd SE, Kilgore M, Kissela B, Bettger JP, Haley WE. Medicare claims indicators of healthcare utilization differences after hospitalization for ischemic stroke: Race, gender, and caregiving effects. Int J Stroke 2016; 11:928-934. [PMID: 27435204 DOI: 10.1177/1747493016660095] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Differences in healthcare utilization after stroke may partly explain race or gender differences in stroke outcomes and identify factors that might reduce post-acute stroke care costs. Aim To examine systematic differences in Medicare claims for healthcare utilization after hospitalization for ischemic stroke in a US population-based sample. Methods Claims were examined over a six-month period after hospitalization for 279 ischemic stroke survivors 65 years or older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Statistical analyses examined differences in post-acute healthcare utilization, adjusted for pre-stroke utilization, as a function of race (African-American vs. White), gender, age, stroke belt residence, income, Medicaid dual-eligibility, Charlson comorbidity index, and whether the person lived with an available caregiver. Results After adjusting for covariates, women were more likely than men to receive home health care and to use emergency department services during the post-acute care period. These effects were maintained even after further adjustment for acute stroke severity. African-Americans had more home health care visits than Whites among patients who received some home health care. Having a co-residing caregiver was associated with reduced acute hospitalization length of stay and fewer post-acute emergency department and primary care physician visits. Conclusions Underutilization of healthcare after stroke does not appear to explain poorer long-term stroke outcomes for women and African-Americans in this epidemiologically-derived sample. Caregiver availability may contribute to reduced formal care and cost during the post-acute period.
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Affiliation(s)
- David L Roth
- 1 Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Orla C Sheehan
- 1 Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jin Huang
- 1 Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - James D Rhodes
- 2 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne E Judd
- 2 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith Kilgore
- 3 Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brett Kissela
- 4 Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - William E Haley
- 6 School of Aging Studies, University of South Florida, Tampa, FL, USA
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Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7:449-90. [PMID: 26604824 PMCID: PMC4655913 DOI: 10.2147/clep.s91125] [Citation(s) in RCA: 2987] [Impact Index Per Article: 331.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The Danish National Patient Registry (DNPR) is one of the world’s oldest nationwide hospital registries and is used extensively for research. Many studies have validated algorithms for identifying health events in the DNPR, but the reports are fragmented and no overview exists. Objectives To review the content, data quality, and research potential of the DNPR. Methods We examined the setting, history, aims, content, and classification systems of the DNPR. We searched PubMed and the Danish Medical Journal to create a bibliography of validation studies. We included also studies that were referenced in retrieved papers or known to us beforehand. Methodological considerations related to DNPR data were reviewed. Results During 1977–2012, the DNPR registered 8,085,603 persons, accounting for 7,268,857 inpatient, 5,953,405 outpatient, and 5,097,300 emergency department contacts. The DNPR provides nationwide longitudinal registration of detailed administrative and clinical data. It has recorded information on all patients discharged from Danish nonpsychiatric hospitals since 1977 and on psychiatric inpatients and emergency department and outpatient specialty clinic contacts since 1995. For each patient contact, one primary and optional secondary diagnoses are recorded according to the International Classification of Diseases. The DNPR provides a data source to identify diseases, examinations, certain in-hospital medical treatments, and surgical procedures. Long-term temporal trends in hospitalization and treatment rates can be studied. The positive predictive values of diseases and treatments vary widely (<15%–100%). The DNPR data are linkable at the patient level with data from other Danish administrative registries, clinical registries, randomized controlled trials, population surveys, and epidemiologic field studies – enabling researchers to reconstruct individual life and health trajectories for an entire population. Conclusion The DNPR is a valuable tool for epidemiological research. However, both its strengths and limitations must be considered when interpreting research results, and continuous validation of its clinical data is essential.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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