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Mori M, Nasir K, Bao H, Jimenez A, Legore SS, Wang Y, Grady J, Lama SD, Brandi N, Lin Z, Kurlansky P, Geirsson A, Bernheim SM, Krumholz HM, Suter LG. Administrative Claims Measure for Profiling Hospital Performance Based on 90-Day All-Cause Mortality Following Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Qual Outcomes 2021; 14:e006644. [PMID: 33535776 DOI: 10.1161/circoutcomes.120.006644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery bypass graft (CABG) surgery is a focus of bundled and alternate payment models that capture outcomes up to 90 days postsurgery. While clinical registry risk models perform well, measures encompassing mortality beyond 30 days do not currently exist. We aimed to develop a risk-adjusted hospital-level 90-day all-cause mortality measure intended for assessing hospital performance in payment models of CABG surgery using administrative data. METHODS Building upon Centers for Medicare and Medicaid Services hospital-level 30-day all-cause CABG mortality measure specifications, we extended the mortality timeframe to 90 days after surgery and developed a new hierarchical logistic regression model to calculate hospital risk-standardized 90-day all-cause mortality rates for patients hospitalized for isolated CABG. The model was derived from Medicare claims data for a 3-year cohort between July 2014 to June 2017. The data set was randomly split into 50:50 development and validation samples. The model performance was evaluated with C statistics, overfitting indices, and calibration plot. The empirical validity of the measure result at the hospital level was evaluated against the Society of Thoracic Surgeons composite star rating. RESULTS Among 137 819 CABG procedures performed in 1183 hospitals, the unadjusted mortality rate within 30 and 90 days were 3.1% and 4.7%, respectively. The final model included 27 variables. Hospital-level 90-day risk-standardized mortality rates ranged between 2.04% and 11.26%, with a median of 4.67%. C statistics in the development and validation samples were 0.766 and 0.772, respectively. We identified a strong positive correlation between 30- and 90-day risk-standardized mortality rates, with a regression slope of 1.09. Risk-standardized mortality rates also showed a stepwise trend of lower 90-day mortality with higher Society of Thoracic Surgeons composite star ratings. CONCLUSIONS We present a measure of hospital-level 90-day risk-standardized mortality rates following isolated CABG. This measure complements Centers for Medicare and Medicaid Services' existing 30-day CABG mortality measure by providing greater insight into the postacute recovery period. It offers a balancing measure to ensure efforts to reduce costs associated with CABG recovery and rehabilitation do not result in unintended consequences.
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Affiliation(s)
- Makoto Mori
- Section of Cardiac Surgery, Department of Surgery, (M.M., A.G.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Khurram Nasir
- Section of Cardiovascular Medicine (K.N., H.M.K), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Haikun Bao
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Andreina Jimenez
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Shani S Legore
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Yongfei Wang
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Jacqueline Grady
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Sonam D Lama
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Nina Brandi
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Zhenqiu Lin
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Paul Kurlansky
- Division of Cardiac Surgery, Columbia University Medical Center, New York, NY (P.K.)
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, (M.M., A.G.), Yale School of Medicine, New Haven, CT
| | - Susannah M Bernheim
- Section of General Internal Medicine (S.M.B.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.)
| | - Harlan M Krumholz
- Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.).,Department of Health Policy and Administration, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Lisa G Suter
- Section of Rheumatology, Department of Internal Medicine (L.G.S.) Yale School of Medicine, New Haven, CT.,Center for Outcomes Research & Evaluation, Yale New Haven Health System, New Haven, CT (M.M., K.N., H.B., A.J., S.L., Y.W., J.G., S.L., N.B., Z.L, S.M.B., H.M.K., L.G.S.).,West Haven Veterans Administration Medical Center, West Haven, CT (L.G.S.)
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Pellacani G, Alessandrini A, Mandel VD, Martella A, Brandi N, Chester J, Piraccini BM, Starace M. Onychoscopy with red light for vascular pattern identification: a study of 33 patients. J Eur Acad Dermatol Venereol 2019; 33:2355-2361. [PMID: 31287600 DOI: 10.1111/jdv.15790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nail dermoscopy (onychoscopy) during physical examination assists in correct diagnosis. Often further magnifications are necessary for an effective differential diagnosis. With the addition of a red light to the dermoscope, important vascular features can be visualized. OBJECTIVE To describe common features observed at onychoscopy with a new device that combines the regular white light with the red light illumination, demonstrating that it is useful for diagnosis of nail disorders. METHODS We enrolled 33 consecutive patients referred to the Nail Diseases Dermatology Unit of the University of Modena and Reggio Emilia and to the Outpatient Consultation for Nail Disease of the Dermatology Unit of the University of Bologna. Patients were assessed with a standard hand-held dermoscope and at the red light dermoscope. Dermoscopic images were collected. RESULTS The new prototype was used during daily clinical practice and allowed a more accurate visualization of some details that classic onychoscopy can miss. In particular, with the help of the red light it was possible to better visualize nail lesions that were characterized by some kind of colour change or vascular alterations. CONCLUSION The new device of red light for vascular pattern onychoscopy can be a new investigation method to observe nail alterations, especially due to vascular pattern, even with low magnification, without the necessity to use higher resolutions.
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Affiliation(s)
- G Pellacani
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - A Alessandrini
- Department of Experimental, Diagnostic and Specialty Medicine-Division of Dermatology, University of Bologna, Bologna, Italy
| | - V D Mandel
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - N Brandi
- Department of Experimental, Diagnostic and Specialty Medicine-Division of Dermatology, University of Bologna, Bologna, Italy
| | - J Chester
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - B M Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine-Division of Dermatology, University of Bologna, Bologna, Italy
| | - M Starace
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Division of Dermatology, University of Bologna, Bologna, Italy
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Vidal S, Brandi N, Pacheco P, Maynou J, Fernandez G, Xiol C, Pascual-Alonso A, Pineda M, Armstrong J, Garcia-Cazorla À, del Carmen Serrano Munuera M, García SC, Troncoso M, Fariña G, García Peñas JJ, Fournier BG, León SR, Guitart M, Baena N, de Nanclares GP, Oci IO, Gutiérrez-Delicado E, Abarrategui B, Barroso E, Santos-Simarro F, Lapunzina P, García FJ, Acedo JM, García A, Martinez MA, Martínez-Bermejo A. The most recurrent monogenic disorders that overlap with the phenotype of Rett syndrome. Eur J Paediatr Neurol 2019; 23:609-620. [PMID: 31105003 DOI: 10.1016/j.ejpn.2019.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/12/2019] [Accepted: 04/28/2019] [Indexed: 12/30/2022]
Abstract
Rett syndrome (RTT) is an early-onset neurodevelopmental disorder that is caused by mutations in the MECP2 gene; however, defects in other genes (CDKL5 and FOXG1) can lead to presentations that resemble classic RTT, although they are not completely identical. Here, we attempted to identify other monogenic disorders that share features of RTT. A total of 437 patients with a clinical diagnosis of RTT-like were studied; in 242 patients, a custom panel with 17 genes related to an RTT-like phenotype was run via a HaloPlex-Target-Enrichment-System. In the remaining 195 patients, a commercial TruSight-One-Sequencing-Panel was analysed. A total of 40 patients with clinical features of RTT had variants which affect gene function in six genes associated with other monogenic disorders. Twelve patients had variants in STXBP1, nine in TCF4, six in SCN2A, five in KCNQ2, four in MEF2C and four in SYNGAP1. Genetic studies using next generation sequencing (NGS) allowed us to study a larger number of genes associated with RTT-like simultaneously, providing a genetic diagnosis for a wider group of patients. These new findings provide the clinician with more information and clues that could help in the prevention of future symptoms or in pharmacologic therapy.
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Affiliation(s)
- S Vidal
- Sant Joan de Déu Research Foundation, Barcelona, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - N Brandi
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - P Pacheco
- Molecular and Genetics Medicine Section, Hospital Sant Joan de Déu, Barcelona, Spain
| | - J Maynou
- Molecular and Genetics Medicine Section, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - G Fernandez
- Molecular and Genetics Medicine Section, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - C Xiol
- Sant Joan de Déu Research Foundation, Barcelona, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Pascual-Alonso
- Sant Joan de Déu Research Foundation, Barcelona, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - M Pineda
- Sant Joan de Déu Research Foundation, Barcelona, Spain
| | | | - J Armstrong
- Molecular and Genetics Medicine Section, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; CIBER-ER (Biomedical Network Research Center for Rare Diseases), Institute of Health Carlos III (ISCIII), Madrid, Spain.
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