scholarly journals Assessment of the Accuracy of the Diagnosis for Heart Failure in a Large Metropolitan Health Care System and the Impact on Readmission Rates

2015 ◽  
Vol 21 (8) ◽  
pp. S6
Author(s):  
Sandra Carey ◽  
Giovanna Saracino ◽  
Cara A. East ◽  
Paul A. Grayburn ◽  
Ravi C. Vallabhan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care System ◽  
Readmission Rates ◽  
The Impact ◽  
Care System

Abstract 094: Evaluation of Readmission and Survival Rates After Heart Failure Hospitalization in the Veterans Affairs Health Care System Between 2006 and 2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Justin Parizo ◽  
Shoutzu Lin ◽  
Anju Sahay ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care System ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Laboratory Data ◽  
Mortality Rates ◽  
Veterans Affairs ◽  
Readmission Rates ◽  
Care System

Objective: Evaluate trends in readmission and mortality rates after heart failure (HF) hospitalization among veterans in the era of improved utilization of guideline directed therapy and nation-wide focus on decreasing hospital readmission rates. Background: In the past decade, a strong emphasis has been placed on decreasing HF readmissions. Concurrently, adherence to guideline directed therapy has improved. A 2002 to 2006 evaluation of the Veterans Affairs Health Care System (VAHCS) showed stagnant HF readmission rates, but declining mortality rates. It is unclear to what extent the recent focus on decreasing readmission and following guidelines has affected these outcomes. Methods: The 30-day mortality and 30-day readmission rates of patients admitted with a first diagnosis of HF from 2006 to 2013 in the VAHCS were assessed for temporal trends. Odds ratios for these outcomes were adjusted for patient demographics, medical history, and laboratory data. Results: This study included 119,261 patients admitted to VAHCS institutions between 2006 and 2013 with a new diagnosis of HF. Among these patients, 116,849 were male, the mean age was 71.1 years, 80,497 were white, 24,753 were black, and 6,548 were Hispanic. During the two years preceding admission, the incidence of renal disease, ischemic heart disease, diabetes, malignancy, hypertension, COPD, CVD, and acute myocardial infarction were 46.1% (54,984 of 119,261), 73.5% (87,640 of 119,261), 56.1% (66,883 of 119,261), 16.2% (19,257 of 119,261), 92.8% (110,687 of 119,261), 53.7% (64,064 of 119,261), 22.9% (27,268 of 119,261), and 26.5% (31,619 of 119,261), respectively. During the study period, the 30-day readmission rate declined from 19.56% (3852 of 19,694) to 13.76% (1420 of 10,317, p < 0.0001) with an adjusted odds ratio of 30-day readmission in 2013 (vs 2006) of 0.66 (95% CI: 0.66 to 0.76) (Figure 1). Conversely, the 30-day mortality rate was stable at 5.62% (1107 of 19,694) in 2006 and 5.30% (547 of 10,317) in 2013 (p = 0.45) with an adjusted odds ratio of 30-day mortality in 2013 (vs 2006) of 1.22 (95% CI: 1.09 to 1.37). This odds ratio was stable from 2007 through 2013. Conclusions: Despite the observed decline in 30-day readmission rates, 30-day mortality rates have been unaffected by the recent focus on preventing readmission and improved guideline adherence.

scholarly journals COVID-19 Infections and Outcomes in a Live Registry of Heart Failure Patients Across an Integrated Health Care System

2020 ◽  
Author(s):  
Cesar Caraballo ◽  
Megan McCullough ◽  
Michael A. Fuery ◽  
Fouad Chouairi ◽  
Craig Keating ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care System ◽  
Integrated Health Care ◽  
Manuscript Preparation ◽  
Heart Failure Patients ◽  
Integrated Health ◽  
Integrated Health Care System ◽  
The Impact ◽  
Care System

AbstractBackgroundPatients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health care system in Connecticut.MethodsIn this retrospective analysis, the Yale Heart Failure Registry (NCT04237701) that includes 26,703 patients with heart failure across a 6-hospital integrated health care system in Connecticut was queried on April 16th, 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as, clinical management, respiratory failure, and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review.ResultsCOVID-19 testing was performed on 900 symptomatic patients, comprising 3.4% of the Yale Heart Failure Registry (N=26,703). Overall, 206 (23%) were COVID-19+. As compared to COVID-19-, these patients were more likely to be older, black, have hypertension, coronary artery disease, and were less likely to be on renin angiotensin blockers (P<0.05, all). COVID-19- patients tended to be more diffusely spread across the state whereas COVID-19+ were largely clustered around urban centers. 20% of COVID-19+ patients died, and age was associated with increased risk of death [OR 1.92 95% CI (1.33–2.78); P<0.001]. Among COVID-19+ patients who were ≥85 years of age rates of hospitalization were 87%, rates of death 36%, and continuing hospitalization 62% at time of manuscript preparation.ConclusionsIn this real-world snapshot of COVID-19 infection among a large cohort of heart failure patients, we found that a small proportion had undergone testing. Patients found to be COVID-19+ tended to be black with multiple comorbidities and clustered around lower socioeconomic status communities. Elderly COVID-19+ patients were very likely to be admitted to the hospital and experience high rates of mortality.

scholarly journals The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System

2019 ◽  
Vol 32 (3) ◽  
pp. 362-374 ◽  
Author(s):  
Thomas F. Northrup ◽  
Kelley Carroll ◽  
Robert Suchting ◽  
Yolanda R. Villarreal ◽  
Mohammad Zare ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Safety Net ◽  
Opioid Prescribing ◽  
Urban Safety ◽  
The Impact ◽  
Care System

scholarly journals The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

2017 ◽  
Vol 27 (6) ◽  
pp. 694-699 ◽  
Author(s):  
Nicolas W. Villelli ◽  
Hong Yan ◽  
Jian Zou ◽  
Nicholas M. Barbaro
Keyword(s):  
Health Care ◽  
New York ◽  
Health Care Reform ◽  
Health Care System ◽  
Spine Surgery ◽  
Private Insurance ◽  
New York State ◽  
Before And After ◽  
The Impact ◽  
Care System

OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

The Impact of Age on Colorectal Cancer Incidence, Treatment, and Outcomes in an Equal-Access Health Care System

2014 ◽  
Vol 57 (3) ◽  
pp. 303-310 ◽  
Author(s):  
Scott R. Steele ◽  
Grace E. Park ◽  
Eric K. Johnson ◽  
Matthew J. Martin ◽  
Alexander Stojadinovic ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Cancer Incidence ◽  
Equal Access ◽  
Colorectal Cancer Incidence ◽  
The Impact ◽  
Care System

Novel Use of a Nurse-Led Telemedicine Team in Acute Stroke: A Retrospective Review of the Impact on a Regional Health Care System

2019 ◽  
Vol 45 (3) ◽  
pp. 242-248 ◽  
Author(s):  
Susan B. Fowler ◽  
Christian A. Rosado ◽  
Jennifer Jones ◽  
Suzanne Ashworth ◽  
Darlene Adams
Keyword(s):  
Health Care ◽  
Acute Stroke ◽  
Health Care System ◽  
Retrospective Review ◽  
Regional Health ◽  
Regional Health Care ◽  
The Impact ◽  
Care System

Patient Experiences, Trust, and Preferences for Health Data Sharing

2021 ◽  
Author(s):  
Rochelle D. Jones ◽  
Chris Krenz ◽  
Kent A. Griffith ◽  
Rebecca Spence ◽  
Angela R. Bradbury ◽  
...  
Keyword(s):  
Health Care ◽  
Data Sharing ◽  
Health Care System ◽  
Lived Experiences ◽  
Care Delivery ◽  
Group Discussion ◽  
Final Analysis ◽  
Secondary Use ◽  
The Impact ◽  
Care System

PURPOSE: Scholars have examined patients' attitudes toward secondary use of routinely collected clinical data for research and quality improvement. Evidence suggests that trust in health care organizations and physicians is critical. Less is known about experiences that shape trust and how they influence data sharing preferences. MATERIALS AND METHODS: To explore learning health care system (LHS) ethics, democratic deliberations were hosted from June 2017 to May 2018. A total of 217 patients with cancer participated in facilitated group discussion. Transcripts were coded independently. Finalized codes were organized into themes using interpretive description and thematic analysis. Two previous analyses reported on patient preferences for consent and data use; this final analysis focuses on the influence of personal lived experiences of the health care system, including interactions with providers and insurers, on trust and preferences for data sharing. RESULTS: Qualitative analysis identified four domains of patients' lived experiences raised in the context of the policy discussions: (1) the quality of care received, (2) the impact of health care costs, (3) the transparency and communication displayed by a provider or an insurer to the patient, and (4) the extent to which care coordination was hindered or facilitated by the interchange between a provider and an insurer. Patients discussed their trust in health care decision makers and their opinions about LHS data sharing. CONCLUSION: Additional resources, infrastructure, regulations, and practice innovations are needed to improve patients' experiences with and trust in the health care system. Those who seek to build LHSs may also need to consider improvement in other aspects of care delivery.

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