Abstract 9152: Incidence of Cardiac Arrest Among Medicare Beneficiaries

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Tyler P Rasmussen ◽  
Danielle Riley ◽  
Mary Vaughan-Sarazzin ◽  
Paul Chan ◽  
Saket Girotra
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Nurse Staffing ◽  
Incidence Rates ◽  
Case Mix ◽  
Medicare Beneficiaries ◽  
Case Mix Index ◽  
Hospital Variation ◽  
Number Of Patients ◽  
Teaching Status

Introduction: Although survival for in-hospital cardiac arrest (IHCA) has improved substantially over the last two decades, survival rates have plateaued in recent years. Our understanding of incidence of IHCA remains limited. We measured incidence of IHCA among Medicare beneficiaries and evaluated hospital variation in incidence of IHCA. Methods: We used an observational cohort study using data from 2014-2017 Get with the Guidelines-Resuscitation (GWTG-R) data linked with Medicare inpatient data summarized by hospital. Hospital incidence of IHCA among Medicare beneficiaries was calculated as the total number of patients 65 years and older with an IHCA divided by the total number of Medicare admissions. Multivariable hierarchical regression models were used to adjust hospital incidence rates for differences in case-mix across study hospitals and evaluate its the association with hospital variables. Results: Among a total of 4.5 million admissions at 170 hospitals, 38,630 patients experienced an IHCA. The median risk-adjusted IHCA incidence was 8.3 per-1000 admissions. Even after adjusting for differences in case-mix index, IHCA incidence varied markedly across hospitals (Figure 1) ranging from 2.1 per-1000 admissions to 24.7 per-1000 admissions (interquartile range: 6.5-11.4; median odds ratio: 1.52; 95% credible interval 1.45-1.59). Among hospital variables, a higher case-mix index, higher nurse staffing and teaching status were associated with a lower hospital incidence of IHCA. Conclusions: Incidence of IHCA varies markedly across hospitals, even after adjustment for differences in patient case-mix. Hospital variables including case-mix severity, nurse staffing and teaching status were significantly associated with incidence rates. Future studies are needed to better understand processes of care at hospitals with exceptionally low IHCA incidence to identify best practices for cardiac arrest prevention.

Association of Hospital Characteristics With Early SEP-1 Performance

2019 ◽  
Vol 35 (2) ◽  
pp. 110-116 ◽  
Author(s):  
Jeff Liao ◽  
Emily Aaronson ◽  
Jungyeon Kim ◽  
Xiu Liu ◽  
Colleen Snydeman ◽  
...  
Keyword(s):  
Case Mix ◽  
Linear Modeling ◽  
For Profit ◽  
Case Mix Index ◽  
Teaching Status ◽  
Acute Hospitals ◽  
Patient Complexity ◽  
Hospital Compare ◽  
Teaching Intensity ◽  
Hospital Characteristics

A variety of hospital characteristics, including teaching status, ownership, location, and size, have been shown to be associated with quality measure performance. The association of hospital characteristics, including teaching intensity, with performance on the Centers for Medicare & Medicaid Services (CMS) SEP-1 sepsis measure has not been well studied. Utilizing a statewide, all-payer database and the CMS Hospital Compare database, this study investigated the association of various hospital characteristics with early SEP-1 performance in 48 acute hospitals in Massachusetts. Hospital teaching intensity and Magnet designation did not have a statistically significant association with SEP-1 performance in multivariable linear modeling. However, SEP-1 performance was higher in smaller, for-profit hospitals with higher case mix index. This finding suggests that emergency department activity, hospital ownership, and patient complexity should be studied further across a larger geographic spectrum and longitudinally as hospitals implement efforts to reduce morbidity associated with sepsis.

scholarly journals Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
B. Y. Gravesteijn ◽  
M. Schluep ◽  
H. F. Lingsma ◽  
R. J. Stolker ◽  
H. Endeman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Quality Of Care ◽  
The Netherlands ◽  
Odds Ratio ◽  
Vegetative State ◽  
Survival Rates ◽  
Cerebral Performance Category ◽  
Case Mix ◽  
Hospital Cardiac Arrest

Abstract Background Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. Methods A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. Results After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). Conclusion In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.

Abstract 350: Hospital Variation in Survival for Pediatric In-Hospital Cardiac Arrest: A Report From Get With the Guidelines -Resuscitation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Natalie Jayaram ◽  
John A Spertus ◽  
Fengming Tang ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
National Registry ◽  
High Performing ◽  
Hierarchical Logistic Regression ◽  
Hospital Survival ◽  
Hospital Variation ◽  
C Statistic ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children, validated methods to risk-standardize pediatric survival rates across sites do not currently exist. Methods: Within the American Heart Association’s Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1,640 cardiac arrests in children from 168 hospitals from 2006 to 2010. Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge. We then applied the coefficients and random hospital intercepts from the model to examine risk-standardized rates of cardiac arrest survival for those hospitals with a minimum of 10 pediatric cardiac arrest cases. Results: A total of 15 patient-level predictors were identified: age, sex, race, cardiac arrest rhythm, location and day of arrest, mechanical ventilation, baseline depression in neurological function, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, and use of intravenous antiarrhythmics or vasopressors at the time of arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 31 hospitals with at least 10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; inter-quartile range [IQR]: 21% to 44%; range: 0% to 59%). After risk-standardization, variation in hospital survival rates persisted (median, 37%; IQR: 33% to 41%; range: 31% to 49%), although the range of outcomes narrowed considerably. Conclusion: In a large national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. Even with risk-standardization, there is significant variation in survival rates across hospitals. Leveraging these models, best practices can be assessed at high-performing hospitals and shared with others to improve care in the setting of pediatric cardiac arrest.

Nationwide trends in the incidence of orbital lymphoma from 1999 to 2016 in South Korea

2020 ◽  
pp. bjophthalmol-2020-316796
Author(s):  
Su Kyung Jung ◽  
Jiwon Lim ◽  
Suk Woo Yang ◽  
Young-Joo Won
Keyword(s):  
South Korea ◽  
B Cell ◽  
Incidence Rate ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Incidence Rates ◽  
Annual Percent Change ◽  
Orbital Lymphoma

Background/AimsLymphomas are the most frequent neoplasm of the orbit. However, the epidemiology of orbital lymphomas is not well reported. This study aimed to provide a population-based report on the epidemiology of orbital lymphomas and measure the trends in the incidence of orbital lymphoma cancer in South Korea.MethodsNationwide cancer incidence data from 1999 to 2016 were obtained from the Korea Central Cancer Registry. Age-standardised incidence rates and annual percent changes were calculated according to sex and histological types. The analysis according to the Surveillance, Epidemiology, and End Results summary stage classifications was performed from 2006 to 2016. Survival rates were estimated for cases diagnosed from 1999 to 2016.ResultsA total of 630 patients (median age: 54 years) with orbital lymphoma in the orbital soft tissue were included in this study. The age-standardised incidence rates increased from 0.03 to 0.08 per 100 000 individuals between 1999 and 2016, with an annual percent change of 6.61%. The most common histopathological type of orbital lymphoma was extra marginal zone B cell lymphoma, accounting for 82.2% of all orbital lymphomas during 1999–2016, followed by diffuse large B cell lymphoma (9.2%). Five-year, 10-year and 15-year overall survival (OS) of orbital lymphoma was 90.8%, 83.8% and 75.8%, respectively. OS showed a significant decrease as age increased and no significant differences between men and women.ConclusionThe incidence rate of orbital lymphoma is very low in South Korea. However, the incidence rate has increased over the past years. Orbital lymphomas have a worse prognosis as age increases.

scholarly journals The contribution of case mix, skill mix and care processes to the outcomes of community hospitals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Lenzi ◽  
K Y C Adja ◽  
D Pianori ◽  
C Reno ◽  
M P Fantini
Keyword(s):  
Older People ◽  
Unmet Needs ◽  
Working Hours ◽  
Case Mix ◽  
Community Hospitals ◽  
Organizational Models ◽  
Skill Mix ◽  
Processes Of Care ◽  
Hospital Variation ◽  
Care Processes

Abstract Background The rapid increase in the proportion of older people underscores the need for new organizational models to face the unmet needs of frail patients with multiple conditions. Community hospitals (CHs) could be a solution to tackle these needs and foster integration between acute and primary care. The aim of this study was to investigate which patients' characteristics and which care processes affect clinical outcomes, in order to identify who could benefit the most from CH care and the best skill mix to deliver in this setting of care. Methods This study included all patients aged ≥65 and discharged in 2017 from the 16 CHs of Emilia-Romagna, northern Italy. Data sources were the regional CH informative system and hospital discharge records. CH skill mix and processes of care were collected with a survey; 3 non-respondent CHs were excluded. The study outcome was in-hospital variation of the Barthel index (BI) (≥10 vs. &lt;10). We performed a 2-level random-intercept logistic regression analysis, and used the variance partition coefficient (VPC) to quantify the proportion of BI improvement that lay at CH level. Results Of the 13 CHs, 7 admitted ≥150 patients, 8 had a general practitioner medical support model, and 6 had &gt;12 nurses' working hours/week/bed. Overall, 53% of the patients had a BI improvement ≥10 (4% to 71% across CHs). The patient case mix (i.e. baseline BI, female, older age, transfer from acute care) explained a portion of variability across CHs, as shown by the VPC that decreased from 0.32 to 0.26. Skill mix and processes of care were not associated with BI change, and the VPC resulting from controlling for these variables was virtually unchanged (0.28). Conclusions Patients' characteristics explained part of between-CH variation in BI improvement. Professional skill mix and processes of care, albeit fundamental to achieve appropriate care and respond to the unmet needs of the frail elderly, did not account for differences in CH-specific outcomes. Key messages A combination of quantitative and qualitative methods might better explain the outcome variability across intermediate care services. Multidisciplinary CH teams and services can be helpful to address the unmet needs of older people, but further studies are necessary.

scholarly journals EPEN-24. SIOP EPENDYMOMA II: CENTRAL EPENDYMOMA MANAGEMENT ADVISORY GROUP – THE UK EXPERIENCE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii312-iii312
Author(s):  
Donald C Macarthur ◽  
Conor Mallucci ◽  
Ian Kamaly-Asl ◽  
John Goodden ◽  
Lisa C D Storer ◽  
...  
Keyword(s):  
Survival Rates ◽  
Target Volume ◽  
Advisory Group ◽  
Subtotal Resection ◽  
Str Analysis ◽  
Oncological Treatment ◽  
Beneficial Effects ◽  
Number Of Patients ◽  
Pathological Review ◽  
The Uk

Abstract Paediatric Ependymoma is the second most common malignant brain tumour of childhood with approximately 50% of cases recurring. It has been described as a “surgical” disease since patients who have undergone a gross total surgical resection (GTR) have a better prognosis than those who have a subtotal resection (STR). Analysis of the UKCCSG/SIOP 1992 04 clinical trial has shown that only 49% of cases had a GTR, with 5-year survival rates for STR of 22–47% and GTR of 67–80%. As part of the SIOP II Ependymoma trial the UK established a panel of experts in the treatment of Ependymoma from Neuro-oncology, Neuro-radiology and Neuro-surgery. Meeting weekly, cases are discussed to provide a consensus on radiological review, ensuring central pathological review, trial stratification and whether further surgery should be advocated on any particular case. Evaluation of the first 68 UK patients has shown a GTR in 47/68 (69%) of patients and STR in 21/68 (31%) of patients. Following discussion at EMAG it was felt that 9/21 (43%) STR patients could be offered early second look surgery. Following this 2nd look surgery the number of cases with a GTR increased to 56/68 (82%). There has been a clear increase in the number of patients for whom a GTR has been achieved following discussion at EMAG and prior to them moving forwards with their oncological treatment. This can only have beneficial effects in decreasing their risk of tumour recurrence or CSF dissemination and also in reducing the target volume for radiotherapy.

scholarly journals Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

2021 ◽  
pp. 1358863X2110082
Author(s):  
Erika Lilja ◽  
Anders Gottsäter ◽  
Mervete Miftaraj ◽  
Jan Ekelund ◽  
Björn Eliasson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Propensity Score ◽  
Vascular Surgery ◽  
Incidence Rate ◽  
Cox Regression ◽  
Major Amputation ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Number Of Patients

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers ( p = 0.034) and had undergone more previous amputations ( p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11–2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00–1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

scholarly journals Bone marrow niche crosses paths with BMPs: a road to protection and persistence in CML

2019 ◽  
Vol 47 (5) ◽  
pp. 1307-1325 ◽  
Author(s):  
Caroline Busch ◽  
Helen Wheadon
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Bone Morphogenetic Proteins ◽  
Kinase Inhibitor ◽  
Survival Rates ◽  
High Survival ◽  
Bone Marrow Niche ◽  
Matrix Deposition ◽  
Bmp Receptors ◽  
Number Of Patients

Abstract Chronic myeloid leukaemia (CML) is a paradigm of precision medicine, being one of the first cancers to be treated with targeted therapy. This has revolutionised CML therapy and patient outcome, with high survival rates. However, this now means an ever-increasing number of patients are living with the disease on life-long tyrosine kinase inhibitor (TKI) therapy, with most patients anticipated to have near normal life expectancy. Unfortunately, in a significant number of patients, TKIs are not curative. This low-level disease persistence suggests that despite a molecularly targeted therapeutic approach, there are BCR-ABL1-independent mechanisms exploited to sustain the survival of a small cell population of leukaemic stem cells (LSCs). In CML, LSCs display many features akin to haemopoietic stem cells, namely quiescence, self-renewal and the ability to produce mature progeny, this all occurs through intrinsic and extrinsic signals within the specialised microenvironment of the bone marrow (BM) niche. One important avenue of investigation in CML is how the disease highjacks the BM, thereby remodelling this microenvironment to create a niche, which enables LSC persistence and resistance to TKI treatment. In this review, we explore how changes in growth factor levels, in particular, the bone morphogenetic proteins (BMPs) and pro-inflammatory cytokines, impact on cell behaviour, extracellular matrix deposition and bone remodelling in CML. We also discuss the challenges in targeting LSCs and the potential of dual targeting using combination therapies against BMP receptors and BCR-ABL1.

scholarly journals Schockraum- und Schwerverletztenversorgung als „Verlustgeschäft“

2020 ◽  
Author(s):  
Thomas Gross ◽  
Felix Amsler
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Diagnosis Related Groups ◽  
Case Mix ◽  
Multivariate Analyse ◽  
New Injury Severity Score ◽  
Case Mix Index

Zusammenfassung Hintergrund Es galt herauszufinden, wie kostendeckend die Versorgung potenziell Schwerverletzter in einem Schweizer Traumazentrum ist, und inwieweit Spitalgewinne bzw. -verluste mit patientenbezogenen Unfall‑, Behandlungs- oder Outcome-Daten korrelieren. Methodik Analyse aller 2018 im Schockraum (SR) bzw. mit Verletzungsschwere New Injury Severity Score (NISS) ≥8 notfallmäßig stationär behandelter Patienten eines Schwerverletztenzentrums der Schweiz (uni- und multivariate Analyse; p < 0,05). Ergebnisse Für das Studienkollektiv (n = 513; Ø NISS = 18) resultierte gemäß Spitalkostenträgerrechnung ein Defizit von 1,8 Mio. CHF. Bei einem Gesamtdeckungsgrad von 86 % waren 66 % aller Fälle defizitär (71 % der Allgemein- vs. 42 % der Zusatzversicherten; p < 0,001). Im Mittel betrug das Defizit 3493.- pro Patient (allg. Versicherte, Verlust 4545.-, Zusatzversicherte, Gewinn 1318.-; p < 0,001). Auch „in“- und „underlier“ waren in 63 % defizitär. SR-Fälle machten häufiger Verlust als Nicht-SR-Fälle (73 vs. 58 %; p = 0,002) wie auch Traumatologie- vs. Neurochirurgiefälle (72 vs. 55 %; p < 0,001). In der multivariaten Analyse ließen sich 43 % der Varianz erhaltener Erlöse mit den untersuchten Variablen erklären. Hingegen war der ermittelte Deckungsgrad nur zu 11 % (korr. R2) durch die Variablen SR, chirurgisches Fachgebiet, Intensivaufenthalt, Thoraxverletzungsstärke und Spitalletalität zu beschreiben. Case-Mix-Index gemäß aktuellen Diagnosis Related Groups (DRG) und Versicherungsklasse addierten weitere 13 % zu insgesamt 24 % erklärter Varianz. Diskussion Die notfallmäßige Versorgung potenziell Schwerverletzter an einem Schweizer Traumazentrum erweist sich nur in einem Drittel der Fälle als zumindest kostendeckend, dies v. a. bei Zusatzversicherten, Patienten mit einem hohen Case-Mix-Index oder einer IPS- bzw. kombinierten Polytrauma- und Schädel-Hirn-Trauma-DRG-Abrechnungsmöglichkeit.

Abstract 17116: Incidence and Outcomes of Out-of-hospital Maternal Cardiac Arrest and Compliance With Resuscitation Guidelines

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alan A Lipowicz ◽  
Sheldon Cheskes ◽  
Sarah H Gray ◽  
Farida Jeejeebhoy ◽  
Janice Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Performance Metrics ◽  
Point Of Care ◽  
Survival Rates ◽  
Rare Event ◽  
Population Based ◽  
Childbearing Age ◽  
Child Bearing ◽  
Resuscitation Guidelines ◽  
Regional Health Authorities

Background: Published survival rates after out-of-hospital cardiac arrests (OHCA) are lower than in-hospital cardiac arrest (IHCA). Current estimates for the incidence and rate of survival for maternal cardiac arrest are published only for IHCA. There are no studies that report the incidence and outcomes of maternal OHCA. Current cardiopulmonary resuscitation guidelines contain specific maternal recommendations, although compliance with recommended benchmarks has not been reported. The objective of this study was to report maternal OHCA incidence, outcomes, and compliance with resuscitation and maternal specific guidelines. Methods: This was a population-based cohort study of consecutive maternal OHCA between May 2010 and April 2014. The denominator was estimated from the total regional population of all women of childbearing age obtained from census and age-specific pregnancy rates provided by regional health authorities. Resuscitation performance was measured against the 2010 AHA Guidelines. Results: A total of 6 maternal OHCA occurred amongst 1,085 OHCA occurring in females of child bearing age (15-49) over 4yrs; Incidence-1.85:100,000 (95% CI 1.76 to 1.95) vs. 19.4 per 100,000 (95% CI, 19.37 to 19.43). Maternal and neonatal survival to discharge was 16.7% and 33.3%, respectively. Compliance with CPR quality metrics averaged 83% with a range from 75% to 100%. Compliance with maternal-specific resuscitation guidelines averaged 46.9%, with a range from 0% to 100%. The only performance metrics with 100% compliance was intravenous line insertion above the diaphragm and prehospital activation of the maternal cardiac arrest team. Uterine displacement compliance was low at 0%. Conclusion: The incidence of maternal OHCA was 1.85:100,000, which is lower than the published estimate for maternal IHCA. Survival after OHCA for mother and for child was higher than OHCA occurring in non-pregnant adult females of child bearing age; however, the number of survivors was small (<5). Compliance rates with recommended resuscitation guidelines were high, yet compliance with maternal-specific guidelines were low suggesting targeted training and implementation optimization at the point of care is required to prepare for this rare event involving two lives.

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