scholarly journals Costs and predictors of early readmissions in patients with Infective Endocarditis. Utilizing the Nationwide Readmission Database

2021 ◽  
Vol 4 (3) ◽  
pp. 01-13
Author(s):  
Jesan Zaman
Keyword(s):  
Infective Endocarditis ◽  
Financial Burden ◽  
Admission Diagnosis ◽  
Weighted Analysis ◽  
Common Causes ◽  
Icd 10 ◽  
Failure Cost ◽  
Nationally Representative ◽  
Nationwide Readmission Database

BACKGROUND: There have been previous studies detailing the variables involved in readmissions in patients with a primary admission diagnosis of infective endocarditis – however those studies were done prior to the 2015 change in AHA guidelines and introduction to ICD-10 codes. OBJECTIVES: The aim of this study was to describe the frequency, causes, factors, and costs associated with infective endocarditis encounters. METHODS: Utilizing the 2017 national readmission database (NRD), we identified all patients that were admitted with infective endocarditis. These patients were evaluated for the rates, predictors, and costs of unplanned 30 days readmissions. Weighted analysis was performed to obtain nationally representative data. RESULTS: 56,357 patients were identified to have been admitted with a diagnosis of infective endocarditis of whom 13,004 patients (23%) were readmitted within 30 days of the index discharge. The most common causes of readmission were septicemia (15.1%), endocarditis and endocardial disease (10.5%), heart failure (9.5%), and complication of cardiovascular device, implant or graft, initial encounter (5.6%). Data showed that there were certain comorbidities that resulted in a higher risk of being readmitted, these include chronic kidney disease, COPD, tobacco use, and hepatic failure. Cost of readmissions per patient was approximately $22,059 (IQR $11,630 - $49,964). CONCLUSIONS: Thirty-day unplanned readmissions remain a significant issue affecting nearly 1 in 6 patients with infective endocarditis. This is associated with significant mortality and financial burden. Multi-disciplinary approach may help decrease readmissions, reduce complications, and improve overall outcomes as well as the overall quality of life of our patients.

scholarly journals Costs and predictors of early readmissions in patients with Infective Endocarditis. Utilizing the Nationwide Readmission Database.

2021 ◽  
Author(s):  
Jesan Zaman ◽  
Amod Amritphale ◽  
Christopher Malozzi ◽  
Nupur Amritphale ◽  
Mukul Sehgal ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Financial Burden ◽  
Admission Diagnosis ◽  
Weighted Analysis ◽  
Common Causes ◽  
Failure Cost ◽  
Nationally Representative ◽  
Nationwide Readmission Database ◽  
Significant Mortality

BACKGROUND: There have been previous studies detailing the variables involved in readmissions in patients with a primary admission diagnosis of infective endocarditis, however those studies were done prior to the 2015 change in AHA guidelines and introduction to ICD10 codes. OBJECTIVES: The aim of this study was to describe the frequency, causes, factors, and costs associated with infective endocarditis encounters. METHODS: Utilizing the 2017 national readmission database (NRD), we identified all patients that were admitted with infective endocarditis. These patients were evaluated for the rates, predictors, and costs of unplanned 30 days readmissions. Weighted analysis was performed to obtain nationally representative data. RESULTS: 56,357 patients were identified to have been admitted with a diagnosis of infective endocarditis of whom 13,004 patients (23%) were readmitted within 30 days of the index discharge. The most common causes of readmission were septicemia (15.1%), endocarditis and endocardial disease (10.5%), heart failure (9.5%), and complication of cardiovascular device, implant or graft, initial encounter (5.6%). Data showed that there were certain comorbidities that resulted in a higher risk of being readmitted, these include chronic kidney disease, COPD, tobacco use, and hepatic failure. Cost of readmissions per patient was approximately $22,059 (IQR $11,630 to $49,964). CONCLUSIONS: Thirty-day unplanned readmissions remain a significant issue affecting nearly 1 in 6 patients with infective endocarditis. This is associated with significant mortality and financial burden. Multi-disciplinary approach may help decrease readmissions, reduce complications, and improve overall outcomes as well as the overall quality of life of our patients.

scholarly journals Dementia Caregiving, Care Recipient Health, and Financial Burdens

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 56-56
Author(s):  
Rashmita Basu
Keyword(s):  
Physical Health ◽  
Healthcare Costs ◽  
Financial Burden ◽  
Care Recipient ◽  
Positive Feeling ◽  
Nationally Representative ◽  
Financial Burdens ◽  
Health Deterioration ◽  
Retirement Study

Abstract Objective: While about 75% of people with ADRD receive care informally by their family members, relatively little is known about the effect of the quality of caregiving on maintaining carerecipient’s health and financial burden of out-of-pocket (OOP) healthcare costs. The goal of this study is to examine the quality of caregiving on the out-of-pocket healthcare costs among ADRD patients and if caregiving prevents deterioration of physical health of carerecipients. Data and Sample: We used a nationally representative sample of people diagnosed with ADRD from the Aging Demographic and Memory Study, subsample of the Health and Retirement Study. The study sample includes carerecipients whose caregivers participated in the survey (N=261). Outcome measures: Primary outcomes were deterioration of carerecipients’ health (1=yes, 0=no) and annual OOP healthcare costs. The quality of caregiving is captured by if caregiving made them feel good, feel useful and fee closer to carerecipients. More than 70% caregivers reported that caregiving make them feel good or useful. About 60% of carerecipients’ physical health was maintained, and average out-of-pocket costs was $3,701/year ($0-$31,051). Multivariable logit for binary health outcome and OLS regression for OOP cost were estimated. Results: The likelihood of health deterioration was significantly lower for carerecipients whose caregivers reported that caregiving made them feel useful (AOR=5.1, 95% CI: 1.9- 14.5) and lower OOP remained significantly associated with presence of usefulness of caregiving (cost decrease, $3000 [95% CI: $6309-$918). Positive feeling of caregiving is independently associated with lower OOP cost and deterioration of physical health among ADRD patients.

scholarly journals 693. Performance of ICD Code Versus Discharge Summary based Query for Endocarditis Cohort Identification

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S448-S448
Author(s):  
H Nina Kim ◽  
Ayushi Gupta ◽  
Kristine F Lan ◽  
Jenell C Stewart ◽  
Shireesha Dhanireddy ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
International Classification Of Diseases ◽  
Discharge Summary ◽  
Admission Diagnosis ◽  
Test Characteristics ◽  
Clinical Narrative ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Icd Codes ◽  
Discharge Summaries

Abstract Background Studies on infective endocarditis (IE) have relied on International Classification of Diseases (ICD) codes to identify cases but few have validated this method which may be prone to misclassification. Examination of clinical narrative data could offer greater accuracy and richness. Methods We evaluated two algorithms for IE identification from 7/1/2015 to 7/31/2019: (1) a standard query of ICD codes for IE (ICD-9: 424.9, 424.91, 424.99, 421.0, 421.1, 421.9, 112.81, 036.42 and ICD-10: I38, I39, I33, I33.9, B37.6 and A39.51) with or without procedure codes for echocardiogram (93303-93356) and (2) a key word, pattern-based text query of discharge summaries (DS) that selected on the term “endocarditis” in fields headed by “Discharge Diagnosis” or “Admission Diagnosis” or similar. Further coding extracted the nature and type of valve and the organism responsible for the IE if present in DS. All identified cases were chart reviewed using pre-specified criteria for true IE. Positive predictive value (PPV) was calculated as the total number of verified cases over the algorithm-selected cases. Sensitivity was the total number of algorithm-matched cases over a final list of 166 independently identified true IE cases from ID and Cardiology services. Specificity was defined using 119 pre-adjudicated non-cases minus the number of algorithm-matched cases over 119. Results The ICD-based query identified 612 individuals from July 2015 to July 2019 who had a hospital billing code for infective endocarditis; of these, 534 also had an echocardiogram. The DS query identified 387 cases. PPV for the DS query was 84.5% (95% confidence interval [CI] 80.6%, 87.8%) compared with 72.4% (95% CI 68.7%, 75.8%) for ICD only and 75.8% (95% CI 72.0%, 79.3%) for ICD + echo queries. Sensitivity was 75.9% for the DS query and 86.8-93.4% for the ICD queries. Specificity was high for all queries >94%. The DS query also yielded valve data (prosthetic, tricuspid, pulmonic, aortic or mitral) in 60% and microbiologic data in 73% of identified cases with an accuracy of 94% and 90% respectively when assessed by chart review. Table 1. Test Characteristics of Three Electronic Health Record Queries for Infective Endocarditis Conclusion Compared to traditional ICD-based queries, text-based queries of discharge summaries have the potential to improve precision of IE case ascertainment and extract key clinical variables. Disclosures All Authors: No reported disclosures

Abstract 17294: Outcomes of ECMO Use in Cardiogenic Shock: Analysis From the Nationwide Readmissions Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Prakash Acharya ◽  
Abdulelah nuqali ◽  
Sagar Ranka ◽  
Zubair Shah ◽  
Kamal gupta
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiogenic Shock ◽  
Secondary Analysis ◽  
Vascular Complications ◽  
Primary Diagnosis ◽  
Index Hospitalization ◽  
Coronary Syndrome ◽  
Icd 10 ◽  
Nationally Representative ◽  
Nationwide Readmission Database

Introduction: Extracorporeal membrane oxygenation (ECMO) is being increasingly used for acute support in patients with cardiogenic shock (CS). Data regarding the indications, outcomes, and readmissions in these patients from a nationally representative sample is lacking. Methods: A secondary analysis of the Nationwide Readmission Database for years 2016-2017 was performed. Patients who were admitted with a primary diagnosis of CS were identified using ICD-10, Clinical Modification codes and were sub-grouped into those with acute coronary syndrome (ACS) and without ACS (non-ACS). Any readmission within 30 days of discharge was considered for analysis. Results: A total of 6,126 patients with CS received ECMO support, among which 35% had concurrent acute coronary syndrome (ACS). Patients on ECMO who had ACS were significantly older (60.5±11 vs 45.1±11 years, p<0.001) compared to non-ACS patients. Time to ECMO placement was also significantly shorter in ACS patients (3.4±5 vs 6.9±15 days, p<0.001). There was no difference in complications during index admission including vascular complications and stroke among the two groups. The length of index hospitalization was longer in the non-ACS group (32.8±36 vs 19.6±22.9 days, p<0.001) whereas mortality was significantly higher in patients with ACS (58.21 vs 49.55%, p<0.001). Every decade increase in the age above 50 years significantly increased odds of mortality in the non-ACS group whereas in the ACS group, mortality increased significantly only when the age is over 70 years [HR 2.32, CI(1.35-3.99), p=0.002]. The rate of readmission among patients who survived to discharge was 18.2% (17.3% in ACS group vs 18.9% in non-ACS group, p=0.35). The most common primary causes of readmission were local complications from ECMO placement (7.65%), CHF, (6.5%), sepsis (6.5%), critical illness poly-myopathy/neuropathy (2.9%) and stroke (1.46%). The mortality during readmission was 8.2%. Conclusions: Only 1 in every 2 patients with CS on ECMO survives to discharge. Survival to discharge in these patients differs significantly according to the presence or absence of ACS. Among the patients who survive to discharge, 18% of patients are readmitted within 30 days.

scholarly journals Hospitalized patients co-diagnosed with infective endocarditis and opioid drug dependence in Florida, 2015-2018

2021 ◽  
Vol 10 (4) ◽  
pp. 26
Author(s):  
Alexander Litvintchouk ◽  
Lori Bilello ◽  
Carmen Smotherman ◽  
Katryn Lukens Bull
Keyword(s):  
Infective Endocarditis ◽  
Financial Burden ◽  
The United States ◽  
Population Characteristics ◽  
Opioid Use ◽  
Discharge Disposition ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Using Data ◽  
Total Charges

Objective: As the opioid addiction epidemic continues to grow, other serious health issues regarding drug use has also increased. This study examines the trends in admissions and population characteristics of those who experience infective endocarditis with opioid drug dependence.Methods: We used ICD-9-CM and ICD-10-CM codes to identify patients admitted to a hospital with infective endocarditis and with a secondary diagnosis of opioid use related disorders using data released by the Florida Agency for Health Care Administration (AHCA). Data included age, gender, ethnicity, race, discharge disposition, admission type, payer status, total charges, and zip code of patients’ residence.Results: During the four-year period, the percent of patients diagnosed with infective endocarditis and a diagnosis code associated with opioid abuse or dependence doubled (4.48% to 8.52%). Of the patients dually diagnosed, the mean age was 37.47 and the majority were white (90.78%), non-Hispanic (91.96%), and female (58.55%). Nearly 47% of the patients did not have health insurance. The percentage of patients with both diagnosis codes living in urban counties was 91.37%. Median length of stay was 10 days and median total charges for patients was $101,604.Conclusions: With the increasing incidence of opioid dependence and addiction within the United States, there is a rise in infective endocarditis, a costly and debilitating disease. Our analysis provides the framework for hospital systems to identify patients who may benefit from addiction services, which through downstream effects will cause less of a health and financial burden.

scholarly journals Causes, Predictors, and Costs of Unplanned 30-Day Readmissions in Patients with Right Heart Failure.

2021 ◽  
Author(s):  
Amod Amritphale ◽  
Jesan Zaman ◽  
Saad Awan ◽  
Nupur Amritphale ◽  
Mustafa Awan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Financial Burden ◽  
Artery Bypass ◽  
Right Heart Failure ◽  
Unplanned Readmission ◽  
Right Heart ◽  
Weighted Analysis ◽  
History Of ◽  
Nationally Representative ◽  
Heart Failure Diagnosis

OBJECTIVES: The aim of this study was to describe the frequency, causes, factors, and costs associated with right heart failure encounters. BACKGROUND: Multiple studies have looked into heart failure readmissions but there is no study to our knowledge specifically analyzing patients with right heart failure. METHODS: Patients with right heart failure diagnosis were identified using the 2017 Nationwide Readmission Database (NRD) and were evaluated for the rates, predictors, and costs of unplanned 30 days readmission. Weighted analysis was performed to obtain nationally representative data. RESULTS: We identified 7142 patients with right heart failure of whom 21% had an unplanned readmission within 30 days of the index discharge. Patients with history of Coronary artery bypass grafting (p=0.033; OR 2.359; 95% CI 1.071 to 5.197), Chronic kidney disease (p<0.001; OR 1.607; 95% CI 1.402 to 1.843), atrial fibrillation (p=0.014; OR 1.417; 95% CI 1.072 to 1.873) had high odds of unplanned 30 day readmissions while obesity (p<0.001; OR 0.686; 95% CI 0.594 to 0.792) had negative odds of such readmissions. CONCLUSIONS: Thirty-day unplanned readmissions remain a significant issue affecting over 1 in 5 patients with right heart failure. Early unplanned readmissions are associated with significant mortality and financial burden in these patients.

Quality of cytogenetic investigations: problems and ways for improvement

2020 ◽  
pp. 22-24
Author(s):  
В.Г. Антоненко ◽  
Н.В. Шилова ◽  
Е.Н. Лукаш ◽  
Э.Р. Бабкеева ◽  
В.Н. Малахов
Keyword(s):  
Quality Assessment ◽  
Russian Federation ◽  
Chromosomal Analysis ◽  
Common Causes

Представлены результаты экспертной оценки качества цитогенетических исследований в лабораториях РФ в системе межлабораторных сличительных испытаний «ФСВОК» в 2018-2019 гг. Обсуждаются наиболее частые причины неудовлетворительных результатов экспертизы и возможные пути улучшения качества цитогенетических исследований. We report the results of quality assessment for preparation of cytogenetic slides and chromosomal analysis in the laboratories of Russian Federation in the system of the interlaboratory comparative examinations “FSVOK” in 2018-2019. Common causes of poor results of assessment and the ways for improvement of quality for cytogenetic investigations are discussed.

Pengaruh Kompetensi Coder terhadap Keakuratan dan Ketepatan Pengkodean Menggunakan ICD 10 di Rumah Sakit X Pekanbaru Tahun 2016

2018 ◽  
Vol 1 (1) ◽  
pp. 31-43
Author(s):  
Nur Maimun ◽  
Jihan Natassa ◽  
Wen Via Trisna ◽  
Yeye Supriatin
Keyword(s):  
Medical Record ◽  
Human Error ◽  
Medical Personnel ◽  
Quality Of Data ◽  
Accuracy And Precision ◽  
Result Show ◽  
Study Implementation ◽  
Icd 10 ◽  
The Cost

The accuracy in administering the diagnosis code was the important matter for medical recorder, quality of data was the most important thing for health information management of medical recorder. This study aims to know the coder competency for accuracy and precision of using ICD 10 at X Hospital in Pekanbaru. This study was a qualitative method with case study implementation from five informan. The result show that medical personnel (doctor) have never received a training about coding, doctors writing that hard and difficult to read, failure for making diagnoses code or procedures, doctor used an usual abbreviations that are not standard, theres still an officer who are not understand about the nomenclature and mastering anatomy phatology, facilities and infrastructure were supported for accuracy and precision of the existing code. The errors of coding always happen because there is a human error. The accuracy and precision in coding very influence against the cost of INA CBGs, medical and the committee did most of the work in the case of severity level III, while medical record had a role in monitoring or evaluation of coding implementation. If there are resumes that is not clearly case mix team check file needed medical record the result the diagnoses or coding for conformity. Keywords: coder competency, accuracy and precision of coding, ICD 10

scholarly journals Garbage codes as causes of death and quality of mortality statistics in Belo Horizonte, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Ishitani ◽  
R Teixeira ◽  
D Abreu ◽  
L Paixão ◽  
E França
Keyword(s):  
Causes Of Death ◽  
Health Planning ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Mortality Statistics ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Hospital Deaths ◽  
Belo Horizonte

Abstract Background Quality of cause-of-death information is fundamental for health planning. Traditionally, this quality has been assessed by the analysis of ill-defined causes from chapter XVIII of the International Classification of Diseases - 10th revision (ICD-10). However, studies have considered other useless diagnoses for public health purposes, defined, in conjunction with ill-defined causes, as garbage codes (GC). In Brazil, despite the high completeness of the Mortality Information System, approximately 30% of deaths are attributable to GCs. This study aims to analyze the frequency of GCs in Belo Horizonte municipality, the capital of Minas Gerais state, Brazil. Methods Data of deaths from 2011 to 2013 in Belo Horizonte were analyzed. GCs were classified according to the GBD 2015 study list. These codes were classified in: a) GCs from chapter XVIII of ICD-10 (GC-R), and b) GC from other chapters of ICD-10 (GC-nonR). Proportions of GC were calculated by sex, age, and place of occurrence. Results In Belo Horizonte, from the total of 44,123 deaths, 5.5% were classified as GC-R. The majority of GCs were GC-nonR (25% of total deaths). We observed a higher proportion of GC in children (1 to 4 years) and in people aged over 60 years. GC proportion was also higher in females, except in the age-groups under 1 year and 30-59 years. Home deaths (n = 7,760) had higher proportions of GCs compared with hospital deaths (n = 30,182), 36.9% and 28.7%, respectively. The leading GCs were the GC-R other ill-defined and unspecified causes of death (ICD-10 code R99)), and the GCs-nonR unspecified pneumonia (J18.9), unspecified stroke (I64), and unspecified septicemia (A41.9). Conclusions Analysis of GCs is essential to evaluate the quality of mortality information. Key messages Analysis of ill-defined causes (GC-R) is not sufficient to evaluate the quality of information on causes of death. Causes of death analysis should consider the total GC, in order to advance the discussion and promote adequate intervention on the quality of mortality statistics.

Preoperative Predictors and Costs of 30-Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States

2021 ◽  
pp. 019459982098070
Author(s):  
Habib Khoury ◽  
Shaghauyegh S. Azar ◽  
Hannah Boutros ◽  
Nina L. Shapiro
Keyword(s):  
Health Care ◽  
Financial Burden ◽  
Preoperative Assessment ◽  
Health Care Expenditures ◽  
The United States ◽  
Postoperative Hemorrhage ◽  
International Classification Of Disease ◽  
Neurologic Disorders ◽  
Common Causes ◽  
National Trends

Objectives To understand national trends in 30-day postoperative readmission following inpatient pediatric tonsillectomy and adenoidectomy. Study Design Retrospective cohort study. Setting Nationwide Readmissions Database. Methods We used the Nationwide Readmissions Database to identify and analyze 30-day readmissions following inpatient tonsillectomy from 2010 to 2015. Using the International Classification of Disease codes, we identified 66,652 patients and analyzed the incidence, causes, risk factors, and costs of 30-day readmission. Results Of 66,652 patients who underwent inpatient tonsillectomy, 2660 (4.0%) experienced a readmission. Readmitted patients were more commonly aged <2 years (23.4 vs 10.6%, P = .01) and had a greater burden of comorbidities, including preoperative anemia (3.9 vs 1.3%, P < .001), coagulopathy (3.5 vs 1.4%, P < .001), and neurologic disorders (19.1 vs 6.6%, P < .001). Readmitted patients experienced higher rates of postoperative complications (17.4 vs 9.0%, P < .001) and had a longer length of stay (4.5 vs 2.2 days, P < .001). Index cost of hospitalization was higher among readmitted patients ($14,129 vs $7307, P < .001), and each readmission cost an additional $7576. Postoperative hemorrhage (21.3%) and dehydration (17.7%) were the 2 most common causes for readmission. Independent predictors of readmission included age <3 years, multiple comorbidities, and postoperative neurologic complications. The incidences of tonsillectomies and readmissions declined during the study period, most notably between 2010 and 2012. Conclusion Readmission after inpatient tonsillectomy and adenoidectomy places a substantial financial burden on the health care system. Targeted strategies to improve preoperative assessment and optimize postoperative care may prevent readmission, reduce unnecessary health care expenditures, and improve patient outcomes.

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