Accuracy and completeness of mortality data in the Department of Veterans Affairs

Sohn, Min-Woong; Arnold, Noreen; Maynard, Charles; Hynes, Denise M.

doi:10.1186/1478-7954-4-2

Cited by 475 publications

(377 citation statements)

References 20 publications

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“…Vital Status combines information from Medicare, the VA, Social Security, and VA compensation and pension benefits to determine date of death (sensitivity, 98.3%; specificity, 99.8%; relative to National Death Index). (18) We used the inpatient files to derive index hospitalization and readmission rates and the Vital Status file to determine date of death used to calculate mortality rates. We used the outpatient visit data to examine outpatient transitional care after discharge from the initial cirrhosis hospitalization.…”

Section: Data Sourcementioning

confidence: 99%

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

et al. 2016

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Preventing readmission has been the focus of numerous quality improvement efforts across many conditions. Early outpatient follow-up has been proposed as the best mechanism for reducing readmissions. The extent to which early outpatient follow-up averts readmission or improves outcomes in cirrhosis is not known. We evaluated the relationship between early outpatient follow-up and short-term readmission and mortality in patients with cirrhosis. We conducted a retrospective cohort study of patients with cirrhosis who were hospitalized with a liver-related diagnosis and discharged to home from 122 Veterans Administration hospitals between 2010 and 2013. We defined early follow-up as an outpatient visit with a clinician within 7 days after discharge. We propensity matched patients who received early visit with those who did not have any visit and examined the associations between early follow-up and all-cause readmission and mortality within 8-30 days after discharge. Of 25,217 patients hospitalized with cirrhosis, 8,123 (32.2%) had an early follow-up visit within 7 days of discharge. A total of 3,492 (13.8%) patients were readmitted and 1,185 (4.6%) died between 8 and 30 days after discharge. In the propensity-matched sample (N 5 16,238), patients with early outpatient follow-up visit had a slightly higher risk of readmission (15.3% vs. 13.8%; hazard ratio [HR] 51.10; 95% confidence interval [CI] 5 1.02-1.19), but significantly lower risk of mortality (3.2% vs. 5.2%; HR 5 0.60; 95% CI 5 0.51-0.70) than those without early visit. The findings persisted in several subgroup and sensitivity analyses. Conclusions: Early outpatient follow-up after discharge was associated with a small increase in readmissions but lower overall mortality in patients with cirrhosis. Transitional care may be effective in improving short-term outcomes in patients with cirrhosis, but readmission performance measures would miss this effect. (HEPATOLOGY 2016;64:569-581) C irrhosis is a common and costly condition.Most patients with cirrhosis require frequent hospitalizations. Approximately 20% of patients with cirrhosis who have been hospitalized get readmitted to the hospital within the first 30 days after discharge, with substantial implications for outcomes and cost of care. (1)(2)(3) Hospital readmission is a problem that is not unique to patients with cirrhosis. (4-6) Readmission rates and consequently readmission reduction programs have been a major focus of recent quality improvement initiatives across many chronic conditions. In 2012, the Centers for Medicare and Medicaid Services (CMS) began to invoke penalties for readmissions of patients who have been discharged after hospitalizations for congestive heart failure (CHF), pneumonia, and acute myocardial infarction. (7) Recently, the CMS also started to reimburse for early transitional care as a

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Section: Data Sourcementioning

confidence: 99%

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

et al. 2016

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“…Mortality was determined by the date of death in the VA Vital Status File (the accuracy of vital status from this source is considered comparable to the National Death Index). 18 Mortality was assessed from the date of diagnosis through July 1, 2013 (censor date).…”

Section: Exposures and Outcomesmentioning

confidence: 99%

Use and impact of adjuvant chemotherapy in patients with resected non‐small cell lung cancer

Williams

Gajra

Ganti

et al. 2014

Cancer

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BACKGROUND Despite clinical trials demonstrating improved survival with adjuvant chemotherapy (AC) for patients with American Joint Committee on Cancer stages I to III non‐small cell lung cancer (NSCLC), it is unclear whether this survival benefit extends to broader populations. The current study evaluated patterns of AC use and examined the impact of AC on survival. METHODS A retrospective analysis was conducted of patients in the Veterans Affairs Central Cancer Registry diagnosed with stages IB to IIIA NSCLC between 2001 and 2008. Descriptive statistics were used to examine patterns of AC use over an 8‐year time period. Cox proportional hazards regression analyses were used to estimate hazards ratios (HR) and 95% confidence intervals (95% CIs) to compare mortality risk among patients treated with and without AC. RESULTS Among 14,306 patients with stages IB to IIIA NSCLC, 4929 underwent surgery and 22% of these received AC. The percentages of patients diagnosed in 2001 through 2003, 2004 through 2005, and 2006 through 2008 receiving AC were 7.0%, 29.8%, and 29.5%, respectively. There was no survival benefit with AC noted for patients diagnosed between 2001 and 2003, but AC was associated with improved survival for the period between 2004 and 2005 (HR, 0.78; 95% CI, 0.67‐0.91) and 2006 through 2008 (HR, 0.79; 95% CI, 0.69‐0.91). Of those patients receiving AC, 89% received platinum‐doublet chemotherapy. Carboplatin remained the most common agent, although cisplatin use reached 43% in the period between 2006 and 2008. The HR for cisplatin relative to carboplatin was 0.96 (95% CI, 0.80‐1.15). CONCLUSIONS There was a significant increase in the use of AC between 2001 and 2008 and AC was associated with an improvement in overall survival. Cancer 2014;120:1939–1947. © 2014 American Cancer Society.

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“…All‐cause mortality was assessed via the VA vital status file. The file has 98.3% sensitivity and 97.6% exact agreement with the National Death Index 11, 12. AMI was assessed via International Classification of Diseases, Ninth Revision (ICD‐9) codes (410.xx) from VA inpatient treatment files.…”

Section: Methodsmentioning

confidence: 99%

Hospital Variation in Premature Clopidogrel Discontinuation After Drug‐Eluting Stent Placement in the Veterans Affairs (VA) Healthcare System

Vigen

Maddox

O’Donnell

et al. 2016

JAHA

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BackgroundPremature clopidogrel discontinuation after drug‐eluting stent placement is associated with adverse outcomes. Little is known about patient and hospital factors associated with premature discontinuation or whether less variation in premature discontinuation exists in integrated health care systems such as the Veterans Affairs (VA).Methods and ResultsWe evaluated the frequency of premature clopidogrel discontinuation, defined as a gap between clopidogrel refills of ≥90 days during the first 6 months of treatment, among 12 707 patients who received drug‐eluting stents in VA hospitals between 2008 and 2010. We evaluated the association between premature discontinuation and all‐cause mortality and/or acute myocardial infarction, variation in the proportion of premature discontinuation among hospitals, the patient and hospital characteristics associated with premature discontinuation, and the extent to which unexplained hospital characteristics contribute to premature discontinuation. Of the patients, 963 (7.6%) discontinued clopidogrel prematurely. Premature discontinuation was associated with acute myocardial infarction and all‐cause mortality (hazard ratio 1.65, 95% CI 1.37–1.99, P<0.001). The proportion of patients with premature discontinuation varied across hospitals from 0% to 16.5% (P<0.001). We found a median of 24% greater odds of patients with identical covariates with premature discontinuation at one randomly selected hospital compared with another (median odds ratio 1.24, 95% CI 1.17–1.44). Patient factors associated with premature discontinuation included lack of cardiology follow‐up within 30 days of discharge and smaller initial clopidogrel fill.ConclusionOne in 13 patients prematurely discontinued clopidogrel, and variation in discontinuation across hospitals was observed. Patient factors were associated with premature discontinuation that may represent targets for quality improvement.

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Accuracy and completeness of mortality data in the Department of Veterans Affairs

Cited by 475 publications

References 20 publications

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

Early outpatient follow‐up and 30‐day outcomes in patients hospitalized with cirrhosis

Use and impact of adjuvant chemotherapy in patients with resected non‐small cell lung cancer

Hospital Variation in Premature Clopidogrel Discontinuation After Drug‐Eluting Stent Placement in the Veterans Affairs (VA) Healthcare System

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