Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data

Moore, Brian J.; White, Susan V.; Washington, Raynard; Coenen, Natalia; Elixhauser, Anne

doi:10.1097/mlr.0000000000000735

Cited by 656 publications

(393 citation statements)

References 18 publications

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“…We included people who were oral anticoagulant (OAC) naïve during the 12 months before the day of the first qualifying rivaroxaban or warfarin dispensing (index date); had ≥2 inpatient or outpatient ICD codes in any position for AF (ICD-10 = I48) without codes suggesting valvular disease; an inpatient or outpatient diagnosis code in any position for HF (ICD-10 = I50, I09.81) 11 ; and ≥12 months of continuous medical and prescription coverage prior to OAC initiation (baseline period). Individuals were excluded if they had a history of venous thrombo-embolism or orthopaedic arthroplasty, were pregnant, had a transient cause of NVAF, or were prescribed >1 OAC.…”

Section: Methodsmentioning

confidence: 99%

“…Propensity scores were calculated using multivariable logistic regression incorporating frequently used variables and potential risk factors for differential OAC exposure ( Table 1) including demographics, co-morbidities, 11 components of the CHA 2 DS 2 -VASc and HASBLED scores, 12 and concomitant non-OAC medications identified during the 12 month baseline period.…”

Section: Methodsmentioning

confidence: 99%

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Effectiveness and safety of rivaroxaban vs. warfarin in patients with non‐valvular atrial fibrillation and heart failure

Martinez

Bunz²,

Eriksson

et al. 2018

ESC Heart Failure

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AimsHeart failure (HF) is a common co‐morbidity in non‐valvular atrial fibrillation (NVAF) patients and a potent risk factor for stroke, bleeding, and a decreased time‐in‐therapeutic range with warfarin. We assessed the real‐world effectiveness and safety of rivaroxaban and warfarin in NVAF patients with co‐morbid HF.Methods and resultsUsing US Truven MarketScan Commercial and Medicare supplemental database claims data from 11/2011 to 12/2016, we identified oral anticoagulant (OAC)‐naïve NVAF patients with HF (International Classification of Diseases, 10th Revision codes of I50 or I09.81) and ≥12 months of insurance coverage prior to the qualifying OAC dispensing. Rivaroxaban users (20 or 15 mg once daily) were 1:1 propensity score matched to warfarin users, with residual absolute standardized differences <0.1 being achieved for all covariates after matching. Patients were followed up until an event, OAC discontinuation/switch, insurance disenrolment, or end of follow‐up. Rates [events per 100 person‐years (PYs) of follow‐up] for stroke or systemic embolism and major bleeding (using the Cunningham algorithm) were compared between the matched cohorts using Cox proportion hazard regression and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). We matched 3418 rivaroxaban (32% receiving the reduced dose) and 3418 warfarin users with NVAF and HF with a median (interquartile range) available follow‐up of 1.4 (0.6, 2.5) years. Median age was 74 (63, 82) years, and median CHA2DS2‐VASc and HASBLED scores were 4 (3, 5) and 2 (2, 3). Common HF medications included beta‐blockers (64%), angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers (62%), loop diuretics (46%), digoxin (11%), and aldosterone receptor antagonists (10%). The hazard of developing stroke or systemic embolism (0.98 events/100PY vs. 1.28 events/100PY; HR = 0.82, 95% CI = 0.47–1.44), ischaemic stroke (0.70 events/100PY vs. 1.02 events/100PY; HR = 0.77, 95% CI = 0.41–1.46), or major bleeding (3.86 events/100PY vs. 4.23 events/100PY; HR = 0.98, 95% CI = 0.73–1.31) was not found to be different between rivaroxaban and warfarin users. Intracranial haemorrhage was infrequent in both cohorts and numerically less with rivaroxaban (0.27 events/100PY vs. 0.36 events/100PY; HR = 0.73, 95% CI = 0.25–2.08).ConclusionsEffectiveness and safety of rivaroxaban vs. warfarin are sustained in NVAF patients with co‐morbid HF treated in routine practice. The general consistency between this real‐world study and those from phase III randomized trial data of rivaroxaban should provide additional reassurance to clinicians regarding the use of rivaroxaban in NVAF patients with HF.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effectiveness and safety of rivaroxaban vs. warfarin in patients with non‐valvular atrial fibrillation and heart failure

Martinez

Bunz²,

Eriksson

et al. 2018

ESC Heart Failure

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“…Patient comorbidity was defined using the Agency for Healthcare Research and Quality Elixhauser 27,28 Comorbidity Index for readmissions. The Elixhauser comorbidity adjustment was developed in 1998 for use with hospital administrative discharge data and includes a set of 30 clinical conditions that exist prior to hospitalization, unrelated to the principal diagnosis, and likely to influence mortality and resource utilization within the hospital.…”

Section: Methodsmentioning

confidence: 99%

“…27 The Elixhauser Index, a single score that incorporates weights for each comorbidity, has been tested using HCUP databases and effectively incorporates the influence of comorbid conditions on the risk of readmission. 28 …”

Section: Methodsmentioning

confidence: 99%

Health System Affiliation and 30-Day Readmission After Heart Attack in Black Men

Williams

Jarosek

Carroll

et al. 2018

American Journal of Preventive Medicine

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Introduction Black patients who experience acute myocardial infarction and receive care in high minority-serving hospitals have higher readmission rates. This study explores how hospital system affiliation (centralized versus decentralized/independent) impacts 30-day readmissions after acute myocardial infarction in black men. Methods In 2018, the Healthcare Cost and Utilization Project State Inpatient Database (2009– 2013) was used to observe 30-day readmission for acute myocardial infarction by race, and data from the American Hospital Association Annual Survey of Hospitals (2009–2013) to determine hospital system affiliation for the states Arizona, California, North Carolina, and Wisconsin. A series of hierarchic logistic regressions were conducted to determine if hospital system affiliation mediates the relationship between race and 30-day readmission. Results Of 63,743 hospitalizations for acute myocardial infarction among men between 2009 and 2013, black men accounted for 7.1% of hospitalizations and 8.0% of readmissions. In both models, race significantly predicted 30-day readmission (unadjusted OR=1.25, 95% CI=1.14, 1.37, p<0.001, AOR=1.13, 95% CI=1.03, 1.25, p=0.046). After controlling for system type, black men were more likely to be readmitted after acute myocardial infarction than white men in both models (unadjusted OR=1.25, 95% CI=1.14, 1.38, p<0.001, AOR=1.14, 95% CI=1.03, 1.25). There was no difference in odds of being readmitted by race and hospital system type (unadjusted OR=0.88, 95% CI=0.25, 3.07, p=0.84, AOR=1.02, 95% CI=0.21, 5.10, p=0.98). Conclusions Black men appear to be more likely to be readmitted after acute myocardial infarction. Centralization does not appear to mediate the relationship between race and 30-day readmissions for acute myocardial infarction.

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“…Among the complications of CMS, acute myocardial infarction (AMI), congestive heart failure (CHF) and diabetes mellitus account for the top most common diagnoses for hospitalizations and post-acute care service uses (6,7). An estimated 16.5 million Americans >20 years of age have coronary heart disease (CHD) (6). About 3% of adults in the US have had a myocardial infarction (MI).…”

Section: Introductionmentioning

confidence: 99%

A review of dual health care system use by veterans with cardiometabolic disease

Coughlin

Young

2018

J Hosp Manag Health Policy

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Many Veterans Affairs (VA) patients with the complications of cardiometabolic syndrome (CMS) use both VA and community providers and facilities outside of VA. Although dual health care systems increase care options, dual use also increases coordination needs. The fragmentation and duplication of health care due to the use of multiple facilities and providers may hinder effective care coordination, result in less efficient and more costly care, and lead to poorer outcomes. This article, which is based upon bibliographic searches in PubMed, reviews the evidence on dual use of VA and community health care by Veterans for acute myocardial infarction (AMI), congestive heart failure (CHF), and diabetes mellitus, the most common CMS complications requiring acute care and post-acute care services. A total of 179 articles were identified. After screening the full texts or abstracts of the 179 articles, 11 studies met the criteria, including two qualitative studies and 9 quantitative using administrative and Medicare records for veterans with AMI, CHF, or diabetes. Among the analytic studies, 3 had a cross-sectional design and 6 were cohort studies. The results of studies completed to date suggest that dual healthcare system use by older male veterans with cardiometabolic conditions is not associated with improved outcomes and may lead to unnecessary tests or procedures and increased healthcare costs. Additional research is warranted to examine the prevalence of dual health care system use by male and female veterans during recent time periods and to compare outcomes among patients who receive only VA care, only community care, or both VA and community care.

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Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data

Abstract: These indices are effective methods to incorporate the influence of comorbid conditions in models designed to assess the risk of in-hospital mortality and readmission using administrative data with limited clinical information, especially when small samples sizes are an issue.

Cited by 656 publications

References 18 publications

Effectiveness and safety of rivaroxaban vs. warfarin in patients with non‐valvular atrial fibrillation and heart failure

Effectiveness and safety of rivaroxaban vs. warfarin in patients with non‐valvular atrial fibrillation and heart failure

Health System Affiliation and 30-Day Readmission After Heart Attack in Black Men

A review of dual health care system use by veterans with cardiometabolic disease

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