Circ Cardiovasc Qual
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Circ Cardiovasc Qual · Sep 2014
Multicenter Study Comparative StudyAccess to coronary artery bypass graft surgery under pay for performance: evidence from the premier hospital quality incentive demonstration.
Although pay for performance (P4P) has become common, many worry that P4P will lead providers to avoid offering surgical procedures to the sickest patients out of concern that poor outcomes will lead to financial penalties. ⋯ Our results show no evidence of a deleterious effect of P4P on access to coronary artery bypass graft surgery for high-risk patients with AMI. These results should be reassuring to those concerned about the potential negative effect of P4P on high-risk patients.
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Circ Cardiovasc Qual · Sep 2014
Assessment of the completeness and accuracy of case ascertainment in the Michigan Stroke Registry.
Accurate case ascertainment is essential for clinical registries to be valid and representative. We assessed case ascertainment in the Michigan Stroke Registry by linking to a statewide hospital discharge database (Michigan Inpatient Database [MIDB]). ⋯ Among registry hospitals, these results revealed relatively high levels of completeness and accuracy. Matching registry data to hospital discharge data identified hospitals that changed their case ascertainment method to a case sampling approach. This study illustrates the value of monitoring case ascertainment in stroke registries using external data sources.
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Circ Cardiovasc Qual · Sep 2014
Improving quality measurement for anticoagulation: adding international normalized ratio variability to percent time in therapeutic range.
Among patients receiving warfarin, percent time in therapeutic range (TTR) and international normalized ratio (INR) variability predict adverse events individually. Here, we examined what is added to the prediction of adverse events by using both measures together. ⋯ Unstable anticoagulation predicts warfarin adverse effects independent of TTR. Moreover, knowledge about anticoagulation stability further stratifies the risk for adverse events at given levels of TTR.