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
Frequent utilization of the emergency department for acute heart failure syndrome: a population-based study.
Although most research on patients with acute heart failure syndrome (AHFS) has focused on readmissions, this may provide an incomplete picture of health-care utilization. We examined the proportion and characteristics of patients with frequent emergency department (ED) visits for AHFS and associated health-care utilization. ⋯ In this large cohort study, we found that one third (31%) of ED patients with AHFS had frequent ED visits for this condition and that minority race/ethnicity and lower socioeconomic status were associated with frequent ED visits. Individuals with frequent ED visits accounted for the majority of ED visits, hospitalizations, and hospital charges.
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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.
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Circ Cardiovasc Qual · Sep 2014
Impact of time of presentation on process performance and outcomes in ST-segment-elevation myocardial infarction: a report from the American Heart Association: Mission Lifeline program.
Prior studies demonstrated that patients with ST-segment-elevation myocardial infarction presenting during off-hours (weeknights, weekends, and holidays) have slower reperfusion times. Recent nationwide initiatives have emphasized 24/7 quality care in ST-segment-elevation myocardial infarction. It remains unclear whether patients presenting off-hours versus on-hours receive similar quality care in contemporary practice. ⋯ In contemporary community practice, achievement of quality performance measures in patients presenting with ST-segment-elevation myocardial infarction was high, regardless of time of presentation. Door-to-balloon time was, however, slightly delayed (by an average of 16 minutes), and risk-adjusted in-hospital mortality was 13% higher in patients presenting off-hours.