Evidence map›Paper›PMID 25951833›Full record

ArticleCirculation2015

Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention: Insights on Short-Term Healthcare Value From the Veterans Affairs Clinical Assessment, Reporting, and Tracking System (VA CART) Program.

Steven M Bradley, Colin I O'Donnell, Gary K Grunwald, Chuan-Fen Liu, Paul L Hebert, Thomas M Maddox, Robert L Jesse, Stephan D Fihn, John S Rumsfeld, P Michael Ho

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Circulation, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
16.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 23 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Steven M BradleyFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.). Steven.Bradley@va.gov.
Colin I O'DonnellFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
Gary K GrunwaldFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
Chuan-Fen LiuFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
Paul L HebertFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
Thomas M MaddoxFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
Robert L JesseFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
Stephan D FihnFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
John S RumsfeldFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
P Michael HoFrom VA Eastern Colorado Health Care System, Denver (S.M.B., C.I.O., G.K.G., T.M.M., J.S.R., P.M.H.); University of Colorado School of Medicine, Aurora (S.M.B., T.M.M., J.S.R., P.M.H.); University of Colorado School of Public Health, Aurora (C.I.O., G.K.G.); VA Puget Sound Health Care System, Seattle, WA (C.-F.L., P.L.H.); and Veterans Health Administration, US Department of Veteran Affairs, Washington, DC (R.L.J., S.D.F.).
Colorado School of Public Health · USUniversity of Colorado Denver · USVA Puget Sound Health Care System · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPolicies to reduce unnecessary hospitalizations after percutaneous coronary intervention (PCI) are intended to improve healthcare value by reducing costs while maintaining patient outcomes. Whether facility-level hospitalization rates after PCI are associated with cost of care is unknown. METHODS AND

resultsWe studied 32,080 patients who received PCI at any 1 of 62 Veterans Affairs hospitals from 2008 to 2011. We identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. Compared with the risk-standardized average, 2 hospitals (3.2%) had a lower-than-expected hospitalization rate, and 2 hospitals (3.2%) had a higher-than-expected hospitalization rate. We observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 hospitals (27.4%) had lower-than-expected costs, and 14 hospitals (22.6%) had higher-than-expected costs. At the facility level, the index PCI accounted for 83.1% of the total cost (range, 60.3%-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range, 2.0%-12.7%) of the 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ=0.16; 95% confidence interval, -0.09 to 0.39; P=0.21).

conclusionsIn this national study, hospitalizations in the 30 day after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates. This challenges the focus on reducing hospitalizations after PCI as an effective means of improving healthcare value. Opportunities remain to improve PCI value by reducing the variation in total cost of PCI without compromising patient outcomes.

Indexed as

HospitalizationVeteransAgedCohort StudiesFemaleHospital CostsHumansMaleMiddle AgedMortalityPatient Identification SystemsPercutaneous Coronary InterventionTime FactorsUnited StatesUnited States Department of Veterans Affairscosts and cost analysishospitalizationoutcome assessment (health care)percutaneous coronary intervention

Identifiers

PMID25951833
OpenAlexW2602077567

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.