Evidence map›Paper›PMID 29530887›Full record

Observational studyCirculation. Cardiovascular quality and outcomes2018

Association Between 30-Day Episode Payments and Acute Myocardial Infarction Outcomes Among Medicare Beneficiaries.

Rishi K Wadhera, Karen E Joynt Maddox, Yun Wang, Changyu Shen, Deepak L Bhatt, Robert W Yeh

Abstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Circulation. Cardiovascular quality and outcomes, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
–field-weighted citation impact
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

13 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Rishi K WadheraFrom the Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (R.K.W., D.L.B.); Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., Y.W., C.S., R.W.Y.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (K.E.J.M.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (Y.W.).
Karen E Joynt MaddoxFrom the Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (R.K.W., D.L.B.); Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., Y.W., C.S., R.W.Y.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (K.E.J.M.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (Y.W.).
Yun WangFrom the Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (R.K.W., D.L.B.); Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., Y.W., C.S., R.W.Y.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (K.E.J.M.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (Y.W.).
Changyu ShenFrom the Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (R.K.W., D.L.B.); Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., Y.W., C.S., R.W.Y.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (K.E.J.M.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (Y.W.).
Deepak L BhattFrom the Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (R.K.W., D.L.B.); Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., Y.W., C.S., R.W.Y.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (K.E.J.M.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (Y.W.).
Robert W YehFrom the Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (R.K.W., D.L.B.); Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA (R.K.W., Y.W., C.S., R.W.Y.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (K.E.J.M.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (Y.W.). ryeh@bidmc.harvard.edu.

Funding

TRAINING PROGRAM IN CARDIOVASCULAR RESEARCHT32HL007604 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI MARK W FEINBERG · 1985 to 2026
$19.0M
Use of Registries, Claims and Health System Data to Enhance the Evaluation of Cardiovascular Therapies in Clinical TrialsR01HL136708 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI Issa J. Dahabreh, Robert Yeh · 2017 to 2026
$6.9M
Balancing the Risks of Ischemia and Bleeding in Percutaneous Coronary InterventioK23HL118138 · NHLBI · MASSACHUSETTS GENERAL HOSPITAL · PI YEH, ROBERT · 2013 to 2017
$740k
THE IMPACT OF PUBLIC REPORTING ON OUTCOMES AND CASE SELECTION FOR PCIK23HL109177 · NHLBI · WASHINGTON UNIVERSITY · PI JOYNT MADDOX, KAREN ELLEN · 2011 to 2017
$691k
NHLBI NIH HHS K23 HL109177NHLBI NIH HHS K23 HL118138NHLBI NIH HHS R01 HL136708NHLBI NIH HHS T32 HL007604
6 · The paper itself

Abstract

backgroundRecent policy efforts have focused on improving the value of acute myocardial infarction (AMI) care. Medicare payment programs, for example, increasingly evaluate hospital performance based on spending, as determined by payments made to institutions and providers, and outcome measures for a longitudinal episode of AMI care. Little is known about the relationship between total 30-day payments-both in the inpatient and immediate postdischarge timeframe-and outcomes after an admission for AMI. METHODS AND

resultsUsing Medicare claims data, we identified Medicare fee-for-service beneficiaries ≥65 years of age who were hospitalized at an acute-care hospital for AMI between July 1, 2011, and June 30, 2014, and examined the association between hospital-level 30-day payments for an episode of AMI care and patient 30-day mortality using mixed regression models with a logit link function and random hospital intercepts. Our cohort included 642 105 index hospitalizations for AMI at 2319 acute-care hospitals. Overall mean 30-day episode payments per beneficiary were $22 128 (SD, $1750). The observed 30-day mortality rate was 12.9%. Higher 30-day payments were associated with lower 30-day mortality after adjustment for patient characteristics and comorbidities (adjusted odds ratio for additional $1000 payments, 0.986; 95% confidence interval, 0.979-0.992;

conclusionsHigher hospital-level 30-day payments-both inpatient and in multiple settings after discharge-for AMI care were associated with lower 30-day mortality among beneficiaries. This may have implications for payment programs that incent reduction in payments without considering value.

Indexed as

Hospital CostsAgedAged, 80 and overAmbulatory CareComorbidityCost-Benefit AnalysisDatabases, FactualFee-for-Service PlansFemaleHumansInsurance BenefitsMaleMedicareMyocardial InfarctionOutcome and Process Assessment, Health CarePatient Dischargehealth expendituresMedicaremortalitymyocardial infarctionpercutaneous coronary intervention

Identifiers

PMID29530887
PMCPMC5922453

What OpenQuestion holds

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Registered trials

None linked

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.