Evidence map›Paper›PMID 32148101›Full record

ArticleCirculation. Cardiovascular quality and outcomes2020

Opportunities and Challenges of Claims-Based Quality Assessment: The Case of Postdischarge β-Blocker Treatment in Patients With Heart Failure With Reduced Ejection Fraction.

Lauren Gilstrap, Jonathan S Skinner, Barbara Gladders, A James O'Malley, Amber E Barnato, Anna N A Tosteson, Andrea M Austin

Open access · bronzeAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Cardiovascular quality and outcomes, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
0.7field-weighted citation impact, top 27% 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

1 citing paper in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

Lauren GilstrapDartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH (L.G., B.G.).
Jonathan S SkinnerThe Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH.
Barbara GladdersDartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH (L.G., B.G.).
A James O'MalleyThe Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH.
Amber E BarnatoThe Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH.
Anna N A TostesonThe Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH.
Andrea M AustinThe Dartmouth Institute for Health Policy and Clinical Practice (L.G., J.S.S., A.J.O., A.E.B., A.N.A.T., A.M.A.), Geisel School of Medicine at Dartmouth, Lebanon, NH.
Dartmouth Institute for Health Policy and Clinical Practice · USDartmouth College · USDartmouth–Hitchcock Medical Center · US

Funding

Translational Engineering in Cancer (TEC)P30CA023108 · NCI · DARTMOUTH COLLEGE · PI Steven D Leach · 1985 to 2026
$91.3M
UNDERSTANDING AND IMPROVING EPISODE-BASED HOSPITAL CAREP01AG019783 · NIA · DARTMOUTH COLLEGE · PI Alistair James O'MALLEY · 2001 to 2026
$52.9M
SYNERGY: The Dartmouth Center for clinical and Translational ScienceUL1TR001086 · NCATS · DARTMOUTH COLLEGE · PI GREEN, ALAN I · 2013 to 2017
$18.3M
The Impact of Quality Metrics on Outcomes Among Elderly Heart Failure PatientsK23HL142835 · NHLBI · DARTMOUTH-HITCHCOCK CLINIC · PI GILSTRAP, LAUREN GRAY · 2018 to 2022
$831k
NCATS NIH HHS UL1 TR001086NCI NIH HHS P30 CA023108NHLBI NIH HHS K23 HL142835NIA NIH HHS P01 AG019783
6 · The paper itself

Abstract

backgroundTo combat the high cost and increasing burden of quality reporting, the Medicare Payment Advisory (MedPAC) has recommended using claims data wherever possible to measure clinical quality. In this article, we use a cohort of Medicare beneficiaries with heart failure with reduced ejection fraction and existing quality metrics to explore the impact of changes in quality metric methodology on measured quality performance, the association with patient outcomes, and hospital rankings. METHODS AND

resultsWe used 100% Medicare Parts A and B and a random 40% sample of Part D from 2008 to 2015 to create (1) a cohort of 295 494 fee-for-service beneficiaries with ≥1 hospitalization for heart failure with reduced ejection fraction and (2) a cohort of 1079 hospitals with ≥11 heart failure with reduced ejection fraction admissions in 2014 and 2015. We used Part D data to calculate β-blocker use after discharge and β-blocker use over time. We then varied the quality metric methodologies to explore the impact on measured performance. We then used multivariable time-to-event analyses to explore the impact of metric methodology on the association between quality performance and patient outcomes and Kendall's Tau to describe impact of quality metric methodology on hospital rankings. We found that quality metric methodology had a significant impact on measured quality performance. The association between quality performance and readmissions was sensitive to changes in methodology but the association with 1-year mortality was not. Changes in quality metric methodology also had a substantial impact on hospital quality rankings.

conclusionsThis article highlights how small changes in quality metric methodology can have a significant impact on measured quality performance, the association between quality performance and utilization-based outcomes, and hospital rankings. These findings highlight the need for standardized quality metric methodologies, better case-mix adjustment and cast further doubt on the use of utilization-based outcomes as quality metrics in chronic diseases.

Indexed as

Administrative Claims, HealthcareStroke VolumeVentricular Function, LeftAdrenergic beta-AntagonistsAgedAged, 80 and overData AccuracyDatabases, FactualFemaleHeart FailureHumansMaleMedicarePatient DischargePatient ReadmissionQuality ImprovementAdrenergic beta-Antagonistschronic diseasefee-for-serviceheart failuremedicaremortality

Identifiers

PMID32148101
PMCPMC7189209
OpenAlexW3011009626

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

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.