Evidence map›Paper›PMID 36494765›Full record

ArticlePerioperative medicine (London, England)2022

Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.

Caitlin R Collins, Mary Kathryn Abel, Amy Shui, Gina Intinarelli, Julie Ann Sosa, Elizabeth C Wick

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Perioperative medicine (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.5field-weighted citation impact, top 32% 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

0 citing papers in PubMed, 3 citations in OpenAlex.

No citing paper in PubMed yet.

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 at 1 institution in 1 country.

Caitlin R CollinsDepartment of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143, USA. caitlin.collins@ucsf.edu.ORCID http://orcid.org/0000-0002-5630-2978
Mary Kathryn AbelSchool of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Amy ShuiDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Gina IntinarelliOffice of Population Health, University of California, San Francisco, San Francisco, CA, USA.
Julie Ann SosaDepartment of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143, USA.
Elizabeth C WickDepartment of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA, 94143, USA.
University of California, San Francisco · US

Funding

RESEARCH TRAINING IN GASTROINTESTINAL SURGERYT32DK007573 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HARRIS, HOBART WHITAKER · 1988 to 2019
$3.0M
agency for healthcare research and quality 5 R01 HS024532-05NIDDK NIH HHS 5-T32-DK-7573-29
6 · The paper itself

Abstract

backgroundAs healthcare costs rise, there is an increasing emphasis on alternative payment models to improve care efficiency. The bundled payment represents an alternative reimbursement model gaining popularity within the surgical sphere. We aimed to assess where the largest opportunities for care improvement lay and how best to identify patients at high risk of suffering costly complications.

methodsWe utilized itemized CMS claims data for a retrospective cohort of patients between 2014 and 2016 who met inclusion criteria for the Major Bowel Bundled Payment Program and performed a cost analysis to identify opportunities for improved care efficiency. Based on the results of this cost analysis, we identified readmissions as a target for improvement. We then assessed whether the American College of Surgeons' National Surgical Quality Improvement Program surgical risk calculator (ACS NSQIP SRC) could accurately identify patients within our bundled payment population who were at high risk of readmission using a logistic regression model.

resultsOur study cohort included 252 patients. Readmissions accounted for 12.8% of the average total care episode cost with a coefficient of variation of 2.72, thereby representing the most substantial, non-fixed cost for our bundled payment patients. Patients readmitted within their 90-day care episode were 2.53 times more likely to be high-cost (>$60,000) than patients not readmitted. However, the ACS NSQIP SRC did not accurately predict patients at high risk of readmission within the first 30 days with an AUROC of 0.58.

conclusionsOur study highlights the importance of reducing readmissions as a central component of improving care for bowel surgery bundled payment patients. Preventing such readmissions requires accurate identification of patients at high risk of readmission; however, current risk prediction models lack the adaptability necessary for this task.

Indexed as

Alternative payment modelsBundled paymentSurgical outcomesSurgical readmissionsSurgical risk calculator

Identifiers

PMID36494765
PMCPMC9733045
OpenAlexW4311283771

What OpenQuestion holds

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LicenceCC BY
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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.