8 results on '"Kreuter, W"'
Search Results
2. Treatment Intensity at the End of Life in Older Adults Receiving Long-term Dialysis.
- Author
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Wong SP, Kreuter W, and O'Hare AM
- Published
- 2012
Catalog
3. Accounting for the Growth of Observation Stays in the Assessment of Medicare's Hospital Readmissions Reduction Program.
- Author
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Sabbatini AK, Joynt-Maddox KE, Liao JM, Basu A, Parrish C, Kreuter W, and Wright B
- Subjects
- Aged, Female, United States, Humans, Male, Retrospective Studies, Fee-for-Service Plans, Hospitalization, Patient Readmission, Medicare
- Abstract
Importance: Decreases in 30-day readmissions following the implementation of the Medicare Hospital Readmissions Reduction Program (HRRP) have occurred against the backdrop of increasing hospital observation stay use, yet observation stays are not captured in readmission measures., Objective: To examine whether the HRRP was associated with decreases in 30-day readmissions after accounting for observation stays., Design, Setting, and Participants: This retrospective cohort study included a 20% sample of inpatient admissions and observation stays among Medicare fee-for-service beneficiaries from January 1, 2009, to December 31, 2015. Data analysis was performed from November 2021 to June 2022. A differences-in-differences analysis assessed changes in 30-day readmissions after the announcement of the HRRP and implementation of penalties for target conditions (heart failure, acute myocardial infarction, and pneumonia) vs nontarget conditions under scenarios that excluded and included observation stays., Main Outcomes and Measures: Thirty-day inpatient admissions and observation stays., Results: The study included 8 944 295 hospitalizations (mean [SD] age, 78.7 [8.2] years; 58.6% were female; 1.3% Asian; 10.0% Black; 2.0% Hispanic; 0.5% North American Native; 85.0% White; and 1.2% other or unknown). Observation stays increased from 2.3% to 4.4% (91.3% relative increase) of index hospitalizations among target conditions and 14.1% to 21.3% (51.1% relative increase) of index hospitalizations for nontarget conditions. Readmission rates decreased significantly after the announcement of the HRRP and returned to baseline by the time penalties were implemented for both target and nontarget conditions regardless of whether observation stays were included. When only inpatient hospitalizations were counted, decreasing readmissions accrued into a -1.48 percentage point (95% CI, -1.65 to -1.31 percentage points) absolute reduction in readmission rates by the postpenalty period for target conditions and -1.13 percentage point (95% CI, -1.30 to -0.96 percentage points) absolute reduction in readmission rates by the postpenalty period for nontarget conditions. This reduction corresponded to a statistically significant differential change of -0.35 percentage points (95% CI, -0.59 to -0.11 percentage points). Accounting for observation stays more than halved the absolute decrease in readmission rates for target conditions (-0.66 percentage points; 95% CI, -0.83 to -0.49 percentage points). Nontarget conditions showed an overall greater decrease during the same period (-0.76 percentage points; 95% CI, -0.92 to -0.59 percentage points), corresponding to a differential change in readmission rates of 0.10 percentage points (95% CI, -0.14 to 0.33 percentage points) that was not statistically significant., Conclusions and Relevance: The findings of this study suggest that the reduction of readmissions associated with the implementation of the HRRP was smaller than originally reported. More than half of the decrease in readmissions for target conditions appears to be attributable to the reclassification of inpatient admission to observation stays. more...
- Published
- 2022
- Full Text
- View/download PDF
4. Outcomes Associated With Left Ventricular Assist Devices Among Recipients With and Without End-stage Renal Disease.
- Author
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Bansal N, Hailpern SM, Katz R, Hall YN, Kurella Tamura M, Kreuter W, and O'Hare AM
- Subjects
- Comorbidity trends, Female, Follow-Up Studies, Heart Failure epidemiology, Humans, Male, Middle Aged, Retrospective Studies, Survival Rate trends, Treatment Outcome, United States epidemiology, Heart Failure therapy, Heart-Assist Devices, Kidney Failure, Chronic epidemiology, Registries
- Abstract
Importance: Left ventricular assist devices (LVADs) are widely used both as a bridge to heart transplant and as destination therapy in advanced heart failure. Although heart failure is common in patients with end-stage renal disease (ESRD), little is known about outcomes after LVAD implantation in this population., Objective: To determine the utilization of and outcomes associated with LVADs in nationally representative cohorts of patients with and without ESRD., Design, Setting and Participants: We described LVAD utilization and outcomes among Medicare beneficiaries after ESRD onset (defined as having received maintenance dialysis or a kidney transplant) from 2003 to 2013 based on Medicare claims linked to data from the United States Renal Data System (USRDS), a national registry for ESRD. We compared Medicare beneficiaries with ESRD to a 5% sample of Medicare beneficiaries without ESRD., Exposures: ESRD (vs no ESRD) among patients who underwent LVAD placement., Main Outcomes and Measures: The primary outcome was survival after LVAD placement., Results: Among the patients with ESRD, the mean age was 58.4 (12.1) years and 62.0% (96) were male. Among those without ESRD, the mean age was 62.2 (12.6) years and 75.1% (196) were male. From 2003 to 2013, 155 Medicare beneficiaries with ESRD (median and interquartile range [IQR] days from ESRD onset to LVAD placement were 1655 days [453-3050 days]) and 261 beneficiaries without ESRD in the Medicare 5% sample received an LVAD. During a median follow-up of 762 days (IQR, 92-3850 days), 127 patients (81.9%) with and 95 (36.4%) without ESRD died. more than half of patients with ESRD (80 [51.6%]) compared with 11 (4%) of those without ESRD died during the index hospitalization. The median time to death was 16 days (IQR 2-447 days) for patients with ESRD compared with 2125 days (IQR, 565-3850 days) for those without ESRD. With adjustment for demographics, comorbidity and time period, patients with ESRD had a markedly increased adjusted risk of death (hazard ratio, 36.3; 95% CI, 15.6-84.5), especially in the first 60 days after LVAD placement., Conclusions and Relevance: Patients with ESRD at the time of LVAD placement had an extremely poor prognosis, with most surviving for less than 3 weeks. This information may be crucial in supporting shared decision-making around treatments for advanced heart failure for patients with ESRD. more...
- Published
- 2018
- Full Text
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5. Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis.
- Author
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Wong SP, Kreuter W, Curtis JR, Hall YN, and O'Hare AM
- Subjects
- Aged, Cardiopulmonary Resuscitation mortality, Female, Heart Arrest therapy, Hospital Mortality, Hospitalization, Humans, Male, Middle Aged, Retrospective Studies, United States epidemiology, Cardiopulmonary Resuscitation trends, Heart Arrest complications, Kidney Failure, Chronic complications, Registries, Renal Dialysis
- Abstract
Importance: Understanding cardiopulmonary resuscitation (CPR) practices and outcomes can help to support advance care planning in patients receiving maintenance dialysis., Objective: To characterize patterns and outcomes of in-hospital CPR in US adults receiving maintenance dialysis., Design, Setting, and Participants: This national retrospective cohort study studied 663,734 Medicare beneficiaries 18 years or older from a comprehensive national registry for end-stage renal disease who initiated maintenance dialysis from January 1, 2000, through December 31, 2010., Exposures: Receipt of in-hospital CPR from 91 days after dialysis initiation through the time of death, first kidney transplantation, or end of follow-up on December 31, 2011., Main Outcomes and Measures: Incidence of CPR and survival after the first episode of CPR recorded in Medicare claims during follow-up., Results: The annual incidence of CPR for the overall cohort was 1.4 events per 1000 in-hospital days (95% CI, 1.3-1.4). A total of 21.9% CPR recipients (95% CI, 21.4%-22.3%) survived to hospital discharge, with a median postdischarge survival of 5.0 months (interquartile range, 0.7-16.8 months). Among patients who died in the hospital, 14.9% (95% CI, 14.8%-15.1%) received CPR during their terminal admission. From 2000 to 2011, there was an increase in the incidence of CPR (1.0 events per 1000 in-hospital days; 95% CI, 0.9-1.1; to 1.6 events per 1000 in-hospital days; 95% CI, 1.6-1.7; P for trend <.001), the proportion of CPR recipients who survived to discharge (15.2%; 95% CI, 11.1%-20.5%; to 28%; 95% CI, 26.7%-29.4%; P for trend <.001), and the proportion of in-hospital deaths preceded by CPR (9.5%; 95% CI, 8.4%-10.8%; to 19.8%; 95% CI, 19.2%-20.4%; P for trend <.001), with no substantial change in duration of postdischarge survival., Conclusions and Relevance: Among a national cohort of patients receiving maintenance dialysis, the incidence of CPR was higher and long-term survival worse than reported for other populations. more...
- Published
- 2015
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- View/download PDF
6. Major medical outcomes with spinal augmentation vs conservative therapy.
- Author
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McCullough BJ, Comstock BA, Deyo RA, Kreuter W, and Jarvik JG
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- Aged, 80 and over, Case-Control Studies, Cohort Studies, Female, Humans, Intensive Care Units statistics & numerical data, Kaplan-Meier Estimate, Male, Multivariate Analysis, Osteoporotic Fractures complications, Osteoporotic Fractures mortality, Patient Admission statistics & numerical data, Propensity Score, Retrospective Studies, Skilled Nursing Facilities statistics & numerical data, Spinal Fractures complications, Spinal Fractures mortality, Kyphoplasty, Osteoporotic Fractures therapy, Spinal Fractures therapy, Vertebroplasty
- Abstract
Importance: The symptomatic benefits of spinal augmentation (vertebroplasty or kyphoplasty) for the treatment of osteoporotic vertebral compression fractures are controversial. Recent population-based studies using medical billing claims have reported significant reductions in mortality with spinal augmentation compared with conservative therapy, but in nonrandomized settings such as these, there is the potential for selection bias to influence results., Objective: To compare major medical outcomes following treatment of osteoporotic vertebral fractures with spinal augmentation or conservative therapy. Additionally, we evaluate the role of selection bias using preprocedure outcomes and propensity score analysis., Design, Setting, and Participants: Retrospective cohort analysis of Medicare claims for the 2002-2006 period. We compared 30-day and 1-year outcomes in patients with newly diagnosed vertebral fractures treated with spinal augmentation (n = 10,541) or conservative therapy (control group, n = 115,851). Outcomes were compared using traditional multivariate analyses adjusted for patient demographics and comorbid conditions. We also used propensity score matching to select 9017 pairs from the initial groups to compare the same outcomes., Exposures: Spinal augmentation (vertebroplasty or kyphoplasty) or conservative therapy., Main Outcomes and Measures: Mortality, major complications, and health care utilization., Results: Using traditional covariate adjustments, mortality was significantly lower in the augmented group than among controls (5.2% vs 6.7% at 1 year; hazard ratio, 0.83; 95% CI, 0.75-0.92). However, patients in the augmented group who had not yet undergone augmentation (preprocedure subgroup) had lower rates of medical complications 30 days post fracture than did controls (6.5% vs 9.5%; odds ratio, 0.66; 95% CI, 0.57-0.78), suggesting that the augmented group was less medically ill. After propensity score matching to better account for selection bias, 1-year mortality was not significantly different between the groups. Furthermore, 1-year major medical complications were also similar between the groups, and the augmented group had higher rates of health care utilization, including hospital and intensive care unit admissions and discharges to skilled nursing facilities., Conclusions and Relevance: After accounting for selection bias, spinal augmentation did not improve mortality or major medical outcomes and was associated with greater health care utilization than conservative therapy. Our results also highlight how analyses of claims-based data that do not adequately account for unrecognized confounding can arrive at misleading conclusions. more...
- Published
- 2013
- Full Text
- View/download PDF
7. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults.
- Author
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Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, and Jarvik JG
- Subjects
- Aged, Cohort Studies, Female, Health Services statistics & numerical data, Humans, Lumbar Vertebrae, Male, Medicare statistics & numerical data, Postoperative Complications mortality, Retrospective Studies, United States epidemiology, Decompression, Surgical adverse effects, Decompression, Surgical economics, Decompression, Surgical trends, Hospital Charges statistics & numerical data, Spinal Fusion adverse effects, Spinal Fusion economics, Spinal Fusion methods, Spinal Fusion trends, Spinal Stenosis surgery
- Abstract
Context: In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over nonoperative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in older patients, so benefits and risks must be carefully weighed in the choice of surgical procedure., Objective: To examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity., Design, Setting, and Patients: Retrospective cohort analysis of Medicare claims for 2002-2007, focusing on 2007 to assess complications and resource use in US hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n = 32,152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (1 or 2 disk levels, single surgical approach), or complex fusion (more than 2 disk levels or combined anterior and posterior approach)., Main Outcome Measures: Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use., Results: Overall, surgical rates declined slightly from 2002-2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100,000 beneficiaries. Life-threatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared with decompression alone was 2.95 (95% confidence interval [CI], 2.50-3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR, 1.94; 95% CI, 1.74-2.17). Adjusted mean hospital charges for complex fusion procedures were US $80,888 compared with US $23,724 for decompression alone., Conclusions: Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use. more...
- Published
- 2010
- Full Text
- View/download PDF
8. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial.
- Author
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Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan SD, Kreuter W, and Deyo RA
- Subjects
- Activities of Daily Living, Adult, Cost of Illness, Cost-Benefit Analysis, Disability Evaluation, Health Care Costs, Health Services statistics & numerical data, Health Status Indicators, Humans, Low Back Pain economics, Middle Aged, Primary Health Care economics, Spine diagnostic imaging, Spine pathology, United States, Low Back Pain diagnosis, Magnetic Resonance Imaging economics, Magnetic Resonance Imaging methods, Outcome and Process Assessment, Health Care, Radiography economics, Technology Assessment, Biomedical
- Abstract
Context: Faster magnetic resonance imaging (MRI) scanning has made MRI a potential cost-effective replacement for radiographs for patients with low back pain. However, whether rapid MRI scanning results in better patient outcomes than radiographic evaluation or a cost-effective alternative is unknown., Objective: To determine the clinical and economic consequences of replacing spine radiographs with rapid MRI for primary care patients., Design, Setting, and Patients: Randomized controlled trial of 380 patients aged 18 years or older whose primary physicians had ordered that their low back pain be evaluated by radiographs. The patients were recruited between November 1998 and June 2000 from 1 of 4 imaging centers in the Seattle, Wash, area: a university-based teaching program, a nonuniversity-based teaching program, and 2 private clinics., Intervention: Patients were randomly assigned to receive lumbar spine evaluation by rapid MRI or by radiograph., Main Outcome Measures: Back-related disability measured by the modified Roland questionnaire. Secondary outcomes included Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), pain, preference scores, satisfaction, and costs., Results: At 12 months, primary outcomes of functional disability were obtained from 337 (89%) of the 380 patients enrolled. The mean back-related disability modified Roland score for the 170 patients assigned to the radiograph evaluation group was 8.75 vs 9.34 for the 167 patients assigned the rapid MRI evaluation group (mean difference, -0.59; 95% CI, -1.69 to 0.87). The mean differences in the secondary outcomes were not statistically significant : pain bothersomeness (0.07; 95% CI -0.88 to 1.22), pain frequency (0.12; 95% CI, -0.69 to 1.37), and SF-36 subscales of bodily pain (1.25; 95% CI, -4.46 to 4.96), and physical functioning (2.73, 95% CI -4.09 to 6.22). Ten patients in the rapid MRI group vs 4 in the radiograph group had lumbar spine operations (risk difference, 0.34; 95% CI, -0.06 to 0.73). The rapid MRI strategy had a mean cost of 2380 dollars vs 2059 dollars for the radiograph strategy (mean difference, 321 dollars; 95% CI, -1100 to 458)., Conclusions: Rapid MRIs and radiographs resulted in nearly identical outcomes for primary care patients with low back pain. Although physicians and patients preferred the rapid MRI, substituting rapid MRI for radiographic evaluations in the primary care setting may offer little additional benefit to patients, and it may increase the costs of care because of the increased number of spine operations that patients are likely to undergo. more...
- Published
- 2003
- Full Text
- View/download PDF
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