10 research outputs found
The Impact of Venous Thromboembolism on Risk of Death or Hemorrhage in Older Cancer Patients
BACKGROUND: Among older cancer patients, there is uncertainty about the degree to which venous thromboembolism (VTE) and its treatment increase the risk of death or major hemorrhage. OBJECTIVE: To determine the prevalence of VTE in a cohort of older cancer patients, as well as the degree to which VTE increased the risk of death or major hemorrhage. METHODS: We conducted a retrospective cohort study of linked Surveillance, Epidemiology, and End Results cancer registry and Medicare administrative claims data. Patients with any of ten invasive cancers diagnosed during 1995 through 1999 were included; the independent variable was VTE diagnosed concomitantly with cancer diagnosis. Outcomes included major hemorrhage during the first year after cancer diagnosis and all-cause mortality; RESULTS: Overall, about 1% of patients who were diagnosed with cancer also had a VTE diagnosed concomitantly. After adjusting for sociodemographic factors and cancer stage and grade, concomitant VTE was associated with a relative increase in the risk of death for 8 of the 10 cancer types; the increase in risk tended to range 20ā40% across most cancer types. Approximately 16.8% (95% confidence interval [CI] 14.9ā18.8%) of patients with a concomitant VTE and 7.9% (95% CI 7.7ā8.0%) of patients without a VTE experienced a major hemorrhage during the year after cancer diagnosis (P value <.001). The excess risk of hemorrhage associated with VTE varied substantially across cancer types, ranging from no significant excess (kidney and uterine cancer) to 11.5% (lymphoma). CONCLUSION: Concomitant VTE is not only a marker and potential mediator of increased risk of death among older cancer patients, but patients with a VTE have a marked increased risk of major hemorrhage
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Association Between Hospital Performance on Patient Safety and 30āDay Mortality and Unplanned Readmission for Medicare FeeāforāService Patients With Acute Myocardial Infarction
Background: Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30āday mortality and unplanned readmission rates for Medicare feeāforāservice patients hospitalized for acute myocardial infarction (AMI). Methods and Results: Using 2009ā2013 medical recordāabstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixedāeffects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospitalāspecific riskāstandardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospitalāspecific 30āday allācause riskāstandardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the riskāstandardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79ā8.94) and 3.44% points (95% CI, 0.19ā6.68) for the riskāstandardized mortality and unplanned readmission rates, respectively. Conclusions: For Medicare feeāforāservice patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30āday allācause mortality and on unplanned readmissions