CMS hospital readmission reduction program and anticoagulants received following a total hip and knee arthroplasty discharge

<p><b>Objectives:</b> To assess association between 30 day readmission rate and treatment received after total hip and knee arthroplasty (THA/TKA) discharge (rivaroxaban vs. warfarin or non-anticoagulant). To subsequently model impact of increasing rivaroxaban use on the Hospital Readmission Reduction Program (HRRP) penalty, which was imposed on hospitals with excess 30 day readmissions after hospitalizations for selected conditions, including THA/TKA.</p> <p><b>Methods:</b> The US Truven Health MarketScan Medicare Supplemental database from 1 July 2010 to 30 April 2015 was used. A retrospective claims analysis was conducted to assess the risk of all-cause 30 day readmission among patients receiving either rivaroxaban or warfarin, or no anticoagulation following THA/TKA discharge. Simulations were performed to estimate the impact of post-discharge treatment on the HRRP penalty.</p> <p><b>Results:</b> The risk-adjusted all-cause 30 day readmission rates were 1.21% (95% confidence interval [95% CI]: 0.94%–1.49%), 1.41% (95% CI: 1.19%–1.58%) and 1.95% (95% CI: 1.81%–2.11%) for rivaroxaban, warfarin and non-anticoagulant cohorts, respectively. Using these rates, simulations illustrated that when switching patients from warfarin or non-anticoagulant to rivaroxaban, annual penalty per hospital would be reduced up to 67% or 88%, respectively.</p> <p><b>Conclusions:</b> Rivaroxaban treatment post-THA/TKA discharge reduced the risk of 30 day readmission compared to non-anticoagulants. Simulations illustrated that increasing rivaroxaban use could decrease the HRRP penalty.</p

Additional file 1 of Identifying individuals with undiagnosed post-traumatic stress disorder in a large United States civilian population – a machine learning approach

Additional file 1. Features used in the development of the random forest model. The “Full list” tab includes all 490 features that were available for modeling. This full list is broken down by category in the “Trauma indicators”, “Symptoms and complications”, “Other diagnoses”, and “Medications” tabs, which provide a description of how each predictor was defined. The “Importance scores” tab includes the 324 predictive features that were used to train the final random forest model (with the corresponding importance scores)

A real-world assessment of healthcare costs associated with agitation in Alzheimer’s dementia

To describe and compare clinical characteristics, healthcare costs, and institutionalization/mortality outcomes among patients with and without agitation associated with Alzheimer’s dementia (AAD). Data from the Reliant Medical Group database (01/01/2016-03/31/2020) were used, including claims, electronic medical records, and clinical information/physician notes abstracted from medical charts. Patients aged ≥55 years with Alzheimer’s dementia (AD) were observed during a randomly selected 12-month study period after AD diagnosis. Using information recorded in medical charts, patients were classified into cohorts based on experiencing (agitation cohort) and not experiencing (no agitation cohort) agitated behaviours during the study period. Entropy balancing was used to create reweighted cohorts with similar characteristics. Study outcomes (patient demographic and clinical characteristics, treatments received, healthcare costs, institutionalization and death events) were compared between cohorts; agitation characteristics were described for the agitation cohort only. Among 711 patients included in the study, 240 were classified in the agitation cohort and 471 in the no agitation cohort. After reweighting, several comorbidities were more frequently observed in the agitation versus no agitation cohort, including infection, depression, and altered mental status. Use of antidepressants, anticonvulsants, antipsychotics, and antianxiety medications was more common in the agitation versus no agitation cohort. Common agitated behaviours included hitting (20.8%), pacing/aimless wandering (17.5%), and cursing/verbal aggression (15.0%). Total all-cause healthcare costs were $4287 per-patient-per-year higher in the agitation cohort versus no agitation cohort (p = 0.04), driven by higher inpatient costs. Death was more common and time to death and institutionalization were shorter in the agitation versus no agitation cohort. Results may not be generalizable to the US population with AD. Among patients with AD, agitation was associated with shorter time to death/institutionalization and increased comorbidities, medication use, and healthcare costs, highlighting the additional clinical and economic burden that agitation poses to patients and the healthcare system.</p

Additional file 1: of External validation of prognostic rules for early post-pulmonary embolism mortality: assessment of a claims-based and three clinical-based approaches

Description of the IMPACT, PESI, sPESI and Hestia Prediction Rules. Table S1. Characteristics of Pulmonary Embolism Patients in the 30-Day Mortality Cohort. Table S2. Description of Patients Whom Died In-Hospital and Had Discordant Risk Categorization. Table S3. Description of Patients Whom Died After Discharge and Within 30-days of Presentation and Had Discordant Risk Categorization. (DOCX 35 kb

Baseline demographic and clinical characteristics of LRPE patients with long versus short LOS.

<p>Baseline demographic and clinical characteristics of LRPE patients with long versus short LOS.</p

PSM-adjusted health care costs among LRPE patients with long vs short LOS in the 90-day follow-up period.

<p>LOS: length of stay.</p

PSM-adjusted hospital-acquired complications and adverse PE events among LRPE patients with long versus short LOS during the 90-day follow-up period.

<p>PSM-adjusted hospital-acquired complications and adverse PE events among LRPE patients with long versus short LOS during the 90-day follow-up period.</p

Additional file 1: of External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications

International Classification of Disease, Ninth Revision-Clinical Modification (ICD-9-CM) codes for independent predictors in the IMPACT model. (DOCX 12 kb