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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 14 of 14 Research Studies DisplayedGroeneveld PW, Yang L, Segal AG
The effects of market competition on cardiologists' adoption of transcatheter aortic valve replacement.
This study examined the effects of market competition and unique regulations on cardiologists’ adoption of transcatheter aortic valve replacement (TAVR). This new technology was introduced around 2012. This retrospective cohort study looked at physician group practices (n=5116) from May 2012 through December 2014. Medicare claim data was used to indicate first usage. The Herfindahl-Hirschman Index was used to show that every 1000 point increase was associated with a 26% relative increase in the rate of TAVR adoption. This was most true in concentrated markets, and adoption of TAVR was favored by physician groups with greater market power.
AHRQ-funded; HS023615.
Citation: Groeneveld PW, Yang L, Segal AG .
The effects of market competition on cardiologists' adoption of transcatheter aortic valve replacement.
Med Care 2020 Nov;58(11):996-1003. doi: 10.1097/mlr.0000000000001391..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Medicare
Modi PK, Moloci N, Herrel LA
Medicare accountable care organizations reduce spending on surgery.
This study examined the impact that Medicare accountable care organization (ACO) alignment has on spending for inpatient and outpatient surgical care. Researchers identified adults 65 years of age and older enrolled in fee-for-service Medicare from among a 20% random sample of beneficiaries and distinguished between those aligned and unaligned with a Medicare ACO, then measured payments for surgical services made on the enrollees’ behalf. Findings showed that ACO alignment was associated with savings on surgical care. These savings resulted from increased outpatient surgery and reduced use of inpatient surgery as well as reduced spending per inpatient surgical episode. Greater focus on surgical care to improve the ability of ACOs to control healthcare spending was recommended.
AHRQ-funded; HS024728; HS024525; HS026908.
Citation: Modi PK, Moloci N, Herrel LA .
Medicare accountable care organizations reduce spending on surgery.
Am J Accountable Care 2020 Sep;8(3):12-19..
Keywords: Medicare, Surgery, Healthcare Costs, Health Insurance, Elderly
Smith ME, Shubeck SP, Nuliyalu U
Local referral of high-risk patients to high-quality hospitals: surgical outcomes, cost savings, and travel burdens.
In this study, the investigators sought to assess the potential changes in Medicare payments and clinical outcomes of referring high-risk surgical patients to local high-quality hospitals within small geographic areas. The investigators concluded that complication rates and Medicare payments were significantly lower for high-risk patients treated at local high-quality hospitals. The investigators suggest that triaging high-risk patients to local high-quality hospitals within small geographic areas may serve as a template for improving the value of surgical care.
AHRQ-funded; HS024763.
Citation: Smith ME, Shubeck SP, Nuliyalu U .
Local referral of high-risk patients to high-quality hospitals: surgical outcomes, cost savings, and travel burdens.
Ann Surg 2020 Jun;271(6):1065-71. doi: 10.1097/sla.0000000000003208..
Keywords: Surgery, Healthcare Costs, Hospitals, Medicare, Outcomes
Sheetz KH, Chhabra K, Nathan H
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
The objective of this study was to assess whether the quality of surgical care changes as hospitals form networks with established, high-quality medical centers. The investigators concluded that network formation was not associated with a significant improvement in quality or reduction in Medicare expenditures across all procedures studied for hospitals joining the networks of America’s highest rated medical centers.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Chhabra K, Nathan H .
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
Ann Surg 2020 May;271(5):862-67. doi: 10.1097/sla.0000000000003195..
Keywords: Surgery, Hospitals, Quality of Care, Medicare, Health Systems
Tang AB, Childers CP, Dworsky JQ
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
The National Surgical Quality Improvement Program (NSQIP) database is increasingly used for surgical research. However, it is unclear how well this database represents the breadth of work performed by different specialties. Using the 2017 NSQIP participant use file and the 2017 Medicare Physician/Supplier Procedure Summary file, the investigators evaluated (1) what proportion of surgical work was captured by NSQIP, (2) what procedures and disciplines were undersampled, and (3) the overall concordance between the NSQIP sample and a national sample.
AHRQ-funded; HS000046.
Citation: Tang AB, Childers CP, Dworsky JQ .
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
Surgery 2020 Mar;167(3):550-55. doi: 10.1016/j.surg.2019.11.013..
Keywords: Surgery, Quality Improvement, Quality of Care, Provider: Physician, Provider, Medicare, Patient-Centered Outcomes Research
Kaye DR, Luckenbaugh AN, Oerline M
Understanding the costs associated with surgical care delivery in the Medicare population.
This study’s objective was to quantify the costs of inpatient and outpatient surgery in the Medicare population. Claims data from a 20% national sample of Medicare beneficiaries was used. Results showed that, while spending on inpatient surgery contributed the most to total surgical payments, it declined over the study period, driven by decreases in index hospitalization and readmissions payments. In contrast, spending on outpatient surgery increased across all sites of care (hospital outpatient department, physician office, and ambulatory surgery center). Ophthalmology and hand surgery witnessed the greatest growth in surgical spending over the study period. Surgical care accounts for half of all Medicare spending.
AHRQ-funded; HS024525; HS024728.
Citation: Kaye DR, Luckenbaugh AN, Oerline M .
Understanding the costs associated with surgical care delivery in the Medicare population.
Ann Surg 2020 Jan;271(1):23-28. doi: 10.1097/sla.0000000000003165..
Keywords: Surgery, Healthcare Delivery, Healthcare Costs, Medicare, Elderly, Hospitalization
Murugiah K, Wang Y, Desai NR
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
The researchers studied hospital performance on transcatheter aortic valve replacement (TAVR) using data from all Medicare fee-for-service (FFS) beneficiaries 65 years of age and older who underwent TAVR from January 1, 2011, to December 31, 2013. They found that for an individual patient, the between-hospital variation translates to a great than 2-fold higher risk of dying within 30 days for a patient undergoing TAVR at a hospital 1 SD above the national average compared with undergoing TAVR at a hospital 1 SD below; the between-hospital variation was
AHRQ-funded; HS023000.
Citation: Murugiah K, Wang Y, Desai NR .
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
J Am Coll Cardiol 2015 Dec 15;66(23):2678-79. doi: 10.1016/j.jacc.2015.10.008.
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Keywords: Cardiovascular Conditions, Hospitals, Medicare, Patient-Centered Outcomes Research, Surgery
Abdelsattar ZM, Birkmeyer JD, Wong SL
Variation in Medicare payments for colorectal cancer surgery.
The researchers assessed the contributions of index hospitalization, physician services, readmissions, and postacute care to the overall variation in payment for colorectal cancer surgery (CRC). They concluded that Medicare spending in the first year after CRC surgery varies across hospitals even after case-mix adjustment and price standardization. Variation is largely driven by postacute care and not the index surgical hospitalization.
AHRQ-funded; HS020937; HS000053.
Citation: Abdelsattar ZM, Birkmeyer JD, Wong SL .
Variation in Medicare payments for colorectal cancer surgery.
J Oncol Pract 2015 Sep;11(5):391-5. doi: 10.1200/jop.2015.004036.
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Keywords: Cancer, Cancer: Colorectal Cancer, Payment, Medicare, Surgery
Shih T, Ryan AM, Gonzalez AA
Medicare's hospital readmissions reduction program in surgery may disproportionately affect minority-serving hospitals.
The authors aimed to project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. They found that minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery.
AHRQ-funded; HS018546.
Citation: Shih T, Ryan AM, Gonzalez AA .
Medicare's hospital readmissions reduction program in surgery may disproportionately affect minority-serving hospitals.
Ann Surg 2015 Jun;261(6):1027-31. doi: 10.1097/sla.0000000000000778.
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Keywords: Hospitals, Medicare, Racial and Ethnic Minorities, Hospital Readmissions, Surgery
Riall TS, Adhikari D, Parmar AD
The risk paradox: use of elective cholecystectomy in older patients is independent of their risk of developing complications.
For older patients with newly diagnosed symptomatic gallstones, researchers calculated their 2-year risk of emergent gallstone-related hospitalization. They found that patients in the high-risk group were less likely to receive elective cholecystectomy than those in the low-risk group. The study used Texas Medicare data for 161,568 patients with an episode of symptomatic gallstones.
AHRQ-funded; HS022134
Citation: Riall TS, Adhikari D, Parmar AD .
The risk paradox: use of elective cholecystectomy in older patients is independent of their risk of developing complications.
J Am Coll Surg. 2015 Apr;220(4):682-90. doi: 10.1016/j.jamcollsurg.2014.12.012..
Keywords: Hospitalization, Elderly, Medicare, Surgery
Hollingsworth JM, Funk RJ, Garrison SA
Differences between physician social networks for cardiac surgery serving communities with high versus low proportions of black residents.
The researchers examined physician social networks, where individual physicians are tied together by a series of shared patients. They mapped these networks using medical claims data from the Medicare program and found substantial differences between physician social networks formed around CABG procedures serving health services areas with high and low proportions of black residents. Their conclusion was that physicians serving these communities are more isolated.
AHRQ-funded; HS020927.
Citation: Hollingsworth JM, Funk RJ, Garrison SA .
Differences between physician social networks for cardiac surgery serving communities with high versus low proportions of black residents.
Med Care 2015 Feb;53(2):160-7. doi: 10.1097/mlr.0000000000000291..
Keywords: Practice Patterns, Surgery, Heart Disease and Health, Medicare
Du DT, McKean SJ, Kelman JA, et al.
AHRQ Author: Encinosa W
Early mortality after aortic valve replacement with mechanical prosthetic vs bioprosthetic valves among Medicare beneficiaries: a population-based cohort study.
The researchers compared early mortality after aortic valve replacement (AVR) between the recipients of mechanical and bioprosthetic aortic valves. Among 66,453 Medicare beneficiaries who received AVRs, use of mechanical valves was associated with a higher risk for death on the date of surgery and within 30 days compared with the bioprosthetic aortic valves. However, this applied only to those who underwent concurrent AVR and coronary artery bypass graft but not isolated AVR.
AHRQ-authored
Citation: Du DT, McKean SJ, Kelman JA, et al..
Early mortality after aortic valve replacement with mechanical prosthetic vs bioprosthetic valves among Medicare beneficiaries: a population-based cohort study.
JAMA Intern Med. 2014 Nov;174(11):1788-95. doi: 10.1001/jamainternmed.2014.4300..
Keywords: Cardiovascular Conditions, Medicare, Mortality, Patient-Centered Outcomes Research, Surgery
Calderwood MS, Kleinman K, Bratzler DW
Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
This study found that among Medicare patients who underwent vascular surgery at 2,512 U.S. hospitals, a patient undergoing surgery in a hospital ranked in the worst-performing decile based on claims had a 2.5 times greater likelihood of developing a chart-confirmed surgical site infection relative to a patient characteristics in a hospital in the best-performing decile.
AHRQ-funded; HS018878
Citation: Calderwood MS, Kleinman K, Bratzler DW .
Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
Med Care. 2014 Oct;52(10):918-25. doi: 10.1097/MLR.0000000000000212..
Keywords: Medicare, Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Hospitals, Adverse Events
Martin BI, Lurie JD, Tosteson AN
Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.
The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. The researchers found that their claims-based hierarchical coding algorithm of spine-related medical encounters correctly classified more than 90 percent of Medicare patients into their respective SPORT cohorts.
AHRQ-funded; HS018405
Citation: Martin BI, Lurie JD, Tosteson AN .
Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.
Spine. 2014 Apr 20;39(9):769-79. doi: 10.1097/brs.0000000000000275..
Keywords: Comparative Effectiveness, Surgery, Outcomes, Medicare