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Sepsis medicare

Emily L Aaronson, Michael R Filbin, David F M Brown, Kathy Tobin, Elizabeth A Mort
BACKGROUND: The release of the Center for Medicare and Medicaid Service's (CMS) latest quality measure, Severe Sepsis/Septic Shock Early Management Bundle (SEP-1), has intensified the long-standing debate over optimal care for severe sepsis and septic shock. Although the last decade of research has demonstrated the importance of comprehensive bundled care in conjunction with compliance mechanisms to reduce patient mortality, it is not clear that SEP-1 achieves this aim. The heterogeneous and often cryptic presentation of severe sepsis and septic shock, along with the multifaceted criteria for the definition of this clinical syndrome, pose a particular challenge for fitting requirements to this disease, and implementation could have unintended consequences...
October 5, 2016: Journal of Emergency Medicine
Carolyn Weaver Swenson, Neil S Kamdar, Helen Levy, Darrell A Campbell, Daniel M Morgan
OBJECTIVES: The aim of this study was to investigate the relationship between primary insurance type and major complications after hysterectomy. METHODS: A retrospective analysis was performed on women with Medicaid, Medicare, and private insurance who underwent hysterectomy from January 1, 2012, to July 1, 2014, and were included in the Michigan Surgical Quality Collaborative. Major complications within 30 days of surgery included the following: deep/organ space surgical site infection, deep venous and pulmonary thromboembolism, myocardial infarction or stroke, pneumonia or sepsis, blood transfusion, readmission, and death...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Vivian S Lee, Kensaku Kawamoto, Rachel Hess, Charlton Park, Jeffrey Young, Cheri Hunter, Steven Johnson, Sandi Gulbransen, Christopher E Pelt, Devin J Horton, Kencee K Graves, Tom H Greene, Yoshimi Anzai, Robert C Pendleton
IMPORTANCE: Transformation of US health care from volume to value requires meaningful quantification of costs and outcomes at the level of individual patients. OBJECTIVE: To measure the association of a value-driven outcomes tool that allocates costs of care and quality measures to individual patient encounters with cost reduction and health outcome optimization. DESIGN, SETTING, AND PARTICIPANTS: Uncontrolled, pre-post, longitudinal, observational study measuring quality and outcomes relative to cost from 2012 to 2016 at University of Utah Health Care...
September 13, 2016: JAMA: the Journal of the American Medical Association
Alexandra I Stavrakis, Nelson F SooHoo
BACKGROUND: This study provides an updated comparison of the reoperation rates following primary ankle arthrodesis and total ankle replacement on the basis of observational, population-based data from California. We previously reported data from 1995 to 2004, and our current study includes new data from 2005 to 2010. Our hypothesis was that total ankle replacement would demonstrate increasing utilization and lower complication rates given advances in implant design and growth in surgeon experience...
September 7, 2016: Journal of Bone and Joint Surgery. American Volume
Vikas R Dharnidharka, Mark A Schnitzler, Jiajing Chen, Daniel C Brennan, David Axelrod, Dorry L Segev, Kenneth B Schechtman, Jie Zheng, Krista L Lentine
We examined integrated national transplant registry, pharmacy fill and medical claims data for Medicare-insured kidney transplant recipients in 2000-2011 (n=45,164) from the United States Renal Data System to assess efficacy and safety endpoints associated with 7 early (first 90 days) immunosuppression (ISx) regimens. Risks of clinical complications over 3 years according to IS regimens were assessed with multivariate regression, including adjustment for covariates and propensity for receipt of a non-reference ISx regimen...
August 26, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Michael J Ward, Wesley H Self, Adam Singer, Danielle Lazar, Jesse M Pines
PURPOSE: To determine the cost-effectiveness of implementing a point-of-care (POC) Lactate Program in the emergency department (ED) for patients with suspected sepsis to identify patients who can benefit from early resuscitation. MATERIALS AND METHODS: We constructed a cost-effectiveness model to examine an ED with 30 000 patients annually. We evaluated a POC lactate program screening patients with suspected sepsis for an elevated lactate ≥4 mmol/L. Those with elevated lactate levels are resuscitated and their lactate clearance is evaluated by serial POC lactate measurements...
July 7, 2016: Journal of Critical Care
Lola Butcher
Sepsis remains one of the most vexing and persistent health care-associated conditions. But hospitals are refusing to back down. Here are strategies they're using to step up the battle.
January 2016: Trustee: the Journal for Hospital Governing Boards
M Rizwan Sohail, Elizabeth L Eby, Michael P Ryan, Candace Gunnarsson, Laura A Wright, Arnold J Greenspon
BACKGROUND: Because of the increasing use of cardiac implantable electronic devices (CIEDs), it is important to estimate the incidence and annual healthcare expenditures associated with CIED infections. METHODS AND RESULTS: Patients with a record of an initial or replacement (full implant or generator only) CIED implant during the calendar years 2009 to 2012 in MarketScan Commercial Claims and Medicare Supplemental database were identified. CIED infections were classified into 4 categories: (1) infection not managed by inpatient admission nor implant removal, (2) infection managed by inpatient admission but no implant removal, (3) infection managed by an implant removal either in an inpatient or in an outpatient setting, and (4) infection with severe sepsis and managed in an inpatient setting with implant removal...
August 2016: Circulation. Arrhythmia and Electrophysiology
John P Donnelly, Jayme E Locke, Paul A MacLennan, Gerald McGwin, Roslyn B Mannon, Monika M Safford, John W Baddley, Paul Muntner, Henry E Wang
BACKGROUND: Solid organ transplant (SOT) recipients are at elevated risk of sepsis. The impact of SOT on outcomes following sepsis is unclear. METHODS: We performed a retrospective cohort study using data from University HealthSystem Consortium, a consortium of academic medical center affiliates. We examined the association between SOT and mortality among patients hospitalized with severe sepsis or explicitly coded sepsis in 2012-2014. We used International Classification of Diseases, Ninth Revision (ICD-9) codes to identify severe sepsis, explicitly coded sepsis, and SOT (kidney, liver, heart, lung, pancreas, or intestine transplants)...
July 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Christine D Jones, Heidi L Wald, Rebecca S Boxer, Frederick A Masoudi, Robert E Burke, Roberta Capp, Eric A Coleman, Adit A Ginde
OBJECTIVE: To assess patient- and hospital-level factors associated with home health care (HHC) referrals following nonelective U.S. patient hospitalizations in 2012. DATA SOURCE: The 2012 National Inpatient Sample (NIS). STUDY DESIGN: Retrospective, cross-sectional multivariable logistic regression modeling to assess patient- and hospital-level variables in patient discharges with versus without HHC referrals. DATA COLLECTION: Analysis included 1,109,905 discharges in patients ≥65 years with Medicare...
May 16, 2016: Health Services Research
Hallie C Prescott, John J Osterholzer, Kenneth M Langa, Derek C Angus, Theodore J Iwashyna
OBJECTIVES:  To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself. DEIGN:  Observational cohort study. SETTING:  US Health and Retirement Study. PARTICIPANTS:  960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions...
2016: BMJ: British Medical Journal
Karl Y Bilimoria, Min-Woong Sohn, Jeanette W Chung, Christina A Minami, Elissa H Oh, Emily S Pavey, Jane L Holl, Bernard S Black, Michelle M Mello, David J Bentrem
CONTEXT: The US medical malpractice system is designed to deter negligence and encourage quality of care through threat of liability. OBJECTIVE: To examine whether state-level malpractice environment is associated with outcomes and costs of colorectal surgery. DESIGN, SETTING, AND PATIENTS: Observational study of 116,977 Medicare fee-for-service beneficiaries who underwent colorectal surgery using administrative claims data. State-level malpractice risk was measured using mean general surgery malpractice insurance premiums; paid claims per surgeon; state tort reforms; and a composite measure...
June 2016: Annals of Surgery
Ian J Barbash, Jeremy M Kahn, B Taylor Thompson
No abstract text is available yet for this article.
July 15, 2016: American Journal of Respiratory and Critical Care Medicine
Pamela L Popp
Sepsis kills more people in the United States than breast cancer, heart attacks, and the next two leading diseases combined. It is the leading cause of readmissions and for treatment costs exceeding twice that of the next most expensive condition. Survivors frequently suffer amputations and postsepsis syndrome, spending years on treatment and medication to recover. One in 150 people will be directly affected by sepsis, compared to the 1 in 33 million chance that a US resident would contact Ebola. We now have federal funding and a structured framework to treat Ebola, yet nothing exists to address sepsis even though the Centers for Medicare & Medicaid Services (CMS) reported spending $20 billion in 2011 treating its symptoms for Medicare and Medicaid patients...
April 2016: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
Chanu Rhee, Sameer S Kadri, Robert L Danner, Anthony F Suffredini, Anthony F Massaro, Barrett T Kitch, Grace Lee, Michael Klompas
BACKGROUND: Sepsis is the focus of national quality improvement programs and a recent public reporting measure from the Centers for Medicare and Medicaid Services. However, diagnosing sepsis requires interpreting nonspecific signs and can therefore be subjective. We sought to quantify interobserver variability in diagnosing sepsis. METHODS: We distributed five case vignettes of patients with suspected or confirmed infection and organ dysfunction to a sample of practicing intensivists...
2016: Critical Care: the Official Journal of the Critical Care Forum
Stephan D Schroeder
No abstract text is available yet for this article.
February 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
Michael W Sjoding, Hallie C Prescott, Hannah Wunsch, Theodore J Iwashyna, Colin R Cooke
OBJECTIVES: Changes in population demographics and comorbid illness prevalence, improvements in medical care, and shifts in care delivery may be driving changes in the composition of patients admitted to the ICU. We sought to describe the changing demographics, diagnoses, and outcomes of patients admitted to critical care units in the U.S. hospitals. DESIGN: Retrospective cohort study. SETTING: U.S. hospitals. PATIENTS: There were 27...
July 2016: Critical Care Medicine
Dusan Ramljak, Adam Davey, Alexey Uversky, Shoumik Roychoudhury, Zoran Obradovic
BACKGROUND: The Hospital Readmissions Reduction Program (HRRP) introduced in October 2012 as part of the Affordable Care Act (ACA), ties hospital reimbursement rates to adjusted 30-day readmissions and mortality performance for a small set of target diagnoses. There is growing concern and emerging evidence that use of a small set of target diagnoses to establish reimbursement rates can lead to unstable results that are susceptible to manipulation (gaming) by hospitals. METHODS: We propose a novel approach to identifying co-occurring diagnoses and procedures that can themselves serve as a proxy indicator of the target diagnosis...
2015: AMIA ... Annual Symposium Proceedings
Lola Butcher
These hospitals have shown that a coordinated, low-cost strategy dramatically reduces infection and mortality. It's an approach others may want to adopt.
January 2016: Hospitals & Health Networks
Shruti K Gohil, Chenghua Cao, Michael Phelan, Thomas Tjoa, Chanu Rhee, Richard Platt, Susan S Huang
BACKGROUND: Sepsis hospitalizations have increased dramatically in the last decade. It is unclear whether this represents an actual rise in sepsis illness or improved capture by coding. We evaluated the impact of Centers of Medicare and Medicaid Services (CMS) guidance after newly introduced sepsis codes and medical severity diagnosis-related group (MS-DRG) systems on sepsis trends. METHODS: In this retrospective cohort study of California hospitalizations from January 2000 to December 2010, sepsis was identified by International Classification of Diseases, Ninth Revision (ICD-9) coding (Dombrovskiy method)...
March 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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