HCUP's 2013 Outstanding Article of the Year Awards
Recipients announced at the 2014 AcademyHealth Annual Research Meeting
The Agency for Healthcare Research and Quality (AHRQ) and AcademyHealth recognized two articles that used HCUP databases to explore and address health care research topics and issues. Both studies were published in peer-reviewed journals in 2013. Authors of each article presented at Poster Session A on Sunday, June 8, at the 2014 AcademyHealth Annual Research Meeting.
"Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence," published in The Journal of the American Medical Association, used the HCUP State Inpatient Databases (SID) from 12 States to study if patient outcomes were affected by CMS' coverage restriction to centers of excellence.
Published in the Journal of Thoracic and Cardiovascular Surgery, "Orthotopic heart transplant versus left ventricular assist device: A national comparison of cost and survival" used HCUP Nationwide Inpatient Sample (NIS) data to examine the techniques used in, mortality of, and costs associated with both orthotopic heart transplantation and left ventricular assist devices.
AHRQ also awarded an honorable mention to a third article, "The Quality of Care Delivered to Patients Within the Same Hospital Varies by Insurance Type". This article used both the HCUP SID and AHRQ's Inpatient Quality Indicators (IQIs) to study in-hospital care and determine if patients' insurance status correlates to the care provided.
"These articles elegantly demonstrate the range of relevant and timely research that can be done with HCUP data," said Dr. Lisa Simpson, President and CEO of AcademyHealth. "They provide important new evidence about what drives quality and outcomes of care in the current healthcare contexts — both in clinical settings and in policy discussions."
"These works exemplify exceptional and influential research that contributes to making health care safer and more accessible," added Dr. Herbert Wong, the AHRQ economist who spearheaded the awards process. "We are honored to see that HCUP is being used to advance both health care clinical knowledge and policy implications, and we hope these articles inspire future research using HCUP."
Detailed descriptions of the research follow.
Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence
In 2006, Medicare restricted coverage of bariatric surgery to Centers of Excellence. Studies had shown that Centers of Excellence (defined by the number of procedures performed annually as well as other infrastructure and procedural standards) typically had fewer complications. However, studies done on this topic had not accounted for general trends in improved outcomes for all patients as bariatric surgery techniques and practices improved.
"Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence" used the 2004-2009 State Inpatient Databases (SID) from 12 States to study Medicare and non-Medicare patients undergoing bariatric surgery, including open Roux-en-Y gastric bypass, laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable banding, and other procedures. All patients included in the study had a primary or secondary diagnosis of morbid obesity.
The article concluded that the rates of complications patients undergoing surgery at hospitals with the Center of Excellence designation were not significantly different than those without the designation: Rates of any complication were 5.5% vs. 6.0%, respectively, while rates of serious complications were 2.2% vs. 2.5%, and reoperation rates were 0.83% vs. 0.96%. Thus, Medicare's coverage restriction to Centers of Excellence was not associated with improved outcomes for bariatric surgery, and may have had the unintended consequence of restricting access.
Justin B. Dimick, M.D., M.P.H. (University of Michigan) was the lead author on this article. In addition to Dr. Dimick, the authors include Lauren H. Nicholas, Ph.D., M.P.P. (Johns Hopkins Bloomberg School of Public Health); Andrew M. Ryan, Ph.D. (Weill Cornell Medical College, Cornell University); Jyothi R. Thumma, M.P.H. (University of Michigan); and John D. Birkmeyer, M.D. (University of Michigan).
Dimick JB, Nicholas LH, Ryan AM, Thumma JR, and Birkmeyer JD. Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence. The Journal of the American Medical Association. 2013 February; Vol 309, No. 8: 792-799.
Orthotopic heart transplant versus left ventricular assist device: A national comparison of cost and survival
Orthotopic heart transplant is the standard of care for end-stage heart failure, but usage of the left ventricular assist device has risen dramatically since the Food and Drug Administration approved the HeartMate II device in 2008.
This article examined the cost and efficacy of both the orthotopic heart transplant and the left ventricular assist device over time. Using the 2005-2009 Nationwide Inpatient Sample (NIS), the authors examined trends in treatment use, mortality, and cost. The number of orthotopic heart transplantations went up slightly over five years, while the use of the left ventricular assist device nearly tripled in the same period. While the mortality rates for the orthotopic heart transplantation remained the same, mortality rates for the left ventricular assist device declined steeply; costs for both treatments increased, with Medicare and Medicaid being the primary payer for both.
The article concluded that while mortality rates for the left ventricular assist device have declined, the rates are still higher than for orthotopic heart transplantation. Further, the costs for the left ventricular assist device are rising and are greater than for the orthotopic heart transplantation. While the left ventricular assist device is an important and useful procedure, its use must be cautious and its costs contained in order to keep it a standard treatment in heart failure.
Daniel P. Mulloy, M.D. (University Of Washington) was the lead author on this article. In addition to Dr. Mulloy, the authors include Castigliano M. Bhamidipati, D.O., Ph.D., M.Sc. (State University of New York Upstate Medical University); Matthew L. Stone, M.D.; Gorav Ailawadi, M.D., FACS; Irving L. Kron, M.D., FACS; and John A. Kern, M.D., FACS, all of the University Of Virginia.
Mulloy DP, Bhamidipati CM, Stone, ML, Ailawadi G, Kron IL, and Kern JA. Orthotopic heart transplant versus left ventricular assist device: A national comparison of cost and survival. The Journal of Thoracic and Cardiovascular Surgery. 2013 February; 145(2):566-73.
The Quality of Care Delivered to Patients Within the Same Hospital Varies by Insurance Type
Researchers have long studied the conditions that result in varied quality of care delivered in hospitals. This article looked at the effect a patient's insurance status had on the quality of care within the same hospital. Using the 2006-2008 State Inpatient Databases (SID) from 11 States, along with the Inpatient Quality Indicators (IQIs) developed by AHRQ, researchers found that privately insured patients fared better than others within hospitals. Privately insured patients have lower risk-adjusted mortality measures than Medicare patients and those in other groups, to various extents. The research suggested that public payers and hospitals should be aware of these differences by measuring care quality for different insurance groups, and should monitor differences in treatment practices within hospitals.
Spencer CS, Gaskin DJ, and Roberts ET. The Quality Of Care Delivered To Patients Within The Same Hospital Varies By Insurance Type. Health Affairs, 32, no.10 (2013):1731-1739.
|Internet Citation: HCUP's Outstanding Article of the Year Awards. Healthcare Cost and Utilization Project (HCUP). June 2014. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/awards.jsp.|
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