Abstract:
BACKGROUND:There is significant interest in measuring health care value, but this concept has not been operationalized in specific patient cohorts. The longitudinal outcomes and costs for patients after percutaneous coronary intervention (PCI) provide an opportunity to measure an aspect of health care value. OBJECTIVES:This study evaluated variations in 1-year outcomes (risk-adjusted mortality) and risk-standardized costs of care for all patients undergoing PCI in the Veterans Affairs (VA) system from 2007 to 2010. METHODS:This retrospective cohort study evaluated all veterans undergoing PCI at any of 60 hospitals in the VA health care system, using data from the national VA Clinical Assessment, Reporting, and Tracking (CART) program. Primary outcomes were 1-year mortality and costs following PCI. Risk-standardized mortality and cost ratios were calculated, adjusting for cardiac and noncardiac comorbidities. RESULTS:A median of 261 PCIs were performed in the 60 hospitals during the study period. Median 1-year unadjusted hospital mortality rate was 6.13%. Four hospitals were significantly above the 1-year risk-standardized median mortality rate, with median mortality ratios ranging from 1.23 to 1.28. No hospitals were significantly below median mortality. Median 1-year total unadjusted hospital costs were $46,302 per patient. There were 16 hospitals above and 19 hospitals below the risk-standardized median cost, with risk-standardized ratios ranging from 0.45 to 2.09, reflecting a much larger magnitude of variability in costs than in mortality. CONCLUSIONS:There is much smaller variation in 1-year risk adjusted mortality than in risk-standardized costs after PCI in the VA. These findings suggest that there are opportunities to improve PCI value by reducing costs without compromising outcomes. This approach to evaluating outcomes and costs together may be a model for other health systems and accountable care organizations interested in operationalizing value measurement.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Ho PM,O'Donnell CI,Bradley SM,Grunwald GK,Helfrich C,Chapko M,Liu CF,Maddox TM,Tsai TT,Jesse RL,Fihn SD,Rumsfeld JSdoi
10.1016/j.jacc.2014.10.048subject
Has Abstractpub_date
2015-01-27 00:00:00pages
236-42issue
3eissn
0735-1097issn
1558-3597pii
S0735-1097(14)07001-6journal_volume
65pub_type
杂志文章abstract:OBJECTIVES:The purpose of this study was to determine the prevalence, characteristics and the predictive value of nonsustained ventricular tachycardia (VT) for subsequent death and arrhythmic events after acute myocardial infarction (AMI). BACKGROUND:Nonsustained VT has been linked to an increased risk for sudden deat...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00108-4
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2008.03.047
更新日期:2008-08-05 00:00:00
abstract:OBJECTIVES:We developed an automatic quantitative algorithm for the measurement of regional myocardial wall motion and wall thickening from three-dimensional gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomographic images. BACKGROUND:The algorithm measures the motion of the three...
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doi:10.1016/s0735-1097(97)00276-3
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVES:This study assessed coronary artery endothelial function in patients with hypercholesterolemia before and after lipid lowering, using quantitative angiography to examine the acetylcholine (Ach) response along the entire analyzable vessel. BACKGROUND:Lipid lowering reverses endothelial dysfunction, but wheth...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)01180-3
更新日期:2001-03-01 00:00:00
abstract:BACKGROUND:Among various cardiac autoantibodies (AAbs), those recognizing the β1-adrenergic receptor (β1AR) demonstrate agonist-like effects and induce myocardial damage that can be reversed by β-blockers and immunoglobulin G3 (IgG3) immunoadsorption. OBJECTIVES:The goal of this study was to investigate the role of β1...
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更新日期:2017-02-28 00:00:00
abstract::Emerging technologies based on mass spectrometry and nuclear magnetic resonance enable the monitoring of hundreds of metabolites from tissues or body fluids, that is, "metabolomics." Because metabolites change rapidly in response to physiologic perturbations, they represent proximal reporters of disease phenotypes. Th...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2008.03.043
更新日期:2008-07-08 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90791-x
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVES:This study sought to determine the long-term outcome of adult patients undergoing percutaneous balloon aortic valvuloplasty. BACKGROUND:Percutaneous balloon aortic valvuloplasty has been offered as an alternative to aortic valve replacement for selected patients with valvular aortic stenosis. Although ballo...
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doi:10.1016/0735-1097(95)00363-0
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:1999-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80143-3
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doi:10.1016/j.jacc.2020.11.047
更新日期:2021-02-02 00:00:00
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pub_type: 杂志文章
doi:10.1016/0735-1097(94)90602-5
更新日期:1994-04-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90742-j
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doi:10.1016/0735-1097(90)90240-p
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更新日期:1998-06-01 00:00:00
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更新日期:2001-01-01 00:00:00
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更新日期:2014-03-25 00:00:00
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pub_type: 杂志文章,评审
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更新日期:1991-03-01 00:00:00
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更新日期:2004-06-16 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:1995-10-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(95)00324-X
更新日期:1995-11-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2005-11-15 00:00:00
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pub_type: 杂志文章
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更新日期:2020-04-28 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2001-08-01 00:00:00