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Saket Girotra - One of the best experts on this subject based on the ideXlab platform.
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evaluation of risk adjusted home time after hospitalization for heart failure as a potential hospital Performance Metric
JAMA Cardiology, 2021Co-Authors: Ambarish Pandey, Neil Keshvani, Mary Vaughansarrazin, Yubo Gao, Gregg C Fonarow, Clyde W Yancy, Saket GirotraAbstract:Importance Thirty-day home time, defined as time spent alive and out of a hospital or facility, is a novel, patient-centered Performance Metric that incorporates readmission and mortality. Objectives To characterize risk-adjusted 30-day home time in patients discharged with heart failure (HF) as a hospital-level quality Metric and evaluate its association with the 30-day risk-standardized readmission rate (RSRR), 30-day risk-standardized mortality rate (RSMR), and 1-year RSMR. Design, Setting, and Participants This hospital-level cohort study retrospectively analyzed 100% of Medicare claims data from 2 968 341 patients from 3134 facilities from January 1, 2012, to November 30, 2017. Exposures Home time, defined as time spent alive and out of a short-term hospital, skilled nursing facility, or intermediate/long-term facility 30 days after discharge. Main Outcomes and Measures For each hospital, a risk-adjusted 30-day home time for HF was calculated similar to the Centers for Medicare & Medicaid Services risk-adjustment models for 30-day RSRR and RSMR. Hospitals were categorized into quartiles (lowest to highest risk-adjusted home time). The correlations between hospital rates of risk-adjusted 30-day home time and 30-day RSRR, 30-day RSMR, and 1-year RSMR were estimated using the Pearson correlation coefficient. Distribution of days lost from a perfect 30-day home time were calculated. Reclassification of hospital Performance using 30-day home time vs 30-day RSRR was also evaluated. Results Overall, 2 968 341 patients (mean [SD] age, 81.0 [8.3] years; 53.6% female) from 3134 hospitals were included in this study. The median hospital risk-adjusted 30-day home time for patients with HF was 21.77 days (range, 8.22-28.41 days). Hospitals in the highest quartile of risk-adjusted 30-day home time (best-performing hospitals) were larger (mean [SD] number of beds, 285 [275]), with a higher volume of patients with HF (median, 797 patients; interquartile range, 395-1484) and were more likely academic hospitals (59.9%) with availability of cardiac surgery (51.1%) and cardiac rehabilitation (68.8%). A total of 72% of home time lost was attributable to stays in an intermediate- or long-term care facility (mean [SD], 2.65 [6.44] days) or skilled nursing facility (mean [SD], 3.96 [9.04] days), 13% was attributable to short-term readmissions (mean [SD], 1.25 [3.25] days), and 15% was attributable to death (mean [SD], 1.37 [6.04] days). Among 30-day outcomes, the 30-day RSRR and 30-day RSMR decreased in a graded fashion across increasing 30-day home time categories (correlation coefficients: 30-day RSRR and 30-day home time, -0.23, P < .001; 30-day RSMR and 30-day home time, -0.31, P < .001). Similar patterns of association were also noted for 1-year RSMR and 30-day home time (correlation coefficient, -0.35, P < .001). Thirty-day home time meaningfully reclassified hospital Performance in 30% of the hospitals compared with 30-day RSRR and in 25% of hospitals compared with 30-day RSMR. Conclusions and Relevance In this study, 30-day home time among patients discharged after a hospitalization for HF was objectively assessed as a hospital-level quality Metric using Medicare claims data and was associated with readmission and mortality outcomes and with reclassification of hospital Performance compared with 30-day RSRR and 30-day RSMR.
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evaluation of risk adjusted home time after acute myocardial infarction as a novel hospital level Performance Metric for medicare beneficiaries
Circulation, 2020Co-Authors: Ambarish Pandey, Neil Keshvani, Mary Vaughansarrazin, Saket GirotraAbstract:Background: The utility of 30-day risk-standardized readmission rate (RSRR) as a hospital Performance Metric has been a matter of debate. Home time is a patient-centered outcome measure that accoun...
Ambarish Pandey - One of the best experts on this subject based on the ideXlab platform.
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evaluation of risk adjusted home time after hospitalization for heart failure as a potential hospital Performance Metric
JAMA Cardiology, 2021Co-Authors: Ambarish Pandey, Neil Keshvani, Mary Vaughansarrazin, Yubo Gao, Gregg C Fonarow, Clyde W Yancy, Saket GirotraAbstract:Importance Thirty-day home time, defined as time spent alive and out of a hospital or facility, is a novel, patient-centered Performance Metric that incorporates readmission and mortality. Objectives To characterize risk-adjusted 30-day home time in patients discharged with heart failure (HF) as a hospital-level quality Metric and evaluate its association with the 30-day risk-standardized readmission rate (RSRR), 30-day risk-standardized mortality rate (RSMR), and 1-year RSMR. Design, Setting, and Participants This hospital-level cohort study retrospectively analyzed 100% of Medicare claims data from 2 968 341 patients from 3134 facilities from January 1, 2012, to November 30, 2017. Exposures Home time, defined as time spent alive and out of a short-term hospital, skilled nursing facility, or intermediate/long-term facility 30 days after discharge. Main Outcomes and Measures For each hospital, a risk-adjusted 30-day home time for HF was calculated similar to the Centers for Medicare & Medicaid Services risk-adjustment models for 30-day RSRR and RSMR. Hospitals were categorized into quartiles (lowest to highest risk-adjusted home time). The correlations between hospital rates of risk-adjusted 30-day home time and 30-day RSRR, 30-day RSMR, and 1-year RSMR were estimated using the Pearson correlation coefficient. Distribution of days lost from a perfect 30-day home time were calculated. Reclassification of hospital Performance using 30-day home time vs 30-day RSRR was also evaluated. Results Overall, 2 968 341 patients (mean [SD] age, 81.0 [8.3] years; 53.6% female) from 3134 hospitals were included in this study. The median hospital risk-adjusted 30-day home time for patients with HF was 21.77 days (range, 8.22-28.41 days). Hospitals in the highest quartile of risk-adjusted 30-day home time (best-performing hospitals) were larger (mean [SD] number of beds, 285 [275]), with a higher volume of patients with HF (median, 797 patients; interquartile range, 395-1484) and were more likely academic hospitals (59.9%) with availability of cardiac surgery (51.1%) and cardiac rehabilitation (68.8%). A total of 72% of home time lost was attributable to stays in an intermediate- or long-term care facility (mean [SD], 2.65 [6.44] days) or skilled nursing facility (mean [SD], 3.96 [9.04] days), 13% was attributable to short-term readmissions (mean [SD], 1.25 [3.25] days), and 15% was attributable to death (mean [SD], 1.37 [6.04] days). Among 30-day outcomes, the 30-day RSRR and 30-day RSMR decreased in a graded fashion across increasing 30-day home time categories (correlation coefficients: 30-day RSRR and 30-day home time, -0.23, P < .001; 30-day RSMR and 30-day home time, -0.31, P < .001). Similar patterns of association were also noted for 1-year RSMR and 30-day home time (correlation coefficient, -0.35, P < .001). Thirty-day home time meaningfully reclassified hospital Performance in 30% of the hospitals compared with 30-day RSRR and in 25% of hospitals compared with 30-day RSMR. Conclusions and Relevance In this study, 30-day home time among patients discharged after a hospitalization for HF was objectively assessed as a hospital-level quality Metric using Medicare claims data and was associated with readmission and mortality outcomes and with reclassification of hospital Performance compared with 30-day RSRR and 30-day RSMR.
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evaluation of risk adjusted home time after acute myocardial infarction as a novel hospital level Performance Metric for medicare beneficiaries
Circulation, 2020Co-Authors: Ambarish Pandey, Neil Keshvani, Mary Vaughansarrazin, Saket GirotraAbstract:Background: The utility of 30-day risk-standardized readmission rate (RSRR) as a hospital Performance Metric has been a matter of debate. Home time is a patient-centered outcome measure that accoun...
Mikko H Lipasti - One of the best experts on this subject based on the ideXlab platform.
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redeeming ipc as a Performance Metric for multithreaded programs
International Conference on Parallel Architectures and Compilation Techniques, 2003Co-Authors: Kevin M Lepak, Harold W Cain, Mikko H LipastiAbstract:Recent work has shown that multithreaded workloads running in execution-driven, full-system simulation environments cannot use instructions per cycle (IPC) as a valid Performance Metric due to non-deterministic program behavior. Unfortunately, invalidating IPC as a Performance Metric introduces its own host of difficulties: special workload setup, consideration of cold-startand end-effects, statistical methodologies leading to increased simulation bandwidth, and workload-specific, higher-level Metrics to measure Performance. This paper explores the non-determinism problem in multithreaded programs, describes a method to eliminate non-determinism across simulations of different experimental machine models, and demonstrates the suitability of this methodology for performing architectural Performance analysis, thus redeeming IPC as a Performance Metric for multithreaded programs.
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IEEE PACT - Redeeming IPC as a Performance Metric for multithreaded programs
Oceans 2002 Conference and Exhibition. Conference Proceedings (Cat. No.02CH37362), 2003Co-Authors: Kevin M Lepak, Harold W Cain, Mikko H LipastiAbstract:Recent work has shown that multithreaded workloads running in execution-driven, full-system simulation environments cannot use instructions per cycle (IPC) as a valid Performance Metric due to non-deterministic program behavior. Unfortunately, invalidating IPC as a Performance Metric introduces its own host of difficulties: special workload setup, consideration of cold-startand end-effects, statistical methodologies leading to increased simulation bandwidth, and workload-specific, higher-level Metrics to measure Performance. This paper explores the non-determinism problem in multithreaded programs, describes a method to eliminate non-determinism across simulations of different experimental machine models, and demonstrates the suitability of this methodology for performing architectural Performance analysis, thus redeeming IPC as a Performance Metric for multithreaded programs.
Mary Vaughansarrazin - One of the best experts on this subject based on the ideXlab platform.
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evaluation of risk adjusted home time after hospitalization for heart failure as a potential hospital Performance Metric
JAMA Cardiology, 2021Co-Authors: Ambarish Pandey, Neil Keshvani, Mary Vaughansarrazin, Yubo Gao, Gregg C Fonarow, Clyde W Yancy, Saket GirotraAbstract:Importance Thirty-day home time, defined as time spent alive and out of a hospital or facility, is a novel, patient-centered Performance Metric that incorporates readmission and mortality. Objectives To characterize risk-adjusted 30-day home time in patients discharged with heart failure (HF) as a hospital-level quality Metric and evaluate its association with the 30-day risk-standardized readmission rate (RSRR), 30-day risk-standardized mortality rate (RSMR), and 1-year RSMR. Design, Setting, and Participants This hospital-level cohort study retrospectively analyzed 100% of Medicare claims data from 2 968 341 patients from 3134 facilities from January 1, 2012, to November 30, 2017. Exposures Home time, defined as time spent alive and out of a short-term hospital, skilled nursing facility, or intermediate/long-term facility 30 days after discharge. Main Outcomes and Measures For each hospital, a risk-adjusted 30-day home time for HF was calculated similar to the Centers for Medicare & Medicaid Services risk-adjustment models for 30-day RSRR and RSMR. Hospitals were categorized into quartiles (lowest to highest risk-adjusted home time). The correlations between hospital rates of risk-adjusted 30-day home time and 30-day RSRR, 30-day RSMR, and 1-year RSMR were estimated using the Pearson correlation coefficient. Distribution of days lost from a perfect 30-day home time were calculated. Reclassification of hospital Performance using 30-day home time vs 30-day RSRR was also evaluated. Results Overall, 2 968 341 patients (mean [SD] age, 81.0 [8.3] years; 53.6% female) from 3134 hospitals were included in this study. The median hospital risk-adjusted 30-day home time for patients with HF was 21.77 days (range, 8.22-28.41 days). Hospitals in the highest quartile of risk-adjusted 30-day home time (best-performing hospitals) were larger (mean [SD] number of beds, 285 [275]), with a higher volume of patients with HF (median, 797 patients; interquartile range, 395-1484) and were more likely academic hospitals (59.9%) with availability of cardiac surgery (51.1%) and cardiac rehabilitation (68.8%). A total of 72% of home time lost was attributable to stays in an intermediate- or long-term care facility (mean [SD], 2.65 [6.44] days) or skilled nursing facility (mean [SD], 3.96 [9.04] days), 13% was attributable to short-term readmissions (mean [SD], 1.25 [3.25] days), and 15% was attributable to death (mean [SD], 1.37 [6.04] days). Among 30-day outcomes, the 30-day RSRR and 30-day RSMR decreased in a graded fashion across increasing 30-day home time categories (correlation coefficients: 30-day RSRR and 30-day home time, -0.23, P < .001; 30-day RSMR and 30-day home time, -0.31, P < .001). Similar patterns of association were also noted for 1-year RSMR and 30-day home time (correlation coefficient, -0.35, P < .001). Thirty-day home time meaningfully reclassified hospital Performance in 30% of the hospitals compared with 30-day RSRR and in 25% of hospitals compared with 30-day RSMR. Conclusions and Relevance In this study, 30-day home time among patients discharged after a hospitalization for HF was objectively assessed as a hospital-level quality Metric using Medicare claims data and was associated with readmission and mortality outcomes and with reclassification of hospital Performance compared with 30-day RSRR and 30-day RSMR.
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evaluation of risk adjusted home time after acute myocardial infarction as a novel hospital level Performance Metric for medicare beneficiaries
Circulation, 2020Co-Authors: Ambarish Pandey, Neil Keshvani, Mary Vaughansarrazin, Saket GirotraAbstract:Background: The utility of 30-day risk-standardized readmission rate (RSRR) as a hospital Performance Metric has been a matter of debate. Home time is a patient-centered outcome measure that accoun...
Neil Keshvani - One of the best experts on this subject based on the ideXlab platform.
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evaluation of risk adjusted home time after hospitalization for heart failure as a potential hospital Performance Metric
JAMA Cardiology, 2021Co-Authors: Ambarish Pandey, Neil Keshvani, Mary Vaughansarrazin, Yubo Gao, Gregg C Fonarow, Clyde W Yancy, Saket GirotraAbstract:Importance Thirty-day home time, defined as time spent alive and out of a hospital or facility, is a novel, patient-centered Performance Metric that incorporates readmission and mortality. Objectives To characterize risk-adjusted 30-day home time in patients discharged with heart failure (HF) as a hospital-level quality Metric and evaluate its association with the 30-day risk-standardized readmission rate (RSRR), 30-day risk-standardized mortality rate (RSMR), and 1-year RSMR. Design, Setting, and Participants This hospital-level cohort study retrospectively analyzed 100% of Medicare claims data from 2 968 341 patients from 3134 facilities from January 1, 2012, to November 30, 2017. Exposures Home time, defined as time spent alive and out of a short-term hospital, skilled nursing facility, or intermediate/long-term facility 30 days after discharge. Main Outcomes and Measures For each hospital, a risk-adjusted 30-day home time for HF was calculated similar to the Centers for Medicare & Medicaid Services risk-adjustment models for 30-day RSRR and RSMR. Hospitals were categorized into quartiles (lowest to highest risk-adjusted home time). The correlations between hospital rates of risk-adjusted 30-day home time and 30-day RSRR, 30-day RSMR, and 1-year RSMR were estimated using the Pearson correlation coefficient. Distribution of days lost from a perfect 30-day home time were calculated. Reclassification of hospital Performance using 30-day home time vs 30-day RSRR was also evaluated. Results Overall, 2 968 341 patients (mean [SD] age, 81.0 [8.3] years; 53.6% female) from 3134 hospitals were included in this study. The median hospital risk-adjusted 30-day home time for patients with HF was 21.77 days (range, 8.22-28.41 days). Hospitals in the highest quartile of risk-adjusted 30-day home time (best-performing hospitals) were larger (mean [SD] number of beds, 285 [275]), with a higher volume of patients with HF (median, 797 patients; interquartile range, 395-1484) and were more likely academic hospitals (59.9%) with availability of cardiac surgery (51.1%) and cardiac rehabilitation (68.8%). A total of 72% of home time lost was attributable to stays in an intermediate- or long-term care facility (mean [SD], 2.65 [6.44] days) or skilled nursing facility (mean [SD], 3.96 [9.04] days), 13% was attributable to short-term readmissions (mean [SD], 1.25 [3.25] days), and 15% was attributable to death (mean [SD], 1.37 [6.04] days). Among 30-day outcomes, the 30-day RSRR and 30-day RSMR decreased in a graded fashion across increasing 30-day home time categories (correlation coefficients: 30-day RSRR and 30-day home time, -0.23, P < .001; 30-day RSMR and 30-day home time, -0.31, P < .001). Similar patterns of association were also noted for 1-year RSMR and 30-day home time (correlation coefficient, -0.35, P < .001). Thirty-day home time meaningfully reclassified hospital Performance in 30% of the hospitals compared with 30-day RSRR and in 25% of hospitals compared with 30-day RSMR. Conclusions and Relevance In this study, 30-day home time among patients discharged after a hospitalization for HF was objectively assessed as a hospital-level quality Metric using Medicare claims data and was associated with readmission and mortality outcomes and with reclassification of hospital Performance compared with 30-day RSRR and 30-day RSMR.
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evaluation of risk adjusted home time after acute myocardial infarction as a novel hospital level Performance Metric for medicare beneficiaries
Circulation, 2020Co-Authors: Ambarish Pandey, Neil Keshvani, Mary Vaughansarrazin, Saket GirotraAbstract:Background: The utility of 30-day risk-standardized readmission rate (RSRR) as a hospital Performance Metric has been a matter of debate. Home time is a patient-centered outcome measure that accoun...
