Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System
Among Medicare value-based payment programs for acute myocardial infarction (AMI), the Hospital Readmissions Reduction Program uses ( ) codes to identify the program denominator, while the Bundled Payments for Care Improvement Advanced program uses diagnosis-related groups (DRGs). The extent to whic...
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| Veröffentlicht in: | Circulation Cardiovascular quality and outcomes 2021-03, Vol.14 (3), p.e006570-e006570 |
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| creator | Levy, Andrew E. Hammes, Andrew Anoff, Debra L. Raines, Joshua D. Beck, Natalie M. Rudofker, Eric W. Marshall, Kimberly J. Nensel, Jessica D. Messenger, John C. Masoudi, Frederick A. Pierce, Read G. Allen, Larry A. Ream, Karen S. Ho, P. Michael |
| description | Among Medicare value-based payment programs for acute myocardial infarction (AMI), the Hospital Readmissions Reduction Program uses
(
) codes to identify the program denominator, while the Bundled Payments for Care Improvement Advanced program uses diagnosis-related groups (DRGs). The extent to which these programs target similar patients, whether they target the intended population (type 1 myocardial infarction), and whether outcomes are comparable between cohorts is not known.
In a retrospective study of 2176 patients hospitalized in an integrated health system, a cohort of patients assigned a principal
diagnosis of AMI and a cohort of patients assigned an AMI DRG were compared according to patient-level agreement and outcomes such as mortality and readmission.
One thousand nine hundred thirty-five patients were included in the
cohort compared with 662 patients in the DRG cohort. Only 421 patients were included in both AMI cohorts (19.3% agreement). DRG cohort patients were older (70 versus 65 years, |
| doi_str_mv | 10.1161/CIRCOUTCOMES.120.006570 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2496238731</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2496238731</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3040-2b31597470cacf7c8d0cbbb11aece44a4e00b5fc95c2e4715ade047c908a1e1b3</originalsourceid><addsrcrecordid>eNpNkdFu0zAUhiMEYmPwCuBLLkg5jpO44a7KxlZpVbWu4zZynJPWkMbFJ2HKw_IuuMmYdmHZOv9_vnPkPwg-cZhxnvKv-XKTrx-2-Xp1dT_jEcwA0kTCq-CcZzEPpYTk9Yv3WfCO6Kf3iCgVb4MzIdJEeNB58Heh-w7ZarBaucqohi3bWjndGduy3O6t64hdYm1arFg5eLVD16qT7L15o4hMbfRYYLZml4ZQEdIXtsW227MN_jF00n6go96jjNq1lgyFG2xU56HXzvZH-sYWHjh4YaKMrs5ottg5xINnMdVW7K5XjekGtvJDeofETOvr41Y7N-JuUDV-7v1AHR7eB29q1RB-eLovgofvV9v8JrxdXy_zxW2oBcQQRqXgSSZjCVrpWup5BbosS84VaoxjFSNAmdQ6S3SEseSJqhBiqTOYK468FBfB54l7dPZ3j9QVB0Mam0a1aHsqojhLIzGXgnurnKzaWSKHdXF05qDcUHAoTtkWL7MtfLbFlK3v_Pg0pC8PWD33_Q_TG-LJ8GgbnxL9avpHdMV-_JECuBDS7xFGEHEQABD641__ALfEtok</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2496238731</pqid></control><display><type>article</type><title>Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Levy, Andrew E. ; Hammes, Andrew ; Anoff, Debra L. ; Raines, Joshua D. ; Beck, Natalie M. ; Rudofker, Eric W. ; Marshall, Kimberly J. ; Nensel, Jessica D. ; Messenger, John C. ; Masoudi, Frederick A. ; Pierce, Read G. ; Allen, Larry A. ; Ream, Karen S. ; Ho, P. Michael</creator><creatorcontrib>Levy, Andrew E. ; Hammes, Andrew ; Anoff, Debra L. ; Raines, Joshua D. ; Beck, Natalie M. ; Rudofker, Eric W. ; Marshall, Kimberly J. ; Nensel, Jessica D. ; Messenger, John C. ; Masoudi, Frederick A. ; Pierce, Read G. ; Allen, Larry A. ; Ream, Karen S. ; Ho, P. Michael</creatorcontrib><description><![CDATA[Among Medicare value-based payment programs for acute myocardial infarction (AMI), the Hospital Readmissions Reduction Program uses
(
) codes to identify the program denominator, while the Bundled Payments for Care Improvement Advanced program uses diagnosis-related groups (DRGs). The extent to which these programs target similar patients, whether they target the intended population (type 1 myocardial infarction), and whether outcomes are comparable between cohorts is not known.
In a retrospective study of 2176 patients hospitalized in an integrated health system, a cohort of patients assigned a principal
diagnosis of AMI and a cohort of patients assigned an AMI DRG were compared according to patient-level agreement and outcomes such as mortality and readmission.
One thousand nine hundred thirty-five patients were included in the
cohort compared with 662 patients in the DRG cohort. Only 421 patients were included in both AMI cohorts (19.3% agreement). DRG cohort patients were older (70 versus 65 years,
<0.001), more often female (48% versus 30%,
<0.001), and had higher rates of heart failure (52% versus 33%,
<0.001) and kidney disease (42% versus 25%,
<0.001). Comparing outcomes, the DRG cohort had significantly higher unadjusted rates of 30-day mortality (6.6% versus 2.5%,
<0.001), 1-year mortality (21% versus 8%,
<0.001), and 90-day readmission (26% versus 19%,
=0.006) than the
cohort. Two observations help explain these differences: 61% of
cohort patients were assigned procedural DRGs for revascularization instead of an AMI DRG, and type 1 myocardial infarction patients made up a smaller proportion of the DRG cohort (34%) than the
cohort (78%).
The method used to identify denominators for value-based payment programs has important implications for the patient characteristics and outcomes of the populations. As national and local quality initiatives mature, an emphasis on
codes to define AMI cohorts would better represent type 1 myocardial infarction patients.]]></description><identifier>ISSN: 1941-7705</identifier><identifier>ISSN: 1941-7713</identifier><identifier>EISSN: 1941-7705</identifier><identifier>DOI: 10.1161/CIRCOUTCOMES.120.006570</identifier><identifier>PMID: 33653116</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Delivery of Health Care, Integrated ; Diagnosis-Related Groups ; Female ; Humans ; International Classification of Diseases ; Male ; Medicare ; Middle Aged ; Myocardial Infarction - diagnosis ; Myocardial Infarction - therapy ; Patient Readmission ; Quality Indicators, Health Care ; Retrospective Studies ; United States - epidemiology</subject><ispartof>Circulation Cardiovascular quality and outcomes, 2021-03, Vol.14 (3), p.e006570-e006570</ispartof><rights>Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3040-2b31597470cacf7c8d0cbbb11aece44a4e00b5fc95c2e4715ade047c908a1e1b3</cites><orcidid>0000-0003-1738-025X ; 0000-0002-9076-9619 ; 0000-0003-2540-3095 ; 0000-0002-1171-9171 ; 0000-0001-6916-7798</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33653116$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Levy, Andrew E.</creatorcontrib><creatorcontrib>Hammes, Andrew</creatorcontrib><creatorcontrib>Anoff, Debra L.</creatorcontrib><creatorcontrib>Raines, Joshua D.</creatorcontrib><creatorcontrib>Beck, Natalie M.</creatorcontrib><creatorcontrib>Rudofker, Eric W.</creatorcontrib><creatorcontrib>Marshall, Kimberly J.</creatorcontrib><creatorcontrib>Nensel, Jessica D.</creatorcontrib><creatorcontrib>Messenger, John C.</creatorcontrib><creatorcontrib>Masoudi, Frederick A.</creatorcontrib><creatorcontrib>Pierce, Read G.</creatorcontrib><creatorcontrib>Allen, Larry A.</creatorcontrib><creatorcontrib>Ream, Karen S.</creatorcontrib><creatorcontrib>Ho, P. Michael</creatorcontrib><title>Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System</title><title>Circulation Cardiovascular quality and outcomes</title><addtitle>Circ Cardiovasc Qual Outcomes</addtitle><description><![CDATA[Among Medicare value-based payment programs for acute myocardial infarction (AMI), the Hospital Readmissions Reduction Program uses
(
) codes to identify the program denominator, while the Bundled Payments for Care Improvement Advanced program uses diagnosis-related groups (DRGs). The extent to which these programs target similar patients, whether they target the intended population (type 1 myocardial infarction), and whether outcomes are comparable between cohorts is not known.
In a retrospective study of 2176 patients hospitalized in an integrated health system, a cohort of patients assigned a principal
diagnosis of AMI and a cohort of patients assigned an AMI DRG were compared according to patient-level agreement and outcomes such as mortality and readmission.
One thousand nine hundred thirty-five patients were included in the
cohort compared with 662 patients in the DRG cohort. Only 421 patients were included in both AMI cohorts (19.3% agreement). DRG cohort patients were older (70 versus 65 years,
<0.001), more often female (48% versus 30%,
<0.001), and had higher rates of heart failure (52% versus 33%,
<0.001) and kidney disease (42% versus 25%,
<0.001). Comparing outcomes, the DRG cohort had significantly higher unadjusted rates of 30-day mortality (6.6% versus 2.5%,
<0.001), 1-year mortality (21% versus 8%,
<0.001), and 90-day readmission (26% versus 19%,
=0.006) than the
cohort. Two observations help explain these differences: 61% of
cohort patients were assigned procedural DRGs for revascularization instead of an AMI DRG, and type 1 myocardial infarction patients made up a smaller proportion of the DRG cohort (34%) than the
cohort (78%).
The method used to identify denominators for value-based payment programs has important implications for the patient characteristics and outcomes of the populations. As national and local quality initiatives mature, an emphasis on
codes to define AMI cohorts would better represent type 1 myocardial infarction patients.]]></description><subject>Aged</subject><subject>Angiotensin Receptor Antagonists</subject><subject>Angiotensin-Converting Enzyme Inhibitors</subject><subject>Delivery of Health Care, Integrated</subject><subject>Diagnosis-Related Groups</subject><subject>Female</subject><subject>Humans</subject><subject>International Classification of Diseases</subject><subject>Male</subject><subject>Medicare</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - therapy</subject><subject>Patient Readmission</subject><subject>Quality Indicators, Health Care</subject><subject>Retrospective Studies</subject><subject>United States - epidemiology</subject><issn>1941-7705</issn><issn>1941-7713</issn><issn>1941-7705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkdFu0zAUhiMEYmPwCuBLLkg5jpO44a7KxlZpVbWu4zZynJPWkMbFJ2HKw_IuuMmYdmHZOv9_vnPkPwg-cZhxnvKv-XKTrx-2-Xp1dT_jEcwA0kTCq-CcZzEPpYTk9Yv3WfCO6Kf3iCgVb4MzIdJEeNB58Heh-w7ZarBaucqohi3bWjndGduy3O6t64hdYm1arFg5eLVD16qT7L15o4hMbfRYYLZml4ZQEdIXtsW227MN_jF00n6go96jjNq1lgyFG2xU56HXzvZH-sYWHjh4YaKMrs5ottg5xINnMdVW7K5XjekGtvJDeofETOvr41Y7N-JuUDV-7v1AHR7eB29q1RB-eLovgofvV9v8JrxdXy_zxW2oBcQQRqXgSSZjCVrpWup5BbosS84VaoxjFSNAmdQ6S3SEseSJqhBiqTOYK468FBfB54l7dPZ3j9QVB0Mam0a1aHsqojhLIzGXgnurnKzaWSKHdXF05qDcUHAoTtkWL7MtfLbFlK3v_Pg0pC8PWD33_Q_TG-LJ8GgbnxL9avpHdMV-_JECuBDS7xFGEHEQABD641__ALfEtok</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Levy, Andrew E.</creator><creator>Hammes, Andrew</creator><creator>Anoff, Debra L.</creator><creator>Raines, Joshua D.</creator><creator>Beck, Natalie M.</creator><creator>Rudofker, Eric W.</creator><creator>Marshall, Kimberly J.</creator><creator>Nensel, Jessica D.</creator><creator>Messenger, John C.</creator><creator>Masoudi, Frederick A.</creator><creator>Pierce, Read G.</creator><creator>Allen, Larry A.</creator><creator>Ream, Karen S.</creator><creator>Ho, P. Michael</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1738-025X</orcidid><orcidid>https://orcid.org/0000-0002-9076-9619</orcidid><orcidid>https://orcid.org/0000-0003-2540-3095</orcidid><orcidid>https://orcid.org/0000-0002-1171-9171</orcidid><orcidid>https://orcid.org/0000-0001-6916-7798</orcidid></search><sort><creationdate>20210301</creationdate><title>Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System</title><author>Levy, Andrew E. ; Hammes, Andrew ; Anoff, Debra L. ; Raines, Joshua D. ; Beck, Natalie M. ; Rudofker, Eric W. ; Marshall, Kimberly J. ; Nensel, Jessica D. ; Messenger, John C. ; Masoudi, Frederick A. ; Pierce, Read G. ; Allen, Larry A. ; Ream, Karen S. ; Ho, P. 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Michael</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Cardiovascular quality and outcomes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Levy, Andrew E.</au><au>Hammes, Andrew</au><au>Anoff, Debra L.</au><au>Raines, Joshua D.</au><au>Beck, Natalie M.</au><au>Rudofker, Eric W.</au><au>Marshall, Kimberly J.</au><au>Nensel, Jessica D.</au><au>Messenger, John C.</au><au>Masoudi, Frederick A.</au><au>Pierce, Read G.</au><au>Allen, Larry A.</au><au>Ream, Karen S.</au><au>Ho, P. Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System</atitle><jtitle>Circulation Cardiovascular quality and outcomes</jtitle><addtitle>Circ Cardiovasc Qual Outcomes</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>14</volume><issue>3</issue><spage>e006570</spage><epage>e006570</epage><pages>e006570-e006570</pages><issn>1941-7705</issn><issn>1941-7713</issn><eissn>1941-7705</eissn><abstract><![CDATA[Among Medicare value-based payment programs for acute myocardial infarction (AMI), the Hospital Readmissions Reduction Program uses
(
) codes to identify the program denominator, while the Bundled Payments for Care Improvement Advanced program uses diagnosis-related groups (DRGs). The extent to which these programs target similar patients, whether they target the intended population (type 1 myocardial infarction), and whether outcomes are comparable between cohorts is not known.
In a retrospective study of 2176 patients hospitalized in an integrated health system, a cohort of patients assigned a principal
diagnosis of AMI and a cohort of patients assigned an AMI DRG were compared according to patient-level agreement and outcomes such as mortality and readmission.
One thousand nine hundred thirty-five patients were included in the
cohort compared with 662 patients in the DRG cohort. Only 421 patients were included in both AMI cohorts (19.3% agreement). DRG cohort patients were older (70 versus 65 years,
<0.001), more often female (48% versus 30%,
<0.001), and had higher rates of heart failure (52% versus 33%,
<0.001) and kidney disease (42% versus 25%,
<0.001). Comparing outcomes, the DRG cohort had significantly higher unadjusted rates of 30-day mortality (6.6% versus 2.5%,
<0.001), 1-year mortality (21% versus 8%,
<0.001), and 90-day readmission (26% versus 19%,
=0.006) than the
cohort. Two observations help explain these differences: 61% of
cohort patients were assigned procedural DRGs for revascularization instead of an AMI DRG, and type 1 myocardial infarction patients made up a smaller proportion of the DRG cohort (34%) than the
cohort (78%).
The method used to identify denominators for value-based payment programs has important implications for the patient characteristics and outcomes of the populations. As national and local quality initiatives mature, an emphasis on
codes to define AMI cohorts would better represent type 1 myocardial infarction patients.]]></abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>33653116</pmid><doi>10.1161/CIRCOUTCOMES.120.006570</doi><orcidid>https://orcid.org/0000-0003-1738-025X</orcidid><orcidid>https://orcid.org/0000-0002-9076-9619</orcidid><orcidid>https://orcid.org/0000-0003-2540-3095</orcidid><orcidid>https://orcid.org/0000-0002-1171-9171</orcidid><orcidid>https://orcid.org/0000-0001-6916-7798</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Circulation Cardiovascular quality and outcomes, 2021-03, Vol.14 (3), p.e006570-e006570 |
| issn | 1941-7705 1941-7713 1941-7705 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2496238731 |
| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Angiotensin Receptor Antagonists Angiotensin-Converting Enzyme Inhibitors Delivery of Health Care, Integrated Diagnosis-Related Groups Female Humans International Classification of Diseases Male Medicare Middle Aged Myocardial Infarction - diagnosis Myocardial Infarction - therapy Patient Readmission Quality Indicators, Health Care Retrospective Studies United States - epidemiology |
| title | Acute Myocardial Infarction Cohorts Defined by International Classification of Diseases, Tenth Revision Versus Diagnosis-Related Groups: Analysis of Diagnostic Agreement and Quality Measures in an Integrated Health System |
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