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[PMID]:29318267
[Au] Autor:Joynt Maddox KE; Orav EJ; Zheng J; Epstein AM
[Ad] Endereço:Washington University School of Medicine, St Louis, Missouri.
[Ti] Título:Participation and Dropout in the Bundled Payments for Care Improvement Initiative.
[So] Source:JAMA;319(2):191-193, 2018 01 09.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hospitais/estatística & dados numéricos
Medicare/economia
Pacotes de Assistência ao Paciente/economia
Mecanismo de Reembolso/utilização
[Mh] Termos MeSH secundário: Centers for Medicare and Medicaid Services (U.S.)
Modelos Logísticos
Estatísticas não Paramétricas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.14771


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[PMID]:29342379
[Au] Autor:Trivedi AN; Leyva B; Lee Y; Panagiotou OA; Dahabreh IJ
[Ad] Endereço:From the Departments of Health Services, Policy and Practice (A.N.T., B.L., Y.L., O.A.P., I.J.D.), and Epidemiology (I.J.D.), Brown University School of Public Health, and the Providence Veterans Affairs Medical Center (A.N.T.) - both in Providence, RI.
[Ti] Título:Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans.
[So] Source:N Engl J Med;378(3):262-269, 2018 01 18.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. METHODS: We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage. RESULTS: In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, -7.3 to 8.1). CONCLUSIONS: The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.).
[Mh] Termos MeSH primário: Custo Compartilhado de Seguro
Mamografia/utilização
Medicare Part C/economia
Patient Protection and Affordable Care Act
[Mh] Termos MeSH secundário: Idoso
Detecção Precoce de Câncer/utilização
Grupos Étnicos
Feminino
Seres Humanos
Mamografia/economia
Medicare
Fatores Socioeconômicos
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMsa1706808


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[PMID]:28449973
[Au] Autor:Sandhu SK; Hua W; MaCurdy TE; Franks RL; Avagyan A; Kelman J; Worrall CM; Ball R; Nguyen M
[Ad] Endereço:Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA. Electronic address: sukhminder.sandhu@fda.hhs.gov.
[Ti] Título:Near real-time surveillance for Guillain-Barré syndrome after influenza vaccination among the Medicare population, 2010/11 to 2013/14.
[So] Source:Vaccine;35(22):2986-2992, 2017 05 19.
[Is] ISSN:1873-2518
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Guillain-Barré syndrome (GBS) is a serious acute demyelinating disease that causes weakness and paralysis. The Food and Drug Administration (FDA) began collaborating with the Centers for Medicare and Medicaid Services (CMS) to develop near real-time vaccine safety surveillance capabilities in 2006 and has been monitoring for the risk of GBS after influenza vaccination for every influenza season since 2008. METHODS: We present results from the 2010/11 to 2013/14 influenza seasons using the Updating Sequential Probability Ratio Test (USPRT), with an overall 1-sided α of 0.05 apportioned equally using a constant alpha-spending plan among 20 consecutive weekly tests, 5 ad hoc tests, and a 26th final end of season test. Observed signals were investigated using the self-controlled risk interval (SCRI) design. RESULTS: Over 15 million people were vaccinated in each influenza season. In the 2010/11 influenza season, we observed an elevated GBS risk during the season, with an end of season SCRI analysis finding a nonsignificant increased risk (RR=1.25, 95% CI: 0.96-1.63). A sensitivity analysis applying the positive predictive value of the ICD-9 code for GBS from the 2009/10 season estimated a RR=1.98 (95% CI: 1.42-2.76). Although the 2010/11 influenza vaccine suggested an increased GBS risk, surveillance of the identical vaccine in the 2011/12 influenza season did not find an increased GBS risk after vaccination. No signal was observed in the subsequent three influenza seasons. CONCLUSIONS: Conducting near real-time surveillance using USPRT has proven to be an excellent method for near real-time GBS surveillance after influenza vaccination, as demonstrated by our surveillance efforts during the 2010/11-2013/14 influenza seasons. In the 2010/2011 influenza season, in addition to the 2009 H1N1 influenza pandemic, using near real-time surveillance we were able to observe a signal early in the influenza season and the method has now become routine.
[Mh] Termos MeSH primário: Síndrome de Guillain-Barré/epidemiologia
Vacinas contra Influenza/efeitos adversos
Medicare
Vigilância da População/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Centers for Medicare and Medicaid Services (U.S.)
Sistemas de Computação
Feminino
Síndrome de Guillain-Barré/etiologia
Seres Humanos
Vacinas contra Influenza/administração & dosagem
Masculino
Medição de Risco
Estados Unidos/epidemiologia
United States Food and Drug Administration
Vacinação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Influenza Vaccines)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:29240910
[Au] Autor:Wehby GL; Domingue BW; Ullrich F; Wolinsky FD
[Ad] Endereço:Department of Health Management and Policy, University of Iowa, Iowa City.
[Ti] Título:Genetic Predisposition to Obesity and Medicare Expenditures.
[So] Source:J Gerontol A Biol Sci Med Sci;73(1):66-72, 2017 Dec 12.
[Is] ISSN:1758-535X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: The relationship between obesity and health expenditures is not well understood. We examined the relationship between genetic predisposition to obesity measured by a polygenic risk score for body mass index (BMI) and Medicare expenditures. Methods: Biennial interview data from the Health and Retirement Survey for a nationally representative sample of older adults enrolled in fee-for-service Medicare were obtained from 1991 through 2010 and linked to Medicare claims for the same period and to Genome-Wide Association Study (GWAS) data. The study included 6,628 Medicare beneficiaries who provided 68,627 complete person-year observations during the study period. Outcomes were total and service-specific Medicare expenditures and indicators for expenditures exceeding the 75th and 90th percentiles. The BMI polygenic risk score was derived from GWAS data. Regression models were used to examine how the BMI polygenic risk score was related to health expenditures adjusting for demographic factors and GWAS-derived ancestry. Results: Greater genetic predisposition to obesity was associated with higher Medicare expenditures. Specifically, a 1 SD increase in the BMI polygenic risk score was associated with a $805 (p < .001) increase in annual Medicare expenditures per person in 2010 dollars (~15% increase), a $370 (p < .001) increase in inpatient expenses, and a $246 (p < .001) increase in outpatient services. A 1 SD increase in the polygenic risk score was also related to increased likelihood of expenditures exceeding the 75th percentile by 18% (95% CI: 10%-28%) and the 90th percentile by 27% (95% CI: 15%-40%). Conclusion: Greater genetic predisposition to obesity is associated with higher Medicare expenditures.
[Mh] Termos MeSH primário: Índice de Massa Corporal
Predisposição Genética para Doença
Custos de Cuidados de Saúde/estatística & dados numéricos
Gastos em Saúde/estatística & dados numéricos
Medicare/estatística & dados numéricos
Herança Multifatorial/genética
Obesidade/genética
[Mh] Termos MeSH secundário: Idoso
Assistência Ambulatorial
Feminino
Seguimentos
Estudo de Associação Genômica Ampla
Seres Humanos
Masculino
Meia-Idade
Obesidade/economia
Obesidade/epidemiologia
Prevalência
Estudos Retrospectivos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.1093/gerona/glx062


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[PMID]:28460061
[Au] Autor:Papaleontiou M; Hughes DT; Guo C; Banerjee M; Haymart MR
[Ad] Endereço:Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48106.
[Ti] Título:Population-Based Assessment of Complications Following Surgery for Thyroid Cancer.
[So] Source:J Clin Endocrinol Metab;102(7):2543-2551, 2017 Jul 01.
[Is] ISSN:1945-7197
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Context: As thyroid cancer incidence rises, more patients undergo thyroid surgery. Although postoperative complication rates have been reported in single institution studies, population-based data are limited. Objective: To determine thyroid cancer surgery complication rates and identify at-risk populations. Design/Setting/Patients: Using the Surveillance, Epidemiology, and End Results-Medicare database, we evaluated general complications within 30 days and thyroid surgery-specific complications within 1 year in 27,912 patients who underwent surgery for differentiated or medullary thyroid cancer between 1998 and 2011. Multivariable analyses of patient characteristics associated with postoperative complications were performed. Main Outcome Measures: General and thyroid surgery-specific complications. Results: Overall, 1820 (6.5%) patients developed general postoperative complications and 3427 (12.3%) developed thyroid surgery-specific complications. In multivariable analyses, general and thyroid surgery-specific complications were significantly higher in patients >65 years [odds ratio (OR), 2.61; 95% confidence interval (CI), 2.31 to 2.95; OR, 3.12; 95% CI, 2.85 to 3.42], those with a Charlson/Deyo comorbidity score of 1 (OR, 2.40; 95% CI, 1.66 to 3.49; OR, 1.88; 95% CI, 1.53 to 2.31) and ≥2 (OR, 7.05; 95% CI, 5.33 to 9.56; OR, 3.62; 95% CI, 3.11 to 4.25), and those with regional (OR, 1.18; 95% CI, 1.03 to 1.35; OR, 1.31; 95% CI, 1.19 to 1.45) or distant disease (OR, 2.83; 95% CI, 2.30 to 3.47; OR, 1.85; 95% CI, 1.54 to 2.21), respectively. Conclusions: The rates of thyroid cancer surgery complications are higher than predicted, and patients with older age, more comorbidities, and advanced disease are at greatest risk. Efforts to reduce complications are needed.
[Mh] Termos MeSH primário: Complicações Pós-Operatórias/epidemiologia
Neoplasias da Glândula Tireoide/patologia
Neoplasias da Glândula Tireoide/cirurgia
Tireoidectomia/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Idoso
Intervalo Livre de Doença
Feminino
Seres Humanos
Incidência
Modelos Logísticos
Masculino
Medicare/estatística & dados numéricos
Meia-Idade
Análise Multivariada
Invasividade Neoplásica/patologia
Estadiamento de Neoplasias
Complicações Pós-Operatórias/fisiopatologia
Estudos Retrospectivos
Medição de Risco
Programa de SEER
Análise de Sobrevida
Neoplasias da Glândula Tireoide/mortalidade
Tireoidectomia/métodos
Estados Unidos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1210/jc.2017-00255


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[PMID]:28747463
[Au] Autor:Man S; Schold JD; Uchino K
[Ad] Endereço:From the Clinical Neuroscience Institute, Miami Valley Hospital, Wright State University Boonshoft School of Medicine Dayton, OH (S.M.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (J.D.S.); and Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (K.U.).
[Ti] Título:Impact of Stroke Center Certification on Mortality After Ischemic Stroke: The Medicare Cohort From 2009 to 2013.
[So] Source:Stroke;48(9):2527-2533, 2017 09.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: An increasing number of hospitals have been certified as primary stroke centers (PSCs). It remains unknown whether the action toward PSC certification has improved the outcome of stroke care. This study aimed to understand whether PSC certification reduced stroke mortality. METHODS: We examined Medicare fee-for-service beneficiaries aged ≥65 years who were hospitalized between 2009 and 2013 for ischemic stroke. Hospitals were classified into 3 groups: new PSCs, the hospitals that received initial PSC certification between 2009 and 2013 (n=634); existing PSCs, the PSCs certified before 2009 (n=785); and non-SCs, the hospitals that have never been certified as PSCs (n=2640). Multivariate logistic regression and Cox proportional hazards model was used to compare the mortality among the 3 groups. RESULTS: Existing PSCs were significantly larger than new PSCs as reflected by total number of beds and annual stroke admission ( <0.0001). Compared with existing PSCs, new PSCs had lower in-hospital (odds ratio, 0.862; 95% confidence interval [CI], 0.817-0.910) and 30-day mortality (hazard ratio [HR], 0.981; 95% CI, 0.968-0.993), after adjusting for patient demographics and comorbidities. Compared with non-SCs, new PSCs had lower adjusted in-hospital (odds ratio, 0.894; 95% CI, 0.848-0.943), 30-day (HR, 0.904; 95% CI, 0.892-0.917), and 1-year mortality (HR, 0.907; 95% CI, 0.898-0.915). Existing PSCs had lower adjusted 30-day (HR, 0.922; 95% CI, 0.911-0.933) and 1-year mortality (HR, 0.900; 95% CI, 0.892-0.907) than non-SCs. CONCLUSIONS: Obtaining stroke certification may reduce stroke mortality and overcome the disadvantage of being smaller hospitals. Further study of other outcome measures will be useful to improve stroke system of care.
[Mh] Termos MeSH primário: Isquemia Encefálica/mortalidade
Certificação/estatística & dados numéricos
Hospitais/estatística & dados numéricos
Acidente Vascular Cerebral/mortalidade
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Planos de Pagamento por Serviço Prestado
Feminino
Seres Humanos
Joint Commission on Accreditation of Healthcare Organizations
Modelos Logísticos
Masculino
Medicare
Análise Multivariada
Prognóstico
Modelos de Riscos Proporcionais
Qualidade da Assistência à Saúde
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016473


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[PMID]:28468784
[Au] Autor:Kalbaugh CA; Kucharska-Newton A; Wruck L; Lund JL; Selvin E; Matsushita K; Bengtson LGS; Heiss G; Loehr L
[Ad] Endereço:Department of Surgery, School of Medicine, The University of North Carolina at Chapel Hill, NC corey_kalbaugh@med.unc.edu.
[Ti] Título:Peripheral Artery Disease Prevalence and Incidence Estimated From Both Outpatient and Inpatient Settings Among Medicare Fee-for-Service Beneficiaries in the Atherosclerosis Risk in Communities (ARIC) Study.
[So] Source:J Am Heart Assoc;6(5), 2017 May 03.
[Is] ISSN:2047-9980
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Outpatient ascertainment of peripheral artery disease (PAD) is rarely considered in the measurement of PAD clinical burden; therefore, the clinical burden of PAD likely has been underestimated while contributing to a decreased awareness of PAD in comparison to other circulatory system disorders. METHODS AND RESULTS: The purpose of this study was to estimate the age-standardized annual period prevalence and incidence of PAD in the outpatient and inpatient settings using data from the Atherosclerosis Risk in Communities (ARIC) study linked with Centers for Medicare and Medicaid Services claims. The majority (>70%) of all PAD encounters occurred in the outpatient setting. The weighted mean age-standardized prevalence and incidence of outpatient PAD was 11.8% (95% CI 11.5-12.1) and 22.4 per 1000 person-years (95% CI 20.8-24.0), respectively. Black patients had higher weighted mean age-standardized prevalence (15.6%; 95% CI 14.6-16.4) compared with white patients (11.4%; 95% CI 11.1-11.7). Black women had the highest weighted mean age-standardized prevalence (16.9%; 95% CI 16.0-17.8). Black patients also had a higher incidence rate of PAD (31.3 per 1000 person-years; 95% CI 27.3-35.4) compared with white patients (25.4 per 1000 person-years; 95% CI 23.5-27.3). PAD prevalence and incidence did not differ by sex alone. CONCLUSIONS: This study provides comprehensive estimates of PAD in the inpatient and outpatient settings where the majority of PAD burden was found. PAD is an important circulatory system disorder similar in prevalence to stroke and coronary heart disease.
[Mh] Termos MeSH primário: Assistência Ambulatorial
Planos de Pagamento por Serviço Prestado
Medicare
Admissão do Paciente
Doença Arterial Periférica/epidemiologia
[Mh] Termos MeSH secundário: Demandas Administrativas em Assistência à Saúde
Afroamericanos
Distribuição por Idade
Idoso
Assistência Ambulatorial/economia
Comorbidade
Grupo com Ancestrais do Continente Europeu
Planos de Pagamento por Serviço Prestado/economia
Feminino
Custos Hospitalares
Seres Humanos
Incidência
Masculino
Medicare/economia
Admissão do Paciente/economia
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/economia
Doença Arterial Periférica/etnologia
Prevalência
Fatores de Risco
Distribuição por Sexo
Fatores de Tempo
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:29428038
[Au] Autor:Shubinets V; Fox JP; Lanni MA; Tecce MG; Pauli EM; Hope WW; Kovach SJ; Fischer JP
[Ti] Título:Incisional Hernia in the United States: Trends in Hospital Encounters and Corresponding Healthcare Charges.
[So] Source:Am Surg;84(1):118-125, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Incisional hernia (IH) is a challenging, potentially morbid condition. This study evaluates recent trends in hospital encounters associated with IH care in the United States. Using Nationwide Inpatient Sample databases from 2007 to 2011, annual estimates of IH-related hospital discharges, charges, and serious adverse events were identified. Significance in observed trends was tested using regression modeling. From 2007 to 2011, there were 583,054 hospital discharges associated with a diagnosis of IH. 81.1 per cent had a concurrent procedure for IH repair. The average discharge included a female patient (63.2%), 59.8 years of age, with either Medicare (45.3%) or Private insurance (38.3%) as the anticipated primary payer. Comparing 2007 to 2011, significant increases in IH discharges (12%; 2007 = 109,702 vs 2011 = 123,034, P = 0.009) and IH repairs (10%; 2007 = 90,588 vs 2011 = 99,622, P < 0.001) were observed. This was accompanied by a 37 per cent increase in hospital charges (2007 = $44,587 vs 2011 = $60,968, P < 0.001), resulting in a total healthcare bill of $7.3 billion in 2011. Significant trends toward greater patient age (2007 = 59.7 years vs 2011 = 60.2 years, P < 0.001), higher comorbidity index (2007 = 3.0 vs 2011 = 3.5, P < 0.001), and increased frequency of serious adverse events (2007 = 13.5% vs 2011 = 17.7%, P < 0.001) were noted. Further work is needed to identify interventions to mitigate the risk of IH development.
[Mh] Termos MeSH primário: Herniorrafia/economia
Preços Hospitalares
Hérnia Incisional/economia
Pacientes Internados
Laparoscopia/economia
Tempo de Internação/economia
Telas Cirúrgicas/economia
[Mh] Termos MeSH secundário: Custos e Análise de Custo
Feminino
Preços Hospitalares/tendências
Hospitais
Seres Humanos
Hérnia Incisional/diagnóstico
Hérnia Incisional/etiologia
Hérnia Incisional/cirurgia
Masculino
Medicare
Meia-Idade
Alta do Paciente/economia
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29428014
[Au] Autor:Fry DE; Pine M; Nedza SM; Reband AM; Huang CJ; Pine G
[Ti] Título:Comparison of Risk-Adjusted Outcomes in Medicare Open Laparoscopic Cholecystectomy.
[So] Source:Am Surg;84(1):12-19, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:More than 90 per cent of cholecystectomies are performed laparoscopically and this has resulted in concern that surgeons will not have sufficient experience to perform open procedures when clinical circumstances require it. We reviewed the open cholecystectomies (OCs) of Medicare patients from 2010 to 2012 in hospitals with 20 or more cases, created risk-adjusted models for adverse outcomes which were evaluated for 90-days after discharge, and compared the hospital-level outcomes with laparoscopic cholecystectomy performed in the same hospitals for the same period of time. Results demonstrated that inpatient deaths, inpatient prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day readmissions were statistically the same with an overall adverse outcome rate of 21.6 per cent in OC versus 20.9 per cent in laparoscopic cholecystectomy. Conversion of laparoscopic to open procedures was not associated with increased adverse outcomes. Laparoscopic cholecystectomy provides patients with many advantages, but when clinical circumstances are necessary, OC continues to be performed with the same overall adverse outcome rates, and the conversion process is not associated with poorer results in this high-risk population of patients.
[Mh] Termos MeSH primário: Colecistectomia
Mortalidade Hospitalar
Tempo de Internação
Medicaid
Medicare
Alta do Paciente
Readmissão do Paciente
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Colecistectomia/efeitos adversos
Colecistectomia Laparoscópica/efeitos adversos
Conversão para Cirurgia Aberta
Seres Humanos
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29405686
[Au] Autor:Eramo LA
[Ti] Título:RAC Audit Underpayments: Does CMS Owe You Money?
[So] Source:J AHIMA;88(2):20-3, 2017 02.
[Is] ISSN:1060-5487
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Auditoria Financeira
Reembolso de Seguro de Saúde
[Mh] Termos MeSH secundário: Contas a Pagar e a Receber
Centers for Medicare and Medicaid Services (U.S.)
Seres Humanos
Revisão da Utilização de Seguros
Medicare
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:180207
[St] Status:MEDLINE



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