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Articles by B. K. Nallamothu
Total Records ( 2 ) for B. K. Nallamothu
  T. J Iwashyna , J. M Kahn , R. A Hayward and B. K. Nallamothu
  Background—

Patients with acute myocardial infarction (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability, yet we know little about the basis for how such revascularization hospitals are selected.

Methods and Results—

We examined interhospital transfer patterns in 71 336 AMI patients admitted to hospitals without revascularization capabilities in the 2006 Medicare claims using network analysis and regression models. A total of 31 607 (44.3%) AMI patients were transferred from 1684 nonrevascularization hospitals to 1104 revascularization hospitals. Median time to transfer was 2 days. Median transfer distance was 26.7 miles, with 96.1% within 100 miles. In 45.8% of cases, patients bypassed a closer hospital to go to a farther hospital that had a better 30-day risk standardized mortality rates. However, in 36.8% of cases, another revascularization hospital with lower 30-day risk-standardized mortality was actually closer to the original admitting nonrevascularization hospital than the observed transfer destination. Adjusted regression models demonstrated that shorter transfer distances were more common than transfers to the hospitals with lowest 30-day mortality rates. Simulations suggest that an optimized system that prioritized the transfer of AMI patients to a nearby hospital with the lowest 30-day mortality rate might produce clinically meaningful reductions in mortality.

Conclusions—

More than 40% of AMI patients admitted to nonrevascularization hospitals are transferred to revascularization hospitals. Many patients are not directed to nearby hospitals with the lowest 30-day risk-standardized mortality, and this may represent an opportunity for improvement.

  S. L Hummel , N. P Pauli , H. M Krumholz , Y Wang , J Chen , S. L. T Normand and B. K. Nallamothu
 

Background— Heart transplant centers are generally considered "centers of excellence" for heart failure care. However, their overall performance has not previously been evaluated in a broad population of elderly patients with heart failure, many of whom are not transplant candidates.

Methods and Results— We identified >1 million elderly Medicare beneficiaries who were hospitalized for heart failure between 2004 and 2006 at >4500 hospitals. We calculated 30-day risk-standardized mortality rates and standardized mortality ratios as well as 30-day risk-standardized readmission rates and standardized readmission ratios at heart transplant centers and non–heart transplant hospitals using risk-standardization models that the Centers for Medicare & Medicaid Services uses for public reporting. The 30-day risk-standardized mortality rates were lower at heart transplant centers than non–heart transplant hospitals nationally (10.6% versus 11.5%, P<0.001) but were similar at peer institutions offering coronary artery bypass grafting within the same geographical region (10.6% versus 10.6%, P=0.96). The mean standardized mortality ratio for heart transplant centers was 0.9 (SD, 0.1; range, 0.7 to 1.3). No differences were noted in 30-day risk-standardized readmission rates between heart transplant centers and non–heart transplant hospitals nationally (23.6% versus 23.8%, P=0.55). The mean standardized readmission ratio for heart transplant centers was 1.0 (SD, 0.1; range, 0.8 to 1.2).

Conclusions— In elderly Medicare patients with heart failure, heart transplant centers have lower 30-day risk-standardized mortality rates than non–heart transplant hospitals nationally; however, this difference is not present in comparison with peer institutions or for 30-day risk-standardized readmission rates.

 
 
 
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