Learning from Real-World Implementation of Daily Home-Based Symptom Monitoring in Patients with Cancer

“Routine use of home-based symptom monitoring and management using electronic patient-reported outcomes (ePRO) to improve care delivery is on the horizon. Randomized clinical trials demonstrate that use of patient-reported symptoms can have marked impact on patient outcomes, including minimizing symptom burden, enhancing quality of life, reducing hospitalizations, increasing time receiving cancer treatments, and, in some studies, improving survival. [..] few health systems have successfully, fully integrated ePRO. [..] In the study by Daly and colleagues, the authors begin to tackle an important question of frequency of assessment administration in ePRO. This study used daily symptom assessment in contrast to the … Read More

How New England caught the COVID deaths much of the country missed

“The USA TODAY Network in New England and the Documenting COVID-19 project partnered to investigate how New England became a positive data anomaly in terms of COVID death reporting accuracy. Across the region, excess deaths during the pandemic are almost completely accounted for by official COVID deaths, according to our analysis of Centers for Disease Control and Prevention mortality data and expected death models developed by demographers at Boston University. In other parts of the country, these COVID deaths were missed or certified incorrectly as other causes. [..] Hospitals are a dominant and central data source to capture the pandemic’s … Read More

Trends in Diagnosis Related Groups for Inpatient Admissions and Associated Changes in Payment From 2012 to 2016

“[Introduction] [..] There are a total of 761 Medicare Severity–DRGs [Diagnosis Related Group], which are organized into families (eg, heart failure) with 2 or 3 levels, most commonly with a base Medicare Severity–DRG (hereafter referred to as DRG) and 1 or 2 higher-complexity DRGs. Assignment to these latter DRGs occurs if 1 or more complications or comorbidities (CC) or major complications or comorbidities (MCC) are present. Of importance, hospital payment for DRGs with CCs or MCCs is often substantially greater. For example, payment for DRG 291 (heart failure and shock with MCC) is approximately twice that for DRG 293 (heart … Read More

Bioinformatics, Sequencing Accuracy, and the Credibility of Clinical Genomics

“The adoption of clinical exome and whole-genome sequencing based on next-generation sequencing technologies has increased rapidly over the last decade; this has been accelerated by increasing coverage of these services by private and public insurers. Examples of use include tumor and germline sequencing in patients with cancer, rapid turn-around sequencing of the genomes of critically ill neonates to diagnose mendelian conditions, and noninvasive prenatal testing for reproductive decision-making. The accuracy of sequencing results is of paramount importance to patients, clinicians, and those paying for testing services; inaccuracy can affect not only the tested individual, but their extended biological family. Understanding … Read More

Association Between Surgical Technical Skill and Long-term Survival for Colon Cancer

“Surgeons were recruited from the Illinois Surgical Quality Improvement Collaborative in 2016 for a video-based technical skills assessment program.4 Each surgeon submitted 1 representative video of a laparoscopic right hemicolectomy that they performed. Videos were reviewed by 12 or more surgeons, including 2 colorectal surgeons with video evaluation experience. Skill scores were assigned using the American Society of Colon & Rectal Surgeons Video Assessment Tool, and the mean score from all raters was used. Skill score was analyzed separately by terciles and as a continuous variable. Patients who underwent any minimally invasive colectomy for stage I to III epithelial-origin colon … Read More

Evaluation of Risk-Adjusted Home Time After Hospitalization for Heart Failure as a Potential Hospital Performance Metric

“Although the implementation of HRRP [Hospital Readmission Reduction Program] has been associated with significant reductions in readmission rates for HF [heart failure], it remains unclear whether current health policies have contributed to improvement in patients’ overall experience or quality of life. Although there has been an increasing emphasis on use of patient-oriented outcomes in evaluation of therapeutic benefits of newer HF therapies in clinical trials, the role of patient-oriented outcomes in defining hospital-level care quality for patients with HF is limited. [..] we assessed home time after hospitalization for HF through Medicare administrative claims data and its association with currently … Read More

Age and environment-related differences in gait in healthy adults using wearables

“[Abstract] Many traditional assessments of physical function utilized in clinical trials are limited because they are episodic, therefore, cannot capture the day-to-day temporal fluctuations and longitudinal changes in activity that individuals experience. In order to understand the sensitivity of gait speed as a potential endpoint for clinical trials, we investigated the use of digital devices during traditional clinical assessments and in real-world environments in a group of healthy younger (n = 33, 18–40 years) and older (n = 32, 65–85 years) adults. We observed good agreement between gait speed estimated using a lumbar-mounted accelerometer and gold standard system during the performance of traditional gait … Read More

Net Adverse Clinical Events With Antiplatelet Therapy in Acute Coronary Syndromes

“Clopidogrel, prasugrel, and ticagrelor are oral platelet P2Y12 receptor inhibitors that decrease the risk of platelet-mediated coronary artery thrombosis. [..] A 1-year composite end point of death, MI [myocardial infarction], and stroke is often used to evaluate efficacy in ACS [acute coronary syndrome] trials. However, death can be defined as all-cause death, cardiovascular death, or death from vascular causes (cardiovascular plus cerebrovascular deaths). Although ticagrelor was associated with a reduction in death in the PLATO trial, no subsequent trial with ticagrelor and no trials with clopidogrel or prasugrel have shown a mortality benefit with DAPT [dual antiplatelet therapy] compared with … Read More

Assessment of Value of Neighborhood Socioeconomic Status in Models That Use Electronic Health Record Data to Predict Health Care Use Rates and Mortality

“Neighborhood socioeconomic status (nSES) variables have been reported to improve predictions in some cases but not others. For instance, Molshatzki et al found that nSES variables improved the prediction of long-term mortality after myocardial infarction but Bhavsar et al found that an nSES index did not improve prediction of a variety of health care use measures within a 3-year window. Another study suggests that neighborhood-level indicators are not predictive above and beyond individual-level indicators. Whether these predictors are useful for risk stratification, and, if so, in what contexts remains unclear. [..] We assess the addition of diverse nSES predictors to … Read More

Misclassification of Hospital Performance Under the Hospital Readmissions Reduction Program: Implications for Value-Based Programs

“In the United States, the Centers for Medicare and Medicaid Services (CMS) have implemented value-based programs that compare the performance of hospitals using risk-standardized outcome measures (eg, readmission, mortality). A critically important characteristic of these measures is that they are point estimates with a margin of error. The CMS use the point estimates to compare hospitals, but the margin of error around each estimate may affect the CMS’s ability to accurately evaluate and distinguish performance. [..] The hospital-level 30-day RSRR [risk-standardized readmission rate] measure used by the CMS is a point estimate based on a finite number of discharges and, … Read More