“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
All posts in Measurement
“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
“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
[From the article’s Abstract] “Clinicians and policy experts have raised concerns that the 30-day readmission measure used in this program [Hospital Readmissions Reduction Program] provides an incomplete picture of performance because it does not capture all hospital encounters that may occur after discharge. In contrast, the excess days in acute care (EDAC) measure, which currently is not used in the HRRP, captures the full spectrum of hospital encounters (emergency department, observation stay, inpatient readmission) and their associated lengths of stay within 30 days of discharge. [..] Overall, only moderate agreement was found on hospital performance rankings by using the readmission … Read More
“Because ESKD [end-stage kidney disease] is operationally defined as receiving long-term dialysis or a kidney transplant, we hypothesized that the number of patients with incident ESKD can vary considerably depending on decisions between patients and physicians about the choice and timing of kidney replacement therapy, and particularly of initiating dialysis. Consistent with this, after publication of the Initiating Dialysis Early and Late (IDEAL) trial—a randomized clinical trial showing no significant difference in death or other outcomes with earlier (eGFR of 9.0 mL/min/1.73 m2) vs later (eGFR of 7.2 mL/min/1.73 m2) initiation of dialysis—a rapid drop in early dialysis initiation was … Read More
“High-quality health data research and the development of ML [machine learning] models requires meaningful data at a sufficient scale. Such data undoubtedly exist. Most health institutions hold clinical imaging data at a scale ranging from tens of thousands to tens of millions of scans. However, these data are often inaccessible to researchers, even where there is an intention to make them available for research, because of barriers of access and usability. Barriers of access can include: governance barriers (difficulties in understanding and working through governance frameworks regulating data usage); cost barriers (there can be considerable overhead costs to datasets and … Read More
“Genome-wide association studies have shown that common diseases are polygenic, ie, thousands of DNA variants contribute to risk, and most of these have very small effect. In spite of this complexity, it is now possible to estimate the degree to which an individual is at risk of common illnesses owing to their genetic makeup. The so-called polygenic risk scores (PRS) are generated from DNA taken from a saliva or blood sample with DNA variants measured using genotyping technologies that are inexpensive (< US $100 per person). From these data, PRS can be calculated for a wide range of diseases (by … Read More
“In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study (July 9 issue), Bhasin et al. evaluated the effectiveness of individualized recommendations to prevent fall injuries. We find the lack of significant success with this strategy to be wholly unsurprising. Referrals or recommendations alone are insufficient to reduce falls. The STRIDE intervention successfully expanded the role of primary care providers to include fall-risk screening, assessment, and individualized care plans. It did not include any direct procedural interventions (e.g., exercise, medication management, home safety modifications, and vision care) or the necessary extensive support to ensure their receipt. [..] … Read More
“First described in 1975 by economist Charles Goodhart, Goodhart’s Law states that “when a measure becomes the target, it ceases to be a good measure.” The famous, and possibly apocryphal, example of Goodhart’s Law is the story of nail factories in the Soviet Union. To boost output, the factory performance was pegged to the number of nails produced, leading to the manufacturing of millions of tiny and useless nails. In response, the performance metric was changed to the nails’ weight. The factories, in turn, adjusted their approach and produced a small number of giant, and equally useless, nails. Hospitals, too, … Read More