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. 2021 Nov 2;10(21):e021629.
doi: 10.1161/JAHA.121.021629. Epub 2021 Oct 23.

Center Variability in Medicare Claims-Based Publicly Reported Transcatheter Aortic Valve Replacement Outcome Measures

Michael P Thompson  1   2 , Hechuan Hou  1 , Alexander A Brescia  1   2 , Francis D Pagani  1   2 , Devraj Sukul  3 , Jeffrey S McCullough  4 , Donald S Likosky  1   2
Affiliations

Center Variability in Medicare Claims-Based Publicly Reported Transcatheter Aortic Valve Replacement Outcome Measures

Michael P Thompson et al. J Am Heart Assoc. .

Abstract

Background Public reporting of transcatheter aortic valve replacement (TAVR) claims-based outcome measures is used to identify high- and low-performing centers. Whether claims-based TAVR outcomes can reliably be used for center-level comparisons is unknown. In this study, we sought to evaluate center variability in claims-based TAVR outcomes used in public reporting. Methods and Results The study sample included 119 554 Medicare beneficiaries undergoing TAVR between January 2014 and October 2018 based on procedure codes in 100% Medicare inpatient claims. Multivariable hierarchical logistic regression was used to estimate center-specific adjusted rates and reliability (R) of 30-day mortality, discharge not to home/self-care, 30-day stroke, and 30-day readmission. Reliability was defined as the ratio of between-hospital variation to the sum of the between- and within-hospital variation. The median (interquartile range [IQR]) center-level adjusted outcome rates were 3.1% (2.9%-3.4%) for 30-day mortality, 41.4% (31.3%-53.4%) for discharge not to home, 2.5% (2.3%-2.7%) for 30-day stroke, and 14.9% (14.4%-15.5%) for 30-day readmission. Median reliability was highest for the discharge not to home measure (R=0.95; IQR, 0.94-0.97), followed by the 30-day stroke (R=0.92; IQR, 0.87-0.94), 30-day mortality (R=0.86; IQR, 0.81-0.91), and 30-day readmission measures (R=0.42; IQR, 0.35-0.51). Across outcomes, there was an inverse relationship between center volume and measure reliability. Conclusions Claims-based TAVR outcome measures for mortality, discharge not to home, and stroke were reliable measures for center-level comparisons, but readmission measures were unreliable. Stakeholders should consider these findings when evaluating claims-based measures to compare center-level TAVR performance.

Keywords: hospital profiling; outcomes; transcatheter aortic valve replacement.

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Figures

Figure 1
Figure 1. Distribution of center‐level TAVR outcomes.
TAVR indicates transcatheter aortic valve replacement.
Figure 2
Figure 2. Relationship between center volume and reliability of TAVR outcome (n=567).
TAVR indicates transcatheter aortic valve replacement.
See this image and copyright information in PMC

References

    1. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, et al. Transcatheter aortic‐valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–1607. doi: 10.1056/NEJMoa1008232 - DOI - PubMed
    1. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J, Kleiman NS, et al. Transcatheter aortic‐valve replacement with a self‐expanding prosthesis. N Engl J Med. 2014;370:1790–1798. doi: 10.1056/NEJMoa1400590 - DOI - PubMed
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, et al. Transcatheter aortic‐valve replacement with a balloon‐expandable valve in low‐risk patients. N Engl J Med. 2019;380:1695–1705. doi: 10.1056/NEJMoa1814052 - DOI - PubMed
    1. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, et al. Transcatheter aortic‐valve replacement with a self‐expanding valve in low‐risk patients. N Engl J Med. 2019;380:1706–1715. doi: 10.1056/NEJMoa1816885 - DOI - PubMed
    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, et al. Transcatheter or surgical aortic‐valve replacement in intermediate‐risk patients. N Engl J Med. 2016;374:1609–1620. doi: 10.1056/NEJMoa1514616 - DOI - PubMed

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