Clopidogrel is associated with Lower Hospital Readmission Rates for Percutaneous Cardiovascular Procedures Patients at Essentia Health St Mary's Medical Center based on Real World Evidence Study of Medicare Claims Data

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In Clopidogrel, Percutaneous Cardiovascular

By: Sara Riascos  Mar. 10, 2022

Background:

Percutaneous Cardiovascular Procedures are frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payers such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing.Clopidogrel is a blood thinner used to It can prevent stroke, heart attack, and other heart problems. Studies have shown that the early and pretreatment use of Clopidogrel reduces the chance of cardiovascular death or ischemic complications before and after PCI.

Dexur’s analysis of Real-World Evidence based on Medicare Claims data showed that the use of Clopidogrel within 7 days of hospitalization was associated with lower hospital readmission rates for Percutaneous Cardiovascular Procedures Patients at Essentia Health St Mary's Medical Center in Duluth, Minnesota. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real-World Evidence from Medicare Claims data, for hospitalizations at Essentia Health St Mary's Medical Center between January 2019 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Percutaneous Cardiovascular Procedures related codes (Listed in table below)
2. Stratified Selected population into cohorts
   1. Percutaneous Cardiovascular Procedures patients who dispensed Clopidogrel within 7 Days of Hospitalization using Part D drugs claims database
   2. Percutaneous Cardiovascular Procedures patients who did not dispense Clopidogrel within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Clopidogrel was associated with lower hospital readmission rates for all Primary DRG Diagnosis Codes examined at Essentia Health St Mary's Medical Center. For patients whose primary DRG Diagnosis was “Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Major Complication Or Comorbidity (MCC)”(247) and when Clopidogrel was used within 7 days of hospitalization, the readmission rate was 11.01% compared to the cohort where Clopidogrel was not used, whose readmission rate was 12.88%. The readmission odds ratio for these cohorts was 0.84. The use of Clopidogrel was associated with a 16% lower readmission rate when used within 7 days of hospitalization. The full list of studied DRG codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Clopidogrel at Essentia Health St Mary's Medical Center is shown below.

Primary DRG Diagnosis Code	Primary DRG Diagnosis Code Description	Total Hospitalizations without Clopidogrel	Readmission Without Clopidogrel	Readmission Rate without Clopidogrel	Total Hospitalizations with Clopidogrel	Readmission with Clopidogrel	Readmission Rate with Clopidogrel	Readmission Odds Ratio	Reduction in Readmission with Clopidogrel (%)	Confidence Interval (-)	Confidence Intervals (+)
247	Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Major Complication Or Comorbidity (MCC)	396

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Percutaneous Cardiovascular Procedures were not prescribed Clopidogrel within 7 days of discharge.

DRG CODE	Hospital	Hospitalizations with Percutaneous Cardiovascular Procedures	% of Hospitalizations without Clopidogrel
247	Cedars Sinai Medical Center	571	At Least 98.1%
	Essentia Health St Mary's Medical Center	408	97.05%

​Hospitalizations with Percutaneous Cardiovascular Procedures = Above Listed DRG Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real-World Evidence of Medicare Claims data, for hospitalizations between January January 2017 to September 2019, the use of Clopidogrel within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Percutaneous Cardiovascular Procedures patients at Essentia Health St Mary's Medical Center. This analysis shows that a significant number of Patients are not dispensed Clopidogrel after Percutaneous Cardiovascular Procedures hospitalizations at Essentia Health St Mary's Medical Center or major US Hospitals.