Dexur & researchers from top institutions such as Harvard Medical School collaborate to publish several research papers based on Real World Evidence (RWE)

Dexur & researchers from top institutions such as Harvard Medical School collaborate to publish several Real-World Evidence (RWE) based research papers in peer-reviewed publications. 

“Dexur and our research team at the Brigham & Women's Hospital and Harvard Medical School have collaborated on multiple research projects related to exploring the impact of opioid use on healthcare systems and patient outcomes, as well as other research topics. Dexur has aggregated one of the largest anonymized medical claims databases in the US and their ability to harness that data to produce in-depth hospital-level quality outcomes disease is unique. Dexur's research team has been very flexible in understanding the scope of the research and has been very quick in their turnaround time to answer key questions and analyze data.” said Dr. Richard Urman, Associate Professor, Harvard Medical School Anesthesia and Pain Management

Paper Title: Racial and socioeconomic disparities in kyphoplasty among the Medicare population

Publication Journal: Pain practice - WILEY Online Library

Publication Date: August 22, 2023

Institutions:

Authors: Sindhu Krishnan, Ethan Y Brovman, Mark R Jones, Joseph Emanuele Manzi, Joshua Seokju Kim, Nikhilesh Rao, Richard D Urman

Abstract:

Introduction: Kyphoplasty is a minimally invasive treatment for chronic refractory pain secondary to spinal compression fracture. This study investigates racial and socioeconomic disparities in kyphoplasty among the Medicare population.

Materials and methods: This study utilized data from the Medicare Limited Data Sets (LDS), a CMS administrative claims database. Patients aged 18 and older with ICD code consistent with spinal pathology and compression fractures were included. Outcome was defined as kyphoplasty by race and socioeconomic status (SES) with low SES defined by dual enrollment in Medicare/Medicaid.

RESULTS: There was a total of 215,502 patients gathered from CMS data, and 717 (0.33%) of these patients underwent kyphoplasty during the study period. Of these patients, 458 (63.8%) were female, the average age was 76.5 years old, 655 (91.3%) were White, 20 (2.7%) were Black, 9 (1.3%) were Hispanic, and 98 (13.7%) were Medicare/Medicaid dual eligible. White patients (32,317/157,177 [20.6%]) were less likely to be dual enrollment eligible in Medicare and Medicaid than Black (5407/13,522 [39.9%]), Hispanic (2833/3675 [77.1%]), Asian (2087/3312 [63.0%]), or North American Native patients (778/1578 [49.1%]). Multivariate regression (MVR) analysis was performed and showed that Blacks were less likely than Whites to have a kyphoplasty performed (OR 0.46 [95% CI: 0.29–0.72], p-value <0.001). Although Hispanics (OR 0.95 [0.49–1.86]), North American Native (OR 0.82 [0.3–2.19]), and unknown race had a decreased odd of undergoing kyphoplasty, it was not statistically significant.

CONCLUSION:Our study showed after adjustment for pertinent comorbidities, Medicare/Medicaid dual-eligible patients and Black patients were significantly less likely to receive kyphoplasty than White patients with Medicare.

Article Link: https://onlinelibrary.wiley.com/doi/10.1111/papr.13286

Paper Title: Racial and Socioeconomic Disparities in Spinal Cord Stimulation Among the Medicare Population

Publication Journal: John Wiley & Sons, Inc.

Publication Date: March 15, 2021

Authors: Mark R. Jones MD Vwaire Orhurhu MD, MPH Brian O'Gara MD, MPH Ethan Y. Brovman MD, MPH Nikhilesh Rao MBA Stephanie G. Vanterpool MD, MBA Lawrence Poree MD, PhD Amitabh Gulati MD Richard D. Urman MD, MBA

Abstract:

BACKGROUND: Spinal cord stimulation (SCS) is used in the treatment of many chronic pain conditions. This study investigates racial and socioeconomic disparities in SCS among Medicare patients with chronic pain.

METHODS: Patients over the age of 18 with a primary diagnosis of postlaminectomy syndrome (ICD‐10 M96.1) or chronic pain syndrome (ICD‐10 G89.4) were identified in the Center for Medicare and Medicaid Services (CMS) Medicare Claims Limited Data Set. We defined our outcome as SCS therapy by race and socioeconomic status. Multivariable logistic regression was used to determine the variables associated with SCS.

RESULTS: We identified 1,244,927 patients treated between 2016 and 2019 with a primary diagnosis of postlaminectomy syndrome (PLS) or chronic pain syndrome (CPS). Of these patients, 59,182 (4.8%) received SCS. Multivariable logistic regression analysis revealed that, compared with White patients, Black (OR [95%CI], 0.62 [0.6–0.65], p < 0.001), Asian (0.66 [0.56–0.76], p < 0.001), Hispanic (0.86 [0.8–0.93], p < 0.001), and North American Native (0.62 [0.56–0.69], p < 0.001) patients were significantly less likely to receive SCS. In addition, patients who were dual‐eligible for Medicare and Medicaid were significantly less likely to receive SCS than those eligible for Medicare only (OR = 0.38 [95% CI: 0.37–0.39], p < 0.001).

CONCLUSION: This study suggests that racial and socioeconomic disparities exist in SCS among Medicare and Medicaid patients with PLS and CPS. Further work is required to elucidate the complex etiology underlying these findings.

Article Link: https://onlinelibrary.wiley.com/doi/10.1111/ner.13373

Paper Title: A Dashboard for Tracking Mortality After Cardiac Surgery Using a National Administrative Database

Publication Journal: Cardiology Research and Elmer Press Inc

Publication Date: February 23, 2021

Institutions:

Authors: Katherine J. Grecoa, Nikhilesh Rao, Richard D. Urman, Ethan Y. Brovman

Abstract:

BACKGROUND: Mortality after cardiac surgery is publicly reportable and used as a quality metric by national organizations. However, detailed institutional comparisons are often limited in publicly reported ratings, while publicly reported mortality data are generally limited to 30-day outcomes. Dashboards represent a useful method for aggregating data to identify areas for quality improvement.

METHODS: We present the development of a dashboard of cardiac surgery performance using cardiac surgery admissions in a national administrative dataset, allowing institutions to better analyze their clinical outcomes. We identified cardiac surgery admissions in the Medicare Limited Data Sets from April 2016 to March 2017 using diagnosis-related group (DRG) codes for cardiac valve and coronary bypass surgeries.

RESULTS: Using these data, we created a dashboard prototype to enable hospitals to compare their individual performance against state and national benchmarks, by all cardiac surgeries, specific cardiac surgery DRGs and by specific surgeons. Mortality rates are provided at 30, 60 and 90 days post-operatively as well as 1 year. Users can filter results by state, hospital and surgeon, and visualize summary data comparing these filtered results to national metrics. Examples of using the dashboard to examine hospital and individual surgeon mortality are provided.

CONCLUSION:We demonstrate how this database can be used to compare data between comparator hospitals on local, state and national levels to identify trends in mortality and areas for quality improvement.

Article Link: https://www.cardiologyres.org/index.php/Cardiologyres/article/view/1220/1190

Paper Title: A Dashboard Prototype for Tracking the Impact of Diabetes on Hospital Readmissions Using a National Administrative Database

Publication Journal: Journal of Clinical Medicine Research

Publication Date: January, 2020

Institutions:

Authors: Timothy Wong, Ethan Y. Brovman, Nikhilesh Rao, Mitchell H. Tsai, Richard D. Urman

Abstract:

BACKGROUND: Over the past several decades, diabetes mellitus has contributed to a significant disease burden in the general population. Evidence suggests that patients with a coexisting diabetes diagnosis consume more hospital resources, and have higher readmission rates compared to those who do not. Against the backdrop of bundled-payment programs, healthcare systems cannot underestimate the importance of monitoring patient health information at the population level.

METHODS: Using the data from the Centers for Medicare and Medicaid Services (CMS) administrative claims database, we created a dashboard prototype to enable hospitals to examine the impact of diabetes on their all-cause readmission rates and financial implications if diabetes was present at the index hospitalization. The technical design involved loading the relevant 10th revision of International Classification of Diseases (ICD-10) codes provided by the medical team and flagging diabetes patients at the claim. These patients were then tagged for readmissions within the same database. The odds ratios were determined based on data from two groups: those with diabetes at index hospitalization which include type 1 only, type 2 only, and type 1 and type 2 diabetes, plus those without diabetes at index hospitalization.

RESULTS: The dashboard presents summary data of diabetes readmissions quality metrics at a national level. Users can visualize summary data of each state and compare odds ratios for readmissions as well as raw hospitalization data at their facility. Dashboard users can also view data classified by a diagnosis-related group (DRG) system. In addition to a “national” data view, for users who inquire about data specific to demographic regions, the DRG view can be further stratified at the state level or county level. At the DRG level, users can view data about the cost per readmissions for all index hospitalization with and without diabetes.

CONCLUSION: The dashboard prototype offers users a virtual interface which displays visual data for quick interpretation, monitors changes at a population level, and enables administrators to benchmark facility data against local and national trends. This is an important step in using data analytics to drive population level decision making to ultimately improve medical systems.

Article Link: https://www.jocmr.org/index.php/JOCMR/article/view/4029/

Paper Title: Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery

Publication Journal: American Journal of Medical Quality

Publication Date: Nov 27, 2019

Institutions:

Authors: Allen KB, Brovman EY, Chhatriwalla AK, Greco KJ, Rao N, Kumar A, Urman RD

Abstract: 

PURPOSE: Opioid-related adverse drug events (ORADEs) increase patient length of stay (LOS) and health care costs. However, ORADE rates may be underreported. This study attempts to understand the degree to which ORADEs are underreported in Medicare patients undergoing cardiac surgery. 

MATERIALS AND METHODS: The Center for Medicare and Medicaid Services administrative claims database was used to identify ORADEs in 110 158 Medicare beneficiaries who underwent cardiac valve (n = 50 525) or coronary bypass (n = 59 633) surgery between April 2016 and March 2017. The International Classification of Disease (ICD)-10 codes specifically linked to ORADEs were used to identify an actual ORADE rate, while additional ICD codes, clinically associated with butas not specific to adverse drug events were analyzed as potential ORADEs. Length of stay (LOS) and hospital daily revenue were analyzed among patients with or without a potential ORADE. 

RESULTS: Among patients undergoing valve or bypass surgery, the documented ORADE rate was 0.7% (743/110 158). However, potential ORADEs may have occurred in up to 32.4% (35 658/110 158) of patients. In patients with a potential ORADE, mean LOS was longer (11.4 vs 8.2 days; P < .0001) and mean Medicare revenue/day was lower ($4016 vs $4412; P < .0001). The mean net difference in revenue/day between patients with and without an ORADE varied between $231 and $1145, depending on the Diagnosis-Related Group analyzed. 

CONCLUSIONS: ORADEs are likely underreported following cardiac surgery. ORADEs can be associated with increased LOS and decreased hospital revenue. Understanding the incidence and economic impact of ORADEs may expedite changes to postoperative pain management. Adopting multimodal pain management strategies that reduce exposure to opioids may improve outcomes by reducing complications, side effects, and health care costs.

PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/31771422

Paper Title: The Association Between Potential Opioid-Related Adverse Drug Events and Outcomes in Colorectal Surgery

Publication Journal: Journal of Laparoendoscopic & Advanced Surgical Techniques

Publication Date: Nov 08, 2019

Institutions:

Authors: Homsi J, Brovman EY, Rao N, Whang EE, Urman RD

Abstract:

INTRODUCTION: Major colorectal surgery procedures are complex operations that can result in significant postoperative pain and complications. More evidence is needed to demonstrate how opioid-related adverse drug events (ORADEs) after colorectal surgery can affect hospital length of stay (LOS), hospital revenue, and what their association is with clinical conditions. By understanding the clinical and economic impact of potential ORADEs within colorectal surgery, we hope to further guide approaches to perioperative pain management in an effort to improve patient care and reduce hospital costs. 

MATERIALS AND METHODS: We conducted a retrospective study utilizing the Centers for Medicare and Medicaid Services (CMS) Administrative Database to analyze Medicare discharges involving three colorectal surgery diagnosis-related groups (DRGs) to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed. 

RESULTS: The potential ORADE rate in patients undergoing colorectal surgery was 23.92%. The mean LOS for discharges with a potential ORADE was 5.35 days longer than without an ORADE. The mean hospital revenue per day with a potential ORADE was $418 less than without an ORADE. Any type of open surgery had a statistically significant higher potential ORADE rate than the matched laparoscopic case (P < .001). Clinical conditions most strongly associated with ORADEs in colorectal surgery included septicemia, pneumonia, shock, and fluid and electrolyte disorders. 

CONCLUSION: The incidence of ORADEs in colorectal surgery is high and is associated with longer hospital stays and reduced hospital revenue. Reducing the use of opioids in the perioperative setting, such as using multimodal analgesia strategies, may lead to positive outcomes with shorter hospital stays, increased hospital revenue, and improved patient care.

PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/31556797

Paper Title: The Association Between Potential Opioid-Related Adverse Drug Events and Outcomes in Total Knee Arthroplasty: A Retrospective Study

Publication Journal: Advances in Therapy

Publication Date: Oct 29, 2019

Institutions:

Authors: Jones MR, Kramer ME, Beutler SS, Kaye AD, Rao N, Brovman EY, Urman RD

Abstract: 

 INTRODUCTION: Characterization of the clinical and economic impact of opioid-related adverse drug events (ORADEs) after total knee arthroplasty (TKA) may guide provider and hospital system approach to managing postoperative pain after TKA. Our analysis quantifies the rate of potential ORADEs after TKA, the impact of potential ORADEs on length of stay (LOS) and hospital revenue, as well as their association with specific patient risk factors and comorbid clinical conditions. 

METHODS: We conducted a retrospective study using the Centers for Medicare and Medicaid Services administrative database to analyze Medicare discharges involving two knee replacement surgery diagnosis-related groups (DRGs) in order to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed. 

RESULTS: The potential ORADE rate in patients who underwent TKA was 25,523 out of 316,858 records analyzed (8.0%). The mean LOS for patients who experienced a potential ORADE was 1.04 days longer than those without an ORADE. The mean hospital revenue per day with a potential ORADE was $1334 (USD) less than without an ORADE. Potential ORADEs were significantly associated with poor patient outcomes such as pneumonia, septicemia, and shock. 

CONCLUSION: Potential ORADEs in TKA are associated with longer hospitalizations, decreased hospital revenue, and poor patient outcomes. Certain risk factors may predispose patients to experiencing an ORADE, and thus perioperative pain management strategies that reduce the frequency of ORADEs particularly in at-risk patients can improve patient satisfaction and increase hospital revenue following TKAs.

PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/31664696

Paper Title: Potential opioid-related adverse events following spine surgery in elderly patients

Publication Journal: Clinical Neurology and Neurosurgery

Publication Date: Oct 03, 2019

Institutions:

Authors:Jones MR, Brovman EY, Novitch MB, Rao N, Urman RD

Abstract:

OBJECTIVE: Understanding the clinical and economic impact of opioid-related adverse drug events (ORADEs) within spine surgery may guide both the clinician's and hospital administration's approach to treating perioperative pain, thus improving patient care and reducing hospital costs. The objective of this analysis is to understand how potential ORADEs after spine surgery in elderly patients affect length of stay, hospital revenue and their association with comorbid conditions.

PATIENTS AND METHODS: We conducted a retrospective study utilizing the Center for Medicare/Medicaid Services Administrative Database to analyze Medicare discharges between April 2016 and March 2017 involving 14 spine surgery DRGs for major spine procedures in order to identify potential ORADEs. An analysis was conducted using this database to identify the incidence of potential ORADEs as well as their impact on mean hospital length of stay and hospital revenue.

RESULTS: There were 177,432 discharges during the study period. The ORADE rate in patients undergoing spine surgery was 13.9% (24,642/177,432). The mean length of stay (LOS) for discharges with an ORADE was 3.13 days longer than without an ORADE (6.29 days with an ORADE vs 3.16 days without an ORADE). The adverse post-operative outcomes most strongly associated with potential ORADEs included shock, pneumonia, and septicemia. The mean hospital revenue per day with an ORADE was $3,076 less than without an ORADE ($7,263 with an ORADE vs $10,339 without an ORADE).

CONCLUSION: Potential ORADEs in spine surgery in elderly patients are common and are associated with longer hospitalizations and decreased hospital revenue. Perioperative pain management strategies that reduce ORADEs may improve patient care and increase hospital revenue.

PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/31610320

Paper Title: A Dashboard for Monitoring Opioid-Related Adverse Drug Events Following Surgery Using a National Administrative Database

Publication Journal: American Journal of Medical Quality

Publication Date: June 25, 2019

Institutions:

Authors: Stone AB, Jones MR, Rao N, Urman RD

Abstract:

Opioid-related adverse drug events (ORADEs) include a range of complications, from respiratory arrest to ileus and urinary retention. ORADEs correlate to morbidity, mortality, and increased costs. The Centers for Medicare & Medicaid Services database, which represents approximately 35% of hospital discharges. The authors searched for previously published ICD-9 codes that defined ORADEs. A group of surgical diagnosis-related groups (DRGs) were selected. Recurring queries were programmed using these ICD codes and DRGs and used to update an online dashboard. The dashboard presents an estimate of the burden of ORADEs to frontline clinicians and hospital leadership and allows users to compare local data on ORADEs rates to other hospitals. Users are able to refine their search by surgery type or ORADE type. An interface was created, using national administrative claims data, to allow hospitals to access their ORADEs and benchmark local data against national trends.

This paper also won an award at ASRA

PubMed Link: https://www.ncbi.nlm.nih.gov/pubmed/29938518