Orlando’s Two Largest Hospitals Implant Cardiovascular Devices at Similar Rates
In Heart Failure
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By: James Pitt Jul. 18, 2018
Heart failure is the most common cause of death in the US, and the variety of treatments may seem intimidating. Even in a seemingly specific category like implants, options range from monitors to electric stimulators to total artificial hearts.
Orlando, Florida is a city with an unusually centralized Medicare inpatient market. Florida Hospital Orlando and Orlando Regional Medical Center treat a very high share of the city's Medicare inpatients, with approximately 36,000 discharges per year at Florida Hospital Orlando and 12,000 per year at Orlando Regional Medical Center.
This market structure provides an opportunity to examine whether hospitals that treat similar patient populations use devices in similar ways. Thanks to the size of each hospital, even rare treatments are well-represented in the data.
Analysts examined inpatient discharge data on implants used to treat cardiovascular disease at these hospitals. The following diagnosis-related groups were included:
- Heart transplant or implant of heart assist system (includes DRGs 001-002)
- Cardiac defibrillator implant (includes DRGs 222-227)
- Permanent cardiac pacemaker implant (includes DRGs 242-244)
- Pacemaker revision or replacement (includes DRGs 258-262)
- Automated implantable cardioverter-defibrillator (AICD) procedures (includes DRGs 245 and 265)
The relative frequencies of different implant-related procedures were very similar across the two hospitals. Orlando Regional Medical Center reported relatively more pacemaker and defibrillator implants, and relatively fewer heart transplants or heart assist system implants.
Florida Hospital Orlando reported notably higher 30-day readmission rates for patients with cardiac defibrillator implants. Higher readmission rates may indicate a population with more serious health needs.
DRG-level data on cardiac defibrillator implants reveals a possible explanation for this gap. Florida Hospital Orlando reported more patients with AMI or shock, DRGs 222 and 223. Florida Hospital Orlando also reported a higher proportion of major complications (DRG 226) relative to no major complications (DRG 227) in patients with defibrillator implants without cardiac catheterization.
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- Total Discharges ( Jan 2013 to Dec 2016 )
- Total Discharges After Exclusion
- All Cause 30 Day Readmissions
- 30 Day HF Readmissions
- 30 Day HF Readmission Rate
- State 30 Day HF Readmission Rate
- National 30 Day HF Readmission Rate
- % 30 Day Readmissions back to Same Hospital
- 30 to 60 Day HF Readmissions
- 30 to 60 Day HF Readmission Rate
- State 30 to 60 Day HF Readmission Rate
- National 30 to 60 Day HF Readmission Rate
For cardiovascular implant diagnosis-related groups at Florida Hospital Orlando (Orlando, FL) and Orlando Regional Medical Center (Orlando, FL).
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