By: James Pitt  Jul. 09, 2018
Hospitals and physicians often struggle with how to evaluate the economic & quality benefits of WCDs. Hospitals & physicians face a number of challenges including:
What should be the appropriate measure that measures the quality & economic benefits of WCDs?
How does one get the data to measure the benefit?
Can we even get the right resources & teams to analyze the data?
Given these challenges, hospitals & physicians are not able to clearly articulate the benefits of WCDs to their hospitals. Dexur can shed light on this evaluation challenge since it has one of the largest anonymized claims databases in the US and also because our analysts have in depth expertise in the topics of HFrEF and AMI.
1) What are some measures to evaluate the benefits of WCDs?
To answer the first question, Dexur looked at the bigger picture to see how Hospitals themselves are benchmarked. CMS has Mortality rates related to Heart Failure & AMI as a key component of value based purchasing (VBP). So, hospitals that have a higher mortality rate related to HF or AMI have negative economic & quality outcomes.
Heart disease is the leading cause of death in the United States. Patients who have already suffered a heart attack (AMI) or have heart failure with reduced ejection fraction (HFrEF, aka LVEF) are particularly vulnerable. Risk of death is thought to be highest shortly after AMI, and a New England Journal of Medicine study found ICD implantation within 30 days after AMI does not reduce this risk. For this reason, wearable cardiac defibrillators (WCDs) are of particular interest as a “bridge to implant” or “bridge to transplant” to protect patients until they become candidates for ICD or heart transplant. This use was most recently reviewed in March 2018 by Weinstock in Cardiac Electrophysiology Clinics.
However, blindly using HF/AMI mortality rates to measure WCDs impact is inappropriate since WCDs are only appropriate for patients with Heart failure with reduced ejection fraction (HFrEF, aka LVEF) AND have either AMI OR Heart Failure. So, the specific impact of WCDs on overall mortality rates have to be calculated from the ground up.
2) What are the appropriate data sets & methodologies to create a measure that is specific to WCD evaluation?
Dexur analyzed CMS Medicare claims data to create a mortality measure that is specific to AMI & HF patients with HFrEF. Here are the very high level steps we followed to create the measure:
Identify appropriate AMI & Heart Failure Patients at Index Hospitalization
Stratify this cohort to only account for patients with HFrEF
Track mortality rates for 30, 60 & 90 days after discharge
To demonstrate this measure, Dexur analysts analyzed data on patients with AMI or HFrEF in Jacksonville, Florida. 1850 unique patients were discharged with HFrEF or AMI with HFrEF at least once from Jacksonville hospitals from January 2013 to December 2016. For this cohort, we calculated 30 day mortality rates by Hospital in the Jacksonville area.
Hospitals and Physicians can now use Dexur’s data sets and dashboard to evaluate the potential impact of WCDs for their specific Institutions.
Premium Subscribers to Dexur’s starter plan get access to detailed metric for this example study in the Jacksonville area. Subscribers to Dexur’s gold plan get access to detailed hospital specific dashboards for WCD quality outcomes and support from Dexur analysts: