Disease Burden News, Research & Data Analysis

DRG 871 Sepsis Patients with VTE Have About 1.5x Odds of In-Hospital Mortality as DRG 871 Sepsis Patients without VTE, at Selected California Hospitals

In Venous Thromboembolism (VTE)

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By: James Pitt  Jun. 20, 2018

Venous thromboembolism (VTE) is a condition in which a blood clot forms in a vein, then may dislodge and block blood supply elsewhere. VTE is a common comorbidity of sepsis. The Surviving Sepsis Campaign recommends that patients with severe sepsis receive daily prophylaxis against VTE, with both pharmacologic therapy and pneumatic compression devices when possible.

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Asthma is a Significant Contributor to 30 Day Readmissions in Mississippi

In Asthma

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By: James Pitt  Jun. 19, 2018

Asthma is a chronic lung disease which narrows the airways. It affects over 25 million people in the US, including 7 million children. Risk factors for developing asthma include air pollution, poverty, and tobacco smoke. Though asthma is often regarded as a childhood disease, 8.8% of adults had asthma as of 2011-2014.

Dexur analysts examined hospital-level data at the twenty hospitals in Mississippi with the most Medicare-eligible inpatient discharges for asthma in 2013-2016. The average readmission rate across these hospitals was close to Mississippi's state average, so they are a fair representation of the state.

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Coronary Artery Disease Affects Half of Discharges With Comorbid Heart Failure and Stroke at Four Texas Hospitals

In Heart Failure

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By: James Pitt  Jun. 18, 2018

Coronary artery disease (CAD) is the leading cause of death in the US, killing approximately 370,000 people each year. (Coronary heart disease is a synonym). It occurs when plaque builds up in the arteries that feed the heart itself, a condition called coronary atherosclerosis.

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Fluid Imbalance Is Associated with More Severe Sepsis Hospitalizations

In Fluid Imbalance

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By: James Pitt  Jun. 15, 2018

Following Dexur's examination of length of stay (LOS) in sepsis patients in Mississippi, analysts examined how fluid imbalance relates to case mix. CMS divides sepsis patients into three diagnosis-related groups:

  • DRG 870 SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS
  • DRG 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC
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Iron Deficiency Anemia Occurs in Up to 8.42% of Renal Failure Discharges in Pennsylvania Hospitals

In Iron Deficiency Anemia (IDA)

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By: James Pitt  Jun. 14, 2018

Anemia is a common complication of chronic kidney disease and renal failure. Gaweda et. al (2014) write that “Anemia in chronic kidney disease (CKD) is primarily a consequence of insufficient erythropoietin (EPO) production.” EPO is a hormone produced primarily in the kidneys, which stimulates red blood cell production in bone marrow. Recombinant human EPO (rHuEPO) can help make up for the lack of EPO production, but rHuEPO alone may not alleviate anemia in all patients, because other components (like iron) are also necessary for normal red blood cell production. According to Nissenson and Strobos (1999), “Deficient available iron is the most common cause of initial poor response to rHuEPO.”

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Analysis of Selected Major Mississippi Hospitals Shows a Difference of About 4 Days in Sepsis LOS between Lowest & Highest Hospitals

In Sepsis

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By: James Pitt  Jun. 08, 2018

Sepsis is a serious condition, in which the immune system mounts a systemic inflammatory response to infection. Controlling fluid balance is an important part of sepsis treatment. Septic shock kills by reducing circulation, and hypovolemia (low fluid) may contribute to worse outcomes, while excess fluid increases the risk of death. Dexur has previously examined fluid balance’s effects on sepsis mortality in California and urosepsis readmissions in Connecticut.

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COPD Incidence Varies By an Order of Magnitude In Oklahoma

In Chronic Obstructive Pulmonary Disease (COPD)

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By: James Pitt  Jun. 01, 2018

Chronic obstructive pulmonary disorder (COPD) is a common lung disease, mainly caused by smoking. There is evidence that COPD patients are at greater risk of mortality when exposed to air pollution, particularly particulate matter. Dexur analysts examined 2016 CMS inpatient discharge data from 20 Oklahoma hospitals with over 1,000 discharges that year. The incidence of COPD varied dramatically across hospitals, from 5.61% of total Medicare discharges at Jackson County Memorial Hospital to 0.54% at Mercy Hospital Oklahoma City.

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Florida Orlando Hospital Has Particularly Low Mortality, Length of Stay, & Readmission Rates for Interstitial Lung Disease With Major Complications

In Interstitial Lung Disease (ILD)

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By: James Pitt  May. 30, 2018

Interstitial lung diseases (ILD) are more than 300 different conditions with similar symptoms. According to the European Respiratory Society, “Only about one in three cases of interstitial lung disease has a known cause.” Different ILDs present very different risks: “Survival rates at 5 years range from 20% for idiopathic pulmonary fibrosis [IPF] to almost 100% for cryptogenic organizing pneumonia.”

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High Variation in Readmissions May Suggest Need For Better Lung Cancer Diagnostics in New York

In Lung Cancer

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By: James Pitt  May. 29, 2018

Lung cancer rates are falling, but it remains the leading cause of cancer deaths in the US. Detecting cancer early can improve survival. But in recent years, overdiagnosis became a concern. The only lung cancer screen the CDC recommends is low dose CT (LDCT). But even LDCT picks up many findings that may not be dangerous. A 2016 randomized clinical trial in The Lancet Oncology found that only 4% of new solid nodules detected on LDCT were lung cancer.

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Cigarette Use Data May Help Pinpoint Patients At Particular Risk of Malignant Hypertension in Kentucky; Louisville at Low Risk

In Hypertension

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By: James Pitt  May. 28, 2018

People in industrialized countries have an over 90% lifetime risk of developing hypertension, according to a 2007 review in The Lancet. Many diseases cause hypertension. Primary or “essential” hypertension is defined as hypertension with no such cause. This definition is misleading because diet, exercise, and several known genes affect the risk of primary hypertension.

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47% of 90-Day Fracture Readmissions in Women Involve Osteoporosis, Which Tymlos May Help Address

In Osteoporosis

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By: James Pitt  May. 17, 2018

Osteoporosis is a disease that weakens bones and increases the risk of fracture, particularly common in elderly women. First-line treatment is with anti-resorptive drugs like bisphosphonates. A 2017 Lancet study found that patient concerns about bisphosphonates’ side effects limit their use. The American Society for Bone and Mineral Research (ASBMR) recommends that patients on bisphosphonates with low fracture risk take “drug holidays” to decrease their risk of serious side effects.

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Hyperkalemia Doubles Odds of ICU Stay Among Patients With Renal Failure With Complications at Large Tennessee Hospitals

In Hyperkalemia

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By: James Pitt  May. 16, 2018

Hyperkalemia, an excess of blood potassium, is an electrolyte imbalance that is especially common in patients with heart failure or chronic kidney disease. Up to 6.35% of patients with HF or CKD have hyperkalemia. Dexur has previously reported on hyperkalemia and heart failure in Florida.

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Atrial Fibrillation Predicts Longer Length of Stay Among Coronary Bypass Patients in Nevada

In Atrial fibrillation (AFib)

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By: James Pitt  May. 15, 2018

Atrial fibrillation (AF) is a type of heart arrhythmia common in patients over 40. A 2016 study in Journal of Internal Medicine found that “the estimated lifetime risk of developing AF is one in four for men and women aged 40 years and above. Projected data from multiple population-based studies in the USA and Europe predict a two- to threefold increase in the number of AF patients by 2060.” Dexur has previously examined how AF affects readmission rates in patients with comorbid respiratory conditions.

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Hyponatremia’s Separate Effects on ICU Admissions and Length of Stay May Present Opportunity to Reduce Length of Stay Among Heart Failure Patients in Maryland

In Hyponatremia

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By: James Pitt  May. 14, 2018

Hyponatremia is a common electrolyte disorder, defined as blood sodium levels under 135 mEq/L. Dexur has previously examined hyponatremia’s effect on ICU stays among patients with heart failure with major comorbidities (DRG 291) in Maryland.

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In Most Louisiana Hospitals, Post-Surgical ABSSSI-Related 30-Day Readmission Rates Exceed National Average

In Acute Bacterial Skin and Skin Structure Infections (ABSSSI)

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By: James Pitt  May. 04, 2018

A Dexur analysis examined 30-day readmission rates among Medicare inpatients discharged after surgery in Louisiana and found that most Louisiana hospitals had ABSSI-related 30-day readmission rates higher than the national average. The analysis was limited to hospitals with over 1,000 CMS inpatient discharges per year.

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