Background: Publically reported data is increasingly important to a hospital’s reputation and bottom line. Programs such as CMS Hospital Value Based Purchasing (HVBP) place 2% of a hospital’s base payments at risk, while the CMS Star Rating is frequently used by consumers to select a hospital for elective care. Both programs incorporate claims data to [...]

Background: Cholangiocarcinoma is an uncommon cancer with a very bad prognosis despite advances made in treatment. Location intrahepatic versus extrahepatic – determines surgical options. In our study, we examined variations in outcomes between patients admitted to the hospital with intrahepatic versus extrahepatic disease. Methods: Data from the National Inpatient Sample (NIS) which is part of [...]

Background: Though the advent of highly active anti-retroviral medications has improved survival in HIV infection, mortality from non-infectious complications such as pulmonary arterial hypertension (PAH) has increased. Also, studies have shown that PAH is the leading cause of hospitalization and death in patients with HIV associated PAH (HIV-PAH). However, not much is known about the [...]

Background: Hospital Readmission Reduction Program(HRRP) implemented by CMS as part of Affordable Care Act (ACA) applies financial penalties to hospitals that have higher-than-expected readmission rates for common conditions such as AMI, pneumonia, and HF. CMS extended this program to include COPD for the fiscal year (FY) 2015. While there has been a reduction in readmissions, [...]

Background: Opening new residency programs in community hospitals is one strategy to address physician shortage. Previous reports have shown better mortality outcomes in university based hospitals. However, less is known about teaching community hospitals. Disrupting well- established workflows in community hospitals is feared to cause an increased cost and possibly a slide in quality of [...]

Background: Readmissions within 30 days of discharge is used as a quality metric for the care of hospitalized patients. However, its prognostic value for patient outcomes has not been examined. We hypothesized that patients who get readmitted within 30 days of their index admission discharge may have higher short and long-term mortality. Methods: Using administrative [...]

Background: Antipsychotics are frequently used in the hospital setting for managing both acute and chronic psychiatric disorders. However, antipsychotics have been associated with higher rates of mortality due to their cardiovascular risk factors, such as QT prolongation. This study aimed to determine the association between cumulative dose of antipsychotics (first and second-generation) and QT prolongation, [...]

Background: Mortality review, well-documented in the medical literature, is a standardized process used to identify patient safety improvement opportunities and also to evaluate providers. As patient safety experts, hospitalists often review mortality cases for their hospitalist group or hospital. As the volume of cases is often not trivial, it can be difficult to allocate the [...]

Background: Since the publication of the Institute of Medicine report To Err Is Human in 1999, preventable inpatient deaths in the United States have been estimated as between 44,000 and 98,000 deaths annually. A more recent review concluded that the number of preventable deaths was over 250,000 cases annually. Critics have pointed out that these [...]

Background: The Obesity Paradox postulates that obesity is a protective factor against mortality in certain chronic conditions such as chronic kidney disease (CKD) and congestive heart failure. Although this paradox is established in CKD, few studies have analyzed the paradox in acute kidney injury (AKI). There are both short and long term ramifications to AKI [...]