TY - JOUR
T1 - Assessment of HF Outcomes Using a Claims-Based Frailty Index
AU - Shashikumar, Sukruth A.
AU - Luke, Alina A.
AU - Johnston, Kenton J.
AU - Joynt Maddox, Karen E.
N1 - Funding Information:
Supported by U.S. National Institutes of Health T35 National Heart, Lung, and Blood Institute (NHLBI) training grant HL007815. Dr. Joynt Maddox has received research support from NHLBI grant R01HL143421, National Institute on Aging grant R01AG060935, and the Commonwealth Fund, and U.S. Department of Health and Human Services. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/6
Y1 - 2020/6
N2 - Objectives: This study used a claims-based frailty index to investigate outcomes of frail patients with heart failure (HF). Background: Medicare value-based payment programs financially reward and penalize hospitals based on HF patients’ outcomes. Although programs adjust risks for comorbidities, they do not adjust for frailty. Hospitals caring for high proportions of frail patients may be unfairly penalized. Understanding frail HF patients’ outcomes may allow improved risk adjustment and more equitable assessment of health care systems. Methods: Adapting a claims-based frailty index, the study assigned a frailty score to each adult in the National in-patient Sample (NIS) from 2012 through September 2015 with a primary diagnosis of HF and dichotomized frailty by using a cutoff value established in the general NIS population. Multivariate regression models were estimated, controlling for comorbidities and hospital characteristics, to investigate relationships between frailty and outcomes. Results: Of 732,932 patients, 369,298 were frail. Frail patients were more likely than nonfrail patients to die during hospital stay (3.57% vs. 2.37%, respectively; adjusted odds ratio [aOR]: 1.67; 95% confidence interval [CI]: 1.61 to 1.72; p < 0.001); were less likely to be discharged to home (66.5% vs. 79.3%, respectively; aOR: 0.58; 95% CI: 0.57 to 0.58; p < 0.001); were hospitalized for more days (5.89 vs. 4.63 days, respectively; adjusted coefficient: 0.21 days; 95% CI: 0.21 to 0.22; p < 0.001); and incurred higher charges ($47,651 vs. $40,173, respectively; adjusted difference = $9,006; 95% CI: $8,596 to $9,416; p < 0.001). Conclusions: Frail patients with HF had significantly poorer outcomes than nonfrail patients after accounting for comorbidities. Clinicians should screen for frailty to identify high-risk patients who could benefit from targeted intervention. Policymakers should perform risk adjustments for frailty for more equitable quality measurement and financial incentive allocation.
AB - Objectives: This study used a claims-based frailty index to investigate outcomes of frail patients with heart failure (HF). Background: Medicare value-based payment programs financially reward and penalize hospitals based on HF patients’ outcomes. Although programs adjust risks for comorbidities, they do not adjust for frailty. Hospitals caring for high proportions of frail patients may be unfairly penalized. Understanding frail HF patients’ outcomes may allow improved risk adjustment and more equitable assessment of health care systems. Methods: Adapting a claims-based frailty index, the study assigned a frailty score to each adult in the National in-patient Sample (NIS) from 2012 through September 2015 with a primary diagnosis of HF and dichotomized frailty by using a cutoff value established in the general NIS population. Multivariate regression models were estimated, controlling for comorbidities and hospital characteristics, to investigate relationships between frailty and outcomes. Results: Of 732,932 patients, 369,298 were frail. Frail patients were more likely than nonfrail patients to die during hospital stay (3.57% vs. 2.37%, respectively; adjusted odds ratio [aOR]: 1.67; 95% confidence interval [CI]: 1.61 to 1.72; p < 0.001); were less likely to be discharged to home (66.5% vs. 79.3%, respectively; aOR: 0.58; 95% CI: 0.57 to 0.58; p < 0.001); were hospitalized for more days (5.89 vs. 4.63 days, respectively; adjusted coefficient: 0.21 days; 95% CI: 0.21 to 0.22; p < 0.001); and incurred higher charges ($47,651 vs. $40,173, respectively; adjusted difference = $9,006; 95% CI: $8,596 to $9,416; p < 0.001). Conclusions: Frail patients with HF had significantly poorer outcomes than nonfrail patients after accounting for comorbidities. Clinicians should screen for frailty to identify high-risk patients who could benefit from targeted intervention. Policymakers should perform risk adjustments for frailty for more equitable quality measurement and financial incentive allocation.
KW - HF
KW - claims-based frailty index
KW - costs
KW - frailty
KW - health policy
UR - http://www.scopus.com/inward/record.url?scp=85084705116&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2019.12.012
DO - 10.1016/j.jchf.2019.12.012
M3 - Article
C2 - 32387065
AN - SCOPUS:85084705116
SN - 2213-1779
VL - 8
SP - 481
EP - 488
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 6
ER -