Studies from Mayo Clinic Yield New Information about Managed Care (Translating Policy To Practice: an Association Between Medicare Access and Children’s Health Insurance Program Reauthorization Act Implementation and Palliative Care …): Managed Care

2023 DEC 06 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Data detailed on Managed Care have been presented. According to news reporting out of Jacksonville, Florida, by NewsRx editors, research stated, “To evaluate the 30-day postoperative mortality and palliative care consultations in patients that underwent surgical procedures in the United States before and after Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) implementation. Retrospective, Observational cohort study.”

Our news journalists obtained a quote from the research from Mayo Clinic, “Secondary data were collected from the U.S. National Inpatient Sample, the largest hospital database in the country. The time span was from 2011 to 2019. Adult patients that electively underwent 1 of 19 major procedures. None. The primary outcome was cumulative postoperative mortality in two study cohorts. The secondary outcome was palliative care use. We identified 4,900,451 patients and categorized them into two study cohorts: PreM: 2011-2014 (n = 2,103,836) and PostM: 2016-2019 (n = 2,796,615). Regression discontinuity estimates and multivariate analysis were used. Across all procedures, 149,372 patients (7.1%) and 156,610 patients (5%) died within 30 days of their index procedures in the PreM and PostM cohorts, respectively. There was no statistically significant increase in mortality rates around postoperative day (POD) 30 (POD 26-30 vs 31-35) for both cohorts. More patients had inpatient palliative consultations during POD 31-60 compared with POD 1-30 in PreM (8,533 of 2,081,207 patients [0.4%] vs 1,118 of 22,629 patients [4.9%]) and PostM (18,915 of 2,791,712 patients [0.7%] vs 417 of 4,903 patients [8.5%]). Patients were more likely to receive palliative care consultations during POD 31-60 compared with POD 1-30 in both the PreM (odds ratio [OR] 5.31; 95% CI, 2.22-8.68; p< 0.001) and the PostM (OR 7.84; 95% CI, 4.83-9.10; p< 0.001) cohorts.We did not observe an increase in postoperative mortality after POD 30 before or after MACRA implementation. However, palliative care use markedly increased after POD 30.”

According to the news editors, the research concluded: “These findings should be considered hypothesis-generating because of several confounders.”

This research has been peer-reviewed.

For more information on this research see: Translating Policy To Practice: an Association Between Medicare Access and Children’s Health Insurance Program Reauthorization Act Implementation and Palliative Care Consultations and Perioperative Mortality In Critical Care. Critical Care Medicine, 2023;51(11):1461-1468. Critical Care Medicine can be contacted at: Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA. (Lippincott Williams and Wilkins - www.lww.com; Critical Care Medicine - http://journals.lww.com/ccmjournal/pages/default.aspx)

Our news journalists report that additional information may be obtained by contacting Ricardo Diaz Milian, Mayo Clinic, Dept. of Critical Care Medicine, Jacksonville, FL 32224, United States. Additional authors for this research include Titilope Olanipekun, Devang Sanghavi, Pablo Moreno Franco, Sean Kiley, Smit Paghdar, Maisha T. Robinson, Mathew Thomas and Basar Sareyyupoglu.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1097/ccm.0000000000005982. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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