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dc.contributor.authorCalderwood, Michael Simmons
dc.contributor.authorKleinman, Kenneth Paul
dc.contributor.authorSoumerai, Stephen Bertram
dc.contributor.authorJin, Robert
dc.contributor.authorGay, Charlene
dc.contributor.authorPiatt, Richard
dc.contributor.authorKassler, William
dc.contributor.authorGoldmann, Donald Alan
dc.contributor.authorJha, Ashish Kumar
dc.contributor.authorLee, Grace M.
dc.date.accessioned2017-05-16T17:21:52Z
dc.date.issued2014
dc.identifier.citationCalderwood, Michael S., Ken Kleinman, Stephen B. Soumerai, Robert Jin, Charlene Gay, Richard Piatt, William Kassler, Donald A. Goldmann, Ashish K. Jha, and Grace M. Lee. 2014. “Impact of Medicare’s Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitals.” Infection Control & Hospital Epidemiology 35 (02) (February): 144–151. doi:10.1086/674861.en_US
dc.identifier.issn0899-823Xen_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:32692606
dc.description.abstractThe Centers for Medicare and Medicaid Services (CMS) implemented a policy in October 2008 to eliminate additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) surgery. To evaluate the impact of this policy on mediastinitis rates, using Medicare claims and National Healthcare Safety Network (NHSN) prospective surveillance data. We used an interrupted time series design to compare mediastinitis rates before and after the policy, adjusted for secular trends. Billing rates came from Medicare inpatient claims following 638,761 CABG procedures in 1,234 US hospitals (January 2006-September 2010). Prospective surveillance rates came from 151 NHSN hospitals in 29 states performing 94,739 CABG procedures (January 2007-September 2010). Logistic regression mixed-effects models estimated trends for mediastinitis rates. We found a sudden drop in coding for index admission mediastinitis at the time of policy implementation (odds ratio, 0.36 [95% confidence interval (CI), 0.23-0.57]) and a decreasing trend in coding for index admission mediastinitis in the postintervention period compared with the preintervention period (ratio of slopes, 0.83 [95% CI, 0.74-0.95]). However, we saw no impact of the policy on infection rates as measured using NHSN data. Our results were not affected by changes in patient risk over time, heterogeneity in hospital demographics, or timing of hospital participation in NHSN. The CMS policy of withholding additional Medicare payment for mediastinitis on the basis of claims-based evidence of infection was associated with changes in coding for infections but not with changes in actual infection rates during the first 2 years after policy implementation.en_US
dc.language.isoen_USen_US
dc.publisherCambridge University Press (CUP)en_US
dc.relation.isversionofdoi:10.1086/674861en_US
dash.licenseLAA
dc.titleImpact of Medicare's Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitalsen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalInfection Control & Hospital Epidemiologyen_US
dash.depositing.authorSoumerai, Stephen Bertram
dc.date.available2017-05-16T17:21:52Z
dc.identifier.doi10.1086/674861*
dash.contributor.affiliatedJha, Ashish
dash.contributor.affiliatedCalderwood, Michael S.
dash.contributor.affiliatedGoldmann, Donald
dash.contributor.affiliatedLee, Grace
dash.contributor.affiliatedKleinman, Kenneth Paul
dash.contributor.affiliatedSoumerai, Stephen


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