First Listed Diagnostic Codes Functioned Well to Identify Hosptialization and Emergency Department Treatment 7.10.09
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The study examined the positive predictive value of inpatient and emergency department diagnostic codes for identifying outpatient cases of sudden cardiac death and ventricular arrhythmias in Medicaid and Medicare claims data. Medical records for a random sample of 100 inpatient encounters and 100 emergency department encounters coded with relevant diagnoses were requested and 58% were obtained. First-listed diagnostic codes correctly identified cases 85.3% of the time overall based on criteria in the medical records.
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![[object Object],First-listed diagnostic codes functioned well to identify hospitalization and emergency department treatment for outpatient-originating sudden cardiac death and ventricular arrhythmia in Medicaid and Medicare data Sean Hennessy, PharmD, PhD 1 , Charles E. Leonard, PharmD 1 , Cristin M. Palumbo, MPH 1 , Rajat Deo, MD 2 , Craig Newcomb MS 1 , Stephen E. Kimmel, MD, MSCE 1,2 , Warren B. Bilker, PhD 1 1 Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, US 2 Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, US ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Conclusions ,[object Object],Results Funding Source : National Institutes of Health (RO1 HL076697) ,[object Object],[object Object],Background ,[object Object],[object Object],* 97.5% CI Methods Aims Principal IP diagnosis First-listed ED diagnosis ICD-9 code Code description Code type Sampled and requested N = 100 Received and reviewable N = 69 Sampled and requested N = 100 Received and reviewable N = 47 427.1 Paroxysmal ventricular tachycardia; ventricular tachycardia (paroxysmal) VA 64 39 1 1 427.4 Ventricular fibrillation and flutter VA 0 0 0 0 427.41 Ventricular fibrillation VA 8 8 0 0 427.42 Ventricular flutter VA 0 0 0 0 427.5 Cardiac arrest; cardiorespiratory arrest SD 28 22 97 45 798 Sudden death, cause unknown SD 0 0 0 0 798.1 Instantaneous death SD 0 0 0 0 798.2 Death occurring in less than 24 hours from onset of symptoms SD 0 0 2 1 IP and ED Claims Combined IP Claims ED Claims N Met Definition PPV 95% CI N Met Definition PPV 95% CI N Met Definition PPV 95% CI Principal/First-listed SD or VA code overall 116 99 85.3% 77.6 - 91.2 69 55 79.7% 68.3 - 88.4 47 44 93.6% 82.5 - 98.7 Principal/First-listed VA code only 43 32 74.4% 58.8 - 86.5 42 31 73.8% 58.0 - 86.1 1 1 100% 2.5 - 100* Principal/First-listed SD code only 65 60 92.3% 83.0 - 97.5 19 17 89.5% 66.9 - 98.7 46 43 93.5% 82.1 - 98.6 Principal/First-listed + secondary SD or VA code 8 7 87.5% 47.3 - 99.7 8 7 87.5% 47.3 - 99.7 0 0 -](https://image.slidesharecdn.com/hennessysean-firstlisteddiagnosticcodesfunctionedwelltoidentifyhosptializationandemergencydepartmenttreatment-7-10-09-100819090750-phpapp02/85/First-Listed-Diagnostic-Codes-Functioned-Well-to-Identify-Hosptialization-and-Emergency-Department-Treatment-7-10-09-1-320.jpg)
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The document discusses the importance and functions of accident and emergency departments in hospitals. It provides definitions of medical emergencies and outlines different types of emergency departments. It also covers key aspects of emergency department planning and design such as location, layout, entrance areas, examination and treatment rooms, and necessary support and administrative areas. Engineering services and communication systems for emergency departments are also addressed.
Triage In Emergency Department
Triage is the process of sorting patients based on the urgency of their condition to provide the right care to the right patient at the right time. It involves initially assessing patients at arrival to identify those needing immediate care, determine the appropriate treatment area, and avoid congestion. The goals are to treat the most severely injured first while maximizing survival in a mass casualty event. Triage categories range from resuscitation to non-urgent to ensure critical patients receive rapid medical attention. Reassessment is important as a patient's condition may deteriorate while waiting.
Introduction to pre hospital care and in
Pre-hospital care aims to reduce morbidity and mortality for patients outside the hospital by providing immediate medical care at the scene and during transport. It involves various providers like paramedics, nurses, and doctors who are specially trained to treat patients in pre-hospital settings. The philosophy is to intervene appropriately and transport patients safely to definitive care in a timely manner. An effective pre-hospital care system requires coordination between various stakeholders including emergency responders, hospitals, and policymakers to ensure patients receive optimal care from the scene to the hospital.
Chapter 2, Myers Psychology 9e
The document provides an overview of key concepts in neural communication and brain anatomy and function. It discusses neurons and how they communicate via electrical signals and neurotransmitters. It describes the nervous system, including the central nervous system (brain and spinal cord) and peripheral nervous system. It also covers the endocrine system and hormones. Regarding the brain, it outlines structures like the brainstem, limbic system, cerebral cortex, and describes techniques used to study the brain like PET scans and MRI scans.
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At the Heart of the Matter: Medical Necessity
PYA Principal Denise Hall and Michael Spake, Vice President of External Affairs and Chief Compliance & Integrity Officer at Lakeland Regional Health System, co-presented “At the Heart of the Matter: Medical Necessity,” at the AHLA Institute on Medicare and Medicaid Payment Issues. They discussed:
Recent cases and legal actions
Impact of medical necessity when interpreting the regulations and guidelines for:
-Stents
-Pacemakers
-Automatic Implantable Cardiac Defibrillators (AICD)
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Common areas of risk in applying local coverage determination (LCD)/national coverage determination (NCD) guidance to cardiac procedures: how to identify your risks and avoid vulnerability
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Managing Ventricular Arrhythmia In First In Man Studies A Nada
The document discusses the increasing need to manage ventricular arrhythmia encountered during early clinical drug development as riskier compounds are advanced. It outlines factors contributing to this issue and strategies for intensive cardiac monitoring in first-in-man studies to ensure safety while accurately assessing potential drug-related arrhythmia events given baseline rates in healthy volunteers. Future directions are highlighted, including expert guidance documents and initiatives to better understand cardiac safety in early development.
MEDICAL CODING
Medical coding systems allow health conditions and procedures to be transformed into standardized codes for administrative and statistical purposes. There are several major medical coding systems:
Diagnostic codes like ICD-9-CM and ICD-10 are used to code diseases, disorders and symptoms. Procedural codes like CPT identify specific medical interventions. Pharmaceutical codes like NDC identify medications.
ICD-9-CM is the current diagnostic coding system used in the US. It codes diseases and will be replaced by ICD-10-CM which provides more codes and specificity. CPT is the procedural coding system used in the US to describe medical services and procedures. NDC is the coding system used in the US to uniquely
MEDICAL CODING
Medical coding systems allow health conditions and procedures to be transformed into standardized codes for administrative and statistical purposes. There are several major medical coding systems:
Diagnostic codes like ICD-9-CM and ICD-10 are used to code diseases, disorders and symptoms. Procedural codes like CPT identify specific medical interventions. Pharmaceutical codes like NDC identify medications.
ICD-9-CM is the current diagnostic coding system used in the US. It codes diseases and will be replaced by ICD-10-CM which provides more codes and specificity. CPT is the procedural coding system used in the US to describe medical services and procedures. NDC is the coding system used in the US to uniquely
Un ejemplo: Dronedarona, de los ensayos clínicos a los datos del "mundo real"
Un ejemplo: Dronedarona, de los ensayos clínicos a los datos del "mundo real"Sociedad Española de Cardiología
Actualización en Fibrilación Auricular: de la evidencia a la práctica clínica.
10 de Junio de 2014, 16:30h
http://www.secardiologia.es/directos/actualizacionFA.html
Un ejemplo: Dronedarona, de los ensayos clínicos a los datos del "mundo real"
Dr. José Luis Merino Llorens
Hospital Universitario La Paz (Madrid)Practice guidelines for the management electrical
1. This document reviews guidelines for managing cardiac monitoring and upper extremity treatment for electrical injuries.
2. It recommends an ECG for all patients and admission for those with loss of consciousness, ECG abnormalities, or other injuries requiring admission.
3. While high-voltage injury patients are routinely admitted, the guidelines question if this is always necessary given most cardiac issues present within hours. More research is needed to determine optimal cardiac monitoring duration and disposition criteria.
Intravenous thrombolysis with rt pa for acute ischemic stroke within 24 hrs o...
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This study evaluated 400 patients who received intravenous thrombolysis treatment for acute ischemic stroke. The study aimed to assess the impact of a transient ischemic attack (TIA) occurring within 24 hours prior to the stroke.
The results found that 7.3% of patients (29 patients) experienced a TIA within 24 hours before their stroke. Having a prior TIA did not significantly impact the likelihood of a favorable outcome or increase mortality rates. However, multivariate analysis showed that a prior TIA was associated with an increased risk of symptomatic intracerebral hemorrhage. Prior TIA within 24 hours had no effect on overall unfavorable outcomes or mortality.Tcd assesment
TCD is useful for assessing stroke risk in sickle cell disease (Type A, Class I evidence). Contrast TCD is comparable to contrast TEE for detecting right to left shunts but TEE provides direct anatomic information (Type A, Class II evidence). TCD is probably useful for evaluating intracranial steno-occlusive disease, particularly in the MCA and ICA siphon, but its value compared to MRA or CTA is unknown (Type B, Class II evidence). TCD can detect cerebral microembolic signals in cardiovascular disorders but data does not support its use for diagnosis or monitoring antithrombotic therapy (Type B, Class II-IV evidence).
SMART transfers vs EDs AAN 2013. 3-8-13 FINAL
1) A study evaluated the safety of applying expanded thrombolysis criteria (SMART criteria) to acute ischemic stroke patients treated at community hospitals via telemedicine consultation before transferring to a comprehensive stroke center.
2) Rates of symptomatic intracranial hemorrhage and good functional outcomes at discharge were similar between patients treated at the emergency department versus those transferred from other hospitals.
3) While over 90% of patients had at least one standard exclusion criteria and transferred patients had higher stroke severity, outcomes were comparable to randomized clinical trials, suggesting it is safe to apply expanded criteria via telemedicine to increase thrombolysis treatment rates.
Myocarditis
This document summarizes the case of a 20-year-old male presenting with new onset dilated cardiomyopathy. Endomyocardial biopsy revealed lymphocytic infiltrates consistent with viral myocarditis. He was initially stabilized with supportive therapies including an LVAD and ECMO. While his EF improved, he suffered multiple complications during his hospital stay including cardiac tamponade, hemorrhagic stroke, and infections, leaving him with residual deficits.
Risk stratification in ARVC
Risk Stratification in Arrhythmic Right
Ventricular Cardiomyopathy Without
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ICPC Tutorial
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Medical errors, negligence, and litigation
The document discusses medical errors and their relationship to negligence and malpractice litigation. Some key points:
- Medical errors are estimated to cause between 44,000-98,000 deaths per year in the US, making it a leading cause of death. However, other studies estimate a lower number of around 5,000 deaths due to errors.
- Only a small percentage (around 1-2%) of medical errors result in negligent injuries. Of those negligent injuries, only 10-13% result in malpractice claims.
- Common reasons for malpractice litigation include needing money, believing there was a cover up, or wanting information or revenge. However, the system rarely identifies or holds providers accountable for substandard care
D-dimer.full
This study evaluated D-dimer levels in 220 patients with suspected acute aortic dissection over 24 hours. D-dimer levels were significantly higher in patients with acute aortic dissection compared to other conditions. Using a cutoff of 500 ng/mL, D-dimer had high sensitivity of 96.6% and moderate specificity of 46.6% for diagnosing acute aortic dissection within 24 hours. D-dimer performed best within the first 6 hours, with an area under the curve of 0.94 for diagnosing acute aortic dissection, suggesting it may help rule out aortic dissection early in presentation.
Effortles Trial
1. The EFFORTLESS study evaluated the outcomes of 331 patients implanted with a subcutaneous implantable cardioverter-defibrillator (S-ICD) over 6 months.
2. Complication rates were low, with the most common being inappropriate shocks for oversensing and discomfort, occurring in 1.1% and 0.8% respectively.
3. The S-ICD effectively provided appropriate therapy for ventricular arrhythmias in 10.6% of patients, with a high rate of conversion to sinus rhythm within 5 shocks. Inappropriate shocks occurred in 8.1% of patients over the first year.
linkedinCDIfundamentals
The principal diagnosis is defined as the condition chiefly responsible for the patient's hospital admission. There are 8 basic rules for assigning the principal diagnosis, including that a definitive diagnosis takes precedence over a symptom-based code. The circumstances of admission, not the patient's presenting complaints, determine the principal diagnosis. A thorough review of the full medical record is required to identify the principal diagnosis after further evaluation.
Acute Heart Failure: Current Standards and Evolution of Care.2015
This document provides an overview of the current standards and evolution of care for acute heart failure (AHF). It summarizes the use of biomarkers like natriuretic peptides and troponins in the diagnosis and risk stratification of AHF. It discusses the clinical considerations in stratifying AHF patients, including systolic blood pressure, worsening renal function, and the distribution of left ventricular ejection fraction. The document reviews current treatment options for AHF such as diuretics, vasodilators like nitroglycerin, and nesiritide based on clinical trials and guidelines.
TDWI STL 20140306 Analytics - Leslie McIntosh
Data mining and analytics in healthcare by Leslie McIntosh from Washington University School of Medicine / BJC Healthcare at the 2014-03-06 TDWI St. Louis chapter meeting. Contact Leslie through LinkedIn (http://www.linkedin.com/pub/leslie-mcintosh/3/176/659)
VIReC CyberSeminar Series 2006 VIReC CyberSeminar Series 2006
This document summarizes a presentation on measuring outpatient healthcare use in the VA system. It discusses challenges in measurement, key VA outpatient databases, and strategies for evaluating different aspects of outpatient care use such as procedures, provider specialty, and care over time. Examples are provided from research studies analyzing VA outpatient and inpatient data to measure diabetes care and compare surgical procedures. Contact information is provided for resources at VIReC that can help with using and understanding VA administrative databases.
Start impaact june 7 2011
The document discusses the START trial, which aims to determine if initiating antiretroviral treatment (ART) earlier in HIV-infected individuals with CD4 counts above 500 cells/mm3 can reduce morbidity and mortality compared to deferring ART until the CD4 count falls below 350 cells/mm3. The START trial plans to enroll 4000 participants and randomly assign them to either immediate ART or deferred ART. The primary endpoint is AIDS or death, and secondary endpoints include non-AIDS complications. Substudies will also examine specific health outcomes. Preliminary results suggest continuous ART use is associated with decreased serious non-AIDS events.
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This study analyzed insurance claims data from before and after the implementation of the Federal Mental Health Parity and Addiction Equity Act to examine the effects of parity on substance use disorder treatment. The results showed:
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2) There was also no change in out-of-pocket spending for substance use disorder treatment users or several HEDIS quality measures related to identification and initiation of treatment.
3) This suggests that concerns about parity greatly increasing health care costs related to substance use disorder treatment were unfounded.Epstein,andy ispor poster_2013
This study analyzed insurance claims data from before and after the implementation of the Federal Mental Health Parity and Addiction Equity Act to examine the effects of parity on substance use disorder treatment. The results showed:
1) There was no change in the use of substance use disorder services or the total annual spending per enrollee on these services (which increased by only $10 per enrollee).
2) There was also no change in out-of-pocket spending for substance use disorder treatment users or several HEDIS quality measures related to identification and initiation of treatment.
3) This suggests that concerns about parity greatly increasing health care costs related to substance use disorder treatment were unfounded.
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TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Ketone bodies and metabolism-biochemistry
This slide consists of all the topics of ketone . This can be used for exam purpose for writing about Diabetic keto acidosis etc . Thank you
Identifying Major Symptoms of Slip Disc.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
The Nervous and Chemical Regulation of Respiration
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Efficacy of Avartana Sneha in Ayurveda
Avartana Sneha is a unique method of Preparation of Sneha Kalpana in Ayurveda, mainly it is indicated for the Vataja rogas.
Role of Mukta Pishti in the Management of Hyperthyroidism
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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