Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty

Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissi...
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Autor*in:	Fillingham, Yale A. [verfasserIn] Krueger, Chad A. [verfasserIn] Rondon, Alexander J. [verfasserIn] Vannello, Chris [verfasserIn] Austin, Matthew S. [verfasserIn] Courtney, P. Maxwell [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2020

Schlagwörter:	bundle buster bundled payments total hip arthroplasty total knee arthroplasty costs

Übergeordnetes Werk:	Enthalten in: The journal of arthroplasty - Orlando, Fla. : Churchill Livingstone, 1986, 35, Seite 1458-1465
Übergeordnetes Werk:	volume:35 ; pages:1458-1465

DOI / URN:	10.1016/j.arth.2020.01.036

Katalog-ID:	ELV00411972X

Internformat


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520			\|a Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs.
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700	1		\|a Krueger, Chad A. \|e verfasserin \|4 aut
700	1		\|a Rondon, Alexander J. \|e verfasserin \|4 aut
700	1		\|a Vannello, Chris \|e verfasserin \|4 aut
700	1		\|a Austin, Matthew S. \|e verfasserin \|4 aut
700	1		\|a Courtney, P. Maxwell \|e verfasserin \|4 aut
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936	b	k	\|a 44.83 \|j Rheumatologie \|j Orthopädie
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publishDate	2020
allfields	10.1016/j.arth.2020.01.036 doi (DE-627)ELV00411972X (ELSEVIER)S0883-5403(20)30073-5 DE-627 ger DE-627 rda eng 610 DE-600 44.83 bkl Fillingham, Yale A. verfasserin aut Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty 2020 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs. bundle buster bundled payments total hip arthroplasty total knee arthroplasty costs Krueger, Chad A. verfasserin aut Rondon, Alexander J. verfasserin aut Vannello, Chris verfasserin aut Austin, Matthew S. verfasserin aut Courtney, P. Maxwell verfasserin aut Enthalten in The journal of arthroplasty Orlando, Fla. : Churchill Livingstone, 1986 35, Seite 1458-1465 Online-Ressource (DE-627)326645411 (DE-600)2041553-9 (DE-576)104194421 1532-8406 nnns volume:35 pages:1458-1465 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_224 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4313 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4393 44.83 Rheumatologie Orthopädie AR 35 1458-1465
spelling	10.1016/j.arth.2020.01.036 doi (DE-627)ELV00411972X (ELSEVIER)S0883-5403(20)30073-5 DE-627 ger DE-627 rda eng 610 DE-600 44.83 bkl Fillingham, Yale A. verfasserin aut Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty 2020 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs. bundle buster bundled payments total hip arthroplasty total knee arthroplasty costs Krueger, Chad A. verfasserin aut Rondon, Alexander J. verfasserin aut Vannello, Chris verfasserin aut Austin, Matthew S. verfasserin aut Courtney, P. Maxwell verfasserin aut Enthalten in The journal of arthroplasty Orlando, Fla. : Churchill Livingstone, 1986 35, Seite 1458-1465 Online-Ressource (DE-627)326645411 (DE-600)2041553-9 (DE-576)104194421 1532-8406 nnns volume:35 pages:1458-1465 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_224 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4313 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4393 44.83 Rheumatologie Orthopädie AR 35 1458-1465
allfields_unstemmed	10.1016/j.arth.2020.01.036 doi (DE-627)ELV00411972X (ELSEVIER)S0883-5403(20)30073-5 DE-627 ger DE-627 rda eng 610 DE-600 44.83 bkl Fillingham, Yale A. verfasserin aut Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty 2020 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs. bundle buster bundled payments total hip arthroplasty total knee arthroplasty costs Krueger, Chad A. verfasserin aut Rondon, Alexander J. verfasserin aut Vannello, Chris verfasserin aut Austin, Matthew S. verfasserin aut Courtney, P. Maxwell verfasserin aut Enthalten in The journal of arthroplasty Orlando, Fla. : Churchill Livingstone, 1986 35, Seite 1458-1465 Online-Ressource (DE-627)326645411 (DE-600)2041553-9 (DE-576)104194421 1532-8406 nnns volume:35 pages:1458-1465 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_224 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4313 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4393 44.83 Rheumatologie Orthopädie AR 35 1458-1465
allfieldsGer	10.1016/j.arth.2020.01.036 doi (DE-627)ELV00411972X (ELSEVIER)S0883-5403(20)30073-5 DE-627 ger DE-627 rda eng 610 DE-600 44.83 bkl Fillingham, Yale A. verfasserin aut Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty 2020 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs. bundle buster bundled payments total hip arthroplasty total knee arthroplasty costs Krueger, Chad A. verfasserin aut Rondon, Alexander J. verfasserin aut Vannello, Chris verfasserin aut Austin, Matthew S. verfasserin aut Courtney, P. Maxwell verfasserin aut Enthalten in The journal of arthroplasty Orlando, Fla. : Churchill Livingstone, 1986 35, Seite 1458-1465 Online-Ressource (DE-627)326645411 (DE-600)2041553-9 (DE-576)104194421 1532-8406 nnns volume:35 pages:1458-1465 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_224 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4313 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4393 44.83 Rheumatologie Orthopädie AR 35 1458-1465
allfieldsSound	10.1016/j.arth.2020.01.036 doi (DE-627)ELV00411972X (ELSEVIER)S0883-5403(20)30073-5 DE-627 ger DE-627 rda eng 610 DE-600 44.83 bkl Fillingham, Yale A. verfasserin aut Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty 2020 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs. bundle buster bundled payments total hip arthroplasty total knee arthroplasty costs Krueger, Chad A. verfasserin aut Rondon, Alexander J. verfasserin aut Vannello, Chris verfasserin aut Austin, Matthew S. verfasserin aut Courtney, P. Maxwell verfasserin aut Enthalten in The journal of arthroplasty Orlando, Fla. : Churchill Livingstone, 1986 35, Seite 1458-1465 Online-Ressource (DE-627)326645411 (DE-600)2041553-9 (DE-576)104194421 1532-8406 nnns volume:35 pages:1458-1465 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_224 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2111 GBV_ILN_2112 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2147 GBV_ILN_2148 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4313 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4393 44.83 Rheumatologie Orthopädie AR 35 1458-1465
language	English
source	Enthalten in The journal of arthroplasty 35, Seite 1458-1465 volume:35 pages:1458-1465
sourceStr	Enthalten in The journal of arthroplasty 35, Seite 1458-1465 volume:35 pages:1458-1465
format_phy_str_mv	Article
bklname	Rheumatologie Orthopädie
institution	findex.gbv.de
topic_facet	bundle buster bundled payments total hip arthroplasty total knee arthroplasty costs
dewey-raw	610
isfreeaccess_bool	false
container_title	The journal of arthroplasty
authorswithroles_txt_mv	Fillingham, Yale A. @@aut@@ Krueger, Chad A. @@aut@@ Rondon, Alexander J. @@aut@@ Vannello, Chris @@aut@@ Austin, Matthew S. @@aut@@ Courtney, P. Maxwell @@aut@@
publishDateDaySort_date	2020-01-01T00:00:00Z
hierarchy_top_id	326645411
dewey-sort	3610
id	ELV00411972X
language_de	englisch
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High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. 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author	Fillingham, Yale A.
spellingShingle	Fillingham, Yale A. ddc 610 bkl 44.83 misc bundle buster misc bundled payments misc total hip arthroplasty misc total knee arthroplasty misc costs Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty
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topic_title	610 DE-600 44.83 bkl Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty bundle buster bundled payments total hip arthroplasty total knee arthroplasty costs
topic	ddc 610 bkl 44.83 misc bundle buster misc bundled payments misc total hip arthroplasty misc total knee arthroplasty misc costs
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title	Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty
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title_full	Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty
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title_sort	traditional risk factors and logistic regression failed to reliably predict a “bundle buster” after total joint arthroplasty
title_auth	Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty
abstract	Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs.
abstractGer	Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs.
abstract_unstemmed	Background: The purpose of this study was to determine if we could identify patient factors that were predictive of Medicare and privately insured patients being “high-cost.”Methods: Ninety-day episode-of-care insurance company payments along with collected demographics, comorbidities, and readmissions were reviewed for a consecutive series of primary total joint arthroplasty patients from 2015 to 2016 at our institution. High-cost patients were identified by determining those patients above the cutoff, where the cost data became demonstrably nonparametric and both univariate analysis and logistical regressions were performed to identify risk factors that lead to increased costs. Receiver operator curves were created to determine the predictive nature of these risk factors.Results: Univariate analysis showed that high-cost privately insured patients were significantly older, more likely to be readmitted and less likely to be discharged to home (P < .001) whereas high-cost Medicare total knee/total hip arthroplasty patients were more likely to have many of the comorbidities analyzed. Logistical regression did not find any predictive factors for privately insured patients and found that diabetes (OR 1.47 and 1.75, respectively), congestive heart failure (OR 1.94 and 3.46, respectively), cerebrovascular event (OR 2.20 and 2.20, respectively) and rheumatic disease (OR 1.78 and 1.78, respectively) were all predictive of being a high-cost Medicare patient.Conclusion: Traditional risk factors for postoperative complications are not reliably associated with increased patient costs after total hip and total knee arthroplasty. Furthermore, the risk factors associated with increased costs vary greatly between privately insured and Medicare-insured patients. Further investigation is necessary to identify cost drivers in this patient subset to preventive higher costs.
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title_short	Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty
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author2	Krueger, Chad A. Rondon, Alexander J. Vannello, Chris Austin, Matthew S. Courtney, P. Maxwell
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up_date	2024-07-06T21:55:00.354Z
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Traditional Risk Factors and Logistic Regression Failed to Reliably Predict a “Bundle Buster” After Total Joint Arthroplasty

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