In each hospital-year, we calculated a 30-day unplanned. readmission rate among patients who survived at least 30 days
|
|
- Cecil Walton
- 5 years ago
- Views:
Transcription
1 Romley JA, Goldman DP, Sood N. US hospitals experienced substantial productivity growth during Health Aff (Millwood). 2015;34(3). Published online February 11, Appendix
2 Adjusting hospital output for readmissions In each hospital-year, we calculated a 30-day unplanned readmission rate among patients who survived at least 30 days beyond their admission, and multiplied the number of survivors by the value of one minus the calculated rate. In calculating readmission rates, we followed the methodology used by CMS for quality reporting, which was developed by the Yale New Haven Health Services Corporation / Center for Outcomes Research & Evaluation.(1) Rates were calculated independently for heart attack, heart failure, and pneumonia. For each condition, index admissions with the corresponding primary diagnosis were identified. Admissions within 30 days of an index admission did not qualify as additional index admissions. Unplanned readmissions within 30 days of discharge from an index admission were then identified. Readmissions for certain treatments (such as chemotherapy) were defined to be planned; other readmissions were defined as potentially planned, and then adjudicated to have been planned if the primary diagnosis of the readmission was neither acute nor a complication of care. Diagnoses were characterized by Clinical Classification Software developed by the Agency for Healthcare Research and Quality and, in some cases, by specific ICD-9-CM codes. Where multiple hospitalizations occurred within 30 days of an index admission, the index admission was defined as not having a readmission if and only if the first subsequent admission was planned, regardless of the nature of the other 2
3 subsequent admissions. An index admission was excluded from the readmission rate (that is, from both the numerator and denominator of the measure) if there was a transfer to another acute-care hospital, as defined by an admission to another hospital within one day of discharge from the index admission; admissions for the same index diagnosis to the same index hospital on the same day as discharge were treated similarly. The study cohorts described in Appendix Exhibit 1 were used consistently across the productivity analyses. Comparing productivity estimates across analyses To compare productivity estimates (for example, unadjusted versus severity-adjusted), we estimated the standard error of the difference in estimates based on the bootstrapped distribution of the differences from 250 sets of regressions. In the bootstrapping, sampling was done at the hospital level to allow for correlation within hospitals over time. 3
4 Appendix Exhibit 1: Cohort Selection Criteria for Heart Attack 4
5 Appendix Exhibit 2: Cohort Selection Criteria for Heart Failure 5
6 Appendix Exhibit 3: Cohort Selection Criteria for Pneumonia 6
7 Appendix Exhibit 3, Continued 7
8 Appendix Exhibit 4: Costs per Stay Costs per Stay (Thousands of $2012) Heart attack Heart failure Pneumonia Note: Costs per stay are adjusted for geographic differences in wages and general inflation in the cost of hospital care over time. 8
9 Appendix Exhibit 5: Trends in Selected Measures of Patient Demographics and Severity of Illness at Admission >1 indicates increasing trend Age, Sex and Race / Ethnicity >1 indicates increasing trend Comorbidities and Inpatient Mortality Risk 9
10 Appendix Exhibit 6: Rate of Survival with No Unplanned Readmissions Rate of Survival with No Unplanned Readmissions (%) Heart attack Heart failure Pneumonia 10
11 Appendix Exhibit 7: Medicare Payment per Stay Medicare Payment per Stay (Thousands of $2012) Heart attack Heart failure Pneumonia Note: Medicare payment per stay is adjusted for inflation in the economy over time. 11
12 Appendix Exhibit 8: Sensitivity Analysis Using Elixhauser Comorbidities and Adjusting for Proportions of Patients Admitted through Emergency Department or Transferred from Another Hospital 12
13 Appendix Exhibit 9: Summary Statistics for Study Cohorts Heart attack Heart failure Pneumonia Patient stays, n 403, , ,623 Hospitals, n 3,315 3,621 3,675 Year of admission Adjusted cost per stay (2012 dollars) $18,762 $10,017 $8, day survival with no unplanned readmissions 78.7% 71.8% 77.4% Teaching hospital 4.4% 3.4% 2.5% AHRQ predicted inpatient mortality 10.7% 4.5% 6.1% Location of heart attack: Anterolateral (410.0x) 2.2% Location of heart attack: Other Anterior Wall (410.1x) 8.6% Location of heart attack: Inferolateral Wall (410.2x) 1.8% Location of heart attack: Inferoposterior Wall (410.3x) 1.2% Location of heart attack: Other Inferior Wall (410.4x) 10.5% Location of heart attack: Other Lateral Wall (410.5x) 1.3% Location of heart attack: True Posterior Wall (410.6x) 0.3% Location of heart attack: Sub-Endocardial (410.7x) 65.7% Location of heart attack: Other Specified Sites (410.8x) 1.6% Location of heart attack: Unspecified site (410.9x) 6.7% No Charlson-Deyo comorbidities 0.0% 1.3% 17.9% 1 Charlson-Deyo comorbidity 28.1% 26.1% 38.4% 2 Charlson-Deyo comorbidities 36.8% 41.0% 29.3% 3 Charlson-Deyo comorbidities 25.0% 24.6% 11.8% 4 Charlson-Deyo comorbidities 8.6% 6.3% 2.3% 5+ Charlson-Deyo comorbidities 1.5% 0.8% 0.2% Age Female 49.4% 56.7% 55.0% African American 7.8% 13.0% 7.9% Hispanic 1.5% 2.0% 1.9% Other race 3.0% 2.6% 3.1% Patient zip code characteristics Median household income ($000) Social Security income ($000) Poor 12.3% 13.1% 12.7% Employed 58.3% 57.9% 58.3% Less than high school education 20.3% 21.2% 20.8% Urban 71.3% 74.5% 71.7% Hispanic 8.6% 9.5% 9.2% Single 42.0% 43.1% 42.2% Elderly in an institution 4.6% 4.6% 4.8% Non-institutionalized elderly with physical disability 29.5% 30.0% 30.0% Sensory disability among elderly 12.3% 13.1% 12.7% Mental disability 11.0% 11.4% 11.4% Self-care disability 9.8% 10.1% 10.0% Difficulty going-outside-the-home disability 20.6% 21.3% 20.9% Notes: Statistics are means unless otherwise indicated; all statistics calculated at the patient stay level. For heart-attack locations, ICD-9-CM diagnosis codes appear in parentheses. AHRQ = Agency for Healthcare Research and Quality. 13
14 Appendix Exhibit 10: Trends in Patient Characteristics Condition Heart attack Heart failure Pneumonia Variable Mean, 2002 Mean, 2011 Ratio Mean, 2002 Mean, 2011 Ratio Mean, 2002 Mean, 2011 Ratio Teaching hospital 4.4% 4.0% % 3.4% % 2.5% AHRQ predicted inpatient mortality 9.9% 11.9% % 6.6% % 8.6% Location of heart attack: Anterolateral (410.0x) 2.6% 1.7% Location of heart attack: Other Anterior Wall (410.1x) 10.7% 6.6% Location of heart attack: Inferolateral Wall (410.2x) 2.1% 1.6% Location of heart attack: Inferoposterior Wall (410.3x) 1.6% 1.0% Location of heart attack: Other Inferior Wall (410.4x) 12.2% 9.1% Location of heart attack: Other Lateral Wall (410.5x) 1.4% 1.0% Location of heart attack: True Posterior Wall (410.6x) 0.4% 0.3% Location of heart attack: Sub-Endocardial (410.7x) 58.8% 73.6% Location of heart attack: Other Specified Sites (410.8x) 1.9% 0.5% Location of heart attack: Unspecified site (410.9x) 8.3% 4.5% No Charlson-Deyo comorbidities 0.0% 0.0% 3.2% 0.1% % 18.3% Charlson-Deyo comorbidity 29.7% 27.5% % 21.8% % 36.6% Charlson-Deyo comorbidities 37.3% 36.0% % 39.8% % 28.9% Charlson-Deyo comorbidities 24.2% 24.7% % 28.5% % 12.9% Charlson-Deyo comorbidities 7.5% 9.9% % 8.6% % 2.9% Charlson-Deyo comorbidities 1.3% 1.9% % 1.2% % 0.4% Age Female 50.3% 47.6% % 55.3% % 55.0% African American 7.4% 8.4% % 12.7% % 7.8% Hispanic 1.5% 1.5% % 1.9% % 2.0% Other race 2.6% 3.4% % 3.0% % 3.3% Patient zip code characteristics Median household income ($000) Social Security income ($000) Poor 12.4% 12.1% % 12.5% % 12.3% Employed 58.2% 58.4% % 58.4% % 58.7% Less than high school education 20.4% 20.2% % 20.5% % 20.4% Urban 72.0% 70.1% % 74.1% % 71.4% Hispanic 8.6% 8.7% % 9.3% % 9.2% Single 42.4% 41.5% % 42.5% % 41.8% Elderly in an institution 4.6% 4.5% % 4.5% % 4.8% Non-institutionalized elderly with physical disability 29.5% 29.6% % 29.7% % 29.8% Sensory disability among elderly 12.4% 12.1% % 14.5% % 14.8% Mental disability 11.0% 11.1% % 11.3% % 11.3% Self-care disability 9.8% 9.8% % 10.0% % 9.9% Difficulty going-outside-the-home disability 20.6% 20.6% % 20.9% % 20.8% Notes: Means calculated at the patient stay level. For heart-attack locations, ICD-9-CM diagnosis codes appear in parentheses. AHRQ = Agency for Healthcare Research and Quality. 14
15 Appendix Exhibit 11: Regression Results for Log of the Number of Survivors without Unplanned Readmissions Divided by Total Costs, Heart Attack Patient Cohort Output Hospital stays Hospital stays Survivors without unplanned readmissions Parameter Estimate (Standard Error) Constant *** (0.008) *** (1.09) *** (1.10) Year of admission *** (0.001) *** (0.001) 0.008*** (0.001) Teaching hospital -0.10*** (0.03) -0.10*** (0.03) AHRQ predicted inpatient mortality risk, logged 0.11* (0.06) -1.19*** (0.06) Location of heart attack: Anterolateral (410.0x) -0.72*** (0.07) -0.67*** (0.07) Location of heart attack: Other Anterior Wall (410.1x) -0.71*** (0.04) -0.54*** (0.05) Location of heart attack: Inferolateral Wall (410.2x) -0.57*** (0.07) -0.39*** (0.08) Location of heart attack: Inferoposterior Wall (410.3x) -0.96*** (0.09) -0.69*** (0.10) Location of heart attack: Other Inferior Wall (410.4x) -0.82*** (0.04) -0.59*** (0.04) Location of heart attack: Other Lateral Wall (410.5x) -0.47*** (0.08) -0.34*** (0.09) Location of heart attack: True Posterior Wall (410.6x) -0.89*** (0.15) -0.55*** (0.16) Location of heart attack: Sub-Endocardial (410.7x) -0.41*** (0.03) -0.19*** (0.03) Location of heart attack: Other Specified Sites (410.8x) -0.28*** (0.06) -0.19*** (0.06) 1 Charlson-Deyo comorbidity 2 Charlson-Deyo comorbidities *** (0.0002) *** (0.0002) 3 Charlson-Deyo comorbidities *** (0.0002) (0.0003) 4 Charlson-Deyo comorbidities *** (0.0003) *** (0.0004) 5+ Charlson-Deyo comorbidities 0.005*** (0.001) 0.002*** (0.001) Age, logged 4.20*** (0.09) 3.33*** (0.09) Female patients *** (0.0002) *** (0.0002) African American patients *** (0.0005) *** (0.0005) Hispanic patients (0.0008) (0.0008) Other non-white patients (0.0005) (0.0005) Zip code characteristics Median household income ($000) (0.06) (0.06) Social Security income ($000) (0.11) (0.11) Poor residents (0.04) (0.03) Employed residents (0.06) 0.03 (0.05) Less than high school education 0.11*** (0.03) 0.08*** (0.03) Urban -0.09*** (0.02) -0.09*** (0.02) Hispanic (0.01) 0.00 (0.01) Single -0.19*** (0.07) -0.18*** (0.07) Elderly in an institution ( ) ( ) Non-institutionalized elderly with physical disability 0.02 (0.07) 0.01 (0.07) Sensory disability 0.23*** (0.05) 0.23*** (0.05) Mental disability (0.04) (0.04) Self-care disability -0.10*** (0.04) -0.10*** (0.04) Difficulty going-outside-the-home disability -0.10* (0.06) -0.11* (0.06) Other Statistics Hospital-years, n R squared , Equality of year parameter, relative to prior column < Notes: Unit of analysis is the hospital-year. Standard errors clustered at the hospital-level. * indicates statistical significance at the 10% level, ** at the 5% level, and *** at the 1% level. For linear time trend, 2002 is year 0. All covariates are percentages from 0-100, unless otherwise noted. Zip code characteristics are logged, except for the percentage of elderly living in an institution. For heart-attack locations, ICD-9-CM diagnosis codes appear in parentheses. Equality of year parameter based on bootstrapped standard error for difference (250 draws). AHRQ = Agency for Healthcare Research and Quality. 15
16 Appendix Exhibit 12: Regression Results for Log of the Number of Survivors without Unplanned Readmissions Divided by Total Costs, Heart Failure Patient Cohort Output Hospital stays Hospital stays Survivors without unplanned readmissions Parameter Estimate (Standard Error) Constant *** (0.007) *** (1.44) *** (1.47) Year of admission *** (0.001) *** (0.001) 0.006*** (0.001) Teaching hospital -0.15*** (0.04) -0.16*** (0.03) AHRQ predicted inpatient mortality risk, logged -2.97*** (0.17) -3.92*** (0.17) Location of heart attack: Anterolateral (410.0x) Location of heart attack: Other Anterior Wall (410.1x) Location of heart attack: Inferolateral Wall (410.2x) Location of heart attack: Inferoposterior Wall (410.3x) Location of heart attack: Other Inferior Wall (410.4x) Location of heart attack: Other Lateral Wall (410.5x) Location of heart attack: True Posterior Wall (410.6x) Location of heart attack: Sub-Endocardial (410.7x) Location of heart attack: Other Specified Sites (410.8x) 1 Charlson-Deyo comorbidity (0.0011) (0.0011) 2 Charlson-Deyo comorbidities *** (0.0010) (0.0011) 3 Charlson-Deyo comorbidities *** (0.0010) (0.0011) 4 Charlson-Deyo comorbidities *** (0.0011) *** (0.0011) 5+ Charlson-Deyo comorbidities 0.007*** (0.001) 0.004*** (0.002) Age, logged 3.08*** (0.13) 2.52*** (0.13) Female patients *** (0.0003) *** (0.0003) African American patients *** (0.0004) *** (0.0004) Hispanic patients (0.0010) (0.0009) Other non-white patients *** (0.0006) *** (0.0006) Zip code characteristics Median household income ($000) (0.06) -0.13*** (0.06) Social Security income ($000) -0.18* (0.10) -0.21*** (0.10) Poor residents *** (0.04) *** (0.04) Employed residents -0.16*** (0.06) (0.06) Less than high school education 0.19*** (0.03) 0.18*** (0.03) Urban -0.11*** (0.02) -0.10*** (0.02) Hispanic -0.02*** (0.01) -0.01*** (0.01) Single -0.30*** (0.07) -0.30*** (0.07) Elderly in an institution ( ) ( ) Non-institutionalized elderly with physical disability 0.12 (0.08) 0.05 (0.08) Sensory disability 0.26*** (0.05) 0.31*** (0.05) Mental disability (0.04) (0.04) Self-care disability -0.10*** (0.04) -0.10*** (0.04) Difficulty going-outside-the-home disability -0.16*** (0.06) -0.19*** (0.06) Other Statistics Hospital-years, n R squared , Equality of year parameter, relative to prior column < < Notes: Unit of analysis is the hospital-year. Standard errors clustered at the hospital-level. * indicates statistical significance at the 10% level, ** at the 5% level, and *** at the 1% level. For linear time trend, 2002 is year 0. All covariates are percentages from 0-100, unless otherwise noted. Zip code characteristics are logged, except for the percentage of elderly living in an institution. For heart-attack locations, ICD-9-CM diagnosis codes appear in parentheses. Equality of year parameter based on bootstrapped standard error for difference (250 draws). AHRQ = Agency for Healthcare Research and Quality. 16
17 Appendix Exhibit 13: Regression Results for Log of the Number of Survivors without Unplanned Readmissions Divided by Total Costs, Pneumonia Patient Cohort Output Hospital stays Hospital stays Survivors without unplanned readmissions Parameter Estimate (Standard Error) Constant *** (0.005) *** (0.89) *** (0.95) Year of admission *** (0.001) 0.008*** (0.001) 0.019*** (0.001) Teaching hospital (0.03) (0.03) AHRQ predicted inpatient mortality risk, logged -2.83*** (0.07) -3.81*** (0.08) Location of heart attack: Anterolateral (410.0x) Location of heart attack: Other Anterior Wall (410.1x) Location of heart attack: Inferolateral Wall (410.2x) Location of heart attack: Inferoposterior Wall (410.3x) Location of heart attack: Other Inferior Wall (410.4x) Location of heart attack: Other Lateral Wall (410.5x) Location of heart attack: True Posterior Wall (410.6x) Location of heart attack: Sub-Endocardial (410.7x) Location of heart attack: Other Specified Sites (410.8x) 1 Charlson-Deyo comorbidity *** (0.0002) *** (0.0002) 2 Charlson-Deyo comorbidities *** (0.0002) *** (0.0003) 3 Charlson-Deyo comorbidities *** (0.0003) *** (0.0003) 4 Charlson-Deyo comorbidities *** (0.0005) *** (0.0006) 5+ Charlson-Deyo comorbidities (0.002) * (0.002) Age, logged 0.88*** (0.08) 0.35*** (0.09) Female patients * (0.0002) (0.0002) African American patients (0.0003) * (0.0003) Hispanic patients *** (0.0007) (0.0007) Other non-white patients *** (0.0006) *** (0.0007) Zip code characteristics Median household income ($000) -0.30*** (0.04) -0.37*** (0.05) Social Security income ($000) -0.15* (0.08) -0.16*** (0.08) Poor residents *** (0.03) *** (0.03) Employed residents (0.04) 0.07* (0.04) Less than high school education 0.07*** (0.02) 0.03* (0.02) Urban -0.04*** (0.02) -0.03*** (0.02) Hispanic -0.02*** (0.00) -0.01*** (0.00) Single 0.04 (0.05) 0.03 (0.05) Elderly in an institution ( ) ( ) Non-institutionalized elderly with physical disability (0.05) (0.06) Sensory disability 0.22*** (0.04) 0.26*** (0.04) Mental disability (0.03) (0.03) Self-care disability -0.06* (0.03) -0.07*** (0.03) Difficulty going-outside-the-home disability (0.05) (0.05) Other Statistics Hospital-years, n R squared , Equality of year parameter, relative to prior column < < Notes: Unit of analysis is the hospital-year. Standard errors clustered at the hospital-level. * indicates statistical significance at the 10% level, ** at the 5% level, and *** at the 1% level. For linear time trend, 2002 is year 0. All covariates are percentages from 0-100, unless otherwise noted. Zip code characteristics are logged, except for the percentage of elderly living in an institution. For heart-attack locations, ICD-9-CM diagnosis codes appear in parentheses. Equality of year parameter based on bootstrapped standard error for difference (250 draws). AHRQ = Agency for Healthcare Research and Quality. 17
18 References 1. Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation Measures Updates and Specifications Report: Hospital-Level 30-Day Risk-Standardized Readmission Measures for Acute Myocardial Infarction, Heart Failure, and Pneumonia (Version 6.0)
APPENDIX EXHIBITS. Appendix Exhibit A2: Patient Comorbidity Codes Used To Risk- Standardize Hospital Mortality and Readmission Rates page 10
Ross JS, Bernheim SM, Lin Z, Drye EE, Chen J, Normand ST, et al. Based on key measures, care quality for Medicare enrollees at safety-net and non-safety-net hospitals was almost equal. Health Aff (Millwood).
More informationHu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: evidence from an urban teaching hospital. Health Aff (Millwood). 2014;33(5).
Appendix Definitions of Index Admission and Readmission Definitions of index admission and readmission follow CMS hospital-wide all-cause unplanned readmission (HWR) measure as far as data are available.
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Bucholz EM, Butala NM, Ma S, Normand S-LT, Krumholz HM. Life
More informationAppendix Identification of Study Cohorts
Appendix Identification of Study Cohorts Because the models were run with the 2010 SAS Packs from Centers for Medicare and Medicaid Services (CMS)/Yale, the eligibility criteria described in "2010 Measures
More informationHeart Attack Readmissions in Virginia
Heart Attack Readmissions in Virginia Schroeder Center Statistical Brief Research by Mitchell Cole, William & Mary Public Policy, MPP Class of 2017 Highlights: In 2014, almost 11.2 percent of patients
More informationNATIONAL QUALITY FORUM
TO: NQF Members and Public FR: NQF Staff RE: Pre-comment review of an addendum to National Voluntary Consensus Standards: Cardiovascular Endorsement Maintenance 2010: A Consensus Report DA: October 6,
More informationComparison of Medicare Fee-for-Service Beneficiaries Treated in Ambulatory Surgical Centers and Hospital Outpatient Departments
Comparison of Medicare Fee-for-Service Beneficiaries Treated in Ambulatory Surgical Centers and Hospital Outpatient Departments Prepared for: American Hospital Association April 4, 2019 Berna Demiralp,
More informationSupplementary figures and tables. Figure A: Study schematic
Supplementary figures and tables Figure A: Study schematic Figure B: Percent of patients with a normal (green), borderline (beige), abnormal (brown), or high (red) electrocardiogram 14-90 days after prescription
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARD FOR HOSPITAL CARE. Measure Information Form Collected For: CMS Outcome Measures (Claims Based)
Last Updated: Version 4.3 NQF-ENDORSED VOLUNTARY CONSENSUS STANDARD FOR HOSPITAL CARE Measure Information Form Collected For: CMS Outcome Measures (Claims Based) Measure Set: CMS Readmission Measures Set
More informationExploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications
MWSUG 2017 - Paper DG02 Exploring the Relationship Between Substance Abuse and Dependence Disorders and Discharge Status: Results and Implications ABSTRACT Deanna Naomi Schreiber-Gregory, Henry M Jackson
More informationMEDCODE READCODE READTERM
Supplementary Table 1A. Codes used to identify MI events in the CPRD MEDCODE READCODE READTERM 241 G30..00 Acute myocardial infarction 13566 G30..11 Attack - heart 2491 G30..12 Coronary thrombosis 30421
More informationSupplementary Online Content
Supplementary Online Content Lee JS, Nsa W, Hausmann LRM, et al. Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010. JAMA Intern Med. Published online September
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE. Measure Information Form Collected For: CMS Outcome Measures (Claims Based)
Last Updated: Version 4.3 NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE Measure Information Form Collected For: CMS Outcome Measures (Claims Based) Measure Set: CMS Mortality Measures Set
More informationEpidemiology of Asthma. In Wayne County, Michigan
Epidemiology of Asthma In Wayne County, Michigan Elizabeth Wasilevich, MPH Asthma Epidemiologist Bureau of Epidemiology Michigan Department of Community Health 517.335.8164 Publication Date: August 2005
More informationChapter 5: Acute Kidney Injury
Chapter 5: Acute Kidney Injury Introduction In recent years, acute kidney injury (AKI) has gained increasing recognition as a major risk factor for the development of chronic kidney disease (CKD). The
More informationHierarchical Generalized Linear Models for Behavioral Health Risk-Standardized 30-Day and 90-Day Readmission Rates
Hierarchical Generalized Linear Models for Behavioral Health Risk-Standardized 30-Day and 90-Day Readmission Rates Allen Hom PhD, Optum, UnitedHealth Group, San Francisco, California Abstract The Achievements
More informationhad non-continuous enrolment in Medicare Part A or Part B during the year following initial admission;
Effectiveness and cost-effectiveness of implantable cardioverter defibrillators in the treatment of ventricular arrhythmias among Medicare beneficiaries Weiss J P, Saynina O, McDonald K M, McClellan M
More informationCategory Code Procedure description
Supplemental Table 1: ICD-9 codes for procedures/surgeries Category Code Procedure description Cesarean 74 Cesarean Section And Removal Of Fetus Cesarean 74.0 Classical cesarean section Cesarean 74.1 Low
More informationSupplementary Online Content
Supplementary Online Content Valley TS, Sjoding MW, Ryan AM, Iwashyna TJ, Cooke CR. Association of intensive care unit admission with mortality among older patients with pneumonia. JAMA. doi:10.1001/jama.2015.11068.
More informationAPPENDIX: Supplementary Materials for Advance Directives And Nursing. Home Stays Associated With Less Aggressive End-Of-Life Care For
Nicholas LH, Bynum JPW, Iwashnya TJ, Weir DR, Langa KM. Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia. Health Aff (MIllwood).
More information2016 Condition-Specific Measures Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Readmission Measures
2016 Condition-Specific Measures Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Readmission Measures Acute Myocardial Infarction Version 9.0 Chronic Obstructive Pulmonary Disease
More informationUnplanned Hospitalizations and Readmissions among Elderly Patients with GI Cancer
Unplanned Hospitalizations and Readmissions among Elderly Patients with GI Cancer September 19, 2014 Joanna-Grace M. Manzano, MD Assistant Professor Department of General Internal Medicine UT MD Anderson
More informationSupplementary Online Content
Supplementary Online Content Callaghan B, McCammon R, Kerber K, Xu X, Langa KM, Feldman E. Tests and expenditures in the initial evaluation of peripheral neuropathy. Arch Intern Med. 2012;172(2):127-132.
More informationTOTAL HIP AND KNEE REPLACEMENTS. FISCAL YEAR 2002 DATA July 1, 2001 through June 30, 2002 TECHNICAL NOTES
TOTAL HIP AND KNEE REPLACEMENTS FISCAL YEAR 2002 DATA July 1, 2001 through June 30, 2002 TECHNICAL NOTES The Pennsylvania Health Care Cost Containment Council April 2005 Preface This document serves as
More informationEpidemiology of Asthma. In the Western Michigan Counties of. Kent, Montcalm, Muskegon, Newaygo, and Ottawa
Epidemiology of Asthma In the Western Michigan Counties of Kent, Montcalm, Muskegon, Newaygo, and Ottawa Elizabeth Wasilevich, MPH Asthma Epidemiologist Bureau of Epidemiology Michigan Department of Community
More informationSupplementary Online Content
Supplementary Online Content Dharmarajan K, Wang Y, Lin Z, et al. Association of changing hospital readmission rates with mortality rates after hospital discharge. JAMA. doi:10.1001/jama.2017.8444 etable
More informationKey Findings. Mortality Rates
Mortality Rates Statewide in-hospital mortality rates showed a statistically significant decrease from federal fiscal year to federal fiscal year in 12 of the 15 conditions reported. The largest decrease
More informationDOES PROCESS QUALITY OF INPATIENT CARE MATTER IN POTENTIALLY PREVENTABLE READMISSION RATES?
DOES PROCESS QUALITY OF INPATIENT CARE MATTER IN POTENTIALLY PREVENTABLE READMISSION RATES? A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY Jae Young Choi,
More informationTECHNICAL NOTES. for Spinal Fusion. June 2016
TECHNICAL NOTES for Spinal Fusion June 2016 Pennsylvania Health Care Cost Containment Council Report Period: Calendar Year 2014 January 1, 2014 through December 31, 2014 Discharges 225 Market Street, Suite
More informationMedicare Quality Monitoring System (MQMS) Report: Pneumonia,
Contract No.: GS-10F-0050L Task Order No.: CMS-02-01175 MPR Reference No.: 8908-150 Medicare Quality Monitoring System (MQMS) Report: Pneumonia, 1992-2002 Final Report August 2004 Robert Schmitz, Ph.D.
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Prada D, Zhong J, Colicino E, et al. Association
More informationInpatient Psychiatric Facilities
Payment Integrity Compass Inpatient Psychiatric Facilities Understanding IPF Calculations Updated 12/05/12 2 Questions from the Group Please use GoToMeeting to Ask a Question Use the Raise Hand function
More informationChapter 3: Morbidity and Mortality
Chapter 3: Morbidity and Mortality Introduction In this chapter we evaluate the morbidity and mortality of chronic kidney disease (CKD) patients continuously enrolled in Medicare. Each year s analysis
More informationNBER WORKING PAPER SERIES IDENTIFYING THE HEALTH PRODUCTION FUNCTION: THE CASE OF HOSPITALS. John A. Romley Neeraj Sood
NBER WORKING PAPER SERIES IDENTIFYING THE HEALTH PRODUCTION FUNCTION: THE CASE OF HOSPITALS John A. Romley Neeraj Sood Working Paper 19490 http://www.nber.org/papers/w19490 NATIONAL BUREAU OF ECONOMIC
More informationSupplementary Online Content
Supplementary Online Content Khera R, Dharmarajan K, Wang Y, et al. Association of the hospital readmissions reduction program with mortality during and after hospitalization for acute myocardial infarction,
More informationYale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE)
701 Pennsylvania Avenue, Ste. 800 Washington, DC 20004 2654 Tel: 202 783 8700 Fax: 202 783 8750 www.advamed.org July 8, 2011 Yale New Haven Health Services Corporation/Center for Outcomes Research and
More informationNew York State Department of Health Center for Environmental Health
New York State Department of Health Center for Environmental Health March 2002 Evaluation of Asthma and Other Respiratory Hospital Admissions among Residents of ZIP Codes 14043 and 14227, Cheektowaga,
More informationMENTAL HEALTH INDICATORS: WITHIN 30-DAY HOSPITAL RE-ADMISSION
MENTAL HEALTH INDICATORS: WITHIN 30-DAY HOSPITAL RE-ADMISSION OECD HCQI Expert Meeting Rie Fujisawa November 16 th 2012 Within 30-day hospital re-admission Data are collected in two different ways: The
More informationAshwini S Erande MPH, Shaista Malik MD University of California Irvine, Orange, California
The Association of Morbid Obesity with Mortality and Coronary Revascularization among Patients with Acute Myocardial Infarction using ARRAYS, PROC FREQ and PROC LOGISTIC ABSTRACT Ashwini S Erande MPH,
More informationPublicly Reported Quality Measures
Publicly Reported Quality Measures Five-Star Quality Rating System As part of the initiative to add five-star quality ratings to its Compare Web sites, the Centers for Medicare & Medicaid Services (CMS)
More informationThe Association of Morbid Obesity with Mortality and Coronary Revascularization among Patients with Acute Myocardial Infarction
PharmaSUG 2014 - Paper HA06 The Association of Morbid Obesity with Mortality and Coronary Revascularization among Patients with Acute Myocardial Infarction ABSTRACT Ashwini S Erande MPH University Of California
More informationTechnical appendix: The impact of integrated care teams on hospital use in North East Hampshire and Farnham
Improvement Analytics Unit September 2018 Technical appendix: The impact of integrated care teams on hospital use in North East Hampshire and Farnham Therese Lloyd, Richard Brine, Rachel Pearson, Martin
More informationBaseline Health Data Report: Cambria and Somerset Counties, Pennsylvania
Baseline Health Data Report: Cambria and Somerset Counties, Pennsylvania 2017 2018 Page 1 Table of Contents Executive Summary.4 Demographic and Economic Characteristics 6 Race and Ethnicity (US Census,
More informationRegional Density Of Cardiologists And Mortality For Acute Myocardial Infarction And Heart Failure
Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine January 2014 Regional Density Of Cardiologists And Mortality For Acute
More informationHEALTH CARE EXPENDITURES ASSOCIATED WITH PERSISTENT EMERGENCY DEPARTMENT USE: A MULTI-STATE ANALYSIS OF MEDICAID BENEFICIARIES
HEALTH CARE EXPENDITURES ASSOCIATED WITH PERSISTENT EMERGENCY DEPARTMENT USE: A MULTI-STATE ANALYSIS OF MEDICAID BENEFICIARIES Presented by Parul Agarwal, PhD MPH 1,2 Thomas K Bias, PhD 3 Usha Sambamoorthi,
More informationRecognition of Complications After Pancreaticoduodenectomy for Cancer Determines Inpatient Mortality
ORIGINAL ARTICLE Recognition of Complications After Pancreaticoduodenectomy for Cancer Determines Inpatient Mortality Evan S Glazer 1, Albert Amini 1, Tun Jie 1, Rainer WG Gruessner 1, Robert S Krouse
More informationCIHI s Population Grouping Methodology: Beyond Predicting Costs
CIHI s Population Grouping Methodology: Beyond Predicting Costs Yvonne Rosehart Canadian Institute for Health Information October 12, 2017 yrosehart@cihi.ca cihi.ca @cihi_icis CIHI s Population Grouping
More informationFocus on Heart Attack in Pennsylvania. Research Methods and Results
Focus on Heart Attack in Pennsylvania Research Methods and Results The Pennsylvania Health Care Cost Containment Council April 1996 2 TABLE OF CONTENTS Methodology and Research for In-hospital Mortality...
More informationThe Cost Burden of Worsening Heart Failure in the Medicare Fee For Service Population: An Actuarial Analysis
Client Report Milliman Client Report The Cost Burden of Worsening Heart Failure in the Medicare Fee For Service Population: An Actuarial Analysis Prepared by Kathryn Fitch, RN, MEd Principal and Healthcare
More informationJUSTUS WARREN TASK FORCE MEETING DECEMBER 05, 2012
SAMUEL TCHWENKO, MD, MPH Epidemiologist, Heart Disease & Stroke Prevention Branch Chronic Disease & Injury Section; Division of Public Health NC Department of Health & Human Services JUSTUS WARREN TASK
More informationA COMPREHENSIVE REPORT ISSUED BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS IN PARTNERSHIP WITH:
A COMPREHENSIVE REPORT ISSUED BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS IN PARTNERSHIP WITH: Amputee Coalition of America Mended Hearts National Federation of the Blind National Kidney Foundation
More informationHospital Discharge Data
Hospital Discharge Data West Virginia Health Care Authority Hospitalization data were obtained from the West Virginia Health Care Authority s (WVHCA) hospital discharge database. Data are submitted by
More informationPHPG. Utilization and Expenditure Analysis for Dually Eligible SoonerCare Members with Chronic Conditions
PHPG The Pacific Health Policy Group Utilization and Expenditure Analysis for Dually Eligible SoonerCare Members with Chronic Conditions Prepared for: State of Oklahoma Oklahoma Health Care Authority April
More informationDemographics and Health Data
Demographics and Health Data Information for Local Planners City of Puyallup, WA Demographic Characteristics Environmental Health Division 3629 South D Street, Tacoma, WA 98418 (253) 798-6470 Table 1 presents
More informationTable S1: Diagnosis and Procedure Codes Used to Ascertain Incident Hip Fracture
Technical Appendix Table S1: Diagnosis and Procedure Codes Used to Ascertain Incident Hip Fracture and Associated Surgical Treatment ICD 9 Code Descriptions Hip Fracture 820.XX Fracture neck of femur 821.XX
More informationDemographics and Health Data
Demographics and Health Data Information for Local Planners City of Lakewood, WA Demographic Characteristics Environmental Health Division 3629 South D Street, Tacoma, WA 98418 (253) 798-6470 Table 1 presents
More informationThe Pennsylvania State University. The Graduate School. Department of Public Health Sciences
The Pennsylvania State University The Graduate School Department of Public Health Sciences THE LENGTH OF STAY AND READMISSIONS IN MASTECTOMY PATIENTS A Thesis in Public Health Sciences by Susie Sun 2015
More informationUtilization of Cardiac Rehabilitation in Medicare
Chapter 7 Utilization of Cardiac Rehabilitation in Medicare Jose A. Suaya, MD, PhD, MBA, MPH Donald S. Shepard, PhD William B. Stason, MD, MSci This chapter describes a study that measures important predictors
More informationPublicly Reported Quality Measures
Publicly Reported Quality Measures Five-Star Quality Rating System As part of the initiative to add five-star quality ratings to its Compare Web sites, the Centers for Medicare & Medicaid Services (CMS)
More informationFunctional Outcomes among the Medically Complex Population
Functional Outcomes among the Medically Complex Population Paulette Niewczyk, PhD, MPH Director of Research Uniform Data System for Medical Rehabilitation 2015 Uniform Data System for Medical Rehabilitation,
More informationTechnical Notes for PHC4 s Report on CABG and Valve Surgery Calendar Year 2005
Technical Notes for PHC4 s Report on CABG and Valve Surgery Calendar Year 2005 The Pennsylvania Health Care Cost Containment Council April 2007 Preface This document serves as a technical supplement to
More informationPotentially Preventable Hospitalizations in Pennsylvania
Potentially Preventable Hospitalizations in Pennsylvania Pennsylvania Health Care Cost Containment Council June 2012 About PHC4 The Pennsylvania Health Care Cost Containment Council (PHC4) is an independent
More informationDisability, race/ethnicity, and medication adherence among Medicare myocardial infarction survivors
Outcomes, Health Policy, and Managed Care Disability, race/ethnicity, and medication adherence among Medicare myocardial infarction survivors Yuting Zhang, PhD, a Seo Hyon Baik, PhD, a Chung-Chou H. Chang,
More informationPredictors of Rehospitalization After Admission for Pneumonia in the Veterans Affairs Healthcare System
ORIGINAL RESEARCH Predictors of Rehospitalization After Admission for Pneumonia in the Veterans Affairs Healthcare System Victoria L. Tang, MD 1,2, Ethan A. Halm, MD, MPH 2, Michael J. Fine, MD, MSc 3,
More informationOverview of H-CUP Application of HCUP in Clinical Research Current articles in Medicine Practice example
Overview of H-CUP Application of HCUP in Clinical Research Current articles in Medicine Practice example 2 What is H-CUP? HCUP includes the LARGEST collection of multi-year hospital care (inpatient, outpatient,
More informationAdverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease
Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease J. Sukanya 05.Jul.2012 Outline Background Methods Results Discussion Appraisal Background Common outcomes in hospitalized
More informationHealthy Montgomery Obesity Work Group Montgomery County Obesity Profile July 19, 2012
Healthy Montgomery Obesity Work Group Montgomery County Obesity Profile July 19, 2012 Prepared by: Rachel Simpson, BS Colleen Ryan Smith, MPH Ruth Martin, MPH, MBA Hawa Barry, BS Executive Summary Over
More informationAppendix A AUTIM SPECTRUM DISORDER FEASIBILITY STUDY
Appendix A AUTIM SPECTRUM DISORDER FEASIBILITY STUDY Description: Representatives from the Departments of Social Services (DSS), Mental Health and Addiction Services (DMHAS), Children and Families (DCF),
More informationThe U.S. national 30-day heart failure readmission
CE Professional Case Management Vol. 17, No. 4, 155-161 Copyright 2012 Wolters Kluwer Health Lippincott Williams & Wilkins Heart Failure Rehospitalization of the Medicare FFS Patient A State-Level Analysis
More informationAnkle fractures are one of
Elevated Risks of Ankle Fracture Surgery in Patients With Diabetes Nelson F. SooHoo, MD, Lucie Krenek, MD, Michael Eagan, MD, and David S. Zingmond, MD, PhD Ankle fractures are one of the most common types
More informationMeasure Information Form Collected For: CMS Outcome Measures (Claims Based)
Last Updated: New Measure Version 4.4a Measure Information Form Collected For: CMS Outcome Measures (Claims Based) Measure Set: CMS Episode-of-Care Payment Measures Set Measure ID #: PAYM-30-HF Performance
More informationNoel Eldridge, MS. AHRQ Center for Quality Improvement and Patient Safety
Presentation on: National trends in the frequency of bladder catheterization and physician-diagnosed catheterassociated urinary tract infections: Results from the Medicare Patient Safety Monitoring System
More informationJAWDA Performance Quarterly KPI Profile (Clinic & Centers) March 2018
JAWDA Performance KPI Profile (Clinic & Centers) March 2018 1 P a g e Introduction: Physician office, clinic, and healthcare centers provide primary care function including health education, prevention,
More informationICU Admission Improves Pneumonia Outcomes
ICU Admission Improves Pneumonia Outcomes 1 Colin R. Cooke, MD, MSc, MS Assistant Professor of Medicine Pulmonary & Critical Care Medicine, Center for Healthcare Outcomes & Policy, Institute for Healthcare
More informationDecision Making and Outcomes of a Hospice Patient Hospitalized With a Hip Fracture
458 Journal of Pain and Symptom Management Vol. 44 No. 3 September 2012 Brief Report Decision Making and Outcomes of a Hospice Patient Hospitalized With a Hip Fracture Natalie E. Leland, PhD, OTR/L, Joan
More informationHealth care spending in the United States is expected to. Article
Annals of Internal Medicine Article The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care Elliott S. Fisher, MD, MPH; David E. Wennberg,
More informationPhysician-Patient Race-Match & Patient Outcomes
Physician-Patient Race-Match & Patient Outcomes Andrew Hill (Montana State University) Daniel Jones (University of Pittsburgh, GSPIA) Lindsey Woodworth (University of South Carolina) ASSA 2019 Two motivating
More informationThe relationship between quality of care and hospital costs in Europe. Unto Häkkinen and EuroDRG teams in Finland, France, Germany, Spain and Sweden
The relationship between quality of care and hospital costs in Europe Unto Häkkinen and EuroDRG teams in Finland, France, Germany, Spain and Sweden 1 Aims and data Motivation: Does introduction of cost
More informationFrom palliative care to GEDI WISE:
From palliative care to GEDI WISE: Evolution of a new emergency care model for older adults with serious illness and association with intensive care use Carine Davila Icahn School of Medicine at Mount
More informationEmergency Department Stroke Registry Indicator Specifications 2018 Report Year (07/01/2017 to 06/30/2018 Discharge Dates)
2018 Report Year (07/01/2017 to 06/30/2018 Discharge Dates) Summary of Changes I62.9 added to hemorrhagic stroke ICD-10-CM diagnosis code list (table 3) Measure Description Methodology Rationale Measurement
More informationUsing claims data to investigate RT use at the end of life. B. Ashleigh Guadagnolo, MD, MPH Associate Professor M.D. Anderson Cancer Center
Using claims data to investigate RT use at the end of life B. Ashleigh Guadagnolo, MD, MPH Associate Professor M.D. Anderson Cancer Center Background 25% of Medicare budget spent on the last year of life.
More information2011 Measures Maintenance Technical Report: Acute Myocardial Infarction, Heart Failure, and Pneumonia 30 Day Risk Standardized Readmission Measures
2011 Measures Maintenance Technical Report: Acute Myocardial Infarction, Heart Failure, and Pneumonia 30 Day Risk Standardized Readmission Measures Submitted By Yale New Haven Health Services Corporation
More informationStandard emergency department care vs. admission to an observation unit for low-risk chest pain patients. A two-phase prospective cohort study
Standard emergency department care vs. admission to an observation unit for low-risk chest pain patients A. STUDY PURPOSE AND RATIONALE Rationale: A two-phase prospective cohort study IRB Proposal Sara
More informationBucks * Chester * Delaware * Montgomery * Philadelphia. An Urban Approach
Bucks * Chester * Delaware * Montgomery * Philadelphia Community Preparedness for Health Emergencies: An Urban Approach Steven Alles, MD MS MFA Program Manager, Bioterrorism and Public Health Preparedness
More informationTRENDS IN PNEUMONIA AND INFLUENZA MORBIDITY AND MORTALITY
TRENDS IN PNEUMONIA AND INFLUENZA MORBIDITY AND MORTALITY AMERICAN LUNG ASSOCIATION RESEARCH AND PROGRAM SERVICES EPIDEMIOLOGY AND STATISTICS UNIT February 2006 TABLE OF CONTENTS Trends in Pneumonia and
More informationInpatient Psychiatric Facility Quality Reporting (IPFQR) Program
FY 2017 IPPS Final Rule IPFQR Changes, APU Determination and Reconsideration Review Questions and Answers Moderator/Speaker: Evette Robinson, MPH Project Lead, IPFQR Inpatient Hospital Value, Incentives,
More informationThe Economic Burden of Hypercholesterolaemia
The Economic Burden of Hypercholesterolaemia November 2018 TABLE OF CONTENTS Acronyms 3 Executive Summary 4 Introduction 5 Approach 5 Structure of the report 5 Economic burden of hypercholesterolaemia
More informationRisk of venous thromboembolism and benefits of prophylaxis use in hospitalized medically ill US patients up to 180 days post-hospital discharge
ORIGINAL CLINICAL INVESTIGATION Open Access Risk of venous thromboembolism and benefits of prophylaxis use in hospitalized medically ill US patients up to 180 days post-hospital discharge Li Wang 1, Nishan
More information2012 PENNSYLVANIA ASTHMA BURDEN REPORT
2012 PENNSYLVANIA ASTHMA BURDEN REPORT Table Of Contents Introduction ----------------------------------------------------------------------------------------------------1 Methodology---------------------------------------------------------------------------------------------------2
More informationDiabetes & the Medicare Population: Idaho
Diabetes & the Medicare Population: Introduction to the Report Diabetes has a considerable impact on the nation s healthcare system and on individuals living with the condition. This report is intended
More informationTHE IOWA CONSORTIUM FOR SUBSTANCE ABUSE RESEARCH AND EVALUATION. Special Report: Opioid Admissions in Iowa August 2016
Special Report: State of Iowa Opioid Treatment Admissions 21-215 THE IOWA CONSORTIUM FOR SUBSTANCE ABUSE RESEARCH AND EVALUATION Special Report: Opioid Admissions in Iowa 21-215 August 216 With Funds Provided
More informationTroubleshooting Audio
Welcome Audio for this event is available via ReadyTalk Internet streaming. No telephone line is required. Computer speakers or headphones are necessary to listen to streaming audio. Limited dial-in lines
More informationNational Bowel Cancer Audit. Detection and management of outliers: Clinical Outcomes Publication
National Bowel Cancer Audit Detection and management of outliers: Clinical Outcomes Publication November 2017 1 National Bowel Cancer Audit (NBOCA) Detection and management of outliers Clinical Outcomes
More informationDeterminants of hospital length of stay for people with serious mental illness in England and implications for payment systems: a regression analysis
Jacobs et al. BMC Health Services Research (2015) 15:439 DOI 10.1186/s12913-015-1107-6 RESEARCH ARTICLE Open Access Determinants of hospital length of stay for people with serious mental illness in England
More informationDiabetic Foot Ulcers
Economic burden of diabetic foot ulcers and amputations Diabetic Foot Ulcers Data Points #3 Diabetes mellitus is a significant illness, both from an individual point of view and a societal perspective.
More informationExecutive Summary. Lupus Awareness Survey. October 2012
Executive Summary Lupus Awareness Survey October 2012 GfK Roper Public Affairs & Corporate Communications Lupus Awareness Survey October 2012 Executive Summary A recent survey of American adults conducted
More informationManagement of Heart Failure: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians
Performance Measurement Management of Heart Failure: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians Writing Committee Amir Qaseem, MD,
More informationThe Burden of Cardiovascular Disease in North Carolina June 2009 Update
The Burden of Cardiovascular Disease in North Carolina June 2009 Update Sara L. Huston, Ph.D. Heart Disease & Stroke Prevention Branch Chronic Disease & Injury Section Division of Public Health North Carolina
More informationKey Findings. Mortality Rates
Mortality Rates Statewide in-hospital mortality rates showed a statistically significant decrease from to in nine of the 15 conditions reported. The largest decrease was in, where the mortality rate decreased
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Chan PS, Nallamothu BK, Krumholz HM, et al. Long-term outcomes
More information