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Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries

Overview of attention for article published in JAMA: Journal of the American Medical Association, May 2016
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (99th percentile)
  • High Attention Score compared to outputs of the same age and source (98th percentile)

Mentioned by

news
98 news outlets
blogs
2 blogs
twitter
462 tweeters
facebook
12 Facebook pages

Readers on

mendeley
48 Mendeley
Title
Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries
Published in
JAMA: Journal of the American Medical Association, May 2016
DOI 10.1001/jama.2016.5618
Pubmed ID
Authors

Andrew M. Ibrahim, Tyler G. Hughes, Jyothi R. Thumma, Justin B. Dimick, Ibrahim, Andrew M, Hughes, Tyler G, Thumma, Jyothi R, Dimick, Justin B

Abstract

Critical access hospitals are a predominant source of care for many rural populations. Previous reports suggest these centers provide lower quality of care for common medical admissions. Little is known about the outcomes and costs of patients admitted for surgical procedures. To compare the surgical outcomes and associated Medicare payments at critical access hospitals vs non-critical access hospitals. Cross-sectional retrospective review of 1 631 904 Medicare beneficiary admissions to critical access hospitals (n = 828) and non-critical access hospitals (n = 3676) for 1 of 4 common types of surgical procedures-appendectomy, 3467 for critical access and 151 867 for non-critical access; cholecystectomy, 10 556 for critical access and 573 435 for non-critical access; colectomy, 10 198 for critical access and 577 680 for non-critical access; hernia repair, 4291 for critical access and 300 410 for non-critical access-between 2009 and 2013. We compared risk-adjusted outcomes using a multivariable logistical regression that adjusted for patient factors (age, sex, race, Elixhauser comorbidities), admission type (elective, urgent, emergency), and type of operation. Undergoing surgical procedures at critical access vs non-critical access hospitals. Thirty-day mortality, postoperative serious complications (eg, myocardial infarction, pneumonia, or acute renal failure and a length of stay >75th percentile). Hospital costs were assessed using price-standardized Medicare payments during hospitalization. Patients (mean age, 76.5 years; 56.2% women) undergoing surgery at critical access hospitals were less likely to have chronic medical problems, and they had lower rates of heart failure (7.7% vs 10.7%, P < .0001), diabetes (20.2% vs 21.7%, P < .001), obesity (6.5% vs 10.6%, P < .001), or multiple comorbid diseases (% of patients with ≥2 comorbidities; 60.4% vs 70.2%, P < .001). After adjustment for patient factors, critical access and non-critical access hospitals had no statistically significant differences in 30-day mortality rates (5.4% vs 5.6%; adjusted odds ratio [OR], 0.96; 95% confidence interval [CI], 0.89-1.03; P = .28). However, critical access vs non-critical access hospitals had significantly lower rates of serious complications (6.4% vs 13.9%; OR, 0.35; 95% CI, 0.32-0.39; P < .001). Medicare expenditures adjusted for patient factors and procedure type were lower at critical access hospitals than non-critical access hospitals ($14 450 vs $15 845; difference, -$1395, P < .001). Among Medicare beneficiaries undergoing common surgical procedures, patients admitted to critical access hospitals compared with non-critical access hospitals had no significant difference in 30-day mortality rates, decreased risk-adjusted serious complication rates, and lower-adjusted Medicare expenditures, but were less medically complex.

Twitter Demographics

The data shown below were collected from the profiles of 462 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 48 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 2 4%
United Kingdom 1 2%
Unknown 45 94%

Demographic breakdown

Readers by professional status Count As %
Researcher 11 23%
Student > Master 6 13%
Other 6 13%
Student > Postgraduate 5 10%
Professor 4 8%
Other 16 33%
Readers by discipline Count As %
Medicine and Dentistry 33 69%
Unspecified 4 8%
Nursing and Health Professions 4 8%
Social Sciences 3 6%
Computer Science 2 4%
Other 2 4%

Attention Score in Context

This research output has an Altmetric Attention Score of 1075. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 April 2018.
All research outputs
#2,093
of 9,724,198 outputs
Outputs from JAMA: Journal of the American Medical Association
#70
of 21,714 outputs
Outputs of similar age
#154
of 277,077 outputs
Outputs of similar age from JAMA: Journal of the American Medical Association
#8
of 422 outputs
Altmetric has tracked 9,724,198 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 21,714 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 41.3. This one has done particularly well, scoring higher than 99% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 277,077 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 422 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 98% of its contemporaries.