{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T21:41:48Z","timestamp":1764020508937,"version":"3.41.2"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Public reporting of transcatheter aortic valve replacement (TAVR) claims\u2013based outcome measures is used to identify high\u2010 and low\u2010performing centers. Whether claims\u2010based TAVR outcomes can reliably be used for center\u2010level comparisons is unknown. In this study, we sought to evaluate center variability in claims\u2010based TAVR outcomes used in public reporting.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">The study sample included 119\u00a0554 Medicare beneficiaries undergoing TAVR between January 2014 and October 2018 based on procedure codes in 100% Medicare inpatient claims. Multivariable hierarchical logistic regression was used to estimate center\u2010specific adjusted rates and reliability (R) of 30\u2010day mortality, discharge not to home\/self\u2010care, 30\u2010day stroke, and 30\u2010day readmission. Reliability was defined as the ratio of between\u2010hospital variation to the sum of the between\u2010 and within\u2010hospital variation. The median (interquartile range [IQR]) center\u2010level adjusted outcome rates were 3.1% (2.9%\u20133.4%) for 30\u2010day mortality, 41.4% (31.3%\u201353.4%) for discharge not to home, 2.5% (2.3%\u20132.7%) for 30\u2010day stroke, and 14.9% (14.4%\u201315.5%) for 30\u2010day readmission. Median reliability was highest for the discharge not to home measure (R=0.95; IQR, 0.94\u20130.97), followed by the 30\u2010day stroke (R=0.92; IQR, 0.87\u20130.94), 30\u2010day mortality (R=0.86; IQR, 0.81\u20130.91), and 30\u2010day readmission measures (R=0.42; IQR, 0.35\u20130.51). Across outcomes, there was an inverse relationship between center volume and measure reliability.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Claims\u2010based TAVR outcome measures for mortality, discharge not to home, and stroke were reliable measures for center\u2010level comparisons, but readmission measures were unreliable. Stakeholders should consider these findings when evaluating claims\u2010based measures to compare center\u2010level TAVR performance.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.021629","type":"journal-article","created":{"date-parts":[[2021,10,23]],"date-time":"2021-10-23T11:29:46Z","timestamp":1634988586000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Center Variability in Medicare Claims\u2013Based Publicly Reported Transcatheter Aortic Valve Replacement Outcome Measures"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9992-593X","authenticated-orcid":false,"given":"Michael P.","family":"Thompson","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery Michigan Medicine Ann Arbor MI"},{"name":"Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0890-0746","authenticated-orcid":false,"given":"Hechuan","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Michigan Medicine Ann Arbor MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6988-7987","authenticated-orcid":false,"given":"Alexander A.","family":"Brescia","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Michigan Medicine Ann Arbor MI"},{"name":"Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis D.","family":"Pagani","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Michigan Medicine Ann Arbor MI"},{"name":"Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4709-3390","authenticated-orcid":false,"given":"Devraj","family":"Sukul","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of General Internal Medicine Michigan Medicine Ann Arbor MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6155-980X","authenticated-orcid":false,"given":"Jeffrey S.","family":"McCullough","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy School of Public Health University of Michigan Ann Arbor MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0416-9359","authenticated-orcid":false,"given":"Donald S.","family":"Likosky","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Michigan Medicine Ann Arbor MI"},{"name":"Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1008232"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1400590"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814052"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1816885"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1514616"},{"key":"e_1_3_1_7_2","unstructured":"Centers for Medicare and Medicaid Services . 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