Translating Policy to Practice: An Association Between Medicare Access and Children’s Health Insurance Program Reauthorization Act Implementation and Palliative Care Consultations and Perioperative Mortality in Critical Care*

Olanipekun, T; Sanghavi, D; Moreno Franco, P; Robinson, MT; Thomas, M; Kiley, S; Paghdar, S; Sareyyupoglu, B; Diaz Milian, R

doi:10.1097/ccm.0000000000005982

Perioperative medicine & outcomes

Translating Policy to Practice: An Association Between Medicare Access and Children’s Health Insurance Program Reauthorization Act Implementation and Palliative Care Consultations and Perioperative Mortality in Critical Care*

Crit Care MedPublished 28 Jun 2023Retrospective observational cohort study

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Authors' conclusion

We did not observe an increase in postoperative mortality after POD 30 before or after MACRA implementation. However, palliative care use markedly increased after POD 30.

Study context

Population: Adults undergoing 1 of 19 elective major procedures, US National Inpatient Sample, 2011–2019
Participants: 4,900,451 adults

Exposure: Before vs after MACRA implementation
PreMn = 2,103,836reference
PostMn = 2,796,615
Outcome: Cumulative postoperative mortality
Follow-up: 30 days

Methodological detailsregression discontinuity, multivariate analysis, national database (National Inpatient Sample)

Regression discontinuity
Multivariate analysis
National database (National Inpatient Sample)

Main finding

As reported in the abstract

30-day postoperative mortality

PreM7.1%149,372 of 2,103,836

PostM5%156,610 of 2,796,615

Observational data: associations, not effects.

Secondary outcomes

Outcome	PreM	PostM	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Inpatient palliative care consultations, POD 31-60 vs POD 1-30PreM: POD 31-60 vs PreM: POD 1-30			0.10.31310	5.31 (2.22–8.68)	P < 0.001
POD 31-60	8,533 of 2,081,207 patients [0.4%]	18,915 of 2,791,712 patients [0.7%]
POD 1-30	1,118 of 22,629 patients [4.9%]	417 of 4,903 patients [8.5%]
Inpatient palliative care consultations, POD 31-60 vs POD 1-30PostM: POD 31-60 vs PostM: POD 1-30			0.10.31310	7.84 (4.83–9.10)	P < 0.001
			0.10.31310Odds ratio (log scale)

Original publication

Translating Policy to Practice: An Association Between Medicare Access and Children’s Health Insurance Program Reauthorization Act Implementation and Palliative Care Consultations and Perioperative Mortality in Critical Care*. Crit Care Med. Published 28 June 2023. doi:10.1097/ccm.0000000000005982

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