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Ramanathan R.,Medical Center | Bhatia J.J.,Georgia Regents University | Sekar K.,The University of Oklahoma Health Sciences Center | Ernst F.R.,Premier Research Services
Journal of Perinatology | Year: 2013

Objective:The objective of this study is to compare all-cause in-hospital mortality in preterm infants with respiratory distress syndrome (RDS) treated with poractant alfa, calfactant or beractant.Study Design:A retrospective cohort study of 14 173 preterm infants with RDS, treated with one of three surfactants between 2005 and 2009, using the Premier Database was done. Multilevel, multivariable logistic regression modeling, adjusting for patient- and hospital-level factors was performed.Result:Calfactant treatment was associated with a 49.6% greater likelihood of death than poractant alfa (odds ratio (OR): 1.496, 95% confidence interval (CI): 1.014-2.209, P=0.043). Beractant treatment was associated with a non-significant 37% increase in mortality, compared with poractant alfa (OR: 1.370, 95% CI: 0.996-1.885, P=0.053). No differences in mortality were observed between calfactant and beractant treatment (OR: 1.092, 95% CI: 0.765-1.559, P=0.626).Conclusion:Poractant alfa treatment for RDS was associated with a significantly reduced likelihood of death when compared with calfactant and a trend toward reduced mortality when compared with beractant. © 2013 Nature America, Inc. All rights reserved.

Pugliese G.,Premier Healthcare Alliance | Gosnell C.,Premier Healthcare Alliance | Bartley J.M.,Premier Healthcare Alliance | Robinson S.,Premier Research Services
American Journal of Infection Control | Year: 2010

Background: Improper use of syringes, needles, and medication vials has resulted in patient-to-patient transmission of bloodborne pathogens, including hepatitis C virus. This study examined the injection practices of health care providers to identify trends and target opportunities for education on safe practices. Methods: An on-line survey was conducted in May and June 2010 of clinicians in US health care settings that prepare and/or administer parenteral medications. Results: The majority of the 5446 eligible respondents reported injection practices consistent with current recommendations. However, the following unsafe practices were identified: 6.0% "sometimes or always" use single-dose/single-use vials for more than 1 patient; 0.9% "sometimes or always" reuse a syringe but change the needle for use on a second patient; 15.1% reuse a syringe to enter a multidose vial and then 6.5% save that vial for use on another patient (1.1% overall). Conclusion: Unsafe injection practices represent an ongoing threat to patient safety. Ensuring safe injection practices in all health care settings will require a multifaceted approach that focuses on surveillance, oversight, enforcement, and continuing education. © 2010 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Magee G.,Premier Research Services | Zbrozek A.,CSL Behring
ClinicoEconomics and Outcomes Research | Year: 2013

Background: Fluid overload, including transfusion-associated circulatory overload (TACO), is a serious complication of fresh frozen plasma (FFP) transfusion. The incidence of fluid overload is underreported and its economic impact is unknown. An evaluation of fluid overload cases in US hospitals was performed to assess the impact of fluid overload on length and cost of hospital stay. Study design and methods: Retrospective analysis was performed using a clinical and economic database covering >600 US hospitals. Data were collected for all inpatients discharged during 2010 who received ≥1 unit FFP during hospitalization. Incidence of fluid overload was determined through International Classification of Diagnosis (ICD-9) codes. Multivariate regression analysis was performed for primary outcome measures: hospital length of stay (LOS) and total hospital costs. Results: Data were analyzed for 129,839 FFP-transfused patients, of whom 4,138 (3.2%) experienced fluid overload (including TACO). Multivariate analysis, adjusting for baseline characteristics, found that increased LOS and hospital costs were independently associated with fluid overload. Patients diagnosed with fluid overload had longer mean LOS (12.9 days versus 10.0 days; P < 0.001) and higher mean hospital cost per visit ($46,644 versus $32,582; P < 0.001) compared with patients without fluid overload. Conclusion: For a population of US inpatients who received FFP during hospitalization, fluid overload was associated with a 29% increase in LOS and a $14,062 increase in hospital costs per visit. These findings suggest that the incidence of fluid overload in the general population is greater than historically reported. A substantial economic burden may be associated with fluid overload in the US. © 2013 Magee and Zbrozek, publisher and licensee Dove Medical Press Ltd.

Burke T.A.,Merck And Co. | Wisniewski T.,Merck And Co. | Ernst F.R.,Premier Research Services
Supportive Care in Cancer | Year: 2011

Purpose: Chemotherapy-induced nausea and vomiting (CINV), common adverse events of chemotherapy, may be associated with considerable healthcare resource utilization. This study was conducted to describe CINV-associated healthcare visits and costs following a first cycle of highly or moderately emetogenic chemotherapy (HEC or MEC). Methods: This retrospective cohort study used the Premier Perspective™ Database to identify adult patients who received their first HEC or MEC and at least one antiemetic agent from 2003 to 2007 at US hospital-based outpatient facilities. Hospital visits with a CINV-related ICD-9 diagnosis were included from the chemotherapy administration date to 30 days later or 1 day before the second chemotherapy, whichever was first. CINV costs were hospital-reported costs. Results: Of 19,139 patients (HEC, 16%; MEC, 84%), mean (SD) age was 59 (14) years; 59% were female; 66% were white. CINV prophylaxis included 5-HT3 antagonists (85%), dexamethasone (76%), and NK-1 antagonists (2%). Overall, 13.8% of patients had a CINV-associated visit (HEC, 18%; MEC, 13%): 0.2% for acute CINV (day of chemotherapy, excluding chemotherapy administration visit) and 13.7% for delayed CINV. CINV-associated visits included inpatient (IP, 64%), outpatient (OP, 26%), and emergency room (ER, 10%) visits. Mean (SD) costs of CINV visits were 5,299 (6,639); for IP, 7,448 (7,271); OP, 1,494 (2,172); and ER, 918 (1,071). Mean per-patient CINV-associated costs across all patients were 731 (3,069). Sensitivity analysis excluding visits where CINV was a secondary diagnosis code resulted in a CINV incidence of 4.4%, a mean CINV visit cost of 4,043, and a mean per-patient CINV-associated cost across all patients of 176. Conclusions: CINV visits in the first HEC or MEC cycle were common and costly, especially inpatient hospitalizations in the delayed phase. Strategies to reduce CINV in the delayed phase could reduce healthcare utilization and costs. © 2010 Springer-Verlag.

Patel P.A.,General Electric | Ernst F.R.,Premier Research Services | Gunnarsson C.L.,S2 Statistical Solutions Inc.
Journal of Medical Economics | Year: 2012

Objective: Abdominal paracentesis is commonly performed for diagnostic, therapeutic, and palliative indications, but the use of ultrasound guidance for these procedures is relatively recent, variable, and not well documented. A retrospective database analysis of abdominal paracentesis procedures was performed to determine whether ultrasound guidance was associated with differences in adverse events (AEs) or hospital costs, compared to procedures without ultrasound guidance. Methods: The hospital database maintained by Premier was used to identify patients with abdominal paracentesis International Classification of Diseases 9th Revision Clinical Modification (ICD-9 code 54.9, Common Procedural Terminology CPT-4 codes 49080, 49081) in 2008. Use of ultrasound guidance was determined via patient billing data. The incidence of selected AEs and patients' hospitalization costs were calculated for two groups: procedures with ultrasound guidance and those without. Univariate and multivariable analyses were performed to evaluate differences between groups. Results: This study identified 1297 abdominal paracentesis procedures, 723 (56%) with ultrasound and 574 (44%) without. The indications for paracentesis were similar between the two groups. The incidence of AEs was lower in ultrasound-guided procedures: all AEs (1.4% vs 4.7%, p=0.01), post-paracentesis infection (0.41% vs 2.44%, p=0.01), hematoma (0.0% vs 0.87%, p=0.01), and seroma (0.14% vs 1.05%, p=0.03). Analyses adjusted for patient and hospital covariates revealed significant reductions in AEs (OR=0.349, 95% CI=0.165, 0.739, p=0.0059) and hospitalization costs ($$8761±$ $5956 vs $$9848±$$6581, p<0.001) for procedures with ultrasound guidance vs those without. Limitations: There are several limitations to using claims data for clinical analyses; causality cannot be determined, the possibility of miscoded or missing data, and the inability to control for elements not captured in claims data that may influence clinical outcomes. Conclusions: The use of ultrasound guidance in abdominal paracentesis procedures is associated with fewer AEs and lower hospitalization costs than procedures where ultrasound is not used. © 2012 Informa UK Ltd. All rights reserved.

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