Publications by authors named "Jonathan D Wolfe"

8 Publications

  • Page 1 of 1

Predictors of Success in the Bundled Payments for Care Improvement Program.

J Gen Intern Med 2021 May 4. Epub 2021 May 4.

Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

Background: Hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program were incented to reduce Medicare payments for episodes of care.

Objective: To identify factors that influenced whether or not hospitals were able to save in the BPCI program, how the cost of different services changed to produce those savings, and if "savers" had lower or decreased quality of care.

Design: Retrospective cohort study.

Participants: BPCI-participating hospitals.

Main Measures: We designated hospitals that met the program goal of decreasing costs by at least 2% from baseline in average Medicare payments per 90-day episode as "savers." We used regression models to determine condition-level, patient-level, hospital-level, and market-level characteristics associated with savings.

Key Results: In total, 421 hospitals participated in BPCI, resulting in 2974 hospital-condition combinations. Major joint replacement of the lower extremity had the highest proportion of savers (77.6%, average change in payments -$2235) and complex non-cervical spinal fusion had the lowest (22.2%, average change +$8106). Medical conditions had a higher proportion of savers than surgical conditions (11% more likely to save, P=0.001). Conditions that were mostly urgent/emergent had a higher proportion of savers than conditions that were mostly elective (6% more likely to save, P=0.007). Having higher than median costs at baseline was associated with saving (OR: 3.02, P<0.001). Hospitals with more complex patients were less likely to save (OR: 0.77, P=0.003). Savings occurred across both inpatient and post-acute care, and there were no decrements in clinical care associated with being a saver.

Conclusions: Certain conditions may be more amenable than others to saving under bundled payments, and hospitals with high costs at baseline may perform well under programs which use hospitals' own baseline costs to set targets. Findings may have implications for the BPCI-Advanced program and for policymakers seeking to use payment models to drive improvements in care.
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http://dx.doi.org/10.1007/s11606-021-06820-7DOI Listing
May 2021

A Short Bridge Over a Wide River: The Role of Extracorporeal Membrane Oxygenation in Older Adults With Cardiogenic Shock.

J Card Fail 2020 12 19;26(12):1090-1092. Epub 2020 Sep 19.

Department of Medicine, Division of Cardiology, Washington University School of Medicine, Saint Louis, Missouri. Electronic address:

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http://dx.doi.org/10.1016/j.cardfail.2020.09.006DOI Listing
December 2020

Preoperative Echo: Overused or Undervalued?

J Am Geriatr Soc 2020 08 11;68(8):1688-1689. Epub 2020 Jun 11.

Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.

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http://dx.doi.org/10.1111/jgs.16557DOI Listing
August 2020

Perioperative care of the geriatric patient for noncardiac surgery.

Clin Cardiol 2020 Feb 11;43(2):127-136. Epub 2019 Dec 11.

Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri.

Adults age 65 and over are the fastest growing segment of the population in the United States and around the world. As the size of this population expands, the number of older adults referred for surgical procedures will continue to increase. Due to the physiologic changes of aging and the increased frequency of comorbidities, older adults are at increased risk for adverse outcomes, and perioperative care is inherently more complex than in younger individuals. In this review, we discuss the physiologic changes of aging relevant to the surgical patient, comprehensive preoperative assessment, and postoperative management of common complications in older adults in order to promote optimal clinical outcomes both perioperatively and long-term.
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http://dx.doi.org/10.1002/clc.23302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021644PMC
February 2020

Heart Failure and the Affordable Care Act: Past, Present, and Future.

JACC Heart Fail 2019 09 7;7(9):737-745. Epub 2019 Aug 7.

Cardiology Division, Washington University School of Medicine, St. Louis, Missouri. Electronic address:

The Affordable Care Act (ACA) and other major health care legislative acts have had an important impact on the care of heart failure patients in the United States. The main effects of the ACA include regulation of the health insurance industry, expansion of access to health care, and health care delivery system reform, which included the creation of several alternative payment models. Particular components of the ACA, such as the elimination of annual and lifetime caps on spending, Medicaid expansion, and the individual and employer mandate, could have positive effects for heart failure patients. However, the benefits of value-based and alternative payment models such as the Hospital Readmissions Reduction Program and bundled payment programs for heart failure outcomes are less clear, and controversy exists regarding whether some of these programs may even worsen outcomes. As the population ages and the prevalence of heart failure continues to rise, this syndrome will likely remain a key clinical focus for policymakers. Therefore, heart failure clinicians should be aware of how legislation affects clinical practice and be prepared to adapt to continued changes in health policy.
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http://dx.doi.org/10.1016/j.jchf.2019.04.021DOI Listing
September 2019

Pulmonary vascular resistance determines mortality in end-stage renal disease patients with pulmonary hypertension.

Clin Transplant 2018 06 15;32(6):e13270. Epub 2018 May 15.

Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

The multifactorial etiology of pulmonary hypertension (PH) in end-stage renal disease (ESRD) includes patients with and without elevated pulmonary vascular resistance (PVR). We explored the prognostic implication of this distinction by evaluating pretransplant ESRD patients who underwent right heart catheterization and echocardiography. Demographics, clinical data, and test results were analyzed. All-cause mortality data were obtained. Median follow-up was 4 years. Of the 150 patients evaluated, echocardiography identified 99 patients (66%) with estimated pulmonary artery (PA) systolic pressure > 36 mm Hg, which correlated poorly with mortality (HR = 1.28, 95% CI 0.72-2.27, P = .387). Right heart catheterization identified 88 (59%) patients with mean PA pressure ≥ 25 mm Hg. Of these, 70 had PVR ≤ 3 Wood units and 18 had PVR > 3 Wood units. Survival analysis demonstrated a significant prognostic effect of an elevated PVR in patients with high mean PA pressures (HR = 2.26, 95% CI 1.07-4.77, P = .03), while patients with high mean PA pressure and normal PVR had equivalent survival to those with normal PA pressure. Despite the high prevalence of PH in ESRD patients, elevated PVR is uncommon and is a determinant of prognosis in patients with PH. Patients with normal PVR had survival equivalent to those with normal PA pressures.
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http://dx.doi.org/10.1111/ctr.13270DOI Listing
June 2018

Characteristics of Inpatient Units Associated With Sustained Hand Hygiene Compliance.

J Patient Saf 2018 Apr 20. Epub 2018 Apr 20.

Objectives: Following institution of a hand hygiene (HH) program at an academic medical center, HH compliance increased from 58% to 92% for 3 years. Some inpatient units modeled early, sustained increases, and others exhibited protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit characteristics.

Methods: Adult inpatient units (N = 35) were categorized into the following three tiers based on their pattern of HH compliance: early adopters, nonsustained and late adopters, and laggards. Unit-based culture measures were collected, including nursing practice environment scores (National Database of Nursing Quality Indicators [NDNQI]), patient rated quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems), patient complaint rates, case mix index, staff turnover rates, and patient volume. Associations between variables and the binary outcome of laggard (n = 18) versus nonlaggard (n = 17) were tested using a Mann-Whitney U test. Multivariate analysis was performed using an ordinal regression model.

Results: In direct comparison, laggard units had clinically relevant differences in NDNQI scores, Hospital Consumer Assessment of Healthcare Provider and Systems scores, case mix index, patient complaints, patient volume, and staff turnover. The results were not statistically significant. In the multivariate model, the predictor variables explained a significant proportion of the variability associated with laggard status, (R = 0.35, P = 0.0481) and identified NDNQI scores and patient complaints as statistically significant.

Conclusions: Uptake of an HH program was associated with factors related to a unit's safety culture. In particular, NDNQI scores and patient complaint rates might be used to assist in identifying units that may require additional attention during implementation of an HH quality improvement program.
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http://dx.doi.org/10.1097/PTS.0000000000000488DOI Listing
April 2018

Vibrational spectroscopy of N-methyliminodiacetic acid (MIDA)-protected boronate ester: examination of the B-N dative bond.

J Phys Chem A 2011 Jun 10;115(24):6426-31. Epub 2011 May 10.

Department of Chemistry and Biochemistry, University of Mississippi, University, Mississippi 38677, United States.

N-methyliminodiacetic acid (MIDA)-protected boronate esters are a new class of reagents that offer great promise in iterative Suzuki-Miyaura cross-coupling reactions. Compared to earlier reagents, MIDA esters are easily handled and are benchtop stable under air indefinitely. The success of this new species is tied to its unique molecular architecture. Compared to the simpler B-N containing molecules ammonia borane and trimethylamine borane, MIDA esters are much larger, and the sp(3) hybridized boron atom is secured by two five membered rings, making this molecular class stable for spectroscopic study. Here, we present infrared, Raman, and surface enhanced Raman (SERS) spectra of methylboronic acid MIDA ester. Comparisons of the spectroscopic results to those from electronic structure calculations suggest that the B-N stretching mode in this molecule lies in the range 560-650 cm(-1), making it among the lowest energy vibrations observed to date that can be primarily attributed to B-N stretching.
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http://dx.doi.org/10.1021/jp112016jDOI Listing
June 2011