The Pittsburgh Intergovernmental Cooperation Authority (Pittsburgh ICA, also known as the Intergovernmental Cooperation Authority for Cities of the Second Class) is a special administrative body created by the Commonwealth of Pennsylvania to oversee the finances of the City of Pittsburgh. The Pittsburgh ICA was created by the Pennsylvania General Assembly though the Intergovernmental Cooperation Authority Act for Cities of the Second Class or Act 11 of 2004 on February 12, 2004.The Pittsburgh ICA is charged with "providing for financing" in Pittsburgh. It may only consider whether city budgets "are balanced, based upon prudent, reasonable and appropriate assumptions and if they comply with the city’s pending Act 47 recovery plan. Policy questions are outside its legal jurisdiction when approving or disapproving budgets." The Pittsburgh ICA operates within the context of an "Intergovernmental Cooperation Agreement" between it and the City of Pittsburgh.The Pittsburgh ICA has had difficulties with its financial records..
Background Black patients with heart failure (HF) have been shown to have worse outcomes (increased readmissions, earlier age of death) compared to White patients. Prior studies have reported variable outcomes between males and females in patients with heart failure with preserved ejection (HFpEF). We analyzed a cohort of HFpEF patients with a focus on sex differences in Black patients with HFpEF. Methods We conducted a retrospective observational study analyzing 53,891 patients admitted to University of Pittsburgh Medical Center (UPMC) hospitals with a primary diagnosis of heart failure HF from 2010 to 2024. These patients had a left ventricular ejection fraction (LVEF) of ≥ 50 % documented on at least two echocardiograms. The primary outcomes included HF readmissions, all-cause readmissions, and all-cause mortality. Additionally, T- tests and Chi-square tests were utilized to examine outcomes within a subgroup of Black patients, stratified by sex. Binary logistic regression estimated age-adjusted outcomes between groups. Results Black females comprised 60.4% of Black patients admitted with HFpEF compared to only 39.6% males. Among, 5108 (9.4%) Black patients, females had a higher mean age (68.1±14.9) compared to males (63.9±14.1). Multivariable Cox regression analysis revealed that Black patients had higher HF readmissions (HR: 1.20, CI: 1.158-1.258, p<0.0001), all-cause readmissions (HR: 1.17, CI: 1.138-1.219, p<0.0001) but no differences in mortality (HR: 0.95, CI: 0.914-1.002, p=0.0588) compared to White patients. Overall, there were no differences in age-adjusted outcomes between both sex groups. Conclusion Black HFpEF patients had higher readmission rates compared to White HFpEF patients in a large multi-hospital health system. Black females made up a significantly higher proportion of this population (60.4% vs 39.6%). Black males were younger, however this did not impact readmissions or mortality.
Background Heart failure with preserved ejection fraction (HFpEF) is strongly associated with mortality. We examined patient-level factors associated with increased risk of mortality in a cohort of patients receiving care in a large, integrated health care system. Methods We conducted a retrospective analysis of patients diagnosed with HFpEF (defined as LVEF ≥50%) on admission to our health care system from 2010-2014. We related demographic and clinical characteristics to 3- and 12-month mortality using binary logistic regression models adjusted for age, sex and comorbidities. Three-month and 1-year mortality groups were compared using T- tests and Chi square tests. Results We identified 53,891 patients diagnosed with HFpEF. The mean age was 74.8± 9.2 and 57% (n= 30,809) of the patients were females. Age, atrial fibrillation, COPD, history of malignancy, type 2 diabetes, chronic kidney disease (CKD) and end stage renal disease (ESRD) were significantly associated with mortality at three months and one year when adjusted for age and sex. ESRD was the strongest predictor, doubling the risk of 12-month mortality (OR: 2.02, CI: 1.71-2.38). Cerebrovascular accident was associated with lower mortality at 12 months (OR: 0.89, CI: 0.82-0.97), while hypertension appeared to be protective at 3 months (OR: 0.85, CI: 0.78-0.93) and one year (OR: 0.82, CI: 0.76-0.88). Females had a lower risk of death compared to males at 12 months follow up duration (Table 1). Conclusion Key co-morbidities associated with three month and one year mortality included atrial fibrillation, COPD, CKD, malignancy, type 2 diabetes, with ESRD being the strongest independent predictor of mortality at any follow up duration. Hypertension was associated with better survival at three months and one year. Further analysis to define subgroups with worse outcomes may be useful for identification of those patients at higher risk for short term mortality.
Background Medical insurance has been shown to influence health outcomes as it is determined by individual’s comorbidities and socioeconomic factors like income. Methods We conducted a retrospective observational study analyzing patients admitted to University of Pittsburgh Medical Center (UPMC) hospitals with a primary diagnosis of heart failure HF from 2010 to 2024. These patients had a left ventricular ejection fraction (LVEF) of ≥ 50 % documented on at least two echocardiograms. The primary outcomes included HF readmissions, all-cause readmissions, and all-cause mortality. Binary logistic regression models were used to compare comorbidities in Medicare vs Medicaid group after adjusting for age. Additionally, T- tests and Chi-square tests were utilized to compare Medicaid and Medicare groups. Results Among 53,891 patients included in our cohort with the mean age of 74.8±9.2, 44,919 (84%) had Medicare as their primary health coverage compared to 3344 (6.2%) Medicaid recipients. Age-adjusted multivariable Cox regression models showed that patients with commercial insurance had lower mortality (HR: 0.73, CI: 0.674-0.791, p <.0001), HF readmissions (HR: 0.84, CI: 0.785-0.898, p<.0001) and all-cause readmissions (HR: 0.85, CI: 0.811-0.904, p<.0001). Medicare had higher HF readmissions (HR: 1.09, CI: 1.029-1.157, p= 0.0038) and all-cause readmissions (HR: 1.17, CI: 1.116-1.229, p<0.001) compared to Medicaid, but similar mortality (HR:1.04, CI: 0.979-1.121, p=0.1779) as showed in Table 1. Patients with Medicare were older (OR: 1.18, CI: 1.174-1.191) compared to Medicaid. Medicare recipients had 3.6-fold increased risk for end stage renal disease (ESRD) vs Medicaid, however no differences for chronic kidney disease (CKD). Atrial fibrillation and hyperlipidemia were higher in the Medicare group. Hypertension and COPD were lower in the Medicare group compared to patients with Medicaid (Table 2). There were no differences between groups for having type 2 diabetes, coronary artery disease, stroke and history of cancer. Conclusion ESRD, atrial fibrillation and hyperlipidemia were independently associated with worse outcomes in Medicare recipients, with ESRD being the strongest predictor. Comorbidity burden appears to influence the association between medical insurance and outcomes.
OBJECTIVE:The substantial financial implications of minimally invasive surgery for adult spinal deformity (ASD) necessitate a thorough assessment of its inherent value and efficacy. Factors contributing to protracted cost-effectiveness (CE) have not been examined in the context of minimally invasive spine surgery (MIS) for ASD (MIS-ASD). Investigating these determinants can yield pivotal insight to optimize the efficacy of such surgical interventions while concurrently moderating associated expenditures. METHODS:MIS-ASD patients who underwent fusion > 2 levels with lateral lumbar interbody fusion or anterior lumbar interbody fusion and 4-year (4Y) follow-up were included. Published methods were used to determine the costs based on the Centers for Medicare & Medicaid Services definitions and average diagnosis-related group (DRG) reimbursement rates. Utility was calculated using quality-adjusted life years (QALYs), with a 3% discount applied for decline with life expectancy. Cost-utility (CU) was determined by dividing costs by total utility gained. Those who met CE at 4 years (CE4+) were evaluated relative to those who did not (CE4-). RESULTS:Eighty-six patients were included. Revision surgery occurred in 27% of patients. The overall mean cost was $73,000. CU at 4 years was $233,000, with 44% meeting CE4+ and a cumulative mean ± SD QALY gain of 0.8 ± 0.7. Among patients without revision, 54% met CE4+, while 76% met CE at life expectancy. There were no differences in length of stay, ICU admission rates, or time in ICU. Those with greater baseline disability (OR 1.1, p < 0.05) and frailty (OR 1.8, p < 0.05) had a higher likelihood of achieving CE4+. Lower comorbidity burden (i.e., lower Charlson Comorbidity Index score) was associated with increased odds of achieving CE4+ (OR 1.8, p < 0.05). Improved correction of pelvic incidence-lumbar lordosis mismatch was associated with achieving CE4+ (OR 3.8, p < 0.05). Those patients with major complications had 6× higher odds of failure to achieve CE4+, whereas those who underwent reoperation had 12× odds (both p < 0.05). CONCLUSIONS:MIS-ASD achieves CE in a significant subset of patients, particularly those with higher baseline disability, lower comorbidity burden, and better correction of spinal deformities. However, major complications and reoperations significantly hinder CE, underscoring the importance of optimizing patient selection and surgical techniques.
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