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Gupta AB, Flanders SA, Petty LA, Gandhi TN, Pulia MS, Horowitz JK, Ratz D, Bernstein SJ, Malani AN, Patel PK, Hofer TP, Basu T, Chopra V, Vaughn VM. Inappropriate Diagnosis of Pneumonia Among Hospitalized Adults. JAMA Intern Med 2024:2816759. [PMID: 38526476 DOI: 10.1001/jamainternmed.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Importance Little is known about incidence of, risk factors for, and harms associated with inappropriate diagnosis of community-acquired pneumonia (CAP). Objective To characterize inappropriate diagnosis of CAP in hospitalized patients. Design, Setting, and Participants This prospective cohort study, including medical record review and patient telephone calls, took place across 48 Michigan hospitals. Trained abstractors retrospectively assessed hospitalized patients treated for CAP between July 1, 2017, and March 31, 2020. Patients were eligible for inclusion if they were adults admitted to general care with a discharge diagnostic code of pneumonia who received antibiotics on day 1 or 2 of hospitalization. Data were analyzed from February to December 2023. Main Outcomes and Measures Inappropriate diagnosis of CAP was defined using a National Quality Forum-endorsed metric as CAP-directed antibiotic therapy in patients with fewer than 2 signs or symptoms of CAP or negative chest imaging. Risk factors for inappropriate diagnosis were assessed and, for those inappropriately diagnosed, 30-day composite outcomes (mortality, readmission, emergency department visit, Clostridioides difficile infection, and antibiotic-associated adverse events) were documented and stratified by full course (>3 days) vs brief (≤3 days) antibiotic treatment using generalized estimating equation models adjusting for confounders and propensity for treatment. Results Of the 17 290 hospitalized patients treated for CAP, 2079 (12.0%) met criteria for inappropriate diagnosis (median [IQR] age, 71.8 [60.1-82.8] years; 1045 [50.3%] female), of whom 1821 (87.6%) received full antibiotic courses. Compared with patients with CAP, patients inappropriately diagnosed were older (adjusted odds ratio [AOR], 1.08; 95% CI, 1.05-1.11 per decade) and more likely to have dementia (AOR, 1.79; 95% CI, 1.55-2.08) or altered mental status on presentation (AOR, 1.75; 95% CI, 1.39-2.19). Among those inappropriately diagnosed, 30-day composite outcomes for full vs brief treatment did not differ (25.8% vs 25.6%; AOR, 0.98; 95% CI, 0.79-1.23). Full vs brief duration of antibiotic treatment among patients was associated with antibiotic-associated adverse events (31 of 1821 [2.1%] vs 1 of 258 [0.4%]; P = .03). Conclusions and Relevance In this cohort study, inappropriate diagnosis of CAP among hospitalized adults was common, particularly among older adults, those with dementia, and those presenting with altered mental status. Full-course antibiotic treatment of those inappropriately diagnosed with CAP may be harmful.
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Affiliation(s)
- Ashwin B Gupta
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Scott A Flanders
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lindsay A Petty
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Tejal N Gandhi
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Michael S Pulia
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jennifer K Horowitz
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - David Ratz
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
| | - Steven J Bernstein
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Anurag N Malani
- Section of Infectious Diseases, Trinity Health Michigan, Ann Arbor
| | | | - Timothy P Hofer
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Tanima Basu
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Vineet Chopra
- Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Valerie M Vaughn
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
- Division of Health System Innovation & Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
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Golbus JR, Jeganathan VSE, Stevens R, Ekechukwu W, Farhan Z, Contreras R, Rao N, Trumpower B, Basu T, Luff E, Skolarus LE, Newman MW, Nallamothu BK, Dorsch MP. A Physical Activity and Diet Just-in-Time Adaptive Intervention to Reduce Blood Pressure: The myBPmyLife Study Rationale and Design. J Am Heart Assoc 2024; 13:e031234. [PMID: 38226507 PMCID: PMC10926831 DOI: 10.1161/jaha.123.031234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/13/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone applications and wearable devices are promising mobile health interventions for hypertension self-management. However, most mobile health interventions fail to use contextual data, potentially diminishing their impact. The myBPmyLife Study is a just-in-time adaptive intervention designed to promote personalized self-management for patients with hypertension. METHODS AND RESULTS The study is a 6-month prospective, randomized-controlled, remotely administered trial. Participants were recruited from the University of Michigan Health in Ann Arbor, Michigan or the Hamilton Community Health Network, a federally qualified health center network in Flint, Michigan. Participants were randomized to a mobile application with a just-in-time adaptive intervention promoting physical activity and lower-sodium food choices as well as weekly goal setting or usual care. The mobile study application encourages goal attainment through a central visualization displaying participants' progress toward their goals for physical activity and lower-sodium food choices. Participants in both groups are followed for up for 6 months with a primary end point of change in systolic blood pressure. Exploratory analyses will examine the impact of notifications on step count and self-reported lower-sodium food choices. The study launched on December 9, 2021, with 484 participants enrolled as of March 31, 2023. Enrollment of participants was completed on July 3, 2023. After 6 months of follow-up, it is expected that results will be available in the spring of 2024. CONCLUSIONS The myBPmyLife study is an innovative mobile health trial designed to evaluate the effects of a just-in-time adaptive intervention focused on improving physical activity and dietary sodium intake on blood pressure in diverse patients with hypertension. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05154929.
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Affiliation(s)
- Jessica R. Golbus
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Michigan Integrated Center for Health Analytics and Medical PredictionUniversity of MichiganAnn ArborMIUSA
| | - V. Swetha E. Jeganathan
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Rachel Stevens
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Weena Ekechukwu
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Zahera Farhan
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Rocio Contreras
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Nikhila Rao
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Brad Trumpower
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Tanima Basu
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Evan Luff
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Lesli E. Skolarus
- Division of Vascular Neurology, Department of Neurology–Internal MedicineNorthwestern UniversityEvanstonILUSA
| | - Mark W. Newman
- School of Information and Computer Science, College of EngineeringUniversity of MichiganAnn ArborMIUSA
| | - Brahmajee K. Nallamothu
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Michigan Integrated Center for Health Analytics and Medical PredictionUniversity of MichiganAnn ArborMIUSA
- The Center for Clinical Management and ResearchAnn ArborMIUSA
| | - Michael P. Dorsch
- Department of Clinical Pharmacy, College of PharmacyUniversity of MichiganAnn ArborMIUSA
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Vaughn VM, Gupta A, Petty LA, Malani AN, Osterholzer D, Patel PK, Younas M, Bernstein SJ, Burdick S, Ratz D, Szymczak JE, McLaughlin E, Czilok T, Basu T, Horowitz JK, Flanders SA, Gandhi TN. A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria. JAMA Intern Med 2023; 183:933-941. [PMID: 37428491 PMCID: PMC10334295 DOI: 10.1001/jamainternmed.2023.2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/23/2023] [Indexed: 07/11/2023]
Abstract
Importance Hospitalized patients with asymptomatic bacteriuria (ASB) often receive unnecessary antibiotic treatment, which increases antibiotic resistance and adverse events. Objective To determine whether diagnostic stewardship (avoiding unnecessary urine cultures) or antibiotic stewardship (reducing unnecessary antibiotic treatment after an unnecessary culture) is associated with better outcomes in reducing antibiotic use for ASB. Design, Setting, and Participants This 3-year, prospective quality improvement study included hospitalized general care medicine patients with a positive urine culture among 46 hospitals participating in a collaborative quality initiative, the Michigan Hospital Medicine Safety Consortium. Data were collected from July 1, 2017, through March 31, 2020, and analyzed from February to October 2022. Exposure Participation in the Michigan Hospital Medicine Safety Consortium with antibiotic and diagnostic stewardship strategies at hospital discretion. Main Outcomes and Measures Overall improvement in ASB-related antibiotic use was estimated as change in percentage of patients treated with antibiotics who had ASB. Effect of diagnostic stewardship was estimated as change in percentage of patients with a positive urine culture who had ASB. Effect of antibiotic stewardship was estimated as change in percentage of patients with ASB who received antibiotics and antibiotic duration. Results Of the 14 572 patients with a positive urine culture included in the study (median [IQR] age, 75.8 [64.2-85.1] years; 70.5% female); 28.4% (n = 4134) had ASB, of whom 76.8% (n = 3175) received antibiotics. Over the study period, the percentage of patients treated with antibiotics who had ASB (overall ASB-related antibiotic use) declined from 29.1% (95% CI, 26.2%-32.2%) to 17.1% (95% CI, 14.3%-20.2%) (adjusted odds ratio [aOR], 0.94 per quarter; 95% CI, 0.92-0.96). The percentage of patients with a positive urine culture who had ASB (diagnostic stewardship metric) declined from 34.1% (95% CI, 31.0%-37.3%) to 22.5% (95% CI, 19.7%-25.6%) (aOR, 0.95 per quarter; 95% CI, 0.93-0.97). The percentage of patients with ASB who received antibiotics (antibiotic stewardship metric) remained stable, from 82.0% (95% CI, 77.7%-85.6%) to 76.3% (95% CI, 68.5%-82.6%) (aOR, 0.97 per quarter; 95% CI, 0.94-1.01), as did adjusted mean antibiotic duration, from 6.38 (95% CI, 6.00-6.78) days to 5.93 (95% CI, 5.54-6.35) days (adjusted incidence rate ratio, 0.99 per quarter; 95% CI, 0.99-1.00). Conclusions and Relevance This quality improvement study showed that over 3 years, ASB-related antibiotic use decreased and was associated with a decline in unnecessary urine cultures. Hospitals should prioritize reducing unnecessary urine cultures (ie, diagnostic stewardship) to reduce antibiotic treatment related to ASB.
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Affiliation(s)
- Valerie M. Vaughn
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
- Division of Health System Innovation & Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Ashwin Gupta
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lindsay A. Petty
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Anurag N. Malani
- Division of Infectious Diseases, Department of Internal Medicine, Trinity Health, St Joseph Mercy Ann Arbor, Ann Arbor, Michigan
| | - Danielle Osterholzer
- Division of Infectious Diseases, Hurley Medical Center, Flint, Michigan
- Department of Internal Medicine, College of Human Medicine, Michigan State University, East Lansing
| | - Payal K. Patel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah
| | - Mariam Younas
- Division of Infectious Diseases, Hurley Medical Center, Flint, Michigan
| | - Steven J. Bernstein
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of General Internal Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Stephanie Burdick
- Division of Hospital Medicine, Corewell Health, Grand Rapids, Michigan
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Julia E. Szymczak
- Division of Health System Innovation & Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Elizabeth McLaughlin
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Tawny Czilok
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Tanima Basu
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Jennifer K. Horowitz
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Scott A. Flanders
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
| | - Tejal N. Gandhi
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor
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Chilukuri S, Mallick I, Agrawal A, Maitre P, Arunsingh M, James FV, Kataria T, Narang K, Gurram BC, Anand AK, Utreja N, Dutta D, Pavamani S, Mitra S, Mallik S, Mahale N, Chandra M, Chinnachamy AN, Shahid T, Raghunathan MS, Kannan V, Mohanty SK, Basu T, Hotwani C, Panigrahi G, Murthy V. Multi-Institutional Clinical Outcomes of Biopsy Gleason Grade Group 5 Prostate Cancers Treated With Contemporary High-Dose Radiation and Long-Term Androgen Deprivation Therapy. Clin Oncol (R Coll Radiol) 2023; 35:454-462. [PMID: 37061457 DOI: 10.1016/j.clon.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
AIMS This multicentric retrospective study reports long-term clinical outcomes of non-metastatic grade group 5 prostate cancers treated with external beam radiotherapy (EBRT) alone with long-term androgen deprivation therapy (ADT). MATERIALS AND METHODS Patients treated across 19 institutions were studied. The key endpoints that were evaluated were 5-year biochemical recurrence-free survival (bRFS), metastases-free survival (MFS), overall survival, together with EBRT-related acute and late toxicities. The impact of various prognostic factors on the studied endpoints was analysed using univariate and multivariate analyses. RESULTS Among the 462 patients, 88% (405) had Gleason 9 disease and 31% (142) had primary Gleason pattern 5. A prostate-specific membrane antigen positron emission tomography-computed tomography scan was used for staging in 33% (153), 80% (371) were staged as T3/T4 and 30% (142) with pelvic nodal disease. The median ADT duration was 24 months; 66% received hypofractionated EBRT and 71.4% (330) received pelvic nodal irradiation. With a median follow-up of 56 months, the 5-year bRFS, MFS and overall survival were 73.1%, 77.4% and 90.5%, respectively. Primary Gleason pattern 5 was associated with worse bRFS, MFS and overall survival with hazard ratios of 0.51 (95% confidence interval 0.35 to 0.73, P < 0.001), 0.64 (95% confidence interval 0.43 to 0.96, P = 0.031) and 0.52 (95% confidence interval 0.28 to 0.97, P = 0.040), respectively, whereas pelvic nodal disease was associated with worse bRFS (hazard ratio 0.67, 95% confidence interval 0.46 to 0.98, P = 0.039) and MFS (hazard ratio 0.56, 95% confidence interval 0.37 to 0.85, P = 0.006). The acute and late radiation-related toxicities were low overall and pelvic nodal irradiation was associated with higher toxicities. CONCLUSION Contemporary EBRT and long-term ADT led to excellent 5-year clinical outcomes and low rates of toxicity in this cohort of non-metastatic grade group 5 prostate cancers. Primary Gleason pattern 5 and pelvic node disease portends inferior clinical outcomes.
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Affiliation(s)
- S Chilukuri
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - A Agrawal
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - F V James
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - T Kataria
- Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India
| | - K Narang
- Division of Radiation Oncology, Cancer Institute, Medanta, Sector-38, Gurugram, India
| | - B C Gurram
- Department of Radiation Oncology, Yashoda Cancer Institute, Somajiguda, Hyderabad, India
| | - A K Anand
- Max Super Speciality Hospital, Saket, New Delhi, India
| | - N Utreja
- Max Super Speciality Hospital, Saket, New Delhi, India
| | - D Dutta
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, India
| | - S Pavamani
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - S Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - S Mallik
- Department of Radiation Oncology, Narayana Superspeciality Hospital, Howrah, India
| | - N Mahale
- Nirali Memorial Radiation Centre and Bharat Cancer Hospital, Surat, India
| | - M Chandra
- Department of Radiation Oncology, Jupiter Hospital, Thane, India
| | - A N Chinnachamy
- Department of Radiation Oncology, VN Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - T Shahid
- Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata, India
| | - M S Raghunathan
- Department of Radiotherapy, Kovai Medical Centre and Hospital, Coimbatore, India
| | - V Kannan
- Department of Radiation Oncology, P.D Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - S K Mohanty
- Department of Radiation Oncology, Sterling Cancer Hospital, Rajkot, Gujrat, India
| | - T Basu
- Department of Radiation Oncology, HCG Cancer Centre, Mumbai, India
| | - C Hotwani
- Department of Radiation Oncology, Alexis Multi-Speciality Hospital, Nagpur, India
| | - G Panigrahi
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital and ACTREC, Homi Bhabha National Institute, Mumbai, India.
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Gershengorn HB, Basu T, Horowitz JK, McLaughlin E, Munroe E, O'Malley M, Hsaiky L, Flanders SA, Bernstein SJ, Paje D, Chopra V, Prescott HC. The Association of Vasopressor Administration through a Midline Catheter with Catheter-related Complications. Ann Am Thorac Soc 2023; 20:1003-1011. [PMID: 37166852 DOI: 10.1513/annalsats.202209-814oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
Rationale: Little is known about the safety of infusing vasopressors through a midline catheter. Objectives: To evaluate safety outcomes after vasopressor administration through a midline. Methods: We conducted a cohort study of adults admitted to 39 hospitals in Michigan (December 2017-March 2022) who received vasopressors while either a midline or peripherally inserted central catheter (PICC) was in place. Patients receiving vasopressors through a midline were compared with those receiving vasopressors through a PICC and, separately, to those with midlines in place but who received vasopressors through a different catheter. We used descriptive statistics to characterize and compare cohort characteristics. Multivariable mixed effects logistic regression models were fit to determine the association between vasopressor administration through a midline with outcomes, primarily catheter-related complications (bloodstream infection, superficial thrombophlebitis, exit site infection, or catheter occlusion). Results: Our cohort included 287 patients with midlines through which vasopressors were administered, 1,660 with PICCs through which vasopressors were administered, and 884 patients with midlines who received vasopressors through a separate catheter. Age (median [interquartile range]: 68.7 [58.6-75.7], 66.6 [57.1-75.0], and 67.6 [58.7-75.8] yr) and gender (percentage female: 50.5%, 47.3%, and 43.8%) were similar in all groups. The frequency of catheter-related complications was lower in patients with midlines used for vasopressors than PICCs used for vasopressors (5.2% vs. 13.4%; P < 0.001) but similar to midlines with vasopressor administration through a different device (5.2% vs. 6.3%; P = 0.49). After adjustment, administration of vasopressors through a midline was not associated with catheter-related complications compared with PICCs with vasopressors (adjusted odds ratios [aOR], 0.65 [95% confidence interval, 0.31-1.33]; P = 0.23) or midlines with vasopressors elsewhere (aOR, 0.85 [0.46-1.58]; P = 0.59). Midlines used for vasopressors were associated with greater risk of systemic thromboembolism (vs. PICCs with vasopressors: aOR, 2.69 [1.31-5.49]; P = 0.008; vs. midlines with vasopressors elsewhere: aOR, 2.42 [1.29-4.54]; P = 0.008) but not thromboses restricted to the ipsilateral upper extremity (vs. PICCs with vasopressors: aOR, 2.35 [0.83-6.63]; P = 0.10; model did not converge for vs. midlines with vasopressors elsewhere). Conclusions: We found no significant association of vasopressor administration through a midline with catheter-related complications. However, we identified increased odds of systemic (but not ipsilateral upper extremity) venous thromboembolism warranting further evaluation.
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Affiliation(s)
- Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
- Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tanima Basu
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Jennifer K Horowitz
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Elizabeth McLaughlin
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Elizabeth Munroe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Megan O'Malley
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Lama Hsaiky
- Department of Pharmacy, Beaumont Hospital, Dearborn, Michigan
| | - Scott A Flanders
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Steven J Bernstein
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; and
| | - David Paje
- Division of Hospital Medicine and
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
| | - Vineet Chopra
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- The Hospital Medicine Safety Consortium Coordinating Center, Ann Arbor, Michigan
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Basu T, Senapati M, Karpe A, Mahuvakar A, Mathur Y, Ambulkar I, Dsouza H, Saxena U, E R, Rajurkar S. Preliminary Outcome and Quality of Life among Geriatric Head and Neck Cancer (GHNC) Patients Treated with Institutional Nimorad (Nimotuzumab-Modulated Radiotherapy) Protocol. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Senapati M, Basu T, Saxena U, Kanjirath Eddam R, Maxwell S, Rajurkar S, Karpe A, Pawar T. Simultaneous Integrated Boost (SIB) Stereotactic Body Radiotherapy (SBRT) for prostate and pelvic nodes in high risk, node positive and oligometastatic prostate cancers: Safety, efficacy and quality of life outcome measures. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Basu T, Senapati M, Saxena U, E R, Rajurkar S, Mathur Y, Mahuvakar A, Karpe A, Dsouza H, Shah P. Carotid Sparing Modulated Radiotherapy (CSMRT) for Early Glottic Cancers: Single Institution Feasibility and Safety Assessment. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saxena U, Basu T, Senapati M, E R, Saran D, Rajurkar S, Patil R, Chiraniya S, Mangalani M. Single Institute Experience – Linear Accelerator Based Total Body Irradiation Using Volumetric Modulated Arc Therapy Planning in Standard Size Linear Accelerator Room. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Background Current guidelines recommend use of sacubitril‐valsartan in patients with heart failure with reduced ejection fraction (HFrEF). Early data suggested low uptake of sacubitril‐valsartan, but contemporary data on real‐world use and their associated cost are limited. Methods and Results This was a retrospective study of individuals enrolled in Optum Clinformatics, a national insurance claims data set from 2016 to 2018. We included all adult patients with HFrEF with 2 outpatient encounters or 1 inpatient encounter with an International Classification of Diseases, Tenth Revision (ICD‐10), diagnosis of HFrEF and 6 months of continuous enrollment, also receiving β‐blockers and angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers within 6 months of HFrEF diagnosis. We included 70 245 patients with HFrEF, and 5217 patients (7.4%) received sacubitril‐valsartan prescriptions. Patients receiving care through a cardiologist compared with a primary care physician alone were more likely to receive sacubitril‐valsartan (odds ratio, 1.61 [95% CI, 1.52–1.71]). Monthly out‐of‐pocket (OOP) cost for sacubitril‐valsartan, compared with angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, was higher for both commercially insured patients (mean, $69 versus $6.74) and Medicare Advantage (mean, $62 versus $2.52). For patients with commercial insurance, OOP cost was lower in 2016 than in 2018. For patients with Medicare Advantage, there was a significant geographic variation in the OOP costs across the country, ranging from $31 to $68 per month across different regions, holding all other patient‐related factors constant. Conclusions Sacubitril‐valsartan use was infrequent among patients with HFrEF. Patients receiving care with a cardiologist were more likely to receive sacubitril‐valsartan. OOP costs remain high, potentially limiting use. Significant geographic variation in OOP costs, unexplained by patient factors, was noted.
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Affiliation(s)
- Supriya Shore
- Division of Internal Medicine University of Michigan Ann Arbor MI.,Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Tanima Basu
- Division of Internal Medicine University of Michigan Ann Arbor MI
| | - Neil Kamdar
- Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Patrick Brady
- Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Edo Birati
- Division of Internal Medicine University of Pennsylvania Philadelphia PA.,Division of Cardiology Poriya Medical Center, Bar Ilan University Tiberias Israel
| | - Scott L Hummel
- Division of Internal Medicine University of Michigan Ann Arbor MI.,Ann Arbor Veterans Affairs Health System Ann Arbor MI
| | | | - Brahmajee K Nallamothu
- Division of Internal Medicine University of Michigan Ann Arbor MI.,Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI
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11
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Murthy V, Chilukuri S, Mallick I, Maitre P, Agarwal A, Moses A, James F, Narang K, Kataria T, Anand A, Dutta D, Mitra S, Pavamani S, Mallick S, Mahale N, Chandra M, Narayan A, Shahid T, Sairam M, Kannan V, Mohanty S, Basu T, Hotwani C, G B. OC-0606 Multi-institutional outcomes of Gleason grade group 5 prostate cancers treated with EBRT and ADT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Basu T, Senapati M, Priyadharshni J, Nair R, Saxena U, Rajurkar S. 94P Preliminary outcome data for deep inspiratory breath hold guided stereotactic radiotherapy (SBRT) with robotic couch correction for early stage non-small cell lung cancers (NSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Edupuganti S, Li M, Wu Z, Basu T, Barnes GD, Carrier M, Sood SL, Griggs JJ, Schaefer JK. Factors Associated With Inferior Vena Cava Filter Placement and Retrieval for Patients With Cancer-Associated Thrombosis. Am J Med 2022; 135:478-487.e5. [PMID: 34861200 DOI: 10.1016/j.amjmed.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Venous thromboembolism is a leading cause of death in patients with cancer. Inferior vena cava filters are utilized to mitigate the risk of pulmonary embolism for patients who have contraindication to, or failure of, anticoagulation. METHODS We reviewed an insurance claims database to identify adults receiving cancer-directed therapy and had a new diagnosis of venous thromboembolism. We then evaluated clinical and sociodemographic characteristics in patients with and without filter placement and retrieval. RESULTS There were 25,788 patients (mean [SD] age: 68.3 [12.7] years) who met the study inclusion criteria, with 2111 individuals (8.2%) undergoing filter placement. Filter placement was associated with the type of thrombosis, malignancy, recent surgery, comorbidities, and income. A total of 137 patients (6.5%) newly started anticoagulation within 3 days of filter placement, and 612 (29%) patients received anticoagulation within 30 days after filter placement. Despite this, only 159 (7.5%) patients had their filters retrieved during the study period. Patients with income of $75-99K (odds ratio 2.13, P = .012) or above $100K (odds ratio 1.8, P = .038) were more likely to have filter retrieval compared with those with income <$50K. Filter retrieval was also more likely in younger patients and those with fewer comorbidities or without central nervous system or lung malignancies. CONCLUSIONS Inferior vena cava filter placement and retrieval are associated with several sociodemographic factors. Filter retrieval rates are low despite re-initiation of anticoagulation in many patients. Efforts are needed to address disparities in filter use and improve retrieval rates.
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Affiliation(s)
| | | | - Zhenke Wu
- Department of Biostatistics; Michigan Institute for Data Science; Institute for Social Research
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation
| | - Geoffrey D Barnes
- Institute for Healthcare Policy and Innovation; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ont, Canada
| | - Suman L Sood
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor
| | - Jennifer J Griggs
- Institute for Healthcare Policy and Innovation; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor
| | - Jordan K Schaefer
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor.
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14
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Gupta A, Petty L, Gandhi T, Flanders S, Hsaiky L, Basu T, Zhang Q, Horowitz J, Masood Z, Chopra V, Vaughn VM. Overdiagnosis of urinary tract infection linked to overdiagnosis of pneumonia: a multihospital cohort study. BMJ Qual Saf 2022; 31:383-386. [PMID: 34987084 DOI: 10.1136/bmjqs-2021-013565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022]
Abstract
Urinary tract infection (UTI) and community-acquired pneumonia (CAP) are the most common infections treated in hospitals. UTI and CAP are also commonly overdiagnosed, resulting in unnecessary antibiotic use and diagnostic delays. While much is known individually about overdiagnosis of UTI and CAP, it is not known whether hospitals with higher overdiagnosis of one also have higher overdiagnosis of the other. Correlation of overdiagnosis of these two conditions may indicate underlying hospital-level contributors, which in turn may represent targets for intervention. To evaluate the association of overdiagnosis of UTI and CAP, we first determined the proportion of hospitalised patients treated for CAP or UTI at 46 hospitals in Michigan who were overdiagnosed according to national guideline definitions. Then, we used Pearson's correlation coefficient to compare hospital proportions of overdiagnosis of CAP and UTI. Finally, we assessed for 'diagnostic momentum' (ie, accepting a previous diagnosis without sufficient scepticism) by determining how often overdiagnosed patients remained on antibiotics on day 3 of hospitalisation. We included 14 085 patients treated for CAP (11.4% were overdiagnosed) and 10 398 patients treated for UTI (27.8% were overdiagnosed) across 46 hospitals. Within hospitals, the proportion of patients overdiagnosed with UTI was moderately correlated with the proportion of patients overdiagnosed with CAP (r=0.53, p<0.001). Over 80% (81.8% (n=952/1164) of UTI; 89.9% (n=796/885) of CAP) of overdiagnosed patients started on antibiotics by an emergency medicine clinician remained on antibiotics on day 3 of hospitalisation. In conclusion, we found overdiagnosis of UTI and CAP to be correlated at the hospital level. Reducing overdiagnosis of these two common infections may benefit from systematic interventions.
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Affiliation(s)
- Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA .,Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lindsay Petty
- Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tejal Gandhi
- Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott Flanders
- Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lama Hsaiky
- Department of Pharmacy, Beaumont Hospital, Dearborn, Michigan, USA
| | - Tanima Basu
- Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Qisu Zhang
- Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Horowitz
- Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Zainab Masood
- Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Valerie M Vaughn
- Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Division of General Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Population Health Science, The University of Utah School of Medicine, Salt Lake City, Utah, USA
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15
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Basu T, Kamdar N, Brady P, Cole CM, King J, Rontal R, Harper DM. Annual Wellness Visits for Persons With Physical Disabilities Before and After ACA Implementation. Ann Fam Med 2021; 19:484-491. [PMID: 34518196 PMCID: PMC8575518 DOI: 10.1370/afm.2712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Persons with disabilities often experience uncoordinated health care, with repeated out-of-pocket copays. One purpose of the Patient Protection and Affordable Care Act (ACA) was to create zero copays for preventive health care including an annual wellness visit (AWV). The purpose of this study was to document the use of AWVs by persons with physical disabilities during the ACA rollout. METHODS An administrative claims database, including both Medicare Advantage (MA) and commercial (COM) payers from 2008 to 2016, was used to identify unique wellness visits for adults with physical disabilities. We used interrupted time series analysis to compare AWV use by insurance type, sex, disability type, and race over time. RESULTS The proportion of zero copays provided a timeline of ACA implementation categorized as pre-ACA, ACA-implementation, and post-ACA periods. By 2016, AWV use maximized at 47.6% (95% CI, 44.7%-50.8%) among COM-insured White women with congenital disabilities. By 2016, the lowest AWV use reached one-half the maximum, at 21.6% (95% CI, 18.4%-25.2%) among COM-insured Hispanic men with acquired disabilities. MA-insured Black and Hispanic men with acquired disabilities reached similarly low levels of AWV use. CONCLUSION The ACA mandated zero copays, thereby allowing persons with physical disabilities the option for preventive health care without cost. Insurance type and sex significantly influenced AWV use, followed by disability type and race. Gaps in AWV use were exposed by insurance type, sex, disability, and race for persons with disabilities. Gaps in AWV use were also exposed between the general population and persons with disabilities.Annals "Online First" article.
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Affiliation(s)
- Tanima Basu
- University of Michigan, Institute for Healthcare Policy & Innovation, Ann Arbor, Michigan
| | - Neil Kamdar
- University of Michigan, Institute for Healthcare Policy & Innovation, Ann Arbor, Michigan
| | - Patrick Brady
- University of Michigan, Institute for Healthcare Policy & Innovation, Ann Arbor, Michigan
| | | | - Jaque King
- University of Michigan, Center for Health and Research Transformation, Ann Arbor, Michigan
| | - Robyn Rontal
- University of Michigan, Center for Health and Research Transformation, Ann Arbor, Michigan
| | - Diane M Harper
- University of Michigan, Departments of Family Medicine, Obstetrics/Gynecology, Bioengineering, Women's & Gender Studies, IHPI, Ann Arbor, Michigan
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16
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Whitney DG, Basu T. Whitney Comorbidity Index to monitor health status for adults with cerebral palsy: validation and thresholds to assist clinical decision making. Dev Med Child Neurol 2021; 63:853-859. [PMID: 33829504 DOI: 10.1111/dmcn.14879] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/23/2022]
Abstract
AIM To validate the Whitney Comorbidity Index (WCI), which was recently developed to monitor disease status for adults with cerebral palsy (CP), and to identify WCI scores associated with an increased mortality risk using a representative sample of adults with CP. METHOD Data from 2016 to 2018 were used from a random 20% sample from the fee-for-service Medicare database for this retrospective cohort study. The WCI was examined as unweighted (WCIunw ) and weighted (WCIw ) among adults at least 18 years old with CP. Cox regression models were developed with mortality as the outcome after adjusting for demographics. A concordance statistic (C-statistic) of at least 0.70 was considered as showing sufficient validity. The hazard ratio of mortality for each WCI score was estimated. Secondary analyses were performed for subgroups with co-occurring epilepsy and/or intellectual disabilities. RESULTS For the entire group (n=16 728) and subgroups, the WCI showed sufficient validity (C-statistic 0.73-0.81). For the entire group, the mortality rate was elevated for a score of 1 compared with 0 from the WCIunw (hazard ratio 3.06; 95% confidence interval [CI] 1.52-6.17) and WCIw (hazard ratio 4.08; 95% CI 1.69-9.85), and became larger with each WCI score. Results were similar for the subgroups. INTERPRETATION The WCI is a valid marker for health/disease status for adults with CP. Several WCI score thresholds were identified to assist in clinical decision making for preventive medicine and intervention implementation. What this paper adds The Whitney Comorbidity Index (WCI) is valid among 16 728 adults with CP. The WCI is valid for those with co-occurring epilepsy and/or intellectual disabilities. Thresholds of the WCI score were identified to assist clinical decision making.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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17
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James M, Philippidou M, Duncan M, Goolamali S, Basu T, Walsh S. Dietary deprivation during the COVID-19 pandemic producing acquired vulval zinc-deficiency dermatitis. Clin Exp Dermatol 2021; 46:1154-1157. [PMID: 33719087 PMCID: PMC8251369 DOI: 10.1111/ced.14605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- M James
- Department of Dermatology, King's College Hospital, London, UK
| | - M Philippidou
- Department of Dermatology, King's College Hospital, London, UK
| | - M Duncan
- Department of Dermatology, King's College Hospital, London, UK
| | - S Goolamali
- Department of Dermatology, King's College Hospital, London, UK
| | - T Basu
- Department of Dermatology, King's College Hospital, London, UK
| | - S Walsh
- Department of Dermatology, King's College Hospital, London, UK
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18
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Schaefer JK, Li M, Wu Z, Basu T, Barnes GD, Carrier M, Griggs JJ, Sood SL. Clinical and sociodemographic factors associated with anticoagulant use for cancer associated venous thromboembolism. J Thromb Thrombolysis 2021; 52:214-223. [PMID: 33544284 DOI: 10.1007/s11239-021-02392-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
Cancer associated thrombosis (CAT) is a leading cause of death among patients with cancer. It is not clear if non-clinical factors are associated with anticoagulation receipt. We conducted a retrospective cohort study of Optum's de-identified Clinformatics® Database of adults with cancer diagnosed between 2009 and 2016 who developed CAT, treated with an outpatient anticoagulant (warfarin, low molecular weight heparin (LMWH), or a direct oral anticoagulant (DOAC)). Of 12,622 patients, three months after an episode of CAT, 1,485 (12%) were on LMWH, 1,546 (12%) on DOACs, and 9,591 (76%) were on warfarin. When controlling for other factors, anticoagulant use was significantly associated with socioeconomic factors, region, co-morbidities, type of thrombosis, and cancer subtype. Patients with a bachelor's degree or greater level of education were less likely to receive warfarin (OR: 0.77; 95% CI: [0.59, 0.99]; p < 0.046) or DOACs (OR: 0.67; 95% CI: [0.55, 0.82]; p < 0.001) compared to LMWH. Patients with higher income levels were more likely to receive LMWH or DOACs compared to warfarin, while patients across all income levels were equally likely to receive LMWH or DOACs. Non-clinical factors including income, education, and region, are associated with anticoagulation receipt three months after an episode of CAT. Sociodemographic factors may result in some patients receiving suboptimal care and contribute to non-guideline concordant care for CAT.
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Affiliation(s)
- Jordan K Schaefer
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Mengbing Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Zhenke Wu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.,Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey D Barnes
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Jennifer J Griggs
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Suman L Sood
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
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19
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Schaefer JK, Li M, Wu Z, Basu T, Dorsch MP, Barnes GD, Carrier M, Griggs JJ, Sood SL. Anticoagulant medication adherence for cancer-associated thrombosis: A comparison of LMWH to DOACs. J Thromb Haemost 2021; 19:212-220. [PMID: 33104289 DOI: 10.1111/jth.15153] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/20/2022]
Abstract
Essentials It is not clear if patients are less adherent to low molecular weight heparin (LMWH) compared to direct oral anticoagulants (DOACs) for cancer-associated thrombosis (CAT). We evaluated medication adherence among two propensity-matched groups of patients with CAT by comparing the proportion of days covered (PDC). Median treatment persistence on DOACs was more than 80 days longer than LMWH. Medication adherence was high (~95%) and was similar with LMWH compared to DOACs. ABSTRACT: Background Low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) are used to treat cancer-associated thrombosis (CAT). It is not clear if patients are less adherent to LMWH compared to DOACs. Objectives To compare medication persistence and adherence between LMWH and DOACs. Patients/Methods We analyzed Optum's de-identified Clinformatics® Data Mart Database of privately insured adults with cancer diagnosed between January 2009 and October 2015 who were undergoing chemotherapy, immunotherapy, targeted or hormonal therapies; developed CAT; and were treated with an outpatient anticoagulant. The proportion of days covered (PDC) was calculated from the date of anticoagulant prescription until the anticoagulant was switched, stopped, or the study end. Medication adherence was defined as PDC ≥ 80%, ≥95%, and by comparing the mean PDC. Results Two propensity-matched groups of 1128 patients were identified. Patient persistence was higher with DOACs compared to LMWH (median 116 days versus 34 days). With adherence defined as PDC ≥ 80%, we found no significant difference (95.6% versus 94.6% adherence with DOACs versus LMWH, P = .33). The mean difference of PDC between the two groups was also similar. With medication adherence defined as PDC ≥ 95%, adherence was evident in 73% of DOAC users and 81% of patients on LMWH (P < .001). Prescription copayments were higher on average for LMWH compared to DOACs (mean $153.61 versus 40.67; standard deviation $306.74 versus $33.11). Conclusion Patients remain on DOACs longer than LMWH, but medication adherence is similar with LMWH.
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Affiliation(s)
- Jordan K Schaefer
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mengbing Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Zhenke Wu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Michael P Dorsch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey D Barnes
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, ON, Canada
| | - Jennifer J Griggs
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Suman L Sood
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
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20
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Basu T, Ambulkar I, Nayek D, Karpe A, Gawde S, Kamwal B, Shah S, Shah P, Behera N, Saldanha V, Sakhare P, Onchineyan S. Outcome and Quality of Life among Geriatric Head and Neck Cancer Patients Treated with Intensity Modulated Radiotherapy: Importance of Comprehensive Geriatric Head and Neck Cancer Clinic. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Shankar V, Sai Shreya V, Vyas H, Bhavya P, Haritha C, Bushra S, Lohith G, Basu T, Saxena U. Frameless Radiosurgery for Intractable Idiopathic Glossopharyngeal Neuralgia. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Basu T. PO-1286: An update from the 1st ESTRO-CARO-RANZCR course on Foundations of Leadership in Radiation Oncology. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Shankar V, Sai Shreya V, Haritha C, Bhavya P, Vyas H, Sebastin S, Basu T, Saxena U. Post SRS Normotensive Hydrocephalus In Acoustic Schwannoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Shankar V, Deshpande R, Raut N, Haritha C, Kendre P, Shreya VS, Bhavya P, Vyas H, Chauhan B, Saxena U, Basu T. Inter-Breath Hold Displacements of Daily GTV Positions With ABC for Lung SBRT. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shankar V, Shreya VS, Bhavya P, Vyas H, Haritha C, Deopujari C, Velho V, Turel K, Andar U, Saxena U, Basu T. Intradural Spine Tumors Radiosurgery Delivery Accuracy using CBCT Image Guidance. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Basu T, Patineedi B, Vyaas H, Kendre P, Karpe A, Raut N, Ambulkar I, Nayek D, Rao S, Gawde S, Saxena U, Vangipuram S, Kasat A, Arrmugam K. PD-0660: Radical chemoradiation with IMRT-SIB for LAHNSCC: Preliminary outcome. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00682-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Basu T, Karpe A, Mathur Y, Patel A, Kendre P, Katna R, Raut N, Rodrigues D, Yadav R, Nayak D, Ambulkar I, Gawde S. 937P Outcome, patterns of failure and toxicity profile following adjuvant intensity modulated radiotherapy for oral cavity squamous cell carcinomas. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Das A, Ghosh S, Das K, Dutta I, Basu T, Das M. Re:(In) visible impact of inadequate WaSH Provision on COVID-19 incidences can be not be ignored in large and megacities of India. Public Health 2020; 185:34-36. [PMID: 32521329 PMCID: PMC7253972 DOI: 10.1016/j.puhe.2020.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
- A Das
- Department of Geography, University of Gour Banga, Malda, India.
| | - S Ghosh
- Department of Geography, Kazi Nazrul University, Asansol, India.
| | - K Das
- Department of Geography, University of Gour Banga, Malda, India.
| | - I Dutta
- Department of Geography, University of Gour Banga, Malda, India.
| | - T Basu
- Department of Geography, University of Gour Banga, Malda, India.
| | - M Das
- Department of Geography, University of Gour Banga, Malda, India.
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Shendge AK, Chaudhuri D, Basu T, Mandal N. A natural flavonoid, apigenin isolated from Clerodendrum viscosum leaves, induces G2/M phase cell cycle arrest and apoptosis in MCF-7 cells through the regulation of p53 and caspase-cascade pathway. Clin Transl Oncol 2020; 23:718-730. [PMID: 32715386 DOI: 10.1007/s12094-020-02461-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND With 9.6 million deaths in 2018, cancer remains the second leading cause of death worldwide. Breast cancer is the most deadly type of cancer among females, with 55.2% of crude incidence rate and 16.6% of crude mortality rate. PURPOSE The present study was aimed to investigate the anti-breast cancer potential of natural dietary flavonoid, apigenin isolated from Clerodendrum viscosum leaves. METHODS Apigenin was evaluated for in-depth anticancer activity in MCF-7 cells using cell viability assay, cell cycle analysis, Annexin-V-FLUOS staining, ROS induction, morphological analysis, and western blot analysis. RESULTS Apigenin showed selective cytotoxicity on MCF-7 cells with an IC50-56.72 ± 2.35 µM, while negligible cytotoxicity was observed on WI-38 cells. Further, the flow cytometer-based analysis showed that apigenin halted MCF-7 cells in the G2/M phase arrest followed by dose-dependent apoptosis. Moreover, the FACS and confocal microscopy results confirmed the elevation of intracellular ROS and nuclear fragmentation in apigenin-treated MCF-7 cells. Western blots showed up-regulation of cell cycle regulatory proteins, increased p53 expression, Bax/Bcl-2 ratio, activation of caspases, and cleavage of PARP. Finally, apigenin treatment in the presence of Pifithrin-µ showed decreased apoptotic population and it was further confirmed through western blotting study. The results revealed the vital role of p53 in apigenin-induced apoptosis in MCF-7 cells. CONCLUSIONS In the present findings, treatment of apigenin-induced intracellular ROS in MCF-7 cells followed by induction of G2/M phase cell cycle arrest and further apoptosis through the regulation of p53 and caspase-cascade signaling pathway.
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Affiliation(s)
- A K Shendge
- Division of Molecular Medicine, Bose Institute, P-1/12 CIT Scheme - VIIM, Kolkata, West Bengal, 700054, India
| | - D Chaudhuri
- Division of Molecular Medicine, Bose Institute, P-1/12 CIT Scheme - VIIM, Kolkata, West Bengal, 700054, India
| | - T Basu
- Division of Molecular Medicine, Bose Institute, P-1/12 CIT Scheme - VIIM, Kolkata, West Bengal, 700054, India
| | - N Mandal
- Division of Molecular Medicine, Bose Institute, P-1/12 CIT Scheme - VIIM, Kolkata, West Bengal, 700054, India.
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Das A, Ghosh S, Das K, Basu T, Das M, Dutta I. Modeling the effect of area deprivation on COVID-19 incidences: a study of Chennai megacity, India. Public Health 2020; 185:266-269. [PMID: 32707468 PMCID: PMC7290224 DOI: 10.1016/j.puhe.2020.06.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022]
Abstract
Objectives Socio-economic inequalities may affect coronavirus disease 2019 (COVID-19) incidence. The goal of the research was to explore the association between deprivation of socio-economic status (SES) and spatial patterns of COVID-19 incidence in Chennai megacity for unfolding the disease epidemiology. Study design This is an ecological (or contextual) study for electoral wards (subcities) of Chennai megacity. Methods Using data of confirmed COVID-19 cases from May 15, 2020, to May 21, 2020, for 155 electoral wards obtained from the official website of the Chennai Municipal Corporation, we examined the incidence of COVID-19 using two count regression models, namely, Poisson regression (PR) and negative binomial regression (NBR). As explanatory factors, we considered area deprivation that represented the deprivation of SES. An index of multiple deprivations (IMD) was developed to measure the area deprivation using an advanced local statistic, geographically weighted principal component analysis. Based on the availability of appropriately scaled data, five domains (i.e., poor housing condition, low asset possession, poor availability of WaSH services, lack of household amenities and services, and gender disparity) were selected as components of the IMD in this study. Results The hot spot analysis revealed that area deprivation was significantly associated with higher incidences of COVID-19 in Chennai megacity. The high variations (adjusted R2: 72.2%) with the lower Bayesian Information Criteria (BIC) (124.34) and Akaike's Information Criteria (AIC) (112.12) for NBR compared with PR suggests that the NBR model better explains the relationship between area deprivation and COVID-19 incidences in Chennai megacity. NBR with two-sided tests and P <0.05 were considered statistically significant. The outcome of the PR and NBR models suggests that when all other variables were constant, according to NBR, the relative risk (RR) of COVID-19 incidences was 2.19 for the wards with high housing deprivation or, in other words, the wards with high housing deprivation having 119% higher probability (RR = e0.786 = 2.19, 95% confidence interval [CI] = 1.98 to 2.40), compared with areas with low deprivation. Similarly, in the wards with poor availability of WaSH services, chances of having COVID-19 incidence was 90% higher than in the wards with good WaSH services (RR = e0.642 = 1.90, 95% CI = 1.79 to 2.00). Spatial risks of COVID-19 were predominantly concentrated in the wards with higher levels of area deprivation, which were mostly located in the northeastern parts of Chennai megacity. Conclusions We formulated an area-based IMD, which was substantially related to COVID-19 incidences in Chennai megacity. This study highlights that the risks of COVID-19 tend to be higher in areas with low SES and that the northeastern part of Chennai megacity is predominantly high-risk areas. Our results can guide measures of COVID-19 control and prevention by considering spatial risks and area deprivation. COVID-19 cases was modelled using Poisson regression and negative binomial regression. An IMD was devised using geographically weighted principal component analysis. Area deprivation in Chennai has both positive and inverse associations with the COVID-19.
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Affiliation(s)
- A Das
- Department of Geography, University of Gour Banga, Malda, India.
| | - S Ghosh
- Department of Geography, Kazi Nazrul University, Asansol, India.
| | - K Das
- Department of Geography, University of Gour Banga, Malda, India.
| | - T Basu
- Department of Geography, University of Gour Banga, Malda, India.
| | - M Das
- Department of Geography, University of Gour Banga, Malda, India.
| | - I Dutta
- Department of Geography, University of Gour Banga, Malda, India.
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Shore S, Basu T, Kamdar N, Brady P, Hummel SL, Chopra VI, Nallamothu BK. Abstract 343: Trends and Predictors of Use of Angiotensin Receptor Blocker and Neprilysin Inhibitor in Patients With Heart Failure. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Current guidelines recommend use of combination therapy with angiotensin receptor blocker and neprilysin inhibitor (ARNI) (i.e., Entresto
®
) in patients with heart failure (HF) with reduced ejection fraction as a class 1 recommendation. Contemporary data on real-world use of these agents is lacking.
Methods:
This is a retrospective cohort study of individuals enrolled in Clinformatics® Data Mart Database (OptumInsight, Eden Prairie, MN from January 1, 2016 to December 31, 2018. We included all individuals ≥ 18 years, with two outpatient encounters or one inpatient encounter with a principal ICD 10 diagnosis for HFand 6 months of continuous enrollment. To further identify patients with reduced ejection fraction, we only included individuals who received prescriptions for beta-blockers and angiotensin converting enzyme inhibitors/ angiotensin receptor blockers. Comorbidities were identified using Elixhauser comorbidity index.. Multivariate logistic regression model was used to identify predictors of ARNI use.
Results:
A total of 154,777 patients were included in our cohort. Overall, 5,834 patients (3.8%) received an ARNI prescription. Use of ARNI increased from 1.4% in 2016 to 3.9% in 2018 (p<0.01). Compared to patients receiving angiotensin converting enzyme inhibitors/angiotensin receptor blockers, patients receiving ARNI were younger (mean age 69.4 ± 11.1 vs. 72.9 ± 11.0 years;), more likely to be male (69.3% vs. 54.4%) and have commercial insurance (22.1% vs. 16.7%) with a higher comorbidity burden. Predictors of ARNI use after multivariable adjustment included age<65 years (OR 1.4; 95% CI 1.3-1.5), Male sex (OR 1.8; 95% CI 1.7 - 1.9) and black race (OR 1.2; 95% CI 1.1 - 1.2). Other predictors of ARNI use are shown in Figure 1. Patients receiving care through a cardiologist compared to a primary care physician were more likely to receive an ARNI (OR 1.8; 95% 1.7 - 1.9). Out of pocket cost for ARNI ranged from $0 to $1006 per month (median $44; IQR $9-$60).
Conclusion:
Rates of ARNI use remain low among patients with heart failure with racial and gender disparities. Heart Failure patients receiving care with a cardiologist were more likely to receive ARNI. Out of pocket cost for this medication remains high and may be a significant barrier to its use.
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Erickson SR, Basu T, Dorsch MP, Kamdar N. Disparities in the Use of Guideline-Based Pharmacotherapy Exist for Atherosclerotic Cardiovascular Disease and Heart Failure Patients Who Have Intellectual/Developmental Disabilities in a Commercially Insured Database. Ann Pharmacother 2020; 54:958-966. [PMID: 32336108 DOI: 10.1177/1060028020916842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients who have intellectual/developmental disabilities (IDDs) develop atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) at rates similar to or higher than the general population. They also face disparities accessing and using health care services. OBJECTIVE To determine if disparities exist in the use of guideline-based pharmacotherapy (GBP) for ASCVD or HF for adults with IDD. METHODS Using the 2014 Clinformatics Data Mart Database, adults with ASCVD or HF were divided into IDD or non-IDD groups. Patients with contraindications for GBP medications were excluded. Use of GBP between IDD and non-IDD groups was examined. Subgroup analysis included comparisons between IDD groups. RESULTS For HF, 1011 patients with IDD and 236,638 non-IDD patients were identified. For ASCVD, 2190 IDD and 790,343 non-IDD patients were identified. We found that 47.9%, 35.8%, and 13.1% of IDD and 58.7%, 48.4%, and 18.9% of non-IDD patients had pharmacy claims for statins (P < 0.001), β-blockers (P < 0.001), or antiplatelet therapy (P < 0.001), respectively. For HF, 46.8% and 50.3% of IDD and 59.8% and 55.4% of non-IDD patients had pharmacy claims for β-blockers (P < 0.001) and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs; P = 0.003), respectively. In all but one multivariate regression models patients with IDD were less likely to use GBP than patients in the non-IDD group. Subgroup analysis revealed that patients who had Down syndrome had lower GBP use in 4 of the 5 measures. CONCLUSION AND RELEVANCE Disparities exist in the use of GBP for patients with IDD with ASCVD or HF. Patients who have an IDD should be examined by clinicians to ensure appropriate access to and use of GBP.
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Affiliation(s)
- Steven R Erickson
- University of Michigan, Ann Arbor, MI, USA.,Wayne State University, Detroit, MI, USA
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Mahajan P, Basu T, Pai CW, Singh H, Petersen N, Bellolio MF, Gadepalli SK, Kamdar NS. Factors Associated With Potentially Missed Diagnosis of Appendicitis in the Emergency Department. JAMA Netw Open 2020; 3:e200612. [PMID: 32150270 PMCID: PMC7063499 DOI: 10.1001/jamanetworkopen.2020.0612] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Appendicitis may be missed during initial emergency department (ED) presentation. OBJECTIVE To compare patients with a potentially missed diagnosis of appendicitis (ie, patients with symptoms associated with appendicitis, including abdominal pain, constipation, nausea and/or vomiting, fever, and diarrhea diagnosed within 1-30 days after initial ED presentation) with patients diagnosed with appendicitis on the same day of ED presentation to identify factors associated with potentially missed appendicitis. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, a retrospective analysis of commercially insured claims data was conducted from January 1 to December 15, 2019. Patients who presented to the ED with undifferentiated symptoms associated with appendicitis between January 1, 2010, and December 31, 2017, were identified using the Clinformatics Data Mart administrative database (Optum Insights). The study sample comprised eligible adults (aged ≥18 years) and children (aged <18 years) who had previous ED visits within 30 days of an appendicitis diagnosis. MAIN OUTCOMES AND MEASURES Potentially missed diagnosis of appendicitis. Adjusted odds ratios (AORs) for abdominal pain and its combinations with other symptoms associated with appendicitis were compared between patients with a same-day diagnosis of appendicitis and patients with a potentially missed diagnosis of appendicitis. RESULTS Of 187 461 patients with a diagnosis of appendicitis, a total of 123 711 (66%; 101 375 adults [81.9%] and 22 336 children [18.1%]) were eligible for analysis. Among adults, 51 923 (51.2%) were women, with a mean (SD) age of 44.3 (18.2) years; among children, 9631 (43.1%) were girls, with a mean (SD) age of 12.2 (18.2) years. The frequency of potentially missed appendicitis was 6060 of 101 375 adults (6.0%) and 973 of 22 336 children (4.4%). Patients with isolated abdominal pain (adults, AOR, 0.65; 95% CI, 0.62-0.69; P < .001; children, AOR, 0.79; 95% CI, 0.69-0.90; P < .001) or with abdominal pain and nausea and/or vomiting (adults, AOR, 0.90; 95% CI, 0.84-0.97; P = .003; children, AOR, 0.84; 95% CI, 0.71-0.98; P = .03) were less likely to have missed appendicitis. Patients with abdominal pain and constipation (adults, AOR, 1.51; 95% CI, 1.31-1.75; P < .001; children, AOR, 2.43; 95% CI, 1.86-3.17; P < .001) were more likely to have missed appendicitis. Stratified by the presence of undifferentiated symptoms, women (abdominal pain, AOR, 1.68; 95% CI, 1.58-1.78; nausea and/or vomiting, AOR, 1.68; 95% CI, 1.52-1.85; fever, AOR, 1.32; 95% CI, 1.10-1.59; diarrhea, AOR, 1.19; 95% CI, 1.01-1.40; and constipation, AOR, 1.50; 95% CI, 1.24-1.82) and girls (abdominal pain, AOR, 1.64; 95% CI, 1.43-1.88; nausea and/or vomiting, AOR, 1.74; 95% CI, 1.42-2.13; fever, AOR, 1.55; 95% CI, 1.14-2.11; diarrhea, AOR, 1.80; 95% CI, 1.19-2.74; and constipation, AOR, 1.25; 95% CI, 0.88-1.78) as well as patients with a comorbidity index of 2 or greater (adults, abdominal pain, AOR, 3.33; 95% CI, 3.09-3.60; nausea and/or vomiting, AOR, 3.66; 95% CI, 3.23-4.14; fever, AOR, 5.00; 95% CI, 3.79-6.60; diarrhea, AOR, 4.27; 95% CI, 3.39-5.38; and constipation, AOR, 4.17; 95% CI, 3.08-5.65; children, abdominal pain, AOR, 2.42; 95% CI, 1.93-3.05; nausea and/or vomiting, AOR, 2.55; 95% CI, 1.89-3.45; fever, AOR, 4.12; 95% CI, 2.71-6.25; diarrhea, AOR, 2.17; 95% CI, 1.18-3.97; and constipation, AOR, 2.19; 95% CI, 1.30-3.70) were more likely to have missed appendicitis. Adult patients who received computed tomographic scans at the initial ED visit (abdominal pain, AOR, 0.58; 95% CI, 0.52-0.65; nausea and/or vomiting, AOR, 0.63; 95% CI, 0.52-0.75; fever, AOR, 0.41; 95% CI, 0.29-0.58; diarrhea, AOR, 0.83; 95% CI, 0.58-1.20; and constipation, AOR, 0.60; 95% CI, 0.39-0.94) were less likely to have missed appendicitis. CONCLUSIONS AND RELEVANCE Regardless of age, a missed diagnosis of appendicitis was more likely to occur in women, patients with comorbidities, and patients who experienced abdominal pain accompanied by constipation. Population-based estimates of the rates of potentially missed appendicitis reveal opportunities for improvement and identify factors that may mitigate the risk of a missed diagnosis.
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Affiliation(s)
- Prashant Mahajan
- Department of Emergency Medicine, University of Michigan, Ann Arbor
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Chih-Wen Pai
- Department of Emergency Medicine, University of Michigan, Ann Arbor
| | - Hardeep Singh
- Department of Health Services Research, Baylor College of Medicine, Houston, Texas
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Nancy Petersen
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - M. Fernanda Bellolio
- Department of Emergency Medicine, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Neil S. Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Mahmoudi E, Basu T, Langa K, McKee M, zazove P, Kamdar N. CAN HEARING AIDS DELAY THE ONSET OF ALZHEIMER’S AND OTHER AGE-RELATED CONDITIONS AMONG ADULTS WITH HEARING LOSS? Innov Aging 2019. [PMCID: PMC6840691 DOI: 10.1093/geroni/igz038.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In this study, we examined the association between hearing aids (HAs) and the onset of Alzheimer’s disease or dementia; depression or anxiety; drug or alcohol disorders; and falls among adults aged 50 and older with hearing loss (HL). We performed a retrospective study of 176,716 adults (50+) with HL diagnoses using a national, insurance claims data (2008-2016). We used Kaplan Meier curves to examine disease-free survival and Cox regression models to examine the risk-adjusted association between HAs and time to diagnosis of 4 age-related/HL-associated conditions within 3 years of HL diagnosis. Large gender and racial/ethnic differences exist in HAs use. Approximately 11.3% of women vs. 14.5% of men used HAs (95% CI Difference: -0.04, -0.03). About 14.1% of Whites (95% CI: 0.14, 0.14) vs. 9.5% of Blacks (95% CI: 0.09, 0.10) and 7.8% of Hispanics (95% CI: 0.07, 0.08) used HAs. The risk-adjusted hazard ratios of being diagnosed with Alzheimer’s disease or dementia, depression or anxiety, drug/alcohol disorders, and injurious falls within 3 years after HL diagnosis, for those who used HA vs. those who did not, were lower by 0.82 (95% CI: 0.76-0.88), 0.92 (95% CI: 0.89-0.95), 0.91 (95% CI:0.80-1.04), and 0.86 (95% CI: 0.81-0.92), respectively. Use of HAs is associated with delayed onset of Alzheimer’s, dementia, depression, anxiety, and injurious falls among adults 50 years of age and older with HL. This is important because HL are increasingly common among older adults and early HL diagnosis and use of HAs may prevent or delay physical and mental decline.
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Affiliation(s)
- Elham Mahmoudi
- University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, United States
| | - Tanima Basu
- University of Michigan, Ann Arbor, Michigan, United States
| | - Kenneth Langa
- University of Michigan, Ann Arbor, Michigan, United States
| | - Michael McKee
- University of Michigan, Ann Arbor, Michigan, United States
| | - Phillip zazove
- University of Michigan, Ann Arbor, Michigan, United States
| | - Neil Kamdar
- University of Michigan, Ann Arbor, Michigan, United States
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Abstract
This cohort study assesses the rates of routine voiding cystourethrogram testing in children with febrile urinary tract infection before and after screening guidelines were issued by the American Academy of Pediatrics.
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Affiliation(s)
- Ted Lee
- Department of Urology, Michigan Medicine, Ann Arbor
| | | | - Tanima Basu
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor
| | - John M. Park
- Department of Urology, Michigan Medicine, Ann Arbor
| | - Julian Wan
- Department of Urology, Michigan Medicine, Ann Arbor
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Mahmoudi E, Basu T, Langa K, McKee MM, Zazove P, Alexander N, Kamdar N. Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults? J Am Geriatr Soc 2019; 67:2362-2369. [PMID: 31486068 DOI: 10.1111/jgs.16109] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine the association between hearing aids (HAs) and time to diagnosis of Alzheimer disease (AD) or dementia, anxiety or depression, and injurious falls among adults, aged 66 years and older, within 3 years of hearing loss (HL) diagnosis. DESIGN Retrospective cohort study. SETTING We used 2008 to 2016 national longitudinal claims data (based on office visit, inpatient, or outpatient healthcare encounters) from a large private payer. We used Kaplan-Meier curves to examine unadjusted disease-free survival and crude and adjusted Cox regression models to examine associations between HAs and time to diagnosis of three age-related/HL-associated conditions within 3 years of HL diagnosis. All models were adjusted for age, sex, race/ethnicity, census divisions, and prior diagnosis of cardiovascular conditions, hypertension, hypercholesterolemia, obesity, and diabetes. PARTICIPANTS The participants included 114 862 adults, aged 66 years and older, diagnosed with HL. MEASUREMENT Diagnosis of (1) AD or dementia; (2) depression or anxiety; and (3) injurious falls. INTERVENTION Use of HAs. RESULTS Large sex and racial/ethnic differences exist in HA use. Approximately 11.3% of women vs 13.3% of men used HAs (95% confidence interval [CI] difference = -0.024 to -0.016). Approximately 13.6% of whites (95% CI = 0.13-0.14) vs 9.8% of blacks (95% CI = 0.09-0.11) and 6.5% of Hispanics (95% CI = 0.06-0.07) used HAs. The risk-adjusted hazard ratios of being diagnosed with AD/dementia, anxiety/depression, and injurious falls within 3 years after HL diagnosis, for those who used HAs vs those who did not, were 0.82 (95% CI = 0.76-0.89), 0.89 (95% CI = 0.86-0.93), and 0.87 (95% CI = 0.80-0.95), respectively. CONCLUSIONS Use of HAs is associated with delayed diagnosis of AD, dementia, depression, anxiety, and injurious falls among older adults with HL. Although we have shown an association between use of HAs and reduced risk of physical and mental decline, randomized trials are needed to determine whether, and to what extent, the relationship is causal. J Am Geriatr Soc 67:2362-2369, 2019.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Kenneth Langa
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Veteran Affairs (VA) Center for Clinical Management Policy Research, Ann Arbor, Michigan
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Philip Zazove
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Neil Alexander
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Saran D, Shankar V, Parekh S, Gedam S, Haritha C, Bhaskar P, Bhange A, Basu T, Saxena U, Samy K, Lohith G. CT Cisternography for Target Delineation in Post MVD Failed Complex Anatomy Trigeminal Neuralgia. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bhaskar P, Shankar V, Haritha C, Bhange A, Samy K, Lohith G, Basu T, Saxena U, Nikam D. Great Vessel Motion Mapping from 4D MRI to 3D CT - Implications for Oligo Metastatic Spinal SBRT Vessel Constraint. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rajesh S, Shankar V, Haritha C, Bhaskar P, Bhange A, Samy K, Maurya S, Basu T, Lohith G. Intra-Fraction Motion in Frameless Trigeminal Radiosurgery. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Triebwasser JE, Kamdar NS, Langen ES, Moniz MH, Basu T, Syrjamaki J, Thomason AC, Smith RD, Morgan DM. Hospital contribution to variation in rates of vaginal birth after cesarean. J Perinatol 2019; 39:904-910. [PMID: 30952949 PMCID: PMC6592715 DOI: 10.1038/s41372-019-0373-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC). STUDY DESIGN This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included. We calculated the hospital-specific risk-standardized VBAC rates and median odds ratio as a measure of variation. RESULT Hospital-level adjusted rates varied nearly tenfold (3.7%-35.5%). Compared to the lowest volume hospitals (1st quartile), the likelihood of VBAC increased for those in the 2nd (adjusted OR 2.75 [95% CI 1.23-6.17]), 3rd (adjusted OR 3.73 [95% CI 1.59-8.75]), and 4th quartiles (adjusted OR 2.9 [95% CI 1.11-7.72]). The median OR suggested significant variation by hospital after adjustment. CONCLUSION The delivery hospital itself explains a large amount of the variation in rates of VBAC after adjustment for patient and hospital characteristics.
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Affiliation(s)
- Jourdan E Triebwasser
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA.
- University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology, Philadelphia, PA, USA.
| | - Neil S Kamdar
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
- University of Michigan, Department of Surgery, Ann Arbor, MI, USA
- University of Michigan, Department of Emergency Medicine, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Elizabeth S Langen
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Michelle H Moniz
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Tanima Basu
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - John Syrjamaki
- University of Michigan, Department of Urology, Ann Arbor, MI, USA
| | - Alexandra C Thomason
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Roger D Smith
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Daniel M Morgan
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
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Kovacs SB, Basu T, Pahl H. PS1454 CAG PROMOTER DRIVEN C-MYC OVEREXPRESSION CAUSES RAPIDLY LETHAL CARDIOMYOPATHY. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000564080.52898.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rogers MA, Kim C, Tipirneni R, Basu T, Lee JM. Duration of Insulin Supply in Type 1 Diabetes: Are 90 Days Better or Worse Than 30 Days? Diabetes Spectr 2019; 32:139-144. [PMID: 31168285 PMCID: PMC6528389 DOI: 10.2337/ds18-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There have been few studies regarding the duration of insulin prescriptions and patient outcomes. This study evaluated whether A1C varied with the duration of insulin prescription in patients with type 1 diabetes. METHODS We conducted a longitudinal investigation (from 2001 to 2015) within a nationwide private health insurer. A cohort study was first used to compare A1C after 30-day only, 90-day only, and a combination (30-day and 90-day) of insulin prescriptions. Second, a self-controlled case series was used to compare A1C levels after 30-day versus 90-day prescriptions for the same person. RESULTS In the cohort study, there were 16,725 eligible patients. Mean A1C was 8.33% for patients with 30-day prescriptions compared to 7.69% for those with 90-day prescriptions and 8.05% for those who had a combination of 30- and 90-day prescriptions (P <0.001). Results were similar when stratified by age and sex. Mean A1C was 7.58% when all prescriptions were mailed versus 8.21% when they were not. In the self-controlled case series, there were 1,712 patients who switched between 30- and 90-day prescriptions. Mean A1C was 7.87% after 30-day prescriptions and 7.69% after 90-day prescriptions (P <0.001). Results were similar when stratified by sex. For this within-person comparison, the results remained significant for those ≥20 years of age (n = 1,536, P <0.001), but not for youth (n = 176, P = 0.972). CONCLUSION There was a statistically significant but clinically modest decrease in A1C with 90-day versus 30-day insulin prescriptions in adults. A mailed 90-day insulin prescription may be a reasonable choice for adults with type 1 diabetes.
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Affiliation(s)
- Mary A.M. Rogers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Catherine Kim
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Renuka Tipirneni
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Tanima Basu
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Joyce M. Lee
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI
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Rogers MAM, Kim C, Lee JM, Basu T, Tipirneni R. Private Insurance Coverage for Diabetes Before and After Enactment of the Preexisting Condition Mandate of the Affordable Care Act, 2005-2016. Am J Public Health 2019; 109:562-564. [PMID: 30789766 DOI: 10.2105/ajph.2018.304933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine private insurance coverage for persons with diabetes before and after enactment of the preexisting condition mandate of the Affordable Care Act (ACA) in the United States. METHODS We conducted a nationwide study in adults aged 20 to 59 years with private health insurance with the Clinformatics Data Mart Database (2005-2016). We used fixed-effects negative binomial regression to evaluate differences in pre-post mandate trends. RESULTS There was a 4% decline in prevalence rates of type 1 diabetes in adults with private health insurance before the mandate and an 11% increase afterward (P < .001). Coverage increased to the greatest extent (-6% before, +20% after) in those aged 50 to 59 years (P < .001). For type 2 diabetes, there was a significant decline in prevalence before the mandate, which increased afterward in those aged 40 to 49 years (-4% before, 3% after; P = .031) and 50 to 59 years (-6% before, 15% after; P < .001). CONCLUSIONS Adults with diabetes may have benefited in obtaining private health insurance after implementation of the preexisting condition mandate of the ACA. Public Health Implications. Efforts to limit enforcement of these protections are likely to contribute to setbacks in access to care.
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Affiliation(s)
- Mary A M Rogers
- Mary A. M. Rogers, Catherine Kim, and Renuka Tipirneni are with the Department of Internal Medicine and the Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor. Tanima Basu is with the Institute of Healthcare Policy and Innovation, University of Michigan. Joyce M. Lee is with the Institute of Healthcare Policy and Innovation and the Department of Pediatrics and Communicable Diseases, University of Michigan
| | - Catherine Kim
- Mary A. M. Rogers, Catherine Kim, and Renuka Tipirneni are with the Department of Internal Medicine and the Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor. Tanima Basu is with the Institute of Healthcare Policy and Innovation, University of Michigan. Joyce M. Lee is with the Institute of Healthcare Policy and Innovation and the Department of Pediatrics and Communicable Diseases, University of Michigan
| | - Joyce M Lee
- Mary A. M. Rogers, Catherine Kim, and Renuka Tipirneni are with the Department of Internal Medicine and the Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor. Tanima Basu is with the Institute of Healthcare Policy and Innovation, University of Michigan. Joyce M. Lee is with the Institute of Healthcare Policy and Innovation and the Department of Pediatrics and Communicable Diseases, University of Michigan
| | - Tanima Basu
- Mary A. M. Rogers, Catherine Kim, and Renuka Tipirneni are with the Department of Internal Medicine and the Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor. Tanima Basu is with the Institute of Healthcare Policy and Innovation, University of Michigan. Joyce M. Lee is with the Institute of Healthcare Policy and Innovation and the Department of Pediatrics and Communicable Diseases, University of Michigan
| | - Renuka Tipirneni
- Mary A. M. Rogers, Catherine Kim, and Renuka Tipirneni are with the Department of Internal Medicine and the Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor. Tanima Basu is with the Institute of Healthcare Policy and Innovation, University of Michigan. Joyce M. Lee is with the Institute of Healthcare Policy and Innovation and the Department of Pediatrics and Communicable Diseases, University of Michigan
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Platt KD, Thompson AN, Lin P, Basu T, Linden A, Fendrick AM. Assessment of Self-monitoring of Blood Glucose in Individuals With Type 2 Diabetes Not Using Insulin. JAMA Intern Med 2019; 179:269-272. [PMID: 30534950 PMCID: PMC6439646 DOI: 10.1001/jamainternmed.2018.5700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This database analysis quantifies the rate of use and cost of self-monitoring blood glucose supplies that are potentially used inappropriately, specifically focusing on test strips.
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Affiliation(s)
- Kevin D Platt
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Amy N Thompson
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Ariel Linden
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - A Mark Fendrick
- Department of Internal Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Affiliation(s)
- Mary A M Rogers
- Department of Internal Medicine, University of Michigan, Bldg 16, Rm 422W North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109. .,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Benjamin S Rogers
- Department of Geography, Bowling Green State University, Bowling Green, Ohio
| | - Tanima Basu
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Wright K, Misal M, Basu T, Siedhoff M. A Rare Case of Pregnancy of Unknown Location Managed with Operative Hysteroscopy and Laparoscopy. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Paolino A, Walsh S, Basu T, Creamer D. Severe drug-induced kidney injury in acute generalized exanthematous pustulosis. Clin Exp Dermatol 2017; 43:323-324. [PMID: 29222845 DOI: 10.1111/ced.13316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A Paolino
- Department of Dermatology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - S Walsh
- Department of Dermatology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - T Basu
- Department of Dermatology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - D Creamer
- Department of Dermatology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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Gupta D, Kataria T, Bisht S, Goyal S, Basu T, Abhishek A, Narang K, Banerjee S. 142PD Reirradiation for glioblastoma with temozolomide: Delicate balance between effectiveness and toxicity. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw578.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bisht S, Kataria T, Gupta D, Abhishek A, Goyal S, Basu T, Narang K, Tayal M, Banarjee S, Arora J, Razdan S. 78P Population based mammographic screening in India: Analysis from community outreach cancer screening program. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw575.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Bisht S, Kataria T, Gupta D, Abhishek A, Goyal S, Basu T, Narang K, Tayal M, Banarjee S, Arora J, Razdan S. 78P Population based mammographic screening in India: Analysis from community outreach cancer screening program. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00238-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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