1
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Feldman SR, Gao R, Bohn RL, Gray S, Walton SE, Déruaz-Luyet A, Wu JJ. Varied treatment pathways with no defined treatment sequencing in patients with generalized pustular psoriasis: A claims-based study. JAAD Int 2024; 15:59-61. [PMID: 38371664 PMCID: PMC10869926 DOI: 10.1016/j.jdin.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
- Steven R. Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ran Gao
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut
| | | | | | | | | | - Jashin J. Wu
- Department of Dermatology, University of Miami, Miller School of Medicine, Miami, Florida
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Kuwauchi A, Yoshida S, Takeda C, Yamashita Y, Kimura T, Takeuchi M, Kawakami K. Validity of Using Japanese Administrative Data to Identify Inpatients With Acute Pulmonary Embolism: Referencing the COMMAND VTE Registry. J Epidemiol 2024; 34:155-163. [PMID: 37088553 PMCID: PMC10918337 DOI: 10.2188/jea.je20220360] [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: 12/28/2022] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Acute pulmonary embolism (PE) is a life-threatening in-hospital complication. Recently, several studies have reported the clinical characteristics of PE among Japanese patients using the diagnostic procedure combination (DPC)/per diem payment system database. However, the validity of PE identification algorithms for Japanese administrative data is not yet clear. The purpose of this study was to evaluate the validity of using DPC data to identify acute PE inpatients. METHODS The reference standard was symptomatic/asymptomatic PE patients included in the COntemporary ManageMent AND outcomes in patients with Venous ThromboEmbolism (COMMAND VTE) registry, which is a cohort study of acute symptomatic venous thromboembolism (VTE) patients in Japan. The validation cohort included all patients discharged from the six hospitals included in both the registry and DPC database. The identification algorithms comprised diagnosis, anticoagulation therapy, thrombolysis therapy, and inferior vena cava filter placement. Each algorithm's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated. RESULTS A total of 43.4% of the validation cohort was female, with a mean age of 67.3 years. The diagnosis-based algorithm showed a sensitivity of 90.2% (222/246; 95% confidence interval [CI], 85.8-93.6%), a specificity of 99.8% (228,485/229,027; 95% CI, 99.7-99.8%), a PPV of 29.1% (222/764; 95% CI, 25.9-32.4%) and an NPV of 99.9% (228,485/229,509; 95% CI, 99.9-99.9%) for identifying symptomatic/asymptomatic PE. Additionally, 94.6% (159/168; 95% CI, 90.1-97.5%) of symptomatic PE patients were identified using the diagnosis-based algorithm. CONCLUSION The diagnosis-based algorithm may be a relatively sensitive method for identifying acute PE inpatients in the Japanese DPC database.
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Affiliation(s)
- Aki Kuwauchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | | | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
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3
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Bommineni VM, Bommineni VL, Gupta R. Quantified trends in provider reimbursement and utilization volume in colorectal cancer screenings: analysis of Medicare claims from 2000 to 2019. Colorectal Dis 2024. [PMID: 38581083 DOI: 10.1111/codi.16971] [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: 07/18/2023] [Revised: 09/05/2023] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
AIM Colorectal cancer (CRC) screening rates in the United States remain persistently below guideline targets, partly due to suboptimal patient utilization and provider reimbursement. To guide long-term national utilization estimates and set reasonable screening adherence targets, this study aimed to quantify trends in utilization of and reimbursement for CRC screenings using Medicare claims. METHOD Inflation-adjusted reimbursements and utilization volume associated with each CRC screening code were abstracted from Medicare claims between 2000 and 2019. Screenings, screenings/100 000 enrolees and reimbursement/screening were analysed with linear regression and compared with the equality of slopes tests. Average reimbursement per screening was compared using analysis of variance with Dunnett's T3 multiple comparisons test. RESULTS The growth rate of multitarget stool DNA tests (mt-sDNA)/100 000 was the highest at 170.4 screenings/year (R2 = 0.99, p ≤ 0.001), while that of faecal occult blood tests/100 000 was the lowest at -446.4 screenings/year (R2 = 0.90, p ≤ 0.001) (p ≤ 0.001). Provider reimbursements averaged $546.95 (95% CI $520.12-$573.78) per mt-sDNA screening, significantly higher than reimbursements for all invasive screenings. Only FOBTs significantly increased in reimbursement per screening at $0.62/year (R2 = 0.91, p ≤ 0.001). CONCLUSION We derived forecastable trend numbers for utilization and provider reimbursement. Faecal immunochemical tests/100 000 and mt-sDNA screenings/100 000 increased most rapidly during the entire study period. The number of nearly all invasive screenings/100 000 decreased rapidly; the number of colonoscopies/100 000 increased slightly, probably due to superior diagnostic strength. These trends indicate the that replacement of other invasive modalities with accessible noninvasive screenings will account for much of future screening behaviour and thus reductions in CRC incidence and mortality, especially given providers' reimbursement incentive to screen average-risk patients with stool-based tests.
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Affiliation(s)
| | | | - Rohan Gupta
- Norton College of Medicine, State University of New York Upstate Medical University, Syracuse, New York, USA
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4
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Sugawara S, Ishihara T, Kunisawa S, Goto E, Imanaka Y. A panel vector autoregression analysis for the dynamics of medical and long-term care expenditures. Health Econ 2024; 33:748-763. [PMID: 38159087 DOI: 10.1002/hec.4794] [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] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024]
Abstract
Although medical and long-term care expenditures for older adults are closely related, providing rigorous statistical analysis for their dynamic relationship is challenging. In this research, we propose a novel approach using the panel vector autoregression model to reveal the realized patterns of the interdependence. As an empirical application, we analyze monthly panel data on individuals in a city of Japan, where social insurance covers many formal services for long-term care. Our estimation results indicate the existence of intertemporal transition from expensive acute medical care to reasonable at-home medical care, then to at-home long-term care. Under this context, the enhancement of formal long-term care sector in Japan might have played an important role in the suppression of the total care cost in spite for its rapid aging over the past 2 decades. Additionally, we find that daycare plays multiple roles in Japanese long-term care, such as respite and rehabilitation, but there is no considerable transition from outpatient rehabilitation to daycare in the long-term care sector.
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Taguchi R, Hamada S, Michihata N, Tsuchiya-Ito R, Kitamura S, Ishikawa T, Iwagami M. Factors associated with the introduction of visiting-pharmacist services in older adults in Japan: A nested case-control study. Geriatr Gerontol Int 2024; 24:344-351. [PMID: 38379434 DOI: 10.1111/ggi.14838] [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] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 02/22/2024]
Abstract
AIM To investigate the factors associated with introducing visiting-pharmacist services for community-dwelling older adults in Japan. METHODS We conducted a nested case-control study using claims data in a cohort from a city in Tokyo. Patients aged ≥65 years who received visiting-pharmacist services for the first time between April 2014 and March 2020 were considered case patients. A maximum of four controls to each case patient were randomly selected on the basis of sex, age, health insurance systems, and month-year. Medical and long-term care service usage and patient condition were assessed using claims data from the index and preceding months, along with long-term care needs certification data. Multivariable conditional logistic regression analysis was conducted to estimate the adjusted odds ratios with 95% confidence intervals for factors associated with visiting-pharmacist service introduction. RESULTS A total of 22 949 participants (4591 cases and 18 358 controls) were included, with a median age of 85 years; 59.3% were women. The adjusted odds ratios (95% confidence intervals) of the three most related factors were 27.61 (23.98-31.80) for physicians' home visits, 5.83 (5.08-6.70) for hospitalization, and 4.97 (4.16-5.95) for designated-facility admission. Factors such as prescribing ≧10 medications, visiting nursing, and cancer were positively associated. In contrast, low household income and a high need for support due to cognitive function or disability were negatively associated. CONCLUSIONS This study provides insights into the introduction of visiting-pharmacist services for older adults in Japan. Geriatr Gerontol Int 2024; 24: 344-351.
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Affiliation(s)
- Reina Taguchi
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Rumiko Tsuchiya-Ito
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Satomi Kitamura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Tomoki Ishikawa
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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Appukkuttan S, Ko G, Fu C, Bannister B, Kong SX, Jhaveri J, Freedland SJ. Drug-drug interaction potential among patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) treated with novel androgen receptor inhibitors. Expert Rev Anticancer Ther 2024:1-9. [PMID: 38469875 DOI: 10.1080/14737140.2024.2328778] [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] [Received: 01/04/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Nonmetastatic castration-resistant prostate cancer (nmCRPC) patients are often older and use concurrent medications that increase the potential for drug-drug interactions (pDDIs). This study assessed pDDI prevalence in real-world nmCRPC patients treated with apalutamide, darolutamide, or enzalutamide. RESEARCH DESIGN AND METHODS Castrated prostate cancer patients without metastases prior to androgen receptor inhibitor initiation were identified retrospectively via Optum Clinformatics Data Mart claims data (8/2019-3/2021). The top 100 concomitant medications were assessed for pDDIs. RESULTS Among 1,515 patients (mean age: 77 ± 8 years; mean Charlson Comorbidity Index: 3 ± 3), 340 initiated apalutamide, 112 darolutamide, and 1,063 enzalutamide. Common concomitant medication classes were cardiovascular (80%) and central nervous system (52%). Two-thirds of the patients received ≥5 concomitant medications; 30 (30/100 medications) pDDIs were identified for apalutamide and enzalutamide each and 2 (2/100 medications) for darolutamide. Most pDDIs had risk ratings of C or D, but four for apalutamide were rated X. Approximately 58% of the patients on apalutamide, 5% on darolutamide, and 54% on enzalutamide had ≥1 identified pDDI. CONCLUSIONS Results showed a higher frequency of pDDIs in patients receiving apalutamide and enzalutamide vs darolutamide. The impact of these could not be determined retrospectively. DDI risk should be carefully evaluated when discussing optimal therapy for patients with nmCRPC.
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Affiliation(s)
| | - Gilbert Ko
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Chunmay Fu
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | | | - Sheldon X Kong
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Jay Jhaveri
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Stephen J Freedland
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
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7
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Rezaeiahari M, Brown CC, Eyimina A, Perry TT, Goudie A, Boyd M, Tilford JM, Jefferson AA. Predicting pediatric severe asthma exacerbations: an administrative claims-based predictive model. J Asthma 2024; 61:203-211. [PMID: 37725084 DOI: 10.1080/02770903.2023.2260881] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Previous machine learning approaches fail to consider race and ethnicity and social determinants of health (SDOH) to predict childhood asthma exacerbations. A predictive model for asthma exacerbations in children is developed to explore the importance of race and ethnicity, rural-urban commuting area (RUCA) codes, the Child Opportunity Index (COI), and other ICD-10 SDOH in predicting asthma outcomes. METHODS Insurance and coverage claims data from the Arkansas All-Payer Claims Database were used to capture risk factors. We identified a cohort of 22,631 children with asthma aged 5-18 years with 2 years of continuous Medicaid enrollment and at least one asthma diagnosis in 2018. The goal was to predict asthma-related hospitalizations and asthma-related emergency department (ED) visits in 2019. The analytic sample was 59% age 5-11 years, 39% White, 33% Black, and 6% Hispanic. Conditional random forest models were used to train the model. RESULTS The model yielded an area under the curve (AUC) of 72%, sensitivity of 55% and specificity of 78% in the OOB samples and AUC of 73%, sensitivity of 58% and specificity of 77% in the training samples. Consistent with previous literature, asthma-related hospitalization or ED visits in the previous year (2018) were the two most important variables in predicting hospital or ED use in the following year (2019), followed by the total number of reliever and controller medications. CONCLUSIONS Predictive models for asthma-related exacerbation achieved moderate accuracy, but race and ethnicity, ICD-10 SDOH, RUCA codes, and COI measures were not important in improving model accuracy.
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Affiliation(s)
- Mandana Rezaeiahari
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clare C Brown
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Arina Eyimina
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Tamara T Perry
- Department of Pediatrics, Allergy & Immunology Division, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Anthony Goudie
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Melanie Boyd
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Mick Tilford
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Akilah A Jefferson
- Department of Pediatrics, Allergy & Immunology Division, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children's Research Institute, Little Rock, AR, USA
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8
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Glass A, Melton NC, Moore C, Myrick K, Thao K, Mogaji S, Howell A, Patton K, Martin J, Korvink M, Gunn LH. A Novel Method for Assessing Risk-Adjusted Diagnostic Coding Specificity for Depression Using a U.S. Cohort of over One Million Patients. Diagnostics (Basel) 2024; 14:426. [PMID: 38396465 PMCID: PMC10887535 DOI: 10.3390/diagnostics14040426] [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] [Received: 01/01/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Depression is a prevalent and debilitating mental health condition that poses significant challenges for healthcare providers, researchers, and policymakers. The diagnostic coding specificity of depression is crucial for improving patient care, resource allocation, and health outcomes. We propose a novel approach to assess risk-adjusted coding specificity for individuals diagnosed with depression using a vast cohort of over one million inpatient hospitalizations in the United States. Considering various clinical, demographic, and socioeconomic characteristics, we develop a risk-adjusted model that assesses diagnostic coding specificity. Results demonstrate that risk-adjustment is necessary and useful to explain variability in the coding specificity of principal (AUC = 0.76) and secondary (AUC = 0.69) diagnoses. Our approach combines a multivariate logistic regression at the patient hospitalization level to extract risk-adjusted probabilities of specificity with a Poisson Binomial approach at the facility level. This method can be used to identify healthcare facilities that over- and under-specify diagnostic coding when compared to peer-defined standards of practice.
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Affiliation(s)
- Alexandra Glass
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (A.G.); (C.M.); (K.T.); (S.M.); (A.H.); (K.P.)
| | - Nalander C. Melton
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (N.C.M.); (K.M.)
| | - Connor Moore
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (A.G.); (C.M.); (K.T.); (S.M.); (A.H.); (K.P.)
| | - Keyerra Myrick
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (N.C.M.); (K.M.)
| | - Kola Thao
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (A.G.); (C.M.); (K.T.); (S.M.); (A.H.); (K.P.)
| | - Samiat Mogaji
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (A.G.); (C.M.); (K.T.); (S.M.); (A.H.); (K.P.)
| | - Anna Howell
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (A.G.); (C.M.); (K.T.); (S.M.); (A.H.); (K.P.)
| | - Kenneth Patton
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (A.G.); (C.M.); (K.T.); (S.M.); (A.H.); (K.P.)
| | - John Martin
- ITS Data Science, Premier, Inc., Charlotte, NC 28277, USA (M.K.)
| | - Michael Korvink
- ITS Data Science, Premier, Inc., Charlotte, NC 28277, USA (M.K.)
| | - Laura H. Gunn
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (A.G.); (C.M.); (K.T.); (S.M.); (A.H.); (K.P.)
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, USA; (N.C.M.); (K.M.)
- School of Public Health, Faculty of Medicine, Imperial College London, London W6 8RP, UK
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Kurisu A, Sugiyama A, Akita T, Takumi I, Yamamoto H, Iida K, Tanaka J. Incidence and Prevalence of Epilepsy in Japan: A Retrospective Analysis of Insurance Claims Data of 9,864,278 Insured Persons. J Epidemiol 2024; 34:70-75. [PMID: 36843107 PMCID: PMC10751190 DOI: 10.2188/jea.je20220316] [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] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION The burden of epilepsy is thought to be high but is difficult to measure. Very few studies in Japan have attempted to estimate prevalence and incidence rates of epilepsy in Japan. METHODS This retrospective cohort study used commercially collected nationwide insurance claims data from a cohort of 10 million persons between 2012 and 2019 among those aged 0 to 74 years. Using the claims data, cases were identified, and incidence and prevalence rates were estimated. RESULTS A total of 9,864,278 persons were included. The average age was 34.5 (standard deviation, 18.5) years. A total of 77,312 persons were diagnosed with epilepsy over the 8-year observation period, with a prevalence rate of 6.0 per 1,000 persons with almost no difference by gender. The highest rates were seen among those aged 70-74 years; prevalence rates tended to rise with calendar year (5.4/1,000 in 2012 and 6.0/1,000 in 2019). The incidence rate of epilepsy was 72.1 per 100,000 person-years with slightly higher rates seen among females. Incidence rates were highest at ages less than 12 months (199.8/100,000 person-years), followed by the eldest age group (70-74 years, 179.4/100,000 person-years). CONCLUSION Understanding the magnitude of disease burden is the basis of determining health policies. In this study, the prevalence and incidence of epilepsy in Japan was shown based on the analysis results of a large-scale general population insurance claims data covering all over Japan.
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Affiliation(s)
- Akemi Kurisu
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
- Project Research Center For Epidemiological & Mega-data Analysis of New Research Area, Hiroshima University
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
- Project Research Center For Epidemiological & Mega-data Analysis of New Research Area, Hiroshima University
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
- Project Research Center For Epidemiological & Mega-data Analysis of New Research Area, Hiroshima University
| | - Ichiro Takumi
- Department of Neurosurgery, St. Marianna University School of Medicine
| | - Hitoshi Yamamoto
- Department of Pediatrics, St. Marianna University School of Medicine
| | - Koji Iida
- Department of Neurosurgery, Hiroshima University Hospital
- Epilepsy Center, Hiroshima University Hospital
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University
- Project Research Center For Epidemiological & Mega-data Analysis of New Research Area, Hiroshima University
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10
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Gall W, Šinkovec H, Niessner A, Sulzgruber P, Heinze G. Development of Cross-Sector Health Care Quality Indicators Based on Claims Data. Stud Health Technol Inform 2024; 310:1404-1405. [PMID: 38269668 DOI: 10.3233/shti231216] [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] [Indexed: 01/26/2024]
Abstract
Quality indicators serve as a tool to measure and improve evidence-based health care. Often the transition from inpatient to outpatient care is not sufficiently included. The focus of this work was to develop and to evaluate methods to define relevant cross-sector quality indicators based on Austrian claims data, using myocardial infarction as tracer.
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Affiliation(s)
- Walter Gall
- Section for Medical Information Management, Medical University of Vienna, Vienna, Austria
| | - Hana Šinkovec
- Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria
| | | | | | - Georg Heinze
- Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria
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11
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Suto M, Takehara K, Morisaki N, Moriichi A, Gai R, Mori R. Disease Trends in Children and Adolescents in Japan: A Retrospective Observational Study Using the Nationwide Claims Data for 2012-2016. Children (Basel) 2024; 11:81. [PMID: 38255394 PMCID: PMC10814281 DOI: 10.3390/children11010081] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
This study aimed to clarify diseases that occur more frequently by age and identify the peaks and trends of each disease from infancy to adolescence for early detection and treatment. This retrospective observational study was conducted using Japan's National Database of Health Insurance Claims Specific Health Checkups from January 2012 to December 2016. Using peak ages and trends in the number of patients, we grouped diseases by the International Classification of Diseases chapters. Although diseases that peaked during infancy were the most common (10 disease chapters), other diseases peaked at school-going age and adolescence. Diseases in four chapters peaked during adolescence and continued to increase toward the age of 18. These four chapters included mental, behavioral, and neurodevelopmental disorders; diseases of the nervous system; the genitourinary system; and pregnancy, childbirth, and the puerperium. Childhood-onset diseases can affect long-term health and healthcare needs, and timely screening and guidance based on disease trends can provide an effective intervention. To establish a child healthcare system that provides preventive support for children and adolescents' physical, psychological, and social health, further research is needed to comprehensively understand the issues per age and developmental stage.
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Affiliation(s)
- Maiko Suto
- Department of Health Policy, National Center for Child Health and Development, 10-1 Okura 2-chome, Setagaya, Tokyo 157-8535, Japan;
| | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, 10-1 Okura 2-chome, Setagaya, Tokyo 157-8535, Japan;
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, 10-1 Okura 2-chome, Setagaya, Tokyo 157-8535, Japan;
| | - Akinori Moriichi
- Division of Specific Paediatric Chronic Disease Information, National Center for Child Health and Development, 10-1 Okura 2-chome, Setagaya, Tokyo 157-8535, Japan;
| | - Ruoyan Gai
- Department of Empirical Social Security Research, National Institute of Population and Social Security Research, 2-2-3, Uchisaiwaicyo, Chiyoda-ku, Tokyo 100-0011, Japan;
| | - Rintaro Mori
- Health Policy for Children and Families, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan;
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12
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Chung MK, Hart B, Santillana M, Patel CJ. Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study. J Med Internet Res 2024; 26:e44249. [PMID: 37967280 PMCID: PMC10768807 DOI: 10.2196/44249] [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] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/18/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth. OBJECTIVE This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic. METHODS Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases. RESULTS After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74). CONCLUSIONS Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants.
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Affiliation(s)
- Ming Kei Chung
- Department of Biomedical Informatics, Harvard Medical School, Harvard University, Boston, MA, United States
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
- Institute of Environment, Energy, and Sustainability, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Brian Hart
- Optum Labs, Eden Prairie, MN, United States
| | - Mauricio Santillana
- Machine Intelligence Group for the Betterment of Health and the Environment, Network Science Institute, Northeastern University, Boston, MA, United States
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Harvard University, Boston, MA, United States
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Hagenström K, Müller K, Garbe C, Augustin M. Prevalence of psoriasis and psoriatic arthritis in Germany - analysis of claims data. J Dtsch Dermatol Ges 2024; 22:45-54. [PMID: 38128108 DOI: 10.1111/ddg.15269] [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: 01/04/2023] [Accepted: 09/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Few studies are available on the epidemiology of psoriasis and psoriatic arthritis in Germany. The aim of this study was to estimate this prevalence based on different case definitions. METHODS Statutory health insurance (SHI) data were examined (2017 to 2019). Prevalence was analyzed and validated using three different case definitions: (1) At least one inpatient or outpatient diagnosis within one year, (2) additionally at least two outpatient diagnoses within one year, (3) additionally within three years. RESULTS The administrative prevalence of psoriasis including psoriatic arthritis ranged from 1.90% to 2.51%. For all case definitions, the prevalence increased with age, decreasing from the age of 70 with psoriasis and from the age of 65 with psoriatic arthritis. Males were more likely to be affected at an older age (p <0.0001), while in the under-20 age group, more girls were affected (p = 0.04). CONCLUSIONS Psoriasis is a common skin disease in Germany. The internal diagnoses validation showed that in future studies with claims data, the narrow and broad criteria should be used to identify patients with psoriasis, depending on the research question.
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Affiliation(s)
- Kristina Hagenström
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katharina Müller
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Garbe
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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14
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Gil-Rojas Y, Lasalvia P, Sáenz V, Virgüez O, Peña MP, Castañeda-Cardona C, Laucho-Contreras ME, González AL, García-Nuncira CY, Rosselli D. Study of the Direct Costs of Asthma at a Healthcare Service Provider in Bogotá, Colombia. Value Health Reg Issues 2024; 39:6-13. [PMID: 37967491 DOI: 10.1016/j.vhri.2023.09.006] [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: 08/25/2021] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES This study aimed to describe clinical characteristics and direct medical costs associated with disease treatment in Colombia patients with asthma from 1 healthcare provider. METHODS This was a descriptive study with a retrospective data collection from a healthcare provider's electronic medical records in Colombia. A clinical, demographic, and healthcare resource utilization profile was developed over a 12-month observation period after the identification of eligible patients. To determine the mean cost per patient per year, the total frequencies of resource utilization were added, and the result was multiplied by the unit cost of each of them. RESULTS A total of 7919 patients were included in the analysis. The mean ± SD cost per patient per year ranged from $189.5 ± $1.900.6 to $240.2 ± $1.903.6 depending on the price guidebook. The total cost had been driven by the medication use (79% of total cost) and by the outpatient visits (20% of total cost). CONCLUSIONS In the population analyzed, the mean total direct cost per patient per year of asthma was $189.5 and $240.2, depending on the cost source. Direct medical costs were higher in cases classified as severe and in the adult and elderly population. When comparing the sources of resource utilization, it was found that the mean cost per patient obtained from real-life data is lower than the theoretical cost obtained from the bottom-up method with quantification of resources from experts. It is important to consider limitations related to study design and the evolving landscape of asthma treatments.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Bogotá, Bogotá DC, Colombia
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Hong LS, Garcia-Albeniz X, Friesen D, Foskett N, Beau-Lejdstrom R. Use of clinical classifications software to address ICD coding transition in large healthcare databases analyzed via high-dimensional propensity scores. Pharmacoepidemiol Drug Saf 2024; 33:e5702. [PMID: 37749072 DOI: 10.1002/pds.5702] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/03/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE The EUPAS26595 study characterized the rate of acute renal failure (ARF) in patients exposed to levetiracetam versus other antiepileptic drugs using healthcare claims data and a high-dimensional propensity score (hd-PS) for confounding adjustment. The data contained several coding systems by design and an update in International Classification of Diseases (ICD) coding dictionary. Such coding heterogeneity can affect the performance of hd-PS, and manually coding harmonization is not feasible. Our objective was to explore the impact of code aggregation via Clinical Classifications Software (CCS) on the analysis of a large claims-based database using hd-PS. METHODS Patients with epilepsy, who were new-users of an antiepileptic drug, were identified from the IBM® MarketScan® Research Databases. We used CCS categories to harmonize coding and compared the results with other alternatives. Incidence rate ratios (IRRs) were computed using modified Poisson regression model with a robust variance estimator. RESULTS For January 2008-October 2015 (before ICD update), 34 833 eligible patients initiated levetiracetam and 52 649 initiated a comparator drug; IRR (95% CI) for ARF for the hd-PS analysis was 1.34 (0.72-2.50) without CCS categories and 1.30 (0.71-2.39) with CCS categories. For January 2008-December 2017 (including ICD coding change), 45 672 eligible patients initiated levetiracetam and 64 664 initiated a comparator drug; IRR (95% CI) for the hd-PS analysis was 1.34 (0.78-2.29) without CCS categories and 1.37 (0.80-2.34) with CCS categories. CONCLUSIONS Using single-level CCS categories to overcome differences in coding provides consistent results and can be used in studies that use large claims data and hd-PS for adjustment.
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Niegisch G, Grimm MO, Hardtstock F, Krieger J, Starry A, Osowski U, Deiters B, Maywald U, Wilke T, Kearney M. Healthcare resource utilization and associated costs in patients with metastatic urothelial carcinoma: a real-world analysis using German claims data. J Med Econ 2024; 27:531-542. [PMID: 38639988 DOI: 10.1080/13696998.2024.2331893] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/13/2024] [Indexed: 04/20/2024]
Abstract
AIMS This retrospective claims data study characterized real-world treatment patterns, healthcare resource utilization (HCRU), and costs in patients with metastatic urothelial carcinoma (mUC) in Germany. MATERIALS AND METHODS Continuously insured adults with incident mUC diagnosis (=index; ICD-10: C65-C68/C77-C79) in 2015-2019 were identified from two German claims databases. Patients who received first-line (1 L) treatment within 12 months of index were divided into three mutually exclusive sub-cohorts: platinum-based chemotherapy (PB-CT), non-PB-CT, and immunotherapy (IO). Patient characteristics were assessed during a 24-month baseline period; treatments, HCRU, and costs (of the health insurance fund) per patient-year (ppy) were described during 12-month follow-up. RESULTS We identified 3,226 patients with mUC (mean age, 73.8 years; male, 70.8%; mean Elixhauser Comorbidity Index, 17.6); 1,286 (39.9%) received 1 L treatment within 12 months of index. Of these, 825 (64.2%) received PB-CT, 322 (25.0%) non-PB-CT, and 139 (10.8%) IO. On average, treated patients had 5.1 hospitalizations ppy. Most UC-related hospitalizations ppy were observed in the PB-CT cohort (5.8), followed by the non-PB-CT (4.2) and IO (2.3) cohorts. Mean UC-related hospitalization costs ppy were €22,218 in the treated cohort, €24,294 in PB-CT, €19,079 in IO, and €18,530 in non-PB-CT cohorts. Cancer-related prescription costs ppy averaged €6,323 in treated patients, and €25,955 in IO, €4,318 in non-PB-CT, and €4,270 in PB-CT cohorts. LIMITATIONS We recognized limitations in our study's sample selection due to unavailable mUC disease status data. We addressed this through an upstream feasibility study conducted in consultation with clinical experts to determine a suitable proxy. Proxies were also used to delineate treatment lines, switches, and discontinuations due to data absence. Furthermore, due to data restrictions, collective dataset analysis was not possible, prompting a meta-analysis for pooled results. CONCLUSIONS The study shows that mUC is associated with significant HCRU and costs across different types of 1 L systemic therapy.
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Affiliation(s)
- Günter Niegisch
- Department of Urology, University Hospital and Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf, Germany
| | | | | | | | | | - Ulrike Osowski
- Merck Healthcare Germany GmbH, Weiterstadt, Germany, an affiliate of Merck KGaA
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Hagenström K, Müller K, Garbe C, Augustin M. Prävalenz der Psoriasis und Psoriasis-Arthritis in Deutschland - Analyse von Routinedaten der gesetzlichen Krankenversicherung: Prevalence of psoriasis and psoriatic arthritis in Germany - analysis of claims data. J Dtsch Dermatol Ges 2024; 22:45-55. [PMID: 38212930 DOI: 10.1111/ddg.15269_g] [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: 01/04/2023] [Accepted: 09/08/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungHintergrund und ZielsetzungEs gibt nur wenige Studien zur Epidemiologie der Psoriasis und Psoriasis‐Arthritis in Deutschland. Ziel dieser Studie war es, diese Prävalenz anhand verschiedener Falldefinitionen zu schätzen.MethodenEs wurden Daten der Gesetzlichen Krankenversicherung (GKV) untersucht (2017 bis 2019). Die Prävalenz wurde anhand von drei verschiedenen Falldefinitionen analysiert und validiert: (1) mindestens eine stationäre oder ambulante Diagnose innerhalb eines Jahres (2) mindestens zwei ambulante Diagnosen innerhalb eines Jahres (3) zusätzlich innerhalb von drei Jahren.ErgebnisseDie administrative Prävalenz der Psoriasis inklusive Psoriasis‐Arthritis lag zwischen 1,90% und 2,51%. Bei allen Falldefinitionen nahm die Prävalenz mit dem Alter zu, wobei sie bei der Psoriasis ab einem Alter von 70 Jahren und bei der Psoriasis‐Arthritis ab einem Alter von 65 Jahren sank. Männer waren im höheren Alter häufiger betroffen (p <0,0001), während in der Altersgruppe der unter 20‐Jährigen mehr Mädchen betroffen waren (p = 0,04).SchlussfolgerungDie Psoriasis ist eine häufige Hauterkrankung in Deutschland. Die interne Diagnosenvalidierung hat gezeigt, dass in zukünftigen Studien mit GKV‐Routinedaten, je nach Fragestellung, die engen oder weiten Kriterien zur Identifizierung von Patienten mit Psoriasis verwendet werden sollten.
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Affiliation(s)
- Kristina Hagenström
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Katharina Müller
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Claudia Garbe
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Matthias Augustin
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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Mehrizi R, Golestani A, Malekpour MR, Karami H, Nasehi MM, Effatpanah M, Ranjbaran H, Shahali Z, Sari AA, Daroudi R. Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data. Front Public Health 2023; 11:1280434. [PMID: 38164450 PMCID: PMC10758044 DOI: 10.3389/fpubh.2023.1280434] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Background Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran. Methods We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models. Results During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% [95% CI: 55.74-55.94]), corticosteroids (54.14% [54.04-54.24]), and antibiotics (42.22% [42.12-42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94-0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI, 0.73-0.76]), corticosteroids (0.97 [0.95-0.99]), antivirals (0.82 [0.80-0.83]), and ACE inhibitor/ARB (0.79 [0.77-0.80]) were significantly associated with lower mortality. Conclusion Over 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.
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Affiliation(s)
- Reza Mehrizi
- National Center for Health Insurance Research, Tehran, Iran
| | - Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Karami
- National Center for Health Insurance Research, Tehran, Iran
| | - Mohammad Mahdi Nasehi
- National Center for Health Insurance Research, Tehran, Iran
- Pediatric Neurology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Effatpanah
- National Center for Health Insurance Research, Tehran, Iran
- School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ranjbaran
- National Center for Health Insurance Research, Tehran, Iran
- Immunogenetics Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Shahali
- National Center for Health Insurance Research, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Waitman LR, Bailey LC, Becich MJ, Chung-Bridges K, Dusetzina SB, Espino JU, Hogan WR, Kaushal R, McClay JC, Merritt JG, Rothman RL, Shenkman EA, Song X, Nauman E. Avenues for Strengthening PCORnet's Capacity to Advance Patient-Centered Economic Outcomes in Patient-Centered Outcomes Research (PCOR). Med Care 2023; 61:S153-S160. [PMID: 37963035 PMCID: PMC10635342 DOI: 10.1097/mlr.0000000000001929] [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] [Indexed: 11/16/2023]
Abstract
PCORnet, the National Patient-Centered Clinical Research Network, provides the ability to conduct prospective and observational pragmatic research by leveraging standardized, curated electronic health records data together with patient and stakeholder engagement. PCORnet is funded by the Patient-Centered Outcomes Research Institute (PCORI) and is composed of 8 Clinical Research Networks that incorporate at total of 79 health system "sites." As the network developed, linkage to commercial health plans, federal insurance claims, disease registries, and other data resources demonstrated the value in extending the networks infrastructure to provide a more complete representation of patient's health and lived experiences. Initially, PCORnet studies avoided direct economic comparative effectiveness as a topic. However, PCORI's authorizing law was amended in 2019 to allow studies to incorporate patient-centered economic outcomes in primary research aims. With PCORI's expanded scope and PCORnet's phase 3 beginning in January 2022, there are opportunities to strengthen the network's ability to support economic patient-centered outcomes research. This commentary will discuss approaches that have been incorporated to date by the network and point to opportunities for the network to incorporate economic variables for analysis, informed by patient and stakeholder perspectives. Topics addressed include: (1) data linkage infrastructure; (2) commercial health plan partnerships; (3) Medicare and Medicaid linkage; (4) health system billing-based benchmarking; (5) area-level measures; (6) individual-level measures; (7) pharmacy benefits and retail pharmacy data; and (8) the importance of transparency and engagement while addressing the biases inherent in linking real-world data sources.
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Affiliation(s)
- Lemuel R. Waitman
- Department of Biomedical Informatics, Biostatistics, and Medical Epidemiology, University of Missouri School of Medicine, Greater Plains Collaborative, PCORnet Clinical Research Network, Columbia, MO
| | | | | | | | | | | | | | - Rainu Kaushal
- Weill Cornell University School of Medicine, New York, NY
| | | | | | | | | | - Xing Song
- University of Missouri School of Medicine, Columbia, MO
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Han E, Kharrazi H, Shi L. Identifying Predictors of Nursing Home Admission by Using Electronic Health Records and Administrative Data: Scoping Review. JMIR Aging 2023; 6:e42437. [PMID: 37990815 PMCID: PMC10686617 DOI: 10.2196/42437] [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] [Received: 09/05/2022] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 11/23/2023] Open
Abstract
Background Among older adults, nursing home admissions (NHAs) are considered a significant adverse outcome and have been extensively studied. Although the volume and significance of electronic data sources are expanding, it is unclear what predictors of NHA have been systematically identified in the literature via electronic health records (EHRs) and administrative data. Objective This study synthesizes findings of recent literature on identifying predictors of NHA that are collected from administrative data or EHRs. Methods The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were used for study selection. The PubMed and CINAHL databases were used to retrieve the studies. Articles published between January 1, 2012, and March 31, 2023, were included. Results A total of 34 papers were selected for final inclusion in this review. In addition to NHA, all-cause mortality, hospitalization, and rehospitalization were frequently used as outcome measures. The most frequently used models for predicting NHAs were Cox proportional hazards models (studies: n=12, 35%), logistic regression models (studies: n=9, 26%), and a combination of both (studies: n=6, 18%). Several predictors were used in the NHA prediction models, which were further categorized into sociodemographic, caregiver support, health status, health use, and social service use factors. Only 5 (15%) studies used a validated frailty measure in their NHA prediction models. Conclusions NHA prediction tools based on EHRs or administrative data may assist clinicians, patients, and policy makers in making informed decisions and allocating public health resources. More research is needed to assess the value of various predictors and data sources in predicting NHAs and validating NHA prediction models externally.
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Affiliation(s)
- Eunkyung Han
- Ho-Young Institute of Community Health, Paju, Republic of Korea
- Asia Pacific Center For Hospital Management and Leadership Research, Johns Hopkins Bloomberg School of Public Health, BaltimoreMD, United States
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins School of Public Health, BaltimoreMD, United States
- Division of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, BaltimoreMD, United States
| | - Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins School of Public Health, BaltimoreMD, United States
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Henke E, Zoch M, Kallfelz M, Ruhnke T, Leutner LA, Spoden M, Günster C, Sedlmayr M, Bathelt F. Assessing the Use of German Claims Data Vocabularies for Research in the Observational Medical Outcomes Partnership Common Data Model: Development and Evaluation Study. JMIR Med Inform 2023; 11:e47959. [PMID: 37942786 PMCID: PMC10653283 DOI: 10.2196/47959] [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] [Received: 04/06/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 11/10/2023] Open
Abstract
Background National classifications and terminologies already routinely used for documentation within patient care settings enable the unambiguous representation of clinical information. However, the diversity of different vocabularies across health care institutions and countries is a barrier to achieving semantic interoperability and exchanging data across sites. The Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) enables the standardization of structure and medical terminology. It allows the mapping of national vocabularies into so-called standard concepts, representing normative expressions for international analyses and research. Within our project "Hybrid Quality Indicators Using Machine Learning Methods" (Hybrid-QI), we aim to harmonize source codes used in German claims data vocabularies that are currently unavailable in the OMOP CDM. Objective This study aims to increase the coverage of German vocabularies in the OMOP CDM. We aim to completely transform the source codes used in German claims data into the OMOP CDM without data loss and make German claims data usable for OMOP CDM-based research. Methods To prepare the missing German vocabularies for the OMOP CDM, we defined a vocabulary preparation approach consisting of the identification of all codes of the corresponding vocabularies, their assembly into machine-readable tables, and the translation of German designations into English. Furthermore, we used 2 proposed approaches for OMOP-compliant vocabulary preparation: the mapping to standard concepts using the Observational Health Data Sciences and Informatics (OHDSI) tool Usagi and the preparation of new 2-billion concepts (ie, concept_id >2 billion). Finally, we evaluated the prepared vocabularies regarding completeness and correctness using synthetic German claims data and calculated the coverage of German claims data vocabularies in the OMOP CDM. Results Our vocabulary preparation approach was able to map 3 missing German vocabularies to standard concepts and prepare 8 vocabularies as new 2-billion concepts. The completeness evaluation showed that the prepared vocabularies cover 44.3% (3288/7417) of the source codes contained in German claims data. The correctness evaluation revealed that the specified validity periods in the OMOP CDM are compliant for the majority (705,531/706,032, 99.9%) of source codes and associated dates in German claims data. The calculation of the vocabulary coverage showed a noticeable decrease of missing vocabularies from 55% (11/20) to 10% (2/20) due to our preparation approach. Conclusions By preparing 10 vocabularies, we showed that our approach is applicable to any type of vocabulary used in a source data set. The prepared vocabularies are currently limited to German vocabularies, which can only be used in national OMOP CDM research projects, because the mapping of new 2-billion concepts to standard concepts is missing. To participate in international OHDSI network studies with German claims data, future work is required to map the prepared 2-billion concepts to standard concepts.
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Affiliation(s)
- Elisa Henke
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Michéle Zoch
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Thomas Ruhnke
- Wissenschaftliches Institut der AOK (AOK Research Institute), Berlin, Germany
| | - Liz Annika Leutner
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Melissa Spoden
- Wissenschaftliches Institut der AOK (AOK Research Institute), Berlin, Germany
| | - Christian Günster
- Wissenschaftliches Institut der AOK (AOK Research Institute), Berlin, Germany
| | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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22
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Xie F, Beukelman T, Sun D, Yun H, Curtis JR. Identifying inpatient mortality in MarketScan claims data using machine learning. Pharmacoepidemiol Drug Saf 2023; 32:1299-1305. [PMID: 37344984 DOI: 10.1002/pds.5658] [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] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/24/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Inpatient mortality is an important variable in epidemiology studies using claims data. In 2016, MarketScan data began obscuring specific hospital discharge status types for patient privacy, including inpatient deaths, by setting the values to missing. We used a machine learning approach to correctly identify hospitalizations that resulted in inpatient death using data prior to 2016. METHODS All hospitalizations from 2011 to 2015 with discharge status of missing, died, or one of the other subsequently obscured values were identified and divided into a training set and two test sets. Predictor variables included age, sex, elapsed time from hospital discharge until last observed claim and until healthcare plan disenrollment, and absence of any discharge diagnoses. Four machine learning methods were used to train statistical models and assess sensitivity and positive predictive value (PPV) for inpatient mortality. RESULTS Overall 1 307 917 hospitalizations were included. All four machine learning approaches performed well in all datasets. Random forest performed best with 88% PPV and 93% sensitivity for the training set and both test sets. The two factors with the highest relative importance for identifying inpatient mortality were having no observed claims for the patient on days 2-91 following hospital discharge and patient disenrollment from the healthcare plan within 60 days following hospital discharge. CONCLUSION We successfully developed machine learning algorithms to identify inpatient mortality. This approach can be applied to obscured data to accurately identify inpatient mortality among hospitalizations with missing discharge status.
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Affiliation(s)
- Fenglong Xie
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Foundation for Science, Technology, Education, and Research (FASTER), Birmingham, Alabama, USA
| | - Timothy Beukelman
- Foundation for Science, Technology, Education, and Research (FASTER), Birmingham, Alabama, USA
| | - Dongmei Sun
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Huifeng Yun
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey R Curtis
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Foundation for Science, Technology, Education, and Research (FASTER), Birmingham, Alabama, USA
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23
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Karcher H, Schoenberger M, Rayban T, Kelly C, Heaney A, Mackay A. Impact of COVID-19 measures on exacerbation rates and healthcare visits in US asthma patients. Allergy Asthma Proc 2023; 44:422-428. [PMID: 37919845 PMCID: PMC10629374 DOI: 10.2500/aap.2023.44.230061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/04/2023]
Abstract
Objective: To compare exacerbation rates and healthcare resource utilization (HCRU) in real-world patients in the United States who had moderate-to-severe asthma on medium- or high-dose inhaled corticosteroid/long-acting β₂-agonist therapy at different stages before and after the pandemic. Methods: This noninterventional, retrospective study described demographics, exacerbations, HCRU, and medication use in patients from a US-wide healthcare claims database in 4 consecutive years anchored around March 15, 2020 (start date of the first emergency health measures against coronavirus disease 2019 [COVID-19], or the first lockdown, in the United States, termed "restriction onset" hereafter). Four cohorts of patients potentially eligible for moderate-to-severe asthma clinical trials at the beginning (index) of each of four 1-year periods (March 15, 2018, 2019, 2020, 2021, respectively) were built. Exacerbations, healthcare visits, and asthma medication use were counted in the 1-year period after the index for each cohort. Results: The prevalence of patients with one or more exacerbation per year decreased by 10.00% in the first year after the restriction onset compared with the year before and attenuated over time to 6.37% in the second year. The proportion of inpatient, emergency department, and physician's office visits remained stable over the time periods evaluated for all patients and those patients who experienced one or more exacerbations. Asthma treatment of patients who experienced one or more exacerbations also remained stable over the 4 years. Conclusion: The effect of COVID-19 public health measures on asthma exacerbation rates might have affected clinical trials being run during this period and should be considered in their analysis. Asthma clinical trials run under pandemic hygiene restrictions should consider lower exacerbation frequency in their study design, while treatment and healthcare visits seem unchanged.
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Affiliation(s)
- Helene Karcher
- From the Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland
| | | | - Tejaswini Rayban
- Real World Evidence, Novartis Healthcare Private Limited, Hyderabad, India; and
| | | | | | - Alexander Mackay
- From the Global Medical Affairs, Novartis Pharma AG, Basel, Switzerland
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24
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Movva N, Pastula ST, Rege SV, Lewis RJ, Bylsma LC. Scoping Review of Employer-Led Research Using Employee Health Claims Data. Popul Health Manag 2023; 26:341-352. [PMID: 37682577 PMCID: PMC10611962 DOI: 10.1089/pop.2023.0140] [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] [Indexed: 09/09/2023] Open
Abstract
Employers may evaluate employee claims data for various reasons, including assessment of medical insurance and wellness plan efficacy, monitoring employee health trends, and identifying focus areas for wellness measures. The objective of this scoping review (ScR) is to describe the available literature reporting the use, applications, and outcomes of employee health claims data by self-insured employers. The ScR was conducted in a stepwise manner using an established framework: identifying the research question, identifying and selecting relevant studies, charting the data, and collating and reporting results. Literature searches were conducted in PubMed and Embase. Studies of self-insured employee populations that were conducted by the employer/s through May 2022 were identified using predefined criteria. Forty-one studies were included. The majority (90%) were cohort study designs; most employers (51%) were in industries such as aluminum production and health insurance providers. Twenty-four (59%) studies supplemented claims data with other sources such as human resource data to evaluate programs and/or health outcomes. A range of exposures (eg, chronic conditions, wellness program participation) and outcomes (eg, rates or costs of conditions, program effectiveness) were considered. Among the 25 studies that reported on patient confidentiality and privacy, 68% indicated institutional review board approval and 48% reported use of deidentified data. Many self-insured employers have used employee health claims data to gain insights into their employees' needs and health care utilization. These data can be used to identify potential improvements for wellness and other targeted programs to improve employee health and decrease absenteeism.
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Affiliation(s)
- Naimisha Movva
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Susan T. Pastula
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
| | - Saumitra V. Rege
- ExxonMobil Biomedical Sciences, Inc. (EMBSI), Annandale, New Jersey, USA
| | - R. Jeffrey Lewis
- Epidemiology Contractor (Retired EMBSI), Lavallette, New Jersey, USA
| | - Lauren C. Bylsma
- EpidStrategies, A Division of ToxStrategies, Rockville, Maryland, USA
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25
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Hou Y, D'Souza K, Kucharska-Newton AM, Freburger JK, Bushnell CD, Halladay JR, Duncan PW, Trogdon JG. Postacute Expenditures Among Patients Discharged Home After Stroke or Transient Ischemic Attack: The COMprehensive Post-Acute Stroke Services (COMPASS) Trial. Value Health 2023; 26:1453-1460. [PMID: 37422076 DOI: 10.1016/j.jval.2023.06.018] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES The COMPASS (COMprehensive Post-Acute Stroke Services) pragmatic trial cluster-randomized 40 hospitals in North Carolina to the COMPASS transitional care (TC) postacute care intervention or usual care. We estimated the difference in healthcare expenditures postdischarge for patients enrolled in the COMPASS-TC model of care compared with usual care. METHODS We linked data for patients with stroke or transient ischemic attack enrolled in the COMPASS trial with administrative claims from Medicare fee-for-service (n = 2262), Medicaid (n = 341), and a large private insurer (n = 234). The primary outcome was 90-day total expenditures, analyzed separately by payer. Secondary outcomes were total expenditures 30- and 365-days postdischarge and, among Medicare beneficiaries, expenditures by point of service. In addition to intent-to-treat analysis, we conducted a per-protocol analysis to compare Medicare patients who received the intervention with those who did not, using randomization status as an instrumental variable. RESULTS We found no statistically significant difference in total 90-day postacute expenditures between intervention and usual care; the results were consistent across payers. Medicare beneficiaries enrolled in the COMPASS intervention arm had higher 90-day hospital readmission expenditures ($682, 95% CI $60-$1305), 30-day emergency department expenditures ($132, 95% CI $13-$252), and 30-day ambulatory care expenditures ($67, 95% CI $38-$96) compared with usual care. The per-protocol analysis did not yield a significant difference in 90-day postacute care expenditures for Medicare COMPASS patients. CONCLUSIONS The COMPASS-TC model did not significantly change patients' total healthcare expenditures for up to 1 year postdischarge.
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Affiliation(s)
- Yucheng Hou
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karishma D'Souza
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jacqueline R Halladay
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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26
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Plate A, Bagnoud C, Rosemann T, Senn O, Di Gangi S. Influenza vaccination uptake among at-risk patients in Switzerland-The potential of national claims data for surveillance. Influenza Other Respir Viruses 2023; 17:e13206. [PMID: 37840841 PMCID: PMC10570900 DOI: 10.1111/irv.13206] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
Abstract
Background Swiss national surveillance of influenza vaccination uptake rates (VURs) relies on self-reported vaccination status. The aim of this study was to determine VURs among at-risk patients, namely, patients ≥65 of age and adult patients with chronic diseases, using claims data, instead of self-reported measures, to investigate factors of vaccine uptake, and to assess different methodological approaches to conduct vaccination surveillance. Methods In this retrospective cross-sectional analysis, we determined VURs in three influenza seasons (2015/2016-2017/2018). Medication, diagnosis, or medical services claims were used as triggers to identify patients. For the calculation of VURs in patients with chronic diseases, we identified those by triggers in the given season only (Model 1) and in the given and previous seasons (Model 2). Regression analysis was used to identify factors associated with vaccination status. Results Data from 214,668 individual patients were analyzed. VURs over all seasons ranged from 18.4% to 19.8%. Most patients with chronic diseases were identified with the medication trigger, and we found no clinical significant differences in VURs comparing both models. Having a chronic disease, age, male gender, and regular health care provider visits were associated with increased odds of being vaccinated. Conclusions VURs were below the recommended thresholds, and our analysis highlighted the need for efforts to increase VURs. We assessed the identification of chronic diseases by medication claims and the calculation of VURs based on data of the given season only as an effective approach to conduct vaccination surveillance. Claims data-based surveillance may complete the national surveillance.
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Affiliation(s)
- Andreas Plate
- Institute of Primary CareUniversity of Zurich and University Hospital ZurichZurichSwitzerland
| | | | - Thomas Rosemann
- Institute of Primary CareUniversity of Zurich and University Hospital ZurichZurichSwitzerland
| | - Oliver Senn
- Institute of Primary CareUniversity of Zurich and University Hospital ZurichZurichSwitzerland
| | - Stefania Di Gangi
- Institute of Primary CareUniversity of Zurich and University Hospital ZurichZurichSwitzerland
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27
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Dammertz L, Schrag A, Bohlken J, Heuer J, Kohring C, Schorlemmer J, Akmatov MK, Bätzing J, Holstiege J. Falling incidence of Parkinson's disease in Germany. Eur J Neurol 2023; 30:3124-3131. [PMID: 37498553 DOI: 10.1111/ene.16000] [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: 06/28/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND AND PURPOSE Idiopathic Parkinson's disease (IPD) is a progressive neurodegenerative disorder that is strongly associated with age. The aim of the present study was to describe current sex- and age-specific trends and regional differences in the incidence of IPD diagnosed in older people in Germany. METHODS This study was based on nationwide outpatient claims and drug prescription data from the German Statutory Health Insurance, covering approximately 87% of the general population. We conducted a cohort study in patients aged 50 years or older with observation time of at least 4 years. To assess the robustness of nationwide annual IPD incidence trends from 2013 to 2019, three case definitions with varying levels of stringency regarding coded outpatient diagnoses and drug prescriptions were applied. RESULTS In 2019, the population at risk comprised 30,575,726 persons. Using the primary and most specific case definition, annual age- and sex-standardized cumulative IPD incidence decreased stepwise from 137 (2013) to 106 (2019) new cases per 100,000 persons. The decline in incidence was seen in both sexes, in all age groups and in the majority of German regions. The relative decrease (2013-2019) in the annual age- and sex-standardized IPD incidence varied from 23% to 28% among case definitions. CONCLUSION Our findings indicate a nationwide decline in the age- and sex-standardized incidence of IPD from 2013 to 2019 in Germany. This trend was consistent using different case definitions. Further research is needed to elucidate the factors underlying this trend.
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Affiliation(s)
- Lotte Dammertz
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig, Leipzig, Germany
| | - Joachim Heuer
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Claudia Kohring
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | | | - Manas K Akmatov
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Jörg Bätzing
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Jakob Holstiege
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
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28
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Yu Y, Zhang M, Mukherjee B. An inverse probability weighted regression method that accounts for right-censoring for causal inference with multiple treatments and a binary outcome. Stat Med 2023; 42:3699-3715. [PMID: 37392070 DOI: 10.1002/sim.9826] [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: 11/30/2021] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 07/02/2023]
Abstract
Comparative effectiveness research often involves evaluating the differences in the risks of an event of interest between two or more treatments using observational data. Often, the post-treatment outcome of interest is whether the event happens within a pre-specified time window, which leads to a binary outcome. One source of bias for estimating the causal treatment effect is the presence of confounders, which are usually controlled using propensity score-based methods. An additional source of bias is right-censoring, which occurs when the information on the outcome of interest is not completely available due to dropout, study termination, or treatment switch before the event of interest. We propose an inverse probability weighted regression-based estimator that can simultaneously handle both confounding and right-censoring, calling the method CIPWR, with the letter C highlighting the censoring component. CIPWR estimates the average treatment effects by averaging the predicted outcomes obtained from a logistic regression model that is fitted using a weighted score function. The CIPWR estimator has a double robustness property such that estimation consistency can be achieved when either the model for the outcome or the models for both treatment and censoring are correctly specified. We establish the asymptotic properties of the CIPWR estimator for conducting inference, and compare its finite sample performance with that of several alternatives through simulation studies. The methods under comparison are applied to a cohort of prostate cancer patients from an insurance claims database for comparing the adverse effects of four candidate drugs for advanced stage prostate cancer.
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Affiliation(s)
- Youfei Yu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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29
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Nakamura J, Nakatsuka K, Uchida K, Akisue T, Maeda M, Murata F, Fukuda H, Ono R. Analysis of post-extraction bleeding in patients taking antithrombotic therapy using data from the longevity improvement and fair evidence study. Gerodontology 2023. [PMID: 37469221 DOI: 10.1111/ger.12703] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Several studies have investigated post-extraction bleeding in patients on antithrombotic therapy, but most included a small sample size. OBJECTIVE This study aimed to analyse post-extraction bleeding in patients on antithrombotic therapy using data from a large database. MATERIALS AND METHODS Claims data of National Health Insurance and Late-Stage Elderly Healthcare System enrollees who underwent tooth extraction between October 2014 and March 2019 (n = 107 767) in a large multiregional cohort study (Longevity Improvement and Fair Evidence study) were included. Antithrombotic therapy was determined based on the drug codes used at the time of tooth extraction (classified into six groups: no antithrombotic, single antiplatelet, dual antiplatelet, Direct Oral Anticoagulant, warfarin and combined antiplatelet and anticoagulant therapies). The outcome was defined as the presence of "post-extraction bleeding" as a receipt disease name in the same month as tooth extraction. To examine the association between antithrombotic therapy and post-extraction bleeding in detail, multiple logistic regression analysis was performed with post-extraction bleeding as the objective variable; each antithrombotic therapy as the explanatory variable; and age, sex and comorbidities as adjustment variables. RESULTS Antithrombotic therapy was administered in 14 343 patients (13.3%), and post-extraction bleeding was observed in 419 patients (0.4%). The rate of post-extraction bleeding was significantly lower in the no antithrombotic therapy and single antiplatelet groups than that in the other groups (odds ratio: 2.00-9.02). CONCLUSION The frequency of post-extraction bleeding is high in patients on anticoagulation or dual antithrombotic therapy. Therefore, careful preparation before extraction is necessary in these patients.
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Affiliation(s)
- Junya Nakamura
- Department of Dentistry and Oral Surgery, National Center for Geriatrics and Gerontology, Aichi, Japan
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Kiyomasa Nakatsuka
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Kazuaki Uchida
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Hyogo, Japan
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Megumi Maeda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Fumiko Murata
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Rei Ono
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
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30
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Sahrmann JM, Olsen MA, Keller MR, Yu H, Dubberke ER. Healthcare Costs of Clostridioides difficile Infection in Commercially Insured Younger Adults. Open Forum Infect Dis 2023; 10:ofad343. [PMID: 37496610 PMCID: PMC10368308 DOI: 10.1093/ofid/ofad343] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023] Open
Abstract
In a US adult population aged <65 years, attributable costs due to Clostridioides difficile infection (CDI) were highest in persons with hospital onset and lowest in those with community-associated CDI treated outside a hospital. The economic burden of CDI in younger adults underscores the need for additional CDI-preventive strategies.
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Affiliation(s)
- John M Sahrmann
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA
| | - Margaret A Olsen
- Correspondence: Margaret A. Olsen, PhD, MPH, Division of Infectious Diseases, Washington University School of Medicine, Mailstop Code 8051-043-0015, 4523 Clayton Ave., Saint Louis, MO 63110 (); Erik R. Dubberke, MD, MSPH, Division of Infectious Diseases, Washington University School of Medicine, Mailstop Code 8051-043-0015, 4523 Clayton Ave., Saint Louis, MO 63110 ()
| | - Matthew R Keller
- Institute for Informatics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Holly Yu
- Health Economics and Outcomes Research, Pfizer, Collegeville, Pennsylvania, USA
| | - Erik R Dubberke
- Correspondence: Margaret A. Olsen, PhD, MPH, Division of Infectious Diseases, Washington University School of Medicine, Mailstop Code 8051-043-0015, 4523 Clayton Ave., Saint Louis, MO 63110 (); Erik R. Dubberke, MD, MSPH, Division of Infectious Diseases, Washington University School of Medicine, Mailstop Code 8051-043-0015, 4523 Clayton Ave., Saint Louis, MO 63110 ()
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31
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Cocoros NM, Gurwitz JH, Cziraky MJ, Granger CB, Harkins T, Haynes K, Li X, Parlett L, Seeger JD, Singh S, McMahill-Walraven CN, Platt R. Pragmatic guidance for embedding pragmatic clinical trials in health plans: Large simple trials aren't so simple. Clin Trials 2023:17407745231160459. [PMID: 37322894 PMCID: PMC10363182 DOI: 10.1177/17407745231160459] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND There are unique opportunities related to the design and conduct of pragmatic trials embedded in health insurance plans, which have longitudinal data on member/patient demographics, dates of coverage, and reimbursed medical care, including prescription drug dispensings, vaccine administrations, behavioral healthcare encounters, and some laboratory results. Such trials can be large and efficient, using these data to identify trial-eligible patients and to ascertain outcomes. METHODS We use our experience primarily with the National Institutes of Health Pragmatic Trials Collaboratory Distributed Research Network, which comprises health plans that participate in the US Food & Drug Administration's Sentinel System, to describe lessons learned from the conduct and planning of embedded pragmatic trials. RESULTS Information is available for research on more than 75 million people with commercial or Medicare Advantage health plans. We describe three studies that have used or plan to use the Network, as well as a single health plan study, from which we glean our lessons learned. CONCLUSIONS Studies that are conducted in health plans provide much-needed evidence to drive clinically meaningful changes in care. However, there are many unique aspects of these trials that must be considered in the planning, implementation, and analytic phases. The type of trial best suited for studies embedded in health plans will be those that require large sample sizes, simple interventions that could be disseminated through health plans, and where data available to the health plan can be leveraged. These trials hold potential for substantial long-term impact on our ability to generate evidence to improve care and population health.
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Affiliation(s)
- Noelle M Cocoros
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jerry H Gurwitz
- Meyers Health Care Institute, A Joint Endeavor of UMass Chan Medical School, Reliant Medical Group and Fallon Health, Worcester, MA, USA
| | | | | | | | - Kevin Haynes
- Janssen Research & Development, Titusville, PA, USA
| | - Xiaojuan Li
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | | | - Sonal Singh
- Meyers Health Care Institute, A Joint Endeavor of UMass Chan Medical School, Reliant Medical Group and Fallon Health, Worcester, MA, USA
| | | | - Richard Platt
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Henke E, Zoch M, Reinecke I, Spoden M, Ruhnke T, Günster C, Sedlmayr M, Bathelt F. German Claims Data for Real-World Research: Content Coverage Evaluation in OMOP CDM. Stud Health Technol Inform 2023; 302:3-7. [PMID: 37203598 DOI: 10.3233/shti230053] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Research on real-world data is becoming increasingly important. The current restriction to clinical data in Germany limits the view of the patient. To gain comprehensive insights, claims data can be added to the existing knowledge. However, standardized transfer of German claims data into OMOP CDM is currently not possible. In this paper, we conducted an evaluation regarding the coverage of source vocabularies and data elements of German claims data in OMOP CDM. We point out the need to extend vocabularies and mappings to support research on German claims data.
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Affiliation(s)
- Elisa Henke
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Michéle Zoch
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ines Reinecke
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | | | | | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Franziska Bathelt
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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McNeely J, Gallagher SD, Mazumdar M, Appleton N, Fernando J, Owens E, Bone E, Krawczyk N, Dolle J, Marcello RK, Billings J, Wang S. Sensitivity of Medicaid Claims Data for Identifying Opioid Use Disorder in Patients Admitted to 6 New York City Public Hospitals. J Addict Med 2023; 17:339-341. [PMID: 37267184 PMCID: PMC10110762 DOI: 10.1097/adm.0000000000001097] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Behavioral health diagnoses are frequently underreported in administrative health data. For a pragmatic trial of a hospital addiction consult program, we sought to determine the sensitivity of Medicaid claims data for identifying patients with opioid use disorder (OUD). METHODS A structured review of electronic health record (EHR) data was conducted to identify patients with OUD in 6 New York City public hospitals. Cases selected for review were adults admitted to medical/surgical inpatient units who received methadone or sublingual buprenorphine in the hospital. For cases with OUD based on EHR review, we searched for the hospitalization in Medicaid claims data and examined International Classification of Diseases, Tenth Revision discharge diagnosis codes to identify opioid diagnoses (OUD, opioid poisoning, or opioid-related adverse events). Sensitivity of Medicaid claims data for capturing OUD hospitalizations was calculated using EHR review findings as the reference standard measure. RESULTS Among 552 cases with OUD based on EHR review, 465 (84.2%) were found in the Medicaid claims data, of which 418 (89.9%) had an opioid discharge diagnosis. Opioid diagnoses were the primary diagnosis in 49 cases (11.7%), whereas in the remainder, they were secondary diagnoses. CONCLUSION In this sample of hospitalized patients receiving OUD medications, Medicaid claims seem to have good sensitivity for capturing opioid diagnoses. Although the sensitivity of claims data may vary, it can potentially be a valuable source of information about OUD patients.
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Affiliation(s)
- Jennifer McNeely
- From the NYU Grossman School of Medicine, New York, NY (JM, MM, NA, JF, EO, EB, NK); NYU Grossman School of Medicine and NYC Health + Hospitals/Bellevue, New York, NY (SG); NYC Health + Hospitals, New York, NY (JD, RKM); NYU Robert F. Wagner Graduate School of Public Service, New York, NY (JB, SW)
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Gaul C, Seidel K, Heuck A, Silaidos C, Mrosowsky T, Eberhardt A, Fritz B, Jacob C. Real-world treatment patterns and healthcare resource utilization among migraine patients: A German claims database analysis. J Med Econ 2023; 26:667-678. [PMID: 37126606 DOI: 10.1080/13696998.2023.2207413] [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] [Indexed: 05/03/2023]
Abstract
AIMS Despite migraine being one of the most common neurological diseases, affected patients are often not effectively treated. This analysis describes the burden of migraine in Germany and assesses real-world treatment patterns and healthcare resource utilization (HCRU) of preventive-treated migraine patients from the perspective of the Statutory Health Insurance. METHODS A retrospective analysis was conducted using InGef Research Database claims data from 2018-2019. Migraine patients were stratified into cohorts by acute and preventive treatment status. Patients on preventive treatment were further stratified according to type of prophylaxis received. Disease burden in preventively treated migraine patients was reported via treatment patterns, pathways, and comorbidities. HCRU was assessed through outpatient provider visits, hospitalizations, and sick leave. RESULTS 160,164 adult migraine patients were identified, of which 55,378 (34.6%) were prescribed preventive treatment with conventional (n = 25,984, 46.9%), calcitonin gene-related peptide monoclonal antibody (CGRP mAb) (n = 613, 1.1%), or off-label therapies (n = 28,781, 52.0%). 936 (1.7%) patients received Botulinum Neurotoxin Type A (BoNTA). CGRP mAb-treated patients had a high rate of triptan prescriptions (2018: 95.5%; 2019: 88.9%), migraine-related hospitalizations (2018: 33.0%; 2019: 21.0%), and sick leave (2018: 26.8%; 2019: 22.5%). A high proportion of CGRP mAb- and BoNTA-treated patients was diagnosed with abdominal and pelvic pain (34.3% and 36.2%) and low back pain (34.1% and 35.3%). These patients also showed a high prevalence of depressive episodes (49.1% and 50.1%) and chronic pain disorders (37.5% and 32.9%). LIMITATIONS This study focused on descriptive analyses which do not allow for assessment of causality when comparing treatment groups. CONCLUSIONS Disease burden was high in patients receiving CGRP mAbs suggesting that patients treated preventively with CGRP mAbs shortly after product launch in Germany were severely affected chronic migraine patients. The same may be true for patients receiving BoNTA who also showed an increased disease burden.
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Affiliation(s)
- Charly Gaul
- Headache Center Frankfurt, Dalbergstraße 2, 65929 Frankfurt am Main, Germany
| | | | - Alexander Heuck
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Carmina Silaidos
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Thora Mrosowsky
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Alice Eberhardt
- Former employee of AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
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Nishimura R, Takeshima T, Iwasaki K, Aoi S. Prescription patterns and therapeutic effects of second-line drugs in Japanese patients with type 2 diabetes mellitus: Analysis of claims data for metformin and dipeptidyl peptidase-4 inhibitors as the first-line hypoglycemic agents. Expert Opin Pharmacother 2023; 24:969-976. [PMID: 37096493 DOI: 10.1080/14656566.2023.2206016] [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: 04/26/2023]
Abstract
BACKGROUND Dipeptidyl peptidase-4 inhibitors (DPP4is) and metformin are the most frequently prescribed first-line drugs for Japanese patients with type 2 diabetes (T2D). We investigated the risk of cardiovascular events by second-line treatment type in these patients. RESEARCH DESIGN AND METHODS Patients with T2D, prescribed either metformin or DPP4i as a first-line drug, were identified in claims data from Japanese acute care hospitals. The primary and secondary outcomes were cumulative risks of MI or stroke and of death, respectively, from second-line treatment initiation. RESULTS Patients prescribed first-line metformin or DPP4i was 16,736 and 74,464, respectively. In patients receiving first-line DPP4i, the death incidence was lower in those receiving second-line metformin than in those receiving second-line sulfonylurea (p < 0.001), whereas the primary outcome was not significantly different. No significant differences were observed for either outcome when DPP4is and metformin were used as first- and second-line drugs or vice versa. CONCLUSIONS Metformin was suggested to have larger effect to reduce death than sulfonylurea in patients receiving first-line DPP4i. The order of first- and second-line for the DPP4i and metformin combination did not affect the outcomes. Given the nature of the study design, certain limitations, including potential under-adjustment for confounders, should be considered.
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Affiliation(s)
- Rimei Nishimura
- Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Sumiko Aoi
- Medical Affairs, Sumitomo Pharma Co., Ltd. Tokyo, Japan
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Papademetriou E, Liu X, Beaudet A, Tsang Y, Potluri R, Panjabi S. Comparative evaluation of costs and healthcare resource utilization of oral selexipag versus inhaled treprostinil or oral treprostinil in patients with pulmonary arterial hypertension. J Med Econ 2023; 26:644-655. [PMID: 37086091 DOI: 10.1080/13696998.2023.2204769] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH), a rare vasculopathy progressively leading to right heart failure and death, is associated with considerable economic burden. Oral prostacyclin pathway agents (PPAs) like selexipag and treprostinil address an underlying PAH pathway, yet are often under-utilized. Data on head-to-head cost comparison of various PPAs is lacking. METHODS In this retrospective study using a large health claims database, we compared the per-patient-per-year (PPPY) costs and healthcare resource utilization (HRU) among PAH patients taking either oral selexipag, inhaled treprostinil or oral treprostinil in the United States between July 2015 and March 2020. Patients with ≥ 1 prescription for one of the drugs of interest, ≥ 1 in-patient pulmonary hypertension (PH) diagnosis, or ≥ 2 outpatient PH diagnoses were included in this study. Baseline differences between the three groups were adjusted using an inverse probability of treatment weighting approach. 411 patients were selected for the final study cohorts. RESULTS All-cause hospitalization costs were highest for oral treprostinil ($39,983) compared to oral selexipag ($20,635) and inhaled treprostinil ($16,548; p = 0.037). Total PAH-related medical costs were 40% lower for patients on oral selexipag compared to patients on oral and inhaled treprostinil ($24,351 vs. $40,398 and $40,339, respectively; p = 0.006). PAH-related outpatient visits were lowest for patients on oral selexipag (14 PPPY visits) compared to oral treprostinil (16 PPPY visits) and inhaled treprostinil (22 PPPY visits; p = 0.001). CONCLUSIONS Compared to oral and inhaled treprostinil, oral selexipag may incur lower medical costs and reduce PAH related outpatient visits for patients with PAH.
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Affiliation(s)
| | - Xing Liu
- Putnam PHMR, Value Pricing and Access, New York
| | - Amélie Beaudet
- Actelion Pharmaceuticals Ltd, Global Market Access, Allschwil, Switzerland
| | - Yuen Tsang
- Janssen Scientific Affairs, LLC, Real World Value & Evidence Titusville
| | | | - Sumeet Panjabi
- Janssen Scientific Affairs, LLC, Real World Value & Evidence Titusville
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Schwarz S, Hornschuch M, Pox C, Haug U. Polyp detection rate and cumulative incidence of post-colonoscopy colorectal cancer in Germany. Int J Cancer 2023; 152:1547-1555. [PMID: 36444495 DOI: 10.1002/ijc.34375] [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] [Received: 05/04/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Abstract
Studies have shown that the quality of colonoscopy influences the incidence of post-colonoscopy colorectal cancer (PCCRC). However, data from Germany on this association are lacking. We aimed to assess cumulative incidence of PCCRC in persons undergoing colonoscopy in Germany according to the physician's polyp detection rate (PDR). Using the German Pharmacoepidemiological Research Database (GePaRD) with claims data of ~20% of the German population, we included persons with a baseline colonoscopy between 2008 and 2017 and categorized them according to the procedure at baseline (snare polypectomy, forceps polypectomy, no polypectomy). In each subgroup, we distinguished between persons examined by physicians with a PDR in the lowest quartile vs higher quartiles and described cumulative CRC incidence during follow-up. Overall, 822 715 persons examined by 1752 physicians were included. One quarter of the physicians had a PDR ≤21.8% (lowest quartile). In all subgroups, the 5-year cumulative CRC incidence was statistically significantly higher in persons examined by physicians with a PDR ≤21.8% vs >21.8%: It was 69% higher in persons with snare polypectomy (0.88% vs 0.52%), 87% higher in persons with forceps polypectomy (0.58% vs 0.31%), and 48% higher in persons without polypectomy at baseline (0.31% vs 0.21%). In conclusion, we found a substantially increased PCCRC risk in persons examined by physicians with a low PDR in Germany, irrespective of the baseline findings. Our study highlights the importance of a high-quality colonoscopy to maximize the preventive effect of colonoscopy on CRC incidence.
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Affiliation(s)
- Sarina Schwarz
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Michel Hornschuch
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Christian Pox
- Department of Medicine, St. Joseph-Stift Bremen, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
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Schulte T, Wurz T, Groene O, Bohnet-Joschko S. Big Data Analytics to Reduce Preventable Hospitalizations-Using Real-World Data to Predict Ambulatory Care-Sensitive Conditions. Int J Environ Res Public Health 2023; 20:4693. [PMID: 36981600 PMCID: PMC10049041 DOI: 10.3390/ijerph20064693] [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] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to develop a prediction model to identify individuals and populations with a high risk of being hospitalized due to an ambulatory care-sensitive condition who might benefit from preventative actions or tailored treatment options to avoid subsequent hospital admission. A rate of 4.8% of all individuals observed had an ambulatory care-sensitive hospitalization in 2019 and 6389.3 hospital cases per 100,000 individuals could be observed. Based on real-world claims data, the predictive performance was compared between a machine learning model (Random Forest) and a statistical logistic regression model. One result was that both models achieve a generally comparable performance with c-values above 0.75, whereas the Random Forest model reached slightly higher c-values. The prediction models developed in this study reached c-values comparable to existing study results of prediction models for (avoidable) hospitalization from the literature. The prediction models were designed in such a way that they can support integrated care or public and population health interventions with little effort with an additional risk assessment tool in the case of availability of claims data. For the regions analyzed, the logistic regression revealed that switching to a higher age class or to a higher level of long-term care and unit from prior hospitalizations (all-cause and due to an ambulatory care-sensitive condition) increases the odds of having an ambulatory care-sensitive hospitalization in the upcoming year. This is also true for patients with prior diagnoses from the diagnosis groups of maternal disorders related to pregnancy, mental disorders due to alcohol/opioids, alcoholic liver disease and certain diseases of the circulatory system. Further model refinement activities and the integration of additional data, such as behavioral, social or environmental data would improve both model performance and the individual risk scores. The implementation of risk scores identifying populations potentially benefitting from public health and population health activities would be the next step to enable an evaluation of whether ambulatory care-sensitive hospitalizations can be prevented.
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Affiliation(s)
- Timo Schulte
- Faculty of Management, Economics and Society, Witten/Herdecke University, 58455 Witten, Germany
- Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
- Department of Business Analytics, Clinics of Maerkischer Kreis, 58515 Luedenscheid, Germany
| | - Tillmann Wurz
- Department of Project and Change Management, University Clinic Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Oliver Groene
- Faculty of Management, Economics and Society, Witten/Herdecke University, 58455 Witten, Germany
- Department of Research & Innovation, OptiMedis AG, 20095 Hamburg, Germany
| | - Sabine Bohnet-Joschko
- Faculty of Management, Economics and Society, Witten/Herdecke University, 58455 Witten, Germany
- Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
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Safieddine B, Trachte F, Sperlich S, Epping J, Lange K, Geyer S. Trends of Antidiabetic and Cardiovascular Diseases Medication Prescriptions in Type 2 Diabetes between 2005 and 2017-A German Longitudinal Study Based on Claims Data. Int J Environ Res Public Health 2023; 20:4491. [PMID: 36901500 PMCID: PMC10001865 DOI: 10.3390/ijerph20054491] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND With an attempt to understand possible mechanisms behind the severity-dependent development of type 2 diabetes (T2D) comorbidities, this study examines the trends of antidiabetic and cardiovascular diseases (CVD) medication prescriptions in individuals with T2D. METHODS The study is based on claims data from a statutory health insurance provider in Lower Saxony, Germany. The period prevalence of antidiabetic and CVD medication prescriptions was examined for the periods 2005-2007, 2010-2012, and 2015-2017 in 240,241, 295,868, and 308,134 individuals with T2D, respectively. (Ordered) logistic regression analyses were applied to examine the effect of time period on the number and prevalence of prescribed medications. Analyses were stratified by gender and three age groups. RESULTS The number of prescribed medications per person has increased significantly for all examined subgroups. For the two younger age groups, insulin prescriptions decreased but those of non-insulin medications increased, while both increased significantly over time for the age group of 65+ years. Except for glycosides and antiarrhythmic medications, the predicted probabilities for CVD medications increased over the examined periods, with lipid-lowering agents demonstrating the highest increase. CONCLUSIONS Results point towards an increase in medication prescriptions in T2D, which is in line with the evidence of the increase in most comorbidities indicating morbidity expansion. The increase in CVD medication prescriptions, especially lipid-lowering agents, could explain the specific development of severe and less severe T2D comorbidities observed in this population.
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Affiliation(s)
- Batoul Safieddine
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Florian Trachte
- Accident and Emergency Department, St. Vincenz Hospital, Am Busdorf 2, 33098 Paderborn, Germany
| | - Stefanie Sperlich
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Wang A, Ferro EG, Xu J, Song Y, Sun T, Strom JB, Kim DH, Yeh RW, Ko D, Kramer DB. Comparative performance of distinct frailty measures among patients undergoing percutaneous left atrial appendage closure. Pacing Clin Electrophysiol 2023; 46:242-250. [PMID: 36530151 PMCID: PMC9998344 DOI: 10.1111/pace.14649] [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: 09/12/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
AIMS Frailty is associated with increased morbidity and mortality in patients undergoing left atrial appendage closure (LAAC). This study aimed to compare the performance of two claims-based frailty measures in predicting adverse outcomes following LAAC. METHODS We identified patients 66 years and older who underwent LAAC between October 1, 2016, and December 31, 2019, in Medicare fee-for-service claims. Frailty was assessed using the previously validated Hospital Frailty Risk Score (HFRS) and Kim Claims-based Frailty Index (CFI). Patients were identified as frail based on HFRS ≥5 and CFI ≥0.25. RESULTS Of the 21,787 patients who underwent LAAC, frailty was identified in 45.6% by HFRS and 15.4% by CFI. There was modest agreement between the two frailty measures (kappa 0.25, Pearson's correlation 0.62). After adjusting for age, sex, and comorbidities, frailty was associated with higher risk of 30-day mortality, 1-year mortality, 30-day readmission, long hospital stay, and reduced days at home (p < .01 for all) regardless of the frailty measure used. The addition of frailty to standard comorbidities significantly improved model performance to predict 1-year mortality, long hospital stay, and reduced days at home (Delong p-value < .001). CONCLUSION Despite significant variation in frailty detection and modest agreement between the two frailty measures, frailty status remained highly predictive of mortality, readmissions, long hospital stay, and reduced days at home among patients undergoing LAAC. Measuring frailty in clinical practice, regardless of the method used, may provide prognostic information useful for patients being considered for LAAC, and may inform shared decision-making in this population.
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Affiliation(s)
- Allen Wang
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Enrico G Ferro
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jiaman Xu
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yang Song
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Tianyu Sun
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dae H Kim
- Harvard Medical School, Boston, Massachusetts, USA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Darae Ko
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Daniel B Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Ortega H, Bharmal N, Khatri S. Primary care referral patterns for patients with asthma: analysis of real-world data. J Asthma 2023; 60:609-615. [PMID: 35620831 DOI: 10.1080/02770903.2022.2082308] [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: 10/18/2022]
Abstract
OBJECTIVE To identify features related to management of patients prior to referral from primary care physicians (PCPs) to pulmonologists and allergists. METHODS This is an analysis of patient claims data from Symphony Health (2013-2018). To characterize referrals, a longitudinal cohort included 12 months with no asthma claims prior to the index date, followed by 36 months of observation. We also assessed a cross-sectional cohort for 12 months at the end of the observational period to characterize disease control and treatment patterns. Referral was defined as the first appearance of a claim from an allergist or pulmonologist for a patient's initial visit for asthma. Descriptive statistics were used to analyze the data. RESULTS The majority of patients with asthma were managed by PCPs (60%), followed by pulmonologists (16%) and allergists (8%). Forty-three percent had uncontrolled asthma. Only 8% were referred to specialists within the first 24 months after initial diagnosis, of which 76% were seen by pulmonologists and 24% by allergists. Referrals resulted in treatment change in 55%-68% of the cases. Patients who received a referral were more likely to be on oral corticosteroids (OCS) and/or have more hospitalizations/ED visits. CONCLUSIONS About one-third of the patients managed by PCPs received intermittent and/or chronic OCS prior to referral, which may be an indication of uncontrolled disease. The referral patterns in this analysis illustrate underutilization of specialists in the consultation and management of patients with uncontrolled asthma.
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Affiliation(s)
- Hector Ortega
- Clinical Development, Nexstone Immunology, Inc, San Diego, CA, USA
| | - Nazleen Bharmal
- Community Health & Partnership, Cleveland Clinic, Community Care, Cleveland, OH, USA
| | - Sumita Khatri
- Cleveland Clinic, Asthma Center, Respiratory Institute, Cleveland, OHSA
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Haug U, Kollhorst B, Schink T, Thöne K, Dathe K, Schaefer C, Onken M. Investigating drug safety in pregnancy based on the German Pharmacoepidemiological Research Database (GePaRD): A proof-of-concept analysis on the association between valproate and spina bifida. Pharmacoepidemiol Drug Saf 2023; 32:148-157. [PMID: 36401747 DOI: 10.1002/pds.5573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/27/2022] [Revised: 09/29/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Large health-care databases are increasingly used for research on drug utilization and safety in pregnancy. For the German Pharmacoepidemiological Research Database (GePaRD), covering ~20% of the German population, algorithms have been developed to identify pregnancies, to estimate their date of onset and to link mothers to their babies. Using this methodology, we aimed to conduct a proof-of-concept analysis on the known association between valproate (VPA) exposure in early pregnancy and spina bifida in the exposed child. METHODS We identified all pregnancies in GePaRD between 2006 and 2016 in women aged 12 to 50 years. To each VPA dispensation of these women, an exposure period was assigned, based on the dispensation date and the number of defined daily doses in the dispensed package. A pregnancy was classified as exposed to VPA in the critical time window if this exposure period overlapped with the first 55 days of pregnancy. Risk ratios were calculated for spina bifida in live births and induced abortions comparing VPA-exposed ones to all pregnancies. RESULTS Overall, we identified 1 271 384 pregnancies fulfilling the inclusion criteria. Of these, 668 pregnancies (0.053%) were classified as exposed to VPA in the critical time window regarding spina bifida. An induced abortion accompanied by a diagnosis of spina bifida was observed in one of the VPA-exposed pregnancies (0.15%) and in 154 of all pregnancies (0.012%), yielding a risk ratio of 12.4 (95% confidence interval [CI]: 1.7-88.2). Out of 775 875 pregnancies ending in a live birth, 366 (0.047%) were classified as VPA exposed. A diagnosis of spina bifida was coded in 3 of 366 VPA-exposed live births (0.82%) and in 260 of all live births (0.03%), yielding a relative risk of 24.5 (95% CI: 7.9-76.0). CONCLUSIONS Our proof-of-concept analysis based on GePaRD showed a strong association between intrauterine exposure to VPA and occurrence of spina bifida. The results are plausible and consistent with the literature, supporting the suitability of GePaRD and the developed algorithms to conduct studies on drug safety in pregnancy.
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Affiliation(s)
- Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Katarina Dathe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Christof Schaefer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Marlies Onken
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
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Eysenbach G, Tan X, Padman R. A Machine Learning Approach to Support Urgent Stroke Triage Using Administrative Data and Social Determinants of Health at Hospital Presentation: Retrospective Study. J Med Internet Res 2023; 25:e36477. [PMID: 36716097 PMCID: PMC9926350 DOI: 10.2196/36477] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/17/2022] [Accepted: 12/18/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The key to effective stroke management is timely diagnosis and triage. Machine learning (ML) methods developed to assist in detecting stroke have focused on interpreting detailed clinical data such as clinical notes and diagnostic imaging results. However, such information may not be readily available when patients are initially triaged, particularly in rural and underserved communities. OBJECTIVE This study aimed to develop an ML stroke prediction algorithm based on data widely available at the time of patients' hospital presentations and assess the added value of social determinants of health (SDoH) in stroke prediction. METHODS We conducted a retrospective study of the emergency department and hospitalization records from 2012 to 2014 from all the acute care hospitals in the state of Florida, merged with the SDoH data from the American Community Survey. A case-control design was adopted to construct stroke and stroke mimic cohorts. We compared the algorithm performance and feature importance measures of the ML models (ie, gradient boosting machine and random forest) with those of the logistic regression model based on 3 sets of predictors. To provide insights into the prediction and ultimately assist care providers in decision-making, we used TreeSHAP for tree-based ML models to explain the stroke prediction. RESULTS Our analysis included 143,203 hospital visits of unique patients, and it was confirmed based on the principal diagnosis at discharge that 73% (n=104,662) of these patients had a stroke. The approach proposed in this study has high sensitivity and is particularly effective at reducing the misdiagnosis of dangerous stroke chameleons (false-negative rate <4%). ML classifiers consistently outperformed the benchmark logistic regression in all 3 input combinations. We found significant consistency across the models in the features that explain their performance. The most important features are age, the number of chronic conditions on admission, and primary payer (eg, Medicare or private insurance). Although both the individual- and community-level SDoH features helped improve the predictive performance of the models, the inclusion of the individual-level SDoH features led to a much larger improvement (area under the receiver operating characteristic curve increased from 0.694 to 0.823) than the inclusion of the community-level SDoH features (area under the receiver operating characteristic curve increased from 0.823 to 0.829). CONCLUSIONS Using data widely available at the time of patients' hospital presentations, we developed a stroke prediction model with high sensitivity and reasonable specificity. The prediction algorithm uses variables that are routinely collected by providers and payers and might be useful in underresourced hospitals with limited availability of sensitive diagnostic tools or incomplete data-gathering capabilities.
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Affiliation(s)
| | - Xuan Tan
- Department of Information Systems and Analytics, Leavey School of Business, Santa Clara University, Santa Clara, CA, United States
| | - Rema Padman
- The H John Heinz III College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
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Leiz M, Moon K, Rehner LK, Stentzel U, Radicke F, Hoffmann W, van den Berg N. Population-Based, Spatial Analysis of Specialised Ambulatory Palliative Care in Mecklenburg-Western Pomerania, Germany, on the Basis of Reimbursement Data. Int J Environ Res Public Health 2023; 20:2231. [PMID: 36767598 PMCID: PMC9916229 DOI: 10.3390/ijerph20032231] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
In rural areas, healthcare providers, patients and relatives have to cover long distances. For specialised ambulatory palliative care (SAPV), a supply radius of max. 30 km is recommended. The aim of this study was to analyse whether there are regional disparities in the supply of SAPV and whether it is associated with the distance between the SAPV team's site and the patient's location. Therefore, anonymised data of the Association of Statutory Health Insurance Physicians of the Federal State of Mecklenburg-Western Pomerania (M-V) were retrospectively analysed for the period of 2014-2017. Identification as a palliative patient was based on palliative-specific items from the ambulatory reimbursement catalogue. In total, 6940 SAPV patients were identified; thereof, 48.9% female. The mean age was 73.3 years. For 28.3% of the identified SAPV patients (n = 1961), the SAPV teams had a travel distance of >30 km. With increasing distance, the average number of treatment days per patient increased. It was found that there are regional disparities in the provision of SAPV services in M-V and that local structures have an important impact on regional supply patterns. The distance between the SAPV team's site and the patient's location is not the only determining factor; other causes must be considered.
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Affiliation(s)
- Maren Leiz
- Institute for Community Medicine, University Medicine, 17475 Greifswald, Germany
| | - Kilson Moon
- Institute for Community Medicine, University Medicine, 17475 Greifswald, Germany
| | - Laura Kerstin Rehner
- Institute for Nursing Science and Interprofessional Learning, University Medicine, 17475 Greifswald, Germany
| | - Ulrike Stentzel
- Institute for Community Medicine, University Medicine, 17475 Greifswald, Germany
| | - Franziska Radicke
- Institute for Community Medicine, University Medicine, 17475 Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine, 17475 Greifswald, Germany
| | - Neeltje van den Berg
- Institute for Community Medicine, University Medicine, 17475 Greifswald, Germany
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Momo K, Kobayashi M, Sasaki T. [Exploring for Drug Development Seeds for Children Using a Large Claims Data-Survey for Powderization or Decapsulation of Oral Tablets or Capsule Formula in Children]. YAKUGAKU ZASSHI 2023; 143:507-510. [PMID: 37258184 DOI: 10.1248/yakushi.22-00179-5] [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: 06/02/2023]
Abstract
Medical big data is accumulated numerous medical related data day by day. These data may have tips for new approach for drug development. Authors tried to find drug-development-needs in children using medical big data analysis with prescription survey. Medical big data were provided from JMDC (Japan Medical Data Centre) Inc. about 3 million participants between January 2005 and June 2017. In these, we identified randomly identified 22787 participants from 466701 participants who are aged ≤11 years. In these participants, 9644 were administered "capsule," "tablet," "orally distegrating tablet," "controlled release tablet/capsule" or "enteric coated tablet" formula drugs. In these, 514 were administered these as powderization or decapsulation. Sixty components administered in 145 participants (28.2%) are not marketed for pediatric formula. On the other hands, 92 components administered in 369 participants (71.8%) are decapsulation or powderization, though pediatric formulas are marketed. These 152 components may have a development seeds for children. In conclusion, prescription survey using medical big data may partially resolve the drug-development-need in pediatrics because by using medical big data will leads low biased data depending each institution.
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Affiliation(s)
- Kenji Momo
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | - Mami Kobayashi
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
- Department of Pharmacy, Showa University Hospital
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Gao W, Mostaghimi A, Gandhi K, Done N, Ray M, Signorovitch J, Swallow E, Carley C, Wang T, Sikirica V. Patient characteristics associated with all-cause healthcare costs of alopecia areata in the United States. J Med Econ 2023; 26:441-444. [PMID: 36896625 DOI: 10.1080/13696998.2023.2188843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Wei Gao
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | | | - Kavita Gandhi
- Immunology & Inflamation, Pfizer Inc., Collegeville, PA, USA
| | - Nicolae Done
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Markqayne Ray
- Immunology & Inflamation, Pfizer Inc., Collegeville, PA, USA
| | - James Signorovitch
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Elyse Swallow
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Christopher Carley
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Travis Wang
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA, USA
| | - Vanja Sikirica
- Immunology & Inflamation, Pfizer Inc., Collegeville, PA, USA
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47
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Berna R, Margolis DJ, Damsky W, Barbieri JS. Annual health care utilization and cost of granuloma annulare in the United States, 2016 to 2019: A cross-sectional study. J Am Acad Dermatol 2023; 88:217-219. [PMID: 35513176 DOI: 10.1016/j.jaad.2022.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Ronald Berna
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - David J Margolis
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Schepens MHJ, van Hooff ML, van Erkelens JA, Bartels R, Hoebink E, Smits M, Kuijpens JLP, van Limbeek J. Outcomes After Lumbar Disk Herniation Surgery in the Dutch Population. Global Spine J 2023; 13:60-66. [PMID: 33576274 PMCID: PMC9837512 DOI: 10.1177/2192568221991124] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE There is only limited data on the outcome of primary surgery of lumbar disk herniation (LDH) in Dutch patients. The objective of this study is to describe undesirable outcomes after primary LDH. METHODS The National Claims Database (Vektis) was searched for primary LDH operations performed from July 2015 until June 2016, for reoperations within 18 months, prescription of opioids between 6 to 12 months and nerve root block within 1 year. A combined outcome measure was also made. Group comparisons were analyzed with the Student's t-test. RESULTS Primary LDH surgery was performed in 6895 patients in 70 hospitals. Weighted mean of reoperations was 7.3%, nerve root block 6.7% and opioid use 15.6%. In total, 23.0% of patients had one or more undesirable outcomes after surgery. The 95% CI interval exceeded the 50% incidence line for 14 out of 26 hospitals with less than 50 surgical interventions per year. Although the data suggested a volume effect on undesired outcomes, the t-tests between hospitals with volume thresholds of 100, 150 and 200 interventions per year did not support this (P values 0.078, 0.129, 0.114). CONCLUSION This unique nationwide claims-based study provides insight into patient-relevant undesirable outcomes such as reoperation, nerve root block and opioid use after LDH surgery. About a quarter of the patients had a serious complication in the first follow up year that prompted further medical treatment. There is a wide variation in complication rates between hospitals with a trend that supports concentration of LDH care.
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Affiliation(s)
- Maike H. J. Schepens
- Department Strategy and Quality of Care, Dutch
Association of Health Insurers (ZN), Zeist, Netherlands
| | - Miranda L. van Hooff
- Department Research, Sint Maartenskliniek,
Ubbergen, Netherlands,Department Orthopedics, Radboud University
Medical Center, Nijmegen, Netherlands,Miranda L. van Hooff, Department Research, Sint
Maartenskliniek, Ubbergen, Netherlands; Department Orthopedics, Radboud University Medical
Center, Nijmegen, Netherlands.
| | | | - Ronald Bartels
- Department Neurosurgery, Radboud University
Medical Center, Nijmegen, Netherlands
| | - Eric Hoebink
- Department Orthopedics, Amphia Hospital,
Breda, Netherlands
| | - Margot Smits
- Department Medical Advice, Zilveren Kruis
Health Insurance Company, Leusden, Netherlands
| | | | - Jacques van Limbeek
- Department Medical Advice, Zilveren Kruis
Health Insurance Company, Leusden, Netherlands
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Steinman MA, Jing B, Shah SJ, Rizzo A, Lee SJ, Covinsky KE, Ritchie CS, Boscardin WJ. Development and validation of novel multimorbidity indices for older adults. J Am Geriatr Soc 2023; 71:121-135. [PMID: 36282202 PMCID: PMC9870862 DOI: 10.1111/jgs.18052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/24/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. We sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes. METHODS Health conditions were assessed using Medicare inpatient and outpatient claims from subjects age 67 and older in the Health and Retirement Study. Separate indices were developed for ADL decline, IADL decline, hospitalization, and death, each over 2 years of follow-up. We validated these indices using data from Medicare claims linked to the National Health and Aging Trends Study. RESULTS The development cohort included 5012 subjects with median age 76 years; 58% were female. Claims-based markers of disease severity and disease-disease interactions yielded minimal gains in predictive power and were not included in the final indices. In the validation cohort, after adjusting for age and sex, c-statistics for the new multimorbidity indices were 0.72 for ADL decline, 0.69 for IADL decline, 0.72 for hospitalization, and 0.77 for death. These c-statistics were 0.02-0.03 higher than c-statistics from Charlson and Elixhauser indices for predicting ADL decline, IADL decline, and hospitalization, and <0.01 higher for death (p < 0.05 for each outcome except death), and were similar to those from the CMS-HCC model. On decision curve analysis, the new indices provided minimal benefit compared with legacy approaches. C-statistics for both new and legacy indices varied substantially across derivation and validation cohorts. CONCLUSIONS A new series of claims-based multimorbidity measures were modestly better at predicting hospitalization and functional decline than several legacy indices, and no better at predicting death. There may be limited opportunity in claims data to measure multimorbidity better than older methods.
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Affiliation(s)
- Michael A. Steinman
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Bocheng Jing
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Sachin J. Shah
- Division of Hospital Medicine, UCSF, San Francisco, California, USA
| | - Anael Rizzo
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
- David Geffen School of Medicine at UCLA, San Francisco, California, USA
| | - Sei J. Lee
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Kenneth E. Covinsky
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and the Mongan Institute Center for Aging and Serious Illness, Boston, MA, USA
| | - W. John Boscardin
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
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50
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Kunicki ZJ, Bayer T, Jiang L, Bozzay ML, Quinn MJ, De Vito AN, Emrani S, Erqou S, McGeary JE, Zullo AR, Duprey MS, Singh M, Primack JM, Kelso CM, Wu WC, Rudolph JL. Comparing Lookback Periods to Ascertain Alzheimer's Disease and Related Dementias. Am J Alzheimers Dis Other Demen 2023; 38:15333175231199566. [PMID: 37650437 PMCID: PMC10623942 DOI: 10.1177/15333175231199566] [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] [Indexed: 09/01/2023]
Abstract
Claims data are a valuable resource for studying Alzheimer's disease and related dementias (ADRD). Alzheimer's disease and related dementias is often identified using a list of claims codes and a fixed lookback period of 3 years of data. However, a 1-year lookback or an approach using all-available lookback data could be beneficial based on different research questions. Thus, the purpose of this study was to compare 1-year and all-available lookback approaches to ascertaining ADRD compared to the standard 3-year approach. Using a cohort of Veterans hospitalized for heart failure (N = 373, 897), our results suggested high agreement (93% or greater) between the lookback periods. The 1-year lookback period had lower sensitivity (60%) and underestimated the prevalence of ADRD. These results suggest that 1-year and all-available lookback periods are viable approaches when using claims data.
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Affiliation(s)
- Zachary J. Kunicki
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | - Thomas Bayer
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lan Jiang
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | | | - McKenzie J. Quinn
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
| | - Alyssa N. De Vito
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sheina Emrani
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sebhat Erqou
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
| | - John E. McGeary
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | - Andrew R. Zullo
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | | | - Mriganka Singh
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer M. Primack
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
| | - Catherine M. Kelso
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
- Office of Patient Care Services, Geriatrics and Extended Care, Veterans Health Administration, Washington, DC, USA
| | - Wen-Chih Wu
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - James L. Rudolph
- VA Center of Innovation in Long Term Services, Providence VA Medical Center, Providence, RI, USA
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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