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Dualeh SH, Powell CA, Kunnath N, Corriere MA, Ibrahim AM. Rate of Emergency Lower Extremity Amputations in the United States Among Medicare Beneficiaries. Ann Surg 2024; 279:714-719. [PMID: 37753648 PMCID: PMC10939986 DOI: 10.1097/sla.0000000000006105] [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: 09/28/2023]
Abstract
OBJECTIVE To determine the rate of emergency versus elective lower extremity amputations in the United States. BACKGROUND Lower extremity amputation is a common endpoint for patients with poorly controlled diabetes and multilevel peripheral vascular disease. Although the procedure is ideally performed electively, patients with limited access may present later and require an emergency operation. To what extent rates of emergency amputation for lower extremities vary across the United States is unknown. METHODS Evaluation of Medicare beneficiaries who underwent lower extremity amputation between 2015 and 2020. The rate was determined for each zip code and placed into rank order from lowest to highest rate. We merged each beneficiary's place of residence and location of care with the American Hospital Association Annual Survey using Google Maps Application Programming Interface to determine the travel distance for patients to undergo their procedure. RESULTS Of 233,084 patients, 66.3% (154,597) were men, 69.8% (162,786) were White. The average age (SD) was 74 years (8). There was wide variation in rates of emergency lower extremity amputation. The lowest quintile of zip codes demonstrated an emergency amputation rate of 3.7%, whereas the highest quintile demonstrated 90%. The median travel distance in the lowest emergency surgery rate quintile was 34.6 miles compared with 10.5 miles in the highest quintile of emergency surgery ( P < 0.001). CONCLUSIONS There is wide variation in the rate of emergency lower extremity amputations among Medicare beneficiaries, suggesting variable access to essential vascular care. Travel distance and rate of amputation have an inverse relationship, suggesting that barriers other than travel distance are playing a role.
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Affiliation(s)
- Shukri H.A. Dualeh
- University of Michigan, Department of Surgery, Ann Arbor, MI
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI
| | - Chloe A. Powell
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI
- University of Michigan, Section of Vascular Surgery, Department of Surgery, Ann Arbor, MI
| | - Nicholas Kunnath
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI
| | - Matthew A. Corriere
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI
- University of Michigan, Section of Vascular Surgery, Department of Surgery, Ann Arbor, MI
| | - Andrew M. Ibrahim
- University of Michigan, Department of Surgery, Ann Arbor, MI
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI
- University of Michigan, Taubman College of Architecture & Urban Planning, Ann Arbor, MI
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Kodumudi V, Gronbeck C, Feng H. Practice Characteristics of Self-Identified Black Dermatologists in the United States. J Clin Aesthet Dermatol 2023; 16:27-29. [PMID: 36950040 PMCID: PMC10027325] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
There is a documented shortage of Black dermatologists in the United States, with little known about their practice characteristics. We analyzed the practice patterns (e.g., location, group setting, beneficiary characteristics, local geographic characteristics) of 221 self-identified Black dermatologists in the Black Dermatologist Directory through analysis of publicly available Medicare datasets. Compared to non-Black dermatologists, Black dermatologists were more likely to be female (80.1% vs. 51.1%), practice in the South (49.8% vs. 34.9%), work in solo practices (35.8% vs. 19.8%) or academic centers (18.1% vs. 15.5%), and practice in counties with a higher proportion of non-Hispanic Black individuals (21.0% vs. 13.2%). Black dermatologists treated a higher proportion of non-Hispanic Black Medicare beneficiaries (21.7% vs. 2.7%) and dual Medicare-Medicaid beneficiaries (15.0% vs. 9.7%). Major limitations include reliance on public data which may incompletely capture all practicing Black dermatologists. Overall, the findings support the important role of Black dermatologists in treating minority and Medicaid beneficiaries; increased representation of Black dermatologists may ultimately allow for improved patient access and promote awareness and knowledge of specific dermatologic needs of Black patients among the broader dermatology community.
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Affiliation(s)
- Vijay Kodumudi
- Dr. Kodumudi is with the University of Connecticut School of Medicine in Farmington, Connecticut
| | - Christian Gronbeck
- Drs. Gronbeck and Feng are with the Department of Dermatology at the University of Connecticut Health Center in Farmington, Connecticut
| | - Hao Feng
- Drs. Gronbeck and Feng are with the Department of Dermatology at the University of Connecticut Health Center in Farmington, Connecticut
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Ng BP, Peach BC, Keith D, Park C, Li Y. Factors Associated with Mental Health of Medicare Beneficiaries During the COVID-19 Pandemic. Clin Gerontol 2023; 46:779-788. [PMID: 36458806 DOI: 10.1080/07317115.2022.2151962] [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: 12/04/2022]
Abstract
OBJECTIVES This study examined factors associated with the mental health of Medicare beneficiaries during the COVID-19 pandemic. METHODS The Medicare Current Beneficiary Survey COVID-19 Supplement administered in the Fall of 2020 of beneficiaries aged ≥65 years was analyzed (n = 6,173). A survey-weighted logistic model, adjusted for socio-demographics and comorbidities, was performed to examine factors (e.g., accessibility of medical/daily needs, financial security, and social connectivity) associated with stress/anxiety. RESULTS Of Medicare beneficiaries, 40.8% reported feeling more stressed/anxious during the pandemic. Factors that were associated with this increased stress/anxiety include the inability to get home supplies (95% CI [3.4%, 16.5%]) or a doctor's appointment (95% CI [1.7%, 20.7%]), feeling less financially secure (95% CI [23.1%, 33.2%]) or socially connected (95% CI [19.1%, 25.6%]), and being female (95% CI [7.2%, 12.2%]), when compared with their respective counterparts. Non-Hispanic blacks were less likely to report feeling more stressed/anxious than non-Hispanic whites (95% CI [-19.9%, -9.0%]). CONCLUSIONS Our findings highlight that beneficiaries' mental health was adversely influenced by the pandemic, particularly in those who felt financially insecure and socially disconnected. CLINICAL IMPLICATIONS It is warranted to screen at risk beneficiaries for stress/anxiety during Medicare wellness visits and advocate for programs to reduce those risk factors.
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Affiliation(s)
- Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, Florida, USA
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, Florida, USA
| | - Brian C Peach
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Daniel Keith
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Yingru Li
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
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Cypher M, Axman LM. Determinants of Location of Death: A Secondary Analysis Utilizing Multinomial Logistic Regression. Am J Hosp Palliat Care 2022; 39:1397-1402. [PMID: 35232266 DOI: 10.1177/10499091221077883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STATEMENT OF PROBLEM A discrepancy exists between where people would like to die and what actually occurs. More research about the factors influencing the location of death is required. Sources of Data and Research Design: Multinomial logistic regression was used to examine a sample taken from the fourth round of data collection performed by the National Health and Aging Trends Study conducted in 2014. Conclusions Reached: Census location, age, dementia, and use of hospice were found to have a statistically significant (P < .05) influence on the location of death (P = .000). The results suggest that the use of hospice increased the odds of dying at home (OR = 17.467, CI = 7.43-41.063) and in a nursing home (OR = 34.334, CI = 12.444-94.727) as compared to dying in the hospital. Further research is required on the topic of geographic location and place of death.
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Alnijadi AA, Yuan J, Wu J, Li M, Lu ZK. Cost-Related Medication Nonadherence (CRN) on Healthcare Utilization and Patient-Reported Outcomes: Considerations in Managing Medicare Beneficiaries on Antidepressants. Front Pharmacol 2021; 12:764697. [PMID: 34950029 PMCID: PMC8688804 DOI: 10.3389/fphar.2021.764697] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Many patients face a financial burden due to their medications, which may lead to poor health outcomes. The behaviors of non-adherence due to financial difficulties, known as cost-related medication non-adherence (CRN), include taking smaller doses of drugs, skipping doses to make prescriptions last longer, or delaying prescriptions. To date, the prevalence of CRN remains unknown, and there are few studies about the association of CRN on self-reported healthcare utilization (Emergency room (ER) visits and outpatient visits) and self-reported health outcomes (health status and disability status) among older adults taking antidepressants. Objectives: The objectives were to 1) examine the CRN prevalence, and 2) determine the association of CRN on self-reported healthcare utilization and self-reported health outcomes. Methods: This study was a cross-sectional study of a sample of older adults from the Medicare Current Beneficiary Survey (MCBS) who reported having used antidepressants in 2017. Four logistic regressions were implemented to evaluate the association of CRN, and self-reported healthcare utilization and self-reported health outcomes. Results: The study identified 602 participants who were Medicare beneficiaries on antidepressants. The prevalence of CRN among antidepressant users was (16.61%). After controlling for covariates, CRN was associated with poorer self-reported outcomes but not statistically significant: general health status [odds ratio (OR): 0.67; 95% confidence interval (CI): 0.39-1.16] and disability status (OR: 1.34; 95% CI: 0.83-2.14). In addition, CRN was associated with increased outpatient visits (OR: 1.89; 95% CI: 1.19-3.02), but not associated with ER visits (OR: 1.10; 95% CI: 0.69-1.76). Conclusion: For Medicare beneficiaries on antidepressants, CRN prevalence was high and contributed to more outpatient visits. The healthcare provider needs to define the reasoning for CRN and provide solutions to reduce the financial burden on the affected patient. Also, health care providers need to consider the factors that may enhance patient health status and healthcare efficiency.
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Affiliation(s)
- Abdulrahman A. Alnijadi
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Fudan University, Shanghai, China
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College, Clinton, SC, United States
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Z. Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
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Pagani FD, Mehra MR, Cowger JA, Horstmanshof DA, Silvestry SC, Atluri P, Cleveland JC, Lindenfeld J, Roberts GJ, Bharmi R, Dalal N, Kormos RL, Rogers JG. Clinical outcomes and healthcare expenditures in the real world with left ventricular assist devices - The CLEAR-LVAD study. J Heart Lung Transplant 2021; 40:323-333. [PMID: 33744086 DOI: 10.1016/j.healun.2021.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several distinctly engineered left ventricular assist devices (LVADs) are in clinical use. However, contemporaneous real world comparisons have not been conducted, and clinical trials were not powered to evaluate differential survival outcomes across devices. OBJECTIVES Determine real world survival outcomes and healthcare expenditures for commercially available durable LVADs. METHODS Using a retrospective observational cohort design, Medicare claims files were linked to manufacturer device registration data to identify de-novo, durable LVAD implants performed between January 2014 and December 2018, with follow-up through December 2019. Survival outcomes were compared using a Cox proportional hazards model stratified by LVAD type and validated using propensity score matching. Healthcare resource utilization was analyzed across device types by using nonparametric bootstrap analysis methodology. Primary outcome was survival at 1-year and total Part A Medicare payments. RESULTS A total of 4,195 de-novo LVAD implants were identified in fee-for-service Medicare beneficiaries (821 HeartMate 3; 1,840 HeartMate II; and 1,534 Other-VADs). The adjusted hazard ratio for mortality at 1-year (confirmed in a propensity score matched analysis) for the HeartMate 3 vs HeartMate II was 0.64 (95% CI; 0.52-0.79, p< 0.001) and for the HeartMate 3 vs Other-VADs was 0.51 (95% CI; 0.42-0.63, p < 0.001). The HeartMate 3 cohort experienced fewer hospitalizations per patient-year vs Other-VADs (respectively, 2.8 vs 3.2 EPPY hospitalizations, p < 0.01) and 6.1 fewer hospital days on average (respectively, 25.2 vs 31.3 days, p < 0.01). The difference in Medicare expenditures, conditional on survival, for HeartMate 3 vs HeartMate II was -$10,722, p < 0.001 (17.4% reduction) and for HeartMate 3 vs Other-VADs was -$17,947, p < 0.001 (26.1% reduction). CONCLUSIONS In this analysis of a large, real world, United States. administrative dataset of durable LVADs, we observed that the HeartMate 3 had superior survival, reduced healthcare resource use, and lower healthcare expenditure compared to other contemporary commercially available LVADs.
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Affiliation(s)
- Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Mandeep R Mehra
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer A Cowger
- Department of Cardiovascular Medicine, Henry Ford Hospitals, Detroit, Michigan
| | | | | | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - JoAnn Lindenfeld
- Section of Heart Failure and Cardiac Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | - Joseph G Rogers
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Rai P, Shen C, Kolodney J, Kelly KM, Scott VG, Sambamoorthi U. Immune checkpoint inhibitor use, multimorbidity and healthcare expenditures among older adults with late-stage melanoma. Immunotherapy 2021; 13:103-112. [PMID: 33148082 PMCID: PMC8008205 DOI: 10.2217/imt-2020-0152] [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: 05/22/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background: The objective of this study is to assess the impact of immune checkpoint inhibitors (ICIs) and multimorbidity on healthcare expenditures among older patients with late-stage melanoma. Materials & methods: A retrospective longitudinal cohort study using Surveillance, Epidemiology and End Results linked with Medicare claims was conducted. Generalized linear mixed models were used to analyze adjusted relationships of ICI, multimorbidity and ICI-multimorbidity interaction on average healthcare expenditures. Results: Patients who received ICI and those who had multimorbidity had significantly higher average total healthcare expenditures compared with ICI nonusers and no multimorbidity. In the fully adjusted model using ICI-multimorbidity interaction, no excess cost was added by multimorbidity. Conclusion: Use of ICIs, regardless of multimorbidity, is associated with increased healthcare expenditures.
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Affiliation(s)
- Pragya Rai
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Chan Shen
- Department of Surgery Chief, Division of Outcomes, Research & Quality Cancer Institute, Cancer Control Penn State Cancer Institute, Hershey 17033, PA
| | - Joanna Kolodney
- Department of Medicine, West Virginia University School of Medicine, Morgantown 26506, WV
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Virginia G Scott
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
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Abstract
BACKGROUND Knowledge regarding antidiabetic medication (ADM) use prior to breast cancer (BC) diagnosis remains limited. The objectives were to (1) evaluate if the prior use of ADM was associated with BC stage at diagnosis and (2) identify and compare patient characteristics among BC patients using different ADMs. RESEARCH DESIGN AND METHODS Newly diagnosed female BC patients exposed to any medication during one year prior to cancer diagnosis were identified in 2008-2013 Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Stage at diagnosis, categorized as early and advanced, was the primary outcome. Chi-square tests were used to compare characteristics and logistic regression models were applied to examine the effect while controlling for patient's characteristics. RESULTS A total of 1,719 female BC patients used ADM while 6,084 patients were non-ADM users. Although a higher proportion of ADM users (20.36%) were diagnosed with advanced stage compared to the non-ADM users (14.46%), the difference was not statistically significant after adjusting for the patients' characteristics. Besides, insulin users were more likely to be diagnosed with advanced stage (adjusted odds ratio 1.69; 95% CI 1.15, 2.48) compared to metformin users. CONCLUSIONS The association between ADM use and BC diagnostic characteristics varied based on different treatments.
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Affiliation(s)
- Shahariar Mohammed Fahim
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, the University of Arizona , Tucson, AZ, USA
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy & School of Pharmacy, College of Medicine, National Taiwan University , Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital , Taipei, Taiwan
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA.,Department of Medical Research, China Medical University Hospital , Taichung, Taiwan
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Abstract
OBJECTIVE To investigate the association between physician characteristics and the value of industry payments. DESIGN Observational study. SETTING AND PARTICIPANTS Using the 2015-2017 Open Payments reports of industry payments linked to the Physician Compare database, we examined the association between physician characteristics (physician sex, years in practice, medical school attended and specialty) and the industry payment value, adjusting for other physician characteristic and institution fixed effects (effectively comparing physicians practicing at the same institution). MAIN OUTCOME MEASURES Our primary outcome was the value of total industry payments to physicians including (1) general payments (all forms of payments other than those classified for research purpose, eg, consulting fees, food, beverage), (2) research payments (payments for research endeavours under a written contract or protocol) and (3) ownership interests (eg, stock or stock options, bonds). We also investigated each category of payment separately. RESULTS Of 544 264 physicians treating Medicare beneficiaries, a total of $5.8 billion in industry payments were made to 365 801 physicians during 2015-2017. The top 5% of physicians, by cumulative payments, accounted for 91% of industry payments. Within the same institution, male physicians, physicians with 21-30 years in practice and physicians who attended top 50 US medical schools (based on the research ranking) received higher industry payments. Across specialties, orthopaedic surgeons, neurosurgeons and endocrinologists received the highest payments. When we investigated individual types of payment, we found that orthopaedic surgeons received the highest general payments; haematologists/oncologists were the most likely to receive research payments and surgeons were the most likely to receive ownership interests compared with other types of physicians. CONCLUSIONS Industry payments to physicians were highly concentrated among a small number of physicians. Male sex, longer length of time in clinical practice, graduated from a top-ranked US medical school and practicing certain specialties, were independently associated with higher industry payments.
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Affiliation(s)
- Kosuke Inoue
- Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Daniel M Blumenthal
- Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Devoted Health, Waltham, Massachusetts, USA
| | - David Elashoff
- Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Medicine Statistics Core, UCLA David Geffen School of Medicine, Los Angeles, California, USA
- General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Yusuke Tsugawa
- General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
- Department of Health Policy Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Culler SD, Jevsevar DS, Shea KG, McGuire KJ, Wright KK, Simon AW. The Incremental Hospital Cost and Length-of-Stay Associated With Treating Adverse Events Among Medicare Beneficiaries Undergoing THA During Fiscal Year 2013. J Arthroplasty 2016; 31:42-8. [PMID: 26318081 DOI: 10.1016/j.arth.2015.07.037] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/20/2015] [Accepted: 07/30/2015] [Indexed: 02/01/2023] Open
Abstract
This paper estimates the incremental hospital resource consumption associated with treating selected adverse events experienced by Medicare beneficiaries (MBs) undergoing total hip arthroplasty (THA). This retrospective study, using the Medicare Provider Analysis and Review file, identified 174,167 MBs who underwent THA in 2013. Overall, 20.16% of MB undergoing THA experienced at least one adverse event. MB experiencing any adverse event consumed significantly higher hospital cost ($3429) and had longer length of stays (1.0 day). The risk-adjusted incremental cost of treating adverse events ranged from a high of $27,116 (pneumonia) to a low of $2626 (hemorrhage or post-operative shock requiring transfusion). Most major adverse events occurred infrequently, however when adverse events occurred, they add substantially to the hospital resource costs of treating MB.
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Affiliation(s)
- Steven D Culler
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kevin G Shea
- St Luke's Health System, Boise, Idaho; Department of Orthopedics, University of Utah, Salt Lake, Utah
| | | | - Kimberly K Wright
- Clinical Data Solutions, Division of HealthTrust Purchasing Group, LLP, Nashville, Tennessee
| | - April W Simon
- Clinical Data Solutions, Division of HealthTrust Purchasing Group, LLP, Nashville, Tennessee
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Ryan M, Merrick EL, Hodgkin D, Horgan CM, Garnick DW, Panas L, Ritter G, Blow FC, Saitz R. Drinking patterns of older adults with chronic medical conditions. J Gen Intern Med 2013; 28:1326-32. [PMID: 23609178 PMCID: PMC3785666 DOI: 10.1007/s11606-013-2409-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 01/10/2013] [Accepted: 02/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population. OBJECTIVES To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions. DESIGN/METHODS This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims. The sample included community-dwelling, fee-for-service beneficiaries 65 years and older with one or more of seven chronic conditions (Alzheimer's disease and other senile dementia, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and stroke; n = 7,422). Based on self-reported alcohol consumption, individuals were categorized as nondrinkers, within-guidelines drinkers, or at-risk drinkers (exceeds guidelines). RESULTS Overall, 30.9 % (CI 28.0-34.1 %) of older adults with at least one of seven chronic conditions reported alcohol consumption in a typical month in the past year, and 6.9 % (CI 6.0-7.8 %) reported at-risk drinking. Older adults with higher chronic disease burdens were less likely to report alcohol consumption and at-risk drinking. CONCLUSIONS Nearly one-third of older adults with selected chronic illnesses report drinking alcohol and almost 7 % drink in excess of National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. It is important for physicians and patients to discuss alcohol consumption as a component of chronic illness management. In cases of at-risk drinking, providers have an opportunity to provide brief intervention or to offer referrals if needed.
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Affiliation(s)
- Marian Ryan
- Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA,
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12
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Qian J, Simoni-Wastila L, Langenberg P, Rattinger GB, Zuckerman IH, Lehmann S, Terrin M. Effects of depression diagnosis and antidepressant treatment on mortality in Medicare beneficiaries with chronic obstructive pulmonary disease. J Am Geriatr Soc 2013; 61:754-61. [PMID: 23617752 PMCID: PMC3656143 DOI: 10.1111/jgs.12220] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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: 11/28/2022]
Abstract
OBJECTIVES To estimate the effects of depression diagnosis and antidepressant treatment on 2-year all-cause mortality in Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) and determine whether Social Security Disability Insurance (SSDI) eligibility modifies these relationships. DESIGN Retrospective cohort study. SETTING A 5% random sample of Medicare beneficiaries aged 65 and older in stand-alone Part D plans in 2006 to 2008. PARTICIPANTS Beneficiaries diagnosed with COPD and continuously enrolled in Medicare Parts A, B, and D (N = 75,699). MEASUREMENTS Depression diagnosis was assessed at baseline (2006). Evidence of antidepressant treatment was measured across time. Covariates included baseline characteristics, comorbidities, and disease severity. Survival analyses using Cox proportional hazards models estimated 2-year mortality associated with depression diagnosis or antidepressant treatment (in beneficiaries with depression). Interaction terms of SSDI eligibility with baseline depression and time-dependent antidepressant treatment were tested. RESULTS More than one-fifth (21.6%) of beneficiaries with COPD had a depression diagnosis at baseline, and 82.1% of those received antidepressants. Nearly one-sixth (16.3%) of the sample were SSDI eligible. Baseline depression heightened risk of death (hazard ratio = 1.13, 95% confidence interval = 1.09-1.18) in beneficiaries who were not eligible for SSDI. In beneficiaries with depression, the association between antidepressant treatment and lower mortality was different according to SSDI eligibility status. CONCLUSION Social Security Disability Insurance eligibility modifies the effects of depression and antidepressant treatment on mortality in Medicare beneficiaries with COPD. These data suggest that clinicians should identify and treat depression in individuals with COPD, but further studies are needed to determine the effect of these interventions.
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Affiliation(s)
- Jingjing Qian
- Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama 36849, USA.
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Simoni-Wastila L, Ryder PT, Qian J, Zuckerman IH, Shaffer T, Zhao L. Association of antipsychotic use with hospital events and mortality among medicare beneficiaries residing in long-term care facilities. Am J Geriatr Psychiatry 2009; 17:417-27. [PMID: 19390299 DOI: 10.1097/JGP.0b013e31819b8936] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Antipsychotic (AP) utilization has grown significantly in long-term care (LTC) settings. Although a growing literature associates AP use with higher mortality in elderly with dementia, the association of APs with hospital events is unclear. The authors examine prevalence and trends in AP use by Medicare beneficiaries residing in LTC and the association of APs and other drug use variables with hospital events and mortality. DESIGN Retrospective analysis using sequential multivariate Cox proportional hazards models. SETTING Medicare Current Beneficiary Survey linked to Institutional Drug Administration and Minimum Data Set files. PARTICIPANTS A total of 2,363 LTC Medicare beneficiaries, 1999-2002. MEASUREMENTS Trends in LTC AP use overall and by type and duplicative use; association of AP utilization and two outcomes: hospital events and all-cause mortality. RESULTS AP use rose markedly from 1999 to 2002 (26.4%-35.9%), predominantly due to increased use of atypical agents. After controlling for sociodemographic and clinical factors, AP use is not related to hospital events (hazard ratio [HR] = 0.98, 95% confidence interval [CI] = 0.82-1.63 p = 0.7951). AP use is associated with reduced mortality in unadjusted and intermediate models, but loss of significance in the final model (HR = 0.83, 95% CI = 0.69-1.00, p = 0.0537) suggests that disease and drug burden factors may confound the AP-mortality relationship. CONCLUSION This study provides no evidence of increased hospital events or mortality in LTC residents who use AP medications. Findings contribute to a growing body of evidence that APs, particularly atypical agents, may be associated with reduced mortality in LTC residents.
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Merrick EL, Hodgkin D, Garnick DW, Horgan CM, Panas L, Ryan M, Saitz R, Blow FC. Unhealthy drinking patterns and receipt of preventive medical services by older adults. J Gen Intern Med 2008; 23:1741-8. [PMID: 18716847 PMCID: PMC2585680 DOI: 10.1007/s11606-008-0753-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [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: 12/11/2007] [Revised: 06/11/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preventive service use among older adults is suboptimal. Unhealthy drinking may constitute a risk factor for failure to receive these services. OBJECTIVES To determine the relationship between unhealthy drinking and receipt of recommended preventive services among elderly Medicare beneficiaries, applying the framework of current alcohol consumption guidelines. DESIGN/METHODS The data source is the nationally representative 2003 Medicare Current Beneficiary Survey. The sample included community-dwelling, fee-for-service Medicare beneficiaries 65 years and older (N = 10,523). Based on self-reported drinking, respondents were categorized as nondrinkers, within-guidelines drinkers, exceeding monthly but not daily limits, or heavy episodic drinkers. Using survey and claims data, influenza vaccination, pneumonia vaccination, glaucoma screening, and mammogram receipt were determined. Bivariate and logistic regression analyses were conducted. RESULTS Overall, 70.3% received flu vaccination and 49% received glaucoma screening during the year, 66.8% received pneumonia vaccination, and 56.2% of women received a mammogram over 2 years. In logistic regression, heavy episodic drinking was associated with lower likelihood of service receipt compared to drinking within guidelines: flu vaccination (OR 0.75, CI 0.59-0.96), glaucoma screening (OR 0.74, CI 0.58-0.95), and pneumonia vaccination (OR 0.75, CI 0.59-0.96). Nondrinkers when compared with those reporting drinking within guidelines were less likely to receive a mammogram (OR 0.83, CI 0.69-1.00). CONCLUSIONS Heavy episodic drinking is associated with lower likelihood of receiving several preventive services. Practitioners should be encouraged to screen all elders regarding alcohol intake and in addition to appropriate intervention, consider elders reporting heavy episodic drinking at higher risk for non-receipt of preventive services.
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Affiliation(s)
- Elizabeth L Merrick
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA
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