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Puckrein GA, Hirsch IB, Parkin CG, Taylor BT, Norman GJ, Xu L, Marrero DG. Assessment of Glucose Monitoring Adherence in Medicare Beneficiaries with Insulin-Treated Diabetes. Diabetes Technol Ther 2023; 25:31-38. [PMID: 36409474 DOI: 10.1089/dia.2022.0377] [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] [Indexed: 11/23/2022]
Abstract
Background: We investigated the potential associations between race/ethnicity and adherence to prescribed glucose monitoring in a sample of Medicare beneficiaries with diabetes and how adherence to the method used impacted diabetes-related inpatient hospitalizations and associated costs among beneficiaries with intensive insulin-treated diabetes. Methods: This 12-month retrospective analysis utilized Centers for Medicare & Medicaid Services data to identify Medicare beneficiaries who used intensive insulin therapy from January through December 2018 and classified them into four groups: (1) persons using real-time continuous glucose monitoring (rtCGM), (2) persons using any method of blood glucose monitoring (BGM) who followed prescribed use patterns (adherent), (3) persons who were prescribed BGM but were nonadherent in its use, and (4) no record of any form of BGM. Analyses compared these groups and the role that comorbidities (Charlson Comorbidity Index [CCI]), and race/ethnicity played on group assignment, diabetes-related inpatient hospitalizations, and costs. Results: Among the 1,329,061 persons assessed, 38.14% had no record of glucose monitoring and 35.42% were BGM nonadherent. Similarly, among the 629,514 beneficiaries with a CCI risk score of ≥2, 466,646 (74.13%) were either nonadherent to BGM or had no monitoring record. The percentage of White (3.65%) rtCGM adherent beneficiaries was significantly larger than Black (1.58%) and Hispanic (1.28%) beneficiaries, both P < 0.0001. Hospitalizations and costs were higher for Black and Hispanic beneficiaries versus Whites within the risk score ≥ 2 group regardless of glucose monitoring method. Conclusions: Race is associated with increased hospitalizations and costs associated with diabetes care and absence of any form of BGM was associated with higher rates of comorbidities. Persons of color were less likely to use rtCGM despite Medicare coverage. New initiatives that promote diabetes self-management education and support services are needed to improve utilization of glucose monitoring within the Medicare diabetes population.
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Affiliation(s)
- Gary A Puckrein
- National Minority Quality Forum, Washington, District of Columbia, USA
| | - Irl B Hirsch
- University of Washington, Seattle, Washington, USA
| | | | | | | | - Liou Xu
- National Minority Quality Forum, Washington, District of Columbia, USA
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2
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Affiliation(s)
- Janet Woodcock
- From the Office of the Commissioner (J.W.) and the Office of Minority Health and Health Equity (R.A., T.T.), Food and Drug Administration, Silver Spring, MD; and the National Minority Quality Forum, Washington, DC (G.A.P.)
| | - Richardae Araojo
- From the Office of the Commissioner (J.W.) and the Office of Minority Health and Health Equity (R.A., T.T.), Food and Drug Administration, Silver Spring, MD; and the National Minority Quality Forum, Washington, DC (G.A.P.)
| | - Twyla Thompson
- From the Office of the Commissioner (J.W.) and the Office of Minority Health and Health Equity (R.A., T.T.), Food and Drug Administration, Silver Spring, MD; and the National Minority Quality Forum, Washington, DC (G.A.P.)
| | - Gary A Puckrein
- From the Office of the Commissioner (J.W.) and the Office of Minority Health and Health Equity (R.A., T.T.), Food and Drug Administration, Silver Spring, MD; and the National Minority Quality Forum, Washington, DC (G.A.P.)
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3
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Shah NR, Bhor M, Latremouille-Viau D, Kumar Sharma V, Puckrein GA, Gagnon-Sanschagrin P, Khare A, Kumar Singh M, Serra E, Davidson M, Xu L, Guerin A. Vaso-occlusive crises and costs of sickle cell disease in patients with commercial, Medicaid, and Medicare insurance - the perspective of private and public payers. J Med Econ 2020; 23:1345-1355. [PMID: 32815766 DOI: 10.1080/13696998.2020.1813144] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM To characterize vaso-occlusive crises (VOCs) and describe healthcare costs among commercially-insured, Medicaid-insured, and Medicare-insured patients with sickle cell disease (SCD). MATERIALS AND METHODS The IBM Truven Health MarketScan Commercial (2000-2018), Medicaid Analytic eXtract (2008-2014), and Medicare Research Identifiable Files (2012-2016) databases were used to identify patients with ≥2 SCD diagnoses. Study measures were evaluated during a 12-month follow-up period, stratified by annual number of VOCs (i.e. 0, 1, and ≥2). RESULTS Among 16,092 commercially-insured patients (mean age = 36.7 years), 35.3% had 1+ VOCs. Mean annual total all-cause healthcare costs were $15,747, $27,194, and $64,555 for patients with 0, 1, and 2+ VOCs, respectively. Total all-cause healthcare costs were mainly driven by inpatient (0 VOC = 31.0%, 1 VOC = 53.1%, 2+ VOCs = 65.4%) and SCD-related costs (0 VOC = 56.4%, 1 VOC = 78.4%, 2+ VOCs = 93.9%). Among 18,287 Medicaid-insured patients (mean age = 28.5 years, fee-for-service = 50.2%), 63.9% had 1+ VOCs. Mean annual total all-cause healthcare costs were $16,750, $29,880, and $64,566 for patients with 0, 1, and 2+ VOCs, respectively. Inpatient costs (0 VOC = 37.2%, 1 VOC = 64.3%, 2+ VOCs = 72.9%) and SCD-related costs (0 VOC = 60.9%, 1 VOC = 73.8%, 2+ VOCs = 92.2%) accounted for a significant proportion of total all-cause healthcare costs. Among 15,431 Medicare-insured patients (mean age = 48.2 years), 55.1% had 1+ VOCs. Mean annual total all-cause healthcare costs were $21,877, $29,250, and $58,308 for patients with 0, 1, and ≥2 VOCs, respectively. Total all-cause healthcare costs were mainly driven by inpatient (0 VOC = 47.9%, 1 VOC = 54.9%, 2+ VOCs = 67.5%) and SCD-related costs (0 VOC = 74.9%, 1 VOC = 84.4%, 2+ VOCs = 95.3%). LIMITATIONS VOCs managed at home were not captured. Analyses were descriptive in an observational setting; thus, no causal relationships can be inferred. CONCLUSIONS A high proportion of patients experienced VOCs across payers. Furthermore, inpatient and SCD-related costs accounted for a significant proportion of total all-cause healthcare costs, which increased with VOC frequency.
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Affiliation(s)
- Nirmish R Shah
- Duke Adult Comprehensive Sickle Cell Center, Durham, NC, USA
| | - Menaka Bhor
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | | | - Ankur Khare
- Novartis Healthcare Pvt. Ltd, Hyderabad, India
| | | | | | | | - Liou Xu
- National Minority Quality Forum, Washington, DC, USA
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4
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Andukuri V, Xu L, Puckrein GA, Walters RW, Kim MH. Abstract 341: Population-level Insights Into 30-day Mortality in Medicare Beneficiaries After Inpatient and Outpatient Catheter Ablation for Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Recent inpatient data abstracted from the National Inpatient Sample and/or National Readmissions Database have shown higher than expected (0.46%) 30-day mortality rates of AF ablation prior to 2016. AF ablation has been increasingly coded as an outpatient procedure and primarily as of late 2015. Prior studies did not include some of these outpatient ablation cases. As such, more complete data on mortality and health-disparity outcomes for combined inpatient and outpatient-coded AF ablation is lacking. The purpose of our study was to assess updated 30-day mortality rates following inpatient or outpatient AF ablation following coding changes with ICD-10. Patients were also stratified by demographics and geographic region.
Method:
Data were abstracted from the 2017 inpatient and outpatient Medicare institutional claims files. AF was identified based on primary or secondary ICD-10 diagnosis codes. Inpatient procedures were identified by matching a CPT code for AF ablation that occurred on the same day as a primary or secondary ICD-10-PCS code for AF ablation. Outpatient AF ablation was identified using the CPT code. AV nodal ablation or a pacemaker procedure on the same day as AF ablation were excluded. AF ablation had to occur within the first 11 months of the calendar year to allow 30-day mortality data for all patients. We used the Medicare Master Beneficiary Summary File to further stratify beneficiaries by sex, race, and ethnicity, and geographic region. Mortality rates are shown as frequency and percent, compared using the chi-square test.
Results:
In 2017, a total of 40,373 AF ablations (58% men) were identified, of which 30,539 (75.6%) were coded as outpatient. The mean age in years was 71.5 (SD = 7.1), and median age was 71 (21 to 100). In total, 294 patients died within 30 days of procedure (0.73%, 95% CI: 0.65% to 0.82%). The 30-day mortality rate was higher following inpatient coded procedures compared to outpatient coded procedures (2.34% vs. 0.21%,
p
< .001). Further, higher 30-day mortality rates were observed for male patients compared to female patients (0.83% vs. 0.59%,
p
= .006) as well as in non-white patients compared to white patients (1.32% vs. 0.69%,
p
< .001). Finally, 30-day mortality rates differed by region (South: 0.85%, Midwest: 0.81%, Northeast: 0.56%, and West: 0.51%;
p
= .007).
Conclusion:
Overall 30-day mortality post-AF ablation appears high, particularly following inpatient coded AF ablation. Most notably, it is significantly higher than the recent estimate of 0.46% mortality risk following AF ablation from primarily inpatient data. The findings of higher mortality in males, in the non-white population, and in certain regions of the US are notable. Further studies are needed to understand the factors impacting mortality.
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Affiliation(s)
| | - Liou Xu
- National Minority Quality Forum, Washington DC, DC
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5
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Hall LL, Puckrein GA, Davidson JA. Comment on Riddle et al. Diabetes Care Editors' Expert Forum 2018: Managing Big Data for Diabetes Research and Care. Diabetes Care 2019;42:1136-1146. Diabetes Care 2019; 42:e183. [PMID: 31636150 DOI: 10.2337/dc19-1262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Jaime A Davidson
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX.,Diabetes Working Group and Equity Task Force, Sustainable Healthy Communities, Washington, DC
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Pawaskar MD, Xu L, Tang Y, Puckrein GA, Rajpathak SN, Stuart B. Effect of Medication Copayment on Adherence and Discontinuation in Medicare Beneficiaries with Type 2 Diabetes: A Retrospective Administrative Claims Database Analysis. Diabetes Ther 2018; 9:1979-1993. [PMID: 30143964 PMCID: PMC6167308 DOI: 10.1007/s13300-018-0489-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Nonadherence to antihyperglycemic agents (AHAs) increases the incidence of morbidity and mortality, as well as healthcare-related costs, in patients with type 2 diabetes (T2D). This study examined the association between medication copayment and adherence and discontinuation among elderly patients with T2D who use generic versus branded AHAs. METHODS A retrospective, observational cohort study used Medicare administrative claims data (index period: 1 June 2012 to 31 December 2013). Drug copayments were measured as the copayment of the index medication for a 30-day supply after patients met their plan deductible. Patients were stratified into a branded or generic cohort based on the index medication. Adherence was measured by the proportion of days covered (≥ 80%) and discontinuation by a treatment gap of > 60 days in 10 months during the follow-up period. Poisson regressions were conducted for medication adherence and discontinuation, while controlling for demographic, clinical, and comorbid conditions. RESULTS Overall, 160,250 patients on AHA monotherapy were included in the analysis; 131,594 (82%) were prescribed a generic and 28,656 (18%) a branded AHA with a mean copay of $6 and $41, respectively. Increases in copayment increased nonadherence and discontinuation for branded medications but not for generic AHA medications. In both cohorts, elderly patients (≥ 75 years of age) had a lower risk of nonadherence and discontinuation. Black patients had a higher risk of nonadherence or discontinuing medication. Patients having more frequent inpatient, emergency room, and/or physician visits were at higher risk of nonadherence or discontinuing therapy in the branded and generic cohorts (P < 0.001). CONCLUSION The impact of drug copayment on adherence and discontinuation varied considerably between branded and generic AHAs. Medicare patients taking branded AHAs had a higher risk of nonadherence with increasing copayment and were more likely to discontinue medication, whereas this association was not observed in patients taking generic medications. FUNDING Merck & Co, Inc., Kenilworth, NJ, USA. Plain language summary available for this article.
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Affiliation(s)
| | - Liou Xu
- National Minority Quality Forums, Washington, DC, USA
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7
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Puckrein GA, Hirsch IB, Parkin CG, Taylor BT, Xu L, Marrero DG. Impact of the 2013 National Rollout of CMS Competitive Bidding Program: The Disruption Continues. Diabetes Care 2018; 41:949-955. [PMID: 29150529 DOI: 10.2337/dc17-0960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/25/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Use of glucose monitoring is essential to the safety of individuals with insulin-treated diabetes. In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Medicare Competitive Bidding Program (CBP) in nine test markets. This resulted in a substantial disruption of beneficiary access to self-monitoring of blood glucose (SMBG) supplies and significant increases in the percentage of beneficiaries with either reduced or no acquisition of supplies. These reductions were significantly associated with increased mortality, hospitalizations, and costs. The CBP was implemented nationally in July 2013. We evaluated the impact of this rollout to determine if the adverse outcomes seen in 2011 persisted. RESEARCH DESIGN AND METHODS This longitudinal study followed 529,627 insulin-treated beneficiaries from 2009 through 2013 to assess changes in beneficiary acquisition of testing supplies in the initial nine test markets (TEST, n = 43,939) and beneficiaries not affected by the 2011 rollout (NONTEST, n = 485,688). All Medicare beneficiary records for analysis were obtained from CMS. RESULTS The percentages of beneficiaries with partial/no SMBG acquisition were significantly higher in both the TEST (37.4%) and NONTEST (37.6%) groups after the first 6 months of the national CBP rollout, showing increases of 48.1% and 60.0%, respectively (both P < 0.0001). The percentage of beneficiaries with no record for SMBG acquisition increased from 54.1% in January 2013 to 62.5% by December 2013. CONCLUSIONS Disruption of beneficiary access to their prescribed SMBG supplies has persisted and worsened. Diabetes testing supplies should be excluded from the CBP until transparent, science-based methodologies for safety monitoring are adopted and implemented.
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Affiliation(s)
| | | | | | | | - Liou Xu
- National Minority Quality Forum, Washington, DC
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8
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Puckrein GA, Nunlee-Bland G, Zangeneh F, Davidson JA, Vigersky RA, Xu L, Parkin CG, Marrero DG. Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis. Diabetes Care 2016; 39:563-71. [PMID: 26993148 DOI: 10.2337/dc15-1264] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 01/09/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In 2011, the Centers for Medicare & Medicaid Services (CMS) launched the Competitive Bidding Program (CBP) in nine markets for diabetes supplies. The intent was to lower costs to consumers. Medicare claims data (2009-2012) were used to confirm the CMS report (2012) that there were no disruptions in acquisition caused by CBP and no changes in health outcomes. RESEARCH DESIGN AND METHODS The study population consisted of insulin users: 43,939 beneficiaries in the nine test markets (TEST) and 485,688 beneficiaries in the nontest markets (NONTEST). TEST and NONTEST were subdivided: those with full self-monitoring of blood glucose (SMBG) supply acquisition (full SMBG) according to prescription and those with partial/no acquisition (partial/no SMBG). Propensity score-matched analysis was performed to reduce selection bias. Outcomes were impact of partial/no SMBG acquisition on mortality, inpatient admissions, and inpatient costs. RESULTS Survival was negatively associated with partial/no SMBG acquisition in both cohorts (P < 0.0001). Coterminous with CBP (2010-2011), there was a 23.0% (P < 0.0001) increase in partial/no SMBG acquisition in TEST vs. 1.7% (P = 0.0002) in NONTEST. Propensity score-matched analysis showed beneficiary migration from full to partial/no SMBG acquisition in 2011 (1,163 TEST vs. 605 NONTEST) was associated with more deaths within the TEST cohort (102 vs. 60), with higher inpatient hospital admissions and associated costs. CONCLUSIONS SMBG supply acquisition was disrupted in the TEST population, leading to increased migration to partial/no SMBG acquisition with associated increases in mortality, inpatient admissions, and costs. Based on our findings, more effective monitoring protocols are needed to protect beneficiary safety.
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Affiliation(s)
| | | | - Farhad Zangeneh
- George Washington University School of Medicine, Washington, DC
| | | | - Robert A Vigersky
- Walter Reed National Military Medical Center, Bethesda, MD Medtronic, Northridge, CA
| | - Liou Xu
- National Minority Quality Forum, Washington, DC
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9
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Sperling LS, Mechanick JI, Neeland IJ, Herrick CJ, Després JP, Ndumele CE, Vijayaraghavan K, Handelsman Y, Puckrein GA, Araneta MRG, Blum QK, Collins KK, Cook S, Dhurandhar NV, Dixon DL, Egan BM, Ferdinand DP, Herman LM, Hessen SE, Jacobson TA, Pate RR, Ratner RE, Brinton EA, Forker AD, Ritzenthaler LL, Grundy SM. The CardioMetabolic Health Alliance: Working Toward a New Care Model for the Metabolic Syndrome. J Am Coll Cardiol 2015; 66:1050-67. [PMID: 26314534 DOI: 10.1016/j.jacc.2015.06.1328] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [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: 04/28/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 12/17/2022]
Abstract
The Cardiometabolic Think Tank was convened on June 20, 2014, in Washington, DC, as a "call to action" activity focused on defining new patient care models and approaches to address contemporary issues of cardiometabolic risk and disease. Individual experts representing >20 professional organizations participated in this roundtable discussion. The Think Tank consensus was that the metabolic syndrome (MetS) is a complex pathophysiological state comprised of a cluster of clinically measured and typically unmeasured risk factors, is progressive in its course, and is associated with serious and extensive comorbidity, but tends to be clinically under-recognized. The ideal patient care model for MetS must accurately identify those at risk before MetS develops and must recognize subtypes and stages of MetS to more effectively direct prevention and therapies. This new MetS care model introduces both affirmed and emerging concepts that will require consensus development, validation, and optimization in the future.
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Affiliation(s)
- Laurence S Sperling
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Jeffrey I Mechanick
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ian J Neeland
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cynthia J Herrick
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | | | - Chiadi E Ndumele
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Maria Rosario G Araneta
- Department of Family and Preventive Medicine, University of California-San Diego, San Diego, California
| | - Quie K Blum
- Inova Heart and Vascular Institute, Fairfax, Virginia
| | | | - Stephen Cook
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Chicago, Illinois, and Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York
| | | | - Dave L Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Brent M Egan
- Department of Medicine, University of South Carolina School of Medicine, Greenville, South Carolina
| | - Daphne P Ferdinand
- Healthy Heart Community Prevention Project, Inc., New Orleans, Louisiana
| | - Lawrence M Herman
- Department of Physician Assistant Studies, New York Institute of Technology, Old Westbury, New York
| | - Scott E Hessen
- Cardiology Consultants of Philadelphia and Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Terry A Jacobson
- Office of Health Promotion and Disease Prevention, Emory University School of Medicine, Atlanta, Georgia
| | - Russell R Pate
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | | | - Eliot A Brinton
- Utah Foundation for Biomedical Research and Utah Lipid Center, Salt Lake City, Utah
| | - Alan D Forker
- Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | - Scott M Grundy
- Department of Clinical Nutrition, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
Cardiometabolic diseases, including diabetes and heart disease, account for >12 million years of life lost annually among Black adults in the United States. Health disparities are geographically localized, with ~80% of health disparities occurring within ~6000 (16%) of all 38,000 US ZIP codes. Socio-economic status (SES), behavioral and environmental factors (social determinants) account for ~80% of variance in health outcomes and cluster geographically. Neighborhood SES is inversely associated with prevalent diabetes and hypertension, and Blacks are four times more likely than Whites to live in lowest SES neighborhoods. In ZIP code 48235 (Detroit, 97% Black, 16.2% unemployed, income/capita $18,343, 23.6% poverty), 1082 Medicare fee-for service (FFS) beneficiaries received care for type 2 diabetes (T2D) and coronary artery disease (CAD) in 2012. Collectively, these beneficiaries had 1082 inpatient admissions and 839 emergency department visits, mean cost $27,759/beneficiary and mortality 2.7%. Nationally in 2011, 236,222 Black Medicare FFS beneficiaries had 213,715 inpatient admissions, 191,346 emergency department visits, mean cost $25,580/beneficiary and 2.4% mortality. In addition to more prevalent hypertension and T2D, Blacks appear more susceptible to clinical complications of risk factors than Whites, including hypertension as a contributor to stroke. Cardiometabolic health equity in African Americans requires interventions on social determinants to reduce excess risk prevalence of risk factors. Social-medical interventions to promote timely access to, delivery of and adherence with evidence-based medicine are needed to counterbalance greater disease susceptibility. Place-based interventions on social and medical determinants of health could reduce the burden of life lost to cardiometabolic diseases in Blacks.
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Affiliation(s)
| | - Brent M Egan
- 2. Care Coordination Institute, Greenville Health System, University of South Carolina School of Medicine, Greenville, South Carolina
| | - George Howard
- 3. University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama
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11
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Kountz DS, Shaya FT, Gradman AH, Puckrein GA, Kim MH, Wilbanks J, Stevenson JG, Larsen DL, Wysong M, Chirikov V, Pan WT, Xu L. A Call for Appropriate Evidence and Outcomes-Based Use and Measurement of Anticoagulation for Atrial Fibrillation: Moving the Population Towards Improved Health Via Multiple Stakeholders. J Manag Care Spec Pharm 2015; 21:1034-8. [PMID: 26521115 PMCID: PMC10397949 DOI: 10.18553/jmcp.2015.21.11.1034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A multidimensional approach involving consideration of available resources, individual patient characteristics, patient preferences, and cost of treatment is often required to optimize clinical decision making in the management of atrial fibrillation (AF). In order to bring together varying perspectives on effective tactics and to formulate innovative strategies to improve the management of AF, a think tank consortium of advisors was assembled from across the spectrum of health care stakeholders. Focus groups were conducted and facilitated by a moderator and a notetaker. Participants were asked to comment on preliminary data for the increased prevalence of AF, patterns of treatment, impact of adherence with anticoagulants on clinical and economic outcomes, and opportunities for optimizing treatment.Several recommendations to reach short- and long-term goals in improving AF management emerged from the focus group discussions. These recommendations specifically targeted 3 stakeholder groups--patients/caregivers, physicians, and payers--and addressed the need for better understanding of determinants of undertreatment and nonadherence for those on anticoagulation therapy. Recommendations included the use of real-world data studies to understand regional and demographic patterns of treatment and outcomes, the development of an enhanced national quality standard for anticoagulation, and engaging patients in shared decision making to optimize satisfaction with treatment. Actionable strategies were presented to address gaps related to anticoagulation management. Balancing new anticoagulants' higher prescription costs and safety concerns with their superior effectiveness and convenience of administration for at-risk individuals would require a concerted effort involving patients and their caregivers, physicians, and payers.
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Affiliation(s)
- David S Kountz
- University of Maryland School of Pharmacy, 220 Arch St., 12th Fl., Rm. 01-204, Baltimore, MD 21201.
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13
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Ferdinand KC, Rodriguez F, Nasser SA, Caballero AE, Puckrein GA, Zangeneh F, Mansour M, Foody JM, Pemu PE, Ofili EO. Cardiorenal metabolic syndrome and cardiometabolic risks in minority populations. Cardiorenal Med 2013; 4:1-11. [PMID: 24847329 DOI: 10.1159/000357236] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/11/2013] [Indexed: 01/22/2023] Open
Abstract
Cardiovascular disease (CVD), including heart disease and stroke, is the leading cause of death in the USA, regardless of self-determined race/ethnicity, and largely driven by cardiometabolic risk (CMR) and cardiorenal metabolic syndrome (CRS). The primary drivers of increased CMR include obesity, hypertension, insulin resistance, hyperglycemia, dyslipidemia, chronic kidney disease as well as associated adverse behaviors of physical inactivity, smoking, and unhealthy eating habits. Given the importance of CRS for public health, multiple stakeholders, including the National Minority Quality Forum (the Forum), the American Association of Clinical Endocrinologists (AACE), the American College of Cardiology (ACC), and the Association of Black Cardiologists (ABC), have developed this review to inform clinicians and other health professionals of the unique aspects of CMR in racial/ethnic minorities and of potential means to improve CMR factor control, to reduce CRS and CVD in diverse populations, and to provide more effective, coordinated care. This paper highlights CRS and CMR as sources of significant morbidity and mortality (particularly in racial/ethnic minorities), associated health-care costs, and an evolving index tool for cardiometabolic disease to determine geographical and environmental factors. Finally, this work provides a few examples of interventions potentially successful at reducing disparities in cardiometabolic health.
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Affiliation(s)
| | - Fatima Rodriguez
- Brigham and Women's Hospital, Joslin Diabetes Center, Harvard Medical School, Boston, Mass., USA
| | - Samar A Nasser
- Department of Clinical Research and Leadership, George Washington University, Washington, D.C., USA
| | - A Enrique Caballero
- Latino Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, Mass., USA
| | - Gary A Puckrein
- Department of National Minority Quality Forum, Washington, D.C., USA
| | - Farhad Zangeneh
- Department of Medicine, School of Medicine and Health Services, George Washington University, Washington, D.C., USA
| | - Michael Mansour
- Department of Medicine, University of Mississippi Medical Center, Jackson, Miss., USA ; Delta Regional Medical Center, Greenville, Miss., USA
| | - JoAnne Micale Foody
- Department of Clinical Research and Leadership, George Washington University, Washington, D.C., USA
| | - Priscilla E Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, Ga., USA
| | - Elizabeth O Ofili
- Department of Medicine, Morehouse School of Medicine, Atlanta, Ga., USA
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Caballero AE, Davidson J, Elmi A, Gavin J, Lee K, Nunlee-Bland GL, Zangeneh F, Puckrein GA. Previously unrecognized trends in diabetes consumption clusters in medicare. Am J Manag Care 2013; 19:541-548. [PMID: 23919418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the annual cost profiles of Medicare beneficiaries with diabetes to identify patterns in their consumption of benefits. METHODS Retrospective expenditure data were collected from Medicare records. Beneficiaries with diabetes were grouped into 5 consumption clusters ranging from "crisis consumers" at the high end to "low consumers" at the low end. RESULTS The percentages of beneficiaries and expenditures for the consumption clusters remained generally constant from year to year. As expected, most of Medicare's budget each year was spent on crisis, heavy, and moderate consumers. However, a notable proportion of low and light consumers from one year go on to become crisis and heavy consumers in subsequent years. A review of total 2001 through 2006 inpatient costs for the year 2000 clusters revealed that 47% of these costs were for year 2000 low and light consumers and only 27% were for year 2000 crisis and heavy consumers. CONCLUSIONS This analysis revealed previously unrecognized trends, whereby a notable proportion of low and light consumers during one year went on to become crisis and heavy consumers in subsequent years, representing a large proportion of inpatient costs. These findings have important implications for disease management programs, which typically focus intervention efforts exclusively on crisis and heavy consumers.
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Ferdinand KC, Orenstein D, Hong Y, Journigan JG, Trogdon J, Bowman J, Zohrabian A, Kilgore M, White A, Mokdad A, Pechacek TF, Goetzel RZ, Labarthe DR, Puckrein GA, Finkelstein E, Wang G, French ME, Vaccarino V. Health economics of cardiovascular disease: Defining the research agenda. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.cvdpc.2011.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Coberley CR, Puckrein GA, Dobbs AC, McGinnis MA, Coberley SS, Shurney DW. Effectiveness of Disease Management Programs on Improving Diabetes Care for Individuals in Health-Disparate Areas. ACTA ACUST UNITED AC 2007; 10:147-55. [PMID: 17590145 DOI: 10.1089/dis.2007.641] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In addition to race and ethnicity, specific geographic regions are associated with poorer outcomes of care. Individuals with diabetes experiencing health disparities typically have worse long-term outcomes, such as increased diabetes complications and mortality. Zip code mapping, or geocoding, was utilized in this study to identify regions of the United States with high diabetes prevalence rates and to identify areas with high densities of minority populations. Use of this methodology to examine the effect of disease management on a large, diverse diabetes population revealed greater improvement in clinical testing rates in health disparity zones compared with members living outside of these areas. In particular, significant improvement was achieved by members living in minority zip codes and by members aged 65 years or older. These findings demonstrate that members living in areas of health disparity obtain even greater benefit from diabetes disease management program participation, helping to reduce gaps in care.
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Puckrein GA. Humoralism and social development in Colonial America. JAMA 1981; 245:1755-7. [PMID: 7012391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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