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Lee W, Lloyd JT, Giuriceo K, Day T, Shrank W, Rajkumar R. Systematic review and meta-analysis of patient race/ethnicity, socioeconomics, and quality for adult type 2 diabetes. Health Serv Res 2020; 55:741-772. [PMID: 32720345 DOI: 10.1111/1475-6773.13326] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 01/08/2023] Open
Abstract
OBJECTIVE To review the evidence of the association between performance in eight indicators of diabetes care and a patient's race/ethnicity and socioeconomic characteristics. DATA SOURCE Studies of adult patients with type 2 diabetes in MEDLINE published between January 1, 2000, and December 31, 2018. STUDY DESIGN Systematic review and meta-analysis of regression-based studies including race/ethnicity and income or education as explanatory variables. Meta-analysis was used to quantify differences in performance associated with patient race/ethnicity or socioeconomic characteristics. The systematic review was used to identify potential mechanisms of disparities. DATA COLLECTION Two coauthors separately conducted abstract screening, study exclusions, data extraction, and scoring of retained studies. Estimates in retained studies were extracted and, where applicable, were standardized and converted to odds ratios and standard errors. PRINCIPAL FINDINGS Performance in intermediate outcomes and process measures frequently exhibited differences by race/ethnicity even after adjustment for socioeconomic, lifestyle, and health factors. Meta-analyses showed black patients had lower odds of HbA1c and blood pressure (BP) control (OR range: 0.67-0.68, P < .05) but higher odds of receiving eye or foot examination (OR range: 1.22-1.47, P < .05) relative to white patients. A high school degree or more was associated with higher odds of HbA1c control and receipt of eye examinations compared to patients without a degree. Meta-analyses of income included a handful of studies and were inconsistently associated with diabetes care performance. Differences in diabetes performance appear to be related to access-related factors such as uninsurance or lacking a usual source of care; food insecurity and trade-offs at very low incomes; and lower adherence among younger and healthier diabetes patients. CONCLUSIONS Patient race/ethnicity and education were associated with differences in diabetes quality measures. Depending on the approach used to rate providers, not adjusting for these patient characteristics may penalize or reward providers based on the populations they serve.
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Affiliation(s)
- Woolton Lee
- Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | | | | | - Timothy Day
- Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | | | - Rahul Rajkumar
- Blue Cross Blue Shield of North Carolina, Durham, North Carolina
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Abstract
Objectives: The objective of this qualitative study was to better understand facilitators and barriers to depression screening for older adults.Methods: We conducted 43 focus groups with 102 providers and 247 beneficiaries or proxies: 13 focus groups with Medicare providers, 28 with older Medicare beneficiaries, and 2 with caregivers of older Medicare beneficiaries. Each focus group was recorded, transcribed, and analyzed using principles of grounded theory.Results: There was widespread consensus among beneficiary and provider focus group participants that depression screening was important. However, several barriers interfered with effective depression screening, including stigma, lack of resources for treatment referrals, and lack of time during medical encounters. Positive communication with providers and an established relationship with a trusted provider were primary facilitators for depression screening. Providers who took the time to put their beneficiaries at ease and used conversational language rather than clinical terms appeared to have the most success in eliciting beneficiary honesty about depressive symptoms. Respondents stressed the need for providers to be attentive, concerned, non-judgmental, and respectful.Conclusion: Findings indicate that using person-centered approaches to build positive communication and trust between beneficiaries and providers could be an effective strategy for improving depression screening. Better screening can lead to higher rates of diagnosis and treatment of depression that could enhance quality of life for older adults.
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Affiliation(s)
- Erin M Colligan
- Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
| | | | - Jennifer T Lloyd
- Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
| | - Jessica McNeely
- Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
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Lloyd JT, Waldstein SR, Hochberg MC, Orwig DL, Alley DE. Overweight and Obese Have Similar Burden of Hip Fracture as Normal Weight Older Adults. J Gen Intern Med 2019; 34:2333-2335. [PMID: 31325126 PMCID: PMC6848362 DOI: 10.1007/s11606-019-05151-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jennifer T Lloyd
- Center for Medicare & Medicaid Innovation, Baltimore, MD, USA.
- Centers for Medicare & Medicaid Services, 7500 Security Blvd., Mail Stop WB-06-05, Baltimore, MD, 21244, USA.
| | - Shari R Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
- Doctoral Program in Gerontology, University of Maryland, Baltimore and Baltimore County, Baltimore, MD, USA
| | - Marc C Hochberg
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Denise L Orwig
- Doctoral Program in Gerontology, University of Maryland, Baltimore and Baltimore County, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Dawn E Alley
- Center for Medicare & Medicaid Innovation, Baltimore, MD, USA
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Kissam SM, Beil H, Cousart C, Greenwald LM, Lloyd JT. States Encouraging Value-Based Payment: Lessons From CMS's State Innovation Models Initiative. Milbank Q 2019; 97:506-542. [PMID: 30957292 DOI: 10.1111/1468-0009.12380] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 11/29/2022] Open
Abstract
Policy Points Six states received $250 million under the federal State Innovation Models (SIM) Initiative Round 1 to increase the proportion of care delivered under value-based payment (VBP) models aligned across multiple payers. Multipayer alignment around a common VBP model occurred within the context of state regulatory and purchasing policies and in states with few commercial payers, not through engaging many stakeholders to act voluntarily. States that made targeted infrastructure investments in performance data and electronic hospital event notifications, and offered grants and technical assistance to providers, produced delivery system changes to enhance care coordination even where VBP models were not multipayer. CONTEXT In 2013, six states (Arkansas, Massachusetts, Maine, Minnesota, Oregon, and Vermont) received $250 million in Round 1 State Innovation Models (SIM) awards to test how regulatory, policy, purchasing, and other levers available to state governments could transform their health care system by implementing value-based payment (VBP) models that shift away from fee-for-service toward payment based on quality and cost. METHODS We gathered and analyzed qualitative data on states' implementation of their SIM Initiatives between 2014 and 2018, including interviews with state officials and other stakeholders; consumer and provider focus groups; and review of relevant state-produced documents. FINDINGS State policymakers leveraged existing state law, new policy development, and federal SIM Initiative funds to implement new VBP models in Medicaid. States' investments promoted electronic health information going from hospitals to primary care providers and collaboration across care team members within practices to enhance care coordination. Multipayer alignment occurred where there were few commercial insurers in a state, or where a state law or state contracting compelled commercial insurer participation. Challenges to health system change included commercial payer reluctance to coordinate on VBP models, cost and policy barriers to establishing bidirectional data exchange among all providers, preexisting quality measurement requirements across payers that impede total alignment of measures, providers' perception of their limited ability to influence patients' behavior that puts them at financial risk, and consumer concerns with changes in care delivery. CONCLUSIONS The SIM Initiative's test of the power of state governments to shape health care policy demonstrated that strong state regulatory and purchasing policy levers make a difference in multipayer alignment around VBP models. In contrast, targeted financial investments in health information technology, data analytics, technical assistance, and workforce development are more effective than policy alone in encouraging care delivery change beyond that which VBP model participation might manifest.
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Rutledge RI, Romaire MA, Hersey CL, Parish WJ, Kissam SM, Lloyd JT. Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts. Milbank Q 2019; 97:583-619. [PMID: 30957294 DOI: 10.1111/1468-0009.12386] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 03/19/2019] [Indexed: 11/30/2022] Open
Abstract
Policy Points Maine, Massachusetts, Minnesota, and Vermont leveraged State Innovation Model awards to implement Medicaid accountable care organizations (ACOs). Flexibility in model design, ability to build on existing reforms, provision of technical assistance to providers, and access to feedback data all facilitated ACO development. Challenges included sustainability of transformation efforts and the integration of health care and social service providers. Early estimates showed promising improvements in hospital-related utilization and Vermont was able to reduce or slow the growth of Medicaid costs. These states are sustaining Medicaid ACOs owing in part to provider support and early successes in generating shared savings. The states are modifying their ACOs to include greater accountability and financial risk. CONTEXT As state Medicaid programs consider alternative payment models (APMs), many are choosing accountable care organizations (ACOs) as a way to improve health outcomes, coordinate care, and reduce expenditures. Four states (Maine, Massachusetts, Minnesota, and Vermont) leveraged State Innovation Model awards to create or expand Medicaid ACOs. METHODS We used a mixed-methods design to assess achievements and challenges with ACO implementation and the impact of Medicaid ACOs on health care utilization, quality, and expenditures in three states. We integrated findings from key informant interviews, focus groups, document review, and difference-in-difference analyses using data from Medicaid claims and an all-payer claims database. FINDINGS States built their Medicaid ACOs on existing health care reforms and infrastructure. Facilitators of implementation included allowing flexibility in design and implementation, targeting technical assistance, and making clinical, cost, and use data readily available to providers. Barriers included provider concerns about their ability to influence patient behavior, sustainability of provider practice transformation efforts when shared savings are reinvested into the health system and not shared with participating clinicians, and limited integration between health care and social service providers. Medicaid ACOs were associated with some improvements in use, quality, and expenditures, including statistically significant reductions in emergency department visits. Only Vermont's ACO demonstrated slower growth in total Medicaid expenditures. CONCLUSIONS Four states demonstrated that adoption of ACOs for Medicaid beneficiaries was both possible and, for three states, associated with some improvements in care. States revised these models over time to address stakeholder concerns, increase provider participation, and enable some providers to accept financial risk for Medicaid patients. Lessons learned from these early efforts can inform the design and implementation of APMs in other Medicaid programs.
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Trombley MJ, Hassol A, Lloyd JT, Buchman TG, Marier AF, White A, Colligan E. The Impact of Enhanced Critical Care Training and 24/7 (Tele-ICU) Support on Medicare Spending and Postdischarge Utilization Patterns. Health Serv Res 2018; 53:2099-2117. [PMID: 29282724 PMCID: PMC6051971 DOI: 10.1111/1475-6773.12821] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] Open
Abstract
OBJECTIVE To estimate the effect of implementing a tele-ICU and a critical care residency training program for advanced practice providers on service utilization and total Medicare episode spending. DATA SOURCES/STUDY SETTINGS Medicare claims data for fee-for-service beneficiaries at 12 large, inpatient hospitals in the Atlanta Hospital Referral Region. STUDY DESIGN Difference-in-differences design where changes in spending and utilization for Medicare beneficiaries eligible for treatment in participating ICUs was compared to changes in a comparison group of clinically similar beneficiaries treated at similar hospitals' ICUs in the same hospital referral region. EXTRACTION METHODS Using Medicare claims data from January 2010 through June 2015, we defined measures of Medicare episode spending during the ICU stay and subsequent 60 days after discharge, and utilization measures within 30 and 60 days after discharge. PRINCIPAL FINDINGS Implementation of the advanced practice provider residency program and tele-ICU was associated with a significant reduction in average Medicare spending per episode, primarily driven by reduced readmissions within 60 days and substitution of home health care for institutional postacute care. CONCLUSIONS Innovations in workforce training and technology specific to the ICU may be useful in addressing the shortage of intensivist physicians, yielding benefits to patients and payers.
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Affiliation(s)
| | | | | | | | | | | | - Erin Colligan
- Center for Medicare and Medicaid InnovationBaltimoreMD
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Abstract
A computational method is presented for representing twins via two-dimensional dislocation statics in an isotropic elastic solid. The method is compared with analytical approximations of twin shape and is used to study how twins evolve within grains subjected to an arbitrary external shear stress. Twin transfer across grains is then studied using the same computational method. The dislocation-based model for twin growth gives the following dependencies: twin thickness increases linearly with grain size and external stress, and increases substantially as the grain is able to traverse multiple grain boundaries with low misorientation angles; the model also predicts that twin transfer becomes less prominent across grain boundaries with high misorientation angles. These predictions are consistent with experimentally measured extension twin growth in magnesium polycrystals. This study suggests that representing twins via discrete dislocations provides a physically reasonable approximation of twinning that can be naturally incorporated into existing dislocation statics and dynamics codes.
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Affiliation(s)
- J T Lloyd
- US Army Research Laboratory, Aberdeen Proving Ground, MD 21005-5066, USA
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Misra A, Lloyd JT, Strawbridge LM, Wensky SG. Use of Welcome to Medicare Visits Among Older Adults Following the Affordable Care Act. Am J Prev Med 2018; 54:37-43. [PMID: 29132952 DOI: 10.1016/j.amepre.2017.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/16/2017] [Accepted: 08/28/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION To encourage greater utilization of preventive services among Medicare beneficiaries, the 2010 Affordable Care Act waived coinsurance for the Welcome to Medicare visit, making this benefit free starting in 2011. The objective of this study was to determine the impact of the Affordable Care Act on Welcome to Medicare visit utilization. METHODS A 5% sample of newly enrolled fee-for-service Medicare beneficiaries for 2005-2016 was used to estimate changes in Welcome to Medicare visit use over time. An interrupted time series model examined whether Welcome to Medicare visits increased significantly after 2011, controlling for pre-intervention trends and other autocorrelation. RESULTS Annual Welcome to Medicare visit rates began at 1.4% in 2005 and increased to 12.3% by 2016. The quarterly Welcome to Medicare visit rate, which was almost 1% at baseline, was increasing by 0.06% before the 2011 Affordable Care Act provision (p<0.001). Immediately following the 2011 Affordable Care Act provision, the rate increased by about 1% in the first quarter of 2011 (intercept, p<0.001), followed by an increase of 0.13% every subsequent quarter (slope, p<0.001). This general trend was observed in subgroup analyses, although this trend varied by subgroups where the pre-Affordable Care Act trends of lower utilization persisted over time for non-whites and improved less quickly for men, regions other than Northeast, and beneficiaries without any supplemental insurance. CONCLUSIONS The Affordable Care Act, and perhaps the removal of cost sharing, was associated with increased use of the Welcome to Medicare visit; however, even with the increased use, there is room for improvement.
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Affiliation(s)
- Arpit Misra
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland.
| | - Jennifer T Lloyd
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Larisa M Strawbridge
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Suzanne G Wensky
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, Maryland
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Lloyd JT, Alley DE, Hochberg MC, Waldstein SR, Harris TB, Kritchevsky SB, Schwartz AV, Strotmeyer ES, Womack C, Orwig DL. Changes in bone mineral density over time by body mass index in the health ABC study. Osteoporos Int 2016; 27:2109-16. [PMID: 26856584 PMCID: PMC5892439 DOI: 10.1007/s00198-016-3506-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 07/06/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Obesity appears protective against osteoporosis in cross-sectional studies. However, results from this longitudinal study found that obesity was associated with bone loss over time. Findings underscore the importance of looking at the longitudinal relationship, particularly given the increasing prevalence and duration of obesity among older adults. INTRODUCTION Cross-sectional studies have found a positive association between body mass index (BMI) and bone mineral density (BMD), but little is known about the longitudinal relationship in US older adults. METHODS We examined average annual rate of change in BMD by baseline BMI in the Health, Aging, and Body Composition Study. Repeated measurement of BMD was performed with dual-energy X-ray absorptiometry (DXA) at baseline and years 3, 5, 6, 8, and 10. Multivariate generalized estimating equations were used to predict mean BMD (femoral neck, total hip, and whole body) by baseline BMI (excluding underweight), adjusting for covariates. RESULTS In the sample (n = 2570), 43 % were overweight and 24 % were obese with a mean baseline femoral neck BMD of 0.743 g/cm(2), hip BMD of 0.888 g/cm(2), and whole-body BMD of 1.09 g/cm(2). Change in total hip or whole-body BMD over time did not vary by BMI groups. However, obese older adults lost 0.003 g/cm(2) of femoral neck BMD per year more compared with normal weight older adults (p < 0.001). Femoral neck BMD change over time did not differ between the overweight and normal weight BMI groups (p = 0.74). In year 10, adjusted femoral neck BMD ranged from 0.696 g/cm(2) among obese, 0.709 g/cm(2) among normal weight, and 0.719 g/cm(2) among overweight older adults. CONCLUSIONS Findings underscore the importance of looking at the longitudinal relationship between body composition and bone mineral density among older adults, indicating that high body mass may not be protective for bone loss over time.
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Affiliation(s)
- J T Lloyd
- Centers for Medicare and Medicaid Services, 7500 Security Blvd, WB-06-05, Baltimore, MD, 21244, USA.
| | - D E Alley
- Centers for Medicare and Medicaid Services, 7500 Security Blvd, WB-06-05, Baltimore, MD, 21244, USA
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - M C Hochberg
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - S R Waldstein
- Doctoral Program in Gerontology, University of Maryland, Baltimore and Baltimore County, Baltimore, MD, USA
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - T B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - S B Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - A V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - E S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA
| | - C Womack
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - D L Orwig
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
- Doctoral Program in Gerontology, University of Maryland, Baltimore and Baltimore County, Baltimore, MD, USA
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Abstract
Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population ( N = 110,064). Medicare administrative and claims files were used to determine DSMT utilization. Multivariate logistic regression analyses evaluated the association of demographic, health status, and provider availability factors with DSMT utilization. Approximately 5% of Medicare beneficiaries with newly diagnosed diabetes used DSMT services. The adjusted odds of any utilization were lower among men compared with women, older individuals compared with younger, non-Whites compared with Whites, people dually eligible for Medicare and Medicaid compared with nondual eligibles, and patients with comorbidities compared with individuals without those conditions. Additionally, the adjusted odds of utilizing DSMT increased as the availability of providers who offered DSMT services increased and varied by Census region. Utilization of DSMT among Medicare beneficiaries with newly diagnosed diabetes is low. There appear to be marked disparities in access to DSMT by demographic and health status factors and availability of DSMT providers. In light of the increasing prevalence of diabetes, future research should identify barriers to DSMT access, describe DSMT providers, and explore the impact of DSMT services. With preventive services being increasingly covered by insurers, the low utilization of DSMT, a preventive service benefit that has existed for almost 15 years, highlights the challenges that may be encountered to achieve widespread dissemination and uptake of the new services.
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Affiliation(s)
| | | | - Ann Meadow
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Gerald F. Riley
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
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Abstract
Population-level data on obesity are difficult to obtain. Claims-based data sets are useful for studying public health at a population level but lack physical measurements. The objective of this study was to determine the validity of a claims-based measure of obesity compared to obesity diagnosed with clinical data as well as the validity among older adults who suffer from chronic disease. This study used data from the National Health and Nutrition Examination Survey 1999-2004 for adults aged ≥ 65 successfully linked to 1999-2007 Medicare claims (N = 3,554). Sensitivity, specificity, positive and negative predictive values, κ statistics as well as logistic regression analyses were computed for the claims-based diagnosis of obesity versus obesity diagnosed with body mass index. The claims-based diagnosis of obesity underestimates the true prevalence in the older Medicare population with a low sensitivity (18.4%). However, this method has a high specificity (97.3%) and is accurate when it is present. Sensitivity was improved when comparing the claim-based diagnosis to Class II obesity (34.2%) and when used in combination with chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, or depression. Understanding the validity of a claims-based obesity diagnosis could aid researchers in understanding the feasibility of conducting research on obesity using claims data.
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Affiliation(s)
- Jennifer T Lloyd
- Research and Rapid-Cycle Evaluation Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Steve A Blackwell
- Research and Rapid-Cycle Evaluation Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Iris I Wei
- Research and Rapid-Cycle Evaluation Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Benjamin L Howell
- Research and Rapid-Cycle Evaluation Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
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Lloyd JT, Alley DE, Hawkes WG, Hochberg MC, Waldstein SR, Orwig DL. Body mass index is positively associated with bone mineral density in US older adults. Arch Osteoporos 2014; 9:175. [PMID: 24664472 DOI: 10.1007/s11657-014-0175-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [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: 06/26/2013] [Accepted: 08/19/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED Literature has been conflicting as to whether obesity is protective against osteoporosis. Understanding the relationship is particularly important in light of the increasing prevalence of obesity among older adults. Study results confirm a protective association between obesity and osteoporosis in a recent, nationally representative sample of US older adults. PURPOSE Currently, the majority of US older adults are either overweight or obese. Evidence regarding the relationship between body composition measures and bone mass is conflicting, possibly because different measures of obesity reflect multiple mechanisms. Additionally, there are important age, gender, and racial differences in a risk of osteoporosis and fat mass composition. The objective of this study was to examine the association between body mass index (BMI) and bone mineral density (BMD) in a recent, nationally representative sample of US older adults as well as to see if this relationship differs by age, sex, and race. METHODS Data for this study were obtained from the National Health and Nutrition Examination Survey (2005-2008) for adults ages 50 and older (n = 3,296). Linear regression models were used to predict BMD of the femoral neck (measured by dual-energy X-ray absorptiometry (DXA)) as a function of BMI (measured height and weight) and a range of study covariates. RESULTS Every unit increase in BMI was associated with an increase of 0.0082 g/cm(2) in BMD (p < 0.001). Interaction terms for BMI and age (p = 0.345), BMI and sex (p = 0.413), and BMI and race (p = 0.725) were not statistically significant. CONCLUSIONS Study results confirm the positive association between BMI and BMD, and this relationship does not differ by age, sex, or race. A 10-unit increase in BMI (e.g., from normal BMI to obese) would result in moving an individual from an osteoporotic BMD level to a normal BMD level. Results demonstrate a protective, cross-sectional association between obesity and osteoporosis in a recent sample of US older adults.
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Affiliation(s)
- Jennifer T Lloyd
- Doctoral Program in Gerontology, University of Maryland, Baltimore and Baltimore County, USA,
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Wei II, Lloyd JT, Shrank WH. The Relationship Between the Low-Income Subsidy and Cost-Related Nonadherence to Drug Therapies in Medicare Part D. J Am Geriatr Soc 2013; 61:1315-23. [DOI: 10.1111/jgs.12364] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Iris I. Wei
- Research and Rapid-Cycle Evaluation Group; Centers for Medicare and Medicaid Services; Center for Medicare and Medicaid Innovation; Baltimore Maryland
| | - Jennifer T. Lloyd
- Research and Rapid-Cycle Evaluation Group; Centers for Medicare and Medicaid Services; Center for Medicare and Medicaid Innovation; Baltimore Maryland
| | - William H. Shrank
- Research and Rapid-Cycle Evaluation Group; Centers for Medicare and Medicaid Services; Center for Medicare and Medicaid Innovation; Baltimore Maryland
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Stuart BC, Simoni-Wastila L, Zhao L, Lloyd JT, Doshi JA. Increased persistency in medication use by U.S. Medicare beneficiaries with diabetes is associated with lower hospitalization rates and cost savings. Diabetes Care 2009; 32:647-9. [PMID: 19171724 PMCID: PMC2660480 DOI: 10.2337/dc08-1311] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the relationship between annual fills for antidiabetes medications, ACE inhibitors, angiotensin II receptor blockers (ARBs), and lipid-lowering agents on hospitalization and Medicare spending for beneficiaries with diabetes. RESEARCH DESIGN AND METHODS Using Medicare Current Beneficiary Survey data from 1997 to 2004, we identified 7,441 community-dwelling beneficiaries with diabetes, who contributed 14,317 person-years of data for the analysis. We used multivariate regression analysis to estimate the effect of persistency in medication fills on hospitalization risk, hospital days, and Medicare spending. RESULTS For users of older oral antidiabetes agents, ACE inhibitors, ARBs, and statins, each additional prescription fill was associated with significantly lower risk of hospitalization, fewer hospital days, and lower Medicare spending. CONCLUSIONS These results suggest an economic case for promoting greater persistency in use of drugs with approved indications by Medicare beneficiaries with diabetes; however, additional research is needed to corroborate the study's cross-sectional findings.
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Affiliation(s)
- Bruce C Stuart
- Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore, Baltimore, Maryland, USA
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Bull AJ, Burbage SE, Crandall JE, Fletcher CI, Lloyd JT, Ravneberg RL, Rockett SL. Effects of noise and intolerance of ambiguity upon attraction for similar and dissimilar others. J Soc Psychol 1972; 88:151-2. [PMID: 4651308 DOI: 10.1080/00224545.1972.9922556] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Lloyd JT. A dual range manometer. J Sci Instrum 1968; 1:490. [PMID: 5675445 DOI: 10.1088/0022-3735/1/4/442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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