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Assi S, Garcia Morales EE, Du EY, Martinez-Amezcua P, Reed NS. Association of Single and Dual Sensory Impairment with Falls among Medicare Beneficiaries. J Aging Health 2024; 36:390-399. [PMID: 37505080 DOI: 10.1177/08982643231190983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective: The purpose of this study was to determine if dual sensory impairment (DSI) is associated with falls and fear of falling among older adults. Methods: Using data from the 2019 Medicare Current Beneficiary Survey (MCBS), we studied the cross-sectional association of self-reported hearing/vision impairment with self-reported history/number of falls over the past year, fear of falling (scale 1-6), and a fall requiring medical help using weighted multivariable regressions adjusted for demographic and clinical covariates. Results: Among 11,089 Medicare beneficiaries (mean age = 74, 55% female, 9% Black), DSI is associated with increased prevalence (prevalence ratio = 1.45 [1.28-1.65]) and incidence (incidence ratio = 2.21 [1.79-2.75]) rate of falls, and greater odds of a higher fear of falling score (odds ratio = 1.38 [1.08-1.77]). Discussion: DSI is associated with falls among older adults. Consideration of DSI as a marker to initiate fall prevention programs and inclusion of sensory interventions in these programs may be valuable.
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Affiliation(s)
- Sahar Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emmanuel E Garcia Morales
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric Y Du
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Pablo Martinez-Amezcua
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Harris JP, Ku E, Harada G, Hsu S, Chiao E, Rao P, Healy E, Nagasaka M, Humphreys J, Hoyt MA. Severity of Financial Toxicity for Patients Receiving Palliative Radiation Therapy. Am J Hosp Palliat Care 2024; 41:592-600. [PMID: 37406195 PMCID: PMC10772523 DOI: 10.1177/10499091231187999] [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: 07/07/2023] Open
Abstract
Introduction: Financial toxicity has negative implications for patient well-being and health outcomes. There is a gap in understanding financial toxicity for patients undergoing palliative radiotherapy (RT). Methods: A review of patients treated with palliative RT was conducted from January 2021 to December 2022. The FACIT-COST (COST) was measured (higher scores implying better financial well-being). Financial toxicity was graded according to previously suggested cutoffs: Grade 0 (score ≥26), Grade 1 (14-25), Grade 2 (1-13), and Grade 3 (0). FACIT-TS-G was used for treatment satisfaction, and EORTC QLQ-C30 was assessed for global health status and functional scales. Results: 53 patients were identified. Median COST was 25 (range 0-44), 49% had Grade 0 financial toxicity, 32% Grade 1, 15% Grade 2, and 4% Grade 3. Overall, cancer caused financial hardship among 45%. Higher COST was weakly associated with higher global health status/Quality of Life (QoL), physical functioning, role functioning, and cognitive functioning; moderately associated with higher social functioning; and strongly associated with improved emotional functioning. Higher income or Medicare or private coverage (rather than Medicaid) was associated with less financial toxicity, whereas an underrepresented minority background or a non-English language preference was associated with greater financial toxicity. A multivariate model found that higher area income (HR .80, P = .007) and higher cognitive functioning (HR .96, P = .01) were significantly associated with financial toxicity. Conclusions: Financial toxicity was seen in approximately half of patients receiving palliative RT. The highest risk groups were those with lower income and lower cognitive functioning. This study supports the measurement of financial toxicity by clinicians.
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Affiliation(s)
- Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Eric Ku
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Garrett Harada
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Sophie Hsu
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Elaine Chiao
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Pranathi Rao
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Erin Healy
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Misako Nagasaka
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Orange, CA, USA
| | - Jessica Humphreys
- Department of Geriatrics and Extended Care, Division of Palliative Care, Tibor Rubin VA Medical Center, Long Beach, CA, USA
- Department of Medicine, Division of Palliative Medicine, University of California, San Francisco, CA, USA
| | - Michael A Hoyt
- Department of Population Health & Disease Prevention, University of California Irvine, Irvine, CA, USA
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Narcisse MR, McElfish PA, Schootman M, Selig JP, Kirkland T, McFarlane SI, Felix HC, Seixas A, Jean-Louis G. Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep. Sleep Med 2024; 117:209-215. [PMID: 38593616 DOI: 10.1016/j.sleep.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+. METHODS Data from the Medicare Health Outcome Survey (2015-2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity. RESULTS Of the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality. CONCLUSION Improving sleep may lead to improvement in QoL in elderly adults with T2D.
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Affiliation(s)
- Marie-Rachelle Narcisse
- Department of Psychiatry and Human Behavior, Brown University, 222 Richmond St., Providence, RI, 02903, USA.
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Mario Schootman
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Tracie Kirkland
- Department of Nursing, University of Southern California, Los Angeles, CA, 90033, USA
| | - Samy I McFarlane
- Department of Medicine, State University of New York-Downstate Health Sciences University, 450 Clarkson Avenue, MSC 50, Brooklyn, NY, 11203, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Azizi Seixas
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
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Steiger K, Herrin J, Swarna KS, Davis EM, McCoy RG. Disparities in Acute and Chronic Complications of Diabetes Along the U.S. Rural-Urban Continuum. Diabetes Care 2024; 47:818-825. [PMID: 38387066 DOI: 10.2337/dc23-1552] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To determine the relative hazards of acute and chronic diabetes complications among people with diabetes across the U.S. rural-urban continuum. RESEARCH DESIGN AND METHODS This retrospective cohort study used the OptumLabs Data Warehouse, a deidentified data set of U.S. commercial and Medicare Advantage beneficiaries, to follow 2,901,563 adults (age ≥18 years) with diabetes between 1 January 2012 and 31 December 2021. We compared adjusted hazard ratios (HRs) of diabetes complications in remote areas (population <2,500), small towns (population 2,500-50,000), and cities (population >50,000). RESULTS Compared with residents of cities, residents of remote areas had greater hazards of myocardial infarction (HR 1.06 [95% CI 1.02-1.10]) and revascularization (HR 1.04 [1.02-1.06]) but lower hazards of hyperglycemia (HR 0.90 [0.83-0.98]) and stroke (HR 0.91 [0.88-0.95]). Compared with cities, residents of small towns had greater hazards of hyperglycemia (HR 1.06 [1.02-1.10]), hypoglycemia (HR 1.15 [1.12-1.18]), end-stage kidney disease (HR 1.04 [1.03-1.06]), myocardial infarction (HR 1.10 [1.08-1.12]), heart failure (HR 1.05 [1.03-1.06]), amputation (HR 1.05 [1.02-1.09]), other lower-extremity complications (HR 1.02 [1.01-1.03]), and revascularization (HR 1.05 [1.04-1.06]) but a smaller hazard of stroke (HR 0.95 [0.94-0.97]). Compared with small towns, residents of remote areas had lower hazards of hyperglycemia (HR 0.85 [0.78-0.93]), hypoglycemia (HR 0.92 [0.87-0.97]), and heart failure (HR 0.94 [0.91-0.97]). Hazards of retinopathy and atrial fibrillation/flutter did not vary geographically. CONCLUSIONS Adults in small towns are disproportionately impacted by complications of diabetes. Future studies should probe for the reasons underlying these disparities.
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Affiliation(s)
- Kyle Steiger
- Internal Medicine Residency, Mayo Clinic, Rochester, MN
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Kavya Sindhu Swarna
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- OptumLabs, Eden Prairie, MN
| | - Esa M Davis
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD
- Institute for Health Computing, University of Maryland, Bethesda, MD
| | - Rozalina G McCoy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- OptumLabs, Eden Prairie, MN
- Institute for Health Computing, University of Maryland, Bethesda, MD
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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5
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Li W, Li L, Ornstein KA, Morrison RS, Liu B. Spatiotemporal Patterns of Hospitalizations Among Older Adults With Co-Presence of Cancer and Dementia in US Counties: 2013-2018. J Appl Gerontol 2024; 43:601-611. [PMID: 37963605 DOI: 10.1177/07334648231213747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
We assessed the spatiotemporal patterns of hospitalization with comorbid cancer and dementia. Using the 2013-2018 inpatient claims data for Medicare fee-for-service (FFS) beneficiaries, we calculated hospitalization rates by dividing the total admissions from individuals with the co-presence of a major cancer (breast, prostate, lung, and colorectal) and dementia diagnoses with the total counts of FFS beneficiaries aged 65 or older. We identified 22 hotspots with high hospitalization rates that showed heterogeneous spatial and temporal utilization patterns. The odds of a county being a hotspot increased significantly with the county-level percentage of dual Medicare-Medicaid beneficiaries (aOR 1.05; 95% CI: 1.04-1.07) and the prevalence of cancer (aOR 1.73; 95% CI: 1.59-1.89), while decreased significantly with increasing degree of rurality (aOR .82; 95% CI: .79-.85) and decreased yearly over time (aOR .72; 95% CI: .68-.75). The identified hotspots and factors at the county-level may help understand healthcare utilization patterns and assess resource allocation for this unique patient group.
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Affiliation(s)
- Weixin Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Center for Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
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Duchesneau ED, Stürmer T, Kim DH, Reeder-Hayes K, Edwards JK, Faurot KR, Lund JL. Performance of a Claims-Based Frailty Proxy Using Varying Frailty Ascertainment Lookback Windows. Med Care 2024; 62:305-313. [PMID: 38498870 PMCID: PMC10997449 DOI: 10.1097/mlr.0000000000001994] [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: 03/20/2024]
Abstract
BACKGROUND Frailty is an aging-related syndrome of reduced physiological reserve to maintain homeostasis. The Faurot frailty index has been validated as a Medicare claims-based proxy for predicting frailty using billing information from a user-specified ascertainment window. OBJECTIVES We assessed the validity of the Faurot frailty index as a predictor of the frailty phenotype and 1-year mortality using varying frailty ascertainment windows. RESEARCH DESIGN We identified older adults (66+ y) in Round 5 (2015) of the National Health and Aging Trends Study with Medicare claims linkage. Gold standard frailty was assessed using the frailty phenotype. We calculated the Faurot frailty index using 3, 6, 8, and 12 months of claims prior to the survey or all-available lookback. Model performance for each window in predicting the frailty phenotype was assessed by quantifying calibration and discrimination. Predictive performance for 1-year mortality was assessed by estimating risk differences across claims-based frailty strata. RESULTS Among 4253 older adults, the 6 and 8-month windows had the best frailty phenotype calibration (calibration slopes: 0.88 and 0.87). All-available lookback had the best discrimination (C-statistic=0.780), but poor calibration. Mortality associations were strongest using a 3-month window and monotonically decreased with longer windows. Subgroup analyses revealed worse performance in Black and Hispanic individuals than counterparts. CONCLUSIONS The optimal ascertainment window for the Faurot frailty index may depend on the clinical context, and researchers should consider tradeoffs between discrimination, calibration, and mortality. Sensitivity analyses using different durations can enhance the robustness of inferences. Research is needed to improve prediction across racial and ethnic groups.
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Affiliation(s)
- Emilie D Duchesneau
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dae Hyun Kim
- Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Roslindale, MA
- Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Brookline, MA
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medicine, Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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7
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Khan MMM, Munir MM, Woldesenbet S, Endo Y, Khalil M, Tsilimigras D, Harzman A, Huang E, Kalady M, Pawlik TM. Association of COVID-19 Pandemic with Colorectal Cancer Screening: Impact of Race/Ethnicity and Social Vulnerability. Ann Surg Oncol 2024; 31:3222-3232. [PMID: 38361094 PMCID: PMC10997707 DOI: 10.1245/s10434-024-15029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted health care delivery, including cancer screening practices. This study sought to determine the impact of the COVID-19 pandemic lockdown on colorectal cancer (CRC) screening relative to social vulnerability. METHODS Using the Medicare Standard Analytic File, individuals 65 years old or older who were eligible for guideline-concordant CRC screening between 2019 and 2021 were identified. These data were merged with the Center for Disease Control Social Vulnerability Index (SVI) dataset. Changes in county-level monthly screening volumes relative to the start of the COVID-19 pandemic (March 2020) and easing of restrictions (March 2021) were assessed relative to SVI. RESULTS Among 10,503,180 individuals continuously enrolled in Medicare with no prior diagnosis of CRC, 1,362,457 (12.97%) underwent CRC screening between 2019 and 2021. With the COVID-19 pandemic, CRC screening decreased markedly across the United States (median monthly screening: pre-pandemic [n = 76,444] vs pandemic era [n = 60,826]; median Δn = 15,618; p < 0.001). The 1-year post-pandemic overall CRC screening utilization generally rebounded to pre-COVID-19 levels (monthly median screening volumes: pandemic era [n = 60,826] vs post-pandemic [n = 74,170]; median Δn = 13,344; p < 0.001). Individuals residing in counties with the highest SVI experienced a larger decline in CRC screening odds than individuals residing in low-SVI counties (reference, low SVI: pre-pandemic high SVI [OR, 0.85] vs pandemic high SVI [OR, 0.81] vs post-pandemic high SVI [OR, 0.85]; all p < 0.001). CONCLUSIONS The COVID-19 pandemic was associated with a decrease in CRC screening volumes. Patients who resided in high social vulnerability areas experienced the greatest pandemic-related decline.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mujtaba Khalil
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis Tsilimigras
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Alan Harzman
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Emily Huang
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Matthew Kalady
- Division of Colorectal Surgery, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Fitzgerald ME, Van Beek MJ, Swerlick RA, Kaye T, Aninos A, Daveluy S, Etkin CD, Jacobs JP. DataDerm: Improving trends in performance measurement. J Am Acad Dermatol 2024; 90:1002-1005. [PMID: 38135157 DOI: 10.1016/j.jaad.2023.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Medicare's legacy quality reporting programs were consolidated into the Merit-Based Incentive Payment System (MIPS) in 2015. PURPOSE The DataDerm registry of the American Academy of Dermatology was examined to understand the potential for and subsequent rate of improvement across 23 performance measures. METHODS We examined the level of performance across 23 performance measures with at least 20 clinicians reporting on at least 50 patients' experience. We calculated the following values: the aggregate performance rate for each measure and the overall aggregate performance rate. RESULTS The aggregate performance rate for each measure ranged from 20.4% for AAD 1 (Psoriasis: Assessment of Disease Activity), to 99.9% for measure ACMS 1 (Avoidance of Opioid Prescriptions for Reconstruction After Skin Resection). Three of 23 measures had an aggregate performance over 95%. The overall aggregate performance rate across all 23 measures was 81.2%, indicating an aggregate potential for improvement of 18.8% across the 23 measures. Nine performance measures reported across the first five years of DataDerm's existence were tracked through time to understand trends in performance through time. The performance across the nine performance measures meeting the inclusion criteria consistently improved in the initial years (2016 through 2018) of DataDerm participation and showed some variation in 2019 and 2020. CONCLUSIONS These data provide evidence that the very act of participation in a multi-institutional registry and tracking compliance with performance measures can lead to improvements in compliance with the performance measures and therefore improvements in quality of care.
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Affiliation(s)
- Matthew E Fitzgerald
- Department of Science and Quality, American Academy of Dermatology [AAD], Rosemont, Illinois
| | | | | | - Toni Kaye
- Department of Science and Quality, American Academy of Dermatology [AAD], Rosemont, Illinois
| | - Arik Aninos
- Department of Science and Quality, American Academy of Dermatology [AAD], Rosemont, Illinois
| | | | - Caryn D Etkin
- Department of Science and Quality, American Academy of Dermatology [AAD], Rosemont, Illinois
| | - Jeffrey P Jacobs
- Department of Science and Quality, American Academy of Dermatology [AAD], Rosemont, Illinois; Division of Cardiothoracic Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida
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9
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Gaines AG, Cagle JG. Associations Between Certificate of Need Policies and Hospice Quality Outcomes. Am J Hosp Palliat Care 2024; 41:471-478. [PMID: 37256687 DOI: 10.1177/10499091231180613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Certificate of need (CON) laws are state-based regulations requiring approval of new healthcare entities and capital expenditures. Varying by state, these regulations impact hospices in 14 states and DC, with several states re-examining provisions. AIM This cross-sectional study examined the association of CON status on hospice quality outcomes using the hospice item set metric (HIS). DESIGN Data from the February 2022 Medicare Hospice Provider and General Information reports of 4870 US hospices were used to compare group means of the 8 HIS measures across CON status. Multiple regression analysis was used to predict HIS outcomes by CON status while controlling for ownership and size. RESULTS Approximately 86% of hospices are in states without a hospice CON provision. The unadjusted mean HIS scores for all measures were higher in CON states (M range 94.40-99.59) than Non-CON (M range 90.50-99.53) with significant differences in all except treatment preferences. In the adjusted model, linear regression analyses showed hospice CON states had significantly higher HIS ratings than those from Non-CON states for beliefs and values addressed (β = .05, P = .009), pain assessment (β = .05, P = .009), dyspnea treatment (β = .08, P < .001) and the composite measure (β = .09, P < .001). Treatment preferences, pain screening, dyspnea screening, and opioid bowel treatment were not statistically significant (P > .05). CONCLUSION The study suggests that CON regulations may have a modest, but beneficial impact on hospice-reported quality outcomes, particularly for small and medium-sized hospices. Further research is needed to explore other factors that contribute to HIS outcomes.
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Affiliation(s)
- Arlen G Gaines
- Doctoral Program in Palliative Care, Department of Pharmacy Practice and Science, University of Maryland, Baltimore, MD, USA
| | - John G Cagle
- Department of Social Work, University of Maryland, Baltimore, MD, USA
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10
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Flaherty E, O'Connor S, Steltenpohl CN, Preiss M, Volckaert A, Pepin RL. Geriatric Interprofessional Team Transformation for Primary Care overview. J Am Geriatr Soc 2024; 72 Suppl 2:S4-S12. [PMID: 38038277 DOI: 10.1111/jgs.18637] [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: 05/03/2023] [Revised: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. METHODS Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. RESULTS Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. CONCLUSIONS The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.
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Affiliation(s)
- Ellen Flaherty
- Dartmouth Health Geriatric Center of Excellence, Lebanon, New Hampshire, USA
| | - Sharon O'Connor
- Center for Program Design and Evaluation, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Crystal N Steltenpohl
- Center for Program Design and Evaluation, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Michaela Preiss
- Dartmouth Health Geriatric Center of Excellence, Lebanon, New Hampshire, USA
| | | | - Renée L Pepin
- Dartmouth Health Geriatric Center of Excellence, Lebanon, New Hampshire, USA
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11
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Sarpal DK, Cole ES, Gannon JM, Li J, Adair DK, Chengappa KNR, Donohue JM. Variation of Clozapine Use for Treatment of Schizophrenia: Evidence from Pennsylvania Medicaid and Dually Eligible Enrollees. Community Ment Health J 2024; 60:743-753. [PMID: 38294579 DOI: 10.1007/s10597-023-01226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
While clozapine is the most effective antipsychotic treatment for treatment-resistant schizophrenia, it remains underutilized across the United States, warranting a more comprehensive understanding of variation in use at the county level, as well as characterization of existing prescribing patterns. Here, we examined both Medicaid and Medicare databases to (1) characterize temporal and geographic variation in clozapine prescribing and, (2) identify patient-level characteristics associated with clozapine use. We included Medicaid and Fee for Service Medicare data in the state of Pennsylvania from January 1, 2013, through December 31, 2019. We focused on individuals with continuous enrollment, schizophrenia diagnosis, and multiple antipsychotic trials. Geographic variation was examined across counties of Pennsylvania. Regression models were constructed to determine demographic and clinical characteristics associated with clozapine use. Out of 8,255 individuals who may benefit from clozapine, 642 received treatment. We observed high medication burden, overall, including multiple antipsychotic trials. We also identified variation in clozapine use across regions in Pennsylvania with a disproportionate number of prescribers in urban areas and several counties with no identified clozapine prescribers. Finally, demographic, and clinical determinants of clozapine use were observed including less use in people identified as non-Hispanic Black, Hispanic, or with a substance use disorder. In addition, greater medical comorbidity was associated with increased clozapine use. Our work leveraged both Medicaid and Medicare data to characterize and surveil clozapine prescribing. Our findings support efforts monitor disparities and opportunities for the optimization of clozapine within municipalities to enhance clinical outcomes.
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Affiliation(s)
- Deepak K Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Evan S Cole
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica M Gannon
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jie Li
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dale K Adair
- Office of Mental Health and Substance Abuse Services, Pennsylvania Department of Human Services, Harrisburg, PA, USA
| | - K N Roy Chengappa
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julie M Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Hotchkiss J, Ridderman E, Buftin W. Overall US Hospice Quality According to Decedent Caregivers-Natural Language Processing and Sentiment Analysis of 3389 Online Caregiver Reviews. Am J Hosp Palliat Care 2024; 41:527-544. [PMID: 37338245 DOI: 10.1177/10499091231185593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Objectives: With an untapped quality resource in online hospice reviews, study aims were exploring hospice caregiver experiences and assessing their expectations of the hospice Medicare benefit. Methods: Topical and sentiment analysis was conducted using natural language processing (NLP) of Google and Yelp caregiver reviews (n = 3393) between 2013-2023 using Google NLP. Stratified sampling weighted by hospice size to approximate the daily census of US hospice enrollees. Results: Overall caregiver sentiment of hospice care was neutral (S = .14). Therapeutic, achievable expectations and misperceptions, unachievable expectations were, respectively, the most and least prevalent domains. Four topics with the highest prevalence, all had moderately positive sentiments: caring staff, staff professionalism and knowledge; emotional, spiritual, bereavement support; and responsive, timely or helpful. Lowest sentiments scores were lack of staffing; promises made, but not kept, pain, symptoms and medications; sped-up death, hasted, or sedated; and money, staff motivations. Significance of Results: Caregivers overall rating of hospice was neutral, largely due to moderate sentiment on achievable expectations in two-thirds of reviews mixed with unachievable expectations in one-sixth of reviews. Hospice caregivers were most likely to recommend hospices with caring staff, providing quality care, responsive to requests, and offering family support. Lack of staff, inadequate pain-symptom management were the two biggest barriers to hospice quality. All eight CAHPS measures were found in the discovered review topics. Close-ended CAHPS scores and open-ended online reviews have complementary insights. Future research should explore associations between CAHPS and review insights.
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13
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Siotos C, Aminzada A, Whitney N, Najafali D, Toms Iii JA, Mpontozis A, Kokosis G, Shenaq DS, Derman GH, Dorafshar AH, Kurlander DE. Trends of Medicare Reimbursement Rates for Lower Extremity Procedures. J Reconstr Microsurg 2024; 40:294-301. [PMID: 37643824 DOI: 10.1055/a-2161-7947] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Data collected across many surgical specialties suggest that Medicare reimbursement for physicians consistently lags inflation. Studies are needed that describe reimbursement rates for lower extremity procedures. Our goal is to analyze the trends in Medicare reimbursement rates from 2010 to 2021 for both lower extremity amputation and salvage surgeries. METHODS The Physician Fee Schedule Look-Up Tool of the Centers for Medicare and Medicaid Services was assessed and Current Procedural Terminology codes for common lower extremity procedures were collected. Average reimbursement rates from 2010 to 2021 were analyzed and adjusted for inflation. The rates of work-, facility-, and malpractice-related relative value units (RVUs) were also collected. RESULTS We found an overall increase in Medicare reimbursement of 4.73% over the study period for lower extremity surgery. However, after adjusting for inflation, the average reimbursement decreased by 13.19%. The adjusted relative difference was calculated to be (-)18.31 and (-)11.34% for lower extremity amputation and salvage procedures, respectively. We also found that physician work-related RVUs decreased by 0.27%, while facility-related and malpractice-related RVUs increased. CONCLUSION Reimbursement for lower extremity amputation and salvage procedures has steadily declined from 2010 to 2021 after adjusting for inflation, with amputation procedures being devaluated at a greater rate than lower extremity salvage procedures. With the recent marked inflation, knowledge of these trends is crucial for surgeons, hospitals, and health care policymakers to ensure appropriate physician reimbursement. LEVEL OF EVIDENCE IV (cross-sectional study).
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Affiliation(s)
- Charalampos Siotos
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Amir Aminzada
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Natalia Whitney
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel Najafali
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - John A Toms Iii
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | | | - George Kokosis
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Deana S Shenaq
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Gordon H Derman
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Amir H Dorafshar
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - David E Kurlander
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
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14
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MacLeod H. Navigating the narrowing effect of public discourse for a healthier future. Healthc Manage Forum 2024; 37:187-190. [PMID: 37929792 DOI: 10.1177/08404704231208597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
This article explores the concerning phenomenon of the narrowing effect in public discourse, particularly in the context of healthcare and Medicare. It discusses the challenges posed by this narrowing effect, the impact of cognitive biases, and the ethical dilemmas faced by healthcare providers and organizations when patients take their concerns public. The article also emphasizes the importance of responsible leadership and offers navigation for overcoming the narrowing of public discourse.
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Affiliation(s)
- Hugh MacLeod
- University of British Columbia, Vancouver, British Columbia, Canada
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15
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Browne J, Wu WC, Jiang L, Singh M, Bozzay ML, Kunicki ZJ, Bayer TA, De Vito AN, Primack JM, McGeary JE, Kelso CM, Rudolph JL. Lower odds of successful community discharge after medical hospitalization for Veterans with schizophrenia: A retrospective cohort study of national data. J Psychiatr Res 2024; 173:58-63. [PMID: 38489871 DOI: 10.1016/j.jpsychires.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse outcomes. This study examined the odds of successful community discharge among Veterans with schizophrenia compared to those with major affective disorders and those without serious mental illness (SMI) after a heart failure hospital admission. Data for Veterans hospitalized for heart failure were obtained from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. Psychiatric diagnoses and medical comorbidities were assessed in the year prior to hospitalization. Successful community discharge was defined as remaining in the community without hospital readmission, death, or hospice for 30 days after hospital discharge. Logistic regression analyses adjusting for relevant factors were used to examine whether individuals with a schizophrenia diagnosis showed lower odds of successful community discharge versus both comparison groups. Out of 309,750 total Veterans in the sample, 7377 (2.4%) had schizophrenia or schizoaffective disorder and 32,472 (10.5%) had major affective disorders (bipolar disorder or recurrent major depressive disorder). Results from adjusted logistic regression analyses demonstrated significantly lower odds of successful community discharge for Veterans with schizophrenia compared to the non-SMI (Odds Ratio [OR]: 0.63; 95% Confidence Interval [CI]: 0.60, 0.66) and major affective disorders (OR: 0.65, 95%; CI: 0.62, 0.69) groups. Intervention efforts should target the transition from hospital to home in the subgroup of Veterans with schizophrenia.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Mriganka Singh
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Jennifer M Primack
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
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Faraj KS, Kaufman SR, Herrel LA, Maganty A, Oerline MK, Caram MEV, Shahinian VB, Hollenbeck BK. Urologist practice divestment from radiation vault ownership and treatment patterns for prostate cancer. Cancer 2024; 130:1609-1617. [PMID: 38146764 PMCID: PMC11009074 DOI: 10.1002/cncr.35168] [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: 08/23/2023] [Revised: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Urologists practicing in single-specialty groups with ownership in radiation vaults are more likely to treat men with prostate cancer. The effect of divestment of vault ownership on treatment patterns is unclear. METHODS A 20% sample of national Medicare claims was used to perform a retrospective cohort study of men with prostate cancer diagnosed between 2010 and 2019. Urology practices were categorized by radiation vault ownership as nonowners, continuous owners, and divested owners. The primary outcome was use of local treatment, and the secondary outcome was use of intensity-modulated radiation therapy (IMRT). A difference-in-differences framework was used to measure the effect of divestment on outcomes compared to continuous owners. Subgroup analyses assessed outcomes by noncancer mortality risk (high [>50%] vs. low [≤50%]). RESULTS Among 72 urology practices that owned radiation vaults, six divested during the study. Divestment led to a decrease in treatment compared with those managed at continuously owning practices (difference-in-differences estimate, -13%; p = .03). The use of IMRT decreased, but this was not statistically significant (difference-in-differences estimate, -10%; p = .13). In men with a high noncancer mortality risk, treatment (difference-in-differences estimate, -28%; p < .001) and use of IMRT (difference-in-differences estimate, -27%; p < .001) decreased after divestment. CONCLUSIONS Urology group divestment from radiation vault ownership led to a decrease in prostate cancer treatment. This decrease was most pronounced in men who had a high noncancer mortality risk. This has important implications for health care reform by suggesting that payment programs that encourage constraints on utilization, when appropriate, may be effective in reducing overtreatment.
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Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary K Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Megan E. V. Caram
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Cadet T, Cusimano J, McKearney S, Honaker J, O'Neal C, Taheri R, Uhley V, Zhang Y, Dreker M, Cohn JS. Describing the evidence linking interprofessional education interventions to improving the delivery of safe and effective patient care: a scoping review. J Interprof Care 2024; 38:476-485. [PMID: 38124506 PMCID: PMC11009096 DOI: 10.1080/13561820.2023.2283119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
Empirical evidence indicates that collaborative interprofessional practice leads to positive health outcomes. Further, there is an abundance of evidence examining student and/or faculty perceptions of learning or satisfaction about the interprofessional education (IPE) learning experience. However, there is a dearth of research linking IPE interventions to patient outcomes. The objective of this scoping review was to describe and summarize the evidence linking IPE interventions to the delivery of effective patient care. A three-step search strategy was utilized for this review with articles that met the following criteria: publications dated 2015-2020 using qualitative, quantitative or mixed methods; the inclusion of healthcare professionals, students, or practitioners who had experienced IPE or training that included at least two collaborators within coursework or other professional education; and at least one of ten Centers for Medicare & Medicaid Services quality measures (length of stay, medication errors, medical errors, patient satisfaction scores, medication adherence, patient and caregiver education, hospice usage, mortality, infection rates, and readmission rates). Overall, n=94 articles were identified, providing overwhelming evidence supporting a positive relationship between IPE interventions and several key quality health measures including length of stay, medical errors, patient satisfaction, patient or caregiver education, and mortality. Findings from this scoping review suggest a critical need for the development, implementation, and evaluation of IPE interventions to improve patient outcomes.
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Affiliation(s)
- Tamara Cadet
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Cusimano
- Bernard J. Dunn School of Pharmacy, Shenandoah University, Winhester, VA, USA
| | - Shelley McKearney
- Interprofessional Education Collaborative, BS Seton Hall University, South Orange, NJ, USA
| | | | - Cynthia O'Neal
- School of Nursing, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Reza Taheri
- Pharmacy Practice Department, Chapman University, Irvine, CA, USA
| | - Virginia Uhley
- Department of Foundational Medical Studies, Department of Family Medicine and Community Health, Oakland University, Rochester, MI, USA
| | - Yingting Zhang
- Department of Medicine, Research Services Librarian Library Faculty, Robert Wood Johnson Library of the Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Margaret Dreker
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ, USA
| | - Judith S Cohn
- Health Sciences Library, Information Services and Department of Health Sciences Libraries Department, George F. Smith Library of the Health Sciences, The State University of New Jersey, Newark, NJ, USA
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Rosenbaum KEF, Lasater KB, McHugh MD, Lake ET. Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and System Ratings: Associations With Nursing Factors. Med Care 2024; 62:288-295. [PMID: 38579145 DOI: 10.1097/mlr.0000000000001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To determine which hospital nursing resources (staffing, skill mix, nurse education, and nurse work environment) are most predictive of hospital Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) performance. BACKGROUND HCAHPS surveying is designed to quantify patient experience, a measure of patient-centered care. Hospitals are financially incentivized through the Centers for Medicare and Medicaid Services to achieve high HCAHPS ratings, but little is known about what modifiable hospital factors are associated with higher HCAHPS ratings. PATIENTS AND METHODS Secondary analysis of multiple linked data sources in 2016 providing information on hospital HCAHPS ratings, hospital nursing resources, and other hospital attributes (eg, size, teaching, and technology status). Five hundred forty non-federal adult acute care hospitals in California, Florida, New Jersey, and Pennsylvania, and 11,786 registered nurses working in those hospitals. Predictor variables included staffing (ie, patient-to-nurse ratio), skill mix (ie, the proportion of registered nurses to all nursing staff), nurse education (ie, percentage of nurses with a bachelor's degree or higher), and nurse work environment (ie, the quality of the environment in which nurses work). HCAHPS ratings were the outcome variable. RESULTS More favorable staffing, higher proportions of bachelor-educated nurses, and better work environments were associated with higher HCAHPS ratings. The work environment had the largest association with higher HCAHPS ratings, followed by nurse education, and then staffing. Superior staffing and work environments were associated with higher odds of a hospital being a "higher HCAHPS performer" compared with peer hospitals. CONCLUSION Improving nursing resources is a strategic organizational intervention likely to improve HCAHPS ratings.
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Affiliation(s)
- Kathleen E Fitzpatrick Rosenbaum
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
- National Clinician Scholars Program, Yale University, New Haven, CT
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT
- Yale New Haven Hospital, New Haven, CT
- Yale School of Nursing, Yale University, New Haven CT
| | - Karen B Lasater
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Mathew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Eileen T Lake
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
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Basourakos SP, An A, Davuluri M, Pinheiro LC, Al Awamlh BAH, Borregales LD, Luan D, Tamimi RM, Hu JC, Kensler KH. Racial and Ethnic Variation in Receipt and Intensity of Active Surveillance for Older Patients With Localized Prostate Cancer. Urol Pract 2024; 11:538-546. [PMID: 38640417 DOI: 10.1097/upj.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/17/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The use of active surveillance (AS) for prostate cancer is increasing, and racial disparities have been identified in its implementation. We investigated differences by race and ethnicity in the utilization and intensity of AS by race and ethnicity among older men with low- and favorable intermediate-risk prostate cancer, with particular focus on the integration of multiparametric MRI (mpMRI) into AS protocols. METHODS Using the Surveillance, Epidemiology, and End Results and Medicare fee-for-service linked database, we identified a cohort of men diagnosed between 2010 and 2017 with low- or favorable intermediate-risk prostate cancer. The odds of receiving AS were compared by patient race and ethnicity using multivariable logistic regression models, while the rates of usage of PSA tests, biopsy, and mpMRI within 2 years of diagnosis among men on AS were assessed using multivariable Poisson regression models. RESULTS Our cohort included 33,542 men. The proportion of men with low-risk disease who underwent AS increased from 29.5% in 2010 to 51.7% in 2017, while the proportion among men with favorable intermediate disease grew from 11.4% to 17.2%. Hispanic (odds ratio [OR] = 0.68, 95% CI 0.58-0.79) and non-Hispanic Black men (OR = 0.78, 95% CI 0.68-0.89) were less likely to receive AS than non-Hispanic White men for low-risk disease, while non-Hispanic Black men were more likely to receive AS for favorable intermediate disease (OR = 1.21, 95% CI 1.04-1.39). Non-Hispanic Black men receiving AS underwent prostate MRI at a lower rate compared to non-Hispanic White men, regardless of whether they had low-risk (incidence rate ratio = 0.77, 95% CI 0.61-0.97) or favorable intermediate-risk (incidence rate ratio = 0.61, 95% CI 0.44-0.83) disease, respectively. CONCLUSIONS The overall adoption of AS for low-risk prostate cancer increased among Medicare fee-for-service beneficiaries. However, a significant disparity exists for non-Hispanic Black men, as they exhibit lower rates of AS utilization. Moreover, non-Hispanic Black men are less likely to have access to novel technologies, such as mpMRI, as part of their AS protocols.
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Affiliation(s)
- Spyridon P Basourakos
- Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Anjile An
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Meenakshi Davuluri
- Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Laura C Pinheiro
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Leonardo D Borregales
- Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Danny Luan
- Department of Hematology and Oncology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Jim C Hu
- Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Kevin H Kensler
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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20
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Kam L, Xia E, Mostaghimi A. Home UVB phototherapy utilization among United States Medicare beneficiaries from 2000 to 2021. Photodermatol Photoimmunol Photomed 2024; 40:e12971. [PMID: 38654591 DOI: 10.1111/phpp.12971] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Lisa Kam
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Plate JF, Deen JT, Deans CF, Pour AE, Yates AJ, Sterling RS. Implementation of the New Medicare-Mandated Patient-Reported Outcomes After Joint Arthroplasty Performance Measure. J Arthroplasty 2024; 39:1136-1139. [PMID: 38278185 DOI: 10.1016/j.arth.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/26/2023] [Accepted: 01/13/2024] [Indexed: 01/28/2024] Open
Abstract
A new mandatory hospital-level, risk-standardized performance measure for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on patient-reported outcomes (THA/TKA PRO-PM) has been implemented by the Centers for Medicare & Medicaid Services (CMS). All THA and TKA in Medicare fee-for-service beneficiaries at inpatient facilities are included. The THA/TKA PRO-PM is the proportion of risk-standardized THA or TKA patients meeting or exceeding the substantial clinical benefit threshold between preoperative and postoperative outcomes measures (Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Knee injury and Osteoarthritis Outcome Score for Joint Replacement). This binary outcome (yes/no) is then divided by all eligible patients creating a percentage of patients reaching substantial clinical benefit. The percentile score among hospitals will be reported. Following 2 voluntary reporting periods, mandatory reporting will begin in 2025. The CMS requires 50% reporting rates; failure leads to annual payment reduction in fiscal year 2028. The CMS intends the THA/TKA PRO-PM to be a patient-centered, meaningful, and relatable measure of hospital performance reported to the public. For surgeons, this is an opportunity to collaborate with hospitals for developing and implementing a THA/TKA data collection system to avoid penalties for the hospital. Further implementation for outpatient surgery and in ambulatory surgery centers has been announced by CMS. Major resources will be needed to succeed in the expected capture rates.
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Affiliation(s)
- Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; American Association of Hip and Knee Surgeons Health Policy Fellowship Program, Rosemont, Illinois
| | - Justin T Deen
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, Florida; American Association of Hip and Knee Surgeons Health Policy Fellowship Program, Rosemont, Illinois
| | - Christopher F Deans
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska; American Association of Hip and Knee Surgeons Health Policy Fellowship Program, Rosemont, Illinois
| | - Aidin E Pour
- Department of Orthopaedics & Rehabilitation, Yale University, New Haven, Connecticut
| | - Adolph J Yates
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert S Sterling
- Department of Orthopaedic, George Washington University, Washington, District of Columbia
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Filson CP, Richards TB, Ekwueme DU, Howard DH. Patterns of Care for Medicare Beneficiaries With Metastatic Prostate Cancer. Urol Pract 2024; 11:489-497. [PMID: 38640419 DOI: 10.1097/upj.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/22/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Therapeutic options for men with metastatic prostate cancer have increased in the past decade. We studied recent treatment patterns for men with metastatic prostate cancer and how treatment patterns have changed over time. METHODS Using the Surveillance, Epidemiology, and End Results‒Medicare database, we identified fee-for-service Medicare beneficiaries who either were diagnosed with metastatic prostate cancer or developed metastases following diagnosis, as indicated by the presence of claims with diagnoses codes for metastatic disease, between 2007 and 2017. We evaluated treatment patterns using claims. RESULTS We identified 29,800 men with metastatic disease, of whom 4721 (18.8%) had metastatic disease at their initial diagnosis. The mean age was 77 years, and 77.9% of patients were non-Hispanic White. The proportion receiving antineoplastic agents within 3 years of the index date increased over time (from 9.7% in 2007 to 25.9% in 2017; P < .001). Opioid use within 3 years of prostate cancer diagnosis was stable during 2007 to 2013 (around 73%) but decreased through 2017 to 65.5% (P < .001). Patients diagnosed during 2015 to 2017 had longer median survival (32.6 months) compared to those diagnosed during 2007 to 2010 (26.6 months; P < .001). CONCLUSIONS Most metastatic prostate cancer patients do not receive life-prolonging antineoplastic therapies. Improved adoption of effective cancer therapies when appropriate may increase length and quality of survival among metastatic prostate cancer patients.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Thomas B Richards
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David H Howard
- Department of Health Policy and Management, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Awtry JA, Abernathy JH, Wu X, Yang J, Zhang M, Hou H, Kaneko T, de la Cruz KI, Stakich-Alpirez K, Yule S, Cleveland JC, Shook DC, Fitzsimons MG, Harrington SD, Pagani FD, Likosky DS. Evaluating the Impact of Operative Team Familiarity on Cardiac Surgery Outcomes: A Retrospective Cohort Study of Medicare Beneficiaries. Ann Surg 2024; 279:891-899. [PMID: 37753657 PMCID: PMC10965508 DOI: 10.1097/sla.0000000000006100] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To associate surgeon-anesthesiologist team familiarity (TF) with cardiac surgery outcomes. BACKGROUND TF, a measure of repeated team member collaborations, has been associated with improved operative efficiency; however, examination of its relationship to clinical outcomes has been limited. METHODS This retrospective cohort study included Medicare beneficiaries undergoing coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), or both (CABG+SAVR) between January 1, 2017, and September 30, 2018. TF was defined as the number of shared procedures between the cardiac surgeon and anesthesiologist within 6 months of each operation. Primary outcomes were 30- and 90-day mortality, composite morbidity, and 30-day mortality or composite morbidity, assessed before and after risk adjustment using multivariable logistic regression. RESULTS The cohort included 113,020 patients (84,397 CABG; 15,939 SAVR; 12,684 CABG+SAVR). Surgeon-anesthesiologist dyads in the highest [31631 patients, TF median (interquartile range)=8 (6, 11)] and lowest [44,307 patients, TF=0 (0, 1)] TF terciles were termed familiar and unfamiliar, respectively. The rates of observed outcomes were lower among familiar versus unfamiliar teams: 30-day mortality (2.8% vs 3.1%, P =0.001), 90-day mortality (4.2% vs 4.5%, P =0.023), composite morbidity (57.4% vs 60.6%, P <0.001), and 30-day mortality or composite morbidity (57.9% vs 61.1%, P <0.001). Familiar teams had lower overall risk-adjusted odds of 30-day mortality or composite morbidity [adjusted odds ratio (aOR) 0.894 (0.868, 0.922), P <0.001], and for SAVR significantly lower 30-day mortality [aOR 0.724 (0.547, 0.959), P =0.024], 90-day mortality [aOR 0.779 (0.620, 0.978), P =0.031], and 30-day mortality or composite morbidity [aOR 0.856 (0.791, 0.927), P <0.001]. CONCLUSIONS Given its relationship with improved 30-day cardiac surgical outcomes, increasing TF should be considered among strategies to advance patient outcomes.
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Affiliation(s)
- Jake A. Awtry
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Boston, MA
| | - James H. Abernathy
- Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xiaoting Wu
- Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI
| | - Jie Yang
- Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Hechuan Hou
- Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St Louis/Barnes-Jewish Hospital, St. Louis, MO
| | - Kim I. de la Cruz
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Korana Stakich-Alpirez
- Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI
| | - Steven Yule
- School of Surgery, University of Edinburgh, Scotland, UK
| | - Joseph C. Cleveland
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Douglas C. Shook
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Michael G. Fitzsimons
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Francis D. Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Donald S. Likosky
- Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI
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Chen L, Orosa D, Ahn G, Putnam J, Layoun H, Saddiqui HU, Hammoud MS, Mahboubi R, Schraufnagel D, Bribriesco A. Are adult thoracic patient education materials designed with patients in mind? J Thorac Cardiovasc Surg 2024; 167:1654-1656.e5. [PMID: 38199291 DOI: 10.1016/j.jtcvs.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/16/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Patients are increasingly using the internet to obtain health care information. US News and World Report Best Hospital rankings received more than 103 million views in 2021. Considering 21% of thoracic surgery patients are minorities, 27.9% are in the bottom quartile of household income, and 70% have Medicare/Medicaid or no insurance, online patient educational materials (PEMs) should be accessible and written at a level easily understood by majority of patients. We performed a comprehensive analysis of readability of websites containing patient-centered resources across all adult thoracic surgery areas. METHODS Online PEMs on thoracic surgical procedures were collected from top 50 hospitals for pulmonology and lung surgery ranked by US News and World Report Best Hospital as of December 1, 2021. Text pertaining to thoracic surgical procedures was collected and divided into 4 procedural genres: esophageal, lung, transplant procedures, and other. Texts were analyzed using OleanderSoftware's Readability Suite through the Raygor readability test. RESULTS Three hundred seventy-two articles met criteria for analysis. Websites were difficult to read; mean (standard deviation) readability score for all content required a 13.9 (3.6) grade level for comprehension. The mean (standard deviation) readability for esophageal, lung, lung transplant, and other surgeries were 14.5 (3.6), 13.1 (3.6), 11.5 (3.9), and 13.4 (3.7), respectively. CONCLUSIONS Online PEMs required at least a college reading level to comprehend, well exceeding the sixth-grade level recommended by the American Medical Association. As digital health becomes increasingly relevant, improving the readability of online PEMs in adult cardiac surgery will facilitate equitable access to high-quality care.
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Affiliation(s)
- Lin Chen
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Dominic Orosa
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gaeun Ahn
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jonathan Putnam
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Habib Layoun
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hafiz Umair Saddiqui
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Miza Salim Hammoud
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rashed Mahboubi
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dean Schraufnagel
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alejandro Bribriesco
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Patel TA, Jain B, Vapiwala N, Chino F, Tringale KR, Mahal BA, Yamoah K, McBride SN, Lam MB, Hubbard A, Nguyen PL, Dee EC. Trends in Utilization and Medicare Spending on Short-Course Radiation Therapy for Breast and Prostate Cancer: An Episode-Based Analysis From 2015 to 2019. Int J Radiat Oncol Biol Phys 2024; 119:17-22. [PMID: 38072324 DOI: 10.1016/j.ijrobp.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE Evidence supports the value of shorter, similarly efficacious, and potentially more cost-effective hypofractionated radiation therapy (RT) regimens in many clinical scenarios for breast cancer (BC) and prostate cancer (PC). However, practice patterns vary considerably. We used the most recent Centers for Medicare and Medicaid Services data to assess trends in RT cost and practice patterns among episodes of BC and PC. METHODS AND MATERIALS We performed a retrospective cohort analysis of all external beam RT episodes for BC and PC from 2015 to 2019 to assess predictors of short-course RT (SCRT) use and calculated spending differences. Multivariable logistic regression defined adjusted odds ratios of receipt of SCRT over longer-course RT (LCRT) by treatment modality, age, year of diagnosis, type of practice, and the interaction between year and treatment setting. Medicare spending was evaluated using multivariable linear regression controlling for duration of RT regimen (SCRT vs LCRT) in addition to the above covariables. RESULTS Of 143,729 BC episodes and 114,214 PC episodes, 63,623 (44.27%) and 25,955 (22.72%) were SCRT regimens, respectively. Median total spending for SCRT regimens among BC episodes was $9418 (interquartile range [IQR], $7966-$10,983) versus $13,602 (IQR, $11,814-$15,499) for LCRT. Among PC episodes, median total spending was $6924 (IQR, $4,509-$12,905) for stereotactic body RT, $18,768 (IQR, $15,421-$20,740) for moderate hypofractionation, and $27,319 (IQR, $25,446-$29,421) for LCRT. On logistic regression, receipt of SCRT was associated with older age among both BC and PC episodes as well as treatment at hospital-affiliated over freestanding sites (P < .001 for all). CONCLUSIONS In this evaluation of BC and PC RT episodes from 2015 to 2019, we found that shorter-course RT resulted in lower costs than longer-course RT. SCRT was also more common in hospital-affiliated sites. Future research focusing on potential payment incentives encouraging SCRT when clinically appropriate in the 2 most common cancers treated with RT will be valuable as the field continues to prospectively evaluate cost-effective hypofractionation in other disease sites.
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Affiliation(s)
- Tej A Patel
- Department of Healthcare Management and Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bhav Jain
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn R Tringale
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiation Medicine and Applied Sciences, University of California, San Diego, School of Medicine, San Diego, California
| | - Brandon A Mahal
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Sean N McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miranda B Lam
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne Hubbard
- Department of Health Policy, American Society for Radiation Oncology, Arlington, Virgnia
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Mihalopoulos M, Okewunmi J, Stern BZ, Huang HH, Galatz LM, Poeran J, Moucha CS. Did the Comprehensive Care for Joint Replacement Bundled Payment Program Impact Sex Disparities in Total Hip and Knee Arthroplasties? J Arthroplasty 2024; 39:1226-1234.e4. [PMID: 37972665 DOI: 10.1016/j.arth.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sex disparities have been noted across various aspects of total hip/knee arthroplasty (THA/TKA). Given incentives to standardize care, bundled payment initiatives including the Comprehensive Care for Joint Replacement (CJR) program may reduce disparities. This study aimed to assess the CJR program's impact on sex disparities in THA/TKA care and outcomes. METHODS This retrospective cohort study included 259,673 THAs (61.7% women) and 506,311 TKAs (64.0% women) from a large national database (2013 to 2017). Sex disparities were assessed for care and outcomes related to the period (1) before surgery, (2) during hospitalization for THA/TKA, and (3) after discharge. Disparities were reported as women:men ratios. Difference-in-differences analyses estimated the impact of the CJR program on pre-existing sex disparities. RESULTS For both THA and TKA, women were less likely than men to present with a Charlson-Deyo comorbidity index >0 (women:men ratio 0.88 to 0.92), but were more likely to require blood transfusions (women:men ratio 1.48 to 1.79) and be discharged to institutional postacute care (women:men ratio 1.50 to 1.66). Difference-in-differences models demonstrated that the CJR bundled payment program reduced sex disparities in institutional postacute care discharges (THA: -2.28%; 95% confidence interval [CI] -4.20 to -0.35%, P = .02; TKA: -2.07%; 95% CI -3.93 to -0.20%; P = .03) and THA 90-day readmissions (-1.00%, 95% CI -1.88 to -0.13%, P = .02), indicating a differential impact of CJR in women versus men for some outcomes. CONCLUSIONS While sex disparities in THA/TKA persist, the CJR program demonstrates potential to impact such differences. Future research should focus on how potential mechanisms could be leveraged to reduce disparities.
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Affiliation(s)
- Meredith Mihalopoulos
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Okewunmi
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brocha Z Stern
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hsin-Hui Huang
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jashvant Poeran
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Calin S Moucha
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Garbarino JT, O'Connor S, Pepin RL, Aitken MS, Flaherty E. Age-friendly health care and the 4Ms in RN-led annual wellness visits. J Am Geriatr Soc 2024; 72 Suppl 2:S13-S20. [PMID: 38038359 DOI: 10.1111/jgs.18671] [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: 05/03/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Medicare annual wellness visits (AWVs) are prevention-focused healthcare visits free to Medicare recipients. These visits focus on health maintenance, health risk assessment, prevention of illness, and maintaining independence, all of which are within the scope of registered nurse (RN) practice as well as aligned with what matters, medication, mentation, and mobility - the 4Ms - of age-friendly health care. The objective of this pilot study was to evaluate the implementation of the 4Ms in the context of RN-led Medicare AWVs in a primary care practice. METHODS In a primary care practice with approximately 2500 patients, including approximately 571 of whom were enrolled in Medicare, RN-led Medicare AWVs were implemented, incorporating the 4Ms framework. During this time, data were collected on the effect of the AWV on access to care-conceptualized here as the number of visits available as well as the type of clinician open to staff these visits. Data collection also included patient responses to the 4Ms question "what matters most?" RESULTS Overall, the RN-led visits were successful and beneficial to the practice. Each RN-led visit allowed for 2 additional acute or monitoring visits per provider (nurse practitioner, MD) per day, increasing patient access to their primary care providers. Inclusion of the 4Ms questions facilitated discussion around overall mental and emotional well-being, life stressors, quality of life, and goals of care. CONCLUSION RN-led Medicare AWVs incorporating the 4Ms framework enhances the role of RNs in primary care by focusing on a health promotion role, utilizing RNs to their full scope of practice. RN-led AWVs increase provider availability for acute and chronic care appointments, as well as foster conversations around quality of life, as well as mental and emotional well-being.
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Affiliation(s)
- Jason T Garbarino
- Department of Nursing, University of Vermont, Burlington, Vermont, USA
- InSpring, Boston, Massachusetts, USA
| | - Sharon O'Connor
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Renée L Pepin
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Margaret S Aitken
- Department of Nursing, University of Vermont, Burlington, Vermont, USA
| | - Ellen Flaherty
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Health, Lebanon, New Hampshire, USA
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Deans CF, Abdeen AR, Ricciardi BF, Deen JT, Schabel KL, Sterling RS. New CMS Merit-Based Incentive Payment System Value Pathway After Total Knee and Hip Arthroplasty: Preparing for Mandatory Reporting. J Arthroplasty 2024; 39:1131-1135. [PMID: 38278186 DOI: 10.1016/j.arth.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/30/2023] [Accepted: 01/13/2024] [Indexed: 01/28/2024] Open
Abstract
This article discusses the implementation of a new Merit-Based Incentive Payment System Value Pathway (MVPs) applicable to elective total hip and total knee arthroplasty as created by Medicare and Medicaid Services (CMS) - the Improving Care for Lower Extremity Joint Repair MVP (MVP ID: G0058). We describe specific quality measures, surgeon-hospital collaborations, future developments with Quality Payment Program, and how lessons from early implementation will empower clinicians to participate in the refining of this MVP. The CMS has designed MVPs as a subset of measures relevant to a specialty or medical condition, in an effort to reduce the burden of reporting and improve assessment of care quality. Physicians and payors must be mindful of detrimental effects these measures in their current form may have on surgeons, institutions, and patients, including disincentivizing care for sicker or more vulnerable populations, and increased administrative costs. Early voluntary participation is crucial to gain valuable experience for the orthopedic community and in an effort to work alongside CMS to maximize care while minimizing cost for patients and burden for providers.
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Affiliation(s)
- Christopher F Deans
- Department of Orthopaedic Surgery & Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska; American Association of Hip and Knee Surgeons Health Policy Fellowship Program, Rosemont, Illinois
| | - Ayesha R Abdeen
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts
| | - Benjamin F Ricciardi
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York
| | | | - Kathryn L Schabel
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Robert S Sterling
- Department of Orthopaedic Surgery, George Washington University, Washington, District of Columbia
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29
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Li M, Lv G, Lee TY, Wu J, Lu K. Economic and clinical burdens and associated health disparities in HIV/AIDS management using big data: potentially inappropriate use and deprescribing of benzodiazepines. AIDS Care 2024; 36:604-611. [PMID: 33213189 DOI: 10.1080/09540121.2020.1842320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to examine factors, healthcare utilization, and medical costs associated with potentially inappropriate use of benzodiazepines in persons living with HIV (PLWH). We used big data from Medicare claims in 2017. Potentially inappropriate use of benzodiazepines was defined as having any benzodiazepine claims in individuals 65+ years or having benzodiazepine claims for more than four weeks in individuals 18-64 years. Logistic regressions, zero-inflated negative binomial regressions, and generalized linear models were used. This study included 1,211 PLWH and 235 (19.41%) had potentially inappropriate use of benzodiazepines. PLWH who were 65+ years (OR: 0.56; 95% CI: 0.33, 0.96), non-Hispanic blacks (OR: 0.29; 95% CI: 0.20, 0.41), or Hispanics (OR: 0.55; 95% CI: 0.35, 0.88) were less likely to use benzodiazepines inappropriately. PLWH who had potentially inappropriate use of benzodiazepines had more inpatient (IRR: 1.46; 95% CI: 1.10, 1.94), outpatient (IRR: 1.14; 95% CI 1.02, 1.28), and emergency room (IRR: 1.32; 95% CI: 1.03, 1.68) visits. Potentially inappropriate use of benzodiazepines was associated with higher total (β: 0.16; 95% CI: 0.07, 0.25), Medicare (β: 0.18; 95% CI: 0.07, 0.28), and out-of-pocket (β: 0.21; 95% CI: 0.05, 0.36) costs. This study provides real-world evidence to support deprescribing benzodiazepines in PLWH.
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Affiliation(s)
- Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gang Lv
- General Surgery Department, 1st Medical Center of PLA General Hospital, Beijing, China
| | - Tai-Ying Lee
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Jun Wu
- Presbyterian College School of Pharmacy, Clinton, SC, USA
| | - Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
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Shiau C, Kim DY, Young PA, Baker A, Bae GH. Trends in dermatologic procedures performed by dermatologists and advanced practice clinicians among Medicare beneficiaries from 2012 to 2020. J Am Acad Dermatol 2024; 90:1054-1057. [PMID: 38242175 DOI: 10.1016/j.jaad.2023.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/22/2023] [Accepted: 12/30/2023] [Indexed: 01/21/2024]
Affiliation(s)
| | | | - Peter A Young
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California; Department of Dermatology, The Permanente Medical Group, Sacramento, California
| | | | - Gordon H Bae
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
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Das Gupta D, Kelekar U, Turner SC. Older Adult Falls in the Community: Does Unsafe Home Environment Have a Risk Role Through the Mediating Effect of Functional Limitations? Gerontologist 2024; 64:gnad139. [PMID: 37870156 DOI: 10.1093/geront/gnad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Fall incidents from unsafe home environments are frequent in older-adult homes but the literature is ambiguous whether it is the presence/absence, or the interplay of such conditions and physical functioning that is of salience. We therefore estimated whether unsafe home environment is adversely associated with subsequent falls among older adults and what proportion of this association was mediated through limitations in daily and instrumental activities of daily living (ADL/IADL). RESEARCH DESIGN AND METHODS Using a nationally representative sample of community-dwelling Medicare beneficiaries (≥65 years) in the 2018-2019 National Health and Aging Trends Study (n = 2,599), we conducted bivariate and multivariable analyses. We examined baseline conditions of home disorders, unsafe bathroom settings, unsafe house/building features, and house disrepairs in 2018 and their relation with subsequent falls in 2019, after controlling for covariates. To assess whether ADL/IADL limitations mediated this relationship, we employed the Karlson-Holm-Breen methodology. RESULTS In 2019, the self-reported prevalence of falls among older adults was estimated at 34.68%. Although baseline home disorders had both a direct (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI]:1.03,1.26) and an indirect effect through limitations in ADL and IADL (aOR: 1.01; 95% CI: 1.00,1.03), the relation between unsafe bathroom settings and subsequent falls was unclear. Unsafe house/building features and house disrepairs were not statistically significantly related either directly or indirectly with subsequent falls. DISCUSSION AND IMPLICATIONS Addressing home disorders through policy and housing assessments to highlight home environmental safety would be essential to address falls among older adults.
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Affiliation(s)
- Debasree Das Gupta
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, Utah, USA
| | - Uma Kelekar
- School of Business, College of Business, Innovation, Leadership and Technology, Marymount University, Marymount Center for Optimal Aging, Arlington, Virginia, USA
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Columbo JA, Scali ST, Jacobs BN, Scully RE, Suckow BD, Huber TS, Neal D, Stone DH. Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration. J Vasc Surg 2024; 79:1069-1078.e8. [PMID: 38262565 PMCID: PMC11032259 DOI: 10.1016/j.jvs.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND The historical size threshold for abdominal aortic aneurysm (AAA) repair is widely accepted to be 5.5 cm for men and 5.0 cm for women. However, contemporary AAA rupture risks may be lower than historical benchmarks, which has implications for when AAAs should be repaired. Our objective was to use contemporary AAA rupture rates to inform optimal size thresholds for AAA repair. METHODS We used a Markov chain analysis to estimate life expectancy for patients with AAA. The primary outcome was AAA-related mortality. We estimated survival using Social Security Administration life tables and published contemporary AAA rupture estimates. For those undergoing repair, we modified survival estimates using data from the Vascular Quality Initiative and Medicare on complications, late rupture, and open conversion. We used this model to estimate the AAA repair size threshold that minimizes AAA-related mortality for 60-year-old average-health men and women. We performed a sensitivity analysis of poor-health patients and 70- and 80-year-old base cases. RESULTS The annual risk of all-cause mortality under surveillance for a 60-year-old woman presenting with a 5.0 cm AAA using repair thresholds of 5.5 cm, 6.0 cm, 6.5 cm, and 7.0 cm was 1.7%, 2.3%, 2.7%, and 2.8%, respectively. The corresponding risk for a man was 2.3%, 2.9%, 3.3%, and 3.4% for the same repair thresholds, respectively. For a 60-year-old average-health woman, an AAA repair size of 6.1 cm was the optimal threshold to minimize AAA-related mortality. Life expectancy varied by <2 months for repair at sizes from 5.7 cm to 7.1 cm. For a 60-year-old average-health man, an AAA repair size of 6.9 cm was the optimal threshold to minimize AAA-related mortality. Life expectancy varied by <2 months for repair at sizes from 6.0 cm to 7.4 cm. Women in poor health, at various age strata, had optimal AAA repair size thresholds that were >6.5 cm, whereas men in poor health, at all ages, had optimal repair size thresholds that were >8.0 cm. CONCLUSIONS The optimal threshold for AAA repair is more nuanced than a discrete size. Specifically, there appears to be a range of AAA sizes for which repair is reasonable to minmized AAA-related mortality. Notably, they all are greater than current guideline recommendations. These findings would suggest that contemporary AAA size thresholds for repair should be reconsidered.
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Affiliation(s)
- Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Surgery, Veteran's Affairs Medical Center, White River Junction, VT.
| | - Salvatore T Scali
- University of Florida School of Medicine, Gainesville, FL; Section of Vascular Surgery, Department of Surgery, University of Florida, Gainesville, FL; Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Benjamin N Jacobs
- University of Florida School of Medicine, Gainesville, FL; Section of Vascular Surgery, Department of Surgery, University of Florida, Gainesville, FL; Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Rebecca E Scully
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Surgery, Veteran's Affairs Medical Center, White River Junction, VT
| | - Bjoern D Suckow
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Surgery, Veteran's Affairs Medical Center, White River Junction, VT
| | - Thomas S Huber
- University of Florida School of Medicine, Gainesville, FL; Section of Vascular Surgery, Department of Surgery, University of Florida, Gainesville, FL; Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Dan Neal
- University of Florida School of Medicine, Gainesville, FL; Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - David H Stone
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Surgery, Veteran's Affairs Medical Center, White River Junction, VT
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DeMik DE, Gold PA, Frisch NB, Kerr JM, Courtney PM, Rana AJ. A Cautionary Tale: Malaligned Incentives in Total Hip and Knee Arthroplasty Payment Model Reforms Threaten Promising Innovation and Access to Care. J Arthroplasty 2024; 39:1125-1130. [PMID: 38336300 DOI: 10.1016/j.arth.2024.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Over the past several years, there have been notable changes and controversies involving Medicare reimbursement for total hip (THA) and total knee arthroplasty (TKA). We have seen the development and implementation of experimental bundled payment model pilot programs goals of improving quality and decreasing overall costs of care during the last decade. Many orthopaedic surgeons have embraced these programs and have demonstrated the ability to succeed in these new models by implementing strategies, such as preservice optimization, to shift care away from inpatient or postdischarge settings and reduce postoperative complications. However, these achievements have been met with continual reductions in surgeon reimbursement rates, lower bundle payment target pricings, modest increases in hospital reimbursement rates, and inappropriate valuations of THA and TKA Common Procedural Terminology (CPT) codes. These challenges have led to an organized advocacy movement and spurred research involving the methods by which improvements have been made throughout the entire episode of arthroplasty care. Collectively, these efforts have recently led to a novel application of CPT codes recognized by payers to potentially capture presurgical optimization work. In this paper, we present an overview of contemporary payment models, summarize notable events involved in the review of THA and TKA CPT codes, review recent changes to THA and TKA reimbursement, and discuss future challenges faced by arthroplasty surgeons that threaten access to high-quality THA and TKA care.
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Affiliation(s)
- David E DeMik
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Peter A Gold
- Panorama Orthopedics & Spine Center, Golden, Colorado
| | | | - Joshua M Kerr
- American Association of Hip and Knee Surgeons, Chicago, Illinois
| | | | - Adam J Rana
- Maine Medical Partners Orthopedics and Sports Medicine, South Portland, Maine
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Lunardi N, Jacob A, Elfenbein D, Schneider DF, Long K, Holoubek SA, MacKinney E, Chiu A, Sippel RS, Balentine CJ. Don't chase the adenoma: A probabilistic approach to imaging before parathyroidectomy. Surgery 2024; 175:1299-1304. [PMID: 38433078 DOI: 10.1016/j.surg.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Preoperative imaging before parathyroidectomy can localize adenomas and reduce unnecessary bilateral neck explorations. We hypothesized that (1) the utility of preoperative imaging varies substantially depending on the preoperative probability of having adenoma(s) and (2) that a selective imaging approach based on this probability could avoid unnecessary patient costs and radiation. METHODS We analyzed 3,577 patients who underwent parathyroidectomy for primary hyperparathyroidism from 2001 to 2022. The predicted probability of patients having single or double adenoma versus hyperplasia was estimated using logistic regression. We then estimated the relationship between the predicted probability of single/double adenoma and the likelihood that sestamibi or 4-dimensional computed tomography was helpful for operative planning. Current Medicare costs and published data on radiation dosing were used to calculate costs and radiation exposure from non-helpful imaging. RESULTS The mean age was 62 ± 13 years; 78% were women. Adenomas were associated with higher mean calcium (11.2 ± 0.74 mg/dL) and parathyroid hormone levels (140.6 ± 94 pg/mL) than hyperplasia (9.8 ± 0.52 mg/dL and 81.4 ± 66 pg/mL). The probability that imaging helped with operative planning increased from 12% to 65%, as the predicted probability of adenoma increased from 30% to 90%. For every 10,000 patients, a selective approach to imaging that considered the preoperative probability of having adenomas could save patients up to $3.4 million and >239,000 millisieverts of radiation. CONCLUSION Rather than imaging all patients with primary hyperparathyroidism, a selective strategy that considers the probability of having adenomas could reduce costs and avoid excess radiation exposure.
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Affiliation(s)
- Nicole Lunardi
- Department of Surgery, University of Texas Southwestern, Dallas, TX; Department of Surgery, North Texas VA Health Care System, Dallas, TX
| | - Allison Jacob
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Dawn Elfenbein
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - David F Schneider
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Kristin Long
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Simon A Holoubek
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Erin MacKinney
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Alexander Chiu
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Rebecca S Sippel
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI
| | - Courtney J Balentine
- Department of Endocrine Surgery, University of Wisconsin, Madison, WI; Wisconsin Surgical Outcomes Research Program, Madison, WI.
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Barrett CC, Laperche J, Clippert D, Glasser J, Garcia D, Antoci V. The Immediate Impact of Total Knee Arthroplasty Removal From the Medicare Inpatient-Only List on Patient Derived Functional Outcomes and Hospital Satisfaction. J Arthroplasty 2024; 39:1253-1258. [PMID: 37952740 DOI: 10.1016/j.arth.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is the standard of treatment for end-stage knee osteoarthritis. On January 1, 2018, the Centers for Medicare and Medicaid (CMS) officially removed TKA from their inpatient-only list. The clinical impact of this change is not fully understood yet. METHODS Electronic records were retrospectively reviewed for patients who underwent TKA between January 1 to June 30, 2017, or January 1 to June 30, 2018. Patients completed Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement surveys which assessed patient reported outcomes prior to and following TKA. Hospital statistics for the 2 time points were determined and compared. This was a single institution study resulting in 351 patients in the pre-CMS change group and 350 patients in the post-CMS change group. RESULTS Analysis of the pre-CMS and post-CMS transition cohorts indicated no significant difference in activities of daily living (ADLs), pain, or pain catastrophizing scale preoperatively or 12-months postoperatively. Additionally, there was no difference in the median change between preoperative and postoperative ADL scores (P = .866), yet pain scores approached significance with a P value of .054. The pre-CMS transition group stayed significantly longer in the hospital postoperatively and was more commonly discharged to a skilled nursing facility. No difference was seen in 30-day readmission rates (P = .253). CONCLUSIONS Results showed that patients had similar scores for ADL, quality of life, pain, and pain catastrophizing 12-months following their TKA. Movement of TKA from the Medicare inpatient only list did not have an immediate negative impact for patient reported outcomes and 30-day readmissions at our institution in the 6-month transition period.
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Affiliation(s)
| | - Jacob Laperche
- University Orthopedics Inc, East Providence, Rhode Island; Frank H. Netter School of Medicine, Quinnipiac University
| | - Drew Clippert
- University Orthopedics Inc, East Providence, Rhode Island
| | | | - Dioscaris Garcia
- Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Orthopaedic Surgery, Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Valentin Antoci
- University Orthopedics Inc, East Providence, Rhode Island; Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Orthopaedic Surgery, Brown University and Rhode Island Hospital, Providence, Rhode Island
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Chen KA, Pak J, Agala CB, Stem JM, Guillem JG, Barnes EL, Herfarth HH, Kapadia MR. Factors Associated With Performing IPAA After Total Colectomy for Ulcerative Colitis. Dis Colon Rectum 2024; 67:674-680. [PMID: 38276963 DOI: 10.1097/dcr.0000000000003130] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND IPAA is considered the procedure of choice for restorative surgery after total colectomy for ulcerative colitis. Previous studies have examined the rate of IPAA within individual states but not at the national level in the United States. OBJECTIVE This study aimed to assess the rate of IPAA after total colectomy for ulcerative colitis in a national population and identify factors associated with IPAA. DESIGN This was a retrospective cohort study. SETTINGS This study was performed in the United States. PATIENTS Patients who were aged 18 years or older and who underwent total colectomy between 2009 and 2019 for a diagnosis of ulcerative colitis were identified within a commercial database. This database excluded patients with public insurance, including all patients older than 65 years with Medicare. MAIN OUTCOME MEASURES The primary outcome was IPAA. Multivariable logistic regression was used to assess the association between covariates and the likelihood of undergoing IPAA. RESULTS In total, 2816 patients were included, of whom 1414 (50.2%) underwent IPAA, 928 (33.0%) underwent no further surgery, and 474 (16.8%) underwent proctectomy with end ileostomy. Younger age, lower comorbidities, elective case, and laparoscopic approach in the initial colectomy were significantly associated with IPAA but socioeconomic status was not. LIMITATIONS This retrospective study included only patients with commercial insurance. CONCLUSIONS A total of 50.2% of patients who had total colectomy for ulcerative colitis underwent IPAA, and younger age, lower comorbidities, and elective cases are associated with a higher rate of IPAA placement. This study emphasizes the importance of ensuring follow-up with colorectal surgeons to provide the option of restorative surgery, especially for patients undergoing urgent or emergent colectomies. See Video Abstract . FACTORES ASOCIADOS CON LA REALIZACIN DE ANASTOMOSIS ANALBOLSA ILEAL DESPUS DE UNA COLECTOMA TOTAL POR COLITIS ULCEROSA ANTECEDENTES:La anastomosis ileo-anal se considera el procedimiento de elección para la cirugía reparadora tras la colectomía total por colitis ulcerosa. Estudios previos han examinado la tasa de anastomosis ileo-anal dentro de los estados individuales, pero no a nivel nacional en los Estados Unidos.OBJETIVO:Evaluar la tasa de anastomosis bolsa ileal-anal después de la colectomía total para la colitis ulcerosa en una población nacional e identificar los factores asociados con la anastomosis bolsa ileal-anal.DISEÑO:Se trata de un estudio de cohortes retrospectivo.LUGAR:Este estudio se realizó en los Estados Unidos.PACIENTES:Los pacientes que tenían ≥18 años de edad que se sometieron a colectomía total entre 2009 y 2019 para un diagnóstico de colitis ulcerosa fueron identificados dentro de una base de datos comercial. Esta base de datos excluyó a los pacientes con seguro público, incluidos todos los pacientes >65 años con Medicare.MEDIDAS DE RESULTADO PRINCIPALES:El resultado primario fue la anastomosis ileal bolsa-anal. Se utilizó una regresión logística multivariable para evaluar la asociación entre las covariables y la probabilidad de someterse a una anastomosis ileal.RESULTADOS:En total, se incluyeron 2.816 pacientes, de los cuales 1.414 (50,2%) se sometieron a anastomosis ileo-anal, 928 (33,0%) no se sometieron a ninguna otra intervención quirúrgica y 474 (16,8%) se sometieron a proctectomía con ileostomía terminal. La edad más joven, las comorbilidades más bajas, el caso electivo, y el abordaje laparoscópico en la colectomía inicial se asociaron significativamente con la anastomosis ileal bolsa-anal, pero no el estatus socioeconómico.LIMITACIONES:Este estudio retrospectivo incluyó sólo pacientes con seguro comercial.CONCLUSIONES:Un 50,2% de los pacientes se someten a anastomosis ileo-anal y la edad más joven, las comorbilidades más bajas y los casos electivos se asocian con una mayor tasa de colocación de anastomosis ileo-anal. Esto subraya la importancia de asegurar el seguimiento con cirujanos colorrectales para ofrecer la opción de cirugía reparadora, especialmente en pacientes sometidos a colectomías urgentes o emergentes. (Traducción-Dr. Yolanda Colorado ).
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Affiliation(s)
- Kevin A Chen
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joyce Pak
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris B Agala
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan M Stem
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jose G Guillem
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sutton KF, Cabell GH, Ashley LW, Lentz TA, Lewis BD, Olson SA, Mather RC. Does psychological distress predict risk of orthopaedic surgery and postoperative opioid prescribing in patients with hip pain? A retrospective study. BMC Musculoskelet Disord 2024; 25:304. [PMID: 38643071 PMCID: PMC11031887 DOI: 10.1186/s12891-024-07418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/05/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Clinicians and public health professionals have allocated resources to curb opioid over-prescription and address psychological needs among patients with musculoskeletal pain. However, associations between psychological distress, risk of surgery, and opioid prescribing among those with hip pathologies remain unclear. METHODS Using a retrospective cohort study design, we identified patients that were evaluated for hip pain from January 13, 2020 to October 27, 2021. Patients' surgical histories and postoperative opioid prescriptions were extracted via chart review. Risk of hip surgery within one year of evaluation was analyzed using multivariable logistic regression. Multivariable linear regression was employed to predict average morphine milligram equivalents (MME) per day of opioid prescriptions within the first 30 days after surgery. Candidate predictors included age, gender, race, ethnicity, employment, insurance type, hip function and quality of life on the International Hip Outcome Tool (iHOT-12), and psychological distress phenotype using the OSPRO Yellow Flag (OSPRO-YF) Assessment Tool. RESULTS Of the 672 patients, n = 350 (52.1%) underwent orthopaedic surgery for hip pain. In multivariable analysis, younger patients, those with TRICARE/other government insurance, and those with a high psychological distress phenotype had higher odds of surgery. After adding iHOT-12 scores, younger patients and lower iHOT-12 scores were associated with higher odds of surgery, while Black/African American patients had lower odds of surgery. In multivariable analysis of average MME, patients with periacetabular osteotomy (PAO) received opioid prescriptions with significantly higher average MME than those with other procedures, and surgery type was the only significant predictor. Post-hoc analysis excluding PAO found higher average MME for patients undergoing hip arthroscopy (compared to arthroplasty or other non-PAO procedures) and significantly lower average MME for patients with public insurance (Medicare/Medicaid) compared to those with private insurance. Among those only undergoing arthroscopy, older age and having public insurance were associated with opioid prescriptions with lower average MME. Neither iHOT-12 scores nor OSPRO-YF phenotype assignment were significant predictors of postoperative mean MME. CONCLUSIONS Psychological distress characteristics are modifiable targets for rehabilitation programs, but their use as prognostic factors for risk of orthopaedic surgery and opioid prescribing in patients with hip pain appears limited when considered alongside other commonly collected clinical information such as age, insurance, type of surgery pursued, and iHOT-12 scores.
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Affiliation(s)
- Kent F Sutton
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Grant H Cabell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Lucas W Ashley
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian D Lewis
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven A Olson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Richard C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Wang HE, Weiner JP, Saria S, Kharrazi H. Evaluating Algorithmic Bias in 30-Day Hospital Readmission Models: Retrospective Analysis. J Med Internet Res 2024; 26:e47125. [PMID: 38422347 DOI: 10.2196/47125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 12/28/2023] [Accepted: 02/27/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The adoption of predictive algorithms in health care comes with the potential for algorithmic bias, which could exacerbate existing disparities. Fairness metrics have been proposed to measure algorithmic bias, but their application to real-world tasks is limited. OBJECTIVE This study aims to evaluate the algorithmic bias associated with the application of common 30-day hospital readmission models and assess the usefulness and interpretability of selected fairness metrics. METHODS We used 10.6 million adult inpatient discharges from Maryland and Florida from 2016 to 2019 in this retrospective study. Models predicting 30-day hospital readmissions were evaluated: LACE Index, modified HOSPITAL score, and modified Centers for Medicare & Medicaid Services (CMS) readmission measure, which were applied as-is (using existing coefficients) and retrained (recalibrated with 50% of the data). Predictive performances and bias measures were evaluated for all, between Black and White populations, and between low- and other-income groups. Bias measures included the parity of false negative rate (FNR), false positive rate (FPR), 0-1 loss, and generalized entropy index. Racial bias represented by FNR and FPR differences was stratified to explore shifts in algorithmic bias in different populations. RESULTS The retrained CMS model demonstrated the best predictive performance (area under the curve: 0.74 in Maryland and 0.68-0.70 in Florida), and the modified HOSPITAL score demonstrated the best calibration (Brier score: 0.16-0.19 in Maryland and 0.19-0.21 in Florida). Calibration was better in White (compared to Black) populations and other-income (compared to low-income) groups, and the area under the curve was higher or similar in the Black (compared to White) populations. The retrained CMS and modified HOSPITAL score had the lowest racial and income bias in Maryland. In Florida, both of these models overall had the lowest income bias and the modified HOSPITAL score showed the lowest racial bias. In both states, the White and higher-income populations showed a higher FNR, while the Black and low-income populations resulted in a higher FPR and a higher 0-1 loss. When stratified by hospital and population composition, these models demonstrated heterogeneous algorithmic bias in different contexts and populations. CONCLUSIONS Caution must be taken when interpreting fairness measures' face value. A higher FNR or FPR could potentially reflect missed opportunities or wasted resources, but these measures could also reflect health care use patterns and gaps in care. Simply relying on the statistical notions of bias could obscure or underplay the causes of health disparity. The imperfect health data, analytic frameworks, and the underlying health systems must be carefully considered. Fairness measures can serve as a useful routine assessment to detect disparate model performances but are insufficient to inform mechanisms or policy changes. However, such an assessment is an important first step toward data-driven improvement to address existing health disparities.
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Affiliation(s)
- H Echo Wang
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jonathan P Weiner
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins Center for Population Health Information Technology, Baltimore, MD, United States
| | - Suchi Saria
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Hadi Kharrazi
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins Center for Population Health Information Technology, Baltimore, MD, United States
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Zheng H, Ash AS, Yang W, Liu SH, Allison J, Ayers DC. Strengthening Quality Measurement to Predict Success for Total Knee Arthroplasty: Results from a Nationally Representative Total Knee Arthroplasty Cohort. J Bone Joint Surg Am 2024; 106:708-715. [PMID: 38271493 PMCID: PMC11023798 DOI: 10.2106/jbjs.23.00602] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND When performed well on appropriate patients, total knee arthroplasty (TKA) can dramatically improve quality of life. Patient-reported outcome measures (PROMs) are increasingly used to measure outcome following TKA. Accurate prediction of improvement in PROMs after TKA potentially plays an important role in judging the surgical quality of the health-care institutions as well as informing preoperative shared decision-making. Starting in 2027, the U.S. Centers for Medicare & Medicaid Services (CMS) will begin mandating PROM reporting to assess the quality of TKAs. METHODS Using data from a national cohort of patients undergoing primary unilateral TKA, we developed an original model that closely followed a CMS-proposed measure to predict success, defined as achieving substantial clinical benefit, specifically at least a 20-point improvement on the Knee injury and Osteoarthritis Outcome Score, Joint Arthroplasty (KOOS, JR) at 1 year, and an enhanced model with just 1 additional predictor: the baseline KOOS, JR. We evaluated each model's performance using the area under the receiver operator characteristic curve (AUC) and the ratio of observed to expected (model-predicted) outcomes (O:E ratio). RESULTS We studied 5,958 patients with a mean age of 67 years; 63% were women, 93% were White, and 87% were overweight or obese. Adding the baseline KOOS, JR improved the AUC from 0.58 to 0.73. Ninety-four percent of those in the top decile of predicted probability of success under the enhanced model achieved success, compared with 34% in its bottom decile. Analogous numbers for the original model were less discriminating: 77% compared with 57%. Only the enhanced model predicted success accurately across the spectrum of baseline scores. The findings were virtually identical when we replicated these analyses on only patients ≥65 years of age. CONCLUSIONS Adding a baseline knee-specific PROM score to a quality measurement model in a nationally representative cohort dramatically improved its predictive power, eliminating ceiling and floor effects and mispredictions for readily identifiable patient subgroups. The enhanced model neither favors nor discourages care for those with greater knee dysfunction and requires no new data collection. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Arlene S Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Wenyun Yang
- Department of Commonwealth Medicine, Public and Private Health Solutions, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Park S, Nguyen AM. Determinants and effectiveness of annual wellness visits among Medicare beneficiaries in 2020. Fam Pract 2024; 41:203-206. [PMID: 37972381 DOI: 10.1093/fampra/cmad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Annual wellness visits (AWVs) have the potential to improve general health and well-being, but little is known about the role of AWVs during the COVID-19 pandemic. OBJECTIVE We examined the determinants and effectiveness of having an AWV among Medicare beneficiaries in 2020. METHODS We employed a cross-sectional study design using data from the 2020 Medicare Current Beneficiary Survey. Our outcomes included AWV utilization, preventive care utilization, health status, and care satisfaction. To examine the determinants for having an AWV, we performed a linear regression model and explored the associations with other individual-level variables (demographic, socioeconomic, and health characteristics). To examine the effectiveness of having an AWV, we performed a linear regression model on each outcome measure while adjusting for individual-level variables. RESULTS We found that there were several determinants of having an AWV. The four most notable determinants were having a usual source of care, enrolling in Medicare Advantage, being non-Hispanic Black, and being Hispanic. We also found that having an AWV was associated with increases in preventive care use (COVID vaccine, flu shot, pneumonia shot, and blood pressure measurement), but was limited in improving health status and care satisfaction. CONCLUSION Our finding raises critical concerns about inequitable access to health care services for disease prevention and health promotion during the pandemic. Furthermore, the effectiveness of AWVs was mostly in increased preventive care use, suggesting a limited role in meeting the wellness needs of a diverse population of older adults.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Ann M Nguyen
- Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, United States
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Han Y, Xu F, Morgenstern H, Bragg-Gresham J, Gillespie BW, Steffick D, Herman WH, Pavkov ME, Veinot T, Saran R. Mapping the Overlap of Poverty Level and Prevalence of Diagnosed Chronic Kidney Disease Among Medicare Beneficiaries in the United States. Prev Chronic Dis 2024; 21:E23. [PMID: 38603519 DOI: 10.5888/pcd21.230286] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Affiliation(s)
- Yun Han
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor
| | - Fang Xu
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hal Morgenstern
- Department of Epidemiology, University of Michigan, Ann Arbor
- Departments of Environmental Health Sciences and Urology, University of Michigan, Ann Arbor
| | - Jennifer Bragg-Gresham
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor
| | | | - Diane Steffick
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor
| | - William H Herman
- Department of Epidemiology, University of Michigan, Ann Arbor
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor
| | - Meda E Pavkov
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tiffany Veinot
- School of Information, University of Michigan, Ann Arbor
| | - Rajiv Saran
- Department of Internal Medicine, Division of Nephrology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48105
- Department of Epidemiology, University of Michigan, Ann Arbor
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Robinson JC, Whaley C, Dhruva SS. Hospital Prices for Physician-Administered Drugs. Reply. N Engl J Med 2024; 390:1347-1348. [PMID: 38598815 DOI: 10.1056/nejmc2402132] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
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Harrison JM, Ernecoff NC, Lai JS, Hanmer J, Weir R, Rodriguez A, Langer MM, Edelen MO. Health system implementation of the PROMIS Cognitive Function Screener in the Medicare Annual Wellness Visit: framing as abilities versus concerns. J Patient Rep Outcomes 2024; 8:43. [PMID: 38598162 PMCID: PMC11006629 DOI: 10.1186/s41687-024-00699-8] [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: 07/27/2023] [Accepted: 02/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Cognitive assessment is a required component of the Medicare Annual Wellness Visit (AWV). In this prospective study, we evaluated acceptability and usefulness of a patient-reported outcome measure (the PROMIS® Cognitive Function Screener, or PRO-CS) to screen for cognitive impairment during the AWV. We compared two versions of the PRO-CS: Abilities and Concerns. METHODS We developed PRO-CS Abilities and PRO-CS Concerns using items from the PROMIS Cognitive Function item banks. We partnered with a large health system in Pennsylvania to implement an electronic health record (EHR)-integrated version of the 4-item PRO-CS into their AWV workflow. PRO-CS Abilities was implemented in June 2022 and then replaced with PRO-CS Concerns in October 2022. We used EHR data to evaluate scores on Abilities versus Concerns and their association with patient characteristics. We gathered feedback from providers on experiences with the PRO-CS and conducted cognitive interviews with patients to evaluate their preferences for Abilities versus Concerns. RESULTS Between June 2022 and January 2023, 3,088 patients completed PRO-CS Abilities and 2,614 patients completed PRO-CS Concerns. Mean T-scores for Abilities (54.8) were slightly higher (indicating better cognition) than for Concerns (52.6). 10% of scores on Abilities and 13% of scores on Concerns indicated concern for cognitive impairment (T-score < 45). Both Abilities and Concerns were associated with clinical characteristics as hypothesized, with lower scores for patients with cognitive impairment diagnoses and those requiring assistance with instrumental activities of daily living. Abilities and Concerns had similar negative correlations with depression (r= -0.31 versus r= -0.33) and anxiety (r= -0.28 for both), while Abilities had a slightly stronger positive correlation with self-rated health (r = 0.34 versus r = 0.28). In interviews, providers commented that the PRO-CS could be useful to facilitate conversations about cognition, though several providers noted potential limitations of patient self-report. Feedback from patients indicated a preference for PRO-CS Concerns. CONCLUSIONS Our findings suggest potential utility of the PRO-CS for cognitive screening in the Medicare AWV. PRO-CS Abilities and Concerns had similar associations with patient clinical characteristics, but the Concerns version was more acceptable to patients.
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Affiliation(s)
- Jordan M Harrison
- RAND Corporation, 4570 Fifth Avenue #600, 15213, Pittsburgh, PA, USA.
| | | | - Jin-Shei Lai
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Michelle M Langer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria O Edelen
- RAND Corporation, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
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Starling CM, Smith M, Kazi S, Milicia A, Grisham R, Gruber E, Blumenthal J, Arem H. Understanding social needs screening and demographic data collection in primary care practices serving Maryland Medicare patients. BMC Health Serv Res 2024; 24:448. [PMID: 38600578 PMCID: PMC11005183 DOI: 10.1186/s12913-024-10948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Health outcomes are strongly impacted by social determinants of health, including social risk factors and patient demographics, due to structural inequities and discrimination. Primary care is viewed as a potential medical setting to assess and address individual health-related social needs and to collect detailed patient demographics to assess and advance health equity, but limited literature evaluates such processes. METHODS We conducted an analysis of cross-sectional survey data collected from n = 507 Maryland Primary Care Program (MDPCP) practices through Care Transformation Requirements (CTR) reporting in 2022. Descriptive statistics were used to summarize practice responses on social needs screening and demographic data collection. A stepwise regression analysis was conducted to determine factors predicting screening of all vs. a targeted subset of beneficiaries for unmet social needs. RESULTS Almost all practices (99%) reported conducting some form of social needs screening and demographic data collection. Practices reported variation in what screening tools or demographic questions were employed, frequency of screening, and how information was used. More than 75% of practices reported prioritizing transportation, food insecurity, housing instability, financial resource strain, and social isolation. CONCLUSIONS Within the MDPCP program there was widespread implementation of social needs screenings and demographic data collection. However, there was room for additional supports in addressing some challenging social needs and increasing detailed demographics. Further research is needed to understand any adjustments to clinical care in response to identified social needs or application of data for uses such as assessing progress towards health equity and the subsequent impact on clinical care and health outcomes.
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Affiliation(s)
- Claire M Starling
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA.
| | - Marjanna Smith
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA
| | - Sadaf Kazi
- Department of Emergency Medicine, Georgetown University School of Medicine, 3900 Reservoir Road, Washington, NWDC, 20007, USA
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Arianna Milicia
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Rachel Grisham
- Maryland Primary Care Program, Maryland Department of Health, 201 W. Preston Street, Baltimore, MD, 21201, USA
| | - Emily Gruber
- Maryland Primary Care Program, Maryland Department of Health, 201 W. Preston Street, Baltimore, MD, 21201, USA
| | - Joseph Blumenthal
- MedStar Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, 3007 Tilden St.Suite 6N, Washington, NWDC, 20008, USA
| | - Hannah Arem
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA
- Department of Oncology, Georgetown University School of Medicine, 3900 Reservoir Road, Washington, NWDC, 20007, USA
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Padula WV, Armstrong DG, Pronovost PJ, Saria S. Predicting pressure injury risk in hospitalised patients using machine learning with electronic health records: a US multilevel cohort study. BMJ Open 2024; 14:e082540. [PMID: 38594078 DOI: 10.1136/bmjopen-2023-082540] [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: 04/11/2024] Open
Abstract
OBJECTIVE To predict the risk of hospital-acquired pressure injury using machine learning compared with standard care. DESIGN We obtained electronic health records (EHRs) to structure a multilevel cohort of hospitalised patients at risk for pressure injury and then calibrate a machine learning model to predict future pressure injury risk. Optimisation methods combined with multilevel logistic regression were used to develop a predictive algorithm of patient-specific shifts in risk over time. Machine learning methods were tested, including random forests, to identify predictive features for the algorithm. We reported the results of the regression approach as well as the area under the receiver operating characteristics (ROC) curve for predictive models. SETTING Hospitalised inpatients. PARTICIPANTS EHRs of 35 001 hospitalisations over 5 years across 2 academic hospitals. MAIN OUTCOME MEASURE Longitudinal shifts in pressure injury risk. RESULTS The predictive algorithm with features generated by machine learning achieved significantly improved prediction of pressure injury risk (p<0.001) with an area under the ROC curve of 0.72; whereas standard care only achieved an area under the ROC curve of 0.52. At a specificity of 0.50, the predictive algorithm achieved a sensitivity of 0.75. CONCLUSIONS These data could help hospitals conserve resources within a critical period of patient vulnerability of hospital-acquired pressure injury which is not reimbursed by US Medicare; thus, conserving between 30 000 and 90 000 labour-hours per year in an average 500-bed hospital. Hospitals can use this predictive algorithm to initiate a quality improvement programme for pressure injury prevention and further customise the algorithm to patient-specific variation by facility.
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Affiliation(s)
- William V Padula
- Department of Pharmaceutical & Health Economics, University of Southern California Mann School of Pharmacy & Pharmaceutical Sciences, Los Angeles, CA, USA
- Stage Analytics, Suwanee, GA, USA
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - David G Armstrong
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
- Department of Surgery, USC Keck School of Medicine, Los Angeles, California, USA
| | - Peter J Pronovost
- University Hospitals of Cleveland, Shaker Heights, Ohio, USA
- Anesthesiology and Critical Care Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Suchi Saria
- Department of Computer Science, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
- Department of Health Policy & Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kim PC, Tan LF, Kreston J, Shariatmadari H, Keyoung ES, Shen JJ, Wang BL. Socioeconomic factors associated with use of telehealth services in outpatient care settings during the COVID-19. BMC Health Serv Res 2024; 24:446. [PMID: 38594743 PMCID: PMC11005124 DOI: 10.1186/s12913-024-10797-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND To examine potential changes and socioeconomic disparities in utilization of telemedicine in non-urgent outpatient care in Nevada since the COVID-19 pandemic. METHODS This retrospective cross-sectional analysis of telemedicine used the first nine months of 2019 and 2020 electronic health record data from regular non-urgent outpatient care in a large healthcare provider in Nevada. The dependent variables were the use of telemedicine among all outpatient visits and using telemedicine more than once among those patients who did use telemedicine. The independent variables were race/ethnicity, insurance status, and language preference. RESULTS Telemedicine services increased from virtually zero (16 visits out of 237,997 visits) in 2019 to 10.8% (24,159 visits out of 222,750 visits) in 2020. Asians (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.85,0.94) and Latinos/Hispanics (OR = 0.89; 95% CI = 0.85, 0.94) were less likely to use telehealth; Spanish-speaking patients (OR = 0.68; 95% CI = 0.63, 0.73) and other non-English-speaking patients (OR = 0.93; 95% CI = 0.88, 0.97) were less likely to use telehealth; and both Medicare (OR = 0.94; 95% CI = 0.89, 0.99) and Medicaid patients (OR = 0.91; 95% CI = 0.87, 0.97) were less likely to use telehealth than their privately insured counterparts. Patients treated in pediatric (OR = 0.76; 95% CI = 0.60, 0.96) and specialty care (OR = 0.67; 95% CI = 0.65, 0.70) were less likely to use telemedicine as compared with patients who were treated in adult medicine. CONCLUSIONS Racial/ethnic and linguistic factors were significantly associated with the utilization of telemedicine in non-urgent outpatient care during COVID-19, with a dramatic increase in telemedicine utilization during the onset of the pandemic. Reducing barriers related to socioeconomic factors can be improved via policy and program interventions.
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Affiliation(s)
- Pearl C Kim
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada in Las Vegas, Las Vegas, USA
| | | | | | - Haniyeh Shariatmadari
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada in Las Vegas, Las Vegas, USA
| | | | - Jay J Shen
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada in Las Vegas, Las Vegas, USA.
- Center for Health Disparities and Research, School of Public Health, University of Nevada in Las Vegas, Las Vegas, USA.
| | - Bing-Long Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Baser O, Samayoa G, Dwivedi A, AlSaleh S, Cigdem B, Kizilkaya E. Cardiovascular events among patients with prostate cancer treated with abiraterone and enzalutamide. Acta Oncol 2024; 63:137-146. [PMID: 38591349 DOI: 10.2340/1651-226x.2024.20337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE There is growing concern about the adverse metabolic and cardiovascular effects of abiraterone acetate (AA) and enzalutamide (ENZ), two standard hormonal therapies for prostate cancer. We analysed the risk of cardiovascular adverse events among patients treated with AA and ENZ. PATIENTS AND METHODS We used Kythera Medicare data from January 2019 to June 2023 to identify patients with at least one pharmacy claim for AA or ENZ. The index date was the first prescription claim date. Patients were required to have 1 year of data pre- and post-index date. New users excluded those with prior AA or ENZ claims and pre-existing cardiovascular comorbidities. Demographic and clinical variables, including age, socioeconomic status (SES), comorbidity score, prostate-specific comorbidities, and healthcare costs, were analysed . Propensity score matching was employed for risk adjustment. RESULTS Of the 8,929 and 8,624 patients in the AA and ENZ cohorts, respectively, 7,647 were matched after adjusting for age, sociodemographic, and clinical factors. Between the matched cohorts (15.54% vs. 14.83%, p < 0.05), there were no statistically significant differences in any cardiovascular event after adjusting for these factors. The most common cardiovascular event in both cohorts was heart failure (5.20% vs. 4.49%), followed by atrial fibrillation (4.42% vs. 3.60%) and hypotension (2.93% vs. 2.48%). INTERPRETATION This study provides real-world evidence of the cardiovascular risk of AA and ENZ that may not appear in clinical trial settings. Adjusting for age, baseline comorbidities, and SES, the likelihood of a cardiovascular event did not differ between treatment groups.
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Affiliation(s)
- Onur Baser
- Department of Economics, Bogazici University, Bebek, Istanbul, Turkiye; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Graduate School of Public Health, City University of New York, New York, USA.
| | | | | | - Sara AlSaleh
- Columbia Data Analytics, Ann Arbor, Michigan, USA
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Riviere P, Morgan KM, Deshler LN, Huang X, Marienfeld C, Coyne CJ, Rose BS, Murphy JD. Opioid tapering in older cancer survivors does not increase psychiatric or drug hospitalization rates. J Natl Cancer Inst 2024; 116:606-612. [PMID: 37971959 PMCID: PMC10995846 DOI: 10.1093/jnci/djad241] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Opioid tapering in the general population is linked to increases in hospitalizations or emergency department visits related to psychiatric or drug-related diagnoses. Cancer survivors represent a unique population with different opioid indications, prescription patterns, and more frequent follow-up care. This study sought to describe patterns of opioid tapering among older cancer survivors and to test the hypothesis of whether older cancer survivors face increased risks of adverse events with opioid tapering. METHODS Using the Surveillance, Epidemiology and End Results Medicare-linked database, we identified 15 002 Medicare-beneficiary cancer survivors diagnosed between 2010 and 2017 prescribed opioids consistently for at least 6 months after their cancer diagnosis. Tapering was defined as a binary time-varying event occurring with any monthly oral morphine equivalent reduction of 15% or more from the previous month. Primary diagnostic billing codes associated with emergency room or hospital admissions were used for the composite endpoint of psychiatric- or drug-related event(s). RESULTS There were 3.86 events per 100 patient-months, with 97.8% events being mental health emergencies, 1.91% events being overdose emergencies, and 0.25% involving both. Using a generalized estimating equation for repeated measure time-based analysis, opioid tapering was not statistically associated with acute events in the 3-month posttaper period (odds ratio [OR] = 1.02; P = .62) or at any point in the future (OR = 0.96; P = .46). CONCLUSIONS Opioid tapering in older cancer survivors does not appear to be linked to a higher risk of acute psychiatric- or drug-related events, in contrast to prior research in the general population.
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Affiliation(s)
- Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
| | - Kylie M Morgan
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
| | - Leah N Deshler
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
| | - Xinyi Huang
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Carla Marienfeld
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Christopher J Coyne
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Emergency Medicine, University of California San Diego, La Jolla, CA, USA
| | - Brent S Rose
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
- Center for Health Equity and Education Research, University of California San Diego, La Jolla, CA, USA
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McIntyre A, Smith RB, Sommers BD. Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility. JAMA Health Forum 2024; 5:e240430. [PMID: 38578627 PMCID: PMC10998158 DOI: 10.1001/jamahealthforum.2024.0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/10/2024] [Indexed: 04/06/2024] Open
Abstract
Importance Policy changes and the COVID-19 pandemic affected health coverage rates, and the "unwinding" of Medicaid's continuous coverage provision in 2023 and 2024 may cause widespread coverage loss. Recent coverage patterns in national survey and administrative data can inform these issues. Objective To assess national and state changes in survey-based Medicaid, private insurance, and uninsured rates between 2019 and 2022, as well as how these changes compare with administrative Medicaid enrollment totals. Design, Setting, and Participants This cross-sectional study analyzes nationally representative survey data for all US residents in the American Community Survey (ACS) from 2019 to 2022 compared with administrative data on Medicaid and the Children's Health Insurance Program from the Centers for Medicare & Medicaid Services (CMS). Data analysis was conducted between June 2023 and January 2024. Exposures The COVID-19 pandemic, the Medicaid continuous coverage provision, and policy efforts to increase Marketplace coverage. Main Outcomes and Measures Medicaid coverage (self-reported [ACS] and administratively recorded [CMS]), survey-reported uninsured, Medicare, and private insurance status. Results A nationally representative sample consisted of 12 506 584 US residents of all ages (survey-weighted 59.7% aged 19-64 years and 50.6% female). CMS statistics showed an increase in Medicaid coverage of 5.2 percentage points as a share of the population from 2019 to 2022. However, changes in the uninsured rate and survey-reported Medicaid were smaller: -1.2 (95% CI, -1.3 to -1.2) percentage points and 1.3 (95% CI, 1.2-1.4) percentage points, respectively. There was a 3.9 percentage point increase in the ACS's "undercount" of Medicaid enrollment, compared with CMS data, from 2019 to 2022. This undercount was larger among children than adults but smaller in states that recently expanded Medicaid. Rates of additional forms of coverage (such as private insurance) among those in Medicaid also grew during this time. Conclusion and Relevance In this cross-sectional study, the uninsured rate declined considerably from 2019 to 2022 but was just one-fourth as large as the growth in administrative Medicaid enrollment under the pandemic continuous coverage provision. Survey-based Medicaid growth was far smaller than administrative growth. This suggests that many people who remained enrolled in Medicaid during the pandemic did not realize that their coverage had continued. These findings have implications for projecting uninsured changes during unwinding, as well as the effect of continuous coverage policies on continuity of care.
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Affiliation(s)
- Adrianna McIntyre
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rebecca B. Smith
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Benjamin D. Sommers
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Shuey B, Halbisen A, Lakoma M, Zhang F, Argetsinger S, Williams EC, Druss BG, Wen H, Wharam JF. High-Acuity Alcohol-Related Complications During the COVID-19 Pandemic. JAMA Health Forum 2024; 5:e240501. [PMID: 38607643 DOI: 10.1001/jamahealthforum.2024.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Importance Research has demonstrated an association between the COVID-19 pandemic and increased alcohol-related liver disease hospitalizations and deaths. However, trends in alcohol-related complications more broadly are unclear, especially among subgroups disproportionately affected by alcohol use. Objective To assess trends in people with high-acuity alcohol-related complications admitted to the emergency department, observation unit, or hospital during the COVID-19 pandemic, focusing on demographic differences. Design, Setting, and Participants This longitudinal interrupted time series cohort study analyzed US national insurance claims data using Optum's deidentified Clinformatics Data Mart database from March 2017 to September 2021, before and after the March 2020 COVID-19 pandemic onset. A rolling cohort of people 15 years and older who had at least 6 months of continuous commercial or Medicare Advantage coverage were included. Subgroups of interest included males and females stratified by age group. Data were analyzed from April 2023 to January 2024. Exposure COVID-19 pandemic environment from March 2020 to September 2021. Main Outcomes and Measures Differences between monthly rates vs predicted rates of high-acuity alcohol-related complication episodes, determined using claims-based algorithms and alcohol-specific diagnosis codes. The secondary outcome was the subset of complication episodes due to alcohol-related liver disease. Results Rates of high-acuity alcohol-related complications were statistically higher than expected in 4 of 18 pandemic months after March 2020 (range of absolute and relative increases: 0.4-0.8 episodes per 100 000 people and 8.3%-19.4%, respectively). Women aged 40 to 64 years experienced statistically significant increases in 10 of 18 pandemic months (range of absolute and relative increases: 1.3-2.1 episodes per 100 000 people and 33.3%-56.0%, respectively). In this same population, rates of complication episodes due to alcohol-related liver disease increased above expected in 16 of 18 pandemic months (range of absolute and relative increases: 0.8-2.1 episodes per 100 000 people and 34.1%-94.7%, respectively). Conclusions and Relevance In this cohort study of a national, commercially insured population, high-acuity alcohol-related complication episodes increased beyond what was expected in 4 of 18 COVID-19 pandemic months. Women aged 40 to 64 years experienced 33.3% to 56.0% increases in complication episodes in 10 of 18 pandemic months, a pattern associated with large and sustained increases in high-acuity alcohol-related liver disease complications. Findings underscore the need for increased attention to alcohol use disorder risk factors, alcohol use patterns, alcohol-related health effects, and alcohol regulations and policies, especially among women aged 40 to 64 years.
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Affiliation(s)
- Bryant Shuey
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
- Now with Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alyssa Halbisen
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Matthew Lakoma
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Argetsinger
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Benjamin G Druss
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Hefei Wen
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - J Franklin Wharam
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Duke University, Durham, North Carolina
- Duke-Margolis Institute for Health Policy, Durham, North Carolina
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