1
|
Ibayashi K, Fujino Y, Mimaki M, Fujimoto K, Matsuda S, Goto YI. Estimation of the Number of Patients With Mitochondrial Diseases: A Descriptive Study Using a Nationwide Database in Japan. J Epidemiol 2023; 33:68-75. [PMID: 33907064 PMCID: PMC9794447 DOI: 10.2188/jea.je20200577] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To provide a better healthcare system for patients with mitochondrial diseases, it is important to understand the basic epidemiology of these conditions, including the number of patients affected. However, little information about them has appeared in Japan to date. METHODS To gather data of patients with mitochondrial diseases, we estimated the number of patients with mitochondrial diseases from April 2018 through March 2019 using a national Japanese health care claims database, the National Database (NDB). Further, we calculated the prevalence of patients, and sex ratio, age class, and geographical distribution. RESULTS From April 2018 through March 2019, the number of patients with mitochondrial diseases was 3,629, and the prevalence was 2.9 (95% confidence interval [CI], 2.8-3.0) per 100,000 general population. The ratio of females and males was 53 to 47, and the most frequent age class was 40-49 years old. Tokyo had the greatest number of patients with mitochondrial diseases, at 477, whereas Yamanashi had the fewest, at 13. Kagoshima had the highest prevalence of patients with mitochondrial diseases, 8.4 (95% CI, 7.1-10.0) per 100,000 population, whereas Yamanashi had the lowest, 1.6 (95% CI, 0.8-2.7). CONCLUSION The number of patients with mitochondrial diseases estimated by this study, 3,269, was more than double that indicated by the Japanese government. This result may imply that about half of all patients are overlooked for reasons such as low severity of illness, suggesting that the Japanese healthcare system needs to provide additional support for these patients.
Collapse
Affiliation(s)
- Koki Ibayashi
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenji Fujimoto
- Department of Public Health, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Shinya Matsuda
- Department of Public Health, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Yu-ichi Goto
- Department of Mental Retardation and Birth Defect Research, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| |
Collapse
|
2
|
Wei L, Zeng PP, Kaplan I, Kong R, Huang A, Winer A. Leaving No Stone Unturned: Factors Associated With Overturning Insurance Claim Denials for Urological Conditions in New York State. Urol Pract 2022; 9:568-573. [PMID: 37145812 DOI: 10.1097/upj.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/28/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Denied health claims in New York State may be appealed by external review. After appeal, the denial can either be upheld or overturned. Regardless, an appeal process results in delays in care and can negatively impact patient health and practice efficiency. This study aimed to describe the epidemiology of New York State urological external appeals and assess factors associated with successful appeals. METHODS The New York State External Appeals database was queried for 2019-2021 urological cases (N=408). Patient age, gender, decision year, appeal reason, diagnosis, treatment, and reference to American Urological Association were extracted. Annual appeal volume was analyzed by linear regression. Relationships between appeal outcomes and characteristics were analyzed by χ2 tests. Multivariate logistic regression analysis was used to identify factors related to overturns. RESULTS Overall, 39.5% of denials in this data set were overturned. Appeal volume increased annually, with overturned cases increasing 244% (mean 29.5, P = .068). Of reviewers, 15.6% referenced American Urological Association guidelines in their decision. Appeals mostly involved ages 40-59 years (32.4%), inpatient stays (63.5%), and infections (32.4%). Female sex, age 80+, diagnosis of incontinence/lower urinary tract symptoms, treatment with home health care, medications, or surgical services, and not referencing American Urological Association guidelines were significantly associated with successful appeal. Referencing American Urological Association guidelines had 70% decreased odds of overturning denials. CONCLUSIONS Our findings suggest that upon appeal of denied claims, practices may have a high chance of overturning an initial denial and this trend is rising. These findings will help serve as a reference for future external appeals research and urology policy and advocacy groups.
Collapse
Affiliation(s)
- Lulu Wei
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Ping Ping Zeng
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Isabelle Kaplan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Ryan Kong
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Aaron Huang
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Andrew Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| |
Collapse
|
3
|
Ghani KR, Rojanasarot S, Cutone B, Bhattacharyya SK, Krambeck AE. The Economic Burden of Cystoscopy-Based Ureteral Stent Removal in the United States: An Analysis of Nearly 30,000 Patients. Urol Pract 2022; 9:40-46. [PMID: 37145558 DOI: 10.1097/upj.0000000000000271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ureteral stents are commonly placed after ureteroscopy. We examined the rate of cystoscopy-based stent removal (CBSR) following ureteroscopy for stone disease and its economic burden in the United States. METHODS Adults undergoing ureteroscopy and stenting (index surgery) for stone disease between 2014 and 2018 were identified using the IBM® MarketScan® Commercial Database. Patients were categorized as those with CBSR or without CBSR within 6 months post-index surgery. Rate and location of CBSR were assessed. To estimate the economic burden of CBSR, medical costs (2019 U.S. dollars) paid by insurers were calculated at 6 months post-index surgery. A generalized linear model examined the association of CBSR with total costs adjusting for patient characteristics. RESULTS Among 29,535 patients meeting the inclusion criteria, 56.5% had CBSR within 6 months. Median time to CBSR was 9 days; 70% of patients with CBSR had their stent removed in the office. Medical costs for CBSR patients were significantly higher than those for nonCBSR patients ($7,808 vs $6,231; p <0.0001). The difference was driven by the cost of CBSR ($1,132 vs $0; p <0.0001) and health care utilization for stone disease ($2,464 vs $2,121; p <0.0001). CBSR was associated with a 17% increase in medical costs compared to nonCBSR (OR: 1.17; 95% CI 3.03, 3.46). CONCLUSIONS Over 50% of patients had CBSR within 6 months following ureteroscopy. Medical costs for patients undergoing CBSR were significantly higher and driven by the cost of CBSR and resource utilization for stone disease. Ureteral stents that avoid CBSR can lower medical costs to the health care system.
Collapse
Affiliation(s)
- Khurshid R Ghani
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | | | - Amy E Krambeck
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
4
|
Dean LT, Chang HY, Goedel WC, Chan PA, Doshi JA, Nunn AS. Novel population-level proxy measures for suboptimal HIV preexposure prophylaxis initiation and persistence in the USA. AIDS 2021; 35:2375-2381. [PMID: 34723852 PMCID: PMC8564020 DOI: 10.1097/qad.0000000000003030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the United States (USA), HIV preexposure prophylaxis (PrEP) use is suboptimal. Population-level metrics on PrEP use are limited and focus on prescriptions issued rather than how much prescriptions are picked up. We introduce PrEP reversals, defined as when patients fail to pick up PrEP prescriptions at the pharmacy point-of-sale, as a proxy for PrEP initiation and persistence. DESIGN We analysed PrEP pharmacy claims and HIV diagnoses from a Symphony Health Solutions dataset across all US states from 1 October 2015 to 30 September 2019. METHODS We calculated the percentage of individuals who were newly prescribed PrEP and who reversed (i.e. patient did not pick up an insurance-approved prescription and pharmacy withdrew the claim), delayed (reversed and then picked up within 90 days), very delayed (reversed and then picked up between 90 and 365 days) or abandoned (not picked up within 365 days), and subsequent HIV diagnosis within 365 days. RESULTS Of 59 219 individuals newly prescribed PrEP, 19% reversed their index prescription. Among those, 21% delayed initiation and 8% had very delayed initiation. Seventy-one percent of patients who reversed their initial prescription abandoned it, 6% of whom were diagnosed with HIV---three times higher than those who persisted on PrEP. CONCLUSION Nearly one in five patients newlyprescribed PrEP reversed initial prescriptions, leading to delayed medication access, being lost to PrEP care, and dramatically higher HIV risk. Reversals could be used for real-time nationwide PrEP population-based initiation and persistence tracking, and for identifying patients that might otherwise be lost to care.
Collapse
Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hsien-Yen Chang
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Philip A Chan
- Department of Medicine, Brown University
- Rhode Island Department of Health
- Rhode Island Public Health Institute, Providence, Rhode Island
| | - Jalpa A Doshi
- Perelman School of Medicine
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| |
Collapse
|
5
|
Black CM, Vesco KK, Mehta V, Ohman-Strickland P, Demissie K, Schneider D. Costs of Severe Maternal Morbidity in U.S. Commercially Insured and Medicaid Populations: An Updated Analysis. Womens Health Rep (New Rochelle) 2021; 2:443-451. [PMID: 34671765 PMCID: PMC8524749 DOI: 10.1089/whr.2021.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Background: The most common reason for hospitalization in the United States is childbirth. The costs of childbirth are substantial. Materials and Methods: This was a retrospective cohort study of hospital deliveries identified in the MarketScan® Commercial and Medicaid health insurance claim databases. Women with an inpatient birth in the calendar year 2016 were included. Severe maternal morbidity (SMM) was identified using the Centers for Disease Control and Prevention algorithm of 21 International Classification of Diseases-10 codes. Mean costs and cost ratios for women with and without SMM were reported. Generalized linear models were used to analyze demographic and clinical variables influencing delivery costs. Results: We identified 1,486 women in the Commercial population, who had a birth in 2016 and met the criteria for SMM. The total mean per-patient costs of care for women with and without SMM were $50,212 and $23,795, respectively. In the Medicaid population there were 29,763 births, of which 342 met the criteria for SMM. The total mean per-patient costs of care for women with and without SMM were $26,513 and $9,652, respectively. A multifetal gestation, a cesarean delivery, maternal age, and pregnancy-related complications were independently predictive of increased delivery costs in both Commercial and Medicaid populations. Conclusions: The occurrence of SMM was associated with an increase in maternity-related costs of 111% in the Commercial and 175% in the Medicaid population. Some of the factors associated with increased delivery hospitalization costs could be treated or avoided.
Collapse
Affiliation(s)
- Christopher M. Black
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
- Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE), Kenilworth, New Jersey, USA
| | | | - Vinay Mehta
- Merck & Co., Inc., Center for Observational and Real-World Evidence (CORE), Kenilworth, New Jersey, USA
| | | | - Kitaw Demissie
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Dona Schneider
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey, USA
| |
Collapse
|
6
|
Shin J, Lee H, Kim H. Association between Exposure to Ambient Air Pollution and Age-Related Cataract: A Nationwide Population-Based Retrospective Cohort Study. Int J Environ Res Public Health 2020; 17:E9231. [PMID: 33321894 PMCID: PMC7763970 DOI: 10.3390/ijerph17249231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
This study aimed to investigate the association between ambient air pollutants and cataracts in the general population aged 50 years or older using data from the Korean National Insurance Service-National Sample Cohort. Cataract patients were defined as those diagnosed by a physician and having undergone cataract surgery. After matching the average concentrations of PM2.5, PM10, NO2, CO, SO2, and O3 in residential areas, the association between quartile level of air pollutants and incidence of cataract was analyzed using a multivariate Cox-proportional hazard risk model. Among the 115,728 participants, 16,814 (14.5%) were newly diagnosed with cataract and underwent related surgery between 1 January 2004, and 31 December 2015. Exposure to PM10, NO2, and SO2 was positively associated with cataract incidence, while O3 was negatively associated. The adjusted hazard ratio (HR) with 95% confidence interval was 1.069 (1.025-1.115) in PM10 and 1.080 (1.030-1.133) in NO2. However, the association between cataract and the quartile of PM2.5 measured during one year in 2015 was not clear. The HR of female participants aged 65 or older was significantly increased according to quartile of air pollutants. We identified exposure to PM10, NO2, SO2, and O3 associated with cataract development in Korean adults aged ≥ 50 years. This information may be helpful for policymaking to control air pollution as a risk factor for eye health.
Collapse
Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Seoul 05030, Korea;
| | - Hyungwoo Lee
- Department of Ophthalmology, Konkuk University Medical Center, Seoul 05030, Korea;
| | - Hyeongsu Kim
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| |
Collapse
|
7
|
Kantor D, Mehta R, Pelletier C, Tian M, Noxon V, Johnson BH, Bonafede M. Treatment Patterns and Relapses Among Newly Treated Multiple Sclerosis Patients From a Retrospective Claims Analysis. Clin Ther 2020; 42:2136-2147.e3. [PMID: 33160682 DOI: 10.1016/j.clinthera.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Although all disease-modifying therapies (DMTs) reduce risk of relapse in multiple sclerosis (MS), many factors, including route of administration, influence selection of first-line DMT. Knowledge of real-world treatment patterns and effectiveness in reducing relapses across DMTs is important to understanding factors influencing this choice. This study sought to describe treatment patterns and relapses among newly treated adults with MS and by DMT route of administration (oral, injectable, and infusion). METHODS IBM MarketScan research databases were used to identify MS adults newly initiating DMTs (index event) from January 1, 2011-April 1, 2016, who had 12 months of continuous preindex and postindex medical and pharmacy benefits. Newly treated patients were those with ≥2 nondiagnostic claims with an International Classification of Diseases, Ninth Revision, Clinical Modification (340) or Tenth Revision, Clinical Modification (G35) code and no DMT prescription claims in the 12 months' preindex. Persistence and adherence were measured from index until the earliest of ≥60 days without DMT, switching DMTs, or end of follow-up. Relapses were defined using a validated claims-based algorithm and measured in the 12-month preindex and postindex periods. Regression analysis adjusting for patient characteristics and prior relapses was used to determine the association between DMT route of administration and odds of 12-month persistence, odds of postindex relapse, and number of postindex relapses. FINDINGS Of 9378 newly treated MS patients meeting inclusion criteria; average age was 46.7 years, and 73.3% were female. Most patients initiated an injectable (65.5%) or oral (26.1%) DMT. Relapses decreased markedly from preindex to postindex (32.9%-24.0%), which was highest among oral users (35.8%-21.6%). Patients with no (vs ≥3) relapses preindex were more likely to be relapse free postindex (81.6% vs 31.4%). Nonpersistence (39.1% overall) was lowest among oral users (33.4%) and higher among those with versus without a postindex relapse (50.6% vs 35.5%). Patients initiating oral versus injectable agents were more likely to be persistent at 12 months (odds ratio [OR], 1.45; p < 0.0001) and less likely to relapse (OR, 0.75; p < 0.0001) postindex. Switches were uncommon (~10%) across cohorts. Preindex relapses were associated with increased odds of postindex relapses (OR, 1.73; p < 0.0001) but not with odds of persistence at 12 months. IMPLICATIONS The 12-month nonpersistence rate was high among all MS patients but lower among oral users. Oral users were also less likely to relapse postindex. Despite the effectiveness of DMTs in reducing relapses, the low persistence, lack of switching to a new DMT, and continued relapses highlight an unmet need in the MS treatment landscape.
Collapse
Affiliation(s)
- Daniel Kantor
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Rina Mehta
- Bristol-Myers Squibb Company, Princeton, NJ, USA
| | | | - Marc Tian
- Bristol-Myers Squibb Company, Princeton, NJ, USA
| | | | | | | |
Collapse
|
8
|
McCoy RG, Lipska KJ, Van Houten HK, Shah ND. Development and evaluation of a patient-centered quality indicator for the appropriateness of type 2 diabetes management. BMJ Open Diabetes Res Care 2020; 8:8/2/e001878. [PMID: 33234510 PMCID: PMC7689069 DOI: 10.1136/bmjdrc-2020-001878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/07/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Current diabetes quality measures are agnostic to patient clinical complexity and type of treatment required to achieve it. Our objective was to introduce a patient-centered indicator of appropriate diabetes therapy indicator (ADTI), designed for patients with type 2 diabetes, which is based on hemoglobin A1c (HbA1c) but is also contextualized by patient complexity and treatment intensity. RESEARCH DESIGN AND METHODS A draft indicator was iteratively refined by a multidisciplinary Delphi panel using existing quality measures, guidelines, and published literature. ADTI performance was then assessed using OptumLabs Data Warehouse data for 2015. Included adults (n=206 279) with type 2 diabetes were categorized as clinically complex based on comorbidities, then categorized as treated appropriately, overtreated, or undertreated based on a matrix of clinical complexity, HbA1c level, and medications used. Associations between ADTI and emergency department/hospital visits for hypoglycemia and hyperglycemia were assessed by calculating event rates for each treatment intensity subset. RESULTS Overall, 7.4% of patients with type 2 diabetes were overtreated and 21.1% were undertreated. Patients with high complexity were more likely to be overtreated (OR 5.60, 95% CI 5.37 to 5.83) and less likely to be undertreated (OR 0.65, 95% CI 0.62 to 0.68) than patients with low complexity. Overtreated patients had higher rates of hypoglycemia than appropriately treated patients (22.0 vs 6.2 per 1000 people/year), whereas undertreated patients had higher rates of hyperglycemia (8.4 vs 1.9 per 1000 people/year). CONCLUSIONS The ADTI may facilitate timely, patient-centered treatment intensification/deintensification with the goal of achieving safer evidence-based care.
Collapse
Affiliation(s)
- Rozalina G McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Kasia J Lipska
- Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Holly K Van Houten
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Nilay D Shah
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
- OptumLabs, Cambridge, Massachusetts, USA
| |
Collapse
|
9
|
Lindgren S, Gustafson P, Hammarskjöld F. Analysis of central venous access injuries from claims to the Swedish Patient Insurance Company 2009-2017. Acta Anaesthesiol Scand 2019; 63:1378-1383. [PMID: 31313279 DOI: 10.1111/aas.13430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/20/2019] [Accepted: 06/07/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Insertion and use of central venous access devices (CVADs) can be associated with serious adverse events. The incidence is generally low but considering the vast use of CVADs the consequences can, from a patient safety and health economics perspective, be severe. No exact knowledge exists of number of catheters or complications in Sweden, as there is currently no comprehensive registry. The aim was to analyse injuries reported to the Swedish National Patient Insurance Company (Löf) within 7 days after insertion or removal of a CVAD. METHODS A retrospective analysis of all injuries filed in the period 2009-2017 was performed, evaluating patient data, type of catheter, insertion technique and type of injury. If the injury was deemed avoidable by Löf, degree of disability and mortality was registered. RESULTS A total of 87 claims of injuries were found of which 36 (41%) were assessed as avoidable. The most common injuries were: bleeding (18%), early infection (17%), pneumothorax (17%) and early thrombosis (15%). No patients died of their injuries, but 17 of 36 suffered permanent disability of varying degrees. Ultrasound-guided insertion was used in 19% of the cases. CONCLUSION In Sweden, few injuries related to CVAD use are reported to Löf. About 40% of filed claims were categorized as having an avoidable injury and therefore eligible for compensation. About half of the compensated patients suffered a permanent disability. The results indicate underreporting of CVC-related injuries in Sweden during the studied time-period.
Collapse
Affiliation(s)
- Sophie Lindgren
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy, Gothenburg University Gothenburg Sweden
| | - Pelle Gustafson
- The Swedish National Patient Insurance Company (Löf) Stockholm Sweden
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive care Ryhov County Hospital Jönköping Sweden
| |
Collapse
|
10
|
Yoon SJ, Kim JS, Jung JG, Ahn SK, Song YS, Bae NK, Seon JY, Kim JH. Factors associated with potentially harmful drug-drug interactions in older Korean people: A population-based study. Geriatr Gerontol Int 2018; 18:1378-1382. [PMID: 30094910 DOI: 10.1111/ggi.13495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/07/2018] [Accepted: 06/26/2018] [Indexed: 12/11/2022]
Abstract
AIM The present study investigated the status of potentially harmful drug-drug interactions (PHDI) in older adults, to obtain insight into factors that influence the risk of PHDI. METHODS The present study included Korean people aged ≥65 years who were prescribed one or more drugs included in the list of PHDI under the Beers Criteria 2015 from January to December, 2016 (n = 1 257 317). PHDI were defined based on the Beers Criteria 2015. Among 10 PHDI, a prevalence of >5% was taken to be clinically significant, and the relationships between multiple variables and PHDI were examined. RESULTS The most frequent PHDI was corticosteroids and non-steroidal anti-inflammatory drugs (n = 259 499, 20.64%), followed by a combination of two or more anticholinergic drugs (n = 139 622, 11.1%), and three or more drugs acting on the central nervous system (n = 86 023, 6.84%). These three types of PHDI were more frequent in women (OR 1.066-1.141) and medical aid beneficiaries (OR 1.095-1.510). The risk of PHDI increased in proportion to the number of healthcare institutions used by the participants and their outpatient visits during the year (OR 1.043-1.079, 1.008-1.010, respectively). The risk of PHDI was low when patients took no more than five medications in a single prescription (OR 0.017-0.791). CONCLUSIONS The findings of the present study highlight the three most frequent PHDI in Korea according to the Beers Criteria 2015. Healthcare providers should take PHDI into account when treating female patients, medical aid beneficiaries, patients using multiple healthcare institutions, frequent outpatient visitors and patients prescribed more than six medications in a single prescription. Geriatr Gerontol Int 2018; 18: 1378-1382.
Collapse
Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong-Sung Kim
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jin-Gyu Jung
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soon-Ki Ahn
- Public Health and Medical Service Office, Chungnam National University Hospital, Daejeon, Korea
| | - Young-Su Song
- Department of Long-term Care Service for Elderly, Korean National Health Insurance Review & Assessment Service, Daejeon, Korea
| | - Nam-Kyou Bae
- Department of Long-term Care Service for Elderly, Korean National Health Insurance Review & Assessment Service, Daejeon, Korea
| | - Jeong-Yeon Seon
- Department of Long-term Care Service for Elderly, Korean National Health Insurance Review & Assessment Service, Daejeon, Korea
| | - Jeong-Hyun Kim
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
11
|
Hess GP, Natarajan P, Faridi KF, Fievitz A, Valsdottir L, Yeh RW. Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Therapy: Payer Approvals and Rejections, and Patient Characteristics for Successful Prescribing. Circulation 2017; 136:2210-2219. [PMID: 29084735 DOI: 10.1161/circulationaha.117.028430] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/08/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are a novel class of medications for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease requiring additional lipid lowering beyond dietary measures and statin use. Because of the drugs' high cost, rates of prescription approval by payers may be low. We aimed to identify payer approval and rejection rates for PCSK9i prescriptions and the potential factors influencing these rates. METHODS This is a retrospective, descriptive cohort study using nationwide pharmacy claims linked to electronic medical records from a nationwide data warehouse. The data set includes >220 million patients from all 50 states and all payer types with 5140 distinct health plans. PCSK9i prescriptions were submitted for 51 466 patients in the pharmacy data set. The main outcome was approval or rejection of PCSK9i prescription claims. Factors associated with approval and rejection of these medications in the United States were assessed. RESULTS Among patients who were prescribed a PCSK9i, 47.0% were approved for coverage by the payer. Variables that were associated with PCSK9i approval included age >65 years (P<0.01), history of atherosclerotic cardiovascular disease (P<0.01), prescription by a cardiologist or nonprimary care provider (P<0.01), statin intolerance (P=0.03), longer statin duration (P=0.01), and noncommercial payers (P<0.01). Higher low-density lipoprotein cholesterol levels were not associated with higher approval rates. Commercial third-party payers had the lowest approval rates (24.4%) and Medicare had the highest (60.9%). CONCLUSIONS Rates of approval for PCSK9i therapy are low, even for patients who appear to meet labeled indications. Although a combination of clinical characteristics increases the likelihood of approval, payer type is the most significant factor.
Collapse
Affiliation(s)
- Gregory P Hess
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Pradeep Natarajan
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Kamil F Faridi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Anna Fievitz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Linda Valsdottir
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Robert W Yeh
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.).
| |
Collapse
|
12
|
Xie F, Colantonio LD, Curtis JR, Safford MM, Levitan EB, Howard G, Muntner P. Linkage of a Population-Based Cohort With Primary Data Collection to Medicare Claims: The Reasons for Geographic and Racial Differences in Stroke Study. Am J Epidemiol 2016; 184:532-544. [PMID: 27651383 DOI: 10.1093/aje/kww077] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/27/2016] [Indexed: 11/13/2022] Open
Abstract
We described the linkage of primary data with administrative claims using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and Medicare. REGARDS study data were linked with Medicare claims by use of Social Security numbers. We compared REGARDS participants by Medicare linkage status, having fee-for-service (FFS) coverage or not, and with a 5% sample of Medicare beneficiaries who had FFS coverage in 2005, overall, by age (45-64 and ≥65 years), and by race. Among REGARDS participants who were ≥65 years of age, 80% had data linked to Medicare on their study-visit date (64% with FFS coverage). No differences except race and sex were present between REGARDS participants without Medicare linkage and those with data linked to Medicare with and without FFS coverage. After the age-sex-race adjustment, comorbid conditions and health-care utilization were similar for those with FFS coverage in the REGARDS study and the 5% sample of Medicare beneficiaries. Among REGARDS participants aged 45-64 years, 11% had FFS coverage on their study-visit date. In this age group, differences were present between participants with and without FFS coverage and the Medicare 5% sample with FFS coverage. In conclusion, REGARDS participants aged ≥65 years with FFS coverage are representative of the study cohort and the US population aged ≥65 years with FFS coverage.
Collapse
|
13
|
Colantonio LD, Kent ST, Kilgore ML, Delzell E, Curtis JR, Howard G, Safford MM, Muntner P. Agreement between Medicare pharmacy claims, self-report, and medication inventory for assessing lipid-lowering medication use. Pharmacoepidemiol Drug Saf 2016; 25:827-35. [PMID: 26823152 DOI: 10.1002/pds.3970] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/18/2015] [Accepted: 12/29/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medicare claims have been used to study lipid-lowering medication (LLM) use among US adults. METHODS We analyzed the agreement between Medicare claims for LLM and LLM use indicated by self-report during a telephone interview and, separately, by a medication inventory performed during an in-home study visit upon enrollment into the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We included REGARDS participants ≥65 years enrolled in 2006-2007 with Medicare pharmacy benefits (Part D) from 120 days before their telephone interview through their medication inventory (n = 899). RESULTS Overall, 39.2% and 39.5% of participants had a Medicare claim for an LLM within 120 days prior to their interview and medication inventory, respectively. Also, 42.7% of participants self-reported using LLMs, and 41.8% had an LLM in their medication inventory. The Kappa statistic (95% confidence interval [CI]) for agreement of Medicare claims with self-report and medication inventory was 0.68 (0.63-0.73) and 0.72 (0.68-0.77), respectively. No Medicare claims for LLMs were present for 22.1% (95%CI: 18.1-26.6%) of participants who self-reported taking LLMs and 18.9% (15.1-23.3%) with LLMs in their medication inventory. Agreement between Medicare claims and self-report was lower among Black male individuals (Kappa = 0.34 [95%CI: 0.14-0.54]) compared with Black female individuals (0.70 [0.61-0.79]), White male individuals (0.65 [0.56-0.75]), and White female individuals (0.79 [0.72-0.86]). Agreement between Medicare claims and the medication inventory was also low among Black male individuals (Kappa = 0.48 [95%CI: 0.29-0.66]). CONCLUSIONS Although substantial agreement exists, many Medicare beneficiaries who self-report LLM use or have LLMs in a medication inventory have no claims for these medications. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shia T Kent
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Delzell
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey R Curtis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Safford
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
14
|
Tseng YJ, Cami A, Goldmann DA, DeMaria A, Mandl KD. Incidence and Patterns of Extended-Course Antibiotic Therapy in Patients Evaluated for Lyme Disease. Clin Infect Dis 2015. [PMID: 26223992 DOI: 10.1093/cid/civ636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most patients with Lyme disease (LD) can be treated effectively with 2-4 weeks of antibiotics. The Infectious Disease Society of America guidelines do not currently recommend extended treatment even in patients with persistent symptoms. METHODS To estimate the incidence of extended use of antibiotics in patients evaluated for LD, we retrospectively analyzed claims from a nationwide US health insurance plan in 14 high-prevalence states over 2 periods: 2004-2006 and 2010-2012. RESULTS As measured by payer claims, the incidence of extended antibiotic therapy among patients evaluated for LD was higher in 2010-2012 (14.72 per 100 000 person-years; n = 684) than in 2004-2006 (9.94 per 100 000 person-years; n = 394) (P < .001). Among these patients, 48.8% were treated with ≥2 antibiotics in 2010-2012 and 29.9% in 2004-2006 (P < .001). In each study period, a distinct small group of providers (roughly 3%-4%) made the diagnosis in >20% of the patients who were evaluated for LD and prescribed extended antibiotic treatment. CONCLUSIONS Insurance claims data suggest that the use of extended courses of antibiotics and multiple antibiotics in the treatment of LD has increased in recent years.
Collapse
Affiliation(s)
- Yi-Ju Tseng
- Computational Health Informatics Program, Boston Children's Hospital
| | - Aurel Cami
- Computational Health Informatics Program, Boston Children's Hospital Department of Pediatrics
| | - Donald A Goldmann
- Department of Institute for Healthcare Improvement, Cambridge Division of Infectious Diseases, Boston Children's Hospital
| | - Alfred DeMaria
- Bureau of Infectious Disease, Massachusetts Department of Public Health, Jamaica Plain
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital Department of Pediatrics Department of Biomedical Informatics, Harvard Medical School, Boston
| |
Collapse
|
15
|
Kim S, Kim J, Park SY, Um HY, Kim K, Kim Y, Park Y, Baek S, Yoon SY, Kwon HS, Cho YS, Moon HB, Kim TB. Effect of pregnancy in asthma on health care use and perinatal outcomes. J Allergy Clin Immunol 2015; 136:1215-23.e1-6. [PMID: 26071938 DOI: 10.1016/j.jaci.2015.04.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is generally known that pregnancy in asthmatic patients increases the risk of asthma exacerbations and poor perinatal outcomes. However, the effect of pregnancy in asthmatic patients on health care use is not known well. In addition, its effect on perinatal outcomes is still controversial because of study limitations caused by ethical issues. National Health Insurance claim data are an ideal resource for studying real-world health care use patterns of asthma. OBJECTIVE We sought to evaluate the effect of pregnancy on asthma in terms of asthma-related health care use and prescription patterns in concert with the effect of asthma exacerbations on adverse pregnancy outcomes. METHODS Among all asthmatic patients in the Korean National Health Insurance claim database from January 2009 to December 2013, pregnant women who delivered in 2011 with pre-existing asthma were enrolled. Analyses included asthma-related health care use and prescription patterns compared between pregnant asthmatic women and nonpregnant female asthmatic control subjects, as well as within the pregnant subjects from before pregnancy throughout postpartum periods. In addition, the association between asthma exacerbation during pregnancy and adverse pregnancy outcomes was assessed. RESULTS A total of 3,357 pregnant asthmatic patients were compared with 50,355 nonpregnant asthmatic patients, and 10,311 pregnant patients were included to determine the effect of asthma exacerbations on adverse pregnancy outcome in the study. Pregnant asthmatic patients underwent more asthma-related hospitalizations (1.3% vs 0.8%, P = .005) but had significantly fewer outpatient visits and prescriptions for most asthma medications than nonpregnant asthmatic patients. The proportion of patients ever hospitalized gradually increased throughout pregnancy (first trimester, 0.2%; second trimester, 0.5%; and third trimester, 0.7%; P = .018). The prevalence of asthma exacerbation during pregnancy was 5.3%, and the patients who had acute exacerbation during pregnancy had significantly higher asthma-related health care use in terms of hospitalization, intensive care unit admission, and emergency department and outpatient visits within 1 year before delivery than those who had not. However, asthma exacerbation during pregnancy was not significantly related to adverse perinatal outcomes, except for cesarean section (27.1% vs 18.9%, P < .001). All exacerbations were managed with systemic corticosteroids, and the patients who ever experienced acute exacerbations maintained asthma medications, including inhaled corticosteroid-based inhalers, throughout the pregnancy period. CONCLUSION Pregnancy profoundly affects asthma-related health care use but to a different degree depending on whether the patient experienced an exacerbation. Asthma exacerbation during pregnancy is not associated with adverse pregnancy outcomes while managed appropriately with systemic corticosteroids. However, further studies are needed to clarify the effect of asthma control on perinatal outcome and delivery method.
Collapse
Affiliation(s)
- Sujeong Kim
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jinhee Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - So Young Park
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Yeon Um
- Korea Institute of Drug Safety and Risk Management, Seoul, Korea
| | - Kyoungjoo Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Yuri Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Yunjin Park
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Seunghee Baek
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Sun-Young Yoon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
16
|
Taneja C, Berger A, Inglese GW, Lamerato L, Sloand JA, Wolff GG, Sheehan M, Oster G. Can dialysis patients be accurately identified using healthcare claims data? Perit Dial Int 2014; 34:643-51. [PMID: 24497600 DOI: 10.3747/pdi.2012.00328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While health insurance claims data are often used to estimate the costs of renal replacement therapy in patients with end-stage renal disease (ESRD), the accuracy of methods used to identify patients receiving dialysis - especially peritoneal dialysis (PD) and hemodialysis (HD) - in these data is unknown. METHODS The study population consisted of all persons aged 18 - 63 years in a large US integrated health plan with ESRD and dialysis-related billing codes (i.e., diagnosis, procedures) on healthcare encounters between January 1, 2005, and December 31, 2008. Using billing codes for all healthcare encounters within 30 days of each patient's first dialysis-related claim ("index encounter"), we attempted to designate each study subject as either a "PD patient" or "HD patient." Using alternative windows of ± 30 days, ± 90 days, and ± 180 days around the index encounter, we reviewed patients' medical records to determine the dialysis modality actually received. We calculated the positive predictive value (PPV) for each dialysis-related billing code, using information in patients' medical records as the "gold standard." RESULTS We identified a total of 233 patients with evidence of ESRD and receipt of dialysis in healthcare claims data. Based on examination of billing codes, 43 and 173 study subjects were designated PD patients and HD patients, respectively (14 patients had evidence of PD and HD, and modality could not be ascertained for 31 patients). The PPV of codes used to identify PD patients was low based on a ± 30-day medical record review window (34.9%), and increased with use of ± 90-day and ± 180-day windows (both 67.4%). The PPV for codes used to identify HD patients was uniformly high - 86.7% based on ± 30-day review, 90.8% based on ± 90-day review, and 93.1% based on ± 180-day review. CONCLUSIONS While HD patients could be accurately identified using billing codes in healthcare claims data, case identification was much more problematic for patients receiving PD.
Collapse
Affiliation(s)
- Charu Taneja
- Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA
| | - Ariel Berger
- Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA
| | - Gary W Inglese
- Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA
| | - Lois Lamerato
- Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA
| | - James A Sloand
- Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA
| | - Greg G Wolff
- Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA
| | - Michael Sheehan
- Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA
| | - Gerry Oster
- Policy Analysis Inc.(PAI), Brookline, MA, USA; Baxter Healthcare Corporation, McGaw Park, IL, USA; and Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
17
|
Cohn JA, Vekhter B, Lyttle C, Steinberg GD, Large MC. Sex disparities in diagnosis of bladder cancer after initial presentation with hematuria: a nationwide claims-based investigation. Cancer 2013; 120:555-61. [PMID: 24496869 DOI: 10.1002/cncr.28416] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Women have disproportionately higher mortality rates relative to incidence for bladder cancer. Multiple etiologies have been proposed, including delayed diagnosis and treatment. Guidelines recommend ruling out malignancy in men and women presenting with hematuria. This study sought to determine the difference in timing from presentation with hematuria to diagnosis of bladder cancer in women versus men. METHODS This is a retrospective population-based study examining the timing from presentation with hematuria to diagnosis of bladder cancer, based on data from the MarketScan databases, which include enrollees of more than 100 health insurance plans of approximately 40 large US employers from 2004 through 2010. All study patients presented with hematuria and were subsequently diagnosed with bladder cancer. The primary outcome measure was number of days between initial presentation with hematuria and diagnosis of bladder cancer by sex. RESULTS A total of 5416 men and 2233 women met inclusion criteria. Mean days from initial hematuria claim to bladder cancer claim was significantly longer in women (85.4 versus 73.6 days, P < .001), and the proportion of women with >6 month delay in bladder cancer diagnosis was significantly higher (17.3% versus 14.1%, P < .001). Women were more likely to be diagnosed with urinary tract infection (odds ratio = 2.32, 95% confidence interval = 2.07-2.59) and less likely to undergo abdominal or pelvic imaging (odds ratio = 0.80, 95% confidence interval = 0.71-0.89). CONCLUSIONS Both men and women experience significant delays between presentation with hematuria and diagnosis of bladder cancer, with longer delays for women. This may be partly responsible for the sex-based discrepancy in outcomes associated with bladder cancer.
Collapse
Affiliation(s)
- Joshua A Cohn
- Department of Surgery, Section of Urology, University of Chicago Hospitals, Chicago, Illinois
| | | | | | | | | |
Collapse
|
18
|
Kim S, Kim J, Kim K, Kim Y, Park Y, Baek S, Park SY, Yoon SY, Kwon HS, Cho YS, Kim TB, Moon HB. Healthcare use and prescription patterns associated with adult asthma in Korea: analysis of the NHI claims database. Allergy 2013; 68:1435-42. [PMID: 24131085 DOI: 10.1111/all.12256] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND National Health Insurance (NHI) claim records could provide valuable data for epidemiological studies of asthma in Korea. The aim of this study is to estimate the prevalence of adult asthma and to investigate asthma-related healthcare use and prescription patterns in Korea over 5 years. METHODS National Health Insurance claim records from January 1, 2006 to December 31, 2010 were analyzed in a retrospective, population-based study. Outcome measures included asthma prevalence, healthcare use, and prescription patterns over time, by type of hospital, and by medical specialty. Additionally, we assessed differences in healthcare use between newly diagnosed and previously diagnosed patients in 2009. RESULTS Over 5 years, the prevalence of asthma among Korean adults increased from 4944 to 5707 cases per 100,000 population (from 3760 to 4445 in men and from 6108 to 6951 in women). Asthma-related outpatient visits decreased from 4.82 ± 8.02 to 3.44 ± 5.50. Approximately 3% of all patients were hospitalized and 2.4% received asthma-related emergency treatment each year. Pulmonary function tests were performed in 10-11% of patients an average of 1.3 times per year. Newly diagnosed patients experienced fewer asthma-related hospitalizations (1.78% vs 4.35%) and emergency department visits (0.80% vs 2.11%) than the previously diagnosed group. Prescriptions of inhaled corticosteroids-based inhalers were maintained with about 20% of average of all types of hospitals. CONCLUSIONS The prevalence of asthma in Korea has increased over a recent 5-year period, and asthma is still suboptimally controlled. Public health strategies are needed to improve the management of asthma in adults.
Collapse
Affiliation(s)
- S. Kim
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - J. Kim
- National Evidence-Based Healthcare Collaborating Agency; Seoul Korea
| | - K. Kim
- National Evidence-Based Healthcare Collaborating Agency; Seoul Korea
| | - Y. Kim
- National Evidence-Based Healthcare Collaborating Agency; Seoul Korea
| | - Y. Park
- Department of Statistics; Dongguk University; Seoul Korea
| | - S. Baek
- Department of Clinical Epidemiology and Biostatistics; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - S. Y. Park
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - S.-Y. Yoon
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - H.-S. Kwon
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Y. S. Cho
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - T.-B. Kim
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - H.-B. Moon
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| |
Collapse
|
19
|
Milland M, Christoffersen JK, Hedegaard M. The size of the labor wards: is bigger better when it comes to patient safety? Acta Obstet Gynecol Scand 2013; 92:1271-6. [PMID: 24015949 DOI: 10.1111/aogs.12229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 07/29/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess possible associations between the size of labor units and the frequency of approved obstetric claims. DESIGN A nationwide retrospective descriptive study. SETTING Denmark. POPULATION All patients seeking financial compensation due to obstetric injuries occurring between 1995 and 2009. METHODS In all, 1440 anonymized obstetrics claims were reviewed; 1326 were included in the study. Information regarding the annual number of deliveries for each place of injury was retrieved from the National Birth Registry. MAIN OUTCOME MEASURES Obstetric injuries approved by the Danish Patient Insurance Association categorized by labor unit size. RESULTS The overall approval rate for submitted claims was 39.7%. Large labor units (3000-3999 deliveries/year) were found to have a lower approval rate (34.2%), compared with very large (≥4000 deliveries/year, 38.6%), intermediate (1000-2999 deliveries/year, 41.7%), and small (<1000 deliveries/year, 50.0%) units, (p < 0.05). The majority of compensation claims were approved with reference to the "specialist rule," assuming that if an experienced specialist had conducted the treatment differently the injury could have been avoided. Claims from small units showed a trend for being more often based on the specialist rule than seen in larger units (p < 0.05, test for trend). CONCLUSION The results may reflect that large labor units are living up to the principle of best practice to a greater degree. Several factors can be linked to the size of the labor unit and a better availability of in-house obstetricians as well as auxiliary specialists could be part of the explanation.
Collapse
Affiliation(s)
- Maria Milland
- Department of Obstetrics, Juliane Marie Center for Women, Children and Reproduction, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark
| | | | | |
Collapse
|
20
|
Lafferty WE, Tyree PT, Bellas AS, Watts CA, Lind BK, Sherman KJ, Cherkin DC, Grembowski DE. Insurance coverage and subsequent utilization of complementary and alternative medicine providers. Am J Manag Care 2006; 12:397-404. [PMID: 16834526 PMCID: PMC1513668] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Since 1996, Washington State law has required that private health insurance cover licensed complementary and alternative medicine (CAM) providers. OBJECTIVE To evaluate how insured people used CAM providers and what role this played in healthcare utilization and expenditures. STUDY DESIGN Cross-sectional analysis of insurance enrollees from western Washington in 2002. METHODS Analysis of insurance demographic data, claims files, benefit information, diagnoses, CAM and conventional provider utilization, and healthcare expenditures for 3 large health insurance companies. RESULTS Among more than 600,000 enrollees, 13.7% made CAM claims. This included 1.3% of enrollees with claims for acupuncture, 1.6% for naturopathy, 2.4% for massage, and 10.9% for chiropractic. Patients enrolled in preferred provider organizations and point-of-service products were notably more likely to use CAM than those with health maintenance organization coverage. The use of CAM was greater among women and among persons 31 to 50 years of age. The use of chiropractic was more frequent in less populous counties. The CAM provider visits usually focused on musculoskeletal complaints except for naturopathic physicians, who treated a broader array of problems. The median per-visit expenditures were 39.00 dollars for CAM care and 74.40 dollars for conventional outpatient care. The total expenditures per enrollee were 2589 dollars, of which 75 dollars(2.9%) was spent on CAM. CONCLUSIONS The number of people using CAM insurance benefits was substantial; the effect on insurance expenditures was modest. Because the long-term trajectory of CAM cost under third-party payment is unknown, utilization of these services should be followed.
Collapse
Affiliation(s)
- William E Lafferty
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Box 357660, Seattle, WA 98195, USA.
| | | | | | | | | | | | | | | |
Collapse
|