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Medical Care

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https://www.readbyqxmd.com/read/28079710/electronic-health-record-data-versus-the-national-health-and-nutrition-examination-survey-nhanes-a-comparison-of-overweight-and-obesity-rates
#1
Luke M Funk, Ying Shan, Corrine I Voils, John Kloke, Lawrence P Hanrahan
BACKGROUND: Estimating population-level obesity rates is important for informing policy and targeting treatment. The current gold standard for obesity measurement in the United States-the National Health and Nutrition Examination Survey (NHANES)-samples <0.1% of the population and does not target state-level or health system-level measurement. OBJECTIVE: To assess the feasibility of using body mass index (BMI) data from the electronic health record (EHR) to assess rates of overweight and obesity and compare these rates to national NHANES estimates...
January 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28079709/meaningful-use-of-electronic-health-records-by-outpatient-physicians-and-readmissions-of-medicare-fee-for-service-beneficiaries
#2
Mark A Unruh, Hye-Young Jung, Joshua R Vest, Lawrence P Casalino, Rainu Kaushal
BACKGROUND: Nearly one-fifth of hospitalized Medicare fee-for-service beneficiaries are readmitted within 30 days. Participation in the Meaningful Use initiative among outpatient physicians may reduce readmissions. OBJECTIVE: To evaluate the impact of outpatient physicians' participation in Meaningful Use on readmissions. SUBJECTS AND RESEARCH DESIGN: The study population included 90,774 Medicare fee-for-service beneficiaries from New York State (2010-2012)...
January 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28060053/safety-net-hospitals-face-more-barriers-yet-use-fewer-strategies-to-reduce-readmissions
#3
Jose F Figueroa, Karen E Joynt, Xiner Zhou, Endel J Orav, Ashish K Jha
OBJECTIVE: US hospitals that care for vulnerable populations, "safety-net hospitals" (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program, which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important. DESIGN: We surveyed leadership at 1600 US acute care hospitals, of whom 980 participated, between June 2013 and January 2014...
January 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28060052/evaluating-the-effects-of-pioneer-accountable-care-organizations-on-medicare-part-d-drug-spending-and-utilization
#4
Yuting Zhang, Kadin J Caines, Christopher A Powers
BACKGROUND: The improvement of medication use is a critical mechanism that accountable care organization (ACO) could use to save overall costs. Currently pharmaceutical spending is not part of the calculation for ACO-shared savings and risks. Thus, ACO providers may have strong incentives to prescribe more medications hoping to avoid expensive downstream medical costs. METHODS: We designed a quasinatural experiment study to evaluate the effects of Pioneer ACOs on Medicare Part D spending and utilization...
January 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28060051/e-prescribing-and-adverse-drug-events-an-observational-study-of-the-medicare-part-d-population-with-diabetes
#5
Meghan Hufstader Gabriel, Christopher Powers, William Encinosa, Julie P W Bynum
BACKGROUND: Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes. OBJECTIVE: To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia. DESIGN: This is a prospective, observational cohort study with patient fixed effects...
January 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28030476/socioeconomic-disparities-in-mortality-among-women-with-incident-breast-cancer-before-and-after-implementation-of-medicare-part-d
#6
Ann B Nattinger, Erica M Wozniak, Emily L McGinley, Jianing Li, Purushottam Laud, Liliana E Pezzin
BACKGROUND: Breast cancer patients exhibit survival disparities based on socioeconomic status (SES). Disparities may be attributable to access to expensive oral endocrine agents. OBJECTIVES: Define recent socioeconomic disparities in breast cancer survival and determine whether these improved after implementation of the Medicare Part D program. DESIGN: Difference-in-difference natural experiment of women diagnosed and treated before or after implementation of Medicare Part D...
December 27, 2016: Medical Care
https://www.readbyqxmd.com/read/28002205/the-role-of-public-and-private-insurance-expansions-and-premiums-for-low-income-parents-lessons-from-state-experiences
#7
Gery P Guy, Emily M Johnston, Patricia Ketsche, Peter Joski, E Kathleen Adams
BACKGROUND: Numerous states have implemented policies expanding public insurance eligibility or subsidizing private insurance for parents. OBJECTIVES: To assess the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. DESIGN: Cross-sectional analysis of the 2000-2013 March supplements to the Current Population Survey, with data from the Medical Expenditure Panel Survey-Insurance Component and the Area Resource File...
December 20, 2016: Medical Care
https://www.readbyqxmd.com/read/28002204/anesthesia-service-use-and-the-uptake-of-screening-colonoscopies
#8
Samuel Hirshman, Soeren Mattke, Hangsheng Liu
BACKGROUND: The Center for Medicare & Medicaid Services recently defined "screening colonoscopy" to include separately furnished anesthesia services. OBJECTIVE: To examine the relationship between anesthesia service use and the uptake of screening colonoscopies. STUDY DESIGN: We correlated metropolitan statistical area (MSA) level anesthesia service use rates, derived from the 2008, 2010, and 2012 Medicare and MarketScan claims data, with the presence of individual level guideline concordant screening colonoscopy using the Behavioral Risk Factor Surveillance System data for the same years...
December 20, 2016: Medical Care
https://www.readbyqxmd.com/read/28002203/differences-in-hospital-risk-standardized-mortality-rates-for-acute-myocardial-infarction-when-assessed-using-transferred-and-nontransferred-patients
#9
Ian J Barbash, Hongwei Zhang, Derek C Angus, Steven E Reis, Chung-Chou H Chang, Francis R Pike, Jeremy M Kahn
BACKGROUND: One in 5 patients with acute myocardial infarction (AMI) are transferred between hospitals. However, current hospital performance measures based on AMI mortality exclude these patients from the evaluation of referral hospitals. OBJECTIVE: To determine the relationship between risk-standardized mortality for transferred and nontransferred patients at referral hospitals. RESEARCH DESIGN: This is a retrospective cohort study. SUBJECTS: Fee-for-service Medicare claims from 2011 for patients hospitalized with a primary diagnosis of AMI, at hospitals admitting at least 15 patients in transfer...
December 20, 2016: Medical Care
https://www.readbyqxmd.com/read/27579912/regional-variation-of-cost-of-care-in-the-last-12-months-of-life-in-switzerland-small-area-analysis-using-insurance-claims-data
#10
Radoslaw Panczak, Xhyljeta Luta, Maud Maessen, Andreas E Stuck, Claudia Berlin, Kurt Schmidlin, Oliver Reich, Viktor von Wyl, David C Goodman, Matthias Egger, Marcel Zwahlen, Kerri M Clough-Gorr
BACKGROUND: Health care spending increases sharply at the end of life. Little is known about variation of cost of end of life care between regions and the drivers of such variation. We studied small-area patterns of cost of care in the last year of life in Switzerland. METHODS: We used mandatory health insurance claims data of individuals who died between 2008 and 2010 to derive cost of care. We used multilevel regression models to estimate differences in costs across 564 regions of place of residence, nested within 71 hospital service areas...
December 19, 2016: Medical Care
https://www.readbyqxmd.com/read/27997456/accelerating-research-impact-in-a-learning-health-care-system-va-s-quality-enhancement-research-initiative-in-the-choice-act-era
#11
Amy M Kilbourne, A Rani Elwy, Anne E Sales, David Atkins
BACKGROUND: Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice. OBJECTIVES: With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA's transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act...
December 16, 2016: Medical Care
https://www.readbyqxmd.com/read/27984346/an-examination-of-claims-based-predictors-of-overdose-from-a-large-medicaid-program
#12
Gerald Cochran, Adam J Gordon, Wei-Hsuan Lo-Ciganic, Walid F Gellad, Winfred Frazier, Carroline Lobo, Chung-Chou H Chang, Ping Zheng, Julie M Donohue
BACKGROUND: Health systems may play an important role in identification of patients at-risk of opioid medication overdose. However, standard measures for identifying overdose risk in administrative data do not exist. OBJECTIVE: Examine the association between opioid medication overdose and 2 validated measures of nonmedical use of prescription opioids within claims data. RESEARCH DESIGN: A longitudinal retrospective cohort study that estimated associations between overdose and nonmedical use...
December 15, 2016: Medical Care
https://www.readbyqxmd.com/read/27787351/utilization-of-positive-and-negative-controls-to-examine-comorbid-associations-in-observational-database-studies
#13
Jigar R Desai, Craig L Hyde, Shaum Kabadi, Matthew St Louis, Vinicius Bonato, A Katrina Loomis, Aaron Galaznik, Marc L Berger
BACKGROUND: Opportunities to leverage observational data for precision medicine research are hampered by underlying sources of bias and paucity of methods to handle resulting uncertainty. We outline an approach to account for bias in identifying comorbid associations between 2 rare genetic disorders and type 2 diabetes (T2D) by applying a positive and negative control disease paradigm. RESEARCH DESIGN: Association between 10 common and 2 rare genetic disorders [Hereditary Fructose Intolerance (HFI) and α-1 antitrypsin deficiency] and T2D was compared with the association between T2D and 7 negative control diseases with no established relationship with T2D in 4 observational databases...
December 12, 2016: Medical Care
https://www.readbyqxmd.com/read/27922910/impact-of-medicare-s-nonpayment-program-on-hospital-acquired-conditions
#14
Caroline P Thirukumaran, Laurent G Glance, Helena Temkin-Greener, Meredith B Rosenthal, Yue Li
BACKGROUND: Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. OBJECTIVE: To determine whether the Program was associated with changes in HAC incidence, and whether this association varies across hospitals with differential Medicare patient load...
December 5, 2016: Medical Care
https://www.readbyqxmd.com/read/27906769/measuring-harm-in-health-care-optimizing-adverse-event-review
#15
Kathleen E Walsh, Polina Harik, Kathleen M Mazor, Deborah Perfetto, Milena Anatchkova, Colleen Biggins, Joann Wagner, Pamela J Schoettker, Cassandra Firneno, Robert Klugman, Jennifer Tjia
OBJECTIVE: The objective of this study was to identify modifiable factors that improve the reliability of ratings of severity of health care-associated harm in clinical practice improvement and research. METHODS: A diverse group of clinicians rated 8 types of adverse events: blood product, device or medical/surgical supply, fall, health care-associated infection, medication, perinatal, pressure ulcer, surgery. We used a generalizability theory framework to estimate the impact of number of raters, rater experience, and rater provider type on reliability...
November 30, 2016: Medical Care
https://www.readbyqxmd.com/read/27755391/predicting-readmission-at-early-hospitalization-using-electronic-clinical-data-an-early-readmission-risk-score
#16
Ying P Tabak, Xiaowu Sun, Carlos M Nunez, Vikas Gupta, Richard S Johannes
BACKGROUND: Identifying patients at high risk for readmission early during hospitalization may aid efforts in reducing readmissions. We sought to develop an early readmission risk predictive model using automated clinical data available at hospital admission. METHODS: We developed an early readmission risk model using a derivation cohort and validated the model with a validation cohort. We used a published Acute Laboratory Risk of Mortality Score as an aggregated measure of clinical severity at admission and the number of hospital discharges in the previous 90 days as a measure of disease progression...
November 29, 2016: Medical Care
https://www.readbyqxmd.com/read/27875482/impact-of-community-health-workers-on-elderly-patients-advance-care-planning-and-health-care-utilization-moving-the-dial
#17
Debra K Litzelman, Thomas S Inui, Wilma J Griffin, Anthony Perkins, Ann H Cottingham, Kathleen M Schmitt-Wendholt, Steven S Ivy
BACKGROUND: Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences. OBJECTIVE: To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment. RESEARCH DESIGN: A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation...
November 21, 2016: Medical Care
https://www.readbyqxmd.com/read/27875481/receipt-of-caregiving-and-fall-risk-in-us-community-dwelling-older-adults
#18
Geoffrey J Hoffman, Ron D Hays, Steven P Wallace, Martin F Shapiro, Olga Yakusheva, Susan L Ettner
BACKGROUND: Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk. DESIGN: Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults...
November 21, 2016: Medical Care
https://www.readbyqxmd.com/read/27870660/patients-negatively-impacted-by-discontinuity-of-nursing-care-during-acute-hospitalization
#19
Olga Yakusheva, Deena K Costa, Marianne Weiss
BACKGROUND: Continuity of nursing care in hospitals remains poor and not prioritized, and we do not know whether discontinuous nursing care is negatively impacting patient outcomes. OBJECTIVES: This study aims to examine nursing care discontinuity and its effect on patient clinical condition over the course of acute hospitalization. RESEARCH DESIGN: Retrospective longitudinal analysis of electronic health records (EHR). Average point-in-time discontinuity was estimated from time of admission to discharge and compared with theoretical predictions for optimal continuity and random nurse assignment...
November 18, 2016: Medical Care
https://www.readbyqxmd.com/read/27820597/a-methodology-to-identify-a-cohort-of-medicare-beneficiaries-residing-in-large-assisted-living-facilities-using-administrative-data
#20
Kali S Thomas, David Dosa, Pedro L Gozalo, David C Grabowski, Jennifer Nazareno, Rajesh Makineni, Vincent Mor
BACKGROUND: Assisted living is a popular option for housing and long-term care. OBJECTIVE: To develop and test a methodology to identify Medicare beneficiaries residing in assisted living facilities (ALFs). RESEARCH DESIGN: We compiled a finder file of 9-digit ZIP codes representing large ALFs (25+ beds) by matching Outcome and Assessment Information Set (OASIS) assessments and Medicare Part B Claims to the Medicare enrollment records and addresses of 11,751 ALFs...
November 4, 2016: Medical Care
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