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Matthias Samwald, Hong Xu, Kathrin Blagec, Philip E Empey, Daniel C Malone, Seid Mussa Ahmed, Patrick Ryan, Sebastian Hofer, Richard D Boyce
Pre-emptive pharmacogenomic (PGx) testing of a panel of genes may be easier to implement and more cost-effective than reactive pharmacogenomic testing if a sufficient number of medications are covered by a single test and future medication exposure can be anticipated. We analysed the incidence of exposure of individual patients in the United States to multiple drugs for which pharmacogenomic guidelines are available (PGx drugs) within a selected four-year period (2009-2012) in order to identify and quantify the incidence of pharmacotherapy in a nation-wide patient population that could be impacted by pre-emptive PGx testing based on currently available clinical guidelines...
2016: PloS One
Daniel J Friedman, Haikun Bao, Erica S Spatz, Jeptha P Curtis, James P Daubert, Sana M Al-Khatib
BACKGROUND: -A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and data are conflicting. METHODS: -We conducted inverse probability weighted (IPW) analyses of 26,451 CRT eligible (EF≤35, QRS≥120ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes...
October 19, 2016: Circulation
Melissa D Zullo, Emily C Gathright, Mary A Dolansky, Richard A Josephson, Vinay K Cheruvu, Joel W Hughes
PURPOSE: On the basis of several small studies, depression is often considered a barrier to cardiac rehabilitation (CR) enrollment and program completion. The purpose of this research was to examine the association between depression diagnosis and participation in CR in a large sample of Medicare beneficiaries with recent myocardial infarction (MI). METHODS: This was a retrospective study of Medicare beneficiaries with an MI during 2008 (N = 158 991). CR enrollment was determined by the Carrier and Outpatient files using the Healthcare Common Procedure Coding System #93797 or #93798...
October 14, 2016: Journal of Cardiopulmonary Rehabilitation and Prevention
Ashish A Deshmukh, Hui Zhao, Prajnan Das, Elizabeth Y Chiao, Yi-Qian Nancy You, Luisa Franzini, David R Lairson, Michael D Swartz, Sharon H Giordano, Scott B Cantor
OBJECTIVE: A comparative assessment of treatment alternatives for T1N0 anal canal cancer has never been conducted. We compared the outcomes associated with the treatment alternatives-chemoradiotherapy (CRT), radiotherapy (RT), and surgery or ablation techniques (surgery/ablation)-for T1N0 anal canal cancer. MATERIALS AND METHODS: This retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results (SEER) registries linked with Medicare longitudinal data (SEER-Medicare database)...
October 17, 2016: American Journal of Clinical Oncology
D Wayne Taylor
Canadians need to talk about their healthcare, about who pays for what, when. Lack of money is not the issue; how that money is spent is the issue-what public healthcare is covering and not covering. The same dollar amount can be spent quite differently and more effectively. The 1950s first-dollar, single-payor decision shifted the burden from the individual to government, but a lot has changed since the 1950s. Today Medicare is not universal, comprehensive, reasonably accessible, or portable. With residual constitutional power residing in Ottawa, there is no reason for the fragmentation and inequalities facing Canadians...
October 15, 2016: Healthcare Management Forum
M Fernanda Bellolio, Lindsey R Sangaralingham, Stephanie R Schilz, Claire M Noel-Miller, Keith D Lind, Pamela Morin, Peter A Noseworthy, Nilay D Shah, Erik P Hess
OBJECTIVES: To compare healthcare utilization including coronary angiography, percutaneous coronary intervention (PCI), rehospitalization, and rate of subsequent acute myocardial infarction (AMI) within 30-days, among patients presenting to the Emergency Department (ED) with chest pain admitted as short-term inpatient (≤2 days) versus observation (in ED observation units combined with in-hospital observation). METHODS: We identified adults diagnosed with acute chest pain in the ED from 2010-2014 using administrative claims from privately insured and Medicare Advantage...
October 14, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Bryce T Fukunaga, Wesley K Sumida, Deborah A Taira, James W Davis, Todd B Seto
Methicillin-resistant Staphylococcus aureus (MRSA) results in almost half of all deaths caused by antibiotic resistant organisms. Current evidence suggests that MRSA infections are associated with antibiotic use. This study examined state-level data to determine whether outpatient antibiotic use was associated with hospital-acquired MRSA (HA-MRSA) infections. The 2013 Centers for Disease Control and Prevention (CDC) Healthcare-Associated Infections Progress Report was used to obtain HA-MRSA infection rates...
October 2016: Hawai'i Journal of Medicine & Public Health: a Journal of Asia Pacific Medicine & Public Health
Craig D Newgard, Rongwei Fu, Eileen Bulger, Jerris R Hedges, N Clay Mann, Dagan A Wright, David P Lehrfeld, Carol Shields, Gregory Hoskins, Craig Warden, Lynn Wittwer, Jennifer N B Cook, Michael Verkest, William Conway, Stephanie Somerville, Matthew Hansen
Importance: Despite a large rural US population, there are potential differences between rural and urban regions in the processes and outcomes following trauma. Objectives: To describe and evaluate rural vs urban processes of care, injury severity, and mortality among injured patients served by 9-1-1 emergency medical services (EMS). Design, Setting, and Participants: This was a preplanned secondary analysis of a prospective cohort enrolled from January 1 through December 31, 2011, and followed up through hospitalization...
October 12, 2016: JAMA Surgery
S L Jackson, S E Safo, L R Staimez, D E Olson, K M V Narayan, Q Long, J Lipscomb, M K Rhee, P Wilson, A M Tomolo, L S Phillips
AIMS: To test the hypothesis that a 50-g oral glucose challenge test with 1-h glucose measurement would have superior performance compared with other opportunistic screening methods. METHODS: In this prospective study in a Veterans Health Administration primary care clinic, the following test performances, measured by area under receiver-operating characteristic curves were compared: oral glucose challenge test; random glucose; and HbA1c level, using an oral glucose tolerance test as the 'gold standard'...
October 11, 2016: Diabetic Medicine: a Journal of the British Diabetic Association
Padmaja Ayyagari, Daifeng He
Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk because of the introduction of Medicare Part D in the U.S. in 2006 to identify the causal effect of medical spending risk on portfolio choice. Consistent with theory, we find that Medicare-eligible persons increased risky investment after the introduction of prescription drug coverage, relative to a younger, ineligible cohort...
October 9, 2016: Health Economics
Jim H Hu, Padraic O'Malley, Bilal Chughtai, Abby Isaacs, Jialin Mao, Jason D Wright, Dawn Hershman, Art Sedrakyan
PURPOSE: Robot-assisted surgery has been rapidly adopted in the U.S. for prostate cancer. Its adoption has been driven by market forces and patient preference, and debate continues regarding whether it offers improved outcomes to justify the higher cost relative to open surgery. We examined the comparative effectiveness of robot-assisted vs open radical prostatectomy in cancer control and survival in a nationally representative population. MATERIALS AND METHODS: This population based observational cohort study of patients with prostate cancer undergoing robot-assisted radical prostatectomy and open radical prostatectomy during 2003 to 2012 used data captured in the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database...
October 5, 2016: Journal of Urology
Kevin M Fain, Carlos Castillo-Salgado, David D Dore, Jodi B Segal, Andrew R Zullo, G Caleb Alexander
OBJECTIVE: We quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naïve prescribing. DESIGN: Cross-sectional study. SETTING: Linked Minimum Data Set (MDS) assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare Part D claims. PARTICIPANTS: From a cross-section of all long-stay US nursing home residents in 2008 with an MDS assessment and Medicare Part D enrollment, we identified individuals (≥65 years old) who initiated transdermal fentanyl, excluding those with Alzheimer disease, severe cognitive impairment, cancer, or receipt of hospice care...
October 6, 2016: Journal of the American Medical Directors Association
E R Wallace, D S Siscovick, C M Sitlani, S Dublin, P Mitchell, J A Robbins, H A Fink, J A Cauley, P Bůžková, L Carbone, Z Chen, S R Heckbert
: In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. INTRODUCTION: AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. METHODS: Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8...
October 7, 2016: Osteoporosis International
Bala Hota, Thomas A Webb, Brian D Stein, Richa Gupta, David Ansell, Omar Lateef
BACKGROUND: Differences between the Centers for Medicare & Medicaid Services (CMS)-measured rates of safety events for Rush University Medical Center (RUMC; Chicago) and the U. S. News & World Report (USNWR)-deter mined patient safety score were evaluated in an attempt to validate the USNWR patient safety score-based ranking. METHODS: The USNWR findings for Patient Safety Indicators (PSIs) were compared with findings derived from RUMC internal billing data, and sensitivity analyses were conducted using a simulated data set derived from the Healthcare Cost and Utilization Project (HCUP) state inpatient data sets...
2016: Joint Commission Journal on Quality and Patient Safety
Lane Koenig, Qian Zhang, Matthew S Austin, Berna Demiralp, Thomas K Fehring, Chaoling Feng, Richard C Mather, Jennifer T Nguyen, Asha Saavoss, Bryan D Springer, Adolph J Yates
BACKGROUND: Demand for total hip arthroplasty (THA) is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery. QUESTIONS/PURPOSES: We asked: (1) What is the expected effect of THA on patients' employment and earnings? (2) How does accounting for these effects influence the cost-effectiveness of THA relative to nonsurgical treatment? METHODS: Taking a societal perspective, we used a Markov model to assess the overall cost-effectiveness of THA compared with nonsurgical treatment...
October 3, 2016: Clinical Orthopaedics and related Research
Shi-Yi Wang, Melissa D Aldridge, Maureen Canavan, Emily Cherlin, Elizabeth Bradley
OBJECTIVES: To identify hospice and patient characteristics associated with the use of continuous home care (CHC), and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. METHODS: Using 100% fee-for-service Medicare claims data for beneficiaries aged 66 years or older who died between July and December 2011, we identified the percentage of hospice agencies in which patients used CHC in 2011 and determined hospice and patient characteristics associated with use of CHC...
September 30, 2016: Journal of Pain and Symptom Management
Nwamaka D Eneanya, Susan M Hailpern, Ann M O'Hare, Manjula Kurella Tamura, Ronit Katz, William Kreuter, Maria E Montez-Rath, Paul L Hebert, Yoshio N Hall
BACKGROUND: Many dialysis patients receive intensive procedures intended to prolong life at the very end of life. However, little is known about trends over time in the use of these procedures. We describe temporal trends in receipt of inpatient intensive procedures during the last 6 months of life among patients treated with maintenance dialysis. STUDY DESIGN: Mortality follow-back study. SETTING & PARTICIPANTS: 649,607 adult Medicare beneficiaries on maintenance dialysis therapy who died in 2000 to 2012...
September 29, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Youjeong Kang, Matthew D McHugh, Jesse Chittams, Kathryn H Bowles
OBJECTIVE: To identify potential risk factors associated with rehospitalization among Medicare recipients with heart failure (HF) receiving telehomecare. MATERIALS AND METHODS: This study is a nonexperimental, cross-sectional secondary data analysis of the Centers for Medicare and Medicaid (CMS) mandated assessment called the Outcome and Assessment Information Set (OASIS)-C, provided by a large home care company. A total of 526 patients who received telehomecare from January 1, 2011 to August 31, 2013 were included in the analyses, which used multiple logistic regression...
September 30, 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Jeff D Jensen, Daniel J Durand
Recent legislation mandates the documentation of appropriateness criteria consultation when ordering advanced imaging for Medicare patients to remain eligible for reimbursement. Implementation of imaging clinical decision support (CDS) is a solution adopted by many systems to automate compliance with the new requirements. This article is intended to help radiologists who are employed by, contracted with, or otherwise affiliated with systems planning to implement CDS in the near future and ensure that they are able to understand and contribute to the process wherever possible...
September 24, 2016: Journal of the American College of Radiology: JACR
Benjamin P Falit, Hubert Y Pan, Benjamin D Smith, Brian M Alexander, Anthony L Zietman
Examinations of the US radiation oncology workforce offer inconsistent conclusions, but recent data raise significant concerns about an oversupply of physicians. Despite these concerns, residency slots continue to expand at an unprecedented pace. Employed radiation oncologists and professional corporations with weak contracts or loose ties to hospital administrators would be expected to suffer the greatest harm from an oversupply. The reduced cost of labor, however, would be expected to increase profitability for equipment owners, technology vendors, and entrenched professional groups...
November 1, 2016: International Journal of Radiation Oncology, Biology, Physics
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