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Healthcare risk adjustment

Manzilat Akande, Peter C Minneci, Katherine J Deans, Henry Xiang, Deena J Chisolm, Jennifer N Cooper
BACKGROUND: Racial/ethnic and socioeconomic disparities in trauma care and outcomes among young adults are well documented. As the Patient Protection and Affordable Care Act Medicaid expansion has increased insurance coverage among young adults, we aimed to investigate its impact on disparities in insurance coverage and outcomes among hospitalized young adult trauma patients. MATERIALS AND METHODS: We used the healthcare cost and utilization project state inpatient databases to examine changes in insurance coverage and risk-adjusted outcomes from before (2012-2013) to after (2014) Medicaid expansion among young adults (age 19-44) hospitalized for injury across 11 Medicaid expansion states...
August 2018: Journal of Surgical Research
Lauren P Wallner, Julia R DiBello, Bonnie H Li, Stephen K Van Den Eeden, Sheila Weinmann, Debra P Ritzwoller, Jill E Abell, Ralph D'Agostino, Ronald K Loo, David S Aaronson, Ralph I Horwitz, Steven J Jacobsen
OBJECTIVE: To compare the risk of mortality among men treated for benign prostatic hyperplasia (BPH) with 5?-reductase inhibitors (5ARI) to those treated with alpha-blockers (AB) in community practice settings. METHODS: We employed a retrospective matched cohort study in 4 regions of an integrated healthcare system. Men ages 50 years and older who initiated pharmaceutical treatment for BPH/LUTS between 1992 and 2008 and had at least 3 consecutive prescriptions were eligible and followed through 2010 (N=174,895)...
June 12, 2018: Urology
Kahoru Fukuoka, Mihoko Furuichi, Kenta Ito, Yoshihiko Morikawa, Ichiro Watanabe, Naoki Shimizu, Yuho Horikoshi
OBJECTIVES: Catheter-associated urinary tract infections account for 30% of healthcare-associated infections. To date, few studies have addressed pediatric catheter-associated urinary tract infection in PICUs. The aim of our study was to assess the risk of catheter-associated urinary tract infection in relation to the duration of catheterization in the PICU. DESIGN: Retrospective cohort study. SETTING: PICU at a tertiary children's hospital...
June 13, 2018: Pediatric Critical Care Medicine
Chang-Ching Wei, Cheng-Li Lin, Te-Chun Shen, An-Chyi Chen
The association between migraine and allergy has remained a subject of debate for more than a century. To systemically investigate the interaction between children with antecedent allergic diseases and their future risks of migraine on reaching school age, we recruited 16,130 children aged 7-18 with migraine diagnosed between 2000 and 2008, and 64,520 matched controls without a history of migraine. The ORs of migraine were calculated for the association with allergic diseases diagnosed before migraine diagnosis...
June 14, 2018: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
Jennie Johnstone, Cynthia Chen, Laura Rosella, Kwaku Adomako, Michelle E Policarpio, Freda Lam, Chatura Prematunge, Gary Garber
BACKGROUND: Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia. METHODS: All patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs)...
June 11, 2018: American Journal of Infection Control
Nicole Lay Tin Tan, Justin Lindley Hunt, Stella May Gwini
BACKGROUND: Enhanced recovery after surgery programs may improve recovery and reduce duration of hospital stay after joint replacement surgery. However, uptake is incomplete, and the relative importance of program components is unknown. This before-and-after quality improvement study was designed to determine whether adding 'non-surgical' components, to pre-existing 'surgical' components, in an Australian private healthcare setting, would improve patient recovery after total hip replacement...
June 13, 2018: BMC Anesthesiology
Mona Rezapour, Artin Galoosian, Benny Liu, Taft Bhuket, Robert J Wong
OBJECTIVE: Inflammatory bowel disease (IBD) patients with Clostridium difficile co-infection (CDCI) have an increased risk of morbidity and mortality. We aim to evaluate the impact of CDCI on in-hospital outcomes among adults with IBD hospitalized in the USA. PATIENTS AND METHODS: Using the 2007-2013 Nationwide Inpatient Sample, hospitalizations among US adults with Crohn's disease (CD), ulcerative colitis (UC) and CDCI were identified using ICD-9 coding. Hospital charges, hospital length of stay (LOS), and in-hospital mortality was stratified by CD and UC and compared using χ-testing and Student's t-test...
June 11, 2018: European Journal of Gastroenterology & Hepatology
Hanaa Dakour-Aridi, Besma Nejim, Satinderjit Locham, Husain Alshaikh, Tammam Obeid, Mahmoud B Malas
PURPOSE: To quantify and compare the incremental cost associated with in-hospital stroke, death, and myocardial infarction (MI) after carotid endarterectomy (CEA) vs carotid artery stenting (CAS). METHODS: A retrospective analysis was performed of 100,185 patients (mean age 70.7±9.5 years; 58.3% men) who underwent CEA (n=86,035) or CAS (n=14,150) between 2009 and 2015 and were entered into the Premier Healthcare Database. Multivariate logistic models and generalized linear models were used to analyze binary outcomes and hospitalization costs, respectively...
June 1, 2018: Journal of Endovascular Therapy
Hyo-Joong Won, Gokyung Chung, Kyeong Ju Lee, Eunkyung Lee, Soonjoo Son, Soyoung Choi, Seon Cheol Park, Yu Jeung Lee
OBJECTIVE: The administration of the usual dosage of medication in elderly patients with renal impairment can cause adverse drug reactions due to patients' decreased renal function. Using retrospective prescription analysis, in a teaching hospital, this study aimed to evaluate medication dosing errors in elderly patients with renal impairment and the risk factors for these dosing errors. MATERIALS AND METHODS: This retrospective study included elderly patients with a creatinine clearance of 59 mL/min or less who were hospitalized in a teaching hospital between July 1, 2015, and September 30, 2015...
June 8, 2018: International Journal of Clinical Pharmacology and Therapeutics
Eric T Wittbrodt, Tong J Gan, Catherine Datto, Charles McLeskey, Meenal Sinha
Purpose: Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC). Patients and methods: This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015...
2018: Journal of Pain Research
Filip Sköldberg, Ola Olén, Anders Ekbom, Peter T Schmidt
BACKGROUND: Appendicitis and acute diverticulitis share clinical features and are both influenced by genetic and environmental factors. Appendectomy has been positively associated with diverticular disease in hospital-based case-control studies. OBJECTIVE: The aim of the present study was to investigate, in a population-based setting, whether appendectomy, with or without appendicitis, is associated with an altered risk of hospitalization with diverticular disease...
July 2018: Diseases of the Colon and Rectum
Leor Perl, Véronique Peiffer, Audelia E Fuhrer, Fabrizio D'Ascenzo, Jan B Pietzsch
BACKGROUND: Despite advancements in treatment, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality in the elderly population. Previous research has highlighted long-standing sex disparities in the care of these patients. However, differences in the patterns of discharge are not well described. One key parameter is the destination of discharge, and in particular - discharge to skilled nursing facilities (SNFs), a factor associated with worse prognosis and greater costs to the healthcare system...
June 6, 2018: Coronary Artery Disease
John S Luque, Yelena N Tarasenko, Chen Chen
Following the latest update of cervical cancer screening guidelines in 2012, we estimate the prevalence of guideline adherent cervical cancer screening and examine its associated factors among a nationally representative sample of US women aged 21-65 years. Our study was based on cross-sectional data from Cycles 3 (2013) and 4 (2014) of the Health Information National Trends Survey. The final analytic sample consisted of 2822 women. Guideline adherent cervical cancer screening was defined as having a Pap test within the last 3 years...
June 6, 2018: Journal of Primary Prevention
Manzilat Akande, Peter C Minneci, Katherine J Deans, Henry Xiang, Jennifer N Cooper
Importance: Trauma is the leading cause of death and disability among young adults in the United States. Young adults are also the age group most likely to be uninsured. Implementation of Medicaid expansion through the Affordable Care Act (ACA) has increased insurance coverage, but its associations with trauma care and outcomes among young adults nationwide remain unknown. We examined whether Medicaid expansion, in its first year, was associated with changes in insurance coverage and improved outcomes in young adults hospitalized for traumatic injury...
June 6, 2018: JAMA Surgery
Monica Teng, Ying Jiao Zhao, Ai Leng Khoo, Rajiv Ananthakrishna, Tiong Cheng Yeo, Boon Peng Lim, Mark Y Chan, Joshua P Loh
AIM: Compared with second-generation durable polymer drug-eluting stents (DP-DES), the cost-effectiveness of biodegradable polymer drug-eluting stents (BP-DES) remains unclear in the real-world setting. We assessed the cost-effectiveness of BP-DES in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS: We developed a decision-analytic model to compare the cost-effectiveness of BP-DES to DP-DES over one year and five years from healthcare payer perspective...
June 5, 2018: Cardiovascular Therapeutics
Nagarajkumar Yenugadhati, Alhanouf Naji Albalawi, Aisha Taha Qureshey, Eiman Taha Qureshey, Hamdan Al-Jahdali, Abdul Rahman Jazieh, Anwar E Ahmed
Purpose: Oral health in cancer patients was known to influence the quality of life. However, the knowledge of possible factors associated with oral health in cancer patients is seriously lacking in Saudi Arabia. In this study, we aimed to determine the burden of adverse oral health in cancer patients and identify the associated factors for oral health problems. Materials and methods: A cross-sectional study design was used to recruit a total of 375 cancer patients who attended oncology outpatient clinics at King Abdulaziz Medical City - Riyadh (KAMC-R) by using a consecutive sampling technique...
2018: Cancer Management and Research
Daniel T Linnen, Patricia Kipnis, June Rondinelli, John D Greene, Vincent Liu, Gabriel J Escobar
BACKGROUND: Research investigating risk factors for hospital-acquired pressure injury (HAPI) has primarily focused on the characteristics of patients and nursing staff. Limited data are available on the association of hospital characteristics with HAPI. OBJECTIVE: We aimed to quantify the association of hospital characteristics with HAPI and their effect on residual hospital variation in HAPI risk. METHODS: We employed a retrospective cohort study design with split validation using hierarchical survival analysis...
June 4, 2018: Nursing Research
Ira L Leeds, Joseph K Canner, Faiz Gani, Patrick M Meyers, Elliott R Haut, Jonathan E Efron, Fabian M Johnston
OBJECTIVE: The purpose of this study was to evaluate the impact of optimization of preoperative comorbidities by nonsurgical clinicians on short-term postoperative outcomes. SUMMARY BACKGROUND DATA: Preoperative comorbidities can have substantial effects on operative risk and outcomes. The modifiability of these comorbidity-associated surgical risks remains poorly understood. METHODS: We identified patients with a major comorbidity (eg, diabetes, heart failure) undergoing an elective colectomy in a multipayer national administrative database (2010-2014)...
June 1, 2018: Annals of Surgery
Jean-Yves Le Heuzey, Jean-Pierre Bassand, Jean-Baptiste Berneau, Paolo Cozzolino, Lucia D'Angiolella, Bernard Doucet, Lorenzo G Mantovani, Michel Martelet, Joseph Mouallem, Jean-Joseph Muller, Karen Pieper
BACKGROUND: GARFIELD-AF is a non-interventional worldwide study of adults with atrial fibrillation. AIMS: To analyse the characteristics of the 1399 patients recruited in France from August 2010 to July 2015, their 1-year outcomes and healthcare resource utilization. METHOD: Patients aged ≥18 years with newly diagnosed atrial fibrillation (≤6 weeks' duration) and ≥1 stroke risk factor were eligible. Patient demographics, medical history and antithrombotic treatment were recorded at baseline...
May 31, 2018: Archives of Cardiovascular Diseases
Cheryl Barnabe, Yufei Zheng, Arto Ohinmaa, Louise Crane, Tyler White, Brenda Hemmelgarn, Gilaad G Kaplan, Liam Martin, Walter P Maksymowych
OBJECTIVE: To examine clinical effectiveness, treatment complications, and healthcare costs for indigenous and non-indigenous Albertans with rheumatoid arthritis (RA) participating in the Alberta Biologics Pharmacosurveillance program. METHODS: Patients initiating biologic therapy in Alberta (2004-2012) were characterized for disease severity and treatment response. Provincial hospitalization separations, physician claims, outpatient department data, and emergency department data were used to estimate treatment complication event rates and healthcare costs...
June 1, 2018: Journal of Rheumatology
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