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Medicare risk adjustment

Nils D Arvold, Matthew Cefalu, Yun Wang, Corwin Zigler, Deborah Schrag, Francesca Dominici
It is unknown whether the addition of temozolomide (TMZ) to radiotherapy (RT) is associated with improved overall survival (OS) among older glioblastoma patients. We performed a retrospective cohort SEER-Medicare analysis of 1652 patients aged ≥65 years with glioblastoma who received ≥10 fractions of RT from 2005 to 2009, or from 1995 to 1999 before TMZ was available. Three cohorts were assembled based on diagnosis year and treatment initiated within 60 days of diagnosis: (1) 2005-2009 and TMZ/RT, (2) 2005-2009 and RT only, or (3) 1995-1999 and RT only...
October 21, 2016: Journal of Neuro-oncology
Momotazur Rahman, David C Grabowski, Vincent Mor, Edward C Norton
OBJECTIVE: To determine whether the observed differences in the risk-adjusted rehospitalization rates across skilled nursing facilities (SNFs) reflect true differences or merely differences in patient severity. SETTINGS: Elderly Medicare beneficiaries newly admitted to an SNF following hospitalization. STUDY DESIGN: We used 2009-2012 Medicare data to calculate SNFs' risk-adjusted rehospitalization rate. We then estimated the effect of these rehospitalization rates on the rehospitalization of incident patients in 2013, using an instrumental variable (IV) method and controlling for patient's demographic and clinical characteristics and residential zip code fixed effects...
October 21, 2016: Health Services Research
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
Kenneth J Woodside, Randall S Sung
Transplantation is one of the most highly regulated fields in health care. An important component of transplant oversight is the performance assessment of transplant centers as measured by 1-year patient and graft survival outcomes. The use of the Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients flagging mechanism for quality improvement as criteria for Center for Medicare and Medicaid Services certification has resulted in greater importance in transplant program operations...
September 2016: Advances in Chronic Kidney Disease
Adan Z Becerra, Christopher T Aquina, Supriya G Mohile, Mohamedtaki A Tejani, Maria J Schymura, Francis P Boscoe, Zhaomin Xu, Carla F Justiniano, Courtney I Boodry, Alex A Swanger, Katia Noyes, John R Monson, Fergal J Fleming
BACKGROUND: There is a paucity of literature quantifying the extent to which time to adjuvant chemotherapy for stage III colon cancer patients varies between individual surgeons, medical oncologists, and hospitals. METHODS: A retrospective cohort study was conducted by merging the New York State Cancer Registry with the Statewide Planning & Research Cooperative System and Medicare claims to identify stage III colon cancer patients from 2004 to 2009 who underwent resection and received adjuvant chemotherapy...
October 13, 2016: Annals of Surgical Oncology
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
R Carter Clement, Caitlin M Gray, Michael M Kheir, Peter B Derman, Rebecca M Speck, L Scott Levin, Lee A Fleisher
BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) recently imposed penalties against hospitals with above-average 30-day readmission rates following total joint arthroplasty (TJA). Hospitals must decide whether investments in readmission prevention are worthwhile. This study examines the financial incentives associated with unplanned readmissions before and after invocation of these penalties. METHODS: Financial data were reviewed for 2028 consecutive primary TJAs performed on Medicare beneficiaries over a 2-year period at an urban academic health system...
August 31, 2016: Journal of Arthroplasty
Jason C Pradarelli, Mark A Healy, Nicholas H Osborne, Amir A Ghaferi, Justin B Dimick, Hari Nathan
Importance: Treating surgical complications presents a major challenge for hospitals striving to deliver high-quality care while reducing costs. Costs associated with rescuing patients from perioperative complications are poorly characterized. Objective: To evaluate differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery. Design, Setting, and Participants: Retrospective cohort study using claims data from the Medicare Provider Analysis and Review files...
October 5, 2016: JAMA Surgery
Fang Chen, Wenqing Su, Shawn H Becker, Mike Payne, Cynthia M Castro Sweet, Anne L Peters, Timothy M Dall
BACKGROUND: Type 2 diabetes and cardiovascular disease impose substantial clinical and economic burdens for seniors (age 65 and above) and the Medicare program. Intensive Behavioral Counseling (IBC) interventions like the National Diabetes Prevention Program (NDPP), have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset. This paper estimated the potential health implications and medical savings of a digital version of IBC modeled after the NDPP...
2016: PloS One
Emily M Bucholz, Neel M Butala, Shuangge Ma, Sharon-Lise T Normand, Harlan M Krumholz
Background Thirty-day risk-standardized mortality rates after acute myocardial infarction are commonly used to evaluate and compare hospital performance. However, it is not known whether differences among hospitals in the early survival of patients with acute myocardial infarction are associated with differences in long-term survival. Methods We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries who were hospitalized for acute myocardial infarction between 1994 and 1996 and who had 17 years of follow-up...
October 6, 2016: New England Journal of Medicine
David J Graham, Marsha E Reichman, Michael Wernecke, Ya-Hui Hsueh, Rima Izem, Mary Ross Southworth, Yuqin Wei, Jiemin Liao, Margie R Goulding, Katrina Mott, Yoganand Chillarige, Thomas E MaCurdy, Chris Worrall, Jeffrey A Kelman
Importance: Dabigatran and rivaroxaban are non-vitamin K oral anticoagulants approved for stroke prevention in patients with nonvalvular atrial fibrillation (AF). There are no randomized head-to-head comparisons of these drugs for stroke, bleeding, or mortality outcomes. Objective: To compare risks of thromboembolic stroke, intracranial hemorrhage (ICH), major extracranial bleeding including major gastrointestinal bleeding, and mortality in patients with nonvalvular AF who initiated dabigatran or rivaroxaban treatment for stroke prevention...
October 3, 2016: JAMA Internal Medicine
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
Benjamin D Smith, Jing Jiang, Ya-ChenTina Shih, Sharon H Giordano, Jinhai Huo, Reshma Jagsi, Adeyiza O Momoh, Abigail S Caudle, Kelly K Hunt, Simona F Shaitelman, Thomas A Buchholz, Shervin M Shirvani
BACKGROUND: Guideline-concordant local therapy options for early breast cancer include lumpectomy plus whole breast irradiation (Lump+WBI), lumpectomy plus brachytherapy, mastectomy alone, mastectomy plus reconstruction, and, in older women, lumpectomy alone. We performed a comparative examination of each treatment's complications and cost to assess their relative values. METHODS: Using the MarketScan database of younger women with private insurance and the SEER-Medicare database of older women with public insurance, we identified 105 211 women with early breast cancer diagnosed between 2000 and 2011...
January 2017: Journal of the National Cancer Institute
Haran Sivakumar, Yaniv Hanoch, Andrew J Barnes, Alex D Federman
Poor Medicare knowledge is associated with worse health outcomes, especially in low-income patients. We examined the association of health literacy and cognition with actual and perceived Medicare knowledge in a sample of inner-city older adults. We conducted a cross-sectional analysis of data on 336 adults ages 65 years and older with Medicare coverage recruited from senior centers and low-income housing facilities in Manhattan, New York. Actual Medicare knowledge was determined by a summary score of 9 true/false questions about the Medicare program and perceived Medicare knowledge with a single item...
2016: Journal of Health Communication
Ling Na, Qiang Pan, Dawei Xie, Jibby E Kurichi, Joel E Streim, Hillary R Bogner, Debra Saliba, Sean Hennessy
BACKGROUND: Activity limitation stages based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are associated with 3-year mortality in elderly Medicare beneficiaries, yet their associations with hospitalization risk in this population have not been studied. OBJECTIVE: To examine the independent association of activity limitation stages with risk of hospitalization within a year among Medicare beneficiaries aged 65 years and older...
September 21, 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Tasneem Khambaty, Christopher M Callahan, Anthony J Perkins, Jesse C Stewart
OBJECTIVES: To examine depression and anxiety screens and their individual items as simultaneous predictors of incident diabetes mellitus. DESIGN: Ten-year follow-up study of individuals screened for the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial. SETTING: Two large urban primary care clinics in Indianapolis, Indiana. PARTICIPANTS: Diverse sample (53% African American, 80% of lower socioeconomic status) of 2,156 older adults initially free of diabetes mellitus...
September 19, 2016: Journal of the American Geriatrics Society
Tacara Soones, Alex Federman, Bruce Leff, Albert L Siu, Katherine Ornstein
OBJECTIVES: To determine the association between homebound status and mortality. DESIGN: Cross-sectional. SETTING: Annual, in-person interviews. PARTICIPANTS: A nationally representative sample of community-dwelling, Medicare beneficiaries aged 65 and older enrolled in the National Health and Aging Trends Study between 2011 and 2013 (N = 6,400). MEASUREMENTS: Two-year mortality and prevalence of homebound status in the year before death are described using three categories of homebound status: homebound (never or rarely left home in the last month), semihomebound (left home with assistance, needed help or had difficulty), and nonhomebound (left home without help or difficulty)...
September 19, 2016: Journal of the American Geriatrics Society
Wayne A Ray, Cecilia P Chung, Katherine T Murray, Walter E Smalley, James R Daugherty, William D Dupont, C Michael Stein
BACKGROUND & AIMS: Proton-pump inhibitors (PPIs) might reduce the risk of serious warfarin-related upper gastrointestinal bleeding, but the evidence of their efficacy for this indication is limited. A gastroprotective effect of PPIs would be particularly important for patients who take warfarin with antiplatelet drugs or nonselective non-steroidal anti-inflammatory drugs (NSAIDs), which further increase the risk of gastrointestinal bleeding. METHODS: This retrospective cohort study of patients beginning warfarin treatment in Tennessee Medicaid and the 5% National Medicare Sample identified 97,430 new episodes of warfarin treatment with 75,720 person-years of follow up...
September 14, 2016: Gastroenterology
Stephen P Juraschek, Natalie Daya, Lawrence J Appel, Edgar R Miller, Beverly Gwen Windham, Lisa Pompeii, Michael E Griswold, Anna Kucharska-Newton, Elizabeth Selvin
BACKGROUND: One-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent. METHODS: We conducted a prospective study of the association between baseline OH (1987-1989) and risk of falls in the Atherosclerosis Risk in Communities (ARIC) Study. Falls were ascertained during follow-up via ICD-9 hospital discharge codes or Centers for Medicare & Medicaid Services claims data...
September 16, 2016: American Journal of Hypertension
Mark D Neuman, Molly R Passarella, Rachel M Werner
BACKGROUND: While 30-day risk-adjusted mortality is a performance measure for hip fracture care, it has not been shown to predict long-term outcomes. We assessed whether hospital rankings based on historical 30-day mortality predicted subsequent hip fracture outcomes. METHODS: Using national Medicare data, we calculated annual hospital performance rankings based on standardized 30-day hip fracture mortality ratios. We used logistic regression to measure the association of patients' survival at 180 days with their hospital's ranking for the year prior to admission...
September 2016: Healthcare
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