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https://www.readbyqxmd.com/read/29319880/competing-risks-of-fracture-and-death-in-older-adults-with-chronic-kidney-disease
#1
Rasheeda K Hall, Richard Sloane, Carl Pieper, Courtney Van Houtven, Joanne LaFleur, Robert Adler, Cathleen Colón-Emeric
OBJECTIVES: To examine whether chronic kidney disease (CKD) at any stage is associated with fracture risk after adjusting for competing mortality and to determine whether age or race modify the relationship between CKD and fracture risk. DESIGN: Prospective cohort study. SETTING: Department of Veterans Affairs (VA) national healthcare system. PARTICIPANTS: Men receiving VA primary care aged 65 and older with no history of fracture or osteoporosis therapy (N = 712, 918)...
January 10, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29319627/opioid-prescription-morbidity-and-mortality-in-us-transplant-recipients
#2
Kevin C Abbott, Chyng-Wen Fwu, Paul W Eggers, Anne W Eggers, Prudence P Kline, Paul L Kimmel
BACKGROUND: CDC guidelines recommend caution in prescribing opioids for chronic pain. The characteristics of opioid prescription (OpRx) among kidney transplant (KTx) recipients has not been described in a national population. METHODS: We assessed OpRx prevalence among prevalent KTx recipients, and associated duration (chronic, defined as ≥90 days in a year) and dosing (in morphine milligram equivalents per day, MME, of <50, 50-89, and ≥90) with outcomes, death and graft loss, among incident KTx recipients using 2006-2010 US Renal Data System files, including Medicare Part D for medication ascertainment...
January 10, 2018: Transplantation
https://www.readbyqxmd.com/read/29317456/neighborhood-deprivation-predicts-heart-failure-risk-in-a-low-income-population-of-blacks-and-whites-in-the-southeastern-united-states
#3
Elvis A Akwo, Edmond K Kabagambe, Frank E Harrell, William J Blot, Justin M Bachmann, Thomas J Wang, Deepak K Gupta, Loren Lipworth
BACKGROUND: Recent data suggest that neighborhood socioeconomic environment predicts heart failure (HF) hospital readmissions. We investigated whether neighborhood deprivation predicts risk of incident HF beyond individual socioeconomic status in a low-income population. METHODS AND RESULTS: Participants were 27 078 whites and blacks recruited during 2002 to 2009 in the SCCS (Southern Community Cohort Study), who had no history of HF and were using Centers for Medicare or Medicaid Services...
January 2018: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/29314093/hospice-care-in-medicare-patients-with-primary-liver-cancer-the-impact-on-resource-utilisation-and-mortality
#4
N Fukui, P Golabi, M Otgonsuren, L de Avila, H Bush, Z M Younossi
BACKGROUND: Few studies have assessed the impact of hospice care in patients with primary liver cancer. AIM: To examine the determinants of hospice care and its effects on resource utilisation and survival among Medicare beneficiaries with primary liver cancer. METHODS: We utilised the Surveillance, Epidemiology and End result Registry (SEER) database from 2002 to 2009 for this cross-sectional study. A total of 3385 patients with primary liver cancer were included...
January 3, 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29290361/dietary-inflammatory-index-and-ovarian-cancer-risk-in-a-new-jersey-case-control-study
#5
Nitin Shivappa, James R Hébert, Lisa E Paddock, Lorna Rodriguez-Rodriguez, Sara H Olson, Elisa V Bandera
OBJECTIVE: Diet may influence the development of ovarian cancer. Although it has been shown that inflammation plays an important etiologic role in ovarian carcinogenesis, little is known about the influence of the inflammatory potential of food consumption. The aim of this study was to evaluate the effect of a proinflammatory diet, as indicated by a high dietary inflammatory index (DII®) score, on ovarian cancer risk, in a New Jersey population. METHODS: Data from a case-control study conducted in New Jersey were used to estimate the relation between DII score and the risk for ovarian cancer...
February 2018: Nutrition
https://www.readbyqxmd.com/read/29290177/health-care-resource-utilization-and-costs-among-newly-diagnosed-and-oral-anticoagulant-naive-nonvalvular-atrial-fibrillation-patients-treated-with-dabigatran-or-warfarin-in-the-united-states
#6
Rahul Jain, An-Chen Fu, Jonathan Lim, Cheng Wang, Jessica Elder, Stephen D Sander, Hiangkiat Tan
BACKGROUND: Warfarin has a long history of use to reduce the risk of stroke in patients with atrial fibrillation (AF), but it requires frequent laboratory monitoring to maintain international normalized ratio levels in the therapeutic range. Dabigatran, a novel oral anticoagulant (OAC), has demonstrated efficacy in reducing the risk of stroke and systemic embolism and does not require laboratory monitoring. OBJECTIVE: To compare health care resource utilization (HCRU) and costs of OAC-naive patients newly diagnosed with nonvalvular atrial fibrillation (NVAF), using dabigatran or warfarin...
January 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29283699/physician-level-variation-in-outcomes-of-mechanically-ventilated-patients
#7
Meeta Prasad Kerlin, Andrew Epstein, Jeremy M Kahn, Theodore J Iwashyna, David A Asch, Michael O Harhay, Sarah J Ratcliffe, Scott D Halpern
RATIONALE: Physicians are increasingly being held accountable for patient outcomes. Yet their specific contribution to the outcomes remains uncertain. OBJECTIVE: To determine variation in outcomes of mechanically ventilated patients among intensivists, as well as associations between intensivist experience and patient outcomes. METHODS: We performed a retrospective cohort study of mechanically ventilated Medicare fee-for-service patients in acute care hospitals in Pennsylvania, using administrative, clinical, and physician data from Centers for Medicare & Medicaid Services and the American Medical Association from 2008 and 2009...
December 28, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29279932/association-of-short-term-exposure-to-air-pollution-with-mortality-in-older-adults
#8
Qian Di, Lingzhen Dai, Yun Wang, Antonella Zanobetti, Christine Choirat, Joel D Schwartz, Francesca Dominici
Importance: The US Environmental Protection Agency is required to reexamine its National Ambient Air Quality Standards (NAAQS) every 5 years, but evidence of mortality risk is lacking at air pollution levels below the current daily NAAQS in unmonitored areas and for sensitive subgroups. Objective: To estimate the association between short-term exposures to ambient fine particulate matter (PM2.5) and ozone, and at levels below the current daily NAAQS, and mortality in the continental United States...
December 26, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29279887/regional-variation-of-computed-tomographic-imaging-in-the-united-states-and-the-risk-of-nephrectomy
#9
H Gilbert Welch, Jonathan S Skinner, Florian R Schroeck, Weiping Zhou, William C Black
Importance: While computed tomography (CT) represents a tremendous advance in diagnostic imaging, it also creates the problem of incidental detection-the identification of tumors unrelated to the clinical symptoms that initiate the test. Objective: To determine the geographic variation in the United States in CT imaging and the corresponding association with one of the most consequential sequelae of incidental detection: nephrectomy. Design, Setting, and Participants: This study is a cross-sectional analysis of age-, sex-, and race-adjusted Medicare data (January 2010-December 2014) from 306 hospital referral regions (HRRs) in the United States and includes information from 15 million fee-for-service Medicare beneficiaries age 65 to 85 years...
December 26, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29275113/alternative-payment-models-should-risk-adjust-for-conversion-total-hip-arthroplasty-a-propensity-score-matched-study
#10
Alexander S McLawhorn, William W Schairer, Ran Schwarzkopf, David A Halsey, Richard Iorio, Douglas E Padgett
BACKGROUND: For Medicare beneficiaries, hospital reimbursement for nonrevision hip arthroplasty is anchored to either diagnosis-related group code 469 or 470. Under alternative payment models, reimbursement for care episodes is not further risk-adjusted. This study's purpose was to compare outcomes of primary total hip arthroplasty (THA) vs conversion THA to explore the rationale for risk adjustment for conversion procedures. METHODS: All primary and conversion THAs from 2007 to 2014, excluding acute hip fractures and cancer patients, were identified in the National Surgical Quality Improvement Program database...
December 6, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29275078/cost-effectiveness-of-adjuvant-intravaginal-brachytherapy-in-high-intermediate-risk-endometrial-carcinoma
#11
John M Stahl, Shari Damast, Trevor J Bledsoe, Yi An, Vivek Verma, James B Yu, Melissa R Young, Nataniel H Lester-Coll
PURPOSE: We assessed the cost-effectiveness of adjuvant intravaginal brachytherapy (IVBT) vs. observation after total hysterectomy and bilateral salpingo-oophorectomy (TH/BSO) for high-intermediate risk (HIR) endometrial carcinoma. METHODS AND MATERIALS: A Markov model was used to assess the cost-effectiveness of IVBT by comparing average cumulative costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) between patients allocated to (1) 'observation' or (2) 'IVBT' after TH/BSO...
December 20, 2017: Brachytherapy
https://www.readbyqxmd.com/read/29261829/association-between-medicare-expenditure-growth-and-mortality-rates-in-patients-with-acute-myocardial-infarction-a-comparison-from-1999-through-2014
#12
Donald S Likosky, Jessica Van Parys, Weiping Zhou, William B Borden, Milton C Weinstein, Jonathan S Skinner
Importance: Many studies have considered the association between Medicare spending and health outcomes at a point in time; few have considered the association between the long-term growth in spending and outcomes. Objective: To assess whether components of growth in Medicare expenditures are associated with mortality rates between January 1, 1999, and June 30, 2014, for beneficiaries hospitalized for acute myocardial infarction. Design, Setting, and Participants: Cross-sectional analysis of a random 20% sample of fee-for-service Medicare beneficiaries from January 1, 1999, through December 31, 2000 (n=72 473) and January 1, 2004, through December 31, 2004 (n=38 248), and 100% sample from January 1, 2008, through December 31, 2008 (n=159 558) and January 1, 2013, through June 30, 2014 (n=209 614) admitted with acute myocardial infarction to 1220 hospitals...
December 20, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29261440/association-of-patient-out-of-pocket-costs-with-prescription-abandonment-and-delay-in-fills-of-novel-oral-anticancer-agents
#13
Jalpa A Doshi, Pengxiang Li, Hairong Huo, Amy R Pettit, Katrina A Armstrong
Purpose The number of novel oral anticancer agents is increasing, but financial barriers may limit access. We examined associations between out-of-pocket (OOP) costs and reduced and/or delayed treatment initiation. Methods This retrospective claims-based study used 2014 to 2015 data from a large, proprietary, integrated database and included Medicare and commercial insurance enrollees with a new, adjudicated prescription for any of 38 oral anticancer agents. We examined rates of claim reversal (failure to purchase approved prescription), delayed initiation (reversal with subsequent fill of same agent within 90 days after adjudication), and abandonment (reversal with no fill of same agent within 90 days after adjudication) for the index oral anticancer agent...
December 20, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/29250770/racial-disparities-in-hospice-outcomes-a-race-or-hospice-level-effect
#14
Jessica Rizzuto, Melissa D Aldridge
OBJECTIVES: To determine whether there is racial variation in hospice enrollees in rates of hospitalization and hospice disenrollment and, if so, whether systematic differences in hospice provider patterns explain the variation. DESIGN: Longitudinal cohort study. SETTING: Hospice. PARTICIPANTS: Medicare beneficiaries (N = 145,038) enrolled in a national random sample of hospices (N = 577) from the National Hospice Survey and followed until death (2009-10)...
December 18, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29248062/insurers-response-to-selection-risk-evidence-from-medicare-enrollment-reforms
#15
Francesco Decarolis, Andrea Guglielmo
Evidence on insurers' behavior in environments with both risk selection and market power is largely missing. We fill this gap by providing one of the first empirical accounts of how insurers adjust plan features when faced with potential changes in selection. Our strategy exploits a 2012 reform allowing Medicare enrollees to switch to 5-star contracts at anytime. This policy increased enrollment into 5-star contracts, but without risk selection worsening. Our findings show that this is due to 5-star plans lowering both premiums and generosity, thus becoming more appealing for most beneficiaries, but less so for those in worse health conditions...
December 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/29248061/does-part-d-abet-advantageous-selection-in-medicare-advantage
#16
Tony Han, Kurt Lavetti
The use of risk-adjustment formulae in setting payments to Medicare Advantage (MA) plans reduces the potential for advantageous selection on factors included in the formulae, but can theoretically worsen overall selection if plans are able to target beneficiaries based on excluded factors. Since MA medical risk-adjustment excludes prescription drug utilization, demand for drugs can be exploited by plans to induce advantageous selection. We show evidence that the introduction of Medicare Part D provided a mechanism for MA plans to increase selection, and that consumers responded, increasing MA market shares among beneficiaries taking drugs associated with the strongest advantageous selection incentives...
December 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/29240910/genetic-predisposition-to-obesity-and-medicare-expenditures
#17
MULTICENTER STUDY
George L Wehby, Benjamin W Domingue, Fred Ullrich, Fredric D Wolinsky
Background: The relationship between obesity and health expenditures is not well understood. We examined the relationship between genetic predisposition to obesity measured by a polygenic risk score for body mass index (BMI) and Medicare expenditures. Methods: Biennial interview data from the Health and Retirement Survey for a nationally representative sample of older adults enrolled in fee-for-service Medicare were obtained from 1991 through 2010 and linked to Medicare claims for the same period and to Genome-Wide Association Study (GWAS) data...
December 12, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/29238240/the-effect-of-dpp-4-inhibitors-on-asthma-control-an-administrative-database-study-to-evaluate-a-potential-pathophysiological-relationship
#18
Gene Colice, David Price, Maria Gerhardsson de Verdier, Karma Rabon-Stith, Christopher Ambrose, Katherine Cappell, Debra E Irwin, Paul Juneau, Anna Vlahiotis
Rationale: DPP-4 may regulate immunological pathways implicated in asthma. Assessing whether DPP-4 inhibitor (DPP-4i) use might affect asthma control is clinically important because DPP-4i use in type 2 diabetes mellitus management (T2DM) is increasing. This study evaluated associations between DPP-4i use and asthma control. Methods: This was a retrospective, observational, matched cohort study using administrative claims in the MarketScan® Commercial Claims and Encounters (Commercial) and Medicare Supplemental and Coordination of Benefits (Medicare Supplemental) databases...
2017: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/29236294/acute-myeloid-leukemia-and-myelodysplastic-syndrome-after-adjuvant-chemotherapy-a-population-based-study-among-older-breast-cancer-patients
#19
Aron S Rosenstock, Jiangong Niu, Sharon H Giordano, Hui Zhao, Antonio C Wolff, Mariana Chavez-MacGregor
BACKGROUND: Chemotherapy for early breast cancer is associated with a small risk of developing myelodysplastic syndrome (MDS) and/or acute myeloid leukemia (AML). The aim of this study was to determine the risk of developing AML or MDS after modern adjuvant chemotherapy in older breast cancer patients and to further define the risk of individual chemotherapy regimens. METHODS: Patients diagnosed with stage I to III breast cancer from 2003 to 2009 were identified in the Surveillance, Epidemiology, and End Results-Medicare and Texas Cancer Registry-Medicare linked databases...
December 13, 2017: Cancer
https://www.readbyqxmd.com/read/29235785/the-evolution-of-private-plans-in-medicare
#20
Yash M Patel, Stuart Guterman
Issue: Since the 1980s, private plans have played an increasingly important role in the Medicare program. While initially created with the goals of reducing costs, improving choice, and enhancing quality, risk-based plans--now known as Medicare Advantage plans--have undergone significant policy changes since their inception; these changes have not always aligned with the original policy objectives. Goal: To examine major policy changes to Medicare risk plans and the effects of these policies on plan participation, enrollment, average premiums and cost-sharing, total costs to Medicare, and quality of care...
December 1, 2017: Issue Brief of the Commonwealth Fund
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