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Medicare risk adjustment

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https://www.readbyqxmd.com/read/28448784/a-motivational-interviewing-intervention-by-pharmacy-students-to-improve-medication-adherence
#1
Susan Abughosh, Xin Wang, Omar Serna, Tara Esse, Amanda Mann, Santhi Masilamani, Marcia McDonnell Holstad, Ekere James Essien, Marc Fleming
BACKGROUND: Diabetes mellitus (DM) patients with comorbid hypertension (HTN) are at a higher risk of developing microvascular and macrovascular DM complications. Through guideline-driven recommendations, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are highly recommended for these patients. Unfortunately, medication adherence to these products, though crucial to achieving therapeutic benefit, is frequently suboptimal. Motivational interviewing (MI) is a patient-centered collaborative communication style that is used to strengthen internal motivation for change that may prove effective in enhancing adherence...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28448783/effectiveness-of-a-clinical-pharmacist-medication-therapy-management-program-in-discontinuation-of-drugs-to-avoid-in-the-elderly
#2
Nicole Caffiero, Thomas Delate, Mercy D Ehizuelen, Kris Vogel
BACKGROUND: Despite evidence of fall risk associated with some drugs to avoid in the elderly (DAEs), many aged patients continue to receive them. OBJECTIVE: To assess the effectiveness of a clinical pharmacist medication therapy management program (MTM) on discontinuation of prescribed DAEs. METHODS: This was a retrospective cohort study conducted at an integrated health care delivery system. Kaiser Permanente Colorado beneficiaries aged ≥65 years who were MTM-eligible and targeted for a DAE dispensing between 01/01/2015 and 09/30/2015 were included in the observation group...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28445559/association-of-us-centers-for-medicare-and-medicaid-services-hospital-30-day-risk-standardized-readmission-metric-with-care-quality-and-outcomes-after-acute-myocardial-infarction-findings-from-the-national-cardiovascular-data-registry-acute-coronary-treatment
#3
Ambarish Pandey, Harsh Golwala, Hurst M Hall, Tracy Y Wang, Di Lu, Ying Xian, Karen Chiswell, Karen E Joynt, Abhinav Goyal, Sandeep R Das, Dharam Kumbhani, Howard Julien, Gregg C Fonarow, James A de Lemos
Importance: The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acute myocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are not well established. Objective: To evaluate the association between ERR for MI with in-hospital process of care measures and 1-year clinical outcomes...
April 26, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28441679/the-drivers-of-discretionary-utilization-clinical-history-versus-physician-supply
#4
Gregory W Ruhnke, Willard G Manning, David T Rubin, David O Meltzer
PURPOSE: Because the effect of physician supply on utilization remains controversial, literature based on non-Medicare populations is sparse, and a physician supply expansion is under way, the potential for physician-induced demand across diverse populations is important to understand. A substantial proportion of gastrointestinal endoscopies may be inappropriate. The authors analyzed the impact of physician supply, practice patterns, and clinical history on esophagogastroduodenoscopy (EGD, defined as discretionary) among patients hospitalized with lower gastrointestinal bleeding (LGIB)...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28437320/development-of-a-claims-based-frailty-indicator-anchored-to-a-well-established-frailty-phenotype
#5
Jodi B Segal, Hsien-Yen Chang, Yu Du, Jeremy D Walston, Michelle C Carlson, Ravi Varadhan
BACKGROUND: Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures. STUDY DESIGN: We used the CHS cohort data linked to participants Medicare claims...
April 21, 2017: Medical Care
https://www.readbyqxmd.com/read/28434458/relationship-between-state-malpractice-environment-and-quality-of-health-care-in-the-united-states
#6
Karl Y Bilimoria, Jeanette W Chung, Christina A Minami, Min-Woong Sohn, Emily S Pavey, Jane L Holl, Michelle M Mello
BACKGROUND: One major intent of the medical malpractice system in the United States is to deter negligent care and to create incentives for delivering high-quality health care. A study was conducted to assess whether state-level measures of malpractice risk were associated with hospital quality and patient safety. METHODS: In an observational study of short-term, acute-care general hospitals in the United States that publicly reported in the Centers for Medicaid & Medicare Services Hospital Compare in 2011, hierarchical regression models were used to estimate associations between state-specific malpractice environment measures (rates of paid claims, average Medicare Malpractice Geographic Practice Cost Index [MGPCI], absence of tort reform laws, and a composite measure) and measures of hospital quality (processes of care, imaging utilization, 30-day mortality and readmission, Agency for Healthcare Research and Quality Patient Safety Indicators, and patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS])...
May 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28424149/comparative-safety-of-sulfonylurea-and-metformin-monotherapy-on-the-risk-of-heart-failure-a-cohort-study
#7
Christianne L Roumie, Jea Young Min, Lucy D'Agostino McGowan, Caroline Presley, Carlos G Grijalva, Amber J Hackstadt, Adriana M Hung, Robert A Greevy, Tom Elasy, Marie R Griffin
BACKGROUND: Medications that impact insulin sensitivity or cause weight gain may increase heart failure risk. Our aim was to compare heart failure and cardiovascular death outcomes among patients initiating sulfonylureas for diabetes mellitus treatment versus metformin. METHODS AND RESULTS: National Veterans Health Administration databases were linked to Medicare, Medicaid, and National Death Index data. Veterans aged ≥18 years who initiated metformin or sulfonylureas between 2001 and 2011 and whose creatinine was <1...
April 19, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28412954/does-a-quality-improvement-campaign-accelerate-take-up-of-new-evidence-a-ten-state-cluster-randomized-controlled-trial-of-the-institute-for-health-improvement-s-project-joints
#8
Eric C Schneider, Melony E Sorbero, Ann Haas, M Susan Ridgely, Dmitry Khodyakov, Claude M Setodji, Gareth Parry, Susan S Huang, Deborah S Yokoe, Don Goldmann
BACKGROUND: A decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices. There have been few rigorous studies of the QI campaign approach. METHODS: Project JOINTS (Joining Organizations IN Tackling SSIs) engaged a network of state-based organizations and professionals in a 6-month QI campaign promoting adherence to three new evidence-based practices known to reduce the risk of infection after joint replacement...
April 17, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28412897/rates-of-cervical-cancer-screening-among-women-with-severe-mental-illness-in-the-public-health-system
#9
Monique James, Melanie Thomas, Latoya Frolov, Nicholas S Riano, Eric Vittinghoff, Dean Schillinger, John W Newcomer, Christina Mangurian
OBJECTIVE: This study aimed to determine cervical cancer screening rates among women with severe mental illness. METHODS: California Medicaid administrative records (2010-2011) for 31,308 women with severe mental illness were examined. Participants received specialty mental health services and were not dually eligible for Medicare. Poisson models assessed association between selected predictors and cervical cancer screening. RESULTS: Overall, 20...
April 17, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28411287/impact-of-a-connected-care-model-on-30-day-readmission-rates-from-skilled-nursing-facilities
#10
Luke D Kim, Lei Kou, Bo Hu, Eiran Z Gorodeski, Michael B Rothberg
BACKGROUND: About one-fifth of hospitalized Medicare beneficiaries are discharged to skilled nursing facilities (SNFs) for post-acute care. Readmissions are common but interventions to reduce readmissions are scarce. OBJECTIVE: To assess the impact of a connected care model on 30-day hospital readmission rates among patients discharged to SNFs. DESIGN: Retrospective cohort. SETTING: SNFs that receive referrals from an academic medical center in Cleveland, Ohio...
April 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28410339/patterns-of-buprenorphine-naloxone-treatment-for-opioid-use-disorder-in-a-multistate-population
#11
Brendan Saloner, Matthew Daubresse, G Caleb Alexander
BACKGROUND: Buprenorphine-naloxone treatment for opioid use disorder has rapidly expanded, yet little is known about treatment outcomes among patients in the general population. OBJECTIVE: To examine predictors of treatment duration, dosage, and continuity in a diverse community setting. RESEARCH DESIGN: We examined QuintilesIMS Real World Data, an all-payer, pharmacy claims database, to conduct an analysis of individuals age 18 years and above initiating buprenorphine-naloxone treatment between January 2010 and July 2012 in 11 states...
April 13, 2017: Medical Care
https://www.readbyqxmd.com/read/28404800/racial-differences-in-statin-adherence-following-hospital-discharge-for-ischemic-stroke
#12
Karen C Albright, Hong Zhao, Justin Blackburn, Nita A Limdi, T Mark Beasley, George Howard, Vera Bittner, Virginia J Howard, Paul Muntner
OBJECTIVE: To compare nonadherence to statins in older black and white adults following an ischemic stroke. METHODS: We studied black and white adults ≥66 years of age with Medicare fee-for-service insurance coverage hospitalized for ischemic stroke from 2007 to 2012 who filled a statin prescription within 30 days following discharge. Nonadherence was defined as a proportion of days covered <80% in the 365 days following hospital discharge. In addition, we evaluated factors associated with nonadherence for white and black participants separately...
April 12, 2017: Neurology
https://www.readbyqxmd.com/read/28402772/delays-in-emergency-care-and-mortality-during-major-u-s-marathons
#13
Anupam B Jena, N Clay Mann, Leia N Wedlund, Andrew Olenski
BACKGROUND: Large marathons frequently involve widespread road closures and infrastructure disruptions, which may create delays in emergency care for nonparticipants with acute medical conditions who live in proximity to marathon routes. METHODS: We analyzed Medicare data on hospitalizations for acute myocardial infarction or cardiac arrest among Medicare beneficiaries (≥65 years of age) in 11 U.S. cities that were hosting major marathons during the period from 2002 through 2012 and compared 30-day mortality among the beneficiaries who were hospitalized on the date of a marathon, those who were hospitalized on the same day of the week as the day of the marathon in the 5 weeks before or the 5 weeks after the marathon, and those who were hospitalized on the same day as the marathon but in surrounding ZIP Code areas unaffected by the marathon...
April 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28396043/body-mass-index-and-cardiorespiratory-fitness-in-mid-life-and-risk-of-heart-failure%C3%A2-hospitalization-in-older-age-findings-from-the-cooper-center-longitudinal-study
#14
Ambarish Pandey, William K Cornwell, Benjamin Willis, Ian J Neeland, Ang Gao, David Leonard, Laura DeFina, Jarett D Berry
OBJECTIVES: This study evaluated the contributions of obesity and changes in body mass index (BMI) in mid-life to long-term heart failure (HF) risk independent of cardiorespiratory fitness (CRF) levels. BACKGROUND: Obesity and low CRF are well-established risk factors for HF. However, given the inverse association between CRF and obesity, the independent contributions of BMI toward HF risk are not fully understood. METHODS: We included 19,485 participants from the Cooper Center Longitudinal Study who survived to receive Medicare coverage, from 1999 to 2009...
March 30, 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28393573/persistence-with-rapid-acting-insulin-and-its-association-with-a1c-level-and-severe-hypoglycemia-among-elderly-patients-with-type-2-diabetes
#15
Usha Sambamoorthi, Rahul Garg, Arijita Deb, Tao Fan, Anders Boss
OBJECTIVE: To examine the persistence with rapid-acting insulin (RAI) and its association with clinical outcomes among elderly patients with type 2 diabetes (T2D). METHODS: This observational, retrospective cohort study analyzed RAI persistence and its association with change in A1C and risk of severe hypoglycemia among elderly (≥65 years) Medicare beneficiaries with T2D who added RAI to their basal insulin regimen. RESULTS: Among T2D patients with >1 RAI prescriptions (n = 3,927), only 21% were persistent...
April 10, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28390680/effect-of-chronic-obstructive-pulmonary-disease-on-in-hospital-mortality-and-clinical-outcomes-after-st-segment-elevation-myocardial-infarction
#16
Manyoo Agarwal, Sahil Agrawal, Lohit Garg, Aakash Garg, Nirmanmoh Bhatia, Dipen Kadaria, Guy Reed
There is controversy regarding in-hospital mortality, revascularization, and other adverse outcomes in patients with ST-segment elevation (STEMI) and chronic obstructive pulmonary disease (COPD). We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients aged ≥18 years with a primary diagnosis of STEMI. Univariate and multivariate analyses were performed to evaluate the association of COPD with in-hospital clinical outcomes. Patients with COPD comprised 13.2% of 2,120,005 patients with STEMI...
March 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28378004/variation-in-the-cost-of-care-for-primary-total-knee-arthroplasties
#17
Derek A Haas, Robert S Kaplan
BACKGROUND: The study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission and complication rates. METHODS: Hospital and physician personnel costs were calculated using time-driven activity-based costing...
March 2017: Arthroplasty Today
https://www.readbyqxmd.com/read/28371808/the-landscape-of-genetic-susceptibility-correlations-among-diseases-and-traits
#18
Jung Hun Ohn
Objective: : The aim of the study was to comprehensively explore the genetic susceptibility correlations among diseases and traits from large-scale individual genotype data. Materials and Methods: : Based on a knowledge base of genetic variants significantly (P < 5 × 10 -8 ) linked with human phenotypes, genetic risk scores (GRSs) of diseases or traits were calculated for 2504 individuals with whole-genome sequencing data from the 1000 Genomes Project...
March 21, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28369885/medicare-s-acute-care-episode-demonstration-effects-of-bundled-payments-on-costs-and-quality-of-surgical-care
#19
Lena M Chen, Andrew M Ryan, Terry Shih, Jyothi R Thumma, Justin B Dimick
OBJECTIVE: To evaluate whether participation in Medicare's Acute Care Episode (ACE) Demonstration Program-an early, small, voluntary episode-based payment program-was associated with a change in expenditures or quality of care. DATA SOURCES/STUDY SETTING: Medicare claims for patients who underwent cardiac or orthopedic surgery from 2007 to 2012 at ACE or control hospitals. STUDY DESIGN: We used a difference-in-differences approach, matching on baseline and pre-enrollment volume, risk-adjusted Medicare payments, and clinical outcomes to identify controls...
March 28, 2017: Health Services Research
https://www.readbyqxmd.com/read/28369774/temporal-trends-in-healthcare-utilization-following-primary-melanoma-diagnosis-among-medicare-beneficiaries
#20
J P Lott, Q Wang, L J Titus, T Onega, H D Nelson, M A Weinstock, J G Elmore, A N A Tosteson
BACKGROUND: Despite increasing melanoma incidence in the United States, little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time. OBJECTIVE: To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis. METHODS: We conducted a before-after multiple time series study of Medicare beneficiaries ages ≥66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results-Medicare database...
March 30, 2017: British Journal of Dermatology
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