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Medicare risk adjustment

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https://www.readbyqxmd.com/read/28338215/delirium-during-postacute-nursing-home-admission-and-risk-for-adverse-outcomes
#1
Cyrus M Kosar, Kali S Thomas, Sharon K Inouye, Vincent Mor
OBJECTIVES: To identify the rate of delirium present during admission to postacute care (PAC) in the nursing home setting and to determine whether patients with delirium had higher risk for adverse outcomes. DESIGN: Retrospective cohort study. SETTING: US Medicare- and Medicaid-certified nursing homes, 2011 to 2014. PARTICIPANTS: Individuals admitted to all US nursing homes for PAC, aged ≥65 years, and without prior history of nursing home residence (n = 5,588,702)...
March 24, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28336325/allogeneic-hematopoietic-stem-cell-transplantation-is-underutilized-in-older-patients-with-myelodysplastic-syndromes
#2
Bartlomiej M Getta, Ashwin Kishtagari, Patrick Hilden, Martin S Tallman, Molly Maloy, Patrick Gonzales, Hugo Castro-Malaspina, Miguel-Angel Perales, Sergio Giralt, Roni Tamari, Virginia Klimek
Allogeneic hematopoietic stem cell transplantation (HCT) is the only curative treatment for myelodysplastic syndrome (MDS). The proportion of MDS patients referred for transplant evaluation, those undergoing transplantation and the reasons for not undergoing transplant are unknown. In this retrospective analysis, pre-defined HCT eligibility and indications criteria were applied to 362 unselected patients with newly diagnosed MDS seen by Leukemia faculty between 2008 and 2015 at Memorial Sloan Kettering Cancer Center...
March 20, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28333708/cost-effectiveness-of-antihypertensive-medication-exploring-race-and-sex-differences-using-data-from-the-reasons-for-geographic-and-racial-differences-in-stroke-study
#3
Gabriel S Tajeu, Stephen Mennemeyer, Nir Menachemi, Robert Weech-Maldonado, Meredith Kilgore
BACKGROUND: Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks. OBJECTIVE: To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults. RESEARCH DESIGN: We constructed a State Transition Model to assess the costs and quality-adjusted life-years (QALYs) associated with either antihypertensive medication treatment or no-treatment using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and published literature...
March 22, 2017: Medical Care
https://www.readbyqxmd.com/read/28329356/sleep-disturbances-and-risk-of-hospitalization-and-inpatient-days-among-older-women
#4
Misti L Paudel, Brent C Taylor, Tien N Vo, Allyson M Kats, John T Schousboe, Li-Yung Lui, Charles E McCulloch, Lisa Langsetmo, Sonia Ancoli-Israel, Susan Redline, Kristine Yaffe, Katie L Stone, Teresa A Hillier, Kristine E Ensrud
Study Objective: Determine the associations of sleep disturbances with hospitalization risk among older women. Methods: 1,827 women (mean age 83.6 years) participating in Study of Osteoporotic Fractures Year 16 (Y16) examination (2002-2004) linked with Medicare and/or HMO claims. At Y16 examination, sleep/wake parameters were measured by actigraphy (total sleep time [TST], sleep efficiency [SE], sleep latency [SL], and wake after sleep onset [WASO]) and subjective sleep measures (sleep quality [Pittsburgh Sleep Quality Index] and daytime sleepiness [Epworth Sleepiness Scale]) were assessed by questionnaire...
March 1, 2017: Sleep
https://www.readbyqxmd.com/read/28329352/costs-and-consequences-of-early-hospital-discharge-after-major-inpatient-surgery-in-older-adults
#5
Scott E Regenbogen, Anne H Cain-Nielsen, Edward C Norton, Lena M Chen, John D Birkmeyer, Jonathan S Skinner
Importance: As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective: To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions...
March 22, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28329087/clinical-definitions-of-sarcopenia-and-risk-of-hospitalization-in-community-dwelling-older-men-the-osteoporotic-fractures-in-men-study
#6
Peggy M Cawthon, Li-Yung Lui, Brent C Taylor, Charles E McCulloch, Jane A Cauley, Jodi Lapidus, Eric Orwoll, Kristine E Ensrud
Background: The association between various definitions of sarcopenia and hospitalization has not been evaluated in community-dwelling older men. Methods: We used data from 1,516 participants at Visit 3 of the Osteoporotic Fractures in Men (MrOS) study who also had linked Medicare Fee-For-Service Claims data available. We examined the association between several sarcopenia definitions (International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman) and hospitalization, using two-part ("hurdle") models, adjusted for age, clinical center, functional limitations, self-reported health, comorbidity, and cognitive function...
January 18, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/28327188/allopurinol-and-the-risk-of-ventricular-arrhythmias-in-the-elderly-a-study-using-us-medicare-data
#7
Jasvinder A Singh, John Cleveland
BACKGROUND: There are no published human studies investigating whether the use of allopurinol, the most commonly used medication for the treatment of hyperuricemia in gout, the most common type of inflammatory arthritis in adults, has any beneficial effects on ventricular electrophysiology. The objective of our study was to assess whether allopurinol use is associated with a reduction in the risk of ventricular arrhythmias (VA). METHODS: We used the 5% random sample of Medicare beneficiaries from 2006-2012 to examine new allopurinol use and the risk of incident VA...
March 22, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28326675/utilization-and-outcomes-of-transcatheter-aortic-valve-replacement-in-the-united-states-shortly-after-device-approval
#8
Michael N Young, Sammy Elmariah, Kevin F Kennedy, Ignacio Inglessis, Robert W Yeh
OBJECTIVE: The objective of this study was to assess the national uptake of TAVR, associated in-hospital outcomes, and the effect of procedural experience on outcomes in the first two years following device approval. BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a newly established therapy for high-risk patients with severe aortic stenosis. Evaluating the manner in which TAVR has disseminated into real-world practice is essential for understanding its impact on population health...
March 22, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28325551/patient-related-risk-factors-for-infection-following-knee-arthroscopy-an-analysis-of-over-700-000-patients-from-two-large-databases
#9
Jourdan M Cancienne, Harrison S Mahon, Ian J Dempsey, Mark D Miller, Brian C Werner
BACKGROUND: To determine patient-related risk factors for infection following knee arthroscopy using two large databases. METHODS: A private-payer (PP) and Medicare national insurance database were queried for patients undergoing simple knee arthroscopy procedures from 2005 to 2015. Patients undergoing concomitant open or complex procedures with grafts were excluded. Postoperative infection within 90days was assessed using ICD-9 and CPT codes. A multivariate logistic regression analysis was utilized to evaluate patient-related risk factors for postoperative infection...
March 18, 2017: Knee
https://www.readbyqxmd.com/read/28324052/skeletal-complications-and-mortality-in-thyroid-cancer-a-population-based-study
#10
Palak Choksi, Maria Papaleontiou, Cui Guo, Francis Worden, Mousumi Banerjee, Megan Haymart
Context: Although bone is a common site for tumor metastases, the burden of bone events (bone metastases and skeletal-related events (SREs)) in patients with thyroid cancer is not well known. Objective: To measure the prevalence of bone events and their impact on mortality in patients with thyroid cancer. Patients, Design, and Setting: We identified patients diagnosed with thyroid cancer between 1991-2011 from the linked Surveillance Epidemiology and End Results-Medicare (SEER-Medicare) dataset...
January 25, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28318554/decubitus-ulcers-in-patients-undergoing-vascular-operations-do-not-influence-mortality-but-affect-resource-utilization
#11
J Hunter Mehaffey, Amani D Politano, Castigliano M Bhamidipati, Margaret C Tracci, Kenneth J Cherry, John A Kern, Irving L Kron, Gilbert R Upchurch
BACKGROUND: While it is anticipated that decubitus ulcers are detrimental to outcomes after vascular operations, the contemporary influence of perioperative decubitus ulcers in vascular surgery remains unknown. METHODS: Using the National Impatient Survey, all adult patients who underwent vascular operation were selected. Patients were stratified by the presence or absence (non-decubitus ulcers) of decubitus ulcer. Case-mix adjusted hierarchical mixed-models examined in-hospital mortality, the occurrence of any complication, and discharge disposition...
March 17, 2017: Surgery
https://www.readbyqxmd.com/read/28315954/trends-in-osteoporosis-and-low-bone-mass-in-older-us-adults-2005-2006-through-2013-2014
#12
A C Looker, N Sarafrazi Isfahani, B Fan, J A Shepherd
This study examined trends in osteoporosis and low bone mass in older US adults between 2005 and 2014 using bone mineral density (BMD) data from the National Health and Nutrition Examination Survey (NHANES). Osteoporosis and low bone mass appear to have increased at the femur neck but not at the lumbar spine during this period. INTRODUCTION: Recent preliminary data from Medicare suggest that the decline in hip fracture incidence among older US adults may have plateaued in 2013-2014, but comparable data on BMD trends for this time period are currently lacking...
March 18, 2017: Osteoporosis International
https://www.readbyqxmd.com/read/28302290/statin-intolerance-and-risk-of-coronary-heart-events-and-all-cause-mortality-following-myocardial-infarction
#13
Maria-Corina Serban, Lisandro D Colantonio, Angelika D Manthripragada, Keri L Monda, Vera A Bittner, Maciej Banach, Ligong Chen, Lei Huang, Ricardo Dent, Shia T Kent, Paul Muntner, Robert S Rosenson
BACKGROUND: Many patients report adverse reactions to, and may not tolerate, statin therapy. These patients may be at increased risk for coronary heart disease (CHD) events and mortality. OBJECTIVES: This study evaluated the risk for recurrent myocardial infarction (MI), CHD events, and all-cause mortality in Medicare beneficiaries with statin intolerance and in those with high adherence to statin therapy. METHODS: We studied 105,329 Medicare beneficiaries who began a moderate- or high-intensity statin dosage after hospitalization for MI between 2007 and 2013...
March 21, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28301778/risk-stratified-versus-non-risk-stratified-diagnostic-testing-for-management-of-suspected-acute-biliary-obstruction-comparative-effectiveness-costs-and-the-role-of-mr-cholangiopancreatography
#14
Stella K Kang, David Hoffman, Bart Ferket, Michelle I Kim, R Scott Braithwaite
Purpose To analyze the cost effectiveness of the American Society for Gastrointestinal Endoscopy (ASGE) risk stratification guidelines versus magnetic resonance (MR) cholangiopancreatography-based treatment of patients with possible choledocholithiasis. Materials and Methods A decision-analytic model was constructed to compare cost and effectiveness of three diagnostic strategies for gallstone disease with possible choledocholithiasis: noncontrast MR cholangiopancreatography, contrast material-enhanced MR imaging/MR cholangiopancreatography, and ASGE risk stratification guidelines for diagnostic evaluation recommending endoscopy (high risk), MR cholangiopancreatography (intermediate risk), or no test (low risk)...
March 16, 2017: Radiology
https://www.readbyqxmd.com/read/28298565/longterm-effectiveness-of-herpes-zoster-vaccine-among-patients-with-autoimmune-and-inflammatory-diseases
#15
Huifeng Yun, Fenglong Xie, John W Baddley, Kevin Winthrop, Kenneth G Saag, Jeffrey R Curtis
OBJECTIVE: The protection duration of herpes zoster (HZ) vaccination is unclear among patients with autoimmune (AI) diseases. METHODS: Using 2006-2013 Medicare data, HZ vaccinated patients with AI were matched 1:2 to unvaccinated HZ. Incidence rates (IR) and adjusted risk ratios over time were calculated using Poisson regression. RESULTS: Of 59,627 vaccinated patients, crude IR increased from 0.75/100 person-years during the first year post-vaccination to 1...
March 15, 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28295278/improving-hospital-performance-rankings-using-discrete-patient-diagnoses-for-risk-adjustment-of-outcomes
#16
Brendan DeCenso, Herbert C Duber, Abraham D Flaxman, Shane M Murphy, Michael Hanlon
OBJECTIVE: To assess the changes in patient outcome prediction and hospital performance ranking when incorporating diagnoses as risk adjusters rather than comorbidity indices. DATA SOURCES: Healthcare Cost and Utilization Project State Inpatient Databases for New York State, 2005-2009. STUDY DESIGN: Conducted tree-based classification for mortality and readmission by incorporating discrete patient diagnoses as predictors, comparing with traditional comorbidity indices such as those used for Centers for Medicare and Medicaid Services (CMS) outcome models...
March 13, 2017: Health Services Research
https://www.readbyqxmd.com/read/28295261/the-role-of-medicare-s-inpatient-cost-sharing-in-medicaid-entry
#17
Laura M Keohane, Amal N Trivedi, Vincent Mor
OBJECTIVE: To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. DATA SOURCES: Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators. STUDY DESIGN: Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge...
March 13, 2017: Health Services Research
https://www.readbyqxmd.com/read/28291765/cervical-spine-surgery-complications-and-risks-in-the-elderly
#18
Kris Radcliff, Kevin L Ong, Scott Lovald, Edmund Lau, Mark Kurd
STUDY DESIGN: Cervical decompression (CD) and cervical fusion (CF) patients in 5% Medicare Part B claims data. OBJECTIVE: Evaluate the complication rate and associated risk factors after cervical spine surgery using a national sample of elderly patients. SUMMARY OF BACKGROUND DATA: The number of cervical spine procedures in the United States has risen along with associated hospital costs. Postoperative complications lead to longer hospitalizations and greater costs...
March 15, 2017: Spine
https://www.readbyqxmd.com/read/28288564/allopurinol-use-and-the-risk-of-acute-cardiovascular-events-in-patients-with-gout-and-diabetes
#19
Jasvinder A Singh, Rekha Ramachandaran, Shaohua Yu, Jeffrey R Curtis
BACKGROUND: Few studies, if any, have examined cardiovascular outcomes in patients with diabetes and gout. Both diabetes and gout are risk factors for cardiovascular disease. The objective of this study was to examine the effect of allopurinol on the risk of incident acute cardiovascular events in patients with gout and diabetes. METHODS: We used the 2007-2010 Multi-Payer Claims Database (MPCD) that linked health plan data from national commercial and governmental insurances, representing beneficiaries with United Healthcare, Medicare, or Medicaid coverage...
March 14, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28288068/emergency-surgery-for-medicare-beneficiaries-admitted-to-critical-access-hospitals
#20
Andrew M Ibrahim, Scott E Regenbogen, Jyothi R Thumma, Justin B Dimick
OBJECTIVE: The aim of this study was to compare the surgical outcomes of emergency operations performed at critical access and non-critical access hospitals. BACKGROUND: Critical access hospitals are often the only source of surgical care for rural populations. Previous studies have demonstrated that patients undergoing common, elective operations at these rural hospitals have similar outcomes to their urban counterparts. Little is known, however, about the quality of care these hospitals provide for emergency operations for which they are most essential...
March 10, 2017: Annals of Surgery
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