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Medicare preventive services

Eric J Lammers, Catherine G McLaughlin, Michael Barna
OBJECTIVE: To test for correlation between the growth in adoption of ambulatory electronic health records (EHRs) in the United States during 2010-2013 and hospital admissions and readmissions for elderly Medicare beneficiaries with at least one of four common ambulatory care-sensitive conditions (ACSCs). DATA SOURCES: SK&A Information Services Survey of Physicians, American Hospital Association General Survey and Information Technology Supplement; and the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013...
October 21, 2016: Health Services Research
Marisa Elena Domino, Mona Kilany, Rebecca Wells, Joseph P Morrissey
OBJECTIVE: To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques. DATA SOURCES/STUDY SETTING: Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility. STUDY DESIGN: We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses...
October 21, 2016: Health Services Research
Ling Na, Sean Hennessy, Hillary R Bogner, Jibby E Kurichi, Margaret Stineman, Joel E Streim, Pui L Kwong, Dawei Xie, Liliana E Pezzin
BACKGROUND: Receipt of recommended care among older adults is generally low. Findings regarding service use among persons with disabilities supports the notion of disparities but provides inconsistent evidence of underuse of recommended care. OBJECTIVE: To examine the extent to which receipt of recommended care among older Medicare beneficiaries varies by disability status, using a newly developed staging method to classify individuals according to disability. METHODS: In a cohort study, we included community-dwelling Medicare beneficiaries aged 65 and older who participated in the Medicare Current Beneficiary Survey between 2001 and 2008...
October 4, 2016: Disability and Health Journal
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
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
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
Sung-Shin Cho, Jin Hyun Joh, Hyung-Joon Ahn, Ho-Chul Park
Stroke imposes a substantial clinical and socioeconomic burden. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) are proven procedures in stroke prevention for the lesions of extracranial carotid disease. Although several studies have addressed national trends regarding carotid revascularization in Western countries, limited data is available with respect to the Korean population. The aim of the present study was to identify the national trend in carotid revascularization in Korea over the previous decade...
October 2016: Experimental and Therapeutic 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
Timothy C Boire, Daniel A Balikov, Yunki Lee, Christy M Guth, Joyce Cheung-Flynn, Hak-Joon Sung
Veins used as grafts in heart bypass or as access points in hemodialysis exhibit high failure rates, thereby causing significant morbidity and mortality for patients. Interventional or revisional surgeries required to correct these failures have been met with limited success and exorbitant costs, particularly for the US Centers for Medicare & Medicaid Services. Vein stenosis or occlusion leading to failure is primarily the result of neointimal hyperplasia. Systemic therapies have achieved little long-term success, indicating the need for more localized, sustained, biomaterial-based solutions...
September 27, 2016: Macromolecular Rapid Communications
Xabier García-Albéniz, John Hsu, Michael Bretthauer, Miguel A Hernán
Background: No randomized, controlled trials of screening colonoscopy have been completed, and ongoing trials exclude persons aged 75 years or older. The Medicare program, however, reimburses screening colonoscopy without an upper age limit. Objective: To evaluate the effectiveness and safety of screening colonoscopy to prevent colorectal cancer (CRC) in persons aged 70 to 74 and those aged 75 to 79 years. Design: Large-scale, population-based, prospective study...
September 27, 2016: Annals of Internal Medicine
Mathieu Boulin, Vakaramoko Diaby, Cara Tannenbaum
BACKGROUND: The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. METHODS: An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older...
2016: PloS One
Denys T Lau, Lisa L Dwyer, Joseph W Shega
OBJECTIVES: To examine laxative use by individuals in hospice who were taking opioids during the last week of life. DESIGN: Retrospective cross-sectional. SETTING: 2007 National Home and Hospice Care Survey. PARTICIPANTS: Individuals in hospice aged 65 and older who were taking opioids during the last week of life (N = 2,825). MEASUREMENTS: Hospice staff were asked the names of all medications and drugs that participants were taking 7 days before and on the day of death while in hospice, including any standing, routine, or as-needed medications...
September 19, 2016: Journal of the American Geriatrics Society
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
John Bian
As a standard way for prevention and early detection of colorectal cancer (CRC), colonoscopy has been used for CRC screening in the United States for more than one decade. An article entitled "Assessing Colorectal Cancer Screening Adherence of Medicare Fee-For-Service Beneficiaries Age 76 to 95 Years" recently published at the Journal of Oncology Practice reports the trends in overuse of CRC screening services among average-risk elderly populations at the age of 76-95 years. Several reasons for overusing colonoscopy have been postulated, and some strategies for reducing overuse of CRC screening services have also been proposed...
2016: Chinese Journal of Cancer
Addie Middleton, James E Graham, Shilpa Krishnan, Kenneth J Ottenbacher
OBJECTIVE: The objective of this work was to present comprehensive descriptive summaries of program interruptions and short-stay transfers among Medicare fee-for-service beneficiaries receiving inpatient rehabilitation after stroke, traumatic brain injury (TBI), and traumatic spinal cord injury (SCI). DESIGN: Retrospective cohort study of Medicare beneficiaries with any of the 3 conditions of interest who were admitted to inpatient rehabilitation directly from an acute hospital between July 1, 2012, and November 15, 2013...
November 2016: American Journal of Physical Medicine & Rehabilitation
Michelle Vu, Annesha White, Virginia P Kelley, Jennifer Kuca Hopper, Cathy Liu
BACKGROUND: The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care...
July 2016: American Health & Drug Benefits
Elizabeth R Burns, Judy A Stevens, Robin Lee
INTRODUCTION: This study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars. METHOD: Incidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey...
September 2016: Journal of Safety Research
Fredric D Wolinsky, Lioness Ayres, Michael P Jones, Yiyue Lou, George L Wehby, Fred A Ullrich
BACKGROUND: Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples. METHODS: We used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples...
2016: BMC Health Services Research
Daniel H Jung, Mari Palta, Maureen Smith, Thomas R Oliver, Eva H DuGoff
INTRODUCTION: In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Quality Bonus Payment Demonstration, a pay-for-performance (P4P) program, into Medicare Advantage plans. Previous studies documented racial/ethnic disparities in receipt of care among participants in these plans. The objective of this study was to determine whether P4P incentives have affected these disparities in Medicare Advantage plans. METHODS: We studied 411 Medicare Advantage health plans that participated in the Medicare Health Outcome Survey in 2010 and 2013...
September 8, 2016: Preventing Chronic Disease
Erika L Moen, Andrea M Austin, Julie P Bynum, Jonathan S Skinner, A James O'Malley
The application of social network analysis to the organization of healthcare delivery is a relatively new area of research that may not be familiar to health services statisticians and other methodologists. We present a methodological introduction to social network analysis with a case study of physicians' adherence to clinical guidelines regarding use of implantable cardioverter defibrillators (ICDs) for the prevention of sudden cardiac death. We focus on two hospital referral regions (HRRs) in Indiana, Gary and South Bend, characterized by different rates of evidence-based ICD use (86% and 66%, respectively)...
September 2016: Health Services & Outcomes Research Methodology
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