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https://www.readbyqxmd.com/read/29221501/lean-methodology-reduces-inappropriate-use-of-antipsychotics-for-agitation-at-a-psychiatric-hospital
#1
Joshana K Goga, Antonio Depaolo, Sunil Khushalani, J Ken Walters, Robert Roca, Marc Zisselman, Christopher Borleis
OBJECTIVE: To Evaluate the Effects of Applying Lean Methodology-Improving Quality Increasing Efficiency by Eliminating Waste and Reducing Costs-An Approach To Decrease the Prescribing Frequency of Antipsychotics for The Indication of Agitation. DESIGN: Historically Controlled Study. SETTING: Bheppard Pratt Health System is the Largest Private Provider of Psychiatric Care in Maryland With a Total Bed Capacity of 300. There Were 4 337 Patient Days From November 1 2012 to October 31 2013 on the Dementia Unit...
January 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/29220741/an-update-on-the-prevalence-and-incidence-of-epilepsy-among-older-adults
#2
Queeny Ip, Daniel C Malone, Jenny Chong, Robin B Harris, David M Labiner
OBJECTIVE: To estimate the prevalence and incidence of epilepsy among beneficiaries of Arizona Medicare aged 65 and over. METHODS: An analysis of Medicare administrative claims data for 2009-2011 for the State of Arizona was conducted. Epilepsy was defined as a beneficiary who had either≥one claim with diagnostic code of 345.xx (epilepsy) or at least two claims with diagnosis code of 780.3x (seizure) ≥30days apart. Stroke-related and psychiatric comorbidities were determined by diagnostic codes...
December 5, 2017: Epilepsy Research
https://www.readbyqxmd.com/read/29220208/changing-utilization-of-noninvasive-diagnostic-imaging-over-2-decades-an-examination-family-focused-analysis-of-medicare-claims-using-the-neiman-imaging-types-of-service-categorization-system
#3
David A Rosman, Richard Duszak, Wenyi Wang, Danny R Hughes, Andrew B Rosenkrantz
OBJECTIVE: The objective of our study was to use a new modality and body region categorization system to assess changing utilization of noninvasive diagnostic imaging in the Medicare fee-for-service population over a recent 20-year period (1994-2013). MATERIALS AND METHODS: All Medicare Part B Physician Fee Schedule services billed between 1994 and 2013 were identified using Physician/Supplier Procedure Summary master files. Billed codes for diagnostic imaging were classified using the Neiman Imaging Types of Service (NITOS) coding system by both modality and body region...
December 8, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29216894/early-winners-and-losers-in-dialysis-center-pay-for-performance
#4
Milda R Saunders, Haena Lee, Marshall H Chin
BACKGROUND: We examined the association of dialysis facility characteristics with payment reductions and change in clinical performance measures during the first year of the United States Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease Quality Incentive Plan (ESRD QIP) to determine its potential impact on quality and disparities in dialysis care. METHODS: We linked the 2012 ESRD QIP Facility Performance File to the 2007-2011 American Community Survey by zip code and dichotomized the QIP total performance scores-derived from percent of patients with urea reduction rate > 65, hemoglobin < 10 g/dL, and hemoglobin > 12 g/dL-as 'any' versus 'no' payment reduction...
December 8, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29212684/do-higher-volume-hospitals-provide-better-value-in-revision-hip-and-knee-arthroplasty
#5
N B Frisch, P M Courtney, B Darrith, C J Della Valle
AIMS: The purpose of this study is to determine if higher volume hospitals have lower costs in revision hip and knee arthroplasty. MATERIALS AND METHODS: We questioned the Centres for Medicare and Medicaid Services (CMS) Inpatient Charge Data and identified 789 hospitals performing a total of 29 580 revision arthroplasties in 2014. Centres were dichotomised into high-volume (performing over 50 revision cases per year) and low-volume. Mean total hospital-specific charges and inpatient payments were obtained from the database and stratified based on Diagnosis Related Group (DRG) codes...
December 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/29210952/survey-of-the-american-neurotology-society-on-cochlear-implantation-part-1-candidacy-assessment-and-expanding-indications
#6
Matthew L Carlson, Douglas P Sladen, Richard K Gurgel, Nicole M Tombers, Christine M Lohse, Colin L Driscoll
OBJECTIVE: To examine practice variance of cochlear implant candidacy assessment and off-label indications across centers in the United States. METHODS: Cross-sectional survey of the American Neurotology Society (ANS). RESULTS: A total of 81 surveys were returned from ANS members who report regular involvement in cochlear implant care. Overall there was a broad distribution in age and clinical experience, with most respondents reporting ACGME accreditation in neurotology and employment at an academic center...
November 28, 2017: Otology & Neurotology
https://www.readbyqxmd.com/read/29206564/advance-care-planning-in-an-accountable-care-organization-is-associated-with-increased-advanced-directive-documentation-and-decreased-costs
#7
William F Bond, Minchul Kim, Chris M Franciskovich, Jason E Weinberg, Jessica D Svendsen, Linda S Fehr, Amy Funk, Robert Sawicki, Carl V Asche
BACKGROUND: Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. OBJECTIVE: To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. DESIGN: This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs...
December 5, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29205926/a-retrospective-review-of-the-persistence-on-bdmards-prescribed-for-the-treatment-of-rheumatoid-arthritis-in-the-australian-population
#8
Graeme Jones, Stephen Hall, Paul Bird, Geoff Littlejohn, Kathleen Tymms, Peter Youssef, Eric Chung, Rina Barrett, Peter Button
AIM: To describe the persistence of biologic disease modifying anti-rheumatic drugs (bDMARDs) in Australian rheumatoid arthritis (RA) patients, and assess the influence of methotrexate and other conventional DMARD (cDMARD) concomitant medications, and treatment line on bDMARD persistence and glucocorticoids usage. METHOD: RA patients, from the 10% Australian Medicare random sample, aged ≥18 for whom bDMARDs were dispensed were included. Individual sub-cutaneous (SC) anti-tumor necrosis factor-α (anti-TNFα) agents were combined as they were equivalent...
December 5, 2017: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/29200349/mortality-quadrupled-among-opioid-driven-hospitalizations-notably-within-lower-income-and-disabled-white-populations
#9
Zirui Song
Hospitals play an important role in caring for patients in the current opioid crisis, but data on the outcomes and composition of opioid-driven hospitalizations in the United States have been lacking. Nationally representative all-payer data for the period 1993-2014 from the National Inpatient Sample were used to compare the mortality rates and composition of hospitalizations with opioid-related primary diagnoses and those of hospitalizations for other drugs and for all other causes. Mortality among opioid-driven hospitalizations increased from 0...
December 2017: Health Affairs
https://www.readbyqxmd.com/read/29199061/should-medicare-remove-total-knee-arthroplasty-from-its-inpatient-only-list-a-total-knee-arthroplasty-is-not-a-partial-knee-arthroplasty
#10
P Maxwell Courtney, Mark I Froimson, R Michael Meneghini, Gwo-Chin Lee, Craig J Della Valle
BACKGROUND: The Centers for Medicare and Medicaid Services have solicited comments to consider removing total knee arthroplasty (TKA) from the Inpatient Only list, as it has done for unicompartmental knee arthroplasty (UKA). The purpose of this study is to determine whether Medicare-aged patients undergoing TKA had comparable outcomes to those undergoing UKA. METHODS: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients aged 65 years or older who underwent elective TKA or UKA from 2014 and 2015...
November 21, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29199056/screening-mammography-utilization-and-medicare-beneficiaries-perceptions-of-their-primary-care-physicians
#11
Andrew B Rosenkrantz, Margaret M Fleming, Linda Moy, James S Babb, Richard Duszak
RATIONALE AND OBJECTIVES: To assess associations between screening mammography utilization and Medicare beneficiaries' relationships with, and impressions of, their primary care physicians. MATERIALS AND METHODS: Using the Medicare Current Beneficiary Survey Access to Care Public Use File, we retrospectively studied responses from a national random cross section of Medicare beneficiaries surveyed in 2013 regarding perceptions of their primary care physicians and their screening mammography utilization...
November 30, 2017: Academic Radiology
https://www.readbyqxmd.com/read/29195858/phosphate-binder-use-in-us-dialysis-patients-prevalence-costs-evidence-and-policies
#12
Wendy L St Peter, Lori D Wazny, Eric D Weinhandl
Medicare costs for phosphate binders for US dialysis patients and patients with chronic kidney disease enrolled in Medicare Part D exceeded $1.5 billion in 2015. Previous data have shown that Part D costs for mineral and bone disorder medications increased faster than costs for all Part D medications for dialysis patients. Despite extensive use of phosphate binders and escalating costs, conclusive evidence is lacking that they improve important clinical end points in dialysis patients or non-dialysis-dependent patients with chronic kidney disease...
November 28, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29195052/accountability-for-community-based-programs-for-the-seriously-ill
#13
Joan M Teno, Russ Montgomery, Tom Valuck, Janet Corrigan, Diane E Meier, Amy Kelley, J Randall Curtis, Ruth Engelberg
Innovation is needed to improve care of the seriously ill, and there are important opportunities as we transition from a volume- to value-based payment system. Not all seriously ill are dying; some recover, while others are persistently functionally impaired. While we innovate in service delivery and payment models for the seriously ill, it is important that we concurrently develop accountability that ensures a focus on high-quality care rather than narrowly focusing on cost containment. The Gordon and Betty Moore Foundation convened a meeting of 45 experts to arrive at guiding principles for measurement, create a starter measurement set, specify a proposed definition of the denominator and its refinement, and identify research priorities for future implementation of the accountability system...
December 1, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29192307/trends-in-cancer-survival-by-health-insurance-status-in-california-from-1997-to-2014
#14
Libby Ellis, Alison J Canchola, David Spiegel, Uri Ladabaum, Robert Haile, Scarlett Lin Gomez
Importance: There have been substantial improvements in the early detection, treatment, and survival from cancer in the United States, but it is not clear to what extent patients with different types of health insurance have benefitted from these advancements. Objective: To examine trends in cancer survival by health insurance status from January 1997 to December 2014. Design, Setting, and Participants: California Cancer Registry (a statewide cancer surveillance system) data were used to estimate population-based survival by health insurance status in 3 calendar periods: January 1997 to December 2002, January 2003 to December 2008, and January 2009 to December 2014 with follow-up through 2014...
November 30, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/29191854/intended-vs-inferred-treatment-after-18f-fluoride-pet-performed-for-evaluation-of-osseous-metastatic-disease-in-the-national-oncologic-pet-registry
#15
Bruce E Hillner, Lucy Hanna, Rajesh Makineni, Fenghai Duan, Anthony F Shields, Rathan M Subramaniam, Ilana Gareen, Barry A Siegel
We have previously reported that PET with 18F-fluoride (NaF-PET) for assessment of osseous metastatic disease led to changes in intended management in a substantial fraction of patients with prostate or other types of cancer participating in the National Oncologic PET Registry (NOPR). This study was performed to assess the concordance of intended patient management after NaF-PET and inferred management based on analysis of Medicare claims. Methods: We analyzed linked post-PET data of consenting NOPR participants age > 65 years from 2011 to 2014 and their corresponding Medicare claims...
November 30, 2017: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/29191764/nursing-home-hospice-collaboration-and-end-of-life-hospitalizations-among-dying-nursing-home-residents
#16
Shubing Cai, Susan C Miller, Pedro L Gozalo
OBJECTIVES: Nursing homes (NHs) collaboration with hospices appears to improve end-of-life (EOL) care among dying NH residents. However, the potential benefits of NH-hospice collaboration may vary with the patterns of this collaboration. This study examines the relationship between the attributes of NH-hospice collaboration, especially the exclusivity of NH-hospice collaboration (ie, the number of hospice providers in a NH), and EOL hospitalizations among dying NH residents. DESIGN: This national retrospective cohort study linked 2000-2009 NH assessments (ie, the Minimum Data Set 2...
November 28, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29189574/the-role-of-mental-health-disease-in-potentially-preventable-hospitalizations-findings-from-a-large-state
#17
Laura N Medford-Davis, Rohan Shah, Danielle Kennedy, Emilie Becker
BACKGROUND: Preventable hospitalizations are markers of potentially low-value care. Addressing the problem requires understanding their contributing factors. OBJECTIVE: The objective of this study is to determine the correlation between specific mental health diseases and each potentially preventable hospitalization as defined by the Agency for Healthcare Research and Quality. DESIGN/SUBJECTS: The Texas Inpatient Public Use Data File, an administrative database of all Texas hospital admissions, identified 7,351,476 adult acute care hospitalizations between 2005 and 2008...
November 17, 2017: Medical Care
https://www.readbyqxmd.com/read/29188286/association-of-dermatologist-density-with-the-volume-and-costs-of-dermatology-procedures-among-medicare-beneficiaries
#18
Sally Y Tan, Daphne Tsoucas, Arash Mostaghimi
Importance: The persistent shortage of dermatologists in the United States affects access to care and patient outcomes. Objective: To characterize the effect of geographic variations in dermatologist density on the provision of dermatology procedures within Medicare. Design, Setting, and Participants: This was a cross-sectional study using the 2013 Medicare Provider Utilization and Payment Database. Dermatology-related procedures were defined by the top 50 billing codes accounting for more than 95% of procedures billed by dermatologists...
November 29, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/29186508/are-all-certified-ehrs-created-equal-assessing-the-relationship-between-ehr-vendor-and-hospital-meaningful-use-performance
#19
A Jay Holmgren, Julia Adler-Milstein, Jeffrey McCullough
Objective: The federal electronic health record (EHR) certification process was intended to ensure a baseline level of system quality and the ability to support meaningful use criteria. We sought to assess whether there was variation across EHR vendors in the degree to which hospitals using products from those vendors were able to achieve high levels of performance on meaningful use criteria. Materials and Methods: We created a cross-sectional national hospital sample from the Office of the National Coordinator for Health Information Technology EHR Products Used for Meaningful Use Attestation public use file and the Centers for Medicare & Medicaid Services Medicare EHR Incentive Program Eligible Hospitals public use file...
November 24, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29186213/returns-to-emergency-department-observation-or-inpatient-care-within-30-days-after-hospitalization-in-4-states-2009-and-2010-versus-2013-and-2014
#20
Teryl K Nuckols, Kathryn R Fingar, Marguerite L Barrett, Grant Martsolf, Claudia A Steiner, Carol Stocks, Pamela L Owens
BACKGROUND: Nationally, readmissions have declined for acute myocardial infarction (AMI) and heart failure (HF) and risen slightly for pneumonia, but less is known about returns to the hospital for observation stays and emergency department (ED) visits. OBJECTIVE: To describe trends in rates of 30-day, all-cause, unplanned returns to the hospital, including returns for observation stays and ED visits. DESIGN: By using Healthcare Cost and Utilization Project data, we compared 210,007 index hospitalizations in 2009 and 2010 with 212,833 matched hospitalizations in 2013 and 2014...
November 22, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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