FN Thomson Reuters Web of Science™ VR 1.0 PT J AU Baker, F Denniston, M Haffer, SC Liberatos, P AF Baker, Frank Denniston, Maxine Haffer, Samuel C. Liberatos, Penny TI Change in Health-related Quality of Life of Newly Diagnosed Cancer Patients, Cancer Survivors, and Controls SO CANCER LA English DT Article DE health-related quality of life; oncology; cancer patients; cancer outcomes; Medicare managed care ID LONG-TERM SURVIVORS; BREAST-CANCER; GENERAL-POPULATION; MANAGED CARE; OLDER-ADULTS; WOMEN; DISEASE; SF-36 AB BACKGROUND: Data from the 1998 Health Outcomes Survey (HOS) of patients who were enrolled in Medicare managed care and follow-up data from the 2000 HOS resurvey were analyzed to examine changes in health-related quality of life (HRQOL) of newly diagnosed cancer patients, cancer survivors, and patients without cancer. METHODS: In 1998, the HOS was mailed to a random sample of 279,135 beneficiaries, and 167,096 respondents (60%) returned completed surveys. Those who were diagnosed with cancer (22,747) were frequency age-matched to an equal number of patients with no cancer. In 2000, the HOS was mailed to the same cohort of beneficiaries. Complete data at both baseline and follow-up were available on 16,850 individuals for inclusion in the current study. RESULTS: After 2 years, respondents who had been diagnosed with cancer at baseline continued to have lower scores on all but 3 scales of the 36-item short-form HRQOL measure. However, there was no evidence that they were declining any faster than or catching up with noncancer patients. Those who had been newly diagnosed with cancer since the baseline survey had lower mean scale scores than the no-cancer group on all scales and lower mean scores than the cancer survivors on all subscales except Bodily Pain, Vitality, and Mental Health. CONCLUSIONS: This study demonstrated that, after 2 years, cancer survivors continued to have poorer HRQOL than the no-cancer group. Newly diagnosed cancer patients had poorer quality of life than both the longer term cancer survivors and the no-cancer group. Cancer 2009;115:3024-33. Published 2009 by the American Cancer Society*. C1 [Baker, Frank] New York Med Coll, Sch Publ Hlth, Dept Behav Sci & Community Hlth, Valhalla, NY 10595 USA. [Denniston, Maxine] Amer Canc Soc, Behav Res Ctr, Atlanta, GA 30329 USA. [Haffer, Samuel C.] Ctr Medicare, Baltimore, MD USA. [Haffer, Samuel C.] Medicaid Serv, Baltimore, MD USA. RP Baker, F (reprint author), New York Med Coll, Sch Publ Hlth, Dept Behav Sci & Community Hlth, Valhalla, NY 10595 USA. EM frank_baker@nymc.edu FU American Cancer Society FX Analyses were supported by intramural funding From the American Cancer Society. NR 26 TC 14 Z9 14 U1 0 U2 8 PU JOHN WILEY & SONS INC PI HOBOKEN PA 111 RIVER ST, HOBOKEN, NJ 07030 USA SN 0008-543X J9 CANCER JI Cancer PD JUL 1 PY 2009 VL 115 IS 13 BP 3024 EP 3033 DI 10.1002/cncr.24330 PG 10 WC Oncology SC Oncology GA 459DL UT WOS:000267080400027 PM 19402049 ER PT J AU Moreno, L Dale, SB Chen, AY Magee, CA AF Moreno, Lorenzo Dale, Stacy B. Chen, Arnold Y. Magee, Carol A. TI Costs to Medicare of the Informatics for Diabetes Education and Telemedicine (IDEATel) Home Telemedicine Demonstration Findings from an independent evaluation SO DIABETES CARE LA English DT Article ID NURSE FOLLOW-UP; AUTOMATED CALLS; CASE-MANAGEMENT; CARE; OUTCOMES; TRIAL AB OBJECTIVE - To estimate the impacts on Medicare costs of providing a particular type of home telemedicine to eligible Medicare beneficiaries with type 2 diabetes. RESEARCH DESIGN AND METHODS - Two cohorts of beneficiaries (n = 1,665 and 504, respectively) living in two medically underserved areas of New York between 2000 and 2007 were randomized to intensive nurse case management via televisits or usual care. Medicare service use and costs covering a 6-year follow-up period were drawn from claims data. Impacts were estimated using regression analyses. RESULTS - Informatics for Diabetes Education and Telemedicine (IDEATel) did not reduce Medicare costs in either Site. Total costs were between 71 and 116% higher for the treatment group than for the control group. CONCLUSIONS - Although IDEATel had modest effects on clinical outcomes (reported elsewhere), it did not reduce Medicare use or costs for health services. The intervention's costs were excessive (over $8,000 per person per year) compared with programs with similar-sized clinical impacts. C1 [Moreno, Lorenzo; Dale, Stacy B.; Chen, Arnold Y.] Math Policy Res Inc, Princeton, NJ USA. [Magee, Carol A.] Ctr Medicare, Baltimore, MD USA. [Magee, Carol A.] Ctr Medicaid Serv, Baltimore, MD USA. RP Moreno, L (reprint author), Math Policy Res Inc, Princeton, NJ USA. EM lmoreno@mathematica-mpr.com FU Centers for Medicare & Medicaid Services and Mathematica Policy Research (MPR) [HHSM-500-2004-00022C] FX This research was funded under contract between the Centers for Medicare & Medicaid Services and Mathematica Policy Research (MPR) (contract no. HHSM-500-2004-00022C). There were no industry sponsors of this study. The authors are either salaried employees of Mathematica Policy Research (L.M., S.B.D., A.Y.C.) or of the Centers for Medicare & Medicaid Services (C.A.M.) and received no compensation from any other source. They do not own stock in the program being evaluated or stand to profit in any way, directly or indirectly, from particular findings in this article. NR 7 TC 20 Z9 20 U1 1 U2 2 PU AMER DIABETES ASSOC PI ALEXANDRIA PA 1701 N BEAUREGARD ST, ALEXANDRIA, VA 22311-1717 USA SN 0149-5992 J9 DIABETES CARE JI Diabetes Care PD JUL PY 2009 VL 32 IS 7 BP 1202 EP 1204 DI 10.2337/dc09-0094 PG 3 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA 469EK UT WOS:000267878300014 PM 19366971 ER PT J AU Heffler, S Nuccio, O Freeland, M AF Heffler, Stephen Nuccio, Olivia Freeland, Mark TI "An Overview of the NHEA With Implications for Cost Analysis Researchers" SO MEDICAL CARE LA English DT Article DE health care costs; national health expenditure accounts; national health spending by source of funds; national health spending by service; national health expenditures in 2006; national income accounting ID NATIONAL-HEALTH-ACCOUNTS; MEPS AB Background/Objective: The National Health Expenditure Accounts (NHEA) are the official government estimates of aggregate US health care spending. We summarize the data sources, methods, strengths, limitations, and applications of the NHEA. Methods: To compile this article, we provide background on the NHEA, a description of the data sources and methods used to produce them, some recent findings that the NHEA produced, as well a discussion of their strengths, limitations, and applications drawn from several different sources, both internal and external to Centers for Medicare and Medicaid Services. Results: The NHEA have a multitude of applications, including comparison with other economic data such as the Gross Domestic Product, reconciliation with other health spending data sources, and use in predictive and analytic models. The NHEA adhere to national income accounting standards and are comprehensive, mutually exclusive, multidimensional, and consistent over time. The NHEA do not contain microlevel detailed data and are subject to both sampling and nonsampling errors during the interim census years, although this is the case for all available data sources. Conclusions: Determining the correct method for measuring health care costs depends oil one's purpose, and analysis of health care cost data that requires aggregate-level statistics should consider use of the NHEA. C1 [Heffler, Stephen] Ctr Medicare, NHSG, OACT, CMS Stephen Heffler,Natl Hlth Stat Grp,Off Actuar, Baltimore, MD 21244 USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Heffler, S (reprint author), Ctr Medicare, NHSG, OACT, CMS Stephen Heffler,Natl Hlth Stat Grp,Off Actuar, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM Stephen.Heffler@cms.hhs.gov NR 14 TC 6 Z9 6 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2009 VL 47 IS 7 BP S37 EP S43 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 463WA UT WOS:000267462500007 PM 19536011 ER PT J AU Riley, GF AF Riley, Gerald F. TI Administrative and Claims Records as Sources of Health Care Cost Data SO MEDICAL CARE LA English DT Article DE claims data; administrative data; health care costs ID BREAST-CANCER; MEDICARE DATA; SERVICES AB Background: Many economic Studies of disease require cost data at the person level to identify diagnosed cases and to capture the type and timing of specific services. One source of cost data is claims and other administrative records associated with health insurance programs and health care providers. Objective: To describe and compare strengths and limitations of various administrative and claims databases. Data and Methods: Data sources included claims and enrollment records from Medicare, Medicaid, and private insurers; Veterans' Health Administration records; state hospital discharge datasets; Healthcare Cost and Utilization Project hospital databases; managed care plan data systems; and provider cost reports. Claims provide information on payments, whereas cost reports yield resource costs incurred to produce services. Administrative data may be significantly augmented by linkage to disease registries and surveys. Results: Administrative data are often available for large, enrolled populations, have detailed information on individual service use, and can be aggregated by service type, episode, and patient. Service use and costs can often be tracked longitudinally. Because they are not collected for research purposes, administrative data can be difficult to access and use. Limitations include generalizability, complexity, coverage and benefit restrictions, and lack of coverage continuity. Linked datasets permit identification of incident cases of disease, and analyses of health care costs by stage at diagnosis, phase of care, comorbidity status, income, and insurance status. Conclusions: Administrative data are an essential source of information for studies of the financial burden of disease. Cost estimates can vary substantially by specific measures (payments, charges, cost to charge ratios) and across data sources. C1 [Riley, Gerald F.] Ctr Medicare, Off Res Dev & Informat, Baltimore, MD 21244 USA. [Riley, Gerald F.] Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Riley, GF (reprint author), Ctr Medicare, Off Res Dev & Informat, 7500 Secur Blvd,Mail Stop C3-21-27, Baltimore, MD 21244 USA. EM gerald.riley@cms.hhs.gov NR 21 TC 87 Z9 87 U1 2 U2 18 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2009 VL 47 IS 7 BP S51 EP S55 PG 5 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 463WA UT WOS:000267462500009 PM 19536019 ER PT J AU Neu, AM Frankenfield, DL AF Neu, Alicia M. Frankenfield, Diane L. TI Clinical outcomes in pediatric hemodialysis patients in the USA: lessons from CMS' ESRD CPM Project SO PEDIATRIC NEPHROLOGY LA English DT Review DE Pediatric; Hemodialysis; Outcomes; Clinical performance measures; CPM; Hospitalization; Mortality ID PERFORMANCE MEASURES PROJECT; STAGE RENAL-DISEASE; ADOLESCENT HEMODIALYSIS; SINGLE-POOL; DIALYSIS; CENTERS; GROWTH; MEDICARE; ADEQUACY; CHILDREN AB Although prospective randomized trials have provided important information and allowed the development of evidence-based guidelines in adult hemodialysis (HD) patients, with approximately 800 prevalent pediatric HD patients in the United States, such studies are difficult to perform in this population. Observational data obtained through the Center for Medicare & Medicaid Services' (CMS') End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project have allowed description of the clinical care provided to pediatric HD patients as well as identification of risk factors for failure to reach adult targets for clinical parameters such as hemoglobin, single-pool Kt/V (spKt/V) and serum albumin. In addition, studies linking data from the ESRD CPM Project and the United States Renal Data System have allowed evaluation of associations between achievement of those targets and the outcomes of hospitalization and death. The results of those studies, while unable to prove cause and effect, suggest that the adult ESRD CPM targets may assist in identifying pediatric HD patients at risk for poor outcomes. C1 [Neu, Alicia M.] Johns Hopkins Med, Div Pediat Nephrol, Baltimore, MD 21287 USA. [Frankenfield, Diane L.] Ctr Medicare & Medicaid Serv CMS, Off Res Dev & Informat, Baltimore, MD USA. RP Neu, AM (reprint author), Johns Hopkins Med, Div Pediat Nephrol, 200 N Wolfe St,Room 3065, Baltimore, MD 21287 USA. EM aneu1@jhmi.edu NR 26 TC 4 Z9 5 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0931-041X J9 PEDIATR NEPHROL JI Pediatr. Nephrol. PD JUL PY 2009 VL 24 IS 7 BP 1287 EP 1295 DI 10.1007/s00467-008-0831-0 PG 9 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 451XN UT WOS:000266504300004 PM 18509683 ER PT J AU Reeve, BB Potosky, AL Smith, AW Han, PK Hays, RD Davis, WW Arora, NK Haffer, SC Clauser, SB AF Reeve, Bryce B. Potosky, Arnold L. Smith, Ashley Wilder Han, Paul K. Hays, Ron D. Davis, William W. Arora, Neeraj K. Haffer, Samuel C. Clauser, Steven B. TI Impact of Cancer on Health-Related Quality of Life of Older Americans SO JOURNAL OF THE NATIONAL CANCER INSTITUTE LA English DT Article ID LOCALIZED PROSTATE-CANCER; PROPENSITY-SCORE; MANAGED CARE; OUTCOMES-SURVEY; BREAST-CANCER; NURSES HEALTH; MEDICARE; SURVIVORS; DIFFERENCE; CARCINOMA AB The impact of cancer on health-related quality of life (HRQOL) is poorly understood because of the lack of baseline HRQOL status before cancer diagnosis. To our knowledge, this is the first population-based study to quantify the nature and extent of HRQOL changes from before to after cancer diagnosis for nine types of cancer patients and to compare their health with individuals without cancer. The Surveillance, Epidemiology, and End Results cancer registry data were linked with the Medicare Health Outcomes Survey (MHOS) data; data were collected from Medicare beneficiaries who were aged 65 years and older from 1998 through 2003. Cancer patients (n = 1432; with prostate, breast, colorectal, lung, bladder, endometrial, or kidney cancers; melanoma; or non-Hodgkin lymphoma [NHL]) were selected whose first cancer diagnosis occurred between their baseline and follow-up MHOS assessments. Control subjects without cancer (n = 7160) were matched to cancer patients by use of propensity scores that were estimated from demographics and comorbid medical conditions. Analysis of covariance models were used to estimate changes in HRQOL as assessed with the Medical Outcomes Study Short Form-36 survey (mean score = 50, SD = 10). All statistical tests were two-sided. Patients with all cancer types (except melanoma and endometrial cancer) reported statistically significant declines in physical health (mean scores: prostate cancer = -3.4, 95% confidence interval [CI] = -2.5 to -4.2; breast cancer = -3.5, 95% CI = -2.5 to -4.5; bladder cancer = -4.3, 95% CI = -2.5 to -6.1; colorectal cancer = -4.4, 95% CI = -3.3 to -5.5; kidney cancer = -5.7, 95% CI = -3.2 to -8.2; NHL = -6.7, 95% CI = -4.4 to -9.1; and lung cancer = -7.5, 95% CI = -5.9 to -9.2) compared with the control subjects (mean score = -1.8, 95% CI = -1.6 to -2.0) (all P < .05). However, only lung (mean score = -5.4, 95% CI = -3.5 to -7.2), colorectal (mean score = -3.5, 95% CI = -2.2 to -4.7), and prostate (mean score = -2.8, 95% CI = -1.8 to -3.7) cancer patients showed statistically significant decreases in mental health relative to the mean change of the control subjects (mean score = -1.2, 95% CI = -0.9 to -1.4) (all P < .05). These findings provide validation of the specific deleterious effects of cancer on HRQOL and an evidence base for future research and clinical interventions aimed at understanding and remediating these effects. C1 [Reeve, Bryce B.; Smith, Ashley Wilder; Han, Paul K.; Arora, Neeraj K.; Clauser, Steven B.] NCI, Outcomes Res Branch, Appl Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. [Davis, William W.] NCI, Statistician Res & Applicat Branch, Surveillance Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. [Potosky, Arnold L.] Georgetown Univ, Med Ctr, Lombardi Comprehens Canc Ctr, Canc Control Program, Washington, DC 20007 USA. [Hays, Ron D.] Univ Calif Los Angeles, Dept Med, Div Gen Internal Med, Los Angeles, CA 90024 USA. [Hays, Ron D.] Univ Calif Los Angeles, Dept Med, Hlth Serv Res, Los Angeles, CA 90024 USA. [Haffer, Samuel C.] Ctr Medicare Serv, Off Res Dev & Informat, Baltimore, MD USA. [Haffer, Samuel C.] Ctr Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Reeve, BB (reprint author), NCI, Outcomes Res Branch, Appl Res Program, Div Canc Control & Populat Sci, EPN 4005,6130 Execut Blvd,MSC 7344, Bethesda, MD 20892 USA. EM reeveb@mail.nih.gov RI Hays, Ronald/D-5629-2013; OI Han, Paul/0000-0003-0165-1940 FU The National Cancer Institute; Centers for Medicare & Medicaid Services; Medicare Health Outcomes Survey FX The National Cancer Institute funded the collection of cancer data from the Surveillance, Epidemiology, and End Results registry, and the Centers for Medicare & Medicaid Services supported the Medicare Health Outcomes Survey. No grants were awarded for this study. NR 43 TC 87 Z9 87 U1 2 U2 10 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0027-8874 J9 J NATL CANCER I JI J. Natl. Cancer Inst. PD JUN 16 PY 2009 VL 101 IS 12 BP 860 EP 868 DI 10.1093/jnci/djp123 PG 9 WC Oncology SC Oncology GA 460XH UT WOS:000267225000008 PM 19509357 ER PT J AU Polinski, JM Mohr, PE Johnson, L AF Polinski, Jennifer M. Mohr, Penny E. Johnson, Lorraine TI Impact of Medicare Part D on Access to and Cost Sharing for Specialty Biologic Medications for Beneficiaries With Rheumatoid Arthritis SO ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH LA English DT Article ID RISK ADJUSTMENT; PHARMACEUTICALS; STRATEGIES; PAYMENTS; BENEFIT; DRUGS AB Objective. Many worry that the use of specialty tiering for biologic disease-modifying antirheumatic drugs (DMARDs) by Medicare Part D plans imposes a heavy financial burden on beneficiaries with rheumatoid arthritis (RA). To date, no one has examined the cost-sharing structures for biologic DMARDs in Part D plans or the resulting cost burden for patients. Methods. We followed 14,929 vulnerable, low-income patients with RA who were enrolled in the Medicare Replacement Drug Demonstration (MRDD) in 2005. As the MRDD population transitioned into Part D in 2006, we examined correlates of Part D enrollment and compared the cost-sharing provisions for biologic DMARDs in the Medicare Advantage and stand-alone plans. We simulated the out-of-pocket costs of beneficiaries under 3 cost-sharing scenarios. Results. Eighty-one percent of MRDD beneficiaries with RA enrolled in Part D. Enrollment predictors were female sex (odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.32-1.67), prior MRDD benefit use (OR 2.29, 95% CI 2.04-2.58), other self-reported drug coverage (OR 1.53, 95% CI 1.36-1.71), and receiving an MRDD subsidy (OR 2.00, 95% CI 1.74-2.30). Compared with stand-alone plans, Medicare Advantage plans had lower deductibles, lower premiums, and fewer prior authorization, step therapy, and quantity limit restrictions. However, similar to 75% of all plans used coinsurance as the preferred form of cost sharing. Out-of-pocket costs exceeded $4,000 annually in all cost-sharing scenarios. Conclusion. Most MRDD beneficiaries with RA enrolled in Part D. Although plans assume some costs for biologic DMARDs, the majority of costs are shifted to beneficiaries and to Medicare. Such cost shifting may place these medications out of the beneficiary's financial reach and expose Medicare to high financial liability. C1 [Polinski, Jennifer M.] Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02120 USA. [Mohr, Penny E.] Ctr Med Technol Policy, Baltimore, MD USA. [Johnson, Lorraine] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Polinski, JM (reprint author), Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon, 1620 Tremont St,Suite 3030, Boston, MA 02120 USA. EM jpolinski@partners.org NR 24 TC 22 Z9 22 U1 1 U2 4 PU WILEY-LISS PI HOBOKEN PA DIV JOHN WILEY & SONS INC, 111 RIVER ST, HOBOKEN, NJ 07030 USA SN 0004-3591 J9 ARTHRIT RHEUM-ARTHR JI Arthritis Rheum-Arthritis Care Res. PD JUN 15 PY 2009 VL 61 IS 6 BP 745 EP 754 DI 10.1002/art.24560 PG 10 WC Rheumatology SC Rheumatology GA 459PI UT WOS:000267115300006 PM 19479704 ER PT J AU Straube, BM AF Straube, Barry M. TI Reform of the US Healthcare System: Care of Undocumented Individuals With ESRD SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, US Dept HHS, Washington, DC USA. RP Straube, BM (reprint author), Ctr Medicare & Medicaid Serv, US Dept HHS, 200 Independence Blvd, Washington, DC USA. EM Barry.Straube@cms.hhs.gov NR 6 TC 11 Z9 11 U1 0 U2 1 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD JUN PY 2009 VL 53 IS 6 BP 921 EP 924 DI 10.1053/j.ajkd.2009.04.010 PG 4 WC Urology & Nephrology SC Urology & Nephrology GA 456RY UT WOS:000266866600004 PM 19463759 ER PT J AU Hamilton, TE AF Hamilton, T. E. TI Accountability in Health Care-Transplant Community Offers Leadership SO AMERICAN JOURNAL OF TRANSPLANTATION LA English DT Article DE Compliance; Medicaid; Medicare; regulatory issues; transplant ID REFORM; SYSTEM AB Two concerns expressed by the American Society of Transplant Surgeons (ASTS) are that (1) the new Medicare regulations for transplant hospitals take a 'punitive' approach and that (2) the outcome requirement may thwart innovation by not including certain risk factors into the risk adjustment used to calculate expected outcomes. This article explains efforts by the Centers for Medicare & Medicaid Services (CMS) to encourage quality improvement. CMS limits outcomes-related enforcement to situations where failure rates exceed certain substantial 'tolerance limits', ensuring opportunity for quality improvement to be effective prior to enforcement. Transplantations involving a disproportionate share of risk factors not incorporated into the risk-adjustment methodology can also be raised through CMS' 'mitigating factors' process. Of the 22 mitigating factor requests completed through March 10, 2009, 7 raised issues of risk adjustment (none involved experimental protocols). Four of the seven requests were approved for other reasons (evidence of effective program changes and improved outcomes). CMS concluded that none of the seven made a persuasive case based on risk factors. The early data indicate that program deficiencies may outweigh risk adjustment issues. CMS agrees to consider the ASTS suggestions for future action and continues to monitor the situation in case a different pattern emerges. C1 [Hamilton, T. E.] Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Hamilton, TE (reprint author), Ctr Medicare Serv, Baltimore, MD USA. EM Thomas.hamilton@cms.hhs.gov NR 9 TC 13 Z9 13 U1 0 U2 1 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1600-6135 J9 AM J TRANSPLANT JI Am. J. Transplant. PD JUN PY 2009 VL 9 IS 6 BP 1287 EP 1293 DI 10.1111/j.1600-6143.2009.02683.x PG 7 WC Surgery; Transplantation SC Surgery; Transplantation GA 451CS UT WOS:000266448900008 PM 19459786 ER PT J AU Davern, M Klerman, JA Baugh, DK Call, KT Greenberg, GD AF Davern, Michael Klerman, Jacob Alex Baugh, David K. Call, Kathleen Thiede Greenberg, George D. TI An Examination of the Medicaid Undercount in the Current Population Survey: Preliminary Results from Record Linking SO HEALTH SERVICES RESEARCH LA English DT Article DE Medicaid undercount; MSIS; CPS-ASEC; survey measurement error; Medicaid ID HEALTH-INSURANCE COVERAGE; STATE; UNINSURANCE; DESIGN; LEVEL AB To assess reasons why survey estimates of Medicaid enrollment are 43 percent lower than raw Medicaid program enrollment counts (i.e., "Medicaid undercount"). Linked 2000-2002 Medicaid Statistical Information System (MSIS) and the 2001-2002 Current Population Survey (CPS). Centers for Medicare and Medicaid Services provided the Census Bureau with its MSIS file. The Census Bureau linked the MSIS to the CPS data within its secure data analysis facilities. We analyzed how often Medicaid enrollees incorrectly answer the CPS health insurance item and imperfect concept alignment (e.g., inclusion in the MSIS of people who are not included in the CPS sample frame and people who were enrolled in Medicaid in more than one state during the year). The extent to which the Medicaid enrollee data were adjusted for imperfect concept alignment reduces the raw Medicaid undercount considerably (by 12 percentage points). However, survey response errors play an even larger role with 43 percent of Medicaid enrollees answering the CPS as though they were not enrolled and 17 percent reported being uninsured. The CPS is widely used for health policy analysis but is a poor measure of Medicaid enrollment at any time during the year because many people who are enrolled in Medicaid fail to report it and may be incorrectly coded as being uninsured. This discrepancy should be considered when using the CPS for policy research. C1 [Davern, Michael; Call, Kathleen Thiede] Univ Minnesota, Sch Publ Hlth, SHADAC, Div Hlth Policy & Management, Minneapolis, MN 55414 USA. [Klerman, Jacob Alex] ABT Associates Inc, Cambridge, MA 02138 USA. [Baugh, David K.] Ctr Medicare, Off Res Dev & Informat, Baltimore, MD USA. [Baugh, David K.] Ctr Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. [Greenberg, George D.] US Dept HHS, Off Assistant Secretary Planning & Evaluat, Off Hlth Policy, Washington, DC 20201 USA. RP Davern, M (reprint author), Univ Minnesota, Sch Publ Hlth, SHADAC, Div Hlth Policy & Management, 2221 Univ Ave SE,Ste 345, Minneapolis, MN 55414 USA. EM daver004@umn.edu FU Robert Wood Johnson Foundation [052084] FX Joint Acknowledgments/Disclosure Statement: This paper was made possible by grant no. 052084 from the Robert Wood Johnson Foundation to the State Health Access Data Assistance Center (Michael Davern, PI) with additional support supplied by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), the Centers for Medicare and Medicare Services (CMS), the National Center for Health Statistics (NCHS), and the U.S. Census Bureau. This paper has undergone a limited review by all the participating organizations in accordance with existing agreements among these organizations. The views expressed are those of the authors and do not represent official positions of ASPE, NCHS, CMS, the U.S. Census Bureau, Abt Associates, or Rand Corporation. For this paper we would also like to thank Bill Clark and Karen Soderberg. NR 27 TC 19 Z9 19 U1 0 U2 1 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD JUN PY 2009 VL 44 IS 3 BP 965 EP 987 DI 10.1111/j.1475-6773.2008.00941.x PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 446HB UT WOS:000266111600012 PM 19187185 ER PT J AU Blackwell, SA Montgomery, MA Baugh, DK Ciborowski, G Levy, JM AF Blackwell, S. A. Montgomery, M. A. Baugh, D. K. Ciborowski, G. Levy, J. M. TI AN ANALYSIS OF SELECT INJURY-INCREASING ANALGESIC MEDICATIONS IN MEDICARE DUAL ELIGIBLE ENROLLEES SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Blackwell, S. A.; Montgomery, M. A.; Baugh, D. K.; Ciborowski, G.; Levy, J. M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2009 VL 12 IS 3 BP A162 EP A162 DI 10.1016/S1098-3015(10)73873-0 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 433WO UT WOS:000265236700805 ER PT J AU Montgomery, MA Ciborowski, G Blackwell, SA Baugh, DK AF Montgomery, M. A. Ciborowski, G. Blackwell, S. A. Baugh, D. K. TI TRENDS IN BEERS DRUG USE IN THE DUALLY ELIGIBLE MEDICARE AND MEDICAID POPULATION USING THE 1997 BEERS DRUG LIST FROM 1999 THROUGH 2004 SO VALUE IN HEALTH LA English DT Meeting Abstract C1 Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2009 VL 12 IS 3 BP A84 EP A84 DI 10.1016/S1098-3015(10)73480-X PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 433WO UT WOS:000265236700412 ER PT J AU Wei, II Howell, BL Frankenfield, DL Anderson, KK Sekscenski, E AF Wei, I. I. Howell, B. L. Frankenfield, D. L. Anderson, K. K. Sekscenski, E. TI IS MEDICARE PART D PLAN BENEFIT DESIGN ASSOCIATED WITH COST-RELATED NONADHERENCE TO PRESCRIPTION DRUGS? AN ANALYSIS USING THE MEDICARE CAHPS DATA SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Wei, I. I.; Howell, B. L.; Frankenfield, D. L.; Anderson, K. K.; Sekscenski, E.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2009 VL 12 IS 3 BP A171 EP A172 DI 10.1016/S1098-3015(10)73920-6 PG 2 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 433WO UT WOS:000265236700852 ER PT J AU Frankenfield, DL Krishnan, SM Ashby, VB Shearon, TH Rocco, MV Saran, R AF Frankenfield, Diane L. Krishnan, Sangeetha M. Ashby, Valarie B. Shearon, Tempie H. Rocco, Michael V. Saran, Rajiv TI Differences in Mortality Among Mexican-American, Puerto Rican, and Cuban-American Dialysis Patients in the United States SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE Hispanic; Mexican American; Puerto Rican; Cuban American; ethnicity; disparity; outcomes; mortality ID STAGE RENAL-DISEASE; HISPANIC HEMODIALYSIS-PATIENTS; PERFORMANCE MEASURES PROJECT; NUTRITION EXAMINATION SURVEY; HEART-STUDY EVIDENCE; NEIGHBORHOOD CONTEXT; SURVIVAL ADVANTAGE; CARDIOVASCULAR MORTALITY; ETHNIC DISPARITIES; ALL-CAUSE AB Background: The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States. Study Design: Prospective observational study. Setting & Participants: Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n - 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States. Predictors: Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values. Outcomes: The major outcome of interest was mortality. Results: In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95% confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21% lower mortality in Mexican Americans to 3% higher mortality in Puerto Ricans compared with non-Hispanics. Limitations: Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups. Conclusion: Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity. Am J Kidney Dis 53:647-657. (C) 2009 by the National Kidney Foundation, Inc. C1 [Krishnan, Sangeetha M.; Ashby, Valarie B.; Shearon, Tempie H.; Saran, Rajiv] Univ Michigan, Kidney Epidemiol & Cost Ctr, Dept Internal Med, Ann Arbor, MI 48103 USA. [Frankenfield, Diane L.] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. [Krishnan, Sangeetha M.; Ashby, Valarie B.; Shearon, Tempie H.; Saran, Rajiv] Univ Michigan, Dept Biostat, Ann Arbor, MI 48103 USA. [Rocco, Michael V.] Wake Forest Univ, Nephrol Sect, Winston Salem, NC 27109 USA. RP Krishnan, SM (reprint author), Univ Michigan, Kidney Epidemiol & Cost Ctr, Dept Internal Med, 315 W Huron,Ste 240, Ann Arbor, MI 48103 USA. EM sangdev@umich.edu FU Centers for Medicare & Medicaid Services [500-01-0056] FX This study was supported through a grant from the Centers for Medicare & Medicaid Services (CMS Contract No. 500-01-0056). NR 67 TC 10 Z9 10 U1 0 U2 0 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD APR PY 2009 VL 53 IS 4 BP 647 EP 657 DI 10.1053/j.ajkd.2008.10.049 PG 11 WC Urology & Nephrology SC Urology & Nephrology GA 425JI UT WOS:000264632400011 PM 19150157 ER PT J AU Gordon, WJ Polansky, JM Boscardin, J Fung, K Steinman, M AF Gordon, W. J. Polansky, J. M. Boscardin, J. Fung, K. Steinman, M. TI CORONARY RISK ASSESSMENT BY POINT-BASED VS. EQUATION-BASED FRAMINGHAM MODELS: SIGNIFICANT IMPLICATIONS FOR CLINICAL CARE SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 32nd Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 13-16, 2009 CL Miami, FL SP Soc Gen Internal Med C1 [Gordon, W. J.] Weill Cornell Med Coll, New York, NY USA. [Polansky, J. M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Boscardin, J.; Steinman, M.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Fung, K.] San Francisco VA Med Ctr, San Francisco, CA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2009 VL 24 SU 1 BP 48 EP 49 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 435ZI UT WOS:000265382000128 ER PT J AU Tillman, K Burton, B Jacques, LB Phurrough, SE AF Tillman, Katherine Burton, Brijet Jacques, Louis B. Phurrough, Steve E. TI Compendia and Anticancer Therapy Under Medicare SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID INVESTIGATIONAL THERAPY AB In 1993, Congress directed the Medicare program to refer to 3 existing published compendia, American Medical Association Drug Evaluations (AMA-DE), United States Pharmacopoeia Drug Information for the Health Professional (USP-DI), and American Hospital Formulary Service Drug Information (AHFS-DI), to identify unlabeled but medically accepted uses of drugs and biologicals in anticancer chemotherapy regimens. Public discussion during the preceding years had centered on whether to designate unlabeled uses of anticancer treatments as experimental and thus outside the scope of Medicare benefits. American Medical Association Drug Evaluations and USP-DI subsequently ceased publication, and the Medicare program faced increasing calls to revise the list of acceptable compendia, as authorized in the statute. In 2007, the Centers for Medicare & Medicaid Services used its regulatory authority to establish a publicly transparent process to revise the list. The Centers for Medicare & Medicaid Services considered 5 requests in 2008 and added National Comprehensive Cancer Network Drugs and Biologics Compendium, DRUGDEX, and Clinical Pharmacology to the list of compendia. DrugPoints was not added, and AMA-DE was removed. Because of the potential for conflicts of interest to lead to biased judgments, the 2008 Medicare Improvements for Patients and Providers Act has a provision that explicitly prohibits inclusion of compendia that do not have a publicly transparent process for evaluating therapies and identifying potential conflicts of interest. C1 [Tillman, Katherine; Burton, Brijet; Jacques, Louis B.; Phurrough, Steve E.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Tillman, K (reprint author), Ctr Medicare & Medicaid Serv, Mailstop C1-09-06,7500 Secur Blvd, Baltimore, MD 21244 USA. EM katherine.tillman@cms.hhs.gov NR 11 TC 17 Z9 17 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAR 3 PY 2009 VL 150 IS 5 BP 348 EP + PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 417CC UT WOS:000264051700007 PM 19221368 ER PT J AU Morgan, RO Petersen, LA Hasche, JC Davila, JA Byrne, MM Osemene, NI Wei, II Johnson, ML AF Morgan, Robert O. Petersen, Laura A. Hasche, Jennifer C. Davila, Jessica A. Byrne, Margaret M. Osemene, Nora I. Wei, Iris I. Johnson, Michael L. TI VHA Pharmacy Use in Veterans With Medicare Drug Coverage SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID RISK ADJUSTMENT; AFFAIRS AB Objective: To determine how Medicare benefits affect veterans' use of Veterans Health Administration (VHA) pharmacy services. Study Design: Retrospective analysis of veterans dually enrolled in the Veterans Health Administration and Medicare healthcare systems. Methods: We used VHA and Medicare administrative data for calendar year 2002 to examine the effect of Medicare HMO pharmacy benefit levels on VHA pharmacy use. Results: In 2002, 64% of the VHA and Medicare dually enrolled veterans in our study sample received medications from the VHA. Use of VHA pharmacy services varied monotonically by the level of pharmacy benefits among Medicare HMO enrollees, with veterans enrolled in plans with both low and high pharmacy benefit levels significantly less likely to use VHA pharmacy services than veterans in plans with no pharmacy benefits (odds ratios = .83 and .53, respectively, versus plans with no benefits). Among VHA pharmacy users, enrollment in plans with high levels of benefits was associated with significantly lower annual pharmacy costs than enrollment in plans with no benefits or enrollment in traditional Medicare. Conclusions: Our findings indicate that non-VHA pharmacy benefits affect both the likelihood and magnitude of VHA pharmacy use. This suggests that Medicare pharmacy coverage (Part D) may significantly reduce the demand for VHA pharmacy services, particularly in geographic regions previously underserved by Medicare managed care plans. C1 [Morgan, Robert O.] Univ Texas Sch Publ Hlth, Div Management Policy & Community Hlth, Houston, TX 77030 USA. [Petersen, Laura A.; Davila, Jessica A.] Baylor Coll Med, Houston, TX 77030 USA. [Petersen, Laura A.; Hasche, Jennifer C.; Davila, Jessica A.] Michael E DeBakey VHA Med Ctr, Houston, TX USA. [Byrne, Margaret M.] Univ Miami, Sch Med, Miami, FL USA. [Osemene, Nora I.] Texas So Univ, Coll Pharm & Hlth Sci, Houston, TX 77004 USA. [Wei, Iris I.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Johnson, Michael L.] Univ Houston, Coll Pharm, Houston, TX 77030 USA. RP Morgan, RO (reprint author), Univ Texas Sch Publ Hlth, Div Management Policy & Community Hlth, 1200 Herman Pressler,Rm E-343, Houston, TX 77030 USA. EM robert.o.morgan@uth.tmc.edu FU Department of Veterans Affairs, Health Services Research and Development Service [IIR 02-081, IIR 02-083, HFP 90-020]; National Institutes of Health [R01 AG19284-01] FX This research was supported by the Department of Veterans Affairs, Health Services Research and Development Service grants IIR 02-081, IIR 02-083, and HFP 90-020, and by National Institutes of Health grant R01 AG19284-01. NR 17 TC 24 Z9 24 U1 0 U2 0 PU MANAGED CARE & HEALTHCARE COMMUNICATIONS LLC PI PLAINSBORO PA 666 PLAINSBORO RD, STE 300, PLAINSBORO, NJ 08536 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD MAR PY 2009 VL 15 IS 3 BP E1 EP E8 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 426LF UT WOS:000264709100007 PM 19298095 ER PT J AU Sisko, A Truffer, C Smith, S Keehan, S Cylus, J Poisal, JA Clemens, MK Lizonitz, J AF Sisko, Andrea Truffer, Christopher Smith, Sheila Keehan, Sean Cylus, Jonathan Poisal, John A. Clemens, M. Kent Lizonitz, Joseph TI Health Spending Projections Through 2018: Recession Effects Add Uncertainty To The Outlook SO HEALTH AFFAIRS LA English DT Article AB During the projection period (2008-2018), average annual growth in national health spending is projected to be 6.2 percent-2.1 percentage points faster than average annual growth in gross domestic product (GDP). The health share of GDP is anticipated to rise rapidly from 16.2 percent in 2007 to 17.6 percent in 2009, largely as a result of the recession, and then climb to 20.3 percent by 2018. Public payers are expected to become the largest source of funding for health care in 2016 and are projected to pay for more than half of all national health spending in 2018. [Health Affairs 28, no. 2 (2009): w346-w357 (published online 24 February 2009; 10.1377/hlthaff.28.2.w346)] C1 [Sisko, Andrea] Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD USA. RP Sisko, A (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD USA. EM DNHS@cms.hhs.gov NR 17 TC 68 Z9 68 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2009 VL 28 IS 2 BP W346 EP W357 DI 10.1377/hlthaff.28.2.w346 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 422RJ UT WOS:000264445100089 PM 19240055 ER PT J AU Petroski, CA Regan, JF AF Petroski, Cara A. Regan, Joseph F. TI Use and Knowledge of the New Enrollee "Welcome to Medicare" Physical Examination Benefit SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The Medicare Current Beneficiary Survey (MCBS) is a large survey utilizing a nationally representative sample of the Medicare population. The MCBS collects data on a whole host of topics including health status, health insurance coverage and financing, access to care, knowledge and understanding of the Medicare Program, as well as use and effectiveness of new program benefits and changes. C1 [Petroski, Cara A.] Ctr Medicare, Baltimore, MD 21244 USA. RP Petroski, CA (reprint author), Ctr Medicare, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM cara.petroski@cms.hhs.gov; joseph.regan@cms.hhs.gov NR 0 TC 7 Z9 7 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2009 VL 30 IS 3 BP 71 EP 76 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 446WR UT WOS:000266152700006 PM 19544936 ER PT J AU Foster, RS Clemens, MK AF Foster, Richard S. Clemens, M. Kent TI Medicare Financial Status, Budget Impact, and Sustainability-Which Concept is Which? SO HEALTH CARE FINANCING REVIEW LA English DT Article AB Medicare is continually undergoing change, as it must in order to reflect advances in medical technology, new health care delivery systems, financial pressures, and other developments. Modifications to the program are debated by policymakers in Congress and the administration, together with academic experts and others. These debates would be improved if policymakers and the public had a clearer understanding of Medicare and certain commonly cited views of the program's overall status. Three such concepts-the financial status of the Medicare trust funds, the impact of Medicare on the Federal budget, and the long-run sustainability of Medicare-are often confused with each other and are sometimes used interchangeably. Each concept is important but needs to be used for its own purpose. This article clarifies the differences among these three views of Medicare and provides examples of each. C1 [Foster, Richard S.] Ctr Medicare, Off Actuary, Baltimore, MD 21244 USA. RP Foster, RS (reprint author), Ctr Medicare, Off Actuary, 7500 Secur Blvd,N3-01-21, Baltimore, MD 21244 USA. EM richard.foster@cms.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2009 VL 30 IS 3 BP 77 EP 90 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 446WR UT WOS:000266152700007 PM 19544937 ER PT J AU Gordon, W Polansky, J Boscardin, J Fung, K Patil, S Steinman, M AF Gordon, W. Polansky, J. Boscardin, J. Fung, K. Patil, S. Steinman, M. TI Point-based vs. equation-based Framingham risk models: Minor simplification with major consequences SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Meeting Abstract CT Annual Meeting of the American-Geriatrics-Society CY APR 29-MAY 02, 2009 CL Chicago, IL SP Amer Geriatr Soc C1 [Gordon, W.] Weill Cornell Med Coll, New York, NY USA. [Gordon, W.] Med Student Training Aging Res Program, San Francisco, CA USA. [Polansky, J.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Fung, K.; Patil, S.; Steinman, M.] San Francisco VA Med Ctr, San Francisco, CA USA. [Boscardin, J.; Fung, K.; Patil, S.; Steinman, M.] UCSF, Div Geriatr, San Francisco, CA USA. [Boscardin, J.] UCSF, Div Biostat, San Francisco, CA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD MAR PY 2009 VL 57 BP S5 EP S6 PG 2 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 425BL UT WOS:000264611900014 ER PT J AU Zhan, CL Elixhauser, A Richards, CL Wang, Y Baine, WB Pineau, M Verzier, N Kliman, R Hunt, D AF Zhan, Chunliu Elixhauser, Anne Richards, Chesley L., Jr. Wang, Yun Baine, William B. Pineau, Michael Verzier, Nancy Kliman, Rebecca Hunt, David TI Identification of Hospital-Acquired Catheter-Associated Urinary Tract Infections From Medicare Claims Sensitivity and Positive Predictive Value SO MEDICAL CARE LA English DT Article DE administrative data; positive predictive value; urinary catheter; urinary tract infections ID NOSOCOMIAL INFECTIONS; ADMINISTRATIVE DATA; UNITED-STATES; SURVEILLANCE; CARE; COMPLICATIONS AB Background and Objective: Hospital-acquired catheter-associated urinary tract infection (CAUTI) is one of the first 6 conditions Medicare is targeting to reduce payment associated with hospital-acquired conditions under Congressional mandate. This study was to determine the positive predictive value (PPV) and sensitivity in identifying patients in Medicare claims who had urinary catheterization and who had hospital-acquired CAUTIs. Research Design: CAUTIs identified by ICD-9-CM codes in Medicare claims were compared with those revealed by medical record abstraction in random samples of Medicare discharges in 2005 to 2006. Hospital discharge abstracts (2005) from the states of New York and California were used to estimate the potential impact of a present-on-admission (POA) indicator on PPV. Results: ICD-9-CM procedure codes for urinary catheterization appeared in only 1.4% of Medicare claims for patients who had urinary catheters. As a proxy, claims with major Surgery had a PPV of 75% and sensitivity of 48%, and claims with any surgical procedure had a PPV of 53% and sensitivity of 79% in identifying urinary catheterization. The PPV and sensitivity for identifying hospital-acquired CAUTIs varied, with the PPV at 30% and sensitivity at 65% in claims with major Surgery. About 80% of the secondary diagnosis codes indicating UTIs were flagged as POA, suggesting that the addition of POA indicators in Medicare claims Would increase PPV up to 86% and sensitivity up to 79% in identifying hospital-acquired CAUTIs. Conclusions: The validity in identifying urinary catheter use and CAUTIs from Medicare claims is limited, but will be increased substantially upon addition of a POA indicator. C1 [Zhan, Chunliu] Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [Richards, Chesley L., Jr.] Ctr Dis Control & Prevent, Atlanta, GA USA. [Wang, Yun; Pineau, Michael; Verzier, Nancy] Qualidigm, Middletown, CT USA. [Kliman, Rebecca] Ctr Medicare, Baltimore, MD USA. [Kliman, Rebecca] Medicaid Serv, Baltimore, MD USA. [Hunt, David] Off Natl Coordinator Hlth Informat Technol, Washington, DC USA. RP Zhan, CL (reprint author), Agcy Healthcare Res & Qual, Ctr Outcomes & Evidence, Dept Hlth & Human Serv, 540 Gaither Rd, Rockville, MD 20850 USA. EM czhan@ahrq.hhs.gov NR 23 TC 30 Z9 30 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAR PY 2009 VL 47 IS 3 BP 364 EP 369 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 412VT UT WOS:000263753000014 PM 19194330 ER PT J AU Bott, DM Kapp, MC Johnson, LB Magno, LM AF Bott, David M. Kapp, Mary C. Johnson, Lorraine B. Magno, Linda M. TI Disease Management For Chronically Ill Beneficiaries In Traditional Medicare SO HEALTH AFFAIRS LA English DT Article ID CARE AB We summarize the Centers for Medicare and Medicaid Services' (CMS's) experience with disease management (DM) in fee-for-service Medicare. Since 1999, the CMS has conducted seven DM demonstrations involving some 300,000 beneficiaries in thirty-five programs. Programs include provider-based, third-party, and hybrid models. Reducing costs sufficient to cover program fees has proved particularly challenging. Final evaluations on twenty programs found three with evidence of quality improvement at or near budget-neutrality, net of fees. Interim monitoring covering at least twenty-one months on the remaining fifteen programs suggests that four are close to covering their fees. Characteristics of the traditional Medicare program present a challenge to these DM models. [Health Affairs 28, no. 1 (2009): 86-98; 10.1377/hlthaff.28.1.86] C1 [Bott, David M.; Kapp, Mary C.; Johnson, Lorraine B.] Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. RP Bott, DM (reprint author), Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. EM david.bott@cms.hhs.gov NR 19 TC 45 Z9 45 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2009 VL 28 IS 1 BP 86 EP 98 DI 10.1377/hlthaff.28.1.86 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 390WM UT WOS:000262194400012 PM 19124858 ER PT J AU Foote, SM AF Foote, Sandra M. TI Next Steps: How Can Medicare Accelerate The Pace Of Improving Chronic Care? SO HEALTH AFFAIRS LA English DT Article ID QUALITY AB David Bott and colleagues report little success so far in demonstrations and pilot programs undertaken since 1999 to improve chronic disease management in the traditional Medicare program. The findings presented are highly generalized. To accelerate learning and progress, the Centers for Medicare and Medicaid Services (CMS) should expedite release of program-specific evaluations and data for external review. In addition, experience from the quality improvement field suggests that a new approach to program development would be beneficial, featuring intensified collaboration and data exchange to facilitate rapid program improvement, and application of a broader set of scientific methods than are used in clinical trials to gauge results. [Health Affairs 28, no. 1 (2009): 99-102; 10.1377/hlthaff.28.1.99] C1 [Foote, Sandra M.] Capitol Hlth, New York, NY USA. [Foote, Sandra M.] Ctr Medicare & Medicaid Serv, Ctr Medicare Management, Chron Care Improvement, Baltimore, MD USA. RP Foote, SM (reprint author), Capitol Hlth, New York, NY USA. EM sfootw@capitolhealth.com FU Medicare Health FX A status review session on the Medicare Health Support initiative, hosted by Mark McClellan at the Brookings Institution, and subsequent discussions with the experts involved contributed to this Perspective. The author is solely responsible for its contents. NR 8 TC 8 Z9 8 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2009 VL 28 IS 1 BP 99 EP 102 DI 10.1377/hlthaff.28.1.99 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 390WM UT WOS:000262194400013 PM 19124859 ER PT J AU Hartman, M Martin, A McDonnell, P Catlin, A AF Hartman, Micah Martin, Anne McDonnell, Patricia Catlin, Aaron CA Natl Hlth Expenditure Accounts TI National Health Spending In 2007: Slower Drug Spending Contributes To Lowest Rate Of Overall Growth Since 1998 SO HEALTH AFFAIRS LA English DT Article AB In 2007, U. S. health care spending growth slowed to its lowest rate since 1998, increasing 6.1 percent to $2.2 trillion, or $7,421 per person. The health care portion of gross domestic product reached 16.2 percent, up from 16.0 percent in 2006. Slower growth in 2007 was largely attributed to retail prescription drug spending and government administration. With the exception of prescription drugs, most other health care services grew at about the same rate as or faster than in 2006. Spending growth from private sources accelerated in 2007 as public spending slowed; however, public spending growth has continued to outpace private sources since 2002. [Health Affairs 28, no. 1 (2009): 246-261; 10.1377/hlthaff.28.1.246] C1 [Hartman, Micah; Catlin, Aaron] Ctr Medicare & Medicaid Serv CMS, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. RP Hartman, M (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. EM micah.hartman@cms.hhs.gov NR 29 TC 86 Z9 86 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2009 VL 28 IS 1 BP 246 EP 261 DI 10.1377/hlthaff.28.1.246 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 390WM UT WOS:000262194400031 PM 19124877 ER PT J AU Janicke, DM Harman, JS Kelleher, KJ Zhang, J AF Janicke, David M. Harman, Jeffrey S. Kelleher, Kelly J. Zhang, Jianyi TI The Association of Psychiatric Diagnoses, Health Service Use, and Expenditures in Children with Obesity-related Health Conditions SO JOURNAL OF PEDIATRIC PSYCHOLOGY LA English DT Article ID PEER VICTIMIZATION; METABOLIC SYNDROME; PHYSICAL-ACTIVITY; OVERWEIGHT YOUTH; CARE USE; ADOLESCENTS; CHILDHOOD; PREVALENCE; ADJUSTMENT; DEPRESSION AB Objective To examine the association of psychiatric diagnoses and use of health care services in children with obesity-related health conditions. Method A retrospective, longitudinal design was used to examine Medicaid claims data. The data set consisted of 13,688 youth diagnosed with type 2 diabetes, metabolic syndrome, dyslipidemia, or obesity. Results The presence of any type of psychiatric diagnosis was associated with higher health service use. In particular, the presence of an internalizing diagnosis was more consistently associated with higher service use than the presence of an externalizing diagnosis. Children with both an externalizing and internalizing disorder diagnosis had greater service use than children with a diagnosis in only one of these categories. Conclusions These data highlight a subgroup of children with obesity-related health conditions who are at greater risk for higher health service use, and the need for further research on the association between psychiatric diagnosis and health service use. C1 [Janicke, David M.] Univ Florida, Dept Clin & Hlth Psychol, Gainesville, FL 32610 USA. [Harman, Jeffrey S.] Univ Florida, Dept Hlth Serv Res Management & Policy, Gainesville, FL 32610 USA. [Kelleher, Kelly J.] Childrens Hosp, Dept Pediat & Publ Hlth, Boston, MA USA. [Zhang, Jianyi] Univ Florida, Ctr Medicaid, Gainesville, FL 32610 USA. RP Janicke, DM (reprint author), Univ Florida, Dept Clin & Hlth Psychol, POB 100165, Gainesville, FL 32610 USA. EM djanicke@phhp.ufl.edu RI Kelleher, Kelly/E-3361-2011 NR 28 TC 7 Z9 7 U1 0 U2 2 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0146-8693 J9 J PEDIATR PSYCHOL JI J. Pediatr. Psychol. PD JAN-FEB PY 2009 VL 34 IS 1 BP 79 EP 88 DI 10.1093/jpepsy/jsn051 PG 10 WC Psychology, Developmental SC Psychology GA 392WW UT WOS:000262333900011 PM 18522995 ER PT J AU Prela, CM Baumgardner, GA Reiber, GE McFarland, LV Maynard, C Anderson, N Maciejewski, M AF Prela, Cecilia M. Baumgardner, Greg A. Reiber, Gayle E. McFarland, Lynne V. Maynard, Charles Anderson, Nancy Maciejewski, Matthew TI Challenges in Merging Medicaid and Medicare Databases to Obtain Healthcare Costs for Dual-Eligible Beneficiaries Using Diabetes as an Example SO PHARMACOECONOMICS LA English DT Article ID QUALITY; STATE; VETERANS; OUTCOMES; RISK AB Background: Dual-eligible Medicaid-Medicare beneficiaries represent a group of people who are in the lowest income bracket in the US, have numerous co-morbidities and place a heavy financial burden on the US healthcare system. As cost-effectiveness analyses are used to inform national policy decisions and to determine the value of implemented chronic disease control programmes, it is imperative that complete and valid determination of healthcare utilization and costs can be obtained from existing state and federal databases. Differences and inconsistencies between the Medicaid and Medicare databases have presented significant challenges when extracting accurate data for dual-eligible beneficiaries. Objectives: To describe the challenges inherent in merging Medicaid and Medicare claims databases and to present a protocol that would allow successful linkage between these two disparate databases. Methods: Healthcare claims and costs were extracted from both Medicaid and Medicare databases for King County, Seattle, WA, USA. Three Medicaid files were linked to eight Medicare files for unique dual-eligible beneficiaries with type 2 diabetes mellitus. Results: Although major differences were identified in how variables and claims were defined in each database, our method enabled us to link these two different databases to compile a complete and accurate assessment of healthcare use and costs for dual-eligible beneficiaries with a costly chronic condition. For example, of the 1759 dual-eligible beneficiaries with diabetes, the average cost of healthcare was $US15 981 per capita, with an average of 76 claims per person per year. Conclusion: The resulting merged database provides a virtually complete documentation of both utilization and costs of medical care for a population who receives coverage from two different programmes. By identifying differences and implementing our linkage protocol, the merged database serves as a foundation for a broad array of analyses on healthcare use and costs for effectiveness research. C1 [Reiber, Gayle E.; McFarland, Lynne V.; Maynard, Charles] VA Puget Sound Healthcare Syst, Hlth Serv Res & Dev, Seattle, WA 98101 USA. [Prela, Cecilia M.] Ctr Medicare & Medicaid Serv, Medicare Plan Payment Grp, Div Risk Adjustment, Baltimore, MD USA. [Baumgardner, Greg A.] Qualis Hlth, Data Anal Team, Seattle, WA USA. [Anderson, Nancy] Med Assistance Adm, Olympia, WA USA. [Maciejewski, Matthew] Univ N Carolina, Chapel Hill, NC USA. RP McFarland, LV (reprint author), VA Puget Sound Healthcare Syst, Hlth Serv Res & Dev, 1100 Olive Way 1400, Seattle, WA 98101 USA. EM lynne.mcfarland@va.gov RI Maynard, Charles/N-3906-2015 OI Maynard, Charles/0000-0002-1644-7814 FU Centers for Medicare & Medicaid Services [500-99-WA02]; US Department of Health and Human Services; Sandy MacColl Foundation, Seattle, Washington; The Robert Wood Johnson Foundation, Princeton, New York; Adventis Pharmaceuticals Inc.; Washington State Department of Health FX The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the Department of Health and Human Services. The authors assume full responsibility for the accuracy and completeness of the ideas presented. NR 31 TC 6 Z9 6 U1 0 U2 3 PU ADIS INT LTD PI AUCKLAND PA 41 CENTORIAN DR, PRIVATE BAG 65901, MAIRANGI BAY, AUCKLAND 1311, NEW ZEALAND SN 1170-7690 J9 PHARMACOECONOMICS JI Pharmacoeconomics PY 2009 VL 27 IS 2 BP 167 EP 177 PG 11 WC Economics; Health Care Sciences & Services; Health Policy & Services; Pharmacology & Pharmacy SC Business & Economics; Health Care Sciences & Services; Pharmacology & Pharmacy GA 432IS UT WOS:000265127300007 PM 19254049 ER PT J AU Hamilton, TE AF Hamilton, T. E. TI Improving Organ Transplantation in the United States-A Regulatory Perspective SO AMERICAN JOURNAL OF TRANSPLANTATION LA English DT Article C1 [Hamilton, T. E.] Ctr Medicare, Survey & Certificat Grp, Baltimore, MD USA. [Hamilton, T. E.] CMS, Baltimore, MD USA. RP Hamilton, TE (reprint author), Ctr Medicare, Survey & Certificat Grp, Baltimore, MD USA. EM mabecass@nmh.org NR 0 TC 15 Z9 15 U1 0 U2 0 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1600-6135 J9 AM J TRANSPLANT JI Am. J. Transplant. PD DEC PY 2008 VL 8 IS 12 BP 2503 EP 2505 DI 10.1111/j.1600-6143.2008.02446.x PG 3 WC Surgery; Transplantation SC Surgery; Transplantation GA 374OM UT WOS:000261053600009 PM 18853947 ER PT J AU Joyce, GF Niaura, R Maglione, M Mongoven, J Larson-Rotter, C Coan, J Lapin, P Morton, S AF Joyce, Geoffrey F. Niaura, Raymond Maglione, Margaret Mongoven, Jennifer Larson-Rotter, Carrie Coan, James Lapin, Pauline Morton, Sally TI The Effectiveness of Covering Smoking Cessation Services for Medicare Beneficiaries SO HEALTH SERVICES RESEARCH LA English DT Article DE Smoking cessation; elderly; Medicare ID SUSTAINED-RELEASE BUPROPION; COST-EFFECTIVENESS; CIGARETTE-SMOKING; DISEASE AB To examine whether reimbursement for Provider Counseling, Pharmacotherapies, and a telephone Quitline increase smoking cessation relative to Usual Care. Randomized comparison trial testing the effectiveness of four smoking cessation benefits. Seven states that best represented the national population in terms of the proportion of those >= 65 years of age and smoking rate. There were 7,354 seniors voluntarily enrolled in the Medicare Stop Smoking Program and they were followed-up for 12 months. (1) Usual Care, (2) reimbursement for Provider Counseling, (3) reimbursement for Provider Counseling with Pharmacotherapy, and (4) telephone counseling Quitline with nicotine patch. Seven-day self-reported cessation at 6- and 12-month follow-ups. Unadjusted quit rates assuming missing data=smoking were 10.2 percent (9.0-11.5), 14.1 percent (11.7-16.5), 15.8 percent (14.4-17.2), and 19.3 percent (17.4-21.2) at 12 months for the Usual Care, Provider Counseling, Provider Counseling + Pharmacotherapy, and Quitline arms, respectively. Results were robust to sociodemographics, smoking history, motivation, health status, and survey nonresponse. The additional cost per quitter (relative to Usual Care) ranged from several hundred dollars to $6,450. A telephone Quitline in conjunction with low-cost Pharmacotherapy was the most effective means of reducing smoking in the elderly. C1 [Joyce, Geoffrey F.; Maglione, Margaret] RAND Corp, Santa Monica, CA 90407 USA. [Niaura, Raymond] Brown Univ, Dept Psychiat & Human Behav, Butler Hosp, Warren Alpert Med Sch, Providence, RI 02912 USA. [Mongoven, Jennifer] Qualidigm, Middletown, CT USA. [Larson-Rotter, Carrie] Cedars Sinai Med Ctr, W Hollywood, CA USA. [Coan, James; Lapin, Pauline] Ctr Medicare, Off Res Dev & Informat, Baltimore, MD USA. [Coan, James; Lapin, Pauline] Ctr Medicaid Serv, Baltimore, MD USA. [Morton, Sally] RTI Int, Res Triangle Pk, NC USA. RP Joyce, GF (reprint author), RAND Corp, 1776 Main St, Santa Monica, CA 90407 USA. EM gjoyce@rand.org FU CMS [500-98-0281] FX This research was conducted under contract to the CMS (Contract No. 500-98-0281). The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. We gratefully acknowledge the assistance of Paul Shekelle, M. D., Ph. D.; Afshin Rastegar, M. S., and Catherine Cruz, B. A. from RAND Health; Maxine Goldsmith, M. B. A. and Sarah Cohen, B. S. from Qualidigm; Donna Novak, Patricia Giles, and Janine Mierzwicki from Trailblazer Health Enterprises; Tim McAfee, M. D., M. P. H.; Susan Zbikowski, Ph. D.; Miriam Philby, M. A. and Tawnya Lictenwalter from the Center for Health Promotion Inc.; and George Brown from CMS. CMS has a contractual right to review the report of funded work, after which it can be submitted without constraint. NR 21 TC 25 Z9 25 U1 1 U2 5 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 EI 1475-6773 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2008 VL 43 IS 6 BP 2106 EP 2123 DI 10.1111/j.1475-6773.2008.00891.x PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 372BZ UT WOS:000260877700012 PM 18783459 ER PT J AU Soran, OZ Pina, IL Lamas, GA Kelsey, SF Selzer, F Pilotte, J Lave, JR Feldman, AM AF Soran, Ozlem Z. Pina, Ileana L. Lamas, Gervasio A. Kelsey, Sheryl F. Selzer, Faith Pilotte, John Lave, Judith R. Feldman, Arthur M. TI A Randomized Clinical Trial of the Clinical Effects of Enhanced Heart Failure Monitoring Using a Computer-Based Telephonic Monitoring System in Older Minorities and Women SO JOURNAL OF CARDIAC FAILURE LA English DT Article DE Clinical outcomes; disease management program; heart failure ID HOME-BASED INTERVENTION; DISEASE-MANAGEMENT PROGRAM; UNPLANNED READMISSIONS; ELDERLY-PATIENTS; RESOURCE USE; MULTIDISCIPLINARY; CARE; HOSPITALIZATION; SURVIVAL; OUTCOMES AB Background: Prior studies suggest that disease management programs may be effective in improving clinical outcomes in patients with heart failure (HF). However, the use of these programs ill settings with limited sources and among diverse population is not know. Thus the present study was designed to assess the impact of a computer-based home disease management program (Alere DayLink HF Monitoring System [HFMS]) oil the clinical outcomes of Medicare beneficiaries with I-IF who were elderly. women, and non-white males who received the care from a community-based primary care practitioner. Methods and Results: The Heart Failure Home Care (HFHC) trial was a multicenter, randomized, controlled trial of HFMS versus standard heart failure care (SC: enhanced patient education, education to clinicians, and follow-up). The primary study end point was treatment failure, defined as a composite of cardiovascular death or rehospitalization for heart failure within 6 months of enrollment. Among patients rehospitalized for HF, length of hospital stay was also considered a primary end point. A total of 315 patients were randomized: 160 to HFMS and 155 to SC. Although the incidence of the primary outcome was somewhat higher in the SC arm (28.8% versus 21.2%, P = .15), the difference was, not statistically different. The length of hospital stay was also similar in both groups. Conclusions: Our study results suggest that enhanced patient education and follow-up is as successful as a sophisticated home monitoring device with an interactive program in patients with HF who are elderly, women and non-Caucasian males and receive the care front a community-based primary care practitioner. C1 [Soran, Ozlem Z.] Univ Pittsburgh, Cardiovasc Inst, Med Ctr, Pittsburgh, PA 15213 USA. [Pina, Ileana L.] Case Western Reserve Univ, Cleveland, OH 44106 USA. [Lamas, Gervasio A.] Univ Miami, Miller Sch Med, Div Cardiovasc, Miami, FL 33136 USA. [Kelsey, Sheryl F.; Selzer, Faith] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA 15213 USA. [Pilotte, John] Ctr Medicare, Baltimore, MD USA. [Pilotte, John] Medicaid Serv, Baltimore, MD USA. [Lave, Judith R.] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Policy & Management, Pittsburgh, PA 15213 USA. [Feldman, Arthur M.] Thomas Jefferson Univ, Jefferson Med Coll, Dept Med, Philadelphia, PA 19107 USA. RP Soran, OZ (reprint author), Univ Pittsburgh, Presbyterian Hosp, Cardiovasc Inst, UPMC,PUH F 748, 200 Lothrop St, Pittsburgh, PA 15213 USA. NR 29 TC 26 Z9 25 U1 0 U2 7 PU CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS PI PHILADELPHIA PA CURTIS CENTER, INDEPENDENCE SQUARE WEST, PHILADELPHIA, PA 19106-3399 USA SN 1071-9164 J9 J CARD FAIL JI J. Card. Fail. PD NOV PY 2008 VL 14 IS 9 BP 711 EP 717 DI 10.1016/j.cardfail.2008.06.448 PG 7 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 377SB UT WOS:000261269800001 PM 18995174 ER PT J AU Wolff, JL Meadow, A Weiss, CO Boyd, CM Leff, B AF Wolff, Jennifer L. Meadow, Ann Weiss, Carlos O. Boyd, Cynthia M. Leff, Bruce TI Medicare Home Health Patients' Transitions Through Acute And Post-Acute Care Settings SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 135th Annual Meeting of the American-Public-Health-Association CY NOV 03-07, 2007 CL Washington, DC SP Amer Public Hlth Assoc DE home health; transitional care; Medicare; post-acute care ID MINIMUM DATA SET; PSYCHOMETRIC CHARACTERISTICS; OUTCOMES; VALIDITY; QUALITY; SERVICES; TRIAL AB Objectives: To describe Medicare beneficiaries' transitions through home health care within the context of other acute and post-acute services, and to examine agreement between administrative claims and Outcome and Assessment Information Set (OASIS) measures of health services use. Data Sources: The 2004 Chronic Condition Data Warehouse, including the Medicare 5% standard analytic file and OASIS. Study participants were 66,5 10 Medicare beneficiaries with a home health start of care assessment between January 15, 2004 and July 15. 2004 who were discharged before December 1, 2004. Results: Home health patients frequently incurred acute and post-acute services during the 14 days preceding admission and the 30 days after discharge, predominantly in acute hospitals. Substantial differences were observed in beneficiaries' health and functioning, across livin,, arrangements; patients living alone were less medically complex, less disabled, and received less assistance than those living with others. Agreement between OASIS and administrative claims was uniformly low with regard to inpatient hospital, inpatient rehabilitation, and skilled nursing facility use in the 14 days preceding the home health start of care. Agreement between OASIS and administrative claims was uneven for the period after discharge from home health care; it was determined to be near perfect for inpatient hospital (kappa = 0.85) but was lower for inpatient rehabilitation and hospice (kappa = 0.22 and 0.10. respectively). Conclusions: Findings reinforce the potential merit of patient-specific rather than setting-specific measures of quality. but underscore practical challenges to constructing measures that span data sources and episodes of care. C1 [Wolff, Jennifer L.; Boyd, Cynthia M.; Leff, Bruce] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD 21205 USA. [Wolff, Jennifer L.; Weiss, Carlos O.; Boyd, Cynthia M.; Leff, Bruce] Johns Hopkins Univ, Johns Hopkins Sch Med, Baltimore, MD USA. [Wolff, Jennifer L.; Meadow, Ann] Ctr Medicare, Baltimore, MD USA. [Wolff, Jennifer L.; Meadow, Ann] Ctr Medicaid Serv, Baltimore, MD USA. RP Wolff, JL (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, 624 N Broadway,Room 692, Baltimore, MD 21205 USA. EM jwolff@jhsph.edu NR 24 TC 12 Z9 12 U1 0 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD NOV PY 2008 VL 46 IS 11 BP 1188 EP 1193 DI 10.1097/MLR.0b013e31817d69d3 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 370EQ UT WOS:000260745900010 PM 18953231 ER PT J AU Al-Khatib, SM Sanders, GD Carlson, M Cicic, A Curtis, A Fonarow, GC Groeneveld, PW Hayes, D Heidenreich, P Mark, D Peterson, E Prystowsky, EN Sager, P Salive, ME Thomas, K Yancy, CW Zareba, W Zipes, D AF Al-Khatib, Sana M. Sanders, Gillian D. Carlson, Mark Cicic, Aida Curtis, Anne Fonarow, Gregg C. Groeneveld, Peter W. Hayes, David Heidenreich, Paul Mark, Daniel Peterson, Eric Prystowsky, Eric N. Sager, Philip Salive, Marcel E. Thomas, Kevin Yancy, Clyde W. Zareba, Wojciech Zipes, Douglas TI Preventing tomorrow's sudden cardiac death today: Dissemination of effective therapies for sudden cardiac death prevention SO AMERICAN HEART JOURNAL LA English DT Editorial Material ID IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR; ACUTE MYOCARDIAL-INFARCTION; CONGESTIVE-HEART-FAILURE; INITIATE LIFESAVING TREATMENT; LEFT-VENTRICULAR DYSFUNCTION; QUALITY-OF-CARE; TRIAL SCD-HEFT; COST-EFFECTIVENESS; RACIAL DISPARITY; ELDERLY-PATIENTS AB Because the burden of sudden cardiac death (SCD) is substantial, it is important to use all guideline-driven therapies to prevent SCD. Among those therapies is the implantable cardioverter defibrillator (ICD). When indicated, ICD use is beneficial and cost-effective. Unfortunately, studies suggest that most patients who have indications for this therapy for primary or secondary prevention of SCD ore not receiving it. To explore potential reasons for this underuse and to propose potential facilitators for ICD dissemination, the Duke Center for the Prevention of SCD at the Duke Clinical Research Institute (Durham, NC) organized a think tank meeting of experts on this issue. The meeting took place on December 12 and 13, 2007, and it included representatives of clinical cardiology, cardiac electrophysiology, general internal medicine, economics, health policy, the US Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Agency for Health care Research and Quality, and the device and pharmaceutical industry. Although the meeting was funded by industry participants, this article summarizing the presentations and discussions that occurred of the meeting presents the expert opinion of the authors. C1 [Al-Khatib, Sana M.; Sanders, Gillian D.; Mark, Daniel; Peterson, Eric; Thomas, Kevin] Duke Clin Res Inst, Durham, NC 27715 USA. [Carlson, Mark] St Jude Med, Sylmar, CA USA. [Cicic, Aida] Medtronic Inc, Mounds View, MN USA. [Curtis, Anne] Univ S Florida, Tampa, FL USA. [Fonarow, Gregg C.] Univ Calif Los Angeles, Los Angeles, CA USA. [Groeneveld, Peter W.] Philadelphia VA Med Ctr, Philadelphia, PA USA. [Hayes, David] Mayo Clin, Rochester, MN USA. [Heidenreich, Paul] Palo Alto Vet Affairs Hlth Care Syst, Palo Alto, CA USA. [Prystowsky, Eric N.] St Vincents Hosp, Indianapolis, IN USA. [Sager, Philip] CardioDx Inc, Palo Alto, CA USA. [Salive, Marcel E.] Ctr Medicare, Baltimore, MD USA. [Salive, Marcel E.] Ctr Medicaid Serv, Baltimore, MD USA. [Yancy, Clyde W.] Baylor Univ, Med Ctr, Dallas, TX USA. [Zareba, Wojciech] Univ Rochester, Rochester, NY USA. [Zipes, Douglas] Indiana Univ, Indianapolis, IN 46204 USA. RP Al-Khatib, SM (reprint author), Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA. EM alkha001@mc.duke.edu OI Mark, Daniel/0000-0001-6340-8087; Zipes, Douglas/0000-0001-7141-6829; Heidenreich, Paul/0000-0001-7730-8490 NR 60 TC 30 Z9 32 U1 0 U2 1 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0002-8703 J9 AM HEART J JI Am. Heart J. PD OCT PY 2008 VL 156 IS 4 BP 613 EP 622 DI 10.1016/j.ahj.2008.05.027 PG 10 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 359CH UT WOS:000259963300001 PM 18926144 ER PT J AU Hopson, S Frankenfield, D Rocco, M McClellan, W AF Hopson, Sari Frankenfield, Diane Rocco, Michael McClellan, William TI Variability in reasons for hemodialysis catheter use by race, sex, and geography: Findings from the ESRD clinical performance measures project SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE hemodialysis; catheter; vascular access ID VASCULAR ACCESS; UNITED-STATES; ARTERIOVENOUS-FISTULAS; RENAL-TRANSPLANTATION; PRACTICE PATTERNS; DIALYSIS OUTCOMES; SURVIVAL; DETERMINANTS; ASSOCIATION; MORTALITY AB Background: Race, sex, and geographic differences in hemodialysis vascular access use have been reported, but differences in reasons for catheter use have not been assessed. Study Design: Cross-sectional. Setting & Participants: Data obtained from the 2005 Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project for adult hemodialysis patients. Predictors: Race, sex, and geographic region. Outcomes & Measurements: Reasons for catheter use were categorized as short term and long term. Race, sex, and geographic associations with reasons were assessed by using bivariate analyses and multivariate logistic regression. Results: Of 8,479 hemodialysis patients, 3,302 (39%) used a fistula, 2,725 (32%) used a graft, and 2,299 (27%) used a catheter. We placed 857 patients with a catheter (37%) in the short-term-reason cohort and 1,404 (61 %) in the long-term-reason cohort, and 38 (2%) lacked information to be placed. Reasons for catheter use were independently associated with race, sex, and geographic region. Whites were 43%, 49%, and 34% less likely than African Americans to use a catheter because of graft maturation, graft interruption, and all vascular access sites exhausted and 70% and 40% more likely because of fistula maturation and no fistula or graft surgically planned, respectively. Men were 50% less likely than women to use a catheter because of graft interruption and 80% more likely because of fistula maturation. Geographic end-stage renal disease network was associated with catheter use because of fistula maturation (P = 0.03), no fistula or graft surgically created (P < 0.001), and no fistula or graft surgically planned (P = 0.05). Limitations: The cross-sectional study design precludes our ability to assess trends over time in reasons for catheter use. Associations were assessed for a limited set of variables. Conclusion: Race, sex, and geographic differences in reasons for hemodialysis catheter use exist. Understanding these differences may aid in developing strategies to decrease catheter initiation rates. C1 [Hopson, Sari; McClellan, William] Emory Univ, Dept Epidemiol, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. [Frankenfield, Diane] Ctr Medicare Serv, Off Res Dev & Informat, Baltimore, MD USA. [Frankenfield, Diane] Ctr Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. [Rocco, Michael] Wake Forest Univ, Sch Med, Nephrol Sect, Winston Salem, NC 27109 USA. RP Hopson, S (reprint author), Emory Univ, Dept Epidemiol, Rollins Sch Publ Hlth, 1518 Clifton Rd NE, Atlanta, GA 30322 USA. EM shopson@sph.emory.edu NR 29 TC 25 Z9 26 U1 0 U2 0 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0272-6386 EI 1523-6838 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD OCT PY 2008 VL 52 IS 4 BP 753 EP 760 DI 10.1053/j.ajkd.2008.04.007 PG 8 WC Urology & Nephrology SC Urology & Nephrology GA 357NR UT WOS:000259853900017 PM 18514986 ER PT J AU Riley, GF AF Riley, Gerald F. TI Trends in Out-of-Pocket Healthcare Costs Among Older Community-Dwelling Medicare Beneficiaries SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID BURDEN AB Objective: To describe trends in out-of-pock. et healthcare costs, including insurance premiums, for older Medicare beneficiaries living in the community. Study Design: Medicare Current Beneficiary Survey data were analyzed for community-dwelling beneficiaries 65 years or older between 1992 and 2004. Methods: The primary focus of the analysis was out-of-pocket healthcare costs and out-of-pocket costs as a percentage of income. Descriptive statistics are presented for 1992, 1996, 2000, and 2004. Results: Inflation-adjusted median out-of-pocket costs were stable between 1992 and 2000 and then rose by 21.7% between 2000 and 2004. Median costs as a percentage of income declined between 1992 and 1996 but increased from 12.6% in 2000 to 15.5% in 2004. Between 1992 and 2004, out-of-pocket costs increased fastest at the upper percentiles of the distribution. High out-of-pocket costs tended to persist from year to year, exacerbating the financial burden for some beneficiaries. Conclusions: Following a period of declining burden between 1992 and 1996, out-of-pocket healthcare costs rose significantly between 2000 and 2004, increasing the financial burden for many older Medicare beneficiaries. These data provide a baseline for evaluating Medicare reform proposals that affect beneficiary spending. (Am J Manag Care. 2008;74(10):692-696) C1 Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Riley, GF (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, 7500 Secur Blvd,Rm C3-21-27, Baltimore, MD 21244 USA. EM gerald.riley@cms.hhs.gov NR 19 TC 6 Z9 6 U1 1 U2 4 PU MANAGED CARE & HEALTHCARE COMMUNICATIONS LLC PI PLAINSBORO PA 666 PLAINSBORO RD, STE 300, PLAINSBORO, NJ 08536 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD OCT PY 2008 VL 14 IS 10 BP 692 EP 696 PG 5 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 357VQ UT WOS:000259875700007 PM 18837647 ER PT J AU Moore, T Walker, D Urdapilleta, O Flanagan, S Eastman, M Hill, S AF Moore, T. Walker, D. Urdapilleta, O. Flanagan, S. Eastman, M. Hill, S. TI MEASURING MEDICAID STATE AGENCY PERFORMANCE THROUGH DEVELOPMENT AND TESTING OF NEW QUALITY INDICATORS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Moore, T.; Walker, D.; Eastman, M.] ABT Associates Inc, Cambridge, MA 02138 USA. [Urdapilleta, O.] IMPAQ Int, Columbia, MD USA. [Flanagan, S.] Westchester Consulting Grp, Washington, DC USA. [Hill, S.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 216 EP 217 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810600751 ER PT J AU Sangl, J Frentzel, E Cosenza, C Brown, J Buchanan, J Levine, R Teichman, L AF Sangl, J. Frentzel, E. Cosenza, C. Brown, J. Buchanan, J. Levine, R. Teichman, L. TI DEVELOPMENT OF THE CAHPS (R) HOME HEALTH CARE SURVEY SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Sangl, J.] AHRQ, Rockville, MD USA. [Frentzel, E.; Levine, R.] Amer Inst Res, Chapel Hill, NC USA. [Cosenza, C.] Univ Massachusetts, Boston, MA 02125 USA. [Brown, J.] RAND Corp, Santa Monica, CA USA. [Buchanan, J.] Harvard Univ, Sch Med, Boston, MA USA. [Teichman, L.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 217 EP 217 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810600753 ER PT J AU Zimmerman, S Bern-Klug, M Bonifas, R Simons, K Zlotnik, J Connolly, R AF Zimmerman, S. Bern-Klug, M. Bonifas, R. Simons, K. Zlotnik, J. Connolly, R. TI SOCIAL WORK SERVICES IN LONG-TERM CARE (LTC): BUILDING ON A STRONG BEGINNING SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Zimmerman, S.] Univ N Carolina, Chapel Hill, NC USA. [Bern-Klug, M.] Univ Iowa, Iowa City, IA USA. [Bonifas, R.] Arizona State Univ, Phoenix, AZ USA. [Simons, K.] Baycrest Kunin Lunenfeld Res, Toronto, ON, Canada. [Zlotnik, J.] Inst Adv SW Res, Washington, DC USA. [Connolly, R.] Ctr Medicare, Baltimore, MD USA. [Connolly, R.] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 489 EP 489 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810601744 ER PT J AU Sangl, J Keller, S Frentzel, E Cosenza, C Brown, J Buchanan, J Sekscenski, E Ginsberg, C AF Sangl, J. Keller, S. Frentzel, E. Cosenza, C. Brown, J. Buchanan, J. Sekscenski, E. Ginsberg, C. TI DEVELOPMENT OF NURSING HOME CAHPS (R) SURVEY FOR FAMILY MEMBERS AS A MEASURE OF QUALITY SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Sangl, J.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Keller, S.; Frentzel, E.] Amer Inst Res, Chapel Hill, NC USA. [Cosenza, C.] Survey Res Ctr, Boston, MA USA. [Brown, J.] RAND Corp, Santa Monica, CA USA. [Buchanan, J.] Harvard Univ, Sch Med, Boston, MA USA. [Sekscenski, E.] Ctr Medicare, Baltimore, MD USA. [Sekscenski, E.] Ctr Medicaid Serv, Baltimore, MD USA. [Ginsberg, C.] WESTAT Corp, Rockville, MD 20850 USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 EI 1758-5341 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2008 VL 48 SI 3 BP 594 EP 594 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 399PA UT WOS:000262810602320 ER PT J AU Riey, GF Warren, JL Potosky, AL Klabunde, CN Harlan, LC Osswald, MB AF Riey, Gerald F. Warren, Joan L. Potosky, Arnold L. Klabunde, Carrie N. Harlan, Linda C. Osswald, Michael B. TI Comparison of Cancer Diagnosis and Treatment in Medicare Fee-for-Service and Managed Care Plans SO MEDICAL CARE LA English DT Article DE managed care; cancer diagnosis; cancer treatment; Medicare ID STAGE BREAST-CANCER; ACUTE MYOCARDIAL-INFARCTION; LOCALIZED PROSTATE-CANCER; QUALITY-OF-LIFE; RADICAL PROSTATECTOMY; COLORECTAL-CANCER; RADIATION-THERAPY; COLON-CANCER; HEALTH-CARE; HMO SETTINGS AB Objective: To compare the Medicare managed care(MC) and fee-for-service (FFS) sectors on stage at diagnosis and treatment patterns for prostate, female breast, and colorectal cancers, and no examine patterns across MC plans. Data: Surveillance, Epidemiology, and End Results-Medicare linked data. Methods: Among cases diagnosed at ages 65-79 between 1998 and 2002, we selected all MC enrollees (n = 42,467) and beneficiaries in FFS (n = 82,998) who resided in the same counties. MC and FFS samples were compared using logistic regression, adjusting for demographic, geographic and clinical covariates. Results: The percentage of late stage cases was similar in MC and FFS for prostate and colorectal cancers; there were slightly fewer late stage breast cancer cases in MC after adjustment (7.3% vs. 8.5%, P < 0.001). Within MC, radical prostatectomy was performed less frequently for clinically localized prostate cancer (18.3% vs 22.4%, P < 0.0001), and 12 or more lymph nodes were examined less often for resected colon cancer cases (40.9% vs 43.0%, P < 0.05). Treatment patterns for early stage breast cancer were similar in MC and FFS. Analyses of treatment patterns at the individual plan level revealed significant variation among plans, as well as within the FFS sector, for all 3 types of cancer. Conclusions: On average, there are few significant differences in cancer diagnosis and treatment MC and FFS. Such comparisons, however mask the wide variability among MC plans, as well as FFS providers. Observed variation in patterns of care may be related to patient selection, but can potentially lead to outcome differences. These findings support the need for quality measures toe evaluate plan practices and performance. C1 [Riey, Gerald F.] Ctr Medicare, Off Res Dev & Informat, Baltimore, MD 21244 USA. [Riey, Gerald F.] Ctr Medicaid Serv, Baltimore, MD 21244 USA. [Warren, Joan L.; Potosky, Arnold L.; Klabunde, Carrie N.; Harlan, Linda C.] NCI, Appl Res Program, Bethesda, MD 20892 USA. [Osswald, Michael B.] USAF, San Antonio Mil Med Ctr, Dept Med, Lackland AFB, TX USA. RP Riey, GF (reprint author), Ctr Medicare, Off Res Dev & Informat, 7500 Secur Blvd,Mail Stop C3-21-27, Baltimore, MD 21244 USA. EM Gerald.riley@cms.hhs.gov NR 50 TC 0 Z9 0 U1 2 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD OCT PY 2008 VL 46 IS 10 BP 1108 EP 1115 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 358IF UT WOS:000259909700018 ER PT J AU Kapp, MC AF Kapp, Mary C. TI Overview: Disease Management SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material C1 [Kapp, Mary C.] Ctr Medicare, Baltimore, MD 21244 USA. RP Kapp, MC (reprint author), Ctr Medicare, 7500 Secur Blvd,Mail Stop C3-19-26, Baltimore, MD 21244 USA. EM mary.kapp@cms.hhs.gov NR 1 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2008 VL 30 IS 1 BP 1 EP 3 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 370HG UT WOS:000260752700001 PM 19040170 ER PT J AU Atkinson, MA Neu, AM Fivush, BA Frankenfield, DL AF Atkinson, Meredith A. Neu, Alicia M. Fivush, Barbara A. Frankenfield, Diane L. TI Disparate outcomes in pediatric peritoneal dialysis patients by gender/race in the End-Stage Renal Disease Clinical Performance Measures project SO PEDIATRIC NEPHROLOGY LA English DT Article DE KDOQI target; renal replacement therapy; anemia; adequacy; albumin ID CHRONIC KIDNEY-DISEASE; CORE INDICATORS PROJECT; HEMODIALYSIS-PATIENTS; INTERMEDIATE OUTCOMES; HEMOGLOBIN TARGETS; ANEMIA; MALNUTRITION; CHILDREN; ADEQUACY; ERYTHROPOIETIN AB Associations between achievement of adult Kidney Disease Outcomes Quality Initiative (KDOQI) targets for hemoglobin, adequacy and albumin, and race and gender were determined for pediatric peritoneal dialysis patients from the End- Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) project for the period October 2004 - March 2005. Fifty-six percent (427/761) of patients were male. Sixty- six percent (500/761) of patients were White. There were no differences in achievement of targets for adults by gender, and no differences in adequacy parameters by race. Blacks had lower mean hemoglobin levels than did Whites (11.1 +/- 1.6 g/dl vs 11.8 +/- 1.4 g/dl, P < 0.0001). Blacks were more likely to have mean hemoglobin levels < 10 g/dl (24% vs 11%, P < 0.0001) and less likely to achieve mean hemoglobin > 11 g/dl (56% vs 72%, P < 0.0001). Whites were more likely to achieve mean serum albumin levels > 4.0/ 3.7 g/dl [bromocresol green/bromocresol purple (BCG/BCP)] than Blacks were (35% vs 26%, P= 0.0376). In multivariate logistic regression models, White race was associated with mean hemoglobin levels > 11 g/dl [adjusted odds ratio (adjOR) 2.7, 95% confidence interval (CI) 1.7, 4.3] and mean serum albumin > 4.0/ 3.7 g/dl (BCG/ BCP) (adjOR 1.9, 95% CI 1.3, 2.9]. Further study is needed of factors associated with anemia on peritoneal dialysis and barriers to its correction. C1 [Atkinson, Meredith A.; Neu, Alicia M.; Fivush, Barbara A.] Johns Hopkins Univ, Div Pediat Nephrol, Baltimore, MD 21287 USA. [Frankenfield, Diane L.] Ctr Medicare, Off Res Dev & Informat, Baltimore, MD USA. [Frankenfield, Diane L.] Ctr Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Atkinson, MA (reprint author), Johns Hopkins Univ, Div Pediat Nephrol, 200 N Wolfe St, Baltimore, MD 21287 USA. EM matkins3@jhmi.edu FU NICHD NIH HHS [T32 HD044355] NR 29 TC 5 Z9 5 U1 2 U2 2 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0931-041X J9 PEDIATR NEPHROL JI Pediatr. Nephrol. PD AUG PY 2008 VL 23 IS 8 BP 1331 EP 1338 DI 10.1007/s00467-008-0832-z PG 8 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 328QA UT WOS:000257811700020 PM 18483747 ER PT J AU Elkin, EB Ishill, N Riley, GF Bach, PB Gonen, M Begg, CB Schrag, D AF Elkin, Elena B. Ishill, Nicole Riley, Gerald F. Bach, Peter B. Gonen, Mithat Begg, Colin B. Schrag, Deborah TI Disenrollment from medicare managed care among beneficiaries with and without a cancer diagnosis SO JOURNAL OF THE NATIONAL CANCER INSTITUTE LA English DT Article ID HEALTH MAINTENANCE ORGANIZATIONS; FEE-FOR-SERVICE; BIASED SELECTION; VOLUNTARY DISENROLLMENT; UNITED-STATES; HMO; ENROLLEES; PERFORMANCE; EXPERIENCE; REGRESSION AB Background Medicare managed care may offer enrollees lower out-of-pocket costs and provide benefits that are not available in the traditional fee-for-service Medicare program. However, managed care plans may also restrict provider choice in an effort to control costs. We compared rates of voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare among Medicare managed care enrollees with and without a cancer diagnosis. Methods We identified Medicare managed care enrollees aged 65 years or older who were diagnosed with a first primary breast (n = 28 331), colorectal (n = 26 494), prostate (n = 29 046), or lung (n = 31 243) cancer from January 1, 1995, through December 31, 2002, in Surveillance, Epidemiology, and End Results (SEER) cancer registry records linked with Medicare enrollment files. Cancer patients were pair-matched to cancer-free enrollees by age, sex, race, and geographic location. We estimated rates of voluntary disenrollment to fee-for-service Medicare in the 2 years after each cancer patient's diagnosis, adjusted for plan characteristics and Medicare managed care penetration, by use of Cox proportional hazards regression. Results In the 2 years after diagnosis, cancer patients were less likely to disenroll from Medicare managed care than their matched cancer-free peers (for breast cancer, adjusted hazard ratio [HR] for disenrollment = 0.78, 95% confidence interval [CI] = 0.74 to 0.82; for colorectal cancer, HR = 0.84, 95% CI = 0.80 to 0.88; for prostate cancer, HR = 0.86, 95% CI = 0.82 to 0.90; and for lung cancer, HR = 0.81, 95% CI = 0.76 to 0.86). Results were consistent across strata of age, sex, race, SEER registry, and cancer stage. Conclusion A new cancer diagnosis between 1995 and 2002 did not precipitate voluntary disenrollment from Medicare managed care to traditional fee-for-service Medicare. C1 [Elkin, Elena B.; Bach, Peter B.; Begg, Colin B.; Schrag, Deborah] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, Hlth Outcomes Res Grp, New York, NY 10021 USA. [Riley, Gerald F.] Ctr Medicare & Madicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Elkin, EB (reprint author), Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, Hlth Outcomes Res Grp, 1275 York Ave,Box 44, New York, NY 10021 USA. EM elkine@mskcc.org RI Gonen, Mithat/E-4826-2012 FU AHRQ HHS [R03 HS14831]; NCI NIH HHS [R21 CA98353] NR 54 TC 2 Z9 2 U1 0 U2 2 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0027-8874 J9 J NATL CANCER I JI J. Natl. Cancer Inst. PD JUL 16 PY 2008 VL 100 IS 14 BP 1013 EP 1021 DI 10.1093/jnci/djn208 PG 9 WC Oncology SC Oncology GA 328HM UT WOS:000257789000010 PM 18612131 ER PT J AU Bhandari, A Dratler, S Raube, K Thulasiraj, RD AF Bhandari, Aman Dratler, Sandra Raube, Kristiana Thulasiraj, R. D. TI Specialty care systems: A pioneering vision for global health SO HEALTH AFFAIRS LA English DT Article ID CATARACT; INDIA AB Successful health-sector reform in developing countries is built on sustainable service delivery models that meet reform goals while addressing community needs. When government efforts fall short, innovative private-sector solutions can offer more-efficient alternatives that provide care to impoverished populations. We identify organizations that use elements of a focused care approach to overcome barriers to delivering care in low-resource settings. Using the experience of the Aravind Eye Care System, we describe the essential elements of the specialty care model, its replication across countries, and the challenges to extending this model beyond eye care. C1 [Bhandari, Aman] Ctr Medicare, Baltimore, MD USA. [Bhandari, Aman] Ctr Medicaid Serv, Baltimore, MD USA. [Dratler, Sandra] Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA. [Raube, Kristiana] Univ Calif Berkeley, Haas Sch Business, Berkeley, CA 94720 USA. [Thulasiraj, R. D.] Lions Aravind Inst Community Ophthalmol, Madurai, Tamil Nadu, India. RP Bhandari, A (reprint author), Ctr Medicare, Baltimore, MD USA. EM amanbhandari@gmail.com NR 22 TC 11 Z9 11 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JUL-AUG PY 2008 VL 27 IS 4 BP 964 EP 976 DI 10.1377/hlthaff.274.964 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 326CQ UT WOS:000257635900008 PM 18607029 ER PT J AU Cotterill, PG AF Cotterill, Philip G. TI Medicare psychiatric admissions, 1987-2004: Does the past offer insights for the future? SO HEALTH AFFAIRS LA English DT Article ID PAYMENT; CARE AB In 2005, Medicare implemented a new prospective payment system (PPS) for inpatient psychiatric facilities (IPFs). Analysis of Medicare psychiatric inpatient claims for 1987-2004 provides insights into future experience after implementation. Growth in the under-age-sixty-five disabled population was the dominant factor driving growth in psychiatric admissions. However, from 1987 until the late 1990s, there was a noteworthy increase in the use rate among the older elderly. In the future, growth of the beneficiary population will be especially important for the elderly. How the use rate responds is likely to depend on supply responses to financial incentives inherent in Medicare payment policy. C1 Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Cotterill, PG (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. EM philip.cotterill@cms.hhs.gov NR 16 TC 4 Z9 4 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JUL-AUG PY 2008 VL 27 IS 4 BP 1132 EP 1139 DI 10.1377/hlthaff.274.1132 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 326CQ UT WOS:000257635900027 PM 18607047 ER PT J AU Wasse, H Speckman, RA Frankenfield, DL Rocco, MV McClellan, WM AF Wasse, Haimanot Speckman, Rebecca A. Frankenfield, Diane L. Rocco, Michael V. McClellan, William M. TI Predictors of central venous catheter use at the initiation of hemodialysis SO SEMINARS IN DIALYSIS LA English DT Article ID VASCULAR ACCESS; MANAGEMENT; MORTALITY; OUTCOMES; CHOICE AB Central venous catheter (CVC) use at hemodialysis (HD) initiation remains high, despite reports of CVC-associated morbidity and mortality, and efforts at early arteriovenous fistula placement. In order to determine predictors of CVC use at the start of HD, data from the end-stage renal disease (ESRD) Clinical Performance Measures (CPM) Project was linked to the Centers for Medicare & Medicaid Services Medical Evidence (2728) Form. Of the 4071 incident hemodialysis patients in study years 1999-2003, 71.6% used a CVC at dialysis initiation. After controlling for demographic and co-morbid variables, patients with a CVC were 24% more likely to be female (p = 0.006), and 38% more likely to have ischemic heart disease (p = 0.002), while those with obesity (BMI >= 30) were 24% less likely to start dialysis with a CVC (p 0.006). Pre-ESRD hypoalbuminemia (< 3.5 g/dl) was associated with a twofold higher risk of CVC use (p = < 0.001), while patients with pre-ESRD anemia (hgb < 11 g/dl) were 29% more likely to use a CVC at dialysis initiation (p = 0.006) compared to those with hemoglobin >= 11 g/dl. Patients receiving predialysis erythropoictin had a 41% lower odds of CVC use at dialysis initiation (p = < 0.001). Finally, dialysis year was predictive of CVC use; in 2002, 76% of patients initiated dialysis with a CVC compared with 66% in 1998 (p < 0.001). Overall, female gender, ischemic heart disease, lack of obesity, factors suggesting poor pre-ESRD care, and successive year of dialysis initiation were predictive of CVC use at hemodialysis initiation. C1 [Wasse, Haimanot; McClellan, William M.] Emory Univ, Div Nephrol, Atlanta, GA 30322 USA. [Wasse, Haimanot; Speckman, Rebecca A.; McClellan, William M.] Emory Univ, Rollins Sch Publ Hlth, Div Epidemiol, Atlanta, GA 30322 USA. [Frankenfield, Diane L.] Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. [Rocco, Michael V.] Wake Forest Univ, Div Nephrol, Winston Salem, NC 27109 USA. RP Wasse, H (reprint author), Emory Univ, Div Nephrol System, WMB Room 338,1639 Pierce Dr, Atlanta, GA 30322 USA. EM hwasse@emory.edu RI Wasse, Haimanot/A-5726-2013 OI Wasse, Haimanot/0000-0001-5756-0242 FU NCATS NIH HHS [UL1 TR000454]; NIDDK NIH HHS [K23 DK065634, K23 DK065634-01A2, K23 DK65634] NR 18 TC 13 Z9 13 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0894-0959 J9 SEMIN DIALYSIS JI Semin. Dial. PD JUL-AUG PY 2008 VL 21 IS 4 BP 346 EP 351 DI 10.1111/j.1525-139X.2008.00447.x PG 6 WC Urology & Nephrology SC Urology & Nephrology GA 335YR UT WOS:000258332000009 PM 18564968 ER PT J AU Sheikh, K AF Sheikh, Kazim TI Medicare's approach to patient referral policy SO ANNALS OF SURGERY LA English DT Letter ID PROVIDER VOLUME; CARE; QUALITY; MORTALITY; STANDARDS; SURGERY C1 US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. EM kazim.sheikh@cms.hhs.gov NR 11 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-4932 J9 ANN SURG JI Ann. Surg. PD JUN PY 2008 VL 247 IS 6 BP 1075 EP 1076 DI 10.1097/SLA.0b013e3181758d5e PG 2 WC Surgery SC Surgery GA 306QI UT WOS:000256262500025 PM 18520239 ER PT J AU Mortimore, E Haselow, D Dolan, M Hawkes, WG Langenberg, P Zimmerman, S Magaziner, J AF Mortimore, Edward Haselow, Dirk Dolan, Melissa Hawkes, William G. Langenberg, Patricia Zimmerman, Sheryl Magaziner, Jay TI Amount of social contact and hip fracture mortality SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE hip fracture; social support; elderly survival ID PSYCHOSOCIAL FACTORS; FOLLOW-UP; RECOVERY; SUPPORT; PREDICTORS; OLDER; POPULATION; SURVIVAL; COUNTY; STROKE AB OBJECTIVES: To study the association between amount of social contact and mortality after hip fracture in elderly participants. DESIGN: Prospective cohort. SETTING:Community residents of Baltimore, Maryland. PARTICIPANTS: Six hundred seventy-four elderly participants. MEASUREMENTS: Amount of telephone and direct personal contact between participants and their relatives and friends and mortality up to 2 years after fracture. RESULTS: No social contact with friends during the 2 weeks before the fracture was associated with a five times greater risk of death over 2 years than daily contact with friends during the 2 weeks before the fracture (hazard ratio (HR)=5.04, 95% confidence interval (CI)=2.75-9.23). Participants with less than daily contact were also at greater risk of dying, although the CI spanned 1 (HR=1.76, 95% CI=0.99-3.13). Participants who had no contact with family members prefracture were more than twice as likely to die as those who communicated daily during the 2 weeks before fracture (HR=2.26, 95% CI=1.36-3.77). Participants who had less than daily contact were also more than twice as likely to die (HR=2.55, 95% CI=1.65-3.94). CONCLUSION: This study suggests that lower social contact before hip fracture is associated with poorer survival after 2 years. C1 [Mortimore, Edward] Ctr Medicare & Medicaid Serv, Div Nursing Home, Baltimore, MD 21244 USA. [Haselow, Dirk] Univ Arkansas, Sch Med, Little Rock, AR 72204 USA. [Dolan, Melissa] RTI Int, Survey Res Div, Hlth Serv Program, Chicago, IL USA. [Hawkes, William G.; Langenberg, Patricia; Magaziner, Jay] Univ Maryland, Sch Med, Dept Epidemiol & Prevent Med, Baltimore, MD 21201 USA. [Zimmerman, Sheryl] Univ N Carolina, Sch Social Work, Chapel Hill, NC USA. [Zimmerman, Sheryl] Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC USA. RP Mortimore, E (reprint author), Ctr Medicare & Medicaid Serv, Div Nursing Home, 7500 Secur Blvd,Room S3-12-11, Baltimore, MD 21244 USA. EM Edward.Mortimore@cms.hhs.gov FU NIA NIH HHS [R37 AG09901, P60 AG012583-10, P60 AG012583, R37 AG009901, R37 AG009901-13, P60 AG12583, R01 AG06322]; NICHD NIH HHS [R01 HD0073] NR 28 TC 13 Z9 13 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD JUN PY 2008 VL 56 IS 6 BP 1069 EP 1074 DI 10.1111/j.1532-5415.2008.01706.x PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 308SU UT WOS:000256411100015 PM 18410322 ER PT J AU Elkin, EB Ishill, NM Riley, GF Bach, PB Gonen, M Begg, CB Schrag, D AF Elkin, E. B. Ishill, N. M. Riley, G. F. Bach, P. B. Gonen, M. Begg, C. B. Schrag, D. TI Disenrollment from Medicare managed care: Does a cancer diagnosis make a difference? SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Meeting Abstract C1 Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER SOC CLINICAL ONCOLOGY PI ALEXANDRIA PA 2318 MILL ROAD, STE 800, ALEXANDRIA, VA 22314 USA SN 0732-183X J9 J CLIN ONCOL JI J. Clin. Oncol. PD MAY 20 PY 2008 VL 26 IS 15 SU S MA 6582 PG 1 WC Oncology SC Oncology GA V25CZ UT WOS:000208457402390 ER PT J AU Amaral, S Hwang, W Fivush, B Neu, A Frankenfield, D Furth, S AF Amaral, Sandra Hwang, Wenke Fivush, Barbara Neu, Alicia Frankenfield, Diane Furth, Susan TI Serum albumin level and risk for mortality and hospitalization in adolescents on hemodialysis SO CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article; Proceedings Paper CT 37th Annual Meeting of the American-Society-of-Nephrology CY OCT 27-NOV 01, 2004 CL St Louis, MO SP Amer Soc Nephrol ID STAGE RENAL-DISEASE; NUTRITION EXAMINATION SURVEY; PEDIATRIC DIALYSIS PATIENTS; C-REACTIVE PROTEIN; MAINTENANCE HEMODIALYSIS; CHRONIC INFLAMMATION; PERITONEAL-DIALYSIS; OUTCOME PREDICTOR; NATIONAL-HEALTH; CHILDREN AB Background and objectives: National Kidney Foundation Dialysis Outcomes Quality Initiative practice guidelines recommend serum albumin <= 4.0 g/dl for adults who are on hemodialysis. There is no established pediatric target for albumin and little evidence to support use of adult guidelines. This study examined the association between albumin and risk for death and hospitalization in adolescents who are on hemodialysis. Design, setting, participants, & measurements: This retrospective cohort study linked data on patients aged 12 to 18 yr in 1999 and 2000 from the Centers for Medicare and Medicaid Services' End Stage Renal Disease Clinical Performance Measures Project with 4-yr hospitalization and mortality records in the United States Renal Data System. Albumin was categorized as <3.5/3.2, >= 3.5/3.2 and <4.0/3.7, and >= 4.0/3.7 g/dl. Results: Of 675 adolescents, 557 were hospitalized and 50 died. Albumin >= 4.0/3.7 g/dl was associated with male gender, Hispanic ethnicity, and higher hemoglobin level. Those with albumin >= 4.0/3.7 g/dl had fewer deaths per 100 patient-years and fewer hospitalizations per time at risk. In multivariate analysis, patients with albumin >= 4.0/3.7 g/dl had 57% decreased risk for death. Poisson regression showed progressive decrease in hospitalization risk as albumin level increased; however, confidence intervals were similar between albumin >= 4.0/3.7 g/dl and albumin >= 3.5/3.2 and <4.0/3.7 g/dl. Conclusions: This study demonstrates decreased mortality and hospitalization risk with albumin >= 3.5/3.2 g/dl and suggests that adolescent hemodialysis patients who are able to achieve serum albumin >= 4.0/3.7 g/dl may have the lowest mortality risk. C1 [Amaral, Sandra] Emory Univ, Sch Med, Dept Pediat, Atlanta, GA 30322 USA. [Hwang, Wenke] Wake Forest Univ, Sch Med, Winston Salem, NC 27109 USA. [Fivush, Barbara; Neu, Alicia; Furth, Susan] Johns Hopkins Med Inst, Dept Pediat, Baltimore, MD 21205 USA. [Frankenfield, Diane] Johns Hopkins Med Inst, Off Res Dev & Informat, Ctr Medicare, Baltimore, MD 21205 USA. [Frankenfield, Diane] Johns Hopkins Med Inst, Off Res Dev & Informat, Ctr Medicaid Serv, Baltimore, MD 21205 USA. [Furth, Susan] Johns Hopkins Med Inst, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD 21205 USA. RP Amaral, S (reprint author), Emory Univ, Sch Med, Dept Pediat, 2015 Uppergate Dr NE, Atlanta, GA 30322 USA. EM sandra_amaral@oz.ped.emory.edu FU NIDDK NIH HHS [5 T32 DK07732, K24 DK078737, R21 DK 064313-01, R21 DK064313, T32 DK007732] NR 26 TC 21 Z9 25 U1 0 U2 0 PU AMER SOC NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1555-905X J9 CLIN J AM SOC NEPHRO JI Clin. J. Am. Soc. Nephrol. PD MAY PY 2008 VL 3 IS 3 BP 759 EP 767 DI 10.2215/CJN.02720707 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 294CS UT WOS:000255382300018 PM 18287254 ER PT J AU Sheikh, K Jiang, YM Bullock, CM AF Sheikh, Kazim Jiang, Yanming Bullock, Claudia M. TI Is there a sex or race difference in 30-day mortality after interruption of vena cava in a medicare population? SO JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY LA English DT Article ID CLINICAL COMORBIDITY INDEX; ICD-9-CM ADMINISTRATIVE DATA; PREDICTING MORTALITY; CO-MORBIDITY; FILTERS; CANCER; CLAIMS; PERFORMANCE; ADJUSTMENT; DATABASES AB PURPOSE: Disparities in health care and its outcome often indicate an opportunity for improving the quality of health care. Sex and rare differences in short-term mortality following interruption of vena cava are not known. The objective of this study was to determine such differences. MATERIALS AND METHODS: With use of Medicare administrative data, 1,823 interruption of vena cava procedures performed between 1994 and 1997 were identified among beneficiaries aged 65-99 years residing in Indiana and Kentucky. In Cox proportional hazard regression models, male-to-female and nonwhite-to-white 30-day mortality ratios were adjusted for age, sex or race, weighted Charlson comorbidity score, length of hospital stay, and fatal coexisting conditions (ascertained from death certificate data). RESULTS: Altogether, 277 patients died within 30 days after the procedure. Women were older than men. The comorbidity score was associated with male sex and mortality. There was no significant race difference in unadjusted or adjusted 30-day mortality after interruption of the vena cava. Unadjusted mortality was higher in men than in women (odds ratio, 1.49; 95% confidence interval [CI] = 1.15,1.92). Although adjustment for age, race, Charlson score, and length of hospital stay reduced the magnitude of sex difference, it remained significant. Further adjustment for fatal coexistent conditions reduced the sex difference to an insignificant level (odds ratio, 1.22; 95% CI = 0.96, 1.56). CONCLUSIONS: There was no significant sex or race difference in adjusted 30-day mortality after interruption of vena cava procedure in the elderly Medicare beneficiary population of two states. C1 US Dept HHS, Ctr Medicare, Kansas City, MO 64106 USA. US Dept HHS, Ctr Mediacids Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare, 601 E 12th St,Rm 235, Kansas City, MO 64106 USA. EM kazim.sheikh@cms.hhs.gov NR 38 TC 0 Z9 0 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1051-0443 J9 J VASC INTERV RADIOL JI J. Vasc. Interv. Radiol. PD MAY PY 2008 VL 19 IS 5 BP 677 EP 682 DI 10.1016/j.jvir.2008.01.008 PG 6 WC Radiology, Nuclear Medicine & Medical Imaging; Peripheral Vascular Disease SC Radiology, Nuclear Medicine & Medical Imaging; Cardiovascular System & Cardiology GA 297NH UT WOS:000255622900008 PM 18440455 ER PT J AU Blackwell, SA Ciborowski, G Baugh, DK Montgomery, MA AF Blackwell, S. A. Ciborowski, G. Baugh, D. K. Montgomery, M. A. TI An analysis of potentially inappropriate medication use in the dually eligibile medicare and medicaid population using the new 2003 beers drug update SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Blackwell, S. A.; Ciborowski, G.; Baugh, D. K.; Montgomery, M. A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2008 VL 11 IS 3 BP A252 EP A253 DI 10.1016/S1098-3015(10)70797-X PG 2 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 302CC UT WOS:000255945400796 ER PT J AU Polinski, JM Mohr, PE Johnson, L AF Polinski, J. M. Mohr, P. E. Johnson, L. TI Specialty biologic drug coverage under medicare Part D: The experience of vulnerable beneficiaries with rheumatoid arthritis (RA) and multiple sclerosis (MS) SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Polinski, J. M.] Brigham & Womens Hosp, Boston, MA 02115 USA. [Mohr, P. E.; Johnson, L.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2008 VL 11 IS 3 BP A35 EP A35 DI 10.1016/S1098-3015(10)70121-2 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 302CC UT WOS:000255945400120 ER PT J AU Polinski, JM Mohr, PE Johnson, L AF Polinski, J. M. Mohr, P. E. Johnson, L. TI Predictors of enrollment in medicare Part D: The experience of medicare drug demonstration participants with rheumatoid arthritis and multiple sclerosis SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Polinski, J. M.] Brigham & Womens Hosp, Boston, MA 02115 USA. [Mohr, P. E.; Johnson, L.] Ctr Medicare, Baltimore, MD USA. [Mohr, P. E.; Johnson, L.] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2008 VL 11 IS 3 BP A34 EP A35 DI 10.1016/S1098-3015(10)70118-2 PG 2 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 302CC UT WOS:000255945400117 ER PT J AU Lynn, J AF Lynn, Joanne TI Making a difference - Palliative care beyond cancer - Reliable comfort and meaningfulness SO BRITISH MEDICAL JOURNAL LA English DT Editorial Material ID QUALITY IMPROVEMENT C1 Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. RP Lynn, J (reprint author), Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM Joanne.Lynn@cms.hhs.gov NR 9 TC 6 Z9 7 U1 1 U2 3 PU B M J PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 0959-8146 J9 BRIT MED J JI Br. Med. J. PD APR 26 PY 2008 VL 336 IS 7650 BP 958 EP + DI 10.1136/bmj.39535.656319.94 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA 296KC UT WOS:000255540900046 PM 18397941 ER PT J AU Madden, JM Graves, AJ Zhang, F Adams, AS Briesacher, BA Ross-Degnan, D Gurwitz, JH Pierre-Jacques, M Safran, DG Adler, GS Soumerai, SB AF Madden, Jeanne M. Graves, Amy J. Zhang, Fang Adams, Alyce S. Briesacher, Becky A. Ross-Degnan, Dennis Gurwitz, Jerry H. Pierre-Jacques, Marsha Safran, Dana Gelb Adler, Gerald S. Soumerai, Stephen B. TI Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID PRESCRIPTION-DRUG COVERAGE; PATIENT POPULATION; COMMON OUTCOMES; NATIONAL-SURVEY; BENEFICIARIES; BENEFIT; RISK; EXPENDITURES; ENROLLEES; HUNGER AB Context Cost- related medication nonadherence ( CRN) has been a persistent problem for individuals who are elderly and disabled in the United States. The impact of Medicare prescription drug coverage ( Part D) on CRN is unknown. Objective To estimate changes in CRN and forgoing basic needs to pay for drugs following Part D implementation. Design, Setting, and Participants In a population- level study design, changes in study outcomes between 2005 and 2006 before and after Medicare Part D implementation were compared with historical changes between 2004 and 2005. The community-dwelling sample of the nationally representative Medicare Current Beneficiary Survey ( unweighted unique n= 24 234; response rate, 72.3%) was used, and logistic regression analyses were controlled for demographic characteristics, health status, and historical trends. Main Outcome Measures Self- reports of CRN ( skipping or reducing doses, not obtaining prescriptions) and spending less on basic needs to afford medicines. Results The unadjusted, weighted prevalence of CRN was 15.2% in 2004, 14.1% in 2005, and 11.5% after Part D implementation in 2006. The prevalence of spending less on basic needs was 10.6% in 2004, 11.1% in 2005, and 7.6% in 2006. Adjusted analyses comparing 2006 with 2005 and controlling for historical changes ( 2005 vs 2004) demonstrated significant decreases in the odds of CRN ( ratio of odds ratios [ ORs], 0.85; 95% confidence interval [ CI], 0.74- 0.98; P=. 03) and spending less on basic needs ( ratio of ORs, 0.59; 95% CI, 0.48- 0.72; P <. 001). No significant changes in CRN were observed among beneficiaries with fair to poor health ( ratio of ORs, 1.00; 95% CI, 0.82- 1.21; P=. 97), despite high baseline CRN prevalence for this group ( 22.2% in 2005) and significant decreases among beneficiaries with good to excellent health ( ratio of ORs, 0.77; 95% CI, 0.63- 0.95; P=. 02). However, significant reductions in spending less on basic needs were observed in both groups ( fair to poor health: ratio of ORs, 0.60; 95% CI, 0.47- 0.75; P <. 001; and good to excellent health: ratio of ORs, 0.57; 95% CI, 0.44- 0.75; P <. 001). Conclusions In this survey population, there was evidence for a small but significant overall decrease in CRN and forgoing basic needs following Part D implementation. However, no net decrease in CRN after Part D was observed among the sickest beneficiaries, who continued to experience higher rates of CRN. C1 [Madden, Jeanne M.; Graves, Amy J.; Zhang, Fang; Adams, Alyce S.; Ross-Degnan, Dennis; Pierre-Jacques, Marsha; Soumerai, Stephen B.] Harvard Univ, Sch Med, Dept Ambulatory Care & Prevent, Boston, MA 02215 USA. [Madden, Jeanne M.; Graves, Amy J.; Zhang, Fang; Adams, Alyce S.; Ross-Degnan, Dennis; Pierre-Jacques, Marsha; Soumerai, Stephen B.] Harvard Pilgrim Hlth Care, Boston, MA 02215 USA. [Briesacher, Becky A.; Gurwitz, Jerry H.] Univ Massachusetts, Sch Med, Div Geriatr Med, Worcester, MA USA. [Briesacher, Becky A.; Gurwitz, Jerry H.] Univ Massachusetts, Sch Med, Meyers Primary Care Inst, Worcester, MA USA. [Safran, Dana Gelb] Tufts Univ, Sch Med, Dept Med, Boston, MA 02111 USA. [Safran, Dana Gelb] Blue Cross & Blue Shield Massachusetts, Boston, MA USA. [Adler, Gerald S.] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Madden, JM (reprint author), Harvard Univ, Sch Med, Dept Ambulatory Care & Prevent, 133 Brookline Ave,6th Floor, Boston, MA 02215 USA. EM jeanne_madden@hms.harvard.edu FU AHRQ HHS [U18 HS010391, 2U18HS010391]; NIA NIH HHS [R01AG022362, K01 AG031836-01A1, R01 AG028745, K01 AG031836, R01 AG022362, R01AG028745] NR 47 TC 136 Z9 140 U1 3 U2 7 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610-0946 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD APR 23 PY 2008 VL 299 IS 16 BP 1922 EP 1928 DI 10.1001/jama.299.16.1922 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 291AD UT WOS:000255163800026 PM 18430911 ER PT J AU Sheikh, K Bullock, CM Jiang, Y Ketner, SD AF Sheikh, Kazim Bullock, Claudia M. Jiang, Yanming Ketner, Stephen D. TI Adherence to guidelines for and disparities in diabetes care utilization in medicaid children SO JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM LA English DT Article DE diabetes care; children; utilization; guidelines; adherence; disparities ID INTENSIVE TREATMENT; SEVERE HYPOGLYCEMIA; METABOLIC-CONTROL; RISK-FACTORS; ADOLESCENTS; MELLITUS; OUTCOMES; COMPLICATIONS; PREDICTORS; TRIAL AB 1999-2002 Medicaid administrative data on 360 children with diabetes mellitus were used to study disparities in and utilization of health care in Missouri, United States. Measures of ambulatory care and its utilization were based on clinical guidelines. Their association with readmission in hospitals and emergency rooms were examined using multivariate analyses. Many children did not visit their doctor's office, have blood tests for glycosylated hemoglobin, or monitor their blood glucose level. There were no sex or race differences in the utilization of ambulatory care or its outcome for all children, except for blood glucose test strip use. Older age and non-white race increased the odds of rehospitalization and three or more physician encounters decreased this risk. Non-white race increased the odds of visiting emergency rooms. In some subpopulations, there were age, sex, and race disparities in ambulatory care utilization. Adherence to diabetes care guidelines was associated with lower risk of re-hospitalization. C1 [Sheikh, Kazim; Bullock, Claudia M.; Jiang, Yanming; Ketner, Stephen D.] US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv, 601 E 12th St,Room 235, Kansas City, MO 64106 USA. EM kazim.sheikh@cms.hhs.gov NR 35 TC 3 Z9 3 U1 0 U2 3 PU FREUND PUBLISHING HOUSE LTD PI TEL AVIV PA PO BOX 35010, TEL AVIV 61350, ISRAEL SN 0334-018X J9 J PEDIATR ENDOCR MET JI J. Pediatr. Endocrinol. Metab. PD APR PY 2008 VL 21 IS 4 BP 349 EP 358 PG 10 WC Endocrinology & Metabolism; Pediatrics SC Endocrinology & Metabolism; Pediatrics GA 311NA UT WOS:000256605700008 PM 18556966 ER PT J AU Murgolo, MS AF Murgolo, Maggie S. TI Characteristics and perceptions of the Medicare population: 2001-2005 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Murgolo, MS (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM maggie.murgolo@cms.hhs.gov NR 0 TC 1 Z9 1 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2008 VL 29 IS 3 BP 59 EP 67 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 301VP UT WOS:000255924300005 PM 18567243 ER PT J AU Adler, GS AF Adler, Gerald S. TI Diabetes in the Medicare aged population, 2004 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Adler, GS (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM gerald.adler@cms.hhs.gov NR 0 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2008 VL 29 IS 3 BP 69 EP 79 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 301VP UT WOS:000255924300006 PM 18567244 ER PT J AU Madden, JM Graves, AJ Zhang, F Adams, AS Briesacher, BA Ross-Degnan, D Gurwitz, JH Pierre-Jacques, M Safran, DG Adler, GS Soumerai, SB AF Madden, J. M. Graves, A. J. Zhang, F. Adams, A. S. Briesacher, B. A. Ross-Degnan, D. Gurwitz, J. H. Pierre-Jacques, M. Safran, D. G. Adler, G. S. Soumerai, S. B. TI Declines in cost-related medication nonadherence and in forgoing basic needs following Medicare Part D SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 31st Annual Meeting of the Society-of-General-Internal-Medicine CY APR 09-12, 2008 CL Pittsburgh, PA SP Soc Gen Internal Med C1 [Madden, J. M.; Graves, A. J.; Zhang, F.; Adams, A. S.; Ross-Degnan, D.; Pierre-Jacques, M.; Soumerai, S. B.] Harvard Univ, Boston, MA 02115 USA. [Briesacher, B. A.; Gurwitz, J. H.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Safran, D. G.] Tufts Univ, Boston, MA 02111 USA. [Adler, G. S.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD MAR PY 2008 VL 23 SU 2 BP 275 EP 275 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 277TH UT WOS:000254237100507 ER PT J AU Sheikh, K AF Sheikh, Kazim TI Total cholesterol, severity of stroke, and all-cause mortality SO STROKE LA English DT Letter ID DENSITY-LIPOPROTEIN CHOLESTEROL; SERUM-CHOLESTEROL; ISCHEMIC-STROKE; RISK; MEN C1 US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. NR 11 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD MAR PY 2008 VL 39 IS 3 BP E61 EP E62 DI 10.1161/STROKEAHA.107.509356 PG 2 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 267XP UT WOS:000253542800051 PM 18239159 ER PT J AU Schermerhorn, ML O'Malley, AJ Jhaveri, A Cotterill, P Pomposelli, F Landon, BE AF Schermerhorn, Marc L. O'Malley, A. James Jhaveri, Ami Cotterill, Philip Pomposelli, Frank Landon, Bruce E. TI Endovascular vs. open repair of abdominal aortic aneurysms in the medicare population SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; EUROSTAR; OUTCOMES; COMPLICATIONS; EXPERIENCE; MORTALITY; REGISTRY AB Background: Randomized trials have shown reductions in perioperative mortality and morbidity with endovascular repair of abdominal aortic aneurysm, as compared with open surgical repair. Longer-term survival rates, however, were similar for the two procedures. There are currently no long-term, population-based data from the comparison of these strategies. Methods: We studied perioperative rates of death and complications, long-term survival, rupture, and reinterventions after open as compared with endovascular repair of abdominal aortic aneurysm in propensity-score-matched cohorts of Medicare beneficiaries undergoing repair during the 2001-2004 period, with follow-up until 2005. Results: There were 22,830 matched patients undergoing open repair of abdominal aortic aneurysm in each cohort. The average age of the patients was 76 years, and approximately 20% were women. Perioperative mortality was lower after endovascular repair than after open repair (1.2% vs. 4.8%, P<0.001), and the reduction in mortality increased with age (2.1% difference for those 67 to 69 years old vs. 8.5% for those 85 years or older, P<0.001). Late survival was similar in the two cohorts, although the survival curves did not converge until after 3 years. By 4 years, rupture was more likely in the endovascular-repair cohort than in the open-repair cohort (1.8% vs. 0.5%, P<0.001), as was reintervention related to abdominal aortic aneurysm (9.0% vs. 1.7%, P<0.001), although most reinterventions were minor. In contrast, by 4 years, surgery for laparotomy-related complications was more likely among patients who had undergone open repair (9.7%, vs. 4.1% among those who had undergone endovascular repair; P<0.001), as was hospitalization without surgery for bowel obstruction or abdominal-wall hernia (14.2% vs. 8.1%, P<0.001). Conclusions: As compared with open repair, endovascular repair of abdominal aortic aneurysm is associated with lower short-term rates of death and complications. The survival advantage is more durable among older patients. Late reinterventions related to abdominal aortic aneurysm are more common after endovascular repair but are balanced by an increase in laparotomy-related reinterventions and hospitalizations after open surgery. C1 [Schermerhorn, Marc L.; Jhaveri, Ami; Pomposelli, Frank] Beth Israel Deaconess Med Ctr, Dept Surg, Div Vasc Surg, Boston, MA 02215 USA. [Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA. [O'Malley, A. James; Landon, Bruce E.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Cotterill, Philip] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Schermerhorn, ML (reprint author), Beth Israel Deaconess Med Ctr, Dept Surg, Div Vasc Surg, 110 Francis St, Boston, MA 02215 USA. EM mscherm@bidmc.harvard.edu NR 18 TC 385 Z9 408 U1 3 U2 9 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JAN 31 PY 2008 VL 358 IS 5 BP 464 EP 474 DI 10.1056/NEJMoa0707348 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 256IW UT WOS:000252722900004 PM 18234751 ER PT J AU Straube, BM AF Straube, Barry M. TI Clinical practice management issues - Commentary SO ADVANCES IN CHRONIC KIDNEY DISEASE LA English DT Editorial Material DE centers for medicare and medicaid services roadmap; physician quality reporting initiative; pay for performance; value-based reporting ID UNITED-STATES; HEALTH-CARE; QUALITY; ADULTS; END AB Americans' spending on health care is the highest in the world, yet it does not equate with the value expected. There are disparities in access to care and a wide variation in quality. It is imperative that the US health care payment and delivery system change. The Centers for Medicare and Medicaid Services (CMS) have defined and are implementing the CMS Quality Roadmap, which includes (1) working with stakeholder collaboratives; (2) reporting to the public; (3) reforming the reimbursement systems to reward quality; (4) promoting health information technology and evidence-based medicine; and (5) increasing availability of new treatments, technologies, innovations, and information. This will fit in the value-driven health care initiative of The Department of Health and Human Services. Strategies included (1) developing quality and efficiency metrics for kidney patients, (2) measuring quality at the individual dialysis facility and nephrologist level, (3) reporting outcomes including as consumer/payer choice incentives by the public, (4) reforming the reimbursement system, (5) promoting interoperable health information technology, (6) focusing on health disparities, (7) coordinating the system of care for patients, and (8) changing treatment-when indicated by new evidence. (c) 2008 by the National Kidney Foundation, Inc. C1 Off Clin Stand & Qual, Ctr Medicare & Medicaid Serv, Baltimore, MD 21222 USA. RP Straube, BM (reprint author), Off Clin Stand & Qual, Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21222 USA. EM Barry.Straube@cms.hhs.gov NR 7 TC 7 Z9 8 U1 0 U2 1 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 1548-5595 J9 ADV CHRONIC KIDNEY D JI Adv. Chronic Kidney Dis. PD JAN PY 2008 VL 15 IS 1 BP 7 EP 9 DI 10.1053/j.ackd.2007.10.013 PG 3 WC Urology & Nephrology SC Urology & Nephrology GA 251OO UT WOS:000252383300003 PM 18155103 ER PT J AU Hartman, M Catlin, A Lassman, D Cylus, J Heffler, S AF Hartman, Micah Catlin, Aaron Lassman, David Cylus, Jonathan Heffler, Stephen TI US health spending by age, selected years through 2004 SO HEALTH AFFAIRS LA English DT Article ID CARE AB This paper examines variations in health spending by children, working-age adults, and seniors for selected years between 1987 and 2004. Seniors spent far more per person than children or working-age adults, but the relative gap between the age groups has not changed much since 1987 except for those age eighty-five and older. Since the inception of the State Children's Health Insurance Program (SCHIP) in 1997, the proportion of children's health spending financed by public sources has increased, while the share paid for out of pocket has decreased. The future age-mix is expected to have a major impact on nursing home spending growth while minimally affecting overall Medicare spending growth. C1 [Hartman, Micah] Ctr Medicare & Medicaid Serv, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD 21244 USA. RP Hartman, M (reprint author), Ctr Medicare & Medicaid Serv, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD 21244 USA. EM micah.hartman@cms.hhs.gov NR 16 TC 30 Z9 31 U1 2 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2008 VL 27 IS 1 BP W1 EP W12 DI 10.1377/hlthaff.27.1.w1 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 319TZ UT WOS:000257188400048 PM 17986478 ER PT J AU Borger, C Rutherford, TF Won, GY AF Borger, Christine Rutherford, Thomas F. Won, Gregory Y. TI Projecting long term medical spending growth SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE general equilibrium; long term medical spending; medicare actuarial balance ID HEALTH-CARE; TECHNOLOGICAL-CHANGE; DEMAND; INSURANCE; EXPENDITURES; INCOME; PRICE AB We present a dynamic general equilibrium model of the U.S. economy and the medical sector in which the adoption of new medical treatments is endogenous and the demand for medical services is conditional on the state of technology. We use this model to prepare 75-year medical spending forecasts and a projection of the Medicare actuarial balance, and we compare our results to those obtained from a method that has been used by government actuaries. Our baseline forecast predicts slower health spending growth in the long run and a lower Medicare actuarial deficit relative to the previous projection methodology. (c) 2007 Elsevier B.V. All rights reserved. C1 [Borger, Christine; Won, Gregory Y.] US Dept HHS, Off Actuary, Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. [Rutherford, Thomas F.] Univ Colorado, Boulder, CO 80309 USA. RP Won, GY (reprint author), US Dept HHS, Off Actuary, Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. EM Rutherford@colorado.edu; gregorywon@comcast.net NR 32 TC 3 Z9 3 U1 0 U2 6 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD JAN PY 2008 VL 27 IS 1 BP 69 EP 88 DI 10.1016/j.jhealeco.2007.03.003 PG 20 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 260KC UT WOS:000253008200004 PM 17459502 ER PT J AU Trockel, M Wall, A Williams, SS Reis, J AF Trockel, Mickey Wall, Andrew Williams, Sunyna S. Reis, Janet TI When the party for some becomes a problem for others: The effect of perceived secondhand consequences of drinking behavior on drinking norms SO JOURNAL OF PSYCHOLOGY LA English DT Article DE alcohol consumption; expectancies; fraternity men; secondhand consequences ID COLLEGE-STUDENTS; ALCOHOL-USE; FRATERNITY MEN; GREEK SYSTEM; IMPACT; CONSUMPTION; PERCEPTION; ABUSE AB The authors examined the influence of fraternity men's expectancies regarding secondhand consequences of excessive drinking behavior on normative standards regarding alcohol use and consumption levels. Participants were 381 men from 26 chapters of 2 national fraternities. One organization participated in a brief intervention involving discussion of secondhand consequences of excessive drinking. Immediate influence of the intervention on perceived secondhand consequences of alcohol use was assessed using a posttest-only, randomized groups design. Results supported a hypothesized measurement model with 1 overall secondhand consequence expectancy construct and 4 subfactors: (a) Noise Disruptive of Sleep and Study, (b) Violence, (c) Sexual Assault, and (d) Property Damage. Cross-sectional analysis at the chapter and individual levels demonstrated that secondhand expectancies had an indirect effect on alcohol consumption, mediated by personal consumption standards for limiting alcohol consumption. The intervention had an effect on secondhand expectancies. Findings suggest that interventions with intact groups can increase secondhand expectancies regarding excessive drinking and may lead to a reduction in excessive alcohol consumption. C1 [Trockel, Mickey] Stanford Univ, Sch Med, Dept Psychiat & Behav Sci, Res Track, Stanford, CA 94305 USA. [Wall, Andrew] Univ Rochester, Margaret Warner Sch Educa & Human Dev, Rochester, NY 14627 USA. [Williams, Sunyna S.] Ctr Medicate & Medicaid Serv, Strateg Res & Campaign Management Grp, Off External Affairs, Baltimore, MD USA. [Reis, Janet] Univ Illinois, Coll Med Urbana Champaign, Dept Family Med, Chicago, IL 60680 USA. RP Trockel, M (reprint author), Stanford Univ, Sch Med, Dept Psychiat & Behav Sci, Res Track, 401 Quarry Rd, Stanford, CA 94305 USA. EM trockel@uiuc.edu NR 26 TC 2 Z9 2 U1 2 U2 8 PU HELDREF PUBLICATIONS PI WASHINGTON PA 1319 EIGHTEENTH ST NW, WASHINGTON, DC 20036-1802 USA SN 0022-3980 J9 J PSYCHOL JI J. Psychol. PD JAN PY 2008 VL 142 IS 1 BP 57 EP 69 DI 10.3200/JRLP.142.1.57-70 PG 13 WC Psychology, Multidisciplinary SC Psychology GA 266JV UT WOS:000253432400004 PM 18350844 ER PT J AU Fadrowski, JJ Frankenfield, D Amaral, S Brady, T Gorman, GH Warady, B Furth, SL Fivush, B Neu, AM AF Fadrowski, Jeffrey J. Frankenfield, Diane Amaral, Sandra Brady, Tammy Gorman, Gregory H. Warady, Bradley Furth, Susan L. Fivush, Barbara Neu, Alicia M. TI Children on long-term dialysis in the United States: Findings from the 2005 ESRD clinical performance measures project SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article; Proceedings Paper CT 39th Annual Meeting of the American-Society-of-Nephrology CY NOV 14-19, 2006 CL San Diego, CA SP Amer Soc Nephrol DE pediatric; end-stage renal disease (ESRD); hemodialysis; peritoneal dialysis ID STAGE RENAL-DISEASE; PEDIATRIC HEMODIALYSIS-PATIENTS; AMBULATORY PERITONEAL-DIALYSIS; ADOLESCENT HEMODIALYSIS; MORTALITY; MODALITY; SURVIVAL; RISK; ALBUMIN; THERAPY AB Background: The Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures (CPM) Project contains one of the largest databases of prevalent pediatric dialysis patients in the United States. Since 2005, the CPM Project has included not only children on long-term hemodialysis (HD) therapy, but also those on long-term peritoneal dialysis (PD) therapy. This study describes demographic and clinical characteristics and compares them between patients on HID and PD therapy. Study Design: Cross-sectional. Setting & Participants: Children aged 0 to younger than 18 years included within the 2005 End-Stage Renal Disease CPM Project. Predictor: Demographic and clinical characteristics, with emphasis on dialysis modality. Outcomes & Measurements: Achievement of values for hemoglobin, dialysis adequacy, and serum albumin as recommended by recent National Kidney Foundation-Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines and Recommendations. Results: Of 1,453 patients examined, 692 received HID and 761 received PD. There was no significant difference by dialysis modality in the likelihood of having a mean hemoglobin level of 11 g/dL or greater; however, HID patients were significantly more likely to have a mean hemoglobin level less than 10 g/dL (19% versus 14% of PD patients; P = 0.02). Although statistically significant, the absolute difference in mean hemoglobin levels between patients receiving HD versus PD was small (11.4 versus 11.6 g/dL). Eighty-nine percent of patients receiving HD and 87% of patients receiving PD achieved the recommended modality-specific Kt/V (P = 0.4). Children receiving HD were more likely than those receiving PD to have a mean serum albumin level of 4.0/3.7 g/dL or greater (bromcresol green/ bromcresol purple laboratory method): 46% versus 33% (P < 0.001). Limitations: Because of study design, only associations can be described. Conclusions: A significant number of children had hemoglobin, serum albumin, and/or Kt/V values outside the recommended targets. Future research is needed to better define the risk relationships of these predictors with morbidity and mortality in children on dialysis therapy, evaluate the benefit of treating to certain treatment targets, and understand reasons for failing to reach treatment targets in individual patients or patient groups. C1 [Fadrowski, Jeffrey J.; Brady, Tammy; Furth, Susan L.; Fivush, Barbara; Neu, Alicia M.] Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21287 USA. [Frankenfield, Diane] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. [Amaral, Sandra] Emory Sch Med, Dept Pediat, Atlanta, GA USA. [Gorman, Gregory H.] Uniformed Serv Univ Hlth Sci, Dept Pediat, Natl Naval Med Ctr, Bethesda, MD 20814 USA. [Warady, Bradley] Univ Missouri, Dept Pediat, Kansas City, MO USA. RP Fadrowski, JJ (reprint author), Johns Hopkins Univ, Sch Med, Dept Pediat, David M Rubenstein Child Hlth Bldg,Rm 3055,200 N, Baltimore, MD 21287 USA. EM jfadrow1@jhmi.edu FU NICHD NIH HHS [K12-HD-027799]; NIDDK NIH HHS [K24 DK078737, R21 DK 064313-01]; NIEHS NIH HHS [K23 ES016514] NR 34 TC 13 Z9 14 U1 0 U2 0 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD DEC PY 2007 VL 50 IS 6 BP 958 EP 966 DI 10.1053/j.ajkd.2007.09.003 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 285TO UT WOS:000254799300010 PM 18037097 ER PT J AU Mobley, LR McCormack, LA Wang, J Squire, C Kenyon, A Lynch, JT Heller, A AF Mobley, Lee R. McCormack, Lauren A. Wang, Jiantong Squire, Claudia Kenyon, Anne Lynch, Judith T. Heller, Amy TI Voluntary disenrollment from medicare advantage plans: Valuable signals of market performance SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID MANAGED CARE; BENEFICIARIES; KNOWLEDGE AB Objective:To examine 2000-2005 trends in the reasons Medicare beneficiaries gave for disenrolling from their Medicare Advantage (MA) plans. Study Design: We used data from 6 consecutive years of Consumer Assessment of Health Plans surveys, which asked about 33 possible reasons for disenrollment, including problems with plan information, out-of-pocket costs, plan benefits, and coverage. Respondents numbered more than 50 000 beneficiaries each year from a variety of MA plan types providing full Medicare benefits in place of traditional fee-for-service Medicare. The survey also collected demographic and health status information. Methods: We classified reasons for disenrollment into 2 key groups: (1) reasons related to plan information and (2) reasons related to cost/benefits problems. We examined whether disparities existed between vulnerable and less vulnerable populations that might reflect different experiences by these groups over time. Results: Disparities between vulnerable and less vulnerable groups were present but generally diminished over time as competition intensified, with noticeable differences between African American and Hispanic subpopulations regarding problems with plan information. Conclusions:The premise of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was that more plans would increase competition, resulting in higher-quality healthcare services. However, an increased number of plan choices complicates the health plan decision-making process for beneficiaries. With further expansion of plans and choices following implementation of Part D, efforts must continue to direct informational materials to all beneficiaries, particularly those in vulnerable subgroups. More help in interpreting the information may be required to maximize consumer benefits. C1 [Mobley, Lee R.; McCormack, Lauren A.; Wang, Jiantong; Squire, Claudia; Kenyon, Anne; Lynch, Judith T.] RTI Int, Res Triangle Pk, NC 27709 USA. [Heller, Amy] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Mobley, LR (reprint author), RTI Int, 3040 Cornwallis Rd,POB 12194, Res Triangle Pk, NC 27709 USA. EM Imobley@rti.org NR 30 TC 3 Z9 3 U1 0 U2 4 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD DEC PY 2007 VL 13 IS 12 BP 677 EP 684 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 241UD UT WOS:000251680400004 PM 18069911 ER PT J AU Poisal, JA AF Poisal, John A. TI Multifactor productivity in health care SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The following overview introduces a series of articles that focuses on multifactor productivity (MFP) growth in health care. This edition of the Health Care Financing Review begins with a theoretical discussion of the Medicare Economic Index (MEI) and the conceptual reasons for the MFP adjustment incorporated into the Medicare physician fee schedule (MPFS). The issue then moves on to an exploratory data-driven analysis of MFP growth in physicians' offices, and an evaluation of that exploration. Finally, the edition concludes with an empirically-based analysis of MFP growth in the hospital sector, as well as a study related to Medicare physician payment that looks at the individual contributors to recent growth in relative value units (RVUs). C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Poisal, JA (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mailstop N3-02-02, Baltimore, MD 21244 USA. EM john.poisal@cms.hhs.gov NR 3 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2007 VL 29 IS 2 BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 272CX UT WOS:000253837700001 PM 18435218 ER PT J AU Cylus, JD Dickensheets, BA AF Cylus, Jonathan D. Dickensheets, Bridget A. TI Hospital multifactor productivity: A presentation and analysis of two methodologies SO HEALTH CARE FINANCING REVIEW LA English DT Article AB In response to recent discussions regarding the ability of hospitals to achieve gains in productivity, we present two methodologies that attempt to measure multifactor productivity (MFP) in the hospital sector We analyze each method and conclude that the inconsistencies in their outcomes make it difficult to estimate a precise level of MFP that hospitals have historically achieved. Our goal in developing two methodologies is to inform the debate surrounding the ability of hospitals to achieve gains in MFP, as well as to highlight some of the challenges that exist in measuring hospital MFP. C1 [Cylus, Jonathan D.; Dickensheets, Bridget A.] Ctr Medicare & Medicaid Serv, Off Acturay, Baltimore, MD 21244 USA. RP Cylus, JD (reprint author), Ctr Medicare & Medicaid Serv, Off Acturay, 7500 Secur Blvd,N3-02-02, Baltimore, MD 21244 USA. EM jonathan.Cylus@cms.hhs.gov NR 9 TC 3 Z9 3 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2007 VL 29 IS 2 BP 49 EP 64 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 272CX UT WOS:000253837700006 PM 18435223 ER PT J AU Soran, O Pina, IL Lamas, GA KelseY, SF Selzer, F Pilotte, J Lave, JR Feldman, AM AF Soran, Ozlem Pina, Ileana L. Lamas, Gervasio A. KelseY, Sheryl F. Selzer, Faith Pilotte, John Lave, Judith R. Feldman, Arthur M. TI Randomized clinical trial of the clinical effects of enhanced heart failure monitoring using a computer-based telephonic monitoring system in older minorities and women SO JOURNAL OF CARDIAC FAILURE LA English DT Meeting Abstract CT 11th Annual Scientific Meeting of the Heart-Failure-Society-of-America CY SEP 16-19, 2007 CL Washington, DC SP Heart Failure Soc Amer C1 [Soran, Ozlem] Univ Pittsburgh, Med Ctr, Cardiovasc Inst, Pittsburgh, PA USA. [Pina, Ileana L.] Case Western Reserve Univ, Cleveland, OH 44106 USA. [Lamas, Gervasio A.] Mt Sinai Med Ctr, Miami Beach, FL 33140 USA. [KelseY, Sheryl F.; Selzer, Faith] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA. [Pilotte, John] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Lave, Judith R.] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Policy & Management, Pittsburgh, PA USA. [Feldman, Arthur M.] Jefferson Med Coll, Dept Med, Philadelphia, PA USA. NR 0 TC 3 Z9 2 U1 0 U2 3 PU CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS PI PHILADELPHIA PA CURTIS CENTER, INDEPENDENCE SQUARE WEST, PHILADELPHIA, PA 19106-3399 USA SN 1071-9164 J9 J CARD FAIL JI J. Card. Fail. PD NOV PY 2007 VL 13 IS 9 BP 793 EP 793 DI 10.1016/j.cardfail.2007.10.005 PG 1 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 240NB UT WOS:000251593200019 ER PT J AU Atkinson, MA Neu, AM Fivush, BA Frankenfield, DL AF Atkinson, Meredith A. Neu, Alicia M. Fivush, Barbara A. Frankenfield, Diane L. TI Ethnic disparity in outcomes for pediatric peritoneal dialysis patients in the ESRD Clinical Performance Measures Project SO PEDIATRIC NEPHROLOGY LA English DT Article DE hispanic; anemia; renal replacement therapy; adequacy; KDOQI target ID STAGE RENAL-DISEASE; HISPANIC HEMODIALYSIS-PATIENTS; CORE INDICATORS PROJECT; UNITED-STATES; INTERMEDIATE OUTCOMES; MEXICAN-AMERICANS; AFRICAN-AMERICANS; MORTALITY; SURVIVAL; HEALTH AB Ethnicity information was collected for all pediatric peritoneal dialysis patients from the End-Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project for the period October 2004 through March 2005. Associations between intermediate outcomes and Hispanic ethnicity were determined. Thirty percent (207/696) of patients in the final cohort were Hispanic, 24% (165/696) non-Hispanic black, and 46% (324/696) non-Hispanic white. Hispanics were more likely to be female, older, and have a lower mean height standard deviation score (SDS). There were no significant differences among ethnic/racial groups regarding clearance parameters. More Hispanics had a mean hemoglobin >= 11 g/dl compared with non-Hispanic blacks and non-Hispanic whites (77% vs. 55% and 70%, P < 0.0001). More Hispanics compared with non-Hispanic blacks and non-Hispanic whites had a mean serum albumin 4.0/3.7 g/dl [bromcresol green/bromcresol purple laboratory method (BCG/BCP)] (50% vs. 24% and 27%, respectively, P < 0.0001). In multivariate analyses, Hispanics remained significantly more likely to achieve a mean serum albumin >= 4.0/3.7 g/dl (BCG/BCP) compared with non-Hispanic whites (referent) and were as likely to achieve clearance and hemoglobin targets. Pediatric Hispanic peritoneal dialysis patients experience equivalent or better intermediate outcomes of dialytic care compared with non-Hispanics. Further study is needed to understand associations of Hispanic ethnicity with outcomes such as hospitalization, transplantation, and mortality. C1 Johns Hopkins Univ, Baltimore, MD 21287 USA. Johns Hopkins Univ, Sch Med, Baltimore, MD USA. Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Atkinson, MA (reprint author), Johns Hopkins Univ, 200 N Wolfe St, Baltimore, MD 21287 USA. EM matkins3@jhmi.edu NR 46 TC 2 Z9 2 U1 1 U2 2 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0931-041X J9 PEDIATR NEPHROL JI Pediatr. Nephrol. PD NOV PY 2007 VL 22 IS 11 BP 1939 EP 1946 DI 10.1007/s00467-007-0593-0 PG 8 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 215OX UT WOS:000249820000016 PM 17876608 ER PT J AU Schafer, J O'Connor, D Feinglass, S Salive, M AF Schafer, Jyme O'Connor, Deirdre Feinglass, Shamiram Salive, Marcel TI Medicare evidence development and coverage advisory committee meeting on lumbar fusion surgery for treatment of chronic back pain from degenerative disc disease SO SPINE LA English DT Editorial Material ID RANDOMIZED CONTROLLED-TRIAL; SPINE C1 Ctr Medicare, Medicaid Serv, Coverage Anal Grp, Baltimore, MD USA. RP Schafer, J (reprint author), Ctr Medicare, Medicaid Serv, 7500 Secur Blvd,Mailstop C1 09 06, Baltimore, MD 21244 USA. NR 2 TC 13 Z9 13 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0362-2436 J9 SPINE JI SPINE PD OCT 15 PY 2007 VL 32 IS 22 BP 2403 EP 2404 PG 2 WC Clinical Neurology; Orthopedics SC Neurosciences & Neurology; Orthopedics GA 221NH UT WOS:000250234100001 PM 18090077 ER PT J AU Lynn, J West, J Hausmann, S Gifford, D Nelson, R McGann, P Bergstrom, N Ryan, JA AF Lynn, Joanne West, Jeff Hausmann, Susan Gifford, David Nelson, Rachel McGann, Paul Bergstrom, Nancy Ryan, Judith A. TI Collaborative clinical quality improvement for pressure ulcers in nursing homes SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE pressure ulcers; nursing homes; quality improvement; quality measures; public reporting; translation of research to practice ID LONG-TERM-CARE; RISK; PREVALENCE; PREVENTION; RESIDENTS AB The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P <.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care. C1 RAND Corp, Arlington, VI USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Qualis Hlth1, Seattle, WA USA. Qual Partners Rhode Isl, Providence, RI USA. Rhode Isl Dept Hlth, Providence, RI 02908 USA. Univ Texas, Hlth Sci Ctr, Houston, TX USA. Evangel Lutheran Good Samaritan Soc, Sioux Falls, SD USA. RP Lynn, J (reprint author), 2318 Ashboro Dr, Chevy Chase, MD 20815 USA. EM jlynn@rand.org NR 35 TC 36 Z9 36 U1 1 U2 3 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD OCT PY 2007 VL 55 IS 10 BP 1663 EP 1669 DI 10.1111/j.1532-5415.2007.01380.x PG 7 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 215RA UT WOS:000249825500025 PM 17714457 ER PT J AU Thomas, FG Caldis, T AF Thomas, Frederick G. Caldis, Todd TI Emerging issues of pay-for-performance in health care SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material C1 [Thomas, Frederick G.; Caldis, Todd] Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. RP Thomas, FG (reprint author), Ctr Medicare & Medicaid Serv CMS, 7500 Security Blvd,Mail Stop C3-19-07, Baltimore, MD USA. EM fred.thomas@cms.hhs.gov NR 3 TC 3 Z9 3 U1 0 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2007 VL 29 IS 1 BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 241BU UT WOS:000251632700001 PM 18624075 ER PT J AU Rudolph, NV Williams, SS AF Rudolph, Noemi V. Williams, Sunyna S. TI Medicare beneficiary knowledge of and experience with prescription drug cards SO HEALTH CARE FINANCING REVIEW LA English DT Article AB Medicare beneficiaries used prescription drug discount cards, both Medicare and non-Medicare cards, to assist them in paying for the cost of prescription drugs. This article describes the beneficiary's awareness and understanding, sources of information, and experience with drug discount cards a year prior and during the implementation of the Medicare-Approved Prescription Drug Discount Card program. Also, it explores beneficiary characteristics that contribute to card ownership and knowledge about drug discount cards. Understanding these experiences and factors can inform future outreach and education campaigns for the Medicare Drug Coverage program. C1 [Rudolph, Noemi V.; Williams, Sunyna S.] Ctr Medicare & Medicaid Serv CMS, Baltimore, MD 21244 USA. RP Rudolph, NV (reprint author), Ctr Medicare & Medicaid Serv CMS, 7500 Security Blvd,Mail Stop C3-19-07, Baltimore, MD 21244 USA. EM Noemi.Rudolph@cms.hhs.gov NR 12 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2007 VL 29 IS 1 BP 87 EP 101 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 241BU UT WOS:000251632700008 PM 18624082 ER PT J AU Regan, JF Petroski, CA AF Regan, Joseph F. Petroski, Cara A. TI Prescription drug coverage among Medicare beneficiaries SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The Medicare Current Beneficiary Survey (MCBS) is a longitudinal survey of a nationally-representative sample of Medicare enrollees. The survey collects information on a variety of topics, including beneficiaries' health status; health care use and financing; and social, economic, and demographic characteristics. Medicare administrative data is regularly coupled with the information collected through the survey for validation purposes. C1 [Regan, Joseph F.; Petroski, Cara A.] Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. RP Regan, JF (reprint author), Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2007 VL 29 IS 1 BP 119 EP 125 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 241BU UT WOS:000251632700010 PM 18624084 ER PT J AU Burwen, DR Ball, R Bryan, WW Izurieta, HS Voie, L Gibbs, N Kliman, R Braun, MM AF Burwen, Dale R. Ball, Robert Bryan, Wilson W. Izurieta, Hector S. La Voie, Lawrence Gibbs, Neville Kliman, Rebecca Braun, M. Miles TI Evaluation of occurrence of Guillain-Barre syndrome among recipients of influenza vaccine in 2000 and 2001 SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 US FDA, Rockville, MD 20857 USA. Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Sci, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU JOHN WILEY & SONS LTD PI CHICHESTER PA THE ATRIUM, SOUTHERN GATE, CHICHESTER PO19 8SQ, W SUSSEX, ENGLAND SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2007 VL 16 SU 2 MA 130 BP S62 EP S63 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 201GT UT WOS:000248820200131 ER PT J AU Sheikh, K Jiang, YM Bullock, CM AF Sheikh, Kazim Jiang, Yanming Bullock, Claudia M. TI Effect of comorbid and fatal coexistent conditions on sex and race differences in vascular surgical mortality SO ANNALS OF VASCULAR SURGERY LA English DT Article ID ARTERY BYPASS-SURGERY; ICD-9-CM ADMINISTRATIVE DATA; IN-HOSPITAL MORTALITY; OPERATIVE MORTALITY; CAROTID-ENDARTERECTOMY; PREDICTING MORTALITY; GENDER DIFFERENCES; UNITED-STATES; CLINICAL-DATA; CO-MORBIDITY AB Many previous studies of vascular procedures have found sex and race differences in surgical mortality that were attributed to differential prevalence of comorbidity. Adjustment for selected comorbid conditions does not entirely remove bias. In addition to adjustments for other covariates, surgical mortality ratios in this study were adjusted for coexistent conditions that caused postoperative death but were unrelated to the procedure. The adjusted mortality was, therefore, attributable to the procedure. Medicare administrative and death certificate data on beneficiaries aged 65-99 years who resided in Indiana and Kentucky and who had 6,016 major vascular procedures in 1994-1997 were used. In Cox proportional hazard models, male-to-female and non-white-to-white surgical mortality ratios were adjusted for age, sex, or race; weighted Charlson comorbidity score; length of hospital stay; and fatal coexisting conditions ( FCCs). Altogether, 3,333 patients died within 30 postoperative days. There were sex and/or race differences in mortality caused by aortic aneurysm, stroke, and diabetes ( P < 0.05). Unadjusted, all-cause 30-day mortality was higher in women and nonwhite patients than in men and white patients following coronary artery bypass graft ( CABG) procedure ( P < 0.03). Mortality following all non-CABG procedures combined was lower in women than in men ( P < 0.02). In multivariate analyses, 30-day mortality following CABG, adjusted for covariates, was lower in men than in women ( hazard ratio [ HR] = 0.88, 95% confidence interval [ CI] 0.79-0.98), but there was no sex difference after adjustment for only FCC ( HR = 0.94, 95% CI 0.85-1.05). Mortality following all non-CABG procedures combined was higher in men than in women, but this difference was insignificant after adjustment for comorbidity and/or FCC ( HR = 1.05, 95% CI 0.93-1.17). Age-and sex-adjusted 30-day mortality following CABG was higher in nonwhite patients than in white patients ( HR = 1.37, 95% CI 1.08-1.74), and this race difference persisted after further adjustments. There were no significant sex or race differences in surgical mortality following carotid endarterectomy, non-CABG thoracoabdominal procedures, or procedures in the limbs. Adjustments for covariates did not alter race difference in post-CABG surgical mortality. Adjustment for comorbid conditions slightly affected sex differences in mortality following CABG and all non-CABG procedures combined, but adjustment for FCC reduced these differences to insignificant levels. C1 [Sheikh, Kazim; Jiang, Yanming; Bullock, Claudia M.] US Dept HHS, Ctr Medicare, Kansas City, MO 64106 USA. [Sheikh, Kazim; Jiang, Yanming; Bullock, Claudia M.] US Dept HHS, Ctr Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare, 601 E 12th St,Room 235, Kansas City, MO 64106 USA. EM kazim.sheikh@cms.hhs.gov NR 42 TC 8 Z9 8 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0890-5096 J9 ANN VASC SURG JI Ann. Vasc. Surg. PD JUL-AUG PY 2007 VL 21 IS 4 BP 496 EP 504 DI 10.1016/j.avsg.2007.03.029 PG 9 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA 277IY UT WOS:000254207100015 PM 17628266 ER PT J AU Burwen, DR La Voie, L Braun, MM Houck, P Ball, R AF Burwen, Dale R. La Voie, Lawrence Braun, M. Miles Houck, Peter Ball, Robert TI Evaluating adverse events after vaccination in the Medicare population SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Article; Proceedings Paper CT 22nd International Conference on Pharmacoepidemiology and Therapeutic Risk Management CY AUG 24-27, 2006 CL Lisbon, PORTUGAL DE adverse effects; vaccines; pharmacoepidemiology; Medicare; influenza vaccines; pneumococcal vaccines ID PNEUMOCOCCAL POLYSACCHARIDE VACCINE; SAFETY INFORMATION; BENEFICIARIES; DESIGN; REVACCINATION AB Purpose Post-licensure observational studies using large linked databases can provide important data about whether adverse events are associated with vaccines, but databases that have been used may not have sufficient statistical power to examine rare events, and may underrepresent the elderly. We assessed the utility of Medicare data for evaluating adverse events after influenza and pneumococcal vaccines, by using an example involving selected clinical conditions, and evaluating aspects of data quality relevant to vaccine safety analyses. Methods We used 2001 data from the National Claims History File and Enrollment Database to determine if hospitalization for urinary tract infection (not likely associated with vaccination) or for cellulitis and abscess of the upper arm and forearm is associated with vaccination. Results For influenza vaccine, the 7-day period after vaccination did not demonstrate an elevation in hospitalization with cellulitis and abscess of the upper arm and forearm; for pneumococcal vaccine, a clear peak was evident. No increase in urinary tract infection was found after either influenza or pneumococcal vaccine. Having a prior Medicare claim for pneumococcal vaccine within 5 years was a risk factor for hospitalization with cellulitis and abscess of the upper arm and forearm (relative risk, 2.6; 95% confidence limits (CL), 1.3, 5.0). Conclusions Medicare data are a useful source for evaluating adverse events after vaccination. Screening analyses can be performed using administrative data, but medical record review to validate diagnoses will often be needed for rigorous study of vaccine-adverse event associations. Published in 2007 by John Wiley & Sons, Ltd. C1 US FDA, Div Epidemiol, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, Rockville, MD 20852 USA. Ctr Medicare & Medicaid Serv, Kansas City Reg Off, Kansas City, MO USA. Ctr Medicare & Medicaid Serv, Seattle Reg Off, Seattle, WA USA. RP Burwen, DR (reprint author), US FDA, Div Epidemiol, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, 1401 Rockville Pike,Suite 200 S,HFM-222, Rockville, MD 20852 USA. EM dale.burwen@fda.hhs.gov NR 40 TC 24 Z9 24 U1 0 U2 4 PU JOHN WILEY & SONS LTD PI CHICHESTER PA THE ATRIUM, SOUTHERN GATE, CHICHESTER PO19 8SQ, W SUSSEX, ENGLAND SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD JUL PY 2007 VL 16 IS 7 BP 753 EP 761 DI 10.1002/pds.1390 PG 9 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 197KH UT WOS:000248553400005 PM 17385786 ER PT J AU Robst, J Levy, JM Ingber, MJ AF Robst, John Levy, Jesse M. Ingber, Melvin J. TI Diagnosis-based risk adjustment for medicare prescription drug plan payments SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA) created Medicare Part D, a voluntary prescription drug benefit program. The benefit is a government subsidized prescription drug benefit within Medicare. This article focuses on the development of the prescription drug risk-adjustment model used to adjust payments to reflect the health status of plan enrollees. C1 Ctr Medicare & Medicaid Serv CMS, Baltimore, MD 21244 USA. Univ S Florida, Tampa, FL 33620 USA. RTI Int, Res Triangle Pk, NC 27709 USA. RP Levy, JM (reprint author), Ctr Medicare & Medicaid Serv CMS, 7500 Secur Blvd,C3-19-26, Baltimore, MD 21244 USA. EM jesse.levy@cms.hhs.gov NR 4 TC 34 Z9 34 U1 1 U2 3 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2007 VL 28 IS 4 BP 15 EP 30 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 193YR UT WOS:000248311600002 PM 17722748 ER PT J AU Lynn, J AF Lynn, Joanne TI Reliable comfort and meaningfulness at a sustainable cost SO JOURNAL OF PALLIATIVE MEDICINE LA English DT Editorial Material ID CARE C1 Ctr Medicare & Medicaid Serv, Qual Measurement & Hlth Assessment Grp, Off Clin Stand & Qual, Baltimore, MD 21244 USA. RP Lynn, J (reprint author), Ctr Medicare & Medicaid Serv, Qual Measurement & Hlth Assessment Grp, Off Clin Stand & Qual, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA. EM joanne.lynn@cms.hhs.gov NR 8 TC 0 Z9 0 U1 1 U2 1 PU MARY ANN LIEBERT INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1096-6218 J9 J PALLIAT MED JI J. Palliat. Med. PD JUN PY 2007 VL 10 IS 3 BP 660 EP 664 DI 10.1089/jpm.2007.9956 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 182IS UT WOS:000247498900014 PM 17592977 ER PT J AU Maglione, M Larson, C Giannotti, T Lapin, P AF Maglione, Margaret Larson, Carrie Giannotti, Tierney Lapin, Pauline TI Use of medicare summary notice inserts to generate interest in the medicare stop smoking program SO AMERICAN JOURNAL OF HEALTH PROMOTION LA English DT Article DE Medicare Beneficiary Outreach; recruitment strategies; mail inserts; prevention research ID RECRUITMENT; CESSATION AB Purpose. Evaluations of outreach strategies that effectively and efficiently reach the senior population open go unreported. The Medicare Stop Smoking Program (MSSP) was a seven-state demonstration project funded by the Centers for Medicare and Medicaid Services. The year recruitment plan for MSSP included a multifaceted paid media campaign; however, enrollment was slower than anticipated. The purpose of this substudy was to test the effects of including envelope-sized advertisement inserts with Medicare Summary Notices (MSNs) as a supplemental recruitment strategy. Methods. Information obtained from enrollees on where they had learned about the program as well as overall enrollment rates were analyzed and compared with the time periods during which the inserts were included in MSN mailings. Results. Average call volume to the enrollment center increased by 65.7% in Alabama, the pilot state, and by more than 200% in the subsequent demonstration states. Despite the introduction of the MSN inserts late in the recruitment period, 32.2% of the 7354 total enrollees stated that they learned about the project through the inserts. Conclusions. This recruitment method is highly recommended as a cost-effective way to reach the senior population. C1 RAND Corp, Santa Monica, CA 90401 USA. Qualidigm, Middletown, CT USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Maglione, M (reprint author), RAND Corp, 1776 Main St, Santa Monica, CA 90401 USA. EM maglione@rand.org NR 9 TC 3 Z9 3 U1 0 U2 0 PU AMER J HEALTH PROMOTION INC PI KEEGO HARBOR PA 1660 CASS LAKE RD, STE 104, KEEGO HARBOR, MI 48320 USA SN 0890-1171 J9 AM J HEALTH PROMOT JI Am. J. Health Promot. PD MAY-JUN PY 2007 VL 21 IS 5 BP 422 EP 425 PG 4 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 164NS UT WOS:000246241400004 PM 17515006 ER PT J AU Sheikh, K AF Sheikh, Kazim TI Investigation of selection bias using inverse probability weighting SO EUROPEAN JOURNAL OF EPIDEMIOLOGY LA English DT Letter ID FOLLOW-UP; COHORT; NONRESPONSE C1 US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, 601 E 12th St,Room 235, Kansas City, MO 64106 USA. EM kazim.sheikh@cms.hhs.gov NR 10 TC 3 Z9 3 U1 0 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0393-2990 J9 EUR J EPIDEMIOL JI Eur. J. Epidemiol. PD MAY PY 2007 VL 22 IS 5 BP 349 EP 350 DI 10.1007/s10654-007-9131-4 PG 2 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 178HE UT WOS:000247211000010 PM 17484025 ER PT J AU Lieberman, D Nadel, M Smith, RA Atkin, W Duggirala, SB Fletcher, R Glick, SN Johnson, CD Levin, TR Pope, JB Potter, MB Ransohoff, D Rex, D Schoen, R Schroy, P Winawer, S AF Lieberman, David Nadel, Marion Smith, Robert A. Atkin, Wendy Duggirala, Subash B. Fletcher, Robert Glick, Seth N. Johnson, C. Daniel Levin, Theodore R. Pope, John B. Potter, Michael B. Ransohoff, David Rex, Douglas Schoen, Robert Schroy, Paul Winawer, Sidney TI Standardized colonoscopy reporting and data system: report of the Quality Assurance Task Group of the National Colorectal Cancer Roundtable SO GASTROINTESTINAL ENDOSCOPY LA English DT Article ID FLEXIBLE SIGMOIDOSCOPY; ASA CLASSIFICATION; ADENOMA DETECTION; CT COLONOGRAPHY; AVERAGE-RISK; SURVEILLANCE; POLYPECTOMY; GUIDELINES; SOCIETY; UPDATE AB Background: Standardized reporting systems for diagnostic and screening tests facilitate quality improvement programs and clear communication among health care providers. Although colonoscopy is commonly used for screening, diagnosis, and therapy, no standardized reporting system for this procedure currently exists. The Quality Assurance Task Group of the National Colorectal Cancer Roundtable developed a reporting and data system for colonoscopy based on continuous quality improvement indicators. Design: The Task Group systematically reviewed quality indicators recommended by the Multi-Society Task Force on Colorectal Cancer and developed consensus-based terminology for reporting and data systems to capture these data elements. The Task Group included experts in several disciplines: gastroenterology, primary care, diagnostic imaging, and health care delivery. Results and Conclusions: The standardized colonoscopy reporting and data system provides a tool that can be used for efforts in continuous quality improvement within and across practices that use colonoscopy. C1 Ctr Dis Control & Prevent, Div Canc Prevent & Control, Atlanta, GA USA. Amer Canc Soc, Atlanta, GA 30329 USA. Ctr Medicare Serv, Chron Care Policy Grp, Baltimore, MD USA. Ctr Medicaid Serv, Chron Care Policy Grp, Baltimore, MD USA. Harvard Univ, Sch Med, Dept Ambulatory Care, Boston, MA USA. Harvard Univ, Sch Med, Dept Prevent Epidemiol & Social Med, Boston, MA USA. Univ Penn, Penn Presbyterian Med Ctr, Dept Med Imaging, Philadelphia, PA 19104 USA. Mayo Clin, Dept Radiol, Rochester, MN USA. Kaiser Permanente Med Ctr, Dept Gastroenterol, Walnut Creek, CA USA. Louisiana State Univ, Hlth Sci Ctr, Dept Family Med, Shreveport, LA 71105 USA. Univ Calif San Francisco, San Francisco, CA 94143 USA. Univ N Carolina, Dept Med, Chapel Hill, NC USA. Indiana Univ, Sch Med, Div Gastroenterol, Indianapolis, IN USA. Univ Pittsburgh, Sch Med, Div Gastroenterol Hepatol & Nutr, Pittsburgh, PA USA. Boston Univ, Sch Med, Gastroenterol Sect, Boston, MA 02118 USA. Mem Sloan Kettering Canc Ctr, Dept Med, Serv Gastroenterol & Nutr, New York, NY 10021 USA. St Marks Hosp, Canc Res UK, Colorectal Canc Unit, Harrow, Middx, England. Oregon Hlth & Sci Univ, Div Gastroenterol, Portland, OR 97239 USA. RP Lieberman, D (reprint author), Oregon Hlth & Sci Univ, Div Gastroenterol, Portland VA Med Ctr, P3-GI,POB 1034, Portland, OR 97239 USA. OI Atkin, Wendy/0000-0001-9073-9658 NR 32 TC 158 Z9 159 U1 0 U2 1 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0016-5107 J9 GASTROINTEST ENDOSC JI Gastrointest. Endosc. PD MAY PY 2007 VL 65 IS 6 BP 757 EP 766 DI 10.1016/j.gie.2006.12.055 PG 10 WC Gastroenterology & Hepatology SC Gastroenterology & Hepatology GA 164EW UT WOS:000246217300003 PM 17466195 ER PT J AU Riley, GF AF Riley, Gerald F. TI Long-term trends in the concentration of Medicare spending SO HEALTH AFFAIRS LA English DT Article ID HEALTH-CARE EXPENDITURES; BENEFICIARIES AB Medicare spending is concentrated among a few high-cost beneficiaries who are often targeted by cost-saving interventions. The Continuous Medicare History Sample file was used to analyze trends in the spending concentration over thirty years. Annual expenditures became less concentrated over time, although the year-to-year persistence of person-level high costs remained strong. There was an increase in the prevalence of chronic conditions among high-cost beneficiaries, which supports the rationale for focusing cost-saving interventions on chronic disease management. However, the decrease in concentration may reduce the potential savings from interventions focused on such beneficiaries. C1 Off Res Dev & Informat, Baltimore, MD USA. Ctr Medicare & Med Serv, Baltimore, MD USA. RP Riley, GF (reprint author), Off Res Dev & Informat, Baltimore, MD USA. EM Gerald.riley@cms.hhs.gov NR 21 TC 38 Z9 38 U1 2 U2 5 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAY-JUN PY 2007 VL 26 IS 3 BP 808 EP 816 DI 10.1377/hlthaff.26.3.808 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 167NL UT WOS:000246458300026 PM 17485760 ER PT J AU Harris, Y AF Harris, Yael TI Biostatistics note: More could be done in predicting nursing home admission using the Cox proportional hazards model - Response SO JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION LA English DT Letter C1 Ctr Medicare & Med Serv, Baltimore, MD USA. RP Harris, Y (reprint author), Ctr Medicare & Med Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1525-8610 J9 J AM MED DIR ASSOC JI J. Am. Med. Dir. Assoc. PD MAY PY 2007 VL 8 IS 4 BP 272 EP 272 DI 10.1016/j.jamda.2007.02.005 PG 1 WC Geriatrics & Gerontology SC Geriatrics & Gerontology GA 170EF UT WOS:000246644300015 ER PT J AU Miranda, DJ AF Miranda, David J. TI Health care quality reporting: Changes and challenges SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Miranda, DJ (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mail Stop S1-15-03, Baltimore, MD 21244 USA. EM david.miranda@cms.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2007 VL 28 IS 3 BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 170MN UT WOS:000246667600001 ER PT J AU Gerteis, M Gerteis, JS Newman, D Koepke, C AF Gerteis, Margaret Gerteis, Jessie S. Newman, David Koepke, Christopher TI Testing consumers' comprehension of quality measures using alternative reporting formats SO HEALTH CARE FINANCING REVIEW LA English DT Article ID INFORMATION AB CMS has publicly reported nursing home quality measures since 2002, but research has shown that many users do not understand them. Alternative visual displays may improve comprehension. We developed seven reporting templates in different formats, including bar graphs like those displayed on the CMS Nursing Home Compare Web site www.medicare.gov, and tested them with 90 individuals age 45-75, using structured protocols. Tests of significance were conducted, and statistically significant findings identified. Fewer than one-half the respondents accurately interpreted bar graphs as currently displayed on the Nursing Home Compare Web site. Respondents made fewest errors on templates using words to characterize performance as better, average, or worse. C1 Math Policy Res Inc, Cambridge, MA 02139 USA. Boston Med Ctr, Boston, MA USA. ABT Associates Inc, Cambridge, MA 02138 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Gerteis, M (reprint author), Math Policy Res Inc, 955 Massachusetts Ave,Suite 800, Cambridge, MA 02139 USA. EM mgerteis@mathematica-mpr.com NR 11 TC 26 Z9 26 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2007 VL 28 IS 3 BP 31 EP 45 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 170MN UT WOS:000246667600004 PM 17645154 ER PT J AU Caldis, T AF Caldis, Todd TI Composite health plan quality scales SO HEALTH CARE FINANCING REVIEW LA English DT Article ID REPORT CARDS; PERFORMANCE; INDICATORS AB This study employs exploratory factor analysis and scale construction methods with commercial Health Plan Employers Data Information Set (HEDIS (R)) process of care and outcome measures from 1999 to uncover evidence for a unidimensional composite health maintenance organization (HMO) quality scale. Summated scales by categories of care are created and are then used in a factor analysis that has a single factor solution. The category of care scales were used to construct a summated composite scale which exhibits strong evidence of internal consistency (alpha= 0.90). External validity of the composite quality scale was checked by regressing the composite scale on Consumer Assessment of Healthcare Providers and Systems (CAHPS (R)) survey results for 1999. C1 Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD 21244 USA. RP Caldis, T (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, Mail Stop N3-02-02,7500 Secur Blvd, Baltimore, MD 21244 USA. EM todd.caldis@cms.hhs.gov FU AHRQ HHS [R03 HS011515, 1 R03 HS11515-01] NR 23 TC 8 Z9 8 U1 2 U2 3 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2007 VL 28 IS 3 BP 95 EP 107 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 170MN UT WOS:000246667600008 PM 17645158 ER PT J AU Caplan, S Rollins, JA Jacques, LB Phurrough, SE AF Caplan, Stuart Rollins, James A. Jacques, Louis B. Phurrough, Steve E. TI Commentary: Medicare Coverage Advisory Committee meeting on noninvasive imaging for coronary artery disease SO AMERICAN HEART JOURNAL LA English DT Editorial Material C1 Ctr Medicare & Medicard Serv, Off Clin Stand & Qualify, Baltimore, MD 21244 USA. RP Caplan, S (reprint author), Ctr Medicare & Medicard Serv, Off Clin Stand & Qualify, 7400 Secur Blvd,C1-09-06, Baltimore, MD 21244 USA. EM stuart.caplan@cms.hhs.gov NR 0 TC 3 Z9 3 U1 0 U2 0 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0002-8703 J9 AM HEART J JI Am. Heart J. PD FEB PY 2007 VL 153 IS 2 BP 159 EP 160 DI 10.1016/j.ahj.2006.10.024 PG 2 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 133XQ UT WOS:000244047600003 PM 17239672 ER PT J AU Wasse, H Speckman, RA Frankenfield, DL Rocco, MV McClellan, WM AF Wasse, Haimanot Speckman, Rebecca A. Frankenfield, Diane L. Rocco, Michael V. McClellan, William M. TI Predictors of delayed transition from central venous catheter use to permanent vascular access among ESRD patients SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE hemodialysis vascular access ID INCIDENT HEMODIALYSIS-PATIENTS; ARTERIOVENOUS-FISTULA; UNITED-STATES; COMPLICATIONS; MORTALITY; SURVIVAL; FAILURE; BACTEREMIA; OUTCOMES; CHOICE AB Background: Early arteriovenous fistula (AVF) creation is necessary to curb the use of central venous catheters (CVCs) and reduce their complications. We sought to examine patient characteristics that may influence persistent CVC use 90 days after dialysis therapy initiation among patients using a CvC. Methods: Data from the 1999 to 2003 Clinical Performance Measures Project was linked to the Centers for Medicare & Medicaid Services Medical Evidence (2728) form. Results: Most patients (59.4%) starting dialysis with a CVC failed to transition to permanent access within 90 days, whereas 25.4% received a graft and only 15.2% received an AVF. Older patients (> 75 years) were more than 2-fold more likely to remain CVC dependent at 90 days (P = 0.0.001) compared with those younger than 50 years. In addition, race and sex were highly predictive of CVC dependence at 90 days; black females, white females, and black males were 75% (P < 0.001), 61 % (P < 0.001), and 35% (P = 0.023) more likely than white males to maintain CVC use, whereas patients with ischemic heart disease and peripheral vascular disease were 35% (P = 0.023) and 39% (P = 0.007) more likely to remain CVC dependent at 90 days, respectively. Conclusion: Prolonged CVC dependence is more likely to occur among patients of older age, females, blacks, and those with cardiovascular comorbidity, suggesting inadequate or late access referral or greater primary access failure. Our findings suggest possible missed opportunities for early conversion of patients to permanent vascular access that may vary by race and sex. C1 Emory Univ, Div Nephrol Syst, Atlanta, GA 30322 USA. Emory Univ, Rollins Sch Publ Hlth, Div Epidemiol, Atlanta, GA 30322 USA. Ctr Medicare, Off Clin Stand & Qual, Baltimore, MD USA. Ctr Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. Wake Forest Univ, Div Nephrol, Winston Salem, NC 27109 USA. RP Wasse, H (reprint author), Emory Univ, Div Nephrol Syst, WMB Rm 338,1639 Pierce Dr, Atlanta, GA 30322 USA. EM hwasse@emory.edu RI Wasse, Haimanot/A-5726-2013 OI Wasse, Haimanot/0000-0001-5756-0242 FU NIDDK NIH HHS [K23 DK065634-02, K23 DK65634, K23 DK065634] NR 29 TC 44 Z9 49 U1 0 U2 0 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD FEB PY 2007 VL 49 IS 2 BP 276 EP 283 DI 10.1053/j.ajkd.2006.11.030 PG 8 WC Urology & Nephrology SC Urology & Nephrology GA 197PJ UT WOS:000248567500013 PM 17261430 ER PT J AU Lindenauer, PK Remus, D Roman, S Rothberg, MB Benjamin, EM Ma, A Bratzler, DW AF Lindenauer, Peter K. Remus, Denise Roman, Sheila Rothberg, Michael B. Benjamin, Evan M. Ma, Allen Bratzler, Dale W. TI Public reporting and pay for performance in hospital quality improvement SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID HEALTH-CARE; US HOSPITALS; IMPACT; INCENTIVES; MEDICARE; LESSONS AB BACKGROUND: Public reporting and pay for performance are intended to accelerate improvements in hospital care, yet little is known about the benefits of these methods of providing incentives for improving care. METHODS: We measured changes in adherence to 10 individual and 4 composite measures of quality over a period of 2 years at 613 hospitals that voluntarily reported information about the quality of care through a national public-reporting initiative, including 207 facilities that simultaneously participated in a pay-for-performance demonstration project funded by the Centers for Medicare and Medicaid Services; we then compared the pay-for-performance hospitals with the 406 hospitals with public reporting only (control hospitals). We used multivariable modeling to estimate the improvement attributable to financial incentives after adjusting for baseline performance and other hospital characteristics. RESULTS: As compared with the control group, pay-for-performance hospitals showed greater improvement in all composite measures of quality, including measures of care for heart failure, acute myocardial infarction, and pneumonia and a composite of 10 measures. Baseline performance was inversely associated with improvement; in pay-for-performance hospitals, the improvement in the composite of all 10 measures was 16.1% for hospitals in the lowest quintile of baseline performance and 1.9% for those in the highest quintile (P<0.001). After adjustments were made for differences in baseline performance and other hospital characteristics, pay for performance was associated with improvements ranging from 2.6 to 4.1% over the 2-year period. CONCLUSIONS: Hospitals engaged in both public reporting and pay for performance achieved modestly greater improvements in quality than did hospitals engaged only in public reporting. Additional research is required to determine whether different incentives would stimulate more improvement and whether the benefits of these programs outweigh their costs. C1 Baystate Med Ctr, Div Healthcare Qual, Springfield, MA 01199 USA. Tufts Univ, Sch Med, Dept Med, Boston, MA 02111 USA. Premier Healthcare Informat, Charlotte, NC USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Oklahoma Fdn Med Qual, Oklahoma City, OK USA. RP Lindenauer, PK (reprint author), Baystate Med Ctr, Div Healthcare Qual, 759 Chestnut St,P-5931, Springfield, MA 01199 USA. EM peter.lindenauer@bhs.org NR 31 TC 431 Z9 435 U1 5 U2 43 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD FEB 1 PY 2007 VL 356 IS 5 BP 486 EP 496 DI 10.1056/NEJMsa064964 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 131HW UT WOS:000243860700009 PM 17259444 ER PT J AU Bach, PB AF Bach, Peter B. TI Costs of cancer care: A view from the centers for Medicare & Medicaid services SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Review AB Fee-for-service Medicare pays for a very substantial portion of all cancer care delivered in the United States. By virtue of its size and visibility, its payment policies at times also influence those of other health care payers. As a result, Medicare affects both the overall economics and the incentive structures of oncology care. Three aspects of how Medicare finances cancer care are particularly germane to the issue of costs. First, Medicare finances all aspects of cancer care in independent payment units, paying separately for physician services, laboratory tests, procedures, imaging, radiation, drug administration, and drugs. Second, Medicare is currently managing and monitoring a very substantial overhaul in payment for cancer care, which aims to reduce or eliminate incentives that have favored aggressive and costly treatments in clinical situations where alternative therapeutic approaches might have been equivalent or preferable. Third, Medicare is trying to increase the focus on care quality and transparency, as improved efficiency and greater value is needed if costs of care are to be contained. Understanding these three aspects of cancer care financing can help clarify what Medicare is capable of doing to control the rising costs that are occurring in cancer today. C1 Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10021 USA. Ctr Medicare Serv, Off Administrator, Washington, DC USA. Ctr Medicaid Serv, Off Administrator, Washington, DC USA. RP Bach, PB (reprint author), Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, 1275 York Ave,Box 221, New York, NY 10021 USA. EM bachp@mskcc.org NR 7 TC 18 Z9 20 U1 0 U2 2 PU AMER SOC CLINICAL ONCOLOGY PI ALEXANDRIA PA 330 JOHN CARLYLE ST, STE 300, ALEXANDRIA, VA 22314 USA SN 0732-183X J9 J CLIN ONCOL JI J. Clin. Oncol. PD JAN 10 PY 2007 VL 25 IS 2 BP 187 EP 190 DI 10.1200/JCO.2006.08.6116 PG 4 WC Oncology SC Oncology GA 129KT UT WOS:000243729100005 PM 17210938 ER PT J AU Goetzel, RZ Shechter, D Ozminkowski, RJ Stapleton, DC Lapin, PJ McGinnis, JM Gordon, CR Breslow, L AF Goetzel, Ron Z. Shechter, David Ozminkowski, Ronald J. Stapleton, David C. Lapin, Pauline J. McGinnis, J. Michael Gordon, Catherine R. Breslow, Lester TI Can health promotion programs save Medicare money? SO CLINICAL INTERVENTIONS IN AGING LA English DT Review DE health promotion; return on investment; Medicare; financial impact; risk reduction programs; demonstration AB The impact of an aging population on escalating US healthcare costs is influenced largely by the prevalence of chronic disease in this population. Consequently, preventing or postponing disease onset among the elderly has become a crucial public health issue. Fortunately, much of the total burden of disease is attributable to conditions that are preventable. In this paper, we address whether well-designed health promotion programs can prevent illness, reduce disability, and improve the quality of life. Furthermore, we assess evidence that these programs have the potential to reduce healthcare utilization and related expenditures for the Medicare program. We hypothesize that seniors who reduce their modifiable health risks can forestall disability, reduce healthcare utilization, and save Medicare money. We end with a discussion of a new Senior Risk Reduction Demonstration, which will be initiated by the Centers for Medicare and Medicaid Services in 2007, to test whether risk reduction programs developed in the private sector can achieve health improvements among seniors and a positive return on investment for the Medicare program. C1 [Goetzel, Ron Z.; Ozminkowski, Ronald J.] Cornell Univ, Inst Hlth & Prod Studies, Washington, DC 20008 USA. [Shechter, David] Thomson Medstat, Hlth & Prod Res, Santa Barbara, CA USA. [Stapleton, David C.] Cornell Univ, Cornell Inst Policy Res, Washington, DC 20008 USA. [Lapin, Pauline J.] Ctr Medicare Serv, Off Res Dev & Informat, Baltimore, MD USA. [Lapin, Pauline J.] Ctr Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. [McGinnis, J. Michael] Natl Acad, Natl Acad Sci, Inst Med, Washington, DC USA. [Gordon, Catherine R.] Ctr Dis Control & Prevent, Off Director, Washington, DC USA. [Breslow, Lester] Univ Calif Los Angeles, Sch Publ Hlth, Dept Hlth Serv, Los Angeles, CA 90024 USA. RP Goetzel, RZ (reprint author), Cornell Univ, Inst Hlth & Prod Studies, 4301 Connecticut Ave NW, Washington, DC 20008 USA. EM ron.goetzel@thomson.com FU Centers for Medicare and Medicaid Services, Medicare Research and Demonstrations [500-00-0034] FX Funding for this project was provided by The Centers for Medicare and Medicaid Services, Medicare Research and Demonstrations Contract #500-00-0034. The authors wish to thank Maryam Tabrizi and Meghan Short for their help in the final preparation of the article. Also, we would like to thank the reviewer(s) of this paper for their comments, which strengthened the manuscript. NR 44 TC 10 Z9 10 U1 0 U2 3 PU DOVE MEDICAL PRESS LTD PI ALBANY PA PO BOX 300-008, ALBANY, AUCKLAND 0752, NEW ZEALAND SN 1176-9092 J9 CLIN INTERV AGING JI Clin. Interv. Aging PY 2007 VL 2 IS 1 BP 117 EP 122 DI 10.2147/ciia.2007.2.1.117 PG 6 WC Geriatrics & Gerontology SC Geriatrics & Gerontology GA V21WS UT WOS:000208238300014 PM 18044084 ER PT J AU Catlin, A Cowan, C Heffier, S Washington, B AF Catlin, Aaron Cowan, Cathy Heffier, Stephen Washington, Benjamin CA National Health Expenditure Accou TI National health spending in 2005: The slowdown continues SO HEALTH AFFAIRS LA English DT Article AB In 2005, U.S. health care spending increased 6.9 percent to almost $2.0 trillion, or $6,697 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than the 15.9 percent share in 2004. This third consecutive year of slower health spending growth was largely driven by prescription drug expenditures. Spending for hospital and physician and clinical services grew at similar rates as they did in 2004. C1 Off Actuary, Ctr Medicare Serv, Baltimore, MD USA. Off Actuary, Ctr Medicaid Serv, Baltimore, MD USA. RP Catlin, A (reprint author), Off Actuary, Ctr Medicare Serv, Baltimore, MD USA. EM Aaron.Catlin@cms.hhs.gov NR 21 TC 95 Z9 95 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2007 VL 26 IS 1 BP 142 EP 153 DI 10.1377/hlthaff.26.1.142 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 136LF UT WOS:000244223200016 PM 17211023 ER PT J AU Rothstein, WG Phuong, LH AF Rothstein, William G. Phuong, Linh H. TI Ethical attitudes of nurse, physician, and unaffiliated members of institutional review boards SO JOURNAL OF NURSING SCHOLARSHIP LA English DT Article DE institutional review boards; health research ethics ID CONFLICT-OF-INTEREST AB Purpose: To evaluate the recommendation for adding unaffiliated members to institutional review boards (IRB) by comparing the attitudes and influence of IRB members of different backgrounds, primarily nurses, physicians, and unaffiliated members. Design: Survey. Method: A closed-ended self-administered questionnaire concerning ethical issues in human subjects research was completed by 284 IRB members in a nonprobability sample of 27 IRBs in 12 U.S. states. The attitudes and influence of IRB members with different backgrounds were compared. Findings: Nurses rated most of the issues as more important than did all other members; physicians rated most of the issues as less important than did all other members; and unaffiliated IRB members rated the issues similar to the whole. Nurses and unaffiliated members were ranked the least influential IRB members, and IRB chairs and physicians were ranked the most influential. Conclusions: The responses of the IRB members in this study indicate that adding more unaffiliated members to IRBs is unlikely to increase IRB concerns with ethical issues. Adding more nurse members to IRBs might increase IRB concerns with ethical issues if the level of influence of the nurses is increased. C1 Univ Maryland, Dept Sociol & Anthropol, Baltimore, MD 21250 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Rothstein, WG (reprint author), Univ Maryland, Dept Sociol & Anthropol, Baltimore, MD 21250 USA. EM rothstei@umbc.edu NR 20 TC 11 Z9 11 U1 1 U2 2 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 1527-6546 J9 J NURS SCHOLARSHIP JI J. Nurs. Scholarsh. PY 2007 VL 39 IS 1 BP 75 EP 81 DI 10.1111/j.1547-5069.2007.00147.x PG 7 WC Nursing SC Nursing GA 139EL UT WOS:000244415000017 PM 17393970 ER PT J AU Harris, Y AF Harris, Yael TI Depression as a risk factor for nursing home admission among older individuals SO JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION LA English DT Article DE depression; managed care; Medicare; nursing homes ID HEALTH-SERVICES; MORTALITY; SYMPTOMS; TERM AB Objectives: Depression is common among those aged 65 and older and has been associated with increased morbidity and mortality. This study investigated whether individuals enrolled in Medicare+Choice with symptoms of depression as measured using the mental health scale from the SF-36 were at increased risk of using nursing home services. Design: A Cox proportional hazards model was used Setting: The study investigated community-based adults aged 65 and older. Participants: Participants were individuals aged 65 years and older enrolled in Medicare+Choice who responded to the Health Outcomes Survey and were not institutionalized or incapable of responding for themselves at the time of survey administration. Measurements: The purpose of the study was to predict the risk of admission to a nursing home over time, controlling for variables related to demographics, comorbidity, age, and functional status. Results: The results indicated that, even after controlling for physical health, functional status, age, demographics, and socioeconomic status, Medicare+Choice enrollees over the age of 65 experiencing symptoms of depression as identified by the SF-36 are at increased risk of using nursing home services. Conclusions: These results have implications for payers of nursing home services such as Medicare and Medicaid as well as for providers and the families of older individuals. While the results do not prove that prevention is possible, they do suggest that better identification and treatment of depression reduce the risk of nursing home admission. Even if nursing home placement cannot be avoided, it is possible that the individual's quality of life could be significantly enhanced by better diagnosis and treatment of depression. These findings have implications beyond the Medicare+Choice population. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Harris, Y (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM yael.harris@cms.hhs.gov NR 27 TC 26 Z9 27 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1525-8610 J9 J AM MED DIR ASSOC JI J. Am. Med. Dir. Assoc. PD JAN PY 2007 VL 8 IS 1 BP 14 EP 20 DI 10.1016/j.jamda.2006.06.005 PG 7 WC Geriatrics & Gerontology SC Geriatrics & Gerontology GA 128HY UT WOS:000243650000003 PM 17210498 ER PT J AU Tinetti, ME Gordon, C Sogolow, E Lapin, P Bradley, EH AF Tinetti, Mary E. Gordon, Catherine Sogolow, Ellen Lapin, Pauline Bradley, Elizabeth H. TI Fall-risk evaluation and management: Challenges in adopting geriatric care practices SO GERONTOLOGIST LA English DT Article DE falls interventions; falls prevention; fall-risk evaluation; medicare; preventive approaches ID OLDER PERSONS; HEALTH-CARE; RESTRICTED ACTIVITY; COMMUNITY; PREVENTION; INJURIES; MEDICARE; INTERVENTIONS; TRIALS; ELDERS AB One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence concerning the effectiveness of fall-prevention services, describe barriers for clinicians and for payers in promoting these services, and suggest strategies to encourage greater use of these services. The challenges are substantial, but strategies for incremental change are available while more broad-based changes in health care financing and clinical practice evolve to better manage the multiple chronic health conditions, including falls, experienced by older Americans. C1 Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06504 USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, New Haven, CT 06510 USA. Ctr Dis Control & Prevent, Natl Ctr Injury Prevent & Control, Washington, DC USA. Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Tinetti, ME (reprint author), Yale Univ, Sch Med, Dept Internal Med, 20 York St,TMP15, New Haven, CT 06504 USA. EM mary.tinetti@yale.edu NR 51 TC 85 Z9 86 U1 1 U2 12 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1030 15TH ST NW, STE 250, WASHINGTON, DC 20005202-842 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD DEC PY 2006 VL 46 IS 6 BP 717 EP 725 PG 9 WC Gerontology SC Geriatrics & Gerontology GA 121NN UT WOS:000243164400004 PM 17169927 ER PT J AU Friedman, RH AF Friedman, Richard H. TI Medicaid information technology architecture: An overview SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The Medicaid Information Technology Architecture (MITA) is a roadmap and toolkit for States to transform their Medicaid Management Information System (MMIS) into an enterprise-wide, beneficiary-centric system. MITA will enable State Medicaid agencies to align their information technology (IT) opportunities with their evolving business needs. It also addresses long-standing issues of interoperability, adaptability, and data sharing, including clinical data, across organizational boundaries by creating models based on nationally accepted technical standards. Perhaps most significantly, MITA allows State Medicaid Programs to actively participate in the DHHS Secretary's vision of a transparent health care market that utilizes electronic health records (EHRs), ePrescribing and personal health records (PHRs). C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Friedman, RH (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,S3-13-15, Baltimore, MD 21244 USA. EM richard.friedman@cms.hhs.gov NR 8 TC 3 Z9 3 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2006 VL 28 IS 2 BP 1 EP 9 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 142DZ UT WOS:000244630800001 PM 17427840 ER PT J AU Tan, RL AF Tan, Ronnie L. TI Medicare beneficiaries' use of computers and Internet: 1998-2005 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Tan, RL (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM ronnie.tan@cms.hhs.gov NR 0 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2006 VL 28 IS 2 BP 45 EP 51 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 142DZ UT WOS:000244630800005 PM 17427844 ER PT J AU Riley, G Zarabozo, C AF Riley, Gerald Zarabozo, Carlos TI Trends in the health status of Medicare risk contract enrollees SO HEALTH CARE FINANCING REVIEW LA English DT Article ID MANAGED CARE; BIASED SELECTION; HMO AB Previous research has found Medicare risk contract enrollees to be healthier than beneficiaries in fee-for-service (FFS). Medicare Current Beneficiary Survey (MCBS) data were used to examine trends in health and functional status measures among risk contract and FFS enrollees from 1991 to 2004. Risk contract enrollees reported better health and functioning, but the differences tended to narrow over time. Most of the differences in trends were observed for functional status measures and institutionalization; differences in trends for perceived health status and prevalence rates of chronic conditions tended to be small or non-existent. The narrowing of functional and health status differences between the risk contract and FFS populations may have implications for payment policy, as well as implications for the role of private health plans in Medicare. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Riley, G (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-20-17, Baltimore, MD 21244 USA. EM gerald.riley@cms.hhs.gov NR 25 TC 10 Z9 10 U1 0 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2006 VL 28 IS 2 BP 81 EP 95 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 142DZ UT WOS:000244630800008 PM 17427847 ER PT J AU Harris, Y Cooper, JK AF Harris, Yael Cooper, James K. TI Depressive symptoms in older people predict nursing home admission - Response SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Letter C1 Dept Hlth & Human Serv, Ctr Medicare Serv, Baltimore, MD USA. Dept Hlth & Human Serv, Ctr Medicaid Serv, Baltimore, MD USA. George Washington Univ, Sch Med, Dept Med, Washington, DC USA. RP Harris, Y (reprint author), Dept Hlth & Human Serv, Ctr Medicare Serv, Baltimore, MD USA. NR 4 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD NOV PY 2006 VL 54 IS 11 BP 1796 EP 1796 DI 10.1111/j.1532-5415.2006.00929.x PG 1 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 100NS UT WOS:000241676400029 ER PT J AU Cahill, M Payne, G AF Cahill, Molly Payne, Glenda TI Online mentoring: ANNA connections SO NEPHROLOGY NURSING JOURNAL LA English DT Editorial Material C1 Arms Dodge Robinson Wilber & Crouch, Kansas City, MO USA. Ctr Medicare & Medicaid Serv, Dallas, TX USA. RP Cahill, M (reprint author), Arms Dodge Robinson Wilber & Crouch, Kansas City, MO USA. NR 7 TC 5 Z9 5 U1 0 U2 0 PU JANNETTI PUBLICATIONS, INC PI PITMAN PA EAST HOLLY AVENUE, BOX 56, PITMAN, NJ 08071-0056 USA SN 1526-744X J9 NEPHROL NURS J JI Nephrol. Nurs. J. PD NOV-DEC PY 2006 VL 33 IS 6 BP 695 EP 697 PG 3 WC Nursing; Urology & Nephrology SC Nursing; Urology & Nephrology GA 121JG UT WOS:000243153300014 PM 17219732 ER PT J AU Gavin, NI Benedict, MB Adams, EK AF Gavin, Norma I. Benedict, M. Beth Adams, E. Kathleen TI Health service use and outcomes among disabled Medicaid pregnant women SO WOMENS HEALTH ISSUES LA English DT Article ID PHYSICAL-DISABILITIES; PRENATAL-CARE; MOTHERS AB Purpose. We investigated differences in health service use and pregnancy outcomes among women enrolled in Medicaid under eligibility categories for the blind and disabled and those enrolled under other eligibility categories. Methods. We used Medicaid enrollment and claims data to create episodes of pregnancy- and delivery-related care for women with and without disabilities who had Medicaid-covered deliveries in Florida, Georgia, and New Jersey during 1995 and Texas during 1997. We linked birth certificate information on prenatal care and birth outcomes to the files for Georgia and Texas. We then computed the unadjusted and adjusted odds ratios for the receipt of selected routine prenatal and illness-related services and the occurrence of selected pregnancy outcomes among women with disabilities relative to women without disabilities. Findings. In all states, women with disabilities were more likely than women without disabilities to have had continuous Medicaid coverage from preconception through the postnatal period. Women with disabilities were equally or less likely to have received adequate prenatal care compared to women without disabilities in the two study states with these data. They were also more likely to have had emergency room visits, hospital admissions during pregnancy, cesarean deliveries, and readmissions within 3 months of delivery in all study states. We also found women with disabilities to have been more likely to deliver preterm and low birthweight infants. Conclusion. Our results suggest that opportunities exist to improve access to prenatal care among women with disabilities enrolled in Medicaid under blind and disabled eligibility categories who become pregnant. C1 RTI Int, Res Triangle Pk, NC 27709 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. RP Gavin, NI (reprint author), RTI Int, 3040 Cornwallis Rd, Res Triangle Pk, NC 27709 USA. EM gavin@rti.org NR 22 TC 11 Z9 11 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1049-3867 J9 WOMEN HEALTH ISS JI Womens Health Iss. PD NOV-DEC PY 2006 VL 16 IS 6 BP 313 EP 322 DI 10.1016/j.whi.2006.10.003 PG 10 WC Public, Environmental & Occupational Health; Women's Studies SC Public, Environmental & Occupational Health; Women's Studies GA 122RF UT WOS:000243243500004 PM 17188214 ER PT J AU Rocco, MV Frankenfield, DL Hopson, SD McClellan, WM AF Rocco, Michael V. Frankenfield, Diane L. Hopson, Sari D. McClellan, William M. TI Relationship between clinical performance measures and outcomes among patients receiving long-term hemodialysis SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID STAGE RENAL-DISEASE; ESRD PATIENTS; MORTALITY; RISK; DEATH; HYPOALBUMINEMIA; PREDICTORS; SURVIVAL; ALBUMIN; IMPACT AB Background: Patients receiving long-term hemodialysis have a yearly mortality rate of 15% to 20%. Objective: To determine whether attaining clinical performance measures for hemodialysis care is associated with favorable 12-month mortality and hospitalization rates. Design: Cohort study. Setting: Outpatient hemodialysis centers in the United States. Patients: 15 287 patients who were selected from a 5% random sample of patients receiving long-term hemodialysis. Measurements: The authors used data from the Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures Project from 1999 and 2000. The clinical performance measure targets were hemoglobin value of 110 g/L or greater; serum albumin value of 40 g/L or greater or 37 g/L or greater (bromcresol green and bromcresol purple laboratory methods, respectively); use of a fistula for vascular access; and measured single-pool Kt/V urea value of 1.2 or greater. The outcome measures were death or hospitalization during 1-year follow-up. Results: 8364 patients (54.7%) were hospitalized and 3062 (20.0%) died during the 12-month follow-up period. Six percent of patients did not meet any clinical measure targets, 24% met 1 target, 39% met 2 targets, 24% met 3 targets, and 7% met all 4 targets. The unadjusted 12-month hospitalization and mortality rates for these 5 groups were 60%, 60%, 56%, 49%, and 43% (P < 0.001) and 29%, 25%, 21%, 14%, and 7% (P < 0.001), respectively. The risk for death increased for each additional guideline indicator that was not met: Adjusted hazard ratios were 4.6 (95% Cl, 3.3 to 6.4), 3.5 (Cl, 2.6 to 4.7), 2.6 (Cl, 1.9 to 3.5), and 1.9 (CI, 1.4 to 2.6) for 0, 1, 2, or 3 targets met, respectively, compared with meeting 4 targets (referent). Similarly, the risk for hospitalization increased for each additional guideline indicator that was not met: Adjusted hazard ratios were 1.6 (Cl, 1.4 to 1.9), 1.5 (Cl, 1.3 to 1.7), 1.3 (Cl, 1.1 to 1.5), and 1.1 (Cl, 0.98 to 1.3), respectively. Limitations: It was not possible to determine the roles of severity of illness, other patient factors, or suboptimal care in failure to meet performance measures. Conclusions: In patients receiving long-term hemodialysis, meeting multiple clinical measure targets is associated with a decrease in hospitalization and mortality rates. C1 Wake Forest Univ, Sch Med, Nephrol Sect, Winston Salem, NC 27157 USA. Emory Univ, Atlanta, GA 30322 USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Rocco, MV (reprint author), Wake Forest Univ, Sch Med, Nephrol Sect, Med Ctr Blvd, Winston Salem, NC 27157 USA. EM mrocco@wfubmc.edu NR 18 TC 78 Z9 83 U1 1 U2 5 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD OCT 3 PY 2006 VL 145 IS 7 BP 512 EP 519 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 092JX UT WOS:000241093900005 PM 17015869 ER PT J AU Amaral, S Hwang, W Fivush, B Neu, A Frankenfield, D Furth, S AF Amaral, Sandra Hwang, Wenke Fivush, Barbara Neu, Alicia Frankenfield, Diane Furth, Susan TI Association of mortality and hospitalization with achievement of adult hemoglobin targets in adolescents maintained on hemodialysis SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article; Proceedings Paper CT 37th Annual Meeting of the American-Society-of-Nephrology CY OCT 27-NOV 01, 2004 CL St Louis, MO SP Amer Soc Nephrol ID RECEIVING HEMODIALYSIS; DIALYSIS OUTCOMES; ANEMIA; HEMATOCRIT; MORBIDITY; DISEASE; IMPACT; PREDICTORS AB With the use of data from the Centers for Medicare & Medicaid Services' ESRD Clinical Performance Measures Project (October through December 1999 and 2000) linked with US Renal Data System hospitalization and mortality records, whether achieving adult target hemoglobin (Hb) levels in adolescents who are on hemodialysis (HD) was associated with decreased risk for death or hospitalization was assessed. Of 677 adolescents, 238 were hospitalized and 54 died. In bivariate analysis, 11.7% with Hb < 11 g/dl at study entry died versus 5% of those with initial Hb >= 11 g/dl (P = 0.001); 40.3% with baseline Hb < 11 g/dl were hospitalized versus 31.1% with initial Hb >= 11 g/dl (P = 0.013). In multivariate analysis, Hb >= 11 g/dl was associated with decreased risk for death (hazard ratio [HR] 0.38; 95% confidence interval [CII 0.20 to 0.72) but did not show a statistically significant association with decreased risk for hospitalization (HR 0.87; 95% CI 0.66 to 1.15). When Hb was recategorized as Hb < 10, >= 10 and < 11, >= 11 and <= 12, and > 12 g/dl, risk of mortality declined as Hb level increased. At Hb 11 to 12 g/dl (versus Hb < 10 g/dl), mortality risk decreased by 69% (HR 0.31; 95% CI 0.14 to 0.65). Risk for mortality was similar for Hb 11 to 12 and > 12 g/dl. For hospitalization, no statistically significant difference in risk between Hb categories was found. This observational study of adolescents who are on HD is consistent with adult literature showing decreased mortality in patients who have ESRD and meet adult Hb targets. Further studies in the form of randomized, clinical trials are needed to assess optimal Hb levels for adolescents who are on HD. C1 Emory Univ, Sch Med, Div Pediat Nephrol, Atlanta, GA 30322 USA. Johns Hopkins Med Inst, Dept Pediat, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD 21205 USA. Off Clin Stand & Qual, Ctr Medicare & Med Serv, Baltimore, MD USA. Wake Forest Univ, Sch Med, Winston Salem, NC 27109 USA. RP Amaral, S (reprint author), Emory Univ, Sch Med, Div Pediat Nephrol, 2015 Uppergate Dr NE, Atlanta, GA 30322 USA. EM sandra_amaral@oz.ped.emory.edu FU NIDDK NIH HHS [R21 DK 064313-01, 5T32 DK 07732] NR 20 TC 34 Z9 34 U1 0 U2 0 PU AMERICAN SOCIETY NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD OCT PY 2006 VL 17 IS 10 BP 2878 EP 2885 DI 10.1681/ASN.2005111215 PG 8 WC Urology & Nephrology SC Urology & Nephrology GA 090BV UT WOS:000240926500027 PM 16943308 ER PT J AU Soumerai, SB Pierre-Jacques, M Zhang, F Ross-Degnan, D Adams, AS Gurwitz, J Adler, G Safran, DG AF Soumerai, Stephen B. Pierre-Jacques, Marsha Zhang, Fang Ross-Degnan, Dennis Adams, Alyce S. Gurwitz, Jerry Adler, Gerald Safran, Dana Gelb TI Cost-related medication nonadherence among elderly and disabled medicare beneficiaries - A national survey 1 year before the medicare drug benefit SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID PRESCRIPTION DRUGS; HEALTH; COVERAGE; UNDERUSE; SENIORS; ADULTS; INDEX; ADL AB Background: Prior to implementation of the Medicare drug benefit, we estimated the prevalence of cost-related medication nonadherence (CRN) among Medicare enrollees, including elderly and nonelderly disabled beneficiaries. Methods: In the fall of 2004, detailed measures of CRN (skipping or reducing doses or not filling prescriptions because of cost) were added to the Medicare Current Beneficiary Survey. We examined the prevalence of CRN nationally and by Medicare eligibility subgroups (elderly vs nonelderly disabled beneficiaries), drug coverage status, socioeconomic status, self-rated health, and number of chronic medical conditions. Results: In a national sample of 13 835 noninstitutionalized Medicare enrollees, 29% of the disabled and 13% of the elderly beneficiaries reported CRN; those in fair to poor health with multiple comorbidities and without coverage were most at risk. Among the disabled enrollees with 4 or more morbidities, 52% (95% confidence interval [CI], 43.3%-60.3%) without drug coverage skipped prescriptions or doses compared with 26% (95% CI, 17.7%-34.8%) with Medicaid drug coverage. Those with partial drug coverage through Medigap policies or Medicare health maintenance organizations reported intermediate rates of CRN. The adjusted odds ratio of CRN among disabled enrollees in poor (vs good) health was 3.9 (95% CI, 1.7-9.2), whereas for those with 4 or more (vs < 4) comorbidities, the odds ratio of CRN was 2.7 (95% CI, 1.7-4.1). Conclusions: One year before Medicare Part D implementation, Medicare beneficiaries reported high rates of CRN. Rates are highest among nonelderly disabled beneficiaries, but among both elderly and disabled beneficiaries, CRN is exacerbated by poor health, multiple morbidities, and limited drug coverage. Given the high cost sharing under Part D, it is important to closely monitor CRN in high-risk subgroups. C1 Harvard Univ, Med Sch & Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, Boston, MA 02215 USA. Univ Massachusetts, Sch Med, Worcester, MA USA. Meyers Primary Care Inst, Worcester, MA USA. US Dept HHS, Ctr Medicare, Baltimore, MD USA. US Dept HHS, Ctr Medicaid, Baltimore, MD USA. Tufts Univ, Sch Med, Boston, MA 02111 USA. Tufts Univ New England Med Ctr, Hlth Inst, Boston, MA USA. RP Soumerai, SB (reprint author), Harvard Univ, Med Sch & Pilgrim Hlth Care, Dept Ambulatory Care & Prevent, 133 Brookline Ave,6 Floor, Boston, MA 02215 USA. EM ssoumerai@hms.harvard.edu FU AHRQ HHS [2U18HS010391]; NIA NIH HHS [R01 AG022362, R01 AG022362-02S1, R01 AG028745] NR 34 TC 139 Z9 147 U1 4 U2 7 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD SEP 25 PY 2006 VL 166 IS 17 BP 1829 EP 1835 DI 10.1001/archinte.166.17.1829 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 087GI UT WOS:000240730500006 PM 17000938 ER PT J AU Rollow, W Lied, TR McGann, P Poyer, J LaVoie, L Kambic, RT Bratzler, DW Ma, A Huff, ED Ramunno, LD AF Rollow, William Lied, Terry R. McGann, Paul Poyer, James LaVoie, Lawrence Kambic, Robert T. Bratzler, Dale W. Ma, Allen Huff, Edwin D. Ramunno, Lawrence D. TI Assessment of the Medicare Quality Improvement Organization program SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; OF-CARE; IMPROVING QUALITY; HOSPITAL-CARE; HEALTH-CARE; BENEFICIARIES; PROJECT; PNEUMONIA AB Background: Studies have shown improvement in quality of health care in the United States. However, the factors responsible for this improvement are largely unknown. Objective: To evaluate the effect of the Medicare Quality Improvement Organization (QIO) Program in 4 clinical settings by using performance data for 41 quality measures during the 7th Scope of Work. Design: Observational study in which differences in quality measures were compared between baseline and remeasurement periods for providers that received different levels of QIO interventions. Setting: Nursing homes, home health agencies, hospitals, and physician offices in the 50 U.S. states, the District of Columbia, and 2 U.S. territories. Participants: Providers receiving focused QIO assistance related to quality measures and providers receiving general informational assistance from QIOs. Measurements: 5 nursing home quality measures, 11 home health measures, 21 hospital measures, and 4 physician office measures. Results: For nursing home, home health, and physician office measures, providers recruited specifically by QIOs for receipt of assistance showed greater improvement in performance on 18 of 20 measures than did providers who were not recruited; similar improvement was seen on the other 2 measures. Nursing homes and home health agencies improved more in all measures on which they chose to work with the QIO than in other measures. Nineteen of 21 hospital measures showed improvement; in this setting, QIOs were contracted for improvement initiatives solely at the statewide level. Overall, improvement was seen in 34 of 41 measures from baseline to remeasurement in the 7th Scope of Work. Limitations: As in any observational study, selection bias, regression to the mean, and secular trends may have influenced the results. Conclusions: These findings are consistent with an impact of the QIO Program and QIO technical assistance on the observed improvement. Future evaluations of the QIO Program will attempt to better address the limitations of the design of this study. C1 Ctr Medicaid Serv, Baltimore, MD 21244 USA. Ctr Medicare Serv, Baltimore, MD 21244 USA. Ctr Medicare Serv, Kansas City, MO USA. Ctr Medicaid Serv, Kansas City, MO USA. Ctr Medicare Serv, Boston, MA USA. Ctr Medicaid Serv, Boston, MA USA. Oklahoma Fdn Med Qual, Oklahoma City, OK USA. Northeast Hlth Care Qual Fdn, Dover, New Hants, England. RP Rollow, W (reprint author), Ctr Medicare Serv, Mail Stop S3-02-01,7500 Security Blvd, Baltimore, MD 21244 USA. EM william.rollow@cms.hhs.gov NR 39 TC 28 Z9 30 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD SEP 5 PY 2006 VL 145 IS 5 BP 342 EP 353 PG 12 WC Medicine, General & Internal SC General & Internal Medicine GA 080NZ UT WOS:000240255900004 PM 16908911 ER PT J AU Fadrowski, JJ Hwang, W Frankenfield, DL Fivush, BA Neu, AM Furth, SL AF Fadrowski, Jeffrey J. Hwang, Wenke Frankenfield, Diane L. Fivush, Barbara A. Neu, Alicia M. Furth, Susan L. TI Clinical course associated with vascular access type in a national cohort of adolescents who receive hemodialysis: Findings from the clinical performance measures and US renal data system projects SO CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the Pediatric-Academic-Society/Society-for-Pediatric-Research CY MAY 14-17, 2005 CL Washington, DC SP Pediat Acad Soc, Soc Pediat Res ID ARTERIOVENOUS-FISTULAS; RISK-FACTORS; CHILDREN; SURVIVAL; COMPLICATIONS; EXPERIENCE; MICROSURGERY; CATHETERS; DIALYSIS; CREATION AB Limited research has described clinical outcomes that are associated with the type of vascular access in pediatric patients who receive maintenance hemodialysis. This retrospective cohort study examined prevalent pediatric patients who were aged 12 to < 18 yr and identified in the 2000 ESRD Clinical Performance Measures Project as receiving in-center hemodialysis. Vascular access type as of December 31, 1999, was identified. These patients were linked with 1 yr of data (January 1, 2000, through December 31, 2000) from US Renal Data System standard analytic files that allow for the comparison of rates of hospitalizations and access complications by access type. Of the 418 patients who met inclusion criteria, the mean age was 15.6 yr, 53% were male, 49% were white, the mean time on dialysis was 22 mo, and 42% had a structural/urologic cause of ESRD; 42% of patients had an arteriovenous graft or fistula, and 58% had a vascular catheter. Patients with a vascular catheter as compared with those with a graft or fistula had the following adjusted relative risks (95% confidence interval): 1.84 (1.38 to 2.44) for hospitalization for any cause, 4.74 (2.02 to 11.14) for hospitalization as a result of infection, and 2.72 (2.00 to 3.69) for a complication of vascular access. Vascular catheters are the predominant access type in adolescent patients who receive maintenance hemodialysis and are associated with significantly more hospitalizations and complications. C1 Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Ctr Medicare & Medicaid Serv, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD 21205 USA. Wake Forest Univ, Sch Med, Dept Publ Hlth, Winston Salem, NC 27109 USA. RP Fadrowski, JJ (reprint author), Pk 335,600 N Wolfe St, Baltimore, MD 21287 USA. EM jfadrow1@jhmi.edu FU NIDDK NIH HHS [R21-DK064313, K24 DK078737]; NIEHS NIH HHS [K23 ES016514] NR 34 TC 14 Z9 14 U1 0 U2 1 PU AMERICAN SOCIETY NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1046-6673 J9 CLIN J AM SOC NEPHRO JI Clin. J. Am. Soc. Nephrol. PD SEP PY 2006 VL 1 IS 5 BP 987 EP 992 DI 10.2215/CJN.00530206 PG 6 WC Urology & Nephrology SC Urology & Nephrology GA 107LL UT WOS:000242173000015 PM 17699317 ER PT J AU Sensenig, AL Donahoe, GF AF Sensenig, Arthur L. Donahoe, Gerald F. TI Improved estimates of capital formation in the National Health Expenditure Accounts SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The National Health Expenditure Accounts (NHEA) were revised with the release of the 2004 estimates. The largest revision was the incorporation of a more comprehensive measure of investment in medical sector capital. The revision raised total health expenditures' share of gross domestic product (GDP) from 15.4 to 15.8 percent in 2003. The improved measure encompasses investment in moveable equipment and software, as well as expenditures for the construction of structures used by the medical sector. C1 Ctr Medicare, Baltimore, MD 21244 USA. Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Sensenig, AL (reprint author), Ctr Medicare, 7500 Secur Blvd,N3-02-02, Baltimore, MD 21244 USA. EM Arthur.Sensenig@cms.hhs.gov NR 17 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2006 VL 28 IS 1 BP 9 EP 23 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 116OI UT WOS:000242811800002 PM 17290665 ER PT J AU Hartman, M Smith, C Heffler, S Freeland, M AF Hartman, Micah Smith, Cynthia Heffler, Stephen Freeland, Mark TI Monitoring health spending increases: Incremental budget analyses reveal challenging tradeoffs SO HEALTH CARE FINANCING REVIEW LA English DT Article ID TRENDS AB With each passing decade, health care has consumed a larger share of gross domestic product (GDP) and Federal budgets. By the 2000-2004 period, society was willing to devote over 20 percent of the cumulative increase in GDP and the cumulative increase in Federal outlays towards health care. The financing challenges are expected to become more acute for private payers as well as Federal, State, and local budgets. With the implementation of Part D in 2006, the U.S. Office of Management and Budget projects that Federal budget. pressures will heighten, bringing increased attention to Medicare's long-term fiscal outlook. C1 Ctr Medicare, Off Actuary, Baltimore, MD 21244 USA. Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Hartman, M (reprint author), Ctr Medicare, Off Actuary, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM Micah.Hartman@cms.hhs.gov NR 16 TC 3 Z9 3 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2006 VL 28 IS 1 BP 41 EP 52 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 116OI UT WOS:000242811800004 PM 17290667 ER PT J AU Riley, GF AF Riley, Gerald F. TI Health insurance and access to care among social security disability insurance beneficiaries during the Medicare waiting period SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID DISABLED-WORKER BENEFICIARIES; COVERAGE; COST AB For most Social Security Disability Insurance (SSDI) beneficiaries, Medicare entitlement begins 24 months after the date of SSDI entitlement. Many may experience poor access to health care during the 24-month waiting period because of a lack of insurance. National Health Interview Survey data for the period 1994-1996 were linked to Social Security and Medicare administrative records to examine health insurance status and access to care during the Medicare waiting period. Twenty-six percent of SSDI beneficiaries reported having no health insurance, with the uninsured reporting many more problems with access to care than insured individuals. Access to health insurance is especially important for people during the waiting period because of their low incomes, poor health, and weak ties to the workforce. C1 Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Riley, GF (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, 7500 Secur Blvd,Room C3-20-17, Baltimore, MD 21244 USA. EM gerald.riley@cms.hhs.gov NR 25 TC 9 Z9 9 U1 1 U2 1 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD FAL PY 2006 VL 43 IS 3 BP 222 EP 230 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 114AJ UT WOS:000242638800005 PM 17176966 ER PT J AU Hsu, CE Mas, FS Hickey, JM Miller, JA Lai, DJ AF Hsu, Chiehwen Ed Mas, Francisco Soto Hickey, Jessica M. Miller, Jerry A. Lai, Dejian TI Surveillance of the colorectal cancer disparities among demographic subgroups: A spatial analysis SO SOUTHERN MEDICAL JOURNAL LA English DT Article DE colorectal cancer; health disparities; public health informatics; Geographic Information Systems; spatial analysis ID MORTALITY STATISTICS; AREA AB Objective: The literature suggests that colorectal cancer mortality in Texas is distributed inhomogeneously among specific demographic subgroups and in certain geographic regions over an extended period. To understand the extent of the demographic and geographic disparities, the present study examined colorectal cancer mortality in 15 demographic groups in Texas counties between 1990 and 2001. Methods: The Spatial Scan Statistic was used to assess the standardized mortality ratio, duration and age-adjusted rates of excess mortality, and their respective p-values for testing the null hypothesis of homogeneity of geographic and temporal distribution. Results: The study confirmed the excess mortality in some Texas counties found in the literature, identified 13 additional excess mortality regions, and found 4 health regions with persistent excess mortality involving several population subgroups. Conclusion: Health disparities of colorectal cancer mortality continue to exist in Texas demographic subpopulations. Health education and intervention programs should be directed to the at-risk subpopulations in the identified regions. C1 Univ Maryland, Dept Publ & Community Hlth, College Pk, MD 20742 USA. Univ Texas, Hlth Sci Ctr, Sch Hlth Informat Sci, Houston, TX USA. Univ Texas, Coll Educ, Dept Teacher Educ, El Paso, TX 79968 USA. Dallas Reg Off, Ctr Medicare, Dallas, TX USA. Dallas Reg Off, Ctr Medicaid Serv, Dallas, TX USA. Ctr Dis Control & Prevent, Natl Ctr birth Defects & Dev Disabil, Atlanta, GA USA. Univ Texas, Hlth Sci Ctr, Div Biostat, Sch Publ Hlth, Houston, TX USA. RP Hsu, CE (reprint author), Univ Maryland, Dept Publ & Community Hlth, Coll Pk,2371 HHP Bldg,Valley Dr, College Pk, MD 20742 USA. NR 19 TC 7 Z9 7 U1 2 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0038-4348 J9 SOUTH MED J JI South.Med.J. PD SEP PY 2006 VL 99 IS 9 BP 949 EP 956 DI 10.1097/01.smj.0000224755.73679.67 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 134GY UT WOS:000244072700013 PM 17004529 ER PT J AU Bratzler, DW Hunt, DR AF Bratzler, Dale W. Hunt, David R. TI The surgical infection prevention and surgical care improvement projects: National initiatives to improve outcomes for patients having surgery SO CLINICAL INFECTIOUS DISEASES LA English DT Article ID LENGTH-OF-STAY; HIGH-RISK SURGERY; ANTIMICROBIAL PROPHYLAXIS; VENOUS THROMBOEMBOLISM; SITE INFECTIONS; POSTOPERATIVE COMPLICATIONS; MEDICARE BENEFICIARIES; NONCARDIAC SURGERY; WOUND-INFECTION; HOSPITAL COSTS AB Among the most common complications that occur after surgery are surgical site infections and postoperative sepsis, cardiovascular complications, respiratory complications (including postoperative pneumonia), and thromboembolic complications. Patients who experience postoperative complications have dramatically increased hospital length of stay, hospital costs, and mortality rates. The Centers for Medicare & Medicaid Services, in collaboration with the Centers for Disease Control and Prevention, has implemented the Surgical Infection Prevention Project to decrease the morbidity and mortality associated with postoperative surgical site infections. More recently, the Surgical Care Improvement Project, a national quality partnership of organizations committed to improving the safety of surgical care, has been announced. This review will provide an update from the Surgical Infection Prevention Project and provide an introduction to the Surgical Care Improvement Project. C1 Oklahoma Fdn Med Qual, Oklahoma City, OK 73134 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Bratzler, DW (reprint author), Oklahoma Fdn Med Qual, 14000 Quail Springs Pkwy,Ste 400, Oklahoma City, OK 73134 USA. EM dbratzler@okqio.sdps.org FU PHS HHS [500-02-OK-03] NR 56 TC 246 Z9 248 U1 2 U2 8 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1058-4838 EI 1537-6591 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD AUG 1 PY 2006 VL 43 IS 3 BP 322 EP 330 DI 10.1086/505220 PG 9 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 057XK UT WOS:000238628300012 PM 16804848 ER PT J AU Goldstein, SL Brem, A Warady, BA Fivush, B Frankenfield, D AF Goldstein, Stuart L. Brem, Andrew Warady, Bradley A. Fivush, Barbara Frankenfield, Diane TI Comparison of single-pool and equilibrated Kt/V values for pediatric hemodialysis prescription management: analysis from the Centers for Medicare & Medicaid Services Clinical Performance Measures Project SO PEDIATRIC NEPHROLOGY LA English DT Article DE Kt/V; adequacy; eKt/V; single-pool; hemodialysis ID MAINTENANCE HEMODIALYSIS; DIALYSIS; CLEARANCE; KINETICS; CHILDREN AB Current formulas that estimate the delivered dose of hemodialysis rely upon pre- and post-treatment blood urea nitrogen ( BUN) concentrations for calculation. Single-pool kinetic modeling ( spKt/V) uses a convenient 30-s post-dialysis BUN sample but does not take urea rebound into account. Double-pool modeling ( eKt/V) uses an equilibrated BUN ( eqBUN) and is the best reflection of the true urea mass removed by hemodialysis but is inconvenient for patients and costly to the dialysis unit to wait to obtain an eqBUN sample. We compared simple spKt/V and eKt/V estimation formulas using data obtained from the Centers for Medicare & Medicaid Services ( CMS) End Stage Renal Disease ( ESRD) Clinical Performance Measures ( CPM) Project to determine how frequently these two results would lead to different prescription management. We set an expected difference Kt/V ( spKt/V-eKt/V) of 0.20 based on results of the Hemodialysis ( HEMO) Study; 1,513 paired spKt/ V and estimated eKt/V results were available for comparison. For patients with an arteriovenous fistula ( AVF) or arteriovenous graft ( AVG) ( n = 720), mean spKt/V and estimated eKt/V were 1.62 +/- 0.30 and 1.37 +/- 0.26, respectively. For patients with a catheter ( n = 793), mean spKt/V and estimated eKt/ V were 1.53 +/- 0.32 and 1.33 +/- 0.29, respectively. Examination of the different spKt/V and estimated eKt/V pairings revealed a greater adequacy discordance rate between a 0.20 difference in spKt/V and estimated eKt/V at higher Kt/V values, but Kt/V discordance rates only varied from 0.3 to 5.5% depending on the paired Kt/V values used. C1 Texas Childrens Hosp, Houston, TX 77030 USA. Johns Hopkins Univ, Baltimore, MD USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Childrens Mercy Hosp & Clin, Kansas City, MO USA. Brown Univ, Sch Med, Providence, RI 02912 USA. Baylor Coll Med, Houston, TX 77030 USA. RP Goldstein, SL (reprint author), Texas Childrens Hosp, 6621 Fannin St,MC 3-2482, Houston, TX 77030 USA. EM stuartg@bcm.tmc.edu NR 12 TC 11 Z9 11 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0931-041X J9 PEDIATR NEPHROL JI Pediatr. Nephrol. PD AUG PY 2006 VL 21 IS 8 BP 1161 EP 1166 DI 10.1007/s00467-006-0112-8 PG 6 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 074NC UT WOS:000239818100017 PM 16705459 ER PT J AU Burwen, DR La Voie, L Braun, MM Houck, P Hudson, R Ball, R AF Burwen, Dale R. La Voie, Lawrence Braun, M. Miles Houck, Peter Hudson, Rebecca Ball, Robert TI Evaluating adverse events after vaccination in the medicare population SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 US FDA, Rockville, MD 20857 USA. Ctr Medicare & Medicaid Serv, Rockville, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU JOHN WILEY & SONS LTD PI CHICHESTER PA THE ATRIUM, SOUTHERN GATE, CHICHESTER PO19 8SQ, W SUSSEX, ENGLAND SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2006 VL 15 SU 1 MA 168 BP S79 EP S79 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 080XG UT WOS:000240281200169 ER PT J AU Love, TP AF Love, Timothy P. TI Read and decide SO HEALTH AFFAIRS LA English DT Letter C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Love, TP (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JUL-AUG PY 2006 VL 25 IS 4 BP 1188 EP 1189 DI 10.1377/hlthaff.25.4.1188-b PG 2 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 071UR UT WOS:000239629900050 PM 16835210 ER PT J AU Nathan, RV Rhew, DC Murray, C Bratzler, DW Houck, PM Weingarten, SR AF Nathan, RV Rhew, DC Murray, C Bratzler, DW Houck, PM Weingarten, SR TI In-hospital observation after antibiotic switch in pneumonia: A national evaluation SO AMERICAN JOURNAL OF MEDICINE LA English DT Article DE pneumonia; antibiotics; hospital; health services research ID COMMUNITY-ACQUIRED PNEUMONIA; LOW-RISK PATIENTS; INTRAVENOUS ANTIBIOTICS; INTERVENTIONAL TRIAL; OBSERVATION PERIOD; DISCHARGE; CARE AB PURPOSE: To evaluate the clinical benefit of in-hospital observation after the switch from intravenous (IV) to oral antibiotics in a large Medicare population. Retrospective studies of relatively small size indicate that the practice of in-hospital observation after the switch from IV to oral antibiotics for patients hospitalized with community-acquired pneumonia (CAP) is unnecessary. METHODS: We performed a retrospective examination of the US Medicare National Pneumonia Project database. Eligible patients were discharged with an ICD-9-CM diagnosis consistent with community-acquired pneumonia and divided into 2 groups: 1) a "not observed" cohort, in which patients were discharged on the same day as the switch from IV to oral antibiotics and 2) an "observed for 1 day" cohort, in which patients remained hospitalized for 1 day after the switch from IV to oral antibiotics. We compared clinical outcomes between these 2 cohorts. RESULTS: A total of 39,242 cases were sampled, representing 4341 hospitals in all 50 states and the District of Columbia. There were 5248 elderly patients who fulfilled eligibility criteria involving a length of stay of no more than 7 hospital days (2536 "not observed" and 2712 "observed for 1 day" patients). Mean length of stay was 3.8 days for the "not observed" cohort and 4.5 days for the "observed for 1 day" cohort (P <.0001). There was no significant difference in 14-day hospital readmission rate (7.8% in the "not observed" cohort vs 7.2% "observed for 1 day" cohort, odds ratio 0.91; 95% confidence interval [CI] 0.74-1.12; P =. 367) and 30-day mortality rate (5.1% "not observed" cohort vs 4.4% in the "observed for 1 day" cohort, odds ratio 0.86; 95% CI, 0.67-1.11; P =. 258) between the "not observed" and "observed for 1 day" cohorts. CONCLUSIONS: Our analysis of the US Medicare Pneumonia Project database provides further evidence that the routine practice of in-hospital observation after the switch from IV to oral antibiotics for patients with CAP may be avoided in patients who are clinically stable although these findings should be verified in a large randomized controlled trial. (c) 2006 Elsevier Inc. All rights reserved. C1 Zynx Hlth Inc, Los Angeles, CA 90024 USA. Vet Affairs Greater Los Angeles Healthcare Syst, Div Infect Dis, Dept Med, Los Angeles, CA USA. Cedars Sinai Med Ctr, Dept Hlth Serv Res, Los Angeles, CA 90048 USA. Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA USA. Oklahoma Fdn Med Qual, Oklahoma City, OK USA. Ctr Medicare, Seattle, WA USA. Ctr Medicaid Serv, Seattle, WA USA. RP Rhew, DC (reprint author), Zynx Hlth Inc, 10880 Wilshire Blvd,Suite 1450, Los Angeles, CA 90024 USA. EM drhew@zynx.com NR 18 TC 14 Z9 16 U1 0 U2 3 PU EXCERPTA MEDICA INC PI NEW YORK PA 650 AVENUE OF THE AMERICAS, NEW YORK, NY 10011 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD JUN PY 2006 VL 119 IS 6 BP 512 EP 518 DI 10.1016/j.amjmed.2005.09.012 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 050TD UT WOS:000238110500012 ER PT J AU Levy, JM Robst, J Ingber, MJ AF Levy, Jesse M. Robst, John Ingber, Melvin J. TI Risk-adjustment system for the Medicare capitated ESRD program SO HEALTH CARE FINANCING REVIEW LA English DT Article AB Medicare is the principal payer for medical services for those in the U.S. population suffering from end-stage renal disease (ESRD). By law, beneficiaries diagnosed with ESRD may not subsequently enroll in Medicare Advantage (MA) plans, however, the potential benefits of managed care for this population have stimulated interest in changing the law and developing demonstration plans. We describe a new risk-adjustment system developed for Medicare to pay for ESRD beneficiaries in managed care plans. The model improves on current payment methodology by adjusting payments for treatment status and comorbidities. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Univ S Florida, Tampa, FL 33620 USA. RP Levy, JM (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-24-07, Baltimore, MD 21244 USA. EM jesse.levy@cms.hhs.gov NR 8 TC 2 Z9 2 U1 0 U2 2 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2006 VL 27 IS 4 BP 53 EP 69 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 080KY UT WOS:000240247800005 PM 17290658 ER PT J AU Weeks, WB Bott, DM Bazos, DA Campbell, SL Lombardo, R Racz, MJ Hannan, EL Wright, SM Fisher, ES AF Weeks, WB Bott, DM Bazos, DA Campbell, SL Lombardo, R Racz, MJ Hannan, EL Wright, SM Fisher, ES TI Veterans health administration patients' use of the private sector for coronary revascularization in New York - Opportunities to improve outcomes by directing care to high-performance hospitals SO MEDICAL CARE LA English DT Article; Proceedings Paper CT 5th World Congress of the International-Health-Economics-Association CY JUL, 2005 CL Barcelona, SPAIN SP Int Hlth Econ Assoc DE VA Health Care System; outcomes ID BYPASS GRAFT-SURGERY; ACUTE MYOCARDIAL-INFARCTION; QUALITY IMPROVEMENT; OPERATIVE MORTALITY; MEDICARE SERVICES; OF-CARE; AFFAIRS; RISK; VOLUME; SYSTEM AB Objective: We sought to quantify Veterans Health Administration (VA) patients' utilization of coronary revascularization in the private sector and to assess the potential impact of directing this care to high-performance hospitals. Methods: Using VA and New York State administrative and clinical databases, we conducted a retrospective cohort study examining residents of New York State who were enrolled in the VA and underwent either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) in 1999 or 2000 (n = 6562) in either the VA or the private sector. We first calculated the proportion of revascularizations obtained in the VA and the private sector. We then identified the private sector hospitals in which these men obtained revascularizations and determined potential changes in mortality and travel burden associated with directing private sector care to high performance hospitals. Results: VA patients in New York were much more likely. to undergo revascularization in the private sector than in VA hospitals: 83% of CABGs (2341/2829) and 87% of PCIs (4054/4665) were obtained in the private sector. Private sector utilization was distributed evenly across high- and low-mortality hospitals. Directing private-sector CABG surgery to high-performance hospitals could have reduced expected mortality by 24% (from 2.3% to 1.7%) and would only increase median travel time from 21 to 30 minutes. The benefit of redirecting PCI care is minimal. Conclusions: For high-mortality procedures that veterans frequently obtain in the private sector, like CABG, directing care to high-performance hospitals may be an effective way to improve outcomes for veterans. C1 Vet Hlth Adm, VA Outcomes Grp, White River Jct, VT USA. Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Ctr Evaluat Clin Sci, Hanover, NH 03756 USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. VA Med Ctr, Off Qual & Performance, Providence, RI USA. Univ Albany, Sch Publ Hlth, Dept Hlth Policy Management & Behav, Rensselaer, NY USA. New York State Dept Hlth, Sch Publ Hlth, Rensselaer, NY USA. Vet Hlth Adm, Off Qual & Performance, Washington, DC USA. RP Weeks, WB (reprint author), VAMC, MBA, 110Q, White River Jct, VT 05009 USA. EM William.B.Weeks@Dartmouth.edu RI Weeks, William/G-7436-2014 NR 41 TC 20 Z9 20 U1 2 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUN PY 2006 VL 44 IS 6 BP 519 EP 526 DI 10.1097/01.mlr.0000215888.20004.5e PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 050FN UT WOS:000238073000005 PM 16708000 ER PT J AU Schrag, D Xu, F Hanger, M Elkin, E Bickell, NA Bach, PB AF Schrag, D Xu, F Hanger, M Elkin, E Bickell, NA Bach, PB TI Fragmentation of care for frequently hospitalized urban residents SO MEDICAL CARE LA English DT Article DE fragmentation; frequent hospital users; chronic illness; insurance; psychosis; substance abuse ID MENTAL-HEALTH-SERVICES; EMERGENCY-DEPARTMENT; CONTINUITY; DISCONTINUITY; OUTCOMES AB Background: Fragmentation across sites of care may impede efficient healthcare delivery. Objectives: The objectives of this study were to evaluate fragmentation of hospital care for chronically ill New York City (NYC) residents and its association with enrollment in the New York State (NYS) Medicaid program. Research Design: We conducted a cross-sectional study using the NYS Department of Health's Statewide Planning and Research Cooperative System discharge database. We identified 53,031 NYC residents admitted 3 or more times to acute care hospitals between 2000 and 2002 with the same principal diagnosis of a specific chronic illness (diabetes, sickle cell anemia, psychosis, substance abuse, cancer, gastrointestinal disease, chronic obstructive pulmonary disease/asthma, coronary artery disease, or congestive heart failure). We also evaluated a larger cohort of 225,421 patients with >= 3 admissions for a specific chronic illness coded as either the principal or a secondary diagnosis. A generalized logit model was used to examine the relationship between fragmentation and each patient's primary insurance adjusted for diagnosis and demographic characteristics. Measures: Fragmentation was characterized as high, moderate, or low based on the number of distinct hospitals a patient visited relative to the patient's total number of hospitalizations over the 3-year interval. Results: Among frequently hospitalized NYC residents with select chronic conditions, 17.1% experienced highly fragmented care. This rate was 9.9% for patients with commercial insurance, 24.4% for those with Medicaid, and 9.7% for those with Medicare. The unadjusted odds ratio describing high fragmentation of Medicaid enrollees compared with commercially insured patients was 3.82 (95% confidence interval [CI], 3.50-4.18) and, although attenuated, remained significant after adjustment for demographic characteristics (odds ratio, 1.33; 95% CI, 1.20-1.47). The strongest predictor of fragmentation was a diagnosis of psychosis (OR, 2.81; 95% CI, 2.43-3.25) or substance abuse (OR, 7.58; 95% CI, 6.55-8.77). Conclusions: In NYC, Medicaid enrollment is associated with greater fragmentation of hospital care, but this is largely attributable to the preponderance of Medicaid enrollees with diagnoses of psychosis and substance abuse. Strategies to improve the efficiency of healthcare delivery should focus on patients with mental illness who are frequently admitted to general hospitals. C1 Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, Ctr Medicare Serv, New York, NY 10021 USA. Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, Ctr Medicaid Serv, New York, NY 10021 USA. Mem Sloan Kettering Canc Ctr, Hlth Outcomes Res Grp, New York, NY 10021 USA. CUNY Mt Sinai Sch Med, Dept Hlth Policy, New York, NY 10029 USA. RP Schrag, D (reprint author), Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, Ctr Medicare Serv, 307 E 63rd St,3rd Floor, New York, NY 10021 USA. EM schragd@mskcc.org NR 25 TC 22 Z9 22 U1 0 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUN PY 2006 VL 44 IS 6 BP 560 EP 567 DI 10.1097/01.mlr.0000215811.68308.ae PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 050FN UT WOS:000238073000010 PM 16708005 ER PT J AU Slayter, EM Garnick, DW Kubisiak, JM Bishop, CE Gilden, DM Hakim, RB AF Slayter, EM Garnick, DW Kubisiak, JM Bishop, CE Gilden, DM Hakim, RB TI Injury prevalence among children and adolescents with mental retardation SO MENTAL RETARDATION LA English DT Article ID HEALTH INTERVIEW SURVEY; DEVELOPMENTAL-DISABILITIES; INTELLECTUAL DISABILITY; YOUNG-PEOPLE; RISK; FRACTURES; MORTALITY; FACILITY; EPILEPSY AB Childhood injuries lead to increased morbidity and result in significant costs to public insurance programs. People with mental retardation, most of whom are covered by Medicaid, are at high risk for injury, which has implications for community inclusion, a central policy goal. Medicaid data from inpatient, outpatient, and long-term care settings represent an important new resource for injury surveillance in this population. Injury prevalence for 8.4 million Medicaid-eligible children in 26 states was measured using 1999 eligibility and claims data; 36.9% Medicaid beneficiaries ages 1 to 20 with mental retardation had at least one injury claim as compared with 23.5% of those without mental retardation. Prevalence rates are reported by gender and age for a variety of injury types. C1 Brandeis Univ, Nathan & Toby Starr Ctr Mental Retardat, Waltham, MA 02454 USA. Brandeis Univ, Heller Sch Social Policy & Management, Schneider Inst Hlth Policy, Waltham, MA 02454 USA. JEN Associates, Cambridge, MA 02139 USA. Ctr Medicare & Medicaid Serv, Coverage & Anal Grp, Off Clin Stand & Qual, Baltimore, MD 21244 USA. RP Slayter, EM (reprint author), Brandeis Univ, Nathan & Toby Starr Ctr Mental Retardat, Waltham, MA 02454 USA. EM eslayter@brandeis.edu RI Garnick, Deborah/I-9009-2012 NR 39 TC 12 Z9 12 U1 1 U2 6 PU AMER ASSOC MENTAL RETARDATION PI WASHINGTON PA 444 N CAPITOL ST, NW, STE 846, WASHINGTON, DC 20001-1512 USA SN 0047-6765 J9 MENT RETARD JI Ment. Retard. PD JUN PY 2006 VL 44 IS 3 BP 212 EP 223 DI 10.1352/0047-6765(2006)44[212:IPACAA]2.0.CO;2 PG 12 WC Education, Special; Rehabilitation SC Education & Educational Research; Rehabilitation GA 048SS UT WOS:000237967400005 PM 16677066 ER PT J AU Bach, PB McClellan, MB AF Bach, PB McClellan, MB TI The first months of the prescription-drug benefit - A CMS update SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 Ctr Medicare, Washington, DC USA. Ctr Medicaid Serv, Washington, DC USA. RP Bach, PB (reprint author), Ctr Medicare, Washington, DC USA. NR 4 TC 23 Z9 23 U1 0 U2 0 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JUN 1 PY 2006 VL 354 IS 22 BP 2312 EP 2314 DI 10.1056/NEJMp068108 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 047ZZ UT WOS:000237918500002 PM 16738266 ER PT J AU Mardon, RE Halim, S Pawlson, LG Haffer, SC AF Mardon, RE Halim, S Pawlson, LG Haffer, SC TI Management of urinary incontinence in Medicare managed care beneficiaries - Results from the 2004 Medicare Health Outcomes Survey SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID COMMUNITY; WOMEN AB Background: Despite the high prevalence of urinary incontinence (UI) among older persons and the existence of effective treatments, UI remains underreported by patients and underdiagnosed by clinicians. We measured the occurrence of UI problems in Medicare managed care beneficiaries, frequency of physician-patient communication regarding UI, and frequency of UI treatment. Methods: We used cross-sectional data from the 2004 Medicare Health Outcomes Survey, which measured self-reported UI (accidental leakage of urine) and UI problems in the past 6 months, 36-Item Short-Form Health Survey health measures, discussions of UI with a health care provider, and receipt of UI treatment. Results: The overall incidence of UI within the past 6 months was 37.3%, consistent with previous estimates. Problems with UI were strongly associated with poorer self- reported health. Mean 36-Item Short-Form Health Survey physical and mental health scores were lower by more than 5 points (on a 100-point scale, P <.001) for respondents with major UI problems when controlling for age, sex, race, Hispanic ethnicity, and major comorbidities. These differences were among the largest of any condition measured. Only 55.5% of those with self-reported UI problems reported discussing these problems during their recent visit to a physician or other health care provider. The rate of patient-reported UI treatment was 56.5% and was lower (P <.001) for older individuals (eg, 46.3% for those aged 90-94 years) or those with poor self-reported health status (50.5%). Conclusions: Among older persons, UI is common, underdiagnosed, and associated with substantial functional impairment. There appears to be considerable opportunity to mitigate the effects of UI on health and quality of life among community-dwelling older persons. C1 Natl Comm Qual Assurance, Washington, DC USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Mardon, RE (reprint author), WESTAT Corp, 1650 Res Blvd, Rockville, MD 20850 USA. EM russmardon@westat.com NR 26 TC 26 Z9 28 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610-0946 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD MAY 22 PY 2006 VL 166 IS 10 BP 1128 EP 1133 DI 10.1001/archinte.166.10.1128 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 045CP UT WOS:000237720500013 PM 16717176 ER PT J AU Goss, JR Maynard, C Aldea, GS Marcus-Smith, M Whitten, RW Johnston, G Phillips, RC Reisman, M Kelley, A Anderson, RP AF Goss, JR Maynard, C Aldea, GS Marcus-Smith, M Whitten, RW Johnston, G Phillips, RC Reisman, M Kelley, A Anderson, RP CA COAP Program TI Effects of a statewide physician-led quality-improvement program on the quality of cardiac care SO AMERICAN HEART JOURNAL LA English DT Article ID NEW-YORK-STATE; BYPASS GRAFT-SURGERY; HOSPITAL MORTALITY; HEALTH-CARE; OUTCOMES; MODEL; RISK AB Background Several states have implemented mandatory public reporting of outcomes of cardiac revascularization procedures. Washington is the first to develop a nonmandatory, physician-led reporting program with public accountability and universal hospital participation. The purpose of this study was to determine whether quality improvement interventions resulted in the correction of data deficiencies and performance outliers for cardiac revascularization procedures. Methods From 1999 through 2003, there were 18 hospitals with coronary bypass surgery and interventional cardiology programs and 12 with only the latter. All patients >= 18 years undergoing 24372 isolated coronary bypass surgeries and 59 656 percutaneous coronary interventions were included. After 1999 to 2001 data were analyzed in early 2002, the Clinical Outcomes Assessment Program implemented a 6-step quality-improvement intervention to measure and remeasure data quality, process compliance, and performance. Results In 2003, 4 of the 18 surgery programs had 1 statistical outlier with respect to 4 performance measures, whereas 2 of 30 coronary intervention programs were mortality outliers. For bypass surgery, all programs maintained full compliance with program standards by adhering to timely and reliable submission of data, developing plans to address performance outliers, and demonstrating that outlier status did not persist from baseline to remeasurement. For coronary interventions, 1 program was a persistent outlier for mortality in 2002 and 2003. Conclusions The Clinical Outcomes Assessment Program has successfully monitored cardiac care patterns in Washington State over a 5-year period. Most hospitals that perform coronary revascularization procedures meet acceptable performance standards. C1 Univ Washington, Dept Med, Seattle, WA 98195 USA. Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. Dept Vet Affairs, Seattle, WA USA. Univ Washington, Dept Surg, Seattle, WA 98195 USA. Fdn Hlth Care Qual, Seattle, WA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. St Joseph Med Ctr, Tacoma, WA USA. Swedish Med Ctr, Seattle, WA USA. Virginia Mason Med Ctr, Seattle, WA 98101 USA. RP Maynard, C (reprint author), VA Puget Sound Hlth Serv Res & Dev, 1100 Olive Way, Seattle, WA 98101 USA. EM cmaynard@u.washington.edu RI Maynard, Charles/N-3906-2015 OI Maynard, Charles/0000-0002-1644-7814 NR 20 TC 10 Z9 10 U1 0 U2 1 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0002-8703 J9 AM HEART J JI Am. Heart J. PD MAY PY 2006 VL 151 IS 5 BP 1033 EP 1042 DI 10.1016/j.ahj.2005.06.035 PG 10 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 043YF UT WOS:000237638200024 PM 16644333 ER PT J AU Frankenfield, DL Atkinson, MA Fivush, BA Neu, AM AF Frankenfield, DL Atkinson, MA Fivush, BA Neu, AM TI Outcomes for adolescent Hispanic hemodialysis patients: Findings from the ESRD Clinical Performance Measures Project SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE adolescent; Hispanic; ethnicity; disparity; outcomes; hospitalization; transplantation; hemodialysis (HD) ID STAGE RENAL-DISEASE; AMERICAN-INDIANS; KIDNEY-DISEASE; UNITED-STATES; MORTALITY; HEALTH; TRANSPLANTATION; RACE/ETHNICITY; MINORITIES; PATTERNS AB Background: There is limited information regarding outcomes of dialytic care for Hispanic adolescent hemodialysis patients. Methods: Ethnicity information was collected for all adolescent in-center hemodialysis patients for the Centers for Medicare & Medicaid Services 2000 End-Stage Renal Disease (ESRD) Clinical Performance Measures Project. Associations between intermediate outcomes and Hispanic ethnicity were determined. Associations of ethnicity and other demographic/clinical variables with hospitalization and transplantation during the 12-month follow-up period were examined. Results: Twenty-two percent of patients were identified as Hispanic; 40%, as non-Hispanic black; and 32%, as non-Hispanic white. Hispanic patients were younger and more likely to have congenital/urological causes of ESRD. More Hispanic patients had a mean single-pool Kt/V of 1.2 or greater compared with non-Hispanic blacks and non-Hispanic whites (87% versus 73% and 79%; P = 0.036). More Hispanic patients had a mean serum albumin level of 3.5/3.2 g/dL (bromcresol green/bromcresol purple method) or greater ( >= 35/32 g/L; 91% versus 82% and 76%; P = 0.017). More Hispanic patients compared with non-Hispanic blacks and non-Hispanic whites were dialyzed with a catheter for 90 days or longer (30% versus 21 % and 23%; P = 0.027). In the final multivariate Cox proportional hazard models, Hispanic patients were at a slightly decreased risk for hospitalization compared with non-Hispanics (adjusted hazard ratio [adjHR], 0.63; P = 0.031) and were as likely to undergo a first transplantation as non-Hispanic whites (adjHR, 0.56; P = 0.099). Conclusion: Adolescent Hispanic hemodialysis patients experience equivalent or better intermediate outcomes of dialytic care than non-Hispanics. They experienced a decreased risk for subsequent hospitalization and are as likely to undergo transplantation within 12 months as non-Hispanic whites. C1 Johns Hopkins Univ, Sch Med, Baltimore, MD 21287 USA. Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP Atkinson, MA (reprint author), Johns Hopkins Univ, Sch Med, 600 N Wolfe St,Pk 335, Baltimore, MD 21287 USA. EM matkins3@jhmi.edu FU NHLBI NIH HHS [T32 HL07024-30]; NICHD NIH HHS [T32 HD044355] NR 33 TC 6 Z9 6 U1 1 U2 1 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD MAY PY 2006 VL 47 IS 5 BP 870 EP 878 DI 10.1053/j.ajkd.2006.01.021 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 043UK UT WOS:000237627500018 PM 16632027 ER PT J AU Contento, IR Williams, SS Michela, JL Franklin, AB AF Contento, IR Williams, SS Michela, JL Franklin, AB TI Understanding the food choice process of adolescents in the context of family and friends SO JOURNAL OF ADOLESCENT HEALTH LA English DT Article ID SOFT DRINK CONSUMPTION; PLANNED BEHAVIOR; CHILDREN; ASSOCIATIONS; PERCEPTION; PATTERNS; ADULTS; HEALTH; TRENDS; FRUIT AB Purpose: To understand from the adolescents' own perspective the decision-making processes they use to make food choices on an everyday basis and how they resolve their need for personal control over food choices with the values of family and peers. Methods: A sample of 108 adolescents, aged 11-18 years, were individually interviewed. They were asked in a simulated task to choose a lunch from a menu of offerings and give reasons for their choices. In addition, open-ended questions probed for meal structures, dinners, perceptions of degree of choice, role of family and peers. Interviews were audio-taped, transcribed, coded, and analyzed for emerging themes. Results: Primary food choice criteria were taste, familiarity/habit, health, dieting, and fillingness. Lunches had a definite structure, and lunches differed from dinners. The food choice process involved personal food decision-making rules such as trade-offs among choice criteria within a meal (e.g., taste for core items and health for secondary items), and between lunches with peers (taste) and family dinners (health); negotiation patterns with the family (autonomy Versus family needs); and interactions with peers. Conclusions: The food choice process for most adolescents seemed to involve cognitive self-regulation where conflicting values for food choices were integrated and brought into alignment with desired consequences. Educators and practitioners should recognize the dilemmas adolescents face in making food choices and help them develop strategies for balancing less healthful with more healthful food items, through: (a) personal food decision-making rules, (b) effective negotiations with family members; and (c) appropriate interaction patterns with peers. (c) 2006 Society for Adolescent Medicine. All rights reserved. C1 Columbia Univ, Teachers Coll, Dept Hlth & Behav Studies, Nutr Program, New York, NY 10027 USA. Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. Univ Waterloo, Dept Psychol, Waterloo, ON N2L 3G1, Canada. Columbia Univ, Teachers Coll, Dept Hlth & Behav Studies, Nutr Program, New York, NY 10027 USA. RP Contento, IR (reprint author), Columbia Univ, Teachers Coll, Dept Hlth & Behav Studies, Nutr Program, New York, NY 10027 USA. EM irc6@columbia.edu FU NICHD NIH HHS [HD-16559] NR 32 TC 85 Z9 88 U1 2 U2 18 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1054-139X J9 J ADOLESCENT HEALTH JI J. Adolesc. Health PD MAY PY 2006 VL 38 IS 5 BP 575 EP 582 DI 10.1016/j.jadohealth.2005.05.025 PG 8 WC Psychology, Developmental; Public, Environmental & Occupational Health; Pediatrics SC Psychology; Public, Environmental & Occupational Health; Pediatrics GA 038JJ UT WOS:000237215500016 PM 16635770 ER PT J AU Krumholz, HM Wang, Y Mattera, JA Wang, YF Han, LF Ingber, MJ Roman, S Normand, SLT AF Krumholz, HM Wang, Y Mattera, JA Wang, YF Han, LF Ingber, MJ Roman, S Normand, SLT TI An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with an acute myocardial infarction SO CIRCULATION LA English DT Article DE health policy; quality of health care; myocardial infarction ID COOPERATIVE CARDIOVASCULAR PROJECT; QUALITY-OF-CARE; OUTCOMES RESEARCH; RISK ADJUSTMENT; ISSUES AB Background-A model using administrative claims data that is suitable for profiling hospital performance for acute myocardial infarction would be useful in quality assessment and improvement efforts. We sought to develop a hierarchical regression model using Medicare claims data that produces hospital risk-standardized 30-day mortality rates and to validate the hospital estimates against those derived from a medical record model. Methods and Results-For hospital estimates derived from claims data, we developed a derivation model using 140 120 cases discharged from 4664 hospitals in 1998. For the comparison of models from claims data and medical record data, we used the Cooperative Cardiovascular Project database. To determine the stability of the model over time, we used annual Medicare cohorts discharged in 1995, 1997, and 1999-2001. The final model included 27 variables and had an area under the receiver operating characteristic curve of 0.71. In a comparison of the risk-standardized hospital mortality rates from the claims model with those of the medical record model, the correlation coefficient was 0.90 (SE=0.003). The slope of the weighted regression line was 0.95 (SE=0.007), and the intercept was 0.008 (SE=0.001), both indicating strong agreement of the hospital estimates between the 2 data sources. The median difference between the claims-based hospital risk-standardized mortality rates and the chart-based rates was <0.001 (25th and 75th percentiles, -0.003 and 0.003). The performance of the model was stable over time. Conclusions-This administrative claims-based model for profiling hospitals performs consistently over several years and produces estimates of risk-standardized mortality that are good surrogates for estimates from a medical record model. C1 Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06520 USA. Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06520 USA. Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, Room I-456 SHM,333 Cedar St,POB 208088, New Haven, CT 06520 USA. EM harlan.krumholz@yale.edu NR 21 TC 232 Z9 233 U1 0 U2 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD APR 4 PY 2006 VL 113 IS 13 BP 1683 EP 1692 DI 10.1161/CIRCULATIONAHA.105.611186 PG 10 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 029EC UT WOS:000236540700011 PM 16549637 ER PT J AU Krumholz, HM Wang, Y Mattera, JA Wang, YF Han, LF Ingber, MJ Roman, S Normand, SLT AF Krumholz, HM Wang, Y Mattera, JA Wang, YF Han, LF Ingber, MJ Roman, S Normand, SLT TI An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with heart failure SO CIRCULATION LA English DT Article DE health policy; quality of health care; myocardial infarction ID QUALITY-OF-CARE; ACUTE MYOCARDIAL-INFARCTION; MEDICARE BENEFICIARIES; OUTCOMES RESEARCH; READMISSION; ASSOCIATION; PREDICTORS; ISSUES AB Background-A model using administrative claims data that is suitable for profiling hospital performance for heart failure would be useful in quality assessment and improvement efforts. Methods and Results-We developed a hierarchical regression model using Medicare claims data from 1998 that produces hospital risk-standardized 30-day mortality rates. We validated the model by comparing state-level standardized estimates with state-level standardized estimates calculated from a medical record model. To determine the stability of the model over time, we used annual Medicare cohorts discharged in 1999-2001. The final model included 24 variables and had an area under the receiver operating characteristic curve of 0.70. In the derivation set from 1998, the 25th and 75th percentiles of the risk-standardized mortality rates across hospitals were 11.6% and 12.8%, respectively. The 95th percentile was 14.2%, and the 5th percentile was 10.5%. In the validation samples, the 5th and 95th percentiles of risk-standardized mortality rates across states were 9.9% and 13.9%, respectively. Correlation between risk-standardized state mortality rates from claims data and rates derived from medical record data was 0.95 (SE=0.015). The slope of the weighted regression line from the 2 data sources was 0.76 (SE=0.04) with intercept of 0.03 (SE=0.004). The median difference between the claims-based state risk-standardized estimates and the chart-based rates was <0.001 (25th percentile =-0.003; 75th percentile=0.002). The performance of the model was stable over time. Conclusions-This administrative claims-based model produces estimates of risk-standardized state mortality that are very good surrogates for estimates derived from a medical record model. C1 Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06520 USA. Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06520 USA. Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, Room I-456 SHM,333 Cedar St,POB 208088, New Haven, CT 06520 USA. EM harlan.krumholz@yale.edu NR 24 TC 200 Z9 202 U1 1 U2 10 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD APR 4 PY 2006 VL 113 IS 13 BP 1693 EP 1701 DI 10.1161/CIRCULATIONAHA.105.611194 PG 9 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 029EC UT WOS:000236540700012 PM 16549636 ER PT J AU Trisolini, M Zerhusen, E Bandel, K Roussel, A Frederick, P Schatell, D Harris, S AF Trisolini, M Zerhusen, E Bandel, K Roussel, A Frederick, P Schatell, D Harris, S TI Evaluation of the Dialysis Facility Compare website tool on Medicare.gov SO DIALYSIS & TRANSPLANTATION LA English DT Article AB Background. Medicare launched its Dialysis Facility Compare (DFC) website tool on Medicare.gov in 2001. This article reports on the methods and results of our recent evaluation of that website tool. Methods. We conducted qualitative research with 270 dialysis and pre-dialysis patients, family members, and dialysis professionals to obtain feedback, to study respondents' information needs, and to identify ways to improve DFC. Results. Participants viewed DFC as providing useful information, but also as needing improvement in both content and usability. Conclusions. We recommended a number of improvements to DFC, many of which have been implemented by the Centers for Medicare & Medicaid Services. Our methods and results can provide guidance for future efforts to evaluate other patient-oriented renal care websites, C1 RTI Int, Res Triangle Pk, NC 27709 USA. Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. Med Educ Inst, Madison, WI USA. RP Trisolini, M (reprint author), RTI Int, Res Triangle Pk, NC 27709 USA. NR 6 TC 3 Z9 3 U1 1 U2 5 PU CREATIVE AGE PUBL PI VAN NUYS PA 7628 DENSMORE AVE, VAN NUYS, CA 91406-2088 USA SN 0090-2934 J9 DIALYSIS TRANSPLANT JI Dial. Transplant. PD APR PY 2006 VL 35 IS 4 BP 196 EP + DI 10.1002/dat.20014 PG 10 WC Engineering, Biomedical; Transplantation; Urology & Nephrology SC Engineering; Transplantation; Urology & Nephrology GA 034AZ UT WOS:000236897900009 ER PT J AU Hammill, S Phurrough, S Brindis, R AF Hammill, S Phurrough, S Brindis, R TI The National ICD Registry: Now and into the future SO HEART RHYTHM LA English DT Article ID ANTIARRHYTHMIC-DRUG THERAPY; IMPLANTABLE DEFIBRILLATORS; CARDIOVERTER-DEFIBRILLATOR; HEART-FAILURE; DISEASE C1 Mayo Clin, Rochester, MN 55905 USA. Ctr Medicare & Medicaid Serv, Bethesda, MD USA. No Calif Kaiser Permanente, San Francisco, CA USA. RP Hammill, S (reprint author), Mayo Clin, 200 1st St SW, Rochester, MN 55905 USA. EM hammill.stephen@mayo.edu NR 13 TC 30 Z9 31 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1547-5271 J9 HEART RHYTHM JI Heart Rhythm PD APR PY 2006 VL 3 IS 4 BP 470 EP 473 DI 10.1016/j.hrthm.2006.01.019 PG 4 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 031ZJ UT WOS:000236743400018 PM 16567298 ER PT J AU Harris, Y Cooper, JK AF Harris, Y Cooper, JK TI Depressive symptoms in older people predict nursing home admission SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE health outcomes survey; depression; mental health; Cox proportional hazards model; Medicare ID MAJOR DEPRESSION; MORTALITY; DISEASE; RISK AB OBJECTIVES: To evaluate the power of several self-reported depressive symptoms to predict nursing home admission (NHA). DESIGN: A Cox proportional hazards model was used to estimate the risk of NHA. SETTING: Data were from the Health Outcomes Survey (a national random sample of 137,000 Medicare + Choice enrollees aged 65 and older), the Nursing Home Minimum Data Set, and the Medicare Enrollment Database. PARTICIPANTS: Medicare beneficiaries aged 65 and older enrolled in a Medicare Managed Care Plan who were self-respondents to the questionnaire and were not institutionalized at the time of the survey. MEASUREMENTS: Variables were self-reported functional status, chronic health conditions, demographics, and several mood-related questions. RESULTS: After controlling for age, race, sex, marital status, home ownership, functional status, and comorbid conditions, individuals who identified themselves as feeling sad or depressed much of the time over the previous year were at significantly higher risk of NHA. CONCLUSION: A single question about depressive symptoms can be used to identify individuals at higher risk of NHA. There may be benefit from better screening and treatment of depression in community-based older people. Depression and social support may be linked. This study was targeted and did not attempt to explain everything that affects NHA. Investigation of the relationship between social support, depression, and NHA should be considered in future research. C1 Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. George Washington Univ, Sch Med, Dept Med, Washington, DC USA. RP Harris, Y (reprint author), Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, 7500 Secur Blvd,Mailstop S3-02-01, Baltimore, MD 21244 USA. EM yharris@cms.hhs.gov NR 24 TC 34 Z9 34 U1 1 U2 2 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD APR PY 2006 VL 54 IS 4 BP 593 EP 597 DI 10.1111/j.1532-5415.2006.00687.x PG 5 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 029SQ UT WOS:000236585100004 PM 16686868 ER PT J AU Birman-Deych, E Radford, MJ Nilasena, DS Gage, BF AF Birman-Deych, E Radford, MJ Nilasena, DS Gage, BF TI Use and effectiveness of warfarin in medicare beneficiaries with atrial fibrillation SO STROKE LA English DT Article DE atrial fibrillation; continental population groups; stroke; warfarin ID STROKE RISK-FACTORS; ANTITHROMBOTIC THERAPY; CLINICAL-PRACTICE; TRIALS TRANSLATE; PREVENTION; ANTICOAGULATION; ASPIRIN; CLASSIFICATION; METAANALYSIS; EFFICACY AB Background and Purpose - More than 2 million Americans have atrial fibrillation, and without antithrombotic therapy, their stroke rate is increased 5-fold. In randomized controlled trials, warfarin prevented 65% of ischemic strokes ( hazard ratio [HR], 0.35; 95% CI, 0.26 to 0.48) compared with no antithrombotic therapy. However, the effectiveness of warfarin therapy outside of clinical trials is unknown, especially in black and Hispanic populations. Our goal was to quantify use of warfarin therapy, frequency of International Normalized Ratio monitoring, and effectiveness for stroke prophylaxis in Medicare beneficiaries with atrial fibrillation. Methods - This was a cohort study of Medicare beneficiaries with atrial fibrillation who were hospitalized between March 1998 and April 1999 in all 50 US states. The primary outcome was incident hospitalizations for ischemic stroke based on validated International Classification of Diseases, 9th Revision, Clinical Modification codes. Results - Two thirds of ideal anticoagulation candidates were prescribed warfarin on hospital discharge. In unadjusted analyses, the stroke rates per 100 patient years of warfarin therapy were 5.2 in (non-Hispanic) white Medicare beneficiaries, 10.6 in black beneficiaries, and 12.2 in Hispanic beneficiaries. After adjusting for comorbid conditions, warfarin prescription was more frequent and monitoring more regular in white Medicare beneficiaries than in black or Hispanic beneficiaries ( P < 0.0001). Warfarin use was associated with 35% fewer ischemic strokes ( HR, 0.65; 95% CI, 0.55 to 0.76) compared with no antithrombotic therapy but was less effective in black and Hispanic beneficiaries ( P for interaction = 0.048). Conclusions - The use, monitoring, and effectiveness of warfarin therapy are suboptimal in Medicare beneficiaries, especially in black and Hispanic beneficiaries. C1 Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO 63110 USA. NYU, Sch Med, New York, NY USA. Ctr Medicare & Medicaid Serv, Dallas, TX USA. RP Gage, BF (reprint author), Washington Univ, Sch Med, Div Gen Med Sci, Campus Box 8005,660 S Euclid, St Louis, MO 63110 USA. EM bgage@im.wustl.edu OI Radford, Martha/0000-0001-7503-9557 NR 28 TC 143 Z9 150 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD APR PY 2006 VL 37 IS 4 BP 1070 EP 1074 DI 10.1161/01.STR.0000208294.46968.a4 PG 5 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 025UJ UT WOS:000236292100032 PM 16528001 ER PT J AU Whitten, R Rogers, WD Loeb, L Cross, JD AF Whitten, R Rogers, WD Loeb, L Cross, JD TI Proceedings adapted fyom a payor panel SO CRITICAL CARE MEDICINE LA English DT Editorial Material DE critical care; coding and billing; public policy; intensive care; healthcare quality; payors AB Background. This panel featured four representatives from the healthcare industry and government, offering an opportunity for critical care professionals to pose questions and discuss issues and concerns relevant to anyone caring for critically ill and injured patients today. A brief biography is provided for each panelist. Discussion: The Society of Critical Care Medicine Advocacy Committee recognized that there are not enough opportunities for clinicians and other members of the critical care team to discuss questions or issues with their counterparts on the payor side of providing clinical care. That is, much of the difficulty faced by providers after providing critical care services could be resolved if the channels of communication were opened, and so a payor panel was organized to start the process. Conclusion: Each of the panelists provided a prepared statement on issues relevant to critical care, as evident from their respective roles. Specific scenarios and other suggestions regarding payment policy, coding, and quality of care are provided. C1 Noridian Adm Serv, Kent, WA USA. Ctr Medicare & Medicaid Serv, Phys Regulatory Issues Team, Baltimore, MD USA. King & Spalding LLP, Washington, DC USA. Aetna, Largo, MD USA. RP Whitten, R (reprint author), Noridian Adm Serv, Kent, WA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0090-3493 J9 CRIT CARE MED JI Crit. Care Med. PD MAR PY 2006 VL 34 IS 3 SU S BP S60 EP S70 DI 10.1097/01.CCM.0000200040.27885.5C PG 11 WC Critical Care Medicine SC General & Internal Medicine GA 017JA UT WOS:000235688700010 PM 16477205 ER PT J AU Borger, C Smith, S Truffer, C Keehan, S Sisko, A Poisal, J Clemens, MK AF Borger, C Smith, S Truffer, C Keehan, S Sisko, A Poisal, J Clemens, MK TI Health spending projections through 2015: Changes on the horizon SO HEALTH AFFAIRS LA English DT Article ID MANAGED CARE AB Growth in national health spending is projected to slow in 2005 to 7.4 percent, from a peak of 9.1 percent in 2002. Private health insurance premiums are projected to slow to 6.6 percent in 2005, with a rebound expected in 2007. The introduction of Medicare Part D drug coverage in 2006 produces a dramatic shift in spending across payers but has little net effect on aggregate spending growth. Health spending is expected to consistently outpace gross domestic product (GDP) over the coming decade, accounting for 20 percent of GDP by 2015. C1 Ctr Medicare & Medicaid Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. RP Borger, C (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. EM DNHS@cms.hhs.gov NR 22 TC 82 Z9 86 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2006 VL 25 IS 2 BP W61 EP W73 DI 10.1377/hlthaff.25.w61 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 022ZK UT WOS:000236094500065 PM 16495287 ER PT J AU Lapin, P AF Lapin, P TI Overview: Medicare and prevention SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, CMS, Baltimore, MD 21244 USA. RP Lapin, P (reprint author), Ctr Medicare & Medicaid Serv, CMS, 7500 Secur Blvd,S3-02-01, Baltimore, MD 21244 USA. EM pauline.lapin@cms.hhs.gov NR 10 TC 1 Z9 1 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2006 VL 27 IS 3 BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 044XZ UT WOS:000237708300001 PM 17290644 ER PT J AU Lied, TR Gonzalez, J Taparanskas, W Shukla, T AF Lied, TR Gonzalez, J Taparanskas, W Shukla, T TI Trends and current drug utilization patterns of Medicaid beneficiaries SO HEALTH CARE FINANCING REVIEW LA English DT Article AB This study used national Medicaid data from 1994-2003 to investigate, trends in noninstitutional drug utilization and expenditures in the Medicaid Program. We found that there was a substantial increase in both drug utilization and expenditures during this timeframe. Increased utilization resulted from increases in Medicaid enrollment, the mean number of prescriptions per enrollee, mean nominal and inflation-adjusted reimbursement per prescription, and the tendency for increased use of more expensive drugs. The top 40 drugs accounted for nearly $14.4 billion, roughly 43 percent of the total drug reimbursements for calendar year (CY) 2003. C1 Ctr Medicaid & Medicare Serv, CMS, Baltimore, MD 21244 USA. RP Lied, TR (reprint author), Ctr Medicaid & Medicare Serv, CMS, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA. EM terrylied@cms.hhs.gov NR 4 TC 7 Z9 7 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2006 VL 27 IS 3 BP 123 EP 132 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 044XZ UT WOS:000237708300010 PM 17290653 ER PT J AU Gorman, G Furth, S Hwang, WK Parekh, R Astor, B Fivush, B Frankenfield, D Neu, A AF Gorman, G Furth, S Hwang, WK Parekh, R Astor, B Fivush, B Frankenfield, D Neu, A TI Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Society-of-Pediatric-Nephrology CY MAY 14-17, 2005 CL Washington, DC SP Amer Soc Pediat Nephrol DE hemodialysis (HD); adequacy; adolescents; hospitalization ID RESIDUAL RENAL-FUNCTION; MAINTENANCE HEMODIALYSIS; MORBIDITY; CHILDREN; TRANSPLANT; MORTALITY; SURVIVAL; PROJECT; IMPACT AB Background: The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines recommend that adult hemodialysis (HD) patients receive a minimum dialysis dose by single-pooled Kt/V (spKtfV) of 1.2 or greater. There are no data to support a minimum spKt/V dose for children on HD therapy. We aim to determine the association of spKt/V with mortality and hospitalization in adolescents. Methods: Clinical characteristics of adolescent HD patients aged 12 to 18 years old included in the 2000/2001 End-Stage Renal Disease Clinical Performance Measures Project were linked to US Renal Data System data from October 1, 1999, to October 15, 2001. Hospitalization risks after adjustment for time on dialysis therapy, access, hemoglobin level, albumin level, and height were determined by means of Poisson regression. spKtfV was analyzed by the adult target (< versus >= 1.2) and by intervals. Results: There were 613 patients with 477 patient-years of follow-up, during which there were 14 deaths and 185 hospitalizations covering 1,108 days. After adjustment, patients with an spKtfV less than 1.2 had increased hospitalization risk (1.59; 95% confidence interval, 0.98 to 2.56; P = 0.06) compared with those with an spKt/V of 1.2 or greater. Compared with patients with an spKt/V of 1.2 to 1.4, patients with an spKt/V less than 1.2 had increased adjusted risk for hospitalization (2.46; 95% confidence interval, 1.23 to 4.94; P = 0.01). Increases in spKt/V beyond 1.4 were not associated with improved outcomes. Conclusion: Applying the current adequacy guideline to adolescent HD patients is justified by the increased hospitalization risk of those who fall to attain an spKt/V of 1.2 or greater. However, attaining an spKtfV in excess of 1.4 was not associated with greater benefit. C1 Johns Hopkins Med Inst, Dept Pediat, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Dept Epidemiol, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD 21205 USA. Johns Hopkins Med Inst, Dept Hlth Policy & Management, Baltimore, MD 21205 USA. Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP Gorman, G (reprint author), Johns Hopkins Univ, 600 N Wolfe St,Pk 335, Baltimore, MD 21287 USA. EM ggorman1@jhmi.edu FU NIDDK NIH HHS [R21 DK64313] NR 22 TC 12 Z9 13 U1 0 U2 1 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD FEB PY 2006 VL 47 IS 2 BP 285 EP 293 DI 10.1053/j.ajkd.2005.10.020 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 010JY UT WOS:000235189300009 PM 16431257 ER PT J AU Gage, BF Birman-Deych, E Radford, MJ Nilasena, DS Binder, EF AF Gage, BF Birman-Deych, E Radford, MJ Nilasena, DS Binder, EF TI Risk of osteoporotic fracture in elderly patients taking warfarin - Results from the National Registry of Atrial Fibrillation 2 SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID BONE-MINERAL DENSITY; DISUSE-AFFECTED LIMBS; VITAMIN-K; HIP FRACTURE; POSTMENOPAUSAL WOMEN; ORAL ANTICOAGULANTS; OLDER-PEOPLE; ATRIAL-FIBRILLATION; RESIDENTIAL CARE; RANDOMIZED-TRIAL AB Background: Vitamin K allows for gamma-carboxylation of glutamyl residues, a conversion that activates clotting factors and bone proteins. Vitamin K antagonists such as warfarin inhibit this process. Our goal was to quantify the association between warfarin and osteoporotic fractures in patients with atrial fibrillation. Methods: This was a retrospective cohort study of Medicare beneficiaries with atrial fibrillation who were hospitalized between March 1998 and April 1999 in all 50 US states. The study outcome was osteoporotic fractures, identified by an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for a fracture of the hip, spine, or wrist. Results: Compared with 7587 patients who were not prescribed warfarin, the adjusted odds ratio (OR) of fracture was 1.25 (95% confidence interval [CI], 1.06-1.48) in 4461 patients prescribed long-term warfarin therapy (>= 1 year). The association between osteoporotic fracture and long-term warfarin use was significant in men (OR, 1.63; 95% CI, 1.26-2.10) but nonsignificant in women (OR, 1.05; 95% CI, 0.88-1.26). In 1833 patients prescribed warfarin for less than a year, the risk of osteoporotic fracture was not increased significantly (OR, 1.03). Odds ratios (95% CIs) of independent predictors of osteoporotic fractures were as follows: increasing age, 1.63 (1.47-1.80) per decade; high fall risk, 1.78 (1.42-2.21); hyperthyroidism, 1.77 (1.16-2.70); neuropsychiatric disease, 1.51 (1.28-1.78); and alcoholism, 1.50 (1.01-2.24). Factors with a reduced OR (95% CI) included African American race, 0.30 (0.18-0.51); male sex, 0.54 (0.46-0.62); and use of beta-adrenergic antagonists, 0.84 (0.70-1.00). Conclusions: Long-term use of warfarin was associated with osteoporotic fractures, at least in men with atrial fibrillation. beta-Adrenergic antagonists may protect against osteoporotic fractures. C1 Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO 63110 USA. Washington Univ, Sch Med, Div Geriatr & Nutr Sci, St Louis, MO USA. NYU Med Ctr, New York, NY 10016 USA. Ctr Medicare & Med Serv, Dallas, TX USA. RP Gage, BF (reprint author), Washington Univ, Sch Med, Div Gen Med Sci, Campus Box 8005,660 S Euclid, St Louis, MO 63110 USA. EM bgage@im.wustl.edu NR 45 TC 97 Z9 102 U1 0 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610-0946 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD JAN 23 PY 2006 VL 166 IS 2 BP 241 EP 246 DI 10.1001/archinte.166.2.241 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 004RH UT WOS:000234769400017 PM 16432096 ER PT J AU Douglas, PS Eckel, RH Gray, DT Loeb, JM Straube, BM AF Douglas, PS Eckel, RH Gray, DT Loeb, JM Straube, BM TI Coming together to achieve quality cardiovascular care SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Editorial Material ID MEDICARE BENEFICIARIES C1 Amer Coll Cardiol, Bethesda, MD USA. Duke Univ, Med Ctr, Durham, NC USA. Amer Heart Assoc, Dallas, TX USA. Univ Colorado, Hlth Sci Ctr, Denver, CO USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Joint Commiss Accreditat Healthcare Org, Div Res, Oak Brook Terrace, IL USA. Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP Douglas, PS (reprint author), Care of Lora C, Amer Coll Cardiol, 9111 Old Georgetown Rd, Bethesda, MD 20814 USA. NR 8 TC 5 Z9 5 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0735-1097 J9 J AM COLL CARDIOL JI J. Am. Coll. Cardiol. PD JAN 3 PY 2006 VL 47 IS 1 BP 266 EP 267 DI 10.1016/j.jacc.2005.11.019 PG 2 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 000UQ UT WOS:000234488300042 PM 16386698 ER PT J AU Fadrowski, JJ Frankenfield, DL Friedman, AL Warady, BA Neu, AM Fivush, BA AF Fadrowski, JJ Frankenfield, DL Friedman, AL Warady, BA Neu, AM Fivush, BA TI Impact of specialization of primary nephrologist on the care of pediatric hemodialysis patients SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE health status; pediatric; end-stage renal disease (ESRD); hemodialysis (HD); specialization AB Background: Children with end-stage renal disease (ESRD) receiving hemodialysis may have their care overseen primarily by a pediatric nephrologist or Internal medicine (IM) nephrologist. Methods: To examine specific clinical outcomes by nephrologist specialization, a cross-sectional analysis of demographic and clinical data collected in the 2002 ESRD Clinical Performance Measures Project was performed. Results: Of 653 pediatric patients meeting inclusion criteria, 27% were cared for by IM nephrologists, and 73%, by pediatric nephrologists. Pediatric nephrologists were significantly more likely than IM nephrologists to care for patients who were younger and of Hispanic ethnicity. Patients of pediatric compared with IM nephrologists also were more likely to have a congenital cause of ESRD, smaller body mass index, and longer time on dialysis therapy. No significant differences in achieving a mean Kt/V of 1.2 or greater or mean hemoglobin level of 11 g/dL or greater (>= 110 g/L) according to nephrologist specialization were observed. After adjustment for patient clinical characteristics, no significant difference in use of arteriovenous fistulae was observed. Patients cared for by pediatric nephrologists were less likely to achieve a mean serum albumin level of 4.0/3.7 g/dL (40/37 g/L; bromcresol green laboratory method/bromcresol purple laboratory method; adjusted odds ratio, 0.60; 95% confidence interval, 0.42 to 0.86). Patients cared for by pediatric nephrologists had significantly greater serum calcium levels, lower serum phosphate levels, and lower intact parathyroid hormone levels. Conclusion: Using adult-focused clinical care targets, care provided by pediatric and IM nephrologists to pediatric patients receiving hemodialysis in the United States is similar. However, differences exist, and the significance of these differences requires further study. C1 Johns Hopkins Univ, Sch Med, Div Pediat Nephrol, Baltimore, MD 21287 USA. Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. Brown Univ, Sch Med, Dept Pediat, Hasbro Childrens Hosp, Providence, RI 02912 USA. Univ Missouri, Childrens Mercy Hosp, Sect Pediat Nephrol, Kansas City, MO 64108 USA. RP Fadrowski, JJ (reprint author), Johns Hopkins Univ, Sch Med, Div Pediat Nephrol, Pk 335,600 N Wolfe St, Baltimore, MD 21287 USA. EM jfadrow1@jhmi.edu NR 10 TC 4 Z9 4 U1 0 U2 0 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD JAN PY 2006 VL 47 IS 1 BP 115 EP 121 DI 10.1053/j.ajkd.2005.10.005 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA 008JG UT WOS:000235036000014 PM 16377392 ER PT J AU Smith, C Cowan, C Heffler, S Catlin, A AF Smith, C Cowan, C Heffler, S Catlin, A CA Natl Hlth Accounts Team TI National health spending in 2004: Recent slowdown led by prescription drug spending SO HEALTH AFFAIRS LA English DT Article AB U.S. health care spending rose 7.9 percent to $1.9 trillion in 2004, or $6,280 per person. Health spending accounted for 16 percent of gross domestic product (GDP), nearly the same as in 2003. The pace of health spending growth has slowed, compared with the 2000-2002 period, for both public and private payers. Hospital spending accounted for 30 percent of the aggregate increase between 2002 and 2004, and prescription drugs accounted for an 11 percent share-smaller than its share of the increase in recent years and much slower in absolute terms. C1 Ctr Medicare & Medicaid Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. RP Smith, C (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. EM Dnhs@cms.hhs.gov NR 16 TC 112 Z9 112 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2006 VL 25 IS 1 BP 186 EP 196 DI 10.1377/hlthaff.25.1.186 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 008RX UT WOS:000235059500020 PM 16403753 ER PT J AU Straube, B AF Straube, B TI The CMS quality roadmap: Quality plus efficiency SO HEALTH AFFAIRS LA English DT Editorial Material AB In addition to demonstrating wide variations in costs, resource inputs, and quality in California hospitals, John Wennberg and colleagues demonstrate that higher quality of care might be associated with increased delivery system efficiencies and lower costs. The Centers for Medicare and Medicaid Services (CMS) is attempting to address issues raised by Wennberg in implementation of its Quality Roadmap. The CMS is actively working with health care stakeholders to identify health care efficiency measures, to address opportunities for improvement in health care quality and efficiency, and to consider policy approaches for reducing regional variation in quality and efficiency. C1 Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP Straube, B (reprint author), Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. EM barry.straube@cms.hhs.gov NR 2 TC 0 Z9 0 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2006 VL 25 IS 1 BP W5555 EP W5557 DI 10.1377/hlthaff.W5.555 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 008RX UT WOS:000235059500045 ER PT J AU Bach, PB McClellan, MB AF Bach, PB McClellan, MB TI A prescription for a modern Medicare program SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 Ctr Medicare & Med Serv, Washington, DC USA. RP Bach, PB (reprint author), Ctr Medicare & Med Serv, Washington, DC USA. NR 0 TC 16 Z9 16 U1 0 U2 0 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD DEC 29 PY 2005 VL 353 IS 26 BP 2733 EP 2735 DI 10.1056/NEJMp058249 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 997LK UT WOS:000234246700001 PM 16382056 ER PT J AU Bach, PB AF Bach, PB TI Using practice guidelines to assess cancer care quality SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Editorial Material ID OF-CARE; TRENDS C1 Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Bach, PB (reprint author), Ctr Medicare & Medicaid Serv, Washington, DC USA. NR 8 TC 10 Z9 10 U1 1 U2 1 PU AMER SOC CLINICAL ONCOLOGY PI ALEXANDRIA PA 330 JOHN CARLYLE ST, STE 300, ALEXANDRIA, VA 22314 USA SN 0732-183X J9 J CLIN ONCOL JI J. Clin. Oncol. PD DEC 20 PY 2005 VL 23 IS 36 BP 9041 EP 9043 DI 10.1200/JCO.2005.03.611l PG 3 WC Oncology SC Oncology GA 997FL UT WOS:000234230400001 PM 16301594 ER PT J AU De Lew, N AF De Lew, N TI Overview: 40th Anniversary of Medicare and Medicaid SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. RP De Lew, N (reprint author), Ctr Medicare & Medicaid Serv, Room 321D Hubert H Humphrey Bldg,200 Independence, Washington, DC 20201 USA. EM nancy.delew@cms.hhs.gov NR 3 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2005 VL 27 IS 2 BP 5 EP 10 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 018RE UT WOS:000235781700001 ER PT J AU Foster, RS Clemens, MK AF Foster, RS Clemens, MK TI Medicare financial status, budget impact, and sustainability - Which concept is which? SO HEALTH CARE FINANCING REVIEW LA English DT Article AB Medicare is continually undergoing change, as it must in order to reflect advances in medical technology, new health care delivery systems, financial pressures, and other developments. Modifications to the program are debated by policymakers in Congress and the administration, together with academic experts and others. These debates would be improved if policymakers and the public had a clearer understanding of Medicare and certain commonly cited views of the program's overall status. Three such concepts-the financial status of the Medicare trust funds, the impact of Medicare on the Federal budget, and the long-run sustainability of Medicare-are often confused with each other and are sometimes used interchangeably. Each concept is important but needs to be used for its own purpose. This article clarifies the differences among these three views of Medicare and provides examples of each. C1 Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD 21244 USA. RP Foster, RS (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, 7500 Secur Blvd,N3-01-21, Baltimore, MD 21244 USA. EM richard.foster@cms.hhs.gov NR 0 TC 1 Z9 1 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2005 VL 27 IS 2 BP 127 EP 140 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 018RE UT WOS:000235781700012 PM 17290643 ER PT J AU White, C Seagrave, S AF White, C Seagrave, S TI What happens when hospital-based skilled nursing facilities close? A propensity score analysis SO HEALTH SERVICES RESEARCH LA English DT Article DE skilled nursing facility; Medicare; propensity score; postacute care ID MEDICARE AB Objective. To assess the effects of hospital-based skilled nursing facility (HBSNF) closures on health care utilization, spending, and outcomes among Medicare fee-for-service beneficiaries. Data Sources. One hundred percent Medicare fee-for-service claims files for 1997-2002 were merged with Medicare Provider of Services files and beneficiary-level enrollment records. Study Design. Medicare spending, the use of postacute care, and health outcomes, were compared among hospitals that did and did not close their HBSNFs between 1997 and 2001. Hospitals were stratified according to propensity scores (i.e., predicted probability of closure from a logistic regression) and analyses were conducted within these strata. Principal Findings. HBSNF closures were associated with increased utilization of alternative postacute care settings, and longer acute care hospital stays. Because of increased use of alternative settings, HBSNF closures were associated with a slight increase in total Medicare spending. There are no statistically robust associations between HBSNF closures and changes in either mortality or rehospitalization. Conclusions. HBSNF closures altered utilization patterns, but there is no indication that closures adversely affect beneficiaries' health outcomes. C1 Congress Budget Off, Washington, DC 20515 USA. Ctr Medicare & Medicard Serv, Baltimore, MD USA. RP White, C (reprint author), Congress Budget Off, Ford House Off Bldg,4th Floor,2nd & D St SW, Washington, DC 20515 USA. FU NIA NIH HHS [T32AG00186, T32 AG000186] NR 17 TC 5 Z9 5 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2005 VL 40 IS 6 BP 1883 EP 1897 DI 10.1111/j.1475-6773.2005.00434.x PN 1 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 982NY UT WOS:000233170100011 PM 16336554 ER PT J AU Goldstein, E Farquhar, M Crofton, C Darby, C Garfinkel, S AF Goldstein, E Farquhar, M Crofton, C Darby, C Garfinkel, S TI Measuring hospital care from the patients' perspective: An overview of the CAHPS (R) Hospital Survey development process SO HEALTH SERVICES RESEARCH LA English DT Article DE patient reports of hospital care; patient satisfaction instruments; hospital quality; patient care AB To describe the developmental process for the CAHPS((R)) Hospital Survey. A pilot was conducted in three states with 19,720 hospital discharges. A rigorous, multi-step process was used to develop the CAHPS Hospital Survey. It included a public call for measures, multiple Federal Register notices soliciting public input, a review of the relevant literature, meetings with hospitals, consumers and survey vendors, cognitive interviews with consumer, a large-scale pilot test in three states and consumer testing and numerous small-scale field tests. The current version of the CAHPS Hospital Survey has survey items in seven domains, two overall ratings of the hospital and five items used for adjusting for the mix of patients across hospitals and for analytical purposes. The CAHPS Hospital Survey is a core set of questions that can be administered as a stand-alone questionnaire or combined with a broader set of hospital specific items. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Amer Inst Res, Chapel Hill, NC 27514 USA. RP Goldstein, E (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. NR 7 TC 91 Z9 91 U1 1 U2 8 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2005 VL 40 IS 6 BP 1977 EP 1995 DI 10.1111/j.1475-6773.2005.00477.x PN 2 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 984GB UT WOS:000233289500002 PM 16316434 ER PT J AU Sofaer, S Crofton, C Goldstein, E Hoy, E Crabb, J AF Sofaer, S Crofton, C Goldstein, E Hoy, E Crabb, J TI What do consumers want to know about the quality of care in hospitals? SO HEALTH SERVICES RESEARCH LA English DT Article DE hospital quality; patient experience surveys; performance reporting; consumer information ID HEALTH-CARE; SATISFACTION; SERVICES AB To guide the development of the Consumer Assessments of Healthcare Providers and Systems (CAHPS((R))) Hospital Survey by identifying which domains of hospital quality included in a survey of recent hospital patients, and which survey items within those domains, would be of greatest interest to consumers and patients. Primary data were collected in four cities (Baltimore, Los Angeles, Phoenix, and Orlando), from a demographically varied mix of people of whom most, but not all, had recently been hospitalized or had a close loved one hospitalized. A total of 16 focus groups were held in these four cities. Groups were structured to be homogeneous with respect to type of health care coverage (Medicare, non-Medicare), and type of recent hospital experience (urgent admission, elective admission, maternity admission, no admission). They were heterogeneous with respect to race/ethnicity, gender, and educational attainment. In addition to moderated discussions, focus group participants completed a pregroup questionnaire and various paper and pencil exercises during the groups. A wide range of features were identified by participants as being relevant to hospital quality. Many were consonant with domains and items in the CAHPS Hospital Survey; however, some addressed structural features of hospitals and hospital outcomes that are not best derived from a patient experience survey. When shown the domains and items being considered for inclusion in the CAHPS Hospital Survey, participants were most interested in items relating to doctor communication with patients, nurse and hospital staff communication with patients, responsiveness to patient needs, and cleanliness of the hospital room and bathroom. Findings were quite consistent across groups regardless of location and participant characteristics. Consumers and patients have a high degree of interest in hospital quality and found a very high proportion of the items being considered for the CAHPS Hospital Survey to be so important they would consider changing hospitals in response to information about them. Hospital choice may well be constrained for patients, but publicly reported information from a patient perspective can also be used to support patient discussions with facilities and physicians about how to ensure patients have the best hospital experience possible. C1 CUNY Bernard M Baruch Coll, Sch Publ Affairs, New York, NY 10010 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Westat Corp, Rockville, MD USA. RP Sofaer, S (reprint author), CUNY Bernard M Baruch Coll, Sch Publ Affairs, 17 Lexington Ave,Box D615, New York, NY 10010 USA. NR 22 TC 63 Z9 63 U1 2 U2 16 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2005 VL 40 IS 6 BP 2018 EP 2036 DI 10.1111/j.1475-6773.2005.00473.x PN 2 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 984GB UT WOS:000233289500004 PM 16316436 ER PT J AU Gorman, G Fivush, B Frankenfield, D Warady, B Watkins, S Brem, A Neu, A AF Gorman, G Fivush, B Frankenfield, D Warady, B Watkins, S Brem, A Neu, A TI Short stature and growth hormone use in pediatric hemodialysis patients SO PEDIATRIC NEPHROLOGY LA English DT Article DE adolescents; growth; hemodialysis ID STAGE-RENAL-DISEASE; CHILDREN; FAILURE; DIALYSIS; TRANSPLANTATION; INSUFFICIENCY; ADOLESCENTS; NAPRTCS; DEATH; RISK AB End-stage renal disease (ESRD) causes growth retardation in children, and poor growth has been linked to worse outcomes. Recombinant human growth hormone (rhGH) can increase growth velocity and final adult height in pediatric ESRD patients. We aimed to identify clinical predictors of short stature (height standard deviation score (Ht SDS) <-1.88) and rhGH use in short stature pediatric hemodialysis patients. In 2002, the Centers for Medicare & Medicaid Services (CMS) Clinical Performances Measures (CPM) ESRD Project collected demographic, clinical and laboratory data as well as rhGH use on all in-center hemodialysis patients in the US aged < 18 years. The odds ratios (OR) of short stature and rhGH use for individual predictors were determined by multivariate logistic regression modeling. Six-hundred and fifty-one (92%) of 710 eligible patients were included for analysis. Of these, 266 (41%) had Ht SDS <-1.88. After adjustment, short stature was predicted by congenital / urologic causes of ESRD ((OR 5.4; 95% confidence interval [CI], 2.1-13.8; p < 0.001) in patients aged 10-14 years; (OR 2.8; 95% CI, 1.5-5.4; p < 0.01) in patients aged 15-18 years) and increasing years on dialysis ((OR 1.2; 95% CI, 1.1-1.4; p < 0.01) in patients aged 10-14 years; (OR 1.2; 95% CI, 1.1-1.4; p < 0.001) in patients aged 15-18 years). Of 266 short stature patients, 214 (80.5%) had data on rhGH use. Of these, 80 (37%) had been prescribed rhGH. After adjustment, use of rhGH in short-stature patients was predicted by white race (OR 2.1; 95% CI, 1.1-4.0; p < 0.05), increasing years on dialysis (OR 1.13; 95% CI, 1.05-1.22; p < 0.01) and patients with BMI < 16.6 kg/m(2) (OR 3.1; 95% CI, 1.2-8.4; p < 0.05). Increasing age and level of intact parathyroid hormone were not associated with rhGH use among short stature patients. A significant proportion of pediatric hemodialysis patients have short stature. The majority of short-stature patients are not receiving rhGH. Patients with short stature who are white, have longer durations on dialysis and have lower BMI are more likely to receive rhGH. C1 Johns Hopkins Univ, Sch Med, Baltimore, MD 21287 USA. Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. Childrens Mercy Hosp, Kansas City, MO 64108 USA. Univ Washington, Childrens Hosp, Seattle, WA 98195 USA. Rhode Isl Hosp, Providence, RI USA. RP Gorman, G (reprint author), Johns Hopkins Univ, Sch Med, 600 N Wolfe St,Pk 335, Baltimore, MD 21287 USA. EM ggorman1@jhmi.edu NR 19 TC 10 Z9 10 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0931-041X J9 PEDIATR NEPHROL JI Pediatr. Nephrol. PD DEC PY 2005 VL 20 IS 12 BP 1794 EP 1800 DI 10.1007/s00467-005-1893-x PG 7 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 985BA UT WOS:000233349900018 PM 16133065 ER PT J AU Sheikh, K AF Sheikh, K TI Re: "interrater reliability: Completing the methods description in medical records review studies" SO AMERICAN JOURNAL OF EPIDEMIOLOGY LA English DT Letter ID AGREEMENT C1 US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO 64106 USA. NR 8 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0002-9262 J9 AM J EPIDEMIOL JI Am. J. Epidemiol. PD NOV 1 PY 2005 VL 162 IS 9 DI 10.1093/aje/kwi287 PG 1 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 976PP UT WOS:000232745900015 ER PT J AU Stevenson, KB Barbera, J Moore, JW Samore, MH Houck, P AF Stevenson, KB Barbera, J Moore, JW Samore, MH Houck, P TI Understanding keys to successful implementation of electronic decision support in rural hospitals: Analysis of a pilot study for antimicrobial prescribing SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Article; Proceedings Paper CT Annual Conference on Antimicrobial Resistance, National Foundation for Infectious Diseases CY 2003 CL Bethesda, MD DE clinical decision support systems; performance improvement; quality improvement; rural hospitals; antimicrobial management; patient safety ID COCKPIT-CABIN COMMUNICATION; PHARMACISTS; CARE; GUIDELINES; OUTCOMES; SYSTEMS AB Electronic clinical decision support systems (CDSS) have been hailed for their potential to improve clinical outcomes. Using a pretest/posttest design, an Internet-based CDSS designed to optimize antimicrobial prescribing was pilot tested for community-acquired pneumonia in 5 rural hospitals in southwestern Idaho. An antimicrobial management team was created in each hospital to address clinicians' perception of excessive time required for direct use of the CDSS. In pooled hospital data, agreement with CDSS recommendations improved to a statistically significant level. However, inspection of data at the individual hospital level demonstrated that almost all improvement occurred in a single hospital. Failure in the other hospitals appeared to be primarily a consequence of organizational and cultural barriers. These barriers are discussed to understand keys for successful future implementation of CDSS in rural hospitals, drawing on experience with cultural barriers from other industries, specifically aviation. C1 Qualis Hlth, Boise, ID USA. VA Salt Lake City Hlth Care Syst, Salt Lake City, UT USA. Univ Utah, Sch Med, Dept Internal Med, Salt Lake City, UT USA. Ctr Medicare & Medicaid Serv, Seattle, WA USA. RP Stevenson, KB (reprint author), Ohio State Univ, Med Ctr, N-1147 Doan Hall,410 W 10th Ave, Columbus, OH 43210 USA. EM stevenson-9@medctr.osu.edu NR 23 TC 6 Z9 6 U1 1 U2 2 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD NOV-DEC PY 2005 VL 20 IS 6 BP 313 EP 318 DI 10.1177/1062860605281175 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 985UL UT WOS:000233404100004 PM 16280394 ER PT J AU Yan, Y Birman-Deych, E Radford, MJ Nilasena, DS Gage, BF AF Yan, Y Birman-Deych, E Radford, MJ Nilasena, DS Gage, BF TI Comorbidity indices to predict mortality from Medicare data - Results from the National Registry of Atrial Fibrillation SO MEDICAL CARE LA English DT Article DE comorbid indices; mortality; atrial fibrillation ID ICD-9-CM ADMINISTRATIVE DATA; RHYTHM MANAGEMENT; RISK-FACTOR; VALIDATION; STROKE; MODELS AB Background: By accounting for level of comorbidity, risk-adjustment models should quantify the risk of death. How accurately comorbidity indices predict risk of death in Medicare beneficiaries with atrial fibrillation is unclear. Objectives: We sought to quantify how well 3 administrative-data based comorbidity indices (Deyo, Romano, and Elixhauser) predict mortality compared with a chart-review index. Design: We undertook a retrospective cohort study using Medicare claim data (1995-1999) and medical record review. Subjects: We studied Medicare beneficiaries (n = 2728; mean age = 77) with a common cardiac dysrhythmia, atrial fibrillation. Measures: The outcome was time to death with the accuracy of the comorbidity indices measured by the c-statistic. Results: Correlation between Deyo and Romano indices was strong, but weak between them and the other indices. Prevalence of many comorbidity conditions varied with different indices. Compared with demographic data alone (c = 0.64), all comorbidity indices predicted death significantly (P < 0.001) better: the c index was 0.76 for Deyo, 0.78 for Romano, 0.76 for Elixhauser, and 0.75 for medical record review. The 95% confidence intervals of the c-statistic for the 4 indices overlapped with one another. Key comorbidity conditions for death included metastatic cancer, neuropsychiatric disease, heart failure, and liver disease. C1 Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO 63110 USA. Washington Univ, Sch Med, Div Urol Surg, St Louis, MO 63110 USA. Yale New Haven Hlth Syst, Ctr Outcomes Res & Evaluat, New Haven, CT USA. Ctr Medicare & Medicaid Serv, Dallas, TX USA. RP Gage, BF (reprint author), Washington Univ, Sch Med, Div Gen Med Sci, Campus Box 8005,660 S Euclid Ave, St Louis, MO 63110 USA. EM bgage@im.wustl.edu OI Yan, Yan/0000-0002-5917-1475 NR 20 TC 28 Z9 28 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3261 USA SN 0025-7079 J9 MED CARE JI Med. Care PD NOV PY 2005 VL 43 IS 11 BP 1073 EP 1077 DI 10.1097/01.mlr.0000182477.29129.86 PG 5 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 983YO UT WOS:000233268500002 PM 16224299 ER PT J AU Jencks, SF AF Jencks, SF TI Quality improvement organizations and hospital care SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP Jencks, SF (reprint author), Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. EM stephen.jencks@cms.hhs.gov NR 1 TC 3 Z9 3 U1 1 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 26 PY 2005 VL 294 IS 16 BP 2028 EP 2028 DI 10.1001/jama.294.16.2028-a PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 977CB UT WOS:000232778900012 PM 16249410 ER PT J AU Flum, DR Salem, L Elrod, JAB Dellinger, EP Cheadle, A Chan, L AF Flum, DR Salem, L Elrod, JAB Dellinger, EP Cheadle, A Chan, L TI Early mortality among medicare beneficiaries undergoing bariatric surgical procedures SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID GASTRIC BYPASS-SURGERY; MORBID-OBESITY; CARDIOVASCULAR RISK; HOSPITAL VOLUME; AGE; GENDER; ADULTS; OLDER AB Context Case series demonstrate that bariatric surgery can be performed with a low rate of perioperative mortality (0.5%), but the rate among high-risk patients and the community at large is unknown. Objectives To evaluate the risk of early mortality among Medicare beneficiaries and to determine the relative risk of death among older patients. Design Retrospective cohort study. Setting and Patients All fee-for-service Medicare beneficiaries, 1997-2002. Main Outcome Measures Thirty-day, 90-day, and 1-year postsurgical all-cause mortality among patients undergoing bariatric procedures. Results A total of 16 155 patients underwent bariatric procedures (mean age, 47.7 years [SD, 11.3 years]; 75.8% women). The rates of 30-day, 90-day, and 1-year mortality were 2.0%, 2.8%, and 4.6%, respectively. Men had higher rates of early death than women (3.7% vs 1.5%, 4.8% vs 2.1 %, and 7.5% vs 3.7% at 30 days, 90 days, and 1 year, respectively; P<.001). Mortality rates were greater for those aged 65 years or older compared with younger patients (4.8% vs 1.7% at 30 days, 6.9% vs 2.3% at 90 days, and 11.1 % vs 3.9% at 1 year; P<.001). After adjustment for sex and comorbidity index, the odds of death within 90 days were 5-fold greater for older Medicare beneficiaries (aged >= 75 years; n = 136) than for those aged 65 to 74 years (n = 1381; odds ratio, 5.0; 95% confidence interval, 3.1-8.0). The odds of death at 90 days were 1.6 times higher (95% confidence interval, 1.3-2.0) for patients of surgeons with less than the median surgical volume of bariatric procedures (among Medicare beneficiaries during the study period) after adjusting for age, sex, and comorbidity index. Conclusions Among Medicare beneficiaries, the risk of early death after bariatric surgery is considerably higher than previously suggested and associated with advancing age, male sex, and lower surgeon volume of bariatric procedures. Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients. C1 Univ Washington, Dept Surg, Seattle, WA 98195 USA. Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. Univ Washington, Dept Rehabil Med, Seattle, WA 98195 USA. Ctr Medicare & Medicaid Serv, Div Clin Stand & Qual, Seattle, WA USA. RP Flum, DR (reprint author), Univ Washington, Dept Surg, Box 356410,1959 NE Pacific St, Seattle, WA 98195 USA. EM daveflum@u.washington.edu FU NIDDK NIH HHS [1UO1DK066568-01, R21 DK069677-01] NR 26 TC 339 Z9 350 U1 0 U2 6 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 19 PY 2005 VL 294 IS 15 BP 1903 EP 1908 DI 10.1001/jama.294.15.1903 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 974OZ UT WOS:000232602600019 PM 16234496 ER PT J AU Malone, DC Hutchins, DS Haupert, H Hansten, P Duncan, B Van Bergen, RC Solomon, SL Lipton, RB AF Malone, DC Hutchins, DS Haupert, H Hansten, P Duncan, B Van Bergen, RC Solomon, SL Lipton, RB TI Assessment of potential drug-drug interactions with a prescription claims database SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article DE age; anticoagulants; antifungals; antiinflammatory agents; antipsychotic agents; cyclosporine; drug interactions; immunosuppressive agents; interventions; pharmacy benefit management companies; pimozide; prescriptions; rifamycins; toxicity; warfarin ID DIGOXIN TOXICITY; ELDERLY-PATIENTS; CLARITHROMYCIN; PATIENT; PREVENTION; RISK; CARE; RECOGNITION; THERAPY; ALERTS AB Purpose. The prevalence of 25 clinically important potential drug-drug interactions (DDIs) in a population represented by the drug claims database of a pharmacy benefit management company (PBM) was studied. Methods. A retrospective cross-sectional analysis of pharmaceutical claims for almost 46 million participants in a PBM was conducted to determine the frequency of 25 DDIs previously identified as clinically important. A DDI was counted when drugs in potentially interacting combinations were dispensed within 30 days of each other during a 25-month period between April 2000 and June 2002. Result's. The number of DDIs ranged from 37 for pimozide and an azole antifungal to 127,684 for warfarin and a nonsteroidal antiinflammatory drug (NSAID). The highest prevalence (278.56 per 100,000 persons) and highest case-exposure rate (242.7 per 1,000 warfarin recipients) occurred with the warfarin-NSAID combination. The combination with the lowest overall, prevalence (cyclosporine and a rifamycin, 0.10/100,000) differed from the combination with the lowest case-exposure rate (pimozide and an azole antifungal, 0.028 per 1,000 azole antifungal recipients). Number of cases, prevalence, and case-exposure rates for both sexes generally increased with age. An estimated 374,000 plan participants were exposed to a clinically important DDI during a 25-month period. Between 20% and 46% of prescription drug claims were reversed (canceled) for a medication with a drug interaction when a warning about the interaction was sent to the pharmacy. Conclusion. Analysis of prescription claims data from a major PBM found that 374,000 of 46 million plan participants had been exposed to a potential DDI of clinical importance. C1 Univ Arizona, Coll Pharm, Tucson, AZ 85721 USA. Univ Washington, Sch Pharm, Seattle, WA 98195 USA. Ctr Medicare & Medicaid Serv, Div Finance & Operat, Reisterstown, MD USA. Ctr Healthier Aging, Elkridge, MD USA. Ctr Dis Control & Prevent, Hlth Syst, Atlanta, GA USA. Albert Einstein Coll Med, Dept Neurol, Bronx, NY 10467 USA. RP Malone, DC (reprint author), Univ Arizona, Coll Pharm, 1703 E Mabel, Tucson, AZ 85721 USA. EM malone@pharmacy.arizon.edu NR 46 TC 65 Z9 70 U1 1 U2 5 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 USA SN 1079-2082 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD OCT 1 PY 2005 VL 62 IS 19 BP 1983 EP 1991 DI 10.2146/ajhp040567 PG 9 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 970XY UT WOS:000232346900015 PM 16174833 ER PT J AU Walsh, E Khatutsky, G Johnson, L AF Walsh, E Khatutsky, G Johnson, L TI Mode of administration effects on disability measures in a sample of frail beneficiaries SO GERONTOLOGIST LA English DT Meeting Abstract C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2005 VL 45 SI 2 BP 184 EP 184 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 988QF UT WOS:000233615000481 ER PT J AU Moore, T Hurd, D Schnelle, J Simmons, S Joslin, S AF Moore, T Hurd, D Schnelle, J Simmons, S Joslin, S TI Feeding assistance in nursing homes: Findings from an all-state inventory SO GERONTOLOGIST LA English DT Meeting Abstract C1 Abt Associates Inc, Cambridge, MA USA. Borun Ctr Gerontol REs, Reseda, CA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2005 VL 45 SI 2 BP 284 EP 284 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 988QF UT WOS:000233615000749 ER PT J AU Yost, J Mattingly, P AF Yost, J Mattingly, P TI CLIA and equivalent quality control: Options for the future SO LABORATORY MEDICINE LA English DT Article; Proceedings Paper CT Conference on Quality Control for the Future CY MAR 18, 2005 CL Baltimore, MD SP Clin & Lab Standards Inst C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Yost, J (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER SOC CLINICAL PATHOLOGY PI CHICAGO PA 2100 W HARRISON ST, CHICAGO, IL 60612 USA SN 0007-5027 J9 LAB MED JI Lab. Med. PD OCT PY 2005 VL 36 IS 10 BP 614 EP 616 DI 10.1309/524HAA6BCGTL04BW PG 3 WC Medical Laboratory Technology SC Medical Laboratory Technology GA 980GJ UT WOS:000233002200025 ER PT J AU Sheikh, K AF Sheikh, K TI Response to an article in the April 2005 issue of Medical Care SO MEDICAL CARE LA English DT Letter ID ACCURACY C1 US Dept HHS, Ctr Medicare, Kansas City, MO 64106 USA. US Dept HHS, Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare, 601 E 12th St,Room 235, Kansas City, MO 64106 USA. NR 8 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3261 USA SN 0025-7079 J9 MED CARE JI Med. Care PD OCT PY 2005 VL 43 IS 10 BP 1063 EP 1063 DI 10.1097/01.mlr.0000180168.63845.2b PG 1 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 968WW UT WOS:000232194700016 PM 16166879 ER PT J AU McClellan, MB AF McClellan, MB TI National provider identifier activities begin in 2005 SO CLINICAL NURSE SPECIALIST LA English DT Editorial Material C1 Ctr Medicare, Dept Hlth & Human Serv, Baltimore, MD USA. Ctr Medicaid Serv, Dept Hlth & Human Serv, Baltimore, MD USA. RP McClellan, MB (reprint author), Ctr Medicare, Dept Hlth & Human Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0887-6274 J9 CLIN NURSE SPEC JI Clin. Nurse Spec. PD SEP-OCT PY 2005 VL 19 IS 5 BP 271 EP 272 DI 10.1097/00002800-200509000-00012 PG 2 WC Nursing SC Nursing GA 036OW UT WOS:000237085300010 ER PT J AU Bell, DS Friedman, MA AF Bell, DS Friedman, MA TI E-prescribing and the Medicare Modernization Act of 2003 SO HEALTH AFFAIRS LA English DT Article ID PHYSICIAN ORDER ENTRY; SYSTEMS; BENEFICIARIES; COST; CARE AB Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 are intended to foster electronic prescribing by requiring standards for interoperability and by permitting third parties to offset implementation costs. Although physicians have been slow to embrace e-prescribing, adoption may increase in 2006, when a new tide of pharmacy messages will arrive from patients entering multi-tier drug coverage under Medicare. However, the e-prescribing systems selected may lack the advanced features needed to improve patient safety and chronic disease control. To optimize the return on Medicare drug spending, the government should consider additional incentives to spur the uptake of more advanced systems. C1 RAND Corp, Santa Monica, CA 90406 USA. Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90024 USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Bell, DS (reprint author), RAND Corp, Santa Monica, CA 90406 USA. EM dbell@mednet.ucla.edu RI Bell, Douglas/G-6702-2013 OI Bell, Douglas/0000-0002-5063-8294 FU AHRQ HHS [HS 13572]; NCRR NIH HHS [RR 03026-13] NR 25 TC 34 Z9 34 U1 4 U2 6 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2005 VL 24 IS 5 BP 1159 EP 1169 DI 10.1377/hlthaff.24.5.1159 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 008IL UT WOS:000235033400012 PM 16162559 ER PT J AU Sheikh, K AF Sheikh, K TI Response to an article in the April 2005 issue of medical care SO MEDICAL CARE LA English DT Letter ID NONRESPONSE BIAS C1 US Dept HHS, Ctr Medicare Serv, Kansas City, MO USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare Serv, Kansas City, MO USA. NR 13 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD SEP PY 2005 VL 43 IS 9 BP 945 EP 945 DI 10.1097/01.mlr.0000177824.59019.f2 PG 1 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 959BU UT WOS:000231492700014 PM 16116362 ER PT J AU McClellan, M AF McClellan, M TI Help your patients become aware of the new medicare prescription drug plans SO ONCOLOGIST LA English DT Editorial Material C1 US Dept HHS, Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. RP McClellan, M (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv, 200 Independence Ave SW, Washington, DC 20201 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU ALPHAMED PRESS PI MIAMISBURG PA ONE PRESTIGE PLACE, STE 290, MIAMISBURG, OH 45342-3758 USA SN 1083-7159 J9 ONCOLOGIST JI Oncologist PD SEP PY 2005 VL 10 IS 8 BP 563 EP 564 DI 10.1634/theoncologist.10-8-563 PG 2 WC Oncology SC Oncology GA 971AB UT WOS:000232352400002 PM 16177280 ER PT J AU Neu, AM Bedinger, M Fivush, BA Warady, BA Watkins, SL Friedman, AL Brem, AS Goldstein, SL Frankenfield, DL AF Neu, AM Bedinger, M Fivush, BA Warady, BA Watkins, SL Friedman, AL Brem, AS Goldstein, SL Frankenfield, DL TI Growth in adolescent hemodialysis patients: Data from the centers for Medicare & Medicaid services ESRD Clinical Performance Measures Project SO PEDIATRIC NEPHROLOGY LA English DT Article; Proceedings Paper CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CA SP Amer Soc Nephrol DE adolescent; growth; hemodialysis; pediatric ID STAGE RENAL-DISEASE; HORMONE TREATMENT; ADULT HEIGHT; CHILDREN; INFLAMMATION; FAILURE; DEATH; RISK AB The Centers for Medicare & Medicaid Services' (CMS) end-stage renal disease (ESRD) Clinical Performance Measures (CPM) Project has collected data on all adolescent hemodialysis patients since 2000. Thus, by 2002 data were available on all adolescents on hemodialysis in the USA for 3 consecutive years. Possible associations between clinical parameters and linear growth in this cohort were evaluated. Ninety-four adolescents were on hemodialysis for the 3 study years. The mean height standard deviation score (ht SDS) fell from -1.97 to -2.36 over the 3 study years. Compared with patients with ht SDS >=-1.88, patients with ht SDS <-1.88 in the 2002 study year (n =53) were more likely to be male (66% vs 44%, p < 0.05), on dialysis longer (6.9 +/- 4.5 years vs 4.1 +/- 2.3 years, p < 0.001), and had lower height SDS in the 2000 study year (-2.90 +/- 1.31 vs -0.772 +/- 1.10, p < 0.001). Patients with a ht SDS <-1.88 had a lower mean hemoglobin (11.4 +/- 1.6 g/dl vs 12.0 +/- 1.1 g/dl, p < 0.05), but there were no differences in other clinical parameters. Among patients with ht SDS <-1.88, 38.8% (n =20) were prescribed recombinant human growth hormone (rhGH) in the 2002 study year. There were no differences in demographic or clinical parameters between rhGH treated and untreated patients. Many adolescents who remain on hemodialysis have poor linear growth. Further evaluation is needed to delineate contributory factors and the possible underutilization of rhGH. C1 Johns Hopkins Univ, Sch Med, Baltimore, MD 21287 USA. Ctr Beneficiary Choices, Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. Childrens Mercy Hosp, Kansas City, MO 64108 USA. Univ Washington, Childrens Hosp, Seattle, WA 98195 USA. Hasbro Childrens Hosp, Providence, RI USA. Baylor Coll Med, Houston, TX 77030 USA. RP Neu, AM (reprint author), Johns Hopkins Univ, Sch Med, 600 N Wolfe St,Pk 335, Baltimore, MD 21287 USA. EM aneu@jhmi.edu NR 12 TC 17 Z9 17 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING STREET, NEW YORK, NY 10013 USA SN 0931-041X J9 PEDIATR NEPHROL JI Pediatr. Nephrol. PD AUG PY 2005 VL 20 IS 8 BP 1156 EP 1160 DI 10.1007/s00467-005-1889-6 PG 5 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 943KV UT WOS:000230353300021 PM 15977027 ER PT J AU Pham, HH Schrag, D Hargraves, JL Bach, PB AF Pham, HH Schrag, D Hargraves, JL Bach, PB TI Delivery of preventive services to older adults by primary care physicians SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID ELDERLY MEDICARE BENEFICIARIES; FECAL OCCULT BLOOD; QUALITY-OF-CARE; HEALTH-CARE; CLAIMS DATA; UNITED-STATES; CANCER; BREAST; WOMEN; GUIDELINES AB Context Rates of preventive services remain below national goals. Objective To identify characteristics of physicians and their practices that are associated with the quality of preventive care their patients receive. Design Cross-sectional analysis of data on US physician respondents to the 20002001 Community Tracking Study Physician Survey linked to claims data on Medicare beneficiaries they treated in 2001. Physician variables included training and qualifications and sex. Practice setting variables included practice type, size, sources of revenue, and access to information technology. Analyses were adjusted for patient demographics and comorbidity, as well as community characteristics. Setting and Participants Primary care delivered by 3660 physicians providing usual care to 24 581 Medicare beneficiaries aged 65 years and older. Main Outcome Measures Proportion of eligible beneficiaries receiving each of 6 preventive services: diabetic monitoring with hemoglobin A(1c) measurement or eye examinations, screening for colon or breast cancer, and vaccination for influenza or pneumococcus in 2001. Results Overall, the proportion of beneficiaries receiving services was below national goals. Physician and, more consistently, practice-level characteristics were both associated with differences in the delivery of services. The strongest associations were with practice type and the percentage of practice revenue derived from Medicaid. For instance, beneficiaries receiving usual care in practices with less than 6% of revenue from Medicaid were more likely than those with more than 15% of revenue derived from Medicaid to receive diabetic eye examinations (48.9% vs43%; P=.02), hemoglobin A(1c) monitoring (61.2% vs 48.4%; P<.001), mammograms (52.1% vs 38.9%; P<.001), colon cancer screening (10.0% vs 8.5%; P=.60), and influenza (50.2% vs 39.2%; P<001) and pneumococcal (8.2% vs 6.4%; P<001) vaccinations. Other variables associated with delivery of preventive services after adjustment for patient and geographic factors included obtaining usual health care from a physician who worked in group practices of 3 or more, who was a graduate of a US or Canadian medical school, or who reported availability of information technology to generate preventive care reminders or access treatment guidelines. Conclusions Delivery of routine preventive services is suboptimal for Medicare beneficiaries. However, patients treated within particular practice settings and by particular subgroups of physicians are at particular risk of low-quality care. Profiling these practices may help develop tailored interventions that can be directed to sites where the opportunities for quality improvement are greatest. C1 Ctr Studying Hlth Syst Change, Washington, DC 20024 USA. Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, Hlth Outcomes Res Grp, New York, NY 10021 USA. Mem Sloan Kettering Canc Ctr, Dept Med, New York, NY 10021 USA. Ctr Medicare & Medicaid Serv, Washington, DC USA. Univ Massachusetts, Sch Med, Dept Family Med & Community Hlth, Worcester, MA USA. RP Pham, HH (reprint author), Ctr Studying Hlth Syst Change, 600 Maryland Ave SW,Suite 550, Washington, DC 20024 USA. EM mpham@hschange.org FU NCI NIH HHS [R01CA090226] NR 47 TC 184 Z9 186 U1 2 U2 10 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 27 PY 2005 VL 294 IS 4 BP 473 EP 481 DI 10.1001/jama.294.4.473 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 948RM UT WOS:000230733400022 PM 16046654 ER PT J AU Bratzler, DW Houck, PM AF Bratzler, DW Houck, PM TI Are cephalosporins adequate for antimicrobial prophylaxis for cardiac surgery involving implants? Reply SO CLINICAL INFECTIOUS DISEASES LA English DT Letter ID RESISTANT STAPHYLOCOCCUS-AUREUS; INFECTIONS; PREVENTION C1 Oklahoma Fdn Med Qual, Oklahoma City, OK 73134 USA. Ctr Medicare & Medicaid Serv, Seattle, WA USA. RP Bratzler, DW (reprint author), Oklahoma Fdn Med Qual, 1400 Quail Springs Pkwy,Ste 400, Oklahoma City, OK 73134 USA. EM dbratzler@okqio.sdps.org NR 11 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1058-4838 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD JUL 1 PY 2005 VL 41 IS 1 BP 123 EP 124 DI 10.1086/430839 PG 2 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 932BY UT WOS:000229530400022 ER PT J AU Alderman, MH Arnett, DK Bakris, GL Black, HR Boerwinkle, E Califf, RM Cushman, WC Cutler, J Davis, BR Devereux, RB Ferdinand, K Fleg, JL Fournier, A Furberg, CD Giles, TD Gottdiener, JS Grimm, RH Hyman, DJ Jamerson, KA Kostis, JB Krauss, RM Leenen, FHH Levey, AS Levy, D MacMahon, S Oparil, S Probstfield, JL Psaty, BM Roccella, E Salive, M Schwartz, WB Svetkey, L Throckmorton, D Turner, ST Velletri, P Wright, J AF Alderman, MH Arnett, DK Bakris, GL Black, HR Boerwinkle, E Califf, RM Cushman, WC Cutler, J Davis, BR Devereux, RB Ferdinand, K Fleg, JL Fournier, A Furberg, CD Giles, TD Gottdiener, JS Grimm, RH Hyman, DJ Jamerson, KA Kostis, JB Krauss, RM Leenen, FHH Levey, AS Levy, D MacMahon, S Oparil, S Probstfield, JL Psaty, BM Roccella, E Salive, M Schwartz, WB Svetkey, L Throckmorton, D Turner, ST Velletri, P Wright, J CA Natl Heart Lung Blood Inst Working TI Major clinical trials of hypertension - What should be done next? SO HYPERTENSION LA English DT Article DE clinical trials; drug therapy ID CHRONIC HEART-FAILURE; BLOOD-PRESSURE CONTROL; EVIDENCE-BASED PROOF; CARDIOVASCULAR-DISEASE; KIDNEY-DISEASE; RANDOMIZED-TRIAL; ANGIOTENSIN-II; UNITED-STATES; PREVENTION; RISK AB The National Heart, Lung, and Blood Institute assembled an ad hoc working group to evaluate opportunities for new major clinical trials in the field of hypertension. The mandate of this working group was to consider the possible designs of major randomized clinical trials focused on clinical outcomes that might merit significant investment by the National Institutes of Health. The group concluded that the ideal pragmatic clinical trial would have a factorial design and include a population at elevated risk of cardiovascular disease events. Subjects would be randomized to a target of systolic blood pressure <130 versus 130 to 150 mm Hg for adequate separation of means. Initial treatment with thiazide diuretic would be followed by randomization to angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blocker, calcium channel blocker, or aldosterone antagonist. A third drug could be added according to a protocol. DNA, proteins, and metabolites would be collected in a sample adequate to assess differential impact of treatment on outcome as a function of genotype, proteomic, and metabolomic expression. Subclinical markers and images would also be measured in a sample of patients to develop evidence of ability to predict ultimate effect on clinical outcomes. This ideal trial would take place within a network, funded for at least a decade, aimed at connecting primary care providers with hypertension specialists. Within the network, substudies or independent studies would be coordinated to develop a continuously improving base of knowledge about the effective delivery of hypertension care. C1 Duke Clin Res Inst, Durham, NC 27715 USA. NHLBI, Framingham Heart Study, Bethesda, MD 20892 USA. Albert Einstein Coll Med, Bronx, NY 10467 USA. Univ Minnesota, Minneapolis, MN 55455 USA. Rush Med Univ, Chicago, IL USA. Rush Presbyterian St Lukes Med Ctr, Chicago, IL 60612 USA. Univ Texas, Hlth Sci Ctr, Houston, TX USA. Univ Tennessee, Hlth Sci Ctr, Knoxville, TN 37996 USA. Univ Texas, Sch Publ Hlth, Austin, TX 78712 USA. New York Presbyterian Hosp, New York, NY USA. Xavier Univ, Coll Pharm, New Orleans, LA 70125 USA. Univ Hosp, Dept Nephrol, Amiens, France. Wake Forest Univ, Sch Med, Winston Salem, NC 27109 USA. Louisiana State Univ, Sch Med, Baton Rouge, LA 70803 USA. Univ Maryland, Sch Med, Baltimore, MD 21201 USA. Baylor Coll Med, Houston, TX 77030 USA. Univ Michigan, Med Ctr, Ann Arbor, MI 48109 USA. Robert Wood Johnson Med Sch, Piscataway, NJ USA. Childrens Hosp Oakland, Res Inst, Oakland, CA 94609 USA. Univ Ottawa, Inst Heart, Ottawa, ON K1N 6N5, Canada. Tufts Univ, Sch Med, Medford, MA 02155 USA. Univ Sydney, Sydney, NSW 2006, Australia. Univ Alabama Birmingham, Vasc Biol & Hypertens Program, Birmingham, AL USA. Univ Washington, Sch Med, Clin Trials Serv Unit, Seattle, WA 98195 USA. NHLBI, OPEC, Bethesda, MD 20892 USA. Ctr Medicare & Medicaid Serv, Div Med & Surg Serv, Baltimore, MD USA. Tufts Univ New England Med Ctr, Div Nephrol, Boston, MA 02111 USA. Duke Univ, Med Ctr, Durham, NC 27706 USA. US FDA, Ctr Drug Evaluat & Res, Rockville, MD 20857 USA. US FDA, Div Cardiorenal Drugs, Rockville, MD 20857 USA. Mayo Clin Rochester, Rochester, MN USA. Case Western Reserve Univ, Cleveland, OH 44106 USA. RP Califf, RM (reprint author), Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA. EM Calif001@mc.duke.edu NR 31 TC 16 Z9 18 U1 2 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0194-911X EI 1524-4563 J9 HYPERTENSION JI Hypertension PD JUL PY 2005 VL 46 IS 1 BP 1 EP 6 DI 10.1161/01.HYP.0000168924.37091.58 PG 6 WC Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 938OM UT WOS:000230012700001 ER PT J AU Valadez-Meltzer, A Silber, TJ Meltzer, AA D'Angelo, LJ AF Valadez-Meltzer, A Silber, TJ Meltzer, AA D'Angelo, LJ TI Will I be alive in 2005? Adolescent level of involvement in risk Behaviors and belief in near-future death SO PEDIATRICS LA English DT Article ID HUMAN-IMMUNODEFICIENCY-VIRUS; URBAN ADOLESCENTS; FOSTER-CARE; UNITED-STATES; SUBSTANCE-ABUSE; CHILDREN; HEALTH; SURVEILLANCE; HOPELESSNESS; CHILDHOOD AB Objective. We examined the association between a belief in one's future mortality and various risk- taking behaviors among urban black adolescents. In particular, we investigated whether adolescents with higher levels of participation in various risk behaviors were more likely to believe in their future death as compared with adolescents with lesser levels of risk- taking behavior. Methods. Data obtained from April 1994 to March 1997 were analyzed for a total of 2694 adolescents, aged 12 to 21 years. The odds of believing that one would die within the next 2 years were calculated for various levels of participation in risk behaviors involving alcohol, drugs, and criminal or violent acts. Results. A total of 160 adolescents ( 7.1% of all boys and 5.4% of all girls) reported that they believed that they would die within the next 2 years. The adjusted odds of future death belief among adolescents who both actively engaged in and knew others who participated in all of the various risk behaviors, relative to adolescents who neither personally engaged in nor knew others who participated in any of the risk behaviors, was 3.22 ( 95% confidence interval [CI]: 2.01 - 5.17) vs 1.14 (95% CI: 0.67 - 1.95) for drug use and drug selling, 2.01 ( 95% CI: 1.38 - 2.92) vs 0.8 ( 95% CI: 0.39 - 1.62) for combined alcohol and drug use, and 5.60 ( 95% CI: 2.03 - 15.47) vs 1.61 ( 95% CI: 1.08 - 2.42) for violent physical behavior. In addition, residence in a foster home was significantly associated with death belief after adjustment for all other variables. Conclusions. There is a significant relationship between certain risk behaviors and belief in near-future death. Moreover, higher levels of involvement in risk behaviors were associated with a stronger likelihood of belief in near-future mortality. Identification of adolescents who engage in certain risky behaviors, combined with a recognition of the degree to which the adolescent participates in the particular behavior(s), may be used to facilitate more rapid intervention among youths who either believe in their imminent demise or engage in behaviors that increase the likelihood of their untimely death. C1 Univ Maryland, Sheppard Pratt Psychiat Residency Program, Baltimore, MD 21201 USA. George Washington Univ, Sch Med & Hlth Sci, Childrens Natl Med Ctr, Div Adolescent & Young Adult Med, Washington, DC 20052 USA. Ctr Medicare, Off Res Dev & Informat, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Valadez-Meltzer, A (reprint author), Univ Maryland, Sheppard Pratt Psychiat Residency Program, 701 W Pratt St, Baltimore, MD 21201 USA. EM ameltzer@cms.hhs.gov NR 42 TC 12 Z9 12 U1 1 U2 7 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 J9 PEDIATRICS JI Pediatrics PD JUL PY 2005 VL 116 IS 1 BP 24 EP 31 DI 10.1542/peds.2004-0892 PG 8 WC Pediatrics SC Pediatrics GA 941IC UT WOS:000230207500026 PM 15995026 ER PT J AU Gage, BF Birman-Deych, E Kerzner, R Radford, MJ Nilasena, DS Rich, MW AF Gage, BF Birman-Deych, E Kerzner, R Radford, MJ Nilasena, DS Rich, MW TI Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall SO AMERICAN JOURNAL OF MEDICINE LA English DT Article DE anticoagulants; aspirin; atrial fibrillation; falls; intracranial hemorrhage; warfarin ID CEREBRAL AMYLOID ANGIOPATHY; RANDOMIZED CONTROLLED-TRIAL; FIXED MINIDOSE WARFARIN; STROKE PREVENTION; RISK-FACTORS; INTRACEREBRAL HEMORRHAGE; OLDER-PEOPLE; RESIDENTIAL CARE; DOSE WARFARIN; HEAD-INJURY AB PURPOSE: Patients at high risk for falls are presumed to be at increased risk for intracranial hemorrhage, and high risk for falls is cited as a contraindication to antithrombotic therapy. Data substantiating this concern are lacking. METHODS: Quality improvement organizations identified 1245 Medicare beneficiaries who were documented in the medical record to be at high risk of falls and 18 261 other patients with atrial fibrillation. The patients were elderly (mean 80 years), and 48% were prescribed warfarin at hospital discharge. The primary endpoint was subsequent hospitalization for an intracranial hemorrhage, based on ICD-9 codes. RESULTS: Rates (95% confidence interval [CI]) of intracranial hemorrhage per 100 patient-years were 2.8 (1.9-4.1) in patients at high risk for falls and 1.1 (1.0-1.3) in other patients. Rates (95% Cl) of traumatic intracranial hemorrhage were 2.0 (1.3-3.1) in patients at high risk for falls and 0.34 (0.27-0.45) in other patients. Hazard ratios (95% CI) of other independent risk factors for intracranial hemorrhage were 1.4 (1.0-3.1) for neuropsychiatric disease, 2.1 (1.6-2.7) for prior stroke, and 1.9 (1.4-2.4) for prior major bleeding. Warfarin prescription was associated with intracranial hemorrhage mortality but not with intracranial hemorrhage occurrence. Ischemic stroke rates per 100 patient-years were 13.7 in patients at high risk for falls and 6.9 in other patients. Warfarin prescription in patients prone to fall who had atrial fibrillation and multiple additional stroke risk factors appeared to protect against a composite endpoint of stroke, intracranial hemorrhage, myocardial infarction, and death. CONCLUSION: Patients at high risk for falls with atrial fibrillation are at substantially increased risk of intracranial hemorrhage, especially traumatic intracranial hemorrhage. However, because of their high stroke rate, they appear to benefit from anticoagulant therapy if they have multiple stroke risk factors. (c) 2005 Elsevier Inc. All rights reserved. C1 Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO 63130 USA. Washington Univ, Sch Med, Div Cardiol, St Louis, MO USA. Yale Univ, Sch Med, Ctr Outcomes Res & Evaluat, Yale New Haven Hlth Syst, New Haven, CT USA. Yale Univ, Sch Med, Div Cardiol, New Haven, CT USA. Ctr Medicare, Dallas, TX USA. Medicaid Serv, Dallas, TX USA. RP Gage, BF (reprint author), Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO 63130 USA. OI Radford, Martha/0000-0001-7503-9557 NR 37 TC 134 Z9 140 U1 1 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD JUN PY 2005 VL 118 IS 6 BP 612 EP 617 DI 10.1016/j.amjmed.2005.02.022 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 932MD UT WOS:000229556900009 PM 15922692 ER PT J AU Krushat, WM Bhatia, AJ AF Krushat, WM Bhatia, AJ TI Estimating payment error for medicare acute care inpatient services SO HEALTH CARE FINANCING REVIEW LA English DT Article ID QUALITY IMPROVEMENT AB CMS recently assumed responsibility for estimating the Medicare fee-for-service (FFS) error rate from the Office of the Inspector General (OIG). Here, the method used to calculate national, by State, and by error type, estimates for the inpatient acute care portion of this rate is presented. For fiscal years (FYs) 1998 and 2000 discharges, national estimates for the net error rate were 2.6 and 2.8 percent, respectively, about $2 billion annually. Wide variation in State rates illustrates that estimates to the State level are essential for targeting and monitoring interventions to reduce improper Medicare inpatient acute care reimbursements. C1 Ctr Medicare & Medicaid Serv, CMS, Baltimore, MD 21244 USA. RP Bhatia, AJ (reprint author), Ctr Medicare & Medicaid Serv, CMS, 7500 Secur Blvd,S3-02-01, Baltimore, MD 21244 USA. EM anita.bhatia@cms.hhs.gov NR 12 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2005 VL 26 IS 4 BP 39 EP 49 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 958GU UT WOS:000231433500003 PM 17288067 ER PT J AU Lied, TR AF Lied, TR TI 2003 Medicaid versus commercial beneficiary experience with care SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, CMS, Baltimore, MD 21244 USA. RP Lied, TR (reprint author), Ctr Medicare & Medicaid Serv, CMS, 7500 Secur Blvd,Mail Stop S3-13-15, Baltimore, MD 21244 USA. EM terry.lied@cms.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2005 VL 26 IS 4 BP 109 EP 116 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 958GU UT WOS:000231433500008 PM 17288072 ER PT J AU McKibben, L Horan, TC Tokars, JI Fowler, G Cardo, DM Pearson, ML Brennan, PJ AF McKibben, L Horan, TC Tokars, JI Fowler, G Cardo, DM Pearson, ML Brennan, PJ CA Healthcare Infection Control TI Guidance on public reporting of healthcare-associated infections: Recommendations of the healthcare infection control practices advisory committee SO INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY LA English DT Article ID BLOOD-STREAM INFECTIONS; NOSOCOMIAL INFECTIONS; SURVEILLANCE SYSTEM; UNITED-STATES; PREVENTION; RATES C1 Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Infect Dis, Atlanta, GA 30330 USA. Ctr Dis Control & Prevent, Healthcare Otucomes Branch, Natl Ctr Infect Dis, Div Healthcare Qual Promot, Atlanta, GA 30330 USA. Ctr Dis Control & Prevent, Prevent & Evaluat Branch, Natl Ctr Infect Dis, Div Healthcare Qual Promot, Atlanta, GA 30330 USA. Univ Penn, Sch Med, Div Infect Dis, Philadelphia, PA 19104 USA. Vanderbilt Univ, Med Ctr, Nashville, TN USA. Sharp Mem Hosp & Rehabil Ctr, San Diego, CA USA. Univ Washington, Sch Med, Seattle, WA 98195 USA. Amer Hosp Assoc, Washington, DC USA. Cleveland Clin Fdn, Cleveland, OH 44195 USA. Duke Univ, Ctr Med, Durham, NC 27706 USA. Univ Minnesota, Minneapolis, MN 55455 USA. Texas Dept Hlth, Austin, TX 78756 USA. Long Beach Mem Med Ctr, Long Beach, CA USA. Wake Forest Univ, Sch Med, Winston Salem, NC 27109 USA. Childrens Natl Med Ctr, Washington, DC 20010 USA. Qualis Hlth Boise, Boise, ID USA. Univ Nebraska, Med Ctr, Omaha, NE 68583 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Assoc PeriOperat Registered Nurses, Denver, CO USA. Assoc Proffes Infect Control & Epidemiol In, Washington, DC USA. Amer Healthcare, Washington, DC USA. Natl Inst Hlth, Bethesda, MD USA. Hlth Serv Resources Adm, Atlanta, GA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Food & Drug Adm, Rockville, MD USA. Amer Coll Occupat & Environm Med, Arlington Hts, IL USA. CDC, Advisory Comm Eliminat TB, Atlanta, GA 30333 USA. Soc Healthcare Epidemiol Amer Inc, Alexandria, VA USA. Joint Comm Accreditat Healthcare Org, Oak Brook, IL USA. RP Pearson, ML (reprint author), Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Infect Dis, Mailstop E-68,1600 Clifton Rd,NE, Atlanta, GA 30330 USA. EM mpearson@cdc.gov NR 42 TC 60 Z9 60 U1 0 U2 1 PU SLACK INC PI THOROFARE PA 6900 GROVE RD, THOROFARE, NJ 08086 USA SN 0899-823X J9 INFECT CONT HOSP EP JI Infect. Control Hosp. Epidemiol. PD JUN PY 2005 VL 26 IS 6 BP 580 EP 587 DI 10.1086/502585 PG 8 WC Public, Environmental & Occupational Health; Infectious Diseases SC Public, Environmental & Occupational Health; Infectious Diseases GA 973QW UT WOS:000232538700015 PM 16018435 ER PT J AU McClellan, MB Tunis, SR AF McClellan, MB Tunis, SR TI Implantable cardioverter-defibrillators - Reply SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21210 USA. RP McClellan, MB (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21210 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD MAY 12 PY 2005 VL 352 IS 19 BP 2025 EP 2025 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 924YL UT WOS:000229017100023 ER PT J AU Birman-Deych, E Waterman, AD Yan, Y Nilasena, DS Radford, MJ Gage, BF AF Birman-Deych, E Waterman, AD Yan, Y Nilasena, DS Radford, MJ Gage, BF TI Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors SO MEDICAL CARE LA English DT Article DE administrative data; ischemic heart disease; Medicare claims analysis; risk adjustment; risk factors ID PROSPECTIVE-PAYMENT SYSTEM; DEEP VENOUS THROMBOSIS; ADMINISTRATIVE DATABASES; ISCHEMIC-STROKE; DIAGNOSTIC-TEST; MORBIDITY DATA; CLINICAL-DATA; IDENTIFICATION; PROJECT; DISEASE AB Objectives: We sought to determine which ICD-9-CM codes in Medicare Part A data identify cardiovascular and stroke risk factors. Design and Participants: This was a cross-sectional study comparing ICD-9-CM data to structured medical record review from 23,657 Medicare beneficiaries aged 20 to 105 years who had atrial fibrillation. Measurements: Quality improvement organizations used standardized abstraction instruments to determine the presence of 9 cardiovascular and stroke risk factors. Using the chart abstractions as the gold standard, we assessed the accuracy of ICD-9-CM codes to identify these risk factors. Main Results: ICD-9-CM codes for all risk factors had high specificity (> 0.95) and low sensitivity (<= 0.76). The positive predictive values were greater than 0.95 for 5 common, chronic risk factors-coronary artery disease, stroke/transient ischemic attack, heart failure, diabetes, and hypertension. The sixth common risk factor, valvular heart disease, had a positive predictive value of 0.93. For all 6 common risk factors, negative predictive values ranged from 0.52 to 0.91. The rare risk factors-arterial peripheral embolus, intracranial hemorrhage, and deep venous thrombosis-had high negative predictive value (>= 0.98) but moderate positive predictive values (range, 0.54-0.77) in this population. Conclusions: Using ICD-9-CM codes alone, heart failure, coronary artery disease, diabetes, hypertension, and stroke can be ruled in but not necessarily ruled out. Where feasible, review of additional data (eg, physician notes or imaging studies) should be used to confirm the diagnosis of valvular disease. arterial peripheral embolus, intracranial hemorrhage, and deep venous thrombosis. C1 Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO 63110 USA. Ctr Medicare & Medicaid Serv, Dallas, TX USA. Yale Hew Haven Hlth Syst, Ctr Outcomes Res & Evaluat, New Haven, CT USA. RP Gage, BF (reprint author), Washington Univ, Sch Med, Div Gen Med Sci, Campus Box 8005,660 S Euclid, St Louis, MO 63110 USA. EM bgage@im.wustl.edu OI Waterman, Amy/0000-0002-7799-0060; Yan, Yan/0000-0002-5917-1475 NR 29 TC 305 Z9 305 U1 0 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD MAY PY 2005 VL 43 IS 5 BP 480 EP 485 DI 10.1097/01.mlr.0000160417.39497.a9 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 921XE UT WOS:000228798100009 PM 15838413 ER PT J AU Mohr, P Paserchia, L Kornfield, T AF Mohr, P Paserchia, L Kornfield, T TI Explicit valuation of pass-through technologies under Medicare: Is it feasible or desirable? SO VALUE IN HEALTH LA English DT Meeting Abstract C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2005 VL 8 IS 3 BP 239 EP 239 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 918PE UT WOS:000228559300015 ER PT J AU Majumdar, SR Ross-Degnan, D Farraye, FA Lee, M Kemp, JA Lecates, RF Henning, JM Tunis, SR Schrammel, P Soumerai, SB AF Majumdar, SR Ross-Degnan, D Farraye, FA Lee, M Kemp, JA Lecates, RF Henning, JM Tunis, SR Schrammel, P Soumerai, SB TI Controlled trial of interventions to increase testing and treatment for Helicobacter pylori and reduce medication use in patients with chronic acid-related symptoms SO ALIMENTARY PHARMACOLOGY & THERAPEUTICS LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; PEPTIC-ULCER-DISEASE; PRIMARY-CARE PATIENTS; UNINVESTIGATED DYSPEPSIA; SUPPRESSION THERAPY; COST-EFFECTIVENESS; HEALTH-CARE; MANAGEMENT; INFECTION; QUALITY AB Background: Many symptomatic patients take proton pump inhibitors or histamine-2 blockers for years and those without gastro-oesophageal reflux disease might benefit from Helicobacter pylori eradication. Aim: To increase testing and treatment of H. pylori and reduce chronic use of proton pump inhibitors and histamine-2 blockers. Methods: We conducted a three-armed controlled trial in 14 managed care practices. We included adults who used proton pump inhibitors or histamine-2 blockers for > 1 year and excluded those with gastro-oesophageal reflux disease or previous endoscopy. We compared usual care (n = 312 patients from 6 practices) to low-intensity (n = 147 from 3 practices) and high-intensity (n = 122 from 5 practices) interventions. Low-intensity intervention consisted of guidelines, patient-lists, and a 'toolkit'; high-intensity intervention added academic group detailing by a gastroenterologist with reinforcement by pharmacists. Results: Compared with usual care, the high-intensity intervention increased H. pylori test-ordering (29% versus 9% at 12 months, P = 0.02). About half (23 of 58) of patients tested positive and 22 received eradication treatments. The high-intensity intervention decreased proton pump inhibitor use by 9% per year (P = 0.028), but did not alter histamine-2 blocker use. The low intensity intervention was ineffective. Conclusions: Providing guidelines, patient-lists, and toolkits was no better than usual care. Adding group detailing and pharmacist reinforcements led to improvements in H. pylori management and decreases in proton pump inhibitor use. C1 Harvard Univ, Sch Med, Dept Ambulatory Care & Prevent, Boston, MA 02215 USA. Harvard Pilgrim Hlth Care, Boston, MA USA. Univ Alberta, Dept Med, Edmonton, AB, Canada. Harvard Vanguard Med Associates, Boston, MA USA. Boston Med Ctr, Gastroenterol Sect, Boston, MA USA. TAP Pharmaceut Prod Inc, Lake Forest, IL USA. Ctr Medicare & Medicaid Serv, Off Clin Standards & Qual, Baltimore, MD USA. Quintiles Late Phase, Boston, MA USA. RP Soumerai, SB (reprint author), Harvard Univ, Sch Med, Dept Ambulatory Care & Prevent, 133 Brookline Ave,6th Floor, Boston, MA 02215 USA. EM ssoumerai@hms.harvard.edu OI Farraye, Francis/0000-0001-6371-2441 FU AHRQ HHS [U18 HS 1039-01]; BHP HRSA HHS [PE 11001-10] NR 29 TC 6 Z9 6 U1 0 U2 0 PU BLACKWELL PUBLISHING LTD PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DG, OXON, ENGLAND SN 0269-2813 J9 ALIMENT PHARM THERAP JI Aliment. Pharmacol. Ther. PD APR 15 PY 2005 VL 21 IS 8 BP 1029 EP 1039 DI 10.1111/j.1365-2036.2005.02431.x PG 11 WC Gastroenterology & Hepatology; Pharmacology & Pharmacy SC Gastroenterology & Hepatology; Pharmacology & Pharmacy GA 913EM UT WOS:000228134400012 PM 15813839 ER PT J AU Chambers, DA Ringeisen, H Hickman, EE AF Chambers, DA Ringeisen, H Hickman, EE TI Federal, state, and foundation initiatives around evidence-based practices for child and adolescent mental health SO CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA LA English DT Article AB This article is a survey of many of the initiatives developed by federal and state agencies and foundations focusing on evidence-based mental health practices for children and adolescents. The article intends to show the tremendous interest in the development, dissemination, and implementation of evidence-based practice in child and adolescent mental health that is held by a wide variety of agencies and organizations. Several "next steps" for the field are suggested that might be developed in a subsequent series of initiatives. These steps include a better understanding of dissemination and implementation processes, increased clarity around definitions and terms, increased efforts to build infrastructure and support policy change, and the potential for an aggregation of data already gathered on the implementation of evidence-based practices. C1 NIMH, NIH, Bethesda, MD 20892 USA. Ctr Medicare & Medicaid Serv, Dept Hlth & Human Serv, Baltimore, MD 21244 USA. RP Chambers, DA (reprint author), NIMH, NIH, MSC 9631,6001 Execut Blvd, Bethesda, MD 20892 USA. EM dachambers@mail.nih.gov NR 11 TC 41 Z9 41 U1 0 U2 1 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 1056-4993 J9 CHILD ADOL PSYCH CL JI Child Adolesc. Psychiatr. N. Am. PD APR PY 2005 VL 14 IS 2 BP 307 EP + DI 10.1016/j.chc.2004.04.006 PG 22 WC Psychiatry SC Psychiatry GA 900HJ UT WOS:000227205700009 PM 15694788 ER PT J AU Bradley, EH Carlson, MDA Gallo, WT Scinto, J Campbell, MK Krumholz, HM AF Bradley, EH Carlson, MDA Gallo, WT Scinto, J Campbell, MK Krumholz, HM TI From adversary to partner: Have quality improvement organizations made the transition? SO HEALTH SERVICES RESEARCH LA English DT Article DE quality; quality improvement organizations; peer review organizations; acute myocardial infarction ID ACUTE MYOCARDIAL-INFARCTION; COOPERATIVE CARDIOVASCULAR PROJECT; BETA-BLOCKER USE; MEDICARE BENEFICIARIES; OPINION LEADERS; HEALTH-CARE; OF-CARE; HOSPITALS; FEEDBACK AB To describe the perceived impact of the Centers for Medicare and Medicaid Services Quality Improvement Organizations (QIOs) on quality of care for patients hospitalized with acute myocardial infarction, in the context of new efforts to work more collaboratively with hospitals in the pursuit of quality improvement. Primary data collected from a national random sample of 105 hospital quality management directors interviewed between January and July 2002. We interviewed quality management directors concerning their interactions with the QIO interventions, the helpfulness of QIO interventions and the degree to which they helped or hindered their hospital quality efforts, and their recommendations for improving QIO effectiveness. More than 90% of hospitals reported that their QIO had initiated specific interventions, the most common being the provision of educational materials, benchmark data, and hospital performance data. Many respondents (60%) rated most QIO interventions as helpful or very helpful, although only one-quarter of respondents believed quality of care would have been worse without the QIO interventions. To increase QIO efficacy, respondents recommended that QIOs appeal more directly to senior administration, target physicians (not just hospital employees), and enhance the perceived validity and timeliness of data used in quality indicators. Our study demonstrates that the QIOs have overcome, to some degree, the previously adversarial and punitive roles of Peer Review Organizations with hospitals. The generally positive view among most hospital quality improvement directors concerning the QIO interventions suggests that QIOs are potentially poised to take a leading role in promoting quality of care. However, the full potential of QIOs will likely not be realized until QIOs are able to engender greater engagement from senior hospital administration and physicians. C1 Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, New Haven, CT 06520 USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Program Aging, New Haven, CT USA. US Dept Hlth & Human Serv, Ctr Med, Div Qual Improvement, Boston, MA USA. US Dept Hlth & Human Serv, Ctr Medicaid Serv, Div Qual Improvement, Boston, MA USA. Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA. RP Bradley, EH (reprint author), Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, 60 Coll St, New Haven, CT 06520 USA. FU NIA NIH HHS [P30 AG021342, P30AG21342] NR 28 TC 13 Z9 13 U1 0 U2 5 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2005 VL 40 IS 2 BP 459 EP 476 DI 10.1111/j.1475-6773.2005.0y368.x PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 015ZK UT WOS:000235590000011 PM 15762902 ER PT J AU Birman-Deych, E Radford, MJ Nilasena, D Gage, BF AF Birman-Deych, E Radford, MJ Nilasena, D Gage, BF TI Real-world effectiveness of warfarin therapy for stroke prevention in medicare beneficiaries of all races. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 28th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 11-14, 2005 CL New Orleans, LA SP Soc General Internal Med C1 Washington Univ, St Louis, MO 63130 USA. Yale Univ, Sch Med, New Haven, CT 06520 USA. Ctr Medicare & Medicaid Serv, Dallas, TX USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING PI OXFORD PA 9600 GARSINGTON RD, OXFORD OX4 2DQ, OXON, ENGLAND SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2005 VL 20 SU 1 BP 126 EP 127 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 922IQ UT WOS:000228831000352 ER PT J AU McClellan, MB Loeb, JM Clancy, CM Francis, GS Jacobs, AK Kizer, KW O'Kane, ME Wolk, MJ AF McClellan, MB Loeb, JM Clancy, CM Francis, GS Jacobs, AK Kizer, KW O'Kane, ME Wolk, MJ TI Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in chronic heart failure SO ANNALS OF INTERNAL MEDICINE LA English DT Letter ID MYOCARDIAL-INFARCTION C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Joint Commiss Accreditat Healthcare Org, Oak Brook Terrace, IL 60181 USA. Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. Heart Failure Soc Amer, St Paul, MN 55114 USA. Amer Heart Assoc, Dallas, TX 75231 USA. Natl Qual Forum, Washington, DC 20005 USA. Natl Comm Qual Assurance, Washington, DC 20036 USA. Amer Coll Cardiol, Bethesda, MD 20814 USA. RP McClellan, MB (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 7 TC 5 Z9 5 U1 0 U2 0 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAR 1 PY 2005 VL 142 IS 5 BP 386 EP 387 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 902BB UT WOS:000227325100012 PM 15738459 ER PT J AU Farris, JR AF Farris, JR TI When insurance is not enough: Racial and ethnic disparities in immunizations for the medicare population SO ETHNICITY & DISEASE LA English DT Article DE disparities; immunization; influenza; insurance; medicare; quality improvement ID INFLUENZA VACCINATION; PHYSICIAN; ATTITUDES AB This review article discusses disparities in immunization rates for beneficiaries of the US Medicare program. The review considers: 1) historical and statistical information on rates of immunization; 2) goals set forward by the Centers for Medicaid and Medicare Services (CMS) to eliminate racial and ethnic health disparities related to adult immunization; 3) barriers experienced by Medicare beneficiaries in receiving immunizations; 4) barriers experienced by health professionals in providing adult immunizations; and 5) CMS efforts to increase influenza and pneumococcal immunization rates and to eliminate immunization rate disparities among Medicare beneficiaries. C1 Ctr Medicaid & Medicare Serv, Dallas Reg Off, Dallas, TX 75202 USA. RP Farris, JR (reprint author), Ctr Medicaid & Medicare Serv, Dallas Reg Off, 1301 Young St,Room 714, Dallas, TX 75202 USA. EM rfarris@cms.hhs.gov NR 13 TC 0 Z9 0 U1 0 U2 0 PU INT SOC HYPERTENSION BLACKS-ISHIB PI ATLANTA PA 100 AUBURN AVE NE STE 401, ATLANTA, GA 30303-2527 USA SN 1049-510X J9 ETHNIC DIS JI Ethn. Dis. PD SPR PY 2005 VL 15 IS 2 SU 3 BP 7 EP 12 PG 6 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 921HP UT WOS:000228755200003 ER PT J AU Heffler, S Smith, S Keehan, S Borger, C Clemens, MK Truffer, C AF Heffler, S Smith, S Keehan, S Borger, C Clemens, MK Truffer, C TI Trends - US health spending projections for 2004-2014 SO HEALTH AFFAIRS LA English DT Article AB National health spending growth is anticipated to remain stable at just over 7.0 percent through 2006, the result of diverging public- and private-sector spending trends. The faster public-sector spending growth is exemplified by the introduction of the new Medicare drug benefit in 2006. While this benefit is anticipated to have only a minor impact on overall health spending, it will result in a significant shift in funding from private payers and Medicaid to Medicare. By 2014, total health spending is projected to constitute 18.7 percent of gross domestic product, from 15.3 percent in 2003. C1 Off Actuary, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Heffler, S (reprint author), Off Actuary, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. EM sheffler@cms.hhs.gov NR 13 TC 0 Z9 0 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2005 VL 24 IS 2 BP W574 EP W585 DI 10.1377/hlthaff.W5.74 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 909CE UT WOS:000227835700049 ER PT J AU Heller, A AF Heller, A TI Social and economic determinants of Medicare managed care participation SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicare Serv, Baltimore, MD 21244 USA. RP Heller, A (reprint author), Ctr Medicare & Medicare Serv, 7500 Secur Blvd,Mail Stop S1-14-21, Baltimore, MD 21244 USA. EM amy.heller@cms.hhs.gov NR 0 TC 1 Z9 1 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2005 VL 26 IS 3 BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PJ UT WOS:000231090500001 PM 17290624 ER PT J AU Nedza, S AF Nedza, S TI Driving improvement in long-term care - Enforcement and quality initiatives SO JOURNAL OF LEGAL MEDICINE LA English DT Article C1 Ctr Medicare & Medicaid Serv, Chicago, IL 60601 USA. Illinois Dept Publ Hlth, Div Emergency Med Serv, Springfield, IL 62761 USA. Northwestern Univ, Feinberg Sch Med, Evanston, IL 60208 USA. RP Nedza, S (reprint author), Ctr Medicare & Medicaid Serv, 233 N Michigan Ave,Suite 600, Chicago, IL 60601 USA. EM snedza@cms.hhs.gov OI Nedza, Susan/0000-0003-2215-1785 NR 13 TC 1 Z9 1 U1 0 U2 0 PU TAYLOR & FRANCIS INC PI PHILADELPHIA PA 325 CHESTNUT ST, SUITE 800, PHILADELPHIA, PA 19106 USA SN 0194-7648 J9 J LEGAL MED JI J. Legal Med. PD MAR PY 2005 VL 26 IS 1 BP 61 EP 68 DI 10.1080/01947640590917954 PG 8 WC Law; Social Sciences, Biomedical SC Government & Law; Biomedical Social Sciences GA 913DJ UT WOS:000228131500004 PM 15849098 ER PT J AU Williams, SS Mulhall, PF AF Williams, SS Mulhall, PF TI Where public school students in Illinois get cigarettes and alcohol: Characteristics of minors who use different sources SO PREVENTION SCIENCE LA English DT Article DE adolescents; alcohol; cigarettes; tobacco ID YOUTH ACCESS; TOBACCO-SALES; ADOLESCENTS; COMMUNITY; LAWS; AVAILABILITY; ENFORCEMENT; PREVALENCE; POLICIES AB The current study examined demographic, behavior, belief, and social influence characteristics of adolescents who use various means to get cigarettes and alcohol. Spring 1998 survey participants were 7,302 6th, 8th, and 10th grade public school students from throughout Illinois, who self-identified as tobacco smokers and/or alcohol drinkers. The sample was not random, but closely matched the demographic composition of the state. Logistic regression analysis was used to examine the effect of each independent variable on each of the cigarette sources and each of the alcohol sources. For both cigarettes and alcohol, adolescents used commercial sources far less than they did social sources such as family and friends. Also, older adolescents and those who are heavier and more entrenched smokers or drinkers were more likely to use both commercial and social sources. Other factors related to use of various sources included beliefs, social influences, and environmental influences. These findings have many implications for intervention, especially by parents and policymakers, and suggest an increased emphasis on social sources adolescents use to obtain cigarettes and alcohol. C1 Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Off Res Dev & Informat, Baltimore, MD 21244 USA. Univ Illinois, Ctr Prevent Res & Dev, Urbana, IL 61801 USA. RP Williams, SS (reprint author), Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Off Res Dev & Informat, 7500 Secur Blvd,Mail Stop C3-20-17, Baltimore, MD 21244 USA. EM sunyna.williams@cms.hhs.gov NR 32 TC 14 Z9 14 U1 2 U2 4 PU SPRINGER/PLENUM PUBLISHERS PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1389-4986 J9 PREV SCI JI Prev. Sci. PD MAR PY 2005 VL 6 IS 1 BP 47 EP 57 DI 10.1007/s11121-005-1252-y PG 11 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 896OS UT WOS:000226944000004 PM 15766005 ER PT J AU Contento, IR Zybert, P Williams, SS AF Contento, IR Zybert, P Williams, SS TI Relationship of cognitive restraint of eating and disinhibition to the quality of food choices of Latina women and their young children SO PREVENTIVE MEDICINE LA English DT Article DE control of eating; dietary restraint; disinhibition; food choices; mothers; young children; Latina ID NUTRITION EXAMINATION SURVEYS; EXPANDING PORTION SIZES; DIETARY RESTRAINT; FREQUENCY QUESTIONNAIRE; BODY DISSATISFACTION; UNRESTRAINED EATERS; PHYSICAL-ACTIVITY; NATIONAL-HEALTH; WEIGHT-GAIN; BEHAVIOR AB Background. Previous studies have examined the association of methods to control eating such as dietary restraint and disinhibition with weight and quantity of foods eaten. The purpose of this study was to examine the association of these constructs with quality of food choices for women and for their young children. Methods. One hundred and eighty-seven Latina women completed the Eating Inventory, which measures cognitive dietary restraint and disinhibition, and reported on the food intakes of themselves and their 5- to 7-year-old child using a food frequency questionnaire. BMIs were also calculated. Results. Cognitive restraint in mothers was generally associated with more healthful food choices of themselves and, to a lesser degree, of their children. Mothers' dietary disinhibition was associated with less healthful choices of themselves and their children. Mothers' control variables were not related to children's BMIs, except disinhibition was positively correlated with boys' BMI. Cognitive restraint in this low-income Latina population is thus associated with higher quality diets of self and child with no negative impact on children's BMIs whereas disinhibition is associated with overeating by self and child of high-fat, high-sugar foods. With the rise of obesity and with dietary quality of most Americans needing improvement, restraint may be a form of necessary cognitive self-regulation; and disinhibition or overeating is of greater concern. (C) 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. C1 Columbia Univ, Coll Teachers, Dept Hlth & Behav Studies, New York, NY 10027 USA. Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21224 USA. RP Contento, IR (reprint author), Columbia Univ, Coll Teachers, Dept Hlth & Behav Studies, New York, NY 10027 USA. EM contento@tc.columbia.edu NR 72 TC 32 Z9 34 U1 8 U2 13 PU ACADEMIC PRESS INC ELSEVIER SCIENCE PI SAN DIEGO PA 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 USA SN 0091-7435 J9 PREV MED JI Prev. Med. PD MAR PY 2005 VL 40 IS 3 BP 326 EP 336 DI 10.1016/j.ypmed.2004.06.008 PG 11 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 881FT UT WOS:000225849500012 PM 15533547 ER PT J AU Sheikh, K AF Sheikh, K TI Consequences of declining survey response rates for smoking prevalance estimates SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Letter ID MAIL SURVEY RESPONSE; BIAS; NONRESPONSE; RISK C1 US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. RP Sheikh, K (reprint author), US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. EM KSheikh@cms.hhs.gov NR 12 TC 0 Z9 0 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD FEB PY 2005 VL 28 IS 2 BP 241 EP 241 DI 10.1016/j.amepre.2004.10.019 PG 1 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 897EK UT WOS:000226986600015 PM 15710284 ER PT J AU Bratzler, DW Houck, PM Richards, C Steele, L Dellinger, EP Fry, DE Wright, C Ma, A Carr, K Red, L AF Bratzler, DW Houck, PM Richards, C Steele, L Dellinger, EP Fry, DE Wright, C Ma, A Carr, K Red, L TI Use of antimicrobial prophylaxis for major surgery - Baseline results from The National Surgical Infection Prevention Project SO ARCHIVES OF SURGERY LA English DT Article ID COAGULASE-NEGATIVE STAPHYLOCOCCI; ARTERY BYPASS-SURGERY; ANTIBIOTIC-PROPHYLAXIS; SITE INFECTIONS; NOSOCOMIAL INFECTIONS; ORTHOPEDIC-SURGERY; CARDIAC-SURGERY; CARDIOVASCULAR-SURGERY; MEDICARE BENEFICIARIES; HOSPITALIZED-PATIENTS AB Hypothesis: Surgical site infections (SSIs) are a major contributor to patient injury, mortality, and health care costs. Despite evidence of effectiveness of antimicrobials to prevent SSIs, previous studies have demonstrated inappropriate timing, selection, and excess duration of administration of antimicrobial prophylaxis. We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery. Design: National retrospective cohort study with medical record review. Setting: Two thousand nine hundred sixty-five acute-care US hospitals. Patients: A systematic random sample of 34133 Medicare inpatients undergoing coronary artery bypass grafting; other open-chest cardiac surgery (excluding transplantation); vascular surgery, including aneurysm repair, thromboendarterectomy, and vein bypass operations; general abdominal colorectal surgery; hip and knee total joint arthroplasty (excluding revision surgery); and abdominal and vaginal hysterectomy from January I through November 30, 2001. Main Outcome Measures: The proportion of patients who had parenteral antimicrobial prophylaxis initiated within 1 hour before the surgical incision; the proportion of patients who, were given a prophylactic antimicrobial agent that was consistent with currently published guidelines; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery. Results: An antimicrobial dose was administered to 55.7% (95% confidence interval [CI], 54.8%-56.6%) of patients within I hour before incision. Antimicrobial agents consistent with published guidelines were administered to 92.6% (95% Cl, 92.3%-92.8%) of the patients. Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7% (95% Cl, 40.2%-41.2%) of patients. Conclusion: Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery. C1 Oklahoma Fdn Med Qual Inc, Oklahoma City, OK 73134 USA. Ctr Medicare & Medicaid Serv, Seattle, WA USA. Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Infect Dis, Atlanta, GA USA. Ctr Dis Control & Prevent, Off Director, Atlanta, GA USA. Univ Washington, Dept Surg, Seattle, WA 98195 USA. Univ New Mexico, Dept Surg, Albuquerque, NM 87131 USA. RP Bratzler, DW (reprint author), Oklahoma Fdn Med Qual Inc, 14000 Quail Springs Pkwy,Suite 400, Oklahoma City, OK 73134 USA. EM dbratzler@okqio.sdps.org NR 79 TC 274 Z9 294 U1 1 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0004-0010 EI 1538-3644 J9 ARCH SURG-CHICAGO JI Arch. Surg. PD FEB PY 2005 VL 140 IS 2 BP 174 EP 182 DI 10.1001/archsurg.140.2.174 PG 9 WC Surgery SC Surgery GA 894JF UT WOS:000226786600014 PM 15724000 ER PT J AU Gage, B Birman-Deych, E Nilasena, DS Radford, MJ AF Gage, B Birman-Deych, E Nilasena, DS Radford, MJ TI Real-world effectiveness of warfarin therapy for stroke prevention in medicare beneficiaries of all races SO STROKE LA English DT Meeting Abstract CT 30th International Stroke Conference CY FEB 02-04, 2005 CL New Orleans, LA SP Amer Stroke Assoc C1 Washington Univ, Sch Med, St Louis, MO USA. Ctr Medicare, Dallas, TX USA. Ctr Medicaid Serv, Dallas, TX USA. Yale New Haven Hlth Syst, Ctr Outcomes Rsch & Evaluat, New Haven, CT USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD FEB PY 2005 VL 36 IS 2 BP 424 EP 424 PG 1 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 904UR UT WOS:000227523800032 ER PT J AU Gage, B Birman-Deych, E Waterman, A Yan, Y Nilasena, DS Radford, M AF Gage, B Birman-Deych, E Waterman, A Yan, Y Nilasena, DS Radford, M TI Accuracy of ICD-9 codes for identifying stroke and cardiovascular risk factors SO STROKE LA English DT Meeting Abstract CT 30th International Stroke Conference CY FEB 02-04, 2005 CL New Orleans, LA SP Amer Stroke Assoc C1 Washington Univ, Sch Med, St Louis, MO USA. Ctr Medicare, Dallas, TX USA. Ctr Medicaid Serv, Dallas, TX USA. Yale New Haven Hlth Syst, Ctr Outcomes Rsch & Evaluat, New Haven, CT USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD FEB PY 2005 VL 36 IS 2 BP 429 EP 429 PG 1 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 904UR UT WOS:000227523800060 ER PT J AU McClellan, MB Tunis, SR AF McClellan, MB Tunis, SR TI Medicare coverage of ICDs SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID MYOCARDIAL-INFARCTION; DEFIBRILLATOR C1 Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP McClellan, MB (reprint author), Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. NR 5 TC 106 Z9 107 U1 0 U2 0 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JAN 20 PY 2005 VL 352 IS 3 BP 222 EP 224 DI 10.1056/NEJMp048354 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 888JP UT WOS:000226370500002 PM 15659721 ER PT J AU Adler, GS Winston, CA AF Adler, GS Winston, CA CA CDC TI Influenza vaccination and self-reported reasons for not receiving influenza vaccination among Medicare beneficiaries aged >= 65 years - United States, 1991-2002 (Reprinted from MMWR, vol 53, pg 1012-1015, 2004) SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Reprint C1 CDC, Off Res Dev & Informat, Ctr Medicare Serv, Atlanta, GA 30333 USA. CDC, Off Res Dev & Informat, Ctr Medicaid Serv, Atlanta, GA 30333 USA. CDC, Immunizat Serv Div, Natl Immunizat Program, Atlanta, GA 30333 USA. RP Adler, GS (reprint author), CDC, Off Res Dev & Informat, Ctr Medicare Serv, Atlanta, GA 30333 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 12 PY 2005 VL 293 IS 2 BP 153 EP 155 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 885QC UT WOS:000226171000010 ER PT J AU Shenson, D DiMartino, D Bolen, J Campbell, M Lu, PJ Singleton, JA AF Shenson, D DiMartino, D Bolen, J Campbell, M Lu, PJ Singleton, JA TI Validation of self-reported pneumococcal vaccination in behavioral risk factor surveillance surveys: experience from the sickness prevention achieved through regional collaboration (SPARC) program SO VACCINE LA English DT Article DE validity; vaccination; self-report; pneumococcal infection ID ELDERLY OUTPATIENTS; INFLUENZA; SAFETY AB Behavioral risk factor surveillance system (BRFSS) is the primary surveillance tool for the ongoing measurement of state-specific delivery of pneumnococcal polysaccharide vaccine. This study is the first validity assessment of self-reported pneumococcal vaccination status in a population-wide BRFSS survey. A subset of respondents to the sickness prevention achieved through regional collaboration (SPARC) BRFSS survey, which was conducted from June to September 1997 in a four-county area were assessed. Self-reporting of pneumococcal vaccination status was validated either by matching to Medicare claims or by reviewing of medical records. Self-reporting of pneumococcal vaccination had a sensitivity of 75% and a specificity of 83%. We conclude that self-reporting of pneumococcal immunization is a moderately sensitive and specific measure and that population-based surveys in the community can be validated when undertaken in collaboration with a local health care agency. (C) 2004 Elsevier Ltd. All rights reserved. C1 Sickness Prevent Achieved Through Reg Collaborat, Lakeville, CT USA. Ctr Dis Control & Prevent, Atlanta, GA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Shenson, D (reprint author), 76 Prince St, Newton, MA 02465 USA. EM dshenson@earthlink.net NR 19 TC 51 Z9 54 U1 0 U2 0 PU ELSEVIER SCI LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, OXON, ENGLAND SN 0264-410X J9 VACCINE JI Vaccine PD JAN 11 PY 2005 VL 23 IS 8 BP 1015 EP 1020 DI 10.1016/j.vaccine.2004.07.039 PG 6 WC Immunology; Medicine, Research & Experimental SC Immunology; Research & Experimental Medicine GA 890XT UT WOS:000226545400006 PM 15620474 ER PT J AU Rathore, SS Foody, JM Wang, YF Herrin, J Masoudi, FA Havranek, EP Ordin, DL Krumholz, HM AF Rathore, SS Foody, JM Wang, YF Herrin, J Masoudi, FA Havranek, EP Ordin, DL Krumholz, HM TI Sex, quality of care and outcomes of elderly patients hospitalized with heart failure: Findings from the National Heart Failure Project SO AMERICAN HEART JOURNAL LA English DT Article ID CONVERTING-ENZYME-INHIBITORS; GENDER-DIFFERENCES; MEDICARE PATIENTS; SURVIVAL; MORTALITY; WOMEN; RACE; MEN; READMISSION; PATTERNS AB Background Previous studies have demonstrated that women hospitalized for heart failure receive poorer quality of care and have worse outcomes than men. However, these studies were based upon selected patient populations and lacked quality of care measures. Methods We used data from the National Heart Failure Project, a national sample of fee-for-service Medicare patients hospitalized with heart failure in the United States in 1998-1999, to evaluate differences in quality of care and patient outcomes between men and women. Multivariable hierarchical logistic regression models and (2)(X) analyses were used to examine sex differences in the documentation of left ventricular systolic function (LVSF), prescription of. angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for patients with left ventricular dysfunction, and mortality within 30 days and 1 year of admission in the study cohort (n 30 996). Results Women had lower overall rates of LVSF assessment than men (64.9% vs 69.5%, P <.001). Among patients classified as candidates for ACE inhibitor prescription, women had lower crude rates of ACE inhibitor prescription than men (70. 1% vs 74.2%, P =.015), but treatment rates were similar when evaluating the prescription of ACE inhibitors or ARBs (78.9% women vs 81.3% men, P 11). Despite lower rates of treatment, women had lower mortality rates than men at 30 days (9.2% vs 11.4%, P <.00 1) and 1 year (36.2% vs 43.0%, P <.00 1) after admission. Results were similar after multivariable adjustment. Conclusions There were small sex differences in the quality of care provided to fee-for-service Medicare patients hospitalized with heart failure, although women had higher rates,of survival than men up to I year after hospitalization. C1 Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06520 USA. Qualidigm, Middletown, CT USA. Flying Buttress Associates, Charlottesville, VA USA. Denver Hlth Med Ctr, Dept Med, Div Cardiol, Denver, CO USA. Univ Colorado, Hlth Care Sci Ctr, Div Geriatr Med, Denver, CO 80202 USA. Univ Colorado, Hlth Care Sci Ctr, Dept Med, Div Cardiol, Denver, CO 80202 USA. Colorado Fdn Med Care, Aurora, CO USA. Ctr Medicare & Medicaid Serv, Boston, MA USA. RP Rathore, SS (reprint author), Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. FU NIGMS NIH HHS [T32 GM007205-35, T32 GM007205, GM07205] NR 46 TC 31 Z9 32 U1 1 U2 2 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0002-8703 J9 AM HEART J JI Am. Heart J. PD JAN PY 2005 VL 149 IS 1 BP 121 EP 128 DI 10.1016/j.ahj.2004.06.008 PG 8 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 888PP UT WOS:000226387000018 PM 15660043 ER PT J AU Storm, S Beaver, SK Giardino, N Kliot, M Franklin, GM Jarvik, JG Chan, L AF Storm, S Beaver, SK Giardino, N Kliot, M Franklin, GM Jarvik, JG Chan, L TI Compliance with electrodiagnostic guidelines for patients undergoing carpal tunnel release SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION LA English DT Article; Proceedings Paper CT 50th Annual Meeting of the American-Association-of-Electrodiagnostic-Medicine CY SEP, 2003 CL San Francisco, CA SP Amer Assoc Electrodiagnost Med DE carpal tunnel syndrome; electrodiagnosis; guidelines; medicare; physician's practice patterns; rehabilitation ID PRACTICE PARAMETER; STATEMENT; SURGERY; ISSUES AB Objective: To describe how clinical practice in those who underwent carpal tunnel release (CTR) matched the American Association of Electrodiagnostic Medicine (AAEM) 1993 practice parameters for electrodiagnostic evaluation of carpal tunnel syndrome (CTS). Design: Cohort study using 1998-1999 Medicare billing data. Setting: Washington State. Participants: State Medicare beneficiaries who underwent CTR in 1999 (N = 1567). Interventions: Not applicable. Main Outcome Measures: Compliance with the AAEM practice parameters. Results: Of the 324 receiving surgery, 24 (20.7%) did not have any electrodiagnostic testing before surgery. One hundred seventy-one (10.9%) had testing performed that did not lead to the diagnosis of CTS. One thousand seventy-two (68.4%) patients were diagnosed with CTS through electrodiagnostic testing; 155 (9.9%) had less than 2 sensory nerves studied, 114 (7.3%) had less than 2 motor nerves studied, and 65 (4.2%) of the studies met neither the standard (sensory nerve testing) nor guideline (motor nerve testing). In a multivariate analysis, neurologists were more likely than physiatrists not to meet the AAEM standards (adjusted relative risk [adj RR] = 1.61; 95% confidence interval [CI], 1.13-2.31) and patients living in rural areas were more likely to have no or inadequate testing (adj RR = 1.6; 95% CI, 1.3-1.9). Conclusions: Over one third of Medicare patients undergoing CTR in Washington State in 1999 may have had an inappropriate electrodiagnostic workup before the surgery. Policymakers should consider mandating an appropriate electrodiagnostic test before approving CTR. C1 Univ Washington, Dept Rehabil Med, Seattle, WA 98195 USA. Univ Washington, Dept Neurosurg, Seattle, WA 98195 USA. Univ Washington, Dept Environm Hlth, Seattle, WA 98195 USA. Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. Univ Washington, Dept Radiol, Seattle, WA 98195 USA. Ctr Medicare & Med Serv, Div Qual Improvement, Seattle Reg Off, Seattle, WA USA. RP Chan, L (reprint author), Univ Washington, Dept Rehabil Med, Box 356490, Seattle, WA 98195 USA. EM leighton@u.washington.edu FU NIAMS NIH HHS [1P60 AR48093] NR 16 TC 15 Z9 15 U1 2 U2 3 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0003-9993 J9 ARCH PHYS MED REHAB JI Arch. Phys. Med. Rehabil. PD JAN PY 2005 VL 86 IS 1 BP 8 EP 11 DI 10.1016/j.apmr.2004.02.027 PG 4 WC Rehabilitation; Sport Sciences SC Rehabilitation; Sport Sciences GA 887OJ UT WOS:000226315100002 PM 15640981 ER PT J AU Smith, C Cowan, C Sensenig, A Catlin, A AF Smith, C Cowan, C Sensenig, A Catlin, A CA Hlth Accounts Team TI Health spending growth slows in 2003 SO HEALTH AFFAIRS LA English DT Article AB The pace of health spending growth slowed in 2003 for the first time in seven years, driven in part by a slowdown in public spending growth. U.S. health care spending rose 7.7 percent in 2003, much slower than the 9.3 percent growth in 2002. Financial constraints on the Medicaid program and the expiration of supplemental funding provisions for Medicare services drove the deceleration. U.S. health spending accounted for 15.3 percent of U.S. gross domestic product in 2003, an increase of 0.4 percentage points from 2002. C1 Natl Hlth Stat Grp, Off Actuary, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Smith, C (reprint author), Natl Hlth Stat Grp, Off Actuary, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. EM csmith7@cms.hhs.gov NR 19 TC 57 Z9 57 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2005 VL 24 IS 1 BP 185 EP 194 DI 10.1377/hlthaff.24.1.185 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 909CD UT WOS:000227835600025 PM 15644387 ER PT J AU Becker, D Kessler, D McClellan, M AF Becker, D Kessler, D McClellan, M TI Detecting Medicare abuse SO JOURNAL OF HEALTH ECONOMICS LA English DT Article DE Medicare abuse; anti-fraud enforcement; Medicare beneficiaries ID VERTICAL INTEGRATION; CORRUPTION; COSTS; PHYSICIANS; STATUTE; FRAUD; RATES; TAX AB This paper identifies which types of patients and hospitals have abusive Medicare billings that are responsive to law enforcement. For a 20% random sample of elderly Medicare beneficiaries hospitalized from 1994 to 1998 with one or more of six illnesses that are prone to abuse, we obtain longitudinal claims data linked with social security death records, hospital characteristics, and state/year-level anti-fraud enforcement efforts. We show that increased enforcement leads certain types of types of patients and hospitals to have lower billings, without adverse consequences for patients' health outcomes. (C) 2004 Elsevier B.V. All rights reserved. C1 Stanford Univ, Grad Sch Business, Hoover Inst, Stanford, CA 94305 USA. NBER, Stanford, CA 94305 USA. Univ Calif Berkeley, Berkeley, CA 94720 USA. NBER, Baltimore, MD 21244 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Kessler, D (reprint author), Stanford Univ, Grad Sch Business, Hoover Inst, Stanford, CA 94305 USA. EM fkessler@stanford.edu NR 39 TC 24 Z9 24 U1 1 U2 9 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0167-6296 J9 J HEALTH ECON JI J. Health Econ. PD JAN PY 2005 VL 24 IS 1 BP 189 EP 210 DI 10.1016/j.jhealeco.2004.07.002 PG 22 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 886ZS UT WOS:000226272400009 PM 15617794 ER PT J AU Buczko, W AF Buczko, W TI Cranial surgery among medicare beneficiaries SO JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE LA English DT Article DE head injury; elderly; disabled ID HEAD-INJURY AB Background: This article examines the incidence of inpatient cranial surgery among Medicare beneficiaries. Many of these surgeries are trauma related or reflect chronic disabilities. The costs of care and the mortality rates are high for these patients. Methods: A retrospective study examined the inpatient discharge data on Medicare fee-for-service beneficiaries during FY 1997 for diagnosis-related groups 1, 2, and 484. Incidence patterns, length of hospital stay, and mortality were examined by age, race, sex, source of admission, and discharge destination. Results: Approximately 86% of the Medicare cranial surgery patients were 65 years of age or older, but only 10.2% were 85 years of age or older. The average patient age was 72 years. Nearly 51% of the patients were male, and 86.3% were white. Approximately 35% of the patients were admitted from the emergency room. The average length of stay was 9.6 days, and the average intensive care unit stay was 3.5 days. Whereas 42.3% of the patients were discharged to home, 44.6% were discharged to postacute care, and 10.9% died in the hospital. The average inpatient charge was $30,746. Conclusions: Cranial surgery in the Medicare population results in high inpatient mortality and high rates of postacute care use, especially as patient age increases. C1 DHHS, Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Buczko, W (reprint author), DHHS, Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, 7500 Secur Blvd,C3-19-07, Baltimore, MD 21244 USA. EM WBuczko@cms.hhs.gov NR 12 TC 3 Z9 3 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0022-5282 J9 J TRAUMA JI J. Trauma-Injury Infect. Crit. Care PD JAN PY 2005 VL 58 IS 1 BP 40 EP 46 DI 10.1097/01.TA.0000149332.17597.36 PG 7 WC Critical Care Medicine; Surgery SC General & Internal Medicine; Surgery GA 894HS UT WOS:000226782300008 PM 15674148 ER PT J AU Chang, NN Murray, CK Houck, PM Bratzler, DW Greenway, C Guglielmo, BJ AF Chang, NN Murray, CK Houck, PM Bratzler, DW Greenway, C Guglielmo, BJ TI Blood culture and susceptibility results and allergy history do not influence fluoroquinolone use in the treatment of community-acquired pneumonia SO PHARMACOTHERAPY LA English DT Article; Proceedings Paper CT 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy CY SEP 26-30, 2002 CL SAN DIEGO, CA DE fluoroquinolone; community-acquired pneumonia; fluoroquinolone-resistant bacteria; gram-positive bacteria; gram-negative bacteria; allergy history; culture results ID RESISTANT STREPTOCOCCUS-PNEUMONIAE; UNITED-STATES; ANTIMICROBIAL RESISTANCE; PNEUMOCOCCAL PNEUMONIA; HOSPITALIZED-PATIENTS; SURVEILLANCE; LEVOFLOXACIN; MANAGEMENT; THERAPY; ADULTS AB Study Objective. To determine the influence of blood culture and susceptibility results and antimicrobial allergy history on fluoroquinolone use in the treatment of community-acquired pneumonia. Design. Retrospective analysis medical records. Setting. Centers for Medicare and Medicaid Services, Seattle, Washington. Patients. A total of 10,275 Medicare beneficiaries hospitalized with the diagnosis of pneumonia received antimicrobial treatment within 24 hours of admission. Of these patients, 288 had blood cultures positive for pneumococcus and were matched one-to-one with patients with negative blood and sputum cultures. Measurements and Main Results. Antimicrobial use at the beginning and end of hospitalization, culture and susceptibility results, and patient allergies were recorded retrospectively and compared between two matched groups: patients with blood cultures positive for Streptococcus pneumoniae and those whose blood and sputum cultures were negative. Neither culture and susceptibility results nor allergy history affected the rate of fluoroquinolone use. Despite infection due to penicillin-susceptible pneumococci and no penicillin allergy, patients received therapy with fluoroquinolones (26.7%) as frequently as those with culture-negative pneumonia (34.9%; p=0.401). Conclusion. Fluoroquinolones are prescribed despite microbiologic confirmation of penicillin-susceptible pneumococcal pneumonia in the absence of penicillin allergy. These prescribing patterns may contribute to selection pressure associated with fluoroquinolone-resistant gram-positive and gram-negative bacteria. C1 Univ Calif San Francisco, Dept Clin Pharm, Sch Pharm, San Francisco, CA 94143 USA. Oklahoma Fdn Med Qual Inc, Oklahoma City, OK USA. Ctr Medicare & Med Serv, Seattle, WA USA. RP Guglielmo, BJ (reprint author), Univ Calif San Francisco, Dept Clin Pharm, Sch Pharm, 521 Parnassus Ave,C-152,Box 0622, San Francisco, CA 94143 USA. EM bjg@itsa.ucsf.edu NR 28 TC 8 Z9 8 U1 0 U2 1 PU PHARMACOTHERAPY PUBLICATIONS INC PI BOSTON PA NEW ENGLAND MEDICAL CENTER, 806, 750 WASHINGTON ST, BOSTON, MA 02111 USA SN 0277-0008 J9 PHARMACOTHERAPY JI Pharmacotherapy PD JAN PY 2005 VL 25 IS 1 BP 59 EP 66 DI 10.1592/phco.25.1.59.55627 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 896KS UT WOS:000226933600008 PM 15767221 ER PT J AU Fleming, B Silver, A Ocepek-Welikson, K Keller, D AF Fleming, B Silver, A Ocepek-Welikson, K Keller, D TI The relationship between organizational systems and clinical quality in diabetes care SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID ELECTRONIC MANAGEMENT-SYSTEM; IMPROVEMENT PROJECT; CHRONIC ILLNESS; UNITED-STATES; OF-CARE; IMPACT; PROVIDERS; DISEASE AB Objective: To assess the clinical quality of diabetes care and the systems of care in place in Medicare managed care organizations (MCOs) to determine which systems are associated with the quality of care. Study Design: Cross-sectional, observational study that included a retrospective review of 2001 diabetes Health Plan Employer and Data Information Set (HEDIS) measures and a mailed survey to MCOS. Methods: One hundred and thirty-four plans received systems surveys. Data on clinical quality were obtained from HEDIS reports of diabetes measures. Results: Ninety plans returned the survey. Composite diabetes quality scores (CDSs) were based on averaging scores for the 6 HEDIS diabetes measures. For the upper quartile of responding plans, the average score was 77.6. The average score for the bottom quartile was 53.9 (P <.001). The mean number of systems or interventions for the upper-quartile group and the bottom-quartile group was 17.5 and 12.5 (P <.01), respectively. There were significant differences in the 2 groups in the following areas: computer-generated reminders, physician champions, practitioner quality-improvement work groups, clinical guidelines, academic detailing, self-management education, availability of laboratory results, and registry use. After adjusting for structural and geographic variables, practitioner input and use of clinical-guidelines software remained as independent predictors of CDS. Structural variables that were independent predictors were nonprofit status and increasing number of Medicare beneficiaries in the MCO. Conclusions: MCO structure and greater use of systems/interventions are associated with higher-quality diabetes care. These relationships require further exploration. C1 IPRO, Lake Success, NY 11042 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Delmarva Fdn Med Care, Easton, MD USA. RP Silver, A (reprint author), IPRO, 1979 Marcus Ave, Lake Success, NY 11042 USA. EM asilver@nyqio.sdps.org NR 29 TC 35 Z9 35 U1 0 U2 3 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD DEC PY 2004 VL 10 IS 12 BP 934 EP 944 PG 11 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 878DW UT WOS:000225627700005 PM 15617369 ER PT J AU Buczko, W AF Buczko, W TI Provider opt-out under Medicare private contracting SO HEALTH CARE FINANCING REVIEW LA English DT Article ID BENEFICIARIES AB The 1997 Balanced Budget Act (BBA) permits private contracting for care between Medicare beneficiaries and providers who have opted out of Medicare. This article examines the number and characteristics of providers who have opted-out, their role in the provision of Part B services, and their impact on beneficiary access from 1998 to 2002. Opt-out providers differ from providers remaining in Medicare with respect to specialty, practice characteristics, and Medicare Program activity. Very few providers found opting-out attractive and the departure of this small group of providers appears not to have created access problems for beneficiaries. C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Buczko, W (reprint author), Ctr Medicare, 7500 Secur Blvd,C3-19-107, Baltimore, MD 21244 USA. EM wbuczko@cms.hhs.gov NR 19 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2004 VL 26 IS 2 BP 43 EP 59 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PI UT WOS:000231090400003 ER PT J AU Waldo, DP AF Waldo, DP TI Accuracy and bias of race/ethnicity codes in the Medicare enrollment database SO HEALTH CARE FINANCING REVIEW LA English DT Article ID RACE; ETHNICITY; HEALTH AB Medicare administrative data are fairly accurate in identifying people who affiliate with White or Black racial groups; but less so for other race groups or for Hispanic/Latino origin. Some differences were found between people who were identified as members of these other race groups and those who were missed by the administrative data. Although Medicare administrative files are a useful source of data for analysis of disparities in health care, researchers should be careful to use alternate data sources to test for Potential differences between identified and unidentified members of racial and ethnic groups in the attributes being studied. C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Waldo, DP (reprint author), Ctr Medicare, 7500 Secur Blvd,Mail Stop C3-16-27, Baltimore, MD 21244 USA. EM dwaldo@cms.hhs.gov NR 12 TC 21 Z9 21 U1 0 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2004 VL 26 IS 2 BP 61 EP 72 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PI UT WOS:000231090400004 ER PT J AU Baugh, DK AF Baugh, DK TI Estimates of dual and full medicaid benefit dual enrollees, 1999 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Baugh, DK (reprint author), Ctr Medicare, 7500 Secur Blvd,Mail Stop C3-20-17, Baltimore, MD 21244 USA. EM dbaugh@cms.hhs.gov NR 9 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2004 VL 26 IS 2 BP 133 EP 139 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PI UT WOS:000231090400009 ER PT J AU Mohr, PE Cheng, CM Claxton, K Conley, RR Feldman, JJ Hargreaves, WA Lehman, AF Lenert, LA Mahmoud, R Marder, SR Neumann, PJ AF Mohr, PE Cheng, CM Claxton, K Conley, RR Feldman, JJ Hargreaves, WA Lehman, AF Lenert, LA Mahmoud, R Marder, SR Neumann, PJ TI The heterogeneity of schizophrenia in disease states SO SCHIZOPHRENIA RESEARCH LA English DT Article DE schizophrenia; outcome assessment; prognosis; treatment costs ID POSITIVE-NEGATIVE DICHOTOMY; HEALTH STATES; SYMPTOMS; MODEL; RISPERIDONE; PREFERENCES; DEPRESSION; OUTCOMES; SCALE AB Previous presentation: Some of the contents of this paper have been previously presented at the 16th Annual Meeting of the International Society for Technology Assessment in Health Care June 20, 2000 in the Hague, Netherlands and at the 21st Annual Meeting of the Society for Medical Decision Making as a poster on October 3, 1999 in Reno, NV. Background: Studies of schizophrenia treatment often oversimplify the array of health outcomes among patients. Our objective was to derive a set of disease states for schizophrenia using the Positive and Negative Symptom Assessment Scale (PANSS) that captured the heterogeneity of symptom responses. Methods: Using data from a 1-year clinical trial that collected PANSS scores and costs on schizophrenic patients (N = 663), we conducted a k-means cluster analyses on PANSS scores for items in five factor domains. Results of the cluster analysis were compared with a conceptual framework of disease states developed by an expert panel. Final disease states were defined by combining our conceptual framework with the empirical results. We tested its utility by examining the influence of disease state on treatment costs and prognosis. Results: Analyses led to an eight-state framework with varying levels of positive, negative, and cognitive impairment. The extent of hostile/aggressive symptoms and mood disorders correlated with severity of disease states. Direct treatment costs for schizophrenia vary significantly across disease states (F = 27.47, df = 7, p<0.0001), and disease state at baseline was among the most important predictors of treatment outcomes. Conclusion: The disease states we describe offer a useful paradigm for understanding the links between symptom profiles and outcomes. (C) 2003 Elsevier B.V. All rights reserved. C1 Ctr Medicare, ORDI, REG, DBR, Baltimore, MD 21244 USA. PacifiCare, Med Informat, Cypress, CA 90630 USA. Univ York, Dept Econ, York YO10 5DD, N Yorkshire, England. Maryland Psychiat Res Ctr, Baltimore, MD 21228 USA. Univ Calif San Francisco, Sch Med, Dept Psychiat, San Francisco, CA 94143 USA. Univ Maryland, Sch Med, Dept Psychiat, Baltimore, MD 21201 USA. Univ Calif San Diego, Sch Med, Hlth Serv Res & Dev, San Diego, CA 92103 USA. Janssen Pharmaceut Prod LP, Med Dev, Titusville, NJ USA. VA Greater Los Angeles Healthcare Syst, Mental Illness Res Educ & Clin Ctr, Los Angeles, CA USA. Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. Ctr Medicaid Serv, ORDI, REG, DBR, Baltimore, MD 21244 USA. RP Mohr, PE (reprint author), Ctr Medicare, ORDI, REG, DBR, Mail Stop C3-19-07 7500,Secur Blvd, Baltimore, MD 21244 USA. EM pmohr@cms.hhs.gov NR 29 TC 27 Z9 32 U1 1 U2 4 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0920-9964 J9 SCHIZOPHR RES JI Schizophr. Res. PD NOV 1 PY 2004 VL 71 IS 1 BP 83 EP 95 DI 10.1016/j.schres.2003.11.008 PG 13 WC Psychiatry SC Psychiatry GA 859BW UT WOS:000224238100010 PM 15374576 ER PT J AU Glavin, Y Noelker, L Clark, W AF Glavin, Y Noelker, L Clark, W TI Development of policy strategies and a service system model for Ohio's aged, blind and disabled population SO GERONTOLOGIST LA English DT Meeting Abstract C1 Case Western Reserve Univ, Moreland Hills, OH USA. Benjamin Rose, Cleveland, OH USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2004 VL 44 SI 1 BP 341 EP 341 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 875YJ UT WOS:000225458801294 ER PT J AU O'Keeffe, J Hulbert, M Wiener, J Siebenaler, K O'Keeffe, J Wiener, J AF O'Keeffe, J Hulbert, M Wiener, J Siebenaler, K O'Keeffe, J Wiener, J TI Federal-funded systems change initiatives to expand home and community services SO GERONTOLOGIST LA English DT Meeting Abstract C1 RTI Int, Ctr Medicare & Medicaid Serv, Res Triangle Pk, NC 27709 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2004 VL 44 SI 1 BP 428 EP 428 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 875YJ UT WOS:000225458801534 ER PT J AU Wren, J Linkins, K Elani, D Alecxih, L Reinhard, S AF Wren, J Linkins, K Elani, D Alecxih, L Reinhard, S TI Aging and disability resource center initiative: Streamlining access to long term care SO GERONTOLOGIST LA English DT Meeting Abstract C1 US Adm Aging, Washington, DC 20001 USA. Lewin Grp, Falls Church, VA 22042 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Rutgers Ctr State Hlth Policy, New Brunswick, NJ 08901 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2004 VL 44 SI 1 BP 544 EP 544 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 875YJ UT WOS:000225458802316 ER PT J AU Gornick, ME Eggers, PW Riley, GF AF Gornick, ME Eggers, PW Riley, GF TI Associations of race, education, and patterns of preventive service use with stage of cancer at time of diagnosis SO HEALTH SERVICES RESEARCH LA English DT Article DE health behaviors; race; socioeconomic status; disparities; preventive service use; stage of cancer ID HEALTH BEHAVIORS; RACIAL VARIATION; BREAST-CANCER; UNITED-STATES; WOMEN; CARE; MAMMOGRAPHY; VALIDATION; EXERCISE; WORKING AB Objective. To go beyond the documentation of disparities by race and SES by analyzing health behaviors regarding preventive and cancer screening services and determining if these behaviors are associated with stage of cancer when first diagnosed. Data. Stage of cancer for Medicare patients diagnosed in 1995 with breast, colorectal, uterine, ovarian, prostate, bladder, or stomach cancer; and use of influenza and pneumonia immunization, mammography, pap smear, colon cancer screening, and the prostate specific antigen test during the two years preceding diagnosis of cancer. Study Design. Hypothesis tested: health behaviors regarding use of preventive and cancer screening services are associated with stage of cancer when first diagnosed. Data Collection/Extraction Methods. Information was extracted from the database formed by the linkage of Surveillance, Epidemiology, and End Results (SEER) cancer registries with Medicare files. Principal Findings. Black and white patients (of higher and lower SES) who used more of the preventive and cancer screening services were at a lower risk of having late stage cancer for six cancers studied (breast, colorectal [male and female], prostate, uterine, and male bladder cancer) than their counterparts who used fewer of these services. Conclusions. The use of preventive and cancer screening services is a health behavior associated with better health outcomes for the elderly diagnosed with cancer. The lack of preventive service use can serve as a marker for identifying persons at risk of late stage cancer when first diagnosed. Strategies that encourage the use of preventive services by low users of these services are likely to reinforce a range of healthy behaviors that help to ameliorate disparities in health outcomes. C1 NIDDKD, NIH, Bethesda, MD 20892 USA. Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Gornick, ME (reprint author), 3704 N Charles St, Baltimore, MD 21218 USA. NR 32 TC 56 Z9 56 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 2004 VL 39 IS 5 BP 1403 EP 1427 DI 10.1111/j.1475-6773.2004.00296.x PG 25 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 893TQ UT WOS:000226742600011 PM 15333115 ER PT J AU Smith, MB Koren, VI Zhang, Z Reed, SM Pan, JJ Moreda, F AF Smith, MB Koren, VI Zhang, Z Reed, SM Pan, JJ Moreda, F TI Runoff response to spatial variability in precipitation: an analysis of observed data SO JOURNAL OF HYDROLOGY LA English DT Article DE rainfall; spatial variability; dampening; hydrologic response; streamflow variability; NEXRAD; radar; precipitation; wavelet transformation; distributed model ID WAVELET TRANSFORM; CATCHMENT RESPONSE; SPECTRAL-ANALYSES; KARSTIC SPRINGS; WEATHER RADAR; TIME-SCALE; RAINFALL; MODEL; SENSITIVITY; BASIN AB We examine the hypothesis that basins characterized by (1) marked spatial variability in precipitation, and (2) less of a filtering effect of the input rainfall signal will show improved outlet simulations from distributed versus lumped models. Basin outflow response to observed spatial variability of rainfall is examined for several basins in the Distributed Model Intercomparison Project. The study basins are located in the Southern Great Plains and range in size from 795 to 1645 km(2). We test our hypothesis by studying indices of rainfall spatial variability and basin filtering. Spatial variability of rainfall is measured using two indices for specific events: a general variability index and a locational index. The variability of basin response to rainfall event is measured in terms of a dampening ratio reflecting the amount of filtering performed on the input rainfall signal to produce the observed basin outflow signal. Analysis of the observed rainfall and streamflow data indicates that all basins perform a range of dampening of the input rainfall signal. All basins except one had a very limited range of rainfall location index. Concurrent time series of observed radar rainfall estimates and observed streamflow are analyzed to avoid model-specific conclusions. The results indicate that one basin contains complexities that suggest the use of distributed modeling approach. Furthermore, the analyses of observed data support the calibrated results from a distributed model. (C) 2004 Elsevier B.V. All rights reserved. C1 NOAA, Natl Weather Serv, Hydrol Lab, Off Hydrol Dev, Silver Spring, MD 20910 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Smith, MB (reprint author), NOAA, Natl Weather Serv, Hydrol Lab, Off Hydrol Dev, WOHD-12,1325 E W Highway, Silver Spring, MD 20910 USA. EM michael.smith@noaa.gov NR 50 TC 73 Z9 74 U1 2 U2 14 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0022-1694 J9 J HYDROL JI J. Hydrol. PD OCT 1 PY 2004 VL 298 IS 1-4 BP 267 EP 286 DI 10.1016/j.jhydrol.2004.03.039 PG 20 WC Engineering, Civil; Geosciences, Multidisciplinary; Water Resources SC Engineering; Geology; Water Resources GA 851GF UT WOS:000223672900013 ER PT J AU Speckman, RA Frankenfield, DL Roman, SH Eggers, PW Bedinger, MR Rocco, MV McClellan, WM AF Speckman, RA Frankenfield, DL Roman, SH Eggers, PW Bedinger, MR Rocco, MV McClellan, WM TI Diabetes is the strongest risk factor for lower-extremity amputation in new hemodialysis patients SO DIABETES CARE LA English DT Article ID STAGE RENAL-DISEASE; DIALYSIS THERAPY; QUALITY; MORTALITY; PRESCRIPTION; MELLITUS; PROJECT; UREMIA AB OBJECTIVE - End-stage renal disease (ESRD) patients, especially those With diabetes, have an increased risk of nontraumatic lower-extremity amputation (LEA). The present study aims to examine the association of demographic and clinical variables With the risk of hospitalization for LEA among incident hemodialysis patients. RESEARCH DESIGN AND METHODS - The study population consisted of incident hemodialysis patients from the study years 1996-1999 of the ESRD Core Indicator/Clinical Performance Measures (CPM) Project. Cox proportional hazard modeling was used to identify factors associated with LEA. RESULTS - Four percent (1.16 of 3,272) of noncensored incident patients had an LEA during the 12-month follow-up period. Factors associated with LEA included diabetes as the cause of ESRD or preexisting comorbidity (hazard ratio 6.4, 95% CI 3.4-12.0), cardiovascular comorbidity (1.8, 1.2-2.8), hemodialysis inadequacy (urea reduction ratio [URR] <58.5% (1.9, 1.1-3.3), and lower serum albumin level (1.6, 1.1-2.3). Among patients with diabetes, hemodialysis inadequacy and cardiovascular comorbidity were risk factors for LEA (2.6, 1.4-4.8, and 1.7, 1.1-2.6, respectively). CONCLUSIONS - These data suggest that diabetes is a potent risk factor for LEA in new hemodialysis patients. In ESRD patients with diabetes, a multipronged approach may reduce the rate of LEA. Potentially beneficial Strategies include adherence to hemodialysis adequacy guidelines, aggressive treatment of cardiovascular comorbidities, and the utilization of LEA prevention strategies recommended for the general population of patients with diabetes. C1 Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. NIH, NIDDKD, Bethesda, MD 20892 USA. Wake Forest Univ, Sch Med, Dept Nephrol, Winston Salem, NC 27109 USA. RP McClellan, WM (reprint author), Georgia Med Care Fdn, 1455 Lincoln Pkwy,Suite 800, Atlanta, GA 30329 USA. EM bmcclellan@gmcf.org NR 24 TC 33 Z9 33 U1 2 U2 2 PU AMER DIABETES ASSOC PI ALEXANDRIA PA 1701 N BEAUREGARD ST, ALEXANDRIA, VA 22311-1717 USA SN 0149-5992 J9 DIABETES CARE JI Diabetes Care PD SEP PY 2004 VL 27 IS 9 BP 2198 EP 2203 DI 10.2337/diacare.27.9.2198 PG 6 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA 851JP UT WOS:000223681700016 PM 15333484 ER PT J AU Baugh, DK Pine, PL Blackwell, S Ciborowski, G AF Baugh, DK Pine, PL Blackwell, S Ciborowski, G TI Medicaid spending and utilization for central nervous system drugs SO HEALTH CARE FINANCING REVIEW LA English DT Article AB Prior research has shown that prescription drug spending grew substantially during the decade of the 1990s. This analysis uses 1996 to 1998 State Medicaid Research File (SMRF) fee-for-service (FFS) data for 29 participating States to provide insight into the factors driving this growth. ne analysis examines cost variation by census region, State, Medicaid basis of eligibility, and therapeutic use of drugs. In 1998, the highest expenditures were for central nervous system (CNS) drugs and for anti-psychotics compared to three other groups of CNS drugs (anti-anxiety agents, anti-depressants, and hypnotics). By eligibility group, expenditures were typically highest for disabled enrollees. There were major variations among SMRF States and their respective regions. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Baugh, DK (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secut Blvd,C3-20-17, Baltimore, MD 21244 USA. EM dbaugh@cms.hhs.gov NR 1 TC 4 Z9 4 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2004 VL 26 IS 1 BP 57 EP 73 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PH UT WOS:000231090200005 PM 15776700 ER PT J AU Cotterill, PG Thomas, FG AF Cotterill, PG Thomas, FG TI Prospective payment for Medicare inpatient psychiatric care: Assessing the alternatives SO HEALTH CARE FINANCING REVIEW LA English DT Article AB This article reports the findings of an empirical analysis of per case and per them models of prospective Payment for Medicare inpatient psychiatric care. Quantitative measures are presented that show the improvement of a per them model over a per case model. The research supports the viability of per them prospective payment and identifies directions for future research that would refine current per them models. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Cotterill, PG (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-21-28, Baltimore, MD 21244 USA. EM pcotterill@cms.hhs.gov NR 11 TC 6 Z9 6 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2004 VL 26 IS 1 BP 85 EP 101 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PH UT WOS:000231090200007 PM 15776702 ER PT J AU Lied, TR AF Lied, TR TI Mental-behavioral health data: 2001 NHIS SO HEALTH CARE FINANCING REVIEW LA English DT Article AB These data highlights are based on analysis of the 2001 National Health Interview Survey (NHIS) public use data (http://www.cdc. gov/nchs/nhis.htm). NHIS is a multi-purpose survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. NHIS has been conducted continuously since 1957. C1 Ctr Medicare & Medicare Serv, Baltimore, MD 21244 USA. RP Lied, TR (reprint author), Ctr Medicare & Medicare Serv, 7500 Secur Blvd,Mail Stop S3-13-15, Baltimore, MD 21244 USA. EM tlied@cms.hhs.gov NR 0 TC 0 Z9 0 U1 2 U2 2 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2004 VL 26 IS 1 BP 137 EP 141 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PH UT WOS:000231090200010 PM 15776705 ER PT J AU Waldo, DR AF Waldo, DR TI Symptoms of depression among aged Medicare enrollees: 2002 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Waldo, DR (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM dwaldo@cms.hhs.gov NR 0 TC 3 Z9 3 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2004 VL 26 IS 1 BP 143 EP 155 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PH UT WOS:000231090200011 PM 15776706 ER PT J AU Tunis, SR AF Tunis, SR TI Medicare coverage for technological innovations - Reply SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Tunis, SR (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. EM stunis@cms.hhs.gov NR 1 TC 0 Z9 0 U1 0 U2 0 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD AUG 12 PY 2004 VL 351 IS 7 BP 720 EP 720 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 845FZ UT WOS:000223225500032 ER PT J AU Stevenson, KB Murphy, CL Samore, MH Hannah, EL Moore, JW Barbera, J Houck, P Gerberding, JL AF Stevenson, KB Murphy, CL Samore, MH Hannah, EL Moore, JW Barbera, J Houck, P Gerberding, JL TI Assessing the status of infection control programs in small rural hospitals in the western United States SO AMERICAN JOURNAL OF INFECTION CONTROL LA English DT Article ID RESISTANT STAPHYLOCOCCUS-AUREUS; NOSOCOMIAL INFECTIONS; ANTIMICROBIAL USE; SURVEILLANCE; PREVALENCE; REQUIREMENTS; PROJECT AB Background: Organized infection control (IC) interventions have been successful in reducing the acquisition of hospital-associated infections. Rural community hospitals, although contributing significantly to the US health care system, have rarely been assessed regarding the nature and quality of their IC programs. Methods: A sample of 77 small rural hospitals in Idaho, Nevada, Utah, and eastern Washington completed a written survey in 2000 regarding IC staffing, infrastructure support, surveillance of nosocomial infections, and IC policies and practices. Results: Almost all hospitals (65 of 67, 97%) had one infection control practitioner (ICP), and 29 of 61 hospitals (47.5%) reported a designated physician with IC oversight. Most ICPs (62 of 64, 96.9%) were also employed for other activities outside of IC. The median number of ICP hours per week for IC activities was 10 (1-40), equating to a median of 1.56 (0.30-21.9) full-time ICPs per 250 hospital beds. Most hospitals performed total house surveillance for nosocomial infections (66 of 73, 90.4%) utilizing Centers for Disease Control and Prevention (CDC) definitions (69 of 74, 93.2%). Most also monitored employee bloodborne exposures (69 of 73, 94.5%). All hospitals had a written bloodborne pathogen exposure plan and isolation policies. CDC guidelines were typically followed when developing IC policies. Access to medical literature and online resources appeared to be limited for many ICPs. Conclusions: Most rural hospitals surveyed have expended reasonable resources to develop IC programs that are patterned after those seen in larger hospitals and conform to recommendations of consensus expert panels. Given these hospitals' small patient census, short length of stay and low infection rates, further studies are needed to evaluate necessary components of effective IC programs in these settings that efficiently utilize limited resources without compromising patient care. C1 Qualis Hlth, Boise, ID 83712 USA. Ctr Dis Control & Prevent, Atlanta, GA USA. Univ Utah, Sch Med, Salt Lake City, UT USA. Ctr Medicare & Medicaid Serv, Seattle, WA USA. RP Stevenson, KB (reprint author), Qualis Hlth, 720 Pk Blvd,Suite 120, Boise, ID 83712 USA. EM kurts@qualishealth.org NR 31 TC 22 Z9 22 U1 0 U2 1 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0196-6553 J9 AM J INFECT CONTROL JI Am. J. Infect. Control PD AUG PY 2004 VL 32 IS 5 BP 255 EP 261 DI 10.1016/j.ajic.2003.10.016 PG 7 WC Public, Environmental & Occupational Health; Infectious Diseases SC Public, Environmental & Occupational Health; Infectious Diseases GA 845AI UT WOS:000223207600001 PM 15292888 ER PT J AU Hakim, RB Benedict, MB Merrick, NJ AF Hakim, RB Benedict, MB Merrick, NJ TI Quality of care for women undergoing a hysterectomy: Effects of insurance and race/ethnicity SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID HOSPITAL PATIENTS; HEALTH-INSURANCE; MEDICAL-CARE; RISK; SERVICES; APPROPRIATENESS; MASSACHUSETTS; COVERAGE; OUTCOMES; CHILDREN AB Objective. We assessed the quality of hospital care for women who underwent a hysterectomy to compare Medicaid-covered women with privately insured women and minority women with White women. Methods. We evaluated medical decisions, inpatient care, quality of inpatient care, and outcomes. Results. Quality of hospital care was equivalent for Medicaid-covered women compared with privately insured women and for non-Hispanic Black women compared with White women. Medicaid-covered women (40%) and Black women (68%) were more likely to have a complication compared with privately insured women and White women, respectively. Conclusions. Increased complications after hysterectomy may result in increased economic burdens to Medicaid. Further studies of the racial/ethnic and sociodemographic issues are needed so that disparities may be adequately addressed. C1 METSTAT Grp, Santa Barbara, CA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Hakim, RB (reprint author), US EPA, IRIS 8601D,1200 Penn Ave NW, Washington, DC 20460 USA. EM hakim.rosemarie@epa.gov NR 28 TC 22 Z9 24 U1 0 U2 3 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD AUG PY 2004 VL 94 IS 8 BP 1399 EP 1405 DI 10.2105/AJPH.94.8.1399 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 843AT UT WOS:000223047600033 PM 15284050 ER PT J AU Selim, AJ Berlowitz, DR Fincke, G Cong, ZX Rogers, W Haffer, SC Ren, XS Lee, A Qian, SX Miller, DR Spiro, A Selim, BJ Kazis, LE AF Selim, AJ Berlowitz, DR Fincke, G Cong, ZX Rogers, W Haffer, SC Ren, XS Lee, A Qian, SX Miller, DR Spiro, A Selim, BJ Kazis, LE TI The health status of elderly veteran enrollees in the veterans health administration SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE elderly; health related quality of life; health status; functional status ID GERIATRIC EVALUATION; AFFAIRS; QUALITY; IMPACT; SF-36; TRIAL AB OBJECTIVES: To examine the health status of elderly veteran enrollees, stratified by age group, and compare with nonveteran populations. DESIGN: Cross-sectional study. SETTING: Outpatient. PARTICIPANTS: A total of 1,406,049 veteran enrollees were surveyed, and 887,775 returned the questionnaire (63.1%). Of these, 663,729 (74%) were aged 65 and older. MEASUREMENTS: Patient demographics, comorbid conditions, and health status, which was assessed using the Veterans 36-item short form (SF-36), a reliable and valid measure of health-related quality of life (HRQoL). RESULTS: Elderly veteran enrollees are a group with poor health status across all scales of the Veterans SF-36. Significant decline in HRQoL was found in patients grouped by increasing age (65-74, 75-84, and greater than or equal to85). Of the Veterans SF-36 scales, the role physical and role emotional scales and physical functioning presented the largest decrements by age group. The elderly veteran enrollees had poorer health status than older people enrolled in Medicare managed care, ranging from 0.5 to 1 standard deviations worse. CONCLUSION: Elderly veteran enrollees have substantial disease burden, as reflected by major impairments across multiple dimensions of HRQoL. These findings bear important implications for use of services, suggesting that the Veterans Health Administration will require considerable resources to provide care for its aging population. C1 Boston VA Hlth Care Syst, Womens Hlth Clin, Gen Internal Med Sect, Boston, MA 02130 USA. Boston VA Hlth Care Syst, Normat Aging Study, Boston, MA 02130 USA. Vet Affairs Med Ctr, Ctr Hlth Qual Outcomes & Econ Res, Bedford, MA USA. Boston Univ, Sch Med, Boston, MA 02215 USA. Boston Univ, Sch Publ Hlth, Boston, MA 02215 USA. Boston Univ, Dept Math, Boston, MA 02215 USA. Tufts Univ New England Med Ctr, Hlth Inst, Boston, MA 02111 USA. Ctr Beneficiary Choices, Ctr Medicare Serv, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Medicaid Serv, Baltimore, MD USA. Univ Maryland Baltimore Cty, Policy Sci Grad Program, Baltimore, MD 21228 USA. RP Selim, AJ (reprint author), Boston VA Hlth Care Syst, Womens Hlth Clin, Gen Internal Med Sect, 150 S Huntington Ave, Boston, MA 02130 USA. EM selim.alfredo_j@boston.med.va.gov NR 29 TC 52 Z9 52 U1 1 U2 5 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD AUG PY 2004 VL 52 IS 8 BP 1271 EP 1276 DI 10.1111/j.1532-5415.2004.52355.x PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 843ZQ UT WOS:000223127000006 PM 15271113 ER PT J AU Houck, PM Bratzler, DW Bratzler, DW Nsa, W Ma, A Bartlett, JG AF Houck, PM Bratzler, DW Bratzler, DW Nsa, W Ma, A Bartlett, JG TI Antibiotic administration in community-acquired pneumonia SO CHEST LA English DT Letter ID OUTCOMES; QUALITY C1 Ctr Medicare, Seattle, WA 98121 USA. Ctr Medicaid Serv, Seattle, WA 98121 USA. Oklahoma Fdn Med Qual, Oklahoma City, OK USA. Johns Hopkins Univ, Sch Med, Baltimore, MD USA. RP Houck, PM (reprint author), Ctr Medicare, Reg 10 Mail Stop RX-40,2201 6th Ave, Seattle, WA 98121 USA. EM phouck@cms.hhs.gov NR 7 TC 5 Z9 5 U1 0 U2 0 PU AMER COLL CHEST PHYSICIANS PI NORTHBROOK PA 3300 DUNDEE ROAD, NORTHBROOK, IL 60062-2348 USA SN 0012-3692 J9 CHEST JI Chest PD JUL PY 2004 VL 126 IS 1 BP 320 EP 321 DI 10.1378/chest.126.1.320 PG 2 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA 841XP UT WOS:000222965900064 PM 15249486 ER PT J AU Scott-Cawiezell, J Schenkman, M Moore, L Vojir, C Connolly, RP Pratt, M Palmer, L AF Scott-Cawiezell, J Schenkman, M Moore, L Vojir, C Connolly, RP Pratt, M Palmer, L TI Exploring nursing staff's perceptions communication home of and leadership to facilitate quality improvement SO JOURNAL OF NURSING CARE QUALITY LA English DT Article DE communication; leadership; nursing homes; quality improvement ID INTENSIVE-CARE UNITS AB Leadership and clinical staff were surveyed to explore communication and leadership in nursing homes. Registered nurses and other professionals perceived communication as better than their nursing colleagues did. Overall, results suggest all factors of communication could improve. In terms of leadership, licensed practical nurses perceived less clarity of expectations, encouragement of initiative, and support than other groups. The study provides insight into what is organizationally necessary to improve quality of care in nursing homes. C1 Univ Missouri, Sinclair Sch Nursing, Columbia, MO 65211 USA. Univ Colorado, Ctr Hlth Sci, Dept Rehabil Med, Denver, CO USA. Univ Colorado, Ctr Hlth Sci, Colorado Hlth Outcomes Program, Denver, CO USA. Univ Colorado, Ctr Hlth Sci, Sch Nursing, Denver, CO USA. Ctr Medicare & Medicaid Ctr Beneficiary Choices, Aurora, CO USA. Colorado Fdn Med Care, Aurora, CO USA. RP Scott-Cawiezell, J (reprint author), Univ Missouri, Sinclair Sch Nursing, Columbia, MO 65211 USA. EM scottji@missouri.edu NR 10 TC 58 Z9 58 U1 3 U2 7 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1057-3631 J9 J NURS CARE QUAL JI J. Nurs. Care Qual. PD JUL-SEP PY 2004 VL 19 IS 3 BP 242 EP 252 PG 11 WC Nursing SC Nursing GA 831SD UT WOS:000222215500010 PM 15326994 ER PT J AU Sheikh, K Bullock, C Preston, SD AF Sheikh, K Bullock, C Preston, SD TI Evaluation of quality improvement interventions for reducing adverse outcomes of carotid endarterectomy SO MEDICAL CARE LA English DT Article DE quality improvement; interventions; evaluation; carotid endarterectomy; surgical mortality; stroke ID CLINICAL-PRACTICE GUIDELINES; CONTINUING MEDICAL-EDUCATION; ACUTE MYOCARDIAL-INFARCTION; PATCH ANGIOPLASTY; BUILDING BRIDGES; BYPASS-SURGERY; OF-CARE; PERFORMANCE; FEEDBACK; PROJECT AB Background: Clinical and health services interventions should be evaluated for their effectiveness. Objectives: The objectives of this study were to evaluate the effectiveness of quality improvement interventions for reducing the adverse outcome of the carotid endarterectomy (CEA) procedure, and to study the relationship between pre- and postintervention 30-day mortality and stroke rates. These interventions were implemented in 1997-1998 by the Peer Review Organizations (PRO) for 7 states. Research Design: In a quasiexperimental study, a control state was matched with each of the 7 intervention states. Pretest-posttest analyses compared the preintervention outcome rates in each intervention and control state with the corresponding postintervention rates. In a time (1991-2001) series analysis, the trends in the preintervention 30-day, 7-state mortality in intervention and control states were compared with the trends in the corresponding postintervention rates. Study Population: We studied Medicare beneficiaries aged 65 years and older who had a CEA procedure in 14 states during 1991-2001. Results: There was no correlation between the state-specific, preintervention 30-day mortality and the corresponding postintervention mortality. After interventions, there was no significant decline in 30-day mortality in any intervention or control state, or in all 7 intervention states combined or all control states combined. Similarly, the 30-day stroke rate did not decrease after interventions in any state. The trend in the 7-state, 30-day mortality also did not show further decline after interventions. Conclusion: After PRO interventions, the post-CEA 30-day mortality and stroke rates did not decrease in any individual intervention state or in all states combined. C1 US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, 601 E 12th St,Room 235, Kansas City, MO 64106 USA. EM ksheikh@cms.hhs.gov NR 56 TC 3 Z9 3 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD JUL PY 2004 VL 42 IS 7 BP 690 EP 699 DI 10.1097/01.mlr.0000129904.30648.04 PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 834VZ UT WOS:000222440300010 PM 15213494 ER PT J AU Bratzler, DW Houck, PM AF Bratzler, DW Houck, PM CA Surg Infect Prevention Guidelines TI Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project SO CLINICAL INFECTIOUS DISEASES LA English DT Article ID RESISTANT STAPHYLOCOCCUS-AUREUS; TOTAL JOINT ARTHROPLASTY; TOTAL KNEE ARTHROPLASTY; TOTAL HIP-REPLACEMENT; ANTIBIOTIC-PROPHYLAXIS; WOUND-INFECTION; SITE INFECTIONS; INTRANASAL MUPIROCIN; ORTHOPEDIC-SURGERY; CLINICAL-TRIALS AB In January 2003, leadership of the Medicare National Surgical Infection Prevention Project hosted the Surgical Infection Prevention Guideline Writers Workgroup (SIPGWW) meeting. The objectives were to review areas of agreement among the most-recently published guidelines for surgical antimicrobial prophylaxis, to address inconsistencies, and to discuss issues not currently addressed. The participants included authors from most of the groups that have published North American guidelines for antimicrobial prophylaxis, as well as authors from several specialty colleges. Nominal group process was used to draft a consensus paper that was widely circulated for comment. The consensus positions of SIPGWW include that infusion of the first antimicrobial dose should begin within 60 min before surgical incision and that prophylactic antimicrobials should be discontinued within 24 h after the end of surgery. This advisory statement provides an overview of other issues related to antimicrobial prophylaxis, including specific suggestions regarding antimicrobial selection. C1 Oklahoma Fdn Med Qual, Oklahoma City, OK 73134 USA. Ctr Medicare Serv, Seattle, WA USA. Ctr Medicaid Serv, Seattle, WA USA. RP Bratzler, DW (reprint author), Oklahoma Fdn Med Qual, 14000 Quail Springs Pkwy,Ste 400, Oklahoma City, OK 73134 USA. EM dbratzler@okqio.sdps.org NR 90 TC 446 Z9 484 U1 1 U2 8 PU UNIV CHICAGO PRESS PI CHICAGO PA 1427 E 60TH ST, CHICAGO, IL 60637-2954 USA SN 1058-4838 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD JUN 15 PY 2004 VL 38 IS 12 BP 1706 EP 1715 DI 10.1086/421095 PG 10 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA 829YH UT WOS:000222087500011 PM 15227616 ER PT J AU Havranek, EP Wolfe, P Masoudi, FA Rathore, SS Krumholz, HM Ordin, DL AF Havranek, EP Wolfe, P Masoudi, FA Rathore, SS Krumholz, HM Ordin, DL TI Provider and hospital characteristics associated with geographic variation in the evaluation and management of elderly patients with heart failure SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; CARDIAC-CATHETERIZATION FACILITIES; RANDOMIZED CONTROLLED-TRIAL; HEALTH-CARE-DELIVERY; QUALITY-OF-CARE; MEDICARE BENEFICIARIES; UNITED-STATES; PROJECT; DYSFUNCTION; PHYSICIAN AB Background: Rates of guideline-based care for elderly patients with heart failure vary by state, and overall are not optimal. Identifying factors associated with the lack of uniformly high-quality health care might aid efforts to improve care. We therefore sought to determine the extent to which provider and hospital characteristics contribute to small-area geographic variation in heart failure care after controlling for patient factors. Methods: We studied 30 228 Medicare patients who were older than 65 years and hospitalized with heart failure. We mapped rates for 2 quality measures-documentation of left ventricular ejection fraction and appropriate prescription of angiotensin-converting enzyme inhibitors-across the United States, using a Bayesian technique that smooths rates and enhances assessment for significant patterns of small-area variation. We used nonlinear hierarchical models to assess for associations between the the quality indicators and provider and hospital characteristics independent of patient characteristics. Results: Smoothed, unadjusted rates of left ventricular ejection fraction documentation ranged from 30.1% to 67.2% and of angiotensin-converting enzyme inhibitor prescription from 55.8% to 87.1% among hospital referral regions; regional patterns were apparent. After patient factors were controlled for, care at hospitals without a medical school affiliation, without invasive cardiac capabilities, or in a rural location, as well as not having a cardiologist as an attending physician, was significantly associated with lower rates of left ventricular ejection fraction documentation. Hospitalization at a non-teaching facility was significantly associated with failure to prescribe angiotensin-converting enzyme inhibitors. Conclusion: Characteristics of providers and hospitals explain in part the geographic variation in guideline-based care for elderly patients with heart failure. C1 Ctr Medicare & Medicaid Serv, Div Cardiol, Boston, MA USA. Yale Univ, Sch Med, Div Cardiol, New Haven, CT USA. Univ Colorado, Hlth Sci Ctr, Div Cardiol, Denver, CO USA. Denver Hlth Med Ctr, Div Cardiol, Denver, CO 80204 USA. Colorado Fdn Med Care, Aurora, CO USA. RP Havranek, EP (reprint author), Denver Hlth Med Ctr, Div Cardiol, Suite 0960,777 Bannock St, Denver, CO 80204 USA. EM ehavrane@dhha.org FU PHS HHS [500-99-C001] NR 37 TC 41 Z9 42 U1 0 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD JUN 14 PY 2004 VL 164 IS 11 BP 1186 EP 1191 DI 10.1001/archinte.164.11.1186 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 830ZN UT WOS:000222162800004 PM 15197043 ER PT J AU Haffer, SC Bowen, SE AF Haffer, SC Bowen, SE TI Measuring and improving health outcomes in medicare: The Medicare HOS program SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Haffer, SC (reprint author), Ctr Medicare, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM shaffer@cms.hhs.gov NR 2 TC 10 Z9 10 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2004 VL 25 IS 4 BP 1 EP 3 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 954VP UT WOS:000231183600001 PM 15493440 ER PT J AU Lied, TR Haffer, SC AF Lied, TR Haffer, SC TI Health status of dually eligible beneficiaries in managed care plans SO HEALTH CARE FINANCING REVIEW LA English DT Article ID MEDICARE; DEPRESSION; PREVALENCE; SMOKING; ADULTS AB We conducted a descriptive study examining the health status of dually eligible beneficiaries using a sample from the Medicare Health Outcomes Survey (HOS), a measure of health status administered to enrollees in Medicare managed care (MMC). Overall, we found that dually eligible beneficiaries were sicker, more depressed, and reporting more pain than Medicare-only beneficiaries. Our results suggest that quality improvement initiatives that center on pain and depression management in the dually eligible population present important opportunities for collaboration between Medicare and Medicaid. C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Lied, TR (reprint author), Ctr Medicare, 7500 Secur Blvd,S3-13-15, Baltimore, MD 21244 USA. EM tlied@cms.hhs.gov NR 12 TC 6 Z9 6 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2004 VL 25 IS 4 BP 59 EP 74 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 954VP UT WOS:000231183600006 PM 15493444 ER PT J AU Cowan, C Catlin, A Smith, C Sensenig, A AF Cowan, C Catlin, A Smith, C Sensenig, A TI National health expenditures, 2002 SO HEALTH CARE FINANCING REVIEW LA English DT Article AB National health expenditures (NHE) were $1.6 trillion in 2002, a 9.3-percent increase from 2001. For the fourth consecutive year health spending grew faster than the overall economy as measured by the GDP Growth in U.S. health care spending rose for most health services in 2002, with hospital spending once again the primary driver. C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Cowan, C (reprint author), Ctr Medicare, 7500 Secur Blvd,N3-02-02, Baltimore, MD 21244 USA. EM along1@cms.hhs.gov NR 0 TC 15 Z9 16 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2004 VL 25 IS 4 BP 143 EP 166 PG 24 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 954VP UT WOS:000231183600011 PM 15493449 ER PT J AU Steinman, MA Sauaia, A Maselli, JH Houck, PM Gonzales, R AF Steinman, MA Sauaia, A Maselli, JH Houck, PM Gonzales, R TI Office evaluation and treatment of elderly patients with acute bronchitis SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article; Proceedings Paper CT Annual Meeting of the American-Geriatrics-Society CY MAY 15-18, 2003 CL BALTIMORE, MD SP Amer Geriatr Soc DE bronchitis; antibiotics; aged; diagnostic techniques and procedures ID RESPIRATORY-TRACT INFECTIONS; UNCOMPLICATED ACUTE BRONCHITIS; COMMUNITY-ACQUIRED PNEUMONIA; RESISTANT STREPTOCOCCUS-PNEUMONIAE; ANTIBIOTIC USE; NATIONAL-SURVEY; PHYSICIANS; IMPACT; ADULTS; INTERVENTION AB OBJECTIVES: To assess the office evaluation of seniors with uncomplicated acute bronchitis and to determine the association between elements of the clinical evaluation and antibiotic prescribing decisions. DESIGN: Cross-sectional chart review. SETTING: Seventy-seven community-based office practices in the Denver metropolitan area. PARTICIPANTS: Elderly fee-for-service Medicare patients. MEASUREMENTS: Medicare administrative data to identify patients with acute bronchitis; medical record review to confirm the diagnosis and record other clinical data. RESULTS: Of 198 elderly patients with acute bronchitis, the mean age+/-standard deviation was 76+/-8.6; 53% had at least one comorbid condition. Clinically important vital signs were frequently not recorded; temperature was missing from 34% of charts and pulse from 50% of charts. When recorded, significant vital sign abnormalities were uncommon, with 7% having a temperature of 100degreesF and 8% having a pulse of 100 beats per minute or greater. However, antibiotics were prescribed to 83% of patients, with more than half of these prescriptions being for extended-spectrum antibiotics. Treatment with antibiotics was more common in men than women (92% vs 78%, P=.007) but was not associated with clinical factors including vital sign measurement, vital sign results, chest radiography, patient age, duration of illness, or the presence of comorbidities. CONCLUSION: The vast majority of seniors with acute bronchitis are treated with antibiotics, regardless of patient characteristics or the type of evaluation received. Reducing inappropriate antibiotic use in seniors with acute bronchitis may depend on improving the evaluation of these patients and encouraging clinicians to act appropriately on the results. C1 Univ Calif San Francisco, San Francisco VA Med Ctr, Div Geriatr, San Francisco, CA 94143 USA. Univ Calif San Francisco, Div Gen Internal Med, San Francisco, CA 94143 USA. Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA. Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA. Univ Colorado, Hlth Sci Ctr, Div Hlth Care Policy & Res, Denver, CO USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Gonzales, R (reprint author), Univ Calif San Francisco, Dept Med, Box 1211,3333 Calif St, San Francisco, CA 94118 USA. EM ralphg@medicine.ucsf.edu NR 30 TC 5 Z9 5 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD JUN PY 2004 VL 52 IS 6 BP 875 EP 879 DI 10.1111/j.1532-5415.2004.52252.x PG 5 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 822JI UT WOS:000221534900003 PM 15161449 ER PT J AU Tunis, SR AF Tunis, SR TI Why medicare has not established criteria for coverage decisions SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD 21202 USA. RP Tunis, SR (reprint author), Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD 21202 USA. NR 11 TC 56 Z9 56 U1 0 U2 0 PU MASSACHUSETTS MEDICAL SOC/NEJM PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD MAY 20 PY 2004 VL 350 IS 21 BP 2196 EP 2198 DI 10.1056/NEJMe048091 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 821XM UT WOS:000221496700015 PM 15152066 ER PT J AU Tunis, SR AF Tunis, SR TI Economic analysis in healthcare decisions SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Editorial Material ID QUALITY C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Tunis, SR (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. NR 10 TC 22 Z9 22 U1 4 U2 4 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD MAY PY 2004 VL 10 IS 5 BP 301 EP 304 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 819KM UT WOS:000221313800001 PM 15152698 ER PT J AU French, C True, S McIntyre, R Sciulli, M Maloy, KA AF French, C True, S McIntyre, R Sciulli, M Maloy, KA TI State implementation of the Breast and Cervical Cancer Prevention and Treatment Act of 2000: A collaborative effort among government agencies SO PUBLIC HEALTH REPORTS LA English DT Article AB The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), administered by the Centers for Disease Control and Prevention through grants to states, tribes, and territories, has successfully provided breast and cervical cancer screening and diagnostic services to low-income women since 1990. On October 24, 2000, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) authorizing states, if they chose, to provide Medicaid coverage for treatment services for women screened under the NBCCEDP. Under BCCPTA, uninsured women younger than age 65 who are screened through the NBCCEDP and found to have breast or cervical cancer (or precancerous conditions) may gain access to Medicaid services for and during their cancer treatment. Implementation of the BCCPTA requires collaboration and coordination among many government agencies, including the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, state Medicaid directors, and directors of state and tribal grant programs. This article describes the implementation of the program and demonstrates to policy makers that coordinating resources among government agencies can facilitate the rapid adoption of public health programs as pathways for specific populations to gain access to publicly funded health insurance coverage. C1 Ctr Dis Control & Prevent, Program Serv Branch, Div Canc Prevent & Control, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA 30341 USA. Ctr Medicare & Medicaid, Baltimore, MD USA. George Washington Univ, Sch Publ Hlth & Hlth Serv, Dept Hlth Policy, Washington, DC USA. RP French, C (reprint author), Ctr Dis Control & Prevent, Program Serv Branch, Div Canc Prevent & Control, Natl Ctr Chron Dis Prevent & Hlth Promot, 4770 Buford Hwy NE,MS K-57, Atlanta, GA 30341 USA. EM cyp2@cdc.gov NR 3 TC 17 Z9 17 U1 0 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD MAY-JUN PY 2004 VL 119 IS 3 BP 279 EP 285 DI 10.1016/j.phr.2004.04.007 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 855FG UT WOS:000223958000008 PM 15158107 ER PT J AU Stevenson, KB Samore, M Barbera, J Hannah, E Moore, JW Gerberding, JL Houck, P AF Stevenson, KB Samore, M Barbera, J Hannah, E Moore, JW Gerberding, JL Houck, P TI Pharmacist involvement in antimicrobial use at rural community hospitals in four Western states SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article; Proceedings Paper CT 11th Annual Meeting of the Society-for-Healthcare-Epidemiology-of-America CY APR 01-03, 2001 CL TORONTO, CANADA SP Soc Healthcare Epidemiol Amer DE administration; antiinfective agents; carbapenems; cephalosporins; compliance; data collection; dosage; drug use; drugs; hospitals; hours; interventions; pharmacists; hospitals; physicians; prescribing; protocols ID INFECTION-CONTROL; ANTIBIOTIC-RESISTANCE; NOSOCOMIAL INFECTIONS; MANAGEMENT PROGRAM; CARE; SURVEILLANCE; PREVALENCE; OUTCOMES; PREVENTION; STRATEGIES AB Purpose. Pharmacist involvement in antimicrobial use at small rural hospitals in four Western states was studied. Methods. Surveys were mailed in July 2000 to hospitals with a daily patient census of <150 in Idaho, Nevada, Utah, and eastern Washington. Results. Seventy-seven (77%) of 100 hospitals returned completed surveys. Only 5% of the hospitals had onsite pharmacists 24 hours per day. An onsite pharmacist was present for a median of 26 hours per week in hospitals without 24-hour pharmacist coverage (range, 0-116 hr/wk). Many hospitals (71%) had policies for monitoring or controlling antimicrobial use, but only 28% had a system capable of monitoring compliance with such policies. Few hospitals had systems for recommending changes in antimicrobial selection on the basis of susceptibility, test results (27%) or for monitoring physician compliance-with dosage recommendations by pharmacists (21%). Onsite pharmacist hours were significantly associated with pharmacists being involved in the initial ordering of antibiotics and providing active oversight of antimicrobial use. There was a negative correlation between onsite pharmacist hours and use of third-generation cephalosporins and carbapenems. Conclusion. A survey showed that rural hospital pharmacists in four Western states spent relatively little time monitoring,and influencing antimicrobial prescribing. C1 Qualis Hlth, Boise, ID 83712 USA. Univ Utah, Sch Med, Dept Med, Div Clin Epidemiol, Salt Lake City, UT USA. Univ Utah, Sch Med, Dept Med, Div Clin Epidemiol, Salt Lake City, UT 84112 USA. Ctr Dis Control & Prevent, Atlanta, GA USA. Ctr Medicare & Medicaid Serv, Seattle Reg Off, Seattle, WA USA. RP Stevenson, KB (reprint author), Qualis Hlth, 720 Pk Blvd,Suite 120, Boise, ID 83712 USA. EM kurts@qualishealth.org NR 38 TC 9 Z9 10 U1 0 U2 0 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 USA SN 1079-2082 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD APR 15 PY 2004 VL 61 IS 8 BP 787 EP 792 PG 6 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 814VR UT WOS:000221002700010 PM 15127962 ER PT J AU Klabunde, CN Riley, GF Mandelson, MT Frame, PS Brown, ML AF Klabunde, CN Riley, GF Mandelson, MT Frame, PS Brown, ML TI Health plan policies and programs for colorectal cancer screening: A national profile SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID ASYMPTOMATIC ADULTS; GUIDELINES; INSURANCE; RATIONALE; SERVICES; COVERAGE AB Background: A consensus has emerged that average-risk adults 50 years of age or older should be screened for colorectal cancer (CRC). Objectives: To describe health plans' coverage policies, guidelines, and organized programs to promote CRC screening. Study Design and Methods: Review of data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices, administered to a national sample of health plans in 1999-2000. The survey inquired about coverage policies for fecal occult blood testing, sigmoidoscopy, colonoscopy, and double-contrast barium enema; the nature of any guidelines the plan had issued to its providers on CRC screening; and systems for recruiting patients into screening and for tracking and reporting the results of screening and follow-up procedures. Results: Of 346 eligible health plans, 180 (52%) responded. Nearly all health plans covered at least 1 CRC screening modality. Plans were most likely to cover fecal occult blood testing (97%) and least likely to cover colonoscopy (57%). Sixty-five percent had issued guidelines on CRC screening to providers. One quarter had a mechanism to remind patients that they are due for CRC screening, but fewer had systems for prompting providers, contacting noncompliant patients, or tracking completion of screening. Conclusions: Health plans have the ability to provide organizational infrastructure for a broad range of preventive services to well-defined populations. However, few health plans had all 3 essential CRC screening delivery components-coverage, guidelines, and tracking systems-in place in 1999-2000. C1 NCI, Appl Res Program, Bethesda, MD 20892 USA. NCI, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. Off Res Dev & Informat, Ctr Medicare, Baltimore, MD USA. Off Res Dev & Informat, Medicaid Serv, Baltimore, MD USA. Grp Hlth Cooperat Puget Sound, Ctr Hlth Studies, Seattle, WA USA. Tri County Family Med, Cohocton, NY USA. Univ Rochester, Sch Med & Dent, Dept Family Med, Rochester, NY USA. RP Klabunde, CN (reprint author), NCI, Appl Res Program, Execut Plaza N Room 4005,6130 Execut Blvd, Bethesda, MD 20892 USA. EM ck97b@nih.gov FU NCI NIH HHS [N01-PC-85169] NR 30 TC 42 Z9 43 U1 0 U2 1 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD APR PY 2004 VL 10 IS 4 BP 273 EP 279 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 811SO UT WOS:000220791800005 PM 15124504 ER PT J AU Gage, BF Birman-Deych, E Kerzner, R Radford, MJ Nilasena, D Rich, MW AF Gage, BF Birman-Deych, E Kerzner, R Radford, MJ Nilasena, D Rich, MW TI Risk of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 27th Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 12-15, 2004 CL Chicago, IL SP Soc Gen Internal Med C1 Washington Univ, St Louis, MO 63130 USA. Yale Univ, Sch Med, New Haven, CT 06520 USA. Ctr Medicare & Medicaid Serv, Dallas, TX USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2004 VL 19 SU 1 BP 207 EP 207 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 816RA UT WOS:000221125800777 ER PT J AU Frankenfield, DL Roman, SH Rocco, MV Bedinger, MR McClellan, WM AF Frankenfield, DL Roman, SH Rocco, MV Bedinger, MR McClellan, WM TI Disparity in outcomes for adult Native American hemodialysis patients? Findings from the ESRD Clinical Performance Measures Project, 1996 to 1999 SO KIDNEY INTERNATIONAL LA English DT Article DE Native American; American Indian; Alaska native; race; disparity; outcomes; morbidity; hospitalization; mortality ID STAGE RENAL-DISEASE; DEPENDENT DIABETES-MELLITUS; ZUNI KIDNEY PROJECT; PIMA-INDIANS; ALASKA NATIVES; COLLABORATIVE APPROACH; DIALYSIS PATIENTS; UNITED-STATES; RISK-FACTORS; EPIDEMIC AB Background. There is a paucity of information regarding the quality of care for Native American hemodialysis patients. Outcomes, including 1-year hospitalization and mortality, for adult Native American in-center hemodialysis patients selected for the Centers for Medicare & Medicaid (CMS) end-stage renal disease (ESRD) Clinical Performance Measures (CPM) Project were compared to those for white and black patients to determine if disparity in care existed for this group. Methods Clinical data were abstracted from medical records for the last quarters of 1995 to 1998 and linked to United States Renal Data System (USRDS) data files for data on comorbidities and 1-year hospitalization and mortality. Associations of race were tested by bivariate analyses and multivariate logistic regression and Cox proportional hazard modeling. Results. Two percent (467 of 27876) of patients were Native American, 37% black, and 51% white. Native American, compared to black and white patients, were more likely to have diabetes mellitus as the cause of ESRD (72%, 37%, and 38%, respectively, P < 0.01). In multivariate analyses, Native American patients were more likely to achieve a mean urea reduction ratio (URR) &GE;65% compared to whites (referent) [hazards ratio (HR) (95% CI) 1.7 (1.3, 2.2)] and be dialyzed with an arteriovenous fistula [HR (95% CI) 1.7 (1.2, 2.5)]. They were as likely as Whites to achieve a mean hematocrit &GE;33% and a mean serum albumin &GE; 4.0/3.7 g/dL. In multivariate analyses, Native Americans were no more likely to be hospitalized or die during the follow-up period than whites. Conclusion. These data suggest that adult Native American hemodialysis patients experience equivalent or better dialytic care and are no more likely to experience 1-year hospitalization or mortality compared to whites. C1 Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD 21244 USA. Wake Forest Univ, Nephrol Sect, Winston Salem, NC 27109 USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. RP Frankenfield, DL (reprint author), Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, 7500 Secur Blvd,Mailstop S3-02-01, Baltimore, MD 21244 USA. EM dfrankenfield@cms.hhs.gov NR 52 TC 18 Z9 18 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0085-2538 J9 KIDNEY INT JI Kidney Int. PD APR PY 2004 VL 65 IS 4 BP 1426 EP 1434 DI 10.1111/j.1523-1755.2004.00515.x PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 802AF UT WOS:000220135700034 PM 15086485 ER PT J AU Riley, GF AF Riley, GF TI The cost of eliminating the 24-month medicare waiting period for social security disabled-worker beneficiaries SO MEDICAL CARE LA English DT Article DE Medicare; disability; waiting period; Social Security Disability Insurance ID HEALTH-CARE; DISABILITY AB Objective: The objective of this study was to estimate the cost of eliminating the 24-month waiting period for Medicare entitlement for Social Security disabled-worker beneficiaries. There is concern that the waiting period could currently result in reduced access to health care. Data: The study linked Social Security and Medicare administrative records. Methods: Social Security records were used to identify a 20% sample of disabled workers aged 61 or less and newly entitled to Social Security Disability Insurance (SSDI) in 1995 (n = 105,328). These records were linked to Medicare enrollment and claims data for 1997-2000. Cost prediction models were developed from the linked data to predict monthly Medicare costs. The prediction models were then used to estimate what Medicare costs would have been in the first 24 months of SSDI entitlement if the waiting period had been eliminated. Results: Among the sample of new SSDI entitlees in 1995, 11.8% died during the waiting period, 2.1% recovered, and 86.1% became entitled to Medicare. For the first 24 months of SSDI entitlement, Medicare costs were predicted to be $10,055 per disabled worker in year 2000 dollars. Costs varied substantially by diagnostic group and whether the person died or recovered during the waiting period. Conclusions: Extrapolating from the study sample, predicted Medicare costs for the 24-month waiting period were $5.3 billion (inflation-adjusted to year 2000 dollars) for all disabled workers aged 61 or less and newly entitled to SSDI in 1995. C1 Ctr Medicare, Off Res Dev & Informat, Baltimore, MD 21244 USA. Ctr Medicaid, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Riley, GF (reprint author), Ctr Medicare, Off Res Dev & Informat, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM griley@cms.hhs.gov NR 16 TC 5 Z9 5 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD APR PY 2004 VL 42 IS 4 BP 387 EP 394 DI 10.1097/01.mlr.0000118873.10396.fc PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 807BA UT WOS:000220475800012 PM 15076816 ER PT J AU Gorman, G Fivush, B Frankenfield, D Warady, B Watkins, S Brem, A Neu, A AF Gorman, G Fivush, B Frankenfield, D Warady, B Watkins, S Brem, A Neu, A TI Factors contributing to growth hormone use in short stature pediatric hemodialysis patients SO PEDIATRIC RESEARCH LA English DT Meeting Abstract CT Annual Meeting of the Pediatric-Academic-Societies CY MAY 04, 2004 CL San Francisco, CA SP Pediatr Acad Soc C1 Johns Hopkins Univ, Sch Med, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Medicare Serv, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Mediaid Serv, Baltimore, MD USA. Childrens Mercy Hosp, Kansas City, MO 64108 USA. Univ Washington, Childrens Hosp, Seattle, WA 98195 USA. Rhode Isl Hosp, Providence, RI USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2004 VL 55 IS 4 SU S MA 3217 BP 567A EP 567A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 808TJ UT WOS:000220591103294 ER PT J AU Fadrowski, J Fivush, B Frankenfield, D Warady, B Friedman, A Goldstein, S Neu, A AF Fadrowski, J Fivush, B Frankenfield, D Warady, B Friedman, A Goldstein, S Neu, A TI Association of hemodialysis access type in pediatric hemodialysis patients and nephrologist specialization SO PEDIATRIC RESEARCH LA English DT Meeting Abstract CT Annual Meeting of the Pediatric-Academic-Societies CY MAY 01-04, 2004 CL San Francisco, CA SP Pediat Acad Soc C1 Johns Hopkins Sch Med, Dept Pediat Nephrol, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Medicare Serv, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 W CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2004 VL 55 IS 4 SU S MA 3223 BP 568A EP 568A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 808TJ UT WOS:000220591103300 ER PT J AU Fadrowski, J Fivush, B Frankenfield, D Warady, B Friedman, A Goldstein, S Neu, A AF Fadrowski, J Fivush, B Frankenfield, D Warady, B Friedman, A Goldstein, S Neu, A TI Association of mean serum albumin levels and nephrologist specialization in pediatric hemodialysis patients SO PEDIATRIC RESEARCH LA English DT Meeting Abstract CT Annual Meeting of the Pediatric-Academic-Societies CY MAY 01-04, 2004 CL San Francisco, CA SP Pediat Acad Soc C1 Johns Hopkins Univ, Sch Med, Div Pediat Nephrol, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Medicare Serv, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 W CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2004 VL 55 IS 4 SU S MA 3224 BP 568A EP 568A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 808TJ UT WOS:000220591103301 ER PT J AU Goldstein, S Neu, A Bradley, W Watkins, S Brem, A Fivush, B Friedman, A Frankenfield, F AF Goldstein, S Neu, A Bradley, W Watkins, S Brem, A Fivush, B Friedman, A Frankenfield, F TI Hemodialysis variables for children less than 12 years: A report from the 2001 Center for Medicaid and Medicare (CMS) Clinical Performance Measures (CPM) Project SO PEDIATRIC RESEARCH LA English DT Meeting Abstract CT Annual Meeting of the Pediatric-Academic-Societies CY MAY 04, 2004 CL San Francisco, CA SP Pediatr Acad Soc C1 Ctr Medicare & Medicaid Serv, Bethesda, MD USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2004 VL 55 IS 4 SU S MA 3274 BP 576A EP 577A PN 2 PG 2 WC Pediatrics SC Pediatrics GA 808TJ UT WOS:000220591103351 ER PT J AU Houck, PM Bratzler, DW Nsa, W Ma, A Bartlett, JG AF Houck, PM Bratzler, DW Nsa, W Ma, A Bartlett, JG TI Timing of antibiotic administration and outcomes for medicare patients hospitalized with community-acquired pneumonia SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID CARE; QUALITY; MANAGEMENT; SEVERITY; THERAPY AB Background: Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital. Methods: We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999. Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS). Results: Among 13 771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%; adjusted odds ratio [AOR], 0.85; 95% confidence interval [CI], 0.74-0.98), mortality within 30 days of admission (11.6% vs 12.7%; AOR, 0.85; 95% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1% vs 45.1%; AOR, 0.90; 95% CI, 0.83-0.96). Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. Timing was not associated with readmission. Antibiotic administration within 4 hours of arrival was documented for 60.9% of all patients and for more than 50% of patients regardless of hospital characteristics. Conclusions: Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients. C1 Ctr Medicare Serv, Seattle, WA 98121 USA. Ctr Medicaid Serv, Seattle, WA 98121 USA. Johns Hopkins Univ, Sch Med, Baltimore, MD USA. Oklahoma Fdn Med Qual Inc, Oklahoma City, OK USA. RP Houck, PM (reprint author), Ctr Medicare Serv, Reg 10,Mail Stop RX-40,2201 6th Ave, Seattle, WA 98121 USA. EM phouck@cms.hhs.gov FU PHS HHS [500-99-P619] NR 18 TC 414 Z9 434 U1 0 U2 4 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD MAR 22 PY 2004 VL 164 IS 6 BP 637 EP 644 DI 10.1001/archinte.164.6.637 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 804QQ UT WOS:000220313600008 PM 15037492 ER PT J AU Poisal, JA AF Poisal, JA TI Medicaid drugs SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The following commentary unites a collection of articles primarily concerned with prescription drug issues in Medicaid. It also features highlights from a piece outlining Australia's pharmaceutical delivery system. Specifically, in this issue, you will find comprehensive analyses of drug expenditure trends, issues regarding access to pharmaceuticals in Medicaid, and an evaluation of ongoing generic drug cost-containment programs. C1 Ctr Medicare, Baltimore, MD 21244 USA. Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Poisal, JA (reprint author), Ctr Medicare, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM jpoisal@cms.hhs.gov NR 2 TC 6 Z9 6 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2004 VL 25 IS 3 BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PG UT WOS:000231090100001 PM 15229992 ER PT J AU Baugh, DK Pine, PL Blackwell, S Ciborowski, G AF Baugh, DK Pine, PL Blackwell, S Ciborowski, G TI Medicaid prescription drug spending in the 1990s: A decade of change SO HEALTH CARE FINANCING REVIEW LA English DT Article ID TRENDS AB Medicaid spending increased dramatically during the 1990s, driven in part by spending for prescription drugs., From 1990 to 2000, Medicaid drug spending increased from $4.4 billion to over $20 billion, an average annual increase of 16.3 percent. Disabled persons experienced an even greater 20 percent average annual increase. By drug category in 1997 (for 29 States), the highest spending amount was for central nervous system (CNS) drugs, accounting for 17 percent of total Medicaid drug spending. These findings provide information on drug spending for dually eligible beneficiaries to policy makers as they seek to target cost-effective coverage and drug therapies. C1 Ctr Medicare, Baltimore, MD 21244 USA. Ctr Medcaid Serv, Baltimore, MD 21244 USA. RP Baugh, DK (reprint author), Ctr Medicare, 7500 Secur Bldv,C3-20-17, Baltimore, MD 21244 USA. EM dbaugh@cms.hhs.gov NR 16 TC 13 Z9 13 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2004 VL 25 IS 3 BP 5 EP 23 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PG UT WOS:000231090100002 PM 15229993 ER PT J AU Tepper, CD Lied, TR AF Tepper, CD Lied, TR TI Trends in Medicaid prescribed drug expenditures and utilization SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The findings show that with the development of a multitude of safe and effective drugs during the later part of the 20th century and the beginning of the 21st century, drugs are, as never before, a true mainstay of medical treatment. CMS continues to monitor drug utilization and expenditures in all of its programs in order to ensure that care is rendered in a cost-effective manner that is beneficial to the patient. This highlight summarizes trends in drug expenditures and utilization in the Medicaid Program. C1 Ctr Medicare, Baltimore, MD 21244 USA. Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Lied, TR (reprint author), Ctr Medicare, 7500 Secur Blvd,S3-13-15, Baltimore, MD 21244 USA. EM tlied@cms.hhs.gov NR 1 TC 3 Z9 3 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2004 VL 25 IS 3 BP 69 EP 78 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PG UT WOS:000231090100006 PM 15229997 ER PT J AU Baldwin, LM MacLehose, RF Hart, LG Beaver, SK Every, N Chan, L AF Baldwin, LM MacLehose, RF Hart, LG Beaver, SK Every, N Chan, L TI Quality of care for acute myocardial infarction in rural and urban US hospitals SO JOURNAL OF RURAL HEALTH LA English DT Article ID COOPERATIVE CARDIOVASCULAR PROJECT; MEDICARE PATIENTS; ELDERLY-PATIENTS; ASSOCIATION; GUIDELINES; MANAGEMENT; RATIOS; SYSTEM; RISK AB Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge, and 30-day mortality. Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI. C1 Univ Washington, Dept Family Med, Sch Med, Seattle, WA 98195 USA. Ctr Medicare, Div Qual Improvement, Seattle, WA USA. Ctr Medicaid Serv, Div Qual Improvement, Seattle, WA USA. Univ Washington, Sch Med, WWAMI Rural Hlth Res Ctr, Seattle, WA USA. Seattle Dept Vet Affairs, Seattle, WA USA. Univ Washington, Sch Med, Dept Rehabil Med, Seattle, WA 98195 USA. RP Baldwin, LM (reprint author), Univ Washington, Dept Family Med, Sch Med, Box 354982, Seattle, WA 98195 USA. EM lmb@fammed.washington.edu NR 31 TC 74 Z9 74 U1 2 U2 6 PU NATL RURAL HEALTH ASSOC PI KANSAS CITY PA ONE WEST ARMOUR BLVD, STE 301, KANSAS CITY, MO 64111 USA SN 0890-765X J9 J RURAL HEALTH JI J. Rural Health PD SPR PY 2004 VL 20 IS 2 BP 99 EP 108 DI 10.1111/j.1748-0361.2004.tb00015.x PG 10 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 966JK UT WOS:000232015800001 PM 15085622 ER PT J AU Chan, L Hart, LG Ricketts, TC Beaver, SK AF Chan, L Hart, LG Ricketts, TC Beaver, SK TI An analysis of Medicare's incentive payment program for physicians in health professional shortage areas SO JOURNAL OF RURAL HEALTH LA English DT Article AB Context: Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians. Purpose: To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's utilization and which types of physicians received payments. Methods: Retrospective cohort design, utilizing complete 1998 Medicare Part B data. Physician specialty was determined through American Medical Association data. Rural status was determined by linking the physician business ZIP code to its Rural-Urban Commuting Area code (RUCA). Findings: There were 2,220,275 patients and 39,749 providers in the cohort, including 9,769 (24.6%) generalists, 21,331 (53.7%) specialists, and 8,649 (21.8%) nonphysician providers. Over $4 million in bonus payments (median payment = $173) were made to providers in HPSAs. Specialists and urban providers received 58% and 14% of the bonus reimbursements, respectively. Two million dollars in payments were not distributed because the providers did not claim them. Over $2.8 million in bonus claims were distributed to providers who likely did not work in approved HPSA sites. Conclusions: The MIP bonus payments given to providers are small. Many providers who should have claimed the bonus did not, and many providers who likely did not qualify for the bonus claimed and received it. Consideration should be given to focusing and enlarging the bonus payments to specific providers, rather than rewarding all providers equally. Policy makers should also consider a system that prospectively determines provider eligibility. C1 Univ Washington, Dept Rehabil Med, Sch Med, Seattle, WA 98195 USA. Univ Washington, WWAMI Rural Hlth Res Ctr, Sch Med, Seattle, WA 98195 USA. Univ Washington, Dept Family Med, Sch Med, Seattle, WA 98195 USA. Univ N Carolina, N Carolina Rural Hlth Res Program, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC 27515 USA. Ctr Medicare, Div Qual Improvement, Seattle, WA USA. Ctr Medicaid Serv, Div Qual Improvement, Seattle, WA USA. RP Chan, L (reprint author), Univ Washington, Dept Rehabil Med, Sch Med, Box 356490, Seattle, WA 98195 USA. EM leighton@u.washington.edu FU PHS HHS [5U1CRH00035-02] NR 8 TC 6 Z9 6 U1 1 U2 3 PU NATL RURAL HEALTH ASSOC PI KANSAS CITY PA ONE WEST ARMOUR BLVD, STE 301, KANSAS CITY, MO 64111 USA SN 0890-765X J9 J RURAL HEALTH JI J. Rural Health PD SPR PY 2004 VL 20 IS 2 BP 109 EP 117 DI 10.1111/j.1748-0361.2004.tb00016.x PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 966JK UT WOS:000232015800002 PM 15085623 ER PT J AU McClellan, WM Hodgin, E Pastan, S McAdams, L Soucie, M AF McClellan, WM Hodgin, E Pastan, S McAdams, L Soucie, M TI A randomized evaluation of two health care quality improvement program (HCQIP) interventions to improve the adequacy of hemodialysis care of ESRD patients: Feedback alone versus intensive intervention SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article ID CORE INDICATORS PROJECT; DIALYSIS; DELIVERY; MORTALITY AB End-stage renal disease (ESRD) Networks are quality improvement organizations that collect, analyze, and report information to clinicians and allied health providers about discrepancies between observed patterns of care of ESRD patients and what has been recommended by clinical practice guidelines. The Networks facilitate response to this information by assisting ESRD treatment centers to develop quality improvement programs to redress inadequate care. The authors evaluated this process of quality improvement by selecting 42 treatment centers in a single ESRD Network with the lowest facility-specific mean urea reduction ratio (URR). The treatment centers were randomly assigned to two intervention strategies: (1) feedback alone; (2) an intensive intervention that included feedback, workshops, distribution of educational materials and clinical practice guidelines, technical assistance with the development of quality improvement plans, and continued monitoring. The intensive intervention had greater improvement in the increased proportions of patients dialyzed with prescribed blood flow (P = 0.02) and documented review of prescription (P = 0.01). Furthermore, the mean center URR increased nearly 3% among intensive intervention centers (from 68.1 to 70.9) but only 0.09% among the feedback centers (68.2 to 69.1) (P = 0.002). Similarly, time on dialysis increased 7.5 min on average among patients in intervention centers but decreased 2 min for patients in comparison centers (P = 0.03). These results demonstrate that Network feedback, coupled with the intensive intervention, resulted in improvement in care that would otherwise not have occurred. C1 Georgia Med Care Fdn, Atlanta, GA 30329 USA. Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA USA. SE Kidney Council, ESRD, Raleigh, NC USA. Ctr Med, Dallas, TX USA. Ctr Medicaid Serv, Dallas, TX USA. RP McClellan, WM (reprint author), Georgia Med Care Fdn, 57 Execut Pk S,Suite 200, Atlanta, GA 30329 USA. EM bmcclell@gmcf.org NR 25 TC 25 Z9 25 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD MAR PY 2004 VL 15 IS 3 BP 754 EP 760 DI 10.1097/01.ASN.0000115701.51613.D7 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA 778BG UT WOS:000189218800027 PM 14978178 ER PT J AU Metersky, ML Ma, A Bratzler, DW Houck, PM AF Metersky, ML Ma, A Bratzler, DW Houck, PM TI Predicting bacteremia in patients with community-acquired pneumonia SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE LA English DT Article; Proceedings Paper CT Annual Meeting of the American-College-of-Chest-Physicians CY NOV 02-07, 2002 CL SAN DIEGO, CALIFORNIA SP Amer Coll Chest Physicians DE respiratory tract infections; decision support techniques; diagnosis ID BLOOD CULTURES; ADULT PATIENTS; MANAGEMENT; THERAPY; SEVERITY; OUTCOMES; ETIOLOGY; CARE AB It is recommended that blood cultures be performed on all patients admitted to the hospital with pneumonia. Questions regarding the cost-effectiveness of this practice have emerged. We used data on 13,043 Medicare patients hospitalized with pneumonia to determine predictors of bacteremia. Predictors included recent antibiotic treatment, liver disease, and three vital-sign and three laboratory abnormalities. Patients were stratified into three groups on the basis of the likelihood of bacteremia. We then created a decision support tool that recommends performing no blood cultures on patients with low likelihood of bacteremia, one blood culture on patients with moderate likelihood of bacteremia, and two blood cultures on patients with higher likelihood of bacteremia. This tool was then applied to a validation cohort of 12,771 patients with pneumonia. Use of the decision support tool would result in 38% fewer blood cultures being performed when compared with the standard practice of performing two blood cultures for each patient and identified 88 to 89% of patients with bacteremia. A simplified tool performed similarly overall but was less sensitive than was the first tool among pneumonia severity index Class V patients. These tools may allow clinicians to target patients with pneumonia in whom blood cultures are most likely to yield a pathogen. C1 Univ Connecticut, Ctr Hlth, Div Pulm, Farmington, CT 06030 USA. Qualidigm, Middletown, CT USA. Med Qual Inc, Oklahoma Fdn, Oklahoma City, OK USA. Ctr Medicare, Seattle, WA USA. Ctr Medicaid Serv, Seattle, WA USA. RP Metersky, ML (reprint author), Univ Connecticut, Ctr Hlth, Div Pulm, 263 Farmington Ave, Farmington, CT 06030 USA. EM Meterskyc@nso.uchc.edu NR 29 TC 107 Z9 116 U1 0 U2 1 PU AMER THORACIC SOC PI NEW YORK PA 1740 BROADWAY, NEW YORK, NY 10019-4374 USA SN 1073-449X J9 AM J RESP CRIT CARE JI Am. J. Respir. Crit. Care Med. PD FEB 1 PY 2004 VL 169 IS 3 BP 342 EP 347 DI 10.1164/rccm.200309-1248OC PG 6 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA 767BA UT WOS:000188417800008 PM 14630621 ER PT J AU Virnig, B Huang, Z Lurie, N Musgrave, D McBean, AM Dowd, B AF Virnig, B Huang, Z Lurie, N Musgrave, D McBean, AM Dowd, B TI Does medicare managed care provide equal treatment for mental illness across races? SO ARCHIVES OF GENERAL PSYCHIATRY LA English DT Article; Proceedings Paper CT Annual Meeting of the Academy-of-Health-Services-Research-and-Health-Policy CY JUN 23-25, 2002 CL WASHINGTON, D.C. SP Acad Hlth Serv Res & Hlth Policy ID RACIAL DISPARITIES; HEALTH-CARE; SCHIZOPHRENIA; ENROLLEES; QUALITY AB Background: While disparities in access to care are well documented, little is known about the quality of mental health care received by racial and ethnic minorities. We examined the quality of mental health care received by elderly enrollees in Medicare+ Choice plans. Methods: An observational study was performed using individual-level Health Plan Employer Data and Information Set data. From 4182 to 5 016 028 individuals 65 years or older and enrolled in Medicare+ Choice plans in 1999 were involved in different measures. Rates of mental health inpatient discharges, average length of stay, percentage of members receiving mental health services, rates of follow-up after hospitalization for mental illness, optimal practitioner contacts for antidepressant medication management, and effective acute- and continuation-phase treatment were assessed. Results: Compared with whites, minorities received substantially less follow-up after hospitalization for mental illness. The 30-day follow-up rates for whites, African Americans, Asians, and Hispanics were 60.2%, 42.4%, 54.1%, and 52.6%, respectively. Minorities also had lower rates of antidepressant medication management for newly diagnosed episodes of depression. The rates of optimal practitioner contacts for whites, African Americans, Asians, and Hispanics were 12.5%, 12.0%, 11.1%, and 10.6%; the rates of effective acute-phase treatment were 60.1%, 48.5%, 40.7%, and 57.6%; and the rates of effective continuation-phase treatment were 46.7%, 32.7%, 31.9%, and 39.6%, respectively. The statistically significant disparities persisted after adjusting for effects of age, sex, income, plan model, profit status, and region of the country. Conclusions: The overall quality of mental health care for people enrolled in Medicare+ Choice managed care plans is far from optimal. There are large and persistent racial differences that merit further attention to better understand their underlying causes and solutions. C1 Univ Minnesota, Sch Publ Hlth, Div Hlth Serv Res & Policy, Minneapolis, MN 55455 USA. RAND Corp, Arlington, VA USA. Ctr Medicarre, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Virnig, B (reprint author), Univ Minnesota, Sch Publ Hlth, Div Hlth Serv Res & Policy, 420 Delaware St SE,MMC 729, Minneapolis, MN 55455 USA. NR 20 TC 49 Z9 49 U1 0 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-990X J9 ARCH GEN PSYCHIAT JI Arch. Gen. Psychiatry PD FEB PY 2004 VL 61 IS 2 BP 201 EP 205 DI 10.1001/archpsyc.61.2.201 PG 5 WC Psychiatry SC Psychiatry GA 769MA UT WOS:000188652800012 PM 14757597 ER PT J AU Kresowik, TF Bratzler, DW Kresowik, RA Hendel, ME Grund, SL Brown, KR Nilasena, DS AF Kresowik, TF Bratzler, DW Kresowik, RA Hendel, ME Grund, SL Brown, KR Nilasena, DS TI Multistate improvement in process and outcomes of carotid endarterectomy SO JOURNAL OF VASCULAR SURGERY LA English DT Article; Proceedings Paper CT 51st Annual Meeting of the American-Association-for-Vascular-Surgery CY JUN 08-11, 2003 CL CHICAGO, ILLINOIS SP Amer Assoc Vasc Surg ID NEW-YORK-STATE; MEDICARE BENEFICIARIES; SURGICAL-PROCEDURES; HOSPITAL VOLUME; SURGEON VOLUME; QUALITY; STENOSIS; MORTALITY; CARE; TRIAL AB Objectives: The purpose of this study was to assess the effect of community-wide performance measurement and feedback on key processes and outcomes of carotid endarterectomy (CEA). Methods: Complete medical record (hospital chart) review for indications, care processes, and outcomes was performed on a random sample of Medicare patients undergoing CEA in 10 states (Arkansas, Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Nebraska, Ohio, Oklahoma) during baseline (Jun 1, 1995 to May 31, 1996) and remeasurement (Jun 1, 1998 to May 31, 1999) periods. In addition to review of the index hospital stay, hospital admissions within 30 days of the procedure were reviewed and the Medicare enrollment database queried to identify out-of-hospital deaths, to determine 30-day outcome results. The baseline data by state were provided to the Medicare Quality Improvement Organizations (QIOs) in the respective states, and quality improvement initiatives were encouraged. Results: We reviewed 9945 primary CEA alone procedures, 236 CEA and coronary artery bypass grafting (CABG) procedures, and 380 repeat CEA operations during the baseline period (B), and 9745 primary CEA alone procedures, 233 CEA and CABG procedures, and 401 repeat CEA operations during the remeasurement period (R). There was a significant decrease in the combined event rate (30-day stroke or mortality) for CEA alone procedures between baseline and remeasurement (13, 5.6%; R, 5.0%). A decrease occurred in each of the indication strata; transient ischemic attack or stroke (13, 7.7%; R, 6.9%), nonspecific symptoms (13, 5.9%; R, 5.4%), and no symptoms (B, 4.1%; R, 3.8%). The combined event rate also decreased for CEA and CABG (B, 17.4%; R, 13.3%) and repeat CEA operations (B, 6.8%; R, 5.7%). The remeasurement period state-to-state variation in combined event rate for CEA alone ranged from 2.7% (Georgia) to 5.9% (Indiana) for all indications combined, from 4.4% (Georgia) to 10.9% (Michigan) in patients with recent transient ischemia or stroke, from 1.4% (Georgia) to 6.0% (Oklahoma) in patients with no symptoms, and from 3.7% (Georgia) to 7.9% (Indiana) in patients with nonspecific symptoms. There were significant increases in preoperative antiplatelet administration (62%-67%; P <.0001) and patching (29%-45%; P =.05) from baseline to remeasurement in the CEA alone subset. Preoperative antiplatelet administration and patching were associated with improved outcomes in the combined baseline and remeasurement data. Conclusions: Community-wide quality improvement initiatives with performance measurement and confidential reporting of provider level data can lead to improvement in important care processes and outcomes. There is considerable variation between states in outcome and process, and thus continued room for improvement. Quality improvement projects that include standardized confidential outcome reporting should be encouraged. Preoperative antiplatelet therapy administration and patching rates should be considered as evidence-based performance measures. C1 Univ Iowa, Carver Coll Med, Iowa City, IA USA. Iowa Fdn Med Care, W Des Moines, IA USA. Oklahoma Fdn Med Qual, Oklahoma City, OK USA. Med Coll Wisconsin, Milwaukee, WI 53226 USA. Ctr Medicare Serv, Dallas, TX USA. Ctr Medicaid Serv, Dallas, TX USA. RP Kresowik, TF (reprint author), Univ Iowa Hosp & Clin, Dept Surg, 200 Hawkins Dr, Iowa City, IA 52242 USA. EM timothy-kresowik@uiowa.edu NR 28 TC 58 Z9 59 U1 0 U2 0 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD FEB PY 2004 VL 39 IS 2 BP 372 EP 379 DI 10.1016/j.jvs.2003.09.023 PG 8 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA 768GJ UT WOS:000188535000027 PM 14743139 ER PT J AU Tunis, SR Stryer, DB AF Tunis, SR Stryer, DB TI Realizing the benefits of practical clinical trials - Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Tunis, SR (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 3 TC 0 Z9 0 U1 0 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 28 PY 2004 VL 291 IS 4 BP 426 EP 426 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 767EF UT WOS:000188426700025 ER PT J AU Kroeker, AD McFarlane, P Mohr, P AF Kroeker, AD McFarlane, P Mohr, P TI A business model approach to quotidian hemodialysis SO DAILY AND NOCTURNAL HEMODIALYSIS SE CONTRIBUTIONS TO NEPHROLOGY LA English DT Article ID DAILY DIALYSIS C1 London Hlth Sci Ctr, London, ON N6A 4G5, Canada. Univ Toronto, St Michaels Hosp, Div Nephrol, Toronto, ON, Canada. Off Res Dev & Informat, Ctr Medicare & Medicaid Serv, Div Beneficiary Res, Baltimore, MD USA. RP Kroeker, AD (reprint author), London Hlth Sci Ctr, Univ Campus,339 Windermere Rd, London, ON N6A 4G5, Canada. EM Andrew.Kroeker@lhse.on.ca NR 12 TC 1 Z9 1 U1 0 U2 4 PU KARGER PI BASEL PA POSTFACH, CH-4009 BASEL, SWITZERLAND SN 0302-5144 J9 CONTRIB NEPHROL JI Contrib.Nephrol. PY 2004 VL 145 BP 106 EP 116 PG 11 WC Urology & Nephrology SC Urology & Nephrology GA BBE88 UT WOS:000225161600013 PM 15496797 ER PT J AU Levit, K Smith, C Cowan, C Sensenig, A Catlin, A AF Levit, K Smith, C Cowan, C Sensenig, A Catlin, A CA Hlth Accounts Team TI Trends - Health spending rebound continues in 2002 SO HEALTH AFFAIRS LA English DT Article AB U.S. health care spending climbed to $1.6 trillion in 2002, or $5,440 per person. Health spending rose 8.5 percent in 2001 and 9.3 percent in 2002, contributing to a spike of 1.6 percentage points in the health share of gross domestic product (GDP) since 2000. Hospital spending accounted for nearly a third of the aggregate increase. During the past three decades, per enrollee spending for a common benefit package has grown at a slightly slower average annual rate for Medicare than for private health insurance, with more pronounced growth differences recently reflecting legislated Medicare reimbursement changes and consumers' calls for more loosely managed care. C1 Hlth Stat Grp, Off Actuary, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Levit, K (reprint author), Hlth Stat Grp, Off Actuary, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 25 TC 82 Z9 85 U1 0 U2 1 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2004 VL 23 IS 1 BP 147 EP 159 DI 10.1377/hlthaff.23.1.147 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 761KH UT WOS:000187907600019 PM 15002637 ER PT J AU Smith, C AF Smith, C TI Trends - Retail prescription drug spending in the National Health Accounts SO HEALTH AFFAIRS LA English DT Article AB Recent rapid spending growth for retail drugs has largely arisen from increased use of new drugs, rather than from increasing prices of existing drugs. A sizable shift in the payment from consumers to third parties has also contributed to faster growth. Strategies such as negotiating for rebates and using tiered copayments have sought to slow spending growth but simultaneously have complicated the estimation of spending in the National Health Accounts (NHA). NHA estimates show that retail pharmaceuticals' share of health spending is not much different than it was in 1960, although its share of gross domestic product (GDP) has tripled. C1 Ctr Medicare & Medicaid Serv, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD USA. RP Smith, C (reprint author), Ctr Medicare & Medicaid Serv, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD USA. NR 16 TC 15 Z9 15 U1 1 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2004 VL 23 IS 1 BP 160 EP 167 DI 10.1377/hlthaff.23.1.160 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 761KH UT WOS:000187907600020 PM 15002638 ER PT J AU Kessler, L Ramsey, SD Tunis, S Sullivan, SD AF Kessler, L Ramsey, SD Tunis, S Sullivan, SD TI From the field - Clinical use of medical devices in the 'Bermuda Triangle' SO HEALTH AFFAIRS LA English DT Article ID PULMONARY-ARTERY CATHETERIZATION; VOLUME-REDUCTION SURGERY; CRITICALLY-ILL PATIENTS; LUNG-VOLUME; RANDOMIZED-TRIAL; SEVERE EMPHYSEMA; CANCER; HEART; CARE AB The pace of medical technological development shows no sign of abating. Analyzing the effect of major federal health agencies on the availability of such technology is critical. This paper describes functions of three government health agencies: the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH). Certain medical technologies fall into gaps between these agencies, which pose challenges in today's era of demand for evidence-based medicine. We suggest new policy and pragmatic strategies that can close the gaps and move decision making relevant to technology forward more rapidly than is now the case. C1 US FDA, Off Sci & Technol, Rockville, MD 20857 USA. Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Washington Univ, Pharm & Hlth Serv, Seattle, WA USA. Washington Univ, Pharm Outcomes Res & Policy Program, Seattle, WA USA. RP Kessler, L (reprint author), US FDA, Off Sci & Technol, Rockville, MD 20857 USA. NR 34 TC 18 Z9 19 U1 1 U2 3 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2004 VL 23 IS 1 BP 200 EP 207 DI 10.1377/hlthaff.23.1.200 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 761KH UT WOS:000187907600025 PM 15002643 ER PT J AU Gonzales, R Sauaia, A Corbett, KK Maselli, JH Erbacher, K Leeman-Castillo, BA Darr, CA Houck, PM AF Gonzales, R Sauaia, A Corbett, KK Maselli, JH Erbacher, K Leeman-Castillo, BA Darr, CA Houck, PM TI Antibiotic treatment of acute respiratory tract infections in the elderly: Effect of a multidimensional educational intervention SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE antibiotics; acute respiratory tract infections; clinical trial; physician practice patterns ID RESISTANT STREPTOCOCCUS-PNEUMONIAE; ACUTE BRONCHITIS; PNEUMOCOCCAL PNEUMONIA; INCREASING PREVALENCE; UNITED-STATES; ADULTS; PENICILLIN; COMMUNITY; IMPACT; PHYSICIANS AB OBJECTIVES: To measure and improve antibiotic use for acute respiratory tract infections (ARIs) in the elderly. DESIGN: Prospective, nonrandomized controlled trial. SETTING: Ambulatory office practices in Denver metropolitan area (n=4 intervention practices; n=51 control practices). PARTICIPANTS: Consecutive patients enrolled in a Medicare managed care program who were diagnosed with ARIs during baseline (winter 2000/2001) and intervention (winter 2001/2002) periods. A total of 4,270 patient visits were analyzed (including 341 patient visits in intervention practices). INTERVENTION: Appropriate antibiotic use and antibiotic resistance educational materials were mailed to intervention practice households. Waiting and examination room posters were provided to intervention office practices. MEASUREMENTS: Antibiotic prescription rates, based on administrative office visit and pharmacy data, for total and condition-specific ARIs. RESULTS: There was wide variation in antibiotic prescription rates for ARIs across unique practices, ranging from 21% to 88% (median=54%). Antibiotic prescription rates varied little by patient age, sex, and underlying chronic lung disease. Prescription rates varied by diagnosis: sinusitis (69%), bronchitis (59%), pharyngitis (50%), and nonspecific upper respiratory tract infection (26%). The educational intervention was not associated with greater reduction in antibiotic prescription rates for total or condition-specific ARIs beyond a modest secular trend (P=.79). CONCLUSION: Wide variation in antibiotic prescription rates suggests that quality improvement efforts are needed to optimize antibiotic use in the elderly. In the setting of an ongoing physician intervention, a patient education intervention had little effect. Factors other than patient expectations and demands may play a stronger role in antibiotic treatment decisions in elderly populations. C1 Univ Calif San Francisco, Dept Med, Div Gen Internal Med, San Francisco, CA 94118 USA. Univ Colorado, Hlth Sci Ctr, Div Hlth Care Policy & Res, Denver, CO USA. Colorado Fdn Med Care, Aurora, CO USA. Univ Colorado, Dept Anthropol, Denver, CO 80202 USA. Univ Colorado, Hlth & Behav Sci Program, Denver, CO 80202 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Gonzales, R (reprint author), Univ Calif San Francisco, Dept Med, Div Gen Internal Med, 3333 Calif St,Suite 430,Box 1211, San Francisco, CA 94118 USA. FU AHRQ HHS [R01HS13001-01] NR 33 TC 14 Z9 14 U1 1 U2 3 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD JAN PY 2004 VL 52 IS 1 BP 39 EP 45 DI 10.1111/j.1532-5415.2004.52008.x PG 7 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 756DR UT WOS:000187451000007 PM 14687313 ER PT J AU Rantz, MJ Connolly, RP AF Rantz, MJ Connolly, RP TI Measuring nursing care quality and using large data sets in nonacute care settings: State of the science SO NURSING OUTLOOK LA English DT Article ID MINIMUM DATA SET; RESIDENT ASSESSMENT INSTRUMENT; ADJUSTED OUTCOME MEASURES; HOME QUALITY; MDS; SCALE; INDICATORS AB The general state of the science of nursing quality measurement in nonacute care settings has accelerated in the last several years. Examples of current research using large data sets to measure quality of nursing care in nursing homes, home health, and other community-based care delivery are presented. Federally available data sets are reviewed as potential measures of care quality, and accessing these data sets is explained. Large data sets are becoming commonly used in long-term care research. Multiple databases are available for researcher use that can provide measures of nursing care quality. Large data sets in nonacute care hold much potential for measuring quality of care in long-term care settings. Public policy makers must facilitate timely data access so that research can move beyond descriptive studies to interventions that can be tested and proven to improve quality of care and outcomes of those we serve. C1 Univ Missouri, Sinclair Sch Nursing S406, Columbia, MO 65201 USA. Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Rantz, MJ (reprint author), Univ Missouri, Sinclair Sch Nursing S406, Columbia, MO 65201 USA. EM rantzm@missouri.edu NR 35 TC 13 Z9 13 U1 0 U2 1 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0029-6554 J9 NURS OUTLOOK JI Nurs. Outlook PD JAN-FEB PY 2004 VL 52 IS 1 BP 23 EP 37 DI 10.1016/j.outlook.2003.11.002 PG 15 WC Nursing SC Nursing GA 801KB UT WOS:000220093700006 PM 15014377 ER PT J AU McBean, AM Huang, Z Virnig, BA Lurie, N Musgrave, D AF McBean, AM Huang, Z Virnig, BA Lurie, N Musgrave, D TI Racial variation in the control of diabetes among elderly Medicare managed care beneficiaries SO DIABETES CARE LA English DT Article ID QUALITY; PREVALENCE; COMPLICATIONS; ORGANIZATION; ENROLLEES AB OBJECTIVE - To examine racial variation in the poor control of GHb, a GHb value >9.5%, or GHb not tested in 1999 among Medicare beneficiaries aged 65-75 years enrolled in managed care plans. RESEARCH DESIGN AND METHODS - The National Committee on Quality Assurance provides person-level data regarding diabetes care services and control for Medicare beneficiaries enrolled in managed care to the Centers for Medicare and Medicaid Services (CMS). We merged this information with information on each individual's race, as well as other person-level and plan-level characteristics obtained from CMS. Bivarate and multivariate analyses were performed. RESULTS - The overall rate of poor GHb control was 32.7%. The age- and sex-adjusted rate of poor control among whites was 32.0%. This rate was significantly higher than the rate among Asians (24.7%) but significantly lower than the rate among blacks (40.6%) and Hispanics (36.5%) (P < 0.001). An increase in the number of comprehensive diabetes care measures received by an individual was associated with a significantly lower percentage of individuals with poor GHb control in all race groups. After controlling for the individual-level, plan-level, and diabetes care measure variables, the difference in GHb control between Asians and whites disappeared. However, blacks and Hispanics continued to have significantly higher rates of poor control than whites. CONCLUSIONS - There is room for significant reduction in the number of patients with poor control of GHb among all races, particularly among blacks and Hispanics. C1 Univ Minnesota, Sch Publ Hlth, Div Hlth Serv Res & Policy, Minneapolis, MN 55455 USA. RAND Corp, Arlington, VA USA. US Dept HHS, Ctr Medicare, Baltimore, MD USA. US Dept HHS, Ctr Med Serv, Baltimore, MD USA. RP McBean, AM (reprint author), Univ Minnesota, Sch Publ Hlth, Div Hlth Serv Res & Policy, MMC 97,Mayo Mem Bldg,420 Delaware St SE, Minneapolis, MN 55455 USA. FU PHS HHS [500-01-0043, 500-96-0023] NR 19 TC 36 Z9 36 U1 0 U2 0 PU AMER DIABETES ASSOC PI ALEXANDRIA PA 1701 N BEAUREGARD ST, ALEXANDRIA, VA 22311-1717 USA SN 0149-5992 J9 DIABETES CARE JI Diabetes Care PD DEC PY 2003 VL 26 IS 12 BP 3250 EP 3256 DI 10.2337/diacare.26.12.3250 PG 7 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA 746AM UT WOS:000186724000008 PM 14633810 ER PT J AU Poisal, JA AF Poisal, JA TI Medicare drugs SO HEALTH CARE FINANCING REVIEW LA English DT Article AB The following overview knits together a collection of articles that focus on prescription drug issues as they relate to the Medicare Program. In general, the articles examine the following themes. drug cost management; drug cost estimation, and racial disparities in drug coverage and use. These commentaries provide information on private-sector experience in administering a drug benefit, models that might be used to estimate take-up rates and their associated costs, and several indepth looks at racial disparities by various chronic conditions. C1 Ctr Medicare, CMS, Baltimore, MD 21244 USA. Ctr Medicaid Serv, CMS, Baltimore, MD 21244 USA. RP Poisal, JA (reprint author), Ctr Medicare, CMS, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM jpoisal@cms.hhs.gov NR 4 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2003 VL 25 IS 2 BP 1 EP 5 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 954VS UT WOS:000231183900001 PM 15124373 ER PT J AU Poisal, JK AF Poisal, JK TI Reporting of drug expenditures in the MCBS SO HEALTH CARE FINANCING REVIEW LA English DT Article ID COVERAGE AB Comparing data from both the 1999 MCBS and drug utilization data supplied by the survey respondents' pharmacies, the author details the methods used to determine the level of misreporting of drug expenditures in the MCBS. Findings suggest that prescription drug expenditures are underreported by 17 percent and the number of prescriptions used is underreported by 17.7 percent. The data also identify demographic factors that predict a beneficiary's likelihood to either overreport or underreport his or her medications, as well as the extent to which beneficiaries misreport their drug use and spending. C1 Ctr Medicare, CMS, Baltimore, MD 21244 USA. Ctr Medicaid Serv, CMS, Baltimore, MD 21244 USA. RP Poisal, JK (reprint author), Ctr Medicare, CMS, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM jpoisal@cms.hhs.gov NR 8 TC 25 Z9 25 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2003 VL 25 IS 2 BP 23 EP 36 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 954VS UT WOS:000231183900003 PM 15124375 ER PT J AU Eppig, FJ Poisal, JA AF Eppig, FJ Poisal, JA TI Medicare beneficiary's use of prescription drug discount cards, CY 2002 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare, CMS, Baltimore, MD 21244 USA. Ctr Medicaid Serv, CMS, Baltimore, MD 21244 USA. RP Eppig, FJ (reprint author), Ctr Medicare, CMS, 7500 Secur Blvd,C3-16-17, Baltimore, MD 21244 USA. EM feppig@cms.hhs.gov NR 0 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2003 VL 25 IS 2 BP 91 EP 94 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 954VS UT WOS:000231183900008 PM 15124380 ER PT J AU Guterman, S AF Guterman, S TI Financing teaching hospital missions: A context SO HEALTH AFFAIRS LA English DT Article AB The issue of what teaching hospitals do, how much it costs, and how it should be financed has been the subject of ongoing debate. This Perspective provides a context for considering the implications of the latest contribution to that debate: the paper by Lane Koenig and colleagues that presents new estimates of teaching hospitals' mission-related costs. I address the system through which teaching hospital activities are financed, the difficulty in identifying and estimating the costs of teaching hospitals' missions, and the problems involved in determining how those missions should be underwritten. C1 Ctr Medicare, Off Rs Dev & Informat, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Guterman, S (reprint author), Ctr Medicare, Off Rs Dev & Informat, Baltimore, MD USA. NR 6 TC 1 Z9 1 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD NOV-DEC PY 2003 VL 22 IS 6 BP 123 EP 125 DI 10.1377/hlthaff.22.6.123 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 744LN UT WOS:000186632200016 PM 14649438 ER PT J AU Fivush, B Neu, A Bedinger, M Goldstein, S Brem, A Warady, B Watkins, S Freidman, A Frankenfield, D AF Fivush, B Neu, A Bedinger, M Goldstein, S Brem, A Warady, B Watkins, S Freidman, A Frankenfield, D TI Growth in pediatric hemodialysis patients less than 18 years data from CMS' ESRD CPM project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Johns Hopkins Univ, Baltimore, MD 21218 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 258A EP 259A PG 2 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219101200 ER PT J AU Fivush, B Neu, A Bedinger, M Warady, B Watkins, S Friedman, A Brem, A Goldstein, S Frankenfield, D AF Fivush, B Neu, A Bedinger, M Warady, B Watkins, S Friedman, A Brem, A Goldstein, S Frankenfield, D TI Impact of specialization of primary nephrologist on care of pediatric hemodialysis patients-data from CMS' ESRD CPM project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Johns Hopkins Univ, Baltimore, MD 21218 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 258A EP 258A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219101198 ER PT J AU Goldstein, SL Neu, A Warady, B Watkins, S Brem, A Fivush, B Friedman, A Frankenfield, D AF Goldstein, SL Neu, A Warady, B Watkins, S Brem, A Fivush, B Friedman, A Frankenfield, D TI Hemodialysis variables for children less than 12 years: A report from the 2001 center for medicaid and medicare (CMS) Clinical Performance Measures (CPM) Project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Baylor Coll Med, Houston, TX 77030 USA. Ctr Medicaid & Medicare Serv, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 258A EP 258A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219101199 ER PT J AU Johnson, CA Frankenfield, DL Wish, JB AF Johnson, CA Frankenfield, DL Wish, JB TI Intravenous iron use among adult Hemodialysis (HD) patients: Results from the 2002 ESRD clinical performance (CPM) project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Univ Wisconsin, Madison, WI USA. Ctr Medicare, Ctr Beneficiary Choices, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. Case Western Reserve Univ, Cleveland, OH 44106 USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 458A EP 458A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219102120 ER PT J AU Frankenfield, DL Rocco, MV McClellan, WM Roman, SH AF Frankenfield, DL Rocco, MV McClellan, WM Roman, SH TI Intermediate outcomes for in-center hemodialysis patients with diabetes treated with insulin: Findings from the 2002 ESRD clinical performance measures project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Ctr Beneficiary Choices, Ctr Medicare, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Mediacid Serv, Baltimore, MD USA. Wake Forest Univ, Sch Med, Nephrol Sect, Winston Salem, NC USA. Emory Univ, Renal Div, Atlanta, GA 30322 USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. NR 0 TC 2 Z9 2 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 504A EP 504A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219102320 ER PT J AU Narva, AS Burrows, NR Woodruff, SD AF Narva, AS Burrows, NR Woodruff, SD TI Longer survival among native Americans than among whites who initiated therapy for diabetes-related end-stage renal disease, United States, 1990-2001. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Indian Hlth Serv, Kidney Dis Program, Albuquerque, NM USA. Ctr Dis Control & Prevent, Div Diabet Translat, Atlanta, GA USA. Ctr Medicare, Intermt EndoStage Renal Dis Network, Denver, CO USA. Ctr Medicaid Serv, Intermt EndoStage Renal Dis Network, Denver, CO USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 504A EP 504A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219102322 ER PT J AU Frankenfield, DL Rocco, MV McClellan, WM Roman, SH AF Frankenfield, DL Rocco, MV McClellan, WM Roman, SH TI Intermediate outcomes for adult Hispanic sub-group hemodialysis patients from the 2002 ESRD clinical performance measures (CPM) project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Wake Forest Univ, Sch Med, Nephrol Sect, Winston Salem, NC USA. Emory Univ, Div Renal, Atlanta, GA USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA USA. Ctr Med & Medicaid Serv, Ctr Benef Choices, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 713A EP 714A PG 2 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219103291 ER PT J AU Frankenfield, DL Bedinger, MR McCellan, WM Rocco, MR AF Frankenfield, DL Bedinger, MR McCellan, WM Rocco, MR TI Outcomes for adult native American hemodialysis patients: A disadvantaged group? SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Ctr Medicare & Medicaid Serv, Ctr Benef Choices, Baltimore, MD USA. Emory Univ, Div Renal, Atlanta, GA USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA USA. Wake Forest Sch Med, Nephrol Sect, Winston Salem, NC USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 716A EP 717A PG 2 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219103304 ER PT J AU Rocco, MV Frankenfield, DL Bedinger, MR AF Rocco, MV Frankenfield, DL Bedinger, MR TI Body mass index (BMI) is not associated with mortality in peritoneal dialysis patients: results from the CMS ESRD CPM project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Wake Forest Sch Med, Winston Salem, NC 27109 USA. Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 739A EP 739A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219103405 ER PT J AU Hedayati, S Olsen, M Frankenfield, D Owen, W Szczech, L Reddan, D AF Hedayati, S Olsen, M Frankenfield, D Owen, W Szczech, L Reddan, D TI Comparison of intermediate outcomes among chronic hemodialysis patients receiving care at veterans health administration (VHA) and non-VHA facilities. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Duke Univ, Med Ctr, Durham, NC USA. VAMC, Durham, NC USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. Baxter Hlth Care, Chicago, IL USA. VAMC, Boston, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 828A EP 828A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219103815 ER PT J AU Rocco, MV Frankenfield, DL Roman, SH Bedinger, MR McClellan, WM AF Rocco, MV Frankenfield, DL Roman, SH Bedinger, MR McClellan, WM TI Intermediate outcomes and mortality in incident HD patients stratified by diabetes mellitus: Findings from the CMS ESRD clinical performance measures project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Wake Forest Sch Med, Winston Salem, NC USA. Ctr Medicare Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Ctr Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Emory Univ, Div Renal, Atlanta, GA 30322 USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. NR 0 TC 0 Z9 0 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 830A EP 831A PG 2 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219103824 ER PT J AU Rocco, MV Frankenfield, DL Bedinger, MR Roman, SH McClellan, WM AF Rocco, MV Frankenfield, DL Bedinger, MR Roman, SH McClellan, WM TI Comparison of mortality and intermediate outcomes in type 1 versus type 2 diabetes mellitus patients receiving chronic hemodialysis therapy: Findings from the CMS CPM project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract CT 36th Annual Meeting of the American-Society-of-Nephrology CY NOV 12-17, 2003 CL SAN DIEGO, CALIFORNIA SP Amer Soc Nephrol C1 Wake Forest Sch Med, Winston Salem, NC USA. Ctr Medicare Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Ctr Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Emory Univ, Div Renal, Atlanta, GA 30322 USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD NOV PY 2003 VL 14 SU S BP 831A EP 831A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 737FE UT WOS:000186219103825 ER PT J AU Neu, AM Fivush, BA Warady, BA Watkins, SL Friedman, AL Brem, AS Goldstein, S Frankenfield, DL AF Neu, AM Fivush, BA Warady, BA Watkins, SL Friedman, AL Brem, AS Goldstein, S Frankenfield, DL TI Longitudinal analysis of intermediate outcomes in adolescent hemodialysis patients SO PEDIATRIC NEPHROLOGY LA English DT Article; Proceedings Paper CT Annual Meeting of the Pediatric-Academic-Societies CY MAY 04-07, 2002 CL BALTIMORE, MARYLAND SP Pediat Acad Soc DE hemodialysis; adolescent; clearance; hemoglobin; access; albumin; growth AB In 2000 and 2001, The Centers for Medicare & Medicaid Services (CMS) End-Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) project collected data on all in-center hemodialysis (HD) patients in the United States aged greater than or equal to12 and <18 years. There were 433 of 486 (89%) patients and 435 of 516 (84%) patients who had the minimum required data submitted and were included in the 2000 and 2001 study years, respectively. There were 188 patients (43%) who had data submitted in both study years, providing longitudinal data on this cohort. A comparison of clinical parameters on these 188 patients in the 2000 and 2001 study years reveals significant improvement in mean calculated spKt/V (1.50+/-0.36 vs. 1.58+/-0.30, P<0.01), mean hemoglobin (11.0+/-1.6 g/dl vs. 11.5+/-1.3 g/dl, P<0.001), mean ferritin (286+/-278 ng/ml vs. 460+/-353 ng/ml, P<0.001), mean transferrin saturation (27.8+/-15.1% vs. 31.3+/-15.0%, P<0.05), mean serum albumin as measured by the bromocresol green method (3.83+/-0.54 g/dl vs. 3.95+/-0.42 g/dl, P<0.01), and mean height standard deviation score (-1.814+/-1.756 vs. -1.699+/-1.657, P<0.05). In addition, 20 of 29 (69%) patients who had a spKt/V <1.2 in the 2000 study year had a spKt/V >1.2 in the 2001 study year. Of 68 (44%) patients who had a catheter as their HD access in the 2000 study year, 30 had an arteriovenous fistula or graft in the 2001 study year and 49 of 80 (61%) patients who had a mean hemoglobin <11 g/dl in the 2000 study year had a hemoglobin >11 g/dl in the 2001 study year. In summary, these longitudinal data demonstrate significant improvements in nearly all clinical parameters studied in these adolescent HD patients. C1 Johns Hopkins Univ, Sch Med, Dept Pediat Nephrol, Baltimore, MD 21287 USA. Childrens Mercy Hosp, Kansas City, MO 64108 USA. Univ Washington, Childrens Hosp, Seattle, WA 98195 USA. Univ Wisconsin, Childrens Hosp, Madison, WI USA. Rhode Isl Hosp, Providence, RI USA. Baylor Coll Med, Houston, TX 77030 USA. Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. RP Neu, AM (reprint author), Johns Hopkins Univ, Sch Med, Dept Pediat Nephrol, 600 N Wolfe St,Pk 327, Baltimore, MD 21287 USA. NR 5 TC 14 Z9 14 U1 0 U2 0 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0931-041X J9 PEDIATR NEPHROL JI Pediatr. Nephrol. PD NOV PY 2003 VL 18 IS 11 BP 1172 EP 1176 DI 10.1007/s00467-003-1133-y PG 5 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 737QW UT WOS:000186244100017 PM 12920629 ER PT J AU Herzog, NS Bratzler, DW Houck, PM Jiang, H Nsa, W Shook, C Weingarten, SR AF Herzog, NS Bratzler, DW Houck, PM Jiang, H Nsa, W Shook, C Weingarten, SR TI Effects of previous influenza vaccination on subsequent readmission and mortality in elderly patients hospitalized with pneumonia SO AMERICAN JOURNAL OF MEDICINE LA English DT Article ID COMMUNITY-ACQUIRED PNEUMONIA; COST-EFFECTIVENESS; REDUCTION; EFFICACY; RISK; MANITOBA; EPIDEMIC; DEATHS; RATES AB PURPOSE: To determine the effect of influenza vaccination on mortality and hospital readmission rates following discharge of elderly patients admitted with pneumonia. METHODS: We reviewed the medical records of 12,566 randomly selected Medicare beneficiaries hospitalized for pneumonia from October I through December 31, 1998, to assess mortality and hospital readmission rates from the date of discharge through the influenza season, May 1, 1999. Patients were grouped based on vaccination status: before hospitalization, during hospitalization, or unknown (no evidence of vaccination). RESULTS: Severity-adjusted mortality rates were 22.4% (95% confidence interval [CI]: 14.4% to 29.7%) for the vaccination before hospitalization group, 26.4% (95% Cl: 20.4% to 31.9%) for the in-hospital vaccination group, and 29.4% (95% Cl: 28.1% to 30.6%) for the unknown vaccination status group. Patients vaccinated before hospitalization had significantly lower mortality than did patients with unknown vaccination status (hazard ratio [HR] = 0.65; 95% CI: 0.59 to 0.70; P < 0.0001). Adjusted readmission rates were 42.6% (95% Cl: 40.0% to 45.1%) for the vaccination before hospitalization group, 40.0% (95% Cl: 33.2% to 46.1%) for the in-hospital vaccination group, and 44.8% (95% CI:43.3% to 46.4%) for the unknown vaccination status group. Patients vaccinated before hospitalization had significantly lower readmission rates than patients with unknown vaccination status (HR = 0.92; 95% Cl: 0.87 to 0.98; P = 0.009). CONCLUSION: Influenza vaccination before hospitalization was effective in decreasing subsequent mortality and hospital readmission in elderly patients with pneumonia. (C) 2003 by Excerpta Medica Inc. C1 Cedars Sinai Med Ctr, Dept Pediat, Los Angeles, CA 90048 USA. Univ Calif Los Angeles, Sch Med, Los Angeles, CA 90024 USA. Zynx Hlth Inc, Beverly Hills, CA USA. Oklahoma Fdn Med Qual Inc, Oklahoma City, OK USA. Ctr Medicare & Medicaid Serv, Seattle, WA USA. RP Herzog, NS (reprint author), Cedars Sinai Med Ctr, Dept Pediat, 8700 Beverly Blvd,1165 W Tower, Los Angeles, CA 90048 USA. FU PHS HHS [500-99-P619] NR 31 TC 14 Z9 14 U1 0 U2 1 PU EXCERPTA MEDICA INC PI NEW YORK PA 650 AVENUE OF THE AMERICAS, NEW YORK, NY 10011 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD OCT 15 PY 2003 VL 115 IS 6 BP 454 EP 461 DI 10.1016/S0002-9343(03)00440-6 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 733AX UT WOS:000185978700005 PM 14563502 ER PT J AU Sugarman, JR Frederick, PR Frankenfield, DL Owen, WF McClellan, WM AF Sugarman, JR Frederick, PR Frankenfield, DL Owen, WF McClellan, WM TI Developing clinical performance measures based on the dialysis outcomes quality initiative clinical practice guidelines: Process, outcomes, and implications SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE clinical performance measures (CPMs); quality improvement; Dialysis Outcomes Quality Initiative (DOQI) AB Background. The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Clinical Practice Guidelines established a widely accepted set of recommendations for high-quality dialysis care. To enhance the End-Stage Renal Disease Core Indicators Project, an ongoing effort to assess and improve dialysis care in the United States, the Centers for Medicare and Medicaid Services (CMS) commissioned a project to develop clinical performance measures (CPMs) based on the NKF-DOQI guidelines. Methods: The CMS contracted with Qualis Health, a private nonprofit organization serving as a Medicare Quality Improvement Organization, to facilitate a 9-month project to develop dialysis CPMs with the participation of a broad range of stakeholders from the renal community. Work groups were established to develop CPMs addressing 4 areas: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access management, and anemia management. The NKF-DOQI guidelines were prioritized based on the strength of the evidence supporting the guidelines, the feasibility of developing performance measures, and the significance of the areas addressed to the quality of care delivered to dialysis patients. Expert panels developed data specifications, sampling approaches, data-collection tools, and analytic strategies. Results: Sixteen CPMs were developed based on 22 of 114 NKF-DOQI guidelines. After establishing reliability through field-testing of data-collection instruments, the CPMs were applied to a sample of 8,838 randomly selected hemodialysis patients and 1,650 randomly selected adult peritoneal dialysis patients in summer 1999. Conclusion: The development of CPMs based on the NKF-DOQI Clinical Practice Guidelines for dialysis care was accomplished in a timely and effective manner by engaging a broad range of stakeholders and technical experts. The CPMs are important tools to assess and improve the quality of dialysis care in the United States. Few comparable efforts exist in other fields of medicine. C1 Qualis Hlth, Seattle, WA 98133 USA. Univ Washington, Sch Med, Dept Family Med, Seattle, WA 98195 USA. Univ Washington, Sch Publ Hlth & Community Med, Dept Epidemiol, Seattle, WA 98195 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Durham, NC USA. Baxter Int Healthcare, Waukegan, IL USA. Georgia Med Care Fdn, Hlth Serv Res, Atlanta, GA USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. RP Sugarman, JR (reprint author), Qualis Hlth, 10700 Meridian Ave N,Ste 100,POB 33400, Seattle, WA 98133 USA. FU PHS HHS [500-99-WA02] NR 13 TC 32 Z9 32 U1 0 U2 7 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD OCT PY 2003 VL 42 IS 4 BP 806 EP 812 DI 10.1053/S0272-6386(03)00867-9 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA 728XK UT WOS:000185741500021 PM 14520632 ER PT J AU Teresi, J Holmes, D Schoeneman, K Calkins, M AF Teresi, J Holmes, D Schoeneman, K Calkins, M TI Culture change I: Beyond case studies to major research initiatives SO GERONTOLOGIST LA English DT Meeting Abstract C1 HHAR Res Div, Riverdale, NY 10471 USA. Hebrew Home Aged, Riverdale, NY USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. IDEAS Inst, Kirtland, OH USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2003 VL 43 SI 1 BP 29 EP 29 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 734VF UT WOS:000186078100075 ER PT J AU Kane, R Pratt, M AF Kane, R Pratt, M TI Zeroing in on resident quality of life (QOL) in nursing homes: Tools, recent findings, and implications from a large-scale study SO GERONTOLOGIST LA English DT Meeting Abstract C1 Univ Minnesota, Div Hlth Serv Res & Policy, Sch Publ Hlth, Minneapolis, MN 55455 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2003 VL 43 SI 1 BP 511 EP 511 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 734VF UT WOS:000186078101399 ER PT J AU Ash, AS Posner, MA Speckman, J Franco, S Yacht, AC Bramwell, L AF Ash, AS Posner, MA Speckman, J Franco, S Yacht, AC Bramwell, L TI Using claims data to examine mortality trends following hospitalization for heart attack in Medicare SO HEALTH SERVICES RESEARCH LA English DT Article DE risk adjustment; Charlson; DCG; CCS; AMI; event-centered database AB Objective. To see if changes in the demographics and illness burden of Medicare patients hospitalized for acute myocardial infarction. (AMI) from 1995 through 1999 can explain an observed rise (from 32 percent to 34 percent) in one-year mortality over that period. Data Sources. Utilization data from the Centers for Medicare and Medicaid Services (CMS) fee-for-service claims (MedPAR, Outpatient, and Carrier Standard Analytic Files); patient demographics and date of death from CMS Denominator and Vital Status files. For over 1.5 million AMI discharges in 1995-1999 we retain diagnoses from one year prior, and during, the case-defining admission. Study Design. We fit logistic regression models to predict one-year mortality for the 1995 cases and apply them to 1996-1999 files. The CORE model uses age, sex, and original reason for Medicare entitlement to predict mortality. Three other models use the CORE variables plus morbidity indicators from well-known morbidity classification methods (Charlson, DCG, and AHRQs CCS). Regressions were used as is-without pruning to eliminate clinical or statistical anomalies. Each model references the same diagnoses-those recorded during the pre- and index admission periods. We compare each model's ability to predict mortality and use each to calculate risk-adjusted mortality in 1996-1999. Principal Findings. The comprehensive morbidity classifications (DCG and CCS) led to more accurate predictions than the Charlson, which dominated the CORE model (validated C-statistics: 0.81, 0.82, 0.74, and 0.66, respectively). Using the CORE model for risk adjustment reduced, but did not eliminate, the mortality increase. In contrast, adjustment using any of the morbidity models produced essentially flat graphs. Conclusions. Prediction models based on claims-derived demographics and morbidity profiles can be extremely accurate. While one-year post-AMI mortality in Medicare may not be worsening, outcomes appear not to have continued to improve as they had in the prior decade. Rich morbidity information is available in claims data, especially when longitudinally tracked across multiple settings of care, and is important in setting performance targets and evaluating trends. C1 Boston Univ, Sch Med, Hlth Care Res Unit, Boston, MA 02118 USA. Boston Univ, Sch Publ Hlth, Boston, MA 02215 USA. Boston Med Ctr, Boston, MA USA. Maimonides Hosp, Dept Med, Brooklyn, NY 11219 USA. Dept Hlth & Human Serv, Ctr Medicare, Washington, DC USA. Dept Hlth & Human Serv, Ctr Medicaid Serv, Washington, DC USA. RP Ash, AS (reprint author), Boston Univ, Sch Med, Hlth Care Res Unit, 720 Harrison Ave 1108, Boston, MA 02118 USA. NR 7 TC 48 Z9 49 U1 1 U2 3 PU BLACKWELL PUBL LTD PI OXFORD PA 108 COWLEY RD, OXFORD OX4 1JF, OXON, ENGLAND SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD OCT PY 2003 VL 38 IS 5 BP 1253 EP 1262 DI 10.1111/1475-6773.00175 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 734JF UT WOS:000186051500004 PM 14596389 ER PT J AU Sheikh, K Bullock, C AF Sheikh, K Bullock, C TI Variation and changes in state-specific carotid endarterectomy and 30-day mortality rates, United States, 1991-2000 SO JOURNAL OF VASCULAR SURGERY LA English DT Article ID CEREBROVASCULAR-DISEASE; MEDICARE BENEFICIARIES; SEX-DIFFERENCES; EPIDEMIOLOGY; STENOSIS AB Objectives: The objectives of this study were to investigate variations between states and changes in state-specific carotid endarterectomy (CEA) and 30-day mortality rates. Cross-sectional variations and changes over time in such measures may be indicative of improvement in the quality of care. Methods: We performed retrospective analyses of pre-existing administrative data on Medicare beneficiaries aged 65 years and older in the United States. Age-adjusted, state-specific CEA rates and 30-day postoperative mortality rates in 1991, 1995 and 2000 were examined, as well as changes in these rates from 1991 to 1995 and from 1995 to 2000. Stroke mortality in the general population of each state was used as a crude measure of the need for CEA procedure in the state. The Spearman rank correlation analysis was used to study correlations between rates. Oldham's method was used to avoid the effect of regression to the mean. Results: There were wide variations in the state-specific CEA rates, 30-day mortality, and in changes in these rates over time. The states with relatively low procedure rates in 1991 also had low rates in 1995 and 2000, and relatively higher increases in the rates. The states with relatively high 30-day mortality in 1991 or 1995 had lower increases or greater decreases in the rate. CEA rates were not correlated with any measure of surgical mortality, but they were correlated with stroke mortality in the general population. Conclusions: The inter-state variation in CEA rates has not changed much since 1991, but variation in 30-day mortality decreased through 2000. The states with low procedure rates in 1991 did not have sufficient increase to catch up with the high-rate states by 1995, but they were prone to experience a higher increase in the subsequent 5 years. The validity of stroke mortality in a state as a measure of the need for CEA is questionable. Further research using clinical data is needed to better explain variations between states. C1 Ctr Medicare & Medicaid Serv, US Dept Hlth & Human Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), Ctr Medicare & Medicaid Serv, US Dept Hlth & Human Serv, 601 E 12th St,Rm 235, Kansas City, MO 64106 USA. NR 20 TC 7 Z9 7 U1 0 U2 0 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD OCT PY 2003 VL 38 IS 4 BP 779 EP 784 DI 10.1016/S0741-5214(03)00616-5 PG 6 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA 730YX UT WOS:000185858700026 PM 14560230 ER PT J AU Sheikh, K AF Sheikh, K TI Reliability of provider volume and outcome associations for healthcare policy SO MEDICAL CARE LA English DT Editorial Material ID ACUTE MYOCARDIAL-INFARCTION; HOSPITAL VOLUME; SURGICAL VOLUME; CAROTID-ENDARTERECTOMY; ELDERLY PATIENTS; PATIENT VOLUME; TRAUMA CENTER; MORTALITY; QUALITY; EXPERIENCE C1 US Dept Hlth & Human Serv, Ctr Medicare, Kansas City, MO 64106 USA. US Dept Hlth & Human Serv, Ctr Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept Hlth & Human Serv, Ctr Medicare, 601 E 12th St,Room 235, Kansas City, MO 64106 USA. NR 63 TC 23 Z9 23 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD OCT PY 2003 VL 41 IS 10 BP 1111 EP 1117 DI 10.1097/01.MLR.0000088085.61714.AE PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 725CK UT WOS:000185525400001 PM 14515105 ER PT J AU Sheikh, K AF Sheikh, K TI Sheikh responds to provider volume-patient outcome association and policy by Luft SO MEDICAL CARE LA English DT Editorial Material ID NEW-YORK-STATE; QUALITY; OPERATIONS; HOSPITALS; MORTALITY C1 US Dept Hlth & Human Serv, Ctr Medicare, Kansas City, MO 64106 USA. US Dept Hlth & Human Serv, Ctr Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept Hlth & Human Serv, Ctr Medicare, 601 E 12th St,Room 235, Kansas City, MO 64106 USA. NR 17 TC 6 Z9 6 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD OCT PY 2003 VL 41 IS 10 BP 1123 EP 1126 DI 10.1097/01.MLR.0000088087.01016.B4 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 725CK UT WOS:000185525400004 ER PT J AU Tunis, SR Stryer, DB Clancy, CM AF Tunis, SR Stryer, DB Clancy, CM TI Practical clinical trials - Increasing the value of clinical research for decision making in clinical and health policy SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; LIPID-LOWERING TREATMENT; OBSTRUCTIVE PULMONARY-DISEASE; BENIGN PROSTATIC HYPERPLASIA; ACUTE MYOCARDIAL-INFARCTION; ABDOMINAL AORTIC-ANEURYSMS; LOW-BACK-PAIN; MEDICAL LITERATURE; USERS GUIDES; PRIMARY-CARE AB Decision makers in health care are increasingly interested in using high-quality scientific evidence to support clinical and health policy choices; however, the quality of available scientific evidence is often found to be inadequate. Reliable evidence is essential to improve health care quality and to support efficient use of limited resources. The widespread gaps in evidence-based knowledge suggest that systematic flaws exist in the production of scientific evidence, in part because there is no consistent effort to conduct clinical trials designed to meet the needs of decision makers. Clinical trials for which the hypothesis and study design are developed specifically to answer the questions faced by decision makers are called pragmatic or practical clinical trials (PCTs). The characteristic features of PCTs are that they (1) select clinically relevant alternative interventions to compare, (2) include a diverse population of study participants, (3) recruit participants from heterogeneous practice settings, and (4) collect data on a broad range of health outcomes. The supply of PCTs is limited primarily because the major funders of clinical research, the National Institutes of Health and the-medical products industry, do not focus on supporting such trials. Increasing the supply of PCTs will depend on the development of a mechanism to establish priorities for these studies, significant expansion of an infrastructure to conduct clinical research within the health care delivery system, more reliance on high-quality evidence by health care decision makers, and a substantial increase in public and private funding for these studies. For these changes to occur, clinical and health policy decision makers will need to become more involved in all aspects of clinical research, including priority, setting, infrastructure development, and funding. C1 Ctr Medicare Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. Ctr Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. RP Tunis, SR (reprint author), Ctr Medicare Serv, Off Clin Stand & Qual, 7500 Secur Blvd,Mailstop 53-02-01, Baltimore, MD 21244 USA. NR 65 TC 997 Z9 1009 U1 9 U2 60 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD SEP 24 PY 2003 VL 290 IS 12 BP 1624 EP 1632 DI 10.1001/jama.290.12.1624 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 723ZK UT WOS:000185461300028 PM 14506122 ER PT J AU Foody, JM Ferdinand, FD Galusha, D Rathore, SS Masoudi, FA Havranek, EP Nilasena, D Radford, MJ Krumholz, HM AF Foody, JM Ferdinand, FD Galusha, D Rathore, SS Masoudi, FA Havranek, EP Nilasena, D Radford, MJ Krumholz, HM TI Patterns of secondary prevention in older patients undergoing coronary artery bypass grafting during hospitalization for acute myocardial infarction SO CIRCULATION LA English DT Article DE heart surgery; risk factors; elderly; quality assessment ID LIPOPROTEIN CHOLESTEROL LEVELS; LOW-DOSE ANTICOAGULATION; MEDICARE BENEFICIARIES; CARDIAC-SURGERY; THERAPY; ASPIRIN; ATHEROSCLEROSIS; PATENCY; TRIAL; REVASCULARIZATION AB Background - Aggressive risk factor modification decreases cardiovascular events and mortality in patients after coronary artery bypass grafting (CABG). Little is known regarding the use of secondary prevention in older patients undergoing CABG during hospitalization for acute myocardial infarction ( AMI). Methods and Results - Medical records were reviewed for a sample of 37,513 patients hospitalized with AMI in the United States between April 1998 and March 1999. Patients greater than or equal to 65 years of age who underwent CABG after AMI ( n = 2,267 [8%]) were evaluated for the prescription of 4 therapies at discharge: aspirin, beta-blockers, angiotensin- converting enzyme ( ACE) inhibitors, and lipid lowering, in eligible patients without contraindications to therapy and compared with patients who did not undergo CABG ( n = 26,484 [92%]). Patients undergoing CABG had higher rates of aspirin than patients who did not undergo CABG (88.0% versus 83.2%, P = 0.0002). However, CABG patients were less likely to receive beta-blockers (61.5% versus 72.1%, P < 0.0001), ACE inhibitors (55.5% versus 72.1%, P < 0.0001), or lipid lowering (34.7% versus 55.7%, P < 0.0001) prescriptions than patients who did not undergo CABG. After adjustment for disease severity, patients undergoing CABG were no longer more likely to receive discharge aspirin, and the magnitude of other differences in care increased. Conclusions - Evidence- based discharge therapies are underutilized in older patients who underwent CABG during hospitalization for AMI. Although national efforts focusing on improving short-term surgical mortality have been successful, strategies should be developed to increase the utilization of therapies known to improve long-term mortality in patients undergoing CABG. C1 Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. Qualidigm, Sect Cardiovasc Med, Middletown, CT USA. Colorado Fdn Med Care, Sect Cardiovasc Med, Aurora, CO USA. Denver Hlth Med Ctr, Div Cardiol, Sect Cardiovasc Med, Denver, CO USA. Lankanau Hosp, Sect Cardiovasc Med, Wynnewood, PA USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Foody, JM (reprint author), Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, 333 Cedar St,POB 208025, New Haven, CT 06520 USA. OI Radford, Martha/0000-0001-7503-9557 NR 30 TC 23 Z9 25 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD SEP 9 PY 2003 VL 108 IS 10 SU S BP 24 EP 28 DI 10.1161/01.cir.0000087654.26917.00 PG 5 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 720MR UT WOS:000185265000005 ER PT J AU Stevenson, KB Samore, M Barbera, J Moore, JW Hannah, E Houck, P Tenover, FC Gerberding, JL AF Stevenson, KB Samore, M Barbera, J Moore, JW Hannah, E Houck, P Tenover, FC Gerberding, JL TI Detection of antimicrobial resistance by small rural hospital microbiology laboratories: comparison of survey responses with current NCCLS laboratory standards SO DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE LA English DT Article ID SPECTRUM BETA-LACTAMASES; UNITED-STATES HOSPITALS; INFECTION-CONTROL; STAPHYLOCOCCUS-AUREUS; NOSOCOMIAL INFECTIONS; CONTROL PROGRAMS; HEALTH-CARE; PREVALENCE; SURVEILLANCE; VANCOMYCIN AB Microbiology laboratory personnel from 77 rural hospitals in Idaho, Nevada, Utah, and eastern Washington were surveyed in July 2000 regarding their routine practices for detecting antimicrobial resistance. Their self-reported responses were compared to recommended laboratory practices. Most hospitals reported performing onsite bacterial identification and susceptibility testing. Many reported detecting targeted antimicrobial resistant organisms. While only 5/61 hospitals (8%) described using screening tests capable of detecting all 8 targeted types of resistance, most (57/61, 93%) were capable of accurately screening for at least 6 types. Conversely, most hospitals (58/61, 95%) reported confirmatory testing capable of identifying only 3 or fewer resistance types with high-level penicillin resistance among pneumococci, methicillin and vancomycin resistance among staphylococci and enterococci, and extended spectrum beta-lactamase production by Gram-negative bacilli presenting the greatest difficulties. Furthermore, only 50% of hospitals compiled annual antibiogram reports to help physicians choose initial therapy for suspected infectious illnesses. This survey suggests that the antimicrobial susceptibility testing in many rural hospitals may be unreliable. (C) 2003 Elsevier Inc. All rights reserved. C1 Qualis Hlth, Boise, ID USA. Univ Utah, Sch Med, Dept Med, Div Clin Epidemiol, Salt Lake City, UT USA. Ctr Medicare Serv, Seattle, WA USA. Ctr Medicaid Serv, Seattle, WA USA. Ctr Dis Control & Prevent, Atlanta, GA USA. RP Stevenson, KB (reprint author), Qualis Hlth, Boise, ID USA. NR 40 TC 21 Z9 21 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0732-8893 J9 DIAGN MICR INFEC DIS JI Diagn. Microbiol. Infect. Dis. PD SEP PY 2003 VL 47 IS 1 BP 303 EP 311 DI 10.1016/S0732-8893(03)00092-0 PG 9 WC Infectious Diseases; Microbiology SC Infectious Diseases; Microbiology GA 722PD UT WOS:000185384500001 PM 12967743 ER PT J AU Murtaugh, CM McCall, N Moore, S Meadow, A AF Murtaugh, CM McCall, N Moore, S Meadow, A TI Trends - Trends in Medicare home health care use: 1997-2001 SO HEALTH AFFAIRS LA English DT Article AB The Balanced Budget Act of 1997 mandated a major overhaul in Medicare payment for home health care with an interim payment system (IPS) preceding a prospective payment system (PPS). This study extends an earlier analysis of the impact of the IPS to determine whether home health use and spending trends changed after the introduction of the PPS. The rapid decline in the incidence of use and visits per user under the IPS slowed in its final year and then picked up again in the first year of the PPS. In addition, average payment per visit increased sharply under the PPS. Little is known about the impact of continued large reductions in home health services since 1999. C1 Visiting Nurse Serv, Ctr Home Care Policy & Res, New York, NY USA. Laguna Res Associates, San Francisco, CA USA. Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Murtaugh, CM (reprint author), Visiting Nurse Serv, Ctr Home Care Policy & Res, New York, NY USA. NR 19 TC 25 Z9 25 U1 1 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2003 VL 22 IS 5 BP 146 EP 156 DI 10.1377/hlthaff.22.5.146 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 722AQ UT WOS:000185352500015 PM 14515890 ER PT J AU Lied, TR Sheingold, SH Landon, BE Shaul, JA Cleary, PD AF Lied, TR Sheingold, SH Landon, BE Shaul, JA Cleary, PD TI Beneficiary reported experience and voluntary disenrollment in medicare managed care SO HEALTH CARE FINANCING REVIEW LA English DT Article ID HEALTH PLANS; ENROLLEES; QUALITY AB Disenrollment rates have often been used as indicators of health plan quality, because they are readily available and easily understood by purchasers, health plans, and consumers. Over the past few years, however, indicators that more directly measure technical quality and consumer experiences with care have become available. In this observational study, we examined the relationship between voluntary disenrollment rates from Medicare managed care (MMC) plans and other measures of health plan quality. The results demonstrate that voluntary disenrollment rates are strongly related to direct measures of patient experiences with care and are an important complement to other measures of health plan performance. C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Lied, TR (reprint author), Ctr Medicare, 7500 Secur Blvd,S3-13-15, Baltimore, MD 21244 USA. EM tlied@cms.hhs.gov FU PHS HHS [500-95-0057(TO#9)] NR 14 TC 30 Z9 30 U1 0 U2 2 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2003 VL 25 IS 1 BP 55 EP 66 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PF UT WOS:000231089900004 PM 14997693 ER PT J AU Frankenfield, DL Neu, AM Warady, BA Fivush, BA Johnson, CA Brem, AS AF Frankenfield, DL Neu, AM Warady, BA Fivush, BA Johnson, CA Brem, AS TI Anemia in pediatric hemodialysis patients: Results from the 2001 ESRD Clinical Performance Measures Project SO KIDNEY INTERNATIONAL LA English DT Article DE pediatric hemodialysis; anemia; hemoglobin; albumin; nutrition ID STAGE RENAL-DISEASE; CARDIOVASCULAR MORTALITY; DIALYSIS PATIENTS; CHILDREN AB Background. Despite improvements in dialysis care, anemia remains a problem in pediatric hemodialysis patients. Methods. To assess possible explanations for the anemia, clinical data were obtained from the Centers for Medicare and Medicaid Services on all hemodialysis patients ages 12 to <18 years between October and December 2000. Complete data were available for 435 of the 516 patients (84%). Results. A total of 160 (37%) patients had a mean hemoglobin of <11 g/dL (anemic). The mean (+/- SD) age for these patients was 15.5 +/- 1.8 years compared to 15.9 +/- 1.5 years for the target hemoglobin patients (P < 0.05). Mean time on chronic dialysis was similar for both the anemic and target hemoglobin patients (greater than or equal to100 g/dL) (similar to3 years) but patients on dialysis <6 months were more likely to be anemic (67%). While nearly all patients were treated with erythropoietin, anemic patients received greater weekly erythropoietin doses (intravenous, anemia 374 +/- 232 units/kg/week vs. target hemoglobin 246 +/- 196 units/kg/week, P < 0.001; and subcutaneous, 304 +/- 238 units/kg/week vs. 167 +/- 99 units/kg/week, P < 0.05). A total of 59% of anemic patients had a mean transferrin saturation (TSAT) greater than or equal to20% compared to 71% of patients with a target hemoglobin (P < 0.01). A mean serum ferritin greater than or equal to100 ng/mL was present in similar to two thirds of the anemic and target hemoglobin patients. Approximately 60% of all children were treated with intravenous iron. The mean Kt/V values were lower for anemic patients (1.46 +/- 0.4 vs. 1.53 +/- 0.3, P < 0.05). Anemic patients were less likely to have a normal serum albumin (29% anemic vs. 52% target hemoglobin patients, P < 0.001). Conclusion. In the final multivariable regression model, dialyzing <6 months, a low albumin, and a mean TSAT <20% remained significant predictors of anemia in children. C1 Rhode Isl Hosp, Providence, RI 02903 USA. Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Johns Hopkins Univ, Baltimore, MD USA. Childrens Mercy Hosp, Kansas City, MO 64108 USA. Univ Wisconsin, Sch Pharm, Madison, WI 53706 USA. RP Brem, AS (reprint author), Rhode Isl Hosp, APC 942,593 Eddy St, Providence, RI 02903 USA. NR 20 TC 26 Z9 26 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0085-2538 J9 KIDNEY INT JI Kidney Int. PD SEP PY 2003 VL 64 IS 3 BP 1120 EP 1124 DI 10.1046/j.1523-1755.2003.00184.x PG 5 WC Urology & Nephrology SC Urology & Nephrology GA 711GY UT WOS:000184732300040 PM 12911565 ER PT J AU Roman, SH Paul, BR AF Roman, SH Paul, BR TI Strategies today for higher quality heart failure care tomorrow SO JOURNAL OF CARDIAC FAILURE LA English DT Editorial Material C1 Ctr Medicaid Serv, Dept Hlth & Human Serv, Baltimore, MD 21244 USA. RP Roman, SH (reprint author), Ctr Medicare, Qual Measurement & Hlth Assessment Grp, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA. NR 4 TC 0 Z9 0 U1 0 U2 0 PU CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS PI PHILADELPHIA PA CURTIS CENTER, INDEPENDENCE SQUARE WEST, PHILADELPHIA, PA 19106-3399 USA SN 1071-9164 J9 J CARD FAIL JI J. Card. Fail. PD AUG PY 2003 VL 9 IS 4 BP 255 EP 257 DI 10.1054/jcaf.2003.49 PG 3 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 715HP UT WOS:000184966000002 PM 13680544 ER PT J AU Frankenfield, DL Ramirez, SPB Mcclellan, WM Frederick, PR Rocco, MV AF Frankenfield, DL Ramirez, SPB Mcclellan, WM Frederick, PR Rocco, MV TI Differences in intermediate outcomes for Asian and non-Asian adult hemodialysis patients in the United States SO KIDNEY INTERNATIONAL LA English DT Article DE Asian; race; intermediate outcomes ID RENAL-DISEASE PATIENTS; SURVIVAL; MORTALITY; DIALYSIS AB Background. There is a paucity of information regarding the clinical experience of Asian hemodialysis patients. This paper describes intermediate outcomes for adult Asian hemodialysis patients compared to Caucasians and African Americans. Methods. Dialysis facility staff abstracted clinical information on a national random sample of adult hemodialysis patients from October through December 2000. Associations of race with intermediate outcomes were tested by bivariate analyses and multivariable logistic regression modeling. Results. A total of 429 patients were identified as Asian, 4403 as Caucasians, and 3103 as African Americans. Asian and Caucasian patients were older than African Americans [mean 63.2 (+/-15.6), 63.9 (+/-15.2), and 57.7 (+/-14.7) years, P < 0.001], and had fewer years on dialysis [mean 3.5 (+/-3.8), 3.1 (+/-3.8), and 4.1 (+/-4.1) years, P < 0.001]. Ninety three percent of Asians, 87% of Caucasians, and 84% of African Americans had a mean Kt/V greater than or equal to1.2 (P < 0.001). In addition, 36% of Asians, 32% of Caucasians, and 26% of African Americans had an arteriovenous (AV) fistula as their vascular access (P < 0.001). Hemoglobin profiles were only slightly different among the three racial groups. More Asians and African Americans had a mean serum albumin greater than or equal to4.0/3.7 g/dL compared to Caucasians (33% and 31% compared to 27%, respectively, P < 0.001). In the final multivariable logistic regression model, Asians were twice as likely to have a mean Kt/V greater than or equal to1.2 compared to Caucasians (the referent group) [odds ratio (OR) (95% CI) 2.10 (1.33, 3.32), P < 0.01]. They experienced similar intermediate outcomes for vascular access, anemia management, and serum albumin compared to the majority racial group. Conclusion. These findings indicate that adult hemodialysis Asian patients experience similar or better intermediate outcomes compared to the majority racial group. Further study is needed to determine if these results are associated with improved survival and less morbidity in this minority group. C1 Ctr Beneficiary Choices, Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Natl Kidney Fdn, Singapore, Singapore. Georgia Med Care Fdn, Atlanta, GA USA. Emory Univ, Dept Med, Rollins Sch Publ Hlth, Atlanta, GA USA. Wake Forest Univ, Nephrol Sect, Winston Salem, NC 27109 USA. RP Frankenfield, DL (reprint author), Ctr Beneficiary Choices, Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mailstop S3-02-01, Baltimore, MD 21244 USA. NR 25 TC 18 Z9 19 U1 1 U2 1 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0085-2538 J9 KIDNEY INT JI Kidney Int. PD AUG PY 2003 VL 64 IS 2 BP 623 EP 631 DI 10.1046/j.1523-1755.2003.00121.x PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 697WP UT WOS:000183966500026 PM 12846759 ER PT J CA Dept Hlth & Human Serv TI 2002 annual report: ESRD clinical performance measures project - Opportunities to improve care for adult in-center hemodialysis, adult peritoneal dialysis, and pediatric in-center hemodialysis patients - December 2002 SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article ID SERUM-ALBUMIN CONCENTRATION; QUALITY ASSURANCE; MORTALITY; PREDICTORS C1 Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. RP Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. NR 34 TC 0 Z9 0 U1 0 U2 0 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0272-6386 EI 1523-6838 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD JUL PY 2003 VL 42 IS 1 SU 2 BP S1 EP S96 PG 96 WC Urology & Nephrology SC Urology & Nephrology GA 699AW UT WOS:000184034600001 ER PT J AU Lurie, N Zhan, CL Sangl, J Bierman, AS Sekscenski, ES AF Lurie, N Zhan, CL Sangl, J Bierman, AS Sekscenski, ES TI Variation in racial and ethnic differences in consumer assessments of health care SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID MEDICAL-CARE; SOCIOECONOMIC-STATUS; RATINGS; RACE; SATISFACTION; DISPARITIES; QUALITY; ACCESS; PERFORMANCE; ENROLLEES AB Background: Prior studies have documented significant racial and ethnic disparities in health and healthcare, but data about disparities from consumer assessments of care are inconsistent. Objective: To examine racial/ethnic differences in consumer assessments and explore variation in such differences across health plans. Methods: Data included 160 694 Consumer Assessment of Health Plans Surveys (CAHPS) responses from 307 commercial health plans and 177 489 Medicare beneficiaries in 308 Medicare+Choice managed care plans collected in 1999. We compared adjusted mean CAHPS global rating and composite scores as well as access to and use of care reported by whites, blacks, Hispanics, and Asians. We assessed variation in the differences between plan means for whites and blacks and between whites and Hispanics. Results: Three minority groups rated their health plans higher than whites on at least 1 measure. Blacks rated their care and doctors higher than whites, while Asians rated their care and doctors lower than whites. Blacks reported better experience with care than whites, but Hispanics and Asians reported worse experience than whites. However, all minority groups reported significantly larger problems with access to and less use of healthcare. The differences between blacks and whites, and blacks and Hispanics in CAHPS measures and access/use measures varied greatly from plan to plan. Conclusions: Significant race/ethnic differences in experience with, access to, and use of care exist in health plans. Substantial variation in racial differences suggests compromised quality of healthcare and opportunities for quality improvement. C1 RAND Corp, Arlington, VA 22202 USA. Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Outcomes & Effectiveness Res & Qual, Rockville, MD USA. Agcy Healthcare Res & Qual, Ctr Medicare, Rockville, MD USA. Agcy Healthcare Res & Qual, Medicaid Serv, Rockville, MD USA. RP Lurie, N (reprint author), RAND Corp, 1200 S Hayes St, Arlington, VA 22202 USA. NR 28 TC 70 Z9 70 U1 1 U2 8 PU AMER MED PUBLISHING, M W C COMPANY PI JAMESBURG PA 241 FORSGATE DR, STE 102, JAMESBURG, NJ 08831 USA SN 1088-0224 J9 AM J MANAG CARE JI Am. J. Manag. Care PD JUL PY 2003 VL 9 IS 7 BP 502 EP 509 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 699VA UT WOS:000184075600003 PM 12866629 ER PT J AU Burwen, DR Galusha, DH Lewis, JM Bedinger, MR Radford, MJ Krumholz, HM Foody, JM AF Burwen, DR Galusha, DH Lewis, JM Bedinger, MR Radford, MJ Krumholz, HM Foody, JM TI National and state trends in quality of care for acute myocardial infarction between 1994-1995 and 1998-1999 - The Medicare Health Care Quality Improvement Program SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID COOPERATIVE CARDIOVASCULAR PROJECT; ELDERLY PATIENTS; BETA-BLOCKERS; MORTALITY AB Background: National efforts have focused attention on quality of care, but relatively little is known about whether, and to what extent, improvement has occurred during this recent period. Furthermore, the variability of the recent change over time is not known. Methods: We sought to determine national and state trends in quality of care for Medicare patients hospitalized with acute myocardial infarction (AMI) between 1994-1995 (n=234754 discharges) and 1998-1999 (n = 35 713 discharges) as part of the Centers for Medicare & Medicaid Services (CMS) National AMI Project. We assessed change in evidence-based, guideline-recommended processes of care. Results: Nationally, among patients without contraindications to therapy, discharge beta-blocker prescription increased by 20.5 percentage points (50.3% to 70.7%); early administration of beta-blocker increased by 17.4 percentage points (51.1% to 68.4%); discharge angiotensin-converting enzyme inhibitor prescription for systolic dysfunction increased by 8.0 percentage points (62.8% to 70.8%); early administration of aspirin increased by 6.6 percentage points (76.4% to 82.9%); and aspirin prescribed at discharge increased by 5.6 percentage points (77.3% to 82.9%) (P<.001 for all categories). Smoking cessation counseling decreased by 3.6 percentage points (40.8% to 37.2%; P<.001). Rates of acute reperfusion therapy did not significantly change (59.2% to 60.6%; P=35). The median time from hospital arrival to initiation of thrombolytic therapy decreased by 7 minutes (P<.001); and the median time from hospital arrival to initiation of primary percutaneous transluminal. coronary angioplasty decreased by 12 minutes (P=.09). Conclusions: During this 4-year period, quality of care for AMI improved, but substantial variation was observed at both time points. While meaningful population-based improvement has been achieved, ample opportunities for improvement exist. Further work is required to elucidate the strategies associated with improvements in quality of care. C1 Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Qualidigm, Middletown, CT USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06520 USA. Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. RP Foody, JM (reprint author), Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, 330 Cedar St,FMP 315B, New Haven, CT 06520 USA. NR 27 TC 78 Z9 79 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD JUN 23 PY 2003 VL 163 IS 12 BP 1430 EP 1439 DI 10.1001/archinte.163.12.1430 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA 693FC UT WOS:000183705400007 PM 12824092 ER PT J AU Gornick, ME AF Gornick, ME TI A decade of research on disparities in Medicare utilization: lessons for the health and health care of vulnerable men (vol 93, pg 753, 2003) SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Correction C1 Ctr Medicaid & Medicare Serv, Baltimore, MD USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD JUN PY 2003 VL 93 IS 6 BP 859 EP 859 PG 1 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 685ZJ UT WOS:000183294800005 ER PT J AU Greer, JW AF Greer, JW TI End stage renal disease and medicare SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21224 USA. RP Greer, JW (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-19-07, Baltimore, MD 21224 USA. EM jgreer3@cms.hhs.gov NR 8 TC 12 Z9 12 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2003 VL 24 IS 4 BP 1 EP 5 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PD UT WOS:000231089600001 PM 14628396 ER PT J AU Shapiro, JR Dykstra, DM Pisoni, R Beronja, N Gaylin, DS Oppenheimer, CC Rubin, RJ Held, PJ AF Shapiro, JR Dykstra, DM Pisoni, R Beronja, N Gaylin, DS Oppenheimer, CC Rubin, RJ Held, PJ TI Patient selection in the ESRD managed care demonstration SO HEALTH CARE FINANCING REVIEW LA English DT Article ID MEDICARE HMOS; HEALTH-STATUS; HEMODIALYSIS; ENROLLEES; MORTALITY AB The Centers for Medicare & Medicaid Service's (CMS') end stage renal disease (ESRD) managed care demonstration offered an opportunity to assess patient selection among a chronically ill and inherently costly population. Patient selection refers to the phenomenon whereby those Medicare beneficiaries who choose to enroll or stay in health maintenance organizations (HMOs) are, on average, younger, healthier, and less costly to treat than beneficiaries who remain in the traditional Medicare fee-for-service (FFS) sector The results presented in this article show that enrollees into the demonstration were generally younger and healthier than a representative group of comparison patients from the same geographic areas. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Lewin Grp, Fairfax, VA 22031 USA. Georgetown Univ, Sch Med, Washington, DC 20057 USA. RP Shapiro, JR (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-20-17, Baltimore, MD 21244 USA. EM jshapiro@cms.hhs.gov NR 18 TC 3 Z9 3 U1 1 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2003 VL 24 IS 4 BP 31 EP 43 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PD UT WOS:000231089600003 PM 14628398 ER PT J AU McCormick, JCC Chulis, GS AF McCormick, JCC Chulis, GS TI Growth in residential alternatives to nursing homes: 2001 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Off Res Dev & Informat, Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP McCormick, JCC (reprint author), Off Res Dev & Informat, Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C-3-16-27, Baltimore, MD 21244 USA. EM cmccormick@cms.hhs.gov NR 4 TC 7 Z9 7 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2003 VL 24 IS 4 BP 143 EP 150 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PD UT WOS:000231089600011 PM 14628406 ER PT J AU Jencks, S AF Jencks, S TI The right care SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Jencks, S (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 3 TC 3 Z9 3 U1 0 U2 0 PU MASSACHUSETTS MEDICAL SOC/NEJM PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD MAY 29 PY 2003 VL 348 IS 22 BP 2251 EP 2252 DI 10.1056/NEJMe030056 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 683EK UT WOS:000183134700013 PM 12773654 ER PT J AU Jencks, SF Huff, ED Cuerdon, T AF Jencks, SF Huff, ED Cuerdon, T TI Measuring improvement in quality of care - Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 Ctr Medicare & Med Serv, Off Clin Stand & Qual, Baltimore, MD USA. Ctr Medicare & Med Serv, Div Clin Stand & Qual Care, Boston, MA USA. NIMH, Hlth & Behav Sci Res Branch, Bethesda, MD 20892 USA. RP Jencks, SF (reprint author), Ctr Medicare & Med Serv, Off Clin Stand & Qual, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 28 PY 2003 VL 289 IS 20 BP 2647 EP 2647 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 682DG UT WOS:000183075600020 ER PT J AU Rathore, SS Foody, JM Wang, YF Smith, GL Herrin, J Masoudi, FA Wolfe, P Havranek, EP Ordin, DL Krumholz, HM AF Rathore, SS Foody, JM Wang, YF Smith, GL Herrin, J Masoudi, FA Wolfe, P Havranek, EP Ordin, DL Krumholz, HM TI Race, quality of care, and outcomes of elderly patients hospitalized with heart failure SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID LEFT-VENTRICULAR DYSFUNCTION; ACUTE MYOCARDIAL-INFARCTION; ENZYME-INHIBITOR THERAPY; RACIAL-DIFFERENCES; UNITED-STATES; MEDICARE PATIENTS; WHITE PATIENTS; OLDER ADULTS; HEALTH-CARE; READMISSION AB Context Black patients hospitalized with heart failure reportedly receive poorer quality of care and have worse outcomes than white patients. Because previous studies have been based on selected patient populations treated more than a decade ago, it is unclear if racial differences in quality of care and outcomes currently exist in the United States. Objective To evaluate differences in quality of care and patient outcomes between black and white Medicare beneficiaries hospitalized with heart failure. Design Retrospective analysis of medical record data systematically collected for the National Heart Failure Project. Setting and Patients Nationwide US sample of 29732 fee-for-service Medicare beneficiaries hospitalized with heart failure in 1998 and 1999. Main Outcome Measures Prescription of angiotensin-converting enzyme (ACE) inhibitors, measurement of left ventricular ejection fraction (LVEF), readmission within 1 year of discharge, and mortality within 30 days and 1 year of admission. Results Black patients and white patients had similar crude rates of LVEF assessment (67.8% black vs 66.6% white; P=.29). Among patients classified as ideal for ACE inhibitor use, black patients had higher crude rates of ACE inhibitor use than white patients (81.0% vs 73.8% white; P<.001) but had similar rates of ACE inhibitor or angiotensin receptor blocker (ARB) use (85.7% black vs 82.5% white; P=.08). After multivariable adjustment, black patients had comparable rates of LVEF assessment (risk ratio [RR], 0.99; 95% confidence interval [CI], 0.95-1.03). Black patients remained more likely to be prescribed ACE inhibitors (RR, 1.22; 95% CI, 1.14-1.28) than were white patients in an adjusted analysis, but there were no significant racial differences in the prescription of ACE inhibitors or ARBs (black vs white, RR, 1.03; 95% CI, 0.97-1.07). Black patients had higher rates of readmission within 1 year of discharge (68.2% vs 63.0%; P<.001) but had lower crude 30-day (6.3% vs 10.7%; P<.001) and 1-year (31.5% vs 40.1%; P<.001) mortality rates than white patients. After multivariable adjustment, black patients had a slightly higher rate of readmission than white patients (RR, 1.09; 95% CI, 1.06-1.13) but remained at lower risk of 30-day mortality (RR, 0.78; 95% CI, 0.68-0.91) and 1-year mortality (RR, 0.93; 95% CI, 0.88-0.98). Conclusions Black Medicare patients hospitalized with heart failure received comparable quality of care and had slightly higher rates of readmission but had lower mortality rates up to 1 year after hospitalization than did white patients. C1 Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06520 USA. Flying Buttress Associates, Charlottesville, VA USA. Denver Hlth Med Ctr, Dept Med, Div Cardiol, Denver, CO USA. Univ Colorado, Hlth Sci Ctr, Dept Med, Div Geriatr Med, Denver, CO 80262 USA. Univ Colorado, Hlth Sci Ctr, Dept Med, Div Cardiol, Denver, CO 80262 USA. Colorado Fdn Med Care, Aurora, CO USA. Ctr Medicare & Medicaid Serv, Boston, MA USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, 333 Cedar St,Room I-456 SHM,POB 208025, New Haven, CT 06520 USA. FU NIA NIH HHS [K08-AG01011] NR 49 TC 136 Z9 136 U1 4 U2 10 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 21 PY 2003 VL 289 IS 19 BP 2517 EP 2524 DI 10.1001/jama.289.19.2517 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 680KL UT WOS:000182976500020 PM 12759323 ER PT J AU Sheikh, K Bullock, C AF Sheikh, K Bullock, C TI Effectiveness of interventions for reducing the frequency of radical prostatectomy procedures in the elderly: An evaluation SO AMERICAN JOURNAL OF MEDICAL QUALITY LA English DT Article DE effectiveness; evaluation; quality improvement interventions; radical prostatectomy rates ID CANCER; MANAGEMENT; MEDICARE; RATES AB Between 1993 and 1997, the Peer Review Organizations (PROs) implemented interventions for reducing radical prostatectomy rates in 50 selected hospitals in 10 states and all hospitals in an additional 4 states. Control hospitals and states were matched with the intervention hospitals and states. Prostate cancer incidence rates were used to estimate the number of Medicare beneficiaries aged 75 years and older with prostate cancer, the denominators for the procedure rates, in the hospital service area of each intervention and control hospital, and in each state and their controls. After interventions, significant reductions in the state-specific radical prostatectomy rates were achieved in the intervention hospitals in 2 states and in 1 of the 4 intervention states where statewide interventions had been implemented. Similar reductions were seen in the control hospitals in 3 other individual states and 8 states combined where hospital-based interventions were implemented. These changes in the procedure rates were most likely due to the national decline in the incidence of prostate cancer, not the PRO interventions. C1 US Dept HHS, Ctr Medicare, Kansas City, MO 64106 USA. US Dept HHS, Ctr Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare, Room 235,601 E 12th St, Kansas City, MO 64106 USA. NR 17 TC 2 Z9 2 U1 0 U2 0 PU AMER COLLEGE MEDICAL QUALITY PI BETHESDA PA 4334 MONTGOMERY AVE, 2ND FL, BETHESDA, MD 20814-4402 USA SN 1062-8606 J9 AM J MED QUAL JI Am. J. Med. Qual. PD MAY-JUN PY 2003 VL 18 IS 3 BP 97 EP 103 DI 10.1177/106286060301800302 PG 7 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 687DJ UT WOS:000183360500002 PM 12836898 ER PT J AU Lee, JM Botteman, MF Stephens, JM Kornfield, T Gramegna, P Redaelli, A AF Lee, JM Botteman, MF Stephens, JM Kornfield, T Gramegna, P Redaelli, A TI Health-related quality of life burden of head and neck cancer SO VALUE IN HEALTH LA English DT Meeting Abstract C1 ABT Associates Inc, Clin Trials, Bethesda, MD USA. Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. Pharm Italia, Milan, Italy. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY-JUN PY 2003 VL 6 IS 3 BP 236 EP 237 DI 10.1016/S1098-3015(10)63943-5 PG 2 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 688DX UT WOS:000183419000145 ER PT J AU Flum, DR Dellinger, EP Cheadle, A Chan, L Koepsell, T AF Flum, DR Dellinger, EP Cheadle, A Chan, L Koepsell, T TI Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID COMPLICATIONS FOLLOWING CHOLECYSTECTOMY; BILIARY-TRACT COMPLICATIONS; LAPAROSCOPIC CHOLECYSTECTOMY; OPERATIVE CHOLANGIOGRAPHY; UNITED-STATES; ULTRASONOGRAPHY AB Context Intraciperative cholangiography (IOC) may decrease the risk of common bile duct (CBD) injury during cholecystectomy by helping to avoid misidentification of the CBD. Objective To characterize the relationship of IOC use and CBD injury while controlling for patient and surgeon characteristics. Design, Setting, and Patients Retrospective nationwide cohort analysis of Medicare patients undergoing cholecystectomy from January 1, 1992, to December 31, 1999. Patients were identified using Current Procedural Terminology codes from the Medicare Part B depository. Common bile duct injury was defined by a second surgical procedure to repair the CBD injury within 1 year of cholecystectomy. Surgeon demographic features were obtained from matching the Medicare Part B data to the American Medical Association Physician Masterfile database. Main Outcome Measure Frequency of CBD injury in patients who did and did not have IOC performed during cholecystectomy, controlling for patient-level (age, sex, race, and case complexity) and surgeon-level (surgeon's age, sex, race, year of surgical procedure, case order, percentage of IOC use in prior surgical procedures, years in medical practice, board certification, and specialization) factors. Results The database search identified 1570361 cholecystectomies and 7911 CBD injuries (0.5%). Common bile duct injury was found in 2380 (0.39%) of 613 706 patients undergoing cholecystectomy with IOC and in 5531 (0.58%) of 956 655 patients undergoing cholecystectomy without IOC (unadjusted relative risk, 1.49; 95% confidence interval, 1.42-1.57). After controlling for patient-level factors and surgeon-level factors, the risk of injury was increased when IOC was not used (adjusted relative risk, 1.71; 95% confidence interval, 1.38-2.28). While surgeons performing IOCs routinely had a lower rate of CBD injuries than those who did not, this difference disappeared when IOC was not used. Conclusions In this study of Medicare patients undergoing cholecystectomy in the 1990s, the risk of CBD injury was significantly higher when IOC was not used. Although IOCs may not prevent all CBD injuries, this study suggests, that the routine use of IOC may decrease the rate of CBD injury. C1 Univ Washington, Dept Surg, Seattle, WA 98195 USA. Univ Washington, Robert Wood Johnson Clin Scholars Program, Seattle, WA 98195 USA. Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. Univ Washington, Dept Rehabil Med, Seattle, WA 98195 USA. Ctr Medicare & Medicaid Serv, Div Clin Stand & Qual, Seattle, WA USA. RP Flum, DR (reprint author), Univ Washington, Dept Surg, BB 431,1959 NE Pacific St,Box 356410, Seattle, WA 98195 USA. EM daveflum@u.washington.edu NR 38 TC 201 Z9 210 U1 1 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD APR 2 PY 2003 VL 289 IS 13 BP 1639 EP 1644 DI 10.1001/jama.289.13.1639 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 662JX UT WOS:000181944500026 PM 12672731 ER PT J AU Rocco, MV Frankenfield, DL Prowant, B Frederick, P Flanigan, MJ AF Rocco, MV Frankenfield, DL Prowant, B Frederick, P Flanigan, MJ CA Ctr Medicare Medicaid Services Per TI Response to inadequate dialysis in chronic peritoneal dialysis patients. Results from the 2000 Centers for Medicare and Medicaid (CMS) ESRD Peritoneal Dialysis Clinical Performance Measures (PD-CPM) Project SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE peritoneal dialysis (PD); dialysis adequacy; Kt/V urea; creatinine clearance; dialysis prescription ID RESIDUAL RENAL-FUNCTION; EXCHANGE VOLUMES; ADEQUACY; PRESCRIPTION; CAPD; LIMITATIONS; CLEARANCES; INDICATORS; FREQUENCY; MORTALITY AB Background., It is not known if patient prescriptions are being changed if patients are receiving an inadequate dose of peritoneal dialysis. Methods: Data from the 2000 Centers for Medicare and Medicaid were used to obtain data on dialysis adequacy and dialysis prescriptions. Results: A total of 359 of 1,268 (28%) adult peritoneal dialysis patients had a total weekly Kt/V urea (twKt/V) less than 2.0 and 436 of 1,245 (35%) patients had a total weekly creatinine clearance (twCrCl) less than 60 L/wk/1.73 m(2), defined as "inadequate dialysis." Among chronic ambulatory peritoneal dialysis (CAPD) patients, 81 of 188 (43%) patients had inadequate dialysis and a change in the peritoneal dialysis prescription within 6 months of the initial adequacy value. Among cycler patients, 106 of 197 (54%) patients had inadequate dialysis and a change in the prescription. Thirty-six of 46 (78%) CAPD patients and 48 of 56 (86%) cycler patients had an improvement in twKt/V after the prescription was revised. Thirty-two of 42 (76%) CAPD patients and 45 of 57 (79%) cycler patients had an improvement in twCrCl after the prescription was changed. For these patients, twKt/V increased from 1.6 +/- 0.3 to 2.1 +/- 0.5, with an increase in the peritoneal Kt/V urea from 1.5 +/- 0.3 to 1.9 +/- 0.4. Similarly, twCrCl increased from 46.3 +/- 7.5 to 59.1 +/- 10.6 L/wk/1.73 m(2) with an increase in the peritoneal CrCl dose from 42.0 +/- 9.1 to 52.7 +/- 9.9 L/wk/1.73 m(2). Conclusion: About half of peritoneal dialysis patients with inadequate dialysis did not have a prescription change and could benefit from modifications in their dialysis prescription. (C) 2003 by the National Kidney Foundation, Inc. C1 Wake Forest Univ, Sch Med, Nephrol Sect, Winston Salem, NC 27157 USA. Ctr Beneficiary Choices, Ctr Medicar, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Medicaid Serv, Baltimore, MD USA. Univ Missouri, Sch Med, Dial Clin, Columbia, MO USA. Univ Iowa, Coll Med, Iowa City, IA USA. RP Rocco, MV (reprint author), Wake Forest Univ, Sch Med, Nephrol Sect, Med Ctr Blvd, Winston Salem, NC 27157 USA. NR 31 TC 2 Z9 3 U1 0 U2 2 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD APR PY 2003 VL 41 IS 4 BP 840 EP 848 DI 10.1016/S0272-6386(03)00032-5 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 675EG UT WOS:000182679600016 PM 12666071 ER PT J AU Arday, DR Milton, MH Husten, CG Haffer, SC Wheeless, SC Jones, SM Johnson, RE AF Arday, DR Milton, MH Husten, CG Haffer, SC Wheeless, SC Jones, SM Johnson, RE TI Smoking and functional status among Medicare managed care enrollees SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID QUALITY-OF-LIFE; UNITED-STATES; SOCIOECONOMIC-STATUS; HEALTH SURVEY; OLDER ADULTS; EX-SMOKERS; OUTCOMES; POPULATION; CESSATION; IMPACT AB Background: Smoking is a major determinant of health status and outcomes. Current smoking has been associated with lower scores on the Short Form-36 Health Survey (SF-36). Whether this occurs among the elderly and disabled Medicare populations is not known. This study assessed the relationships between smoking status and both physical and mental functioning in the Medicare managed-care population. Methods: During the spring of 1998, data were collected from 134,309 elderly and 8640 disabled Medicare beneficiaries for Cohort 1, Round 1 of the Medicare Health Outcomes Survey. We subsequently used these data to calculate mean standardized SF-36 scores, self-reported health status, and prevalence of smoking-related illness, by smoking status, after adjusting for demographic factors. Results: Among the disabled, everyday and someday smokers had lower standardized physical component (PCS) and mental component (MCS) scores than never smokers (-2.4 to -4.5 points; p <0.01 for all). Among the elderly, the lowest PCS and MCS scores were seen among recent quitters (-5.1 and -3.7 points, respectively, below those for never smokers; p <0.01 for both), but current smokers also had significantly lower scores on both scales. For the elderly and disabled populations, MCS scores of long-term quitters were the same as nonsmokers. Similar patterns were seen across all eight SF-36 scales. Ever smokers had higher odds of reporting both less-than-good health and a history of smoking-related chronic disease. Conclusions: In the elderly and disabled Medicare populations, smokers report worse physical and mental functional status than never smokers. Long-term quitters have better functional status than those who still smoke. More effort should be directed at helping elderly smokers to quit earlier. Smoking cessation has implications for improving both survival and functional status. C1 CDC, NCCDPHP, Off Smoking & Hlth, Atlanta, GA 30341 USA. USA, Army Med Surveillance Act, Div Epidemiol & Dis Surveillance, Ctr Hlth Promot & Prevent Med, Washington, DC 20310 USA. Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Qual Measurement & Hlth Assessment Grp, Baltimore, MD USA. Res Triangle Inst, Res Triangle Pk, NC 27709 USA. RP Milton, MH (reprint author), CDC, NCCDPHP, Off Smoking & Hlth, 4770 Buford Hwy NE,K-50, Atlanta, GA 30341 USA. NR 48 TC 18 Z9 18 U1 0 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0749-3797 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2003 VL 24 IS 3 BP 234 EP 241 DI 10.1016/S0749-3797(02)00643-8 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 667CR UT WOS:000182213700004 PM 12657341 ER PT J AU McBean, A Huang, Z Virnig, B Lurie, N Dowd, BE Musgrave, D AF McBean, A Huang, Z Virnig, B Lurie, N Dowd, BE Musgrave, D TI Differences by race in the control of diabetes among medicare managed care beneficiaries. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 26th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 30-MAY 03, 2003 CL VANCOUVER, CANADA SP Soc Gen Internal Med C1 Univ Minnesota, Minneapolis, MN 55455 USA. RAND Corp, Arlington, VA USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2003 VL 18 SU 1 BP 182 EP 182 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 673DF UT WOS:000182564300698 ER PT J AU Steinman, MA Sauala, A Maselli, J Houck, P Gonzales, R AF Steinman, MA Sauala, A Maselli, J Houck, P Gonzales, R TI Processes and outcomes of care in elderly patients with acute bronchitis. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 26th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 30-MAY 03, 2003 CL VANCOUVER, CANADA SP Soc Gen Internal Med C1 Univ Calif San Francisco, San Francisco, CA 94143 USA. San Francisco VA Med Ctr, San Francisco, CA USA. Univ Colorado, Hlth Sci Ctr, Denver, CO 80202 USA. Univ Calif San Francisco, San Francisco, CA 94143 USA. Ctr Medicare & Medicaid Serv, Seattle, WA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2003 VL 18 SU 1 BP 296 EP 297 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 673DF UT WOS:000182564301236 ER PT J AU Rathore, SS Wang, YF Radford, MJ Ordin, DL Krumholz, HM AF Rathore, SS Wang, YF Radford, MJ Ordin, DL Krumholz, HM TI Quality of care of medicare beneficiaries with acute myocardial infarction: Who is included in quality improvement measurement? SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE myocardial infarction; older people; quality of care ID COOPERATIVE CARDIOVASCULAR PROJECT; THERAPY AB Objectives: To determine the proportion of older patients hospitalized with acute myocardial infarction (AMI) incorporated in a commonly used set of AMI quality indicators. Design: Retrospective analysis of a medical record database. Setting: Nongovernmental U.S. acute care hospitals. Participants: Medicare patients hospitalized for AMI between January 1994 and February 1996. Measurements: Proportion of patients aged 65 and older classified as ideal candidates (without absolute or relative contraindications) for six Centers for Medicare & Medicaid Services AMI quality indicators: aspirin (admission, discharge), beta-blocker (admission, discharge), angiotensin-converting enzyme (ACE) inhibitors at discharge, and time to reperfusion therapy. Resuts: Of the 149,996 patients eligible for admission therapies, 10.1% were ideal candidates for reperfusion therapy, 65.0% for aspirin, and 34.7% for beta-blockers. Of the 116,919 patients eligible for discharge therapies, 47.7% were ideal candidates for aspirin, 17.6% for beta-blockers, and 15.2% for ACE inhibitors. More than one-quarter (26.8%) of all patients were ineligible for any of the six quality indicators; this proportion increased with age, ranging from 23.7% of patients aged 65 to 69 to 30.2% of patients aged 85 and older. Conclusion: A substantial proportion of older patients were not included in AMI process quality measurement, with the proportion excluded higher in successively older age groups. The data highlight the need for additional research to determine effective treatment strategies for patients for whom the evidence base for clinical decision-making remains weak. C1 Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06510 USA. Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. Qualidigm, Middletown, CT USA. Ctr Medicare Serv, Boston, MA USA. Ctr Med Serv, Boston, MA USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, 333 Cedar St,Room IE-61 SHM, New Haven, CT 06520 USA. NR 16 TC 16 Z9 16 U1 1 U2 1 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD APR PY 2003 VL 51 IS 4 BP 466 EP 475 DI 10.1046/j.1532-5415.2003.51154.x PG 10 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 659XD UT WOS:000181803000004 PM 12657065 ER PT J AU Steinman, MA Sauaia, A Maselli, JH Houck, P Gonzalez, R AF Steinman, MA Sauaia, A Maselli, JH Houck, P Gonzalez, R TI Processes and outcomes of care in elderly patients with acute bronchitis. SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Meeting Abstract CT Annual Scientific Meeting of the American-Geriatrics-Society CY MAY 14-18, 2003 CL BALTIMORE, MARYLAND SP American Geriatr Soc C1 SFVA Med Ctr, Div Geriatr, San Francisco, CA USA. Univ Calif San Francisco, Dept Med, San Francisco, CA USA. Univ Colorado, Hlth Sci Ctr, Denver, CO USA. Ctr Medicare & Medicaid Serv, Seattle, WA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD APR PY 2003 VL 51 IS 4 SU S MA P499 BP S210 EP S211 PG 2 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 667VP UT WOS:000182255100544 ER PT J AU Neu, A Fivush, B Bedinger, M Warady, B Watkins, S Friedman, A Brem, A Goldstein, S Frankenfield, D AF Neu, A Fivush, B Bedinger, M Warady, B Watkins, S Friedman, A Brem, A Goldstein, S Frankenfield, D TI Adolescent hemodialysis-three year longitudinal data from CMS' 2002 ESRD CPM Project SO PEDIATRIC RESEARCH LA English DT Meeting Abstract CT Annual Meeting of the Pediatric-Academic-Society CY MAY 03-06, 2003 CL SEATTLE, WASHINGTON SP Pediat Acad Soc, Amer Pediat Soc, Soc Pediat Res, Ambulatory Pediat Assoc, Tulane Univ Hlth Sci Ctr, Ctr Continuing Educ C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2003 VL 53 IS 4 SU S MA 2977 BP 526A EP 526A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 661PA UT WOS:000181897902974 ER PT J AU Fivush, B Neu, A Bedinger, M Warady, B Watkins, S Friedman, A Brem, A Goldstein, S Frankenfield, D AF Fivush, B Neu, A Bedinger, M Warady, B Watkins, S Friedman, A Brem, A Goldstein, S Frankenfield, D TI Impact of specialization of primary nephrologist on care of pediatric hemodialysis patients SO PEDIATRIC RESEARCH LA English DT Meeting Abstract CT Annual Meeting of the Pediatric-Academic-Society CY MAY 03-06, 2003 CL SEATTLE, WASHINGTON SP Pediat Acad Soc, Amer Pediat Soc, Soc Pediat Res, Ambulatory Pediat Assoc, Tulane Univ Hlth Sci Ctr, Ctr Continuing Educ C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2003 VL 53 IS 4 SU S MA 2978 BP 527A EP 527A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 661PA UT WOS:000181897902975 ER PT J AU Rathore, SS Foody, JAM Radford, MJ Ordin, DL Krumholz, HM AF Rathore, SS Foody, JAM Radford, MJ Ordin, DL Krumholz, HM TI Sex differences in elderly patients - Use of coronary Revascularization after acute myocardial infarction: A tale of two therapies SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Meeting Abstract CT 52nd Annual Scientific Session of the American-College-of-Cardiology CY MAR 30-APR 02, 2003 CL CHICAGO, ILLINOIS SP American Coll Cardiol C1 Yale Univ, Sch Med, New Haven, CT 06520 USA. Ctr Medicare, Boston, MA USA. Ctr Medicaid Serv, Boston, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0735-1097 J9 J AM COLL CARDIOL JI J. Am. Coll. Cardiol. PD MAR 19 PY 2003 VL 41 IS 6 SU A BP 179A EP 179A PG 1 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 657LW UT WOS:000181669500774 ER PT J AU Clancy, CM Scully, T AF Clancy, CM Scully, T TI Perspective - A call to excellence SO HEALTH AFFAIRS LA English DT Article AB Health care improvement affects us all and is not optional. For change to occur, consumers must demand excellence from their providers and clinicians. Patient safety is part of a broader set of health care quality issues.. Championing this view will not be easy, for it means fundamental change to the myriad interrelated systems that make up U.S. health care. HHS is taking the lead on patient safety through a number of initiatives and activities. C1 Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20852 USA. NR 6 TC 6 Z9 6 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP 113 EP 115 DI 10.1377/hlthaff.22.2.113 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400019 PM 12674413 ER PT J AU Smith, DG AF Smith, DG TI Flexibility works SO HEALTH AFFAIRS LA English DT Letter C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Smith, DG (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP 279 EP 280 DI 10.1377/hlthaff.22.2.279-a PG 2 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400041 PM 12674431 ER PT J AU Heffler, S Smith, S Keehan, S Clemens, MK Won, G Zezza, M AF Heffler, S Smith, S Keehan, S Clemens, MK Won, G Zezza, M TI Trends - Health spending projections for 2002-2012 SO HEALTH AFFAIRS LA English DT Article AB We forecast a slowdown in national health spending growth in 2002 and 2003, reflecting slower projected Medicare and private personal health spending growth. These factors outweigh higher projected Medicaid spending growth, caused by weak labor markets, and an expectation of continued high private health insurance premium inflation related to the underwriting cycle. Over the entire projection period, national health spending growth is still expected to outpace economic growth. The result is that the health share of gross domestic product is projected to increase from 14.1 percent in 2001 to 17.7 percent in 2012. C1 Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD USA. RP Heffler, S (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD USA. NR 21 TC 3 Z9 3 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2003 VL 22 IS 2 BP W54 EP W65 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 653RG UT WOS:000181450400003 ER PT J AU Riley, GF Lubitz, JD Zhang, N AF Riley, GF Lubitz, JD Zhang, N TI Patterns of health care and disability for Medicare beneficiaries under 65 SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article AB Disabled people under age 65 are a vulnerable and growing segment of the Medicare population, yet Medicare reform has focused on the needs of the aged. This study linked the Medicare Current Beneficiary Survey to Social Security Administration records to analyze patterns of health care for disabled beneficiaries by reason for disability. We found substantial variation in average health care costs by type of service, including prescription drugs, and in sources of payment. Rates of institutionalization were high among some disability categories and there was heavy reliance on Medicaid and other public programs for payment. It is essential that the special needs of the disabled not be overlooked as policymakers consider fundamental modifications to Medicare and Medicaid. C1 Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. Natl Ctr Hlth Stat, Off Anal Epidemiol & Hlth Promot, Aging Studies Branch, Hyattsville, MD 20782 USA. Univ Minnesota, Sch Publ Hlth, Minneapolis, MN 55455 USA. RP Riley, GF (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, 7500 Secur Blvd,Room C3-20-17, Baltimore, MD 21244 USA. NR 16 TC 12 Z9 12 U1 0 U2 1 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD SPR PY 2003 VL 40 IS 1 BP 71 EP 83 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 691JH UT WOS:000183602500006 PM 12836909 ER PT J AU Klabunde, CN Frame, PS Meadow, A Jones, E Nadel, M Vernon, SW AF Klabunde, CN Frame, PS Meadow, A Jones, E Nadel, M Vernon, SW TI A national survey of primary care physicians' colorectal cancer screening recommendations and practices SO PREVENTIVE MEDICINE LA English DT Article DE colorectal cancer; screening; primary care; health services delivery ID FECAL-OCCULT-BLOOD; RANDOMIZED CONTROLLED TRIAL; FLEXIBLE SIGMOIDOSCOPY; HOSPITAL VOLUME; SURGEON VOLUME; PREVENTION; MORTALITY; POLYPECTOMY; COLONOSCOPY; GUIDELINES AB Background. National data on providers' colorectal cancer (CRC) screening knowledge, attitudes, and practices are sparse. This study assessed primary care physicians' (PCPs') beliefs about the effectiveness of CRC screening, their recommendations for screening, their perceptions of the influence of published guidelines on their CRC screening recommendations, and how they conduct CRC screening in their clinical practices. Methods. A questionnaire was administered to a nationally representative sample of practicing PCPs. Of 1718 eligible physicians, 1235 (72%) responded. Results. Only 2% of PCPs said they did not recommend CRC screening. Over 80% indicated that they most often recommend CRC screening with fecal occult blood testing and/or flexible sigmoidoscopy, although colonoscopy was perceived as the more effective screening modality. Nearly two-thirds of obstetrician/gynecologists and one-fourth of other practitioners reported conducting fecal occult blood testing exclusively by digital rectal exam. Only 29% of PCPs said they perform sigmoidoscopy. Estimated volumes of ordering, performing, or referring for CRC screening were low, and <20% reported that three-fourths or more of their older patients were up to date with CRC screening as recommended by the physician. Many PCPs reported recommending CRC screening at nonstandard starting ages or too-frequent intervals. Conclusions. Awareness of CRC screening among PCPs in the United States is high. However, knowledge gaps about the timing and frequency of screening and suboptimal screening delivery were evident. (C) 2003 American Health Foundation and Elsevier Science (USA). All rights reserved. C1 NCI, Hlth Serv, Appl Res Program, Bethesda, MD 20892 USA. NCI, Econ Branch, Appl Res Program, Bethesda, MD 20892 USA. Univ Rochester, Sch Med & Dent, Dept Family Med, Rochester, NY USA. Tri Cty Family Med, New York, NY USA. Ctr Medicare, Off Res Dev & Informat, Baltimore, MD USA. Medicaid Serv, Baltimore, MD USA. Natl Inst Hlth, Ctr Clin, Dept Diagnost Radiol, Bethesda, MD USA. Ctr Dis Control & Prevent, Div Canc Prevent & Control, Atlanta, GA USA. Univ Texas, Hlth Sci Ctr, Sch Publ Hlth, Houston, TX USA. RP Klabunde, CN (reprint author), NCI, Hlth Serv, Appl Res Program, Execut Plaza N Room 4005,6130 Execut Blvd, Bethesda, MD 20892 USA. FU NCI NIH HHS [N01-PC-85169]; PHS HHS [99FED06571] NR 52 TC 148 Z9 149 U1 1 U2 3 PU ACADEMIC PRESS INC ELSEVIER SCIENCE PI SAN DIEGO PA 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 USA SN 0091-7435 J9 PREV MED JI Prev. Med. PD MAR PY 2003 VL 36 IS 3 BP 352 EP 362 DI 10.1016/S0091-7435(02)00066-X PG 11 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 661RY UT WOS:000181904600011 PM 12634026 ER PT J AU Sheikh, K Bullock, C AF Sheikh, K Bullock, C TI Sex differences in carotid endarterectomy utilization and 30-day postoperative mortality SO NEUROLOGY LA English DT Article; Proceedings Paper CT 53rd Annual Meeting of the American-Academy-of-Neurology CY MAY 05-12, 2001 CL PHILADELPHIA, PENNSYLVANIA SP Amer Acad Neurol ID ACUTE MYOCARDIAL-INFARCTION; CORONARY-ARTERY DISEASE; AMERICAN-HEART-ASSOCIATION; MEDICARE BENEFICIARIES; GENDER DIFFERENCES; CEREBROVASCULAR-DISEASE; PATIENT CHARACTERISTICS; ISCHEMIC STROKE; APPROPRIATE USE; UNITED-STATES AB Objective: To study trends, and sex and regional differences in utilization of the carotid endarterectomy (CEA) procedure and 30-day postoperative mortality from 1991 to 1999. Methods: Retrospective analysis of fee-for-service claims and mortality data for Medicare beneficiaries aged 65 years and older in the United States. Results: The male and female CEA rates and 30-day mortality increased with age up to the age of 79 years. From 1991 to 1995, the age-adjusted male and female CEA rates increased 72% from 26.6 and 14.2 procedures per 10,000 beneficiaries. Thereafter, the CEA rates slightly decreased except for the 80 years and older age group, which increased through 1999. In each year from 1991 to 1999, the age-adjusted male CEA rates were approximately 1.9 times higher than the corresponding female rates. From 1991 to 1998, the age-adjusted male and female 30-day mortality decreased 29.3% and 46.4% from 19.2 and 18.1 deaths per 1,000 procedures. From 1992 to 1997, except 1994, 30-day mortality was higher in men than in women. This sex difference was not present in the 65 to 69 years age group. There were small differences in CEA rates between two of the four regions of the United States in 3 of the 9 years. Conclusions: Increasing CEA rates with decreasing postoperative mortality suggest that CEA may have been more frequently performed on low-risk patients. The apparent sex differences in CEA rates may not be true differences. C1 US Dept Hlth & Human Serv, Ctr Medicare, Kansas City, MO 64106 USA. US Dept Hlth & Human Serv, Med Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept Hlth & Human Serv, Ctr Medicare, 601 E 12th St,Rm 235, Kansas City, MO 64106 USA. NR 52 TC 13 Z9 14 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0028-3878 J9 NEUROLOGY JI Neurology PD FEB 11 PY 2003 VL 60 IS 3 BP 471 EP 476 PG 6 WC Clinical Neurology SC Neurosciences & Neurology GA 646BG UT WOS:000181014500019 PM 12578929 ER PT J AU Frankenfield, DL Brier, ME Bedinger, MR Milam, RA Eggers, PW Cain, JA Aronoff, GR Frederick, PR AF Frankenfield, DL Brier, ME Bedinger, MR Milam, RA Eggers, PW Cain, JA Aronoff, GR Frederick, PR TI Comparison of urea reduction ratio and hematocrit data reported in different data systems: Results from the Centers for Medicare & Medicaid Services and The Renal Network Inc. SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE urea reduction ratio (URR); hematocrit; Centers for Medicare & Medicaid Services (CMS); The Renal Network Data System (TRNDS); NephTrak; reliability; dialysis adequacy; anemia management AB Background: Urea reduction ratio (URR) and hematocrit values reported on the Centers for Medicare & Medicaid Services (CMS) claims were compared with data from two different databases. Methods: URRs and hematocrits from two different CMS databases (National Claims History and End-Stage Renal Disease Clinical Performance Measures [CPM] Project) and one Network database (The Renal Network Data System [TRNDS]) were compared for October through December 1998 and December 1998, respectively. A sample of records from the regional database was validated by independent chart review. Results: Nationally, the percentage of agreement for patients with URRs of 65% or greater and less than 65% was 94% (kappa, 0.81; 95% confidence interval [CI], 0.80 to 0.83); regionally, the percentage of agreement was 95% (kappa, 0.85; 95% CI, 0.84 to 0.86). Nationally, linear regression of hematocrit values from both data sources yielded r(2)= 0.61 each month and r(2)= 0.70 for average values during the 3-month study period. Nationally, the percentage of agreement for patients with hematocrits of 33% or greater and less than 33% was 84% (kappa similar to 0.66) each month. Regionally, linear regression of monthly hematocrit values from both data sources yielded r(2) = 0.66, and percentage of agreement for patients with hematocrits of 33% or greater and less than 33% was 87% (kappa, 0.71; 95% CI, 0.70 to 0.73). Validation of a sample of records in the TRNDS database resulted in 98% agreement for patients with URRs of 65% or greater and less than 65% and 96% agreement for patients with hematocrits of 33% or greater and less than 33%. Conclusion: Although there is general agreement between clinical variables submitted on the claims and in the CPM Project, some variation exists. Data from either source yield the same information when classifying patients as above or below threshold values. C1 Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD 21244 USA. NIDDKD, NIH, Bethesda, MD 20892 USA. Univ Louisville, Dept Med, Louisville, KY 40292 USA. Renal Network Inc, Indianapolis, IN USA. RP Frankenfield, DL (reprint author), Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Mailstop S3-02-01,7500 Secur Blvd, Baltimore, MD 21244 USA. RI Brier, Michael/B-9805-2013 OI Brier, Michael/0000-0002-5952-9561 NR 6 TC 3 Z9 3 U1 0 U2 0 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD FEB PY 2003 VL 41 IS 2 BP 433 EP 441 DI 10.1053/ajkd.2003.50053 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 642EE UT WOS:000180790600020 PM 12552507 ER PT J AU Baker, F Haffer, SC Denniston, M AF Baker, F Haffer, SC Denniston, M TI Health-related quality of life of cancer and noncancer patients in medicare managed care SO CANCER LA English DT Article; Proceedings Paper CT Conference on Partnerships for Health in the New Millenium: Launching Health People 2010 CY JAN 26, 2000 CL WASHINGTON, D.C. DE quality of life; oncology; cancer survivors; managed care; Medicare; program planning; American Cancer Society; prostate carcinoma; breast carcinoma; colorectal carcinoma ID OF-LIFE; SURVIVORS AB BACKGROUND. Data from the Health Care Financing Administration's (HCFA) Medicare Health Outcomes Survey (MHOS) of patients enrolled in managed care services through Medicare were analyzed. The MHOS provided baseline estimates of quality of life of cancer survivors in comparison to a frequency age-matched cohort of noncancer patients. METHOD. In 1998, the MHOS was mailed to a random sample of 279,135 beneficiaries. Completed surveys were received from 167,096 respondents (60%). Some 22,747 respondents who had been diagnosed with cancer were frequency age matched to an equal number of noncancer patients. RESULTS. Cancer survivors had statistically significantly poorer scores than noncancer patients on all eight subscales as well as on the Physical Component and Mental Component summary measures of the Medical Outcomes Study Short Form-36 (MOS SF-36). Comparisons by type and number of cancers for which an individual was currently in treatment showed lowest quality of life for those in treatment for lung carcinoma, followed by those who were in treatment for more than one type of cancer. CONCLUSION. The data suggest that cancer shows negative effects on health-related quality of-life that are not explainable by simple effects of age because frequency age-matched cancer survivors had statistically significantly lower scores on all 10 scores of the MOS SF-36. Effect sizes are evaluated to determine the clinical significance of these differences in health-related quality of life. The MHOS offers useful data for planning and improving cancer policy and programs. Cancer 2003; 97:674-81. Published (C) 2003 by the American Cancer Sociery. C1 Amer Canc Soc, Behav Res Ctr, Atlanta, GA 30329 USA. Ctr Med, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Baker, F (reprint author), Amer Canc Soc, Behav Res Ctr, 1599 Clifton Rd, Atlanta, GA 30329 USA. NR 18 TC 96 Z9 98 U1 0 U2 3 PU JOHN WILEY & SONS INC PI HOBOKEN PA 111 RIVER ST, HOBOKEN, NJ 07030 USA SN 0008-543X J9 CANCER JI Cancer PD FEB 1 PY 2003 VL 97 IS 3 BP 674 EP 681 DI 10.1002/cncr.11085 PG 8 WC Oncology SC Oncology GA 637WH UT WOS:000180536400018 PM 12548610 ER PT J AU Robst, J VanGilder, J Polachek, S AF Robst, J VanGilder, J Polachek, S TI Perceptions of female faculty treatment in higher education: which institutions treat women more fairly? SO ECONOMICS OF EDUCATION REVIEW LA English DT Article DE discrimination; worker perceptions; faculty treatment ID SEXUAL HARASSMENT; ACADEMIC DEPARTMENTS; STATISTICAL EVIDENCE; LABOR-MARKETS; GENDER; DISCRIMINATION; SATISFACTION; IMPACT AB This paper analyzes a national sample of postsecondary faculty first to determine whether treatment of female faculty is perceived as fair and second to examine what institutional characteristics are related to fair treatment. The results indicate that the majority of male and female faculty believe female faculty are treated fairly. However, perceived treatment varies with a number of institutional and faculty characteristics. (C) 2001 Elsevier Science Ltd. All rights reserved. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. Calif State Univ Bakersfield, Dept Econ, Bakersfield, CA 93311 USA. SUNY Binghamton, Dept Econ, Binghamton, NY 13902 USA. RP Robst, J (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mail Stop C3-19-26, Baltimore, MD 21244 USA. NR 25 TC 2 Z9 2 U1 1 U2 7 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0272-7757 J9 ECON EDUC REV JI Econ. Educ. Rev. PD FEB PY 2003 VL 22 IS 1 BP 59 EP 67 DI 10.1016/S0272-7757(01)00056-5 PG 9 WC Economics; Education & Educational Research SC Business & Economics; Education & Educational Research GA 638JA UT WOS:000180566800006 ER PT J AU Yost, JA AF Yost, JA TI Laboratory inspection: The view from CMS SO LABORATORY MEDICINE LA English DT Article C1 Ctr Medicare Serv, Div Labs, Baltimore, MD USA. Ctr Medicaid Serv, Div Labs, Baltimore, MD USA. RP Yost, JA (reprint author), Ctr Medicare Serv, Div Labs, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER SOC CLINICAL PATHOLOGY PI CHICAGO PA 2100 W HARRISON ST, CHICAGO, IL 60612 USA SN 0007-5027 J9 LAB MED JI Lab. Med. PD FEB PY 2003 VL 34 IS 2 BP 136 EP 140 DI 10.1309/UV7DPF0U581Y2M8H PG 5 WC Medical Laboratory Technology SC Medical Laboratory Technology GA 639QE UT WOS:000180640100023 ER PT J AU Jencks, SF Huff, ED Cuerdon, T AF Jencks, SF Huff, ED Cuerdon, T TI Change in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001 SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID PROSPECTIVE PAYMENT SYSTEM; IMPLEMENTATION AB Context Despite widespread concern regarding the quality and safety of healthcare, and a Medicare Quality Improvement Organization (QIO) program intended to improve that care in the United States, there is only limited information on whether quality is improving. Objective To track national and state-level changes in performance on 22 quality indicators for care of Medicare beneficiaries. Design, Patients, and Setting National observational cross-sectional studies of national and state-level fee-for-service data for Medicare beneficiaries during 19981999 (baseline) and 2000-2001 (follow-up). Main Outcome Measures Twenty-two QIO quality indicators abstracted from statewide random samples of medical records for inpatient fee-for-service care and from Medicare beneficiary, surveys or Medicare claims for outpatient care. Absolute improvement is defined as the change in performance from baseline to follow-up (measured in percentage points for all indicators except those measured in minutes); relative improvement is defined as the absolute improvement divided by the difference between the baseline performance and perfect performance (100%). Results The median state's performance improved from baseline to follow-up on 20 of the 22 indicators. In the median state, the percentage of patients receiving appropriate care on the median indicator increased from 69.5% to 73.4%, a 12.8% relative improvement. The average relative improvement was 19.9% for outpatient indicators combined and 11.9% for inpatient indicators combined (P<.001). For all but one indicator, absolute improvement was greater in states in which performance was low at baseline than those in which it was high at baseline (median r=-0.43; range: 0.12 to -0.93). When states were ranked on each indicator, the state's average rank was highly stable over time (r=0.93 for 1998-1999 vs 2000-2001). Conclusions Care for Medicare fee-for-service plan beneficiaries improved substantially between 1998-1999 and 2000-2001, but a much larger opportunity remains for further improvement. Relative rankings among states changed little. The improved care is consistent with QIO activities over this period, but these cross-sectional data do not provide conclusive information about the degree to which the improvement can be attributed to the QIOs' quality improvement efforts. C1 Ctr Medicare Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. Ctr Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. Ctr Medicare Serv, Div Clin Stand & Qual, Boston, MA USA. Ctr Medicaid Serv, Div Clin Stand & Qual, Boston, MA USA. NIMH, Hlth & Behav Sci Res Branch, Bethesda, MD 20892 USA. RP Jencks, SF (reprint author), Ctr Medicare Serv, Off Clin Stand & Qual, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA. NR 15 TC 361 Z9 362 U1 0 U2 10 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 15 PY 2003 VL 289 IS 3 BP 305 EP 312 DI 10.1001/jama.289.3.305 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 634MV UT WOS:000180345100025 PM 12525231 ER PT J AU Masoudi, FA Havranek, EP Smith, G Fish, RH Steiner, JF Ordin, DL Krumholz, HM AF Masoudi, FA Havranek, EP Smith, G Fish, RH Steiner, JF Ordin, DL Krumholz, HM TI Gender, age, and heart failure with preserved left ventricular systolic function SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Article ID EJECTION FRACTION; NATURAL-HISTORY; HYPERTROPHY; POPULATION; COHORT AB Objectives This study was designed to determine if women are more likely than men to have heart failure (HF) with preserved systolic function after adjustment for potential confounders, including age. Background Although prior evidence suggests an independent association between female gender and preserved left ventricular systolic function (LVSF) in patients with HF, existing studies are limited by referral biases, small sample sizes, or the inability to adjust for a wide range of potential confounding variables. Methods This is a cross-sectional study using data from retrospective medical chart abstraction of a national sample of Medicare beneficiaries hospitalized with the principal discharge diagnosis of HF in acute-care nongovernmental hospitals in the U.S. between April 1998 and March 1999. Patients were eligible for this analysis if they were age 65 years or older, had documentation of LVSF, and corroboration of the diagnosis of HF. We used multivariable logistic regression to identify the correlates of preserved LVSF, which was defined as qualitatively normal function or quantitatively reported ejection fraction greater than or equal to0.50. Stratified regressions by gender were performed to identify significant interactions. Results Of the 19,710 patients in the analysis, preserved LVSF was present in 6,700 (35%), 79% of whom were women. In contrast, among the 12,956 patients with impaired LVSF, only 49% were women. Patients with preserved LVSF were 1.5 years older than those with impaired LVSF. After adjustment for age and other patient factors, female gender remained strongly associated with preserved LVSF (calculated risk ratio=1.71; 95% confidence interval 1.63 to 1.78). The association was consistent in all age groups, and was similar in patients with or without coronary artery disease, hypertension, pulmonary disease, renal insufficiency, or atrial fibrillation. Conclusions In elderly patients hospitalized with HF, preserved systolic function is primarily a condition of women, independent of important demographic and clinical characteristics. C1 Denver Hlth Med Ctr, Div Cardiol MC 0960, Denver, CO 80204 USA. Univ Colorado, Hlth Sci Ctr, Denver, CO USA. Colorado Fdn Med Care, Aurora, CO USA. Yale Univ, Sch Med, New Haven, CT USA. Ctr Medicare & Med Serv, Boston, MA USA. RP Masoudi, FA (reprint author), Denver Hlth Med Ctr, Div Cardiol MC 0960, 777 Bannock St, Denver, CO 80204 USA. FU NIA NIH HHS [K08-AG1011-01] NR 22 TC 230 Z9 242 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0735-1097 J9 J AM COLL CARDIOL JI J. Am. Coll. Cardiol. PD JAN 15 PY 2003 VL 41 IS 2 BP 217 EP 223 AR PII S0735-1097(02)02696-7 DI 10.1016/S0735-1097(02)02696-7 PG 7 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 634VQ UT WOS:000180362800009 PM 12535812 ER PT J AU Frankenfield, DL Rocco, MV Roman, SH McClellan, WM AF Frankenfield, DL Rocco, MV Roman, SH McClellan, WM TI Survival advantage for adult Hispanic hemodialysis patients? Findings from the end-stage renal disease clinical performance measures project SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article ID UNITED-STATES; MORTALITY; OUTCOMES; MINORITIES; PATTERNS; DIALYSIS; PARADOX; MEXICAN; HEALTH; WHITES AB One-year follow-up mortality in Hispanic and non-Hispanic patients and its association with intermediate outcomes of dialytic care were examined utilizing the Center for Medicare & Medicaid Services' (CMS) ESRD Clinical Performance Measures (CPM) Project and administrative data. Demographic and clinical information was collected on a national random sample of adult in-center hemodialysis (HD) patients for the period of October through December, 1998. Patients were categorized as Hispanic, non-Hispanic White, or non-Hispanic Black. Of 8336 patients 994 (12%) were identified as Hispanic, 3618 (43%) as non-Hispanic White, and 3111 (37%) as non-Hispanic Black. The adjusted 12-mo mortality risk (99% CI) for Hispanics was 0.76 (0.60 to 0.96; P < 0.01) and for non-Hispanic Blacks 0.66 (0.56 to 0.78, P < 0.001) compared with non-Hispanic Whites (referent). Similar 12-mo mortality risks were noted in the groups with diabetes mellitus or hypertension as the causes of ESRD and among patients greater than or equal to65 yr. After controlling for demographic and geographic variables, Hispanics compared with the referent group, non-Hispanic Whites, were more likely to have a mean serum albumin greater than or equal to4.0/3.7 g/dL (BCG/BCP) (1.5 [1.2 to 1.7]; P < 0.001) and as likely to have a mean Kt/V &GE;1.2, mean hemoglobin &GE;11 g/dL, and an arteriovenous fistula as their vascular access. These data suggest that adult Hispanic HD patients have a 12-mo survival intermediate to non-Hispanic Blacks and non-Hispanic Whites and experience equivalent or better intermediate outcomes of dialytic care compared with non-Hispanic Whites. C1 Ctr Beneficiary Choices, Ctr Medicare Serv, Baltimore, MD 21244 USA. Ctr Beneficiary Choices, Ctr Med Sev, Baltimore, MD 21244 USA. Wake Forest Univ, Sch Med, Nephrol Sect, Winston Salem, NC 27109 USA. Georgia Med Care Fdn, Atlanta, GA USA. Emory Univ, Rollins Sch Publ Hlth, Dept Med, Atlanta, GA 30322 USA. RP Frankenfield, DL (reprint author), Ctr Beneficiary Choices, Ctr Medicare Serv, 7500 Secur Blvd,Mailstop S3-02-01, Baltimore, MD 21244 USA. NR 31 TC 39 Z9 39 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD JAN PY 2003 VL 14 IS 1 BP 180 EP 186 DI 10.1097/01.ASN.0000037400.83593.E6 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA 629VR UT WOS:000180072800019 PM 12506150 ER PT J AU Reddan, DN Frankenfield, DL Klassen, PS Coladonato, JA Szczech, L Johnson, CA Besarab, A Rocco, M McClellan, W Wish, J Owen, WF AF Reddan, DN Frankenfield, DL Klassen, PS Coladonato, JA Szczech, L Johnson, CA Besarab, A Rocco, M McClellan, W Wish, J Owen, WF CA CMS's ESRD CPM Workgroup TI Regional variability in anaemia management and haemoglobin in the US SO NEPHROLOGY DIALYSIS TRANSPLANTATION LA English DT Article DE anaemia; Centers for Medicare & Medicaid Services; end-stage renal disease; erythropoietin; haemodialysis; iron ID CORE INDICATORS PROJECT; HEMODIALYSIS-PATIENTS; IRON SUPPLEMENTATION; ERYTHROPOIETIN; EPOETIN; ANEMIA; DEFICIENCY; REDUCTION; THERAPY AB Background. Regional differences in haemoglobin values and process care measures were examined using data from the Centers for Medicare & Medicaid Services' End-Stage Renal Disease (ESRD) Clinical Performance Measures Project. It was posited that regional differences in haemoglobin values are consequent upon differences in components of clinical practice. Methods. A national random sample of 8336 adult in-centre haemodialysis patients, stratified by the 18 regional ESRD Networks, was drawn. Information was collected for October-December 1998. Multivariable stepwise linear and logistic regression analyses were performed to identify variables associated with haemoglobin. Linear regression analysis was used to identify variables associated with EPo/Hb index (mean weight-adjusted treatment level erythropoietin (Epo) dose divided by mean haemoglobin). Results. The percentage of patients with haemoglobin concentration <11 g/dl ranged from 34 to 52% across ESRD Networks. In addition to haemoglobin there was significant, non-random variation among ESRD Networks with regard to prescribed Epo dose and administration route, intravenous (IV) iron prescription and dialyser flux (high flux = KUf greater than or equal to 20 ml/mmHg/h) (all P-values < 0.001). Higher haemoglobin was associated with older age, male gender, higher serum albumin, higher transferrin saturation, higher Kt/V, lower serum ferritin and lower prescribed Epo dose (all P-values <0.01). Diabetes mellitus as cause of ESRD, high-flux dialyser use, IV iron prescription or subcutaneous Epo prescription were not associated with haemoglobin. Male gender, diabetes as cause of ESRD, older age, higher transferrin saturation and higher albumin concentrations were associated with lower Epo/Hb index. Prescription of IV iron and IV Epo were associated with higher Epo/Hb index. Conclusions. Regional mean haemoglobin levels vary considerably across the US and the variation in haemoglobin is explained by both non-modifiable factors and modifiable clinical practice-derived variables. C1 Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Durham, NC 27710 USA. Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Univ Wisconsin, Sch Pharm, Madison, WI 53706 USA. W Virginia Univ, Morgantown, WV 26506 USA. Wake Forest Univ, Bowman Gray Sch Med, Winston Salem, NC USA. Emory Univ, Atlanta, GA 30322 USA. Univ Hosp Cleveland, Cleveland, OH 44106 USA. RP Reddan, DN (reprint author), Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Box 3646, Durham, NC 27710 USA. NR 22 TC 28 Z9 29 U1 0 U2 0 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0931-0509 J9 NEPHROL DIAL TRANSPL JI Nephrol. Dial. Transplant. PD JAN PY 2003 VL 18 IS 1 BP 147 EP 152 DI 10.1093/ndt/18.1.147 PG 6 WC Transplantation; Urology & Nephrology SC Transplantation; Urology & Nephrology GA 633QK UT WOS:000180293800024 PM 12480973 ER PT J AU Wattigney, WA Croft, JB Mensah, GA Alberts, MJ Shephard, TJ Gorelick, PB Nilasena, DS Hess, DC Walker, MD Hanley, DF Shwayder, P Girgus, M Neff, LJ Williams, JE LaBarthe, DR Collins, JL AF Wattigney, WA Croft, JB Mensah, GA Alberts, MJ Shephard, TJ Gorelick, PB Nilasena, DS Hess, DC Walker, MD Hanley, DF Shwayder, P Girgus, M Neff, LJ Williams, JE LaBarthe, DR Collins, JL TI Establishing data elements for the Paul Coverdell National Acute Stroke Registry - Part 1: Proceedings of an expert panel SO STROKE LA English DT Article DE data collection; registry; stroke assessment; stroke, acute; thrombolytic therapy ID ACUTE ISCHEMIC-STROKE; RANDOMIZED TRIALS; CARE; STATE; PREVENTION; EMERGENCY; QUALITY; TPA AB Background and Purpose-Stroke is the third-leading cause of death and a leading cause of disability in adults in the United States. In recent years, leaders in the stroke care community identified a national registry as a critical tool to monitor the practice of evidence-based medicine for acute stroke patients and to target areas for continuous quality of care improvements. An expert panel was convened by the Centers for Disease Control and Prevention to recommend a standard list of data elements to be considered during development of prototypes of the Paul Coverdell National Acute Stroke Registry. Methods-A multidisciplinary panel of representatives of the Brain Attack Coalition, professional associations, nonprofit stroke organizations, and federal health agencies convened in February 2001 to recommend key data elements. Agreement was reached among all participants before an element was added to the list. Results-The recommended elements included patient-level data to track the process of delivering stroke care from symptom onset through transport to the hospital, emergency department diagnostic evaluation, use of thrombolytic therapy when indicated, other aspects of acute care, referral to rehabilitation services, and 90-day follow-up. Hospital-level measures pertaining to stroke center guidelines were also recommended to augment patient-level data. Conclusions-Routine monitoring of the suggested parameters could promote community awareness campaigns, support quality improvement interventions for stroke care and stroke prevention in each state, and guide professional education in hospital and emergency system settings. Such efforts would reduce disability and death among stroke patients. C1 Ctr Dis Control & Prevent, Atlanta, GA 30341 USA. NW Univ, Sch Med, Chicago, IL USA. Stroke Syst Consulting, Dallas, TX USA. Rush Med Coll, Chicago, IL 60612 USA. Ctr Medicare & Medicaid Serv, Dallas, TX USA. Med Coll Georgia, Augusta, GA 30912 USA. VA Med Ctr, Augusta, GA USA. NINDS, Bethesda, MD 20892 USA. Johns Hopkins Med Inst, Baltimore, MD 21205 USA. Natl Stroke Assoc, Denver, CO USA. Amer Stroke Assoc, Div Amer Heart Assoc, Dallas, TX USA. RP Wattigney, WA (reprint author), Ctr Dis Control & Prevent, 4770 Buford Hwy NE,Mailstop K-47, Atlanta, GA 30341 USA. OI Mensah, George/0000-0002-0387-5326 NR 22 TC 46 Z9 51 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD JAN PY 2003 VL 34 IS 1 BP 151 EP 156 DI 10.1161/01.STR.0000048160.41821.B5 PG 6 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 632XX UT WOS:000180251100040 PM 12511767 ER PT J AU Rathore, SS Ordin, DL Krumholz, HM AF Rathore, SS Ordin, DL Krumholz, HM TI Race and sex differences in the refusal of cardiac catheterization among elderly patients hospitalized with acute myocardial infarction SO AMERICAN HEART JOURNAL LA English DT Article ID RACIAL-DIFFERENCES; MEDICARE PATIENTS; DECISION-MAKING; HEART-DISEASE; CARE; PREFERENCES; GENDER; ACCESS AB Background Prior studies have reported race and sex differences in cardiac catheterization use after acute myocardial infarction (AMI). It is unclear whether race or sex differences in procedure refusal may contribute to this difference. We sought to determine whether cardiac catheterization refusal rates differ by patient race or sex. Methods We evaluated medical records of 74,745 Medicare beneficiaries hospitalized for AMI between January 1994 and February 1996 to ascertain refusal of cardiac catheterization during hospitalization. Patient race and sex were evaluated for their association with cardiac catheterization refusal adjusting for patient, physician, and hospital characteristics. Results The cardiac catheterization refusal rate in the overall cohort was 2.92% (95% CI 2.80%-3.04%). Race and sex differences in cardiac catheterization were observed after multivariate adjustment, with white women (odds ratio [OR] 1.28), black men (OR 1.34), and black women (OR 1.37) more likely to refuse cardiac catheterization than white men (OR 1.00). Relative differences in refusal were associated with only modest absolute differences in risk-standardized rates of cardiac catheterization refusal; rates were lowest for white men (2.55%), and higher for white women (3.21%), black men (3.36%), and black women (3.38%, P <.001 for global comparison). Conclusions Patient race and sex were associated with cardiac catheterization refusal among elderly patients hospitalized with AMI. However, absolute race and sex differences in rates of procedure refusal were small, suggesting that race and sex differences in cardiac catheterization refusal provide only a partial explanation of observed differences in cardiac procedure use. C1 Yale Univ, Sch Med, Sect Cardiovasc Med, Dept Internal Med, New Haven, CT 06520 USA. Yale Univ, Sch Med, Sect Hlth Policy & Adm, Dept Epidemiol & Publ Hlth, New Haven, CT 06520 USA. Ctr Medicare & Medicaid Serv, Boston, MA USA. Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. Qualidigm, Middletown, CT USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Sect Cardiovasc Med, Dept Internal Med, Room IE-61 SHM,333 Cedar St,POB 208025, New Haven, CT 06520 USA. NR 20 TC 25 Z9 25 U1 0 U2 0 PU MOSBY, INC PI ST LOUIS PA 11830 WESTLINE INDUSTRIAL DR, ST LOUIS, MO 63146-3318 USA SN 0002-8703 J9 AM HEART J JI Am. Heart J. PD DEC PY 2002 VL 144 IS 6 BP 1052 EP 1056 DI 10.1067/mhj.2002.126122 PG 5 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 631UY UT WOS:000180186200015 PM 12486430 ER PT J AU Arday, DR Fleming, BB Keller, DK Pendergrass, PW Vaughn, RJ Turpin, JM Nicewander, DA AF Arday, DR Fleming, BB Keller, DK Pendergrass, PW Vaughn, RJ Turpin, JM Nicewander, DA TI Variation in diabetes care among states - Do patient characteristics matter? SO DIABETES CARE LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; IMPAIRED FASTING GLUCOSE; CORONARY-HEART-DISEASE; MEDICARE BENEFICIARIES; GEOGRAPHIC-VARIATION; HEALTH; QUALITY; COMPLICATIONS; IMPROVEMENT; MELLITUS AB Objective- To examine state variability in diabetes care for Medicate beneficiaries and the impact of certain beneficiary characteristics on those variations. Research Design and Methods-Medicare beneficiaries with diabetes, aged 18-75 years, were identified from 1997 to 099 claims data. Claims data were used to construct rates for three quality of care measures (HbA(1c) tests, eye examinations, and lipid profiles); Person-level variables (e.g., age, sex, race, and socioeconomic status) were used to adjust state rates using logistic regression. Results-A third of 2 million beneficiaries with diabetes aged 18-75 years did not have annual HbA(1c) tests, biennial eye examinations, or biennial lipid profiles. There was wide variability in the measures among states (e.g., receipt of HbA(1c) tests ranged from 52 to 83%). Adjustment using person-level variables reduced the variance in HbA(1c) tests, eye examinations, and lipid profiles by 30, 23, and 27%, respectively, but considerable variability remained. The impact of the adjustment variables was also inconsistent across measures. Conclusions-Opportunities remain for improvement in diabetes care. Large variations in care among states were reduced significantly by adjustment for characteristics of state residents. However, much variability remained unexplained. Variability of measures within states and variable impact of the adjustment variables argues against systems effects operating with uniformity on the three measures. These findings suggest that a single approach to quality improvement is unlikely to be effective. Further understanding variability will be important to improving quality. C1 Texas Med Fdn, Austin, TX 78746 USA. Army Med Surveillance Act, Washington, DC USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Delmarva Fdn Med Care Inc, Easton, PA USA. RP Turpin, JM (reprint author), Texas Med Fdn, 901 Mopac Expressway S,Barton Oaks Plaza 2,Suite, Austin, TX 78746 USA. NR 45 TC 55 Z9 55 U1 0 U2 1 PU AMER DIABETES ASSOC PI ALEXANDRIA PA 1701 N BEAUREGARD ST, ALEXANDRIA, VA 22311-1717 USA SN 0149-5992 J9 DIABETES CARE JI Diabetes Care PD DEC PY 2002 VL 25 IS 12 BP 2230 EP 2237 DI 10.2337/diacare.25.12.2230 PG 8 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA 724UJ UT WOS:000185504800019 PM 12453966 ER PT J AU Robst, J King, CT AF Robst, J King, CT TI Improving the odds: Increasing the effectiveness of publicly funded training SO ECONOMICS OF EDUCATION REVIEW LA English DT Book Review C1 Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Robst, J (reprint author), Ctr Medicare, Baltimore, MD USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU PERGAMON-ELSEVIER SCIENCE LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND SN 0272-7757 J9 ECON EDUC REV JI Econ. Educ. Rev. PD DEC PY 2002 VL 21 IS 6 BP 642 EP 643 AR PII S0272-7757(01)00064-4 DI 10.1016/S0272-7757(01)00064-4 PG 2 WC Economics; Education & Educational Research SC Business & Economics; Education & Educational Research GA 619KH UT WOS:000179474800011 ER PT J AU Cotterill, PG Gage, BJ AF Cotterill, PG Gage, BJ TI Overview: Medicare post-acute care since the Balanced Budget Act of 1997 SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material C1 Ctr Medicare Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. Ctr Medicaid Serv, CMS, Baltimore, MD 21244 USA. RP Cotterill, PG (reprint author), Ctr Medicare Serv, Off Res Dev & Informat, 7500 Secur Blvd,C3-21-28, Baltimore, MD 21244 USA. EM pcotteriff@cms.hhs.gov NR 5 TC 18 Z9 18 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2002 VL 24 IS 2 BP 1 EP 6 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PA UT WOS:000231089200001 PM 12690691 ER PT J AU Shatto, A AF Shatto, A TI Comparing Medicare beneficiaries, by type of post-acute care received: 1999 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare Serv, CMS, Baltimore, MD USA. Ctr Medicaid Serv, CMS, Baltimore, MD USA. RP Shatto, A (reprint author), Ctr Medicare Serv, CMS, 7500 Secur Blvd,C3-16-27, Baltimore, MD USA. EM ashatto@cms.hhs.gov NR 0 TC 5 Z9 5 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD WIN PY 2002 VL 24 IS 2 BP 137 EP 142 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953PA UT WOS:000231089200009 PM 12690699 ER PT J AU Jackson, Y Dietz, WH Sanders, C Kolbe, LJ Whyte, JJ Wechsler, H Schneider, BS McNally, LA Charles-Azure, J Vogel-Taylor, M Starke-Reed, P Hubbard, VS Johnson-Taylor, WL Troiano, RP Donato, K Yanovski, S Kuczmarski, RJ Haverkos, L McMurry, K Wykoff, RF Woo, V Noonan, AS Rowe, J McCarty, K Spain, CB AF Jackson, Y Dietz, WH Sanders, C Kolbe, LJ Whyte, JJ Wechsler, H Schneider, BS McNally, LA Charles-Azure, J Vogel-Taylor, M Starke-Reed, P Hubbard, VS Johnson-Taylor, WL Troiano, RP Donato, K Yanovski, S Kuczmarski, RJ Haverkos, L McMurry, K Wykoff, RF Woo, V Noonan, AS Rowe, J McCarty, K Spain, CB TI Summary of the 2000 Surgeon General's listening session: Toward a national action plan on overweight and obesity SO OBESITY RESEARCH LA English DT Article DE schools; worksites; media; family and community; health care ID UNITED-STATES AB Objective: To provide insight into discussions at the Surgeon General's Listening Session, "Toward a National Action Plan on Overweight and Obesity," and to complement The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Research Methods and Procedures: On December 7 and 8, 2000, representatives from federal, state, academic, and private sectors attended the Surgeon General's Listening Session and were given an opportunity to recommend what to include in a national plan to address overweight and obesity. The public was invited to comment during a corresponding public comment period. The Surgeon General's Listening Session was also broadcast on the Internet, allowing others to view the deliberations live or access the archived files. Significant discussion points from the Listening Session have been reviewed by representatives of the federal agencies and are the basis of this complementary document. Results: Examples of issues, strategies, and barriers to change are discussed within five thematic areas: schools, health care, family and community, worksite, and media. Suggested cooperative or collaborative actions for preventing and decreasing overweight and obesity are described. An annotated list of some programmatic partnerships is included. Discussion: The Surgeon General's Listening Session provided an opportunity for representatives from family and community groups, schools, the media, the health-care environment, and worksites to become partners and to unite around the common goal of preventing and decreasing overweight and obesity. The combination of approaches from these perspectives offers a rich resource of opportunity to combat the public health epidemic of overweight and obesity. C1 NIH, Div Nutr Res Coordinat, DHHS, Bethesda, MD 20892 USA. Adm Aging, US Dept HHS, Washington, DC USA. Ctr Dis Control & Prevent, Div Nutr & Phys Act, DHHS, Atlanta, GA USA. Ctr Dis Control & Prevent, Div Adolescent & Sch Hlth, DHHS, Atlanta, GA USA. Ctr Medicare & Medicaid Serv, Agcy Healthcare Res & Qual, DHHS, Baltimore, MD USA. US FDA, DHHS, Rockville, MD 20857 USA. US Hlth Resources & Serv Adm, DHHS, Rockville, MD 20857 USA. Indian Hlth Serv, US Dept HHS, Rockville, MD USA. NIH, Off Director, DHHS, Bethesda, MD 20892 USA. NCI, NIH, DHHS, Bethesda, MD 20892 USA. NHLBI, NIH, DHHS, Bethesda, MD 20892 USA. NIDDKD, NIH, DHHS, Bethesda, MD 20892 USA. NICHHD, NIH, DHHS, Bethesda, MD 20892 USA. Off Dis Prevent & Hlth Promot, DHHS, Washington, DC USA. Off Surg Gen, DHHS, Washington, DC USA. Off Womens Hlth, DHHS, Washington, DC USA. Presidents Council Phys Fitness & Sports, Off Publ Hlth & Sci, DHHS, Washington, DC USA. RP Johnson-Taylor, WL (reprint author), NIH, Div Nutr Res Coordinat, DHHS, 2 Democracy Plaza,Room 640,6707 Democracy Blvd,MS, Bethesda, MD 20892 USA. OI Troiano, Richard/0000-0002-6807-989X NR 12 TC 22 Z9 22 U1 0 U2 0 PU NORTH AMER ASSOC STUDY OBESITY PI SILVER SPRING PA 8630 FENTON ST, SUITE 918, SILVER SPRING, MD 20910 USA SN 1071-7323 J9 OBES RES JI Obes. Res. PD DEC PY 2002 VL 10 IS 12 BP 1299 EP 1305 DI 10.1038/oby.2002.176 PG 7 WC Endocrinology & Metabolism; Nutrition & Dietetics SC Endocrinology & Metabolism; Nutrition & Dietetics GA 625MY UT WOS:000179821300014 PM 12490675 ER PT J AU Bratzler, DW Houck, PM Jiang, H Nsa, W Shook, C Moore, L Red, L AF Bratzler, DW Houck, PM Jiang, H Nsa, W Shook, C Moore, L Red, L TI Failure to vaccinate medicare inpatients - A missed opportunity SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID PNEUMOCOCCAL POLYSACCHARIDE VACCINE; PLACEBO-CONTROLLED TRIAL; PREVIOUS HOSPITAL-CARE; CHRONIC LUNG-DISEASE; HIGH-RISK ADULTS; INFLUENZA VACCINATION; ELDERLY PERSONS; COST-EFFECTIVENESS; CLINICAL EFFECTIVENESS; PROTECTIVE EFFICACY AB Background: Hospitalized elderly patients are at risk for subsequent influenza and pneumococcal disease. Despite this risk, they are often not vaccinated in this setting. Methods: We reviewed the medical records of a national sample of 107311 fee-for-service Medicare patients, 65 years or older, discharged from April 1, 1998, through March 31, 1999, with a principal diagnosis of acute myocardial infarction, heart failure, pneumonia, or stroke. We linked patient identifiers to Medicare Part B claims to identify influenza and pneumococcal vaccines paid for before, during, or after hospitalization. The main outcome measures were documentation by chart review or paid claim of influenza or pneumococcal vaccination. Results: Of the 104976 patients with a single hospitalization, 35 169 (33.5%; 95% confidence interval [CI], 33.2%-33.8%) received pneumococcal vaccination prior to admission, 444 (0.4%; 95% Cl, 0.4%-0.5%) were vaccinated in the hospital, and 1076 (1.0%; 95% Cl, 1.0%-1.1%) were vaccinated within 30 days of discharge. In the. subgroup of 40488 patients discharged from October through December, 12782 (31.6%; 95% CI, 31.1%-32.0%) received influenza vaccination prior to admission, 755 (1.9%; 95% Cl, 1.7%-2.0%) were vaccinated in the hospital, and 4302 (10.6%; 95% Cl, 10.3%-10.9%) were vaccinated after discharge. Of patients who were unvaccinated prior to admission, 97.3% (95% Cl, 97.1%-97.5%) did not receive influenza vaccine and 99.4% (95% Cl, 99.3%-99.4%) did not receive pneumococcal vaccine before hospital discharge. Conclusion: National recommendations for inpatient vaccination against influenza and pneumococcal disease are not being followed for the vast majority of eligible Medicare patients admitted to the hospital. C1 Oklahoma Fdn Med Qual Inc, Hlth Care Qual Improvement Program, Oklahoma City, OK 73134 USA. Ctr Medicare Serv, Seattle, WA USA. Ctr Medicaid Serv, Seattle, WA USA. RP Bratzler, DW (reprint author), Oklahoma Fdn Med Qual Inc, Hlth Care Qual Improvement Program, 14000 Quail Springs Pkwy,Suite 400, Oklahoma City, OK 73134 USA. NR 87 TC 49 Z9 55 U1 1 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0003-9926 J9 ARCH INTERN MED JI Arch. Intern. Med. PD NOV 11 PY 2002 VL 162 IS 20 BP 2349 EP 2356 DI 10.1001/archinte.162.20.2349 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 613TV UT WOS:000179148300009 PM 12418949 ER PT J AU Foody, JM Ferdinand, FD Galusha, DH Masoudi, FA Ordin, DL Havranek, EP Radford, MJ Krumholz, HM AF Foody, JM Ferdinand, FD Galusha, DH Masoudi, FA Ordin, DL Havranek, EP Radford, MJ Krumholz, HM TI Older patients undergoing CABG less likely to receive evidence-based therapies at discharge: Insights from the National AMI Project SO CIRCULATION LA English DT Meeting Abstract CT American-Heart-Association Abstracts From Scientific Sessions CY NOV 17-20, 2002 CL CHICAGO, ILLINOIS SP Amer Heart Assoc C1 Yale Univ, Sch Med, New Haven, CT USA. Lankenau Hosp, Wynnewood, PA USA. Denver Hlth Med Ctr, Denver, CO USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Yale Univ, Sch Med, New Haven, CT USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD NOV 5 PY 2002 VL 106 IS 19 SU S MA 2987 BP 604 EP 605 PG 2 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 613QJ UT WOS:000179142703025 ER PT J AU Rathore, SS Foody, JM Wang, YF Masoudi, FA Wolfe, P Havranek, EP Ordin, DL Krumholz, HM AF Rathore, SS Foody, JM Wang, YF Masoudi, FA Wolfe, P Havranek, EP Ordin, DL Krumholz, HM TI Race, sex, and the treatment of elderly patients hospitalized with heart failure SO CIRCULATION LA English DT Meeting Abstract CT American-Heart-Association Abstracts From Scientific Sessions CY NOV 17-20, 2002 CL CHICAGO, ILLINOIS SP Amer Heart Assoc C1 Yale Univ, Sch Med, New Haven, CT USA. Denver Hlth Med Ctr, Denver, CO USA. Colorado Fdn Med Care, Aurora, CO USA. Ctr Medicare & Medicaid Serv, Boston, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD NOV 5 PY 2002 VL 106 IS 19 SU S MA 3359 BP 681 EP 681 PG 1 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 613QJ UT WOS:000179142703397 ER PT J AU Luepker, R Lumley, T Jollis, J Rao, S Lapin, P McBean, AM Huang, Z Siscovick, D AF Luepker, R Lumley, T Jollis, J Rao, S Lapin, P McBean, AM Huang, Z Siscovick, D TI Medicare costs of physical inactivity in older adults SO CIRCULATION LA English DT Meeting Abstract CT American-Heart-Association Abstracts From Scientific Sessions CY NOV 17-20, 2002 CL CHICAGO, ILLINOIS SP Amer Heart Assoc C1 Univ Minnesota, Minneapolis, MN USA. Univ Washington, Seattle, WA 98195 USA. Duke Univ, Med Ctr, Durham, NC USA. Duke Univ, Clin Res Inst, Durham, NC USA. Ctr Medicare & Med Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD NOV 5 PY 2002 VL 106 IS 19 SU S MA 3509 BP 712 EP 712 PG 1 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 613QJ UT WOS:000179142703546 ER PT J AU Foody, JM Masoudi, FA Galusha, DH Rathore, SS Ordin, DL Havranek, EP Radford, MJ Krumholz, HM AF Foody, JM Masoudi, FA Galusha, DH Rathore, SS Ordin, DL Havranek, EP Radford, MJ Krumholz, HM TI Trends in AMI care: The national AMI project 1998 to 2002 SO CIRCULATION LA English DT Meeting Abstract CT American-Heart-Association Abstracts From Scientific Sessions CY NOV 17-20, 2002 CL CHICAGO, ILLINOIS SP Amer Heart Assoc C1 Yale Univ, Sch Med, New Haven, CT USA. Denver Hlth Med Ctr, Denver, CO USA. Qualidigm, Middletown, CT USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD NOV 5 PY 2002 VL 106 IS 19 SU S MA 3558 BP 722 EP 722 PG 1 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 613QJ UT WOS:000179142703594 ER PT J AU Primack, A AF Primack, A TI Future of obesity and disease management in health care: The government perspective SO OBESITY RESEARCH LA English DT Article; Proceedings Paper CT Task Force on Developing Obesity Outcomes and Learning Standards Symposium (TOOLS) CY JUN 11-13, 1999 CL WARRENTON, VIRGINIA C1 Fogarty Int Ctr, NIH, Hlth Care Financing Adm, Ctr Medicare, Bethesda, MD 20892 USA. Fogarty Int Ctr, NIH, Hlth Care Financing Adm, Ctr Medicaid, Bethesda, MD 20892 USA. RP Primack, A (reprint author), Fogarty Int Ctr, NIH, Hlth Care Financing Adm, Ctr Medicare, Bldg 31,Rm B2C39,31 Ctr Dr, Bethesda, MD 20892 USA. NR 1 TC 1 Z9 1 U1 0 U2 0 PU NORTH AMER ASSOC STUDY OBESITY PI SILVER SPRING PA 8630 FENTON ST, SUITE 918, SILVER SPRING, MD 20910 USA SN 1071-7323 J9 OBES RES JI Obes. Res. PD NOV PY 2002 VL 10 SU 1 BP 82S EP 83S DI 10.1038/oby.2002.196 PG 2 WC Endocrinology & Metabolism; Nutrition & Dietetics SC Endocrinology & Metabolism; Nutrition & Dietetics GA 619DX UT WOS:000179460000016 PM 12446865 ER PT J AU Streim, JE Beckwith, EW Arapakos, D Banta, P Dunn, R Hoyer, H AF Streim, JE Beckwith, EW Arapakos, D Banta, P Dunn, R Hoyer, H TI Regulatory oversight, payment policy, an quality improvement in mental health care in nursing homes SO PSYCHIATRIC SERVICES LA English DT Article ID PSYCHOTROPIC PRESCRIBING PRACTICES; OBRA-87 REGULATIONS; DRUG-USE; RESIDENTS; IMPACT AB During the past 15 years, federal regulations, survey and inspection programs, and payment policies have presented conflicting incentives and disincentives for the provision of mental health services in nursing homes in the United States. Policies and regulatory measures have reflected the concern that many patients in nursing homes are not receiving the mental health care they need, and, more prominently, the concern that some of the services that are provided. seem to be inappropriate or medically unnecessary. Despite evidence that payment policy and regulatory oversight can be used effectively to promote quality improvement, the need for improved access and quality of mental health services in long-term care remains substantial, Recent reports issued by the Surgeon General and by the Institute of Medicine identify a need for,refinements in the assessment process, the use of outcomes-based quality measures, and payment policies designed to improve access and quality. These elements must be coordinated to promote humane treatment in nursing homes, including access to medically necessary psychiatric care. C1 Univ Penn, Sect Geriat Psychiat, Philadelphia, PA 19104 USA. Philadelphia VA Med Ctr, Mental Illness Res Educ & Clin Ctr, Washington, DC USA. Dept Hlth & Human Serv, Off Inspector Gen, New York, NY USA. Dept Hlth & Human Serv, Ctr Medicare, New York, NY USA. Dept Hlth & Human Serv, Ctr Medicaid, New York, NY USA. RP Streim, JE (reprint author), Univ Penn, Sect Geriat Psychiat, 3535 Market St, Philadelphia, PA 19104 USA. FU NIMH NIH HHS [MH-52129] NR 27 TC 10 Z9 10 U1 0 U2 1 PU AMER PSYCHIATRIC PRESS, INC PI WASHINGTON PA 1400 K ST, N W, STE 1101, WASHINGTON, DC 20005 USA SN 1075-2730 J9 PSYCHIATR SERV JI Psychiatr. Serv. PD NOV PY 2002 VL 53 IS 11 BP 1414 EP 1418 DI 10.1176/appi.ps.53.11.1414 PG 5 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA 610EZ UT WOS:000178948900013 PM 12407269 ER PT J AU Foody, JM Rathore, SS Galusha, DH Masoudi, FA Havranek, EP Radford, MJ Ordin, DL Krumholz, HM AF Foody, JM Rathore, SS Galusha, DH Masoudi, FA Havranek, EP Radford, MJ Ordin, DL Krumholz, HM TI National patterns of care for patients with non ST-elevation MI: Insights from the national AMI project SO CIRCULATION LA English DT Meeting Abstract CT 4th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke CY OCT 13-14, 2002 CL WASHINGTON, D.C. SP Amer Heart Assoc Councils Cardiovasc Dis Young, Cardiovasc Nursing, Cardio Thorac & Vasc Surg, Amer Coll Cardiol Fdn, Dept Vet Affairs C1 Yale Univ, Sch Med, New Haven, CT USA. Qualidigm, Middletown, CT USA. Denver Hlth Med Ctr, Denver, CO USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD OCT 15 PY 2002 VL 106 IS 16 MA 1 BP E77 EP E77 PG 1 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 605NH UT WOS:000178683600024 ER PT J AU Hakim, RB Ronsaville, DS AF Hakim, RB Ronsaville, DS TI Effect of compliance with health supervision guidelines among US infants on emergency department visits SO ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE LA English DT Article ID IMMUNIZATION STATUS; MEXICAN-AMERICAN; CARE UTILIZATION; AMBULATORY CARE; UNITED-STATES; MEDICAL-CARE; CHILDREN; SERVICES; RATES; HOSPITALIZATION AB Background: There are few studies that demonstrate the health benefit of compliance with early periodic health supervision. Objective: To examine the association between emergency department (ED) use and compliance with prevailing guidelines for periodic health supervision for conditions that potentially could be avoided among a national cohort of US children. Design: This was a historic cohort study that combined maternal and primary care physician reports of the use of preventive care services for infants during the first 7 months of life from the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-up study. A preventive care scale used in Cox proportional hazards survival regression predicted the time to the first ED visit for selected diagnoses and all-cause visits controlling for illness severity. Results: Among children with incomplete well-child care in the first 6 months of life, there was an increased risk of having an ED visit for an upper respiratory tract infection (hazard ratio, 2.3; 95% confidence interval, 1.6-3.2), gastroenteritis (hazard ratio, 1.8; 95% confidence interval, 1.0-3.0), asthma (hazard ratio, 2.1; 95% confidence interval, 1.0-4.3), and all-cause ED visits (hazard ratio, 1.6; 95% confidence interval, 1.4-1.98). Conclusions: Because of the positive effect compliance with national guidelines for early well-child care has on lowering the risk of experiencing ED use, national efforts to improve the quality of child health services for young children should focus on increasing compliance with periodic preventive care for young children. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21224 USA. KEVRIC Co Inc, Baltimore, MD USA. RP Hakim, RB (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21224 USA. NR 39 TC 33 Z9 33 U1 0 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 1072-4710 J9 ARCH PEDIAT ADOL MED JI Arch. Pediatr. Adolesc. Med. PD OCT PY 2002 VL 156 IS 10 BP 1015 EP 1020 PG 6 WC Pediatrics SC Pediatrics GA 602EY UT WOS:000178493900012 PM 12361448 ER PT J AU Jha, A Patrick, DL MacLehose, RF Doctor, JN Chan, L AF Jha, A Patrick, DL MacLehose, RF Doctor, JN Chan, L TI Dissatisfaction with medical services among Medicare beneficiaries with disabilities SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION LA English DT Article; Proceedings Paper CT Annual Conference of the Association-of-Academic-Physiatrists CY MAR, 2000 CL LA JOLLA, CALIFORNIA SP Assoc Acad Physiatrists DE activities of daily living; disabled persons; Medicare; patient satisfaction; rehabilitation; survey ID PATIENT SATISFACTION; HEALTH-CARE; PREVENTIVE SERVICES; META-ANALYSIS; PREVALENCE; QUALITY; ADULTS; REHABILITATION; DISENROLLMENT; PERCEPTIONS AB Objective: To test the hypothesis that Medicare beneficiaries who have difficulties performing activities of daily living (ADLs) are more likely to report dissatisfaction with their health care than those without ADL difficulties. Design: Cross-sectional study. Setting: Sample from the 1998 Medicare Current Beneficiaries Survey. Participants: A population-based sample (N=19,650) of noninstitutionalized Medicare beneficiaries. Interventions: Not applicable. Main Outcome Measures: Satisfaction with overall quality and 9 specific aspects of medical services received in the last year. Results: After adjusting for sociodemographic, behavioral, and system characteristics and compared with those without ADL difficulties, Medicare enrollees were more likely to report dissatisfaction with the overall quality of their health care as their number of activity restrictions increased (1-2 ADLs: odds ratio [OR]=1.5; 95% confidence interval [CI], 1.2-2.0; 3-4 ADLs: OR=1.7; 95% CI, 1.2-2.4; 5-6 ADLs: OR=1.9; 95% CI, 1.4-2.8). Analysis of satisfaction with the 9 specific aspects of care yielded similar results. Conclusion: Disability is a significant independent risk factor for dissatisfaction with health care in the Medicare population. Efforts should be made to identify individuals with ADL difficulties and to improve their ease and convenience of getting to a doctor, the availability of care off hours, the access to specialists, and the follow-up care received. C1 Craig Hosp, Res Dept, Denver Hlth Med Ctr, Englewood, CO 80110 USA. Univ Colorado, Dept Rehabil Med, Denver, CO 80202 USA. Ctr Medicare & Medicaid Serv, Div Clin Stand & Qual, Seattle, WA USA. Univ Washington, Dept Rehabil Med, Seattle, WA 98195 USA. Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA. RP Jha, A (reprint author), Craig Hosp, Res Dept, Denver Hlth Med Ctr, 3425 S Clarkson St, Englewood, CO 80110 USA. FU NICHD NIH HHS [K 12 HD01097] NR 57 TC 35 Z9 35 U1 4 U2 7 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0003-9993 J9 ARCH PHYS MED REHAB JI Arch. Phys. Med. Rehabil. PD OCT PY 2002 VL 83 IS 10 BP 1335 EP 1341 DI 10.1053/apmr.2002.33986 PG 7 WC Rehabilitation; Sport Sciences SC Rehabilitation; Sport Sciences GA 600NT UT WOS:000178397800001 PM 12370864 ER PT J AU Ejaz, F Sangl, J Darby, C Larwook, D Hampton, N Bernard, S Hirsh, M Hornbostel, R Walley, J Lucenti, L Shriver, M Bailer, A Noble, R Straker, J Lucas, J Lowe, T AF Ejaz, F Sangl, J Darby, C Larwook, D Hampton, N Bernard, S Hirsh, M Hornbostel, R Walley, J Lucenti, L Shriver, M Bailer, A Noble, R Straker, J Lucas, J Lowe, T TI Federal and state initiatives in nursing home consumer satisfaction: Building relationships in a changing world - Part I SO GERONTOLOGIST LA English DT Meeting Abstract C1 Benjamin Rose, Cleveland, OH 44114 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Ctr Medicare & Medicaid, Baltimore, MD USA. Res Triangle Inst, Res Triangle Pk, NC USA. Vital Res LLC, Los Angeles, CA USA. Ohio Dept Aging, Columbus, OH USA. Dept Aging & Disabil, Waterbury, CT USA. Vermont Hlth Care Assoc, Montpellier, France. Scripps Gerontol Ctr, Oxford, OH USA. Dept Math, Oxford, OH USA. Inst Hlth Hlth Care Policy, Brunswick, NJ USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 159 EP 159 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541400560 ER PT J AU Visconti, M Gilden, D Kubisiak, J Hakim, R Blum, J Garnick, D AF Visconti, M Gilden, D Kubisiak, J Hakim, R Blum, J Garnick, D TI Missed opportunity : identifying causes of injury for medicare beneficiaries SO GERONTOLOGIST LA English DT Meeting Abstract C1 Brandeis Univ, Schneider Inst Hlth Policy, Waltham, MA USA. JEN Associates Inc, Cambridge, MA USA. Ctr Medicare, Baltimore, MD USA. Ctr Medicaid, Baltimore, MD USA. Schneider Inst Hlth Policy, Waltham, MA USA. Brandeis Univ, Schneider Inst Hlth Policy, Waltham, MA USA. RI Garnick, Deborah/I-9009-2012 NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 162 EP 162 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541400569 ER PT J AU Bernard, S Uhrig, J Elliott, M Bernard, S Sekcenski, E AF Bernard, S Uhrig, J Elliott, M Bernard, S Sekcenski, E TI Hearing from older adults about the quality of their health care experience: The medicare fee-for-service CAHPS survey SO GERONTOLOGIST LA English DT Meeting Abstract C1 Res Triangle Inst, Chapel Hill, NC 27514 USA. Rand Corp, Santa Monica, CA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. EM sbernard@rti.org NR 0 TC 0 Z9 0 U1 0 U2 0 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 298 EP 299 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541401065 ER PT J AU Noelker, L Clark, W Flanders, D Parker, P Glavin, Y Weiner, G Wilber, K Yip, J Gilden, D AF Noelker, L Clark, W Flanders, D Parker, P Glavin, Y Weiner, G Wilber, K Yip, J Gilden, D TI Linked medicare/medicaid date initiatives: Findings from four states SO GERONTOLOGIST LA English DT Meeting Abstract C1 Benjamin Rose, Cleveland, OH 44114 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Massachusetts Div Med Assistance, Boston, MA USA. Minnesota Dept Human Serv, St Paul, MN USA. Ohio Medicaid Finance Policy Anal Project, Moreland Hills, OH USA. Federat Commun Planning, Cleveland, OH USA. Andrus Gerontol Ctr, Los Angeles, CA USA. JEN Assoc Inc, Cambridge, MA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 314 EP 315 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541401124 ER PT J AU Robinson, K Velkoff, V Bernstein, A Smith, A Smith, D Potter, D Drabek, J McCormick, J Chulis, G AF Robinson, K Velkoff, V Bernstein, A Smith, A Smith, D Potter, D Drabek, J McCormick, J Chulis, G TI Issues in classifying and counting assisted living and other long-term care residences SO GERONTOLOGIST LA English DT Meeting Abstract C1 Natl Ctr Hlth Stat, Fed Forum Aging Related Stat, Hyattsville, MD 20782 USA. US Bur Census, Int Program Ctr, Washington, DC 20233 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. DHHS, OSASPE, Washington, DC USA. Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 342 EP 343 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541401196 ER PT J AU Murphy, K Moore, T Morris, J Mor, V Berg, K Harris, Y AF Murphy, K Moore, T Morris, J Mor, V Berg, K Harris, Y TI Ongoing development and validation of quality indicators(QIS): Utility of measures for public reporting SO GERONTOLOGIST LA English DT Meeting Abstract C1 Hebrew Rehabil Ctr Aged, Boston, MA 02131 USA. ABT Associates Inc, Cambridge, MA 02138 USA. HRCA, Res Training Inst, Boston, MA USA. Brown Univ, Sch Med, Providence, RI 02912 USA. McGill Univ, Montreal, PQ H3A 2T5, Canada. Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU GERONTOLOGICAL SOCIETY AMER PI WASHINGTON PA 1275 K STREET NW SUITE 350, WASHINGTON, DC 20005-4006 USA SN 0016-9013 J9 GERONTOLOGIST JI Gerontologist PD OCT PY 2002 VL 42 SI 1 BP 343 EP 343 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 620PH UT WOS:000179541401197 ER PT J AU Arday, DR Lapin, P Chin, J Preston, JA AF Arday, DR Lapin, P Chin, J Preston, JA TI Smoking patterns among seniors and the medicare stop smoking program SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE aged; cigarette smoking; health surveys; Medicare; smoking cessation ID RISK FACTOR SURVEILLANCE; OLDER SMOKERS; CESSATION; MORTALITY; COMMUNITIES; DISEASE; WOMEN; MEN; AGE AB Objectives: To characterize smoking patterns in the older U.S. community-dwelling Medicare population at the national level and in states chosen to participate in the new Medicare Stop Smoking Program (MSSP) demonstration. To describe the MSSP. Design: Data from the Behavioral Risk Factor Surveillance System (BRFSS) 1996 to 1999 were analyzed. Setting: The BRFSS is a cross-sectional random-digit-dialed telephone survey conducted in all states plus the District of Columbia and Puerto Rico. Participants: BRFSS respondents aged 65 and older who self-identified as receiving Medicare benefits. Measurements: Using BRFSS core questionnaire variables, recent trends in prevalence of current smoking and smoking cessation were estimated, as were prevalences by various demographic characteristics, for both the nation and the MSSP states as a group. Results: As of 1999, an estimated 10.2% of this population were current smokers, with those aged 65 to 74 smoking at twice the rate (12.9%) of those aged 75 and older (6.1%) and blacks (14.7%) smoking more than whites (10.0%). Between 1996 and 1999, the prevalence of everyday smokers indicating they had attempted to quit for 1 day or longer in the past year rose from 37.1% to 42.2%. National patterns were mirrored in the states chosen to participate in the MSSP. Conclusions: Young-old Medicare recipients have a higher smoking prevalence, although interest in quitting appears to be rising. The chosen MSSP states appear to be a representative of national smoking patterns in the older Medicare population. C1 Ctr Beneficiary Choices, Qual Measurements & Hlth Assessment Grp, Baltimore, MD USA. Ctr Medicare & Medicaid, Off Clin Stand & Qual, Coverage & Anal Grp, Baltimore, MD USA. Qualidigm, Middletown, CT USA. RP Arday, DR (reprint author), Attn MCHB TS EDM, Army Med Surveillance Activ, Bldg T-20,Rm 213,6900 Georgia Ave NW, Washington, DC 20307 USA. NR 40 TC 11 Z9 12 U1 3 U2 4 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD OCT PY 2002 VL 50 IS 10 BP 1689 EP 1697 DI 10.1046/j.1532-5415.2002.50461.x PG 9 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 602AP UT WOS:000178482800010 PM 12366623 ER PT J AU Rathore, SS Wang, YF Radford, MJ Ordin, DL Krumholz, HM AF Rathore, SS Wang, YF Radford, MJ Ordin, DL Krumholz, HM TI Sex differences in cardiac catheterization after acute myocardial infarction: The role of procedure appropriateness SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID CORONARY-ARTERY DISEASE; GENDER DIFFERENCES; HEART-DISEASE; ELDERLY PATIENTS; MANAGED CARE; ANGIOGRAPHY; WOMEN; MEN; OUTCOMES; BIAS AB Background: many studies have found that women are less likely than men to have cardiac catheterization after an acute myocardial infarction; however, it is unknown whether sex differences reflect inappropriate treatment. Objective: To ascertain whether cardiac catheterization use after acute myocardial infarction in men and women varied by sex and the appropriateness of the procedure, as determined by clinical guidelines. Design: Retrospective analysis of chart-abstracted data. Setting: U.S. acute-care hospitals. Patients: 143 444 Medicare patients who were hospitalized for acute myocardial infarction between 1994 and 1996. Measurements: Cardiac catheterization use within 60 days of hospitalization for acute myocardial infarction. Results: Women had lower crude rates of cardiac catheterization than men (35.7% for women vs. 46.5% for men [P < 0.001]; difference, 10.8 percentage points). Multivariable adjustment for demographic, clinical, and hospital characteristics reduced most of the sex differences in procedure use (risk-standardized rates, 40.3% for women vs. 41.9% for men [P < 0.001]; difference, 1.6 percentage points), Sex differences in cardiac catheterization use varied by the appropriateness of the procedure. Risk-standardized rates of cardiac catheterization were similar for men and women with strong indications for the procedure (44.1% for women vs. 44.6% for men [P > 0.2]; difference, 0.5 percentage point). Rates of cardiac catheterization use among patients with weak indications did not significantly differ between men and women (16.5% for women vs. 18.0% for men [P = 0.096]; difference, 1.5 percentage points). Sex differences in cardiac catheterization use were largest for patients with equivocal indications (39.4% for women vs. 42.5% for men [P < 0.001]; difference, 3.1 percentage points). Conclusions: Among elderly persons, women have lower rates of cardiac catheterization use after an acute myocardial infarction than men. However, this difference was attenuated after multivariable adjustment, and it occurred primarily in patients with equivocal indications. We found no sex variations in procedure use among patients who had strong indications for cardiac catheterization. C1 Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06520 USA. Yale New Haven Med Ctr, New Haven, CT 06504 USA. Qualidigm, Middletown, CT USA. Ctr Medicare Serv, Boston, MA USA. Ctr Medicaid Serv, Boston, MA USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Dept Internal Med, Room 1E-61 SHM,333 Cedar St,POB 208025, New Haven, CT 06520 USA. NR 42 TC 60 Z9 63 U1 0 U2 1 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 J9 ANN INTERN MED JI Ann. Intern. Med. PD SEP 17 PY 2002 VL 137 IS 6 BP 487 EP 493 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 594UJ UT WOS:000178069100002 PM 12230349 ER PT J AU Chan, L Beaver, S MacLehose, RF Jha, A Maciejewski, M Doctor, JN AF Chan, L Beaver, S MacLehose, RF Jha, A Maciejewski, M Doctor, JN TI Disability and health care costs in the medicare population SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION LA English DT Article DE activities of daily living; health care costs; medicare; rehabilitation ID PREVENTIVE SERVICES; ELDERLY PERSONS; SATISFACTION; CHARGES AB Objective: To determine the effect of activity limitations on health care expenditures. Design: Cross-sectional. Setting: National survey. Participants: Data from the 1997 Medicare Current Beneficiary Survey (n=9298), a nationally representative sample of community-dwelling Medicare beneficiaries who were older than 64 years of age. Interventions: Not applicable. Main Outcome Measures: The impact of patient disability on health care costs (inpatient, outpatient, skilled nursing facility, home health, medications). Activity limitations were determined by patient assessment of restrictions in activities of daily living (ADLs). Results: Over 20% (n=6,500,000) of the entire Medicare population had at least 1 health-related activity limitation. Total median health care costs per year (interquartile range [IQR]) increased as the number of these limitation increased (0 ADLs: $1934 [IQR, $801-$4761]; 1-2 ADLs: $4540 [IQR, $1744-$12,937]; 3-4 ADLs: $7589.[IQR, $2580-$23,149]; 5-6 ADLs: $14,399 [IQR, $5425-$33,014]). After adjusting for confounding characteristics including the impact of comor-bid illnesses, Medicare enrollees incurred higher health care costs as their number of activity limitations increased (0 ADLs: cost ratio=1.0; 1-2 ADLs: cost ratio=1.4 [95% confidence interval (CI), 1.2-1.6]; 3-4 ADLs: cost ratio=1.6 [95% CI, 1.3-2.0]; 5-6 ADLs: cost ratio=2.3 [95% CI, 1.7-3.2]). The cost increases were because of an increase in the frequency of all events (eg, hospital admissions, outpatient visits) rather than an increase in the intensity or cost of those events. In addition, with increasing activity limitations, there was a significant increase in the proportional impact of home health costs such that, for those with 5 or 6 limitations, home health costs exceeded the cost of outpatient visits. Conclusions: Activity limitation is an independent risk factor for increased health care costs and appears to be more than just a proxy for chronic illness. C1 Div Clin Standards, Seattle, WA 98121 USA. Ctr Medicare & Medicare Serv, Seattle, WA 98121 USA. Hlth Care Financing Adm, Seattle, WA USA. Univ Washington, Dept Rehabil Med, Seattle, WA 98195 USA. Univ Washington, Dept Rehabil Med, Seattle, WA 98195 USA. RP Chan, L (reprint author), Div Clin Standards, Reg 10,6Th Ave,Rm 800,MS-RX 40, Seattle, WA 98121 USA. NR 23 TC 53 Z9 54 U1 1 U2 4 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0003-9993 J9 ARCH PHYS MED REHAB JI Arch. Phys. Med. Rehabil. PD SEP PY 2002 VL 83 IS 9 BP 1196 EP 1201 DI 10.1053/apmr.2002.34811 PG 6 WC Rehabilitation; Sport Sciences SC Rehabilitation; Sport Sciences GA 591AE UT WOS:000177856500002 PM 12235597 ER PT J AU Feinglass, SR AF Feinglass, SR TI From chaos to care: The promise of team-based medicine SO HEALTH AFFAIRS LA English DT Book Review C1 Univ Washington, Seattle, WA 98195 USA. RP Feinglass, SR (reprint author), Ctr Medicare & Medicaid Serv, Coverage Anal Grp, Baltimore, MD USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2002 VL 21 IS 5 BP 297 EP 298 DI 10.1377/hlthaff.21.5.297 PG 2 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 591VE UT WOS:000177900300037 ER PT J AU Zarabozo, C AF Zarabozo, C TI Issues in managed care SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material AB This issue of the Health Care Financing Review includes a collection of articles on managed care topics in the public programs of Medicaid and Medicare. The first article looks at developments in Medicaid in the broader context of overall changes in the managed care marketplace, while the remaining articles examine specific topics that have significant policy implications for the public sector programs. C1 Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. RP Zarabozo, C (reprint author), Ctr Medicare & Medicaid Serv, 200 Independence Ave SW,325D Hubert H Humphrey Bl, Washington, DC 20201 USA. EM czarabozo@cms.hhs.gov NR 3 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2002 VL 24 IS 1 BP 1 EP 10 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OZ UT WOS:000231089100001 PM 12545596 ER PT J AU Murgolo, MS AF Murgolo, MS TI Comparison of medicare risk HMO and FFS enrollees SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Murgolo, MS (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM mmurgolo@cms.hhs.gov NR 0 TC 5 Z9 5 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2002 VL 24 IS 1 BP 177 EP 185 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OZ UT WOS:000231089100012 PM 12545605 ER PT J AU Daniels, FX Solid, CA Chen, SC Frankenfield, DL Collins, AJ AF Daniels, FX Solid, CA Chen, SC Frankenfield, DL Collins, AJ TI Assessment of anemia management in the ESRD population using the CPM data source SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract C1 Minneapolis Med Res Fdn Inc, US Renal Data Syst, Minneapolis, MN USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD SEP PY 2002 VL 13 SU S BP 219A EP 220A PG 2 WC Urology & Nephrology SC Urology & Nephrology GA 589KL UT WOS:000177757501077 ER PT J AU Frankenfield, DL Neu, AM Warady, BA Fivush, BA Johnson, CA Brem, AS AF Frankenfield, DL Neu, AM Warady, BA Fivush, BA Johnson, CA Brem, AS TI Intermediate outcomes for pediatric patients with low hemoglobin: Results from the 2001 ESRD CPM project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract C1 Ctr Medicare, Ctr Beneficiary Choices, Baltimore, MD USA. Ctr Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Johns Hopkins Univ, Dept Pediat Nephrol, Baltimore, MD USA. Childrens Mercy Hosp, Kansas City, MO 64108 USA. Rhode Isl Hosp, Providence, RI USA. Univ Wisconsin, Sch Pharm, Madison, WI 53706 USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD SEP PY 2002 VL 13 SU S BP 597A EP 597A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 589KL UT WOS:000177757502922 ER PT J AU Neu, A Frankenfield, D Warady, B Watkins, S Fivush, B AF Neu, A Frankenfield, D Warady, B Watkins, S Fivush, B TI Adolescent hemodialysis-longitudinal data from CMS' 2000 and 2001 ESRD CPM project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract C1 Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD SEP PY 2002 VL 13 SU S BP 618A EP 618A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 589KL UT WOS:000177757503024 ER PT J AU Frankenfield, DL Rocco, MV McClellan, WM AF Frankenfield, DL Rocco, MV McClellan, WM TI Intermediate outcomes for adult Asian hemodialysis patients in the US: Results from the 2001 ESRD CPM project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract C1 Ctr Medicare Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Ctr Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Wake Forest Univ, Nephrol Sect, Winston Salem, NC 27109 USA. Emory Univ, Dept Epidemiol, Atlanta, GA 30322 USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD SEP PY 2002 VL 13 SU S BP 622A EP 622A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 589KL UT WOS:000177757503042 ER PT J AU Frankenfield, D McClellan, W Rocco, M AF Frankenfield, D McClellan, W Rocco, M CA CMS CPM Project TI Are elderly hemodialysis patients at increased risk for adverse intermediate outcomes? Results from the 2001 CMS ESRD CPM Project. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract C1 Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD SEP PY 2002 VL 13 SU S BP 625A EP 626A PG 2 WC Urology & Nephrology SC Urology & Nephrology GA 589KL UT WOS:000177757503059 ER PT J AU McClellan, W Frankenfield, D Rocco, M AF McClellan, W Frankenfield, D Rocco, M TI Prevalence and characteristics of uncorrected anemia among hemodialysis patients: A population-based study. SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Meeting Abstract C1 Wake Forest Univ, Bowman Gray Sch Med, Nephrol Sect, Winston Salem, NC USA. Ctr Medicare Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD SEP PY 2002 VL 13 SU S BP 636A EP 636A PG 1 WC Urology & Nephrology SC Urology & Nephrology GA 589KL UT WOS:000177757503110 ER PT J AU Reddan, D Klassen, P Frankenfield, DL Szczech, L Schwab, S Coladonato, J Rocco, M Lowrie, EG Owen, WF AF Reddan, D Klassen, P Frankenfield, DL Szczech, L Schwab, S Coladonato, J Rocco, M Lowrie, EG Owen, WF CA Natl ESRD CPM Work Grp TI National profile of practice patterns for hemodialysis vascular access in the United States SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article ID CATHETERS; DIALYSIS; FISTULAS; MANAGEMENT; MORBIDITY; GRAFTS; US AB The Centers for Medicare & Medicaid Service's (CMS), national End-Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project is a data collection initiative to identify opportunities for improvement of care to adult, Medicare maintenance dialysis beneficiaries. This analysis of 1999 CPM data characterizes the profile of hemodialysis vascular access in the United States and identifies determinants of vascular access type 2 yr after the translation of vascular access clinical practice guideline statements into national CPMs. CPM data were collected during October to December 1999 and stratified by the 18 regional ESRD networks. Univariate and multivariable analyses were conducted to examine associations of access type with demographic, laboratory, and geographic variables. Multivariable logistic regression analyses were performed to identify independent variables associated with access type. A total of 8154 hemodialysis patients were sampled; 17% (n = 1399) were incident. Twenty-eight percent were dialyzed through an autologous arteriovenous fistula (AVF), 49% through a prosthetic graft (AVG), and 23% through a percutaneous catheter. Independent predictors of having a catheter for hemodialysis were female gender, white race, incident to hemodialysis status, and lower hemoglobin and serum albumin. For patients with a fistula or AVG, female gender (odds ration [OR], 2.46 [2.18 to 2.78]) and black race (OR, 1.70 [1.50 to 1.93]) were the strongest predictors of dialysis through an AVG. Other predictors of dialysis through an AVG were older age, increased body mass index (BMI), diabetes mellitus as the cause of ESRD, and lower serum albumin. Even in adjusted analyses, there was significant geographic variability with respect to hemodialysis access type. Despite translation of practice guidelines for hemodialysis vascular access into national CPMs, there is substantial geographic variability and gender and racial disparity in angioaccess allocation in the United States. Quality improvement strategies to improve the prevalence of fistulae should focus on selected regions and include physician education about their practice patterns and potential biases. C1 Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Durham, NC 27710 USA. Duke Univ, Med Ctr, Div Nephrol, Durham, NC 27710 USA. Ctr Medicare Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Ctr Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD USA. Wake Forest Univ, Bowman Gray Sch Med, Div Nephrol, Winston Salem, NC USA. RP Reddan, D (reprint author), Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Box 3646, Durham, NC 27710 USA. NR 35 TC 82 Z9 85 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD AUG PY 2002 VL 13 IS 8 AR UNSP 1046-6673/1308-2117 DI 10.1097/01.ASN.0000022422.79790.A8 PG 8 WC Urology & Nephrology SC Urology & Nephrology GA 575RE UT WOS:000176961000022 PM 12138144 ER PT J AU Warren, JL Klabunde, CN Schrag, D Bach, PB Riley, GF AF Warren, JL Klabunde, CN Schrag, D Bach, PB Riley, GF TI Overview of the SEER-Medicare data - Content, research applications, and generalizability to the United States elderly population SO MEDICAL CARE LA English DT Article; Proceedings Paper CT SEER-Medicare Workshop CY NOV, 2000 CL BETHESDA, MARYLAND DE SEER Program; Medicare; cancer; health services research; epidemiology ID HEALTH MAINTENANCE ORGANIZATIONS; BREAST-CANCER; CLAIMS DATA; COLORECTAL-CANCER; LUNG-CANCER; OLDER WOMEN; PROSTATE-CANCER; COLON-CANCER; ADJUVANT CHEMOTHERAPY; HOSPITAL VOLUME AB BACKGROUND. The Surveillance, Epidemiology and End,Results (SEER)-Medicare-linked database combines clinical information from population-based cancer, registries with claims information from the Medicare program. The use of this database to study cancer screening, treatment, outcomes, and costs has grown in recent years. RESEARCH DESIGN. This paper provides an overview of the SEER-Medicare files for investigators interested in using these data for epidemiologic and health services research. The overview includes a description of the linkage of SEER and Medicare data and the files included as part of SEER-Medicare. The paper also describes the types of research projects that have been undertaken using the SEER-Medicare data. The overview concludes with a comparison of selected characteristics of elderly persons residing in the SEER areas to the US total aged. RESULTS. The paper identifies a number of potential uses of. the SEER-Medicare data. The comparison of the elderly population in SEER to the US total shows that in the SEER areas areas there are a lower percentage of white and individuals living in poverty, and persons and, a higher percentage of urban-dwellers than the US total. Elderly persons in the SEER regions also have higher rates of HMO enrollment and lower rates of cancer mortality. CONCLUSIONS. The SEER-Medicare data are a unique resource that can be used for a variety of health services research projects. Although there are some differences between the elderly residing in the SEER areas and the US total, the SEER-Medicare data offer a large population-based cohort that can be used to longitudinally track care for persons over the course of cancer p, diagnosis, treatment, and follow-up. C1 NCI, Appl Res Program, DCCPS, Bethesda, MD 20892 USA. Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, Hlth Outcomes Res Grp, New York, NY 10021 USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Warren, JL (reprint author), NCI, Appl Res Program, DCCPS, Execut Plaza N,Room 4005,6130 Execut Blvd,MSC 734, Bethesda, MD 20892 USA. NR 67 TC 751 Z9 753 U1 11 U2 30 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD AUG PY 2002 VL 40 IS 8 SU S BP 3 EP 18 PG 16 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 581NY UT WOS:000177300200002 ER PT J AU Brown, ML Riley, GF Schussler, N Etzioni, R AF Brown, ML Riley, GF Schussler, N Etzioni, R TI Estimating health care costs related to cancer treatment from SEER-Medicare data SO MEDICAL CARE LA English DT Article; Proceedings Paper CT SEER-Medicare Workshop CY NOV, 2000 CL BETHESDA, MARYLAND DE SEER; Medicare; cancer; cost; expenditures ID COLORECTAL-CANCER; MASTECTOMY; SERVICES; DISEASE; IMPACT AB BACKGROUND. Cancer-specific medical care costs are used by health service researchers, medical decision analysts, and health care policymakers. The SEER-Medicare database is a unique data resource that makes it possible to derive incidence- and prevalence-based estimates of cancer-related medical care costs by site and stage of disease, by treatment approach, and for age and gender strata for individuals older than 65 years. OBJECTIVES. This paper describes the cost-related data available in the SEER-Medicare database, and discusses techniques and methods that have been used to derive various cost estimates from these data. The limitations of SEER-Medicare data as a source of cost estimates are also discussed., RESULTS. Examples of cost estimates for colorectal and breast cancer derived from SEER-Medicare are presented, including estimates of incidence-based cost (average cost per patient) by the initial, terminal, and continuing care phases of cancer treatment. Estimates of cancer-related treatment costs, costs by type of treatment, and long-term costs are presented, as are prevalence-based costs (aggregate Medicare and national expenditures) by cancer type. C1 NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. IMS Inc, Silver Spring, MD USA. Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA. RP Brown, ML (reprint author), NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, EPN-4005,6130 Execut Blvd, Bethesda, MD 20892 USA. NR 23 TC 212 Z9 214 U1 1 U2 8 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0025-7079 J9 MED CARE JI Med. Care PD AUG PY 2002 VL 40 IS 8 SU S BP 104 EP 117 PG 14 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 581NY UT WOS:000177300200014 ER PT J AU Martin, A Whittle, L Levit, K Won, G Hinman, L AF Martin, A Whittle, L Levit, K Won, G Hinman, L TI Health care spending during 1991-1998: A fifty-state review SO HEALTH AFFAIRS LA English DT Review ID ETHNIC-DIFFERENCES; SERVICES; INCOME; ACCESS AB Health care spending varies considerably across states. Spending per person ranged from $2,731 in Utah to $4,810 in Massachusetts in 1998, with Medicaid's share of total health care spending ranging from 9.1 percent in Nevada to 31.5 percent in New York. Research has suggested many reasons for such differences, including socioeconomic and demographic factors, market forces, and diversity in practice patterns. By using consistent methodologies among states, these 1991-1998 estimates, last produced for 1991 alone, will further the understanding of these differences. C1 Ctr Medicare Serv, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD USA. Ctr Medicaid Serv, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD USA. RP Martin, A (reprint author), Ctr Medicare Serv, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD USA. NR 29 TC 15 Z9 15 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JUL-AUG PY 2002 VL 21 IS 4 BP 112 EP 126 DI 10.1377/hlthaff.21.4.112 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 575ZM UT WOS:000176978400017 PM 12117122 ER PT J AU Kapp, MC AF Kapp, MC TI Provider- and plan-specific measures of quality SO HEALTH CARE FINANCING REVIEW LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Kapp, MC (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, 7500 Secur Blvd,C3-19-07, Baltimore, MD 21244 USA. EM mkapp@cms.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2002 VL 23 IS 4 BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OX UT WOS:000231088900001 PM 12500466 ER PT J AU Harris, Y Clauser, SB AF Harris, Y Clauser, SB TI Achieving improvement through nursing home quality measurement SO HEALTH CARE FINANCING REVIEW LA English DT Article ID RESIDENT ASSESSMENT INSTRUMENT AB CMS has initiated the Nursing Home Quality Initiative (NHQI) to improve the quality of nursing home care. Central to the NHQI is the public reporting of nursing home quality measures that serve as the basis for the Initiative's communication and quality improvement program. This article provides an overview of the NHQI, focusing on the role of nursing home quality measures in achieving improvements in nursing home care. We also describe the evolution of quality measurement in nursing homes, a recent CMS project to improve measures through risk adjustment and other refinements, the use of these measures in a pilot of the NHQI, and the lessons learned for future work in this area. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NCI, Bethesda, MD 20892 USA. RP Harris, Y (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,S3-02-01, Baltimore, MD 21244 USA. EM yharris@cms.hhs.gov NR 16 TC 29 Z9 29 U1 0 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2002 VL 23 IS 4 BP 5 EP 18 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OX UT WOS:000231088900002 PM 12500467 ER PT J AU Frederick, PR Maxey, NL Clauser, SB Sugarman, JR AF Frederick, PR Maxey, NL Clauser, SB Sugarman, JR TI Developing dialysis facility-specific performance measures for public reporting SO HEALTH CARE FINANCING REVIEW LA English DT Article ID STANDARDIZED MORTALITY RATIO; LIMITATIONS; CARE AB The Balanced Budget Act (BBA) of 1997 directed CMS to implement a system to measure and report the quality of dialysis services under Medicare by 2000. Because of this tight timeframe, a rapid-cycle measurement development process was initiated to develop dialysis facility-specific measures that could be released to the public. The result was "Dialysis Facility Compare" which has served as a template for the development of public reporting initiatives for other providers in the Medicare Program. This article describes the process used for developing and reporting these performance measures and the lessons learned for future work in this area. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NCI, Bethesda, MD 20892 USA. RP Frederick, PR (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,S3-02-01, Baltimore, MD 21244 USA. EM pfrederick@cms.hhs.gov NR 18 TC 12 Z9 12 U1 1 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2002 VL 23 IS 4 BP 37 EP 50 PG 14 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OX UT WOS:000231088900004 PM 12500469 ER PT J AU Lied, TR Malsbary, R Eisenberg, C Ranck, J AF Lied, TR Malsbary, R Eisenberg, C Ranck, J TI Combining HEDIS (R) indicators: A new approach to measuring plan performance SO HEALTH CARE FINANCING REVIEW LA English DT Article ID QUALITY; INFORMATION; CARE AB We developed a new framework for combining 17 Health Plan Employer Data and Information Set (HEDIS (R)) indicators into a single composite score. The resultant scale was highly reliable (coefficient alpha =0.88). A principal components analysis yielded three components to the scale: effectiveness of disease management, access to preventive and followup care, and achieving medication compliance in treating depression. This framework for reporting could improve the interpretation of HEDIS (R) performance data and is an important step for CMS as it moves towards a Medicare managed care (MMC) performance assessment program focused on outcomes-based measurement. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Lied, TR (reprint author), Ctr Medicare & Medicaid Serv, C4-13-01,7500 Secur Blvd, Baltimore, MD 21244 USA. EM tlied@cms.hhs.gov NR 20 TC 10 Z9 11 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2002 VL 23 IS 4 BP 117 EP 129 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OX UT WOS:000231088900009 PM 12500474 ER PT J AU Adler, GS Shatto, A AF Adler, GS Shatto, A TI Screening for osteoporosis and colon cancer under Medicare SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Adler, GS (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-16-27, Baltimore, MD 21244 USA. EM gadler@cms.hhs.gov NR 2 TC 4 Z9 4 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SUM PY 2002 VL 23 IS 4 BP 189 EP 200 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OX UT WOS:000231088900014 PM 12500479 ER PT J AU Coladonato, JA Frankenfield, DL Reddan, DN Klassen, PS Szczech, LA Johnson, CA Owen, WF AF Coladonato, JA Frankenfield, DL Reddan, DN Klassen, PS Szczech, LA Johnson, CA Owen, WF CA CMS ESRD Clin Performance Measu TI Trends in anemia management among US hemodialysis patients SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article ID RECOMBINANT-HUMAN-ERYTHROPOIETIN; CHRONIC-RENAL-FAILURE; CORE INDICATORS PROJECT; INTRAVENOUS IRON; CLINICAL-TRIAL; OUTCOME PREDICTOR; DIALYSIS; THERAPY; PHARMACOKINETICS; DISEASE AB This study was undertaken to describe the relationship between hematocrit (Hct) and changes in the prescribed dose of erythropoietin (EPO) as well as selected patient and process care measures across annual national samples of hemodialysis patients from 1994 to 1998. This study uses the cohorts identified in the ESRD Core Indicators Project, random samples of 6181. 6241, 6364. 6634, and 7660 patients stratified by ESRD Networks drawn for each year from 1994 to 1998. Patient demographic and clinical information was collected from October to December for each year. Surrogates of iron stores and patterns of iron and EPO administration were profiled from 1996 to 1998. Multivariable stepwise linear regression analyses were performed to adjust for potential confounding variables and to identify independent variables associated with Hct and EPO dose. Mean Hct and EPO dose increased each year from 3 1.1 +/- 5.2% to 34.1 +/- 3.7% and from 58.2 +/- 41.8 U/kg to 68.2 +/- 55.0 U/kg, respectively (P = 0.0001). Increasing Hct was positively associated with male gender more years on dialysis, older age, higher urea reduction ratio and transferrin saturation prescription of intravenous iron, and lower ferritin and EPO dose in multivariable models (all P = 0.0001). Male gender, older age, diabetes, higher Het, and increasing weight, urea reduction ration, and transferrin saturation were associated with lower EPO doses (all P < 0.01). Conversely intravenous EPO and iron were associated with higher prescribed EPO doses (all P = 0.0001). Although increasing Hct is associated with decreasing EPO dose at the patient level, the increase in Hct seen across years among the cohorts of hemodialysis patients in the United States has been associated with increasing doses of EPO at the population level. C1 Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Durham, NC 27710 USA. Ctr Medicare Serv, Off Clin Qual & Stand, Baltimore, MD USA. Ctr Medicaid Serv, Off Clin Qual & Stand, Baltimore, MD USA. Univ Wisconsin, Sch Pharm, Madison, WI 53706 USA. RP Coladonato, JA (reprint author), Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Box 3646, Durham, NC 27710 USA. FU AHRQ HHS [T32 HS0079-03]; NIDDK NIH HHS [DK02724-01A1] NR 56 TC 49 Z9 52 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1046-6673 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD MAY PY 2002 VL 13 IS 5 BP 1288 EP 1295 DI 10.1097/01.ASN.0000013294.11876.80 PG 8 WC Urology & Nephrology SC Urology & Nephrology GA 545HG UT WOS:000175210800019 PM 11961017 ER PT J AU Eggers, PW Frankenfield, DL Greer, JW McClellan, W Owen, WF Rocco, MV AF Eggers, PW Frankenfield, DL Greer, JW McClellan, W Owen, WF Rocco, MV TI Comparison of mortality and intermediate outcomes between medicare dialysis patients in HMO and fee for service SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE hemodialysis (HD); health maintenance organization (HMO); mortality; Medicare; transplantation ID UREA REDUCTION RATIO; HEMODIALYSIS-PATIENTS; BREAST-CANCER; MANAGED CARE; BENEFICIARIES; DISENROLLMENT; DIAGNOSIS; ENROLLEES; STAGE AB End-stage renal disease (ESRD) is the only disease entitlement for Medicare; therefore, most patients with ESRD have Medicare coverage. Patients with ESRD are prohibited by law from enrolling in health maintenance organizations (HMOs), the only group prohibited within Medicare. However, they may remain in an HMO if they enrolled in such a plan before their kidneys failed. Thus, it Is possible to compare patients with ESRD In HMOs with those In fee-for-service (FFS) plans. To determine whether mortality, transplantation rates, and intermediate outcomes differed between Medicare ESRD beneficiaries enrolled in HMO versus FFS providers, a retrospective cohort analysis was performed of patients with ESRD from three Health Care Financing Administration data sets containing administrative and outcome information for Medicare ESRD beneficiaries from 1990 to 1998. On December 31, 1998, a total of 278,510 prevalent patients with ESRD were In FFS plans, and 18,332 patients were In HMOs. HMO patients were older and more likely to be white and male and have diabetes mellitus and comorbid cardiovascular conditions than FFS patients. Unadjusted 2-year survival rates were 48.4% and 49.3% for FFS and HMO patients, respectively. In a multivariate model, HMO status had no significant effect on mortality, which was greater with older age, male sex, and white race. In 1998, unadjusted renal transplantation rates were 23.5% and 15.5% for FFS and HMO patients, respectively; age adjustment abrogated the apparent difference. For FFS and HMO patients, adequate hemodialysis was delivered to 72% and 82%, and 56% and 62% had hematocrits greater than the benchmark, respectively. There was no statistical difference in these outcomes in multivariate comparison. In conclusion, care by HMO for patients with an expensive chronic illness can achieve outcomes similar to those for FFS patients. Claims of poorer care and worse outcomes for patients with ESRD enrolled onto an HMO, an argument used to justify continued prohibition against widespread participation by patients with ESRD, are not supported. (C) 2002 by the National Kidney Foundation, Inc. C1 NIDDKD, Bethesda, MD 20892 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Durham, NC USA. W Georgia Med Ctr, La Grange, GA USA. Wake Forest Univ, Bowman Gray Sch Med, Nephrol Sect, Winston Salem, NC USA. RP Eggers, PW (reprint author), NIDDKD, Rm 615,6707 Democracy Blvd, Bethesda, MD 20892 USA. NR 31 TC 8 Z9 8 U1 0 U2 2 PU W B SAUNDERS CO PI PHILADELPHIA PA INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA SN 0272-6386 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD APR PY 2002 VL 39 IS 4 BP 796 EP 804 DI 10.1053/ajkd.2002.32000 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 538VD UT WOS:000174835000016 PM 11920346 ER PT J AU Yacht, AC Chaisson, CE Freund, KM Bramwell, L Ash, AS AF Yacht, AC Chaisson, CE Freund, KM Bramwell, L Ash, AS TI Sex and racial disparities in post-AMI procedures and mortality. SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 Boston Univ, Sch Med, Boston, MA 02118 USA. Boston Univ, Sch Publ Hlth, Boston, MA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL PUBLISHING INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0884-8734 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2002 VL 17 SU 1 BP 170 EP 170 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 544LB UT WOS:000175158200665 ER PT J AU Goldstein, SL Frankenfield, D Neu, A Warady, B Brem, A Watkins, S Friedman, A Fivush, B AF Goldstein, SL Frankenfield, D Neu, A Warady, B Brem, A Watkins, S Friedman, A Fivush, B TI Improvements in dialysis adequacy and anemia status in adolescent hemodialysis patients: Comparison between CMS' 2000 and 2001 ESRD CPM Projects SO PEDIATRIC RESEARCH LA English DT Meeting Abstract C1 Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2002 VL 51 IS 4 SU S MA 2516 BP 432A EP 432A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 536RA UT WOS:000174714602514 ER PT J AU Neu, A Frandenfield, D Warady, B Watkins, S Fivush, B AF Neu, A Frandenfield, D Warady, B Watkins, S Fivush, B TI Adolescent hemodialysis-longitudinal data from CMS' ESRD CPM project SO PEDIATRIC RESEARCH LA English DT Meeting Abstract C1 Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. NR 0 TC 2 Z9 2 U1 0 U2 0 PU INT PEDIATRIC RESEARCH FOUNDATION, INC PI BALTIMORE PA 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 USA SN 0031-3998 J9 PEDIATR RES JI Pediatr. Res. PD APR PY 2002 VL 51 IS 4 SU S MA 2522 BP 433A EP 433A PN 2 PG 1 WC Pediatrics SC Pediatrics GA 536RA UT WOS:000174714602520 ER PT J AU Foody, JM Rathore, SS Wang, YF Masoudi, FA Ordin, DL Krumholz, HM AF Foody, JM Rathore, SS Wang, YF Masoudi, FA Ordin, DL Krumholz, HM TI Cardiologists care for a distinct clinical subset of older patients hospitalized with heart failure: Experience from the national heart failure project SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Meeting Abstract C1 Yale Univ, Sch Med, Ctr Medicare, New Haven, CT 06520 USA. Yale Univ, Sch Med, Ctr Medicaid Serv, New Haven, CT 06520 USA. Colorado Fdn Med Care, Denver, CO USA. NR 0 TC 0 Z9 0 U1 0 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0735-1097 J9 J AM COLL CARDIOL JI J. Am. Coll. Cardiol. PD MAR 6 PY 2002 VL 39 IS 5 SU A BP 458A EP 458A PG 1 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 526AR UT WOS:000174106702061 ER PT J AU Foody, JM Rathore, SS Wang, YF Masoudi, FA Havranek, EP Ordin, DL Krumholz, HM AF Foody, JM Rathore, SS Wang, YF Masoudi, FA Havranek, EP Ordin, DL Krumholz, HM TI Physician specialty and quality of care for elderly patients hospitalized with heart failure SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Meeting Abstract C1 Yale Univ, Sch Med, Ctr Medicare, New Haven, CT 06520 USA. Colorado Fdn Med Care, Denver, CO USA. Yale Univ, Sch Med, Ctr Medicaid Serv, New Haven, CT 06520 USA. NR 0 TC 0 Z9 0 U1 0 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0735-1097 J9 J AM COLL CARDIOL JI J. Am. Coll. Cardiol. PD MAR 6 PY 2002 VL 39 IS 5 SU A BP 458A EP 458A PG 1 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 526AR UT WOS:000174106702060 ER PT J AU Frankenfield, DL Johnson, CA AF Frankenfield, DL Johnson, CA TI Current management of anemia in adult hemodialysis patients with end-stage renal disease SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article; Proceedings Paper CT American-Society-of-Health-System-Pharmacists Mid-Year Clinical Meeting CY DEC 06, 2001 CL NEW ORLEANS, LOUISIANA SP Amer Soc Hlth Syst Pharmacists DE anemia; dialysis; disease management; dosage; drug use; epoetin alfa; hematopoietic agents; injections; iron; iron preparations; kidney failure; race; sex ID PHARMACIST; EVENTS; CARE AB The management of anemia in adult end-stage renal disease (ESRD) patients receiving hemodialysis in dialysis facilities is examined. Clinical information was collected for a random sample of adult (age greater than or equal to 18 years) patients who received hemodialysis for ESRD between October and December 1999 and included hemoglobin concentrations, epoetin alfa doses and routes of administration, iron prescribing patterns, transferrin saturation levels, and serum ferritin concentrations. Patients whose data did not include hemoglobin concentrations with the weekly epoetin dose were excluded from the analysis. Associations by patient characteristics and geographic region were examined for clinical intermediate outcomes and epoetin alfa and iron prescribing practice patterns. Data were submitted for 8154 patients, and hemoglobin values linked to weekly epoetin alfa doses were available for 7573 of those patients. The mean hemoglobin concentration for patients in the sample was 11.4 +/- 1.3 g/dL. Sixty-seven percent of patients had mean hemoglobin values greater than or equal to 11 g/dL. Females, blacks, patients 18-44 years old, and patients receiving hemodialysis for less than six months exhibited significantly lower mean hemoglobin values despite being prescribed, on average, significantly higher epoetin alfa doses than males, whites, older patients, and patients receiving hemodialysis for six months or more (p < 0.001). There was significant regional variation in the prescribing patterns for s.c. epoetin alfa and i.v. iron (p < 0.001). Multi-variable logistic regression analysis found significant associations between mean hemoglobin values > 11 g/dL and certain patient characteristics, including white race, hemodialysis for six months or longer, lower prescribed weekly epoetin alfa doses, prescription of i.v. iron, mean transferrin saturation levels greater than or equal to 20%, mean KtN 2 greater than or equal to 1.2, and higher mean serum albumin values. Prescribing patterns for i.v. iron did not vary by the status of patients' iron stores. Regional and patient-specific variations in parameters of anemia management provide pharmacists with the opportunity to contribute to a multidisciplinary team approach to improve the care of hemodialysis patients. C1 Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Baltimore, MD 21244 USA. Univ Wisconsin, Sch Pharm, Madison, WI 53706 USA. RP Frankenfield, DL (reprint author), Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices, Mailstop S3-02-01,7500 Secur Blvd, Baltimore, MD 21244 USA. NR 18 TC 9 Z9 11 U1 0 U2 0 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 USA SN 1079-2082 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD MAR 1 PY 2002 VL 59 IS 5 BP 429 EP 435 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 527EW UT WOS:000174174600009 PM 11887409 ER PT J AU Heffler, S Smith, S Won, G Clemens, MK Keehan, S Zezza, M AF Heffler, S Smith, S Won, G Clemens, MK Keehan, S Zezza, M TI Health spending projections for 2001-2011: The latest outlook SO HEALTH AFFAIRS LA English DT Article AB This paper describes the most recent ten-year projections of national health spending. The projections, produced annually, are based on econometric and actuarial models of the health sector. Our current outlook includes a sharper near-term increase in the health sector's share of gross domestic product (GDP), which reaches 16.8 percent by 2010, compared with the 15.9 percent projected last year. This difference largely reflects legislation-cl riven increases in public spending growth combined with a weaker economic outlook. Recent acceleration in private-sector health spending is projected to peak in 2002. C1 Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD USA. RP Heffler, S (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD USA. NR 25 TC 70 Z9 71 U1 0 U2 2 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD MAR-APR PY 2002 VL 21 IS 2 BP 207 EP 218 DI 10.1377/hlthaff.21.2.207 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 530WN UT WOS:000174382100022 PM 11900160 ER PT J AU Goody, B Mentnech, R Riley, G AF Goody, B Mentnech, R Riley, G TI Changing nature of public and private health insurance SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Modicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Goody, B (reprint author), Ctr Medicare & Modicaid Serv, Off Res Dev & Informat, 7500 Secur Blvd,C3-24-07, Baltimore, MD 21244 USA. EM bgoody@cms.hhs.gov NR 14 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2002 VL 23 IS 3 BP 1 EP 7 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OW UT WOS:000231088800001 PM 12500345 ER PT J AU Murray, LA Eppig, FJ AF Murray, LA Eppig, FJ TI Insurance trends for the Medicare population, 1991-1999 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare, Baltimore, MD 21224 USA. Medicaid Serv, Baltimore, MD 21224 USA. RP Murray, LA (reprint author), Ctr Medicare, 7500 Secur Blvd,C3-17-07, Baltimore, MD 21224 USA. EM lmurray@cms.hhs.gov NR 7 TC 7 Z9 7 U1 0 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2002 VL 23 IS 3 BP 9 EP 15 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OW UT WOS:000231088800002 PM 12500346 ER PT J AU Wiatrowski, W Harvey, H Levit, KR AF Wiatrowski, W Harvey, H Levit, KR TI Employment-related health insurance: Federal agencies' roles in meeting data needs SO HEALTH CARE FINANCING REVIEW LA English DT Article AB Employer-sponsored health insurance accounts for almost one-third of all health care spending. As health care cost growth accelerates affecting the availability of employer-sponsored insurance and depth of coverage, the importance of timely and accurate information for measuring and monitoring these changes and formulating policy options increases. Identifying a growing gap between the need for and availability of data to inform policy on employment-related health insurance issues, the Office of Management and Budget (OMB) established a committee of Federal agency representatives to evaluate and advise data collection efforts. This article reports on the committee's current efforts, focusing on evaluation of results from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) and the National Compensation Survey (NCS). C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Levit, KR (reprint author), Ctr Medicare, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM klevit@cms.hhs.gov NR 7 TC 1 Z9 1 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2002 VL 23 IS 3 BP 115 EP 130 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OW UT WOS:000231088800008 PM 12500352 ER PT J AU Cowan, CA McDonnell, PA Levit, KR Zezza, MA AF Cowan, CA McDonnell, PA Levit, KR Zezza, MA TI Burden of health care costs: Businesses, households, and governments, 1987-2000 SO HEALTH CARE FINANCING REVIEW LA English DT Article AB In this article, we estimate expenditures by businesses, households, and governments in providing financing for health care for 1987-2000 and track measures of burden that these costs impose. Although burden measures for businesses and the Federal Government have stabilized or improved since 1993, measures of burden for State and local governments are deteriorating slightly-a situation that is likely to worsen in the near future. As health care spending accelerates and an economywide recession seems imminent, businesses, households, and governments that finance health care will face renewed health cost pressures on their revenue and income. C1 Off Actuary, Ctr Medicare, Baltimore, MD 21244 USA. Off Actuary, Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Cowan, CA (reprint author), Off Actuary, Ctr Medicare, 7500 Secur Blvd,N3-02-02, Baltimore, MD 21244 USA. EM along1@cms.hhs.gov NR 27 TC 12 Z9 12 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2002 VL 23 IS 3 BP 131 EP 159 PG 29 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OW UT WOS:000231088800009 PM 12500353 ER PT J AU Murray, LA Eppig, FJ AF Murray, LA Eppig, FJ TI Supplemental insurance for community aged and disabled beneficiaries: 1999 SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare, Baltimore, MD 21244 USA. Medicaid Serv, Baltimore, MD 21244 USA. RP Murray, LA (reprint author), Ctr Medicare, 7500 Secur Blvd,C3-17-07, Baltimore, MD 21244 USA. EM lmurray@cms.hhs.gov NR 0 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD SPR PY 2002 VL 23 IS 3 BP 161 EP 163 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 953OW UT WOS:000231088800010 PM 12500354 ER PT J AU Sheikh, K Bullock, C AF Sheikh, K Bullock, C TI Rise and fall of radical prostatectomy rates from 1989 to 1996 SO UROLOGY LA English DT Article ID CANCER; MEDICARE; TRENDS; PROGRAM; STROKE AB Objectives. To describe the changes in the rates of radical prostatectomy procedures, prostate-specific antigen (PSA) screening tests among Medicare beneficiaries, and the incidence of prostate cancer in the United States and to explain the exaggerated increase and decrease in the frequency of radical prostatectomy from 1989 to 1996. Methods. Medicare claims data on radical prostatectomy procedures and screening PSA tests and the National Cancer Institute's Surveillance, Epidemiology, and End Results prostate cancer incidence data were used to estimate the rates of PSA testing and radical prostatectomy among Medicare beneficiaries aged 65 to 74 years and 75 years and older (population rates). The age-specific true rates of the procedure were also estimated for the incident cases of prostate cancer (the population at risk of undergoing radical prostatectomy) among the beneficiaries. Results. The PSA test, prostate cancer incidence, and radical prostatectomy rates increased from 1989 to 1992. Thereafter, the incidence of prostate cancer, and the population and true rates of radical prostatectomy declined. The percentage of increase and decrease in the population rate of radical prostatectomy was approximately twice that in its true rate. Conclusions. The radical prostatectomy rates based on all Medicare beneficiaries grossly exaggerated the changes in the use of the procedure. Where possible, true rates, using the population at risk as the denominator, should be used in the studies of diagnostic and therapeutic procedures, complications, and adverse effects. C1 Ctr Medicare & Medicaid, US Dept HHS, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), Ctr Medicare & Medicaid, US Dept HHS, 601 E 12th St, Kansas City, MO 64106 USA. NR 26 TC 12 Z9 12 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0090-4295 J9 UROLOGY JI UROLOGY PD MAR PY 2002 VL 59 IS 3 BP 378 EP 382 AR PII S0090-4295(01)01588-6 DI 10.1016/S0090-4295(01)01588-6 PG 5 WC Urology & Nephrology SC Urology & Nephrology GA 530CT UT WOS:000174338600015 PM 11880074 ER PT J AU Hynes, DM Stroupe, KT Greer, JW Reda, DJ Frankenfield, DL Kaufman, JS Henderson, WG Owen, WF Rocco, MV Wish, JB Kang, J Feussner, JR AF Hynes, DM Stroupe, KT Greer, JW Reda, DJ Frankenfield, DL Kaufman, JS Henderson, WG Owen, WF Rocco, MV Wish, JB Kang, J Feussner, JR TI Potential cost savings of erythropoietin administration in end-stage renal disease SO AMERICAN JOURNAL OF MEDICINE LA English DT Article ID RECOMBINANT-HUMAN-ERYTHROPOIETIN; PATIENTS RECEIVING HEMODIALYSIS; EPOETIN; PHARMACOKINETICS; POPULATION; THERAPY; TRENDS; PAIN AB BACKGROUND: In a Department of Veterans Affairs randomized controlled trial, a lower dose of recombinant human erythropoietin (epoetin) was shown to attain target hematocrit levels when administered subcutaneously compared with intravenously. Since epoetin is expensive, optimizing the therapeutic effect of epoetin using a strategy that includes subcutaneous administration could lead to substantial cost savings. METHODS: We used an economic cost projection model to estimate potential savings to the Medicare End-Stage Renal Disease Program that could occur during a transition from intravenous to subcutaneous administration of epoetin among hemodialysis patients. Data included clinical results from the Department of Veterans Affairs randomized controlled trial, the 1998 Centers for Medicare and Medicaid Services' End-Stage Renal Disease Core Indicators Survey, and the 1997-1998 Medicare claims files. In sensitivity analyses, we varied the expected dose reductions (10% to 50%) and the proportion of patients (25% to 100%) who switched to subcutaneous administration. RESULTS: Medicare cost savings were estimated at $47 to $142 million annually as 25% to 75% of hemodialysis patients who received epoetin intravenously switched to subcutaneous administration while reducing the dose by 32%. A minimal reduction (10%) in epoetin dose would result in Medicare cost savings of an estimated $15 to $44 million annually. CONCLUSION: Administering epoetin subcutaneously would provide substantial cost savings to Medicare. For the transition to occur, consensus among stakeholders is needed, especially among patients whose treatment satisfaction and health-related quality of life would be most affected. (C)2002 by Excerpta Medica, Inc. C1 Dept Vet Affairs, Cooperat Studies Program Coordinating Ctr, Hines, IL USA. Midwest Ctr Hlth Serv & Policy Res, Hines, IL USA. VA Informat Resource Ctr, Hines, IL USA. Loyola Univ, Dept Med, Maywood, IL 60153 USA. Northwestern Univ, Dept Med, Chicago, IL 60611 USA. Ctr Medicare, Off Strateg Planning, Baltimore, MD USA. Ctr Medicaid Serv, Off Strateg Planning, Baltimore, MD USA. Off Clin Stand & Qual, Baltimore, MD USA. VA Boston Healthcare Syst, Renal Sect, Boston, MA USA. Duke Univ, Med Ctr, Duke Inst Renal Outcomes Res & Hlth Policy, Durham, NC USA. Wake Forest Univ, Bowman Gray Sch Med, Winston Salem, NC USA. Univ Hosp Cleveland, Div Nephrol, Cleveland, OH 44106 USA. Dept Vet Affairs, Washington, DC USA. RP Hynes, DM (reprint author), Edward Hines Jr Vet Adm Hosp, VA Cooperat Studies Program Coordinating Ctr 151K, 5th & Roosevelt Rd,Bldg 1,Room B240, Hines, IL 60141 USA. NR 22 TC 37 Z9 38 U1 0 U2 0 PU EXCERPTA MEDICA INC PI NEW YORK PA 650 AVENUE OF THE AMERICAS, NEW YORK, NY 10011 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD FEB 15 PY 2002 VL 112 IS 3 BP 169 EP 175 AR PII S0002-9343(01)01103-2 DI 10.1016/S0002-9343(01)01103-2 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 534TD UT WOS:000174602100001 PM 11893342 ER PT J AU Burken, MI Whyte, JJ AF Burken, MI Whyte, JJ TI Home international normalized ratio monitoring: Where evidence-based medicine is exemplified in the medicare coverage process SO JOURNAL OF THROMBOSIS AND THROMBOLYSIS LA English DT Article DE international normalized ratio; home monitoring; medicare ID SELF-MANAGEMENT; ANTICOAGULATION C1 Ctr Medicare Serv, Coverage & Anal Grp, Woodlawn, MD 21244 USA. Ctr Medicaid Serv, Coverage & Anal Grp, Woodlawn, MD 21244 USA. RP Burken, MI (reprint author), Ctr Medicare Serv, Coverage & Anal Grp, Mailstop C1-09-06,7500 Secur Blvd, Woodlawn, MD 21244 USA. NR 6 TC 3 Z9 3 U1 0 U2 0 PU KLUWER ACADEMIC PUBL PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0929-5305 J9 J THROMB THROMBOLYS JI J. Thromb. Thrombolysis PD FEB PY 2002 VL 13 IS 1 BP 5 EP 7 PG 3 WC Hematology; Peripheral Vascular Disease SC Hematology; Cardiovascular System & Cardiology GA 549AD UT WOS:000175421600001 PM 11994553 ER PT J AU Levit, K Smith, C Cowan, C Lazenby, H Martin, A AF Levit, K Smith, C Cowan, C Lazenby, H Martin, A TI Inflation spurs health spending in 2000 SO HEALTH AFFAIRS LA English DT Article C1 Ctr Medicare Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. Ctr Medicaid Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. RP Levit, K (reprint author), Ctr Medicare Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. NR 22 TC 62 Z9 62 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD JAN-FEB PY 2002 VL 21 IS 1 BP 172 EP 181 DI 10.1377/hlthaff.21.1.172 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 511LC UT WOS:000173264500024 PM 11900074 ER PT J AU Hoffman, ED Klees, BS Curtis, CA AF Hoffman, ED Klees, BS Curtis, CA TI Overview of the Medicare and Medicaid programs SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Off Actuary, Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Hoffman, ED (reprint author), Off Actuary, Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,N3-02-02, Baltimore, MD 21244 USA. NR 0 TC 2 Z9 2 U1 0 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PY 2002 SU S BP 1 EP + PG 377 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 945HV UT WOS:000230494500001 PM 15630768 ER PT J AU Warren, JL Brown, ML Fay, MP Schussler, N Potosky, AL Riley, GF AF Warren, JL Brown, ML Fay, MP Schussler, N Potosky, AL Riley, GF TI Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Article ID HEALTH MAINTENANCE ORGANIZATION; OLDER WOMEN; CONSERVING SURGERY; CARE; AGE; COMORBIDITY; MASTECTOMY; DIAGNOSIS; CARCINOMA; PATTERNS AB Purpose: This study provides population-based estimates of the treatment costs for elderly women with early-stage breast cancer, with emphasis on costs of modified radical mastectomy (MRM) compared with breast-conserving surgery (BCS) and radiation therapy (RT). Patients and Methods: Women with breast cancer from the Surveillance, Epidemiology, and End Results cancer registries were linked with their Medicare claims, 1990 through 1998. Each claim was assigned to an initial, continuing, or terminal care phase after a cancer diagnosis. Mean monthly phase-specific costs were determined for all health care and for treatment related only to cancer. Cumulative long-term costs of care that accrue during a women's remaining lifetime were calculated by treatment group. Results: Initial care costs for the 6 months after diagnosis for women who underwent BCS with RT were approximately $450 per month higher than for women with MRM. During the continuing-care phase, costs for women undergoing BCS with RT were significantly less expensive than for MRM cases. The two groups had similar costs in the terminal-care phase. Assuming the same survival distributions, long-term costs for women undergoing BCS with RT were not statistically different than for women undergoing MRM. Conclusion: Although mastectomy was less costly in the initial phase, the lifetime costs of BCS with RT and mastectomy were equivalent. Thus, women's preferences, resources to cover out-of-pocket costs, and life situations should be the major factors addressed in shared decision making about treatment options. (C) 2001 by American Society of Clinical Oncology. C1 NCI, Appl Res Program, Bethesda, MD 20892 USA. Informat Management Serv Inc, Silver Spring, MD USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Warren, JL (reprint author), NCI, Appl Res Program, Execut Plaza N,Rm 4005,6130 Execut Blvd, Bethesda, MD 20892 USA. RI Fay, Michael/A-2974-2008; OI Fay, Michael P./0000-0002-8643-9625 NR 45 TC 72 Z9 72 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0732-183X J9 J CLIN ONCOL JI J. Clin. Oncol. PD JAN 1 PY 2002 VL 20 IS 1 BP 307 EP 316 DI 10.1200/JCO.20.1.307 PG 10 WC Oncology SC Oncology GA 510XE UT WOS:000173231900040 PM 11773184 ER PT J AU Frankenfield, DL Neu, AM Warady, BA Watkins, SL Friedman, AL Fivush, BA AF Frankenfield, DL Neu, AM Warady, BA Watkins, SL Friedman, AL Fivush, BA TI Adolescent hemodialysis: results of the 2000 ESRD clinical performance measures project SO PEDIATRIC NEPHROLOGY LA English DT Article; Proceedings Paper CT 12th Congress of the International-Pediaric-Nephrology-Association CY SEP 04, 2001 CL SEATTLE, WASHINGTON SP Int Pediat Nephrol Assoc DE pediatric; adolescent; hemodialysis; clearance; access; hemoglobin; anemia; albumin AB In 2000, the Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration (HCFA) 2000 ESRD Clinical Performance Measures (CPM) Project, was expanded to obtain demographic characteristics and clinical information on all adolescent (age greater than or equal to12 years, <18 years) patients receiving in-center hemodialysis on 31 December, 1999. Of the 486 patients identified, 433 (89%) had the minimum required data submitted. Demographic characteristics included mean age of 15.8 years (+/-1.6 years). Forty-nine percent were white, 42% black; 21% were Hispanic. Congenital/urologic disease and focal and segmental sclerosis were the leading causes of end-stage renal disease. Forty-one percent had a catheter as their dialysis access, while 37% had an AV fistula and 22% an AV graft in place. The mean Kt/V was 1.47 (+/-0.38) and 79% had a mean calculated Kt/Vgreater than or equal to1.2, although residual renal function was not included in this measurement. After multivariate logistic regression, male gender and black race were among the factors predictive of mean calculated Kt/Vgreater than or equal to1.2. The mean serum albumin was 3.85 g/dl (+/-0.51) in patients with bromcresol green measurements and 3.62 mg/dl (+/-0.52) in patients with bromcresol purple measurements. The mean hemoglobin was 10.99 g/dl (+/-1.6) and 55% had a mean hemoglobin greater than or equal to11 g/dl. After multivariate logistic regression, lower epoetin dose and mean serum albumin greater than or equal to3.5/3.2 g/dl (BCG/BCP) remained predictive of mean hemoglobin greater than or equal to11 g/dl. These data provide important information about the clinical status of adolescent hemodialysis patients in the United States. Continued data collection and analyses are planned to identify areas for potential improvement in patient care. C1 Johns Hopkins Univ, Baltimore, MD 21287 USA. Ctr Beneficiary Choices, Ctr Medicare Serv, CMS, Baltimore, MD USA. Ctr Beneficiary Choices, Ctr Medicaid Serv, CMS, Baltimore, MD USA. Childrens Mercy Hosp, Kansas City, MO 64108 USA. Univ Washington, Childrens Hosp, Seattle, WA 98195 USA. Univ Wisconsin, Childrens Hosp, Madison, WI USA. Johns Hopkins Univ, Baltimore, MD USA. RP Neu, AM (reprint author), Johns Hopkins Univ, 600 N Wolfe St,Pk 327, Baltimore, MD 21287 USA. NR 6 TC 17 Z9 17 U1 0 U2 0 PU SPRINGER-VERLAG PI NEW YORK PA 175 FIFTH AVE, NEW YORK, NY 10010 USA SN 0931-041X J9 PEDIATR NEPHROL JI Pediatr. Nephrol. PD JAN PY 2002 VL 17 IS 1 BP 10 EP 15 PG 6 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 510GQ UT WOS:000173200700003 PM 11793128 ER PT J AU Sheikh, K AF Sheikh, K TI Cholesterol and carotid stenosis SO STROKE LA English DT Letter C1 US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. NR 3 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD JAN PY 2002 VL 33 IS 1 BP 321 EP 321 PG 1 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 509KV UT WOS:000173147700067 PM 11779935 ER PT J AU Nilasena, DS Kresowik, TF Wiblin, RT Piskac, AF Kresowik, RA Brenton, MA Wilwert, JM Hendel, ME AF Nilasena, DS Kresowik, TF Wiblin, RT Piskac, AF Kresowik, RA Brenton, MA Wilwert, JM Hendel, ME TI Assessing patterns of tPA use in acute stroke (AS) SO STROKE LA English DT Meeting Abstract C1 Ctr Medicare, Dallas, TX USA. Ctr Medicald Serv, Dallas, TX USA. Iowa Fdn Med Care, W Des Moines, IA USA. NR 0 TC 22 Z9 25 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0039-2499 J9 STROKE JI Stroke PD JAN PY 2002 VL 33 IS 1 MA 68 BP 354 EP 354 PG 1 WC Clinical Neurology; Peripheral Vascular Disease SC Neurosciences & Neurology; Cardiovascular System & Cardiology GA 509KV UT WOS:000173147700145 ER PT J AU Sheikh, K AF Sheikh, K TI Utility of provider volume as an indicator of medical care quality and for policy decisions SO AMERICAN JOURNAL OF MEDICINE LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; HEALTH-CARE; SURGICAL VOLUME; EXPERIENCE; REGIONALIZATION; SPHINCTEROTOMY; PREFERENCES; HOSPITALS; MORTALITY; SURVIVAL AB Associations between hospital volume or physician caseload and patient outcome have been used to assess the performance of health care providers. Although most studies have focused on major surgical procedures, in-hospital or 30-day mortality from many nonsurgical conditions and procedures has also been examined. Although high volume may be a surrogate for the provider's skill and experience, and better outcomes may attract greater volumes, aggregate data on provider volume show many outliers indicating that the outcome for some low-volume providers is better than that for high-volume providers. Mortality is only one measure of medical care quality. Although high volume may not always be indicative of favorable outcome, referral of patients from low-volume to high-volume providers has been recommended. It has also been suggested that patients choose health care providers on the basis of physician caseload. It is unclear how such recommendations could be implemented in practice; furthermore, they would deprive many patients from access to, as well as disrupt the provision of, adequate health care in many areas. An alternative to requiring patients to receive care from high-volume providers is to adopt other measures for improving outcomes, such as improving the quality of care provided by low-volume providers and attracting better providers to low-volume areas. Am J Med. 2001;111:712-715. (C) 2001 by Excerpta Medica, Inc. C1 US Dept HHS, Ctr Medicare Serv, Kansas City, MO 64106 USA. US Dept HHS, Ctr Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare Serv, Room 227,601 E 12th St, Kansas City, MO 64106 USA. NR 37 TC 10 Z9 10 U1 0 U2 2 PU EXCERPTA MEDICA INC PI NEW YORK PA 650 AVENUE OF THE AMERICAS, NEW YORK, NY 10011 USA SN 0002-9343 J9 AM J MED JI Am. J. Med. PD DEC 15 PY 2001 VL 111 IS 9 BP 712 EP 715 AR PII S0002-9343(01)00924-X DI 10.1016/S0002-9343(01)00924-X PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 539CC UT WOS:000174851300006 PM 11747851 ER PT J AU Sheikh, K AF Sheikh, K TI Clinical cause of death and autopsy results SO CHEST LA English DT Letter C1 US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, 601 E 12th St, Kansas City, MO 64106 USA. NR 5 TC 1 Z9 1 U1 0 U2 0 PU AMER COLL CHEST PHYSICIANS PI NORTHBROOK PA 3300 DUNDEE ROAD, NORTHBROOK, IL 60062-2348 USA SN 0012-3692 J9 CHEST JI Chest PD DEC PY 2001 VL 120 IS 6 BP 2114 EP 2114 DI 10.1378/chest.120.6.2114 PG 1 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA 504EF UT WOS:000172843800063 PM 11742952 ER PT J AU Flanigan, MJ Rocco, MV Prowant, B Frederick, PR Frankenfield, DL AF Flanigan, MJ Rocco, MV Prowant, B Frederick, PR Frankenfield, DL TI Clinical performance measures: The changing status of peritoneal dialysis SO KIDNEY INTERNATIONAL LA English DT Article DE CAPD; cycler dialysis; 1998 PD-CIS; solute clearance; adequacy of dialysis ID CORE INDICATORS; HEMODIALYSIS-PATIENTS; SERUM-ALBUMIN; CAPD PATIENTS; HEALTH-CARE; LONG-TERM; MORTALITY; ADEQUACY; NUTRITION; OUTCOMES AB Background. The Peritoneal Dialysis-Clinical Performance Measures Project (PD-CPM) characterizes peritoneal dialysis within the U.S. Current survey results are reported and compared to those of previous years. Methods. Prevalence data from random national samples of adult peritoneal dialysis (PD) patients participating in the United States End-Stage Renal Disease (ESRD) program have been collected annually since 1995. Results. In 1995, 79% of the respondents used continuous ambulatory peritoneal dialysis (CAPD) rather than automated peritoneal dialysis (APD). The mean hematocrit (Hct) of PD patients was 32% and only 66% of individuals had a measurement of dialysis adequacy reported. The mean weekly Kt/V-urea (wKt/V) and weekly creatinine clearance (wC(Cr)) reported for CAPD patients in 1995 were 1.9 and 67 L/1.73 m(2)/week, respectively. In 2000 the median age of PD patients was 55 years and 63% were white. The leading cause of ESRD was diabetes mellitus (34%) and 54% of adult PD patients performed some form of APD rather than CAPD. Age, sex, size, hematocrit, peritoneal permeability, dialysis adequacy, residual renal function and nutritional indices did not differ between APD and CAPD patients. The mean hemoglobin (Hb) for the 2000 PD-CPM population was 11.6 +/- 1.4 g/dL (mean +/- 1 SD) and 11% of patients had an average Hb below 10 g/dL. The average serum albumin was 3.5 +/- 0.5 g/dL by the bromcresol green method and 56% of subjects had an average serum albumin equal to or above 3.5 g/dL (or 3.2 g/dL by bromcresol purple). In 2000 85% of patients had a dialysis adequacy measurement reported and the mean calculated wKt/V and wC(Cr) were 2.3 +/- 0.6 and 72.7 +/- 24.9 liters/1.73 m(2)/week for CAPD patients and 2.3 0.6 and 71.6 +/- 25.1 L/1.73 m(2)/week for APD patients. PD subjects had a mean body weight of 76 +/- 19 kg and body mass index (BMI) of 27.5 +/- 6.4 kg/m(2). The protein equivalent of nitrogen appearance (nPNA) of these patients was 0.95 +/- 0.31 g/kg/day, their normalized creatinine appearance rate (nCAR) equaled 17 +/- 6.5 mg/kg/day, resulting in a percent lean body mass (%LBM) of 64 +/- 17% of actual body weight. Serum albumin correlated in a positive fashion with BMI, nPNA, nCAR and %LBM, but not with wC(Cr),. Conclusions. The majority of indicator variables monitored by the PD-CPM have improved since 1995. PD patients have higher hemoglobins and a greater proportion of patients meet the criteria for adequate dialysis. Serum albumin values, however, remain marginal and unchanged over the five-year project. Furthermore, serum albumin values fail to correlate with the intensity of renal replacement therapy and are not strongly correlated with alternative estimates of nutritional status. C1 Univ Iowa, Coll Med, Iowa City, IA USA. Wake Forest Univ, Sch Med, Winston Salem, NC USA. Univ Missouri, Sch Med, Dialysis Clin Inc, Columbia, MO USA. Ctr Medicare & Medicaid Serv, Qual Measurement & Hlth Assessment Grp, Off Clin Stand & Qual, Baltimore, MD USA. RP Flanigan, MJ (reprint author), Univ Iowa Hosp & Clin, Dept Med, T-305-GH,200 Hawkins Dr, Iowa City, IA 52242 USA. NR 32 TC 22 Z9 22 U1 0 U2 2 PU BLACKWELL SCIENCE INC PI MALDEN PA 350 MAIN ST, MALDEN, MA 02148 USA SN 0085-2538 J9 KIDNEY INT JI Kidney Int. PD DEC PY 2001 VL 60 IS 6 BP 2377 EP 2384 DI 10.1046/j.1523-1755.2001.00060.x PG 8 WC Urology & Nephrology SC Urology & Nephrology GA 493RN UT WOS:000172237400033 PM 11737613 ER PT J AU Cooper, JK Kohlmann, T AF Cooper, JK Kohlmann, T TI Factors associated with health status of older Americans SO AGE AND AGEING LA English DT Article DE back pain; health status; heart disease; lung disease; Medicare; SF-36 ID QUALITY-OF-LIFE; SURVEY SF-36; OUTCOMES; SURGERY AB Background: health status is increasingly used as a measure of healthcare effectiveness. How diseases and symptoms are associated with health status is not completely understood. Objectives: to find diseases, symptoms and demographic factors associated with physical and mental health status in older Americans. Methods: we analysed data from a survey of over 100 000 Medicare beneficiaries aged 65 and older. We used the short-form 36 physical and mental summary scores as measures of health status. Other data collected included demographic details, symptoms and diagnoses. Results: age as a single variable explained 4% of variation in physical health status. Adding other demographic information and increased disease burden explained variation to 8% and 27% respectively. Together, shortness of breath, back pain, difficulty getting in and out of chairs, arthritis of hip or knee, a recent change in health and age explained 54% of variation. All available variables explained 59%. The role of age as an independent factor decreased markedly after disease and symptoms were considered. Similar factors were associated with lower mental health status, but age was not. Conclusion: these data suggest that heart and lung disease and back pain are the most important factors affecting the average physical health status of older people. Sex, marital status and race have very little independent effect. Efforts to improve average physical health status scores might best be targeted at these conditions rather than demographic characteristics. Mental health status does not decline with age, and similar factors affect it but to a lesser degree. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. George Washington Univ, Med Ctr, Washington, DC 20037 USA. Univ Lubeck, Lubeck, Germany. RP Cooper, JK (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. NR 19 TC 30 Z9 32 U1 0 U2 0 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0002-0729 J9 AGE AGEING JI Age Ageing PD NOV PY 2001 VL 30 IS 6 BP 495 EP 501 DI 10.1093/ageing/30.6.495 PG 7 WC Geriatrics & Gerontology SC Geriatrics & Gerontology GA 510MY UT WOS:000173212900015 PM 11742779 ER PT J AU Robst, J AF Robst, J TI Cost efficiency in public higher education institutions SO JOURNAL OF HIGHER EDUCATION LA English DT Article ID ECONOMIES; SCALE; UNIVERSITIES; QUALITY; SCOPE AB This study reexamines the revenue and cost structures of higher education institutions. First, the article documents the reduced importance of state appropriations and the increased importance of tuition revenues during the early 1990s in public universities. Second it considers how the changed revenue structure influenced cost efficiency in public higher education institutions. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Robst, J (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 37 TC 19 Z9 20 U1 0 U2 14 PU OHIO STATE UNIV PRESS PI COLUMBUS PA 1050 CARMACK RD, COLUMBUS, OH 43210 USA SN 0022-1546 J9 J HIGH EDUC JI J. High. Educ. PD NOV-DEC PY 2001 VL 72 IS 6 BP 730 EP + DI 10.2307/2672901 PG 22 WC Education & Educational Research SC Education & Educational Research GA 486EX UT WOS:000171806400004 ER PT J AU Fishman, A Fessler, H Martinez, F McKenna, RJ Naunheim, K Piantadosi, S Weinmann, G Wise, R AF Fishman, A Fessler, H Martinez, F McKenna, RJ Naunheim, K Piantadosi, S Weinmann, G Wise, R CA National Emphysema Treatment Trial TI Patients at high risk of death after lung-volume-reduction surgery SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID OBSTRUCTIVE PULMONARY-DISEASE; SEVERE EMPHYSEMA; DIFFUSING-CAPACITY; PREDICTORS; MORBIDITY; MORTALITY; VALUES; REHABILITATION; PNEUMONOPLASTY; PNEUMOPLASTY AB Background: Lung-volume-reduction surgery is a proposed treatment for emphysema, but optimal selection criteria have not been defined. The National Emphysema Treatment Trial is a randomized, multicenter clinical trial comparing lung-volume-reduction surgery with medical treatment. Methods: After evaluation and pulmonary rehabilitation, we randomly assigned patients to undergo lung-volume-reduction surgery or receive medical treatment. Outcomes were monitored by an independent data and safety monitoring board. Results: A total of 1033 patients had been randomized by June 2001. For 69 patients who had a forced expiratory volume in one second (FEV(sub 1)) that was no more than 20 percent of their predicted value and either a homogeneous distribution of emphysema on computed tomography or a carbon monoxide diffusing capacity that was no more than 20 percent of their predicted value, the 30-day mortality rate after surgery was 16 percent (95 percent confidence interval, 8.2 to 26.7 percent), as compared with a rate of 0 percent among 70 medically treated patients (P<0.001). Among these high-risk patients, the overall mortality rate was higher in surgical patients than medical patients (0.43 deaths per person-year vs. 0.11 deaths per person-year; relative risk, 3.9; 95 percent confidence interval, 1.9 to 9.0). As compared with medically treated patients, survivors of surgery had small improvements at six months in the maximal workload (P=0.06), the distance walked in six minutes (P=0.03), and FEV(sub 1) (P<0.001), but a similar health-related quality of life. The results of the analysis of functional outcomes for all patients, which accounted for deaths and missing data, did not favor either treatment. Conclusions: Caution is warranted in the use of lung-volume-reduction surgery in patients with emphysema who have a low FEV(sub 1) and either homogeneous emphysema or a very low carbon monoxide diffusing capacity. These patients are at high risk for death after surgery and also are unlikely to benefit from the surgery. (N Engl J Med 2001;345:1075-83.) Copyright (C) 2001 Massachusetts Medical Society. C1 Baylor Coll Med, Houston, TX 77030 USA. Brigham & Womens Hosp, Boston, MA 02115 USA. Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. Cleveland Clin Fdn, Cleveland, OH 44195 USA. Columbia Univ, New York, NY USA. Long Isl Jewish Med Ctr, New Hyde Pk, NY 11042 USA. Duke Univ, Med Ctr, Durham, NC USA. Mayo Clin & Mayo Fdn, Rochester, MN 55905 USA. Natl Jewish Med & Res Ctr, Denver, CO USA. Ohio State Univ, Columbus, OH 43210 USA. St Louis Univ, St Louis, MO 63103 USA. Temple Univ, Philadelphia, PA 19122 USA. Univ Calif San Diego, San Diego, CA 92103 USA. Univ Maryland, College Pk, MD 20742 USA. Johns Hopkins Univ Hosp, Baltimore, MD 21287 USA. Univ Michigan, Ann Arbor, MI 48109 USA. Univ Penn, Philadelphia, PA 19104 USA. Univ Pittsburgh, Pittsburgh, PA 15260 USA. Univ Washington, Seattle, WA 98195 USA. Agcy Healthcare Res & Qual, Rockville, MD USA. Johns Hopkins Univ, Coordinating Ctr, Baltimore, MD USA. Fred Hutchinson Canc Res Ctr, Cost Effectivness Data Ctr, Seattle, WA 98104 USA. Univ Iowa, CT Scan Image Storage & Anal Ctr, Iowa City, IA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Temple Univ, Mkt Ctr, Philadelphia, PA 19122 USA. Univ Penn, Off Chair Steering Comm, Philadelphia, PA 19104 USA. NHLBI, Project Off, Bethesda, MD 20892 USA. RP Piantadosi, S (reprint author), NETT, Coordinating Ctr, 615 N Wolfe St,Rm 5010, Baltimore, MD 21205 USA. OI Wise, Robert/0000-0002-8353-2349 NR 50 TC 296 Z9 301 U1 0 U2 3 PU MASSACHUSETTS MEDICAL SOC/NEJM PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 J9 NEW ENGL J MED JI N. Engl. J. Med. PD OCT 11 PY 2001 VL 345 IS 15 BP 1075 EP 1083 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 480QH UT WOS:000171473100001 ER PT J AU Sheikh, K AF Sheikh, K TI High-density lipoprotein cholesterol and risk of stroke SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv, Kansas City, MO USA. NR 5 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60610 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 3 PY 2001 VL 286 IS 13 BP 1573 EP 1573 DI 10.1001/jama.286.13.1573 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 478HH UT WOS:000171340600010 PM 11585466 ER PT J AU Wilcox, SA Koepke, CP Levenson, R Thalheimer, JC AF Wilcox, SA Koepke, CP Levenson, R Thalheimer, JC TI Registry-driven, community-based immunization outreach: A randomized controlled trial SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID PRENATAL-CARE UTILIZATION; INNER-CITY; CHILDREN; COVERAGE; ADEQUACY; PROGRAM; RATES AB Objectives. This study evaluated the effectiveness of registry-driven, community-based outreach directed toward children with immunization delays. Methods. A sample of 1856 children aged 6 to 10 months was randomly assigned to receive either outreach or no intervention. Results. Children in the outreach group were more likely to receive an immunization during the observation period than children in the control group (61% vs 43%). Outreach was most effective for children with multiple risks, as measured by their immunization record; it was not effective for children whose mothers had received inadequate prenatal care. Conclusions. Registry-driven outreach can effectively identify high-risk children and bring them to care. C1 Kent State Univ, Dept Sociol, Kent, OH 44242 USA. Albert Einstein Med Ctr, Off Childrens Hlth Policy Res, Philadelphia, PA 19141 USA. Div Dis Control City Philadelphia, Philadelphia, PA USA. RP Koepke, CP (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. NR 15 TC 10 Z9 10 U1 0 U2 2 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 1015 FIFTEENTH ST NW, WASHINGTON, DC 20005 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD SEP PY 2001 VL 91 IS 9 BP 1507 EP 1511 DI 10.2105/AJPH.91.9.1507 PG 5 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 466MY UT WOS:000170650400044 PM 11527789 ER PT J AU Tunis, SR Kang, JL AF Tunis, SR Kang, JL TI Improvements in Medicare coverage of new technology SO HEALTH AFFAIRS LA English DT Editorial Material C1 Ctr Medicare Serv, Coverage & Anal Grp, Off Clin Stand & Qual, Baltimore, MD USA. Ctr Medicaid Serv, Coverage & Anal Grp, Off Clin Stand & Qual, Baltimore, MD USA. RP Tunis, SR (reprint author), Ctr Medicare Serv, Coverage & Anal Grp, Off Clin Stand & Qual, Baltimore, MD USA. NR 8 TC 19 Z9 20 U1 0 U2 0 PU PROJECT HOPE PI BETHESDA PA 7500 OLD GEORGETOWN RD, STE 600, BETHESDA, MD 20814-6133 USA SN 0278-2715 J9 HEALTH AFFAIR JI Health Aff. PD SEP-OCT PY 2001 VL 20 IS 5 BP 83 EP 85 DI 10.1377/hlthaff.20.5.83 PG 3 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 470GP UT WOS:000170862800008 PM 11558723 ER PT J AU Goldstein, E AF Goldstein, E TI CMS's consumer information efforts SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Goldstein, E (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Bvd,S1-15-03, Baltimore, MD 21244 USA. EM egoldstein@cms.hhs.gov NR 4 TC 8 Z9 8 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2001 VL 23 IS 1 BP 1 EP 4 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 943TZ UT WOS:000230378800001 PM 12500358 ER PT J AU Goldstein, E Teichman, L Crawley, B Gaumer, G Joseph, C Reardon, L AF Goldstein, E Teichman, L Crawley, B Gaumer, G Joseph, C Reardon, L TI Lessons learned from the national Medicare & you education program SO HEALTH CARE FINANCING REVIEW LA English DT Article AB In fall 1998 CMS implemented the National Medicare Education Program (NMEP) to educate beneficiaries about their Medicare program benefits,health plan choices,- supplemental health insurance,-beneficiary rights, responsibilities, and protections; and health behaviors. CMS has been monitoring the implementation of the NMEP in six case study sites as well as monitoring each of the information channels for communicating with beneficiaries. This article describes select findings from the case studies, and highlights from assessment activities related to the Medicare & You handbook, the toll-free 1-800-MEDICARE Helpline, Internet, and Regional Education About Choices in Health (REACH). C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. ABT Associates Inc, Cambridge, MA 02138 USA. RP Goldstein, E (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,S1-15-03, Baltimore, MD 21244 USA. EM egoldstein@cms.hhs.gov NR 4 TC 16 Z9 16 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2001 VL 23 IS 1 BP 5 EP 20 PG 16 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 943TZ UT WOS:000230378800002 PM 12500359 ER PT J AU Fyock, J Koepke, CP Meitl, J Sutton, S Thompson, E Engelberg, M AF Fyock, J Koepke, CP Meitl, J Sutton, S Thompson, E Engelberg, M TI Beneficiary decisionmaking: The impact of labeling health plan choices SO HEALTH CARE FINANCING REVIEW LA English DT Article ID MEDICARE; INFORMATION AB One critical health plan decision concerns choosing an original Medicare plan or a Medicare managed care plan. Evidence suggests that people are confused by the phrase "Original Medicare plan." Using focus group and Q-sort methodology, the authors sought to identify a name for the Medicare fee-for-service (FFS) product. Two key insights were gained. First, participants used the word "Medicare" to name the FFS product. Second, participants did not choose between two plans. Rather, they decided between supplemental insurance and a managed care product. These factors should influence how CMS "brands" not only the FFS product but also the overall Medicare program. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Fyock, J (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,S1-15-03, Baltimore, MD 21244 USA. EM jfyock@cms.hhs.gov NR 14 TC 7 Z9 7 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2001 VL 23 IS 1 BP 63 EP 75 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 943TZ UT WOS:000230378800006 PM 12500363 ER PT J AU Swift, EK Koepke, CP Ferrer, JA Miranda, D AF Swift, EK Koepke, CP Ferrer, JA Miranda, D TI Preventing medical errors: Communicating a role for Medicare beneficiaries SO HEALTH CARE FINANCING REVIEW LA English DT Article ID INFORMED DECISION-MAKING; DOCTORS; INFORMATION AB This study used a focus group methodology to examine how Medicare beneficiaries reacted to messages on specific kinds of preventive action, including those adopted by public and private section health organizations. Beneficiaries were asked to rank the messages on their own, and then to discuss their rankings in focus groups. The best-received messages advocated a collaborative patient-provider relationship. They also specified which actions to take, and how to implement them. The authors conclude that public health campaigns to reduce errors need not undermine trust in providers. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Koepke, CP (reprint author), Ctr Medicare & Medicaid Serv, S1-15-03,7500 Secur Blvd, Baltimore, MD 21244 USA. EM ekoepke@cms.hhs.gov NR 34 TC 11 Z9 11 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2001 VL 23 IS 1 BP 77 EP 85 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 943TZ UT WOS:000230378800007 PM 12500364 ER PT J AU Riley, G Herboldsheimer, C AF Riley, G Herboldsheimer, C TI Including hospice in Medicare capitation payments: Would it save money? SO HEALTH CARE FINANCING REVIEW LA English DT Article ID CARE; LIFE AB Hospice, services received by Medicare risk-based health maintenance organization (HMO) enrollees are paid on a non-capitated basis, creating financial incentives for HMOs to encourage their terminally ill patients to elect hospice. Using Medicare administrative records for 1998, we found that hospice enrollment in the last month of life was significantly higher among HMO enrollees than among beneficiaries in fee-for-service (FFS). However, low mortality rates among HMO enrollees produced similar population-based rates of hospice use in the HMO and FFS sectors. Simulations showed that including hospice care under capitation payments in July 1998 would have produced very small savings for Medicare. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Riley, G (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,C3-20-17, Baltimore, MD 21244 USA. EM griley@cms.hhs.gov NR 18 TC 3 Z9 3 U1 1 U2 1 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2001 VL 23 IS 1 BP 137 EP 147 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 943TZ UT WOS:000230378800011 PM 12500368 ER PT J AU Lied, TR Sheingold, S AF Lied, TR Sheingold, S TI HEDIS (R) performance trends in Medicare managed care SO HEALTH CARE FINANCING REVIEW LA English DT Article ID QUALITY AB The authors analyzed performance trends between 1996 and 1998 for health plans in the Medicare managed care program. Four measures from the Health Employer Data and Information Set (HEDIS (R)) were used to track performance changes: adult access to preventive/ambulatory health services, beta blocker treatment following heart attacks, breast cancer screening, and eye exams for people with diabetes. Using a cohort analysis at the health plan level, statistically significant improvements in performance rates were observed for all measures. Health plans exhibiting relatively poor performance in 1996 accounted for the largest share of overall improvement in these measures across years. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Lied, TR (reprint author), Ctr Medicare & Medicaid Serv, C4-13-01,7500 Secur Blvd, Baltimore, MD 21244 USA. EM tlied@cms.hhs.gov NR 12 TC 13 Z9 13 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PD FAL PY 2001 VL 23 IS 1 BP 149 EP 160 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 943TZ UT WOS:000230378800012 PM 12500369 ER PT J AU Hoffman, ED Klees, BS Curtis, CA AF Hoffman, ED Klees, BS Curtis, CA TI Overview of the Medicare and Medicaid programs SO HEALTH CARE FINANCING REVIEW LA English DT Article C1 Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD 21244 USA. RP Hoffman, ED (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, 7500 Security Blvd,N3-02-02, Baltimore, MD 21244 USA. EM dholt@cms.hhs.gov NR 0 TC 2 Z9 2 U1 0 U2 0 PU CENTERS FOR MEDICARE & MEDICAID SERVICES PI BALTIMORE PA 7500 SECURITY BOULEVARD, BALTIMORE, MD 21244-1850 USA SN 0195-8631 J9 HEALTH CARE FINANC R JI Health Care Finan. Rev. PY 2001 SU S BP 1 EP 355 PG 355 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 945HT UT WOS:000230494300001 PM 12820295 ER EF