FN Thomson Reuters Web of Science™ VR 1.0 PT J AU Lloyd-Jones, DM Huffman, MD Karmali, KN Sanghavi, DM Wright, JS Pelser, C Gulati, M Masoudi, FA Goff, DC AF Lloyd-Jones, Donald M. Huffman, Mark D. Karmali, Kunal N. Sanghavi, Darshak M. Wright, Janet S. Pelser, Colleen Gulati, Martha Masoudi, Frederick A. Goff, David C., Jr. TI Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology SO CIRCULATION LA English DT Article DE AHA Scientific Statements; cardiovascular diseases; morbidity; mortality; myocardial infarction; population; prevention; stroke ID ADULT TREATMENT PANEL; SERVICES TASK-FORCE; RANDOMIZED-TRIALS; OUTCOME INCIDENCE; NATIONAL-HEALTH; STATIN THERAPY; MULTIFACTORIAL INTERVENTION; QUITTING SMOKING; FACTOR BURDEN; EXCESS RISK AB The Million Hearts Initiative has a goal of preventing 1 million heart attacks and strokes-the leading causes of mortality-through several public health and healthcare strategies by 2017. The American Heart Association and American College of Cardiology support the program. The Cardiovascular Risk Reduction Model was developed by Million Hearts and the Center for Medicare & Medicaid Services as a strategy to assess a value-based payment approach toward reduction in 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) by implementing cardiovascular preventive strategies to manage the "ABCS" (aspirin therapy in appropriate patients, blood pressure control, cholesterol management, and smoking cessation). The purpose of this special report is to describe the development and intended use of the Million Hearts Longitudinal ASCVD Risk Assessment Tool. The Million Hearts Tool reinforces and builds on the "2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk" by allowing clinicians to estimate baseline and updated 10-year ASCVD risk estimates for primary prevention patients adhering to the appropriate ABCS over time, alone or in combination. The tool provides updated risk estimates based on evidence from high-quality systematic reviews and meta-analyses of the ABCS therapies. This novel approach to personalized estimation of benefits from risk-reducing therapies in primary prevention may help target therapies to those in whom they will provide the greatest benefit, and serves as the basis for a Center for Medicare & Medicaid Services program designed to evaluate the Million Hearts Cardiovascular Risk Reduction Model. C1 [Lloyd-Jones, Donald M.] Northwestern Univ, Evanston, IL 60208 USA. [Goff, David C., Jr.] Colorado Sch Publ Hlth, Aurora, CO USA. [Gulati, Martha] Univ Arizona, Tucson, AZ 85721 USA. [Huffman, Mark D.; Karmali, Kunal N.] Northwestern Univ Prevent Med, Chicago, IL USA. [Masoudi, Frederick A.] Univ Colorado, Boulder, CO 80309 USA. [Masoudi, Frederick A.] Colorado Cardiovasc Outcomes Consortium, Denver, CO USA. [Pelser, Colleen] Mitre Corp, Mclean, VA USA. [Sanghavi, Darshak M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Wright, Janet S.] Ctr Dis Control & Prevent, Atlanta, GA USA. RP Lloyd-Jones, DM (reprint author), Northwestern Univ, Evanston, IL 60208 USA. FU Center for Medicare and Medicaid Innovation; National Cancer Institute; NHLBI; National Institute of Biomedical Imaging and Bioengineering; Center for Medicare and Medicaid Innovation/The MITRE Corporation; JR Alberts Foundation (FoodSwitch USA); World Heart Federation FX Donald M. Lloyd-Jones Northwestern University Center for Medicare and Medicaid Innovation; Mark D. Huffman Northwestern University Preventive Medicine National Cancer Institute; NHLBI; National Institute of Biomedical Imaging and Bioengineering; Center for Medicare and Medicaid Innovation/The MITRE Corporation; JR Alberts Foundation (FoodSwitch USA); World Heart Federation NR 77 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0009-7322 EI 1524-4539 J9 CIRCULATION JI Circulation PD MAR 28 PY 2017 VL 135 IS 13 BP E793 EP + DI 10.1161/CIR.0000000000000467 PG 37 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA EP4YY UT WOS:000397387200001 PM 27815375 ER PT J AU Izurieta, HS Wernecke, M Kelman, J Wong, S Forshee, R Pratt, D Lu, Y Sun, Q Jankosky, C Krause, P Worrall, C MaCurdy, T Harpaz, R AF Izurieta, Hector S. Wernecke, Michael Kelman, Jeffrey Wong, Sarah Forshee, Richard Pratt, Douglas Lu, Yun Sun, Qin Jankosky, Christopher Krause, Philip Worrall, Chris MaCurdy, Tom Harpaz, Rafael TI Effectiveness and Duration of Protection Provided by the Live-attenuated Herpes Zoster Vaccine in the Medicare Population Ages 65 Years and Older SO CLINICAL INFECTIOUS DISEASES LA English DT Article DE Herpes Zoster vaccine; vaccine effectiveness; post-herpetic neuralgia; opthalmic zoster; elderly ID POSTHERPETIC NEURALGIA; VARICELLA-VACCINATION; PROPENSITY SCORE; ADULTS; RISK; ASSOCIATION; EFFICACY; RATES; PAIN; BIAS AB Background. Tens of millions of seniors are at risk of herpes zoster (HZ) and its complications. Live attenuated herpes zoster vaccine (HZV) reduces that risk, although questions regarding effectiveness and durability of protection in routine clinical practice remain. We used Medicare data to investigate HZV effectiveness (VE) and its durability. Methods. This retrospective cohort study included beneficiaries ages >= 65 years during January 2007 through July 2014. Multiple adjustments to account for potential bias were made. HZV-vaccinated beneficiaries were matched to unvaccinated beneficiaries (primary analysis) and to HZV-unvaccinated beneficiaries who had received pneumococcal vaccination (secondary analysis). HZ outcomes in community and hospital settings were analyzed, including ophthalmic zoster (OZ) and postherpetic neuralgia (PHN). Results. Among eligible beneficiaries (average age 77 years), the primary analysis found VE for community HZ of 33% (95% CI: 32%-35%) and 19% (95% CI: 17%-22%), for the first 3, and subsequent 4+ years postvaccination, respectively. In the secondary analysis, VE was, respectively, 37% (95% CI: 36%-39%) and 22% (95% CI: 20%-25%). In the primary analysis, VE for PHN was 57% (95% CI: 52%-61%) and 45% (95% CI: 36%-53%) in the first 3 and subsequent 4+ years, respectively; VE for hospitalized HZ was, respectively, 74% (95% CI: 67%-79%) and 55% (95% CI: 39%-67%). Differences in VE by age group were not significant. Conclusions. In both the primary and secondary analyses, HZV provided protection against HZ across all ages, but effectiveness declined over time. VE was higher and better preserved over time for PHN and HZ-associated hospitalizations than for community HZ. C1 [Izurieta, Hector S.; Forshee, Richard; Pratt, Douglas; Lu, Yun; Jankosky, Christopher; Krause, Philip] US FDA, Ctr Biol Evaluat & Res, Silver Spring, MD USA. [Wernecke, Michael; Wong, Sarah; Sun, Qin; MaCurdy, Tom] Acumen LLC, Burlingame, CA USA. [Kelman, Jeffrey; Worrall, Chris] Ctr Medicare & Medicaid Serv, Washington, DC USA. [Harpaz, Rafael] Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, Atlanta, GA USA. [Izurieta, Hector S.] Univ Rey Juan Carlos, Madrid, Spain. RP Izurieta, HS (reprint author), 10903 New Hampshire Ave, Silver Spring, MD 20993 USA. EM Hector.izurieta@fda.hhs.gov FU Food and Drug Administration; office of the Assistant Secretary of Planning and Evaluation FX This work was funded by the Food and Drug Administration. Additional funding was provided by the office of the Assistant Secretary of Planning and Evaluation. NR 34 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 EI 1537-6591 J9 CLIN INFECT DIS JI Clin. Infect. Dis. PD MAR 15 PY 2017 VL 64 IS 6 BP 785 EP 793 DI 10.1093/cid/ciw854 PG 9 WC Immunology; Infectious Diseases; Microbiology SC Immunology; Infectious Diseases; Microbiology GA EP3TI UT WOS:000397304200014 PM 28362955 ER PT J AU Ng, JH Ye, FY Ward, LM Haffer, SC Scholle, SH AF Ng, Judy H. Ye, Faye Ward, Lauren M. Haffer, Samuel C Scholle, Sarah Hudson TI Data On Race, Ethnicity, And Language Largely Incomplete For Managed Care Plan Members SO HEALTH AFFAIRS LA English DT Article ID DISPARITIES AB The Affordable Care Act requires the federal government to collect and report population data on race, ethnicity, and language needs to help reduce health and health care disparities. We assessed data availability in commercial, Medicaid, and Medicare managed care plans using the Healthcare Effectiveness Data and Information Set. Data availability varied but remained largely incomplete. C1 [Ng, Judy H.; Ye, Faye; Ward, Lauren M.; Scholle, Sarah Hudson] Natl Comm Qual Assurance, Washington, DC 20005 USA. [Ng, Judy H.] Princeton Univ, Woodrow Wilson Sch Publ & Int Affairs, Princeton, NJ 08544 USA. [Haffer, Samuel C] Ctr Medicare & Medicaid Serv, Off Minor Hlth, Data & Policy Analyt Grp, Baltimore, MD USA. RP Ng, JH (reprint author), Natl Comm Qual Assurance, Washington, DC 20005 USA.; Ng, JH (reprint author), Princeton Univ, Woodrow Wilson Sch Publ & Int Affairs, Princeton, NJ 08544 USA. EM ng@ncqa.org FU Centers for Medicare and Medicaid Services (CMS) [HHSM-500-2014-00442G] FX An early version of this article was presented at the 2016 AcademyHealth Annual Research Meeting, in Boston, Massachusetts, June 27, 2016. The research in this article was supported by the Centers for Medicare and Medicaid Services (CMS) (Contract No. HHSM-500-2014-00442G). The views expressed in this article are those of the authors and do not necessarily reflect those of CMS or the Department of Health and Human Services. No author has a financial conflict of interest to disclose other than employment at the National Committee for Quality Assurance, which developed the performance metrics used in this study. Helpful edits from Jessica Briefer French and Holly Spalt are gratefully acknowledged. NR 15 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 PY 2017 VL 36 IS 3 BP 548 EP 552 DI 10.1377/hlthaff.2016.1044 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA EN9RS UT WOS:000396337900023 PM 28264958 ER PT J AU Keehan, SP Stone, DA Poisal, JA Cuckler, GA Sisko, AM Smith, SD Madison, AJ Wolfe, CJ Lizonitz, JM AF Keehan, Sean P. Stone, Devin A. Poisal, John A. Cuckler, Gigi A. Sisko, Andrea M. Smith, Sheila D. Madison, Andrew J. Wolfe, Christian J. Lizonitz, Joseph M. TI National Health Expenditure Projections, 2016-25: Price Increases, Aging Push Sector To 20 Percent Of Economy SO HEALTH AFFAIRS LA English DT Article AB Under current law, national health expenditures are projected to grow at an average annual rate of 5.6 percent for 2016-25 and represent 19.9 percent of gross domestic product by 2025. For 2016, national health expenditure growth is anticipated to have slowed 1.1 percentage points to 4.8 percent, as a result of slower Medicaid and prescription drug spending growth. For the rest of the projection period, faster projected growth in medical prices is partly offset by slower projected growth in the use and intensity of medical goods and services, relative to that observed in 2014-16 associated with the Affordable Care Act coverage expansions. The insured share of the population is projected to increase from 90.9 percent in 2015 to 91.5 percent by 2025. C1 [Keehan, Sean P.] Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD 21244 USA. [Stone, Devin A.; Cuckler, Gigi A.; Sisko, Andrea M.; Smith, Sheila D.; Madison, Andrew J.; Wolfe, Christian J.; Lizonitz, Joseph M.] CMS Off Actuary, Baltimore, MD USA. [Poisal, John A.] CMS Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. RP Keehan, SP (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD 21244 USA. EM sean.keehan@cms.hhs.gov NR 14 TC 0 Z9 0 U1 8 U2 8 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 PY 2017 VL 36 IS 3 BP 553 EP 563 DI 10.1377/hlthaff.2016.1627 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA EN9RS UT WOS:000396337900024 PM 28202501 ER PT J AU Joynt, KE De Lew, N Sheingold, SH Conway, PH Goodrich, K Epstein, AM AF Joynt, Karen E. De Lew, Nancy Sheingold, Steven H. Conway, Patrick H. Goodrich, Kate Epstein, Arnold M. TI Should Medicare Value-Based Purchasing Take Social Risk into Account? SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Joynt, Karen E.; Epstein, Arnold M.] Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA. [Joynt, Karen E.; Epstein, Arnold M.] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA. [Joynt, Karen E.; De Lew, Nancy; Sheingold, Steven H.] Dept Hlth & Human Serv, Off Assistant Secretary Planning & Evaluat, Washington, DC 20201 USA. [Conway, Patrick H.; Goodrich, Kate] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Joynt, KE (reprint author), Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA.; Joynt, KE (reprint author), Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA.; Joynt, KE (reprint author), Dept Hlth & Human Serv, Off Assistant Secretary Planning & Evaluat, Washington, DC 20201 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 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD FEB 9 PY 2017 VL 376 IS 6 BP 510 EP 513 DI 10.1056/NEJMp1616278 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA EJ8XL UT WOS:000393510500003 PM 28029802 ER PT J AU Press, MJ Howe, R Schoenbaum, M Cavanaugh, S Marshall, A Baldwin, L Conway, PH AF Press, Matthew J. Howe, Ryan Schoenbaum, Michael Cavanaugh, Sean Marshall, Ann Baldwin, Lindsey Conway, Patrick H. TI Medicare Payment for Behavioral Health Integration SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID CARE C1 [Press, Matthew J.; Howe, Ryan; Cavanaugh, Sean; Marshall, Ann; Baldwin, Lindsey; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Schoenbaum, Michael] NIMH, Bethesda, MD 20892 USA. RP Press, MJ (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 5 TC 0 Z9 0 U1 1 U2 1 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD FEB 2 PY 2017 VL 376 IS 5 BP 405 EP 407 DI 10.1056/NEJMp1614134 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA EJ8WH UT WOS:000393507200001 PM 27973984 ER PT J AU Tefera, L Lehrman, WG Goldstein, EG Agrawal, S AF Tefera, Lemeneh Lehrman, William G. Goldstein, Elizabeth G. Agrawal, Shantanu TI A Special Contribution from the Centers for Medicare and Medicaid Services: Valuing Patient Experience While Addressing the Prescription Opioid Epidemic SO ANNALS OF EMERGENCY MEDICINE LA English DT Editorial Material ID UNITED-STATES; PAIN INTENSITY; SATISFACTION; SURGERY; RESPONSES C1 [Tefera, Lemeneh] Ctr Medicare & Medicaid Serv, Qual Measurement & Value Based Incent Grp, Baltimore, MD 21244 USA. [Lehrman, William G.; Goldstein, Elizabeth G.] Ctr Medicare & Medicaid Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD USA. [Agrawal, Shantanu] Ctr Medicare & Medicaid Serv, Ctr Program Integr, Baltimore, MD USA. RP Tefera, L (reprint author), Ctr Medicare & Medicaid Serv, Qual Measurement & Value Based Incent Grp, Baltimore, MD 21244 USA. EM lemeneh.tefera@hhs.cms.gov NR 18 TC 1 Z9 1 U1 0 U2 0 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD FEB PY 2017 VL 69 IS 2 BP 181 EP 183 DI 10.1016/j.annemergmed.2016.06.047 PG 3 WC Emergency Medicine SC Emergency Medicine GA EJ9FV UT WOS:000393532900009 PM 27451119 ER PT J AU Winpenny, E Elliott, MN Haas, A Haviland, AM Orr, N Shadel, WG Ma, S Friedberg, MW Cleary, PD AF Winpenny, Eleanor Elliott, Marc N. Haas, Ann Haviland, Amelia M. Orr, Nate Shadel, William G. Ma, Sai Friedberg, Mark W. Cleary, Paul D. TI Advice to Quit Smoking and Ratings of Health Care among Medicare Beneficiaries Aged 65+ SO HEALTH SERVICES RESEARCH LA English DT Article DE Survey research and questionnaire design; clinical practice; incentives in health care; Medicare; patient assessment; satisfaction; substance abuse: alcohol; chemical dependency; tobacco ID RESPIRATORY-TRACT INFECTIONS; AFFECT PATIENT SATISFACTION; CONSEQUENCES; EXPERIENCES; CESSATION AB ObjectiveTo examine the relationship between physician advice to quit smoking and patient care experiences. Data SourceThe 2012 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Study DesignFixed-effects linear regression models were used to analyze cross-sectional survey data, which included a nationally representative sample of 26,432 smokers aged 65+. Principal FindingsEleven of 12 patient experience measures were significantly more positive among smokers who were always advised to quit smoking than those advised to quit less frequently. There was an attenuated but still significant and positive association of advice to quit smoking with both physician rating and physician communication, after controlling for other measures of care experiences. ConclusionsPhysician-provided cessation advice was associated with more positive patient assessments of their physicians. C1 [Elliott, Marc N.] RAND Corp, 1776 Main St, Santa Monica, CA 90407 USA. [Winpenny, Eleanor] Univ Cambridge, MRC Epidemiol Unit, Cambridge, England. [Winpenny, Eleanor] Univ Cambridge, Ctr Diet & Activ Res CEDAR, Cambridge, England. [Haas, Ann; Haviland, Amelia M.; Shadel, William G.] RAND Corp, RAND Hlth, Pittsburgh, PA USA. [Haviland, Amelia M.] Carnegie Mellon Univ, Heinz Sch Publ Policy & Management, Stat, Pittsburgh, PA 15213 USA. [Orr, Nate] RAND Corp, Santa Monica, CA USA. [Ma, Sai] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Friedberg, Mark W.] RAND Corp, RAND Hlth, Boston, MA USA. [Cleary, Paul D.] Yale Sch Publ Hlth, Sch Publ Hlth, New Haven, CT USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St, Santa Monica, CA 90407 USA. EM elliott@rand.org FU Centers for Medicare & Medicaid Services [HHSM-500-2005-00028I] FX We thank Fergal McCarthy for preparing the manuscript. This study was funded by contract HHSM-500-2005-00028I from the Centers for Medicare & Medicaid Services to RAND. NR 22 TC 0 Z9 0 U1 0 U2 0 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 FEB PY 2017 VL 52 IS 1 BP 207 EP 219 DI 10.1111/1475-6773.12491 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA EJ9XC UT WOS:000393579500012 PM 27061081 ER PT J AU Frilling, S AF Frilling, Stephanie TI Medicare Telehealth Services and Nephrology: Policies for Eligibility and Payment SO ADVANCES IN CHRONIC KIDNEY DISEASE LA English DT Article DE Medicare telehealth; Telehealth originating site; Telehealth distant site; Eligible Medicare telehealth individual; Medicare telehealth reimbursement AB The criteria for Medicare payment of telehealth nephrology services, and all other Medicare telehealth services, are set forth in section 1834(m) of the Social Security Act. There are just over 80 professional physician or practitioner services that may be furnished via telehealth and paid under Medicare Part B, when an interactive audio and video telecommunication system that permits real-time communication between a beneficiary at the originating site and the physician or practitioner at the distant site substitutes for an in-person encounter. These services include 16 nephrology billing codes for furnishing ESRD services for monthly monitoring and assessment and two billing codes for chronic kidney disease education. In recent years, many mobile health devices and other web-based tools have been developed in support of monitoring, observation, and collaboration for people living with chronic disease. This article reviews the statutory and program guidance that governs Medicare telehealth services, defines payment policy terms (e.g., originating site and distant site), and explains payment policies when telehealth services are furnished. C1 [Frilling, Stephanie] Ctr Medicare Serv, Ctr Clin Stand & Qual, Div Value Incent & Qual Reporting, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA. [Frilling, Stephanie] Ctr Medicaid Serv, Ctr Clin Stand & Qual, Div Value Incent & Qual Reporting, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA. RP Frilling, S (reprint author), Ctr Medicare Serv, Ctr Clin Stand & Qual, Div Value Incent & Qual Reporting, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA.; Frilling, S (reprint author), Ctr Medicaid Serv, Ctr Clin Stand & Qual, Div Value Incent & Qual Reporting, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA. EM stephanie.frilling@cms.hhs.gov NR 13 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 1548-5595 EI 1548-5609 J9 ADV CHRONIC KIDNEY D JI Adv. Chronic Kidney Dis. PD JAN PY 2017 VL 24 IS 1 BP 46 EP 50 DI 10.1053/j.ackd.2016.11.003 PG 5 WC Urology & Nephrology SC Urology & Nephrology GA EN0UI UT WOS:000395725600009 PM 28224943 ER PT J AU Martin, AB Hartman, M Washington, B Catlin, A AF Martin, Anne B. Hartman, Micah Washington, Benjamin Catlin, Aaron CA Natl Hlth Expenditure Accounts TI National Health Spending: Faster Growth In 2015 As Coverage Expands And Utilization Increases SO HEALTH AFFAIRS LA English DT Article AB Total nominal US health care spending increased 5.8 percent and reached $3.2 trillion in 2015. On a per person basis, spending on health care increased 5.0 percent, reaching $9,990. The share of gross domestic product devoted to health care spending was 17.8 percent in 2015, up from 17.4 percent in 2014. Coverage expansions that began in 2014 as a result of the Affordable Care Act continued to affect health spending growth in 2015. In that year, the faster growth in total health care spending was primarily due to accelerated growth in spending for private health insurance (growth of 7.2 percent), hospital care (5.6 percent), and physician and clinical services (6.3 percent). Continued strong growth in Medicaid (9.7 percent) and retail prescription drug spending (9.0 percent), albeit at a slower rate than in 2014, contributed to overall health care spending growth in 2015. C1 [Martin, Anne B.] Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD 21244 USA. [Hartman, Micah; Washington, Benjamin] CMS Off Actuary, Baltimore, MD USA. [Catlin, Aaron] CMS Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. RP Martin, AB (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD 21244 USA. EM anne.martin@cms.hhs.gov NR 14 TC 2 Z9 2 U1 6 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 JAN PY 2017 VL 36 IS 1 BP 166 EP 176 DI 10.1377/hlthaff.2016.1330 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA EN9RE UT WOS:000396336500021 PM 27913569 ER PT J AU Khatana, SAM Patton, EW Sanghavi, DM AF Khatana, Sameed Ahmed M. Patton, Elizabeth W. Sanghavi, Darshak M. TI Public Policy and Physician Involvement: Removing Barriers, Enhancing Impact SO AMERICAN JOURNAL OF MEDICINE LA English DT Editorial Material ID HEALTH-POLICY; MEDICINE C1 [Khatana, Sameed Ahmed M.] Brigham & Womens Hosp, Dept Med, 75 Francis St, Boston, MA 02115 USA. [Khatana, Sameed Ahmed M.] Harvard Med Sch, Boston, MA USA. [Patton, Elizabeth W.] Univ Michigan, Dept Obstet & Gynecol, Ann Arbor, MI 48109 USA. [Patton, Elizabeth W.] VA Ctr Clin Management Res, Ann Arbor, MI USA. [Sanghavi, Darshak M.] US Dept HHS, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. EM Sameed.Khatana@uphs.upenn.edu NR 12 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 0002-9343 EI 1555-7162 J9 AM J MED JI Am. J. Med. PD JAN PY 2017 VL 130 IS 1 BP 8 EP 10 DI 10.1016/j.amjmed.2016.07.020 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA EI6QS UT WOS:000392621500018 PM 27555096 ER PT J AU Burd, C Brown, NC Puri, P Sanghavi, D AF Burd, Carlye Brown, Nina C. Puri, Pranav Sanghavi, Darshak TI A Centers for Medicare & Medicaid Services Lens Toward Value-Based Preventive Care and Population Health SO PUBLIC HEALTH REPORTS LA English DT Editorial Material C1 [Burd, Carlye; Brown, Nina C.; Puri, Pranav; Sanghavi, Darshak] US Dept HHS, Ctr Medicare Serv, Baltimore, MD USA. [Burd, Carlye; Brown, Nina C.; Puri, Pranav; Sanghavi, Darshak] US Dept HHS, Ctr Medicaid Serv, Baltimore, MD USA. [Puri, Pranav] Univ Chicago, Chicago, IL 60637 USA. [Sanghavi, Darshak] Optum Labs, Boston, MA USA. RP Burd, C (reprint author), US Dept HHS, Ctr Medicare Serv, 2810 Lord Baltimore Dr, Windsor Mill, MD 21244 USA.; Burd, C (reprint author), US Dept HHS, Ctr Medicaid Serv, 2810 Lord Baltimore Dr, Windsor Mill, MD 21244 USA. EM carlye.burd@cms.hhs.gov NR 17 TC 0 Z9 0 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0033-3549 EI 1468-2877 J9 PUBLIC HEALTH REP JI Public Health Rep. PD JAN-FEB PY 2017 VL 132 IS 1 BP 6 EP 10 DI 10.1177/0033354916681508 PG 5 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA EI3AW UT WOS:000392363100002 PM 28005483 ER PT J AU Goodman, RA Lochner, KA Thambisetty, M Wingo, TS Posner, SF Ling, SM AF Goodman, Richard A. Lochner, Kimberly A. Thambisetty, Madhav Wingo, Thomas S. Posner, Samuel F. Ling, Shari M. TI Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011-2013 SO ALZHEIMERS & DEMENTIA LA English DT Article DE Alzheimer's disease; Dementia; Epidemiology; Medicare; Prevalence; Subtypes ID IDENTIFYING ALZHEIMERS-DISEASE; PUBLIC-HEALTH IMPACT; VASCULAR DEMENTIA; CLINICAL-CRITERIA; PRIMARY-CARE; LEWY BODIES; CLAIMS; EPIDEMIOLOGY; ACCURACY; RECOMMENDATIONS AB Introduction: Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk United States (US) population. Methods: We analyzed Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011-2013 and age >= 68 years as of December 31, 2013 (n = 21.6 million). Results: Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype. Dementia not otherwise specified was the most common diagnosis (present in 92.9%). The most common subtype was Alzheimer's (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%). The prevalence of other types of diagnosed dementia was 0.2%. Discussion: This study is the first to document concurrent prevalence of primary dementia subtypes among this US population. The findings can assist in prioritizing dementia research, clinical services, and caregiving resources. (C) 2016 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved. C1 [Goodman, Richard A.; Posner, Samuel F.] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA 30333 USA. [Goodman, Richard A.] Emory Univ, Sch Med, Dept Family & Prevent Med, Atlanta, GA 30322 USA. [Lochner, Kimberly A.; Ling, Shari M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Thambisetty, Madhav] NIA, Clin & Translat Neurosci Unit, Lab Behav Neurosci, NIH, Baltimore, MD 21224 USA. [Wingo, Thomas S.] Emory Univ, Sch Med, Dept Neurol & Human Genet, Atlanta, GA USA. [Wingo, Thomas S.] Atlanta VA Med Ctr, Div Neurol, Atlanta, GA USA. RP Goodman, RA (reprint author), Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA 30333 USA.; Goodman, RA (reprint author), Emory Univ, Sch Med, Dept Family & Prevent Med, Atlanta, GA 30322 USA. EM rgood02@emory.edu FU Department of Veteran's Affairs; National Institutes of Health FX To the best of our knowledge, no conflict of interest, financial, or other exists. Work related to this article by R.A.G, K.A.L., M.T., S.F.P., and S.M.L. was carried out in their official capacities as employees of the federal government and their respective HHS federal agencies. T.W.'s work is supported by grants from the Department of Veteran's Affairs and the National Institutes of Health. The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, or Department of Veterans Affairs. NR 48 TC 0 Z9 0 U1 6 U2 6 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1552-5260 EI 1552-5279 J9 ALZHEIMERS DEMENT JI Alzheimers. Dement. PD JAN PY 2017 VL 13 IS 1 BP 28 EP 37 DI 10.1016/j.jalz.2016.04.002 PG 10 WC Clinical Neurology SC Neurosciences & Neurology GA EH6VP UT WOS:000391912300004 PM 27172148 ER PT J AU Califf, RM Sherman, RE Slavitt, A AF Califf, Robert M. Sherman, Rachel E. Slavitt, Andrew TI Knowing When and How to Use Medical Products A Shared Responsibility for the FDA and CMS SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Califf, Robert M.; Sherman, Rachel E.] US FDA, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA. [Slavitt, Andrew] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Califf, RM (reprint author), US FDA, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA. EM robert.califf@fda.hhs.gov NR 4 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD DEC 20 PY 2016 VL 316 IS 23 BP 2485 EP 2486 DI 10.1001/jama.2016.16734 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA EG3QH UT WOS:000390959300012 PM 27820637 ER PT J AU Califf, RM Robb, MA Bindman, AB Briggs, JP Collins, FS Conway, PH Coster, TS Cunningham, FE De Lew, N DeSalvo, KB Dymek, C Dzau, VJ Fleurence, RL Frank, RG Gaziano, M Kaufmann, P Lauer, M Marks, PW McGinnis, JM Richards, C Selby, JV Shulkin, DJ Shuren, J Slavitt, AM Smith, SR Washington, BV White, PJ Woodcock, J Woodson, J Sherman, RE AF Califf, Robert M. Robb, Melissa A. Bindman, Andrew B. Briggs, Josephine P. Collins, Francis S. Conway, Patrick H. Coster, Trinka S. Cunningham, Francesca E. De Lew, Nancy DeSalvo, Karen B. Dymek, Christine Dzau, Victor J. Fleurence, Rachael L. Frank, Richard G. Gaziano, Michael Kaufmann, Petra Lauer, Michael Marks, Peter W. McGinnis, J. Michael Richards, Chesley Selby, Joe V. Shulkin, David J. Shuren, Jeffrey Slavitt, Andrew M. Smith, Scott R. Washington, B. Vindell White, P. Jon Woodcock, Janet Woodson, Jonathan Sherman, Rachel E. TI Transforming Evidence Generation to Support Health and Health Care Decisions SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID TECHNOLOGY; GUIDELINES; SYSTEM C1 [Califf, Robert M.; Sherman, Rachel E.] US FDA, Off Commissioner, Silver Spring, MD USA. [Robb, Melissa A.; Sherman, Rachel E.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Marks, Peter W.] US FDA, Biol Evaluat & Res, Silver Spring, MD USA. [Shuren, Jeffrey] US FDA, Devices & Radiol Hlth, Silver Spring, MD USA. [Bindman, Andrew B.] Agcy Healthcare Res & Qual, Off Director, Rockville, MD USA. [Dymek, Christine] Agcy Healthcare Res & Qual, Ctr Evidence & Practice Improvement, Rockville, MD USA. [Briggs, Josephine P.] NIH, Natl Ctr Complementary & Integrat Hlth, Bldg 10, Bethesda, MD 20892 USA. [Collins, Francis S.] NIH, Off Director, Bldg 10, Bethesda, MD 20892 USA. [Kaufmann, Petra] NIH, Natl Ctr Adv Translat Sci, Bldg 10, Bethesda, MD 20892 USA. [Lauer, Michael] NIH, Off Extramural Res Act, Bldg 10, Bethesda, MD 20892 USA. [Conway, Patrick H.; Slavitt, Andrew M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Coster, Trinka S.] US Army, Off Surg Gen Pharmacovigilance Ctr, Falls Church, VA USA. [Shulkin, David J.] Dept Vet Affairs, Off Secretary Hlth, Washington, DC USA. [De Lew, Nancy; DeSalvo, Karen B.] Off Assistant Secretary Planning & Evaluat, Off Hlth Policy, Washington, DC USA. [DeSalvo, Karen B.] Off Assistant Secretary Hlth, Washington, DC USA. [Washington, B. Vindell; White, P. Jon] Off Natl Coordinator Hlth Informat Technol, Washington, DC USA. [Dzau, Victor J.; McGinnis, J. Michael] Natl Acad Med, Dept Hlth & Human Serv, Washington, DC USA. [Fleurence, Rachael L.; Selby, Joe V.] Patient Centered Outcomes Res Inst, Washington, DC USA. [Cunningham, Francesca E.] Dept Vet Affairs, Ctr Medicat Safety, Hines, IL USA. [Frank, Richard G.] Harvard Univ, Dept Hlth Care Policy, Boston, MA 02115 USA. [McGinnis, J. Michael] Brigham & Womens Hosp, Div Aging, Mill Veteran Program, Vet Affairs Boston Healthcare Syst, Boston, MA 02115 USA. [McGinnis, J. Michael] Harvard Med Sch, Boston, MA USA. [Woodson, Jonathan] Boston Univ, Sch Med, Dept Surg, Boston, MA 02118 USA. [Richards, Chesley] Ctr Dis Control & Prevent, Off Publ Hlth Sci Serv, Atlanta, GA USA. RP Califf, RM (reprint author), US FDA, Off Commissioner, Silver Spring, MD USA. NR 13 TC 0 Z9 0 U1 1 U2 1 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD DEC 15 PY 2016 VL 375 IS 24 BP 2395 EP 2400 DI 10.1056/NEJMsb1610128 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA EF0SO UT WOS:000390036500014 PM 27974039 ER PT J AU Matthews, KA Holt, J Gaglioti, AH Lochner, KA Shoff, C McGuire, LC Greenlund, KJ AF Matthews, Kevin A. Holt, James Gaglioti, Anne H. Lochner, Kim A. Shoff, Carla McGuire, Lisa C. Greenlund, Kurt J. TI County-Level Variation in Per Capita Spending for Multiple Chronic Conditions Among Fee-for-Service Medicare Beneficiaries, United States, 2014 SO PREVENTING CHRONIC DISEASE LA English DT Editorial Material C1 [Matthews, Kevin A.] Ctr Dis Control & Prevent, Div Populat Hlth, Natl Ctr Chron Dis Prevent & Hlth Promot, 4770 Buford Hwy NE,MS F78, Atlanta, GA 30341 USA. [Holt, James; McGuire, Lisa C.; Greenlund, Kurt J.] Ctr Dis Control & Prevent, Atlanta, GA USA. [Gaglioti, Anne H.] Morehouse Sch Med, Atlanta, GA 30310 USA. [Lochner, Kim A.; Shoff, Carla] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Matthews, KA (reprint author), Ctr Dis Control & Prevent, Div Populat Hlth, Natl Ctr Chron Dis Prevent & Hlth Promot, 4770 Buford Hwy NE,MS F78, Atlanta, GA 30341 USA. EM yrp4@cdc.gov NR 6 TC 0 Z9 0 U1 0 U2 0 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1545-1151 J9 PREV CHRONIC DIS JI Prev. Chronic Dis. PD DEC PY 2016 VL 13 AR E162 DI 10.5888/pcd13.160240 PG 3 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA EJ3KP UT WOS:000393111400002 PM 27906647 ER PT J AU Wang, CL Kane, R Levenson, M Kelman, J Wernecke, M Lee, JY Kozlowski, S Dekmezian, C Zhang, ZW Thompson, A Smith, K Wu, YT Wei, YQ Chillarige, Y Ryan, Q Worrall, C MaCurdy, TE Graham, DJ AF Wang, Cunlin Kane, Robert Levenson, Mark Kelman, Jeffrey Wernecke, Michael Lee, Joo-Yeon Kozlowski, Steven Dekmezian, Carmen Zhang, Zhiwei Thompson, Aliza Smith, Kimberly Wu, Yu-te Wei, Yuqin Chillarige, Yoganand Ryan, Qin Worrall, Chris MaCurdy, Thomas E. Graham, David J. TI Association Between Changes in CMS Reimbursement Policy and Drug Labels for Erythrocyte-Stimulating Agents With Outcomes for Older Patients Undergoing Hemodialysis Covered by Fee-for-Service Medicare SO JAMA INTERNAL MEDICINE LA English DT Article ID CHRONIC KIDNEY-DISEASE; SMALL DIALYSIS ORGANIZATIONS; PROSPECTIVE-PAYMENT SYSTEM; ANEMIA MANAGEMENT; BUNDLED PAYMENT; UNITED-STATES; MORTALITY; EPOETIN; IMPACT; TRENDS AB IMPORTANCE In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect. OBJECTIVE To assess the effects of the changes in reimbursement policy and the ESA drug label on patients who underwent incident hemodialysis. DESIGN, SETTING, AND PARTICIPANTS For this retrospective cohort study, patients 66 years or older who had undergone incident hemodialysis, and were enrolled in Medicare parts A, B, or D for at least 12 months prior to hemodialysis initiation between January 1, 2008, and December 31, 2013, were recruited from hemodialysis centers across the United States. Patients were divided into 2 cohorts based on their date of hemodialysis initiation and followed: January 1, 2008, to December 31, 2009, for the prepolicy cohort and July 1, 2011, to June 30, 2013, for the postpolicy cohort, with the exclusion of January 1, 2010, to June 30, 2011, as a transition period. INTERVENTIONS Changes in CMS reimbursement policy for dialysis and the FDA label for ESAs. MAIN OUTCOMES AND MEASURES Major adverse cardiovascular events (MACEs), including acutemyocardial infarction (AMI), stroke, and all-cause mortality; hospitalized congestive heart failure (H-CHF); venous thromboembolism; and red blood cell transfusions. Secondary outcomes included evaluating effects on black and other patient subgroups. RESULTS Baseline characteristics of the 69 718 incident hemodialysis patients were similar between cohorts. Compared with the prepolicy period, the risk of MACE, death, H-CHF, and venous thromboembolism were similar in the postpolicy period, and the risk of stroke decreased (hazard ratio [HR], 0.77; 95% CI, 0.64-0.93; P = .01); the use of ESAs also decreased, and the rate of blood transfusions increased (HR, 1.09; 95% CI, 1.07-1.12; P < .001). In the post-postpolicy period, black patients had a significant reduction in risk of MACE (HR, 0.82; 95% CI, 0.73-0.92; P < .001) and all-cause mortality (HR, 0.82; 95% CI, 0.73-0.93; P = .002). CONCLUSIONS AND RELEVANCE After the bundling policy and ESA labeling changes in 2011, the risks of MACE and death for patients 66 years or older and covered by fee-for-service Medicare who had undergone incident hemodialysis did not change; the risk of stroke was reduced, and the rate of blood transfusions modestly increased. Black patients had substantial reductions in the risks of MACE and death. C1 [Wang, Cunlin; Graham, David J.] US FDA, Off Surveillance & Epidemiol, CDER, Silver Spring, MD USA. [Kane, Robert; Thompson, Aliza; Smith, Kimberly; Ryan, Qin] US FDA, Off New Drugs, CDER, Silver Spring, MD USA. [Levenson, Mark; Lee, Joo-Yeon; Wu, Yu-te] US FDA, Off Biostat, CDER, Silver Spring, MD USA. [Kelman, Jeffrey; Worrall, Chris] Ctr Medicare & Med Serv, Washington, DC USA. [Wernecke, Michael; Dekmezian, Carmen; Wei, Yuqin; Chillarige, Yoganand; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Kozlowski, Steven] US FDA, Off Pharmaceut Qual, CDER, Silver Spring, MD USA. [Zhang, Zhiwei] US FDA, Ctr Device & Radiol Hlth, Silver Spring, MD USA. RP Wang, CL (reprint author), US FDA, Div Epidemiol 1, Off Surveillance & Epidemiol, CDER, 10903 New Hampshire Ave, Silver Spring, MD 20903 USA. EM cunlin.wang@fda.hhs.gov FU Centers for Medicare & Medicaid Services; US Food and Drug Administration FX This study was funded through an intra-agency agreement between the Centers for Medicare & Medicaid Services and the US Food and Drug Administration. NR 23 TC 1 Z9 1 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 2168-6106 EI 2168-6114 J9 JAMA INTERN MED JI JAMA Intern. Med. PD DEC 1 PY 2016 VL 176 IS 12 BP 1818 EP 1825 DI 10.1001/jamainternmed.2016.6520 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA EF3WN UT WOS:000390255700019 PM 27775769 ER PT J AU Ketcham, JD Kuminoff, NV Powers, CA AF Ketcham, Jonathan D. Kuminoff, Nicolai V. Powers, Christopher A. TI Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program: Comment SO AMERICAN ECONOMIC REVIEW LA English DT Article ID HEALTH-INSURANCE; DECISION-MAKING; BEHAVIOR; INFORMATION; PATERNALISM; ECONOMICS; SELECTION; MARKETS; INERTIA AB Consumers' enrollment decisions in Medicare Part D call be explained by Abaluck and Gruber's (2011) model of utility maximization with psychological biases or by a neoclassical version of their model that precludes such biases. We evaluate these competing hypotheses by applying nonparametric tests of utility maximization and model validation tests to administrative data. We find that 79 percent of enrollment decisions from 2006 to 2010 satisfied basic axioms of consumer theory under the assumption of full information. The validation tests provide evidence against widespread psychological biases. In particular, we find that precluding psychological biases improves the structural model's out-of-sample predictions for consumer behavior. C1 [Ketcham, Jonathan D.] Arizona State Univ, Dept Mkt, Box 874106, Tempe, AZ 85287 USA. [Kuminoff, Nicolai V.] Arizona State Univ, Dept Econ, Tempe, AZ 85287 USA. [Kuminoff, Nicolai V.] NBER, Cambridge, MA 02138 USA. [Powers, Christopher A.] US Dept HHS, Ctr Medicare Serv, Off Enterprise Data & Analyt, 7500 Secur Blvd,Mailstop B2-29-04, Baltimore, MD 21244 USA. [Powers, Christopher A.] US Dept HHS, Ctr Medicaid Serv, Off Enterprise Data & Analyt, 7500 Secur Blvd,Mailstop B2-29-04, Baltimore, MD 21244 USA. RP Ketcham, JD (reprint author), Arizona State Univ, Dept Mkt, Box 874106, Tempe, AZ 85287 USA. EM ketcham@asu.edu; kuminoff@asu.edu; christopher.powers@cms.hhs.gov NR 30 TC 1 Z9 1 U1 8 U2 8 PU AMER ECONOMIC ASSOC PI NASHVILLE PA 2014 BROADWAY, STE 305, NASHVILLE, TN 37203 USA SN 0002-8282 EI 1944-7981 J9 AM ECON REV JI Am. Econ. Rev. PD DEC PY 2016 VL 106 IS 12 BP 3932 EP 3961 DI 10.1257/aer.20131048 PG 30 WC Economics SC Business & Economics GA EE3AS UT WOS:000389459100010 ER PT J AU Peterson, GG Zurovac, J Brown, RS Coburn, KD Markovich, PA Marcantonio, SA Clark, WD Mutti, A Stepanczuk, C AF Peterson, G. Greg Zurovac, Jelena Brown, Randall S. Coburn, Kenneth D. Markovich, Patricia A. Marcantonio, Sherry A. Clark, William D. Mutti, Anne Stepanczuk, Cara TI Testing the Replicability of a Successful Care Management Program: Results from a Randomized Trial and Likely Explanations for Why Impacts Did Not Replicate SO HEALTH SERVICES RESEARCH LA English DT Article DE Care management; care coordination; chronic disease; Medicare Coordinated Care Demonstration; cost savings ID HIGH-RISK PATIENTS; MEDICAL HOME; QUALITY; HOSPITALIZATION; INTERVENTION; ASSOCIATION; SUBGROUP; SAVINGS AB Objectives. To test whether a care management program could replicate its success in an earlier trial and determine likely explanations for why it did not. Data Sources/Setting. Medicare claims and nurse contact data for Medicare fee-for-service beneficiaries with chronic illnesses enrolled in the trial in eastern Pennsylvania (N = 483). Study Design. A randomized trial with half of enrollees receiving intensive care management services and half receiving usual care. We developed and tested hypotheses for why impacts declined. Data Extraction. All outcomes and covariates were derived from claims and the nurse contact data. Principal Findings. From 2010 to 2014, the program did not reduce hospitalizations or generate Medicare savings to offset program fees that averaged $260 per beneficiary per month. These estimates are statistically different (p < .05) from the large reductions in hospitalizations and spending in the first trial (2002-2010). The treatment-control differences in the second trial disappeared because the control group's risk-adjusted hospitalization rate improved, not because the treatment group's outcomes worsened. Conclusion. Even if demonstrated in a randomized trial, successful results from one test may not replicate in other settings or time periods. Assessing whether gaps in care that the original program filled exist in other settings can help identify where earlier success is likely to replicate. C1 [Peterson, G. Greg; Zurovac, Jelena; Mutti, Anne] Math Policy Res, 1100 1st St NE, Washington, DC 20002 USA. [Brown, Randall S.; Stepanczuk, Cara] Math Policy Res, Princeton, NJ USA. [Coburn, Kenneth D.; Marcantonio, Sherry A.] Hlth Qual Partners, Doylestown, PA USA. [Markovich, Patricia A.; Clark, William D.] Ctr Medicare & Medicaid Serv, Res & Rapid Cycle Evaluat Grp, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. RP Peterson, GG (reprint author), Math Policy Res, 1100 1st St NE, Washington, DC 20002 USA. EM GPeterson@Mathematica-Mpr.com FU Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services [HHSM-500-2014-00429G]; Medicare Coordinated Care Demonstration (MCCD) FX The analyses upon which this publication is based were performed under contract HHSM-500-2014-00429G, funded by the Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services. The views expressed in this article are solely those of the authors and do not necessarily represent the policy or views of the Centers for Medicare and Medicaid Services (CMS), or does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. CMS also funded both phases of the Medicare Coordinated Care Demonstration (MCCD). NR 27 TC 1 Z9 1 U1 1 U2 1 PU WILEY 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 2016 VL 51 IS 6 BP 2115 EP 2139 DI 10.1111/1475-6773.12595 PG 25 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA ED8UP UT WOS:000389146700005 PM 27778316 ER PT J AU Beckett, MK Elliott, MN Gaillot, S Haas, A Dembosky, JW Giordano, LA Brown, J AF Beckett, Megan K. Elliott, Marc N. Gaillot, Sarah Haas, Ann Dembosky, Jacob W. Giordano, Laura A. Brown, Julie TI ESTABLISHING LIMITS FOR SUPPLEMENTAL ITEMS ON A STANDARDIZED NATIONAL SURVEY SO PUBLIC OPINION QUARTERLY LA English DT Article ID RESPONSE RATES; QUESTIONNAIRES; METAANALYSIS AB Given the high costs of collecting survey data, adding supplemental questions to large, ongoing survey data collection efforts potentially offers a cost-effective way to collect additional information customized to the specific needs of users of a general survey. The Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (MA CAHPS) Surveys use mail with telephone follow-up to survey Medicare beneficiaries about their experiences with health plans. These surveys are administered by trained survey vendors, who were allowed to add any number of supplementary survey items to the core survey in 2012, as long as the items met content requirements. Vendors and health plans create these supplemental items for internal quality improvement efforts. Because the results of the core items from the surveys are publicly reported and used to calculate Medicare Quality Bonus Payments to health plans under the Affordable Care Act, concern arose that an excessive number of supplementary items might adversely affect response rates and the reliability of plan-level estimates. To estimate the effect of supplemental items on response rates, we used logistic regression, controlling for survey vendor and characteristics of beneficiaries and plans. Response rates were lower in both telephone and mail modes with more supplemental items (p < 0.001). The use of 12 supplemental items was associated with response rates 2.5 percentage points lower, compared with surveys with no supplemental items. These results were used to develop new guidelines suggesting that supplemental items be limited to a maximum of 12. C1 [Beckett, Megan K.; Elliott, Marc N.] RAND Corp, Santa Monica, CA USA. [Gaillot, Sarah] Ctr Medicare & Medicaid Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD USA. [Haas, Ann; Dembosky, Jacob W.] RAND Corp, Pittsburgh, PA USA. [Giordano, Laura A.] Hlth Serv Advisory Grp, Surveys Res & Anal Div, Phoenix, AZ USA. [Brown, Julie] RAND Corp, RAND Survey Res Grp, Santa Monica, CA USA. RP Elliott, MN (reprint author), RAND Hlth, 1776 Main St,POB 2138, Santa Monica, CA 90407 USA. EM Elliott@rand.org FU Centers for Medicare and Medicaid Services [HHSM-500-2005-000281] FX MEGAN K. BECKETT is a behavioral scientist at the RAND Corporation, Santa Monica, CA, USA. MARC N. ELLIOTT is a senior principal researcher at the RAND Corporation, Santa Monica, CA, USA. SARAH GAILLOT is a social science research analyst in the Division of Consumer Assessment & Plan Performance in the Centers for Medicare & Medicaid Services, Baltimore, MD, USA. ANN HAAS is a project associate at the RAND Corporation, Pittsburgh, PA, USA. JACOB W. DEMBOSKY is a project associate at the RAND Corporation, Pittsburgh, PA, USA. LAURA A. GIORDANO is the vice president of the Surveys, Research & Analysis Division in the Health Services Advisory Group, Phoenix, AZ, USA. JULIE BROWN is the director of the RAND Survey Research Group, RAND Corporation, Santa Monica, CA, USA. The authors thank Fergal McCarthy for preparation of the manuscript. This study was supported by the Centers for Medicare and Medicaid Services [HHSM-500-2005-000281 to the RAND Corporation]. No author possesses a conflict of interest. *Address correspondence to Marc N. Elliott, RAND Health, 1776 Main St., PO Box 2138, Santa Monica, CA 90407, USA; e-mail: Elliott@rand.org. NR 17 TC 0 Z9 0 U1 2 U2 2 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0033-362X EI 1537-5331 J9 PUBLIC OPIN QUART JI Public Opin. Q. PD WIN PY 2016 VL 80 IS 4 BP 964 EP 976 DI 10.1093/poq/nfw028 PG 13 WC Communication; Political Science; Social Sciences, Interdisciplinary SC Communication; Government & Law; Social Sciences - Other Topics GA ED1AI UT WOS:000388575500007 ER PT J AU Fitzler, S Raia, P Buckley, FO Wang, M AF Fitzler, Sandra Raia, Paul Buckley, Fredrick O., Jr. Wang, Mei TI Does Nursing Facility Use of Habilitation Therapy Improve Performance on Quality Measures? SO AMERICAN JOURNAL OF ALZHEIMERS DISEASE AND OTHER DEMENTIAS LA English DT Article DE habilitation therapy; interdisciplinary behavior team; nursing home; quality measures AB The purpose of the project, Centers for Medicare & Medicaid Services (CMS) Innovation study, was to evaluate the impact on 12 quality measures including 10 Minimum Data Set (MDS) publicly reported measures and 2 nursing home process measures using habilitation therapy techniques and a behavior team to manage dementia-related behaviors. A prospective design was used to assess the changes in the measures. A total of 30 Massachusetts nursing homes participated in the project over a 12-month period. Project participation required the creation of an interdisciplinary behavior team, habilitation therapy training, facility visit by the program coordinator, attendance at bimonthly support and sharing calls, and monthly collection of process measure data. Participating facilities showed improvement in 9 of the 12 reported measures. Findings indicate potential quality improvement in having nursing homes learn habilitation therapy techniques and know how to use the interdisciplinary team to manage problem behaviors. C1 [Fitzler, Sandra] Healthcentr Advisors, 500 West Cummings Pk,Suite 4000, Woburn, MA 01801 USA. [Raia, Paul] Alzheimers Assoc, Watertown, MA USA. [Buckley, Fredrick O., Jr.] Massachusetts Gen Phys Org, Boston, MA USA. [Wang, Mei] Ctr Medicare Serv, Boston, MA USA. [Wang, Mei] Ctr Medicaid Serv, Boston, MA USA. RP Fitzler, S (reprint author), Healthcentr Advisors, 500 West Cummings Pk,Suite 4000, Woburn, MA 01801 USA. EM sfitzler@comcast.net FU Centers for Medicare & Medicaid Services (CMS); US Department of Health and Human Services (DHHS) [HHSM-500-2011-MA] FX The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services (DHHS), under Contract Number HHSM-500-2011-MA, titled "Improving Dementia Care in Skilled Nursing Facilities" in the state of Massachusetts. NR 4 TC 0 Z9 0 U1 0 U2 0 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1533-3175 EI 1938-2731 J9 AM J ALZHEIMERS DIS JI Am. J. Alzheimers Dis. Other Dement. PD DEC PY 2016 VL 31 IS 8 BP 687 EP 692 DI 10.1177/1533317516662335 PG 6 WC Geriatrics & Gerontology; Clinical Neurology SC Geriatrics & Gerontology; Neurosciences & Neurology GA EB6IP UT WOS:000387485900010 PM 27650126 ER PT J AU Elliott, M Klein, DJ Adams, JL Haviland, AM Edwards, C Dembosky, JW Gaillot, S AF Elliott, M. Klein, D. J. Adams, J. L. Haviland, A. M. Edwards, C. Dembosky, J. W. Gaillot, S. TI BETTER PATIENT-REPORTED CARE COORDINATION PREDICTS HIGHER QUALITY CLINICAL CARE SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Elliott, M.; Edwards, C.; Dembosky, J. W.] RAND Corp, Hlth, Santa Monica, CA USA. [Klein, D. J.] Boston Childrens Hosp, Boston, MA USA. [Adams, J. L.] Kaiser Permanente, Pasadena, CA USA. [Haviland, A. M.] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA. [Gaillot, S.] Ctr Medicare Serv, Baltimore, MD USA. [Gaillot, S.] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 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 NOV PY 2016 VL 56 SU 3 BP 40 EP 41 PG 2 WC Gerontology SC Geriatrics & Gerontology GA ED1DT UT WOS:000388585000155 ER PT J AU Haviland, AM Ma, S Hambarsoomian, K Elliott, M AF Haviland, A. M. Ma, S. Hambarsoomian, K. Elliott, M. TI INSURANCE PREMIUMS AND PATIENT EXPERIENCE: DO YOU GET WHAT YOU PAY FOR IN MEDICARE ADVANTAGE PLANS? SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Hambarsoomian, K.; Elliott, M.] RAND Corp, Hlth, Santa Monica, CA USA. [Haviland, A. M.] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA. [Ma, S.] Ctr Medicare Serv, Baltimore, MD USA. [Ma, S.] 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 NOV PY 2016 VL 56 SU 3 BP 40 EP 40 PG 1 WC Gerontology SC Geriatrics & Gerontology GA ED1DT UT WOS:000388585000154 ER PT J AU Elliott, M Haviland, AM Hambarsoomian, K Dembosky, JW Haffer, SC AF Elliott, M. Haviland, A. M. Hambarsoomian, K. Dembosky, J. W. Haffer, S. C. TI INDIRECT ESTIMATION OF RACE/ETHNICITY FOR SURVEY RESPONDENTS WHO DO NOT REPORT RACE/ETHNICITY SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Elliott, M.; Haviland, A. M.; Hambarsoomian, K.; Dembosky, J. W.] RAND Corp, Hlth, Santa Monica, CA USA. [Haviland, A. M.] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA. [Haffer, S. C.] 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 NOV PY 2016 VL 56 SU 3 BP 278 EP 278 PG 1 WC Gerontology SC Geriatrics & Gerontology GA ED1DT UT WOS:000388585001298 ER PT J AU Fortinsky, RH Ling, SM AF Fortinsky, R. H. Ling, Shari M. TI COGNITIVE IMPAIRMENT DETECTION & EARLIER DIAGNOSIS OF DEMENTIA: THE KAER PROCESS APPLIED TO PRACTICE SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Fortinsky, R. H.] Univ Connecticut, Sch Med, Hlth Net Inc, UConn Ctr Aging, Farmington, CT USA. [Fortinsky, R. H.] Univ Connecticut, Sch Med, Hlth Net Inc, Dept Med, Farmington, CT USA. [Ling, Shari M.] 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 NOV PY 2016 VL 56 SU 3 BP 289 EP 290 PG 2 WC Gerontology SC Geriatrics & Gerontology GA ED1DT UT WOS:000388585001348 ER PT J AU Kirk, MA Birken, SA Sherif, N Brazil, M Rokoske, F AF Kirk, M. A. Birken, S. A. Sherif, N. Brazil, M. Rokoske, F. TI IMPLEMENTATION OF THE HOSPICE ITEM SET (HIS): LESSONS LEARNED AND FUTURE IMPLICATIONS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Kirk, M. A.; Sherif, N.; Rokoske, F.] RTI Int, End Of Life Palliat & Hosp Care, Durham, NC USA. [Kirk, M. A.; Birken, S. A.] Univ N Carolina, Chapel Hill, NC USA. [Brazil, M.] Ctr Medicare Serv, Baltimore, MD USA. [Brazil, M.] 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 NOV PY 2016 VL 56 SU 3 BP 432 EP 433 PG 2 WC Gerontology SC Geriatrics & Gerontology GA ED1DT UT WOS:000388585002062 ER PT J AU Pardasaney, P Ingber, M Broyles, I Deutsch, A Clayton, D Frank, J Haines, E McMullen, T AF Pardasaney, P. Ingber, M. Broyles, I. Deutsch, A. Clayton, D. Frank, J. Haines, E. McMullen, T. TI ASSESSING DISCHARGE TO COMMUNITY OUTCOMES IN POST-ACUTE CARE SETTINGS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Pardasaney, P.; Ingber, M.; Broyles, I.; Deutsch, A.; Clayton, D.; Frank, J.; Haines, E.] RTI Int, Qual Measures & Hlth Policy, Waltham, MA USA. [McMullen, T.] Ctr Med Serv, Baltimore, MD USA. [McMullen, T.] Ctr Medicaid Serv, Baltimore, MD USA. [Ingber, M.] Massachusetts Gen Hosp, Boston, MA 02114 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 NOV PY 2016 VL 56 SU 3 BP 599 EP 599 PG 1 WC Gerontology SC Geriatrics & Gerontology GA ED1DT UT WOS:000388585002714 ER PT J AU Elliott, M Martsolf, GR Haviland, AM Burkhart, Q Orr, NE Gaillot, S Saliba, D AF Elliott, M. Martsolf, G. R. Haviland, A. M. Burkhart, Q. Orr, N. E. Gaillot, S. Saliba, D. TI HEALTH CARE EXPERIENCES AMONG MEDICARE BENEFICIARIES WITH AND WITHOUT A PERSONAL PHYSICIAN SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Elliott, M.; Martsolf, G. R.; Burkhart, Q.; Orr, N. E.; Saliba, D.] RAND Corp, Santa Monica, CA USA. [Haviland, A. M.] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA. [Gaillot, S.] Ctr Medicare Serv, Baltimore, MD USA. [Gaillot, S.] Ctr Medicaid Serv, Baltimore, MD USA. [Saliba, D.] US Dept Vet Affairs, Los Angeles, CA USA. [Saliba, D.] Univ Calif Los Angeles, Borun Ctr, Los Angeles, CA 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 NOV PY 2016 VL 56 SU 3 BP 663 EP 663 PG 1 WC Gerontology SC Geriatrics & Gerontology GA ED1DT UT WOS:000388585003180 ER PT J AU Graham, DJ Reichman, ME Wernecke, M Hsueh, H Izem, R Southworth, MR Wei, YQ Liao, JM Goulding, MR Mott, K Chillarige, Y MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Reichman, Marsha E. Wernecke, Michael Hsueh, Hui Izem, Rima Southworth, Mary Ross Wei, Yuqin Liao, Jiemin Goulding, Margie R. Mott, Katrina Chillarige, Yoganand MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Stroke, Bleeding, and Mortality Risks in Elderly Medicare Beneficiaries Treated With Dabigatran or Rivaroxaban for Nonvalvular Atrial Fibrillation SO JAMA INTERNAL MEDICINE LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; POSITIVE PREDICTIVE-VALUE; POPULATION-BASED COHORT; ORAL ANTICOAGULANTS; ADMINISTRATIVE DATA; CODING ACCURACY; WARFARIN; METAANALYSIS; VALIDATION; PREVENTION AB IMPORTANCE Dabigatran and rivaroxaban are non-vitamin K oral anticoagulants approved for stroke prevention in patients with nonvalvular atrial fibrillation (AF). There are no randomized head-to-head comparisons of these drugs for stroke, bleeding, or mortality outcomes. OBJECTIVE To compare risks of thromboembolic stroke, intracranial hemorrhage (ICH), major extracranial bleeding including major gastrointestinal bleeding, and mortality in patients with nonvalvular AF who initiated dabigatran or rivaroxaban treatment for stroke prevention. DESIGN, SETTING, AND PARTICIPANTS Retrospective new-user cohort study of 118 891 patients with nonvalvular AF who were 65 years or older, enrolled in fee-for-service Medicare, and who initiated treatment with dabigatran or rivaroxaban from November 4, 2011, through June 30, 2014. Differences in baseline characteristics were adjusted using stabilized inverse probability of treatment weights based on propensity scores. The data analysis was performed from May 7, 2015, through June 30, 2016. EXPOSURES Dabigatran, 150 mg, twice daily; rivaroxaban, 20 mg, once daily. MAIN OUTCOMES AND MEASURES Adjusted hazard ratios (HRs) for the primary outcomes of thromboembolic stroke, ICH, major extracranial bleeding including major gastrointestinal bleeding, and mortality, with dabigatran as reference. Adjusted incidence rate differences (AIRDs) were also estimated. RESULTS A total of 52 240 dabigatran-treated and 66 651 rivaroxaban-treated patients (47% female) contributed 15 524 and 20 199 person-years of on-treatment follow-up, respectively, during which 2537 primary outcome events occurred. Rivaroxaban use was associated with a statistically nonsignificant reduction in thromboembolic stroke (HR, 0.81; 95% CI, 0.65-1.01; P = .07; AIRD = 1.8 fewer cases/1000 person-years), statistically significant increases in ICH (HR, 1.65; 95% CI, 1.20-2.26; P = .002; AIRD = 2.3 excess cases/1000 person-years) and major extracranial bleeding (HR, 1.48; 95% CI, 1.32-1.67; P < .001; AIRD = 13.0 excess cases/1000 person-years), including major gastrointestinal bleeding (HR, 1.40; 95% CI, 1.23-1.59; P < .001; AIRD = 9.4 excess cases/1000 person-years), and with a statistically nonsignificant increase in mortality (HR, 1.15; 95% CI, 1.00-1.32; P = .051; AIRD = 3.1 excess cases/1000 person-years). In patients 75 years or older or with CHADS(2) score greater than 2, rivaroxaban use was associated with significantly increased mortality compared with dabigatran use. The excess rate of ICH with rivaroxaban use exceeded its reduced rate of thromboembolic stroke. CONCLUSIONS AND RELEVANCE Treatment with rivaroxaban 20 mg once daily was associated with statistically significant increases in ICH and major extracranial bleeding, including major gastrointestinal bleeding, compared with dabigatran 150mg twice daily. C1 [Graham, David J.; Reichman, Marsha E.; Goulding, Margie R.; Mott, Katrina] US FDA, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, 10903 New Hampshire Ave,Bldg 22,Room 4314, Silver Spring, MD 20993 USA. [Wernecke, Michael; Wei, Yuqin; Liao, Jiemin; Chillarige, Yoganand; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Hsueh, Hui; Izem, Rima] US FDA, Off Biostat, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Southworth, Mary Ross] US FDA, Off New Drugs, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [MaCurdy, Thomas E.] Stanford Univ, Dept Econ, Stanford, CA 94305 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Graham, DJ (reprint author), US FDA, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, 10903 New Hampshire Ave,Bldg 22,Room 4314, Silver Spring, MD 20993 USA. EM david.graham1@fda.hhs.gov FU SafeRx project, a joint initiative of the Centers for Medicare & Medicaid Services (CMS); US Food and Drug Administration (FDA) FX This study was performed as part of the SafeRx project, a joint initiative of the Centers for Medicare & Medicaid Services (CMS) and the US Food and Drug Administration (FDA), and was funded through an interagency agreement. NR 49 TC 12 Z9 12 U1 6 U2 6 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 2168-6106 EI 2168-6114 J9 JAMA INTERN MED JI JAMA Intern. Med. PD NOV PY 2016 VL 176 IS 11 BP 1662 EP 1671 DI 10.1001/jamainternmed.2016.5954 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA EC4KK UT WOS:000388097700019 PM 27695821 ER PT J AU Wilensky, G AF Wilensky, Gail TI Two Perspectives on the Future of Medicare Advantage SO POPULATION HEALTH MANAGEMENT LA English DT Editorial Material C1 [Wilensky, Gail] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Wilensky, Gail] Medicare Payment Advisory Commiss, Washington, DC USA. [Wilensky, Gail] Project HOPE, Bethesda, MD USA. RP Wilensky, G (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU MARY ANN LIEBERT, INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1942-7891 EI 1942-7905 J9 POPUL HEALTH MANAG JI Popul. Health Manag. PD NOV PY 2016 VL 19 SU 3 BP S7 EP S8 PG 2 WC Health Care Sciences & Services SC Health Care Sciences & Services GA EC5IW UT WOS:000388169100006 ER PT J AU Colvin, JD Hall, M Berry, JG Gottlieb, LM Bettenhausen, JL Shah, SS Fieldston, ES Conway, PH Chung, PJ AF Colvin, Jeffrey D. Hall, Matt Berry, Jay G. Gottlieb, Laura M. Bettenhausen, Jessica L. Shah, Samir S. Fieldston, Evan S. Conway, Patrick H. Chung, Paul J. TI Financial Loss for Inpatient Care of Medicaid-Insured Children SO JAMA PEDIATRICS LA English DT Article ID COMPLEX CHRONIC CONDITIONS; SAFETY-NET HOSPITALS; HEALTH-CARE; EMERGENCY-DEPARTMENT; PAYMENT CUTS; ACT; REFORM; COSTS AB IMPORTANCE Medicaid payments tend to be less than the cost of care. Federal Disproportionate Share Hospital (DSH) payments help hospitals recover such uncompensated costs of Medicaid-insured and uninsured patients. The Patient Protection and Affordable Care Act reduces DSH payments in anticipation of fewer uninsured patients and therefore decreased uncompensated care. However, unlike adults, few hospitalized children are uninsured, while many have Medicaid coverage. Therefore, DSH payment reductions may expose extensive Medicaid financial losses for hospitals serving large absolute numbers of children. OBJECTIVES To identify types of hospitals with the highest Medicaid losses from pediatric inpatient care and to estimate the proportion of losses recovered through DSH payments. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional analysis evaluated Medicaid-insured hospital discharges of patients 20 years and younger from 23 states in the 2009 Kids' Inpatient Database. The dates of the analysis were March to September 2015. Hospitals were categorized as freestanding children's hospitals (FSCHs), children's hospitals within general hospitals, non-children's hospital teaching hospitals, and non-children's hospital nonteaching hospitals. Financial records of FSCHs in the data set were used to estimate the proportion of Medicaid losses recovered through DSH payments. MAIN OUTCOMES AND MEASURES Hospital financial losses from inpatient care of Medicaid-insured children (defined as the reimbursement minus the cost of care) were compared across hospital types. For our subsample of FSCHs, Medicaid-insured inpatient financial losses were calculated with and without each hospital's DSH payment. RESULTS The 2009 Kids' Inpatient Database study population included 1485 hospitals and 843 725 Medicaid-insured discharges. Freestanding children's hospitals had a higher median number of Medicaid-insured discharges (4082; interquartile range [IQR], 3524-5213) vs non-children's hospital teaching hospitals (674; IQR, 258-1414) and non-children's hospital nonteaching hospitals (161; IQR, 41-420). Freestanding children's hospitals had the largest median Medicaid losses from pediatric inpatient care (-$9 722 367; IQR, -$16 248 369 to -$2 137 902). Smaller losses were experienced by non-children's hospital teaching hospitals (-$204 100; IQR, -$1 014 100 to $14 700]) and non-children's hospital nonteaching hospitals (-$28 310; IQR, -$152 370 to $9040]). Disproportionate Share Hospital payments to FSCHs reduced their Medicaid losses by almost half. CONCLUSIONS AND RELEVANCE Estimated financial losses from pediatric inpatients covered by Medicaid were much larger for FSCHs than for other hospital types. For children's hospitals, small anticipated increases in insured children are unlikely to offset the reductions in DSH payments. C1 [Colvin, Jeffrey D.; Bettenhausen, Jessica L.] Univ Missouri, Childrens Mercy Hosp & Clin, Sch Med, Dept Pediat, 3101 Broadway Blvd,10th Floor, Kansas City, MO 64111 USA. [Hall, Matt] Childrens Hosp Assoc, Overland Pk, KS USA. [Berry, Jay G.] Boston Childrens Hosp, Div Gen Pediat, Dept Med, Boston, MA USA. [Berry, Jay G.] Harvard Med Sch, Dept Pediat, Boston, MA USA. [Gottlieb, Laura M.] Univ Calif San Francisco, Dept Family & Community Med, San Francisco, CA 94143 USA. [Shah, Samir S.] Univ Cincinnati, Sch Med, Dept Pediat, Cincinnati Childrens Hosp & Med Ctr, Cincinnati, OH USA. [Fieldston, Evan S.] Univ Penn, Childrens Hosp Philadelphia, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USA. [Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Chung, Paul J.] Univ Calif Los Angeles, Dept Pediat, Los Angeles, CA 90024 USA. [Chung, Paul J.] Univ Calif Los Angeles, Dept Hlth Policy & Management, Los Angeles, CA USA. [Chung, Paul J.] RAND Corp, RAND Hlth, Santa Monica, CA USA. [Chung, Paul J.] Univ Calif Los Angeles, Childrens Discovery & Innovat Inst, Mattel Childrens Hosp, Los Angeles, CA USA. RP Colvin, JD (reprint author), Univ Missouri, Childrens Mercy Hosp & Clin, Sch Med, Dept Pediat, 3101 Broadway Blvd,10th Floor, Kansas City, MO 64111 USA. EM jdcolvin@cmh.edu FU Children's Mercy Hospitals and Clinics FX This work was supported by internal funds from Children's Mercy Hospitals and Clinics (Dr Colvin). This research was completed as a part of the Academic Pediatrics Association Research Scholars Program (Drs Colvin and Bettenhausen). NR 32 TC 1 Z9 1 U1 3 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 2168-6203 EI 2168-6211 J9 JAMA PEDIATR JI JAMA Pediatr. PD NOV PY 2016 VL 170 IS 11 BP 1055 EP 1062 DI 10.1001/jamapediatrics.2016.1639 PG 8 WC Pediatrics SC Pediatrics GA EC4KM UT WOS:000388097900012 PM 27618284 ER PT J AU Henke, RM Johann, J Senathirajah, M Crandell, M Parker, L Riley, L Adams, G Echoles, F Mack, M Donovan, J Fleming, R Tulloch, W AF Henke, Rachel Mosher Johann, Jayne Senathirajah, Mahil Crandell, Maren Parker, Lisa Riley, Lynn Adams, Grafton Echoles, Fred Mack, Michelle Donovan, Jennifer Fleming, Robert Tulloch, William TI Implementation of the Patient-Centered Medical Home Model in Facilities Providing Comprehensive Care to Medically Underserved Populations SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Editorial Material DE Vulnerable populations; patient-centered medical home; federally qualified health center; primary health care; quality of health care AB During the three-year Centers for Medicare & Medicaid Services Federally Qualified Health Center (FQHC) Advanced Primary Care Practice (APCP) Demonstration, 393 FQHCs (78.6% of the original 500 and 90.6% of the 434 continually-enrolled FQHCs) achieved patient-centered medical home (PCMH) recognition. Facilitators included survey fee coverage and technical assistance. C1 [Henke, Rachel Mosher] Truven Hlth Analyt, Cambridge, MA 02140 USA. [Henke, Rachel Mosher] Truven Hlth Analyt, Santa Barbara, CA 93111 USA. [Johann, Jayne; Senathirajah, Mahil; Crandell, Maren] Truven Hlth, Ann Arbor, MI USA. [Parker, Lisa; Riley, Lynn; Adams, Grafton; Echoles, Fred; Mack, Michelle; Donovan, Jennifer; Fleming, Robert] Ctr Medicare & Medicaid Innovat, Ctr Medicare Serv, Baltimore, MD USA. [Parker, Lisa; Riley, Lynn; Adams, Grafton; Echoles, Fred; Mack, Michelle; Donovan, Jennifer; Fleming, Robert] Ctr Medicare & Medicaid Innovat, Ctr Medicaid Serv, Baltimore, MD USA. [Tulloch, William] Natl Comm Qual Assurance, Washington, DC USA. RP Henke, RM (reprint author), Truven Hlth Analyt, Cambridge, MA 02140 USA.; Henke, RM (reprint author), Truven Hlth Analyt, Santa Barbara, CA 93111 USA. EM rachel.henke@truvenhealth.com NR 8 TC 0 Z9 0 U1 4 U2 4 PU JOHNS HOPKINS UNIV PRESS PI BALTIMORE PA JOURNALS PUBLISHING DIVISION, 2715 NORTH CHARLES ST, BALTIMORE, MD 21218-4363 USA SN 1049-2089 EI 1548-6869 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PD NOV PY 2016 VL 27 IS 4 BP 1638 EP 1646 PG 9 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA EB1EQ UT WOS:000387092800003 PM 27818428 ER PT J AU Clough, JD Patel, K Shrank, WH AF Clough, Jeffrey D. Patel, Kavita Shrank, William H. TI Variation in Specialty Outpatient Care Patterns in the Medicare Population SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article ID OBSERVATIONAL INTENSITY BIAS; CROSS-SECTIONAL ANALYSIS; REGIONAL-VARIATIONS; UNITED-STATES; GEOGRAPHIC-VARIATION; INSURANCE CLAIMS; HEALTH-CARE; PAYMENT; BENEFICIARIES; PHYSICIANS AB Multiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care. To describe regional variation in outpatient visits for individual specialties and the association between specialty physician-specific payments and patient-reported satisfaction with care and health status. Retrospective cross-sectional study. A 20 % random sample of Medicare fee-for-service beneficiaries in 2012. Regions were grouped into quartiles of specialist index, defined as the observed/expected regional likelihood of having an outpatient visit to a specialist, for ten common specialties, adjusting for age, sex, and race. Outcomes were per capita specialty-specific physician payments and Medicare Current Beneficiary Survey responses. The proportion of beneficiaries seeing a specialist varied the most for endocrinology and gastroenterology (3.7- and 3.9-fold difference between the highest and lowest quartiles, respectively) and least for orthopedics and urology (1.5- and 1.7-fold difference, respectively). Multiple analyses suggested that this variation was not explained by prevalence of disease. Average specialty-specific payments were strongly associated with the likelihood of visiting a specialist. Differences in per capita payments from lowest (Q1) to highest quartiles (Q4) were greatest for cardiology ($89, $135, $172, $251) and dermatology ($46, $64, $82, $124). Satisfaction with overall care (median [interquartile range] across specialties: Q1, 93.3 % [92.6-93.7 %]; Q4, 93.1 % [92.9-93.2 %]) and self-reported health status (Q1, 37.1 % [36.9-37.7 %]; Q4, 38.2 % [37.2-38.4 %]) was similar across quartiles. Satisfaction with access to specialty care was consistently lower in the lowest quartile of specialty index (Q1, 89.7 % [89.2-91.1 %]; Q4, 94.5 % [94.4-94.8 %]). Substantial regional variability in outpatient specialist visits is associated with greater payments with limited benefits in terms of patient-reported satisfaction with care or reported health status. Reducing outpatient physician visits may represent an important opportunity to improve the efficiency of care. C1 [Clough, Jeffrey D.] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC 27708 USA. [Clough, Jeffrey D.] Duke Univ, Sch Med, Dept Med, Durham, NC 27706 USA. [Clough, Jeffrey D.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Patel, Kavita] Brookings Inst, Washington, DC 20036 USA. [Shrank, William H.] CVS, Woonsocket, RI USA. RP Clough, JD (reprint author), Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC 27708 USA.; Clough, JD (reprint author), Duke Univ, Sch Med, Dept Med, Durham, NC 27706 USA. EM jeffrey.clough@duke.edu NR 45 TC 2 Z9 2 U1 4 U2 4 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD NOV PY 2016 VL 31 IS 11 BP 1278 EP 1286 DI 10.1007/s11606-016-3745-8 PG 9 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA EA5SL UT WOS:000386683200009 PM 27259290 ER PT J AU Holmes, DR Califf, R Farb, A Abel, D Mack, M Jensen, TS Zuckerman, B Leon, M Shuren, J AF Holmes, David R., Jr. Califf, Robert Farb, Andrew Abel, Dorothy Mack, Michael Jensen, Tamara Syrek Zuckerman, Bram Leon, Martin Shuren, Jeff TI Overcoming the Challenges of Conducting Early Feasibility Studies of Medical Devices in the United States SO JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY LA English DT Review DE equipment design; new device development strategies; research design; research ethics committees; United States Food and Drug Administration AB Initial clinical studies of new medical technologies involve a complex balance of research participant benefits versus risks and costs of uncertainty when novel concepts are tested. The Food and Drug Administration Center for Devices and Radiological Health has recently introduced the Early Feasibility Study (EFS) Program for facilitating the conduct of these studies under the Investigational Device Exemption regulations. However, a systematic approach is needed to successfully implement this program while affording appropriate preservation of the rights and interests of patients. For this to succeed, a holistic reform of the clinical studies ecosystem for performing early-stage clinical research in the United States is necessary. The authors review the current landscape of the U.S. EFS and make recommendations for developing an efficient EFS process to meet the goal of improving access to early-stage, potentially beneficial medical devices in the United States. (C) 2016 by the American College of Cardiology Foundation. All rights reserved. C1 [Holmes, David R., Jr.] Mayo Clin, Dept Cardiol, Rochester, MN USA. [Califf, Robert; Farb, Andrew; Abel, Dorothy; Zuckerman, Bram; Shuren, Jeff] Food & Drug Adm, Silver Spring, MD USA. [Mack, Michael] Baylor Scott & White Hlth, Plano, TX USA. [Jensen, Tamara Syrek] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Leon, Martin] Columbia Univ, Med Ctr, Ctr Intervent Vasc Therapy, New York, NY USA. RP Holmes, DR (reprint author), Mayo Clin, Dept Cardiovasc Dis & Internal Med, 200 First St SW, Rochester, MN 55905 USA. EM holmes.david@mayo.edu FU Patient-Centered Outcomes Research Institute; National Institutes of Health; U.S. Food and Drug Administration; Amylin; Eli Lilly and Company; Bristol-Myers Squibb; Janssen Research and Development; Merck; Novartis; Amgen; Bayer Healthcare; BMEB Services; Genentech; GlaxoSmithKline; Heart.org/Daiichi-Sankyo; Kowa; Les Laboratoires Servier; Medscape/Heart.org; Regado; Roche FX Dr. Califf currently holds the post of Commissioner of Food and Drugs, U.S. Food and Drug Administration; prior to his appointment to the FDA, Dr. Califf received research grant funding from the Patient-Centered Outcomes Research Institute, the National Institutes of Health, the U.S. Food and Drug Administration, Amylin, and Eli Lilly and Company; research grants and consulting payments from Bristol-Myers Squibb, Janssen Research and Development, Merck, and Novartis; received consulting payments from Amgen, Bayer Healthcare, BMEB Services, Genentech, GlaxoSmithKline, Heart.org/Daiichi-Sankyo, Kowa, Les Laboratoires Servier, Medscape/Heart.org, Regado, and Roche; and held equity in N30 Pharma and Portola. Dr. Mack has served as an uncompensated coprimary investigator of the Partner 3 and COAPT trials. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Robert Harrington, MD, served as Guest Editor for this paper. NR 12 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 EI 1558-3597 J9 J AM COLL CARDIOL JI J. Am. Coll. Cardiol. PD OCT 25 PY 2016 VL 68 IS 17 BP 1908 EP 1915 DI 10.1016/j.jacc.2016.07.769 PG 8 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA EA7QN UT WOS:000386826700012 PM 27765194 ER PT J AU Jones, CM Baldwin, GT Tefera, L AF Jones, Christopher M. Baldwin, Grant T. Tefera, Lemeneh TI State Regulations and Opioid Use among Disabled Adults SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter ID DRUG-MONITORING PROGRAMS; REDUCTIONS C1 [Jones, Christopher M.] US Dept HHS, Washington, DC 20201 USA. [Baldwin, Grant T.] Ctr Dis Control & Prevent, Atlanta, GA USA. [Tefera, Lemeneh] Ctr Medicare Serv, Baltimore, MD USA. [Tefera, Lemeneh] Ctr Medicaid Serv, Baltimore, MD USA. RP Jones, CM (reprint author), US Dept HHS, Washington, DC 20201 USA. EM christopher.jones@hhs.gov NR 4 TC 0 Z9 0 U1 1 U2 1 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD OCT 6 PY 2016 VL 375 IS 14 BP 1396 EP 1397 DI 10.1056/NEJMc1610108 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA DY3EZ UT WOS:000384974900021 PM 27705248 ER PT J AU Hargraves, J Brennan, N AF Hargraves, John Brennan, Niall TI Medicare Hospice Spending Hit $15.8 Billion In 2015, Varied By Locale, Diagnosis SO HEALTH AFFAIRS LA English DT Article AB Between 2007 and 2015, Medicare hospice spending rose by 52 percent, from $10.4 billion to $15.8 billion. The rise was driven primarily by an increase in the number of patients in hospice care. Medicare spending on hospice care was $642 million, or 4.2 percent, higher in 2015 than it was in 2014. Spending and spending growth varied by geographic region and diagnosis. C1 [Hargraves, John; Brennan, Niall] Ctr Medicare & Medicaid Serv CMS, Off Enterprise Data & Analyt, Washington, DC 20201 USA. RP Hargraves, J (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Enterprise Data & Analyt, Washington, DC 20201 USA. EM john.hargraves@cms.hhs.gov NR 12 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 OCT PY 2016 VL 35 IS 10 BP 1902 EP 1907 DI 10.1377/hlthaff.2016.0650 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA EB1NA UT WOS:000387118000023 PM 27702965 ER PT J AU Hager, ER Rubio, DS Eidel, GS Penniston, ES Lopes, M Saksvig, BI Fox, RE Black, MM AF Hager, Erin R. Rubio, Diana S. Eidel, G. Stewart Penniston, Erin S. Lopes, Megan Saksvig, Brit I. Fox, Renee E. Black, Maureen M. TI Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities SO JOURNAL OF SCHOOL HEALTH LA English DT Article DE health policy; nutrition and diet; physical fitness and sport ID ELEMENTARY-SCHOOLS; PHYSICAL-ACTIVITY; ENVIRONMENTS; PREVENTION; PROGRAMS; MIDDLE AB BACKGROUNDWritten local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). METHODSOnline surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. RESULTSResponse rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (75%) African-American/Hispanic students, and 25.5% majority (75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). CONCLUSIONSSchools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities. C1 [Hager, Erin R.] Univ Maryland, Dept Pediat, Dept Epidemiol & Publ Hlth, Sch Med,Growth & Nutr Div, 737 West Lombard St,Room 163, Baltimore, MD 21201 USA. [Rubio, Diana S.] Univ Maryland, Dept Pediat, Sch Med, Growth & Nutr Div, 737 West Lombard St, Baltimore, MD 21201 USA. [Eidel, G. Stewart] Maryland Dept Educ, Off Sch & Community Nutr Programs, Baltimore, MD 21201 USA. [Penniston, Erin S.] Maryland Dept Hlth & Mental Hyg, Ctr Chron Dis Prevent & Control, 201 West Preston St, Baltimore, MD 21201 USA. [Lopes, Megan] Marland State Dept Educ, Team Nutr, Profess Dev & Tech Assistance Sect, Off Sch & Community Nutr Programs,Off Sch Effecti, Baltimore, MD 21201 USA. [Saksvig, Brit I.] Univ Maryland, Dept Epidemiol & Biostat, Sch Publ Hlth, College Pk, MD 20742 USA. [Fox, Renee E.] CMCS CAHPG, DQHO, Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. [Black, Maureen M.] Univ Maryland, Dept Pediat, Sch Med, 737 West Lombard St,Room 161, Baltimore, MD 21201 USA. [Black, Maureen M.] Univ Maryland, Dept Epidemiol & Publ Hlth, Sch Med, Div Growth & Nutr, 737 West Lombard St,Room 161, Baltimore, MD 21201 USA. RP Hager, ER (reprint author), Univ Maryland, Dept Pediat, Dept Epidemiol & Publ Hlth, Sch Med,Growth & Nutr Div, 737 West Lombard St,Room 163, Baltimore, MD 21201 USA. EM ehager@peds.umaryland.edu; drubio@peds.umaryland.edu; stewart.eidel@maryland.gov; erin.penniston@maryland.gov; megan.sweatlopes@maryland.gov; bsaksvig@umd.edu; Renee.Fox@cms.hhs.gov; mblack@peds.umaryland.edu NR 26 TC 0 Z9 0 U1 5 U2 5 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0022-4391 EI 1746-1561 J9 J SCHOOL HEALTH JI J. Sch. Health PD OCT PY 2016 VL 86 IS 10 BP 742 EP 750 DI 10.1111/josh.12430 PG 9 WC Education & Educational Research; Education, Scientific Disciplines; Health Care Sciences & Services; Public, Environmental & Occupational Health SC Education & Educational Research; Health Care Sciences & Services; Public, Environmental & Occupational Health GA DW5NN UT WOS:000383692700006 PM 27619765 ER PT J AU Clough, JD Strawbridge, LM LeBlanc, TW Hammill, BG Kamal, AH AF Clough, Jeffrey D. Strawbridge, Larisa M. LeBlanc, Thomas W. Hammill, Bradley G. Kamal, Arif H. TI Association of Practice-Level Hospital Use With End-of-Life Outcomes, Readmission, and Weekend Hospitalization Among Medicare Beneficiaries With Cancer SO JOURNAL OF ONCOLOGY PRACTICE LA English DT Article ID PALLIATIVE CARE; QUALITY IMPROVEMENT; ONCOLOGY PRACTICE; UNITED-STATES; PROGRAM; IMPACT AB Purpose To determine the relationships between hospital use of treating oncology practices and patient outcomes. Patients and Methods Retrospective analysis of 397,646 Medicare beneficiaries who received anticancer therapy in 2012. Each beneficiary was associated with a practice; practices were ranked on the basis of risk-adjusted hospital use, that is, inpatient intensity. Outcomes included 30-day readmission, weekend admissions, intensive care unit stays in the last month of life, and hospice stay of >= 7 days. Outcomes were measured for each quartile of practice-level inpatient intensity. We fit multivariable logistic regression models to calculate adjusted odds ratios (ORs) for each outcome for each quartile of inpatient intensity. Results Total 30-day readmissions were 22.8% and 31.9% (OR, 1.45; 95% CI, 1.39 to 1.50) for patients in practices with the lowest versus highest quartiles of inpatient intensity, respectively; unplanned readmissions were 19.8% and 27.1% (OR, 1.36; 95% CI, 1.31 to 1.41), respectively. The proportion of admissions that occurred on weekends was similar across quartiles. Patients of practices in the highest quartiles of inpatient intensity had higher rates of death in an ICU stay in the last month of life (25.5% versus 18.0%; OR, 1.33; 95% CI, 1.19 to 1.49) and a lower rate of hospice stay of at least 7 days (50.9% to 42.5%; OR, 0.79; 95% CI, 0.74 to 0.86). Conclusion Medical oncology practices that seek to reduce hospitalizations should consider focusing initially on processes related to end-of-life care and care transitions. C1 Duke Univ, Sch Med, Durham, NC 27715 USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Clough, JD (reprint author), Duke Univ, Sch Med, Duke Clin Res Inst, POB 17969, Durham, NC 27715 USA. EM jeffrey.clough@duke.edu NR 27 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 1554-7477 EI 1935-469X J9 J ONCOL PRACT JI J. Oncol. Pract. PD OCT PY 2016 VL 12 IS 10 BP E933 EP + DI 10.1200/JOP.2016.013102 PG 11 WC Health Care Sciences & Services SC Health Care Sciences & Services GA DZ6NF UT WOS:000385978500026 PM 27531384 ER PT J AU Conway, P AF Conway, Patrick TI REINVENTING HEALTH CARE: HEALTH SYSTEM TRANSFORMATION SO PEDIATRIC PULMONOLOGY LA English DT Meeting Abstract C1 [Conway, Patrick] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 8755-6863 EI 1099-0496 J9 PEDIATR PULM JI Pediatr. Pulmonol. PD OCT PY 2016 VL 51 SU S45 MA S07.2 BP 140 EP 140 PG 1 WC Pediatrics; Respiratory System SC Pediatrics; Respiratory System GA DY0VW UT WOS:000384815300023 ER PT J AU Caines, K Shoff, C Bott, DM Pines, JM AF Caines, Kadin Shoff, Carla Bott, David M. Pines, Jesse M. TI County-Level Variation in Emergency Department Admission Rates Among US Medicare Beneficiaries SO ANNALS OF EMERGENCY MEDICINE LA English DT Article AB Study objective: Hospital-based emergency departments (EDs) are the gatewayto hospital admissions for many Americans. Approximately half of all US hospital admissions originate from EDs, and more than 3 in 4 are among Medicare beneficiaries. Recent literature has demonstrated nearly 2-fold variation in both physician- and hospital-level ED admission rates. We study geographic variation at the county level in ED admission rates among Medicare fee-for-service beneficiaries. Methods: Using the 100% population data from the Centers for Medicare & Medicaid Services (CMS), we analyzed beneficiaries continuously enrolled in Medicare fee-for-service Parts A and B who resided in the 50 states and the District of Columbia in 2012. The ED admission rate was aggregated to the county level. ED admission rates were adjusted with the CMS Hierarchical Condition Categories (HCC) risk score. The resulting HCC adjusted ED admission rate was mapped to display the variation by county. Results: The average county HCC adjusted ED admission rate was 30.8% in the Medicare population. Counties in the lowest quintile had an ED admission rate of 19.9% or lower. By comparison, counties in the highest quintile had an ED admission rate of 40.3% or higher. Conclusion: Among Medicare beneficiaries, county-level ED admission rates varied 2-fold between counties in the lowest and highest quintiles. Future work should focus on exploring causes for this variation, such as racial ethnic composition, socioeconomic status, and health care delivery system characteristics and the research of effectiveness of policies that affect ED admission decisions. C1 [Caines, Kadin; Shoff, Carla; Bott, David M.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Pines, Jesse M.] George Washington Univ, Washington, DC USA. RP Caines, K (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. EM kadin.caines@cms.hhs.gov NR 10 TC 0 Z9 0 U1 1 U2 1 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD OCT PY 2016 VL 68 IS 4 BP 456 EP 460 DI 10.1016/j.annemergmed.2016.03.019 PG 5 WC Emergency Medicine SC Emergency Medicine GA DY0IW UT WOS:000384781500011 PM 27085370 ER PT J AU Dember, LM Archdeacon, P Krishnan, M Lacson, E Ling, SM Roy-Chaudhury, P Smith, KA Flessner, MF AF Dember, Laura M. Archdeacon, Patrick Krishnan, Mahesh Lacson, Eduardo, Jr. Ling, Shari M. Roy-Chaudhury, Prabir Smith, Kimberly A. Flessner, Michael F. TI Pragmatic Trials in Maintenance Dialysis: Perspectives from the Kidney Health Initiative SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Review ID CLINICAL-TRIALS; QUALITY; CARE; NEPHROLOGY; CLINICALTRIALS.GOV; INCREASE; CONSENT; POLICY; SAFETY; PBRN AB Pragmatic clinical trials are conducted under the real-world conditions of clinical care delivery. As a result, these trials yield findings that are highly generalizable to the nonresearch setting, identify interventions that are readily translatable into clinical practice, and cost less than trials that require extensive research infrastructures. Maintenance dialysis is a setting especially well suited for pragmatic trials because of inherently frequent and predictable patient encounters, highly granular and uniform data collection, use of electronic data systems, and delivery of care by a small number of provider organizations to approximately 90% of patients nationally. Recognizing the potential for pragmatic trials to generate much needed evidence to guide the care of patients receiving maintenance dialysis, the Kidney Health Initiative assembled a group of individuals with relevant expertise from academia, industry, and government to provide the nephrology community with information about the design and conduct of such trials, with a specific focus on the dialysis setting. Here, we review this information, and where applicable, use experience from the ongoing Time to Reduce Mortality in End Stage Renal Disease Trial, a large cluster-randomized, pragmatic trial evaluating hemodialysis session duration, to illustrate challenges and solutions to operational, ethical, and regulatory issues. C1 [Dember, Laura M.] Univ Penn, Renal Electrolyte & Hypertens Div, Perelman Sch Med, Philadelphia, PA 19104 USA. [Dember, Laura M.] Univ Penn, Dept Biostat & Epidemiol, Perelman Sch Med, Philadelphia, PA 19104 USA. [Archdeacon, Patrick] US FDA, Off Med Policy, Silver Spring, MD USA. [Archdeacon, Patrick; Smith, Kimberly A.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Krishnan, Mahesh] DaVita Healthcare Partners, Denver, CO USA. [Lacson, Eduardo, Jr.] Tufts Med Ctr, Div Nephrol, Boston, MA USA. [Lacson, Eduardo, Jr.] Tufts Univ, Sch Med, Boston, MA 02111 USA. [Ling, Shari M.] Ctr Medicare Serv, Ctr Clin Stand & Qual, Baltimore, MD USA. [Ling, Shari M.] Ctr Medicaid Serv, Ctr Clin Stand & Qual, Baltimore, MD USA. [Roy-Chaudhury, Prabir] Univ Arizona, Coll Med, Div Nephrol, Tucson, AZ USA. [Roy-Chaudhury, Prabir] Southern Arizona Vet Adm Hlth Care Syst, Tucson, AZ USA. [Flessner, Michael F.] NIDDK, Div Kidney Urol & Hematol, Bethesda, MD 20892 USA. RP Dember, LM (reprint author), Univ Penn, Perelman Sch Med, Blockley Hall,Room 920,423 Guardian Dr, Philadelphia, PA 19104 USA. EM ldember@upenn.edu FU Kidney Health Initiative (KHI); American Society of Nephrology; US Food and Drug Administration; National Institutes of Health Office of the Director; National Institute of Diabetes and Digestive and Kidney Diseases [UH2-AT007797, UH3-DK102384] FX This work was supported by the Kidney Health Initiative (KHI), a public-private partnership between the American Society of Nephrology, the US Food and Drug Administration, and >75 member organizations and companies to enhance patient safety and foster innovation in kidney disease. KHI funds were used to defray costs incurred during the conduct of the project, including project management support which was expertly provided by American Society of Nephrology staff members, Melissa West and Ryan Murray. There was no honorarium or other financial support provided to KHI workgroup members. The authors of this paper had final review authority and are fully responsible for its content.; KHI makes every effort to avoid actual, potential, or perceived conflicts of interest that may arise as a result of industry relationships or personal interests among the members of the workgroup. More information on KHI, the workgroup, or the conflict of interest policy can be found at www.kidneyhealthinitiative.org. The TiME Trial is funded by the National Institutes of Health Office of the Director and the National Institute of Diabetes and Digestive and Kidney Diseases (UH2-AT007797 and UH3-DK102384 to L.M.D.). The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any agency of the US Government, DaVita Healthcare Partners, or Fresenius Medical Care. NR 43 TC 0 Z9 0 U1 0 U2 0 PU AMER SOC NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1046-6673 EI 1533-3450 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD OCT PY 2016 VL 27 IS 10 BP 2955 EP 2963 DI 10.1681/ASN.2016030340 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA DX8HK UT WOS:000384628500008 PM 27401689 ER PT J AU Barile, JP Horner-Johnson, W Krahn, G Zack, M Miranda, D DeMichele, K Ford, D Thompson, WW AF Barile, John P. Horner-Johnson, Willi Krahn, Gloria Zack, Matthew Miranda, David DeMichele, Kimberly Ford, Derek Thompson, William W. TI Measurement characteristics for two health-related quality of life measures in older adults: The SF-36 and the CDC Healthy Days items SO DISABILITY AND HEALTH JOURNAL LA English DT Article DE Health-related quality of life; Measurement; SF-36; Healthy Days; Functional limitations ID INFORMATION-SYSTEM PROMIS; MEASUREMENT INVARIANCE; PERCEIVED HEALTH; IQOLA PROJECT; 10 COUNTRIES; DISABILITY; OUTCOMES; PEOPLE; QUESTIONNAIRE; INSTRUMENTS AB Background: The Short Form Health Survey (SF-36) and the Centers for Disease Control and Prevention (CDC) Healthy Days items are well known measures of health-related quality of life. The validity of the SF-36 for older adults and those with disabilities has been questioned. Objective: Assess the extent to which the SF-36 and the Centers for Disease Control and Prevention (CDC) Healthy Days items measure the same aspects of health; whether the SF-36 and the CDC unhealthy days items are invariant across gender, functional status, or the presence of chronic health conditions of older adults; and whether each of the SF-36's eight subscales is independently associated with the CDC Healthy Days items. Methods: We analyzed data from 66,269 adult Medicare advantage members age 65 and older. We used confirmatory factor analyses and regression modeling to test associations between the CDC Healthy Days items and subscales of the SF-36. Results: The CDC Healthy Days items were associated with the SF-36 global measures of physical and mental health. The CDC physically unhealthy days item was associated with the SF-36 subscales for bodily pain, physical role limitations, and general health, while the CDC mentally unhealthy days item was associated with the SF-36 subscales for mental health, emotional role limitations, vitality and social functioning. The SF-36 physical functioning subscale was not independently associated with either of the CDC Healthy Days items. Conclusions: The CDC Healthy Days items measure similar domains as the SF-36 but appear to assess HRQOL without regard to limitations in functioning. (C) 2016 Elsevier Inc. All rights reserved. C1 [Barile, John P.] Univ Hawaii Manoa, Dept Psychol, 2530 Dole St,Sakamaki Hall C404, Honolulu, HI 96822 USA. [Horner-Johnson, Willi] Oregon Hlth & Sci Univ, Inst Dev & Disabil, 3181 SW Sam Jackson Pk Rd, Portland, OR 97239 USA. [Krahn, Gloria] Oregon State Univ, Coll Publ Hlth & Human Sci, Hallie Ford Ctr 255, Corvallis, OR 97331 USA. [Zack, Matthew] US Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, 1600 Clifton Rd, Atlanta, GA 30329 USA. [Miranda, David; DeMichele, Kimberly] Ctr Medicare Serv, Div Consumer Assessment & Plan Performance, 7500 Secur Blvd, Baltimore, MD 21244 USA. [Miranda, David; DeMichele, Kimberly] Ctr Medicaid Serv, Div Consumer Assessment & Plan Performance, 7500 Secur Blvd, Baltimore, MD 21244 USA. [Ford, Derek] US Ctr Dis Control & Prevent, Natl Ctr Injury Prevent & Control, 1600 Clifton Rd, Atlanta, GA 30329 USA. [Thompson, William W.] US Ctr Dis Control & Prevent, Natl Ctr Birth Defects & Dev Disabil, 1600 Clifton Rd, Atlanta, GA 30329 USA. RP Barile, JP (reprint author), Univ Hawaii Manoa, Dept Psychol, 2530 Dole St,Sakamaki Hall C404, Honolulu, HI 96822 USA. EM Barile@Hawaii.edu OI Barile, John/0000-0003-4098-0640 FU Intramural CDC HHS [CC999999] NR 39 TC 0 Z9 0 U1 9 U2 9 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1936-6574 EI 1876-7583 J9 DISABIL HEALTH J JI Disabil. Health J. PD OCT PY 2016 VL 9 IS 4 BP 567 EP 574 DI 10.1016/j.dhjo.2016.04.008 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health; Rehabilitation SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Rehabilitation GA DX0BF UT WOS:000384025800003 PM 27259343 ER PT J AU Fleischman, W Ross, JS Agrawal, S AF Fleischman, William Ross, Joseph S. Agrawal, Shantanu TI Link between prescribing and gifting of educational materials should be studied Reply SO BMJ-BRITISH MEDICAL JOURNAL LA English DT Letter C1 [Fleischman, William] Yale Sch Med, Robert Wood Johnson Fdn Clin Scholars Program, 333 Cedar St,SHM IE 61, New Haven, CT 06510 USA. [Ross, Joseph S.] Yale Sch Med, Dept Med, Sect Gen Internal Med, New Haven, CT USA. [Agrawal, Shantanu] US Dept HHS, Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. RP Fleischman, W (reprint author), Yale Sch Med, Robert Wood Johnson Fdn Clin Scholars Program, 333 Cedar St,SHM IE 61, New Haven, CT 06510 USA. EM wf3@buffalo.edu NR 2 TC 0 Z9 0 U1 0 U2 0 PU BMJ PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1756-1833 J9 BMJ-BRIT MED J JI BMJ-British Medical Journal PD SEP 29 PY 2016 VL 354 AR i5255 DI 10.1136/bmj.i5255 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA DZ4UN UT WOS:000385856100006 ER PT J AU Dummit, LA Kahvecioglu, D Marrufo, G Rajkumar, R Marshall, J Tan, E Press, MJ Flood, S Muldoon, LD Gu, Q Hassol, A Bott, DM Bassano, A Conway, PH AF Dummit, Laura A. Kahvecioglu, Daver Marrufo, Grecia Rajkumar, Rahul Marshall, Jaclyn Tan, Eleonora Press, Matthew J. Flood, Shannon Muldoon, L. Daniel Gu, Qian Hassol, Andrea Bott, David M. Bassano, Amy Conway, Patrick H. TI Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID ARTHROPLASTY; HEALTH; CARE AB IMPORTANCE Bundled Payments for Care Improvement (BPCI) is a voluntary initiative of the Centers for Medicare & Medicaid Services to test the effect of holding an entity accountable for all services provided during an episode of care on episode payments and quality of care. OBJECTIVE To evaluate whether BPCI was associated with a greater reduction in Medicare payments without loss of quality of care for lower extremity joint(primarily hip and knee) replacement episodes initiated in BPCI-participating hospitals that are accountable for total episode payments (for the hospitalization and Medicare-covered services during the 90 days after discharge). DESIGN, SETTING, AND PARTICIPANTS A difference-in-differences approach estimated the differential change in outcomes for Medicare fee-for-service beneficiaries who had a lower extremity joint replacement at a BPCI-participating hospital between the baseline (October 2011 through September 2012) and intervention (October 2013 through June 2015) periods and beneficiaries with the same surgical procedure at matched comparison hospitals. EXPOSURE Lower extremity joint replacement at a BPCI-participating hospital. MAIN OUTCOMES AND MEASURES Standardized Medicare-allowed payments (Medicare payments), utilization, and quality (unplanned readmissions, emergency department visits, and mortality) during hospitalization and the 90-day postdischarge period. RESULTS There were 29 441 lower extremity joint replacement episodes in the baseline period and 31 700 in the intervention period (mean [SD] age, 74.1 [8.89] years; 65.2% women) at 176 BPCI-participating hospitals, compared with 29 440 episodes in the baseline period (768 hospitals) and 31 696 episodes in the intervention period (841 hospitals) (mean [SD] age, 74.1 [8.92] years; 64.9% women) at matched comparison hospitals. The BPCI mean Medicare episode payments were $30 551(95% CI,$30 201 to $30901) in the baseline period and declined by $3286 to $27 265 (95% CI, $26 838 to $27 692) in the intervention period. The comparison mean Medicare episode payments were $30 057 (95% CI, $29 765 to $30 350) in the baseline period and declined by $2119 to $27 938 (95% CI, $27 639 to $28 237). The mean Medicare episode payments declined by an estimated $1166 more (95% CI, -$1634 to -$699; P < .001) for BPCI episodes than for comparison episodes, primarily due to reduced use of institutional postacute care. There were no statistical differences in the claims-based quality measures, which included 30-day unplanned readmissions(-0.1%; 95% CI, -0.6% to 0.4%), 90-day unplanned readmissions(-0.4%; 95% CI, -1.1% to 0.3%), 30-day emergency department visits(-0.1%; 95% CI, -0.7% to 0.5%), 90-day emergency department visits(0.2%; 95% CI,-0.6% to 1.0%), 30-day postdischarge mortality(-0.1%; 95% CI, -0.3% to 0.2%), and 90-day postdischarge mortality (-0.0%; 95% CI, -0.3% to 0.3%). CONCLUSIONS AND RELEVANCE In the first 21 months of the BPCI initiative, Medicare payments declined more for lower extremity joint replacement episodes provided in BPCI-participating hospitals than for those provided in comparison hospitals, without a significant change in quality outcomes. Further studies are needed to assess longer-term follow-up as well as patterns for other types of clinical care. C1 [Dummit, Laura A.; Marrufo, Grecia; Marshall, Jaclyn; Tan, Eleonora] Lewin Grp, 3130 Fairview Pk Dr,Ste 500, Falls Church, VA 22042 USA. [Kahvecioglu, Daver; Press, Matthew J.; Flood, Shannon; Muldoon, L. Daniel; Bott, David M.; Bassano, Amy; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Rajkumar, Rahul] CareFirst Blue Cross Blue Shield, Baltimore, MD USA. [Hassol, Andrea] ABT Associates Inc, Cambridge, MA 02138 USA. RP Dummit, LA (reprint author), Lewin Grp, 3130 Fairview Pk Dr,Ste 500, Falls Church, VA 22042 USA. EM laura.dummit@lewin.com NR 20 TC 4 Z9 4 U1 12 U2 12 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD SEP 27 PY 2016 VL 316 IS 12 BP 1267 EP 1278 DI 10.1001/jama.2016.12717 PG 12 WC Medicine, General & Internal SC General & Internal Medicine GA DW9EW UT WOS:000383959800018 PM 27653006 ER PT J AU Ritchey, M Chang, AP Powers, C Loustalot, F Schieb, L Ketcham, M Durthaler, J Hong, YL AF Ritchey, Matthew Chang, Anping Powers, Christopher Loustalot, Fleetwood Schieb, Linda Ketcham, Michelle Durthaler, Jeffrey Hong, Yuling TI Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries - United States, 2014 SO MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT LA English DT Article ID BLOOD-PRESSURE CONTROL; OLDER-ADULTS; ADHERENCE; HYPERTENSION; DISEASE; IMPACT AB Introduction: Nonadherence to taking prescribed antihypertensive medication (antihypertensive) regimens has been identified as a leading cause of poor blood pressure control among persons with hypertension and an important risk factor for adverse cardiovascular disease outcomes. CDC and the Centers for Medicare and Medicaid Services analyzed geographic, racial-ethnic, and other disparities in nonadherence to antihypertensives among Medicare Part D beneficiaries in 2014. Methods: Antihypertensive nonadherence, defined as a proportion of days a beneficiary was covered with antihypertensives of <80%, was assessed using prescription drug claims data among Medicare Advantage or Medicare fee-for-service beneficiaries aged >= 65 years with Medicare Part D coverage during 2014 (N = 18.5 million). Analyses were stratified by antihypertensive class, beneficiaries' state and county of residence, type of prescription drug plan, and treatment and demographic characteristics. Results: Overall, 26.3% (4.9 million) of Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen. Nonadherence differed by multiple factors, including medication class (range: 16.9% for angiotensin II receptor blockers to 28.9% for diuretics); race-ethnicity (24.3% for non-Hispanic whites, 26.3% for Asian/Pacific Islanders, 33.8% for Hispanics, 35.7% for blacks, and 38.8% for American Indians/Alaska Natives); and state of residence (range 18.7% for North Dakota to 33.7% for the District of Columbia). Considerable county-level variation in nonadherence was found; the highest nonadherence tended to occur in the southern United States (U.S. Census region nonadherence = 28.9% [South], 26.7% [West], 24.1% [Northeast], and 22.8% [Midwest]) Conclusions and Implications for Public Health Practice: More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes. C1 [Ritchey, Matthew; Chang, Anping; Loustalot, Fleetwood; Schieb, Linda; Durthaler, Jeffrey; Hong, Yuling] CDC, Div Heart Dis & Stroke Prevent, Atlanta, GA 30333 USA. [Powers, Christopher] Ctr Medicare & Medicaid Serv, Off Enterprise Data & Analyt, Baltimore, MD USA. [Ketcham, Michelle] Ctr Medicare & Medicaid Serv, Medicare Drug Benefit & C&D Data Grp, Baltimore, MD USA. RP Ritchey, M (reprint author), CDC, Div Heart Dis & Stroke Prevent, Atlanta, GA 30333 USA. EM MRitchey@cdc.gov NR 23 TC 1 Z9 1 U1 1 U2 1 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 0149-2195 EI 1545-861X J9 MMWR-MORBID MORTAL W JI MMWR-Morb. Mortal. Wkly. Rep. PD SEP 16 PY 2016 VL 65 IS 36 BP 967 EP 976 PG 10 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA DW1EP UT WOS:000383386100006 PM 27632693 ER PT J AU Koh, HK Rajkumar, R McDonough, JE AF Koh, Howard K. Rajkumar, Rahul McDonough, John E. TI Reframing Prevention in the Era of Health Reform SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID AFFORDABLE CARE ACT; COST C1 [Koh, Howard K.; McDonough, John E.] Harvard TH Chan Sch Publ Hlth, 677 Huntington Ave,Kresge 401, Boston, MA 02115 USA. [Koh, Howard K.] Harvard Kennedy Sch, Cambridge, MA USA. [Rajkumar, Rahul] US Dept HHS, Ctr Medicare Serv, Bethesda, MD USA. [Rajkumar, Rahul] US Dept HHS, Ctr Medicaid Serv, Bethesda, MD USA. [Rajkumar, Rahul] CareFirst Blue Cross Blue Shield, Baltimore, MD USA. RP Koh, HK (reprint author), Harvard TH Chan Sch Publ Hlth, 677 Huntington Ave,Kresge 401, Boston, MA 02115 USA. EM hkoh@hsph.harvard.edu NR 8 TC 3 Z9 3 U1 1 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD SEP 13 PY 2016 VL 316 IS 10 BP 1039 EP 1040 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA DV5TB UT WOS:000382991100011 PM 27623457 ER PT J AU Elliott, MN Beckett, MK Lehrman, WG Cleary, P Cohea, CW Giordano, LA Goldstein, EH Damberg, CL AF Elliott, Marc N. Beckett, Megan K. Lehrman, William G. Cleary, Paul Cohea, Christopher W. Giordano, Laura A. Goldstein, Elizabeth H. Damberg, Cheryl L. TI Understanding The Role Played By Medicare's Patient Experience Points System In Hospital Reimbursement SO HEALTH AFFAIRS LA English DT Article ID PAY-FOR-PERFORMANCE; SAFETY-NET HOSPITALS; RACIAL DISPARITIES; MANAGED CARE; HEALTH-CARE; QUALITY; PROGRAMS; HCAHPS; IMPROVEMENT; LESSONS AB In 2015 the Medicare Hospital Value-Based Purchasing (VBP) program paid hospitals $1.4 billion in performance-based incentives; 30 percent of a hospital's VBP Total Performance Score was based on performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures of the patient experience of care. Hospitals receive patient experience points based on three components: achievement, improvement, and consistency. For 2015 we examined how the three components affected reimbursement for 3,152 hospitals, including their impact on low-performing and high-minority hospitals. Achievement accounted for 96 percent of the differences among hospitals in total HCAHPS points. Although achievement had the biggest influence on payments, payments related to improvement and consistency were more beneficial for low-performing hospitals that disproportionately served minority patients. The findings highlight the important inducement that paying for improvement provides to initially low-performing hospitals to improve care and the role this incentive structure plays in minimizing resource redistributions away from hospitals serving minority populations. Additional emphasis on improvement points could benefit hospitals serving disadvantaged patients. C1 [Elliott, Marc N.; Damberg, Cheryl L.] RAND Corp, Hlth, Santa Monica, CA 90401 USA. [Beckett, Megan K.] RAND Corp, Santa Monica, CA 90401 USA. [Lehrman, William G.; Goldstein, Elizabeth H.] Ctr Medicare & Medicaid Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD USA. [Cleary, Paul] Yale Univ Sch Publ Hlth, New Haven, CT USA. [Cohea, Christopher W.; Giordano, Laura A.] Hlth Serv Advisory Grp, Surveys Res & Anal, Phoenix, AZ USA. RP Elliott, MN (reprint author), RAND Corp, Hlth, Santa Monica, CA 90401 USA. EM elliott@rand.org FU Centers for Medicare and Medicaid Services (CMS) [HHSM-500-2011-AZ10C] FX This article was presented at the AcademyHealth Annual Research Meeting, Baltimore, Maryland, June 23-25, 2013, and the American Statistical Association's Joint Statistical Meetings, Montreal, Quebec, August 3-8, 2013. This work was supported by contract No. HHSM-500-2011-AZ10C from the Centers for Medicare and Medicaid Services (CMS) to the Health Services Advisory Group. Two of the authors, William Lehrman and Elizabeth Goldstein, are employed by CMS, which implements the Hospital Value-Based Purchasing program; the views expressed here are those of the authors and not necessarily of their organizations. The authors have no other conflicts of interest. The authors thank Fergal McCarthy and Lynn Polite for assistance with the preparation of this article. NR 29 TC 0 Z9 0 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 SEP PY 2016 VL 35 IS 9 BP 1673 EP 1680 DI 10.1377/hlthaff.2015.0691 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA EB1LT UT WOS:000387114300019 PM 27605650 ER PT J AU Clough, JD Riley, GF Cohen, M Hanley, SM Sanghavi, D DeWalt, DA Rajkumar, R Conway, PH AF Clough, Jeffrey D. Riley, Gerald F. Cohen, Melissa Hanley, Sheila M. Sanghavi, Darshak DeWalt, Darren A. Rajkumar, Rahul Conway, Patrick H. TI Patterns of care for clinically distinct segments of high cost Medicare beneficiaries SO HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION LA English DT Article DE Accountable care; Population health; Risk-stratification; Population segmentation; Payment reform ID ACCOUNTABLE CARE; HEALTH-CARE; ORGANIZATIONS; COORDINATION; CLAIMS; MODEL AB Background: Efforts to improve the efficiency of care for the Medicare population commonly target high cost beneficiaries. We describe and evaluate a novel management approach, population segmentation, for identifying and managing high cost beneficiaries. Methods: A retrospective cross-sectional analysis of 6,919,439 Medicare fee-for-service beneficiaries in 2012. We defined and characterized eight distinct clinical population segments, and assessed heterogeneity in managing practitioners. Results: The eight segments comprised 9.8% of the population and 47.6% of annual Medicare payments. The eight segments included 61% and 69% of the population in the top decile and top 5% of annual Medicare payments. The positive-predictive values within each segment for meeting thresholds of Medicare payments ranged from 72% to 100%, 30% to 83%, and 14% to 56% for the upper quartile, upper decile, and upper 5% of Medicare payments respectively. Sensitivity and positive-predictive values were substantially improved over predictive algorithms based on historical utilization patterns and co morbidities. The mean [95% confidence interval] number of unique practitioners and practices delivering E&M services ranged from 1.82 [1.79-1.84] to 6.94 [6.91-6.98] and 1.48 [1.46-1.50] to 4.98 [4.95-5.00] respectively. The percentage of cognitive services delivered by primary care practitioners ranged from 23.8% to 67.9% across segments, with significant variability among specialty types. Conclusions: Most high cost Medicare beneficiaries can be identified based on a single clinical reason and are managed by different practitioners. Implications: Population segmentation holds potential to improve efficiency in the Medicare population by identifying opportunities to improve care for specific populations and managing clinicians, and forecasting and evaluating the impact of specific interventions. (C) 2015 Elsevier Inc. All rights reserved. C1 [Clough, Jeffrey D.; Riley, Gerald F.; Cohen, Melissa; Hanley, Sheila M.; Sanghavi, Darshak; DeWalt, Darren A.; Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD USA. [Clough, Jeffrey D.; Riley, Gerald F.; Cohen, Melissa; Hanley, Sheila M.; Sanghavi, Darshak; DeWalt, Darren A.; Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD USA. [Clough, Jeffrey D.] Duke Clin Res Inst, Durham, NC USA. [Clough, Jeffrey D.] Duke Univ, Sch Med, Durham, NC USA. RP Clough, JD (reprint author), Duke Univ, Dept Med, Duke Clin Res Inst, 2400 Pratt St, Durham, NC 27705 USA. EM Jeffrey.clough@duke.edu OI DeWalt, Darren/0000-0003-2270-751X NR 25 TC 0 Z9 0 U1 0 U2 0 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 2213-0764 EI 2213-0772 J9 HEALTHCARE JI HealthCare PD SEP PY 2016 VL 4 IS 3 BP 160 EP 165 DI 10.1016/j.hjdsi.2015.09.005 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA EC4NE UT WOS:000388107800011 PM 27637821 ER PT J AU Shah, AY LLanos, K Dougherty, D Cha, S Conway, PH AF Shah, Ankoor Y. LLanos, Karen Dougherty, Denise Cha, Stephen Conway, Patrick H. TI State challenges to child health quality measure reporting and recommendations for improvement SO HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION LA English DT Article DE Medicaid; CHIP; Quality ID CARE QUALITY; MEDICAID AB Objective: The Children's Health Insurance Program (CHIP) was re-authorized in 2009, ushering in an unprecedented focus on children's health care quality one of which includes identifying a core set of performance measures for voluntary reporting by states' Medicaid/CHIP programs. However, there is a wide variation in the quantity and quality of measures states chose to report to the Center's for Medicare & Medicaid Services (CMS). The objective of this study is to assess reporting barriers and to identify potential opportunities for improvement. Methods: From 2013 to 2014 a questionnaire developed in coordination with CMS and the Agency for Healthcare Research and Quality (AHRQ) was sent to state Medicaid and CHIP officials to assess barriers to child health quality reporting for Federal Fiscal Year 2012. States were categorized as high, medium, or low reporting for comparative analysis. Results: Twenty-five of the 50 states and the District of Columbia agreed to participate in the study and completed the questionnaire. States placed a high priority on children's health care quality reporting (4.2 of 5 point Likert Scale, SD 0.99) and 96% plan to use measurement results to further improve their quality initiatives. However, low reporting states believed they had inadequate staffing and that data collection and extraction was too time-consuming than high reporting states. Conclusion: Based on state responses, possible solutions to improve reporting includes funding and staff support, refining the technical assistance provided, and creating venues for state-to-state interaction. Realistic and tangible improvements are within reach and opportunities for CMS and states to collaborate to improve child health care quality. (C) 2016 Elsevier Inc. All rights reserved. C1 [Shah, Ankoor Y.] Childrens Natl Hlth Syst, 111 Michigan Ave NW,W3-5-700A, Washington, DC 20010 USA. [LLanos, Karen; Cha, Stephen; Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD USA. [LLanos, Karen; Cha, Stephen; Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD USA. [Dougherty, Denise] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Shah, AY (reprint author), Childrens Natl Hlth Syst, 111 Michigan Ave NW,W3-5-700A, Washington, DC 20010 USA. EM Anshah@cnmc.org NR 16 TC 0 Z9 0 U1 0 U2 0 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 2213-0764 EI 2213-0772 J9 HEALTHCARE JI HealthCare PD SEP PY 2016 VL 4 IS 3 BP 217 EP 224 DI 10.1016/j.hjdsi.2016.03.001 PG 8 WC Health Care Sciences & Services SC Health Care Sciences & Services GA EC4NE UT WOS:000388107800019 PM 27637829 ER PT J AU Bayliss, EA McQuillan, DB Ellis, JL Maciejewski, ML Zeng, C Barton, MB Boyd, CM Fortin, M Ling, SM Tai-Seale, M Ralston, JD Ritchie, CS Zulman, DM AF Bayliss, Elizabeth A. McQuillan, Deanna B. Ellis, Jennifer L. Maciejewski, Matthew L. Zeng, Chan Barton, Mary B. Boyd, Cynthia M. Fortin, Martin Ling, Shari M. Tai-Seale, Ming Ralston, James D. Ritchie, Christine S. Zulman, Donna M. TI Using Electronic Health Record Data to Measure Care Quality for Individuals with Multiple Chronic Medical Conditions SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE quality; multimorbidity; electronic health record ID PERFORMANCE-MEASURES; OF-CARE; OUTCOMES; MULTIMORBIDITY; SERVICES AB OBJECTIVES: To inform the development of a data-driven measure of quality care for individuals with multiple chronic conditions (MCCs) derived from an electronic health record (EHR). DESIGN: Qualitative study using focus groups, interactive webinars, and a modified Delphi process. SETTING: Research department within an integrated delivery system. PARTICIPANTS: The webinars and Delphi process included 17 experts in clinical geriatrics and primary care, health policy, quality assessment, health technology, and health system operations. The focus group included 10 individuals aged 70-87 with three to six chronic conditions selected from a random sample of individuals aged 65 and older with three or more chronic medical conditions. MEASUREMENTS: Through webinars and the focus group, input was solicited on constructs representing highquality care for individuals with MCCs. A working list was created of potential measures representing these constructs. Using a modified Delphi process, experts rated the importance of each possible measure and the feasibility of implementing each measure using EHR data. RESULTS: High-priority constructs reflected processes rather than outcomes of care. High-priority constructs that were potentially feasible to measure included assessing physical function, depression screening, medication reconciliation, annual influenza vaccination, outreach after hospital admission, and documented advance directives. High-priority constructs that were less feasible to measure included goal setting and shared decision-making, identifying drug-drug interactions, assessing social support, timely communication with patients, and other aspects of good customer service. Lower-priority domains included pain assessment, continuity of care, and overuse of screening or laboratory testing. CONCLUSION: High-quality MCC care should be measured using meaningful process measures rather than outcomes. Although some care processes are currently extractable from electronic data, capturing others will require adapting and applying technology to encourage holistic, person-centered care. C1 [Bayliss, Elizabeth A.; McQuillan, Deanna B.; Ellis, Jennifer L.; Zeng, Chan] Kaiser Permanente Colorado, Inst Hlth Res, 10065 E Harvard Ave,Suite 300, Denver, CO 80231 USA. [Bayliss, Elizabeth A.] Univ Colorado, Sch Med, Dept Family Med, Aurora, CO USA. [Maciejewski, Matthew L.] Durham Vet Affairs Med Ctr, Hlth Serv Res & Dev, Durham, NC USA. [Maciejewski, Matthew L.] Duke Univ, Med Ctr, Dept Med, Div Gen Internal Med, Durham, NC 27710 USA. [Barton, Mary B.] Natl Comm Qual Assurance, Washington, DC USA. [Boyd, Cynthia M.] Johns Hopkins Univ, Dept Med, Div Geriatr Med & Gerontol, Baltimore, MD USA. [Fortin, Martin] Univ Sherbrooke, Fac Med & Sci, Dept Family Med, Quebec City, PQ, Canada. [Ling, Shari M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Tai-Seale, Ming] Palo Alto Med Fdn Res Inst, Palo Alto, CA USA. [Ralston, James D.] Grp Hlth Cooperat Puget Sound, Grp Hlth Res Inst, Seattle, WA USA. [Ritchie, Christine S.] Univ Calif San Francisco, Dept Med, San Francisco, CA USA. [Zulman, Donna M.] Vet Affairs Palo Alto Hlth Care Syst, Ctr Innovat Implementat, Menlo Pk, CA USA. [Zulman, Donna M.] Stanford Univ, Div Gen Med Disciplines, Stanford, CA 94305 USA. RP Bayliss, EA (reprint author), Kaiser Permanente Colorado, Inst Hlth Res, 10065 E Harvard Ave,Suite 300, Denver, CO 80231 USA. EM elizabeth.bayliss@kp.org FU Agency for Healthcare Research and Quality [R21 HS023083] FX The Agency for Healthcare Research and Quality funded this investigation (R21 HS023083). NR 30 TC 1 Z9 1 U1 2 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 EI 1532-5415 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD SEP PY 2016 VL 64 IS 9 BP 1839 EP 1844 DI 10.1111/jgs.14248 PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA EB0FC UT WOS:000387017800042 PM 27385077 ER PT J AU O'Brien, SM Cohen, DJ Rumsfeld, JS Brennan, JM Shahian, DM Dai, D Holmes, DR Hakim, RB Thourani, VH Peterson, ED Edwards, FH AF O'Brien, Sean M. Cohen, David J. Rumsfeld, John S. Brennan, J. Matthew Shahian, David M. Dai, David Holmes, David R. Hakim, Rosemarie B. Thourani, Vinod H. Peterson, Eric D. Edwards, Fred H. CA STS ACC TVT Registry TI Variation in Hospital Risk-Adjusted Mortality Rates Following Transcatheter Aortic Valve Replacement in the United States: A Report From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry SO CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES LA English DT Article DE aortic stenosis; case-mix adjustment; outcomes analysis; outcomes research; transcatheter aortic valve replacement ID RELIABILITY ADJUSTMENT; OUTCOMES; PERFORMANCE; SURGERY; MODELS AB Background The use of transcatheter aortic valve replacement (TAVR) to treat aortic stenosis in the United States is growing, yet little is known about the variation in procedural outcomes in community practice. We developed a TAVR in-hospital mortality risk model and used it to quantify variation in mortality rates across United States (US) TAVR centers. Methods and Results We analyzed data from 22248 TAVR procedures performed at 318 sites participating in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (November 2011 to October 2014). A Bayesian hierarchical model was developed to estimate hospital-specific risk-adjusted mortality rates adjusting for 40 patient baseline factors. A total of 1130 in-hospital deaths (5.1%) were observed. Reliability-adjusted risk-adjusted mortality rate estimates ranged from 3.4% to 7.7% with an interquartile range of 4.8% to 5.4%. A patient's predicted odds of dying was 80% higher if treated by a hospital 1 standard deviation above the mean compared with a hospital 1 standard deviation below the mean (odds ratio =1.8; 95% credible interval, 1.4%-2.2%). Conclusions Risk modeling of TAVR in-hospital mortality revealed variation in risk-adjusted mortality rates during the US early commercial experience. Transcatheter Valve Therapy Registry analyses using this model will support research, feedback reporting, and the identification of factors associated with quality. C1 [O'Brien, Sean M.; Brennan, J. Matthew; Dai, David; Peterson, Eric D.] Duke Univ, Med Ctr, Durham, NC USA. [Cohen, David J.] St Lukes Mid Amer Heart Inst, Kansas City, MO USA. [Rumsfeld, John S.] Denver VA Med Ctr, Denver, CO USA. [Shahian, David M.] Massachusetts Gen Hosp, Boston, MA 02114 USA. [Holmes, David R.] Mayo Clin, Rochester, MN USA. [Hakim, Rosemarie B.] Ctr Medicare Serv, Baltimore, MD USA. [Hakim, Rosemarie B.] Ctr Medicaid Serv, Baltimore, MD USA. [Thourani, Vinod H.] Emory Univ, Sch Med, Atlanta, GA USA. [Edwards, Fred H.] Univ Florida, Jacksonville, FL USA. RP O'Brien, SM (reprint author), Duke Clin Res Inst, Duke Box 2721, Durham, NC 27715 USA. EM sean.m.obrien@duke.edu FU Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry is an initiative of the Society of Thoracic Surgeons; American College of Cardiology Foundation; American College of Cardiology Foundation's National Cardiovascular Data Registry; Society of Thoracic Surgeons FX The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry is an initiative of the Society of Thoracic Surgeons and the American College of Cardiology Foundation. This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry and the Society of Thoracic Surgeons. NR 25 TC 3 Z9 3 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 1941-7705 EI 1941-7713 J9 CIRC-CARDIOVASC QUAL JI Circ.-Cardiovasc. Qual. Outcomes PD SEP PY 2016 VL 9 IS 5 BP 560 EP 565 DI 10.1161/CIRCOUTCOMES.116.002756 PG 6 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA DX5ZL UT WOS:000384461300011 PM 27625404 ER PT J AU Menis, M Forshee, RA Izurieta, HS Kessler, Z McKean, S Warnock, R Verma, S Worrall, CM Kelman, JA Anderson, S AF Menis, M. Forshee, R. A. Izurieta, H. S. Kessler, Z. McKean, S. Warnock, R. Verma, S. Worrall, C. M. Kelman, J. A. Anderson, S. TI Transfusion-Associated Circulatory Overload Among the Inpatient US Elderly Medicare Beneficiaries, as Recorded During 2011-2014 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting CY OCT 22-25, 2016 CL Orlando, FL SP AABB C1 [Menis, M.; Forshee, R. A.; Izurieta, H. S.; Anderson, S.] US FDA, CBER, Silver Spring, MD USA. [Kessler, Z.; McKean, S.; Warnock, R.; Verma, S.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD SEP PY 2016 VL 56 SU 4 SI SI MA S23-020A BP 14A EP 14A PG 1 WC Hematology SC Hematology GA DX8NS UT WOS:000384646400030 ER PT J AU Menis, M Forshee, RA Izurieta, HS Kessler, Z McKean, S Warnock, R Worrall, CM Kelman, A Anderson, S AF Menis, M. Forshee, R. A. Izurieta, H. S. Kessler, Z. McKean, S. Warnock, R. Worrall, C. M. Kelman, A. Anderson, S. TI Transfusion-related Anaphylaxis among Inpatient US Elderly Medicare Beneficiaries during 2012-2014 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting CY OCT 22-25, 2016 CL Orlando, FL SP AABB C1 [Menis, M.; Forshee, R. A.; Izurieta, H. S.; Anderson, S.] FDA CBER, Silver Spring, MD USA. [Kessler, Z.; McKean, S.; Warnock, R.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD SEP PY 2016 VL 56 SU 4 SI SI MA SP342 BP 161A EP 162A PG 2 WC Hematology SC Hematology GA DX8NS UT WOS:000384646400446 ER PT J AU Menis, M Forshee, RA Izurieta, HS Kessler, Z McKean, S Warnock, R Worrall, CM Kelman, JA Anderson, S AF Menis, M. Forshee, R. A. Izurieta, H. S. Kessler, Z. McKean, S. Warnock, R. Worrall, C. M. Kelman, J. A. Anderson, S. TI Post-transfusion Purpura (PTP) among US Elderly Medicare Beneficiaries, as Recorded during 2011-2014 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting CY OCT 22-25, 2016 CL Orlando, FL SP AABB C1 [Menis, M.; Forshee, R. A.; Izurieta, H. S.; Anderson, S.] FDA CBER, Silver Spring, MD USA. [Kessler, Z.; McKean, S.; Warnock, R.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD SEP PY 2016 VL 56 SU 4 SI SI MA SP341 BP 161A EP 161A PG 1 WC Hematology SC Hematology GA DX8NS UT WOS:000384646400445 ER PT J AU Menis, M Forshee, RA Izurieta, HS Kessler, Z McKean, S Warnock, R Worrall, CM Kelman, A Anderson, S AF Menis, M. Forshee, R. A. Izurieta, H. S. Kessler, Z. McKean, S. Warnock, R. Worrall, C. M. Kelman, A. Anderson, S. TI Febrile Non-hemolytic Transfusion Reaction among Inpatient US Elderly Medicare Beneficiaries, as Recorded during 2011-2014 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting CY OCT 22-25, 2016 CL Orlando, FL SP AABB C1 [Menis, M.; Forshee, R. A.; Izurieta, H. S.; Anderson, S.] FDA CBER, Silver Spring, MD USA. [Kessler, Z.; McKean, S.; Warnock, R.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD SEP PY 2016 VL 56 SU 4 SI SI MA SP340 BP 161A EP 161A PG 1 WC Hematology SC Hematology GA DX8NS UT WOS:000384646400444 ER PT J AU Menis, M Forshee, RA Izurieta, HS Kessler, Z McKean, S Warnock, R Verma, S Worrall, CM Kelman, JA Anderson, S AF Menis, M. Forshee, R. A. Izurieta, H. S. Kessler, Z. McKean, S. Warnock, R. Verma, S. Worrall, C. M. Kelman, J. A. Anderson, S. TI Transfusion-related Acute Lung Injury among Inpatient US Elderly Medicare Beneficiaries during 2007-2014 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting CY OCT 22-25, 2016 CL Orlando, FL SP AABB C1 [Menis, M.; Forshee, R. A.; Izurieta, H. S.; Anderson, S.] FDA CBER, Silver Spring, MD USA. [Kessler, Z.; McKean, S.; Warnock, R.; Verma, S.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD SEP PY 2016 VL 56 SU 4 SI SI MA SP343 BP 162A EP 162A PG 1 WC Hematology SC Hematology GA DX8NS UT WOS:000384646400447 ER PT J AU Simonetti, A Menis, M Kumar, S McKean, S Kelman, JA Worrall, CM Anderson, S Forshee, RA AF Simonetti, A. Menis, M. Kumar, S. McKean, S. Kelman, J. A. Worrall, C. M. Anderson, S. Forshee, R. A. TI Testing Strategies for Babesia microti in Blood Donors to Reduce Risk of Transfusion-transmitted Babesiosis in the United States SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting CY OCT 22-25, 2016 CL Orlando, FL SP AABB C1 [Simonetti, A.; Menis, M.; Anderson, S.; Forshee, R. A.] US FDA, Ctr Biol Evaluat & Res, Off Biostat & Epidemiol, Silver Spring, MD USA. [Kumar, S.] US FDA, Ctr Biol Evaluat & Res, Off Blood Res & Review, Silver Spring, MD USA. [McKean, S.] Acumen LLC, Burlingame, CA USA. [Kelman, J. A.; Worrall, C. M.] Ctr Medicare Serv, Baltimore, MD USA. [Kelman, J. A.; Worrall, C. M.] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD SEP PY 2016 VL 56 SU 4 SI SI MA SP420 BP 190A EP 190A PG 1 WC Hematology SC Hematology GA DX8NS UT WOS:000384646400524 ER PT J AU Menis, M Forshee, RA Izurieta, HS Kessler, Z McKean, S Warnock, R Verma, S Worrall, CM Kelman, JA Anderson, S AF Menis, M. Forshee, R. A. Izurieta, H. S. Kessler, Z. McKean, S. Warnock, R. Verma, S. Worrall, C. M. Kelman, J. A. Anderson, S. TI Acute Infection Following Transfusion among US Elderly Medicare Beneficiaries, as Recorded by Large Administrative Databases during 2012-2014 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting CY OCT 22-25, 2016 CL Orlando, FL SP AABB C1 [Menis, M.; Forshee, R. A.; Izurieta, H. S.; Anderson, S.] US FDA, CBER, Silver Spring, MD USA. [Kessler, Z.; McKean, S.; Warnock, R.; Verma, S.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare Serv, Baltimore, MD USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD SEP PY 2016 VL 56 SU 4 SI SI MA SP437 BP 195A EP 195A PG 1 WC Hematology SC Hematology GA DX8NS UT WOS:000384646400541 ER PT J AU Reider, L Beck, T Alley, D Miller, R Shardell, M Schumacher, J Magaziner, J Cawthon, PM Barbour, KE Cauley, JA Harris, T AF Reider, Lisa Beck, Thomas Alley, Dawn Miller, Ram Shardell, Michelle Schumacher, John Magaziner, Jay Cawthon, Peggy M. Barbour, Kamil E. Cauley, Jane A. Harris, Tamara CA Hlth ABC Study TI Evaluating the relationship between muscle and bone modeling response in older adults SO BONE LA English DT Article DE Femoral stress; Bone modeling response; Muscle ID PROXIMAL FEMUR GEOMETRY; HIP FRACTURE; FEMORAL-NECK; CORTICAL BONE; AGE; STRENGTH; RISK; DENSITY; HEALTH; WOMEN AB Bone modeling, the process that continually adjusts bone strength in response to prevalent muscle-loading forces throughout an individual's lifespan, may play an important role in bone fragility with age. Femoral stress, an index of bone modeling response, can be estimated using measurements of DXA derived bone geometry and loading information incorporated into an engineering model. Assuming that individuals have adapted to habitual muscle loading forces, greater stresses indicate a diminished response and a weaker bone. The purpose of this paper was to evaluate the associations of lean mass and muscle strength with the femoral stress measure generated from the engineering model and to examine the extent to which lean mass and muscle strength account for variation in femoral stress among 2539 healthy older adults participating in the Health ABC study using linear regression. Mean femoral stress was higher in women (9.51, SD = 1.85 Mpa) than in men (8.02, SD = 1.43 Mpa). Percent lean mass explained more of the variation in femoral stress than did knee strength adjusted for body size (R-2 = 0.187 vs. 0.055 in men; R-2 = 0237 vs. 0.095 in women). In models adjusted for potential confounders, for every percent increase in lean mass, mean femoral stress was 0.121 Mpa lower (95% CI: 0.138, 0.104; p < 0.001) in men and 0.139 Mpa lower (95% CI: 0.158, 0.121; p < 0.001) in women. The inverse association of femoral stress with lean mass and with knee strength did not differ by category of BMI. Results from this study provide insight into bone modeling differences as measured by femoral stress among older men and women and indicate that lean mass may capture elements of bone's response to load. (C) 2016 Elsevier Inc. All rights reserved. C1 [Reider, Lisa] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. [Beck, Thomas] Beck Radiol Innovat Inc, Catonsville, MD USA. [Alley, Dawn] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Miller, Ram] Novartis Inst Biomed Res, Cambridge, MA USA. [Miller, Ram] Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD USA. [Shardell, Michelle] NIA, Longitudinal Study Sect, Bethesda, MD USA. [Schumacher, John] Univ Maryland Baltimore Cty, Dept Sociol & Anthropol, Baltimore, MD USA. [Magaziner, Jay] Univ Maryland, Sch Med, Baltimore, MD USA. [Cawthon, Peggy M.] Calif Pacific Med Ctr, Res Inst, San Francisco, CA USA. [Cawthon, Peggy M.] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA. [Barbour, Kamil E.] Ctr Dis Control, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA. [Cauley, Jane A.] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA. [Harris, Tamara] NIA, Lab Epidemiol & Populat Sci, Intramural Res Program, Bethesda, MD USA. RP Reider, L (reprint author), 415 N Washington St,Room 351, Baltimore, MD 21231 USA. EM lsemani1@jhu.edu FU [P30 AG028747]; [R37 AG009901] FX Magaziner: During the past year Jay Magaziner consulted with or served on advisory boards for: Ammonett; Novartis; Regeneron; Sanofi; Viking; partially supported by grants P30 AG028747; R37 AG009901. NR 33 TC 1 Z9 1 U1 3 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 8756-3282 EI 1873-2763 J9 BONE JI Bone PD SEP PY 2016 VL 90 BP 152 EP 158 DI 10.1016/j.bone.2016.06.012 PG 7 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA DT1MK UT WOS:000381246600019 PM 27352990 ER PT J AU Fleischman, W Agrawal, S King, M Venkatesh, AK Krumholz, HM McKee, D Brown, D Ross, JS AF Fleischman, William Agrawal, Shantanu King, Marissa Venkatesh, Arjun K. Krumholz, Harlan M. McKee, Douglas Brown, Douglas Ross, Joseph S. TI Association between payments from manufacturers of pharmaceuticals to physicians and regional prescribing: cross sectional ecological study SO BMJ-BRITISH MEDICAL JOURNAL LA English DT Article ID KEY OPINION LEADERS; INDUSTRY PAYMENTS; SUNSHINE ACT; RADIATION ONCOLOGISTS; DRUG COMPANIES; FREE LUNCH; POPULATION; DISCLOSURE; PROMOTIONS; MEDICARE AB OBJECTIVE To examine the association between payments made by the manufacturers of pharmaceuticals to physicians and prescribing by physicians within hospital referral regions. DESIGN Cross sectional analysis of 2013 and 2014 Open Payments and Medicare Part D prescribing data for two classes of commonly prescribed, commonly marketed drugs: oral anticoagulants and non-insulin diabetes drugs, overall and stratified by physician and payment type. Setting 306 hospital referral regions, United States. Participants 45 949 454 Medicare Part D prescriptions written by 623 886 physicians to 10 513 173 patients for two drug classes: oral anticoagulants and non-insulin diabetes drugs. Main outcome measures Proportion, or market share, of marketed oral anticoagulants and non-insulin diabetes drugs prescribed by physicians among all drugs in each class and within hospital referral regions. Results Among 306 hospital referral regions, there were 977 407 payments to physicians totaling $61 026 140 (46 pound 174 600; (sic)54 632 500) related to oral anticoagulants, and 1 787 884 payments totaling $108 417 616 related to non-insulin diabetes drugs. The median market share of the hospital referral regions was 21.6% for marketed oral anticoagulants and 12.6% for marketed non-insulin diabetes drugs. Among hospital referral regions, one additional payment (median value $13, interquartile range, $10-$18) was associated with 94 (95% confidence interval 76 to 112) additional days filled of marketed oral anticoagulants and 107 (89 to 125) additional days filled of marketed non-insulin diabetes drugs (P<0.001). Payments to specialists were associated with greater prescribing of marketed drugs than payments to non-specialists (212 v 100 additional days filled per payment of marketed oral anticoagulants, 331 v 114 for marketed non-insulin diabetes drugs, P<0.001). Payments for speaker and consulting fees for non-insulin diabetes drugs were associated with greater prescribing of marketed drugs than payments for food and beverages or educational materials (484 v 110, P<0.001). Conclusions and study limitations Payments by the manufacturers of pharmaceuticals to physicians were associated with greater regional prescribing of marketed drugs among Medicare Part D beneficiaries. Payments to specialists and payments for speaker and consulting fees were predominantly associated with greater regional prescribing of marketed drugs than payments to non-specialists or payments for food and beverages, gifts, or educational materials. As a cross sectional, ecological study, we cannot prove causation between payments to physicians and increased prescribing. Furthermore, our findings should be interpreted only at the regional level. Our study is limited to prescribing by physicians and the two drug classes studied. C1 [Fleischman, William] Yale Sch Med, Robert Wood Johnson Fdn, Clin Scholars Program, SHM IE61, New Haven, CT 06510 USA. [Agrawal, Shantanu; Brown, Douglas] US Dept HHS, Ctr Medicare & Medicaid Serv, Washington, DC USA. [King, Marissa] Yale Sch Management, New Haven, CT USA. [Venkatesh, Arjun K.] Yale Sch Med, Dept Emergency Med, SHM IE61, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Sch Med, Sect Cardiovasc Med, Dept Med, SHM IE61, New Haven, CT 06510 USA. [McKee, Douglas] Yale Univ, Dept Econ, New Haven, CT 06520 USA. [Ross, Joseph S.] Yale Sch Med, Dept Med, Sect Gen Internal Med, SHM IE61, New Haven, CT USA. RP Fleischman, W (reprint author), Yale Sch Med, Robert Wood Johnson Fdn, Clin Scholars Program, SHM IE61, New Haven, CT 06510 USA. EM WFleischmanwf3@buffalo.edu NR 36 TC 3 Z9 3 U1 1 U2 3 PU BMJ PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 1756-1833 J9 BMJ-BRIT MED J JI BMJ-British Medical Journal PD AUG 18 PY 2016 VL 354 AR i4189 DI 10.1136/bmj.i4189 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA DT9HB UT WOS:000381806600002 PM 27540015 ER PT J AU Andrews, E Sturmer, T McGrath, LJ Funk, MJ Lund, JL Johannes, CB Gilsenan, AW Powers, C AF Andrews, Elizabeth Sturmer, Til McGrath, Leah J. Funk, Michele Jonsson Lund, Jennifer L. Johannes, Catherine B. Gilsenan, Alicia W. Powers, Christopher TI Exploring Innovative Methods to Conduct Validation Using United States Medicare Administrative Claims Data SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Andrews, Elizabeth; McGrath, Leah J.; Gilsenan, Alicia W.] RTI Hlth Solut, Pharmacoepidemiol & Risk Management, Res Triangle Pk, NC USA. [Sturmer, Til; Funk, Michele Jonsson; Lund, Jennifer L.] Univ North Carolina Chapel Hill, Dept Epidemiol, Gillings Sch Global Publ Hlth, Chapel Hill, NC USA. [Johannes, Catherine B.] RTI Hlth Solut, Pharmacoepidemiol & Risk Management, Waltham, MA USA. [Powers, Christopher] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2016 VL 25 SU S3 MA 79 BP 50 EP 50 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA DY9VP UT WOS:000385483501079 ER PT J AU Qiang, YD Chillarige, Y Said, M Liu, T Dekmezian, C Winiecki, S Nguyen, MD Worrall, CM Kelman, JA Wernecke, M Hua, W AF Qiang, Yandong Chillarige, Yoganand Said, Maria Liu, Tina Dekmezian, Carmen Winiecki, Scott Nguyen, Michael D. Worrall, Chris M. Kelman, Jeffrey A. Wernecke, Michael Hua, Wei TI Feasibility of Using the Medicaid Statistical Information System (MSIS) to Assess Safety and Effectiveness of 3rd Trimester Vaccination: A Case Study with Tetanus Toxoid, Reduced Diphtheria Toxoid And Acellular Pertussis (Tdap) SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Qiang, Yandong; Said, Maria; Winiecki, Scott; Nguyen, Michael D.; Hua, Wei] US FDA, Ctr Biol Evaluat & Res, Silver Spring, MD USA. [Chillarige, Yoganand; Liu, Tina; Dekmezian, Carmen; Wernecke, Michael] Acumen LLC, Burlingame, CA USA. [Worrall, Chris M.; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2016 VL 25 SU S3 MA 571 BP 333 EP 333 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA DY9VP UT WOS:000385483502203 ER PT J AU Graham, DJ Reichman, ME Wernecke, M Hsueh, YH Izem, R Southworth, MR Wei, YQ Liao, JM Goulding, MR Mott, K Chillarige, Y MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Reichman, Marsha E. Wernecke, Michael Hsueh, Ya-Hui Izem, Rima Southworth, Mary Ross Wei, Yuqin Liao, Jiemin Goulding, Margie R. Mott, Katrina Chillarige, Yoganand MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Stroke, Bleeding, and Mortality Risks in Older Patients Treated with Dabigatran or Rivaroxaban for Nonvalvular Atrial Fibrillation SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Graham, David J.; Reichman, Marsha E.; Hsueh, Ya-Hui; Izem, Rima; Southworth, Mary Ross; Goulding, Margie R.; Mott, Katrina] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Wernecke, Michael; Wei, Yuqin; Liao, Jiemin; Chillarige, Yoganand; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2016 VL 25 SU S3 MA 862 BP 500 EP 501 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA DY9VP UT WOS:000385483503125 ER PT J AU Keehan, SP Poisal, JA Cuckler, GA Sisko, AM Smith, SD Madison, AJ Stone, DA Wolfe, CJ Lizonitz, JM AF Keehan, Sean P. Poisal, John A. Cuckler, Gigi A. Sisko, Andrea M. Smith, Sheila D. Madison, Andrew J. Stone, Devin A. Wolfe, Christian J. Lizonitz, Joseph M. TI National Health Expenditure Projections, 2015-25: Economy, Prices, And Aging Expected To Shape Spending And Enrollment SO HEALTH AFFAIRS LA English DT Article AB Health spending growth in the United States for 2015-25 is projected to average 5.8 percent-1.3 percentage points faster than growth in the gross domestic product-and to represent 20.1 percent of the total economy by 2025. As the initial impacts associated with the Affordable Care Act's coverage expansions fade, growth in health spending is expected to be influenced by changes in economic growth, faster growth in medical prices, and population aging. Projected national health spending growth, though faster than observed in the recent history, is slower than in the two decades before the recent Great Recession, in part because of trends such as increasing cost sharing in private health insurance plans and various Medicare payment update provisions. In addition, the share of total health expenditures paid for by federal, state, and local governments is projected to increase to 47 percent by 2025. C1 [Keehan, Sean P.] Ctr Medicare Serv, Off Actuary, Baltimore, MD 21244 USA. [Keehan, Sean P.] Ctr Medicaid Serv, Off Actuary, Baltimore, MD 21244 USA. [Poisal, John A.] CMS, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. [Cuckler, Gigi A.; Sisko, Andrea M.; Smith, Sheila D.; Madison, Andrew J.; Stone, Devin A.; Wolfe, Christian J.; Lizonitz, Joseph M.] CMS, Off Actuary, Baltimore, MD USA. RP Keehan, SP (reprint author), Ctr Medicare Serv, Off Actuary, Baltimore, MD 21244 USA.; Keehan, SP (reprint author), Ctr Medicaid Serv, Off Actuary, Baltimore, MD 21244 USA. EM sean.keehan@cms.hhs.gov NR 15 TC 2 Z9 2 U1 3 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 AUG PY 2016 VL 35 IS 8 BP 1522 EP 1531 DI 10.1377/hlthaff.2016.0459 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA DY0QO UT WOS:000384801500025 PM 27411572 ER PT J AU Amico, P Pope, GC Meadow, A West, P AF Amico, Peter Pope, Gregory C. Meadow, Ann West, Pamela TI Episode-Based Payment for the Medicare Outpatient Therapy Benefit SO ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION LA English DT Article DE Episode of care; Health services research; Physical therapy specialty; Prospective payment system; Rehabilitation AB Objective: To conduct an analysis of Medicare outpatient therapy episodes of care and associated payment implications. Design: Retrospective observational design using Medicare claims data. To descriptively analyze the composition of outpatient therapy episodes, both variable- and fixed-length episodes are explored. The variable-length episode definition organizes services into episodes based on the time pattern of therapy service utilization, using 60-day clean periods. Fixed-length episodes are also examined, beginning with the first therapy utilization in calendar year 2010 and extending 30, 60, and 90 days. Setting: The study is focused on community-dwelling users of outpatient therapy. Participants: The sample includes all Medicare patients who used outpatient therapy beginning at any point in 2010. Interventions: Not applicable. Main Outcome Measures: Mean episode payments and episode lengths in calendar days. Results: Variable -length outpatient therapy episodes have a mean payment of $881. On average, outpatient therapy episodes last 43 calendar days. Mean therapy durations for the 30-, 60-, and 90 -day fixed-length episodes are 20, 31, and 38 calendar days, respectively. The 30-, 60-, and 90 -day fixed-length initial episodes account for 40%, 55%, and 63%, respectively, of total Medicare payments. Simulations of episode-based payment illustrate the difficulty of avoiding a large number of substantial underpayments, because of the right-skewed distribution of total actual payments. Conclusions: A strength of episode payment is that it reduces cost and potentially wasteful variation within episodes. Given the substantial variation in therapy episode expenditures, absent improvements in available data and in predictive information, a pure lump sum episode payment would result in substantial revenue changes for many episodes. Additional data are needed to better explain the wide variation in episode expenditures. (C) 2016 by the American Congress of Rehabilitation Medicine C1 [Amico, Peter; Pope, Gregory C.] Res Triangle Inst Int, 307 Waverly Oaks Rd,Ste 101, Waltham, MA 02452 USA. [Meadow, Ann] Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [West, Pamela] Ctr Medicare, Baltimore, MD USA. [West, Pamela] Ctr Medicaid Serv, Baltimore, MD USA. RP Amico, P (reprint author), Res Triangle Inst Int, 307 Waverly Oaks Rd,Ste 101, Waltham, MA 02452 USA. EM pamico@rti.org FU Centers for Medicare & Medicaid Services (CMS) FX Supported by the Centers for Medicare & Medicaid Services (CMS). Any interpretations, opinions, or errors are the responsibility of the authors and not those of CMS. NR 18 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 0003-9993 EI 1532-821X J9 ARCH PHYS MED REHAB JI Arch. Phys. Med. Rehabil. PD AUG PY 2016 VL 97 IS 8 BP 1323 EP 1328 DI 10.1016/j.apmr.2016.02.028 PG 6 WC Rehabilitation; Sport Sciences SC Rehabilitation; Sport Sciences GA DT1LM UT WOS:000381244200015 PM 27060033 ER PT J AU Furno, R Agrawal, S AF Furno, Robert Agrawal, Shantanu TI The Open Payments Program and the Emergency Physician SO ANNALS OF EMERGENCY MEDICINE LA English DT Editorial Material ID SUNSHINE ACT; INDUSTRY C1 [Furno, Robert] Ctr Medicare & Medicaid Serv, Chicago, IL 60601 USA. [Agrawal, Shantanu] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Furno, R (reprint author), Ctr Medicare & Medicaid Serv, Chicago, IL 60601 USA. EM robert.furno@cms.hhs.gov NR 10 TC 0 Z9 0 U1 0 U2 0 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD AUG PY 2016 VL 68 IS 2 BP 159 EP 161 DI 10.1016/j.annemergmed.2016.02.038 PG 3 WC Emergency Medicine SC Emergency Medicine GA DT0II UT WOS:000381166800003 PM 27033140 ER PT J AU Martino, SC Elliott, MN Hambarsoomian, K Weech-Maldonado, R Gaillot, S Haffer, SC Hays, RD AF Martino, Steven C. Elliott, Marc N. Hambarsoomian, Katrin Weech-Maldonado, Robert Gaillot, Sarah Haffer, Samuel C. Hays, Ron D. TI Racial/Ethnic Disparities in Medicare Beneficiaries' Care Coordination Experiences SO MEDICAL CARE LA English DT Article DE CAHPS; care coordination; health disparities; Medicare; race/ethnicity ID SELF-MANAGEMENT PROGRAM; CULTURAL COMPETENCE; PATIENT EXPERIENCES; RACIAL DISPARITIES; HEALTH-STATUS; DISEASE; QUALITY; CAHPS; RACE/ETHNICITY; NONRESPONSE AB Background: Little is known about racial/ethnic differences in the experience of care coordination. To the extent that they exist, such differences may exacerbate health disparities given the higher prevalence of some chronic conditions among minorities. Objective: To investigate the extent to which racial/ethnic disparities exist in the receipt of coordinated care by Medicare beneficiaries. Subjects: A total of 260,974 beneficiaries who responded to the 2013 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Methods: We fit a series of linear, case-mix adjusted models predicting Medicare CAHPS measures of care coordination from race/ethnicity. Results: Hispanic, black, and Asian/Pacific Islander (API) beneficiaries reported that their personal doctor had medical records and other relevant information about their care significantly less often than did non-Hispanic white beneficiaries (-2 points for Hispanics, -1 point for blacks, and -4 points for APIs on a 100-point scale). These 3 groups also reported significantly greater difficulty getting timely follow-up on test results than non-Hispanic white beneficiaries (-9 points for Hispanics, -1 point for blacks, -5 points for APIs). Hispanic and black beneficiaries reported that help was provided in managing their care significantly less often than did non-Hispanic white beneficiaries (-2 points for Hispanics, -3 points for blacks). API beneficiaries reported that their personal doctor discussed their medications and had up-to-date information on care from specialists significantly less often than did non-Hispanic white beneficiaries (-2 and -4 points, respectively). Discussion: These results suggest a need for efforts to address racial/ethnic disparities in care coordination to help ensure high-quality care for all patients. Public reporting of plan-level performance data by race/ethnicity may also be helpful to Medicare beneficiaries and their advocates. C1 [Martino, Steven C.] RAND Corp, 4570 Fifth Ave,Suite 600, Pittsburgh, PA 15213 USA. [Elliott, Marc N.; Hambarsoomian, Katrin] RAND Corp, Santa Monica, CA USA. [Weech-Maldonado, Robert] Univ Alabama Birmingham, Dept Hlth Serv Adm, Birmingham, AL USA. [Gaillot, Sarah; Haffer, Samuel C.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Hays, Ron D.] Univ Calif Los Angeles, Div GIM HSR, Los Angeles, CA USA. RP Martino, SC (reprint author), RAND Corp, 4570 Fifth Ave,Suite 600, Pittsburgh, PA 15213 USA. EM martino@rand.org FU Centers for Medicare & Medicaid Services [HHSM-500-2005-00028I] FX Supported by a contract from the Centers for Medicare & Medicaid Services (HHSM-500-2005-00028I). NR 39 TC 0 Z9 0 U1 3 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0025-7079 EI 1537-1948 J9 MED CARE JI Med. Care PD AUG PY 2016 VL 54 IS 8 BP 765 EP 771 DI 10.1097/MLR.0000000000000556 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA DS1ZM UT WOS:000380502800007 PM 27116106 ER PT J AU Townsend, SR Rivers, E Tefera, L AF Townsend, Sean R. Rivers, Emanuel Tefera, Lemeneh TI Definitions for Sepsis and Septic Shock SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 [Townsend, Sean R.] Calif Pacific Med Ctr, San Francisco, CA USA. [Rivers, Emanuel] Henry Ford Hosp, Dept Emergency Med, Detroit, MI 48202 USA. [Tefera, Lemeneh] Ctr Medicare & Medicaid Serv, Qual Measurement & Value Based Incent Grp, 7500 Secur Blvd,S3-02-04, Baltimore, MD 21244 USA. RP Tefera, L (reprint author), Ctr Medicare & Medicaid Serv, Qual Measurement & Value Based Incent Grp, 7500 Secur Blvd,S3-02-04, Baltimore, MD 21244 USA. EM lemeneh.tefera@cms.hhs.gov NR 4 TC 1 Z9 1 U1 1 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 26 PY 2016 VL 316 IS 4 BP 457 EP 458 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA DR9MV UT WOS:000380221700033 PM 27458959 ER PT J AU Wang, Y Eldridge, N Metersky, ML Sonnenfeld, N Fine, JM Pandolfi, MM Eckenrode, S Bakullari, A Galusha, DH Jaser, L Verzier, NR Nuti, SV Hunt, D Normand, SLT Krumholz, HM AF Wang, Yun Eldridge, Noel Metersky, Mark L. Sonnenfeld, Nancy Fine, Jonathan M. Pandolfi, Michelle M. Eckenrode, Sheila Bakullari, Anila Galusha, Deron H. Jaser, Lisa Verzier, Nancy R. Nuti, Sudhakar V. Hunt, David Normand, Sharon-Lise T. Krumholz, Harlan M. TI Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction SO JOURNAL OF THE AMERICAN HEART ASSOCIATION LA English DT Article DE Medicare; mortality; myocardial infarction; patient safety; readmission ID HEART-FAILURE; QUALITY; RATES; CARE; OUTCOMES; PROGRAM; BENEFICIARIES; REDUCTION; TRENDS AB Background-Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30-day mortality and unplanned readmission rates for Medicare fee-for-service patients hospitalized for acute myocardial infarction (AMI). Methods and Results-Using 2009-2013 medical record-abstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixed-effects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospital-specific risk-standardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospital-specific 30-day all-cause risk-standardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the risk-standardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79-8.94) and 3.44% points (95% CI, 0.19-6.68) for the risk-standardized mortality and unplanned readmission rates, respectively. Conclusions-For Medicare fee-for-service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30-day all-cause mortality and on unplanned readmissions. C1 [Wang, Yun; Normand, Sharon-Lise T.] Harvard TH Chan Sch Publ Hlth, Dept Biostat, SPH 2 Room 437F,655 Huntington Ave, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Med Sch, Dept Hlth Care Policy, Boston, MA USA. [Fine, Jonathan M.] Norwalk Hosp, Sect Pulm & Crit Care Med, Norwalk, CT USA. [Metersky, Mark L.] Univ Connecticut, Sch Med, Div Pulm & Crit Care Med, Farmington, CT USA. [Pandolfi, Michelle M.; Eckenrode, Sheila; Bakullari, Anila; Verzier, Nancy R.] Qualidigm, Wethersfield, CT USA. [Jaser, Lisa] Griffin Hosp, Dept Pharm, Derby, CT USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Robert Wood Johnson Fdn Clin Scholars Program, New Haven, CT 06510 USA. [Galusha, Deron H.; Nuti, Sudhakar V.; Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Gen Internal Med Sect, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Sch Publ Hlth, Dept Hlth Policy & Management, New Haven, CT USA. [Wang, Yun; Nuti, Sudhakar V.; Krumholz, Harlan M.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, 20 York St, New Haven, CT 06504 USA. [Eldridge, Noel] US Dept Hlth & Human Serv, Agcy Healthcare Res & Qual, Rockville, MD USA. [Sonnenfeld, Nancy] US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Rockville, MD USA. [Hunt, David] US Dept Hlth & Human Serv, Off Natl Coordinator Hlth Informat Technol, Rockville, MD USA. RP Wang, Y (reprint author), Harvard TH Chan Sch Publ Hlth, Dept Biostat, SPH 2 Room 437F,655 Huntington Ave, Boston, MA 02115 USA. EM yunwang@hsph.harvard.edu FU Agency for Healthcare Research and Quality, US Department of Health and Human Services (Rockville, MD) [HHSA290201200003C, K18 HS021991]; National Heart, Lung, and Blood Institute [1U01HL105270-02]; National Institutes of Health [R01 GM111339, R21 ES022585-01, R21 ES024012, R01 ES024332]; US Environmental Protection Agency [RD83490001] FX This work was supported by contract HHSA290201200003C from the Agency for Healthcare Research and Quality, US Department of Health and Human Services (Rockville, MD). Qualidigm was the contractor. Dr Krumholz is partially funded by grant 1U01HL105270-02 (Krumholz, Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. Dr Normand is partially supported by a grant (R01 GM111339, Normand) from the National Institutes of Health, and Dr Wang is partially supported by the US Environmental Protection Agency (RD-83490001, Dominici), National Institutes of Health (R21 ES022585-01, Dominici; R21 ES024012, Zanobetti; R01 GM111339, Normand; R01 ES024332, Zanobetti), and the Agency for Healthcare Research and Quality (K18 HS021991, Dominici). NR 44 TC 1 Z9 1 U1 1 U2 1 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 2047-9980 J9 J AM HEART ASSOC JI J. Am. Heart Assoc. PD JUL PY 2016 VL 5 IS 7 AR e003731 DI 10.1161/JAHA.116.003731 PG 13 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA EA6CT UT WOS:000386713800058 ER PT J AU Linde, PG Archdeacon, P Breyer, MD Ibrahim, T Inrig, JK Kewalramani, R Lee, CC Neuland, CY Roy-Chaudhury, P Sloand, JA Meyer, R Smith, KA Snook, J West, M Falk, RJ AF Linde, Peter G. Archdeacon, Patrick Breyer, Matthew D. Ibrahim, Tod Inrig, Jula K. Kewalramani, Reshma Lee, Celeste Castillo Neuland, Carolyn Y. Roy-Chaudhury, Prabir Sloand, James A. Meyer, Rachel Smith, Kimberly A. Snook, Jennifer West, Melissa Falk, Ronald J. TI Overcoming Barriers in Kidney Health-Forging a Platform for Innovation SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article ID EVALUATION PROGRAM KEEP; RANDOMIZED CONTROLLED-TRIALS; DISEASE; NEPHROLOGY; QUALITY; DESIGN; CKD AB Innovation in kidney diseases is not commensurate with the effect of these diseases on human health and mortality or innovation in other key therapeutic areas. A primary cause of the dearth in innovation is that kidney diseases disproportionately affect a demographic that is largely disenfranchised, lacking sufficient advocacy, public attention, and funding. A secondary and likely consequent cause is that the existing infrastructure supporting nephrology research pales in comparison with those for other internal medicine specialties, especially cardiology and oncology. Citing such inequities, however, is not enough. Changing the status quo will require a coordinated effort to identify and redress the existing deficits. Specifically, these deficits relate to the need to further develop and improve the following: understanding of the disease mechanisms and pathophysiology, patient engagement and activism, clinical trial infrastructure, and investigational clinical trial designs as well as coordinated efforts among critical stakeholders. This paper identifies potential solutions to these barriers, some of which are already underway through the Kidney Health Initiative. The Kidney Health Initiative is unique and will serve as a current and future platform from which to overcome these barriers to innovation in nephrology. C1 [Linde, Peter G.] AbbVie Inc, Global Pharmaceut Res & Dev, N Chicago, IL USA. [Archdeacon, Patrick] US FDA, Ctr Drug Evaluat & Res, Off Med Policy, Silver Spring, MD USA. [Neuland, Carolyn Y.] US FDA, Ctr Devices & Radiol Hlth, Off Device Evaluat, Div Reprod Gastrorenal & Urol Devices, Silver Spring, MD USA. [Breyer, Matthew D.] Eli Lilly & Co, Biotechnol Discovery Res, Indianapolis, IN 46285 USA. [Ibrahim, Tod; Meyer, Rachel; West, Melissa] Amer Soc Nephrol, Washington, DC 20005 USA. [Inrig, Jula K.] Quintiles Therapeut Sci & Strategy Unit, San Diego, CA USA. [Kewalramani, Reshma] Amgen Inc, Thousand Oaks, CA 91320 USA. [Lee, Celeste Castillo] Vasculitis Fdn, Chapel Hill, NC USA. [Roy-Chaudhury, Prabir] Univ Arizona, Div Nephrol, Tucson, AZ USA. [Sloand, James A.] Baxter Healthcare Corp, Deerfield, IL USA. [Smith, Kimberly A.] Ctr Medicare & Medicaid Serv, Ctr Clin Stand & Qual, Baltimore, MD USA. [Snook, Jennifer] Amer Soc Nephrol, Chicago, IL USA. [Falk, Ronald J.] Univ N Carolina, Dept Med, Div Nephrol, Chapel Hill, NC USA. [Smith, Kimberly A.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. RP Linde, PG; Falk, RJ (reprint author), Amer Soc Nephrol, Kidney Hlth Initiat, 1510 H St NW,Suite 800, Washington, DC 20005 USA. EM peter.linde@abbvie.com; ronald_falk@med.unc.edu FU Kidney Health Initiative (KHI); KHI funds FX This work was supported by the Kidney Health Initiative (KHI), a public-private partnership between the American Society of Nephrology, the US Food and Drug Administration, and >75 member organizations and companies to enhance patient safety and foster innovation in kidney disease. The KHI funds were used to defray costs incurred during the conduct of the project, including project management support. However, there was no honorarium or other financial support provided to the KHI workgroup members. The KHI workgroup, including the authors of this paper, had final review authority and is fully responsible for its content. The KHI makes every effort to avoid actual, potential, or perceived conflicts of interest that may arise as a result of industry relationships or personal interests among the members of the writing committee and work group. More information on the KM, the workgroup, or the conflict of interest policy can be found at www.kidneyhealthinitiative.org. NR 24 TC 3 Z9 3 U1 1 U2 5 PU AMER SOC NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1046-6673 EI 1533-3450 J9 J AM SOC NEPHROL JI J. Am. Soc. Nephrol. PD JUL PY 2016 VL 27 IS 7 BP 1902 EP 1910 DI 10.1681/ASN.2015090976 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA DP9OD UT WOS:000378824800007 PM 27127187 ER PT J AU Karikari-Martin, P McCann, JJ Farran, CJ Hebert, LE Haffer, SC Phillips, M AF Karikari-Martin, Pauline McCann, Judith J. Farran, Carol J. Hebert, Liesi E. Haffer, Samuel C. Phillips, Marcia TI Race, Any Cancer, Income, or Cognitive Function: What Influences Hospice or Aggressive Services Use at the End of Life Among Community-Dwelling Medicare Beneficiaries? SO AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE LA English DT Article ID OLDER-ADULTS; UNITED-STATES; CARE; ENROLLMENT; HOSPITALIZATION; POPULATIONS; DISEASE; TRENDS; DEATH C1 [Karikari-Martin, Pauline] US PHS, Rockville, MD 20852 USA. [McCann, Judith J.; Hebert, Liesi E.] Rush Inst Hlth Aging, Chicago, IL USA. [McCann, Judith J.; Farran, Carol J.; Phillips, Marcia] Rush Univ, Coll Nursing, Chicago, IL 60612 USA. [Haffer, Samuel C.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Karikari-Martin, P (reprint author), US PHS, Rockville, MD 20852 USA.; McCann, JJ (reprint author), Rush Univ, Med Ctr, Chicago, IL 60612 USA. EM pkarikar@jhsph.edu; judy_j_mccann@rush.edu FU NIA/NIH [R01 AG11101, R01 AG030544]; Golden Lamp Society of Rush University College of Nursing Dissertation Award; Rush University Graduate Student Council Travel Award; Veteran's GI Educational Benefit FX The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by NIA/NIH grants R01 AG11101 and R01 AG030544; Golden Lamp Society of Rush University College of Nursing Dissertation Award; Rush University Graduate Student Council Travel Award; and the Veteran's GI Educational Benefit. NR 40 TC 3 Z9 3 U1 1 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1049-9091 EI 1938-2715 J9 AM J HOSP PALLIAT ME JI Am. J. Hosp. Palliat. Med. PD JUL PY 2016 VL 33 IS 6 BP 537 EP 545 DI 10.1177/1049909115574263 PG 9 WC Health Care Sciences & Services SC Health Care Sciences & Services GA DP3NJ UT WOS:000378401100004 PM 25753184 ER PT J AU Hodgkin, D Thomas, CP O'Brien, PL Levit, K Richardson, J Mark, TL Malone, K AF Hodgkin, Dominic Thomas, Cindy Parks O'Brien, Peggy L. Levit, Katharine Richardson, John Mark, Tami L. Malone, Kevin TI Projected Spending on Psychotropic Medications 2013-2020 SO ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH LA English DT Article DE Psychotropic medications; Spending growth; Generic drugs ID SUBSTANCE USE DISORDERS; MENTAL-HEALTH; GROWTH; SCHIZOPHRENIA; INSURANCE; DRUGS AB Spending on psychotropic medications has grown rapidly in recent decades. Using national data on drug expenditures, patent expirations, future drug development and expert interviews, we project that spending will grow more slowly over the period 2012-2020. The average annual increase is projected to be just 3.0 % per year, continuing the steady deceleration in recent years. The main drivers of this expected deceleration include slower development of new drugs, upcoming patent expirations which will lower prices, and payers' growing ability to manage utilization and promote generic use. The slowdown will relieve some cost pressures on payers, particularly Medicare and Medicaid. C1 [Hodgkin, Dominic; Thomas, Cindy Parks] Brandeis Univ, Heller Sch Social Policy & Management, Mailstop 35, Waltham, MA 02454 USA. [O'Brien, Peggy L.] Truven Hlth Analyt, Behav Hlth & Qual Res, Cambridge, MA USA. [Levit, Katharine; Mark, Tami L.] Truven Hlth Analyt, Behav Hlth & Qual Res, Bethesda, MD USA. [Richardson, John] Univ Michigan, Sch Publ Hlth, Ann Arbor, MI 48109 USA. [Malone, Kevin] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Hodgkin, D (reprint author), Brandeis Univ, Heller Sch Social Policy & Management, Mailstop 35, Waltham, MA 02454 USA. EM hodgkin@brandeis.edu NR 24 TC 0 Z9 0 U1 1 U2 2 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0894-587X EI 1573-3289 J9 ADM POLICY MENT HLTH JI Adm. Policy. Ment. Health PD JUL PY 2016 VL 43 IS 4 BP 497 EP 505 DI 10.1007/s10488-015-0661-x PG 9 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA DN9YP UT WOS:000377436900004 PM 26041078 ER PT J AU Sessums, LL McHugh, SJ Rajkumar, R AF Sessums, Laura L. McHugh, Sarah J. Rajkumar, Rahul TI Medicare's Vision for Advanced Primary Care New Directions for Care Delivery and Payment SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID QUALITY C1 [Sessums, Laura L.; McHugh, Sarah J.; Rajkumar, Rahul] Ctr Medicare & Medicaid Serv, Mail Stop WB 06-05,7500 Security Blvd, Baltimore, MD 21244 USA. RP Sessums, LL (reprint author), Ctr Medicare & Medicaid Serv, CMS, Seamless Care Models Grp, Mail Stop WB 06-05,7500 Security Blvd, Baltimore, MD 21244 USA. EM laura.sessums@cms.hhs.gov NR 5 TC 5 Z9 5 U1 0 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 28 PY 2016 VL 315 IS 24 BP 2665 EP 2666 DI 10.1001/jama.2016.4472 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA DP7WG UT WOS:000378709300014 PM 27065435 ER PT J AU Dale, SB Ghosh, A Peikes, DN Day, TJ Yoon, FB Taylor, EF Swankoski, K O'Malley, AS Conway, PH Rajkumar, R Press, MJ Sessums, L Brown, R AF Dale, Stacy B. Ghosh, Arkadipta Peikes, Deborah N. Day, Timothy J. Yoon, Frank B. Taylor, Erin Fries Swankoski, Kaylyn O'Malley, Ann S. Conway, Patrick H. Rajkumar, Rahul Press, Matthew J. Sessums, Laura Brown, Randall TI Two-Year Costs and Quality in the Comprehensive Primary Care Initiative SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID CENTERED MEDICAL HOME; PATIENT EXPERIENCE; PAYMENT REFORM; HEALTH-CARE; TRANSFORMATION; PROVIDERS; LESSONS AB BACKGROUND The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. METHODS We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. RESULTS During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI] -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (P<0.001) and changes in two of the six domains of patient experience discussion of decisions regarding medication with patients and the provision of support for patients taking care of their own health both of which showed a small improvement in initiative practices relative to comparison practices (P=0.006 and P<0.001, respectively). CONCLUSIONS Midway through this 4-year intervention, practices participating in the initiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after accounting for care-management fees, nor have they shown an appreciable improvement in the quality of care or patient experience. C1 [Dale, Stacy B.] Math Policy Res, 111 E Upper Wacker Dr, Chicago, IL 60601 USA. [Ghosh, Arkadipta; Peikes, Deborah N.; Yoon, Frank B.; Swankoski, Kaylyn; Brown, Randall] Math Policy Res, Princeton, NJ USA. [Taylor, Erin Fries; O'Malley, Ann S.] Math Policy Res, Washington, DC USA. [Day, Timothy J.; Conway, Patrick H.; Rajkumar, Rahul; Press, Matthew J.; Sessums, Laura] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Dale, SB (reprint author), Math Policy Res, 111 E Upper Wacker Dr, Chicago, IL 60601 USA. EM sdale@mathematica-mpr.com FU Department of Health and Human Services, Centers for Medicare and Medicaid Services FX Funded by the Department of Health and Human Services, Centers for Medicare and Medicaid Services; ClinicalTrials.gov number, NCT02320591. NR 36 TC 11 Z9 11 U1 1 U2 1 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JUN 16 PY 2016 VL 374 IS 24 BP 2345 EP 2356 DI 10.1056/NEJMsa1414953 PG 12 WC Medicine, General & Internal SC General & Internal Medicine GA DO5WW UT WOS:000377854600008 PM 27074035 ER PT J AU Press, MJ Rajkumar, R Conway, PH AF Press, Matthew J. Rajkumar, Rahul Conway, Patrick H. TI Medicare's Bundled Payment Program and Health Care Utilization Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 [Press, Matthew J.; Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mailstop WB-06-05, Baltimore, MD 21244 USA. RP Rajkumar, R (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mailstop WB-06-05, Baltimore, MD 21244 USA. EM rahul.rajkumar@cms.hhs.gov NR 1 TC 0 Z9 0 U1 1 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 14 PY 2016 VL 315 IS 22 BP 2471 EP 2471 DI 10.1001/jama.2016.3823 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA DO3CE UT WOS:000377656900033 PM 27299631 ER PT J AU Khullar, D Rao, SK Chaguturu, SK Rajkumar, R AF Khullar, Dhruv Rao, Sandhya K. Chaguturu, Sreekanth K. Rajkumar, Rahul TI The Evolving Role of Subspecialties in Population Health Management and New Healthcare Delivery Models SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Editorial Material ID MEDICAL NEIGHBORHOOD; SAFETY-NET; SPECIALISTS AB New healthcare delivery models, including accountable care organizations (ACOs) and patient-centered medical homes, emphasize a more robust role for primary care. However, it is less clear how the roles and responsibilities of subspecialists should change as we enter a new paradigm of alternative payment models. Health systems seeking to better manage population health and control costs will need a clearer understanding of how best to incorporate subspecialty practitioners: What is a subspecialist's role? How does it vary by subspecialty? How should they be compensated? We argue that subspecialist compensation in ACOs and other new care delivery models should recognize the range of ways in which specialists can provide value to patients across a population-which varies depending on the provider's role in a patient's care. Only by more thoughtfully engaging, equipping, and compensating subspecialty practitioners can we achieve reform's central goal of better population health at a lower cost. C1 [Khullar, Dhruv; Rao, Sandhya K.; Chaguturu, Sreekanth K.] Massachusetts Gen Hosp, Dept Med, 55 Fruit St, Boston, MA 02114 USA. [Chaguturu, Sreekanth K.] Partners HealthCare, Populat Hlth Management, Boston, MA USA. [Rajkumar, Rahul] Ctr Medicare Serv, Washington, DC USA. [Rajkumar, Rahul] Ctr Medicaid Serv, Washington, DC USA. RP Khullar, D (reprint author), Massachusetts Gen Hosp, Dept Med, 55 Fruit St, Boston, MA 02114 USA. EM dkhullar@partners.org NR 8 TC 0 Z9 0 U1 4 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 JUN PY 2016 VL 22 IS 6 BP E192 EP E195 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA DR9VX UT WOS:000380245300001 PM 27355905 ER PT J AU Kangovi, S Cafardi, SG Smith, RA Kulkarni, R Grande, D AF Kangovi, Shreya Cafardi, Susannah G. Smith, Robyn A. Kulkarni, Rains Grande, David TI The Authors Reply II, "Patient Financial Responsibility for Observation Care" and "Observation Versus Inpatient Hospitalization: What Do Medicare Beneficiaries Pay?" SO JOURNAL OF HOSPITAL MEDICINE LA English DT Letter C1 [Kangovi, Shreya; Smith, Robyn A.; Grande, David] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. [Kangovi, Shreya; Grande, David] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA. [Kangovi, Shreya; Smith, Robyn A.; Kulkarni, Rains] Penn Ctr Community Hlth Workers, Philadelphia, PA USA. [Cafardi, Susannah G.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Kangovi, S (reprint author), Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. NR 2 TC 0 Z9 0 U1 1 U2 1 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1553-5592 EI 1553-5606 J9 J HOSP MED JI J. Hosp. Med. PD JUN PY 2016 VL 11 IS 6 BP 458 EP 458 DI 10.1002/jhm.2564 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA DR6VW UT WOS:000380040400014 PM 26914531 ER PT J AU Greenwald, AS Bassano, A Wiggins, S Froimson, MI AF Greenwald, A. Seth Bassano, Amy Wiggins, Stephen Froimson, Mark I. TI Alternative Reimbursement Models: Bundled Payment and Beyond AOA Critical Issues SO JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME LA English DT Article ID IMPROVEMENT AB The Bundled Payments for Care Improvement (BPCI) initiative was begun in January 2013 by the U.S. Centers for Medicare & Medicaid Services (CMS) through its Innovation Center authority, which was created by the U.S. Patient Protection and Affordable Care Act (PPACA). The BPCI program seeks to improve health-care delivery and to ultimately reduce costs by allowing providers to enter into prenegotiated payment arrangements that include financial and performance accountability for a clinical episode in which a risk-and-reward calculus must be determined. BPCI is a contemporary 3-year experiment designed to test the applicability of episode-based payment models as a viable strategy to transform the CMS payment methodology while improving health outcomes. A summary of the 4 models being evaluated in the BPCI initiative is presented in addition to the awardee types and the number of awardees in each model. Data from one of the BPCI-designated pilot sites demonstrate that strategies do exist for successful implementation of an alternative payment model by keeping patients first while simultaneously improving coordination, alignment of care, and quality and reducing cost. Providers will need to embrace change and their areas of opportunity to gain a competitive advantage. Health-care providers, including orthopaedic surgeons, health-care professionals at post-acute care institutions, and product suppliers, all have a role in determining the strategies for success. Open dialogue between CMS and awardees should be encouraged to arrive at a solution that provides opportunity for gainsharing, as this program continues to gain traction and to evolve. C1 [Greenwald, A. Seth] Orthopaed Res Labs, Cleveland, OH 44114 USA. [Bassano, Amy] Ctr Medicare & Medicaid Serv, Patient Care Models Grp, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Wiggins, Stephen] Remedy Partners & Essex Woodlands, New York, NY USA. Euclid Hosp, Euclid, OH USA. [Froimson, Mark I.] Trinity Hlth, Livonia, MI USA. RP Greenwald, AS (reprint author), Orthopaed Res Labs, Cleveland, OH 44114 USA. EM seth@orl-inc.com NR 7 TC 2 Z9 2 U1 0 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0021-9355 EI 1535-1386 J9 J BONE JOINT SURG AM JI J. Bone Joint Surg.-Am. Vol. PD JUN 1 PY 2016 VL 98 IS 11 AR e45 DI 10.2106/JBJS.15.01174 PG 7 WC Orthopedics; Surgery SC Orthopedics; Surgery GA DP6ZK UT WOS:000378648500001 PM 27252442 ER PT J AU Berwick, D Fox, DM AF Berwick, Donald Fox, Daniel M. TI "Evaluating the Quality of Medical Care": Donabedian's Classic Article 50 Years Later SO MILBANK QUARTERLY LA English DT Article C1 [Berwick, Donald] Inst Healthcare Improvement, Cambridge, MA USA. [Berwick, Donald] Ctr Medicare Serv, Baltimore, MD USA. [Berwick, Donald] Ctr Medicaid Serv, Baltimore, MD USA. [Berwick, Donald] Harvard Univ, Sch Med, Pediat & Hlth Care Policy, Cambridge, MA 02138 USA. [Berwick, Donald] Harvard Univ, Sch Med, Hlth Policy & Management, Cambridge, MA 02138 USA. [Berwick, Donald] Harvard Univ, Sch Med, Dept Hlth Care Policy, Cambridge, MA 02138 USA. [Fox, Daniel M.] Milbank Mem Fund, New York, NY USA. RP Fox, DM (reprint author), 100 W 12th St,3T, New York, NY 10011 USA. EM dmfox@milbank.org NR 3 TC 0 Z9 0 U1 10 U2 13 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0887-378X EI 1468-0009 J9 MILBANK Q JI Milbank Q. PD JUN PY 2016 VL 94 IS 2 BP 237 EP 241 DI 10.1111/1468-0009.12189 PG 5 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA DP5OX UT WOS:000378548000002 PM 27265554 ER PT J AU Parikh, K Fleischman, W Agrawal, S AF Parikh, Kavita Fleischman, William Agrawal, Shantanu TI Industry Relationships With Pediatricians: Findings From the Open Payments Sunshine Act SO PEDIATRICS LA English DT Article ID CONFLICTS-OF-INTEREST; PHYSICIANS; DIAGNOSIS; CHILDREN; GIFT AB BACKGROUND AND OBJECTIVES: Ties between physicians and pharmaceutical/medical device manufactures have received considerable attention. The Open Payments program, part of the Affordable Care Act, requires public reporting of payments to physicians from industry. We sought to describe payments from industry to physicians caring for children by (1) comparing payments to pediatricians to other medical specialties, (2) determining variation in payments among pediatric subspecialties, and (3) identifying the types of payment and the products associated with payments to pediatricians. METHODS: We conducted a descriptive, cross-sectional analysis of Open Payments data from January 1 to December 31, 2014. The primary outcomes included percent of physicians receiving payments, median total pay per physician, the types of payments received, and the drugs and devices associated with payments. RESULTS: There were 9638825 payments to physicians, totaling $1186217157. There were 244915 payments to general pediatricians and pediatric subspecialists, totaling >$32 million. The median individual payment to general pediatricians was $14.63 (interquartile range 12-20), and median total pay per general pediatrician was $89 (interquartile range 32-186). General pediatricians accounted for 1.7% of total payments, and 0.9% of the sum of payments. Developmental pediatricians had the highest percentage of pediatric physicians receiving payment, and pediatric endocrinologists received the highest median payment. Top marketed medications were for attention-deficient/hyperactivity disorder and vaccinations. CONCLUSIONS: More than 40% of pediatricians received payments from industry in 2014, a lower percentage than family physicians or internists. There was considerable variation in physician-industry ties among the pediatric subspecialties. Most payments were associated with medications that treat attention-deficient/hyperactivity disorder and vaccinations. C1 [Parikh, Kavita] Childrens Natl Med Ctr, Dept Pediat, Div Hospitalist Med, 111 Michigan Ave NW, Washington, DC 20010 USA. [Parikh, Kavita] George Washington Sch Med, 111 Michigan Ave NW, Washington, DC 20010 USA. [Fleischman, William] Yale Univ, Sch Med, Robert Wood Johnson Fdn, Clin Scholars Program, New Haven, CT USA. [Fleischman, William; Agrawal, Shantanu] Ctr Medicare & Medicaid Serv, Dept Hlth & Human Serv, Washington, DC USA. RP Parikh, K (reprint author), Childrens Natl Med Ctr, Dept Pediat, Div Hospitalist Med, 111 Michigan Ave NW, Washington, DC 20010 USA.; Parikh, K (reprint author), George Washington Sch Med, 111 Michigan Ave NW, Washington, DC 20010 USA. EM kparikh@childrensnational.org NR 25 TC 3 Z9 3 U1 1 U2 1 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 EI 1098-4275 J9 PEDIATRICS JI Pediatrics PD JUN PY 2016 VL 137 IS 6 AR e20154440 DI 10.1542/peds.2015-4440 PG 7 WC Pediatrics SC Pediatrics GA DP5EZ UT WOS:000378520100031 ER PT J AU Colligan, EM Pines, JM Colantuoni, E Howell, B Wolff, JL AF Colligan, Erin M. Pines, Jesse M. Colantuoni, Elizabeth Howell, Benjamin Wolff, Jennifer L. TI Risk Factors for Persistent Frequent Emergency Department Use in Medicare Beneficiaries SO ANNALS OF EMERGENCY MEDICINE LA English DT Article ID HEALTH-CARE-SYSTEM; CONTINUITY; SERVICES; ACCESS; MATTER; URBAN; PREDICTORS; COSTS; MODEL AB Study objective: We examine factors associated with persistent frequent emergency department (ED) use during a 2-year period among Medicare beneficiaries. Methods: We conducted a retrospective, claims-based analysis of fee-for-service Medicare beneficiaries, using the Chronic Condition Data Warehouse's random 20% sample files. We used multinomial logistic regression models to compare frequent ED use (defined as 4 or more ED visits per year) with infrequent use (1 to 3 visits per year), non-ED use, and death in 2010 as a function of sociodemographic, primary care, clinical characteristics, and 2009 ED use. Results: Approximately 1.1% of Medicare beneficiaries were persistent frequent ED users, defined as experiencing frequent ED use in 2009 and 2010 consecutively. Of the 3.3% of Medicare beneficiaries who were frequent ED users in 2009, 34.3% were frequent ED users, 19.4% were non-ED users, 39.0% were infrequent ED users, and 7.4% died in 2010. Frequent ED use in 2009 was highly associated with frequent ED use in 2010 (relative risk ratio 35.2; 95% confidence interval 34.5 to 35.8). Younger age, Medicaid status, and mental illness were also strong predictors of frequent ED use. The probability of frequent ED use in 2010 was 3.4% for the total sample, but was 19.4% for beneficiaries who were frequent users in 2009 and 49.0% for beneficiaries in the youngest age group who had mental illness, Medicaid, and frequent ED use in 2009. Conclusion: Efforts to curtail frequent ED use in Medicare should focus on disabled, socially vulnerable beneficiaries. C1 [Colligan, Erin M.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD 21244 USA. [Pines, Jesse M.] George Washington Univ, Sch Med & Hlth Sci, Washington, DC 20052 USA. [Colantuoni, Elizabeth; Wolff, Jennifer L.] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Howell, Benjamin] CVS Hlth, Cumberland, RI USA. RP Colligan, EM (reprint author), Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD 21244 USA. EM erin.colligan@cms.hhs.gov FU Department of Health and Human Services Pathways Program; Agency for Healthcare Research and Quality T32 student grant FX By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This work was funded through the Department of Health and Human Services Pathways Program and the Agency for Healthcare Research and Quality T32 student grant. NR 38 TC 1 Z9 1 U1 4 U2 4 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD JUN PY 2016 VL 67 IS 6 BP 721 EP 729 DI 10.1016/j.annemergmed.2016.01.033 PG 9 WC Emergency Medicine SC Emergency Medicine GA DN9TU UT WOS:000377424400008 PM 26947801 ER PT J AU Lorden, AL Radcliff, TA Jiang, L Horel, SA Smith, ML Lorig, K Howell, BL Whitelaw, N Ory, M AF Lorden, Andrea L. Radcliff, Tiffany A. Jiang, Luohua Horel, Scott A. Smith, Matthew L. Lorig, Kate Howell, Benjamin L. Whitelaw, Nancy Ory, Marcia TI Leveraging Administrative Data for Program Evaluations: A Method for Linking Data Sets Without Unique Identifiers SO EVALUATION & THE HEALTH PROFESSIONS LA English DT Article DE administrative data; fuzzy matching; linkage; Medicare; program evaluation ID SELF-MANAGEMENT PROGRAM AB In community-based wellness programs, Social Security Numbers (SSNs) are rarely collected to encourage participation and protect participant privacy. One measure of program effectiveness includes changes in health care utilization. For the 65 and over population, health care utilization is captured in Medicare administrative claims data. Therefore, methods as described in this article for linking participant information to administrative data are useful for program evaluations where unique identifiers such as SSN are not available. Following fuzzy matching methodologies, participant information from the National Study of the Chronic Disease Self-Management Program was linked to Medicare administrative data. Linking variables included participant name, date of birth, gender, address, and ZIP code. Seventy-eight percent of participants were linked to their Medicare claims data. Linking program participant information to Medicare administrative data where unique identifiers are not available provides researchers with the ability to leverage claims data to better understand program effects. C1 [Lorden, Andrea L.; Radcliff, Tiffany A.] Texas A&M Hlth Sci Ctr, Dept Hlth Policy & Management, Sch Publ Hlth, 1266 TAMU, College Stn, TX 77843 USA. [Jiang, Luohua; Horel, Scott A.] Texas A&M Hlth Sci Ctr, Dept Epidemiol & Biostat, Sch Publ Hlth, College Stn, TX USA. [Smith, Matthew L.] Univ Georgia, Dept Hlth Promot & Behav, Coll Publ Hlth, Athens, GA 30602 USA. [Lorig, Kate] Stanford Univ, Dept Med Immunol & Rheumatol, Stanford, CA 94305 USA. [Howell, Benjamin L.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Howell, Benjamin L.] Ctr Medicare & Medicaid Serv, Ctr Strateg Planning, Baltimore, MD USA. [Whitelaw, Nancy] Natl Council Aging, Ctr Healthy Aging, Washington, DC USA. [Ory, Marcia] Texas A&M Hlth Sci Ctr, Dept Hlth Promot & Community Hlth Sci, Sch Publ Hlth, College Stn, TX USA. RP Lorden, AL (reprint author), Texas A&M Hlth Sci Ctr, Dept Hlth Policy & Management, Sch Publ Hlth, 1266 TAMU, College Stn, TX 77843 USA. EM lorden@sph.tamhsc.edu FU National Council on Aging (NCOA) [HHSM-500-2011-00088C] FX The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication was made possible by funding through Contract: HHSM-500-2011-00088C to the National Council on Aging (NCOA). NR 13 TC 0 Z9 0 U1 2 U2 4 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0163-2787 EI 1552-3918 J9 EVAL HEALTH PROF JI Eval. Health Prof. PD JUN PY 2016 VL 39 IS 2 BP 245 EP 259 DI 10.1177/0163278714547568 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA DM2OU UT WOS:000376186900006 PM 25139849 ER PT J AU Lloyd, JT Alley, DE Hochberg, MC Waldstein, SR Harris, TB Kritchevsky, SB Schwartz, AV Strotmeyer, ES Womack, C Orwig, DL AF Lloyd, J. T. Alley, D. E. Hochberg, M. C. Waldstein, S. R. Harris, T. B. Kritchevsky, S. B. Schwartz, A. V. Strotmeyer, E. S. Womack, C. Orwig, D. L. CA Hlth ABC Study TI Changes in bone mineral density over time by body mass index in the health ABC study SO OSTEOPOROSIS INTERNATIONAL LA English DT Article DE Aging; Longitudinal; Obesity; Osteoporosis ID NORMAL POSTMENOPAUSAL WOMEN; VITAMIN-D SUPPLEMENTATION; OLDER US ADULTS; FOLLOW-UP; FEMORAL-NECK; NHANES-III; OBESITY; OSTEOPOROSIS; ASSOCIATION; WEIGHT AB Obesity appears protective against osteoporosis in cross-sectional studies. However, results from this longitudinal study found that obesity was associated with bone loss over time. Findings underscore the importance of looking at the longitudinal relationship, particularly given the increasing prevalence and duration of obesity among older adults. Cross-sectional studies have found a positive association between body mass index (BMI) and bone mineral density (BMD), but little is known about the longitudinal relationship in US older adults. We examined average annual rate of change in BMD by baseline BMI in the Health, Aging, and Body Composition Study. Repeated measurement of BMD was performed with dual-energy X-ray absorptiometry (DXA) at baseline and years 3, 5, 6, 8, and 10. Multivariate generalized estimating equations were used to predict mean BMD (femoral neck, total hip, and whole body) by baseline BMI (excluding underweight), adjusting for covariates. In the sample (n = 2570), 43 % were overweight and 24 % were obese with a mean baseline femoral neck BMD of 0.743 g/cm(2), hip BMD of 0.888 g/cm(2), and whole-body BMD of 1.09 g/cm(2). Change in total hip or whole-body BMD over time did not vary by BMI groups. However, obese older adults lost 0.003 g/cm(2) of femoral neck BMD per year more compared with normal weight older adults (p < 0.001). Femoral neck BMD change over time did not differ between the overweight and normal weight BMI groups (p = 0.74). In year 10, adjusted femoral neck BMD ranged from 0.696 g/cm(2) among obese, 0.709 g/cm(2) among normal weight, and 0.719 g/cm(2) among overweight older adults. Findings underscore the importance of looking at the longitudinal relationship between body composition and bone mineral density among older adults, indicating that high body mass may not be protective for bone loss over time. C1 [Lloyd, J. T.; Alley, D. E.] Ctr Medicare & Medicaid Serv, 7500 Security Blvd,WB-06-05, Baltimore, MD 21244 USA. [Alley, D. E.; Hochberg, M. C.; Orwig, D. L.] Univ Maryland, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA. [Hochberg, M. C.; Orwig, D. L.] Univ Maryland, Doctoral Program Gerontol, Baltimore, MD 21201 USA. [Waldstein, S. R.] Univ Maryland, Dept Psychol, Baltimore, MD 21201 USA. [Harris, T. B.] NIA, Lab Epidemiol & Populat Sci, Intramural Res Program, Bethesda, MD 20892 USA. [Kritchevsky, S. B.] Wake Forest Sch Med, Sticht Ctr Aging, Winston Salem, NC USA. [Schwartz, A. V.] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA. [Strotmeyer, E. S.] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA. [Womack, C.] Univ Tennessee, Hlth Sci Ctr, Memphis, TN USA. RP Lloyd, JT (reprint author), Ctr Medicare & Medicaid Serv, 7500 Security Blvd,WB-06-05, Baltimore, MD 21244 USA. EM Jennifer.Lloyd@cms.hhs.gov OI Strotmeyer, Elsa/0000-0002-4093-6036 NR 37 TC 2 Z9 2 U1 2 U2 5 PU SPRINGER LONDON LTD PI LONDON PA 236 GRAYS INN RD, 6TH FLOOR, LONDON WC1X 8HL, ENGLAND SN 0937-941X EI 1433-2965 J9 OSTEOPOROSIS INT JI Osteoporosis Int. PD JUN PY 2016 VL 27 IS 6 BP 2109 EP 2116 DI 10.1007/s00198-016-3506-x PG 8 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA DM1JE UT WOS:000376100700017 PM 26856584 ER PT J AU Tefera, L Lehrman, WG Conway, P AF Tefera, Lemeneh Lehrman, William G. Conway, Patrick TI Measurement of the Patient Experience Clarifying Facts, Myths, and Approaches SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID NONRESPONSE; CARE C1 [Tefera, Lemeneh] Ctr Medicare & Medicaid Serv, Qual Measurement & Value Based Incent Grp, 7500 Secur Blvd,S3-02-04, Baltimore, MD 21244 USA. [Lehrman, William G.] Ctr Medicare & Medicaid Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD 21244 USA. RP Tefera, L (reprint author), Ctr Medicare & Medicaid Serv, Qual Measurement & Value Based Incent Grp, 7500 Secur Blvd,S3-02-04, Baltimore, MD 21244 USA. EM lemeneh.tefera@cms.hhs.gov NR 8 TC 3 Z9 3 U1 2 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 24 PY 2016 VL 315 IS 20 BP 2167 EP 2168 DI 10.1001/jama.2016.1652 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA DM4US UT WOS:000376343000009 PM 26967744 ER PT J AU Shen, X Stuart, B Powers, C Tom, S Magder, L Perfetto, EM AF Shen, X. Stuart, B. Powers, C. Tom, S. Magder, L. Perfetto, E. M. TI HOW DO FORMULARY RESTRICTIONS AFFECT MEDICATION USE AND COSTS FOR LOW-INCOME SUBSIDY RECIPIENTS IN MEDICARE PART D PLANS? SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Shen, X.; Stuart, B.; Tom, S.; Perfetto, E. M.] Univ Maryland, Sch Pharm, Baltimore, MD 21201 USA. [Powers, C.] Ctr Medicare Serv, Baltimore, MD USA. [Powers, C.] Ctr Medicaid Serv, Baltimore, MD USA. [Magder, L.] Univ Maryland, Sch Med, Baltimore, MD 21201 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 1098-3015 EI 1524-4733 J9 VALUE HEALTH JI Value Health PD MAY PY 2016 VL 19 IS 3 MA PHP17 BP A261 EP A261 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA EL9HP UT WOS:000394931600284 ER PT J AU Metersky, ML Eldridge, N Wang, Y Jaser, L Bona, R Eckenrode, S Bakullari, A Andrawis, M Classen, D Krumholz, HM AF Metersky, Mark L. Eldridge, Noel Wang, Yun Jaser, Lisa Bona, Robert Eckenrode, Sheila Bakullari, Anila Andrawis, Mary Classen, David Krumholz, Harlan M. TI Predictors of warfarin-associated adverse events in hospitalized patients: Opportunities to prevent patient harm SO JOURNAL OF HOSPITAL MEDICINE LA English DT Article ID PROPENSITY SCORE METHODS; ANTICOAGULATION SERVICE; ANTITHROMBOTIC THERAPY; MANAGEMENT; SAFETY AB BACKGROUNDThe optimum international normalized ratio (INR) monitoring frequency for hospitalized patients receiving warfarin is unknown. OBJECTIVEAssess relationship between daily versus less frequent INR monitoring and overanticoagulation and warfarin-related adverse events. DESIGNRetrospective cohort study using Medicare Patient Safety Monitoring System data. SETTINGRandomly selected acute care hospitals across the United States. PATIENTSPatients hospitalized from 2009 to 2013 for pneumonia, acute cardiac disease, or surgery who received warfarin. INTERVENTIONSNone. MEASUREMENTS(1) Association between frequency of INR monitoring and an INR 6.0 or warfarin-related adverse event. (2) Association between the rate of change of the INR and a subsequent INR 5.0 and 6.0. RESULTSAmong 8529 patients who received warfarin for 3 days, for 1549 (18.2%) the INR was not measured on 2 or more days. These patients had higher propensity-adjusted odds ratios (ORs) of having a warfarin-associated adverse event (OR: 1.48, 95% confidence interval [CI]: 1.02-2.17) for cardiac patients and surgical patients (OR: 1.73, 95% CI: 1.20-2.48), with no significant association for pneumonia patients. Cardiac and pneumonia patients with 1 day or more without an INR measurement had higher propensity-adjusted ORs of having an INR 6.0 (OR: 1.61, 95% CI: 1.07-2.41 and OR: 1.92, 95% CI: 1.36-2.71, respectively). A 1-day increase in the INR of 0.9 occurred in 621 patients (12.5%) and predicted a subsequent INR of 6.0 (positive likelihood ratio of 4.2). CONCLUSIONDaily INR measurement and recognition of a rapidly rising INR might decrease the frequency of warfarin-associated adverse events in hospitalized patients. Journal of Hospital Medicine 2016;11:276-282. (c) 2015 Society of Hospital Medicine C1 [Metersky, Mark L.; Jaser, Lisa; Eckenrode, Sheila; Bakullari, Anila] Qualidigm, Wethersfield, CT USA. [Metersky, Mark L.] Univ Connecticut, Sch Med, Div Pulm & Crit Care Med, 263 Farmington Ave, Farmington, CT 06030 USA. [Eldridge, Noel] Agcy Healthcare Res & Qual, US Dept Hlth & Human Serv, Rockville, MD USA. [Wang, Yun] Harvard Univ, TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. [Jaser, Lisa] Griffin Hosp, Dept Pharm, Derby, CT USA. [Bona, Robert] Frank H Netter MD Sch Med Quinnipiac, Hamden, CT USA. [Andrawis, Mary] US Dept Hlth & Human Serv, Ctr Medicare, Baltimore, MD USA. [Andrawis, Mary] US Dept Hlth & Human Serv, Ctr Medicaid, Baltimore, MD USA. [Classen, David] Univ Utah, Sch Med, Dept Internal Med, Salt Lake City, UT USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Gen Internal Med Sect, New Haven, CT USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Robert Wood Johnson Fdn Clin Scholars Program, New Haven, CT USA. [Krumholz, Harlan M.] Yale Univ, Sch Publ Hlth, Dept Hlth Policy & Management, New Haven, CT USA. [Krumholz, Harlan M.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, 20 York St, New Haven, CT 06504 USA. RP Metersky, ML (reprint author), Univ Connecticut, Sch Med, Div Pulm & Crit Care Med, 263 Farmington Ave, Farmington, CT 06030 USA. EM metersky@uchc.edu FU Agency for Healthcare Research and Quality, United States Department of Health and Human Services, Rockville, Maryland [HHSA290201200003C]; Medtronic, Inc. through Yale University FX This work was supported by contract HHSA290201200003C from the Agency for Healthcare Research and Quality, United States Department of Health and Human Services, Rockville, Maryland. Qualidigm was the contractor. The authors assume full responsibility for the accuracy and completeness of the ideas. Dr. Metersky has worked on various quality improvement and patient safety projects with Qualidigm, Centers for Medicare & Medicaid Services, and the Agency for Healthcare Research and Quality. His employer has received remuneration for this work. Dr. Krumholz works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures. Dr. Krumholz is the chair of a cardiac scientific advisory board for United-Health and the recipient of a research grant from Medtronic, Inc. through Yale University. The other authors report no conflicts of interest. NR 24 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1553-5592 EI 1553-5606 J9 J HOSP MED JI J. Hosp. Med. PD APR PY 2016 VL 11 IS 4 BP 276 EP 282 DI 10.1002/jhm.2528 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA DJ0TE UT WOS:000373916500006 PM 26662851 ER PT J AU Barradas, DT Wasserman, MP Daniel-Robinson, L Bruce, MA DiSantis, KI Navarro, FH Jones, WA Manzi, NM Smith, MW Goodness, BM AF Barradas, Danielle T. Wasserman, Martin P. Daniel-Robinson, Lekisha Bruce, Marino A. DiSantis, Katherine Isselmann Navarro, Frederick H. Jones, Warren A. Manzi, Nadine M. Smith, Mark W. Goodness, Brian M. TI Hospital Utilization and Costs Among Preterm Infants by Payer: Nationwide Inpatient Sample, 2009 SO MATERNAL AND CHILD HEALTH JOURNAL LA English DT Article DE Preterm birth; Low birth weight; Insurance ID NEONATAL INTENSIVE-CARE; BIRTH-WEIGHT INFANTS; PRENATAL-CARE; WOMEN AB Objectives To describe hospital utilization and costs associated with preterm or low birth weight births (preterm/LBW) by payer prior to implementation of the Affordable Care Act and to identify areas for improvement in the quality of care received among preterm/LBW infants. Methods Hospital utilization-defined as mean length of stay (LOS, days), secondary diagnoses for birth hospitalizations, primary diagnoses for rehospitalizations, and transfer status-and costs were described among preterm/LBW infants using the 2009 Nationwide Inpatient Sample. Results Approximately 9.1 % of included hospitalizations (n = 4,167,900) were births among preterm/LBW infants; however, these birth hospitalizations accounted for 43.4 % of total costs. Rehospitalizations of all infants occurred at a rate of 5.9 % overall, but accounted for 22.6 % of total costs. This pattern was observed across all payer types. The prevalence of rehospitalizations was nearly twice as high among preterm/LBW infants covered by Medicaid (7.6 %) compared to commercially-insured infants (4.3 %). Neonatal transfers were more common among preterm/LBW infants whose deliveries and hospitalizations were covered by Medicaid (7.3 %) versus commercial insurance (6.5 %). Uninsured/self-pay preterm and LBW infants died in-hospital during the first year of life at a rate of 91 per 1000 discharges-nearly three times higher than preterm and LBW infants covered by either Medicaid (37 per 1000) or commercial insurance (32 per 1000). Conclusions When comparing preterm/LBW infants whose births were covered by Medicaid and commercial insurance, there were few differences in length of hospital stays and costs. However, opportunities for improvement within Medicaid and CHIP exist with regard to reducing rehospitalizations and neonatal transfers. C1 [Barradas, Danielle T.] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Reprod Hlth, 4770 Buford Hwy NE,MS F-74, Atlanta, GA 30341 USA. [Wasserman, Martin P.; Bruce, Marino A.; DiSantis, Katherine Isselmann; Navarro, Frederick H.; Jones, Warren A.; Manzi, Nadine M.] Provider Resources Inc, Healthcare Qual & Dispar Div, Erie, PA USA. [Daniel-Robinson, Lekisha] Ctr Medicare & Medicaid Serv, Ctr Medicaid & CHIP Serv, Children & Adults Hlth Programs Grp, Div Qual Evaluat & Hlth Outcomes, Baltimore, MA USA. [Smith, Mark W.; Goodness, Brian M.] Truven Hlth Analyt, Ann Arbor, MI USA. RP Barradas, DT (reprint author), Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Div Reprod Hlth, 4770 Buford Hwy NE,MS F-74, Atlanta, GA 30341 USA. EM dbarradas@cdc.gov FU Intramural CDC HHS [CC999999] NR 17 TC 0 Z9 0 U1 4 U2 7 PU SPRINGER/PLENUM PUBLISHERS PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 1092-7875 EI 1573-6628 J9 MATERN CHILD HLTH J JI Matern. Child Health J. PD APR PY 2016 VL 20 IS 4 BP 808 EP 818 DI 10.1007/s10995-015-1911-y PG 11 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA DG6BR UT WOS:000372167700009 PM 26740227 ER PT J AU Clough, JD Strawbridge, LM LeBlanc, TW Hammill, BG Kamal, A AF Clough, Jeffrey D. Strawbridge, Larisa M. LeBlanc, Thomas William Hammill, Bradley G. Kamal, Arif TI Association of high rates of practice-level inpatient-intensity with end-of-life outcomes, readmission rates, and weekend hospitalizations among Medicare patients with cancer SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Meeting Abstract CT ASCO Quality Care Symposium CY FEB 26-27, 2016 CL Phoenix, AZ SP Amer Soc Clin Oncol C1 Duke Clin Res Inst, Durham, NC USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. Duke Canc Inst, Durham, NC 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 EI 1527-7755 J9 J CLIN ONCOL JI J. Clin. Oncol. PD MAR 1 PY 2016 VL 34 IS 7 SU S MA 5 PG 1 WC Oncology SC Oncology GA DO9ME UT WOS:000378109900006 ER PT J AU Kent, EE Mollica, M Gaillot, S Halpern, MT Hays, RD Lines, LM Topor, MA Yuan, G Schussler, NC Ramirez, E Smith, AW AF Kent, Erin E. Mollica, Michelle Gaillot, Sarah Halpern, Michael T. Hays, Ron D. Lines, Lisa M. Topor, Marie A. Yuan, Gigi Schussler, Nicola C. Ramirez, Edgardo Smith, Ashley Wilder TI Cancer registry-survey data linkages to measure patient-centered quality of care: SEER-MHOS and SEER-CAHPS SO JOURNAL OF CLINICAL ONCOLOGY LA English DT Meeting Abstract CT ASCO Quality Care Symposium CY FEB 26-27, 2016 CL Phoenix, AZ SP Amer Soc Clin Oncol C1 NCI, NIH, Rockville, MD USA. NCI, Rockville, MD USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. Univ Arizona, Coll Publ Hlth, Tucson, AZ USA. Univ Calif Los Angeles, Los Angeles, CA USA. RTI Int, Waltham, MA USA. Informat Management Serv Inc, Rockville, MA USA. Informat Management Serv Inc, Rockville, MD USA. Informat Management Serv Inc, Calverton, MD USA. NCI, Bethesda, MD 20892 USA. RI Lines, Lisa/R-4983-2016 OI Lines, Lisa/0000-0002-9202-3466 NR 0 TC 0 Z9 0 U1 1 U2 1 PU AMER SOC CLINICAL ONCOLOGY PI ALEXANDRIA PA 2318 MILL ROAD, STE 800, ALEXANDRIA, VA 22314 USA SN 0732-183X EI 1527-7755 J9 J CLIN ONCOL JI J. Clin. Oncol. PD MAR 1 PY 2016 VL 34 IS 7 SU S MA 303 PG 1 WC Oncology SC Oncology GA DO9ME UT WOS:000378109900292 ER PT J AU Cortes, TA Sullivan-Marx, EM AF Cortes, Tara A. Sullivan-Marx, Eileen M. TI A Case Exemplar for National Policy Leadership Expanding Program of All-Inclusive Care for the Elderly (PACE) SO JOURNAL OF GERONTOLOGICAL NURSING LA English DT Article AB In November 2015, President Obama signed the Program of All-Inclusive Care for the Elderly (PACE) Innovation Act, which expands a proven model of care to serve high-cost and high-need populations. Specifically, the law provides the Centers for Medicare & Medicaid Services with the authority to waive Medicaid requirements that could not be waived without additional statutory authority. Those requirements include the age of the beneficiary to be served and nursing home eligibility as a condition for PACE enrollment. The law also allows providers and other entities who are not current PACE providers the opportunity to become PACE providers and serve a predominately dually eligible population that has high needs and high cost through a coordinated, integrated model. The current article describes the impact of nursing on the legislation and policy that has shaped the evolution of the PACE program for more than 40 years. C1 [Cortes, Tara A.] NYU, Coll Nursing, Nursing, 433 First Ave,6th Floor, New York, NY 10010 USA. [Cortes, Tara A.] NYU, Coll Nursing, Hartford Inst Geriatr Nursing, 433 First Ave,6th Floor, New York, NY 10010 USA. [Sullivan-Marx, Eileen M.] NYU, Coll Nursing, New York, NY 10010 USA. [Cortes, Tara A.] US Dept HHS, Medicare Medicaid Coordinat Off, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Cortes, TA (reprint author), NYU, Coll Nursing, Nursing, 433 First Ave,6th Floor, New York, NY 10010 USA.; Cortes, TA (reprint author), NYU, Coll Nursing, Hartford Inst Geriatr Nursing, 433 First Ave,6th Floor, New York, NY 10010 USA. EM tara.cortes@nyu.edu NR 11 TC 1 Z9 1 U1 4 U2 7 PU SLACK INC PI THOROFARE PA 6900 GROVE RD, THOROFARE, NJ 08086 USA SN 0098-9134 EI 1938-243X J9 J GERONTOL NURS JI J. Gerontol. Nurs. PD MAR PY 2016 VL 42 IS 3 BP 9 EP 14 DI 10.3928/00989134-20160212-04 PG 6 WC Geriatrics & Gerontology; Gerontology; Nursing SC Geriatrics & Gerontology; Nursing GA DK9ZB UT WOS:000375289800002 PM 26934968 ER PT J AU Cummings, DM Wu, JR Cene, C Halladay, J Donahue, KE Hinderliter, A Miller, C Garcia, B Penn, D Tillman, J DeWalt, D AF Cummings, Doyle M. Wu, Jia-Rong Cene, Crystal Halladay, Jacquie Donahue, Katrina E. Hinderliter, Alan Miller, Cassandra Garcia, Beverly Penn, Dolly Tillman, Jim DeWalt, Darren TI Perceived Social Standing, Medication Nonadherence, and Systolic Blood Pressure in the Rural South SO JOURNAL OF RURAL HEALTH LA English DT Article DE health disparities; health services research; hypertension; medication adherence; social determinants of health ID AFRICAN-AMERICANS; REFILL ADHERENCE; HEALTH; PREDICTORS; DISEASE; HEART; RISK AB PurposeLittle is known about how perceived social standing versus traditional socioeconomic characteristics influence medication adherence and blood pressure (BP) among African American and white patients with hypertension in the rural southeastern United States. MethodsPerceived social standing, socioeconomic characteristics, self-reported antihypertensive medication adherence, and BP were measured at baseline in a cohort of rural African American and white patients (n = 495) with uncontrolled hypertension attending primary care practices. Multivariate models examined the relationship of perceived social standing and socioeconomic indicators with medication adherence and systolic BP. FindingsMedication nonadherence was reported by 40% of patients. Younger age [ = 0.20; P = .001], African American race [ = -0.30; P = .03], and lower perceived social standing [ = 0.08; P = .002] but not sex or traditional socioeconomic characteristics including education and household income, were significantly associated with lower medication adherence. Race-specific analyses revealed that this pattern was limited to African Americans and not observed in whites. In stepwise modeling, older age [ = 0.57, P = .001], African American race [ = 4.4; P = .03], and lower medication adherence [ = -1.7, P = .01] but not gender, education, or household income, were significantly associated with higher systolic BP. ConclusionsLower perceived social standing and age, but not traditional socioeconomic characteristics, were significantly associated with lower medication adherence in African Americans. Lower medication adherence was associated with higher systolic BP. These findings suggest the need for tailored, culturally relevant medication adherence interventions in rural communities. C1 [Cummings, Doyle M.] E Carolina Univ, Dept Family Med, Brody Sch Med, 101 Heart Dr,MS 654, Greenville, NC 27834 USA. [Cummings, Doyle M.] Univ N Carolina, Sch Pharm, Chapel Hill, NC USA. [Wu, Jia-Rong] Univ N Carolina, Sch Nursing, Chapel Hill, NC USA. [Cene, Crystal] Univ N Carolina, Sch Med, Dept Gen Internal Med, Chapel Hill, NC USA. [Halladay, Jacquie; Donahue, Katrina E.] Univ N Carolina, Dept Family Med, Sch Med, Chapel Hill, NC 27514 USA. [Hinderliter, Alan] Univ N Carolina, Sch Med, Div Cardiol, Chapel Hill, NC USA. [Miller, Cassandra; Garcia, Beverly] Univ N Carolina, Gillings Sch Global Publ Hlth, Ctr Hlth Promot Dis Prevent, Chapel Hill, NC USA. [Penn, Dolly] Univ N Carolina, Sch Med, Dept Social Med, Chapel Hill, NC USA. [Tillman, Jim] Community Care Plan Eastern Carolina, Greenville, NC USA. [DeWalt, Darren] Ctr Medicare & Medicaid Serv, CMS Innovat Ctr, Baltimore, MD USA. RP Cummings, DM (reprint author), E Carolina Univ, Dept Family Med, Brody Sch Med, 101 Heart Dr,MS 654, Greenville, NC 27834 USA. EM cummingsd@ecu.edu FU National Heart Lung and Blood Institute [NHLBI 1P50HL10584-01] FX The source of funding for this manuscript preparation is from the National Heart Lung and Blood Institute via award number NHLBI 1P50HL10584-01. The funding body had no role in the collection, analysis, and interpretation of study data, nor did it play a role in the writing of the manuscript or the submission of the manuscript for publication. Trial registration: ClinicalTrials.gov NCT01425515. NR 20 TC 1 Z9 1 U1 1 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0890-765X EI 1748-0361 J9 J RURAL HEALTH JI J. Rural Health PD SPR PY 2016 VL 32 IS 2 BP 156 EP 163 DI 10.1111/jrh.12138 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA DI6MD UT WOS:000373612100005 PM 26334761 ER PT J AU Adesanya, MR Bailey, W Belcher, DC Beltran, M Branch, T Brand, MK Craft, EM Donahue, AH Dye, BA Thornton-Evans, G Garcia, I Hyman, F Joskow, R Lester, AM Makrides, NS Manski, RJ Mehegan, M Mouden, LD Nelson, D Norris, L O'Hara, J Cherry-Peppers, G Ricks, TL Rollins, R AF Adesanya, Margo R. Bailey, William Belcher, Donald C. Beltran, Marco Branch, Tracy Brand, Marcia K. Craft, Edwin M. Donahue, Agnes H. Dye, Bruce A. Thornton-Evans, Gina Garcia, Isabel Hyman, Frederick Joskow, Renee Lester, Arlene M. Makrides, Nicholas S. Manski, Richard J. Mehegan, Marian Mouden, Lynn Douglas Nelson, Danielle Norris, Laurie O'Hara, Jessica Cherry-Peppers, Gail Ricks, Timothy L. Rollins, Rochelle CA US Dept Hlth Human Serv TI US Department of Health and Human Services Oral Health Strategic Framework, 2014-2017 SO PUBLIC HEALTH REPORTS LA English DT Editorial Material ID DENTAL-CARE; CARIES C1 [Adesanya, Margo R.] Natl Inst Dent & Craniofacial Res, NIH, Off Sci Policy & Anal, Rockville, MD USA. [Bailey, William] Ctr Dis Control & Prevent, Atlanta, GA USA. [Belcher, Donald C.] US Coast Guard, Qual & Performance Improvement, Washington, DC USA. [Beltran, Marco; Rollins, Rochelle] Adm Children & Families, Washington, DC USA. [Branch, Tracy; Lester, Arlene M.] OS Off Minor Hlth, Washington, DC USA. [Brand, Marcia K.; Joskow, Renee] Hlth Resources & Serv Adm, Rockville, MD USA. [Craft, Edwin M.] Subst Abuse & Mental Hlth Serv Adm, Rockville, MD USA. [Donahue, Agnes H.] OS Off Assistant Secretary Hlth, OASH Intergovt Affairs RHA, Washington, DC USA. [Dye, Bruce A.] Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. [Thornton-Evans, Gina] Ctr Dis Control & Prevent, Div Oral Hlth, Atlanta, GA USA. [Garcia, Isabel] Natl Inst Dent & Craniofacial Res, NIH, Rockville, MD USA. [Hyman, Frederick] US FDA, Ctr Drug Evaluat & Res, Div Dermatol & Dent Prod, Silver Spring, MD USA. [Makrides, Nicholas S.] Fed Bur Prisons, Washington, DC USA. [Manski, Richard J.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Mehegan, Marian] Off Assistant Secretary Hlth, Off Womens Hlth, Washington, DC USA. [Mouden, Lynn Douglas] Ctr Medicare & Medicaid Serv, Div Qual Evaluat & Hlth Outcomes, Children & Adults Hlth Programs Grp, Washington, DC USA. [Nelson, Danielle] Adm Community Living, Washington, DC USA. [Norris, Laurie] Ctr Medicare & Medicaid Serv, Oral Hlth Initiat, Div Qual Evaluat & Hlth Outcomes, Washington, DC USA. [O'Hara, Jessica] Off Secretary, Off Assistant Secretary Planning & Evaluat, Washington, DC USA. [Cherry-Peppers, Gail] US FDA, Ctr Tobacco Prod, Off Sci, Silver Spring, MD USA. [Ricks, Timothy L.] Indian Hlth Serv, Nashville Area Off Publ Hlth, Nashville, TN USA. RP Adesanya, MR (reprint author), Natl Inst Dent & Craniofacial Res, NIH, Off Sci Policy & Anal, Rockville, MD USA. NR 56 TC 0 Z9 0 U1 2 U2 2 PU ASSOC SCHOOLS PUBLIC HEALTH PI WASHINGTON PA 1900 M ST NW, STE 710, WASHINGTON, DC 20036 USA SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD MAR-APR PY 2016 VL 131 IS 2 BP 242 EP 257 PG 16 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA DG9HH UT WOS:000372392900007 ER PT J AU Sacarny, A Yokum, D Finkelstein, A Agrawal, S AF Sacarny, Adam Yokum, David Finkelstein, Amy Agrawal, Shantanu TI Medicare Letters To Curb Overprescribing Of Controlled Substances Had No Detectable Effect On Providers SO HEALTH AFFAIRS LA English DT Article ID UNITED-STATES; PHYSICIAN; REMINDERS AB Inappropriate prescribing is a rising threat to the health of Medicare beneficiaries and a drain on Medicare's finances. In this study we used a randomized controlled trial approach to evaluate a low-cost, light-touch intervention aimed at reducing the inappropriate provision of Schedule II controlled substances in the Medicare Part D program. Potential overprescribers were sent a letter explaining that their practice patterns were highly unlike those of their peers. Using rich administrative data, we were unable to detect an effect of these letters on prescribing. We describe ongoing efforts to build on this null result with alternative interventions. Learning about the potential of light-touch interventions, both effective and ineffective, will help produce a better toolkit for policy makers to improve the value and safety of health care. C1 [Sacarny, Adam] Columbia Univ, Mailman Sch Publ Hlth, Dept Hlth Policy & Management, New York, NY USA. [Yokum, David] White House Social & Behav Sci Team, Washington, DC USA. [Yokum, David] Gen Serv Adm, Off Evaluat Sci, Washington, DC USA. [Finkelstein, Amy] MIT, Dept Econ, Econ, Cambridge, MA 02139 USA. [Finkelstein, Amy] J PAL North Amer, Cambridge, MA USA. [Finkelstein, Amy] NBER, Publ Econ Program, Cambridge, MA 02138 USA. [Agrawal, Shantanu] Ctr Medicare & Medicaid Serv, Ctr Program Integr, Baltimore, MD USA. RP Sacarny, A (reprint author), Columbia Univ, Mailman Sch Publ Hlth, Dept Hlth Policy & Management, New York, NY USA. EM ajs2102@columbia.edu FU J-PAL North America from Alfred P. Sloan Foundation; Laura and John Arnold Foundation FX An earlier version of this research was presented at the Robert Wood Johnson Foundation Scholars in Health Policy Research program's annual meeting, San Diego, California, June 4, 2015. The authors acknowledge funding through J-PAL North America from the Alfred P. Sloan Foundation and the Laura and John Arnold Foundation. Amy Finkelstein is a member of the Congressional Budget Office Panel of Health Advisers. She has no relevant or material financial interests that relate to the research described in this article. Adam Sacarny, David Yokum, and Shantanu Agrawal have no relevant or material financial interests that relate to the research described in this article. This study was registered on the American Economic Association Randomized Controlled Trials Registry and ClinicalTrials.gov (see Note 32). The views expressed in this article represent those of the authors and not their respective organizations, including the Centers for Medicare and Medicaid Services (CMS). The contents of this article were reviewed for compliance by CMS. NR 29 TC 2 Z9 2 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 MAR PY 2016 VL 35 IS 3 BP 471 EP 479 DI 10.1377/hlthaff.2015.1025 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA DG1KA UT WOS:000371825000015 PM 26953302 ER PT J AU Clough, JD Rajkumar, R Crim, MT Ott, LS Desai, NR Conway, PH Maresh, S Kahvecioglu, DC Krumholz, HM AF Clough, Jeffrey D. Rajkumar, Rahul Crim, Matthew T. Ott, Lesli S. Desai, Nihar R. Conway, Patrick H. Maresh, Sha Kahvecioglu, Daver C. Krumholz, Harlan M. TI Practice-Level Variation in Outpatient Cardiac Care and Association With Outcomes SO JOURNAL OF THE AMERICAN HEART ASSOCIATION LA English DT Article DE mortality; physician practice variation; population ID CORONARY-ARTERY-DISEASE; CARDIOVASCULAR DATA REGISTRY; APPROPRIATE USE CRITERIA; MEDICARE PATIENTS; PHYSICIAN-PAYMENT; CLINICAL-PRACTICE; DECISION-MAKING; UNITED-STATES; DATA RELEASE; INTERVENTION AB Background-Utilization of cardiac services varies across regions and hospitals, yet little is known regarding variation in the intensity of outpatient cardiac care across cardiology physician practices or the association with clinical endpoints, an area of potential importance to promote efficient care. Methods and Results-We included 7 160 732 Medicare beneficiaries who received services from 5635 cardiology practices in 2012. Beneficiaries were assigned to practices providing the plurality of office visits, and practices were ranked and assigned to quartiles using the ratio of observed to predicted annual payments per beneficiary for common cardiac services (outpatient intensity index). The median (interquartile range) outpatient intensity index was 1.00 (0.81-1.24). Mean payments for beneficiaries attributed to practices in the highest (Q4) and lowest (Q1) quartile of outpatient intensity were: all cardiac payments (Q4 $1272 vs Q1 $581; ratio, 2.2); cardiac catheterization (Q4 $215 vs Q1 $64; ratio, 3.4); myocardial perfusion imaging (Q4 $253 vs Q1 $83; ratio, 3.0); and electrophysiology device procedures (Q4 $353 vs Q1 $142; ratio, 2.5). The adjusted odds ratios (95% CI) for 1 incremental quartile of outpatient intensity for each outcome was: cardiac surgical/procedural hospitalization (1.09 [1.09, 1.10]); cardiac medical hospitalization (1.00 [0.99, 1.00]); noncardiac hospitalization (0.99 [0.99, 0.99]); and death at 1 year (1.00 [0.99, 1.00]). Conclusion-Substantial variation in the intensity of outpatient care exists at the cardiology practice level, and higher intensity is not associated with reduced mortality or hospitalizations. Outpatient cardiac care is a potentially important target for efforts to improve efficiency in the Medicare population. C1 [Clough, Jeffrey D.; Rajkumar, Rahul; Conway, Patrick H.; Maresh, Sha; Kahvecioglu, Daver C.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Clough, Jeffrey D.] Duke Univ, Dept Med, Duke Clin Res Inst, Durham, NC USA. [Crim, Matthew T.] Emory Univ, Dept Med, Atlanta, GA 30322 USA. [Ott, Lesli S.; Desai, Nihar R.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, 20 York St, New Haven, CT 06504 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Robert Wood Johnson Fdn,Clin Scholars Program, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Publ Hlth, Dept Hlth Policy & Management, New Haven, CT USA. RP Clough, JD (reprint author), 0311 Terrace Level,2400 Pratt St, Durham, NC 27705 USA. EM Jeffrey.clough@duke.edu FU National Heart, Lung, and Blood Institute [U01 HL105270-05]; Medtronic; Johnson & Johnson, through Yale University FX Dr Krumholz is supported by grant U01 HL105270-05 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. Dr Krumholz is a recipient of research grants from Medtronic and from Johnson & Johnson, through Yale University, to develop methods of clinical trial data sharing and is chair of a cardiac scientific advisory board for UnitedHealth. The remaining authors have no disclosures to report. NR 44 TC 1 Z9 1 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 2047-9980 J9 J AM HEART ASSOC JI J. Am. Heart Assoc. PD FEB PY 2016 VL 5 IS 2 AR e002594 DI 10.1161/JAHA.115.002594 PG 12 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA DO9TW UT WOS:000378131100009 ER PT J AU Goodman, RA Ling, SM Briss, PA Parrish, RG Salive, ME Finke, BS AF Goodman, Richard A. Ling, Shari M. Briss, Peter A. Parrish, R. Gibson Salive, Marcel E. Finke, Bruce S. TI Multimorbidity Patterns in the United States: Implications for Research and Clinical Practice SO JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES LA English DT Editorial Material ID CARDIOVASCULAR-DISEASE; HEALTH; PREVALENCE; ADULTS; COMORBIDITIES; DEPRESSION; STRATEGIES; GUIDELINES; ARTHRITIS C1 [Goodman, Richard A.] US Dept HHS, Off Assistant Secretary Hlth, Washington, DC 20201 USA. [Goodman, Richard A.; Briss, Peter A.] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Mailstop K40,4770 Buford Highway NE, Atlanta, GA 30341 USA. [Ling, Shari M.] Ctr Medicare, Baltimore, MD USA. [Ling, Shari M.] Ctr Medicaid Serv, Baltimore, MD USA. [Goodman, Richard A.; Parrish, R. Gibson] Publ Hlth Informat Inst, Decatur, GA USA. [Salive, Marcel E.] NIA, NIH, Bethesda, MD 20892 USA. [Ling, Shari M.; Finke, Bruce S.] Indian Hlth Serv, Nashville Area, Nashville, TN USA. RP Briss, PA (reprint author), Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Mailstop K40,4770 Buford Highway NE, Atlanta, GA 30341 USA. EM pxb5@cdc.gov NR 40 TC 4 Z9 4 U1 3 U2 5 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1079-5006 EI 1758-535X J9 J GERONTOL A-BIOL JI J. Gerontol. Ser. A-Biol. Sci. Med. Sci. PD FEB PY 2016 VL 71 IS 2 BP 215 EP 220 DI 10.1093/gerona/glv199 PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA DJ4XY UT WOS:000374212600009 PM 26714567 ER PT J AU Hays, RD Mallett, JS Gaillot, S Elliott, MN AF Hays, Ron D. Mallett, Joshua S. Gaillot, Sarah Elliott, Marc N. TI Performance of the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Physical Functioning Items SO MEDICAL CARE LA English DT Article DE self-reported health; CAHPS; Medicare; physical functioning ID ITEM RESPONSE THEORY; OUTCOMES MEASUREMENT; ARTHRITIS; PROGRESS AB Background: Physical functioning is an important health domain for adults. Objective: Evaluate physical functioning items in Medicare beneficiaries. Research Design: Survey data from the 2010 Consumer Assessment of Healthcare Providers and Systems Medicare survey. Subjects: The 366,701 respondents were 58% female; 38% were 75 or older; 57% had high school education or less. Measures: Walking, getting in or out of chairs, bathing, dressing, toileting, and eating assessed with 3 response choices: unable to do, have difficulty, do not have difficulty. Results: Pearson correlations among the 6 items ranged from 0.515 to 0.835 (coefficient alpha=0.92). A single factor categorical factor analytic model fit the data well (comparative fit index=0.998; root mean square error of approximation=0.083). The item with the highest percentage of respondents reporting no difficulty was eating, followed by toileting, dressing, bathing, getting in and out of a chair, and walking. Threshold parameters from an item response theory-graded response model ranged from -1.983 (between unable to do and have difficulty eating) to -0.551 (between have difficulty and no difficulty walking). Item discrimination parameters ranged from 4.632 (walking) to 8.228 (dressing). IRT-scored physical functioning scores correlated with self-rated general health (r=0.389, n=344,843, P < 0.0001) mental health (r=0.296, n=351,254, P < 0.0001) and number of chronic conditions (r=-0.229, n=284,507, P < 0.0001). Conclusions: The physical functioning items target relatively easy activities, providing information for a minority of people in the sample with the lowest levels of physical functioning. Items representing higher levels of physical functioning are needed for the majority of the Medicare beneficiaries. C1 [Hays, Ron D.] Univ Calif Los Angeles, Dept Med, 911 Broxton Ave, Los Angeles, CA 90024 USA. [Mallett, Joshua S.; Elliott, Marc N.] RAND Corp, Santa Monica, CA USA. [Gaillot, Sarah] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Hays, RD (reprint author), Univ Calif Los Angeles, Dept Med, 911 Broxton Ave, Los Angeles, CA 90024 USA. EM drhays@ucla.edu FU CMS [HHSM-500-2005-000281]; AHRQ [2U18 HS016980]; NIA [P30AG021684]; NIMHD [2P20MD000182]; NCI [1U2-CCA186878-01] FX Supported by CMS contract HHSM-500-2005-000281 to RAND. R.D.H. was also supported in part by grants from AHRQ (2U18 HS016980), NIA (P30AG021684), NIMHD (2P20MD000182), and NCI (1U2-CCA186878-01). NR 19 TC 0 Z9 0 U1 1 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0025-7079 EI 1537-1948 J9 MED CARE JI Med. Care PD FEB PY 2016 VL 54 IS 2 BP 205 EP 209 DI 10.1097/MLR.0000000000000475 PG 5 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA DH6XI UT WOS:000372935000014 PM 26683780 ER PT J AU Miller, J Blackstock, SC AF Miller, Jeannie Blackstock, Sheila C. TI Nurses on a Different Front Line SO AMERICAN JOURNAL OF NURSING LA English DT Editorial Material AB Helping to shape U.S. health care policy. C1 [Miller, Jeannie; Blackstock, Sheila C.] Ctr Medicare & Medicaid Serv, Clin Stand Grp, Ctr Clin Stand & Qual, Baltimore, MD USA. [Blackstock, Sheila C.] US PHS, Washington, DC 20201 USA. RP Miller, J (reprint author), Ctr Medicare & Medicaid Serv, Clin Stand Grp, Ctr Clin Stand & Qual, Baltimore, MD USA. EM jeanmil21043@verizon.net NR 0 TC 0 Z9 0 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0002-936X EI 1538-7488 J9 AM J NURS JI Am. J. Nurs. PD FEB PY 2016 VL 116 IS 2 BP 11 EP 11 DI 10.1097/01.NAJ.0000480476.12266.f9 PG 1 WC Nursing SC Nursing GA DC7GV UT WOS:000369388600001 PM 26817535 ER PT J AU Press, MJ Rajkumar, R Conway, PH AF Press, Matthew J. Rajkumar, Rahul Conway, Patrick H. TI Medicare's New Bundled Payments Design, Strategy, and Evolution SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Press, Matthew J.; Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Rajkumar, R (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mailstop WB 06-05, Baltimore, MD 21244 USA. EM Rahul.Rajkumar@cms.hhs.gov NR 4 TC 16 Z9 16 U1 2 U2 7 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 12 PY 2016 VL 315 IS 2 BP 131 EP 132 DI 10.1001/jama.2015.18161 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA DA6XO UT WOS:000367949200010 PM 26720889 ER PT J AU Alley, DE Asomugha, CN Conway, PH Sanghavi, DM AF Alley, Dawn E. Asomugha, Chisara N. Conway, Patrick H. Sanghavi, Darshak M. TI Accountable Health Communities - Addressing Social Needs through Medicare and Medicaid SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Alley, Dawn E.; Asomugha, Chisara N.; Conway, Patrick H.; Sanghavi, Darshak M.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Alley, DE (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 5 TC 24 Z9 24 U1 0 U2 3 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JAN 7 PY 2016 VL 374 IS 1 BP 8 EP 11 DI 10.1056/NEJMp1512532 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA DA1UH UT WOS:000367580500003 PM 26731305 ER PT J AU Shaw, PA AF Shaw, Penelope Ann TI Untitled SO JOURNAL OF GERONTOLOGICAL SOCIAL WORK LA English DT Letter C1 [Shaw, Penelope Ann] Massachusetts Advocates Nursing Home Reform, Medford, MA 02156 USA. [Shaw, Penelope Ann] Ctr Medicare Serv, Div Nursing Homes, Survey & Certificat Grp, Baltimore, MD 21244 USA. [Shaw, Penelope Ann] Ctr Medicaid Serv, Div Nursing Homes, Survey & Certificat Grp, Baltimore, MD 21244 USA. RP Shaw, PA (reprint author), Massachusetts Advocates Nursing Home Reform, Medford, MA 02156 USA.; Shaw, PA (reprint author), Ctr Medicare Serv, Div Nursing Homes, Survey & Certificat Grp, Baltimore, MD 21244 USA.; Shaw, PA (reprint author), Ctr Medicaid Serv, Div Nursing Homes, Survey & Certificat Grp, Baltimore, MD 21244 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD PI ABINGDON PA 2-4 PARK SQUARE, MILTON PARK, ABINGDON OX14 4RN, OXON, ENGLAND SN 1540-4048 EI 0163-4372 J9 J GERONTOL SOC WORK JI J. Gerontol. Soc. Work PY 2016 VL 59 IS 4 BP 274 EP 276 DI 10.1080/01634372.2016.1211578 PG 3 WC Geriatrics & Gerontology; Social Work SC Geriatrics & Gerontology; Social Work GA EC0XG UT WOS:000387824400002 ER PT B AU Yang, TC Noah, AJ Shoff, C AF Yang, Tse-Chuan Noah, Aggie J. Shoff, Carla BE Howell, FM Porter, JR Matthews, SA TI Revisiting the Rural Paradox in US Counties with Spatial Durbin Modeling SO RECAPTURING SPACE: NEW MIDDLE-RANGE THEORY IN SPATIAL DEMOGRAPHY SE Spatial Demography Book Series LA English DT Article; Book Chapter ID INCOME INEQUALITY; MORTALITY; HEALTH; MATTER C1 [Yang, Tse-Chuan] SUNY Albany, Ctr Social & Demog Anal, Dept Sociol, New York, NY 12222 USA. [Noah, Aggie J.] Penn State Univ, Dept Sociol & Criminol, State Coll, PA USA. [Shoff, Carla] Off Enterprise Data & Analyt, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Yang, TC (reprint author), SUNY Albany, Ctr Social & Demog Anal, Dept Sociol, New York, NY 12222 USA. EM tyang3@albany.edu NR 53 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER INT PUBLISHING AG PI CHAM PA GEWERBESTRASSE 11, CHAM, CH-6330, SWITZERLAND BN 978-3-319-22810-5; 978-3-319-22809-9 J9 SPAT DEMOG BOOK SER PY 2016 VL 1 BP 253 EP 273 DI 10.1007/978-3-319-22810-5_13 D2 10.1007/978-3-319-22810-5 PG 21 WC Demography; Geography SC Demography; Geography GA BG0BP UT WOS:000386140100013 ER PT J AU Kent, EE Malinoff, R Rozjabek, HM Ambs, A Clauser, SB Topor, MA Yuan, GG Burroughs, J Rodgers, AB DeMichele, K AF Kent, Erin E. Malinoff, Rochelle Rozjabek, Heather M. Ambs, Anita Clauser, Steven B. Topor, Marie A. Yuan, Gigi Burroughs, James Rodgers, Anne B. DeMichele, Kimberly TI Revisiting the Surveillance Epidemiology and End Results Cancer Registry and Medicare Health Outcomes Survey (SEER-MHOS) Linked Data Resource for Patient-Reported Outcomes Research in Older Adults with Cancer SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE cancer; patient-reported outcomes; health-related quality of life; Medicare advantage; surveillance ID QUALITY-OF-LIFE; URINARY-INCONTINENCE; AMERICANS; SURVIVORS; MORTALITY; IMPACT; CARE; POPULATION AB Researchers and clinicians are increasingly recognizing the value of patient-reported outcome (PRO) data to better characterize people's health and experiences with illness and care. Considering the rising prevalence of cancer in adults aged 65 and older, PRO data are particularly relevant for older adults with cancer, who often require complex cancer care and have additional comorbid conditions. A data linkage between the Surveillance Epidemiology and End Results (SEER) cancer registry and the Medicare Health Outcomes Survey (MHOS) was created through a partnership between the National Cancer Institute and the Centers for Medicare and Medicaid Services that created the opportunity to examine PROs in Medicare Advantage enrollees with and without cancer. The December 2013 linkage of SEER-MHOS data included the linked data for 12 cohorts, bringing the number of individuals in the linked data set to 95,723 with cancer and 1,510,127 without. This article reviews the features of the resource and provides information on some descriptive characteristics of the individuals in the data set (health-related quality of life, body mass index, fall risk management, number of unhealthy days in the past month). Individuals without (n = 258,108) and with (n = 3,440) cancer (1,311 men with prostate cancer, 982 women with breast cancer, 689 with colorectal cancer, 458 with lung cancer) were included in the current descriptive analysis. Given increasing longevity, advances in effective therapies and earlier detection, and population growth, the number of individuals aged 65 and older with cancer is expected to reach more than 12 million by 2020. SEER-MHOS provides population-level, self-reported, cancer registry-linked data for person-centered surveillance research on this growing population. C1 [Kent, Erin E.] NCI, Outcomes Res Branch, Healthcare Delivery Res Program, Div Canc Control & Populat Sci, Rockville, MD USA. [Malinoff, Rochelle; Burroughs, James] Medicare Hlth Outcomes Study, Hlth Serv Advisory Grp, Phoenix, AZ USA. [Rozjabek, Heather M.] Drexel Univ, Sch Publ Hlth, Philadelphia, PA 19104 USA. [Ambs, Anita; Rodgers, Anne B.] NCI, Appl Res Program, Div Canc Control & Populat Sci, Rockville, MD USA. [Clauser, Steven B.] Patient Ctr Outcomes Res Inst, Washington, DC USA. [Topor, Marie A.; Yuan, Gigi] Informat Management Serv Inc, Rockville, MD USA. [DeMichele, Kimberly] Ctr Medicare, Baltimore, MD USA. [Kent, Erin E.; DeMichele, Kimberly] Medicaid Serv, Baltimore, MD USA. RP Kent, EE (reprint author), 9609 Med Ctr Dr, Rockville, MD 20850 USA. EM Erin.Kent@nih.gov NR 37 TC 0 Z9 0 U1 2 U2 4 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 EI 1532-5415 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD JAN PY 2016 VL 64 IS 1 BP 186 EP 192 DI 10.1111/jgs.13888 PG 7 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA DF2FQ UT WOS:000371157900028 PM 26782871 ER PT J AU Martin, AB Hartman, M Benson, J Catlin, A AF Martin, Anne B. Hartman, Micah Benson, Joseph Catlin, Aaron CA Natl Hlth Expenditure Accounts TI National Health Spending In 2014: Faster Growth Driven By Coverage Expansion And Prescription Drug Spending SO HEALTH AFFAIRS LA English DT Article AB US health care spending increased 5.3 percent to $3.0 trillion in 2014. On a per capita basis, health spending was $9,523 in 2014, an increase of 4.5 percent from 2013. The share of gross domestic product devoted to health care spending was 17.5 percent, up from 17.3 percent in 2013. The faster growth in 2014 that followed five consecutive years of historically low growth was primarily due to the major coverage expansions under the Affordable Care Act, particularly for Medicaid and private health insurance, which contributed to an increase in the insured share of the population. Additionally, the introduction of new hepatitis C drugs contributed to rapid growth in retail prescription drug expenditures, which increased by 12.2 percent in 2014. Spending by the federal government grew at a faster rate in 2014 than spending by other sponsors of health care, leading to a 2-percentage-point increase in its share of total health care spending between 2013 and 2014. C1 [Martin, Anne B.] Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD USA. RP Martin, AB (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD USA. EM anne.martin@cms.hhs.gov NR 15 TC 23 Z9 23 U1 4 U2 7 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 PY 2016 VL 35 IS 1 BP 150 EP 160 DI 10.1377/hlthaff.2015.1194 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA DD1PV UT WOS:000369694700020 PM 26631494 ER PT J AU Marshall, JK Mbah, OM Ford, JG Phelan-Emrick, D Ahmed, S Bone, L Wenzel, J Shapiro, GR Howerton, M Johnson, L Brown, Q Ewing, A Pollack, CE AF Marshall, Jessie Kimbrough Mbah, Olive M. Ford, Jean G. Phelan-Emrick, Darcy Ahmed, Saifuddin Bone, Lee Wenzel, Jennifer Shapiro, Gary R. Howerton, Mollie Johnson, Lawrence Brown, Qiana Ewing, Altovise Pollack, Craig Evan TI Effect of Patient Navigation on Breast Cancer Screening Among African American Medicare Beneficiaries: A Randomized Controlled Trial SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE patient navigation; mammography; African American ID HEALTH DISPARITIES; ETHNIC-DIFFERENCES; MAMMOGRAPHY USE; WOMEN; BLACK; OLDER; COMMUNITY; LITERACY; SURVIVAL; ADULTS AB There is growing evidence that patient navigation improves breast cancer screening rates; however, there are limited efficacy studies of its effect among African American older adult women. To evaluate the effect of patient navigation on screening mammography among African American female Medicare beneficiaries in Baltimore, MD. The Cancer Prevention and Treatment Demonstration (CPTD), a multi-site study, was a randomized controlled trial conducted from April 2006 through December 2010. Community-based and clinical setting. The CPTD Screening Trial enrolled 1905 community-dwelling African American female Medicare beneficiaries who were a parts per thousand yen65 years of age and resided in Baltimore, MD. Participants were recruited from health clinics, community centers, health fairs, mailings using Medicare rosters, and phone calls. Participants were randomized to either: printed educational materials on cancer screening (control group) or printed educational materials + patient navigation services designed to help participants overcome barriers to cancer screening (intervention group). Self-reported receipt of mammography screening within 2 years of the end of the study. The median follow-up period for participants in this analysis was 17.8 months. In weighted multivariable logistic regression analyses, women in the intervention group had significantly higher odds of being up to date on mammography screening at the end of the follow-up period compared to women in the control group (odds ratio [OR] 2.26, 95 % confidence interval [CI]1.59-3.22). The effect of the intervention was stronger among women who were not up to date with mammography screening at enrollment (OR 3.63, 95 % CI 2.09-6.38). Patient navigation among urban African American Medicare beneficiaries increased self-reported mammography utilization. The results suggest that patient navigation for mammography screening should focus on women who are not up to date on their screening. C1 [Marshall, Jessie Kimbrough] Univ Michigan Hlth Syst, Div Gen Med, Ann Arbor, MI USA. [Mbah, Olive M.; Wenzel, Jennifer] Johns Hopkins Sch Med, Dept Oncol, Baltimore, MD USA. [Ford, Jean G.] Brooklyn Hosp Ctr, Dept Med, Brooklyn, NY 11201 USA. [Phelan-Emrick, Darcy; Pollack, Craig Evan] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA. [Ahmed, Saifuddin] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Populat Family & Reprod Hlth, Baltimore, MD USA. [Ahmed, Saifuddin] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Biostat, Baltimore, MD USA. [Bone, Lee] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Behav & Soc, Baltimore, MD USA. [Wenzel, Jennifer] Johns Hopkins Sch Nursing, Dept Acute & Chron Care, Baltimore, MD USA. [Shapiro, Gary R.] Hlth Partners Canc Program, Minneapolis, MN USA. [Shapiro, Gary R.] Inst Educ & Res, Minneapolis, MN USA. [Howerton, Mollie] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Johnson, Lawrence] Pk West Hlth Syst, Baltimore, MD USA. [Brown, Qiana] TVCOFA Corp, Baltimore, MD USA. [Ewing, Altovise] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Behav & Soc, Baltimore, MD USA. [Pollack, Craig Evan] Johns Hopkins Sch Med, Dept Med, Baltimore, MD USA. RP Ford, JG (reprint author), Brooklyn Hosp Ctr, Dept Med, Brooklyn, NY 11201 USA. EM jgf9001@nyp.org FU CPTD for Ethnic and Racial Minorities of the Centers for Medicare and Medicaid Services [1A0CMS300066]; Community Networks Program of the National Cancer Institute [U54CA153710]; National Research Service Award from the Health Services and Resources Administration (HRSA) [5 T32 HL007180-34 0]; National Cancer Institute; Office of Behavioral and Social Sciences [K07 CA151910]; National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health [1UL1TR001079] FX This work was funded by the CPTD for Ethnic and Racial Minorities of the Centers for Medicare and Medicaid Services (cooperative agreement #1A0CMS300066), and supported in part by the Community Networks Program (grant U54CA153710) of the National Cancer Institute. In addition, Dr. Jessie Kimbrough Marshall was supported by the National Research Service Award (5 T32 HL007180-34 0) from the Health Services and Resources Administration (HRSA), Ms. Olive Mbah was supported by the Community Networks Program (grant U54CA153710) of the National Cancer Institute, and Dr. Craig Pollack was supported by the National Cancer Institute and Office of Behavioral and Social Sciences (K07 CA151910). We would like to acknowledge partial support for the statistical analysis from the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through grant number 1UL1TR001079. NR 53 TC 7 Z9 7 U1 3 U2 7 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JAN PY 2016 VL 31 IS 1 BP 68 EP 76 DI 10.1007/s11606-015-3484-2 PG 9 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA DA1FB UT WOS:000367540600015 PM 26259762 ER PT J AU Cafardi, SG Pines, JM Deb, P Powers, CA Shrank, WH AF Cafardi, Susannah G. Pines, Jesse M. Deb, Partha Powers, Christopher A. Shrank, William H. TI Increased observation services in Medicare beneficiaries with chest pain SO AMERICAN JOURNAL OF EMERGENCY MEDICINE LA English DT Article ID OBSERVATION UNITS; OBSERVATION CARE; HOSPITALS; COST AB Introduction: We examined trends in the use of observation services and the relationship between index service type (observation services, emergency department [ED] visits, inpatient stays) and both clinical outcomes and Medicare payments. Methods: We created a yearly cohort panel of Medicare beneficiaries with chest pain. We evaluate the relationships between index service type and 30-day clinical outcomes using a multinomial logit model and between index service type and Medicare payments using generalized linear models. Results: In 2009, 24% of patients with chest pain received observation services; this rose to 29% in 2011. Conversely, 20% were treated as hospital inpatients in 2009; this fell to 16% in 2011. In the adjusted analysis, the risk of 30-day return to the hospital was 7% less ( 95% confidence interval, 5%-8%) for those receiving observation services as compared with inpatients. Average Medicare payments ranged from $3032 for beneficiaries initially treated in the ED to $3885 for those initially treated in observation to $6545 for those initially treated as inpatients. Discussion: Patients treated in observation are less likely than those treated in the ED or as inpatients to have an adverse event within 30 days. Adjusted Medicare payments, including the index stay and the subsequent 30 days, were substantially less for those treated in observation as compared with those treated as inpatients, but more than for those treated and released from the ED. Higher rates of observation service use do not appear to be negatively affecting patient outcomes and may lower costs relative to inpatient treatment. Published by Elsevier Inc. C1 [Cafardi, Susannah G.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Res & Rapid Cycle Evaluat Grp, Baltimore, MD USA. [Pines, Jesse M.] George Washington Univ, Dept Emergency Med, Washington, DC USA. [Pines, Jesse M.] George Washington Univ, Dept Hlth Policy, Washington, DC USA. [Deb, Partha] CUNY Hunter Coll, Dept Econ, New York, NY 10021 USA. [Deb, Partha] Ctr Medicare & Medicaid Innovat, Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Powers, Christopher A.] Ctr Medicare & Medicaid Serv, Off Informat Prod & Data Analyt, Baltimore, MD USA. [Shrank, William H.] CVS Caremark, Birmingham, AL USA. RP Cafardi, SG (reprint author), Ctr Medicare & Medicaid Innovat, Res & Rapid Cycle Evaluat Grp, Mail Stop WB-06-05,7500 Secur Blvd, Baltimore, MD 21244 USA. EM Susannah.Cafardi@cms.hhs.gov NR 14 TC 0 Z9 0 U1 1 U2 3 PU W B SAUNDERS CO-ELSEVIER INC PI PHILADELPHIA PA 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA SN 0735-6757 EI 1532-8171 J9 AM J EMERG MED JI Am. J. Emerg. Med. PD JAN PY 2016 VL 34 IS 1 BP 16 EP 19 DI 10.1016/j.ajem.2015.08.049 PG 4 WC Emergency Medicine SC Emergency Medicine GA CY1IH UT WOS:000366159400003 PM 26490388 ER PT J AU Botticelli, MP Brock, I Brooks, P Byram, D Clark, KJ Curro, FA Daw, J Duggan, M Erensen, J Fan, J Francis, W Gammitoni, A Ghods, MP Greenberg, P Jan, SA Jeffrey, PL Kowalski, T Lee, J McNally, DL Nowak, LE Peppin, JF Schroeder, A Schmidt, P Stoddard, J Tanzman, B Thomson, H Wesolowicz, L Dragovich, C Eichelberger, B Mackowiak, J Oh, S Sega, T Singh, P Singh, R AF Botticelli, Michael P. Brock, Irwin Pete, III Brooks, Phyllis Byram, David Clark, Kelly J. Curro, Frederick A. Daw, Jessica Duggan, Mike Erensen, Jennifer Fan, Jennifer Francis, William Gammitoni, Arnold Ghods, Mary P. Greenberg, Peggy Jan, Saira A. Jeffrey, Paul L. Kowalski, Thomas Lee, Jinhee McNally, Diane L. Nowak, Lynne E. Peppin, John F. Schroeder, Allie Schmidt, Pete Stoddard, Jeff Tanzman, Beth Thomson, Heather Wesolowicz, Laurie Dragovich, Charlie Eichelberger, Bernadette Mackowiak, John Oh, Susan Sega, Todd Singh, Puneet Singh, Ruby TI Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder SO JOURNAL OF MANAGED CARE & SPECIALTY PHARMACY LA English DT Article ID UNITED-STATES AB Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment. Copyright (C) 2015, Academy of Managed Care Pharmacy. All rights reserved. C1 [Botticelli, Michael P.] Off Natl Drug Control Policy, London, England. [Brock, Irwin Pete, III] Optum Hlth Behav Solut, Affordabil, New York, NY USA. [Brooks, Phyllis] Humana, Drug Utilizat Review, Louisville, KY USA. [Byram, David] Orexo, Market Access, Stockholm, Sweden. [Clark, Kelly J.] CVS Hlth, Med Affairs, London, England. [Curro, Frederick A.] PEARL Clin Translat Network, New York, NY USA. [Curro, Frederick A.] NYU, New York, NY 10003 USA. [Daw, Jessica] Univ Pittsburgh, Med Ctr, Clin Pharm, Pittsburgh, PA USA. [Erensen, Jennifer] Purdue Pharma, Hlth Policy, Stamford, CT USA. [Fan, Jennifer] SAMHSA Ctr Substance Abuse Prevent, Rockville, MD USA. [Francis, William] Medlmpact, Pharm Management Serv, San Diego, CA USA. [Gammitoni, Arnold] Zogenix, Med & Sci Affairs, Bloomsburg, PA USA. [Ghods, Mary P.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Greenberg, Peggy] Peggy Greenberg Consulting & Training, Silver Spring, MD USA. [Jan, Saira A.] State Univ, Rutgers, New Brunswick, NJ USA. [Jan, Saira A.] Horizon BCBS New Jersey, Clin Pharm, Newark, NJ USA. [Jeffrey, Paul L.] MassfHlth, Pharm, Boston, MA USA. [Kowalski, Thomas] Blue Cross & Blue Shield Massachusetts, Clin Pharm, Boston, MA USA. [Lee, Jinhee] SAMHSA Ctr Substance Abuse Treatment, Baltimore, MD USA. [McNally, Diane L.] Ctr Medicare, Baltimore, MD USA. [McNally, Diane L.] Ctr Medicaid Serv, Baltimore, MD USA. [Nowak, Lynne E.] Express Scripts, London, England. [Peppin, John F.] Mallinchrodt, Global Med Affairs, Dublin, Ireland. [Schroeder, Allie] Univ Colorado, Skaggs Sch Pharm, Kaiser Permanente Colorado, Boulder, CO USA. [Schmidt, Pete] Depomed, Newark, CA USA. [Stoddard, Jeff] Alkermes, Med Profess Serv, London, England. [Tanzman, Beth] Vermont Blueprint Hlth, Waterbury, VT USA. [Thomson, Heather] Kaleo, Managed Care, Austin, TX USA. [Wesolowicz, Laurie] BCBS Michigan, Pharm Serv Clin, Detroit, MI USA. [Dragovich, Charlie] Business Development, Sao Paulo, Brazil. [Eichelberger, Bernadette] Pharm Affairs, Rio De Janeiro, Brazil. [Mackowiak, John] Journal Managed Care & Specialty Pharm, Rio De Janeiro, Brazil. [Oh, Susan; Sega, Todd] Pharm Affairs, Lagos, Nigeria. [Singh, Puneet; Singh, Ruby] Educ, Brasilia, DF, Brazil. RP Oh, S (reprint author), Acad Managed Care Pharm, Pharm Affairs, 100 N Pitt St,Ste 400, Alexandria, VA 22314 USA. EM soh@amcp.org FU Alkermes; Depomed; kaleo; Mallinckrodt; Orexo; Purdue Pharma; Teva; Zogemx FX The AMCP Partnership Forum on Breaking the Link Between Pain Management and Opioid Use Disorder and the development of this proceedings document were supported by Alkermes, Depomed, kaleo, Mallinckrodt, Orexo, Purdue Pharma, Teva, and Zogemx. NR 24 TC 0 Z9 0 U1 1 U2 1 PU ACAD MANAGED CARE PHARMACY PI ALEXANDRIA PA 100 N PITT ST, 400, ALEXANDRIA, VA 22314-3134 USA SN 2376-0540 EI 2376-1032 J9 J MANAG CARE SPEC PH JI J. Manag. Care Spec. Pharm. PD DEC PY 2015 VL 21 IS 12 BP 1116 EP 1122 PG 7 WC Health Care Sciences & Services; Pharmacology & Pharmacy SC Health Care Sciences & Services; Pharmacology & Pharmacy GA DC6UW UT WOS:000369356100003 ER PT J AU McMullen, TL Resnick, B Hansen, JC Miller, N Rubinstein, R AF McMullen, Tara L. Resnick, Barbara Hansen, Jennie Chin Miller, Nancy Rubinstein, Robert TI Certified Nurse Aides and Scope of Practice Clinical Outcomes and Patient Safety SO JOURNAL OF GERONTOLOGICAL NURSING LA English DT Article ID QUALITY-OF-CARE; MINIMUM DATA SET; STAFFING LEVELS; HOMES; DEFICIENCIES; IMPACT; OLDER AB To understand the impact of scope of practice and allowable certified nurse aide (CNA) tasks across states, the current study compared clinical outcomes in states with a basic scope of practice versus those that allowed for an expanded scope. The current study used data from the Minimum Data Set as well as staffing data from the Centers for Medicare and Medicaid Services. Clinical outcomes included: (a) percent of residents whose need for help with daily activities has increased, (b) percent of high-risk residents with pressure ulcers, (c) percent of residents who self-report moderate to severe pain, (d) percent of residents experiencing one or more falls with major injury, and (e) CNA staffing hours. There was no difference in clinical outcomes between states with expanded or basic scopes. Many factors influence clinical outcomes among residents and additional staffing and facility characteristics should be considered in future studies. C1 [McMullen, Tara L.] Ctr Medicare & Medicaid Serv, Div Chron & Post Acute Care, 7500 Secur Blvd,S3-11-06, Baltimore, MD 21224 USA. [Resnick, Barbara] Univ Maryland Baltimore Cty, Sch Nursing, Gerontol, Baltimore, MD 21228 USA. [Miller, Nancy] Univ Maryland Baltimore Cty, Sch Publ Policy, Baltimore, MD 21228 USA. [Rubinstein, Robert] Univ Maryland Baltimore Cty, Dept Sociol & Anthropol, Baltimore, MD 21228 USA. [Hansen, Jennie Chin] Amer Geriatr Soc, New York, NY USA. RP McMullen, TL (reprint author), Ctr Medicare & Medicaid Serv, Div Chron & Post Acute Care, 7500 Secur Blvd,S3-11-06, Baltimore, MD 21224 USA. EM Tara.mcmullen@cms.hhs.gov NR 42 TC 1 Z9 1 U1 2 U2 5 PU SLACK INC PI THOROFARE PA 6900 GROVE RD, THOROFARE, NJ 08086 USA SN 0098-9134 EI 1938-243X J9 J GERONTOL NURS JI J. Gerontol. Nurs. PD DEC PY 2015 VL 41 IS 12 BP 32 EP 39 DI 10.3928/00989134-20151008-58 PG 8 WC Geriatrics & Gerontology; Gerontology; Nursing SC Geriatrics & Gerontology; Nursing GA DB5BV UT WOS:000368529000005 PM 26468657 ER PT J AU Berdahl, C Schuur, JD Fisher, NL Burstin, H Pines, JM AF Berdahl, Carl Schuur, Jeremiah D. Fisher, Nancy L. Burstin, Helen Pines, Jesse M. TI Policy Measures and Reimbursement for Emergency Medical Imaging in the Era of Payment Reform: Proceedings From a Panel Discussion of the 2015 Academic Emergency Medicine Consensus Conference SO ACADEMIC EMERGENCY MEDICINE LA English DT Article; Proceedings Paper CT Academic-Emergency-Medicine (AEM) Consensus Conference CY MAY 12, 2015 CL San Diego, CA SP Acad Emergency Med ID DEPARTMENT ADMISSION RATES; BLOOD-STREAM INFECTIONS; COMPUTED-TOMOGRAPHY USE; UNITED-STATES; PERFORMANCE-MEASURES; QUALITY MEASUREMENT; HEALTH-CARE; TRENDS; PNEUMONIA; VISITS AB The Affordable Care Act (ACA) of 2010 is expanding the use of quality measurement and promulgating new payment models that place downward pressure on health care utilization and costs. As emergency department (ED) computed tomography utilization has tripled in the past decade, stakeholders have identified advanced imaging as an area where quality and efficiency measures should expand. On May 12, 2015, Academic Emergency Medicine convened a consensus conference titled "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." As part of the conference, a panel of health care policy leaders and emergency physicians discussed the effect of the ACA and other quality programs on ED diagnostic imaging, specifically the way that quality metrics may affect ED care and how ED diagnostic imaging fits in the broader strategy of the U.S. government. This article discusses the content of the panel's presentations. (C) 2015 by the Society for Academic Emergency Medicine C1 [Berdahl, Carl] Univ So Calif, Dept Emergency Med, Los Angeles, CA 90089 USA. [Schuur, Jeremiah D.] Brigham & Womens Hosp, Dept Emergency Med, Boston, MA 02115 USA. [Fisher, Nancy L.] Region 10, Ctr Medicare Serv, Seattle, WA USA. [Fisher, Nancy L.] Region 10, Ctr Medicaid Serv, Seattle, WA USA. [Burstin, Helen] Natl Qual Forum, Washington, DC USA. [Pines, Jesse M.] George Washington Univ, Dept Emergency Med, Washington, DC USA. [Pines, Jesse M.] George Washington Univ, Dept Hlth Policy & Management, Washington, DC USA. RP Berdahl, C (reprint author), Univ So Calif, Dept Emergency Med, Los Angeles, CA 90089 USA. EM carlberdahl@gmail.com FU Agency for Healthcare Research and Quality (AHRQ) [1R13HS023498-01]; National Institute of Biomedical Imaging and Bioengineering [1 R13 EB 019813-01] FX Funding for this conference was made possible (in part) by grant number 1R13HS023498-01 from the Agency for Healthcare Research and Quality (AHRQ) and grant number 1 R13 EB 019813-01 from the National Institute of Biomedical Imaging and Bioengineering. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. NR 40 TC 1 Z9 1 U1 1 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1069-6563 EI 1553-2712 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD DEC PY 2015 VL 22 IS 12 SI SI BP 1393 EP 1399 DI 10.1111/acem.12829 PG 7 WC Emergency Medicine SC Emergency Medicine GA DA5FP UT WOS:000367828900005 PM 26568025 ER PT J AU Weech-Maldonado, R Elliott, MN Adams, JL Haviland, AM Klein, DJ Hambarsoomian, K Edwards, C Dembosky, JW Gaillot, S AF Weech-Maldonado, Robert Elliott, Marc N. Adams, John L. Haviland, Amelia M. Klein, David J. Hambarsoomian, Katrin Edwards, Carol Dembosky, Jacob W. Gaillot, Sarah TI Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups? SO HEALTH SERVICES RESEARCH LA English DT Article DE Medicare; disparities; CAHPS; HEDIS; race/ethnicity ID RACIAL DISPARITIES; MANAGED CARE; PSYCHOMETRIC PROPERTIES; HEALTH-CARE; OF-CARE; CULTURAL COMPETENCE; ORGANIZATIONS; BENEFICIARIES; INTERPRETERS; ASSESSMENTS AB Objective. To examine how similar racial/ethnic disparities in clinical quality (Healthcare Effectiveness Data and Information Set [HEDIS]) and patient experience (Consumer Assessment of Healthcare Providers and Systems [CAHPS]) measures are for different measures within Medicare Advantage (MA) plans. Data Sources/Study Setting. 5.7 million/492,495 MA beneficiaries with 2008-2009 HEDIS/CAHPS data. Study Design. Binomial (HEDIS) and linear (CAHPS) hierarchical mixed models generated contract estimates for HEDIS/CAHPS measures for Hispanics, blacks, Asian-Pacific Islanders, and whites. We examine the correlation of within-plan disparities for HEDIS and CAHPS measures across measures. Principal Findings. Plans with disparities for a given minority group (vs. whites) for a particular measure have a moderate tendency for similar disparities for other measures of the same type (mean r = 0.51/. 21 and 53/34 percent positive and statistically significant for CAHPS/HEDIS). This pattern holds to a lesser extent for correlations of CAHPS disparities and HEDIS disparities (mean r = 0.05/0.14/0.23 and 4.4/5.6/4.4 percent) positive and statistically significant for blacks/Hispanics/API. Conclusions. Similarities in CAHPS and HEDIS disparities across measures might reflect common structural factors, such as language services or provider incentives, affecting several measures simultaneously. Health plan structural changes might reduce disparities across multiple measures. C1 [Elliott, Marc N.; Hambarsoomian, Katrin; Edwards, Carol] RAND Corp, Santa Monica, CA 90407 USA. [Weech-Maldonado, Robert] Univ Alabama Birmingham, Dept Hlth Serv Adm, Birmingham, AL USA. [Adams, John L.] Kaiser Permanente, Ctr Effectiveness & Res, Pasadena, CA USA. [Haviland, Amelia M.] Carnegie Mellon Univ, H John Heinz Coll Publ Policy & Management 3, Pittsburgh, PA 15213 USA. [Klein, David J.] Boston Childrens Hosp, Dept Pediat, Boston, MA USA. [Dembosky, Jacob W.] RAND Corp, Pittsburgh, PA USA. [Gaillot, Sarah] Ctr Medicare & Medicaid Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St,POB 2138, Santa Monica, CA 90407 USA. EM elliott@rand.org FU Centers for Medicare & Medicaid Services (CMS) [HHSM-500-2005-000281] FX This article was funded by the Centers for Medicare & Medicaid Services (CMS) under contract number HHSM-500-2005-000281. No author has a conflict of interest relating to this manuscript. However, please note that one of the authors, Dr. Sarah Gaillot, is an employee of CMS, the Federal Agency that sponsors the collection of CAHPS and HEDIS data discussed within the manuscript. We would like to thank Fergal McCarthy, M.Phil., for his assistance with manuscript preparation. NR 41 TC 3 Z9 3 U1 1 U2 2 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 2015 VL 50 IS 6 BP 1829 EP 1849 DI 10.1111/1475-6773.12297 PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA DA3JF UT WOS:000367692300007 PM 25757356 ER PT J AU Elliott, MN Cohea, CW Lehrman, WG Goldstein, EH Cleary, PD Giordano, LA Beckett, MK Zaslavsky, AM AF Elliott, Marc N. Cohea, Christopher W. Lehrman, William G. Goldstein, Elizabeth H. Cleary, Paul D. Giordano, Laura A. Beckett, Megan K. Zaslavsky, Alan M. TI Accelerating Improvement and Narrowing Gaps: Trends in Patients' Experiences with Hospital Care Reflected in HCAHPS Public Reporting SO HEALTH SERVICES RESEARCH LA English DT Article DE HCAHPS; for-profit; improvement; bedsize ID PATIENTS PERCEPTIONS; QUALITY MEASUREMENT; NONRESPONSE RATES; INPATIENT CARE; UNITED-STATES; PERFORMANCE; BIAS; PAY; MIX AB Objective. Measure HCAHPS improvement in hospitals participating in the second and fifth years of HCAHPS public reporting; determine whether change is greater for some hospital types. Data. Surveys from 4,822,960 adult inpatients discharged July 2007-June 2008 or July 2010-June 2011 from 3,541 U.S. hospitals. Study Design. Linear mixed-effect regression models with fixed effects for time, patient mix, and hospital characteristics (bedsize, ownership, Census division, teaching status, Critical Access status); random effects for hospitals and hospital-time interactions; fixed-effect interactions of hospital characteristics and patient characteristics (gender, health, education) with time predicted HCAHPS measures correcting for regression-to-the-mean biases. Data Collection Methods. National probability sample of adult inpatients in any of four approved survey modes. Principal Findings. HCAHPS scores increased by 2.8 percentage points from 2008 to 2011 in the most positive response category. Among the middle 95 percent of hospitals, changes ranged from a 5.1 percent decrease to a 10.2 percent gain overall. The greatest improvement was in for-profit and larger (200 or more beds) hospitals. Conclusions. Five years after HCAHPS public reporting began, meaningful improvement of patients' hospital care experiences continues, especially among initially low-scoring hospitals, reducing some gaps among hospitals. C1 [Elliott, Marc N.; Beckett, Megan K.] RAND Corp, Santa Monica, CA 90407 USA. [Giordano, Laura A.] Hlth Serv Advisory Grp, Surveys Res & Anal Div, Phoenix, AZ USA. [Lehrman, William G.; Goldstein, Elizabeth H.] Ctr Medicare & Medicaid Serv, Ctr Beneficiary Choices Dept, Baltimore, MD USA. [Cleary, Paul D.] Yale Univ, Sch Publ Hlth, New Haven, CT USA. [Zaslavsky, Alan M.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St,POB 2138, Santa Monica, CA 90407 USA. EM elliott@rand.org FU CMS [HHSM-500-2011-AZ10C] FX This study was funded by CMS contract HHSM-500-2011-AZ10C to the Health Services Advisory Group. Elizabeth Goldstein and William Lehrman are employees of the sponsoring agency, the CMS. The authors have no conflicts of interest to report. We thank Fergal McCarthy, M.Phil., for assistance with manuscript preparation. NR 27 TC 8 Z9 8 U1 1 U2 4 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 2015 VL 50 IS 6 BP 1850 EP 1867 DI 10.1111/1475-6773.12305 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA DA3JF UT WOS:000367692300008 PM 25854292 ER PT J AU Sanghavi, DM Conway, PH AF Sanghavi, Darshak M. Conway, Patrick H. TI Approaches to Prevention of Cardiovascular Disease Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 [Sanghavi, Darshak M.; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Sanghavi, DM (reprint author), Ctr Medicare & Medicaid Serv, Prevent & Populat Hlth Models Grp, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM darshak.sanghavi@cms.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD DEC 1 PY 2015 VL 314 IS 21 BP 2306 EP 2307 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA CX2GT UT WOS:000365515700028 PM 26624835 ER PT J AU Amico, P Pope, GC Pardasaney, P Silver, B Dever, JA Meadow, A West, P AF Amico, Peter Pope, Gregory C. Pardasaney, Poonam Silver, Ben Dever, Jill A. Meadow, Ann West, Pamela TI Refinements of the Medicare Outpatient Therapy Annual Expenditure Limit Policy SO PHYSICAL THERAPY LA English DT Article ID PHYSICAL-THERAPY; EPISODES; CARE; ADULTS; BACK AB Background. A Medicare beneficiary's annual outpatient therapy expenditures that exceed congressionally established. caps are subject to extra documentation and review requirements. In 2011, these caps were $1,870 for physical therapy and speech-language pathology combined and $1,870 for occupational therapy separately. Objective. This article considers the distributional effects of replacing current cap policy with equal caps by therapy discipline (physical therapy, occupational therapy, and speech-language pathology) or a single combined cap, and risk adjusting the physical therapy cap using beneficiary characteristics and functional status. Methods. Alternative therapy cap policies are simulated with 100% Medicare claims for 2011 therapy users (N=4.9 million). A risk-adjusted cap for annual physical therapy expenditures is calculated from a quantile regression estimated on a sample of physical therapy users with diagnoses and clinician assessments of functional ability merged to their claims (n=4,210). Results. Equal discipline-specific caps of $1,710 each for physical therapy, occupational therapy, and speech-language pathology result in the same aggregate Medicare expenditures above the caps as 2011 cap policy. A single combined-disciplines cap of $2,485 also results in the same aggregate expenditures above the cap. Risk adjustment varies the physical therapy cap by as much as 5 to 1 across beneficiaries and equalizes the probability of exceeding the physical therapy cap across diagnosis and functional status groups. Limitations. One limitation of the study was the assumption of no behavioral response on the part of beneficiaries or providers to a change in cap policy. Additionally, analysis of risk adjusting the therapy caps was limited by sample size. Conclusions. Equal discipline-specific caps for physical therapy, occupational therapy, and speech-language pathology are more equitable to high users of both physical therapy and speech-language pathology than current cap policy. Separating the physical therapy and speech-language pathology caps is a change that policy makers could consider. Risk adjustment of the therapy caps is a first step in incorporating beneficiary need for services into Medicare outpatient therapy payment policy. C1 [Amico, Peter; Pope, Gregory C.; Pardasaney, Poonam; Dever, Jill A.] RTI Int, Waltham, MA 02451 USA. [Silver, Ben] Brown Univ, Providence, RI 02912 USA. [Meadow, Ann] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [West, Pamela] Ctr Medicare & Medicaid Serv, Ctr Medicare Serv, Baltimore, MD USA. RP Amico, P (reprint author), RTI Int, 1440 Main St,Ste 310, Waltham, MA 02451 USA. EM pamico@rti.org FU Centers for Medicare & Medicaid Services (CMS) FX The Centers for Medicare & Medicaid Services (CMS) funded this research. Any interpretations, opinions, or errors are the responsibility of the authors and not those Of the CMS. NR 25 TC 2 Z9 2 U1 1 U2 4 PU AMER PHYSICAL THERAPY ASSOC PI ALEXANDRIA PA 1111 N FAIRFAX ST, ALEXANDRIA, VA 22314 USA SN 0031-9023 EI 1538-6724 J9 PHYS THER JI Phys. Ther. PD DEC PY 2015 VL 95 IS 12 BP 1638 EP 1649 DI 10.2522/ptj.20140423 PG 12 WC Orthopedics; Rehabilitation SC Orthopedics; Rehabilitation GA CX6VS UT WOS:000365840400006 PM 26089039 ER PT J AU Lloyd, JT Blackwell, SA Wei, II Howell, BL Shrank, WH AF Lloyd, Jennifer T. Blackwell, Steve A. Wei, Iris I. Howell, Benjamin L. Shrank, William H. TI Validity of a Claims-Based Diagnosis of Obesity Among Medicare Beneficiaries SO EVALUATION & THE HEALTH PROFESSIONS LA English DT Article DE aging; body mass index; Medicare; NHANES; epidemiology ID HEALTH-CARE COST; BODY-MASS INDEX; DISEASE BURDEN; PREVALENCE; OVERWEIGHT; CHILDREN; TRENDS; AGE AB Population-level data on obesity are difficult to obtain. Claims-based data sets are useful for studying public health at a population level but lack physical measurements. The objective of this study was to determine the validity of a claims-based measure of obesity compared to obesity diagnosed with clinical data as well as the validity among older adults who suffer from chronic disease. This study used data from the National Health and Nutrition Examination Survey 1999-2004 for adults aged 65 successfully linked to 1999-2007 Medicare claims (N = 3,554). Sensitivity, specificity, positive and negative predictive values, statistics as well as logistic regression analyses were computed for the claims-based diagnosis of obesity versus obesity diagnosed with body mass index. The claims-based diagnosis of obesity underestimates the true prevalence in the older Medicare population with a low sensitivity (18.4%). However, this method has a high specificity (97.3%) and is accurate when it is present. Sensitivity was improved when comparing the claim-based diagnosis to Class II obesity (34.2%) and when used in combination with chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, or depression. Understanding the validity of a claims-based obesity diagnosis could aid researchers in understanding the feasibility of conducting research on obesity using claims data. C1 [Lloyd, Jennifer T.; Blackwell, Steve A.; Wei, Iris I.; Howell, Benjamin L.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Res & Rapid Cycle Evaluat Grp, Baltimore, MD 21244 USA. [Shrank, William H.] CVS Caremark, Woonsocket, RI USA. RP Lloyd, JT (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,WB-06-05, Baltimore, MD 21244 USA. EM jennifer.lloyd@cms.hhs.gov NR 14 TC 0 Z9 0 U1 0 U2 3 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 0163-2787 EI 1552-3918 J9 EVAL HEALTH PROF JI Eval. Health Prof. PD DEC PY 2015 VL 38 IS 4 BP 508 EP 517 DI 10.1177/0163278714553661 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CX0ZO UT WOS:000365426200004 PM 25380698 ER PT J AU Smith, LM Anderson, WL Kenyon, A Kinyara, E With, SK Teichman, L Dean-Whittaker, D Goldstein, E AF Smith, Laura M. Anderson, Wayne L. Kenyon, Anne Kinyara, Elizabeth With, Sarah K. Teichman, Lori Dean-Whittaker, Debra Goldstein, Elizabeth TI V Racial and Ethnic Disparities in Patients' Experience With Skilled Home Health Care Services SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE HHCAHPS; patient experience; home health care; patient satisfaction; disparities ID MEDICAID MANAGED CARE; RACIAL/ETHNIC DISPARITIES; OLDER-ADULTS; SATISFACTION; CAHPS; RACE/ETHNICITY; RATINGS; ASSESSMENTS; PERFORMANCE; QUALITY AB Racial and ethnic disparities are found in many health care settings; however, there is little prior research on such disparities among patients receiving home health care services. This study used 2012 Home Health Care CAHPS((R)) data to identify any overall patient-level disparities in self-reported experience of care and to decompose these disparities according to whether they result from within-agency versus between-agency differences. Although patient experience of care ratings were high across all groups, the study identified consistently lower ratings for all minority groups on two of three Home Health Care CAHPS measures, with Asians reporting the greatest disparities. Three quarters of disparities were found to be within-agency disparities, which were primarily related to care processes and provider/patient communications rather than to specific health care services received. Despite high ratings in general, home health agencies may need to focus on cultural competency initiatives to address racial and ethnic disparities within their agencies. C1 [Smith, Laura M.] RTI Int, Waltham, MA 02451 USA. [Anderson, Wayne L.; Kenyon, Anne; Kinyara, Elizabeth; With, Sarah K.] RTI Int, Res Triangle Pk, NC USA. [Teichman, Lori; Dean-Whittaker, Debra; Goldstein, Elizabeth] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Smith, LM (reprint author), RTI Int, 1440 Main St,Suite 310, Waltham, MA 02451 USA. EM lsmith@rti.org FU Centers for Medicare & Medicaid Services [HHSM-500-2014-00447G] FX The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Support for preparation of this article for this research comes from the Centers for Medicare & Medicaid Services (contract number HHSM-500-2014-00447G). NR 28 TC 0 Z9 0 U1 1 U2 4 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 EI 1552-6801 J9 MED CARE RES REV JI Med. Care Res. Rev. PD DEC PY 2015 VL 72 IS 6 BP 756 EP 774 DI 10.1177/1077558715597398 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CV6YF UT WOS:000364417500006 PM 26238122 ER PT J AU Perla, RJ Finke, B DeWalt, DA AF Perla, Rocco J. Finke, Bruce DeWalt, Darren A. TI Learning Systems at Scale Where Policy Meets Practice SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Perla, Rocco J.; Finke, Bruce; DeWalt, Darren A.] Ctr Medicare & Medicaid Innovat, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Perla, RJ (reprint author), US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Innovat, Ctr Medicare & Medicaid Serv, 2810 Lord Baltimore Dr, Baltimore, MD 21244 USA. EM Rocco.Perla@cms.hhs.gov NR 5 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD NOV 24 PY 2015 VL 314 IS 20 BP 2131 EP 2132 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA CW9XQ UT WOS:000365351900014 PM 26599182 ER PT J AU Wang, CL Graham, DJ Kane, RC Xie, DQ Wernecke, M Levenson, M MaCurdy, TE Houstoun, M Ryan, Q Wong, S Mott, K Sheu, TC Limb, S Worrall, C Kelman, JA Reichman, ME AF Wang, Cunlin Graham, David J. Kane, Robert C. Xie, Diqiong Wernecke, Michael Levenson, Mark MaCurdy, Thomas E. Houstoun, Monica Ryan, Qin Wong, Sarah Mott, Katrina Sheu, Ting-Chang Limb, Susan Worrall, Chris Kelman, Jeffrey A. Reichman, Marsha E. TI Comparative Risk of Anaphylactic Reactions Associated With Intravenous Iron Products SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID FERRIC GLUCONATE COMPLEX; ADVERSE DRUG EVENTS; HEMODIALYSIS-PATIENTS; PARENTERAL IRON; SYSTEMATIC ANALYSIS; DEXTRAN; SAFETY; ANEMIA; THERAPY; SUCROSE AB IMPORTANCE All intravenous (IV) iron products are associated with anaphylaxis, but the comparative safety of each product has not been well established. OBJECTIVE To compare the risk of anaphylaxis among marketed IV iron products. DESIGN, SETTING, AND PARTICIPANTS Retrospective new user cohort study of IV iron recipients (n = 688 183) enrolled in the US fee-for-service Medicare program from January 2003 to December 2013. Analyses involving ferumoxytol were limited to the period January 2010 to December 2013. EXPOSURES Administrations of IV iron dextran, gluconate, sucrose, or ferumoxytol as reported in outpatient Medicare claims data. MAIN OUTCOMES AND MEASURES Anaphylaxiswas identified using a prespecified and validated algorithm defined with standard diagnosis and procedure codes and applied to both inpatient and outpatient Medicare claims. The absolute and relative risks of anaphylaxis were estimated, adjusting for imbalances among treatment groups. RESULTS A total of 274 anaphylaxis cases were identified at first exposure, with an additional 170 incident anaphylaxis cases identified during subsequent IV iron administrations. The risk for anaphylaxis at first exposure was 68 per 100 000 persons for iron dextran (95% CI, 57.8-78.7 per 100 000) and 24 per 100 000 persons for all nondextran IV iron products combined (iron sucrose, gluconate, and ferumoxytol) (95% CI, 20.0-29.5 per 100 000), with an adjusted odds ratio (OR) of 2.6 (95% CI, 2.0-3.3; P <.001). At first exposure, when compared with iron sucrose, the adjusted OR of anaphylaxis for iron dextran was 3.6 (95% CI, 2.4-5.4); for iron gluconate, 2.0 (95% CI 1.2, 3.5); and for ferumoxytol, 2.2 (95% CI, 1.1-4.3). The estimated cumulative anaphylaxis risk following total iron repletion of 1000mg administered within a 12-week period was highest with iron dextran (82 per 100 000 persons, 95% CI, 70.5-93.1) and lowest with iron sucrose (21 per 100 000 persons, 95% CI, 15.3-26.4). CONCLUSIONS AND RELEVANCE Among patients in the US Medicare nondialysis population with first exposure to IV iron, the risk of anaphylaxis was highest for iron dextran and lowest for iron sucrose. C1 [Wang, Cunlin; Graham, David J.; Mott, Katrina; Reichman, Marsha E.] US FDA, Div Epidemiol 1, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, Silver Spring, MD 20903 USA. [Kane, Robert C.; Houstoun, Monica; Ryan, Qin; Limb, Susan] US FDA, Off New Drugs, Ctr Drug Evaluat & Res, Silver Spring, MD 20903 USA. [Xie, Diqiong; Levenson, Mark] US FDA, Off Biostat, Ctr Drug Evaluat & Res, Silver Spring, MD 20903 USA. [Wernecke, Michael; MaCurdy, Thomas E.; Wong, Sarah; Sheu, Ting-Chang] Acumen LLC, Burlingame, CA USA. [Mott, Katrina] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Limb, Susan] Genentech Inc, San Francisco, CA 94080 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Wang, CL (reprint author), US FDA, Div Epidemiol 1, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, 10903 New Hampshire Ave, Silver Spring, MD 20903 USA. EM cunlin.wang@fda.hhs.gov FU Centers for Medicare & Medicaid Services; US Food and Drug Administration FX This study was funded through an intraagency agreement between the Centers for Medicare & Medicaid Services and the US Food and Drug Administration. NR 26 TC 26 Z9 26 U1 2 U2 9 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD NOV 17 PY 2015 VL 314 IS 19 BP 2062 EP 2068 DI 10.1001/jama.2015.15572 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA CW1PR UT WOS:000364764200021 PM 26575062 ER PT J AU Patel, A Rajkumar, R Colmers, JM Kinzer, D Conway, PH Sharfstein, JM AF Patel, Ankit Rajkumar, Rahul Colmers, John M. Kinzer, Donna Conway, Patrick H. Sharfstein, Joshua M. TI Maryland's Global Hospital Budgets - Preliminary Results from an All-Payer Model SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID REFORM C1 [Patel, Ankit] Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. [Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Colmers, John M.] Johns Hopkins Med, Dept Hlth Care Transformat & Strateg Planning, Baltimore, MD USA. [Kinzer, Donna] Hlth Serv Cost Review Commiss, Baltimore, MD USA. [Sharfstein, Joshua M.] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. RP Patel, A (reprint author), Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. NR 4 TC 6 Z9 6 U1 0 U2 1 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD NOV 12 PY 2015 VL 373 IS 20 BP 1899 EP 1901 DI 10.1056/NEJMp1508037 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA CV7IL UT WOS:000364445500003 PM 26559570 ER PT J AU Mandl, S McMullen, TL Reilly, K Thaker, S Smith, L Deutsch, A Lines, LM Schwartz, ML AF Mandl, S. McMullen, T. L. Reilly, K. Thaker, S. Smith, L. Deutsch, A. Lines, L. M. Schwartz, M. L. TI IMPACT ACT OF 2014 QUALITY DOMAINS/MEASURES: DESIGN & IMPLEMENTATION ON AN URGENT TIMELINE SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Reilly, K.; Thaker, S.; Smith, L.; Deutsch, A.; Lines, L. M.; Schwartz, M. L.] RTI Int, Waltham, MA USA. [Mandl, S.; McMullen, T. L.] Ctr Medicare Serv, Baltimore, MD USA. [Mandl, S.; McMullen, T. L.] Ctr Medicaid Serv, Baltimore, MD USA. RI Lines, Lisa/R-4983-2016 OI Lines, Lisa/0000-0002-9202-3466 NR 0 TC 0 Z9 0 U1 1 U2 1 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 NOV PY 2015 VL 55 SU 2 BP 243 EP 243 PG 1 WC Gerontology SC Geriatrics & Gerontology GA DJ5BV UT WOS:000374222701331 ER PT J AU Rokoske, FS Zheng, N Kirk, A Broyles, I Li, Q Sherif, N Brazil, ML AF Rokoske, F. S. Zheng, N. Kirk, A. Broyles, I. Li, Q. Sherif, N. Brazil, M. L. TI ENGAGING HOSPICE PATIENTS AND CAREGIVERS IN CMS QUALITY MEASURE DEVELOPMENT EFFORTS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Rokoske, F. S.; Zheng, N.; Kirk, A.; Broyles, I.; Li, Q.; Sherif, N.] RTI Int, Durham, NC USA. [Brazil, M. L.] Ctr Medicare Serv, Baltimore, MD USA. [Brazil, M. L.] 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 NOV PY 2015 VL 55 SU 2 BP 305 EP 306 PG 2 WC Gerontology SC Geriatrics & Gerontology GA DJ5BV UT WOS:000374222701562 ER PT J AU McMullen, TL AF McMullen, T. L. TI LEARNING IS A LIFELONG PROCESS: MAKING INROADS INTO THE FIELD OF POLICY AND AGING SO GERONTOLOGIST LA English DT Meeting Abstract C1 [McMullen, T. L.] Ctr Medicare Serv, Gerontol Doctoral Program, Sykesville, MD USA. [McMullen, T. L.] Ctr Medicaid Serv, Gerontol Doctoral Program, Sykesville, MD USA. NR 0 TC 0 Z9 0 U1 4 U2 4 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 NOV PY 2015 VL 55 SU 2 BP 587 EP 587 PG 1 WC Gerontology SC Geriatrics & Gerontology GA DJ5BV UT WOS:000374222702763 ER PT J AU McMullen, TL Resnick, B AF McMullen, T. L. Resnick, B. TI UNDERSTANDING AND EXPANDING SCOPE OF PRACTICE AMONG CERTIFIED NURSE AIDES. SO GERONTOLOGIST LA English DT Meeting Abstract C1 [McMullen, T. L.] Ctr Medicare Serv, Baltimore, MD USA. [McMullen, T. L.] Ctr Medicaid Serv, Baltimore, MD USA. [Resnick, B.] Univ Maryland, Sch Nursing, Baltimore, MD 21201 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 NOV PY 2015 VL 55 SU 2 BP 614 EP 614 PG 1 WC Gerontology SC Geriatrics & Gerontology GA DJ5BV UT WOS:000374222703018 ER PT J AU Lehrman, WG Friedberg, MW AF Lehrman, William G. Friedberg, Mark W. TI CAHPS Surveys: Valid and Valuable Measures of Patient Experience SO HASTINGS CENTER REPORT LA English DT Letter AB A commentary on Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?, byAlexandra Junewicz and Stuart J. Youngner in the May-June 2015 issue.. C1 [Lehrman, William G.] Ctr Medicare & Medicaid Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD 21244 USA. [Friedberg, Mark W.] RAND Corp, Santa Monica, CA 90406 USA. RP Lehrman, WG (reprint author), Ctr Medicare & Medicaid Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD 21244 USA. NR 0 TC 1 Z9 1 U1 1 U2 1 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0093-0334 EI 1552-146X J9 HASTINGS CENT REP JI Hastings Cent. Rep. PD NOV-DEC PY 2015 VL 45 IS 6 BP 3 EP 4 DI 10.1002/hast.507 PG 2 WC Ethics; Health Care Sciences & Services; Medical Ethics; Social Sciences, Biomedical SC Social Sciences - Other Topics; Health Care Sciences & Services; Medical Ethics; Biomedical Social Sciences GA CW1YD UT WOS:000364787000002 PM 26556135 ER PT J AU Kangovi, S Cafardi, SG Smith, RA Kulkarni, R Grande, D AF Kangovi, Shreya Cafardi, Susannah G. Smith, Robyn A. Kulkarni, Raina Grande, David TI Patient financial responsibility for observation care SO JOURNAL OF HOSPITAL MEDICINE LA English DT Article ID OBSERVATION SERVICES; ENROLLEES; MORTALITY; COST; RISK AB BACKGROUNDAs observation care grows, Medicare beneficiaries are increasingly likely to revisit observation care instead of being readmitted. This trend has potential financial implications for Medicare beneficiaries because observation carealthough typically hospital basedis classified as an outpatient service. Beneficiaries who are readmitted pay the inpatient deductible only once per benefit period. In contrast, beneficiaries who have multiple care episodes under observations status are subject to coinsurance at every stay and could accrue higher cumulative costs. OBJECTIVESWe were interested in answering the question: Do Medicare beneficiaries who revisit observation care pay more than they would have had they been readmitted? DESIGNWe used a 20% sample of the Medicare Outpatient Standard Analytic File (2010-2012) to determine the total cumulative financial liability for Medicare beneficiaries who revisit observation care multiple times within a 60-day period. PARTICIPANTSParticipants were fee-for-service Medicare beneficiaries who had Part A and Part B coverage for a full calendar year (or until death) during the study period. MEASUREMENTSOur primary measure was beneficiary financial responsibility for facilities fees. RESULTSOn average, beneficiaries with multiple observation stays in a 60-day period had a cumulative financial liability of $947.40 (803.62), which is significantly lower than the $1100 inpatient deductible (P < 0.01). However, 26.6% of these beneficiaries had a cumulative financial liability that exceeded the inpatient deductible. CONCLUSIONSMore than a quarter of Medicare beneficiaries with multiple observation stays in a 60-day time period have a higher financial liability than they would have had under Part A benefits. Journal of Hospital Medicine 2015;10:718-723. (c) 2015 Society of Hospital Medicine C1 [Kangovi, Shreya; Smith, Robyn A.; Grande, David] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. [Kangovi, Shreya; Grande, David] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA. [Kangovi, Shreya; Smith, Robyn A.; Kulkarni, Raina] Penn Ctr Community Hlth Workers, Philadelphia, PA USA. [Cafardi, Susannah G.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Kangovi, S (reprint author), 1233 Blockley Hall,423 Guardian Dr, Philadelphia, PA 19104 USA. EM kangovi@mail.med.upenn.edu NR 18 TC 6 Z9 6 U1 0 U2 4 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1553-5592 EI 1553-5606 J9 J HOSP MED JI J. Hosp. Med. PD NOV PY 2015 VL 10 IS 11 BP 718 EP 723 DI 10.1002/jhm.2436 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA CU6YD UT WOS:000363680300003 PM 26292192 ER PT J AU Menis, M Forshee, RA Kumar, S McKean, S Warnock, R Izurieta, HS Gondalia, R Johnson, C Mintz, PD Walderhaug, MO Worrall, CM Kelman, JA Anderson, SA AF Menis, Mikhail Forshee, Richard A. Kumar, Sanjai McKean, Stephen Warnock, Rob Izurieta, Hector S. Gondalia, Rahul Johnson, Chris Mintz, Paul D. Walderhaug, Mark O. Worrall, Christopher M. Kelman, Jeffrey A. Anderson, Steven A. TI Babesiosis Occurrence among the Elderly in the United States, as Recorded in Large Medicare Databases during 2006-2013 SO PLOS ONE LA English DT Article ID NUTRITION EXAMINATION SURVEY; 3RD NATIONAL-HEALTH; NEW-YORK-STATE; LYME-DISEASE; PHYSICAL-ACTIVITY; LEISURE-TIME; BLOOD-TRANSFUSION; IXODES-SCAPULARIS; MICROTI; USA AB Background Human babesiosis, caused by intraerythrocytic protozoan parasites, can be an asymptomatic or mild-to-severe disease that may be fatal. The study objective was to assess babesiosis occurrence among the U.S. elderly Medicare beneficiaries, ages 65 and older, during 2006-2013. Methods Our retrospective claims-based study utilized large Medicare administrative databases. Babesiosis occurrence was ascertained by recorded ICD-9-CM diagnosis code. The study assessed babesiosis occurrence rates (per 100,000 elderly Medicare beneficiaries) overall and by year, age, gender, race, state of residence, and diagnosis months. Results A total of 10,305 elderly Medicare beneficiaries had a recorded babesiosis diagnosis during the eight-year study period, for an overall rate of about 5 per 100,000 persons. Study results showed a significant increase in babesiosis occurrence over time (p < 0.05), with the largest number of cases recorded in 2013 (N = 1,848) and the highest rates (per 100,000) in five Northeastern states: Connecticut (46), Massachusetts (45), Rhode Island (42), New York (27), and New Jersey (14). About 75% of all cases were diagnosed from May through October. Babesiosis occurrence was significantly higher among males vs. females and whites vs. non-whites. Conclusion Our study reveals increasing babesiosis occurrence among the U.S. elderly during 20062013, with highest rates in the babesiosis-endemic states. The study also shows variation in babesiosis occurrence by age, gender, race, state of residence, and diagnosis months. Overall, our study highlights the importance of large administrative databases in assessing the occurrence of emerging infections in the United States. C1 [Menis, Mikhail; Forshee, Richard A.; Kumar, Sanjai; Izurieta, Hector S.; Mintz, Paul D.; Walderhaug, Mark O.; Anderson, Steven A.] US FDA, Silver Spring, MD 20993 USA. [McKean, Stephen; Warnock, Rob; Gondalia, Rahul; Johnson, Chris] Acumen LLC, Burlingame, CA USA. [Worrall, Christopher M.; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Menis, M (reprint author), US FDA, Silver Spring, MD 20993 USA. EM Mikhail.Menis@fda.hhs.gov FU U.S. Food and Drug Administration, Center for Biologics Evaluation and Research; FDA FX This study was internally funded by the U.S. Food and Drug Administration, Center for Biologics Evaluation and Research. Acumen LLC is a CMS contractor funded by FDA to conduct analyses of CMS data. All authors made substantial contributions to research design, or the acquisition, analysis or interpretation of data and were involved in drafting of the paper or revising it critically. NR 58 TC 2 Z9 2 U1 1 U2 6 PU PUBLIC LIBRARY SCIENCE PI SAN FRANCISCO PA 1160 BATTERY STREET, STE 100, SAN FRANCISCO, CA 94111 USA SN 1932-6203 J9 PLOS ONE JI PLoS One PD OCT 15 PY 2015 VL 10 IS 10 AR e0140332 DI 10.1371/journal.pone.0140332 PG 12 WC Multidisciplinary Sciences SC Science & Technology - Other Topics GA CU0CX UT WOS:000363184600042 PM 26469785 ER PT J AU Beckett, MK Elliott, MN Haviland, AM Burkhart, Q Gaillot, S Montfort, D Saliba, D AF Beckett, Megan K. Elliott, Marc N. Haviland, Amelia M. Burkhart, Q. Gaillot, Sarah Montfort, Daisy Saliba, Debra TI Living Alone and Patient Care Experiences: The Role of Gender in a National Sample of Medicare Beneficiaries SO JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES LA English DT Article DE Living arrangements; Patient experience; Gender; Medicare ID CAHPS(R) HOSPITAL SURVEY; PSYCHOMETRIC PROPERTIES; CONSUMER ASSESSMENT; TRANSITIONAL CARE; ELDERLY PERSONS; MARITAL-STATUS; HEART-FAILURE; MANAGED CARE; HEALTH PLANS; OLDER-ADULTS AB Seniors who live alone are a large, growing population with poorer health outcomes. We examine the little-studied health care experiences and immunizations of older adults who live alone. We use regression-based case-mix adjustment to compare immunizations and health care experiences of 325,649 adults aged 65 and older who lived alone to those who did not, overall and by gender and health status, using nationally representative data from the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Outcomes were five global care ratings (health plan, drug plan, doctor, specialists, all care), six composite care measures (getting needed care, getting care quickly, doctor communication, customer service, getting needed drugs, getting information from drug plan), and two immunization measures (influenza, pneumonia). About 30.3% of respondents lived alone. Women, older beneficiaries, and low income (Medicaid eligible) beneficiaries reported living alone at substantially higher rates than their counterparts. Care experiences for 8 of the 13 measures were significantly worse for those who lived alone than for others. The association differed significantly in magnitude by gender for 10 measures, with larger average differences for men. The largest disadvantages for those living alone were for immunization measures (eg, influenza -6 percentage points, for men living alone vs other men). The disadvantages of living alone were not consistently greater for those in worse health. Living alone is associated with worse care experiences and immunization, especially for men. Health plans should target quality improvement and outreach efforts to beneficiaries who live alone, especially men. C1 [Beckett, Megan K.; Elliott, Marc N.; Haviland, Amelia M.; Burkhart, Q.; Montfort, Daisy; Saliba, Debra] RAND Corp, Santa Monica, CA 90401 USA. [Haviland, Amelia M.] Carnegie Mellon Univ, H John Heinz III Coll Publ Policy & Management, Pittsburgh, PA 15213 USA. [Gaillot, Sarah] Ctr Medicare & Medicaid Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD USA. [Saliba, Debra] Ctr Geriatr Res Educ & Clin, US Dept Vet Affairs, Los Angeles, CA USA. [Saliba, Debra] Univ Calif Los Angeles, Dept Med, Borun Ctr, Los Angeles, CA 90024 USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St, Santa Monica, CA 90401 USA. EM elliott@rand.org FU Centers for Medicare and Medicare Services [HHSM-500-2005-00028I] FX This work was supported by the Centers for Medicare and Medicare Services (contract HHSM-500-2005-00028I awarded to RAND). NR 34 TC 1 Z9 1 U1 1 U2 7 PU OXFORD UNIV PRESS INC PI CARY PA JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA SN 1079-5006 EI 1758-535X J9 J GERONTOL A-BIOL JI J. Gerontol. Ser. A-Biol. Sci. Med. Sci. PD OCT PY 2015 VL 70 IS 10 BP 1242 EP 1247 DI 10.1093/gerona/glv037 PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA CU4FD UT WOS:000363481600009 PM 25869525 ER PT J AU Price, RA Haviland, AM Hambarsoomian, K Dembosky, JW Gaillot, S Weech-Maldonado, R Williams, MV Elliott, MN AF Price, Rebecca Anhang Haviland, Amelia M. Hambarsoomian, Katrin Dembosky, Jacob W. Gaillot, Sarah Weech-Maldonado, Robert Williams, Malcolm V. Elliott, Marc N. TI Do Experiences with Medicare Managed Care Vary According to the Proportion of Same-Race/Ethnicity/Language Individuals Enrolled in One's Contract? SO HEALTH SERVICES RESEARCH LA English DT Article DE Patient experiences with care; health care disparities; racial and ethnic minorities; Hispanic Americans; Medicare; managed care ID HEALTH-CARE; PSYCHOMETRIC PROPERTIES; ETHNIC-DIFFERENCES; RACIAL/ETHNIC DISPARITIES; IMMUNIZATION DISPARITIES; PATIENT EXPERIENCES; CONSUMER ASSESSMENT; QUALITY; BENEFICIARIES; ASSESSMENTS AB Objective. To examine whether care experiences and immunization for racial/ethnic/language minority Medicare beneficiaries vary with the proportion of same-group beneficiaries in Medicare Advantage (MA) contracts. Data Sources/Study Setting. Exactly 492,495 Medicare beneficiaries responding to the 2008-2009 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Data Collection/Extraction Methods. Mixed-effect regression models predicted eight CAHPS patient experience measures from self-reported race/ethnicity/language preference at individual and contract levels, beneficiary-level case-mix adjustors, along with contract and geographic random effects. Principal Findings. As a contract's proportion of a given minority group increased, overall and non-Hispanic, white patient experiences were poorer on average; for the minority group in question, however, high-minority plans may score as well as low-minority plans. Spanish-preferring Hispanic beneficiaries also experience smaller disparities relative to non-Hispanic whites in plans with higher Spanish-preferring proportions. Conclusions. The tendency for high-minority contracts to provide less positive patient experiences for others in the contract, but similar or even more positive patient experiences for concentrated minority group beneficiaries, may reflect cultural competency, particularly language services, that partially or fully counterbalance the poorer overall quality of these contracts. For some beneficiaries, experiences may be just as positive in some high-minority plans with low overall scores as in plans with higher overall scores. C1 [Price, Rebecca Anhang; Hambarsoomian, Katrin; Dembosky, Jacob W.; Williams, Malcolm V.; Elliott, Marc N.] RAND Corp, Santa Monica, CA 90407 USA. [Haviland, Amelia M.] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA. [Gaillot, Sarah] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Weech-Maldonado, Robert] Univ Alabama Birmingham, Birmingham, AL USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St,POB 2138, Santa Monica, CA 90407 USA. EM elliott@rand.org FU CMS [HHSM-500-2005-000281] FX Joint Acknowledgment/Disclosure Statement: This article was funded by CMS under contract number HHSM-500-2005-000281. We thank Fergal McCarthy MPhil for assistance with manuscript preparation. NR 45 TC 2 Z9 2 U1 2 U2 3 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 OCT PY 2015 VL 50 IS 5 BP 1649 EP 1687 DI 10.1111/1475-6773.12292 PG 39 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CT8JX UT WOS:000363063300015 PM 25752334 ER PT J AU Kent, EE Yuan, GG Topor, MS Chawla, N Gaillot, S DeMichele, K AF Kent, Erin E. Yuan, Gigi Topor, Marie S. Chawla, Neetu Gaillot, Sarah DeMichele, Kimberly TI Cancer registry-linked data with patient-reported outcomes and patient experiences with care: an overview of findings from the centers for medicare & medicaid and national cancer institute SEER-MHOS and SEER-CAHPS data resources SO QUALITY OF LIFE RESEARCH LA English DT Meeting Abstract C1 [Kent, Erin E.] NCI, Rockville, MD USA. [Yuan, Gigi; Topor, Marie S.] Informat Management Serv Inc, Calverton, MD USA. [Chawla, Neetu] Kaiser Permanente No Calif, Oakland, CA USA. [Gaillot, Sarah; DeMichele, Kimberly] Ctr Medicare Serv, Baltimore, MD USA. [Gaillot, Sarah; DeMichele, Kimberly] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 3 U2 3 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0962-9343 EI 1573-2649 J9 QUAL LIFE RES JI Qual. Life Res. PD OCT PY 2015 VL 24 SU 1 MA 1095 BP 93 EP 94 PG 2 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA CS3RA UT WOS:000361991100210 ER PT J AU Sorace, J Rogers, M Millman, M Rogers, D Price, K Queen, S Worrall, C Kelman, J AF Sorace, James Rogers, Michael Millman, Michael Rogers, Daniel Price, Kyle Queen, Susan Worrall, Chris Kelman, Jeffrey TI A Comparison of Disease Burden Between Twins and Control Pairs in Medicare: Quantification of Heredity's Role in Human Health SO POPULATION HEALTH MANAGEMENT LA English DT Article ID FAMILIAL ATRIAL-FIBRILLATION; MONOZYGOTIC TWINS; DANISH TWINS; RISK; IMPACT; MODEL AB To quantify heredity's effects on the burden of illness in the Medicare population, this study linked information between participants in a research twin registry to a comprehensive set of Medicare claims. To calculate disease categories, the authors used the Centers for Medicare & Medicaid Services Hierarchical Conditions Categories (HCC) model that was developed to risk adjust Medicare's capitation payments to private health care plans based on the health expenditure risk of their enrollees. Using the Medicare database, 2 sets of unrelated but demographically matched control pairs (MCPs) were generated, one specific for the monozygotic twin population and the second specific for the dizygotic twin population. The concordance and correlation rates of the 70 HCC categories for the 2 twin populations, in comparison to their corresponding MCP, was then calculated using Medicare claims data from 1991 through 2011. When indicated, HCCs for which there was a statistically significant difference between the twin and corresponding MCP control group were analyzed by calculating concordance and correlation rates of the International Classification of Diseases, Ninth Revision codes that compose the HCC. Findings reveal that monozygotic twins share 6.5% more HCC disease categories than their MCP while dizygotic twins share 3.8% more HCC disease categories than their MCP. Atrial fibrillation is a highly heritable disease category, a finding consistent with prior literature describing the heritability of the cardiac arrhythmias. These findings are consistent with qualitative assessments of heredity's role found in previous models of population health, and provide both novel methods and quantitative evidence to support future model development. (Population Health Management 2015;18:383-391) C1 [Sorace, James; Millman, Michael; Queen, Susan] Off Sci & Data Policy, Washington, DC 20201 USA. [Rogers, Michael; Rogers, Daniel; Price, Kyle] Acumen LLC, Burlingame, CA USA. [Worrall, Chris; Kelman, Jeffrey] Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Sorace, J (reprint author), Off Sci & Data Policy, Planning & Evaluat, Hubert Humphrey Bldg,Room 443E, Washington, DC 20201 USA. EM james.sorace@hhs.gov FU Department of Health and Human Services [HHSM-500-2006-00006I]; Acumen LLC [HHSM-500-2006-00006I] FX The authors received the following financial support for this article: This work was supported by contract HHSM-500-2006-00006I between the Department of Health and Human Services and Acumen LLC. The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Assistant Secretary for Planning and Evaluation, the Centers for Medicare & Medicaid Services, or the Department of Health and Human Services. NR 26 TC 0 Z9 0 U1 0 U2 3 PU MARY ANN LIEBERT, INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1942-7891 EI 1942-7905 J9 POPUL HEALTH MANAG JI Popul. Health Manag. PD OCT 1 PY 2015 VL 18 IS 5 BP 383 EP 391 DI 10.1089/pop.2014.0145 PG 9 WC Health Care Sciences & Services SC Health Care Sciences & Services GA CR5EV UT WOS:000361364200011 PM 25658666 ER PT J AU Pham, HH Pilotte, J Rajkumar, R Richter, E Cavanaugh, S Conway, PH AF Pham, Hoangmai H. Pilotte, John Rajkumar, Rahul Richter, Elizabeth Cavanaugh, Sean Conway, Patrick H. TI Medicare's Vision for Delivery-System Reform - The Role of ACOs SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Pham, Hoangmai H.; Pilotte, John; Rajkumar, Rahul; Richter, Elizabeth; Cavanaugh, Sean; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Pham, HH (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 3 TC 5 Z9 5 U1 1 U2 4 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD SEP 10 PY 2015 VL 373 IS 11 BP 987 EP 990 DI 10.1056/NEJMp1507319 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA CQ9TV UT WOS:000360959000002 PM 26352812 ER PT J AU Burcu, M Zito, JM McKean, S Warnock, R Herbert, P Verma, S Worrall, CM Chu, S Mohamadi, A AF Burcu, Mehmet Zito, Julie M. McKean, Stephen Warnock, Rob Herbert, Peter Verma, Sumit Worrall, Chris M. Chu, Steve Mohamadi, Ali TI The Effect of Medicaid Peer Review Prior Authorization Policies on Pediatric Use of Antipsychotic Medications SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Burcu, Mehmet; Zito, Julie M.] Univ Maryland, Pharmaceut Hlth Serv Res, Baltimore, MD 21201 USA. [McKean, Stephen; Warnock, Rob; Herbert, Peter; Verma, Sumit] Acumen LLC, Burlingame, CA USA. [Worrall, Chris M.; Chu, Steve] Ctr Medicare & Medicaid Serv, Washington, DC USA. [Mohamadi, Ali] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD SEP PY 2015 VL 24 SU 1 SI SI MA 28 BP 16 EP 17 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA DD5QW UT WOS:000369980200029 ER PT J AU Wang, CL Kane, R Levenson, M Kelman, J Wernecke, M Lee, JY Worrall, C MaCurdy, T Graham, DJ AF Wang, Cunlin Kane, Robert Levenson, Mark Kelman, Jeffrey Wernecke, Mickel Lee, Joo-Yeon Worrall, Chris MaCurdy, Thomas Graham, David J. TI Risk of Major Adverse Cardiovascular Events and Transfusion Among US Hemodialysis Patients After CMS and FDA Policy Changes in 2011 SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Wang, Cunlin; Kane, Robert; Levenson, Mark; Lee, Joo-Yeon; Graham, David J.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Kelman, Jeffrey; Worrall, Chris] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Wernecke, Mickel; MaCurdy, Thomas] ACUMEN LLC, Burlingame, CA USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD SEP PY 2015 VL 24 SU 1 SI SI MA 27 BP 16 EP 16 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA DD5QW UT WOS:000369980200028 ER PT J AU Graham, DJ Howery, AE Major, JM Xie, DQ Bipat, V Moeny, D Voss, S Young, J Lan, L MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Howery, Andrew E. Major, Jacqueline M. Xie, Diqiong Bipat, Vedita Moeny, David Voss, Stephen Young, Jessica Lan, Ling MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Risk of Esophageal or Gastric Cardia Cancer in Elderly Medicare Beneficiaries Treated with Oral Bisphosphonates SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Graham, David J.; Major, Jacqueline M.; Xie, Diqiong; Moeny, David; Voss, Stephen; Lan, Ling] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Howery, Andrew E.; Bipat, Vedita; Young, Jessica; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Stanford, CA 94305 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare Serv, Washington, DC USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicaid Serv, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD SEP PY 2015 VL 24 SU 1 SI SI MA 51 BP 30 EP 31 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA DD5QW UT WOS:000369980200052 ER PT J AU Reichman, ME Wernecke, M Yap, J Chillarige, Y Liao, JM Keeton, S Goulding, M Mott, K Kelman, JA Graham, DJ AF Reichman, Marsha E. Wernecke, Michael Yap, John Chillarige, Yoganand Liao, Jiemin Keeton, Stephine Goulding, Margie Mott, Katrina Kelman, Jeffrey A. Graham, David J. TI Drug-associated Angioedema: Effect Modification by Race SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Reichman, Marsha E.; Yap, John; Keeton, Stephine; Goulding, Margie; Mott, Katrina; Graham, David J.] US FDA, Silver Spring, MD USA. [Wernecke, Michael; Chillarige, Yoganand; Liao, Jiemin] Acumen LLC, Burlingame, CA USA. [Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD SEP PY 2015 VL 24 SU 1 SI SI MA 546 BP 312 EP 312 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA DD5QW UT WOS:000369980200537 ER PT J AU Graham, DJ Nelson, LM Yang, J Calia, K Wyman, J Howery, AE MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Nelson, Lorene M. Yang, Jeff Calia, Katlyn Wyman, Jason Howery, Andrew E. MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Diabetes, Pancreatitis, and Pancreatic Cancer Risk: Implications for Study of Associations Between Diabetes Medications and Pancreatic Cancer SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Graham, David J.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Nelson, Lorene M.; MaCurdy, Thomas E.] Stanford Univ, Stanford, CA 94305 USA. [Yang, Jeff; Calia, Katlyn; Wyman, Jason; Howery, Andrew E.; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare Serv, Washington, DC USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicaid Serv, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD SEP PY 2015 VL 24 SU 1 SI SI MA 751 BP 429 EP 429 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA DD5QW UT WOS:000369980201043 ER PT J AU Powers, C Gabriel, MH Encinosa, W Mostashari, F Bynum, J AF Powers, Christopher Gabriel, Meghan Hufstader Encinosa, William Mostashari, Farzad Bynum, Julie TI Meaningful use stage 2 e-prescribing threshold and adverse drug events in the Medicare Part D population with diabetes SO JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION LA English DT Article DE electronic prescribing; adverse drug events; Medicare Part D ID HEALTH INFORMATION-TECHNOLOGY; BENEFITS; COSTS; CARE AB Evidence supports the potential for e-prescribing to reduce the incidence of adverse drug events (ADEs) in hospital-based studies, but studies in the ambulatory setting have not used occurrence of ADE as their outcome. Using the "prescription origin code" in 2011 Medicare Part D prescription drug events files, the authors investigate whether physicians who meet the meaningful use stage 2 threshold for e-prescribing (a parts per thousand yen50% of prescriptions e-prescribed) have lower rates of ADEs among their diabetic patients. Risk of any patient with diabetes in the provider's panel having an ADE from anti-diabetic medications was modeled adjusted for prescriber and patient panel characteristics. Physician e-prescribing to Medicare beneficiaries was associated with reduced risk of ADEs among their diabetes patients (Odds Ratio: 0.95; 95% CI, 0.94-0.96), as were several prescriber and panel characteristics. However, these physicians treated fewer patients from disadvantaged populations. C1 [Powers, Christopher] Off Enterprise Data & Analyt, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Gabriel, Meghan Hufstader] Off Natl Coordinator Hlth Informat Technol, Washington, DC 20201 USA. [Encinosa, William] Agcy Healthcare Res, Ctr Delivery Org & Markets, Rockville, MD 20850 USA. [Mostashari, Farzad] Aledade, Bethesda, MD 20814 USA. [Bynum, Julie] Geisel Sch Med Dartmouth, Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH 03766 USA. RP Bynum, J (reprint author), 35 Centerra Pkwy, Lebanon, NH 03766 USA. EM julie.bynum@dartmouth.edu FU Department for Health and Human Services; CMS (Bynum) FX All authors made substantial contribution to the manuscript (planning, analysis, writing, and editing). Christopher Powers had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis and he conducted and is responsible for the data analysis. No direct funding was provided for this study although investigators where either employees (Powers, Gabriel, Encinosa, Mostashari) of the Department for Health and Human Services or on an intergovernmental personnel agreement with the CMS (Bynum). The design and conduct of the study; collection, management, analysis, interpretation of the data, manuscript preparation, and the decision to submit the manuscript for publication were conducted by authors without input from HHS or CMS; the manuscript had to be cleared for submission by CMS prior to submission. NR 18 TC 1 Z9 1 U1 2 U2 4 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 1067-5027 EI 1527-974X J9 J AM MED INFORM ASSN JI J. Am. Med. Inf. Assoc. PD SEP PY 2015 VL 22 IS 5 BP 1094 EP 1098 DI 10.1093/jamia/ocv036 PG 5 WC Computer Science, Information Systems; Computer Science, Interdisciplinary Applications; Health Care Sciences & Services; Information Science & Library Science; Medical Informatics SC Computer Science; Health Care Sciences & Services; Information Science & Library Science; Medical Informatics GA CR4DS UT WOS:000361282600019 PM 25948698 ER PT J AU Lurie, N Finne, K Worrall, C Jauregui, M Thaweethai, T Margolis, G Kelman, J AF Lurie, Nicole Finne, Kristen Worrall, Chris Jauregui, Maria Thaweethai, Tanayott Margolis, Gregg Kelman, Jeffrey TI Early Dialysis and Adverse Outcomes After Hurricane Sandy SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE Disaster preparedness; emergency response; natural disaster; vulnerable population; early dialysis; hemodialysis; end-stage renal disease (ESRD); emergency department (ED) visit; hospitalization; mortality; missed dialysis session; adverse outcome; Hurricane Sandy ID DISASTER PREPAREDNESS; CARE; LESSONS; KATRINA AB Background: Hemodialysis patients have historically experienced diminished access to care and increased adverse outcomes after natural disasters. Although "early dialysis" in advance of a storm is promoted as a best practice, evidence for its effectiveness as a protective measure is lacking. Building on prior work, we examined the relationship between the receipt of dialysis ahead of schedule before the storm (also known as early dialysis) and adverse outcomes of patients with end-stage renal disease in the areas most affected by Hurricane Sandy. Study Design: Retrospective cohort analysis, using claims data from the Centers for Medicare & Medicaid Services Datalink Project. Setting & Participants: Patients receiving long-term hemodialysis in New York City and the state of New Jersey, the areas most affected by Hurricane Sandy. Factor: Receipt of early dialysis compared to their usual treatment pattern in the week prior to the storm. Outcomes: Emergency department (ED) visits, hospitalizations, and 30-day mortality following the storm. Results: Of 13,836 study patients, 8,256 (60%) received early dialysis. In unadjusted logistic regression models, patients who received early dialysis were found to have lower odds of ED visits (OR, 0.75; 95% CI, 0.63-0.89; P = 0.001) and hospitalizations (OR, 0.77; 95% CI, 0.65-0.92; P = 0.004) in the week of the storm and similar odds of 30-day mortality (OR, 0.80; 95% CI, 0.58-1.09; P = 0.2). In adjusted multivariable logistic regression models, receipt of early dialysis was associated with lower odds of ED visits (OR, 0.80; 95% CI, 0.67-0.96; P = 0.01) and hospitalizations (OR, 0.79; 95% CI, 0.66-0.94; P = 0.01) in the week of the storm and 30-day mortality (OR, 0.72; 95% CI, 0.52-0.997; P = 0.048). Limitations: Inability to determine which patients were offered early dialysis and declined and whether important unmeasured patient characteristics are associated with receipt of early dialysis. Conclusions: Patients who received early dialysis had significantly lower odds of having an ED visit and hospitalization in the week of the storm and of dying within 30 days. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is a US Government Work. There are no restrictions on its use. C1 [Lurie, Nicole; Finne, Kristen; Margolis, Gregg] US Dept HHS, Off Assistant Secretary Preparedness & Response, Washington, DC 20201 USA. [Worrall, Chris; Kelman, Jeffrey] US Dept HHS, Ctr Medicare Serv, Washington, DC 20201 USA. [Worrall, Chris; Kelman, Jeffrey] US Dept HHS, Ctr Medicaid Serv, Washington, DC 20201 USA. [Jauregui, Maria; Thaweethai, Tanayott] Acumen LLC, Burlingame, CA USA. RP Lurie, N (reprint author), US Dept HHS, Preparedness & Response, Off Secretary, 200 Independence Ave SW,Rm 638G, Washington, DC 20201 USA. EM nicole.lurie@hhs.gov FU CMS DataLink contract; Acumen LLC. FX Support: This study was supported through the CMS DataLink contract with Acumen LLC. The funders of this study had a role in the study design, interpretation of the data, writing the report, and the decision to submit the report for publication. NR 24 TC 2 Z9 2 U1 0 U2 2 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 SEP PY 2015 VL 66 IS 3 BP 507 EP 512 DI 10.1053/j.ajkd.2015.04.050 PG 6 WC Urology & Nephrology SC Urology & Nephrology GA CP8BG UT WOS:000360115400024 PM 26120039 ER PT J AU Keehan, SP Cuckler, GA Sisko, AM Madison, AJ Smith, SD Stone, DA Poisal, JA Wolfe, CJ Lizonitz, JM AF Keehan, Sean P. Cuckler, Gigi A. Sisko, Andrea M. Madison, Andrew J. Smith, Sheila D. Stone, Devin A. Poisal, John A. Wolfe, Christian J. Lizonitz, Joseph M. TI National Health Expenditure Projections, 2014-24: Spending Growth Faster Than Recent Trends SO HEALTH AFFAIRS LA English DT Article AB Health spending growth in the United States is projected to average 5.8 percent for 2014-24, reflecting the Affordable Care Act's coverage expansions, faster economic growth, and population aging. Recent historically low growth rates in the use of medical goods and services, as well as medical prices, are expected to gradually increase. However, in part because of the impact of continued cost-sharing increases that are anticipated among health plans, the acceleration of these growth rates is expected to be modest. The health share of US gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024. C1 [Keehan, Sean P.] Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD 21244 USA. [Cuckler, Gigi A.; Sisko, Andrea M.; Madison, Andrew J.; Smith, Sheila D.; Stone, Devin A.; Wolfe, Christian J.; Lizonitz, Joseph M.] CMS Off Actuary, New York, NY USA. [Poisal, John A.] CMS Off Actuary, Natl Hlth Stat Grp, New York, NY USA. RP Keehan, SP (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD 21244 USA. EM sean.keehan@cms.hhs.gov NR 15 TC 44 Z9 44 U1 3 U2 10 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 AUG PY 2015 VL 34 IS 8 BP 1407 EP 1417 DI 10.1377/hlthaff.2015.0600 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CR2FH UT WOS:000361141000022 PM 26220668 ER PT J AU Drawz, PE Archdeacon, P McDonald, CJ Powe, NR Smith, KA Norton, J Williams, DE Patel, UD Narva, A AF Drawz, Paul E. Archdeacon, Patrick McDonald, Clement J. Powe, Neil R. Smith, Kimberly A. Norton, Jenna Williams, Desmond E. Patel, Uptal D. Narva, Andrew TI CKD as a Model for Improving Chronic Disease Care through Electronic Health Records SO CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article ID CHRONIC KIDNEY-DISEASE; INCIDENT HEMODIALYSIS-PATIENTS; INFORMATION-TECHNOLOGY; CONTROLLED-TRIAL; AMBULATORY-CARE; CLINICAL-TRIALS; CHRONIC ILLNESS; BLOOD-PRESSURE; UNITED-STATES; MORTALITY AB Electronic health records have the potential to improve the care of patients with chronic medical conditions. CKD provides a unique opportunity to show this potential: the disease is common in the United States, there is significant room to improve CKD detection and management, CKD and its related conditions are defined primarily by objective laboratory data, CKD care requires collaboration by a diverse team of health care professionals, and improved access to CKD-related data would enable identification of a group of patients at high risk for multiple adverse outcomes. However, to realize the potential for improvement in CKD-related care, electronic health records will need to provide optimal functionality for providers and patients and interoperability across multiple health care settings. The goal of the National Kidney Disease Education Program Health Information Technology Working Group is to enable and support the widespread interoperability of data related to kidney health among health care software applications to optimize CKD detection and management. Over the course of the last 2 years, group members met to identify general strategies for using electronic health records to improve care for patients with CKD. This paper discusses these strategies and provides general goals for appropriate incorporation of CKD-related data into electronic health records and corresponding design features that may facilitate (1) optimal care of individual patients with CKD through improved access to clinical information and decision support, (2) clinical quality improvement through enhanced population management capabilities, (3) CKD surveillance to improve public health through wider availability of population-level CKD data, and (4) research to improve CKD management practices through efficiencies in study recruitment and data collection. Although these strategies may be most effectively applied in the setting of CKD, because it is primarily defined by laboratory abnormalities and therefore, an ideal computable electronic health record phenotype, they may also apply to other chronic diseases. C1 [Drawz, Paul E.] Univ Minnesota, Div Renal Dis & Hypertens, Minneapolis, MN USA. [Archdeacon, Patrick] US FDA, Off Med Policy, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [McDonald, Clement J.] Natl Lib Med, Lister Hill Natl Ctr Biomed Commun, Bethesda, MD USA. [Powe, Neil R.] Univ Calif San Francisco, Dept Med, San Francisco, CA USA. [Smith, Kimberly A.] Ctr Medicare & Medicaid Serv, Ctr Clin Stand & Qual, Baltimore, MD USA. [Norton, Jenna; Narva, Andrew] NIDDK, Natl Kidney Dis Educ Program, Bethesda, MD 20892 USA. [Williams, Desmond E.] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA. [Patel, Uptal D.] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA. RP Narva, A (reprint author), NIDDK, Natl Kidney Dis Educ Program, NIH, Bldg 31,Room 9A27 MSC 2560,31 Ctr Dr, Bethesda, MD 20892 USA. EM narvaa@niddk.nih.gov FU National Institutes of Health (NIH) [R01-DK093938, R34-DK102166]; NKDEP HIT Intern FX U.D.P. was supported by National Institutes of Health (NIH) Grants R01-DK093938 and R34-DK102166.; Thanks for support from the NKDEP HIT Intern, Jessica Pereira. NR 56 TC 1 Z9 1 U1 1 U2 7 PU AMER SOC NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1555-9041 EI 1555-905X J9 CLIN J AM SOC NEPHRO JI Clin. J. Am. Soc. Nephrol. PD AUG PY 2015 VL 10 IS 8 BP 1488 EP 1499 DI 10.2215/CJN.00940115 PG 12 WC Urology & Nephrology SC Urology & Nephrology GA CO5AU UT WOS:000359172800025 PM 26111857 ER PT J AU Strawbridge, LM Lloyd, JT Meadow, A Riley, GF Howell, BL AF Strawbridge, Larisa M. Lloyd, Jennifer T. Meadow, Ann Riley, Gerald F. Howell, Benjamin L. TI Use of Medicare's Diabetes Self-Management Training Benefit SO HEALTH EDUCATION & BEHAVIOR LA English DT Article DE diabetes; disparities; Medicare; self-management ID QUALITY-OF-CARE; OLDER-PEOPLE; HEALTH-CARE; DISEASE; COSTS; MULTIMORBIDITY; COMPLICATIONS; DISPARITIES; DISORDERS; EDUCATION AB Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to determine DSMT utilization. Multivariate logistic regression analyses evaluated the association of demographic, health status, and provider availability factors with DSMT utilization. Approximately 5% of Medicare beneficiaries with newly diagnosed diabetes used DSMT services. The adjusted odds of any utilization were lower among men compared with women, older individuals compared with younger, non-Whites compared with Whites, people dually eligible for Medicare and Medicaid compared with nondual eligibles, and patients with comorbidities compared with individuals without those conditions. Additionally, the adjusted odds of utilizing DSMT increased as the availability of providers who offered DSMT services increased and varied by Census region. Utilization of DSMT among Medicare beneficiaries with newly diagnosed diabetes is low. There appear to be marked disparities in access to DSMT by demographic and health status factors and availability of DSMT providers. In light of the increasing prevalence of diabetes, future research should identify barriers to DSMT access, describe DSMT providers, and explore the impact of DSMT services. With preventive services being increasingly covered by insurers, the low utilization of DSMT, a preventive service benefit that has existed for almost 15 years, highlights the challenges that may be encountered to achieve widespread dissemination and uptake of the new services. C1 [Strawbridge, Larisa M.; Lloyd, Jennifer T.; Meadow, Ann; Riley, Gerald F.; Howell, Benjamin L.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Strawbridge, LM (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM lara.strawbridge@cms.hhs.gov NR 34 TC 4 Z9 4 U1 0 U2 1 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1090-1981 EI 1552-6127 J9 HEALTH EDUC BEHAV JI Health Educ. Behav. PD AUG PY 2015 VL 42 IS 4 BP 530 EP 538 DI 10.1177/1090198114566271 PG 9 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA CO8GX UT WOS:000359406300012 PM 25616412 ER PT J AU Sanghavi, DM Conway, PH AF Sanghavi, Darshak M. Conway, Patrick H. TI Paying for Prevention A Novel Test of Medicare Value-Based Payment for Cardiovascular Risk Reduction SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Sanghavi, Darshak M.] Ctr Medicare & Medicaid Serv, Prevent & Populat Hlth Models Grp, Baltimore, MD 21244 USA. [Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Sanghavi, DM (reprint author), Ctr Medicare & Medicaid Serv, Prevent & Populat Hlth Models Grp, 7500 Secur Blvd,WB-08-27, Baltimore, MD 21244 USA. EM darshak.sanghavi@cms.hhs.gov NR 4 TC 7 Z9 7 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 14 PY 2015 VL 314 IS 2 BP 123 EP 124 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA CM7JI UT WOS:000357867500008 PM 26021568 ER PT J AU Ganduglia, CM Zezza, M Smith, JD John, SD Franzini, L AF Ganduglia, Cecilia M. Zezza, Mark Smith, Jonathan D. John, Susan D. Franzini, Luisa TI Effect of Public Reporting on MR Imaging Use for Low Back Pain SO RADIOLOGY LA English DT Article ID QUALITY; CARE AB Purpose: To determine whether magnetic resonance (MR) imaging examination rates for low back pain before conservative therapy in the Medicare and privately insured populations changed after introduction of a Centers for Medicare & Medicaid Services public reporting initiative. Materials and Methods: Institutional review board approval was obtained, with waiver of informed consent. A retrospective study was performed by using fee-for-service claims data from Medicare and a commercial carrier (Blue Cross Blue Shield of Texas [BCBSTX]) for Texas enrollees. OP-8 was calculated, which is a publicly reported measure as of 2009 of the proportion of MR imaging examinations performed for low back pain without history of conservative therapy. For 330 463 MR imaging examinations, OP-8 rates, trends, and regional variation were analyzed for 2008-2011 within different outpatient settings-outpatient hospital department (OHD) and nonhospital outpatient department (NOD)-according to payer. Largest-volume hospitals were also evaluated within the Medicare population. Results: No significant reduction was found in annual OP-8 values for Medicare or BCBSTX (Medicare OHD, 0.35 for 2008 vs 0.36 for 2009 [P = .01]; BCBSTX OHD, 0.42 for 2008 vs 0.44 for 2009 [P = .03]; Medicare NOD, 0.33 for 2008 vs 0.35 for 2009 [P < .0001]; and BCBSTX NOD, 0.43 for 2008 vs 0.42 for 2009[P = .23]). These changes were not sustained during subsequent years in the BCBSTX population, and there were no further changes in Medicare rates. Among hospitals with highest Medicare volumes, those with the highest OP-8 rates in 2008 were associated with the highest decrease in their measure. (The annual change rate was negative for all years, with 2008 as the reference [P,.0001 for 2009-2011].) Hospitals with the lowest OP-8 rates had increases in OP-8 rates, which persisted in following years (P = .006 for 2009, P = .037 for 2010, and P = .004 for 2011). Hospitals with baseline OP-8 rates in the 25th-75th percentile remained relatively steady over time. Conclusion: No evidence was found that public reporting (OP-8) reduced MR imaging rates for low back pain without conservative therapy in either Medicare or commercially insured populations in hospital or nonhospital settings. C1 [Ganduglia, Cecilia M.; Franzini, Luisa] Univ Texas Sch Publ Hlth, Dept Management Policy & Community Hlth, Houston, TX 77030 USA. [Zezza, Mark] Commonwealth Fund, New York, NY USA. [Smith, Jonathan D.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [John, Susan D.] Univ Texas Sch Med, Dept Radiol, Houston, TX USA. RP Ganduglia, CM (reprint author), Univ Texas Sch Publ Hlth, Dept Management Policy & Community Hlth, 1200 Pressler St, Houston, TX 77030 USA. EM Cecilia.m.gandugliacazaban@uth.tmc.edu NR 23 TC 1 Z9 1 U1 1 U2 1 PU RADIOLOGICAL SOC NORTH AMERICA PI OAK BROOK PA 820 JORIE BLVD, OAK BROOK, IL 60523 USA SN 0033-8419 J9 RADIOLOGY JI Radiology PD JUL PY 2015 VL 276 IS 1 BP 175 EP 183 DI 10.1148/radiol.15141145 PG 9 WC Radiology, Nuclear Medicine & Medical Imaging SC Radiology, Nuclear Medicine & Medical Imaging GA CP2LL UT WOS:000359708400019 PM 25759966 ER PT J AU Gargis, AS Kalman, L Bick, DP da Silva, C Dimmock, DP Funke, BH Gowrisankar, S Hegde, MR Kulkarni, S Mason, CE Nagarajan, R Voelkerding, KV Worthey, EA Aziz, N Barnes, J Bennett, SF Bisht, H Church, DM Dimitrova, Z Gargis, SR Hafez, N Hambuch, T Hyland, FCL Luna, RA MacCannell, D Mann, T McCluskey, MR McDaniel, TK Ganova-Raeval, LM Rehm, HL Reid, J Campo, DS Resnick, RB Ridge, PG Salit, ML Skums, P Wong, LJC Zehnbauer, BA Zook, JM Lubin, IM AF Gargis, Amy S. Kalman, Lisa Bick, David P. da Silva, Cristina Dimmock, David P. Funke, Birgit H. Gowrisankar, Sivakumar Hegde, Madhuri R. Kulkarni, Shashikant Mason, Christopher E. Nagarajan, Rakesh Voelkerding, Karl V. Worthey, Elizabeth A. Aziz, Nazneen Barnes, John Bennett, Sarah F. Bisht, Himani Church, Deanna M. Dimitrova, Zoya Gargis, Shaw R. Hafez, Nabil Hambuch, Tina Hyland, Fiona C. L. Luna, Ruth Ann MacCannell, Duncan Mann, Tobias McCluskey, Megan R. McDaniel, Timothy K. Ganova-Raeval, Lilia M. Rehm, Heidi L. Reid, Jeffrey Campo, David S. Resnick, Richard B. Ridge, Perry G. Salit, Marc L. Skums, Pavel Wong, Lee-Jun C. Zehnbauer, Barbara A. Zook, Justin M. Lubin, Ira M. TI Good laboratory practice for clinical next-generation sequencing informatics pipelines SO NATURE BIOTECHNOLOGY LA English DT Letter ID ACMG RECOMMENDATIONS; INCIDENTAL FINDINGS; STANDARDS C1 [Gargis, Amy S.; Kalman, Lisa; Zehnbauer, Barbara A.; Lubin, Ira M.] Ctr Dis Control & Prevent, Div Lab Syst, Atlanta, GA USA. [Bick, David P.; Dimmock, David P.; Worthey, Elizabeth A.] Med Coll Wisconsin, Dept Pediat, Milwaukee, WI 53226 USA. [da Silva, Cristina; Hegde, Madhuri R.] Emory Univ, Sch Med, Dept Human Genet, Atlanta, GA USA. [Funke, Birgit H.; Gowrisankar, Sivakumar; Rehm, Heidi L.] Partners Healthcare Personalized Med, Lab Mol Med, Cambridge, MA USA. [Funke, Birgit H.; Gowrisankar, Sivakumar; Rehm, Heidi L.] Harvard Univ, Sch Med, Dept Pathol, Boston, MA USA. [Kulkarni, Shashikant] Washington Univ, Sch Med, Dept Genet, St Louis, MO 63110 USA. [Kulkarni, Shashikant] Washington Univ, Sch Med, Dept Pediat, St Louis, MO 63110 USA. [Kulkarni, Shashikant; Nagarajan, Rakesh] Washington Univ, Sch Med, Dept Pathol & Immunol, St Louis, MO USA. [Mason, Christopher E.] Cornell Univ, Dept Physiol & Biophys, New York, NY 10021 USA. [Voelkerding, Karl V.; Ridge, Perry G.] Univ Utah, Dept Pathol, Salt Lake City, UT USA. [Voelkerding, Karl V.] Associated Reg & Univ Pathologists ARUP Labs, Inst Clin & Expt Pathol, Salt Lake City, UT USA. [Aziz, Nazneen] Coll Amer Pathologists, Northfield, IL USA. [Barnes, John] Ctr Dis Control & Prevent, Natl Ctr Immunizat & Resp Dis, Atlanta, GA USA. [Bennett, Sarah F.] Ctr Medicare & Medicaid Serv, Div Lab Serv, Baltimore, MD USA. [Bisht, Himani] US FDA, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [Church, Deanna M.] NIH, Natl Ctr Biotechnol Informat, Bethesda, MD 20892 USA. [Dimitrova, Zoya; Ganova-Raeval, Lilia M.; Campo, David S.] Ctr Dis Control & Prevent, Div Viral Hepatitis, Atlanta, GA USA. [Gargis, Shaw R.] Ctr Dis Control & Prevent, Div Select Agents & Toxins, Atlanta, GA USA. [Hafez, Nabil; Resnick, Richard B.; Skums, Pavel] GenomeQuest, Westborough, MA USA. [Hambuch, Tina] Illumina, Clin Serv, San Diego, CA USA. [Hyland, Fiona C. L.] Thermo Fisher Sci, San Francisco, CA USA. [Luna, Ruth Ann] Texas Childrens Hosp, Texas Childrens Microbiome Ctr, Houston, TX USA. [Luna, Ruth Ann] Baylor Coll Med, Dept Pathol & Immunol, Houston, TX 77030 USA. [MacCannell, Duncan] Ctr Dis Control & Prevent, Natl Ctr Emerging & Zoonot Infect Dis, Atlanta, GA USA. [Mann, Tobias] Illumina, San Diego, CA USA. [McCluskey, Megan R.] SoftGenetics, State Coll, State Coll, PA USA. [McDaniel, Timothy K.; Wong, Lee-Jun C.] Illumina, Oncol, San Diego, CA USA. [Reid, Jeffrey] Baylor Coll Med, Dept Mol & Human Genet, Houston, TX 77030 USA. [Salit, Marc L.; Zook, Justin M.] NIST, Mat Measurement Lab, Gaithersburg, MD 20899 USA. RP Gargis, AS (reprint author), Ctr Dis Control & Prevent, Div Preparedness & Emerging Infect, Atlanta, GA 30322 USA. RI Zook, Justin/B-7000-2008 OI Zook, Justin/0000-0003-2309-8402 FU NHGRI NIH HHS [U01HG006500, U41HG006834] NR 11 TC 26 Z9 28 U1 2 U2 12 PU NATURE PUBLISHING GROUP PI NEW YORK PA 75 VARICK ST, 9TH FLR, NEW YORK, NY 10013-1917 USA SN 1087-0156 EI 1546-1696 J9 NAT BIOTECHNOL JI Nat. Biotechnol. PD JUL PY 2015 VL 33 IS 7 BP 689 EP 693 DI 10.1038/nbt.3237 PG 5 WC Biotechnology & Applied Microbiology SC Biotechnology & Applied Microbiology GA CN4JJ UT WOS:000358396100018 PM 26154004 ER PT J AU Goede, SL Kuntz, KM van Ballegooijen, M Knudsen, AB Lansdorp-Vogelaar, I Tangka, FK Howard, DH Chin, J Zauber, AG Seeff, LC AF Goede, Simon L. Kuntz, Karen M. van Ballegooijen, Marjolein Knudsen, Amy B. Lansdorp-Vogelaar, Iris Tangka, Florence K. Howard, David H. Chin, Joseph Zauber, Ann G. Seeff, Laura C. TI Cost-Savings to Medicare From Pre-Medicare Colorectal Cancer Screening SO MEDICAL CARE LA English DT Article DE colorectal cancer; screening; computer simulation; prevention and control ID SOCIETY-TASK-FORCE; LARGE-BOWEL; AMERICAN-COLLEGE; LARGE-INTESTINE; UNITED-STATES; COLONOSCOPY; POLYPS; AUTOPSY; COLON; CARE AB Background:Many individuals have not received recommended colorectal cancer (CRC) screening before they become Medicare eligible at the age of 65. We aimed to estimate the long-term implications of increased CRC screening in the pre-Medicare population (50-64 y) on costs in the pre-Medicare and Medicare populations (65+ y).Methods:We used 2 independently developed microsimulation models [Microsimulation Screening Analysis Colon (MISCAN) and Simulation Model of CRC (SimCRC)] to project CRC screening and treatment costs under 2 scenarios, starting in 2010: current trends (60% of the population up-to-date with screening recommendations) and enhanced participation (70% up-to-date). The population was scaled to the projected US population for each year between 2010 and 2060. Costs per year were derived by age group (50-64 and 65+ y).Results:By 2060, the discounted cumulative total costs in the pre-Medicare population were $35.7 and $28.1 billion higher with enhanced screening participation, than in the current trends scenario ($252.1 billion with MISCAN and $239.5 billion with SimCRC, respectively). Because of CRC treatment savings with enhanced participation, cumulative costs in the Medicare population were $18.3 and $32.7 billion lower (current trends: $423.5 billion with MISCAN and $372.8 billion with SimCRC). Over the 50-year time horizon an estimated 60% (MISCAN) and 89% (SimCRC) of the increased screening costs could be offset by savings in Medicare CRC treatment costs.Conclusion:Increased CRC screening participation in the pre-Medicare population could reduce CRC incidence and mortality, whereas the additional screening costs can be largely offset by long-term Medicare treatment savings. C1 [Goede, Simon L.; van Ballegooijen, Marjolein; Lansdorp-Vogelaar, Iris] Erasmus Univ, Dept Publ Hlth, Med Ctr, NL-3000 CA Rotterdam, Netherlands. [Kuntz, Karen M.] Univ Minnesota, Div Hlth Policy & Management, Minneapolis, MN USA. [Knudsen, Amy B.] Massachusetts Gen Hosp, Dept Radiol, Inst Technol Assessment, Boston, MA 02114 USA. [Tangka, Florence K.; Seeff, Laura C.] Ctr Dis Control & Prevent, Div Canc Prevent & Control, Atlanta, GA USA. [Howard, David H.] Emory Univ, Dept Hlth Policy & Management, Atlanta, GA 30322 USA. [Chin, Joseph] Ctr Medicare Serv, Coverage & Anal Grp, Baltimore, MD USA. [Chin, Joseph] Ctr Medicaid Serv, Coverage & Anal Grp, Baltimore, MD USA. [Zauber, Ann G.] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10021 USA. RP Goede, SL (reprint author), Erasmus Univ, Dept Publ Hlth, Med Ctr, POB 2040, NL-3000 CA Rotterdam, Netherlands. EM s.goede@erasmusmc.nl FU National Cancer Institute at the National Institutes of Health [U01-CA-088204, U01-CA-097426, U01-CA-115953, U01-CA-152959]; Centers for Disease Control and Prevention FX Supported by the National Cancer Institute at the National Institutes of Health (grants: U01-CA-088204, U01-CA-097426, U01-CA-115953, and U01-CA-152959) for the Cancer Intervention and Surveillance Modeling Network with supplemental funding from the Centers for Disease Control and Prevention. D.H.H.'s time on the project was supported by an Interagency Personnel Agreement with the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the National Cancer Institute, or the National Institutes of Health. NR 47 TC 2 Z9 2 U1 0 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0025-7079 EI 1537-1948 J9 MED CARE JI Med. Care PD JUL PY 2015 VL 53 IS 7 BP 630 EP 638 DI 10.1097/MLR.0000000000000380 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA CL4QE UT WOS:000356937400010 PM 26067885 ER PT J AU Chenoweth, CE Hines, SC Hall, KK Saran, R Kalbfleisch, JD Spencer, T Frank, KM Carlson, D Deane, J Roys, E Scholz, N Parrotte, C Messana, JM AF Chenoweth, Carol E. Hines, Stephen C. Hall, Kendall K. Saran, Rajiv Kalbfleisch, John D. Spencer, Teri Frank, Kelly M. Carlson, Diane Deane, Jan Roys, Erik Scholz, Natalie Parrotte, Casey Messana, Joseph M. TI Variation in Infection Prevention Practices in Dialysis Facilities: Results From the National Opportunity to Improve Infection Control in ESRD (End-Stage Renal Disease) Project SO INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY LA English DT Article ID BLOOD-STREAM INFECTIONS; HEMODIALYSIS AB OBJECTIVE. To observe patient care across hemodialysis facilities enrolled in the National Opportunity to Improve Infection Control in ESRD (end-stage renal disease) (NOTICE) project in order to evaluate adherence to evidence-based practices aimed at prevention of infection. SETTING AND PARTICIPANTS. Thirty-four hemodialysis facilities were randomly selected from among 772 facilities in 4 end-stage renal disease participating networks. Facility selection was stratified on dialysis organization affiliation, size, socioeconomic status, and urban/rural status. MEASUREMENTS. Trained infection control evaluators used an infection control worksheet to observe 73 distinct infection control practices at the hemodialysis facilities, from October 1, 2011, through January 31, 2012. RESULTS. There was considerable variation in infection control practices across enrolled facilities. Overall adherence to recommended practices was 68% (range, 45%-92%) across all facilities. Overall adherence to expected hand hygiene practice was 72% (range, 10%-100%). Compliance to hand hygiene before and after procedures was high; however, during procedures hand hygiene compliance averaged 58%. Use of chlorhexidine as the specific agent for exit site care was 19% overall but varied from 0% to 35% by facility type. The 8 checklists varied in the frequency of perfect performance from 0% for meeting every item on the checklist for disinfection practices to 22% on the arteriovenous access practices at initiation. CONCLUSIONS. Our findings suggest that there are many areas for improvement in hand hygiene and other infection prevention practices in end-stage renal disease. These NOTICE project findings will help inform the development of a larger quality improvement initiative at dialysis facilities. C1 [Chenoweth, Carol E.; Saran, Rajiv; Kalbfleisch, John D.; Roys, Erik; Scholz, Natalie; Parrotte, Casey; Messana, Joseph M.] Univ Michigan, Ann Arbor, MI 48109 USA. [Hines, Stephen C.] Hlth Res & Educ Trust, Chicago, IL USA. [Hall, Kendall K.] Agcy Healthcare Res & Qual, Rockville, MD USA. [Spencer, Teri] TB Spencer Consulting, Fallbrook, CA USA. [Frank, Kelly M.] Ctr Medicaid Serv, Waterloo, IA USA. [Frank, Kelly M.] Ctr Medicare Serv, Waterloo, IA USA. [Carlson, Diane; Deane, Jan] Renal Network Upper Midwest, St Paul, MN USA. RP Chenoweth, CE (reprint author), Univ Michigan, Med Ctr, Taubman Ctr 3119, 1500 E Med Ctr Dr, Ann Arbor, MI 48109 USA. EM cchenow@umich.edu FU Agency for Healthcare Research and Quality; Health Research Educational Trust [HHSA290200600022I] FX The Agency for Healthcare Research and Quality and the Health Research Educational Trust (contract HHSA290200600022I, "Improving Infection Control Practices in End-Stage Renal Disease [ESRD] Facilities"). NR 17 TC 1 Z9 1 U1 0 U2 2 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 32 AVENUE OF THE AMERICAS, NEW YORK, NY 10013-2473 USA SN 0899-823X EI 1559-6834 J9 INFECT CONT HOSP EP JI Infect. Control Hosp. Epidemiol. PD JUL PY 2015 VL 36 IS 7 BP 802 EP 806 DI 10.1017/ice.2015.55 PG 5 WC Public, Environmental & Occupational Health; Infectious Diseases SC Public, Environmental & Occupational Health; Infectious Diseases GA CK8UE UT WOS:000356513400007 PM 25773538 ER PT J AU Stevens, JP Nyweide, D Maresh, S Zaslavsky, A Shrank, W Howell, MD Landon, BE AF Stevens, Jennifer P. Nyweide, David Maresh, Sha Zaslavsky, Alan Shrank, William Howell, Michael D. Landon, Bruce E. TI Variation in Inpatient Consultation Among Older Adults in the United States SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE consultation; hospital care; variation; medicare ID PREOPERATIVE MEDICAL CONSULTATION; GEOGRAPHIC-VARIATION; INTENSIVE-CARE; IMPACT; PHYSICIANS; SERVICES; TRIAL AB Differences among hospitals in the use of inpatient consultation may contribute to variation in outcomes and costs for hospitalized patients, but basic epidemiologic data on consultations nationally are lacking. The purpose of the study was to identify physician, hospital, and geographic factors that explain variation in rates of inpatient consultation. This was a retrospective observational study. This work included 3,118,080 admissions of Medicare patients to 4,501 U.S. hospitals in 2009 and 2010. The primary outcome measured was number of consultations conducted during the hospitalization, summarized at the hospital level as the number of consultations per 1,000 Medicare admissions, or "consultation density." Consultations occurred 2.6 times per admission on average. Among non-critical access hospitals, use of consultation varied 3.6-fold across quintiles of hospitals (933 versus 3,390 consultations per 1,000 admissions, lowest versus highest quintiles, p < 0.001). Sicker patients received greater intensity of consultation (rate ratio [RR] 1.18, 95 % CI 1.17-1.18 for patients admitted to ICU; and RR 1.19, 95 % CI 1.18-1.20 for patients who died). However, even after controlling for patient-level factors, hospital characteristics also predicted differences in rates of consultation. For example, hospital size (large versus small, RR 1.31, 95 % CI 1.25-1.37), rural location (rural versus urban, RR 0.78, CI 95 % 0.76-0.80), ownership status (public versus not-for-profit, RR 0.94, 95 % CI 0.91-0.97), and geographic quadrant (Northeast versus West, RR 1.17, 95 % CI 1.12-1.21) all influenced the intensity of consultation use. Hospitals exhibit marked variation in the number of consultations per admission in ways not fully explained by patient characteristics. Hospital "consultation density" may constitute an important focus for monitoring resource use for hospitals or health systems. C1 [Stevens, Jennifer P.; Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Ctr Healthcare Delivery Sci, Boston, MA 02215 USA. [Stevens, Jennifer P.] Beth Israel Deaconess Med Ctr, Dept Med, Div Pulm Crit Care & Sleep Med, Boston, MA 02215 USA. [Nyweide, David; Maresh, Sha] Ctr Medicare Serv, Ctr Medicare & Medicaid Innovat, Dept Hlth & Human Serv, Baltimore, MD USA. [Nyweide, David; Maresh, Sha] Ctr Medicaid Serv, Ctr Medicare & Medicaid Innovat, Dept Hlth & Human Serv, Baltimore, MD USA. [Zaslavsky, Alan; Landon, Bruce E.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Shrank, William] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02115 USA. [Howell, Michael D.] Univ Chicago, Ctr Qual, Chicago, IL 60637 USA. [Howell, Michael D.] Univ Chicago, Sect Pulm & Crit Care, Chicago, IL 60637 USA. [Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Boston, MA 02215 USA. RP Landon, BE (reprint author), Harvard Univ, Sch Med, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA. EM landon@hcp.med.harvard.edu NR 25 TC 3 Z9 3 U1 1 U2 2 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUL PY 2015 VL 30 IS 7 BP 992 EP 999 DI 10.1007/s11606-015-3216-7 PG 8 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA CK8AL UT WOS:000356459400023 PM 25693650 ER PT J AU Howell, BL Conway, PH Rajkumar, R AF Howell, Benjamin L. Conway, Patrick H. Rajkumar, Rahul TI Guiding Principles for Center for Medicare & Medicaid Innovation Model Evaluations SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Howell, Benjamin L.; Conway, Patrick H.; Rajkumar, Rahul] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Conway, PH (reprint author), Ctr Medicare & Medicaid Serv, 7500 Security Blvd,Mailstop S3-02-01, Baltimore, MD 21244 USA. EM patrick.conway@cms.hhs.gov NR 8 TC 8 Z9 8 U1 1 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 16 PY 2015 VL 313 IS 23 BP 2317 EP 2318 DI 10.1001/jama.2015.2902 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA CK5XE UT WOS:000356300200011 PM 25893889 ER PT J AU Khullar, D Chokshi, DA Kocher, R Reddy, A Basu, K Conway, PH Rajkumar, R AF Khullar, Dhruv Chokshi, Dave A. Kocher, Robert Reddy, Ashok Basu, Karna Conway, Patrick H. Rajkumar, Rahul TI Behavioral Economics and Physician Compensation - Promise and Challenges SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID HEALTH-CARE C1 [Khullar, Dhruv] Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA. [Chokshi, Dave A.] New York City Hlth & Hosp Corp, New York, NY USA. [Chokshi, Dave A.] NYU, Langone Med Ctr, Dept Populat Hlth, New York, NY USA. [Basu, Karna] CUNY, Hunter Coll, Dept Econ, New York, NY 10021 USA. [Basu, Karna] CUNY, Grad Ctr, New York, NY USA. [Kocher, Robert] Venrock Partners, Palo Alto, CA USA. [Reddy, Ashok] Univ Penn, Robert Wood Johnson Fdn, Clin Scholars Program, Philadelphia, PA 19104 USA. [Conway, Patrick H.; Rajkumar, Rahul] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Khullar, D (reprint author), Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA. OI Chokshi, Dave/0000-0001-7467-4591 NR 5 TC 16 Z9 16 U1 0 U2 5 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JUN 11 PY 2015 VL 372 IS 24 BP 2281 EP 2283 DI 10.1056/NEJMp1502312 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA CK2DB UT WOS:000356019200003 PM 26061834 ER PT J AU Nyweide, DJ Lee, W Cuerdon, TT Pham, HH Cox, M Rajkumar, R Conway, PH AF Nyweide, David J. Lee, Woolton Cuerdon, Timothy T. Pham, Hoangmai H. Cox, Megan Rajkumar, Rahul Conway, Patrick H. TI Association of Pioneer Accountable Care Organizations vs Traditional Medicare Fee for Service With Spending, Utilization, and Patient Experience SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID ALTERNATIVE QUALITY; CONTRACT; BENEFICIARIES; PERFORMANCE; GROWTH AB IMPORTANCE The Pioneer Accountable Care Organization (ACO) Model aims to drive health care organizations to reduce expenditures while improving quality for fee-for-service (FFS) Medicare beneficiaries. OBJECTIVE To determine whether FFS beneficiaries aligned with Pioneer ACOs had smaller increases in spending and utilization than other FFS beneficiaries while retaining similar levels of care satisfaction in the first 2 years of the Pioneer ACO Model. DESIGN, SETTING, AND PARTICIPANTS Participants were FFS Medicare beneficiaries aligned with 32 ACOs (n = 675 712 in 2012; n = 806 258 in 2013) and a comparison group of alignment-eligible beneficiaries in the same markets (n = 13 203 694 in 2012; n = 12 134 154 in 2013). Analyses comprised difference-in-differences multivariable regression with Oaxaca-Blinder reweighting to model expenditure and utilization outcomes over a 2-year performance period (2012-2013) and 2-year baseline period (2010-2011) as well as adjusted analyses of Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey responses among random samples of beneficiaries in Pioneer ACOs (n = 13 097), FFS (n = 116 255), or Medicare Advantage (n = 203 736) for 2012 care. EXPOSURES Beneficiary alignment with a Pioneer ACO in 2012 or 2013. MAIN OUTCOMES AND MEASURES Medicare spending, utilization, and CAHPS domain scores. RESULTS Total spending for beneficiaries aligned with Pioneer ACOs in 2012 or 2013 increased from baseline to a lesser degree relative to comparison populations. Differential changes in spending were approximately -$ 35.62 (95% CI, -$ 40.12 to -$ 31.12) per-beneficiary-per-month (PBPM) in 2012 and -$ 11.18 (95% CI, -$ 15.84 to -$ 6.51) PBPM in 2013, which amounted to aggregate reductions in increases of approximately -$ 280 (95% CI, -$ 315 to -$ 244) million in 2012 and -$ 105 (95% CI, -$ 148 to -$ 61) million in 2013. Inpatient spending showed the largest differential change of any spending category (-$ 14.40 [95% CI, -$ 17.31 to -$ 11.49] PBPM in 2012; -$ 6.46 [95% CI, -$ 9.26 to -$ 3.66] PBPM in 2013). Changes in utilization of physician services, emergency department, and postacute care followed a similar pattern. Compared with other Medicare beneficiaries, ACO-aligned beneficiaries reported higher mean scores for timely care (77.2 [ACO] vs 71.2 [FFS] vs 72.7 [MA]) and for clinician communication (91.9 [ACO] vs 88.3 [FFS] vs 88.7 [MA]). CONCLUSIONS AND RELEVANCE In the first 2 years of the Pioneer ACO Model, beneficiaries aligned with Pioneer ACOs, as compared with general Medicare FFS beneficiaries, exhibited smaller increases in total Medicare expenditures and differential reductions in utilization of different health services, with little difference in patient experience. C1 [Nyweide, David J.; Lee, Woolton; Cuerdon, Timothy T.; Pham, Hoangmai H.; Cox, Megan; Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD 21244 USA. [Nyweide, David J.; Lee, Woolton; Cuerdon, Timothy T.; Pham, Hoangmai H.; Cox, Megan; Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD 21244 USA. [Nyweide, David J.; Lee, Woolton; Cuerdon, Timothy T.; Pham, Hoangmai H.; Cox, Megan; Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. RP Rajkumar, R (reprint author), Ctr Medicare Serv, Ctr Medicare & Medicaid Innovat, 7500 Secur Blvd,Mailstop WB-06-05, Baltimore, MD 21244 USA. EM rahul.rajkumar@cms.hhs.gov FU Centers for Medicare & Medicaid Services (CMS) [HHSM-500-2011-00019i/HHSM-500-T0002] FX CMS contracted L&M Policy Research LLC and its partners-Abt Associates, Avalere Health, Social & Scientific Systems, and Truven Health Analytics-to conduct the claims and CAHPS analyses. SAS EG (version 5.1) was used to create the claims files, and STATA (version 13.0) was used to analyze claims and CAHPS data. CMS provided guidance with performing and interpreting the analyses and designed and wrote the manuscript. This article is based on the work of the evaluation contractors for the Evaluation of CMMI Accountable Care Organization Initiative performed under Contract HHSM-500-2011-00019i/HHSM-500-T0002 with the Centers for Medicare & Medicaid Services (CMS). CMS provided access to the data to the evaluation contractors to perform analyses under the guidance of Drs Nyweide, Lee, and Cuerdon. In conjunction with the contractors, Drs Nyweide, Lee, and Cuerdon designed the study and helped with interpretation of the data. NR 25 TC 64 Z9 64 U1 1 U2 16 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 2 PY 2015 VL 313 IS 21 BP 2152 EP 2161 DI 10.1001/jama.2015.4930 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA CJ4CC UT WOS:000355430900015 PM 25938875 ER PT J AU Hussey, PS Timbie, JW Burgette, LF Wenger, NS Nyweide, DJ Kahn, KL AF Hussey, Peter S. Timbie, Justin W. Burgette, Lane F. Wenger, Neil S. Nyweide, David J. Kahn, Katherine L. TI Appropriateness of Advanced Diagnostic Imaging Ordering Before and After Implementation of Clinical Decision Support Systems SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 [Hussey, Peter S.] RAND Corp, Boston, MA 02116 USA. [Timbie, Justin W.; Burgette, Lane F.] RAND Corp, Arlington, VA USA. [Wenger, Neil S.; Kahn, Katherine L.] RAND UCLA, Los Angeles, CA USA. [Nyweide, David J.] Ctr Medicare Serv, Baltimore, MD USA. [Nyweide, David J.] Ctr Medicaid Serv, Baltimore, MD USA. RP Hussey, PS (reprint author), RAND Corp, 20 Pk Plaza, Boston, MA 02116 USA. EM hussey@rand.org NR 4 TC 5 Z9 5 U1 1 U2 7 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 2 PY 2015 VL 313 IS 21 BP 2181 EP 2182 DI 10.1001/jama.2015.5089 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA CJ4CC UT WOS:000355430900020 PM 26034960 ER PT J AU James, CV AF James, Cara V. TI Medicare and Minority Communities: Reflections on 50 Years of Progress and a Vision for the Future SO GENERATIONS-JOURNAL OF THE AMERICAN SOCIETY ON AGING LA English DT Article ID CIVIL-RIGHTS; HOSPITALS; CARE; DISPARITIES; RESIDENTS C1 [James, Cara V.] Ctr Medicare & Medicaid Serv, Off Minor Hlth, Baltimore, MD USA. RP James, CV (reprint author), Ctr Medicare & Medicaid Serv, Off Minor Hlth, Baltimore, MD USA. EM cara.james@cms.hhs.gov NR 20 TC 0 Z9 0 U1 0 U2 0 PU AMER SOC AGING PI SAN FRANCISCO PA 833 MARKET ST, STE 511, SAN FRANCISCO, CA 94103-1824 USA SN 0738-7806 J9 GENERATIONS JI Generations-J. Am. Soc. Aging PD SUM PY 2015 VL 39 IS 2 BP 58 EP 66 PG 9 WC Gerontology SC Geriatrics & Gerontology GA DE1JK UT WOS:000370383000010 ER PT J AU Tefera, L Poyer, J Goodrich, K AF Tefera, Lemeneh Poyer, James Goodrich, Kate TI Medicare's Hospital Value-Based Purchasing Program SO HEALTH AFFAIRS LA English DT Letter C1 [Tefera, Lemeneh; Poyer, James; Goodrich, Kate] Ctr Medicare & Medicaid Serv, Baltimore, MD 21218 USA. RP Tefera, L (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21218 USA. NR 4 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 JUN PY 2015 VL 34 IS 6 DI 10.1377/hlthaff.2015.0458 PG 1 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CN5EY UT WOS:000358453800040 ER PT J AU Casalino, LP Pesko, MF Ryan, AM Nyweide, DJ Iwashyna, TJ Sun, XM Mendelsohn, J Moody, J AF Casalino, Lawrence P. Pesko, Michael F. Ryan, Andrew M. Nyweide, David J. Iwashyna, Theodore J. Sun, Xuming Mendelsohn, Jayme Moody, James TI Physician Networks and Ambulatory Care-sensitive Admissions SO MEDICAL CARE LA English DT Article DE physician networks; referrals; ambulatory care-sensitive admissions ID PATIENT-SHARING NETWORKS; ADMINISTRATIVE DATA; SOCIAL NETWORKS; QUALITY; COSTS AB Background: Research on the quality and cost of care traditionally focuses on individual physicians or medical groups. Social network theory suggests that the care a patient receives also depends on the network of physicians with whom a patient's physician is connected. Objectives: The objectives of the study are: (1) identify physician networks; (2) determine whether the rate of ambulatory care-sensitive hospital admissions (ACSAs) varies across networks-even different networks at the same hospital; and (3) determine the relationship between ACSA rates and network characteristics. Research Design: We identified networks by applying network detection algorithms to Medicare 2008 claims for 987,000 beneficiaries in 5 states. We estimated a fixed-effects model to determine the relationship between networks and ACSAs and a multivariable model to determine the relationship between network characteristics and ACSAs. Results: We identified 417 networks. Mean size: 129 physicians; range, 26-963. In the fixed-effects model, ACSA rates varied significantly across networks: there was a 46% difference in rates between networks at the 25th and 75th performance percentiles. At 95% of hospitals with admissions from 2 networks, the networks had significantly different ACSA rates; the mean difference was 36% of the mean ACSA rate. Networks with a higher percentage of primary-care physicians and networks in which patients received care from a larger number of physicians had higher ACSA rates. Conclusions: Physician networks have a relationship with ACSAs that is independent of the physicians in the network. Physician networks could be an important focus for understanding variations in medical care and for intervening to improve care. C1 [Casalino, Lawrence P.] Weill Cornell Med Coll, Dept Healthcare Policy & Res, Div Hlth Policy & Econ, New York, NY 10065 USA. [Pesko, Michael F.; Mendelsohn, Jayme] Weill Cornell Med Coll, Dept Healthcare Policy & Res, New York, NY 10065 USA. [Ryan, Andrew M.] Univ Michigan, Sch Publ Hlth, Dept Hlth Management & Policy, Ann Arbor, MI 48109 USA. [Nyweide, David J.] Ctr Medicare & Medicaid Innovat, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Iwashyna, Theodore J.] Univ Michigan, Dept Pulm & Crit Care, Ann Arbor, MI 48109 USA. [Sun, Xuming] Bur HIV AIDS Prevent & Control, Dept Hlth & Mental Hyg, HIV Epidemiol & Field Serv Program, New York, NY USA. [Moody, James] Duke Univ, Dept Sociol, Durham, NC 27706 USA. [Moody, James] King Abdulaziz Univ, Durham, NC USA. RP Casalino, LP (reprint author), Weill Cornell Med Coll, Dept Healthcare Policy & Res, Div Hlth Policy & Econ, 402 E 67th St,Room LA 217, New York, NY 10065 USA. EM lac2021@med.cornell.edu OI Iwashyna, Theodore/0000-0002-4226-9310 FU Robert Wood Johnson Foundation FX Supported by the Robert Wood Johnson Foundation. NR 19 TC 1 Z9 1 U1 1 U2 12 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0025-7079 EI 1537-1948 J9 MED CARE JI Med. Care PD JUN PY 2015 VL 53 IS 6 BP 534 EP 541 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA CI4NI UT WOS:000354726500011 PM 25906013 ER PT J AU Vaz, LE Kleinman, KP Kawai, AT Jin, R Kassler, WJ Grant, PS Rett, MD Goldmann, DA Calderwood, MS Soumerai, SB Lee, GM AF Vaz, Louise Elaine Kleinman, Kenneth P. Kawai, Alison Tse Jin, Robert Kassler, William J. Grant, Patricia S. Rett, Melisa D. Goldmann, Donald A. Calderwood, Michael S. Soumerai, Stephen B. Lee, Grace M. TI Impact of Medicare's Hospital-Acquired Condition Policy on Infections in Safety Net and Non-Safety Net Hospitals SO INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY LA English DT Article ID CARE-ASSOCIATED INFECTIONS; BLOOD-STREAM INFECTIONS; PAYMENT POLICY; US HOSPITALS; FINANCIAL IMPACT; HEALTH; SURVEILLANCE; ASSOCIATION; PAY AB BACKGROUND. Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals. OBJECTIVE. To determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non-safety net hospitals. design. Interrupted time-series design. SETTING AND PARTICIPANTS. Nonfederal acute care hospitals that reported central line-associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention's National Health Safety Network from July 1, 2007, through December 31, 2013. RESULTS. We did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84-1.09]) or non-safety net (0.99 [0.90-1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non-safety net hospitals (P for 2-way interaction,.87). CONCLUSIONS. The Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line-associated bloodstream infection in safety net or non-safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States. C1 [Vaz, Louise Elaine] Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Div Pediat Infect Dis, Portland, OR 97239 USA. [Kleinman, Kenneth P.; Kawai, Alison Tse; Jin, Robert; Rett, Melisa D.; Calderwood, Michael S.; Soumerai, Stephen B.; Lee, Grace M.] Harvard Univ, Sch Med, Dept Populat Med, Boston, MA USA. [Kleinman, Kenneth P.; Kawai, Alison Tse; Jin, Robert; Rett, Melisa D.; Calderwood, Michael S.; Soumerai, Stephen B.; Lee, Grace M.] Harvard Pilgrim Hlth Care Inst, Boston, MA USA. [Kassler, William J.] Ctr Medicare Serv, Boston, MA USA. [Kassler, William J.] Ctr Medicaid Serv, Boston, MA USA. [Grant, Patricia S.] Methodist Hosp Surg, Addison, TX USA. [Grant, Patricia S.] Assoc Profess Infect Control & Epidemiol, Washington, DC USA. [Goldmann, Donald A.; Lee, Grace M.] Boston Childrens Hosp, Div Infect Dis, Boston, MA USA. [Goldmann, Donald A.] Inst Healthcare Improvement, Cambridge, MA USA. [Calderwood, Michael S.] Brigham & Womens Hosp, Boston, MA 02115 USA. RP Vaz, LE (reprint author), Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Mail Code CDRC P, 707 SW Gaines St, Portland, OR 97239 USA. EM vaz@ohsu.edu FU Agency for Healthcare Research and Quality [R01HS018414]; National Institute of Child Health and Human Development [5T32HD066148, 1T32HD075727] FX Agency for Healthcare Research and Quality (grant R01HS018414 to G.M.L.) and National Institute of Child Health and Human Development (training grants 5T32HD066148 and 1T32HD075727 to L.E.V.). NR 46 TC 4 Z9 4 U1 1 U2 4 PU CAMBRIDGE UNIV PRESS PI NEW YORK PA 32 AVENUE OF THE AMERICAS, NEW YORK, NY 10013-2473 USA SN 0899-823X EI 1559-6834 J9 INFECT CONT HOSP EP JI Infect. Control Hosp. Epidemiol. PD JUN PY 2015 VL 36 IS 6 BP 649 EP 655 DI 10.1017/ice.2015.38 PG 7 WC Public, Environmental & Occupational Health; Infectious Diseases SC Public, Environmental & Occupational Health; Infectious Diseases GA CI7XZ UT WOS:000354981400006 PM 25732568 ER PT J AU Andrade, AA Li, J Radford, MJ Nilasena, DS Gage, BF AF Andrade, Ambar A. Li, Juan Radford, Martha J. Nilasena, David S. Gage, Brian F. TI Clinical Benefit of American College of Chest Physicians versus European Society of Cardiology Guidelines for Stroke Prophylaxis in Atrial Fibrillation SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE atrial fibrillation; epidemiology; outcomes; stroke; thromboembolism ID RISK STRATIFICATION SCHEMES; ANTITHROMBOTIC THERAPY; CLASSIFICATION SCHEMES; NATIONAL REGISTRY; PREDICTING STROKE; WARFARIN; HEMORRHAGE; PREVENTION; ANTICOAGULATION; VALIDATION AB Guidelines for anticoagulant therapy in patients with atrial fibrillation (AF) conflict with each other. The American College of Chest Physicians (ACCP) guidelines suggest no anticoagulant therapy for patients with a CHADS(2) score of 0. The European Society of Cardiology (ESC) prefer anticoagulant therapy for patients with a CHA(2)DS(2)-VASc of 1, which includes 65-74-year-olds with a CHADS(2) score of 0. Resolving this conflicting advice is important, because these guidelines have potential to change anticoagulant therapy in 10 % of the AF population. Using the National Registry of Atrial Fibrillation (NRAF) II data set, we compared these guidelines using stroke equivalents. Based on structured review of 23,657 patient records, we identified 65-74-year-old patients with a CHADS(2) stroke score of 0 and no contraindication to warfarin. We used Medicare claims data to ascertain rates of ischemic stroke, intracranial hemorrhage, and other hemorrhage. We calculated net stroke equivalents for these (N = 478) patients using a weight of 1.5 for intracranial hemorrhages (ICH) and 1.0 for ischemic stroke. In a multivariate analysis, we used 14,466 records with documented atrial fibrillation and adjusted for CHADS(2) and HEMORR2 HAGES score. In 65-74-year-old patients with a CHADS(2) stroke score of 0, the stroke equivalents per 100 patient-years was 2.6 with warfarin and 2.9 without warfarin; the difference between these two strategies was not significant (0.3 stroke equivalents, 95 % CI -3.2 to 3.7). However, rates of hemorrhage per 100 patient-years were nearly tripled (hazard ratio 2.9; 95 % CI 1.5-5.4; p = 0.0011) with warfarin (21.1) versus without it (7.4). The most common site for major hemorrhage was gastrointestinal (ICD-9 code 578.9). By expanding warfarin use to 65--74-year-olds with a CHADS(2) score of 0, rates of hemorrhages would rise without a significant reduction in stroke equivalents. C1 [Andrade, Ambar A.; Gage, Brian F.] Washington Univ, St Louis, MO 63130 USA. [Li, Juan; Gage, Brian F.] Washington Univ, St Louis, MO USA. NYU, Sch Med, New York, NY USA. [Radford, Martha J.] Ctr Medicare Serv, Reg 6, Dallas, TX USA. [Radford, Martha J.] Ctr Medicaid Serv, Reg 6, Dallas, TX USA. [Nilasena, David S.; Gage, Brian F.] Washington Univ, Sch Med, St Louis, MO USA. RP Gage, BF (reprint author), Washington Univ, Med Sch Campus,Box 8005,660 S Euclid Ave, St Louis, MO 63130 USA. EM bgage@im.wustl.edu RI 刘, 李陆/H-8469-2015; OI Radford, Martha/0000-0001-7503-9557 FU Mentors in Medicine Program at Washington University in St. Louis; American Heart Association FX This work was supported by the Mentors in Medicine Program at Washington University in St. Louis and the American Heart Association. NR 36 TC 4 Z9 5 U1 0 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2015 VL 30 IS 6 BP 777 EP 782 DI 10.1007/s11606-015-3201-1 PG 6 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA CI7RE UT WOS:000354961100016 PM 25666214 ER PT J AU Chin, J Jensen, TS Ashby, L Hermansen, J Hutter, JD Conway, PH AF Chin, Joseph Jensen, Tamara Syrek Ashby, Lori Hermansen, Jamie Hutter, Joseph D. Conway, Patrick H. TI Screening for Lung Cancer with Low-Dose CT - Translating Science into Medicare Coverage Policy SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID TRIAL C1 [Chin, Joseph; Jensen, Tamara Syrek; Ashby, Lori; Hermansen, Jamie; Hutter, Joseph D.; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Ctr Clin Stand & Qual, Woodlawn, MD 21244 USA. RP Chin, J (reprint author), Ctr Medicare & Medicaid Serv, Ctr Clin Stand & Qual, Woodlawn, MD 21244 USA. NR 5 TC 6 Z9 6 U1 1 U2 3 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD MAY 28 PY 2015 VL 372 IS 22 BP 2083 EP 2085 DI 10.1056/NEJMp1502598 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA CJ0EI UT WOS:000355146800003 PM 26017822 ER PT J AU Rajkumar, R Press, MJ Conway, PH AF Rajkumar, Rahul Press, Matthew J. Conway, Patrick H. TI The CMS Innovation Center - A Five-Year Self-Assessment SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Rajkumar, Rahul; Press, Matthew J.; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Rajkumar, R (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 4 TC 8 Z9 8 U1 0 U2 3 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD MAY 21 PY 2015 VL 372 IS 21 BP 1981 EP 1983 DI 10.1056/NEJMp1501951 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA CI5PD UT WOS:000354809300003 PM 25992744 ER PT J AU Schumacher, H AF Schumacher, Heidi TI Funding Cancer Quality Improvement: Payer's Perspective SO JOURNAL OF ONCOLOGY PRACTICE LA English DT Editorial Material C1 [Schumacher, Heidi] Ctr Medicare Serv, Baltimore, MD 21244 USA. [Schumacher, Heidi] Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Schumacher, H (reprint author), Ctr Medicare Serv, 2810 Lord Baltimore Dr,Suite 130, Baltimore, MD 21244 USA. EM heidi.schumacher@cms.hhs.gov NR 2 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 1554-7477 EI 1935-469X J9 J ONCOL PRACT JI J. Oncol. Pract. PD MAY PY 2015 VL 11 IS 3 BP 180 EP + DI 10.1200/JOP.2015.003913 PG 3 WC Health Care Sciences & Services SC Health Care Sciences & Services GA CY1PL UT WOS:000366179600030 PM 25804984 ER PT J AU Price, WA Aliaga, SR Massie, SE DeWalt, DA Laughon, MM Malcolm, WF Van Meurs, K Klein, JM El-Ferzli, G Magnus, BE Tolleson-Rinehart, S AF Price, Wayne A. Aliaga, Sofia R. Massie, Sara E. DeWalt, Darren A. Laughon, Matthew M. Malcolm, William F. Van Meurs, Krisa Klein, Jonathan M. El-Ferzli, George Magnus, Brooke E. Tolleson-Rinehart, Sue TI Development and Validation of the Proxy-Reported Pulmonary Outcomes Scale for Premature Infants SO AMERICAN JOURNAL OF PERINATOLOGY LA English DT Article DE bronchopulmonary dysplasia; infant; premature; outcome assessment; lung disease; neonatal ID BRONCHOPULMONARY DYSPLASIA; DEFINITION; IMPACT AB Objective Test the feasibility of using a bedside nurse reported tool (Proxy-Reported Pulmonary Outcome Scale, PRPOS) for evaluating the severity of bronchopulmonary dysplasia (BPD) by assessing functional, disease-related measures. Study Design Bedside nurses tested the 26-item instrument by observing preterm infants (23-30 weeks at birth) at 36 to 37(4/7) weeks postmenstrual age before, during, and after a care time. We analyzed item reliability, validity, and model fit to determine the six items to include in the final measurement tool. Result We completed assessments on 188 preterm infants. The frequency of an abnormal PRPOS item score increased with increasing National Institute of Child Health and Development (NICHD) BPD category. The six-candidate items produced an internally consistent scale. Addition of the NICHD BPD classification increased reliability moderately; addition of feeding items decreased reliability. The PRPOS score correlated with postmenstrual age at discharge. Infants discharged on oxygen or diuretics had higher median PRPOS scores than did infants who were not prescribed those therapies. Conclusion The PRPOS is an internally consistent, proxy-reported measure of respiratory function in premature infants, based on observable, functional performance measures. Initial testing demonstrates known-groups validity and ongoing testing can assess predictive validity. C1 [Price, Wayne A.; Aliaga, Sofia R.; Laughon, Matthew M.; Tolleson-Rinehart, Sue] Univ N Carolina, Dept Pediat, Sch Med, Chapel Hill, NC 27599 USA. [Massie, Sara E.] Ctr Publ Hlth Qual, Raleigh, NC USA. [DeWalt, Darren A.] Ctr Medicare Serv, Learning & Diffus Grp, Baltimore, MD USA. [DeWalt, Darren A.] Ctr Medicaid Serv, Learning & Diffus Grp, Baltimore, MD USA. [Malcolm, William F.] Duke Univ, Dept Pediat, Durham, NC 27706 USA. [Van Meurs, Krisa] Stanford Univ, Sch Med, Dept Pediat, Palo Alto, CA 94304 USA. [Van Meurs, Krisa] Lucile Salter Packard Childrens Hosp, Palo Alto, CA USA. [Klein, Jonathan M.] Univ Iowa, Stead Family Dept Pediat, Roy J & Lucille A Carver Coll Med, Iowa City, IA USA. [El-Ferzli, George] Univ Alabama Birmingham, Dept Pediat, Birmingham, AL USA. [Magnus, Brooke E.] Univ N Carolina, Dept Psychol, Chapel Hill, NC 27599 USA. [Tolleson-Rinehart, Sue] Univ N Carolina, North Carolina Translat & Clin Sci Inst, Chapel Hill, NC 27599 USA. RP Price, WA (reprint author), Univ N Carolina, Dept Pediat, CB 7596, Chapel Hill, NC 27599 USA. EM waprice@unc.edu OI DeWalt, Darren/0000-0003-2270-751X FU National Center for Research Resources; Eunice Kennedy Shriver National Institute of Child Health and Human Development as a UNC Clinical and Translational Science Award Administrative Supplement [3UL1RR025747-02S3] FX All phases of this study were supported by the National Center for Research Resources and the Eunice Kennedy Shriver National Institute of Child Health and Human Development as a UNC Clinical and Translational Science Award Administrative Supplement, award number 3UL1RR025747-02S3; Price, Project PI. NR 17 TC 0 Z9 0 U1 0 U2 0 PU THIEME MEDICAL PUBL INC PI NEW YORK PA 333 SEVENTH AVE, NEW YORK, NY 10001 USA SN 0735-1631 EI 1098-8785 J9 AM J PERINAT JI Am. J. Perinatol. PD MAY PY 2015 VL 32 IS 6 BP 583 EP 589 DI 10.1055/s-0035-1544946 PG 7 WC Obstetrics & Gynecology; Pediatrics SC Obstetrics & Gynecology; Pediatrics GA CH9FW UT WOS:000354342400011 PM 25715315 ER PT J AU De Lew, N Epstein, AM Mann, C AF De Lew, Nancy Epstein, Arnold M. Mann, Cynthia TI The Children's Health Insurance Program as Adolescence Ends: Nearly 2 Decades of Children's Coverage SO ACADEMIC PEDIATRICS LA English DT Editorial Material C1 [De Lew, Nancy; Epstein, Arnold M.] Dept Hlth & Human Serv, Off Assistant Secretary Planning & Evaluat, Washington, DC USA. [Mann, Cynthia] Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Washington, DC USA. RP De Lew, N (reprint author), US Dept Hlth & Human Serv, Off Secretary, 200 Independence Ave, Washington, DC 20201 USA. EM nancy.delew@hhs.gov NR 3 TC 2 Z9 2 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 EI 1876-2867 J9 ACAD PEDIATR JI Acad. Pediatr. PD MAY-JUN PY 2015 VL 15 IS 3 SU S BP S7 EP S8 PG 2 WC Pediatrics SC Pediatrics GA CH2MT UT WOS:000353860000002 PM 25906963 ER PT J AU Chawla, N Urato, M Ambs, A Schussler, N Hays, RD Clauser, SB Zaslavsky, AM Walsh, K Schwartz, M Halpern, M Gaillot, S Goldstein, EH Arora, NK AF Chawla, Neetu Urato, Matthew Ambs, Anita Schussler, Nicola Hays, Ron D. Clauser, Steven B. Zaslavsky, Alan M. Walsh, Kayo Schwartz, Margot Halpern, Michael Gaillot, Sarah Goldstein, Elizabeth H. Arora, Neeraj K. TI Unveiling SEER-CAHPSA (R): A New Data Resource for Quality of Care Research SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE patient experiences; cancer; chronic disease; data linkage; Medicare claims; quality of care; CAHPS; SEER registry ID MEDICARE CONSUMER ASSESSMENT; HEALTH-CARE; PATIENT EXPERIENCES; MULTILEVEL FACTORS; BENEFICIARIES; CONTINUUM; PROVIDERS AB Since 1990, the National Cancer Institute (NCI) and Centers for Medicare and Medicaid Services (CMS) have collaborated to create linked data resources to improve our understanding of patterns of care, health care costs, and trends in utilization. However, existing data linkages have not included measures of patient experiences with care. To describe a new resource for quality of care research based on a linkage between the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPSA (R)) patient surveys and the NCI's Surveillance, Epidemiology and End Results (SEER) data. This is an observational study of CAHPS respondents and includes both fee-for-service and Medicare Advantage beneficiaries with and without cancer. The data linkage includes: CAHPS survey data collected between 1998 and 2010 to assess patient reports on multiple aspects of their care, such as access to needed and timely care, doctor communication, as well as patients' global ratings of their personal doctor, specialists, overall health care, and their health plan; SEER registry data (1973-2007) on cancer site, stage, treatment, death information, and patient demographics; and longitudinal Medicare claims data (2002-2011) for fee-for-service beneficiaries on utilization and costs of care. In total, 150,750 respondents were in the cancer cohort and 571,318 were in the non-cancer cohort. The data linkage includes SEER data on cancer site, stage, treatment, death information, and patient demographics, in addition to longitudinal data from Medicare claims and information on patient experiences from CAHPS surveys. Sizable proportions of cases from common cancers (e.g., breast, colorectal, prostate) and short-term survival cancers (e.g., pancreas) by time since diagnosis enable comparisons across the cancer care trajectory by MA vs. FFS coverage. SEER-CAHPS is a valuable resource for information about Medicare beneficiaries' experiences of care across different diagnoses and treatment modalities, and enables comparisons by type of insurance. C1 [Chawla, Neetu; Ambs, Anita; Arora, Neeraj K.] NCI, Div Canc Control & Populat Sci, Rockville, MD 20892 USA. [Urato, Matthew; Schwartz, Margot; Halpern, Michael] RTI Int, Res Triangle Pk, NC USA. [Schussler, Nicola] Informat Management Serv Inc, Calverton, MD USA. [Hays, Ron D.] Univ Calif Los Angeles, Dept Med, Div Gen Internal Med & Hlth Serv Res, Los Angeles, CA 90024 USA. [Clauser, Steven B.] Patient Ctr Outcomes Res Inst, Washington, DC USA. [Zaslavsky, Alan M.; Walsh, Kayo] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Gaillot, Sarah; Goldstein, Elizabeth H.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Chawla, N (reprint author), NCI, Div Canc Control & Populat Sci, 9609 Med Ctr Dr,3E450, Rockville, MD 20892 USA. EM neetu.chawla@nih.gov FU Indian Health Service in Alaska [Y1-PC-0064]; Connecticut Department of Public Health [HHSN261201000024C]; Emory University [HSN261201000025C]; University of Iowa [HHSN261201000032C]; University of Medicine and Dentistry of New Jersey [HHSN261201000027C]; University of Utah [HHSN261201000026C]; Cancer Prevention Institute of California [HHSN261201000140C]; University of Hawaii [HHSN261201000037C]; University of New Mexico [HHSN261201000033C]; Public Health Institute [HHSN261201000034C]; University of Southern California [HHSN261201000035C]; Fred Hutchinson Cancer Research Center [HHSN261201000029C]; University of Kentucky Research Foundation [HHSN261201000031C]; Wayne State University [HHSN261201000028C]; Louisiana State University Health Sciences Center [HHSN261201000030C] FX SEER is supported by an interagency agreement with Indian Health Service in Alaska (No. Y1-PC-0064) and the following contract agreements: Connecticut Department of Public Health (No. HHSN261201000024C); Emory University (No. HSN261201000025C); University of Iowa (No. HHSN261201000032C); University of Medicine and Dentistry of New Jersey (No. HHSN261201000027C); University of Utah (No. HHSN261201000026C); Cancer Prevention Institute of California (No. HHSN261201000140C); University of Hawaii (No. HHSN261201000037C); University of New Mexico (No. HHSN261201000033C); Public Health Institute (No. HHSN261201000034C); University of Southern California (No. HHSN261201000035C); Fred Hutchinson Cancer Research Center (No. HHSN261201000029C); University of Kentucky Research Foundation (No. HHSN261201000031C); Wayne State University (No. HHSN261201000028C); and Louisiana State University Health Sciences Center (No. HHSN261201000030C). Data from this paper was presented at the Academy Health Annual Research Meeting on June 8-10, 2014. NR 25 TC 5 Z9 5 U1 0 U2 0 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD MAY PY 2015 VL 30 IS 5 BP 641 EP 650 DI 10.1007/s11606-014-3162-9 PG 10 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA CF7CJ UT WOS:000352713400020 PM 25586868 ER PT J AU Orr, MF Wu, J Sloop, SL AF Orr, Maureen F. Wu, Jennifer Sloop, Sue L. TI Acute Chemical Incidents Surveillance - Hazardous Substances Emergency Events Surveillance, Nine States, 1999-2008 SO MMWR SURVEILLANCE SUMMARIES LA English DT Article AB Problem/Condition: Although they are infrequent, acute chemical incidents (i.e., uncontrolled or illegal release or threatened release of hazardous substances lasting <72 hours) with mass casualties or extraordinary levels of damage or disruption severely affecting the population, infrastructure, environment, and economy occur, and thousands of less damaging chemical incidents occur annually. Surveillance data enable public health and safety professionals to better understand the patterns and causes of these incidents, which can improve prevention efforts and preparation for future incidents. Reporting Period: 1999-2008. Description of System: The Hazardous Substances Emergency Events Surveillance (HSEES) system was operated by the Agency for Toxic Substances and Disease Registry (ATSDR) during January 1991-September 2009 to describe the public health consequences of chemical releases and to develop activities aimed at reducing the harm. This report provides a historical overview of HSEES and summarizes incidents from the nine states (Colorado, Iowa, Minnesota, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin) that participated in HSEES during its last 10 full years of data collection (1999-2008). Results: During 1999-2008, a total of 57,975 chemical incidents occurred: 41,993 (72%) occurred at fixed facilities, and 15,981 (28%) were transportation related. Chemical manufacturing (NAICS 325) (23%) was the industry with the most incidents; however, the number of chemical incidents in chemical manufacturing decreased substantially over time (R-2 = 0.78), whereas the educational services category (R-2 = 0.65) and crop production category (R-2 = 0.61) had a consistently increasing trend. The most common contributing factors for an incident were equipment failure (n = 22,535, 48% of incidents) and human error (n = 16,534, 36%). The most frequently released chemical was ammonia 3,366 (6%). Almost 60% of all incidents occurred in two states, Texas and New York. A decreasing trend occurred in the number of incidents in Texas, Wisconsin, and Colorado, and an increasing trend occurred in Minnesota. Interpretation: Although chemical manufacturing accounted for the largest percentage of incidents in HSEES, the number of chemical incidents over time decreased substantially for this industry while heightened awareness and prevention measures were being implemented. However, incidents in educational services and crop production settings increased. Trends in incidents and number of incidents varied by state. Only a certain few chemicals, sectors, and areas were found to be related to the majority of incidents and injured persons. Equipment failure and human error, both common casual factors, are preventable. Public Health Implications: The findings in this collection of surveillance summaries underscore the need for educational institutions and the general public to receive more focused outreach. In addition, the select few chemicals and industries that result in numerous incidents can be the focus of prevention activities. The data in these surveillance summaries show that equipment maintenance, as well as training to prevent human error, could alleviate many of the incidents; NTSIP has begun work in these areas. State surveillance allows a state to identify its problem areas and industries and chemicals for prevention and preparedness. Beginning in 2010, ATSDR replaced HSEES with the National Toxic Substance Incidents Program (NTSIP) to expand on the work of HSEES. NTSIP helps states to collect surveillance data and to promote cost-effective, proactive measures such as converting to an inherently safer design, developing geographic mapping of chemically vulnerable areas, and adopting the principles of green chemistry (design of chemical products and processes that reduce or eliminate the generation of hazardous substances). Because the more populous states such as New York and Texas had the most incidents, areas with high population density should be carefully assessed for preparedness and prevention measures. NTSIP develops estimated incident numbers for states that do not collect data to help with state and national planning. NTSIP also collects more detailed data on chemical incidents with mass casualties. HSEES and NTSIP data can be used by public and environmental health and safety practitioners, worker representatives, emergency planners, preparedness coordinators, industries, emergency responders, and others to prepare for and prevent chemical incidents and injuries. C1 [Orr, Maureen F.; Wu, Jennifer] CDC, Div Toxicol & Human Hlth Sci, Agcy Toxic Subst & Dis Registry, Atlanta, GA 30333 USA. [Sloop, Sue L.] Ctr Medicare & Medicaid Serv, Off Informat Serv, Independence, MO USA. RP Orr, MF (reprint author), CDC, Div Toxicol & Human Hlth Sci, Agcy Toxic Subst & Dis Registry, Atlanta, GA 30333 USA. EM morr@cdc.gov NR 25 TC 0 Z9 0 U1 2 U2 6 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1545-8636 J9 MMWR SURVEILL SUMM JI MMWR Surv. Summ. PD APR 10 PY 2015 VL 64 IS 2 BP 1 EP 9 PG 9 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA CI4AN UT WOS:000354688800001 PM 25856532 ER PT J AU Hughes, LS Peltz, A Conway, PH AF Hughes, Lauren S. Peltz, Alon Conway, Patrick H. TI State Innovation Model Initiative A State-Led Approach to Accelerating Health Care System Transformation SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID COSTS; QUALITY C1 [Hughes, Lauren S.] Univ Michigan, Dept Family Med, Robert Wood Johnson Fdn Clin Scholars Program, Ann Arbor, MI 48109 USA. [Hughes, Lauren S.; Peltz, Alon; Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD USA. [Hughes, Lauren S.; Peltz, Alon; Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD USA. [Peltz, Alon] Boston Childrens Hosp, Boston, MA USA. [Peltz, Alon] Boston Med Ctr, Boston, MA USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA. RP Hughes, LS (reprint author), Univ Michigan, Robert Wood Johnson Fdn Clin Scholars Program, North Campus Res Ctr, 2800 Plymouth Rd,Bldg 10,Room G016-4A, Ann Arbor, MI 48109 USA. EM lshughes@umich.edu NR 7 TC 2 Z9 2 U1 0 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD APR 7 PY 2015 VL 313 IS 13 BP 1317 EP 1318 DI 10.1001/jama.2015.2017 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA CF1OL UT WOS:000352315900015 PM 25730488 ER PT J AU Mark, TL Wier, LM Malone, K Penne, M Cowell, AJ AF Mark, Tami L. Wier, Lauren M. Malone, Kevin Penne, Michael Cowell, Alexander J. TI National Estimates of Behavioral Health Conditions and Their Treatment Among Adults Newly Insured Under the ACA SO PSYCHIATRIC SERVICES LA English DT Article ID AFFORDABLE CARE ACT; COVERAGE AB Objective: Approximately 25 million individuals are projected to gain insurance as a result of the Affordable Care Act (ACA). This study estimated the prevalence of behavioral health conditions and their treatment among individuals likely to gain coverage. Methods: Pooled 2008-2011 National Survey on Drug Use and Health data for adults (ages 18-64) were used. Estimates were created for all adults, current Medicaid beneficiaries, and uninsured adults with incomes that might make them eligible for the Medicaid expansion or tax credits for use in the health insurance marketplace. Results: Individuals who may gain insurance under the ACA had lower rates of serious mental illnesses (5.4%, Medicaid expansion; 4.7%, marketplace) compared with current Medicaid beneficiaries (9.6%). They had higher rates of substance use disorders (13.6%, Medicaid expansion; 14.3%, marketplace) compared with Medicaid recipients (11.9%). Conclusions: There is significant need for behavioral health treatment among individuals who may gain insurance under the ACA. C1 [Mark, Tami L.] Truven Hlth Analyt, Bethesda, MD USA. [Wier, Lauren M.] Truven Hlth Analyt, Providence, RI USA. [Malone, Kevin] Ctr Medicare Serv, Fed Coordinated Hlth Care Off, Baltimore, MD USA. [Malone, Kevin] Ctr Medicaid Serv, Fed Coordinated Hlth Care Off, Baltimore, MD USA. [Malone, Kevin] Subst Abuse & Mental Hlth Serv Adm, Rockville, MD USA. [Penne, Michael; Cowell, Alexander J.] RTI Int, Hlth Social & Econ Res, Res Triangle Pk, NC USA. RP Wier, LM (reprint author), Truven Hlth Analyt, Providence, RI USA. EM lauren.wier@truvenhealth.com FU SAMHSA FX This study was funded through a contract from SAMHSA. The opinions expressed do not necessarily reflect those of SAMHSA or the U.S. Department of Health and Human Services. NR 14 TC 7 Z9 7 U1 0 U2 1 PU AMER PSYCHIATRIC PUBLISHING, INC PI ARLINGTON PA 1000 WILSON BOULEVARD, STE 1825, ARLINGTON, VA 22209-3901 USA SN 1075-2730 EI 1557-9700 J9 PSYCHIAT SERV JI Psychiatr. Serv. PD APR PY 2015 VL 66 IS 4 BP 426 EP 429 DI 10.1176/appi.ps.201400078 PG 4 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA DE5QW UT WOS:000370687300016 PM 25555031 ER PT J AU Vashi, AA Cafardi, SG Powers, CA Ross, JS Shrank, WH AF Vashi, Anita A. Cafardi, Susannah G. Powers, Christopher A. Ross, Joseph S. Shrank, William H. TI Observation Encounters and Subsequent Nursing Facility Stays SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID PAIN OBSERVATION UNIT; EMERGENCY AB Background: Medicare coverage of skilled nursing facility (SNF) care requires that beneficiaries have a 3-night inpatient stay in the prior 30 days to be eligible. Time spent by beneficiaries receiving hospital-based observation services does not count toward this requirement. Objectives: To examine the frequency of Medicare beneficiary discharge from hospital-based observation services to SNFs and its impact on Medicare coverage. Study Design: Retrospective cohort study. Methods: We performed a beneficiary-level analysis using a 20% nationally representative sample of community-dwelling fee-for-service Medicare beneficiaries from 2010, examining all discharges from hospital-based observation services. We assessed differences in beneficiary and encounter characteristics and post discharge utilization rates of covered and non-covered SNFs. Results: In 2010, 195,068 community-dwelling beneficiaries received hospital-based observation services. Beneficiaries were overwhelmingly (96.5%) discharged back to the community without home health services. Only 1.2% (2319) were discharged to non-covered SNFs, while 0.6% (1196) were discharged to covered SNFs. Patients discharged to SNFs experienced longer lengths of stay (LOS) than those discharged back to the community (34.9 hours vs 25.5 hours; P < .01). Approximately one-fourth of beneficiaries discharged to SNFs had an observation LOS of 48 hours or more. Conclusions: While only a small minority of community-dwelling Medicare beneficiaries who received hospital-based observation services in 2010 were discharged to an SNF not covered by Medicare, the implications for these patients and the associated costs deserve attention. These findings have important implications for Medicare's observation service and 2-midnight policies. C1 [Vashi, Anita A.] VA Palo Alto Healthcare Syst, Ctr Innovat Implementat, Palo Alto, CA USA. [Cafardi, Susannah G.] CMS, Ctr Medicare, Rapid Cycle Evaluat Grp, Baltimore, MD USA. [Cafardi, Susannah G.] CMS, Ctr Medicaid Innovat, Rapid Cycle Evaluat Grp, Baltimore, MD USA. [Powers, Christopher A.] CMS, Off Informat Prod & Data Analyt, Baltimore, MD USA. [Ross, Joseph S.] Yale Univ, Sch Med, Gen Internal Med Sect, New Haven, CT USA. [Ross, Joseph S.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Shrank, William H.] Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA. [Shrank, William H.] Harvard Univ, Sch Med, Boston, MA USA. RP Vashi, AA (reprint author), 16 Laguna St,Apt 303, San Francisco, CA 94102 USA. EM anitavashi@gmail.com FU Robert Wood Johnson Foundation; National Institute on Aging [K08 AG032886]; American Federation for Aging Research through the Paul B. Beeson Career Development Award Program FX This work was not supported by any external grants or funds. At the time this work was conducted, Dr Vashi was a fellow in the Clinical Scholars program at Yale University sponsored by the Robert Wood Johnson Foundation. Dr Ross is supported by the National Institute on Aging (K08 AG032886) and by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program. NR 11 TC 0 Z9 0 U1 0 U2 1 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 APR PY 2015 VL 21 IS 4 BP E276 EP E281 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA CN7ZZ UT WOS:000358656900006 PM 26244791 ER PT J AU Parikh, K Agrawal, S AF Parikh, Kavita Agrawal, Shantanu TI Establishing Superior Benchmarks of Care in Clinical Practice A Proposal to Drive Achievable Health Care Value SO JAMA PEDIATRICS LA English DT Editorial Material ID BRONCHIOLITIS; MANAGEMENT; PNEUMONIA; CHILDREN C1 [Parikh, Kavita] Childrens Natl Hlth Syst, George Washington Sch Med, Dept Pediat, Washington, DC 20010 USA. [Agrawal, Shantanu] Ctr Medicare & Medicaid Serv, Ctr Program Integr, Washington, DC USA. RP Parikh, K (reprint author), Childrens Natl Hlth Syst, George Washington Sch Med, Dept Pediat, 111 Michigan Ave NW, Washington, DC 20010 USA. EM kparikh@childrensnational.org NR 7 TC 2 Z9 2 U1 3 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 2168-6203 EI 2168-6211 J9 JAMA PEDIATR JI JAMA Pediatr. PD APR PY 2015 VL 169 IS 4 BP 301 EP 302 DI 10.1001/jamapediatrics.2014.3580 PG 2 WC Pediatrics SC Pediatrics GA CI8CP UT WOS:000354995600004 PM 25643128 ER PT J AU Clough, JD Patel, K Riley, GF Rajkumar, R Conway, PH Bach, PB AF Clough, Jeffrey D. Patel, Kavita Riley, Gerald F. Rajkumar, Rahul Conway, Patrick H. Bach, Peter B. TI Wide Variation In Payments For Medicare Beneficiary Oncology Services Suggests Room For Practice-Level Improvement SO HEALTH AFFAIRS LA English DT Article ID CANCER; CARE AB In recent years many policy makers have recommended alternative payment models in medical oncology in order to reduce costs and improve patient outcomes. Yet information on how oncology practices differ in their use of key service categories is limited. We measured annual payments for key service categories delivered to fee-for-service Medicare beneficiaries receiving care from 1,534 medical oncology practices in 2011-12. In 2012, differences in payments per beneficiary at the seventy-fifth-percentile practice compared to the twenty-fifth-percentile practice were $3,866 for chemotherapy (including administration and supportive care drugs), $1,872 for acute medical hospitalizations, and $439 for advanced imaging. Supportive care drugs, bevacizumab, and positron-emission tomography accounted for the greatest percentage of variation. Average practice payments for service categories were highly correlated across years but not correlated with each other, which suggests that service categories may be affected by different physician practice characteristics. These differences, even when clinical guidelines exist, demonstrate the potential for quality improvement that could be accelerated through alternative payment models. C1 [Clough, Jeffrey D.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Patel, Kavita] Engelberg Ctr Hlth Care Reform Brookings, Clin Transformat, Washington, DC USA. [Bach, Peter B.] Mem Sloan Kettering Canc Ctr, Ctr Hlth Policy & Outcomes, New York, NY 10021 USA. RP Clough, JD (reprint author), Duke Univ, Dept Med, Durham, NC 27708 USA. EM jeffrey.clough@duke.edu FU Genentech FX Peter Bach received speaking fees and an honorarium from Genentech and serves as a consultant to Foundation Medicine. The views in this article represent those of the authors and not necessarily the policy or views of the Centers for Medicare and Medicaid Services. NR 18 TC 6 Z9 6 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 APR PY 2015 VL 34 IS 4 BP 601 EP 608 DI 10.1377/hlthaff.2014.0964 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CI5JX UT WOS:000354792900009 PM 25847642 ER PT J AU Venkatesh, AK Goodrich, K AF Venkatesh, Arjun K. Goodrich, Kate TI Emergency Care and the National Quality Strategy: Highlights From the Centers for Medicare & Medicaid Services SO ANNALS OF EMERGENCY MEDICINE LA English DT Article ID MEDICINE AB The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs. C1 [Venkatesh, Arjun K.] Yale Univ, Sch Med, Robert Wood Johnson Fdn, Clin Scholars Program, New Haven, CT 06520 USA. [Venkatesh, Arjun K.] Yale Univ, Sch Med, Dept Emergency Med, New Haven, CT USA. [Goodrich, Kate] Ctr Medicare & Medicaid Serv, Ctr Clin Stand & Qual, Baltimore, MD USA. [Goodrich, Kate] George Washington Univ, Sch Med, Dept Med, Div Hosp Med, Washington, DC USA. RP Venkatesh, AK (reprint author), Yale Univ, Sch Med, Robert Wood Johnson Fdn, Clin Scholars Program, New Haven, CT 06520 USA. EM arjun.venkatesh@yale.edu NR 20 TC 2 Z9 2 U1 0 U2 3 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD APR PY 2015 VL 65 IS 4 BP 396 EP 399 DI 10.1016/j.annemergmed.2014.07.009 PG 4 WC Emergency Medicine SC Emergency Medicine GA CE9RN UT WOS:000352181200010 PM 25128008 ER PT J AU Lochner, KA Wynne, MA Wheatcroft, GH Worrall, CM Kelman, JA AF Lochner, Kimberly A. Wynne, Marc A. Wheatcroft, Gloria H. Worrall, Chris M. Kelman, Jeffrey A. TI Medicare Claims Versus Beneficiary Self-Report for Influenza Vaccination Surveillance SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID ELDERLY OUTPATIENTS; VALIDATION AB Background: Although self-reported influenza vaccination status is routinely used in surveillance to estimate influenza vaccine coverage, Medicare data are becoming a promising resource for influenza surveillance to inform vaccination program management and planning. Purpose: To evaluate the concordance between self-reported influenza vaccination and influenza vaccination claims among Medicare beneficiaries. Methods: This study compared influenza vaccination based upon Medicare claims and self-report among a sample of Medicare beneficiaries (N=9,378) from the 2011 Medicare Current Beneficiary Survey, which was the most recent year of data at the time of analysis (summer 2013). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using self-reported data as the referent standard. Logistic regression was used to compute the marginal mean proportions for whether a Medicare influenza vaccination claim was present among beneficiaries who reported receiving the vaccination. Results: Influenza vaccination was higher for self-report (69.4%) than Medicare claims (48.3%). For Medicare claims, sensitivity=67.5%, specificity=96.3%, positive predictive value=97.6%, and negative predictive value=56.7%. Among beneficiaries reporting receiving an influenza vaccination, the percentage of beneficiaries with a vaccination claim was lower for beneficiaries who were aged <65 years, male, non-Hispanic black or Hispanic, and had less than a college education. Conclusions: The classification of influenza vaccination status for Medicare beneficiaries can differ based upon survey and claims. To improve Medicare claims-based surveillance studies, further research is needed to determine the sources of discordance in self-reported and Medicare claims data, specifically for sensitivity and negative predictive value. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine C1 [Lochner, Kimberly A.] Sam Nunn Atlanta Fed Ctr, Ctr Medicare & Medicaid Serv, Atlanta, GA 30303 USA. [Wynne, Marc A.; Worrall, Chris M.; Kelman, Jeffrey A.] Ctr Medicare, Baltimore, MD USA. RP Lochner, KA (reprint author), Sam Nunn Atlanta Fed Ctr, 61 Forsyth St,SW,Suite 4T20, Atlanta, GA 30303 USA. EM kimberly.lochner@CMS.hhs.gov NR 19 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 EI 1873-2607 J9 AM J PREV MED JI Am. J. Prev. Med. PD APR PY 2015 VL 48 IS 4 BP 384 EP 391 DI 10.1016/j.amepre.2014.10.016 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA CD7DM UT WOS:000351251000003 PM 25700653 ER PT J AU Menis, M Forshee, RA Anderson, SA McKean, S Gondalia, R Warnock, R Johnson, C Mintz, PD Worrall, CM Kelman, JA Izurieta, HS AF Menis, M. Forshee, R. A. Anderson, S. A. McKean, S. Gondalia, R. Warnock, R. Johnson, C. Mintz, P. D. Worrall, C. M. Kelman, J. A. Izurieta, H. S. TI Febrile non-haemolytic transfusion reaction occurrence and potential risk factors among the US elderly transfused in the inpatient setting, as recorded in Medicare databases during 2011-2012 SO VOX SANGUINIS LA English DT Article DE administrative databases; elderly; febrile non-haemolytic transfusion reaction; inpatient; Medicare; potential risk factors ID OUTCOMES FOLLOWING INSTITUTION; CELLULAR BLOOD COMPONENTS; UNIVERSAL LEUKOREDUCTION; ADMINISTRATIVE DATA; NONINFECTIOUS COMPLICATIONS; REDUCTION; PLATELETS; RATES; RBCS AB Background and ObjectivesFebrile non-haemolytic transfusion reaction (FNHTR) is an acute transfusion complication resulting in fever, chills and/or rigours. Study's objective was to assess FNHTR occurrence and potential risk factors among inpatient U.S. elderly Medicare beneficiaries, ages 65 and older, during 2011-2012. Materials and MethodsOur retrospective claims-based study utilized large Medicare administrative databases. FNHTR was ascertained via ICD-9-CM diagnosis code, and transfusions were identified by recorded procedure and revenue centre codes. The study ascertained FNHTR rates among the inpatient elderly overall and by age, gender, race, blood components and units transfused. Multivariate logistic regression analyses were used to assess potential risk factors. ResultsAmong 4336338 inpatient transfusion stays for elderly during 2011-2012, 2517 had FNHTR diagnosis recorded, an overall rate of 580 per 100000 stays. FNHTR rates (per 100000 stays) varied by age, gender, number of units and blood components transfused. FNHTR rates were substantially higher for RBCs- and platelets-containing transfusions as compared to plasma only. Significantly higher odds of FNHTR were identified with greater number of units transfused (P<001), for females vs. males (OR=115, 95% CI 104-127), and with 1-year histories of transfusion (OR=125, 95% CI 110-142), lymphoma (OR=122, 95% CI 102-146), leukaemia (OR=190, 95% CI 156-231) and other diseases. ConclusionsOur study shows increased FNHTR occurrence among elderly with greater number of units and with RBCs- and platelets-containing transfusions, suggesting need to evaluate effectiveness of prestorage leucoreduction in elderly. The study also suggests importance of prior recipient alloimmunization and underlying health conditions in the development of FNHTR. C1 [Menis, M.; Forshee, R. A.; Anderson, S. A.; Mintz, P. D.; Izurieta, H. S.] US FDA, Silver Spring, MD 20993 USA. [McKean, S.; Gondalia, R.; Warnock, R.; Johnson, C.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare Serv, Baltimore, MD USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicaid Serv, Baltimore, MD USA. RP Menis, M (reprint author), US FDA, Ctr Biol Evaluat & Res, Off Biostat & Epidemiol, 10903 New Hampshire Ave,White Oak Bldg 71, Silver Spring, MD 20993 USA. EM mikhail.menis@fda.hhs.gov FU U.S. Food and Drug Administration, Center for Biologics Evaluation and Research FX This study was funded by the U.S. Food and Drug Administration, Center for Biologics Evaluation and Research. NR 45 TC 3 Z9 3 U1 0 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0042-9007 EI 1423-0410 J9 VOX SANG JI Vox Sang. PD APR PY 2015 VL 108 IS 3 BP 251 EP 261 DI 10.1111/vox.12215 PG 11 WC Hematology SC Hematology GA CE0CW UT WOS:000351473000006 PM 25470076 ER PT J AU Riley, GF Rupp, K AF Riley, Gerald F. Rupp, Kalman TI Cumulative Expenditures under the DI, SSI, Medicare, and Medicaid Programs for a Cohort of Disabled Working-Age Adults SO HEALTH SERVICES RESEARCH LA English DT Article DE Disability; Medicare; Medicaid; Social Security Disability Insurance; Supplemental Security Income ID CARE; LENGTH; COSTS AB ObjectiveTo estimate cumulative DI, SSI, Medicare, and Medicaid expenditures from initial disability benefit award to death or age 65. Data SourcesAdministrative records for a cohort of new CY2000 DI and SSI awardees aged 18-64. Study DesignActual expenditures were obtained for 2000-2006/7. Subsequent expenditures were simulated using a regression-adjusted Markov process to assign individuals to annual disability benefit coverage states. Program expenditures were simulated conditional on assigned benefit coverage status. Estimates reflect present value of expenditures at initial award in 2000 and are expressed in constant 2012 dollars. Expenditure estimates were also updated to reflect benefit levels and characteristics of new awardees in 2012. Data CollectionWe matched records for a 10 percent nationally representative sample. Principal FindingsOverall average cumulative expenditures are $292,401 through death or age 65, with 51.4 percent for cash benefits and 48.6 percent for health care. Expenditures are about twice the average for individuals first awarded benefits at age 18-30. Overall average expenditures increased by 10 percent when updated for a simulated 2012 cohort. ConclusionsData on cumulative expenditures, especially combined across programs, are useful for evaluating the long-term payoff of investments designed to modify entry to and exit from the disability rolls. C1 [Rupp, Kalman] Social Secur Adm, Off Res Evaluat & Stat, Washington, DC USA. RP Riley, GF (reprint author), Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, 7500 Secur Blvd,Mail Stop WB-06-05, Baltimore, MD 21244 USA. EM gerald.riley@cms.hhs.gov NR 33 TC 0 Z9 0 U1 0 U2 0 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 APR PY 2015 VL 50 IS 2 BP 514 EP 536 DI 10.1111/1475-6773.12219 PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CD5ZL UT WOS:000351167600010 PM 25109322 ER PT J AU Kline, RM Bazell, C Smith, E Schumacher, H Rajkumar, R Conway, PH AF Kline, Ronald M. Bazell, Carol Smith, Erin Schumacher, Heidi Rajkumar, Rahul Conway, Patrick H. TI Centers for Medicare and Medicaid Services: Using an Episode-Based Payment Model to Improve Oncology Care SO JOURNAL OF ONCOLOGY PRACTICE LA English DT Article ID CANCER AB Purpose: Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. Design: The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. Conclusion: New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. C1 [Kline, Ronald M.; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Kline, RM (reprint author), Ctr Medicare & Medicaid Serv, WB 09-49,2810 Lord Baltimore Dr, Baltimore, MD 21244 USA. EM Ron.Kline@cms.hhs.gov NR 9 TC 19 Z9 19 U1 2 U2 4 PU AMER SOC CLINICAL ONCOLOGY PI ALEXANDRIA PA 2318 MILL ROAD, STE 800, ALEXANDRIA, VA 22314 USA SN 1554-7477 EI 1935-469X J9 J ONCOL PRACT JI J. Oncol. Pract. PD MAR PY 2015 VL 11 IS 2 BP 114 EP U476 DI 10.1200/JOP.2014.002337 PG 4 WC Health Care Sciences & Services SC Health Care Sciences & Services GA CY1PA UT WOS:000366178400025 PM 25690596 ER PT J AU Rumsfeld, JS Holmes, DR Stough, WG Edwards, FH Jacques, LB Mack, MJ AF Rumsfeld, John S. Holmes, David R. Stough, Wendy Gattis Edwards, Fred H. Jacques, Louis B. Mack, Michael J. TI Insights From the Early Experience of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry SO JACC-CARDIOVASCULAR INTERVENTIONS LA English DT Article DE Centers for Medicare and Medicaid Services (US); heart valve prosthesis implantation; investigational device exemption; National Cardiovascular Data Registry; registries; transcatheter aortic valve replacement; US Food and Drug Administration ID INFRASTRUCTURE; SURVEILLANCE AB The current system for postmarket surveillance of medical devices in the United States is limited. To help change this paradigm for transcatheter valve therapies (TVTs), starting with transcatheter aortic valve replacement, the Society of Thoracic Surgeons and the American College of Cardiology partnered to form the TVT Registry program in close collaboration with the U.S. Food and Drug Administration and the Center for Medicare and Medicaid Services. The goal of the TVT Registry is to measure and improve quality of care and patient outcomes in clinical practice and to have a pivotal role in the scientific evidence and surveillance for medical devices. Challenges were faced in the early experience of the registry included developing multistakeholder partnerships, data collection requirements, and the use of the registry for pre- and post-market device evaluations. In addressing these challenges, the TVT Registry demonstrates that it is feasible for professional societies to assume a pivotal role in pre- and/or post-market studies, leveraging a clinical registry infrastructure. Sharing the TVT Registry experience may help other professional societies and stakeholders better anticipate and plan for these challenges. (C) 2015 by the American College of Cardiology Foundation. C1 [Rumsfeld, John S.] Denver VA Med Ctr, Denver, CO 80220 USA. [Holmes, David R.] Mayo Clin, Div Cardiovasc Dis, Rochester, MN USA. [Stough, Wendy Gattis] Campbell Univ, Coll Pharm & Hlth Sci, Buies Creek, NC 27506 USA. [Edwards, Fred H.] Univ Florida, Hlth Sci Ctr, Jacksonville, FL 32209 USA. [Jacques, Louis B.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Mack, Michael J.] Heart Hosp Baylor, Baylor Healthcare Syst, Dallas, TX USA. RP Rumsfeld, JS (reprint author), Denver VA Med Ctr, Cardiol 111B, 1055 Clermont St, Denver, CO 80220 USA. EM john.rumsfeld@va.gov RI Stough, Wendy/R-4287-2016 OI Stough, Wendy/0000-0001-8290-1205 NR 7 TC 8 Z9 8 U1 1 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1936-8798 EI 1876-7605 J9 JACC-CARDIOVASC INTE JI JACC-Cardiovasc. Interv. PD MAR PY 2015 VL 8 IS 3 BP 377 EP 381 DI 10.1016/j.jcin.2014.09.022 PG 5 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA CD6TC UT WOS:000351221300007 PM 25703888 ER PT J AU Smolowitz, J Speakman, E Wojnar, D Whelan, EM Ulrich, S Hayes, C Wood, L AF Smolowitz, Janice Speakman, Elizabeth Wojnar, Danuta Whelan, Ellen-Marie Ulrich, Suzan Hayes, Carolyn Wood, Laura TI Role of the registered nurse in primary health care: Meeting health care needs in the 21st century SO NURSING OUTLOOK LA English DT Article DE Primary care; Primary health care; Registered nurse ID AMBULATORY-CARE; WORKFORCE; REFORM AB There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status; chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered. C1 [Smolowitz, Janice] Columbia Univ, Sch Nursing, New York, NY USA. [Speakman, Elizabeth] Thomas Jefferson Univ, Jefferson Interprofess Educ Ctr, Philadelphia, PA 19107 USA. [Wojnar, Danuta] Seattle Univ, Dept Maternal Child & Family Nursing, Seattle, WA 98122 USA. [Whelan, Ellen-Marie] Ctr Medicare Serv, Baltimore, MD USA. [Whelan, Ellen-Marie] Ctr Medicaid Serv, Baltimore, MD USA. [Ulrich, Suzan] St Catherine Univ, St Paul, MN USA. [Hayes, Carolyn] Dana Faber Canc Inst, Adult Inpatient & Integrat Oncol, Boston, MA USA. [Hayes, Carolyn] Brigham & Womens Hosp, Boston, MA 02115 USA. [Wood, Laura] Boston Childrens Hosp, Boston, MA USA. RP Smolowitz, J (reprint author), 101 Carrollwood Dr, Tarrytown, NY 10591 USA. EM js928@columbia.edu FU Robert Wood Johnson Foundation Executive Nurse Fellow Program; American Academy of Nursing; American Board of Internal Medicine Foundation FX This work was funded by the Robert Wood Johnson Foundation Executive Nurse Fellow Program. The authors are grateful for the support and guidance provided by the American Academy of Nursing, specifically Joanne Disch, Joanne Pohl, Virginia Tilden and Cheryl Sullivan, and the American Board of Internal Medicine Foundation, specifically Thomas A. Sinsky and Daniel Wolfson. NR 38 TC 9 Z9 9 U1 1 U2 21 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0029-6554 EI 1528-3968 J9 NURS OUTLOOK JI Nurs. Outlook PD MAR-APR PY 2015 VL 63 IS 2 BP 130 EP 136 DI 10.1016/j.outlook.2014.08.004 PG 7 WC Nursing SC Nursing GA CD8CQ UT WOS:000351323200007 PM 25261382 ER PT J AU Izurieta, HS Thadani, N Shay, DK Lu, Y Maurer, A Foppa, IM Franks, R Pratt, D Forshee, RA MaCurdy, T Worrall, C Howery, AE Kelman, J AF Izurieta, Hector S. Thadani, Nicole Shay, David K. Lu, Yun Maurer, Aaron Foppa, Ivo M. Franks, Riley Pratt, Douglas Forshee, Richard A. MaCurdy, Thomas Worrall, Chris Howery, Andrew E. Kelman, Jeffrey TI Comparative effectiveness of high-dose versus standard-dose influenza vaccines in US residents aged 65 years and older from 2012 to 2013 using Medicare data: a retrospective cohort analysis SO LANCET INFECTIOUS DISEASES LA English DT Article ID RESPIRATORY SYNCYTIAL VIRUS; PLACEBO-CONTROLLED TRIAL; ELDERLY-PEOPLE; UNITED-STATES; MORTALITY BENEFITS; SEASONAL INFLUENZA; VACCINATION; SURVEILLANCE; ADULTS; RISK AB Background A high-dose trivalent inactivated influenza vaccine was licensed in 2009 by the US Food and Drug Administration (FDA) on the basis of serological criteria. We sought to establish whether high-dose inactivated influenza vaccine was more effective for prevention of influenza-related visits and hospital admissions in US Medicare beneficiaries than was standard-dose inactivated influenza vaccine. Methods In this retrospective cohort study, we identified Medicare beneficiaries aged 65 years and older who received high-dose or standard-dose inactivated influenza vaccines from community pharmacies that offered both vaccines during the 2012-13 influenza season. Outcomes were defined with billing codes on Medicare claims. The primary outcome was probable influenza infection, defined by receipt of a rapid influenza test followed by dispensing of the neuraminidase inhibitor oseltamivir. The secondary outcome was a hospital or emergency department visit, listing a Medicare billing code for influenza. We estimated relative vaccine effectiveness by comparing outcome rates in Medicare beneficiaries during periods of high influenza circulation. Univariate and multivariate Poisson regression models were used for analyses. Findings Between Aug 1, 2012 and Jan 31, 2013, we studied 929 730 recipients of high-dose vaccine and 1 615 545 recipients of standard-dose vaccine. Participants enrolled in each cohort were well balanced with respect to age and presence of underlying medical disorders. The high-dose vaccine (1.30 outcomes per 10 000 person-weeks) was 22% (95% CI 15-29) more effective than the standard-dose vaccine (1.01 outcomes per 10 000 person-weeks) for prevention of probable influenza infections (rapid influenza test followed by oseltamivir treatment) and 22% (95% CI 16-27%) more effective for prevention of influenza hospital admissions (0.86 outcomes per 10 000 person-weeks in the high-dose cohort vs 1.10 outcomes per 10 000 person-weeks in the standard-dose cohort). Interpretation Our retrospective cohort study in US Medicare beneficiaries shows that, in people 65 years of age and older, high-dose inactivated influenza vaccine was significantly more effective than standard-dose vaccine in prevention of influenza-related medical encounters. Additionally, the large population in our study enabled us to show, for the first time, a significant reduction in influenza-related hospital admissions in high-dose compared to standard-dose vaccine recipients, an outcome not shown in randomised studies. These results provide important new information to be considered by policy makers recommending influenza vaccinations for elderly people. C1 [Izurieta, Hector S.; Lu, Yun; Pratt, Douglas; Forshee, Richard A.] US FDA, Ctr Biol Evaluat & Res, Silver Spring, MD 20993 USA. [Thadani, Nicole; Maurer, Aaron; Franks, Riley; MaCurdy, Thomas; Howery, Andrew E.] Acumen LLC, Burlingame, CA USA. [Shay, David K.; Foppa, Ivo M.] Ctr Dis Control & Prevent, Influenza Div, Atlanta, GA USA. [Foppa, Ivo M.] Battelle Mem Inst, Atlanta, GA USA. [Worrall, Chris; Kelman, Jeffrey] Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Forshee, RA (reprint author), US FDA, Silver Spring, MD 20993 USA. EM richard.forshee@fda.hhs.gov OI Shay, David/0000-0001-9619-4820 FU FDA; office of the Assistant Secretary of Planning and Evaluation FX FDA and the office of the Assistant Secretary of Planning and Evaluation. NR 36 TC 31 Z9 31 U1 1 U2 7 PU ELSEVIER SCI LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, OXON, ENGLAND SN 1473-3099 EI 1474-4457 J9 LANCET INFECT DIS JI Lancet Infect. Dis. PD MAR PY 2015 VL 15 IS 3 BP 293 EP 300 DI 10.1016/S1473-3099(14)71087-4 PG 8 WC Infectious Diseases SC Infectious Diseases GA CC3SA UT WOS:000350268500027 PM 25672568 ER PT J AU Carroll, JD Shuren, J Jensen, TS Hernandez, J Holmes, D Marinac-Dabic, D Edwards, FH Zuckerman, BD Wood, LL Kuntz, RE Mack, MJ AF Carroll, John D. Shuren, Jeff Jensen, Tamara Syrek Hernandez, John Holmes, David Marinac-Dabic, Danica Edwards, Fred H. Zuckerman, Bram D. Wood, Larry L. Kuntz, Richard E. Mack, Michael J. TI Transcatheter Valve Therapy Registry Is A Model For Medical Device Innovation And Surveillance SO HEALTH AFFAIRS LA English DT Article ID HIGH-RISK PATIENTS; AORTIC-STENOSIS; MITRAL REGURGITATION; HEALTH-STATUS; REPLACEMENT; SURGERY; INFRASTRUCTURE; IMPLANTATION; ASSOCIATION; REPAIR AB Heart valve diseases are increasingly prevalent, especially in people older than age seventy. Many of these elderly people have other comorbid conditions, making them poor candidates for surgical treatment of heart valve diseases. Since 2011 such patients have been eligible to receive new nonsurgical heart valve treatments approved by the Food and Drug Administration (FDA) and covered by Medicare. This article examines the Transcatheter Valve Therapy Registry, which captures clinical information on all US patients undergoing new nonsurgical heart valve treatments. The registry has patient-level data from more than 27,000 patients treated with the novel devices. Patient-and procedure-related data are gathered from hospitals, patient-reported outcomes are assessed pre- and postprocedure, and longer-term data on mortality and repeat hospitalization are provided by linking the registry's data to Medicare patient data. The registry is a model of collaboration among professional societies, the FDA, the Centers for Medicare and Medicaid Services, hospitals, patients, and the medical device industry. It has been used to support Medicare coverage decisions, expand device indications, provide comprehensive device surveillance, and establish national quality benchmarks. Beyond having it serve as a collaborative model, future goals for the registry include shortening the FDA-approval timeline for devices, providing data for decision-making tools for patients, and public reporting of hospital performance. C1 [Carroll, John D.] Univ Colorado, Sch Med, Med, Aurora, CO 80045 USA. [Shuren, Jeff] US FDA, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [Jensen, Tamara Syrek] Ctr Medicare Serv, Ctr Clin Stand & Qual, Coverage & Anal Grp, Baltimore, MD USA. [Jensen, Tamara Syrek] Ctr Medicaid Serv, Ctr Clin Stand & Qual, Coverage & Anal Grp, Baltimore, MD USA. [Hernandez, John] Abbott Vasc, Hlth Econ & Outcomes Res, Santa Clara, CA USA. [Holmes, David] Mayo Clin, Coll Med, Med, Rochester, MN USA. [Marinac-Dabic, Danica] US FDA, Div Epidemiol, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [Edwards, Fred H.] Univ Florida, Gainesville, FL 32611 USA. [Zuckerman, Bram D.] US FDA, Div Cardiovasc Devices, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [Wood, Larry L.] Edwards Lifesci Corp, Irvine, CA USA. [Kuntz, Richard E.] Medtronic, Minneapolis, MN USA. [Mack, Michael J.] Baylor Scott & White Hlth, Plano, TX USA. RP Carroll, JD (reprint author), Univ Colorado, Sch Med, Med, Aurora, CO 80045 USA. EM john.carroll@ucdenver.edu NR 30 TC 9 Z9 9 U1 1 U2 4 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 FEB PY 2015 VL 34 IS 2 BP 328 EP 334 DI 10.1377/hlthaff.2014.1010 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CE3HA UT WOS:000351716100020 PM 25646114 ER PT J AU Bonner, AF Field, TS Lemay, CA Mazor, KM Andersen, DA Compher, CJ Tjia, J Gurwitz, JH AF Bonner, Alice F. Field, Terry S. Lemay, Celeste A. Mazor, Kathleen M. Andersen, Daniel A. Compher, Christina J. Tjia, Jennifer Gurwitz, Jerry H. TI Rationales that Providers and Family Members Cited for the Use of Antipsychotic Medications in Nursing Home Residents with Dementia SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE nursing home; antipsychotic medication; dementia ID METAANALYSIS AB ObjectivesTo describe the rationales that providers and family members cite for the use of antipsychotic medications in people with dementia living in nursing homes (NHs). DesignQualitative, descriptive study. SettingTwenty-six medium-sized and large facilities in five Centers for Medicare and Medicaid Services regions. ParticipantsIndividuals diagnosed with dementia who received an antipsychotic medication. MeasurementsData were collected from medical record abstraction and interviews with prescribers, administrators, direct care providers, and family members. Textual data from medical record abstraction and responses to open-ended interview questions were analyzed using directed content analysis techniques. A coding scheme was developed, and coded reasons for antipsychotic prescribing were summarized across all sources. ResultsMajor categories of reasons for use of antipsychotic medications in the 204 NH residents in the study sample were behavioral (n=171), psychiatric (n=159), emotional states (n=105), and cognitive diagnoses or symptoms (n=114). The most common behavioral reasons identified were verbal (n=91) and physical (n=85) aggression. For the psychiatric category, psychosis (n=95) was most frequently described. Anger (n=93) and sadness (n=20) were the most common emotional states cited. ConclusionThe rationale for use of antipsychotic drug therapy frequently relates to a wide variety of indications for which these drugs are not approved and for which evidence of efficacy is lacking. These findings have implications for clinical practice and policy. C1 [Bonner, Alice F.] Northeastern Univ, Sch Nursing, Boston, MA 02115 USA. [Bonner, Alice F.] Northeastern Univ, Ctr Hlth Policy, Boston, MA 02115 USA. [Field, Terry S.; Lemay, Celeste A.; Mazor, Kathleen M.; Gurwitz, Jerry H.] Univ Massachusetts, Sch Med, Meyers Primary Care Inst, Reliant Med Grp, Worcester, MA USA. [Andersen, Daniel A.] Ctr Medicare & Medicaid Serv, Div Nursing Homes, Baltimore, MD USA. [Compher, Christina J.] Healthcare Management Solut LLC, Fairmont, WV USA. [Tjia, Jennifer] Univ Massachusetts, Sch Med, Dept Quantitat Hlth Sci, Worcester, MA USA. RP Bonner, AF (reprint author), Northeastern Univ, Sch Nursing, 360 Huntington Ave, Boston, MA 02115 USA. EM a.bonner@neu.edu FU Centers for Medicare and Medicaid Services [HHSM-500-2011-00078C] FX This work was performed as part of a contract with The Centers for Medicare and Medicaid Services (Contract HHSM-500-2011-00078C). NR 16 TC 5 Z9 5 U1 0 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 EI 1532-5415 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD FEB PY 2015 VL 63 IS 2 BP 302 EP 308 DI 10.1111/jgs.13230 PG 7 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA CB8PP UT WOS:000349893300012 PM 25643635 ER PT J AU Menis, M Forshee, RA Anderson, SA McKean, S Gondalia, R Warnock, R Johnson, C Mintz, PD Worrall, CM Kelman, JA Izurieta, HS AF Menis, Mikhail Forshee, Richard A. Anderson, Steven A. McKean, Stephen Gondalia, Rahul Warnock, Rob Johnson, Chris Mintz, Paul D. Worrall, Christopher M. Kelman, Jeffrey A. Izurieta, Hector S. TI Posttransfusion purpura occurrence and potential risk factors among the inpatient US elderly, as recorded in large Medicare databases during 2011 through 2012 SO TRANSFUSION LA English DT Article ID POST-TRANSFUSION PURPURA; ADMINISTRATIVE DATA; BLOOD-TRANSFUSION; NONINFECTIOUS COMPLICATIONS; THROMBOCYTOPENIA; DIAGNOSIS; IMMUNOGLOBULIN; ANTIBODIES AB BackgroundPosttransfusion purpura (PTP) is a serious transfusion complication resulting in sudden thrombocytopenia with bleeding. The study's objective was to assess PTP occurrence and potential risk factors among the inpatient US elderly, ages 65 and older, during 2011 through 2012. Study Design and MethodsThis retrospective claims-based study utilized large Medicare databases for calendar years 2011 and 2012. Transfusions of blood and blood components were identified by recorded ICD-9-CM procedure codes and revenue center codes, and PTP was ascertained via ICD-9-CM diagnosis code. Our study evaluated PTP rates (per 100,000 inpatient transfusion stays) among elderly Medicare beneficiaries, overall and by age, sex, race, number of units, and blood components transfused. Multivariate regression analyses were used to assess potential risk factors. ResultsAmong 4,336,338 inpatient transfusion stays for elderly beneficiaries during the study period, 78 had a PTP diagnosis code recorded, an overall rate of 1.8 per 100,000 stays. PTP occurrence varied by the blood components, units transfused, and other characteristics. Significantly higher odds of PTP were found for platelet (PLT)-containing transfusions, with greater number of units transfused, as well as for elderly with histories of cardiac arrhythmias (odds ratio [OR],2.65; 95% confidence interval [CI], 1.43-4.93), coagulopathy (OR,1.79; 95% CI, 1.01-3.21), leukemia (OR,2.37; 95% CI, 1.07-5.26), transplant (OR,2.68; 95% CI, 1.41-5.09), and other conditions. ConclusionOur population-based study suggests a substantially higher PTP risk with PLT-containing transfusions. The study also suggests increased PTP risk with greater number of units transfused as well as the importance of underlying health conditions and prior recipient alloimmunization for PTP occurrence among the elderly. C1 [Menis, Mikhail; Forshee, Richard A.; Anderson, Steven A.; Mintz, Paul D.; Izurieta, Hector S.] US FDA, Silver Spring, MD 20993 USA. [McKean, Stephen; Gondalia, Rahul; Warnock, Rob; Johnson, Chris] Acumen LLC, Burlingame, CA USA. [Worrall, Christopher M.; Kelman, Jeffrey A.] Ctr Medicare Serv, Baltimore, MD USA. [Worrall, Christopher M.; Kelman, Jeffrey A.] Ctr Medicaid Serv, Baltimore, MD USA. RP Menis, M (reprint author), US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA. EM Mikhail.Menis@fda.hhs.gov FU US Food and Drug Administration, Center for Biologics Evaluation and Research FX This study was funded by the US Food and Drug Administration, Center for Biologics Evaluation and Research. NR 44 TC 7 Z9 7 U1 0 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD FEB PY 2015 VL 55 IS 2 BP 284 EP 295 DI 10.1111/trf.12782 PG 12 WC Hematology SC Hematology GA CB7PX UT WOS:000349820900010 PM 25065878 ER PT J AU van Hasselt, M McCall, N Keyes, V Wensky, SG Smith, KW AF van Hasselt, Martijn McCall, Nancy Keyes, Vince Wensky, Suzanne G. Smith, Kevin W. TI Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes SO HEALTH SERVICES RESEARCH LA English DT Article DE Patient-centered medical home; Medicare payments; health care utilization ID HEALTH; QUALITY; MANAGEMENT; MODEL AB ObjectiveTo compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. Data SourcesMedicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file. Study DesignThis study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008-June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition. Data Collection MethodsIndividual Medicare fee-for-service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008. Principal FindingsRelative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices. ConclusionsThis study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care. C1 [van Hasselt, Martijn] Univ N Carolina, Greensboro, NC 27412 USA. [McCall, Nancy] RTI Int, Washington, DC USA. [Keyes, Vince] RTI Int, Res Triangle Pk, NC USA. [Wensky, Suzanne G.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Smith, Kevin W.] RTI Int, Waltham, MA USA. RP Univ N Carolina, 1400 Spring Garden St, Greensboro, NC 27412 USA. EM mnvanhas@uncg.edu FU Centers for Medicare & Medicaid Services (CMS) FX This research was supported by funding from the Centers for Medicare & Medicaid Services (CMS). Preliminary findings of this research were presented at a Federal PCMH Collaborative webinar on October 18, 2011 and at the AcademyHealth conference on June 24, 2012. The authors thank Ann Larsen at RTI International for her assistance with programming and data management and two anonymous referees for comments on an earlier version of the manuscript. NR 27 TC 17 Z9 17 U1 3 U2 11 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 FEB PY 2015 VL 50 IS 1 BP 253 EP 272 DI 10.1111/1475-6773.12217 PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CA7OD UT WOS:000349105900015 PM 25077375 ER PT J AU Graham, DJ Reichman, ME Wernecke, M Zhang, RM Southworth, MR Levenson, M Sheu, TC Mott, K Goulding, MR Houstoun, M MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Reichman, Marsha E. Wernecke, Michael Zhang, Rongmei Southworth, Mary Ross Levenson, Mark Sheu, Ting-Chang Mott, Katrina Goulding, Margie R. Houstoun, Monika MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Cardiovascular, Bleeding, and Mortality Risks in Elderly Medicare Patients Treated With Dabigatran or Warfarin for Nonvalvular Atrial Fibrillation SO CIRCULATION LA English DT Article DE anticoagulant; pharmacoepidemiology; safety; thrombin inhibitor; warfarin ID ACUTE MYOCARDIAL-INFARCTION; POSITIVE PREDICTIVE-VALUE; ADMINISTRATIVE DATA; CODING ACCURACY; STROKE; METAANALYSIS; VALIDATION; THERAPY; DIAGNOSIS; OLDER AB Background-The comparative safety of dabigatran versus warfarin for treatment of nonvalvular atrial fibrillation in general practice settings has not been established. Methods and Results-We formed new-user cohorts of propensity score-matched elderly patients enrolled in Medicare who initiated dabigatran or warfarin for treatment of nonvalvular atrial fibrillation between October 2010 and December 2012. Among 134 414 patients with 37 587 person-years of follow-up, there were 2715 primary outcome events. The hazard ratios (95% confidence intervals) comparing dabigatran with warfarin (reference) were as follows: ischemic stroke, 0.80 (0.67-0.96); intracranial hemorrhage, 0.34 (0.26-0.46); major gastrointestinal bleeding, 1.28 (1.14-1.44); acute myocardial infarction, 0.92 (0.78-1.08); and death, 0.86 (0.77-0.96). In the subgroup treated with dabigatran 75 mg twice daily, there was no difference in risk compared with warfarin for any outcome except intracranial hemorrhage, in which case dabigatran risk was reduced. Most patients treated with dabigatran 75 mg twice daily appeared not to have severe renal impairment, the intended population for this dose. In the dabigatran 150-mg twice daily subgroup, the magnitude of effect for each outcome was greater than in the combined-dose analysis. Conclusions-In general practice settings, dabigatran was associated with reduced risk of ischemic stroke, intracranial hemorrhage, and death and increased risk of major gastrointestinal hemorrhage compared with warfarin in elderly patients with nonvalvular atrial fibrillation. These associations were most pronounced in patients treated with dabigatran 150 mg twice daily, whereas the association of 75 mg twice daily with study outcomes was indistinguishable from warfarin except for a lower risk of intracranial hemorrhage with dabigatran. C1 [Graham, David J.; Reichman, Marsha E.; Mott, Katrina; Goulding, Margie R.; Houstoun, Monika] US FDA, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Zhang, Rongmei; Levenson, Mark] US FDA, Off Biostat, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Southworth, Mary Ross] US FDA, Off New Drugs, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Wernecke, Michael; Sheu, Ting-Chang; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Dept Econ, Stanford, CA 94305 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare Serv, Washington, DC USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicaid Serv, Washington, DC USA. RP Graham, DJ (reprint author), Off Surveillance & Epidemiol, 10903 New Hampshire Ave,Bldg 22,Room 4314, Silver Spring, MD 20993 USA. EM david.graham1@fda.hhs.gov OI Mott, Katrina/0000-0001-8322-7830 FU Centers for Medicare & Medicaid Services; US Food and Drug Administration FX This study was funded through an intra-agency agreement between the Centers for Medicare & Medicaid Services and the US Food and Drug Administration. NR 33 TC 202 Z9 208 U1 5 U2 37 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA SN 0009-7322 EI 1524-4539 J9 CIRCULATION JI Circulation PD JAN 13 PY 2015 VL 131 IS 2 BP 157 EP 164 DI 10.1161/CIRCULATIONAHA.114.012061 PG 8 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA AY8FY UT WOS:000347791000012 PM 25359164 ER PT J AU Kassler, WJ Tomoyasu, N Conway, PH AF Kassler, William J. Tomoyasu, Naomi Conway, Patrick H. TI Beyond a Traditional Payer - CMS's Role in Improving Population Health SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID CARE C1 [Kassler, William J.] Ctr Medicare Serv, Boston, MA 02203 USA. [Kassler, William J.] Ctr Medicaid Serv, Boston, MA USA. [Tomoyasu, Naomi; Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD USA. [Tomoyasu, Naomi; Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA. RP Kassler, WJ (reprint author), Ctr Medicare Serv, Boston, MA 02203 USA. NR 4 TC 18 Z9 18 U1 0 U2 2 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JAN 8 PY 2015 VL 372 IS 2 BP 109 EP 111 DI 10.1056/NEJMp1406838 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA AY2UA UT WOS:000347443300005 PM 25564896 ER PT J AU Stevens, JP Nyweide, D Maresh, S Shrank, W Howell, MD Landon, BE AF Stevens, J. P. Nyweide, D. Maresh, S. Shrank, W. Howell, M. D. Landon, B. E. TI Inpatient Consultations Among Patients Admitted For Respiratory Diseases SO AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE LA English DT Meeting Abstract CT International Conference of the American-Thoracic-Society (ATS) CY MAY 15-20, 2015 CL Denver, CO SP Amer Thorac Soc C1 [Stevens, J. P.] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA. [Stevens, J. P.; Nyweide, D.; Maresh, S.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Shrank, W.] Brigham & Womens Hosp, Boston, MA 02115 USA. [Howell, M. D.] Univ Chicago, Chicago, IL 60637 USA. [Landon, B. E.] Harvard Univ, Sch Med, Boston, MA USA. EM jpsteven@bidmc.harvard.edu NR 0 TC 0 Z9 0 U1 0 U2 0 PU AMER THORACIC SOC PI NEW YORK PA 25 BROADWAY, 18 FL, NEW YORK, NY 10004 USA SN 1073-449X EI 1535-4970 J9 AM J RESP CRIT CARE JI Am. J. Respir. Crit. Care Med. PY 2015 VL 191 MA A3698 PG 1 WC Critical Care Medicine; Respiratory System SC General & Internal Medicine; Respiratory System GA DO2AW UT WOS:000377582804340 ER PT J AU Catlin, MK Poisal, JA AF Catlin, Mary K. Poisal, John A. TI Out-Of-Pocket Health Care Expenditures, By Insurance Status, 2007-10 SO HEALTH AFFAIRS LA English DT Article AB Out-of-pocket health care spending in the United States totaled $306.2 billion in 2010 and represented 11.8 percent of total national health expenditures, according to the Centers for Medicare and Medicaid Services' National Health Expenditure Accounts. Spending by people with employer-sponsored health insurance and those covered by Medicare accounted for over 80 percent of total out-of-pocket spending. People without comprehensive medical coverage accounted for less than 8 percent of all out-of-pocket expenditures in 2010. Between 2007 and 2010 per person out-of-pocket spending grew most rapidly for people primarily covered by employer-sponsored insurance and declined for people primarily covered by Medicare and those without coverage. C1 [Catlin, Mary K.] CMS, Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD 21244 USA. [Poisal, John A.] CMS, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD USA. RP Catlin, MK (reprint author), CMS, Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD 21244 USA. EM mary.catlin@cms.hhs.gov NR 9 TC 7 Z9 7 U1 3 U2 8 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 PY 2015 VL 34 IS 1 BP 111 EP 116 DI 10.1377/hlthaff.2014.0422 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA CE3GZ UT WOS:000351716000016 PM 25561651 ER PT J AU Shadel, WG Elliott, MN Haas, AC Haviland, AM Orr, N Farmer, MM Ma, S Weech-Maldonado, R Farley, DO Cleary, PD AF Shadel, William G. Elliott, Marc N. Haas, Ann C. Haviland, Amelia M. Orr, Nate Farmer, Melissa M. Ma, Sai Weech-Maldonado, Robert Farley, Donna O. Cleary, Paul D. TI Clinician advice to quit smoking among seniors SO PREVENTIVE MEDICINE LA English DT Article DE Physician/patient communication; Medicare; Patient education; Smoking cessation ID ALZHEIMER-DISEASE; TOBACCO MEASURES; HEALTH-CARE; CESSATION; SMOKERS; OLDER; RISK; INTERVENTIONS; US; DISPARITIES AB Objective. Little smoking research in the past 20 years includes persons 50 and older; herein we describe patterns of clinician cessation advice to US seniors, including variation by Medicare beneficiary characteristics. Method. In 2012-4, we analyzed 2010 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Medicare beneficiaries over age 64 (n=346,674). We estimated smoking rates and the proportion of smokers whose clinicians encouraged cessation. Results. 12% of male and 8% of female respondents aged 65 and older smoke. The rate decreases with age (14% of 65-69,3% of 85+) and education (12-15% with no high school degree, 5-6% with BA +). Rates are highest among American Indian/Alaskan Native (16%), multiracial (14%), and African-American (13%) seniors, and in the Southeast (14%). Only 51% of smokers say they receive cessation advice "always" or "usually" at doctor visits, with advice more often given to the young, those in low-smoking regions, Asians, and women. For all results cited p < 0.05. Conclusions. Smoking cessation advice to seniors is variable. Providers may focus on groups or areas in which smoking is less common or when they are most comfortable giving advice. More consistent interventions are needed, including cessation advice from clinicians. (C) 2014 Elsevier Inc. All rights reserved. C1 [Shadel, William G.; Haas, Ann C.; Haviland, Amelia M.; Farley, Donna O.] RAND Corp, Pittsburgh, PA 15213 USA. [Elliott, Marc N.; Orr, Nate] RAND Corp, Santa Monica, CA 90407 USA. [Haviland, Amelia M.] Carnegie Mellon Univ, H John Heinz Coll 3, Pittsburgh, PA 15213 USA. [Orr, Nate] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Weech-Maldonado, Robert] Univ Alabama Birmingham, Dept Hlth Serv Adm, Birmingham, AL 35294 USA. [Farmer, Melissa M.] VA Greater Los Angeles Healthcare Syst, Vet Adm HSR&D Ctr Study Healthcare Innovat Implem, Sepulveda, CA 91343 USA. [Cleary, Paul D.] Yale Univ, Sch Publ Hlth, New Haven, CT 06520 USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St, Santa Monica, CA 90401 USA. EM shadel@rand.org; elliott@rand.org; ahaas@rand.org; haviland@cmu.edu; orr@rand.org; Melissa.Farmer@va.gov; sai.ma@cms.hhs.gov; rweech@uab.edu; farley@rand.org; paul.cleary@yale.edu FU CMS [HHSM-500-2005-00028I] FX This study was funded by CMS contract HHSM-500-2005-00028I to RAND. NR 48 TC 5 Z9 5 U1 1 U2 5 PU ACADEMIC PRESS INC ELSEVIER SCIENCE PI SAN DIEGO PA 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495 USA SN 0091-7435 EI 1096-0260 J9 PREV MED JI Prev. Med. PD JAN PY 2015 VL 70 BP 83 EP 89 DI 10.1016/j.ypmed.2014.11.020 PG 7 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA CB9GB UT WOS:000349938900016 PM 25482423 ER PT J AU Chapman, WC Reich, D Kasiske, B Andreoni, K Hamilton, T O'Rourke, M Greenstein, S Ho, B AF Chapman, William C. Reich, David Kasiske, Bertram Andreoni, Kenneth Hamilton, Thomas O'Rourke, Mariane Greenstein, Stuart Ho, Bing TI ASTS Business Practice and Legislative Seminar SO AMERICAN JOURNAL OF TRANSPLANTATION LA English DT Meeting Abstract CT 15th Annual State of the Art Winter Symposium of the American-Society-of-Transplant-Surgeons (ASTS) CY JAN 15-18, 2015 CL Miami, FL SP Amer Soc Transplant Surg C1 [Chapman, William C.] Washington Univ, Sch Med, St Louis, MO USA. [Reich, David] Drexel Univ, Philadelphia, PA 19104 USA. [Kasiske, Bertram] Univ Minnesota, Minneapolis, MN USA. [Andreoni, Kenneth] Univ Florida Hlth, Gainesville, FL USA. [Hamilton, Thomas] Ctr Medicare Serv, Washington, DC USA. [O'Rourke, Mariane] Univ Miami, Miami, FL USA. [Greenstein, Stuart] Yeshiva Univ Albert Einstein Coll Med, Bronx, NY 10461 USA. [Ho, Bing] Northwestern Univ, Sch Med, Chicago, IL USA. NR 0 TC 0 Z9 0 U1 3 U2 3 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1600-6135 EI 1600-6143 J9 AM J TRANSPLANT JI Am. J. Transplant. PD JAN PY 2015 VL 15 SU 1 SI SI MA BPS-1 BP 46 EP 46 PG 1 WC Surgery; Transplantation SC Surgery; Transplantation GA AZ1YF UT WOS:000348030600014 ER PT J AU Ketcham, JD Lucarelli, C Powers, CA AF Ketcham, Jonathan D. Lucarelli, Claudio Powers, Christopher A. TI Paying Attention or Paying Too Much in Medicare Part D SO AMERICAN ECONOMIC REVIEW LA English DT Article ID PRESCRIPTION DRUG BENEFIT; AUTOMOBILE INSURANCE; DECISION-MAKING; CHOICE OVERLOAD; SWITCHING COSTS; MODEL; MARKET; IMPROVEMENTS; PREFERENCES; DEPENDENCE AB We study whether people became less likely to switch Medicare prescription drug plans (PDPs) due to more options and more time in Part D. Panel data for a random 20 percent sample of enrollees from 2006-2010 show that 50 percent were not in their original PDPs by 2010. Individuals switched PDPs in response to higher costs of their status quo plans, saving them money. Contrary to choice overload, larger choice sets increased switching unless the additional plans were relatively expensive. Neither switching overall nor responsiveness to costs declined over time, and above-minimum spending in 2010 remained below the 2006 and 2007 levels. C1 [Ketcham, Jonathan D.] Arizona State Univ, WP Carey Sch Business, Dept Mkt, Tempe, AZ 85287 USA. [Lucarelli, Claudio] Univ Los Andes, Sch Business & Econ, Santiago 12455, Chile. [Lucarelli, Claudio] Leonard Davis Inst Hlth Econ, Philadelphia, PA USA. [Powers, Christopher A.] Ctr Medicare & Medicaid Serv, Off Informat Prod & Data Analyt, Baltimore, MD 21244 USA. RP Ketcham, JD (reprint author), Arizona State Univ, WP Carey Sch Business, Dept Mkt, Box 874106, Tempe, AZ 85287 USA. EM Ketcham@asu.edu; Claudio.Lucarelli@uandes.cl; Christopher.Powers@cms.hhs.gov NR 71 TC 5 Z9 5 U1 2 U2 8 PU AMER ECONOMIC ASSOC PI NASHVILLE PA 2014 BROADWAY, STE 305, NASHVILLE, TN 37203 USA SN 0002-8282 EI 1944-7981 J9 AM ECON REV JI Am. Econ. Rev. PD JAN PY 2015 VL 105 IS 1 BP 204 EP 233 DI 10.1257/aer.20120651 PG 30 WC Economics SC Business & Economics GA AY3DI UT WOS:000347464300007 ER PT J AU Kelman, J Finne, K Bogdanov, A Worrall, C Margolis, G Rising, K MaCurdy, TE Lurie, N AF Kelman, Jeffrey Finne, Kristen Bogdanov, Alina Worrall, Chris Margolis, Gregg Rising, Kristin MaCurdy, Thomas E. Lurie, Nicole TI Dialysis Care and Death Following Hurricane Sandy SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE Dialysis; end-stage renal disease (ESRD); emergency preparedness; disaster planning; Kidney Community Emergency Response (KCER) Program; Hurricane Sandy; natural disaster; vulnerable; population ID ADVERSE EVENTS; VACCINE SAFETY; LESSONS; KATRINA; SURVEILLANCE; DISASTERS AB Background: Hurricane Sandy affected access to critical health care infrastructure. Patients with end-stage renal disease (ESRD) historically have experienced problems accessing care and adverse outcomes during disasters. Study Design: Retrospective cohort study with 2 comparison groups. Setting & Participants: Using Centers for Medicare & Medicaid Services claims data, we assessed the frequency of early dialysis, emergency department (ED) visits, hospitalizations, and 30-day mortality for patients with ESRD in Sandy-affected areas (study group) and 2 comparison groups: (1) patients with ESRD living in states unaffected by Sandy during the same period and (2) patients with ESRD living in the Sandy-affected region a year prior to the hurricane (October 1, 2011, through October 30, 2011). Factor: Regional variation in dialysis care patterns and mortality for patients with ESRD in New York City and the State of New Jersey. Measurements: Frequency of early dialysis, ED visits, hospitalizations, and 30-day mortality. Results: Of 13,264 study patients, 59% received early dialysis in 70% of the New York City and New Jersey dialysis facilities. The ED visit rate was 4.1% for the study group compared with 2.6% and 1.7%, respectively, for comparison groups 1 and 2 (both P < 0.001). The hospitalization rate for the study group also was significantly higher than that in either comparison group (4.5% vs 3.2% and 3.8%, respectively; P < 0.001 and P < 0.003). 23% of study group patients who visited the ED received dialysis in the ED compared with 9.3% and 6.3% in comparison groups 1 and 2, respectively (both P < 0.001). The 30-day mortality rate for the study group was slightly higher than that for either comparison group (1.83% vs 1.47% and 1.60%, respectively; P < 0.001 and P = 0.1). Limitations: Lack of facility level damage and disaster-induced power outage severity data. Conclusions: Nearly half the study group patients received early dialysis prior to Sandy's landfall. Poststorm increases in ED visits, hospitalizations, and 30-day mortality were found in the study group, but not in the comparison groups. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. C1 [Kelman, Jeffrey; Worrall, Chris] US Dept HHS, Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. [Finne, Kristen; Margolis, Gregg; Lurie, Nicole] US Dept HHS, Offi Assistant Secretary Preparedness & Response, Washington, DC 20201 USA. [Bogdanov, Alina; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Rising, Kristin] Thomas Jefferson Univ, Dept Emergency Med, Philadelphia, PA 19107 USA. RP Lurie, N (reprint author), US Dept HHS, Off Secretary, 200 Independence Ave SW,Rm 638G, Washington, DC 20201 USA. EM nicole.lurie@hhs.gov FU CMS DataLink contract [HHSM-500-2011-00115G]; Acumen LLC FX This study was supported through the CMS DataLink contract (HHSM-500-2011-00115G) with Acumen LLC. The funders of this study had a role in the study design, interpretation of the data, writing the report, and the decision to submit the report for publication. NR 21 TC 8 Z9 8 U1 0 U2 5 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 JAN PY 2015 VL 65 IS 1 BP 109 EP 115 DI 10.1053/j.ajkd.2014.07.005 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA AW5ZW UT WOS:000346350300017 PM 25156306 ER PT J AU Trivedi, AN Nsa, W Hausmann, LRM Lee, JS Ma, A Bratzler, DW Mor, MK Baus, K Larbi, F Fine, MJ AF Trivedi, Amal N. Nsa, Wato Hausmann, Leslie R. M. Lee, Jonathan S. Ma, Allen Bratzler, Dale W. Mor, Maria K. Baus, Kristie Larbi, Fiona Fine, Michael J. TI Quality and Equity of Care in US Hospitals SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID TO-BALLOON TIME; ACUTE MYOCARDIAL-INFARCTION; HEALTH-CARE; OF-CARE; ETHNIC DISPARITIES; RACIAL DISPARITIES; BLACK PATIENTS; PERFORMANCE; RACE; VACCINATION AB BACKGROUND Nearly every U.S. hospital publicly reports its performance on quality measures for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia. Because performance rates are not reported according to race or ethnic group, it is unclear whether improvements in equity of care have accompanied aggregate improvements in health care quality over time. METHODS We assessed performance rates for quality measures covering three conditions (six measures for acute myocardial infarction, four for heart failure, and seven for pneumonia). These rates, adjusted for patient-and hospital-level covariates, were compared among non-Hispanic white, non-Hispanic black, and Hispanic patients who received care between 2005 and 2010 in acute care hospitals throughout the United States. RESULTS Adjusted performance rates for the 17 quality measures improved by 3.4 to 57.6 percentage points between 2005 and 2010 for white, black, and Hispanic adults (P<0.001 for all comparisons). In 2005, as compared with adjusted performance rates for white patients, adjusted performance rates were more than 5 percentage points lower for black patients on 3 measures (range of differences, 12.3 to 14.2) and for Hispanic patients on 6 measures (5.6 to 14.5). Gaps decreased significantly on all 9 of these measures between 2005 and 2010, with adjusted changes for differences between white patients and black patients ranging from -8.5 to -11.8 percentage points and from -6.2 to -15.1 percentage points for differences between white patients and Hispanic patients. Decreasing differences according to race or ethnic group were attributable to more equitable care for white patients and minority patients treated in the same hospital, as well as to greater performance improvements among hospitals that disproportionately serve minority patients. CONCLUSIONS Improved performance on quality measures for white, black, and Hispanic adults hospitalized for acute myocardial infarction, heart failure, or pneumonia was accompanied by increased racial and ethnic equity in performance rates both within and among U.S. hospitals. C1 [Trivedi, Amal N.] Brown Univ, Sch Publ Hlth, Providence Vet Affairs VA Med Ctr, Providence, RI 02903 USA. [Trivedi, Amal N.] Brown Univ, Sch Publ Hlth, Dept Hlth Serv Policy & Practice, Providence, RI 02903 USA. [Nsa, Wato; Ma, Allen] Oklahoma Fdn Med Qual, Oklahoma City, OK USA. [Bratzler, Dale W.] Univ Oklahoma, Hlth Sci Ctr, Coll Med, Oklahoma City, OK 73190 USA. [Bratzler, Dale W.] Univ Oklahoma, Hlth Sci Ctr, Coll Publ Hlth, Oklahoma City, OK 73190 USA. [Hausmann, Leslie R. M.; Mor, Maria K.; Fine, Michael J.] VA Ctr Hlth Equ Res & Promot, VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA. [Hausmann, Leslie R. M.; Lee, Jonathan S.; Fine, Michael J.] Univ Pittsburgh, Sch Med, Dept Med, Div Gen Internal Med, Pittsburgh, PA 15213 USA. [Mor, Maria K.] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA. [Baus, Kristie; Larbi, Fiona] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Trivedi, AN (reprint author), Brown Univ, Sch Publ Hlth, Dept Hlth Serv Policy & Practice, 121 S Main St,6th Fl, Providence, RI 02903 USA. EM amal_trivedi@brown.edu FU Centers for Medicare and Medicaid Services; Veterans Affairs Health Services Research and Development Career Development Program FX Funded by the Centers for Medicare and Medicaid Services and the Veterans Affairs Health Services Research and Development Career Development Program. NR 39 TC 11 Z9 11 U1 0 U2 7 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD DEC 11 PY 2014 VL 371 IS 24 BP 2298 EP 2308 DI 10.1056/NEJMoa1405003 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA AW1KQ UT WOS:000346048800010 PM 25494269 ER PT J AU Cassel, CK Conway, PH Delbanco, SF Jha, AK Saunders, RS Lee, TH AF Cassel, Christine K. Conway, Patrick H. Delbanco, Suzanne F. Jha, Ashish K. Saunders, Robert S. Lee, Thomas H. TI Getting More Performance from Performance Measurement SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD USA. [Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD USA. [Delbanco, Suzanne F.] Catalyst Payment Reform, San Francisco, CA USA. [Jha, Ashish K.; Saunders, Robert S.] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Lee, Thomas H.] Press Ganey, Boston, MA USA. NR 5 TC 28 Z9 28 U1 0 U2 4 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD DEC 4 PY 2014 VL 371 IS 23 BP 2145 EP 2147 DI 10.1056/NEJMp1408345 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA AW0IY UT WOS:000345976700001 PM 25470691 ER PT J AU Conway, P Wagner, D McGann, P Joshi, M AF Conway, Patrick Wagner, Dennis McGann, Paul Joshi, Maulik TI Did Hospital Engagement Networks Actually Improve Care? SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter C1 [Conway, Patrick; Wagner, Dennis; McGann, Paul] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Joshi, Maulik] Amer Hosp Assoc, Washington, DC USA. RP Conway, P (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. EM paul.mcgann@cms.hhs.gov NR 3 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 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD NOV 20 PY 2014 VL 371 IS 21 BP 2040 EP 2041 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA AT5ST UT WOS:000345002900028 PM 25409390 ER PT J AU Venkatesh, A Goodrich, K Conway, PH AF Venkatesh, Arjun Goodrich, Kate Conway, Patrick H. TI Opportunities for Quality Measurement to Improve the Value of Care for Patients With Multiple Chronic Conditions SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID HEALTH OUTCOMES; GUIDELINES AB Quality measurement efforts have not historically focused on patients with multiple chronic conditions (MCCs), despite them comprising one quarter of the population and two thirds of health care spending. The Patient Protection and Affordable Care Act (ACA) creates several mechanisms for the Centers for Medicare & Medicaid Services (CMS) to transform quality measurement into an organized enterprise designed to support clinicians caring for this vulnerable population. This article highlights 3 emerging policy opportunities for CMS to guide public and private quality measurement efforts for patients with MCCs. First, it discusses infusing an MCC framework into measure development to promote patient-centered, as opposed to single-disease-specific, performance measurement. Second, it describes the importance of using common performance measures for individual clinicians, hospitals, and communities to accelerate meaningful improvement in the prevention and management of chronic conditions across local populations. Finally, the need for longitudinal measurement as a foundation for sustained quality improvement is presented. The ACA's expansion of insurance access and portability necessitates collaborative alignment of chronic condition quality measurement efforts between public and private programs to develop a high-value lifelong health system. C1 [Venkatesh, Arjun] Yale Univ, Sch Med, Dept Emergency Med, New Haven, CT 06519 USA. [Goodrich, Kate; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Ctr Clin Stand & Qual, Baltimore, MD 21244 USA. George Washington Univ, Sch Med, Washington, DC USA. Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA. RP Venkatesh, A (reprint author), Yale Univ, Sch Med, Dept Emergency Med, 464 Congress St,Suite 260, New Haven, CT 06519 USA. EM arjun.venkatesh@yale.edu FU Robert Wood Johnson Foundation FX By the Robert Wood Johnson Foundation Clinical Scholars Program (Dr. Venkatesh). NR 26 TC 6 Z9 6 U1 1 U2 3 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD NOV 18 PY 2014 VL 161 IS 10 SU S BP S76 EP S80 DI 10.7326/M13-3014 PG 5 WC Medicine, General & Internal SC General & Internal Medicine GA CW3RR UT WOS:000364909900011 PM 25402407 ER PT J AU Carrier, E Cunningham, P AF Carrier, Emily Cunningham, Peter TI Medical Cost Burdens Among Nonelderly Adults With Asthma SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID EXPENDITURE PANEL SURVEY; HEALTH-CARE USE; DISEASE MANAGEMENT; OUTCOMES; IMPACT; RISK AB Objectives We used the 2003-2009 Medical Expenditure Panel Survey to evaluate average annual total and out-of-pocket expenditures by nonelderly adults with asthma. Study Design We divided patients diagnosed with asthma into 4 groups, based on whether or not they had had an asthma attack in the previous year (a crude marker for disease severity) and whether or not they reported using treatment for their asthma. Methods For each group we calculated total and out-of-pocket average annual spending for hospital inpatient, hospital outpatient, emergency department, and physician office care, as well as for prescription drugs. These averages were adjusted to account for differences in respondents' overall health (presence of other co-morbidities, self-reported health status, and self-reported activity limitations), sociodemographic characteristics (age, sex, race/ethnicity, income), and insurance status. Results We found that among the 4 groups, those who were receiving treatment but continued to experience asthma attacks had the highest total and out-of-pocket expenditures in all categories, consistent with their likely higher illness severity. However, patients who reported receiving treatment and did not experience attacks also reported relatively high adjusted total and out-of-pocket expenditures-most notably $536 per year out of pocket for prescription medications and $231 per year out of pocket for physician office visits. After adjustment, about the same proportion of patients in these 2 groups (13.5% who did not get treated and had attacks, and 13.8% who did get treated and avoided attacks) reported high financial burden. Conclusions Patients may experience financial challenges to appropriate self-management of asthma, even when they are able to avoid exacerbations. C1 [Carrier, Emily] CMS, CMS Innovat Ctr, Seamless Care Models Grp, Baltimore, MD USA. [Cunningham, Peter] Virginia Commonwealth Univ, Dept Healthcare Policy & Res, Richmond, VA USA. RP Carrier, E (reprint author), Ctr Medicare & Medicaid Serv, CMS Innovat Ctr, Seamless Care Models Grp, 7500 Security Blvd,WB-15-64, Baltimore, MD 21244 USA. EM Emily.Carrier@cms.hhs.gov FU Commonwealth Fund FX This study was supported by the Commonwealth Fund. NR 21 TC 2 Z9 2 U1 2 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 NOV PY 2014 VL 20 IS 11 BP 925 EP 932 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA CD3SM UT WOS:000351001000013 PM 25495113 ER PT J AU Christian, TJ Plotzke, MR Teno, JM Lucas, KE Loeffler, H AF Christian, T. J. Plotzke, M. R. Teno, J. M. Lucas, K. E. Loeffler, H. TI TOTAL MEDICARE EXPENDITURES UNDERTAKEN BY HOSPICE BENEFICIARIES DURING HOSPICE ELECTION SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Christian, T. J.; Plotzke, M. R.] Abt Associates Inc, Cambridge, MA USA. [Teno, J. M.] Brown Univ, Ctr Gerontol & Hlth Care Res, Providence, RI 02912 USA. [Lucas, K. E.; Loeffler, H.] 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 NOV PY 2014 VL 54 SU 2 BP 17 EP 18 PG 2 WC Gerontology SC Geriatrics & Gerontology GA AW5TU UT WOS:000346337500090 ER PT J AU Du, DY McKean, S Kelman, JA Laschinger, J Johnson, C Warnock, R Worrall, CM Sedrakyan, A Encinosa, W MaCurdy, TE Izurieta, HS AF Du, Dongyi (Tony) McKean, Stephen Kelman, Jeffrey A. Laschinger, John Johnson, Chris Warnock, Rob Worrall, Chris M. Sedrakyan, Art Encinosa, William MaCurdy, Thomas E. Izurieta, Hector S. TI Early Mortality After Aortic Valve Replacement With Mechanical Prosthetic vs Bioprosthetic Valves Among Medicare Beneficiaries A Population-Based Cohort Study SO JAMA INTERNAL MEDICINE LA English DT Article ID PROPENSITY SCORE; HEART-VALVE; SOCIETY; DISEASE; SURGERY AB IMPORTANCE Early mortality for patients who undergo aortic valve replacement (AVR) may differ between mechanical and biological prosthetic (hereinafter referred to as bioprosthetic) valves. Clinical trials may have difficulty addressing this issue owing to limited sample sizes and low mortality rates. OBJECTIVE To compare early mortality after AVR between the recipients of mechanical and bioprosthetic aortic valves. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of patients 65 years or older in the Medicare databases who underwent AVR from July 1, 2006, through December 31, 2011. In the mixed-effects models adjusting for physician and hospital random effects, we estimated odds ratios (OR) of early mortality to compare mechanical vs bioprosthetic valves. EXPOSURES Mechanical or bioprosthetic aortic valve replacement. MAIN OUTCOMES AND MEASURES Early mortalitywas measured as death on the date of surgery, death within 1 to 30 or 31 to 365 days after the date of surgery, death within 30 days after the date of hospital discharge, and operative mortality (death within 30 days after surgery or at discharge, whichever is longer). RESULTS Of the 66 453 Medicare beneficiaries who met inclusion criteria, 19 190 (28.88%) received a mechanical valve and 47 263 (71.12%) received a bioprosthetic valve. The risk for death on the date of surgery was 60% higher for recipients of mechanical valves than recipients of bioprosthetic valves (OR, 1.61 [95% CI, 1.27-2.04; P <.001]; risk ratio [RR], 1.60). The risk difference decreased to 16% during the 30 days after the date of surgery (OR, 1.18 [95% CI, 1.09-1.28; P < .001]; RR, 1.16). We found no differences within 31 to 365 days after the date of surgery and within the 30 days after discharge. The risk for operative mortality was 19% higher for recipients of mechanical compared with bioprosthetic valves (OR, 1.21 [95% CI, 1.13-1.30; P < .001]; RR, 1.19). The number needed to treat with mechanical valves to observe 1 additional death on the surgery date was 290; to observe 1 additional death within 30 days of surgery, 121. Consistent findings were observed in subgroup analyses of patients who underwent concurrent AVR and coronary artery bypass graft, but not in the subgroup undergoing isolated AVR. CONCLUSIONS AND RELEVANCE In this cohort analysis of Medicare beneficiaries, use of mechanical aortic valves was associated with a higher risk for death on the date of surgery and within the 30 days after surgery compared with bioprosthetic aortic valves among patients who underwent concurrent AVR and coronary artery bypass graft but not isolated AVR. C1 [Du, Dongyi (Tony); Izurieta, Hector S.] US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, Rockville, MD 20857 USA. [Du, Dongyi (Tony)] US FDA, Off Surveillance & Biometr, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [McKean, Stephen; Warnock, Rob; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Kelman, Jeffrey A.; Worrall, Chris M.] Ctr Medicare & Medicaid Serv, Washington, DC USA. [Laschinger, John] US FDA, Off Device Evaluat, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [Sedrakyan, Art] Weill Cornell Med Coll, Patient Ctr Comparat Effectiveness Program, New York, NY USA. [Sedrakyan, Art] Weill Cornell Med Coll, MDEpiNet Sci & Infrastruct Ctr, New York, NY USA. [Encinosa, William] Agcy Healthcare Res & Qual, Ctr Delivery Org & Markets, Rockville, MD USA. [MaCurdy, Thomas E.] Stanford Univ, Dept Econ, Stanford, CA 94305 USA. RP Du, DY (reprint author), Ctr Devices & Radiol Hlth Food & Drug Adm, Off Surveillance & Biometr, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA. EM dongyi.du@fda.hhs.gov FU SafeRx Project, Centers for Medicare & Medicaid Services; SafeRx Project, US Food and Drug Administration FX This study was performed as part of the SafeRx Project, a joint initiative of the Centers for Medicare & Medicaid Services and the US Food and Drug Administration. NR 37 TC 7 Z9 7 U1 1 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 2168-6106 EI 2168-6114 J9 JAMA INTERN MED JI JAMA Intern. Med. PD NOV PY 2014 VL 174 IS 11 BP 1788 EP 1795 DI 10.1001/jamainternmed.2014.4300 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA AU9KA UT WOS:000345909900018 PM 25221895 ER PT J AU Lee, JS Nsa, W Hausmann, LRM Trivedi, AN Bratzler, DW Auden, D Mor, MK Baus, K Larbi, FM Fine, MJ AF Lee, Jonathan S. Nsa, Wato Hausmann, Leslie R. M. Trivedi, Amal N. Bratzler, Dale W. Auden, Dana Mor, Maria K. Baus, Kristie Larbi, Fiona M. Fine, Michael J. TI Quality of Care for Elderly Patients Hospitalized for Pneumonia in the United States, 2006 to 2010 SO JAMA INTERNAL MEDICINE LA English DT Article ID COMMUNITY-ACQUIRED PNEUMONIA; ALL-CAUSE MORTALITY; PNEUMOCOCCAL VACCINATION; INFLUENZA VACCINATION; PERFORMANCE-MEASURES; MEDICARE PATIENTS; ADULTS; OUTCOMES; METAANALYSIS; ASSOCIATIONS AB IMPORTANCE Nearly every US acute care hospital reports publicly on adherence to recommended processes of care for patients hospitalized with pneumonia. However, it remains uncertain how much performance of these process measures has improved over time or whether performance is associated with superior patient outcomes. OBJECTIVES To describe trends in processes of care, mortality, and readmission for elderly patients hospitalized for pneumonia and to assess the independent associations between processes and outcomes of care. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study conducted from January 1, 2006, to December 31, 2010, at 4740 US acute care hospitals. The cohort included 1 818 979 cases of pneumonia in elderly (>= 65 years), Medicare fee-for-service patients who were eligible for at least 1 of 7 pneumonia inpatient processes of care tracked by the Centers for Medicare & Medicaid Services (CMS). MAIN OUTCOMES AND MEASURES Annual performance rates for 7 pneumonia processes of care and an all-or-none composite of these measures; and 30-day, all-cause mortality and hospital readmission, adjusted for patient and hospital characteristics. RESULTS Adjusted annual performance rates for all 7 CMS processes of care (expressed in percentage points per year) increased significantly from 2006 to 2010, ranging from 1.02 for antibiotic initiation within 6 hours to 5.30 for influenza vaccination (P < .001). All 7 measures were performed in more than 92% of eligible cases in 2010. The all-or-none composite demonstrated the largest adjusted relative increase over time (6.87 percentage points per year; P < .001) and was achieved in 87.4% of cases in 2010. Adjusted annual mortality decreased by 0.09 percentage points per year (P < .001), driven primarily by decreasing mortality in the subgroup not treated in the intensive care unit (ICU) (-0.18 percentage points per year; P < .001). Adjusted annual readmission rates decreased significantly by 0.25 percentage points per year (P < .001). All 7 processes of care were independently associated with reduced 30-day mortality, and 5 were associated with reduced 30-day readmission. CONCLUSIONS AND RELEVANCE Performance of processes of care for elderly patients hospitalized for pneumonia improved substantially from 2006 to 2010. Adjusted 30-day mortality declined slightly over time primarily owing to improved survival among non-ICU patients, and all individual processes of care were independently associated with reduced mortality. C1 [Lee, Jonathan S.; Hausmann, Leslie R. M.; Fine, Michael J.] Univ Pittsburgh, Sch Med, Dept Med, Div Gen Internal Med, Pittsburgh, PA 15213 USA. [Nsa, Wato; Auden, Dana] Oklahoma Fdn Med Qual, Oklahoma City, OK USA. [Hausmann, Leslie R. M.; Mor, Maria K.; Fine, Michael J.] VA Pittsburgh Healthcare Syst, Ctr Hlth Equ Res & Promot, Pittsburgh, PA 15240 USA. [Trivedi, Amal N.] Brown Univ, Dept Hlth Serv Policy & Practice, Providence, RI 02912 USA. [Bratzler, Dale W.] Univ Oklahoma, Hlth Sci Ctr, Coll Med & Publ Hlth, Oklahoma City, OK USA. [Mor, Maria K.] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA 15261 USA. [Baus, Kristie; Larbi, Fiona M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Fine, MJ (reprint author), VA Pittsburgh Healthcare Syst, Ctr Hlth Equ Res & Promot, Bldg 30,Univ Dr 151C, Pittsburgh, PA 15240 USA. EM michael.fine@va.gov FU CMS, an agency of the US Department of Health and Human Services [HHSM-500-2011-OK10C] FX The analyses on which this study is based were performed under contract No. HHSM-500-2011-OK10C funded by the CMS, an agency of the US Department of Health and Human Services. NR 48 TC 12 Z9 12 U1 1 U2 6 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 2168-6106 EI 2168-6114 J9 JAMA INTERN MED JI JAMA Intern. Med. PD NOV PY 2014 VL 174 IS 11 BP 1806 EP 1814 DI 10.1001/jamainternmed.2014.4501 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA AU9KA UT WOS:000345909900021 PM 25201438 ER PT J AU Shaw, PA AF Shaw, Penelope Ann TI Treatment Intervention: Learning Residents' Rights SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Editorial Material C1 [Shaw, Penelope Ann] Massachusetts Advocates Nursing Home Reform, Medford, MA USA. [Shaw, Penelope Ann] Ctr Medicare Serv, Div Nursing Homes, Baltimore, MD USA. [Shaw, Penelope Ann] Ctr Medicaid Serv, Div Nursing Homes, Baltimore, MD USA. RP Shaw, PA (reprint author), 1102 Washington St, Braintree, MA 02184 USA. EM pennyshaw3@gmail.com NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 EI 1532-5415 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD NOV PY 2014 VL 62 IS 11 BP 2199 EP 2200 DI 10.1111/jgs.13100 PG 2 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA AU3GO UT WOS:000345500700025 PM 25367075 ER PT J AU Straube, BM AF Straube, Barry M. TI CT Lung Cancer Screening: Public Healthcare Policy and Guidelines Collide SO ONCOLOGY-NEW YORK LA English DT Editorial Material C1 Marwood Grp, New York, NY 10017 USA. [Straube, Barry M.] Ctr Medicare & Medicaid Serv, Woodlawn, MD USA. RP Straube, BM (reprint author), Marwood Grp, New York, NY 10017 USA. NR 3 TC 0 Z9 0 U1 0 U2 2 PU UBM MEDICA PI NORWALK PA 535 CONNECTICUT AVE, STE 300, NORWALK, CT 06854 USA SN 0890-9091 J9 ONCOLOGY-NY JI Oncology-NY PD NOV PY 2014 VL 28 IS 11 BP 971 EP 972 PG 2 WC Oncology SC Oncology GA AT9RX UT WOS:000345264900010 PM 25381212 ER PT J AU Graham, DJ By, K McKean, S Mosholder, A Kornegay, C Racoosin, JA Young, J Levenson, M MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. By, Kunthel McKean, Stephen Mosholder, Andrew Kornegay, Cynthia Racoosin, Judith A. Young, Jessica Levenson, Mark MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Cardiovascular and mortality risks in older Medicare patients treated with varenicline or bupropion for smoking cessation: an observational cohort study SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Article DE varenicline; bupropion; cardiovascular risk; mortality; pharmacoepidemiology ID POSITIVE PREDICTIVE-VALUE; ACUTE MYOCARDIAL-INFARCTION; CORONARY-HEART-DISEASE; ADMINISTRATIVE DATA; CAUSAL INFERENCE; CODING ACCURACY; PARTIAL AGONIST; EVENTS; METAANALYSIS; DEPENDENCE AB PurposeTo compare cardiovascular and mortality risks in elderly patients treated with varenicline or bupropion for smoking cessation. MethodsElderly Medicare beneficiaries were entered into new-user cohorts of varenicline or bupropion for smoking cessation and followed on therapy for primary outcomes of acute myocardial infarction (AMI), stroke, mortality, and a composite of any of these events. Secondary outcomes were unstable angina, coronary revascularization, and a composite of any primary or secondary outcome event. Propensity score stratification was used to adjust for baseline differences in potential confounding factors. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards, with bupropion as reference. ResultsIn cohorts of 74824 varenicline and 14133 bupropion users, there were 164 AMI, 96 stroke, 87 death, 317 primary composite, and 814 secondary composite events while on therapy. The HRs (95%CI) were 0.79 (0.50-1.24) for AMI, 1.27 (0.63-2.55) for stroke, 0.58 (0.30-1.13) for death, 0.84 (0.58-1.23) for the primary composite, and 0.92 (0.73-1.14) for the secondary composite. The risk of AMI or the primary composite outcome did not differ in subgroups defined by age, diabetes status, or presence of underlying ischemic heart disease. Only 30% of patients remained on either study drug beyond their first prescription. ConclusionCardiovascular and mortality risks were not increased in older patients treated with varenicline compared with bupropion for smoking cessation. A potential increase in the risk of stroke with varenicline could not be excluded. Treatment persistence with either drug was low. Published 2014. This article is a U.S. Government work and is in the public domain in the USA. C1 [Graham, David J.; Mosholder, Andrew; Kornegay, Cynthia] US FDA, Off Surveillance & Epidemiol, Silver Spring, MD 20993 USA. [By, Kunthel; Levenson, Mark] US FDA, Off Biostat, Silver Spring, MD 20993 USA. [McKean, Stephen; Young, Jessica; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Racoosin, Judith A.] US FDA, Off New Drugs, Silver Spring, MD 20993 USA. [MaCurdy, Thomas E.] Stanford Univ, Stanford, CA 94305 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Graham, DJ (reprint author), US FDA, Off Surveillance & Epidemiol, 10903 New Hampshire Ave,Bldg 22,Room 4314, Silver Spring, MD 20993 USA. EM david.graham1@fda.hhs.gov FU Centers for Medicare & Medicaid Services; FDA FX This study was funded through an intraagency agreement between the Centers for Medicare & Medicaid Services and the FDA. NR 37 TC 3 Z9 3 U1 0 U2 3 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD NOV PY 2014 VL 23 IS 11 BP 1205 EP 1212 DI 10.1002/pds.3678 PG 8 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA AT6WA UT WOS:000345076200012 PM 25044169 ER PT J AU Yusuf, AA Howell, BL Powers, CA Peter, WLS AF Yusuf, Akeem A. Howell, Benjamin L. Powers, Christopher A. Peter, Wendy L. St. TI Utilization and Costs of Medications Associated With CKD Mineral and Bone Disorder in Dialysis Patients Enrolled in Medicare Part D SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE Chronic kidney disease (CKD); Medicare Part D; medication costs; dialysis; mineral and bone disorder; phosphate binders; calcimimetics; vitamin D analogues ID HEMODIALYSIS-PATIENTS; BENEFICIARIES; RACE AB Background: Information is limited regarding utilization patterns and costs for chronic kidney disease-mineral and bone disorder (CKD-MBD) medications in Medicare Part D-enrolled dialysis patients. Study Design: Retrospective cohort study. Setting & Participants: Annual cohorts of dialysis patients, 2007-2010. Predictors: Cohort year, low-income subsidy status, and dialysis provider. Outcomes: Utilization and costs of prescription phosphate binders, oral and intravenous vitamin D analogues, and cinacalcet. Measurements: Using logistic regression, we calculated adjusted odds of medication use for low-income subsidy versus non-low-income subsidy patients and for patients from various dialysis organizations, and we report per-member-per-month and average out-of-pocket costs. Results: Phosphate binders (similar to 83%) and intravenous vitamin D (77.5%-79.3%) were the most commonly used CKD-MBD medications in 2007 through 2010. The adjusted odds of prescription phosphate-binder, intravenous vitamin D, and cinacalcet use were significantly higher for low-income subsidy than for non-low-income subsidy patients. Total Part D versus CKD-MBD Part D medication costs increased 22% versus 36% from 2007 to 2010. For Part D-enrolled dialysis patients, CKD-MBD medications represented similar to 50% of overall net Part D costs in 2010. Limitations: Inability to describe utilization and costs of calcium carbonate, an over-the-counter agent not covered under Medicare Part D; inability to reliably identify prescriptions filled through a non-Part D reimbursement or payment mechanism; findings may not apply to dialysis patients without Medicare Part D benefits or with Medicare Advantage plans, or to pediatric dialysis patients; could identify only prescription drugs dispensed in the outpatient setting; inability to adjust for MBD laboratory values. Conclusions: Part D net costs for CKD-MBD medications increased at a faster rate than costs for all Part D medications in dialysis patients despite relatively stable use within medication classes. In a bundled environment, there may be incentives to shift to generic phosphate binders and reduce cinacalcet use. (C) 2014 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. C1 [Yusuf, Akeem A.; Peter, Wendy L. St.] Minneapolis Med Res Fdn Inc, Chron Dis Res Grp, Minneapolis, MN 55404 USA. [Yusuf, Akeem A.; Peter, Wendy L. St.] Univ Minnesota, Coll Pharm, Minneapolis, MN 55455 USA. [Howell, Benjamin L.] Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Powers, Christopher A.] Ctr Medicare & Medicaid Serv, Ctr Strateg Planning, Baltimore, MD USA. RP Peter, WLS (reprint author), Minneapolis Med Res Fdn Inc, Chron Dis Res Grp, 914 S 8th St,Ste S4-100, Minneapolis, MN 55404 USA. EM wstpeter@cdrg.org OI St Peter, Wendy/0000-0002-2201-3019 FU National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health [HHSN267200715002C] FX This study was performed as a deliverable under contract no. HHSN267200715002C (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government. NR 15 TC 9 Z9 10 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 EI 1523-6838 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD NOV PY 2014 VL 64 IS 5 BP 770 EP 780 DI 10.1053/j.ajkd.2014.04.014 PG 11 WC Urology & Nephrology SC Urology & Nephrology GA AS4IM UT WOS:000344237900018 PM 24833203 ER PT J AU Richardson, GB Freedlander, JM Katz, EC Dai, CL Chen, CC AF Richardson, George B. Freedlander, Jonathan M. Katz, Elizabeth C. Dai, Chia-Liang Chen, Ching-Chen TI Impulsivity links reward and threat sensitivities to substance use: a functional model SO FRONTIERS IN PSYCHOLOGY LA English DT Article DE reward sensitivity; threat sensitivity; impulsivity; substance use; college students ID LIFE-HISTORY THEORY; SENSATION-SEEKING; ANXIETY-SENSITIVITY; ANTISOCIAL-BEHAVIOR; PERSONALITY-TRAITS; ALCOHOL; PREDICTION; EVOLUTION; SAMPLE; INDEX AB This study used structural equations modeling and undergraduate student data to examine the effects of reward and threat sensitivities on substance use, along with the extent to which impulsivity explained these effects. Our results suggest that impulsivity may translate inversely related reward and threat sensitivities into substance use, completely mediate the effect between threat sensitivity and substance use, and partially mediate the effect between reward sensitivity and substance use. Our results also suggest that individuals with a combination of higher levels on both reward and threat sensitivities may be most impulsive and vulnerable to heightened substance use. We discuss implications for research at the interface of personality and substance use and also substance abuse prevention and treatment. C1 [Richardson, George B.; Dai, Chia-Liang; Chen, Ching-Chen] Univ Cincinnati, Sch Human Serv, Cincinnati, OH 45221 USA. [Freedlander, Jonathan M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Katz, Elizabeth C.] Towson Univ, Dept Psychol, Towson, MD USA. RP Richardson, GB (reprint author), Univ Cincinnati, Sch Human Serv, POB 210002, Cincinnati, OH 45221 USA. EM george.richardson@uc.edu OI Richardson, George/0000-0001-6918-159X NR 80 TC 4 Z9 4 U1 3 U2 9 PU FRONTIERS RESEARCH FOUNDATION PI LAUSANNE PA PO BOX 110, LAUSANNE, 1015, SWITZERLAND SN 1664-1078 J9 FRONT PSYCHOL JI Front. Psychol. PD OCT 27 PY 2014 VL 5 AR 1194 DI 10.3389/fpsyg.2014.01194 PG 10 WC Psychology, Multidisciplinary SC Psychology GA AS1QG UT WOS:000344054600001 PM 25386147 ER PT J AU Pham, HH Cohen, M Conway, PH AF Pham, Hoangmai H. Cohen, Melissa Conway, Patrick H. TI The Pioneer Accountable Care Organization Model Improving Quality and Lowering Costs SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Pham, Hoangmai H.; Cohen, Melissa; Conway, Patrick H.] Ctr Medicare Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD 21244 USA. [Pham, Hoangmai H.; Cohen, Melissa; Conway, Patrick H.] Ctr Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD 21244 USA. RP Conway, PH (reprint author), Ctr Medicare Serv, 7500 Secur Blvd,Mail Stop S3-02-01, Baltimore, MD 21244 USA. EM patrick.conway@cms.hhs.gov NR 2 TC 25 Z9 25 U1 4 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 22 PY 2014 VL 312 IS 16 BP 1635 EP 1636 DI 10.1001/jama.2014.13109 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA AR0YF UT WOS:000343301400017 PM 25229477 ER PT J AU Sisko, AM Keehan, SP Cuckler, GA Madison, AJ Smith, SD Wolfe, CJ Stone, DA Lizonitz, JM Poisal, JA AF Sisko, Andrea M. Keehan, Sean P. Cuckler, Gigi A. Madison, Andrew J. Smith, Sheila D. Wolfe, Christian J. Stone, Devin A. Lizonitz, Joseph M. Poisal, John A. TI National Health Expenditure Projections, 2013-23: Faster Growth Expected With Expanded Coverage And Improving Economy SO HEALTH AFFAIRS LA English DT Article AB In 2013 health spending growth is expected to have remained slow, at 3.6 percent, as a result of the sluggish economic recovery, the effects of sequestration, and continued increases in private health insurance cost-sharing requirements. The combined effects of the Affordable Care Act's coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth this year and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015-23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990-2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013-23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023. C1 [Sisko, Andrea M.] Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD 21244 USA. RP Sisko, AM (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD 21244 USA. EM DNHS@cms.hhs.gov NR 20 TC 26 Z9 26 U1 8 U2 17 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 OCT PY 2014 VL 33 IS 10 BP 1841 EP 1850 DI 10.1377/hlthaff.2014.0560 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA AR2IE UT WOS:000343406500020 PM 25187525 ER PT J AU Patrick, SW Kawai, AT Kleinman, K Jin, R Vaz, L Gay, C Kassler, W Goldmann, D Lee, GM AF Patrick, Stephen W. Kawai, Alison Tse Kleinman, Ken Jin, Robert Vaz, Louise Gay, Charlene Kassler, William Goldmann, Don Lee, Grace M. TI Health Care-Associated Infections Among Critically III Children in the US, 2007-2012 SO PEDIATRICS LA English DT Article DE central line-associated bloodstream infections; ventilator-associated pneumonia; catheter-associated urinary tract infections; health care-associated infections; Medicaid ID VENTILATOR-ASSOCIATED PNEUMONIA; BLOOD-STREAM INFECTIONS; NEONATAL INTENSIVE-CARE; URINARY-TRACT-INFECTION; LATE-ONSET SEPSIS; UNIT-ACQUIRED INFECTIONS; BIRTH-WEIGHT INFANTS; QUALITY-IMPROVEMENT; RESEARCH NETWORK; SURVEILLANCE AB BACKGROUND: Health care-associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012. METHODS: In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention's National Healthcare Safety Network for central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates. RESULTS: A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94-0.97) and in PICUs from 4.7 to 1.0 per 1000 centralline days (IRR per quarter = 0.96 [0.94-0.98]). Rates of ventilatorassociated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93-0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92-0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs. CONCLUSIONS: Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children. Pediatrics 2014; 134: 705-712 C1 [Patrick, Stephen W.] Vanderbilt Univ, Dept Pediat, Nashville, TN USA. [Patrick, Stephen W.] Vanderbilt Univ, Mildred Stahlman Div Neonatol, Nashville, TN 37235 USA. [Patrick, Stephen W.] Vanderbilt Ctr Hlth Serv Res, Nashville, TN USA. [Kawai, Alison Tse; Kleinman, Ken; Jin, Robert; Vaz, Louise; Gay, Charlene; Lee, Grace M.] Ctr Child Hlth Care Studies, Harvard Pilgrim Hlth Care Inst, Dept Populat Med, Boston, MA USA. [Kawai, Alison Tse; Kleinman, Ken; Jin, Robert; Vaz, Louise; Gay, Charlene; Lee, Grace M.] Harvard Univ, Sch Med, Boston, MA USA. [Vaz, Louise; Lee, Grace M.] Boston Childrens Hosp, Dept Med, Div Infect Dis, Boston, MA USA. [Vaz, Louise; Lee, Grace M.] Boston Childrens Hosp, Dept Lab Med, Boston, MA USA. [Kassler, William] Ctr Medicare & Medicaid Serv, Boston, MA USA. [Goldmann, Don] Inst Healthcare Improvement, Boston, MA USA. RP Patrick, SW (reprint author), Monroe Carell Jr Childrens Hosp Vanderbilt, Mildred Stahlman Div Neonatol, 11111 Doctors Off Tower,2200 Childrens Way, Nashville, TN 37232 USA. EM stephen.patrick@vanderbilt.edu FU AHRQ HHS [5R01HS018414-04] NR 40 TC 10 Z9 10 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 EI 1098-4275 J9 PEDIATRICS JI Pediatrics PD OCT PY 2014 VL 134 IS 4 BP 705 EP 712 DI 10.1542/peds.2014-0613 PG 8 WC Pediatrics SC Pediatrics GA AQ9CV UT WOS:000343140500053 PM 25201802 ER PT J AU Price, RA Elliott, MN Zaslavsky, AM Hays, RD Lehrman, WG Rybowski, L Edgman-Levitan, S Cleary, PD AF Price, Rebecca Anhang Elliott, Marc N. Zaslavsky, Alan M. Hays, Ron D. Lehrman, William G. Rybowski, Lise Edgman-Levitan, Susan Cleary, Paul D. TI Examining the Role of Patient Experience Surveys in Measuring Health Care Quality SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE patient experience; patient satisfaction; CAHPS; health care surveys; health care quality measurement; health care quality ID HOSPITAL PERFORMANCE-MEASURES; ACUTE MYOCARDIAL-INFARCTION; MEDICARE MANAGED CARE; CONSUMER ASSESSMENT; PSYCHOMETRIC PROPERTIES; CENTERED CARE; PHYSICIAN COMMUNICATION; CLINICAL-QUALITY; PROVIDER COMMUNICATION; PREVENTIVE SERVICES AB Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs. C1 [Price, Rebecca Anhang] RAND Corp, Arlington, VA 22202 USA. [Elliott, Marc N.] RAND Corp, Santa Monica, CA USA. [Zaslavsky, Alan M.] Harvard Univ, Sch Med, Boston, MA USA. [Hays, Ron D.] Univ Calif Los Angeles, Dept Med, Los Angeles, CA 90024 USA. [Lehrman, William G.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Rybowski, Lise] Severyn Grp, Ashburn, VA USA. [Edgman-Levitan, Susan] Massachusetts Gen Hosp, Boston, MA 02114 USA. [Cleary, Paul D.] Yale Univ, Sch Publ Hlth, New Haven, CT USA. RP Price, RA (reprint author), RAND Corp, 1200 South Hayes St, Arlington, VA 22202 USA. EM ranhangp@rand.org FU Agency for Health Care Research and Quality (AHRQ) [2U18HS016980, 2U18HSO16978]; Centers for Medicare & Medicaid Services (CMS); AHRQ; NIA [P30-AG021684]; NIMHD [P20MD000182] FX The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Support for preparation of this manuscript comes from cooperative agreements from the Agency for Health Care Research and Quality (AHRQ; 2U18HS016980; 2U18HSO16978). The authors have been funded by the Centers for Medicare & Medicaid Services (CMS; RAP, MNE, AMZ, and PDC) and AHRQ (RAP, MNE, AMZ, RDH, LR, SEL, and PDC) as investigators in development and implementation of CAHPS surveys. RDH was also supported in part by grants from the NIA (P30-AG021684) and the NIMHD (P20MD000182). NR 109 TC 16 Z9 16 U1 4 U2 28 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 EI 1552-6801 J9 MED CARE RES REV JI Med. Care Res. Rev. PD OCT PY 2014 VL 71 IS 5 BP 522 EP 554 DI 10.1177/1077558714541480 PG 33 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA AQ5KJ UT WOS:000342847000005 ER PT J AU Du, DY McKean, S Kelman, J Laschinger, J Johnson, C Warnock, R Worrall, C MaCurdy, TE Izurieta, H AF Du, Dongyi (Tony) McKean, Stephen Kelman, Jeffrey Laschinger, John Johnson, Chris Warnock, Rob Worrall, Chris MaCurdy, Thomas E. Izurieta, Hector TI The Selection of Prosthetics Aortic Valves for Elderly Medicare Patients from 2006 to 2011-A Population Based Cross-Sectional Study SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Du, Dongyi (Tony); Laschinger, John] US FDA, Ctr Devices & Radiol Healh, Silver Spring, MD USA. [McKean, Stephen; Johnson, Chris; Warnock, Rob; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Kelman, Jeffrey; Worrall, Chris] Ctr Medicare & Medicaid, Washington, DC USA. [Izurieta, Hector] US FDA, Ctr Biol Evaluat & Res, Rockville, MD 20857 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD OCT PY 2014 VL 23 SU 1 SI SI MA 898 BP 483 EP 483 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA AQ4JZ UT WOS:000342763600890 ER PT J AU Franks, R Sandhu, S Avagyan, A Lu, Y Hong, H Garcia, B Worrall, C Kelman, J Ball, R MaCurdy, T AF Franks, Riley Sandhu, Sukhminder Avagyan, Armen Lu, Yun Hong, Han Garcia, Bruno Worrall, Christopher Kelman, Jeffrey Ball, Robert MaCurdy, Thomas TI Robustness Properties of a Sequential Test for Vaccine Safety in the Presence of Misspecification SO STATISTICAL ANALYSIS AND DATA MINING LA English DT Article DE sequential surveillance; active surveillance; claims delay; pharmacovigilance; vaccine safety; uncertainty; administrative data ID SURVEILLANCE; PROGRAM AB The Updating Sequential Probability Ratio Test (USPRT) developed by MaCurdy et al. (2009, Updating sequential probability ratio test for real-time surveillance of vaccine safety, unpublished working paper) has been used by the U.S. Food and Drug Administration for near real-time surveillance of the safety of the flu vaccine since 2008. This procedure was the first method developed to account for data delay in pharmacovigilance studies. However, the current implementation is based on the strong assumption that the clinical and reporting delays do not vary from previous years. When this assumption does not hold, size distortion of the USPRT procedure might result. The goal of this article is to numerically investigate the robustness of the detection probabilities of the USPRT method with respect to possible misspecification of the clinical and reporting delay distributions through extensive simulations. We find that if the delay distribution used in calibrating the critical bound is lengthier than the delay distribution in the data generating process, then there is a higher rate of false signaling and vice versa. This is an inherent property of a real-time testing procedure. However, the distortion created by misspecifying the reporting delay distribution appears to be insignificant when compared to the overall power generated by an elevation of the adverse event rate. The size distortion is unevenly distributed across the interim tests, so the effect of misspecification of the delay distributions is more prominent in the median time-to-signal. In summary, although a misspecified delay distribution induces size distortion, we find that it does not erode the overall power. (C) 2014 Wiley Periodicals, Inc. C1 [Franks, Riley; Avagyan, Armen; Hong, Han; Garcia, Bruno; MaCurdy, Thomas] Acumen LLC, Burlingame, CA 94010 USA. [Sandhu, Sukhminder; Lu, Yun; Ball, Robert] US FDA, Silver Spring, MD USA. [Hong, Han; MaCurdy, Thomas] Stanford Univ, Dept Econ, Palo Alto, CA 94304 USA. [Worrall, Christopher; Kelman, Jeffrey] Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. RP Franks, R (reprint author), Acumen LLC, Burlingame, CA 94010 USA. EM rfranks@acumenllc.com NR 12 TC 2 Z9 2 U1 1 U2 1 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1932-1864 EI 1932-1872 J9 STAT ANAL DATA MIN JI Stat. Anal. Data Min. PD OCT PY 2014 VL 7 IS 5 SI SI BP 368 EP 375 DI 10.1002/sam.11234 PG 8 WC Computer Science, Artificial Intelligence; Computer Science, Interdisciplinary Applications; Statistics & Probability SC Computer Science; Mathematics GA CV3US UT WOS:000364192400004 ER PT J AU Parekh, AK Kronick, R Tavenner, M AF Parekh, Anand K. Kronick, Richard Tavenner, Marilyn TI Optimizing Health for Persons With Multiple Chronic Conditions SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID CARE C1 [Parekh, Anand K.] US Dept HHS, Off Assistant Secretary Hlth, Washington, DC 20201 USA. [Kronick, Richard] US Dept HHS, Agcy Healthcare Res & Qual, Washington, DC 20201 USA. [Tavenner, Marilyn] US Dept HHS, Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. RP Parekh, AK (reprint author), US Dept HHS, Off Assistant Secretary Hlth, 200 Independence Ave SW, Washington, DC 20201 USA. EM anand.parekh@hhs.gov NR 7 TC 22 Z9 22 U1 0 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD SEP 24 PY 2014 VL 312 IS 12 BP 1199 EP 1200 DI 10.1001/jama.2014.10181 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA AP3QA UT WOS:000341990600016 PM 25133982 ER PT J AU Riley, GF Rupp, K AF Riley, Gerald F. Rupp, Kalman TI Expenditure Patterns Under the Four Major Public Cash Benefit and Health Insurance Programs for Working-Age Adults With Disabilities SO JOURNAL OF DISABILITY POLICY STUDIES LA English DT Article DE disability; social security disability insurance; supplemental security income; Medicare; Medicaid AB Using linked administrative records, we examined expenditure patterns under cash benefit and health insurance programs for 68,794 individuals first eligible for Social Security Disability Insurance (DI) and/or Supplemental Security Income (SSI) in 2000. Expenditures were tracked until death, age 65, or December 31, 2006. Cumulative per capita expenditures averaged US$111,160 in 2006 constant dollars, with 54% incurred under DI, 5% under SSI, and about 20% each under Medicare and Medicaid. SSI and Medicaid expenditures were somewhat higher early on. We concluded that SSI is a relatively low-expenditure program, but it has a major impact on total expenditures by providing access to Medicaid. An important role of SSI and Medicaid is to provide a temporary safety net supporting DI beneficiaries during their DI and Medicare waiting periods. The linkage of expenditure data under these four programs may be useful for evaluating the potential savings of initiatives to encourage individuals with disabilities to remain in the workforce. C1 [Riley, Gerald F.] Ctr Medicare Serv, Baltimore, MD 21244 USA. [Riley, Gerald F.] Ctr Medicaid Serv, Baltimore, MD 21244 USA. [Rupp, Kalman] Social Secur Adm, Washington, DC USA. RP Riley, GF (reprint author), Ctr Medicare Serv, Ctr Medicare & Medicaid Innovat, 7500 Security Blvd,Mail Stop WB-06-05, Baltimore, MD 21244 USA. EM Gerald.riley@cms.hhs.gov NR 32 TC 2 Z9 2 U1 2 U2 4 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1044-2073 EI 1538-4802 J9 J DISABIL POLICY STU JI J. Disabil. Policy Stud. PD SEP PY 2014 VL 25 IS 2 BP 71 EP 80 DI 10.1177/1044207312469828 PG 10 WC Rehabilitation SC Rehabilitation GA AQ1VA UT WOS:000342569800001 ER PT J AU Willy, ME Graham, DJ Racoosin, JA Gill, R Kropp, GF Young, J Yang, J Choi, J MaCurdy, TE Worrall, C Kelman, JA AF Willy, Mary E. Graham, David J. Racoosin, Judith A. Gill, Rajdeep Kropp, Garner F. Young, Jessica Yang, Jeff Choi, Joyce MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Candidate Metrics for Evaluating the Impact of Prescriber Education on the Safe Use of Extended-Release/Long-Acting (ER/LA) Opioid Analgesics SO PAIN MEDICINE LA English DT Article DE REMS; Opioids; Metrics; Evaluation ID CHRONIC PAIN; THERAPY; RISK AB ObjectiveThe objective of this study was to develop metrics to assess opioid prescribing behavior as part of the evaluation of the Extended-Release/Long-Acting (ER/LA) Opioid Analgesic Risk Evaluation and Mitigation Strategies (REMS). DesignCandidate metrics were selected using published guidelines, examined using sensitivity analyses, and applied to cross-sectional rolling cohorts of Medicare patients prescribed with extended-release oxycodone (ERO) between July 2, 2006 and July 1, 2011. Potential metrics included prescribing opioid-tolerant-only ER/LA opioid analgesics to non-opioid-tolerant patients, prescribing early fills to patients, and ordering drug screens. ResultsProposed definitions for opioid tolerance were seven continuous days of opioid usage of at least 30mg oxycodone equivalents, within the 7 days (primary) or 30 days (secondary) prior to first opioid-tolerant-only ERO prescription. Forty-four percent of opioid-tolerant-only ERO episodes met the primary opioid tolerance definition; 56% met the secondary definition. Fills were deemed early if a prescription was filled before 70% (primary) or 50% (secondary) of the prior prescription's days' supply was to be consumed. Five percent (primary) and 2% (secondary) of episodes had more than or equal to two early fills during treatment. At least one drug screen was billed in 14% of episodes. Stratified analyses indicated that older patients were less likely to be opioid tolerant at the time of the first opioid-tolerant-only ERO prescription. ConclusionsInvestigators propose three metrics to monitor changes in prescribing behaviors for opioid analgesics that might be used to evaluate the ER/LA Opioid Analgesics REMS. Low frequencies of patients, particularly those >85 years, were likely to be opioid tolerant prior to receiving prescriptions for opioid-tolerant-only ERO. C1 [Willy, Mary E.; Graham, David J.; Racoosin, Judith A.; Gill, Rajdeep] Food & Drug Adm, Ctr Drug Evaluat & Res, Silver Spring, MD 20993 USA. [Kropp, Garner F.; Young, Jessica; Yang, Jeff; Choi, Joyce; MaCurdy, Thomas E.] Acumen LLC, SafeRx, Burlingame, CA USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Willy, ME (reprint author), Food & Drug Adm, Ctr Drug Evaluat & Res, 10903 New Hampshire Ave,Bldg 22,Room 2420, Silver Spring, MD 20993 USA. EM mary.willy@fda.hhs.gov FU Centers for Medicare & Medicaid Services (CMS); Food and Drug Administration (FDA) FX Funding: This study was funded by the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration (FDA) under an intra-agency agreement. NR 20 TC 3 Z9 3 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1526-2375 EI 1526-4637 J9 PAIN MED JI Pain Med. PD SEP PY 2014 VL 15 IS 9 BP 1558 EP 1568 DI 10.1111/pme.12459 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA AQ2QA UT WOS:000342631300014 PM 24828968 ER PT J AU Dougherty, D Mistry, KB Lindly, O Desoto, M LLanos, K Chesley, F AF Dougherty, Denise Mistry, Kamila B. Lindly, Olivia Desoto, Maushami LLanos, Karen Chesley, Francis TI Systematic Evidence-Based Quality Measurement Life-Cycle Approach to Measure Retirement in CHIPRA SO ACADEMIC PEDIATRICS LA English DT Article DE AHRQ; CHIPRA; CMS; quality measures ID HEALTH-CARE QUALITY; CHILDREN AB OBJECTIVE: In 2009, Centers for Medicare and Medicaid Services (CMS) publicly released an initial child core set (CCS) of health care quality measures for voluntary reporting by state Medicaid and Children's Health Insurance Program (CHIP) programs. CMS is responsible for implementing the reporting program and for updating the CCS annually. We assessed selected CCS measures for potential retirement. METHODS: We identified a 23-member external advisory group to provide relevant expertise. We worked with the group to identify 4 major criteria with multiple subcomponents for assessing the measures. We provided information corresponding to each criterion and subcriterion, using a variety of sources such as the 2009 Medicaid Analytic eXtract (MAX), state-level Medicaid and CHIP data submitted to the CMS, and summaries of published literature on clinical and quality improvement effectiveness related to the CCS topics. Using this information, the group: 1) used a modified Delphi process to score the measures in 2 anonymous scoring rounds (on a scale of 1 to 9 in each round); 2) voted on whether each measure should be retired; and 3) provided narrative explanations of their choices (which formed the basis of our qualitative findings). Recommendations were reviewed by CMS before promulgation to state programs. RESULTS: The Subcommittee of the National Advisory Council on Healthcare Research and Quality (SNAC) recommended that the 4 major criteria be importance, scientific acceptability, feasibility, and usability. The SNAC recommended 3 measures for retirement: access to primary care; testing for strep before recommending antibiotics for pharyngitis; and annual HbA1c testing of children with diabetes. Explanations for suggesting retirement of the measures included: views that the well-visit measures were a better measure of access than the primary care measure; a likely ceiling effect (pharyngitis); and the paucity of clinical evidence and low prevalence (both for HbA1c). CMS recommended that state Medicaid and CHIP programs retire 2 of the recommended measures from the CCS, but retained the access to primary care measure. CONCLUSIONS: Periodic reassessment of the value of health care quality measures can reduce reporting burden and allow measure users to focus on measures with higher likelihood of leading to improvements in quality of care and child health outcomes. C1 [Dougherty, Denise; Lindly, Olivia] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Mistry, Kamila B.; Desoto, Maushami; Chesley, Francis] Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, Rockville, MD USA. [LLanos, Karen] Ctr Medicare & Medicaid Serv, Ctr Medicaid, Baltimore, MD USA. [LLanos, Karen] Ctr Medicare & Medicaid Serv, CHIP Serv, Baltimore, MD USA. RP Dougherty, D (reprint author), Agcy Healthcare Res & Qual, Child Hlth & Qual Improvement, 540 Gaither Rd, Rockville, MD 20850 USA. EM Denise.dougherty@ahrq.hhs.gov NR 25 TC 4 Z9 4 U1 0 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 EI 1876-2867 J9 ACAD PEDIATR JI Acad. Pediatr. PD SEP-OCT PY 2014 VL 14 IS 5 SU S BP S97 EP S103 PG 7 WC Pediatrics SC Pediatrics GA AP2KE UT WOS:000341900300020 PM 25169466 ER PT J AU Dougherty, D Mistry, KB LLanos, K Lillie-Blanton, M Chesley, F AF Dougherty, Denise Mistry, Kamila B. LLanos, Karen Lillie-Blanton, Marsha Chesley, Francis TI An AHRQ and CMS Perspective on the Pediatric Quality Measures Program SO ACADEMIC PEDIATRICS LA English DT Editorial Material ID HEALTH-CARE C1 [Dougherty, Denise; Mistry, Kamila B.; Chesley, Francis] US Dept Hlth & Human Serv, Off Extramural Res Educ & Prior Populat, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [LLanos, Karen; Lillie-Blanton, Marsha] Ctr Medicare Serv, Ctr Medicaid & CHIP Serv, Baltimore, MD USA. [LLanos, Karen; Lillie-Blanton, Marsha] Ctr Medicaid Serv, Ctr Medicaid & CHIP Serv, Baltimore, MD USA. RP Dougherty, D (reprint author), US Dept Hlth & Human Serv, Off Extramural Res Educ & Prior Populat, Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. EM Kamila.Mistry@ahrq.hhs.gov NR 9 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 1876-2859 EI 1876-2867 J9 ACAD PEDIATR JI Acad. Pediatr. PD SEP-OCT PY 2014 VL 14 IS 5 SU S BP S17 EP S18 PG 2 WC Pediatrics SC Pediatrics GA AP2KE UT WOS:000341900300008 PM 25169452 ER PT J AU Mistry, KB Chesley, F LLanos, K Dougherty, D AF Mistry, Kamila B. Chesley, Francis LLanos, Karen Dougherty, Denise TI Advancing Children's Health Care and Outcomes Through the Pediatric Quality Measures Program SO ACADEMIC PEDIATRICS LA English DT Article DE children; quality ID IMPROVE AB In 2009 Congress passed the Children's Health Insurance Program Reauthorization Act (CHIPRA), which presented an unprecedented opportunity to measure and improve health care quality and outcomes for children. The Agency for Healthcare Research and Quality, in partnership with the Centers for Medicare & Medicaid Services, has worked to fulfill a number of quality measurement provisions under CHIPRA, including establishing the Pediatric Quality Measures Program (PQMP). The PQMP was charged with establishing a publicly available portfolio of new and enhanced evidence-based pediatric quality measures for use by Medicaid/Children's Health Insurance Program and other public and private programs and to also provide opportunities to improve and strengthen the Child Core Set of quality measures. This article focuses on the PQMP and provides an overview of the program's goals and related activities, lessons learned, and future opportunities. C1 [Mistry, Kamila B.; Chesley, Francis; Dougherty, Denise] Agcy Healthcare Res & Qual, Childrens Hlth Insurance Program Reauthorizat Act, Pediat Qual Measures Program, Off Extramural Res Educ & Prior Populat, Rockville, MD 20850 USA. [LLanos, Karen] Ctr Medicare Serv, Ctr Medicaid & CHIP Serv, Baltimore, MD USA. [LLanos, Karen] Ctr Medicaid Serv, Ctr Medicaid & CHIP Serv, Baltimore, MD USA. RP Mistry, KB (reprint author), Agcy Healthcare Res & Qual, Off Extramural Res Educ & Prior Populat, 540 Gaither Rd, Rockville, MD 20850 USA. EM Kamila.Mistry@ahrq.hhs.gov FU CMS FX The PQMP is funded by CMS. NR 26 TC 9 Z9 9 U1 0 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 EI 1876-2867 J9 ACAD PEDIATR JI Acad. Pediatr. PD SEP-OCT PY 2014 VL 14 IS 5 SU S BP S19 EP S26 DI 10.1016/j.acap.2014.06.025 PG 8 WC Pediatrics SC Pediatrics GA AP2KE UT WOS:000341900300009 PM 25169453 ER PT J AU Hackbarth, AD Munier, WB Eldridge, N Jordan, J Richards, C Brennan, NJ Wagner, D McGann, P AF Hackbarth, Andrew D. Munier, William B. Eldridge, Noel Jordan, Jack Richards, Chesley Brennan, Niall J. Wagner, Dennis McGann, Paul TI An Overview of Measurement Activities in the Partnership for Patients SO JOURNAL OF PATIENT SAFETY LA English DT Article DE partnership for patients; measurement; adverse events ID ADVERSE EVENTS; SAFETY; TRENDS; CARE AB The Partnership for Patients, launched in April 2011, is a national quality improvement initiative from the Department of Health and Human Services that has set ambitious goals for U. S. providers to improve patient safety and care transitions. This paper outlines the initiative's measurement strategy, describing four measurement-related objectives: (1) to track national progress toward the program goals that U. S. hospitals reduce preventable adverse events by 40% and readmissions by 20%; (2) to support local quality improvement measurement in participating hospitals by providing the appropriate tools, training, and programmatic structure; (3) to obtain feedback on hospital and contractor progress, in close to real time, so the project can be effectively managed; and (4) to evaluate the program's impact on adverse event and readmission rates. C1 [Hackbarth, Andrew D.; Jordan, Jack; Brennan, Niall J.; Wagner, Dennis; McGann, Paul] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Munier, William B.; Eldridge, Noel] Agcy Healthcare Res & Qual, Rockville, MD USA. [Richards, Chesley] Ctr Dis Control & Prevent, Atlanta, GA USA. RP Hackbarth, AD (reprint author), Ctr Medicare & Medicaid Serv, 200 Independence Ave SW, Washington, DC 20201 USA. EM andrew.hackbarth@cms.hhs.gov NR 13 TC 2 Z9 2 U1 1 U2 5 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1549-8417 EI 1549-8425 J9 J PATIENT SAF JI J. Patient Saf. PD SEP PY 2014 VL 10 IS 3 BP 125 EP 132 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA AP7AW UT WOS:000342230900002 PM 25119788 ER PT J AU Menis, M Anderson, SA Forshee, RA McKean, S Johnson, C Warnock, R Gondalia, R Mintz, PD Holness, L Worrall, CM Kelman, JA Izurieta, HS AF Menis, Mikhail Anderson, Steven A. Forshee, Richard A. McKean, Stephen Johnson, Chris Warnock, Rob Gondalia, Rahul Mintz, Paul D. Holness, Leslie Worrall, Christopher M. Kelman, Jeffrey A. Izurieta, Hector S. TI Transfusion-related acute lung injury and potential risk factors among the inpatient US elderly as recorded in Medicare claims data, during 2007 through 2011 SO TRANSFUSION LA English DT Article ID CIRCULATORY OVERLOAD; BLOOD-TRANSFUSION; CRITICALLY-ILL; ADMINISTRATIVE DATABASES; PULMONARY-EDEMA; TRALI; REDUCTION; COMPLICATIONS; EPIDEMIOLOGY; PATHOGENESIS AB BackgroundTransfusion-related acute lung injury (TRALI) is a serious complication leading to pulmonary edema and respiratory failure. This study's objective was to assess TRALI occurrence and potential risk factors among inpatient US elderly Medicare beneficiaries, ages 65 and older, during 2007 through 2011. Study Design and MethodsThis retrospective claims-based study utilized large Medicare administrative databases. Transfusions were identified by recorded procedure and revenue center codes. TRALI was ascertained via ICD-9-CM diagnosis code. The study evaluated TRALI rates among the inpatient elderly overall and by calendar year, age, sex, race, blood components, and units transfused. Logistic regression analyses were used to assess potential risk factors. ResultsOf 11,378,264 inpatient transfusion stays for elderly Medicare beneficiaries, 2556 had a recorded TRALI diagnosis code, an overall rate of 22.46 per 100,000 stays. TRALI rates were higher for platelet (PLT)- and plasma-containing transfusions and increased by year and number of units transfused (p<0.0001). Significantly higher odds of TRALI were also found for persons ages 65 to 79 years versus more than 79 years (OR, 1.19; 95% confidence interval CI, 1.09-1.29), females versus males (OR, 1.26; 95% CI, 1.16-1.38), white versus nonwhite (OR, 1.43; 95% CI, 1.27-1.66), and with 6-month histories of postinflammatory pulmonary fibrosis (OR, 1.89; 95% CI, 1.52-2.20), tobacco use (OR, 1.16; 95% CI, 1.00-1.26), and other diseases. ConclusionOur study among the elderly suggests TRALI to be a severe event and identifies a substantially increased TRALI occurrence with greater number of units and with PLT- or plasma-containing transfusions. The study also suggests importance of underlying health conditions, prior recipient alloimmunization, and nonimmune mechanism in TRALI development among the elderly. C1 [Menis, Mikhail; Anderson, Steven A.; Forshee, Richard A.; Mintz, Paul D.; Holness, Leslie; Izurieta, Hector S.] US FDA, Rockville, MD 20852 USA. [McKean, Stephen; Johnson, Chris; Warnock, Rob; Gondalia, Rahul] Acumen LLC, Burlingame, CA USA. [Worrall, Christopher M.; Kelman, Jeffrey A.] Ctr Medicare Serv, Baltimore, MD USA. [Worrall, Christopher M.; Kelman, Jeffrey A.] Ctr Medicaid Serv, Baltimore, MD USA. RP Menis, M (reprint author), US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, 1401 Rockville Pike,HFM 225, Rockville, MD 20852 USA. EM Mikhail.Menis@fda.hhs.gov FU US Food and Drug Administration, Center for Biologics Evaluation and Research FX This study was funded by the US Food and Drug Administration, Center for Biologics Evaluation and Research. NR 68 TC 9 Z9 9 U1 0 U2 1 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 EI 1537-2995 J9 TRANSFUSION JI Transfusion PD SEP PY 2014 VL 54 IS 9 BP 2182 EP 2193 DI 10.1111/trf.12626 PG 12 WC Hematology SC Hematology GA AP5TJ UT WOS:000342141300009 PM 24673344 ER PT J AU Schermerhorn, ML Buck, DB Curran, T McCallum, JC O'Malley, AJ Cotterill, P Darling, J Landon, BE AF Schermerhorn, Marc L. Buck, Dominique B. Curran, Thomas McCallum, John C. O'Malley, Alistair J. Cotterill, Philip Darling, Jeremy Landon, Bruce E. TI Long-Term Outcomes and Temporal Trends With Endovascular vs Open Repair of Abdominal Aortic Aneurysms in the Medicare Population SO JOURNAL OF VASCULAR SURGERY LA English DT Meeting Abstract CT Joint Annual Meeting of the New-England-Society-for-Vascular-Surgery (NESVS) and the Eastern-Vascular-Society (EVS) CY SEP 11-14, 2014 CL Boston, MA SP New England Soc Vasc Surg, Eastern Vasc Soc C1 [Schermerhorn, Marc L.; Buck, Dominique B.; Curran, Thomas; McCallum, John C.; O'Malley, Alistair J.; Darling, Jeremy; Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA. [Cotterill, Philip] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 1 U1 0 U2 1 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD SEP PY 2014 VL 60 IS 3 BP 830 EP 830 PG 1 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA AO8UE UT WOS:000341629700099 ER PT J AU Lebrun-Harris, LA Tomoyasu, N Ngo-Metzger, Q AF Lebrun-Harris, Lydie A. Tomoyasu, Naomi Ngo-Metzger, Quyen TI Substance Use, Risk of Dependence, Counseling and Treatment among Adult Health Center Patients SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Article DE Health centers; primary care; substance use; counseling; treatment ID SERIOUS MENTAL-ILLNESS; PSYCHOLOGICAL DISTRESS; GENERAL-POPULATION; SCREENING SCALES; NATIONAL-SURVEY; TRENDS; ABUSE; PROVISION; SERVICES; K6 AB Health centers provide primary care to 20 million underserved patients. We examined the prevalence of substance use and risk of dependence among health center patients, and identified factors associated with desire for counseling/treatment and discussions about substance use with a doctor. National data on 3,949 adults came from the 2009 Health Center Patient Survey. Forty percent of patients reported past-year binge drinking, 14% of patients had used any drug in the past three months, and 13% of these recent users were at high risk of dependence. Eighty-four percent of patients who desired substance use counseling or treatment reported receiving it. Several factors were associated with patients discussing substance use with their doctors (e.g., younger age, being male, severe mental illness, current smoking). Patients most likely to desire substance use counseling or treatment were male, unmarried, insured, current smokers, and indicated mental health problems. C1 [Lebrun-Harris, Lydie A.] US Dept Hlth & Human Serv DHHS, Hlth Resources & Serv Adm HRSA, Off Planning Anal & Evaluat, Rockville, MD USA. [Tomoyasu, Naomi] DHHS, Ctr Medicare Serv, Baltimore, MD USA. [Tomoyasu, Naomi] DHHS, Ctr Medicaid Serv CMS, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Ngo-Metzger, Quyen] DHHS, Agcy Healthcare Res & Qual, Washington, DC USA. [Ngo-Metzger, Quyen] Ctr Primary Care Prevent & Clin Partnerships, Rockville, MD USA. RP Lebrun-Harris, LA (reprint author), US Dept HHS, Hlth Resources & Serv Adm, Off Planning Anal & Evaluat, Off Res & Evaluat, 5600 Fishers Lane,10-29, Rockville, MD 20857 USA. EM Ilebrun-harris@hrsa.gov NR 29 TC 1 Z9 1 U1 0 U2 4 PU JOHNS HOPKINS UNIV PRESS PI BALTIMORE PA JOURNALS PUBLISHING DIVISION, 2715 NORTH CHARLES ST, BALTIMORE, MD 21218-4363 USA SN 1049-2089 EI 1548-6869 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PD AUG PY 2014 VL 25 IS 3 BP 1217 EP 1230 PG 14 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA AN0XC UT WOS:000340306300020 PM 25130235 ER PT J AU Shahian, DM He, X O'Brien, SM Grover, FL Jacobs, JP Edwards, FH Welke, KF Suter, LG Drye, E Shewan, CM Han, L Peterson, E AF Shahian, David M. He, Xia O'Brien, Sean M. Grover, Frederick L. Jacobs, Jeffrey P. Edwards, Fred H. Welke, Karl F. Suter, Lisa G. Drye, Elizabeth Shewan, Cynthia M. Han, Lein Peterson, Eric TI Development of a Clinical Registry-Based 30-Day Readmission Measure for Coronary Artery Bypass Grafting Surgery SO CIRCULATION LA English DT Article DE coronary artery bypass; patient readmission; registries; risk adjustment ID ADULT CARDIAC-SURGERY; PROFILING HOSPITAL PERFORMANCE; ACUTE MYOCARDIAL-INFARCTION; HEART-FAILURE; SOCIOECONOMIC-STATUS; QUALITY MEASUREMENT; RISK; CARE; RATES; MEDICARE AB Background-Reducing readmissions is a major healthcare reform goal, and reimbursement penalties are imposed for higherthan- expected readmission rates. Most readmission risk models and performance measures are based on administrative rather than clinical data. Methods and Results-We examined rates and predictors of 30-day all-cause readmission following coronary artery bypass grafting surgery by using nationally representative clinical data (2008-2010) from the Society of Thoracic Surgeons National Database linked to Medicare claims records. Among 265 434 eligible Medicare records, 226 960 (86%) were successfully linked to Society of Thoracic Surgeons records; 162 572 (61%) isolated coronary artery bypass grafting admissions constituted the study cohort. Logistic regression was used to identify readmission risk factors; hierarchical regression models were then estimated. Risk-standardized readmission rates ranged from 12.6% to 23.6% (median, 16.8%) among 846 US hospitals with >= 30 eligible cases and >= 90% of eligible Centers for Medicare and Medicaid Services records linked to the Society of Thoracic Surgeons database. Readmission predictors (odds ratios [95% confidence interval]) included dialysis (2.02 [1.87-2.19]), severe chronic lung disease (1.58 [1.49-1.68]), creatinine (2.5 versus 1.0 or lower: 1.49 [1.41-1.57]; 2.0 versus 1.0 or lower: 1.37 [1.32-1.43]), insulin-dependent diabetes mellitus (1.45 [1.39-1.51]), obesity in women (body surface area 2.2 versus 1.8: 1.44 [1.35-1.53]), female sex (1.38 [1.33-1.43]), immunosuppression (1.38 [1.28-1.49]), preoperative atrial fibrillation (1.36 [1.30-1.42]), age per 10-year increase (1.36 [1.33-1.39]), recent myocardial infarction (1.24 [1.08-1.42]), and low body surface area in men (1.22 [1.14-1.30]). C-statistic was 0.648. Fifty-two hospitals (6.1%) had readmission rates statistically better or worse than expected. Conclusions-A coronary artery bypass grafting surgery readmission measure suitable for public reporting was developed by using the national Society of Thoracic Surgeons clinical data linked to Medicare readmission claims. C1 [Shahian, David M.] Massachusetts Gen Hosp, Boston, MA 02114 USA. [Shahian, David M.] Harvard Univ, Sch Med, Boston, MA USA. [He, Xia; O'Brien, Sean M.; Peterson, Eric] Duke Clin Res Inst, Durham, NC USA. [Grover, Frederick L.] Univ Colorado, Sch Med, Aurora, CO USA. [Grover, Frederick L.] Denver Dept Vet Affairs Med Ctr, Denver, CO USA. [Jacobs, Jeffrey P.] Johns Hopkins Univ, All Childrens Hosp, St Petersburg, FL USA. [Edwards, Fred H.] Univ Florida, Coll Med, Jacksonville, FL USA. [Welke, Karl F.] Childrens Hosp Illinois, Peoria, IL USA. [Welke, Karl F.] Univ Illinois, Coll Med, Peoria, IL 61656 USA. [Suter, Lisa G.; Drye, Elizabeth] Yale New Haven Hlth Serv Corp, CORE, New Haven, CT USA. [Suter, Lisa G.; Drye, Elizabeth] Yale Univ, Sch Med, New Haven, CT USA. [Shewan, Cynthia M.] Soc Thorac Surg, Chicago, IL USA. [Han, Lein] Ctr Medicare Serv, Baltimore, MD USA. [Han, Lein] Ctr Medicaid Serv, Baltimore, MD USA. RP Shahian, DM (reprint author), Massachusetts Gen Hosp, Dept Surg, 55 Fruit St, Boston, MA 02114 USA. EM dshahian@partners.org FU DHHS/CMS [HHSM-500-2011-STS01C] FX This project was funded by DHHS/CMS contract HHSM-500-2011-STS01C. NR 37 TC 14 Z9 14 U1 0 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 EI 1524-4539 J9 CIRCULATION JI Circulation PD JUL 29 PY 2014 VL 130 IS 5 BP 399 EP 409 DI 10.1161/CIRCULATIONAHA.113.007541 PG 11 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA AN1TQ UT WOS:000340366900011 PM 24916208 ER PT J AU Brennan, N Conway, PH Tavenner, M AF Brennan, Niall Conway, Patrick H. Tavenner, Marilyn TI The Medicare Physician-Data Release - Context and Rationale SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Brennan, Niall; Conway, Patrick H.; Tavenner, Marilyn] Ctr Medicare Serv, Baltimore, MD 21244 USA. [Brennan, Niall; Conway, Patrick H.; Tavenner, Marilyn] Ctr Medicaid Serv, Baltimore, MD USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Cincinnati, OH 45229 USA. RP Brennan, N (reprint author), Ctr Medicare Serv, Baltimore, MD 21244 USA. NR 4 TC 13 Z9 13 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 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JUL 10 PY 2014 VL 371 IS 2 BP 99 EP 101 DI 10.1056/NEJMp1405026 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA AK7YZ UT WOS:000338645500004 PM 24869599 ER PT J AU Shaw, FE Asomugha, CN Conway, PH Rein, AS AF Shaw, Frederic E. Asomugha, Chisara N. Conway, Patrick H. Rein, Andrew S. TI The Patient Protection and Affordable Care Act: opportunities for prevention and public health SO LANCET LA English DT Article ID MEDICARE; AGENCIES AB The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage-and the health benefits of insurance-to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population. C1 [Shaw, Frederic E.; Rein, Andrew S.] US Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. [Asomugha, Chisara N.; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Rein, AS (reprint author), US Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. EM reinandys@yahoo.com NR 58 TC 27 Z9 27 U1 4 U2 29 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0140-6736 EI 1474-547X J9 LANCET JI Lancet PD JUL 5 PY 2014 VL 384 IS 9937 BP 75 EP 82 DI 10.1016/S0140-6736(14)60259-2 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA AL1XL UT WOS:000338919600028 PM 24993913 ER PT J AU DeSalvo, K Lurie, N Finne, K Worrall, C Bogdanov, A Dinkler, A Babcock, S Kelman, J AF DeSalvo, Karen Lurie, Nicole Finne, Kristen Worrall, Chris Bogdanov, Alina Dinkler, Ayame Babcock, Sarah Kelman, Jeffrey TI Using Medicare Data to Identify Individuals Who Are Electricity Dependent to Improve Disaster Preparedness and Response SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Editorial Material ID EMERGENCY; BLACKOUT; IMPACT; VISITS AB During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity dependent populations. C1 [DeSalvo, Karen; Dinkler, Ayame; Babcock, Sarah] City New Orleans Hlth Dept, New Orleans, LA USA. [Lurie, Nicole; Finne, Kristen] US Dept HHS, Off Assistant Secretary Preparedness & Response, Washington, DC 20201 USA. [Worrall, Chris; Kelman, Jeffrey] US Dept HHS, Ctr Medicare Serv, Washington, DC 20201 USA. [Worrall, Chris; Kelman, Jeffrey] US Dept HHS, Ctr Medicaid Serv, Washington, DC 20201 USA. [Bogdanov, Alina] Acumen LLC, Burlingame, CA USA. RP Lurie, N (reprint author), US Dept HHS, Off Secretary, 200 Independence Ave SW,Room 638G, Washington, DC 20201 USA. EM nicole.lurie@hhs.gov NR 10 TC 8 Z9 8 U1 1 U2 6 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 800 I STREET, NW, WASHINGTON, DC 20001-3710 USA SN 0090-0036 EI 1541-0048 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD JUL PY 2014 VL 104 IS 7 BP 1160 EP 1164 DI 10.2105/AJPH.2014.302009 PG 5 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA AP1EM UT WOS:000341809500026 PM 24832404 ER PT J AU Brennan, N Oelschlaeger, A Cox, C Tavenner, M AF Brennan, Niall Oelschlaeger, Allison Cox, Christine Tavenner, Marilyn TI Leveraging The Big-Data Revolution: CMS Is Expanding Capabilities To Spur Health System Transformation SO HEALTH AFFAIRS LA English DT Article AB As the largest single payer for health care in the United States, the Centers for Medicare and Medicaid Services (CMS) generates enormous amounts of data. Historically, CMS has faced technological challenges in storing, analyzing, and disseminating this information because of its volume and privacy concerns. However, rapid progress in the fields of data architecture, storage, and analysis-the big-data revolution-over the past several years has given CMS the capabilities to use data in new and innovative ways. We describe the different types of CMS data being used both internally and externally, and we highlight a selection of innovative ways in which big-data techniques are being used to generate actionable information from CMS data more effectively. These include the use of real-time analytics for program monitoring and detecting fraud and abuse and the increased provision of data to providers, researchers, beneficiaries, and other stakeholders. C1 [Brennan, Niall] Ctr Medicare & Medicaid Serv CMS, Off Enterprise Management, Washington, DC 20201 USA. [Oelschlaeger, Allison; Cox, Christine] CMS, Off Enterprise Management, Off Informat Prod & Data Analyt, Baltimore, MD USA. [Tavenner, Marilyn] CMS, Baltimore, MD USA. RP Brennan, N (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Enterprise Management, Washington, DC 20201 USA. EM niall.brennan@cms.hhs.gov NR 19 TC 8 Z9 8 U1 3 U2 24 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 PY 2014 VL 33 IS 7 BP 1195 EP 1202 DI 10.1377/hlthaff.2014.0130 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA AN3FC UT WOS:000340469700013 PM 25006146 ER PT J AU Wagner, DC Isetts, BJ AF Wagner, Dennis C. Isetts, Brian J. TI Choosing to use the most powerful model in the world SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Editorial Material C1 [Wagner, Dennis C.] Partnership Patients, Baltimore, MD USA. [Wagner, Dennis C.] Ctr Clin Stand, Qual Improvement Innovat Model Testing Grp, Dept Hlth & Human Serv, Baltimore, MD USA. [Wagner, Dennis C.] Ctr Clin Qual, Qual Improvement Innovat Model Testing Grp, Dept Hlth & Human Serv, Baltimore, MD USA. [Wagner, Dennis C.] Partnership Patients, Ctr Medicare & Medicaid Innovat, Dept Hlth & Human Serv, Ctr Medicare Serv, Baltimore, MD USA. [Wagner, Dennis C.] Partnership Patients, Ctr Medicare & Medicaid Innovat, Dept Hlth & Human Serv, Ctr Medicaid Serv, Baltimore, MD USA. [Isetts, Brian J.] Univ Minnesota, Coll Pharm, Dept Pharmaceut Care & Hlth Syst, Minneapolis, MN 55455 USA. [Isetts, Brian J.] CMS, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. RP Isetts, BJ (reprint author), Univ Minnesota, Coll Pharm, Dept Pharmaceut Care & Hlth Syst, Minneapolis, MN 55455 USA. EM isett001@umn.edu NR 11 TC 0 Z9 0 U1 0 U2 0 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 USA SN 1079-2082 EI 1535-2900 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD JUL 1 PY 2014 VL 71 IS 13 BP 1128 EP 1135 DI 10.2146/ajhp140108 PG 8 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA AK9OY UT WOS:000338757600015 PM 24939503 ER PT J AU Brady, PW Brinkman, WB Simmons, JM Yau, C White, CM Kirkendall, ES Schaffzin, JK Conway, PH Vossmeyer, MT AF Brady, Patrick W. Brinkman, William B. Simmons, Jeffrey M. Yau, Connie White, Christine M. Kirkendall, Eric S. Schaffzin, Joshua K. Conway, Patrick H. Vossmeyer, Michael T. TI Oral antibiotics at discharge for children with acute osteomyelitis: a rapid cycle improvement project SO BMJ QUALITY & SAFETY LA English DT Article ID ACUTE HEMATOGENOUS OSTEOMYELITIS; EVIDENCE-BASED GUIDELINE; SHARED DECISION-MAKING; CLINICAL PATHWAY; JOINT INFECTIONS; MANAGEMENT; AID; BRONCHIOLITIS; IMPACT; VACCINATION AB Background Substantial evidence demonstrates comparable cure rates for oral versus intravenous therapy for routine osteomyelitis. Evidence adoption is often slow and in our centre virtually all patients with osteomyelitis were discharged on intravenous therapy. Objective For patients with acute osteomyelitis admitted to the hospital medicine service, we aimed to increase the proportion of cases discharged on oral antibiotics to at least 70%. Methods The setting for our observational time series study was a large academic children's hospital. The model for improvement and plan-do-study-act cycles were used to test, refine and implement interventions identified through our key driver diagram. Our multifaceted intervention included a shared decision-making tool, an order set in our electronic health record, and education to faculty and trainees. We also included an identify and mitigate intervention to target providers caring for children with osteomyelitis in near-real time and reinforce the evidence-based recommendations. Data were analysed on an annotated g-chart of osteomyelitis cases between patients discharged on intravenous antibiotics. Structured chart review was used to identify treatment failures as well as length of stay and hospital charges in preintervention and postintervention groups. Results The osteomyelitis cases between patients discharged on intravenous antibiotics increased from a median of 0 preintervention to a maximum of 9 cases following our identify and mitigate intervention. The direction and magnitude of successive improvements observed satisfied criteria for special cause variation. Improvement has been sustained for 1 year. Treatment failure and complications were uncommon in preintervention and postintervention phases. No significant differences in length of stay or charges were detected. Conclusions Even for uncommon conditions, rapid and sustained evidence adoption is possible using quality improvement methods. C1 [Brady, Patrick W.; Brinkman, William B.; Simmons, Jeffrey M.; Yau, Connie; White, Christine M.; Kirkendall, Eric S.; Schaffzin, Joshua K.; Conway, Patrick H.; Vossmeyer, Michael T.] Cincinnati Childrens Hosp Med Ctr, Div Hosp Med, Cincinnati, OH 45229 USA. [Brady, Patrick W.; Brinkman, William B.] Cincinnati Childrens Hosp Med Ctr, James M Anderson Ctr Hlth Syst Excellence, Cincinnati, OH 45229 USA. [Brinkman, William B.] Cincinnati Childrens Hosp Med Ctr, Div Gen & Community Pediat, Cincinnati, OH 45229 USA. [Kirkendall, Eric S.] Cincinnati Childrens Hosp Med Ctr, Div Biomed Informat, Cincinnati, OH 45229 USA. [Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD USA. [Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD USA. RP Brady, PW (reprint author), Cincinnati Childrens Hosp Med Ctr, Div Hosp Med, James M Anderson Ctr Hlth Syst Excellence, Dept Pediat, 3333 Burnet Ave,ML 9016, Cincinnati, OH 45229 USA. EM patrick.brady@cchmc.org OI Kirkendall, Eric/0000-0001-6225-8320 FU National Institute of Mental Health [K23MH083027] FX WBB is supported by Award Number K23MH083027 from the National Institute of Mental Health. NR 39 TC 2 Z9 2 U1 0 U2 5 PU BMJ PUBLISHING GROUP PI LONDON PA BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND SN 2044-5415 EI 2044-5423 J9 BMJ QUAL SAF JI BMJ Qual. Saf. PD JUN PY 2014 VL 23 IS 6 BP 499 EP 507 DI 10.1136/bmjqs-2013-002179 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA AI5NM UT WOS:000336914900009 PM 24347649 ER PT J AU Volkow, ND Frieden, TR Hyde, PS Cha, SS AF Volkow, Nora D. Frieden, Thomas R. Hyde, Pamela S. Cha, Stephen S. TI Medication-Assisted Therapies - Tackling the Opioid-Overdose Epidemic SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID DEATHS C1 [Volkow, Nora D.] NIDA, NIH, Bethesda, MD 20892 USA. [Hyde, Pamela S.] Subst Abuse & Mental Hlth Serv Adm, Rockville, MD USA. [Cha, Stephen S.] Ctr Medicare Serv, Ctr Medicaid & CHIP Serv, Baltimore, MD USA. [Cha, Stephen S.] Ctr Medicaid Serv, Ctr Medicaid & CHIP Serv, Baltimore, MD USA. [Frieden, Thomas R.] Ctr Dis Control & Prevent, Atlanta, GA USA. RP Volkow, ND (reprint author), NIDA, NIH, Bethesda, MD 20892 USA. NR 5 TC 133 Z9 133 U1 3 U2 14 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD MAY 29 PY 2014 VL 370 IS 22 BP 2063 EP 2066 DI 10.1056/NEJMp1402780 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA AH9BM UT WOS:000336434000003 PM 24758595 ER PT J AU Rajkumar, R Conway, PH Tavenner, M AF Rajkumar, Rahul Conway, Patrick H. Tavenner, Marilyn TI CMS-Engaging Multiple Payers in Payment Reform SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Rajkumar, Rahul; Conway, Patrick H.; Tavenner, Marilyn] Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. [Rajkumar, Rahul] Brigham & Womens Hosp, Boston, MA 02115 USA. [Conway, Patrick H.] Cincinnati Childrens Hosp, Cincinnati, OH USA. RP Rajkumar, R (reprint author), Ctr Medicare & Medicaid Serv, 200 Independence Ave SW, Washington, DC 20201 USA. EM rahul.rajkumar@cms.hhs.gov NR 4 TC 34 Z9 34 U1 0 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 21 PY 2014 VL 311 IS 19 BP 1967 EP 1968 DI 10.1001/jama.2014.3703 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA AH4UA UT WOS:000336122800014 PM 24752342 ER PT J AU Witt, CM Aickin, M Cherkin, D Che, CT Elder, C Flower, A Hammerschlag, R Liu, JP Lao, LX Phurrough, S Ritenbaugh, C Rubin, LH Schnyer, R Wayne, PM Withers, SR Zhao-Xiang, B Young, J Berman, BM AF Witt, Claudia M. Aickin, Mikel Cherkin, Daniel Che, Chun Tao Elder, Charles Flower, Andrew Hammerschlag, Richard Liu, Jian-Ping Lao, Lixing Phurrough, Steve Ritenbaugh, Cheryl Rubin, Lee Hullender Schnyer, Rosa Wayne, Peter M. Withers, Shelly Rafferty Zhao-Xiang, Bian Young, Jeanette Berman, Brian M. TI Effectiveness guidance document (EGD) for Chinese medicine trials: a consensus document SO TRIALS LA English DT Article DE Comparative effectiveness research; Effectiveness guidance document; Chinese medicine research ID CLUSTER RANDOMIZED-TRIALS; CONSORT STATEMENT; ACUPUNCTURE RESEARCH; ALLOCATION METHODS; HERBAL MEDICINE; CLINICAL-TRIAL; USUAL CARE; BACK-PAIN; EXTENSION; OUTCOMES AB Background: There is a need for more Comparative Effectiveness Research (CER) on Chinese medicine (CM) to inform clinical and policy decision-making. This document aims to provide consensus advice for the design of CER trials on CM for researchers. It broadly aims to ensure more adequate design and optimal use of resources in generating evidence for CM to inform stakeholder decision-making. Methods: The Effectiveness Guidance Document (EGD) development was based on multiple consensus procedures (survey, written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders, including patients, clinicians, researchers and payers were involved in creating this document. Results: Recommendations were developed for "using available data" and "future clinical studies". The recommendations for future trials focus on randomized trials and cover the following areas: designing CER studies, treatments, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication. Conclusion: The present EGD provides the first systematic methodological guidance for future CER trials on CM and can be applied to single or multi-component treatments. While CONSORT statements provide guidelines for reporting studies, EGDs provide recommendations for the design of future studies and can contribute to a more strategic use of limited research resources, as well as greater consistency in trial design. C1 [Witt, Claudia M.] Univ Zurich Hosp, Inst Complementary & Integrat Med, CH-8091 Zurich, Switzerland. [Witt, Claudia M.; Berman, Brian M.] Univ Maryland, Ctr Integrat Med, Sch Med, Baltimore, MD 21201 USA. [Aickin, Mikel; Ritenbaugh, Cheryl] Univ Arizona, Dept Family & Community Med, Tucson, AZ USA. [Cherkin, Daniel] Grp Hlth Res Inst, Seattle, WA USA. [Che, Chun Tao] Univ Illinois, Dept Med Chem & Pharmacognosy, Chicago, IL USA. [Elder, Charles] Kaiser Permanente Northwest, Ctr Hlth Res, Portland, OR USA. [Flower, Andrew] Univ Southampton, Dept Primary Care, Complementary & Integrated Med Res Unit, Southampton, Hants, England. [Hammerschlag, Richard; Rubin, Lee Hullender] Oregon Coll Oriental Med, Res Dept, Portland, OR USA. [Liu, Jian-Ping] Beijing Univ Chinese Med, Ctr Evidence Based Chinese Med, Beijing, Peoples R China. [Lao, Lixing] Univ Maryland, Med Ctr, Complementary Med Program & Integrat Med, Baltimore, MD 21201 USA. [Phurrough, Steve] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Schnyer, Rosa] Univ Texas Austin, Sch Nursing, Austin, TX 78712 USA. [Wayne, Peter M.] Brigham & Womens Hosp, Osher Ctr Integrat Med, Div Prevent Med, Boston, MA 02115 USA. [Wayne, Peter M.] Harvard Univ, Sch Med, Boston, MA USA. [Withers, Shelly Rafferty; Berman, Brian M.] Inst Integrat Hlth, Baltimore, MD USA. [Zhao-Xiang, Bian] Hong Kong Baptist Univ, Sch Chinese Med, Kowloon, Hong Kong, Peoples R China. [Young, Jeanette] Patient stakeholder, New York, NY 10001 USA. RP Witt, CM (reprint author), Univ Zurich Hosp, Inst Complementary & Integrat Med, CH-8091 Zurich, Switzerland. EM claudia.witt@uzh.ch OI Lewith, George/0000-0002-2364-3960; Lao, Lixing/0000-0003-0198-9714 FU Department of Health [PDF-2011-04-027] NR 36 TC 8 Z9 10 U1 1 U2 11 PU BIOMED CENTRAL LTD PI LONDON PA 236 GRAYS INN RD, FLOOR 6, LONDON WC1X 8HL, ENGLAND SN 1745-6215 J9 TRIALS JI Trials PD MAY 13 PY 2014 VL 15 AR 169 DI 10.1186/1745-6215-15-169 PG 11 WC Medicine, Research & Experimental SC Research & Experimental Medicine GA AI3ZZ UT WOS:000336806000001 PM 24885146 ER PT J AU Shoff, C Chen, VYJ Yang, TC AF Shoff, Carla Chen, Vivian Yi-Ju Yang, Tse-Chuan TI When homogeneity meets heterogeneity: the geographically weighted regression with spatial lag approach to prenatal care utilisation SO GEOSPATIAL HEALTH LA English DT Article DE prenatal care; geographically weighted regression; spatial non-stationarity; United States of America ID LOW-INCOME WOMEN; HIGH-RISK CONDITIONS; UNITED-STATES; INSURANCE-COVERAGE; PRETERM BIRTHS; WELFARE-REFORM; PREGNANT TEENS; INITIATION; HEALTH; IMPACT AB Using geographically weighted regression (GWR), a recent study by Shoff and colleagues (2012) investigated the place-specific risk factors for prenatal care utilisation in the United States of America (USA) and found that most of the relationships between late or no prenatal care and its determinants are spatially heterogeneous. However, the GWR approach may be subject to the confounding effect of spatial homogeneity. The goal of this study was to address this concern by including both spatial homogeneity and heterogeneity into the analysis. Specifically, we employed an analytic framework where a spatially lagged (SL) effect of the dependent variable is incorporated into the GWR model, which is called GWR-SL. Using this framework, we found evidence to argue that spatial homogeneity is neglected in the study by Shoff et al. (2012) and that the results change after considering the SL effect of prenatal care utilisation. The GWR-SL approach allowed us to gain a place-specific understanding of prenatal care utilisation in USA counties. In addition, we compared the GWR-SL results with the results of conventional approaches (i.e., ordinary least squares and spatial lag models) and found that GWR-SL is the preferred modelling approach. The new findings help us to better estimate how the predictors are associated with prenatal care utilisation across space, and determine whether and how the level of prenatal care utilisation in neighbouring counties matters. C1 [Shoff, Carla] Ctr Medicare & Medicaid Serv, Off Informat Prod & Data Analyt, Baltimore, MD 21244 USA. [Chen, Vivian Yi-Ju] Tamkang Univ, Dept Stat, New Taipei City, Taiwan. [Yang, Tse-Chuan] SUNY Albany, Dept Sociol, Ctr Social & Demog Anal, New York, NY USA. RP Shoff, C (reprint author), Ctr Medicare & Medicaid Serv, Off Informat Prod & Data Analyt, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM carla.shoff@cms.hhs.gov FU Population Research Institute (Penn State) [R24-HD41025]; Center for Social and Demographic Analysis (University at Albany) [R24-HD044943]; National Science Council of Taiwan [NSC102-2119-M-032-001] FX We received support from the Population Research Institute (Penn State; R24-HD41025), the Center for Social and Demographic Analysis (University at Albany; R24-HD044943), and the National Science Council of Taiwan (NSC102-2119-M-032-001). NR 72 TC 2 Z9 2 U1 2 U2 10 PU UNIV NAPLES FEDERICO II PI NAPLES PA FAC VET MED, DEP PATHOLOGY & ANIMAL HEALTH, VET PARASITOLOGY, VIA DELLA VETERINARIA 1, NAPLES, 80137, ITALY SN 1827-1987 EI 1970-7096 J9 GEOSPATIAL HEALTH JI Geospatial Health PD MAY PY 2014 VL 8 IS 2 BP 557 EP 568 PG 12 WC Health Care Sciences & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA AL6HF UT WOS:000339232500024 PM 24893033 ER PT J AU Lassman, D Hartman, M Washington, B Andrews, K Catlin, A AF Lassman, David Hartman, Micah Washington, Benjamin Andrews, Kimberly Catlin, Aaron TI US Health Spending Trends By Age And Gender: Selected Years 2002-10 SO HEALTH AFFAIRS LA English DT Article AB This article presents estimates of personal health care spending by age and gender in selected years during the period 2002-10 and an analysis of the variation in spending among children, working-age adults, and the elderly. Our research found that in this period, aggregate spending on children's health care increased at the slowest rate. However, per capita spending for children grew more rapidly than that for working-age adults and the elderly. Per capita spending for the elderly remained about five times higher than spending for children. Overall, females spent more per capita than males, but the gap had decreased by 2010. The implementation of Medicare Part D, the effects of the recent recession, and the aging of the baby boomers affected the spending trends and distributions during the period of this study. C1 [Lassman, David] Ctr Medicare & Medicaid Serv CMS, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD 21218 USA. RP Lassman, D (reprint author), Ctr Medicare & Medicaid Serv CMS, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD 21218 USA. EM David.Lassman2@cms.hhs.gov NR 21 TC 16 Z9 16 U1 0 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 PY 2014 VL 33 IS 5 BP 815 EP 822 DI 10.1377/hlthaff.2013.1224 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA AI2DD UT WOS:000336666500014 PM 24799579 ER PT J AU Koller, EA Roche, JC Rollins, JA AF Koller, Elizabeth A. Roche, Jeffrey C. Rollins, James A. TI Genotype-Guided Dosing of Vitamin K Antagonists SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter ID RANDOMIZED-TRIAL; WARFARIN; RISK C1 [Koller, Elizabeth A.] Ctr Medicare Serv, Baltimore, MD 21218 USA. Ctr Medicaid Serv, Baltimore, MD USA. RP Koller, EA (reprint author), Ctr Medicare Serv, Baltimore, MD 21218 USA. EM jeffrey.roche@cms.hhs.gov NR 8 TC 3 Z9 3 U1 1 U2 4 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD MAY 1 PY 2014 VL 370 IS 18 BP 1761 EP 1761 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA AG4QM UT WOS:000335405200018 PM 24785214 ER PT J AU Meisel, ZF Pitts, SR Pines, JM Goodrich, K Carr, BG AF Meisel, Zachary F. Pitts, Stephen R. Pines, Jesse M. Goodrich, Kate Carr, Brendan G. TI Policy Roundtable: Emergency Department Boarding and Hospital Quality SO ACADEMIC EMERGENCY MEDICINE LA English DT Editorial Material C1 [Meisel, Zachary F.; Carr, Brendan G.] Univ Penn, Leonard Davis Inst Hlth Econ, Ctr Emergency Care Policy Res, Dept Emergency Med,Perelman Sch Med, Philadelphia, PA 19104 USA. [Pitts, Stephen R.] Emory Univ, Dept Emergency Med, Atlanta, GA 30322 USA. [Pines, Jesse M.] George Washington Univ, Sch Med & Hlth Sci, Washington, DC 20052 USA. [Goodrich, Kate] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Goodrich, Kate] George Washington Univ, Sch Med & Hlth Sci, Dept Med, Washington, DC 20052 USA. [Carr, Brendan G.] US Dept HHS, Ctr Off Assistant Secretary Preparedness & Respon, Washington, DC 20201 USA. RP Meisel, ZF (reprint author), Univ Penn, Leonard Davis Inst Hlth Econ, Ctr Emergency Care Policy Res, Dept Emergency Med,Perelman Sch Med, Philadelphia, PA 19104 USA. EM zachary.meisel@uphs.upenn.edu NR 1 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1069-6563 EI 1553-2712 J9 ACAD EMERG MED JI Acad. Emerg. Med. PD MAY PY 2014 VL 21 IS 5 BP 570 EP 573 DI 10.1111/acem.12381 PG 4 WC Emergency Medicine SC Emergency Medicine GA AH6VI UT WOS:000336269600013 PM 24842510 ER PT J AU Doarn, CR Pruitt, S Jacobs, J Harris, Y Bott, DM Riley, W Lamer, C Oliver, AL AF Doarn, Charles R. Pruitt, Sherilyn Jacobs, Jessica Harris, Yael Bott, David M. Riley, William Lamer, Christopher Oliver, Anthony L. TI Original Research Federal Efforts to Define and Advance Telehealth-A Work in Progress SO TELEMEDICINE AND E-HEALTH LA English DT Article DE telemedicine; telehealth; U; S; Government; healthcare reform ID ARMY TELEMEDICINE; MOBILE HEALTH; TECHNOLOGY; FUTURE; CARE; IMPLEMENTATION; PERSPECTIVES; MANAGEMENT; SUPPORT; HOME AB Background:The integration of telecommunications and information systems in healthcare is not new or novel; indeed, it is the current practice of medicine and has been an integral part of medicine in remote locations for several decades. The U.S. Government has made a significant investment, measured in hundreds of millions of dollars, and therefore has a strong presence in the integration of telehealth/telemedicine in healthcare. However, the terminologies and definitions in the lexicon vary across agencies and departments of the U.S. Government. The objective of our survey was to identify and evaluate the definitions of telehealth/telemedicine across the U.S. Government to provide a better understanding of what each agency or department means when it uses these terms.Methodology:The U.S. Government, under the leadership of the Health Resources and Services Administration in the U.S. Department of Health and Human Services, established the Federal Telemedicine (FedTel) Working Group, through which all members responded to a survey on each agency or department's definition and use of terms associated with telehealth.Results and Conclusions:Twenty-six agencies represented by more than 100 individuals participating in the FedTel Working Group identified seven unique definitions of telehealth in current use across the U.S. Government. Although many definitions are similar, there are nuanced differences that reflect each organization's legislative intent and the population they serve. These definitions affect how telemedicine has been or is being applied across the healthcare landscape, reflecting the U.S. Government's widespread and influential role in healthcare access and service delivery. The evidence base suggests that a common nomenclature for defining telemedicine may benefit efforts to advance the use of this technology to address the changing nature of healthcare and new demands for services expected as a result of health reform. C1 [Doarn, Charles R.] NASA Headquarters, Washington, DC USA. [Doarn, Charles R.] Univ Cincinnati, Coll Med, Dept Family & Community Med, Cincinnati, OH 45267 USA. [Pruitt, Sherilyn; Oliver, Anthony L.] US Dept HHS, Off Adv Telehlth, Rockville, MD USA. [Jacobs, Jessica] Aetna, Washington, DC USA. [Harris, Yael] US Dept HHS, Div Healthcare Qual, Off Dis Prevent & Hlth Promot, Rockville, MD USA. [Bott, David M.] US Dept HHS, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Riley, William] NCI, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. [Lamer, Christopher] Indian Hlth Serv, Rockville, MD USA. RP Doarn, CR (reprint author), Univ Cincinnati, Coll Med, Dept Family & Community Med, Cincinnati, OH 45267 USA. EM charles.doarn@uc.edu NR 36 TC 9 Z9 9 U1 0 U2 5 PU MARY ANN LIEBERT, INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1530-5627 EI 1556-3669 J9 TELEMED E-HEALTH JI Telemed. e-Health PD MAY 1 PY 2014 VL 20 IS 5 BP 409 EP 418 DI 10.1089/tmj.2013.0336 PG 10 WC Health Care Sciences & Services SC Health Care Sciences & Services GA AG4MG UT WOS:000335393400004 PM 24502793 ER PT J AU Reid, RO Deb, P Howell, BL Shrank, W AF Reid, Rachel O. Deb, Partha Howell, Benjamin L. Shrank, William TI THE ROLES OF COST AND QUALITY INFORMATION IN MEDICARE ADVANTAGE PLAN ENROLLMENT DECISIONS SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 37th Annual Meeting of the Society-General-Internal-Medicine CY APR 23-26, 2014 CL San Diego, CA SP Soc Gen Internal Med C1 [Reid, Rachel O.; Shrank, William] Brigham & Womens Hosp, Boston, MA 02115 USA. [Howell, Benjamin L.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Deb, Partha] CUNY Hunter Coll, New York, NY 10021 USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD APR PY 2014 VL 29 SU 1 BP S234 EP S234 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA AO0JZ UT WOS:000340996201182 ER PT J AU Graham, DJ Zhou, EH McKean, S Levenson, M Calia, K Gelperin, K Ding, X MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Zhou, Esther H. McKean, Stephen Levenson, Mark Calia, Katlyn Gelperin, Kate Ding, Xiao MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Cardiovascular and mortality risk in elderly Medicare beneficiaries treated with olmesartan versus other angiotensin receptor blockers SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Article DE olmesartan; angiotensin receptor blockers (ARBs); cardiovascular; mortality; pharmacoepidemiology ID ACUTE MYOCARDIAL-INFARCTION; POSITIVE PREDICTIVE-VALUE; ADMINISTRATIVE DATA; CODING ACCURACY; MULTICENTER; DIAGNOSIS; STROKE; DEATH AB PurposeIn the randomized trial, Randomized Olmesartan and Diabetes Microalbuminuria Prevention, acute cardiovascular death was increased nearly fivefold in diabetic patients treated with high-dose olmesartan, an angiotensin receptor blocker (ARB), compared with placebo. MethodsMedicare beneficiaries were entered into new-user cohorts of olmesartan or other ARBs and followed on therapy for occurrence of acute myocardial infarction, stroke, or death. Analyses focused on specific subgroups defined by diabetes status, ARB dose, and duration of therapy. Hazard ratios (HR) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression, with other ARBs as reference. ResultsA total of 158054 olmesartan and 724673 other ARB users were followed for 54285 and 260390 person-years, respectively, during which 9237 endpoint events occurred. Lower-dose olmesartan was not associated with increased risk for any endpoint, regardless of duration of use. High-dose olmesartan for 6 months or longer was associated with increased risk of death in patients with diabetes (HR 2.03, 95%CI 1.09-3.75, p=0.02) and with reduced risk in nondiabetic patients (HR 0.46, 95%CI 0.24-0.86, p=0.01). Some, but not all, sensitivity analyses suggested that selective prescribing of olmesartan to healthier patients (channeling bias) may have accounted for the reduced risk in nondiabetic patients. ConclusionsHigh-dose olmesartan was associated with an increased risk of death in diabetic patients treated for 6 months or longer and with a reduced risk of death in nondiabetic patients, when compared with use of other ARBs. This latter effect was probably because of selective prescribing of olmesartan to healthier patients, although effect modification cannot be excluded. Published 2013. This article is a U.S. Government work and is in the public domain in the USA. C1 [Graham, David J.; Zhou, Esther H.; Levenson, Mark; Gelperin, Kate; Ding, Xiao] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD 20993 USA. [McKean, Stephen; Calia, Katlyn; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Palo Alto, CA 94304 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Graham, DJ (reprint author), US FDA, Off Surveillance & Epidemiol, 10903 New Hampshire Ave,Bldg 22,Room 4314, Silver Spring, MD 20993 USA. EM david.graham1@fda.hhs.gov FU Centers for Medicare & Medicaid Services; Food and Drug Administration FX This study was funded through an intra-agency agreement between the Centers for Medicare & Medicaid Services and the Food and Drug Administration. NR 21 TC 8 Z9 8 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD APR PY 2014 VL 23 IS 4 BP 331 EP 339 DI 10.1002/pds.3548 PG 9 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA AE1MB UT WOS:000333732300001 PM 24277678 ER PT J AU Nyweide, DJ AF Nyweide, David J. TI Concordance Between Continuity of Care Reported by Patients and Measured From Administrative Data SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE measurement; Medicare; survey; continuity of care ID PHYSICIAN VISIT CONTINUITY; INTERPERSONAL CONTINUITY; HEALTH; COORDINATION; ACCURACY; OUTCOMES; TRENDS AB Continuity of care can be measured using patient survey or administrative data, though the degree of concordance between continuity of care reported by patients and measured from their actual utilization is not well understood. A cross-sectional analysis of the 2010 Medicare Current Beneficiary Survey and linked 2009-2010 Medicare Carrier and outpatient claims data measured the concentration of ambulatory care visit patterns according to two commonly used metrics of continuity of care. Continuity of care measured from claims data did not align with patient reports of having a usual care provider. However, high levels of continuity for patients with a usual care provider were associated with a longer patient-provider relationship, greater patient-perceived provider knowledge of the patient's medical condition and history, and more confidence in the provider. Inferences about a patient's continuity of care must be placed in the context of the data source with which continuity is measured. C1 [Nyweide, David J.] Ctr Medicare, Baltimore, MD 21244 USA. [Nyweide, David J.] Ctr Medicaid Serv, Baltimore, MD USA. RP Nyweide, DJ (reprint author), Ctr Medicare, 7500 Secur Blvd,Mailstop WB-06-05, Baltimore, MD 21244 USA. EM david.nyweide@cms.hhs.gov NR 26 TC 3 Z9 3 U1 2 U2 10 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 EI 1552-6801 J9 MED CARE RES REV JI Med. Care Res. Rev. PD APR PY 2014 VL 71 IS 2 BP 138 EP 155 DI 10.1177/1077558713505685 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA AC4AY UT WOS:000332464200002 PM 24177138 ER PT J AU Hays, RD Martino, S Brown, JA Cui, M Cleary, P Gaillot, S Elliott, M AF Hays, Ron D. Martino, Steven Brown, Julie A. Cui, Mike Cleary, Paul Gaillot, Sarah Elliott, Marc TI Evaluation of a Care Coordination Measure for the Consumer Assessment of Healthcare Providers and Systems (CAHPS (R)) Medicare Survey SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE CAHPS (R); Medicare beneficiaries; patient experience surveys; care coordination ID PREVENTIVE SERVICES; DELIVERY; NEEDS; HOME AB There is widespread interest in assessing care coordination to improve overall care quality. We evaluated a five-item measure of care coordination included in the 2012 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey (n = 326,194 respondents, 46% response rate). This measure includes patient reports of whether their personal doctor discusses their medicines, has medical records and other relevant information, and is informed about care from specialists, and whether the patient gets help in managing care and timely follow-up on test results. A one-factor categorical confirmatory factor analytic model indicated that five items constituted a coherent scale. Estimated health-plan-level reliability was 0.70 at about 102 responses per plan. The composite had a strong unique association with the CAHPS global rating of health care, controlling for the CAHPS core composite scores. This measure can be used to evaluate relative plan performance and characteristics associated with better care coordination. C1 [Hays, Ron D.] Univ Calif Los Angeles, Div GIM HSR, Los Angeles, CA 90095 USA. [Martino, Steven] RAND, Pittsburgh, PA USA. [Brown, Julie A.; Cui, Mike; Elliott, Marc] RAND, Santa Monica, CA USA. [Cleary, Paul] Yale Sch Publ Hlth, New Haven, CT USA. [Gaillot, Sarah] Ctr Medicare Serv, Baltimore, MD USA. [Gaillot, Sarah] Ctr Medicaid Serv, Baltimore, MD USA. RP Hays, RD (reprint author), Univ Calif Los Angeles, Div GIM HSR, 911 Broxton Ave, Los Angeles, CA 90095 USA. EM drhays@ucla.edu FU CMS [HHSM-500-2005-000281]; AHRQ [2U18 HS016980]; NIA [P30AG021684]; NIMHD [2P20MD000182] FX The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by CMS contract HHSM-500-2005-000281 to RAND. Ron D. Hays was also supported in part by grants from AHRQ (2U18 HS016980), NIA (P30AG021684), and the NIMHD (2P20MD000182). NR 20 TC 7 Z9 7 U1 2 U2 9 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 EI 1552-6801 J9 MED CARE RES REV JI Med. Care Res. Rev. PD APR PY 2014 VL 71 IS 2 BP 192 EP 202 DI 10.1177/1077558713508205 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA AC4AY UT WOS:000332464200005 PM 24227813 ER PT J AU Daughtridge, GW Archibald, T Conway, PH AF Daughtridge, Giffin W. Archibald, Traci Conway, Patrick H. TI Quality Improvement of Care Transitions and the Trend of Composite Hospital Care SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Daughtridge, Giffin W.] Univ Penn, Philadelphia, PA 19104 USA. [Archibald, Traci; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA. RP Conway, PH (reprint author), Ctr Medicare & Medicaid Serv, Mailstop S3-02-01,7500 Secur Blvd, Baltimore, MD 21244 USA. EM patrick.conway@cms.hhs.gov NR 5 TC 10 Z9 10 U1 1 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAR 12 PY 2014 VL 311 IS 10 BP 1013 EP 1014 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA AC5QO UT WOS:000332575800015 PM 24618959 ER PT J AU Peikes, DN Reid, RJ Day, TJ Cornwell, DDF Dale, SB Baron, RJ Brown, RS Shapiro, RJ AF Peikes, Deborah N. Reid, Robert J. Day, Timothy J. Cornwell, Derekh D. F. Dale, Stacy B. Baron, Richard J. Brown, Randall S. Shapiro, Rachel J. TI Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative SO ANNALS OF FAMILY MEDICINE LA English DT Article DE primary care; staffing; patient-centered medical home; team-based care ID CENTERED MEDICAL HOME; QUALITY IMPROVEMENT STRATEGIES; PROPOSED SOLUTIONS; PHYSICIANS; TEAMS; CONTINUITY; MANAGEMENT; OUTCOMES; SIZE AB PURPOSE Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative. METHODS We undertook a descriptive analysis of CPC initiative practices' baseline staffing using data from initial applications and a practice survey. CMS selected 502 primary care practices (from 987 applicants) in 7 regions based on their health information technology, number of patients covered by participating payers, and other factors; 496 practices were included in this analysis. RESULTS Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators-all of these positions are more common in larger practices. Other clinical staff were reported infrequently regardless of practice size. Compared with other CPC initiative practices, designated patient-centered medical homes were more likely to have care managers/coordinators but otherwise had similar staff types. Larger practices had fewer FTE staff per physician. CONCLUSIONS At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost. C1 [Peikes, Deborah N.; Cornwell, Derekh D. F.; Dale, Stacy B.; Brown, Randall S.; Shapiro, Rachel J.] Math Policy Res, Princeton, NJ USA. [Reid, Robert J.] Grp Hlth Res Inst, Seattle, WA USA. [Day, Timothy J.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Baron, Richard J.] American Board Internal Med, Philadelphia, PA USA. RP Peikes, DN (reprint author), Math Policy Res Inc, POB 2393, Princeton, NJ 08543 USA. EM dpeikes@mathematica-mpr.com FU Centers for Medicare and Medicaid Services [HHSM-500-2010-00026I/HHSM-500-T0006] FX This study was funded by the Centers for Medicare and Medicaid Services, contract No. HHSM-500-2010-00026I/HHSM-500-T0006. NR 47 TC 23 Z9 23 U1 1 U2 14 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672 USA SN 1544-1709 EI 1544-1717 J9 ANN FAM MED JI Ann. Fam. Med. PD MAR-APR PY 2014 VL 12 IS 2 BP 142 EP 149 DI 10.1370/afm.1626 PG 8 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA AI3XV UT WOS:000336799900008 PM 24615310 ER PT J AU Calonge, N Klein, RD Berg, AO Berg, JS Armstrong, K Botkin, J Campos-Outcalt, D Djulbegovic, B Fisher, NL Ganiats, TG Haddow, JE Hayes, M Janssens, ACJW Kaye, C Lyman, DO Offit, K Pauker, SG Phillips, KA Piper, M Richards, CS Scott, JA Strickland, OL Teutsch, S Tunis, SR Veenstra, DL Williams, MS Zallen, DT AF Calonge, Ned Klein, Roger D. Berg, Alfred O. Berg, Jonathan S. Armstrong, Katrina Botkin, Jeffrey Campos-Outcalt, Doug Djulbegovic, Benjamin Fisher, Nancy L. Ganiats, Theodore G. Haddow, James E. Hayes, Maxine Janssens, A. Cecile J. W. Kaye, Celia Lyman, Donald O. Offit, Kenneth Pauker, Stephen G. Phillips, Kathryn A. Piper, Margaret Richards, Carolyn Sue Scott, Joan A. Strickland, Ora L. Teutsch, Steven Tunis, Sean R. Veenstra, David L. Williams, Marc S. Zallen, Doris T. CA EGAPP Working Grp TI The EGAPP initiative: lessons learned SO GENETICS IN MEDICINE LA English DT Review DE evidence-based medicine; genetics; guideline development; public health genomics; systematic review methods ID IMPROVE HEALTH OUTCOMES; WORKING-GROUP; RECOMMENDATIONS; CANCER; MORBIDITY; MORTALITY AB The Evaluation of Genomic Applications in Practice and Prevention Working Group was first convened in 2005 to develop and test evidence-based methods for the evaluation of genomic tests in transition from research to clinical and public health practice. Over the ensuing years, the Working Group has met 26 times, publishing eight recommendation statements, two methods papers, and one outcomes paper, as well as planning and serving as technical experts on numerous associated systematic reviews. Evaluation of Genomic Applications in Practice and Prevention methods have evolved to address implications of the proliferation of genome-wide association studies and are currently expanding to face challenges expected from clinical implementation of whole-genome sequencing tests. In this article, we review the work of the Evaluation of Genomic Applications in Practice and Prevention Working Group over the first 8 years of its existence with an emphasis on lessons learned throughout the process. It is hoped that in addition to the published methods of the Working Group, the lessons we have learned along the way will be informative to others who are producers and consumers of evidence-based guidelines in the field of genomic medicine. C1 [Calonge, Ned] Colorado Trust, Denver, CO 80202 USA. [Klein, Roger D.] Cleveland Clin Fdn, Cleveland, OH USA. [Berg, Alfred O.] Univ Washington, Dept Family Med, Seattle, WA 98195 USA. [Berg, Jonathan S.] Univ N Carolina, Sch Med, Dept Genet, Chapel Hill, NC USA. [Armstrong, Katrina] Univ Penn, Leonard Davis Inst Hlth Econ, Sch Med, Philadelphia, PA 19104 USA. [Botkin, Jeffrey] Univ Utah, Sch Med, Dept Pediat, Salt Lake City, UT 84112 USA. [Campos-Outcalt, Doug] Univ Arizona, Coll Med, Dept Family Community & Prevent Med, Phoenix, AZ USA. [Djulbegovic, Benjamin] Univ S Florida, Tampa, FL 33620 USA. [Djulbegovic, Benjamin] H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL USA. [Fisher, Nancy L.] Ctr Medicare & Medicaid Serv, Seattle Reg Off, Seattle, WA USA. [Ganiats, Theodore G.] Univ Calif San Diego, Sch Med, Dept Family & Prevent Med, La Jolla, CA 92093 USA. [Ganiats, Theodore G.] Univ Calif San Diego, Hlth Serv Res Ctr, La Jolla, CA 92093 USA. [Haddow, James E.] Brown Univ, Warren Alpert Med Sch, Dept Pathol & Lab Med, Providence, RI 02912 USA. [Hayes, Maxine] Washington State Dept Hlth, Tumwater, WA USA. [Janssens, A. Cecile J. W.] Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA. [Kaye, Celia] Univ Colorado, Sch Med, Boulder, CO 80309 USA. [Offit, Kenneth] Mem Sloan Kettering Canc Ctr, Clin Genet Serv, New York, NY USA. [Pauker, Stephen G.] Tufts Med Ctr, Dept Med, Div Clin Decis Making Informat & Telemed, Boston, MA USA. [Phillips, Kathryn A.] Univ Calif San Francisco, Sch Pharm, Inst Hlth Policy Studies, San Francisco, CA 94143 USA. [Phillips, Kathryn A.] Univ Calif San Francisco, UCSF Comprehens Canc Ctr, San Francisco, CA 94143 USA. [Piper, Margaret] Kaiser Permanente, Ctr Hlth Res, Oakland, CA USA. [Richards, Carolyn Sue] Oregon Hlth & Sci Univ, Dept Mol & Med Genet, Portland, OR 97201 USA. [Scott, Joan A.] Natl Coalit Hlth Profess Educ Genet, Washington, DC USA. [Strickland, Ora L.] Florida Int Univ, Coll Nursing & Hlth Sci, Miami, FL 33199 USA. [Teutsch, Steven] Los Angeles Cty Dept Publ Hlth, Los Angeles, CA USA. [Veenstra, David L.] Univ Washington, Pharmaceut Outcomes Res & Policy Program, Seattle, WA 98195 USA. [Veenstra, David L.] Univ Washington, Inst Publ Hlth Genet, Seattle, WA 98195 USA. [Williams, Marc S.] Geisinger Hlth Syst, Genom Med Inst, Danville, PA USA. [Zallen, Doris T.] Virginia Polytech Inst & State Univ, Dept Sci & Technol Soc, Blacksburg, VA 24061 USA. RP Calonge, N (reprint author), Colorado Trust, Denver, CO 80202 USA. EM egappinfo@egappreviews.org RI Djulbegovic, Benjamin/I-3661-2012 OI Janssens, A Cecile/0000-0002-6153-4976; Djulbegovic, Benjamin/0000-0003-0671-1447 FU National Institutes of Health [P50HG003374, RC2CA148570, UO1GM092676, UO1HG006507]; Centers for Disease Control and Prevention [U18GD000005]; Novartis FX D.L.V. reports that he was a consultant for Medco, Novartis Molecular Diagnostics, and Genentech and is supported by the following genomics-related research grants: P50HG003374, RC2CA148570, UO1GM092676, and UO1HG006507 from the National Institutes of Health and U18GD000005 from the Centers for Disease Control and Prevention. S.G.P. reports that one of his research studies was supported by a fund from Novartis to Tufts Medical Center. S.R.T. has no personal conflicts of interest to disclose. The Center for Medical Technology Policy receives funding from several sources, listed at http://www.cmtpnet.org/about/funding-sources/. The other authors declare no conflict of interest. NR 17 TC 10 Z9 10 U1 0 U2 6 PU NATURE PUBLISHING GROUP PI NEW YORK PA 75 VARICK ST, 9TH FLR, NEW YORK, NY 10013-1917 USA SN 1098-3600 EI 1530-0366 J9 GENET MED JI Genet. Med. PD MAR PY 2014 VL 16 IS 3 BP 217 EP 224 DI 10.1038/gim.2013.110 PG 8 WC Genetics & Heredity SC Genetics & Heredity GA AC3SP UT WOS:000332441800002 ER PT J AU Bonner, A Field, T Lemay, C Mazor, K Andersen, D Compher, C Tjia, J Gurwitz, J AF Bonner, A. Field, T. Lemay, C. Mazor, K. Andersen, D. Compher, C. Tjia, J. Gurwitz, J. TI Understanding the Reasons for Antipsychotic Use in Nursing Homes Residents with Dementia SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Meeting Abstract CT Annual Scientific Meeting of the American-Geriatrics-Society CY MAY 15-17, 2014 CL Orlando, FL SP Amer Geriatr Soc C1 [Bonner, A.] Northeastern Univ, Boston, MA 02115 USA. [Field, T.; Lemay, C.; Mazor, K.; Tjia, J.; Gurwitz, J.] Univ Massachusetts, Sch Med, Meyers Primary Care Inst, Worcester, MA USA. [Andersen, D.] Ctr Medicare, Div Nursing Homes, Baltimore, MD USA. [Andersen, D.] Ctr Medicaid, Baltimore, MD USA. [Compher, C.] Healthcare Management Solut LLC, Columbia, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 EI 1532-5415 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD MAR PY 2014 VL 62 SU 1 SI SI BP S126 EP S126 PG 1 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA AD6XT UT WOS:000333405500343 ER PT J AU Block, JP Choudhry, NK Carpenter, DP Fischer, MA Brennan, TA Tong, AY Matlin, OS Shrank, WH AF Block, Jason P. Choudhry, Niteesh K. Carpenter, Daniel P. Fischer, Michael A. Brennan, Troyen A. Tong, Angela Y. Matlin, Olga S. Shrank, William H. TI Time Series Analyses of the Effect of FDA Communications on use of Prescription Weight Loss Medications SO OBESITY LA English DT Article ID CONTROLLED-RELEASE; OBESITY; WARNINGS; OVERWEIGHT; TRIAL; SIBUTRAMINE; IMPACT AB Objective: To determine the impact of FDA safety communications regarding the weight loss medications sibutramine and orlistat. Methods: The 2008 to 2011 pharmacy claims data from CVS Caremark were used to determine the effect of the relevant FDA warnings on (1) use of sibutramine and orlistat, (2) their rates of discontinuation, and (3) substitution to an alternate weight loss medication in the 3-month period following discontinuation. Results: The use of sibutramine, orlistat, or phentermine declined from 45 users per 100,000 Caremark enrollees in May 2008 to 24 users per 100,000 enrollees in December 2010. In the time series analyses of overall use of medications, a very small decline in the trend of use of sibutramine after the FDA communication (0.000002% per month decline after the communication; P< 0.001) was found. However, rates of discontinuation of sibutramine and orlistat were similar before and after relevant FDA communications (all P values > 0.1 for both level and trend changes post-warning). Patients discontinuing sibutramine post-communication increased use of phentermine at a rate of 0.004% per month after discontinuation (P=0.01). Conclusion: From 2008 to 2010, use of prescription weight loss medications was low and declined over time. FDA communications regarding the safety of these medications had limited effect on use. C1 [Block, Jason P.] Harvard Univ, Sch Med, Dept Populat Med, Boston, MA 02130 USA. [Block, Jason P.] Harvard Pilgrim Hlth Care Inst, Boston, MA USA. [Choudhry, Niteesh K.; Fischer, Michael A.; Tong, Angela Y.; Shrank, William H.] Brigham & Womens Hosp, Dept Med, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02115 USA. [Choudhry, Niteesh K.; Fischer, Michael A.; Tong, Angela Y.; Shrank, William H.] Harvard Univ, Sch Med, Boston, MA USA. [Carpenter, Daniel P.] Harvard Univ, Dept Govt, Cambridge, MA 02138 USA. [Brennan, Troyen A.; Matlin, Olga S.] CVS Caremark, Northbrook, IL USA. [Shrank, William H.] US Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. RP Block, JP (reprint author), Harvard Univ, Sch Med, Dept Populat Med, Boston, MA 02130 USA. EM Jason_block@harvardpilgrim.org FU CVS Caremark FX Several of the authors for this study received funding from CVS Caremark for their work on this study. CVS Caremark directly provided the data, which was analyzed independently by the research team at Brigham and Women's Hospital. While two of the co-authors on this study are employed by CVS Caremark, CVS Caremark had no other role in the analysis, interpretation of data, or final approval of the manuscript. NR 28 TC 6 Z9 6 U1 1 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1930-7381 EI 1930-739X J9 OBESITY JI Obesity PD MAR PY 2014 VL 22 IS 3 BP 943 EP 949 DI 10.1002/oby.20596 PG 7 WC Endocrinology & Metabolism; Nutrition & Dietetics SC Endocrinology & Metabolism; Nutrition & Dietetics GA AC0ZU UT WOS:000332224800046 PM 23929685 ER PT J AU Edwards, ST Schermerhorn, ML O'Malley, AJ Bensley, RP Hurks, R Cotterill, P Landon, BE AF Edwards, Samuel T. Schermerhorn, Marc L. O'Malley, A. James Bensley, Rodney P. Hurks, Rob Cotterill, Philip Landon, Bruce E. TI Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population SO JOURNAL OF VASCULAR SURGERY LA English DT Article ID RANDOMIZED-CONTROLLED-TRIAL; OPERATIVE MORTALITY; OUTCOMES; EXPERIENCE; MANAGEMENT; PROTOCOL; MODELS AB Objective: Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries. Methods: We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders. Results: Of 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P < .001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P < .001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P < .001; all surgical complications, 4.4% vs 9.1%; P < .001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%. Conclusions: EVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade. C1 [Edwards, Samuel T.; Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA. [Schermerhorn, Marc L.; Bensley, Rodney P.; Hurks, Rob] Beth Israel Deaconess Med Ctr, Dept Surg, Boston, MA 02215 USA. [O'Malley, A. James; Landon, Bruce E.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Hurks, Rob] Univ Med Ctr Utrecht, Dept Vasc Surg, Utrecht, Netherlands. [Cotterill, Philip] Ctr Medicare Serv, Baltimore, MD USA. [Cotterill, Philip] Ctr Medicaid Serv, Baltimore, MD USA. RP Landon, BE (reprint author), Harvard Univ, Sch Med, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA. EM landon@hcp.med.harvard.edu FU National Institutes of Health (NIH) [5R01-HL-105453-02, 1RC4-MH-092717-01]; NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant [HL-007734] FX M.S., A.O., and B. L. were supported by National Institutes of Health (NIH) grants 5R01-HL-105453-02 and 1RC4-MH-092717-01 for comparative effectiveness research. R. B. was supported by the NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant HL-007734. NR 40 TC 30 Z9 30 U1 0 U2 5 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD MAR PY 2014 VL 59 IS 3 BP 575 EP + DI 10.1016/j.jvs.2013.08.093 PG 14 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA AB8AL UT WOS:000332012400002 PM 24342064 ER PT J AU Rajkumar, R Patel, A Murphy, K Colmers, JM Blum, JD Conway, PH Sharfstein, JM AF Rajkumar, Rahul Patel, Ankit Murphy, Karen Colmers, John M. Blum, Jonathan D. Conway, Patrick H. Sharfstein, Joshua M. TI Maryland's All-Payer Approach to Delivery-System Reform SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material AB Maryland, with its all-payer rate-setting system for hospital services, and the Centers for Medicare and Medicaid Services are launching a new model that will transform the state's delivery system and may guide other federal-state partnerships in improving health care. On January 10, 2014, the Centers for Medicare and Medicaid Services (CMS) and the State of Maryland jointly announced the launch of a statewide model that will transform Maryland's health care delivery system. Although some aspects of the new approach may be unique to Maryland and not applicable elsewhere, both the principles of this model and the process that led to its development may serve as a guide for future federal-state partnership efforts aiming to improve health care and to lower costs through an all-payer approach. Since the late 1970s, Maryland has operated what is now the country's only all-payer ... C1 [Rajkumar, Rahul; Patel, Ankit; Murphy, Karen; Colmers, John M.; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Colmers, John M.] Maryland Hlth Serv Cost Review Commiss, Baltimore, MD USA. [Colmers, John M.] Johns Hopkins Med, Baltimore, MD USA. [Sharfstein, Joshua M.] Maryland Dept Hlth & Mental Hyg, Baltimore, MD USA. [Rajkumar, Rahul] Brigham & Womens Hosp, Boston, MA 02115 USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA. RP Rajkumar, R (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. NR 2 TC 18 Z9 18 U1 0 U2 1 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD FEB 6 PY 2014 VL 370 IS 6 BP 493 EP 495 DI 10.1056/NEJMp1314868 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA AA4NT UT WOS:000331073500003 PM 24410022 ER PT J AU Menis, M Anderson, SA Forshee, RA McKean, S Johnson, C Holness, L Warnock, R Gondalia, R Worrall, CM Kelman, JA Ball, R Izurieta, HS AF Menis, M. Anderson, S. A. Forshee, R. A. McKean, S. Johnson, C. Holness, L. Warnock, R. Gondalia, R. Worrall, C. M. Kelman, J. A. Ball, R. Izurieta, H. S. TI Transfusion-associated circulatory overload (TACO) and potential risk factors among the inpatient US elderly as recorded in Medicare administrative databases during 2011 SO VOX SANGUINIS LA English DT Article DE Transfusion-Associated Circulatory Overload; risk factors; inpatient elderly; Medicare administrative databases ID ACUTE LUNG INJURY; PULMONARY-EDEMA AB Background and Objectives Transfusion-associated circulatory overload (TACO) is a serious transfusion complication resulting in respiratory distress. The study's objective was to assess TACO occurrence and potential risk factors among elderly Medicare beneficiaries (ages 65 and older) in the inpatient setting during 2011. Materials and Methods This retrospective claims-based study utilized Medicare administrative databases in coordination with Centers for Medicare & Medicaid Services. Transfusions were identified by recorded procedure and revenue centre codes, while TACO was ascertained via ICD-9-CM diagnosis code. We evaluated TACO diagnosis code rates overall and by age, gender, race, number of units and blood components transfused. Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Among 2147038 inpatient transfusion stays for elderly in 2011, 1340 had TACO diagnosis code, overall rate of 624 per 100000 stays. TACO rates increased significantly with age and units transfused (P<00001). After adjustment for confounding, significantly higher odds of TACO were found for women vs. men (OR=140, 95% CI 126-160), White people vs. non-White people (OR=138, 95% CI 120-162) and persons with congestive heart failure (OR=161, 95% CI 144-188), chronic pulmonary disease (OR=119, 95% CI 108-132) and different anaemias. Conclusion Our study identified largest number of potential TACO cases to date and showed a substantial increase in TACO occurrence with age and number of units transfused. The study suggested increased TACO risk in elderly with congestive heart failure, chronic pulmonary disease and anaemias. Overall, study shows importance of large administrative databases as an additional epidemiological tool. C1 [Menis, M.; Anderson, S. A.; Forshee, R. A.; Holness, L.; Ball, R.; Izurieta, H. S.] US FDA, Rockville, MD 20852 USA. [McKean, S.; Johnson, C.; Warnock, R.; Gondalia, R.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Menis, M (reprint author), US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, 1401 Rockville Pike,HFM 225, Rockville, MD 20852 USA. EM mikhail.menis@fda.hhs.gov FU US Food and Drug Administration, Center for Biologics Evaluation and Research FX This study was funded by the US Food and Drug Administration, Center for Biologics Evaluation and Research. We thank Garner Kropp and Emily Wang for their contribution during the initial stages of study analyses. All authors made substantial contributions to research design, or the acquisition, analysis or interpretation of data and were involved in drafting of the paper or revising it critically. The manuscript has been approved by all authors. NR 27 TC 13 Z9 13 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0042-9007 EI 1423-0410 J9 VOX SANG JI Vox Sang. PD FEB PY 2014 VL 106 IS 2 BP 144 EP 152 DI 10.1111/vox.12070 PG 9 WC Hematology SC Hematology GA AA4SL UT WOS:000331086300007 PM 23848234 ER PT J AU Hansen, LO Tinney, B Asomugha, CN Barron, JL Rao, M Curry, LA Lucas, G Rosenthal, MS AF Hansen, Luke O. Tinney, Barbara Asomugha, Chisara N. Barron, Jill L. Rao, Mitesh Curry, Leslie A. Lucas, Georgina Rosenthal, Marjorie S. TI "You Get Caught Up'': Youth Decision-Making and Violence SO JOURNAL OF PRIMARY PREVENTION LA English DT Article DE Youth violence; Adolescent development; Qualitative research; Focus groups ID INNER-CITY; QUALITATIVE RESEARCH; SELF-EFFICACY; RISK-FACTORS; HEALTH-CARE; ADOLESCENTS; BEHAVIOR; STREET; CODE; PERSPECTIVES AB Violence is a major cause of morbidity and mortality among adolescents. We conducted serial focus groups with 30 youth from a violence prevention program to discuss violence in their community. We identified four recurrent themes characterizing participant experiences regarding peer decision-making related to violence: (1) youth pursue respect, among other typical tasks of adolescence; (2) youth pursue respect as a means to achieve personal safety; (3) youth recognize pervasive risks to their safety, frequently focusing on the prevalence of firearms; and (4) as youth balance achieving respect in an unsafe setting with limited opportunities, they express conflict and frustration. Participants recognize that peers achieve peer-group respect through involvement in unsafe or unhealthy behavior including violence; however they perceive limited alternative opportunities to gain respect. These findings suggest that even very high risk youth may elect safe and healthy alternatives to violence if these opportunities are associated with respect and other adolescent tasks of development. C1 [Hansen, Luke O.] Northwestern Univ, Feinberg Sch Med, Div Hosp Med, Chicago, IL 60611 USA. [Tinney, Barbara] New Haven Family Alliance, New Haven, CT USA. [Asomugha, Chisara N.] Ctr Medicare Serv, Dept Hlth & Human Serv, Baltimore, MD USA. [Asomugha, Chisara N.] Ctr Medicaid Serv, Dept Hlth & Human Serv, Baltimore, MD USA. [Barron, Jill L.; Curry, Leslie A.; Lucas, Georgina] Yale Univ, Sch Med, New Haven, CT USA. [Rao, Mitesh] Northwestern Univ, Chicago, IL 60611 USA. [Curry, Leslie A.; Lucas, Georgina; Rosenthal, Marjorie S.] Robert Wood Johnson Fdn, Clin Scholars Program, New Haven, CT USA. [Rosenthal, Marjorie S.] Yale Univ, Sch Med, Dept Pediat, New Haven, CT 06510 USA. RP Hansen, LO (reprint author), Northwestern Univ, Feinberg Sch Med, Div Hosp Med, 211 East Ontario St,7th Floor, Chicago, IL 60611 USA. EM l-hansen@northwestern.edu NR 64 TC 0 Z9 0 U1 4 U2 10 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0278-095X EI 1573-6547 J9 J PRIM PREV JI J. Prim. Prev. PD FEB PY 2014 VL 35 IS 1 BP 21 EP 31 DI 10.1007/s10935-013-0328-x PG 11 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 297CK UT WOS:000330232700003 PM 24141641 ER PT J AU Calderwood, MS Kleinman, K Soumerai, SB Jin, R Gay, C Platt, R Kassler, W Goldmann, DA Jha, AK Lee, GM AF Calderwood, Michael S. Kleinman, Ken Soumerai, Stephen B. Jin, Robert Gay, Charlene Platt, Richard Kassler, William Goldmann, Donald A. Jha, Ashish K. Lee, Grace M. TI Impact of Medicare's Payment Policy on Mediastinitis Following Coronary Artery Bypass Graft Surgery in US Hospitals SO INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY LA English DT Article ID SURGICAL-SITE INFECTION; URINARY-TRACT-INFECTION; PAY-FOR-PERFORMANCE; HIP-ARTHROPLASTY; RISK INDEX; CARE; SURVEILLANCE; NONPAYMENT; QUALITY; MORTALITY AB Background.The Centers for Medicare and Medicaid Services (CMS) implemented a policy in October 2008 to eliminate additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) surgery.Objective.To evaluate the impact of this policy on mediastinitis rates, using Medicare claims and National Healthcare Safety Network (NHSN) prospective surveillance data.Methods.We used an interrupted time series design to compare mediastinitis rates before and after the policy, adjusted for secular trends. Billing rates came from Medicare inpatient claims following 638,761 CABG procedures in 1,234 US hospitals (January 2006--September 2010). Prospective surveillance rates came from 151 NHSN hospitals in 29 states performing 94,739 CABG procedures (January 2007--September 2010). Logistic regression mixed-effects models estimated trends for mediastinitis rates.Results.We found a sudden drop in coding for index admission mediastinitis at the time of policy implementation (odds ratio, 0.36 [95% confidence interval (CI), 0.23--0.57]) and a decreasing trend in coding for index admission mediastinitis in the postintervention period compared with the preintervention period (ratio of slopes, 0.83 [95% CI, 0.74--0.95]). However, we saw no impact of the policy on infection rates as measured using NHSN data. Our results were not affected by changes in patient risk over time, heterogeneity in hospital demographics, or timing of hospital participation in NHSN.Conclusions.The CMS policy of withholding additional Medicare payment for mediastinitis on the basis of claims-based evidence of infection was associated with changes in coding for infections but not with changes in actual infection rates during the first 2 years after policy implementation. C1 [Calderwood, Michael S.] Brigham & Womens Hosp, Div Infect Dis, Boston, MA 02115 USA. [Calderwood, Michael S.; Kleinman, Ken; Soumerai, Stephen B.; Jin, Robert; Gay, Charlene; Platt, Richard; Lee, Grace M.] Harvard Pilgrim Hlth Care Inst, Dept Populat Med, Boston, MA USA. [Calderwood, Michael S.; Kleinman, Ken; Soumerai, Stephen B.; Jin, Robert; Gay, Charlene; Platt, Richard; Lee, Grace M.] Harvard Univ, Sch Med, Boston, MA USA. [Kassler, William] Ctr Medicare & Medicaid Serv, Boston, MA USA. [Goldmann, Donald A.] Inst Healthcare Improvement, Cambridge, MA USA. [Jha, Ashish K.] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA. [Lee, Grace M.] Boston Childrens Hosp, Div Infect Dis, Boston, MA USA. [Lee, Grace M.] Boston Childrens Hosp, Dept Lab Med, Boston, MA USA. RP Calderwood, MS (reprint author), Brigham & Womens Hosp, Div Infect Dis, 181 Longwood Ave,MCP Bldg,5th Floor, Boston, MA 02115 USA. EM mcalderwood@partners.org FU Agency for Healthcare Research and Quality [5R01HS018414] FX Financial support. G.M.L. received grant support from the Agency for Healthcare Research and Quality (5R01HS018414). NR 47 TC 6 Z9 7 U1 0 U2 3 PU UNIV CHICAGO PRESS PI CHICAGO PA 1427 E 60TH ST, CHICAGO, IL 60637-2954 USA SN 0899-823X EI 1559-6834 J9 INFECT CONT HOSP EP JI Infect. Control Hosp. Epidemiol. PD FEB 1 PY 2014 VL 35 IS 2 BP 144 EP 151 DI 10.1086/674861 PG 8 WC Public, Environmental & Occupational Health; Infectious Diseases SC Public, Environmental & Occupational Health; Infectious Diseases GA 292AC UT WOS:000329873000006 PM 24442076 ER PT J AU Wang, Y Eldridge, N Metersky, ML Verzier, NR Meehan, TP Pandolfi, MM Foody, JM Ho, SY Galusha, D Kliman, RE Sonnenfeld, N Krumholz, HM Battles, J AF Wang, Yun Eldridge, Noel Metersky, Mark L. Verzier, Nancy R. Meehan, Thomas P. Pandolfi, Michelle M. Foody, JoAnne M. Ho, Shih-Yieh Galusha, Deron Kliman, Rebecca E. Sonnenfeld, Nancy Krumholz, Harlan M. Battles, James TI National Trends in Patient Safety for Four Common Conditions, 2005-2011 SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; MEDICARE BENEFICIARIES; MONITORING-SYSTEM; AMERICAN-COLLEGE; MORTALITY-RATES; HEALTH-CARE; OUTCOMES; QUALITY; ERRORS; INTERVENTION AB BackgroundChanges in adverse-event rates among Medicare patients with common medical conditions and conditions requiring surgery remain largely unknown. MethodsWe used Medicare Patient Safety Monitoring System data abstracted from medical records on 21 adverse events in patients hospitalized in the United States between 2005 and 2011 for acute myocardial infarction, congestive heart failure, pneumonia, or conditions requiring surgery. We estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations. ResultsThe study included 61,523 patients hospitalized for acute myocardial infarction (19%), congestive heart failure (25%), pneumonia (30%), and conditions requiring surgery (27%). From 2005 through 2011, among patients with acute myocardial infarction, the rate of occurrence of adverse events declined from 5.0% to 3.7% (difference, 1.3 percentage points; 95% confidence interval [CI], 0.7 to 1.9), the proportion of patients with one or more adverse events declined from 26.0% to 19.4% (difference, 6.6 percentage points; 95% CI, 3.3 to 10.2), and the number of adverse events per 1000 hospitalizations declined from 401.9 to 262.2 (difference, 139.7; 95% CI, 90.6 to 189.0). Among patients with congestive heart failure, the rate of occurrence of adverse events declined from 3.7% to 2.7% (difference, 1.0 percentage points; 95% CI, 0.5 to 1.4), the proportion of patients with one or more adverse events declined from 17.5% to 14.2% (difference, 3.3 percentage points; 95% CI, 1.0 to 5.5), and the number of adverse events per 1000 hospitalizations declined from 235.2 to 166.9 (difference, 68.3; 95% CI, 39.9 to 96.7). Patients with pneumonia and those with conditions requiring surgery had no significant declines in adverse-event rates. ConclusionsFrom 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery. C1 [Metersky, Mark L.] Univ Connecticut, Sch Med, Div Pulm & Crit Care Med, Farmington, CT USA. [Wang, Yun; Krumholz, Harlan M.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Krumholz, Harlan M.] Yale Univ, Sch Publ Hlth, Dept Hlth Policy & Management, New Haven, CT USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06510 USA. [Meehan, Thomas P.; Galusha, Deron; Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Gen Internal Med Sect, New Haven, CT 06510 USA. [Wang, Yun] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. [Foody, JoAnne M.] Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA. [Foody, JoAnne M.] Harvard Univ, Sch Med, Boston, MA USA. [Eldridge, Noel; Battles, James] Agcy Healthcare Res & Qual, Dept Hlth & Human Serv, Rockville, MD 20850 USA. [Kliman, Rebecca E.; Sonnenfeld, Nancy] Ctr Medicare Serv, Dept Hlth & Human Serv, Baltimore, MD USA. [Kliman, Rebecca E.; Sonnenfeld, Nancy] Ctr Medicaid Serv, Dept Hlth & Human Serv, Baltimore, MD USA. RP Wang, Y (reprint author), Harvard Univ, Sch Publ Hlth, Dept Biostat, SPH2,Rm 437F,655 Huntington Ave, Boston, MA 02115 USA. EM yunwang@hsph.harvard.edu; noel.eldridge@ahrq.hhs.gov FU Agency for Healthcare Research and Quality FX Funded by the Agency for Healthcare Research and Quality and others. NR 39 TC 57 Z9 58 U1 1 U2 8 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JAN 23 PY 2014 VL 370 IS 4 BP 341 EP 351 DI 10.1056/NEJMsa1300991 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 294HP UT WOS:000330036200009 PM 24450892 ER PT S AU Bali, RK Bos, L Gibbons, MC Ibell, SR AF Bali, Rajeev K. Bos, Lodewijk Gibbons, Michael Christopher Ibell, Simon R. BE Bali, RK Bos, L Gibbons, MC Ibell, SR TI Rare Diseases in the Age of Health 2.0 Preface SO RARE DISEASES IN THE AGE OF HEALTH 2.0 SE Communications in Medical and Care Compunetics LA English DT Editorial Material; Book Chapter C1 [Bali, Rajeev K.] Coventry Univ, Coventry, W Midlands, England. [Gibbons, Michael Christopher] Johns Hopkins Urban Hlth Inst, Baltimore, MD USA. [Gibbons, Michael Christopher] Johns Hopkins Sch Med, Baltimore, MD USA. [Gibbons, Michael Christopher] Johns Hopkins Sch Publ Hlth, Baltimore, MD USA. [Gibbons, Michael Christopher] Urban Hlth Inst, New York, NY USA. [Gibbons, Michael Christopher] Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. RP Bali, RK (reprint author), Coventry Univ, Coventry, W Midlands, England. NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER-VERLAG BERLIN PI BERLIN PA HEIDELBERGER PLATZ 3, D-14197 BERLIN, GERMANY SN 2191-3811 BN 978-3-642-38643-5; 978-3-642-38642-8 J9 COMMUN MED CARE COMP PY 2014 VL 4 BP XI EP XII D2 10.1007/978-3-642-38643-5 PG 2 WC Engineering, Biomedical; Medical Informatics SC Engineering; Medical Informatics GA BA1ZV UT WOS:000333205300002 ER PT S AU Bali, RK Bos, L Gibbons, MC Ibell, SR AF Bali, Rajeev K. Bos, Lodewijk Gibbons, M. Chris Ibell, Simon R. BE Bali, RK Bos, L Gibbons, MC Ibell, SR TI Rare Diseases in the Age of Health 2.0 Epilogue SO RARE DISEASES IN THE AGE OF HEALTH 2.0 SE Communications in Medical and Care Compunetics LA English DT Editorial Material; Book Chapter C1 [Bali, Rajeev K.] Coventry Univ, Coventry, W Midlands, England. [Bali, Rajeev K.] Biomed Comp & Engn Technol BIOCORE Appl Res Grp, Knowledge Management Healthcare KARMAH Res Subgrp, Coventry, W Midlands, England. [Gibbons, M. Chris] Johns Hopkins Urban Hlth Inst, Baltimore, MD USA. [Gibbons, M. Chris] Johns Hopkins Sch Med, Baltimore, MD USA. [Gibbons, M. Chris] Johns Hopkins Sch Publ Hlth, Baltimore, MD USA. [Gibbons, M. Chris] Urban Hlth Inst, Baltimore, MD USA. [Gibbons, M. Chris] Ctr Medicare & Medicaid Serv CMS, Woodlawn, IL USA. RP Bali, RK (reprint author), Coventry Univ, Coventry, W Midlands, England. EM r.bali@ieee.org; lobos@icmcc.org; mgibbons@jhsph.edu; simon@ibellieve.com NR 0 TC 0 Z9 0 U1 0 U2 0 PU SPRINGER-VERLAG BERLIN PI BERLIN PA HEIDELBERGER PLATZ 3, D-14197 BERLIN, GERMANY SN 2191-3811 BN 978-3-642-38643-5; 978-3-642-38642-8 J9 COMMUN MED CARE COMP PY 2014 VL 4 BP 291 EP 292 DI 10.1007/978-3-642-38643-5 D2 10.1007/978-3-642-38643-5 PG 2 WC Engineering, Biomedical; Medical Informatics SC Engineering; Medical Informatics GA BA1ZV UT WOS:000333205300032 ER PT J AU Martin, AB Hartman, M Whittle, L Catlin, A AF Martin, Anne B. Hartman, Micah Whittle, Lekha Catlin, Aaron CA Natl Hlth Expenditure Accounts Tea TI National Health Spending In 2012: Rate Of Health Spending Growth Remained Low For The Fourth Consecutive Year SO HEALTH AFFAIRS LA English DT Article AB For the fourth consecutive year, growth in health care spending remained low, increasing by 3.7 percent in 2012 to $2.8 trillion. At the same time, the share of the economy devoted to health fell slightly (from 17.3 percent to 17.2 percent) as the nominal gross domestic product (GDP) grew by 4.6 percent. Faster growth in hospital services and in physician and clinical services was mitigated by slower growth in prices for prescription drugs and nursing home services. Despite an uptick in enrollment growth, Medicare spending growth slowed slightly in 2012, mainly due to lower payment updates. For Medicaid, slowing enrollment growth kept spending growth near historic lows. Growth in private health insurance spending also remained near historically low rates in 2012, largely influenced by the nation's modest economic recovery and its impact on enrollment. C1 [Martin, Anne B.] Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD USA. RP Martin, AB (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD USA. EM anne.martin@cms.hhs.gov NR 18 TC 39 Z9 39 U1 1 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 JAN PY 2014 VL 33 IS 1 BP 67 EP 77 DI 10.1377/hlthaff.2013.1254 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 297XV UT WOS:000330289300010 PM 24395937 ER PT J AU Riley, GF Zhao, LR Tilahun, N AF Riley, Gerald F. Zhao, Lirong Tilahun, Negussie TI Understanding Factors Associated With Loss Of Medicaid Coverage Among Dual Eligibles Can Help Identify Vulnerable Enrollees SO HEALTH AFFAIRS LA English DT Article ID CARE AB For people who receive both Medicare and Medicaid benefits (dual-eligible beneficiaries), the loss of Medicaid coverage may lead to problems with care coordination, higher out-of-pocket expenses, or reduced access to services. Using administrative data, we followed 292,242 full-benefit and 91,020 partial-benefit dual eligibles from January 2009 through December 2011. Among those with full Medicaid benefits, 15.6 percent lost Medicaid coverage at least once, with more frequent losses among younger beneficiaries. Many of these losses lasted only one to three months and were followed by reinstatement. Loss of Medicaid coverage was more common (23.2 percent) among enrollees with partial Medicaid benefits. Medicare Current Beneficiary Survey data indicate that most dual eligibles who lost Medicaid coverage had no other source of supplemental insurance. Medicaid coverage is relatively stable among dual eligibles. However, some lose Medicaid for several months or more, putting them at risk for poor outcomes and potentially complicating their care, especially when it needs to be integrated under the two programs. C1 [Riley, Gerald F.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. [Zhao, Lirong; Tilahun, Negussie] Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. RP Riley, GF (reprint author), Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD USA. EM gerald.riley@cms.hhs.gov NR 19 TC 1 Z9 1 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 PY 2014 VL 33 IS 1 BP 147 EP 152 DI 10.1377/hlthaff.2013.0396 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 297XV UT WOS:000330289300020 PM 24395947 ER PT J AU Du, DY Wagoner, A Barone, SB Zinderman, CE Kelman, JA MaCurdy, TE Forshee, RA Worrall, CM Izurieta, HS AF Du, Dongyi (Tony) Wagoner, Austin Barone, Samuel B. Zinderman, Craig E. Kelman, Jeffrey A. MaCurdy, Thomas E. Forshee, Richard A. Worrall, Chris M. Izurieta, Hector S. TI Incidence of Endophthalmitis after Corneal Transplant or Cataract Surgery in a Medicare Population SO OPHTHALMOLOGY LA English DT Article ID ONSET POSTOPERATIVE ENDOPHTHALMITIS; VISUAL-ACUITY OUTCOMES; PENETRATING KERATOPLASTY; FUNGAL ENDOPHTHALMITIS; NATIONAL OUTCOMES; RETINAL-DETACHMENT; EXTRACTION; KERATITIS; BACTERIAL AB Objective: To estimate the incidence of infectious endophthalmitis after corneal transplant or cataract surgery, to evaluate the trend of endophthalmitis during the study period, and to assess demographic risk factors for endophthalmitis after surgeries. Design: A retrospective population-based cohort study. Participants and Controls: Study cohorts were derived from the Medicare claims databases, 2006 to 2011. Patients were continuously enrolled in Medicare Part A, Part B, and Part D. Patients undergoing corneal transplant or cataract surgery were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes. Methods: Endophthalmitis was defined in 3 different ways: (1) using ICD-9-CM codes (sensitive definition), (2) combining ICD-9-CM codes with Current Procedural Terminology, Fourth Edition (CPT-4) codes (specific definition), or (3) combining ICD-9-CM codes with antifungal prescriptions for endophthalmitis caused by fungal infection. Demographic risk factors for endophthalmitis were examined using multivariate Cox models. Main Outcome Measures: Incidence rates of endophthalmitis were calculated and compared for each definition of endophthalmitis at 6-week and 6-month intervals after corneal transplant or cataract surgery. Results: The infectious endophthalmitis incidence rates ranged from 0.11% to 1.05% in the corneal transplant cohort, 0.06% to 0.20% in the cataract surgery cohort, and 0.16% to 0.68% in the concurrent surgery cohort, depending on the definition and time interval after surgery. Compared with the cataract surgery cohort, the corneal transplant cohort had a higher adjusted hazard ratio (HR) of endophthalmitis within the 6-week postoperative interval (HR, 2.744; 95% confidence interval [CI], 1.544-4.880 in the sensitive definition and HR, 2.792; 95% CI, 1.146-6.802 in the specific definition) and within the 6-month postoperative interval (HR, 4.607; 95% CI, 3.144-6.752 for the sensitive definition and HR, 4.385; 95% CI, 2.245-8.566 for the specific definition). Conclusions: It is possible to monitor the trend of infectious endophthalmitis after corneal transplant or cataract surgery through examining Medicare claims databases as long as a consistent definition of endophthalmitis is used. The annual incidence of endophthalmitis was stable over time during the study period for both corneal transplant and cataract surgery procedures; however, there was a wider year-to-year variation for the corneal transplant cohort. (C) 2014 by the American Academy of Ophthalmology. C1 [Du, Dongyi (Tony); Zinderman, Craig E.; Forshee, Richard A.; Izurieta, Hector S.] US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, Rockville, MD 20852 USA. [Wagoner, Austin] Acumen LLC, Berkeley, CA USA. [Barone, Samuel B.] US FDA, Off Cellular Tissue & Gene Therapies, Ctr Biol Evaluat & Res, Rockville, MD 20852 USA. [Kelman, Jeffrey A.; Worrall, Chris M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [MaCurdy, Thomas E.] Stanford Univ, Dept Econ, Stanford, CA 94305 USA. RP Du, DY (reprint author), US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, WOC1 RM343N HFM 222,1401 Rockville Pike, Rockville, MD 20852 USA. EM dongyi.du@fda.hhs.gov NR 25 TC 16 Z9 16 U1 0 U2 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0161-6420 EI 1549-4713 J9 OPHTHALMOLOGY JI Ophthalmology PD JAN PY 2014 VL 121 IS 1 BP 290 EP 298 DI 10.1016/j.ophtha.2013.07.016 PG 9 WC Ophthalmology SC Ophthalmology GA 282KG UT WOS:000329169500047 PM 23993357 ER PT J AU Chisholm, L Weech-Maldonado, R Laberge, A Lin, FC Hyer, K AF Chisholm, Latarsha Weech-Maldonado, Robert Laberge, Alex Lin, Feng-Chang Hyer, Kathryn TI Nursing Home Quality and Financial Performance: Does the Racial Composition of Residents Matter? SO HEALTH SERVICES RESEARCH LA English DT Article DE Nursing homes; racial composition; quality; financial performance; blacks ID LONG-TERM-CARE; OF-CARE; UNITED-STATES; DISPARITIES; EQUITY; DEMOGRAPHICS; FACILITIES; OWNERSHIP; PAYMENT; DRIVEN AB ObjectiveTo examine the effects of the racial composition of residents on nursing homes' financial and quality performance. The study examined Medicare and Medicaid-certified nursing homes across the United States that submitted Medicare cost reports between the years 1999 and 2004 (11,472 average per year). Data SourceData were obtained from the Minimum Data Set, the On-Line Survey Certification and Reporting, Medicare Cost Reports, and the Area Resource File. Study DesignPanel data regression with random intercepts and negative binomial regression were conducted with state and year fixed effects. Principal FindingsFinancial and quality performance differed between nursing homes with high proportions of black residents and nursing homes with no or medium proportions of black residents. Nursing homes with no black residents had higher revenues and higher operating margins and total profit margins and they exhibited better processes and outcomes than nursing homes with high proportions of black residents. ConclusionNursing homes' financial viability and quality of care are influenced by the racial composition of residents. Policy makers should consider initiatives to improve both the financial and quality performance of nursing homes serving predominantly black residents. C1 [Chisholm, Latarsha] Univ Cent Florida, Dept Hlth Management & Informat, Orlando, FL 32816 USA. [Weech-Maldonado, Robert] Univ Alabama Birmingham, Dept Hlth Serv Adm, Birmingham, AL USA. [Laberge, Alex] Ctr Medicare & Medicaid Serv, Div Hlth Promot & Dis, Woodlawn, MD USA. [Lin, Feng-Chang] Univ N Carolina, Dept Biostat, Chapel Hill, NC USA. [Hyer, Kathryn] Univ S Florida, Florida Policy Exchange Ctr Aging, Sch Aging Studies, Tampa, FL USA. RP Chisholm, L (reprint author), Univ Cent Florida, Dept Hlth Management & Informat, 12805 Pegasus Dr, Orlando, FL 32816 USA. EM Latarsha.Chisholm@ucf.edu FU Agency for Health Care Research and Quality; Cecil G. Sheps Center for Health Service Research University of North Carolina at Chapel Hill [5T32HS000032]; UAB Center of Excellence Comparative Effectiveness for Eliminating Disparities (CERED); NIH/NCMHD [3P60MD000502-08S1]; Deep South Resource Center on Minority Aging National Institute on Aging [P30AG031054] FX Latarsha Chisholm was partially supported by a National Service Research Award pre-Doctoral traineeship from the Agency for Health Care Research and Quality sponsored by the Cecil G. Sheps Center for Health Service Research University of North Carolina at Chapel Hill, grant no. 5T32HS000032. Robert Weech-Maldonado was funded in part by the UAB Center of Excellence Comparative Effectiveness for Eliminating Disparities (CERED), NIH/NCMHD Grant 3P60MD000502-08S1, and the Deep South Resource Center on Minority Aging National Institute on Aging Grant P30AG031054. NR 36 TC 6 Z9 6 U1 4 U2 7 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 2013 VL 48 IS 6 BP 2060 EP 2080 DI 10.1111/1475-6773.12079 PN 1 PG 21 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 257NT UT WOS:000327392300015 PM 23800123 ER PT J AU Brennan, N AF Brennan, Niall TI Sharing of Medicare Claims Data SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 [Brennan, Niall] Ctr Medicare & Medicaid Serv, Off Informat Prod & Data Analyt, Washington, DC 20201 USA. RP Brennan, N (reprint author), Ctr Medicare & Medicaid Serv, 200 Independence Ave SW, Washington, DC 20201 USA. EM niall.brennan@cms.hhs.gov NR 1 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD NOV 27 PY 2013 VL 310 IS 20 BP 2202 EP 2203 DI 10.1001/jama.2013.278353 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 257RS UT WOS:000327404400037 PM 24281470 ER PT J AU Lemay, CA Bonner, A Compher, CJ Field, T Freedlander, J Joslin, S Tjia, J Gurwitz, J AF Lemay, C. A. Bonner, A. Compher, C. J. Field, T. Freedlander, J. Joslin, S. Tjia, J. Gurwitz, J. TI UNDERSTANDING ANTIPSYCHOTIC DRUG USE IN THE NURSING HOME SETTING SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Lemay, C. A.; Field, T.; Tjia, J.; Gurwitz, J.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Bonner, A.; Joslin, S.] Ctr Medicare, Baltimore, MD USA. [Bonner, A.; Joslin, S.] Ctr Medicaid, Baltimore, MD USA. [Freedlander, J.] Towson Univ, Towson, MD USA. [Compher, C. J.] Healthcare Management Solut LLC, Whitehall, WV USA. [Lemay, C. A.; Field, T.; Gurwitz, J.] Meyers Primary Care Inst, Worcester, MA 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 NOV PY 2013 VL 53 SU 1 BP 444 EP 445 PG 2 WC Gerontology SC Geriatrics & Gerontology GA 258EN UT WOS:000327442105185 ER PT J AU Christian, TJ Teno, JM Patel, A Vontran, KA Lucas, KE Plotzke, MR AF Christian, T. J. Teno, J. M. Patel, A. Vontran, K. A. Lucas, K. E. Plotzke, M. R. TI FEATURES OF OPIOID MEDICATIONS PRESCRIBED TO MEDICARE HOSPICE BENEFICIARIES AND BILLED TO MEDICARE PART D SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Christian, T. J.; Plotzke, M. R.] Abt Associates Inc, Cambridge, MA USA. [Teno, J. M.] Brown Univ, Providence, RI 02912 USA. [Patel, A.; Vontran, K. A.; Lucas, K. E.] Ctr Medicare Serv, Baltimore, MD USA. [Patel, A.; Vontran, K. A.; Lucas, K. E.] Ctr 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 NOV PY 2013 VL 53 SU 1 BP 616 EP 616 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 258EN UT WOS:000327442106446 ER PT J AU Morefield, B Patel, A Knight, M Lucas, KE Plotzke, MR AF Morefield, B. Patel, A. Knight, M. Lucas, K. E. Plotzke, M. R. TI HOSPICE COST REPORTS: BENCHMARKS AND TRENDS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Morefield, B.; Plotzke, M. R.] Abt Associates Inc, Durham, NC USA. [Patel, A.; Knight, M.; Lucas, K. E.] Ctr Medicare Serv, Baltimore, MD USA. [Patel, A.; Knight, M.; Lucas, K. E.] Ctr Medicaide 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 NOV PY 2013 VL 53 SU 1 BP 616 EP 616 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 258EN UT WOS:000327442106443 ER PT J AU Mosholder, AD Racoosin, JA Young, S Wernecke, M Shoaibi, A MaCurdy, TE Worrall, C Kelman, JA AF Mosholder, Andrew D. Racoosin, Judith A. Young, Stephanie Wernecke, Michael Shoaibi, Azadeh MaCurdy, Thomas E. Worrall, Christopher Kelman, Jeffrey A. TI Bleeding Events Following Concurrent Use of Warfarin and Oseltamivir by Medicare Beneficiaries SO ANNALS OF PHARMACOTHERAPY LA English DT Article DE warfarin; oseltamivir; drug-drug interaction; influenza; bleeding ID POSITIVE PREDICTIVE-VALUE; INFLUENZA; DATABASE; DISEASE; CODES; RISK AB Background: During the 2009 H1N1 influenza pandemic, the UK Medicines and Healthcare Products Regulatory Agency received case reports suggesting a potentiation of warfarin anticoagulation by the antiviral drug oseltamivir. We evaluated this putative interaction using Medicare data. Objective: To determine the frequency of bleeding following addition of oseltamivir or comparator drugs among Medicare beneficiaries taking warfarin. Methods: This was a retrospective cohort evaluation using Medicare nationwide data. Cohort members were Medicare Parts A, B, and D beneficiaries from June 30, 2006 to October 31, 2010 receiving warfarin for at least 1 month prior to a concomitant drug of interest (oseltamivir, ampicillin, trimethoprim-sulfamethoxazole (TMP-SMX), and angiotensin-converting enzyme (ACE) inhibitors). Bleeding within 14 days of new prescriptions for oseltamivir or comparators was identified using inpatient or emergency department ICD-9 (International Classification of Diseases, ninth revision) discharge diagnosis codes for gastrointestinal hemorrhage, epistaxis, hematuria, and intracranial bleeding. Patients with bleeding within 30 days preceding the prescription concomitant to warfarin were excluded. Results: With concomitant ACE inhibitors as reference, adjusted odds ratios (ORs) for any bleeding events within 14 days were 1.47 (95% confidence interval [CI] = 1.08-1.88), 1.24 (95% CI = 0.97-1.57), and 2.74 (95% CI = 2.53-3.03), for warfarin plus ampicillin, oseltamivir, and TMP-SMX, respectively. In a sensitivity analysis, adjusted ORs over a 7-day period were 1.89 (95% CI = 1.29-2.59), 1.47 (95% CI = 1.06-2.02), and 3.07 (95% CI = 2.76-3.49) for warfarin plus ampicillin, oseltamivir, and TMP-SMX, respectively. Conclusions: Bleeding with oseltamivir plus warfarin was not significantly increased over a 14-day observation period; a sensitivity analysis showed a statistically significant increase over a 7-day period; in contrast, the data consistently showed the known tendency of TMP-SMX to potentiate the effects of warfarin. The results should be interpreted with the limitations of this approach in mind, including the inability to control for unmeasured confounders. C1 [Mosholder, Andrew D.; Racoosin, Judith A.; Shoaibi, Azadeh] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD 20993 USA. [Young, Stephanie] Univ Calif Los Angeles, Los Angeles, CA USA. [Wernecke, Michael; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Stanford, CA 94305 USA. [Worrall, Christopher; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Mosholder, AD (reprint author), US FDA, Ctr Drug Evaluat & Res, Off Pharmacovigilance & Epidemiol, Div Epidemiol 2, 10903 New Hampshire Ave, Silver Spring, MD 20993 USA. EM andrew.mosholder@fda.hhs.gov FU SafeRx Project, a joint initiative of the Centers for Medicare & Medicaid Services (CMS); US Food and Drug Administration (FDA); US Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) FX The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article:; This work was supported by the SafeRx Project, a joint initiative of the Centers for Medicare & Medicaid Services (CMS), US Food and Drug Administration (FDA), and the US Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE). Acumen LLC is a contractor to CMS. NR 18 TC 0 Z9 0 U1 1 U2 5 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1060-0280 EI 1542-6270 J9 ANN PHARMACOTHER JI Ann. Pharmacother. PD NOV PY 2013 VL 47 IS 11 BP 1420 EP 1428 DI 10.1177/1060028013500940 PG 9 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 268DA UT WOS:000328147400005 PM 24285759 ER PT J AU Simon, TD Starmer, AJ Conway, PH Landrigan, CP Shah, SS Shen, MW Sectish, TC Spector, ND Tieder, JS Srivastava, R Willis, LE Wilson, KM AF Simon, Tamara D. Starmer, Amy J. Conway, Patrick H. Landrigan, Christopher P. Shah, Samir S. Shen, Mark W. Sectish, Theodore C. Spector, Nancy D. Tieder, Joel S. Srivastava, Rajendu Willis, Leah E. Wilson, Karen M. TI Quality Improvement Research in Pediatric Hospital Medicine and the Role of the Pediatric Research in Inpatient Settings (PRIS) Network SO ACADEMIC PEDIATRICS LA English DT Article DE hospital medicine; hospitalists; implementation; pediatric; quality improvement; research networks ID OF-THE-LITERATURE; CARE QUALITY; CHILDRENS HOSPITALS; HEALTH-CARE; INFECTION; HANDOFFS; PROJECT AB Pediatric hospitalists care for many hospitalized children in community and academic settings, and they must partner with administrators, other inpatient care providers, and researchers to assure the reliable delivery of high-quality, safe, evidence-based, and cost-effective care within the complex inpatient setting. Paralleling the growth of the field of pediatric hospital medicine is the realization that innovations are needed to address some of the most common clinical questions. Some of the unique challenges facing pediatric hospitalists include the lack of evidence for treating common conditions, children with chronic complex conditions, compressed time frame for admissions, and the variety of settings in which hospitalists practice. Most pediatric hospitalists are engaged in some kind of quality improvement (QI) work as hospitals provide many opportunities for QI activity and innovation. There are multiple national efforts in the pediatric hospital medicine community to improve quality, including the Children's Hospital Association (CHA) collaboratives and the Value in Pediatrics Network (VIP). Pediatric hospitalists are also challenged by the differences between QI and QI research; understanding that while improving local care is important, to provide consistent quality care to children we must study single-center and multi-center QI efforts by designing, developing, and evaluating interventions in a rigorous manner, and examine how systems variations impact implementation. The Pediatric Research in Inpatient Setting (PRIS) network is a leader in QI research and has several ongoing projects. The Prioritization project and Pediatric Health Information System Plus (PHIS+) have used administrative data to study variations in care, and the IIPE-PRIS Accelerating Safe Sign-outs (I-PASS) study highlights the potential for innovative QI research methods to improve care and clinical training. We address the importance, current state, accomplishments, and challenges of QI and QI research in pediatric hospital medicine; define the role of the PRIS Network in QI research; describe an exemplary QI research project, the I-PASS Study; address challenges for funding, training and mentorship, and publication; and identify future directions for QI research in pediatric hospital medicine. C1 [Simon, Tamara D.; Tieder, Joel S.] Univ Washington, Sch Med, Dept Pediat, Div Hosp Med, Seattle, WA 98195 USA. [Simon, Tamara D.; Tieder, Joel S.] Seattle Childrens Hosp, Seattle, WA USA. [Starmer, Amy J.] Oregon Hlth & Sci Univ, Doernbecher Mem Hosp Children, Dept Pediat, Portland, OR 97201 USA. [Starmer, Amy J.] Oregon Hlth & Sci Univ, Portland, OR 97201 USA. [Starmer, Amy J.; Landrigan, Christopher P.; Sectish, Theodore C.] Boston Childrens Hosp, Div Gen Pediat, Dept Med, Boston, MA USA. [Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Landrigan, Christopher P.] Brigham & Womens Hosp, Dept Med, Div Sleep Med, Boston, MA 02115 USA. [Landrigan, Christopher P.; Sectish, Theodore C.] Harvard Univ, Sch Med, Boston, MA USA. [Conway, Patrick H.; Shah, Samir S.] Cincinnati Childrens Hosp Med Ctr, Div Hosp Med, Cincinnato, OH USA. [Conway, Patrick H.; Shah, Samir S.] Univ Cincinnati, Coll Med, Dept Pediat, Cincinnati, OH USA. [Shen, Mark W.] Dell Childrens Med Ctr Cent Texas, Div Hosp Med, Austin, TX USA. [Shen, Mark W.] Univ Texas Southwestern, Dept Pediat, Austin, TX USA. [Spector, Nancy D.] St Christophers Hosp Children, Sect Gen Pediat, Philadelphia, PA 19133 USA. [Spector, Nancy D.] Drexel Univ, Coll Med, Dept Pediat, Philadelphia, PA 19104 USA. [Srivastava, Rajendu; Willis, Leah E.] Intermt Hlth Care, Primary Childrens Med Ctr, Salt Lake City, UT USA. [Srivastava, Rajendu; Willis, Leah E.] Univ Utah, Hlth Sci Ctr, Dept Pediat, Salt Lake City, UT USA. [Wilson, Karen M.] Childrens Hosp Colorado, Pediat Hosp Med, Aurora, CO USA. [Wilson, Karen M.] Univ Colorado, Sch Med, Aurora, CO USA. RP Simon, TD (reprint author), M-S C-9S-9,1900 Ninth Ave, Seattle, WA 98101 USA. EM Tamara.Simon@seattlechildrens.org FU CHA; National Institute of Neurological Disorders And Stroke [K23NS062900]; Seattle Children's Center for Clinical and Translational Research; CTSA from the National Center for Research Resources (NCRR), a component of the NIH [ULI RR025014]; Oregon Health and Science University; [1K12HS019456-01] FX The Pediatric Research in Inpatient Setting Network Executive Council members (CPL, SSS, TDS, RS, JST, KMW) and staff (LEW) are supported in part for their work on behalf of PRIS by a grant from the CHA. TDS is supported by Award K23NS062900 from the National Institute of Neurological Disorders And Stroke and Seattle Children's Center for Clinical and Translational Research and CTSA Grant Number ULI RR025014 from the National Center for Research Resources (NCRR), a component of the NIH. AJS is supported in part by an institutional K12 award from Oregon Health and Science University and the, grant 1K12HS019456-01. None of the sponsors participated in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Its contents represent the views of the authors and are solely the responsibility of the authors; they do not necessarily represent the opinion, policies, or official view of their respective institutions or the NCRR or NIH. NR 32 TC 4 Z9 4 U1 1 U2 4 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 EI 1876-2867 J9 ACAD PEDIATR JI Acad. Pediatr. PD NOV-DEC PY 2013 VL 13 IS 6 SU S BP S54 EP S60 PG 7 WC Pediatrics SC Pediatrics GA 261TY UT WOS:000327688700013 PM 24268086 ER PT J AU Manthripragada, AD Pinheiro, SP MaCurdy, TE Saneinejad, S Worrall, CM Kelman, JA Graham, DJ AF Manthripragada, Angelika D. Pinheiro, Simone P. MaCurdy, Thomas E. Saneinejad, Shahin Worrall, Chris M. Kelman, Jeffrey A. Graham, David J. TI Off-Label Topical Calcineurin Inhibitor Use in Children SO PEDIATRICS LA English DT Article DE topical calcineurin inhibitors; pharmacoepidemiology; off-label drug use AB OBJECTIVE: To assess off-label use of the topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, in children during periods before and after regulatory action by the US Food and Drug Administration (FDA) in 2005. METHODS: We identified new pediatric (age <20 years) users of topical tacrolimus or pimecrolimus in US Medicaid from 2001 to 2009, and examined the annual rate of drug use (pre-and postregulatory action) by age. We assessed medical claims for diagnoses consistent with an indication for a TCI, and assessed prescriptions for evidence of first-line atopic dermatitis therapy use before TCI initiation. RESULTS: There were 57 664 eligible pediatric tacrolimus users and 425 242 eligible pediatric pimecrolimus users at baseline. The rate of TCI use decreased substantially after FDA regulatory action. The proportion of new users younger than 2 years of age significantly decreased for both tacrolimus (36.7% to 22.5%, P,.001) and pimecrolimus (47.0% to 33.7%, P < .001) after regulatory actions. Previous use of topical corticosteroids increased by similar to 7% for both TCIs from the pre-to postregulatory period. However, after regulatory actions, there was only a small increase in the proportion of tacrolimus or pimecrolimus users with an atopic dermatitis or eczema diagnosis before drug initiation, and high strength use of tacrolimus was unchanged. CONCLUSIONS: The rate of TCI use in children younger than 2 years of age fell substantially after FDA regulatory action in 2005. Off-label use of TCI as first-line therapy changed little. C1 [Manthripragada, Angelika D.; Pinheiro, Simone P.; Graham, David J.] US FDA, Silver Spring, MD USA. [MaCurdy, Thomas E.; Saneinejad, Shahin] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Dept Econ, Stanford, CA 94305 USA. [Worrall, Chris M.; Kelman, Jeffrey A.] Ctr Medicare, Washington, DC USA. [Worrall, Chris M.; Kelman, Jeffrey A.] Ctr Medicaid Serv, Washington, DC USA. RP Manthripragada, AD (reprint author), Amgen Inc, Ctr Observat Res, 1 Amgen Dr, Newbury Pk, CA 91320 USA. EM awahnerm@amgen.com NR 7 TC 4 Z9 4 U1 0 U2 2 PU AMER ACAD PEDIATRICS PI ELK GROVE VILLAGE PA 141 NORTH-WEST POINT BLVD,, ELK GROVE VILLAGE, IL 60007-1098 USA SN 0031-4005 EI 1098-4275 J9 PEDIATRICS JI Pediatrics PD NOV PY 2013 VL 132 IS 5 BP E1327 EP E1332 DI 10.1542/peds.2013-0931 PG 6 WC Pediatrics SC Pediatrics GA 245PE UT WOS:000326475000025 PM 24127469 ER PT J AU VanLare, JM Wong, HH Gibbs, J Timp, R Whang, S Worrall, C Kelman, J Conway, PH AF VanLare, Jordan M. Wong, Hui-Hsing Gibbs, Jonathan Timp, Rolf Whang, Stephanie Worrall, Chris Kelman, Jeffrey Conway, Patrick H. TI Comparative effectiveness research in practice: the Drug Effectiveness Review Project experience SO JOURNAL OF COMPARATIVE EFFECTIVENESS RESEARCH LA English DT Article DE comparative effectiveness research; evidence-based medicine; implementation research; Medicaid ID HEALTH-CARE; LISTS AB Aim: Assess the effect of the Drug Effectiveness Review Project's comparative effectiveness research findings on prescribing behavior independently and in conjunction with a Medicaid preferred drug list. Method: We queried prescription drug claims and enrollment information from the 2001-2008 Medicaid Analytic eXtract and Medicaid Statistical Information System for 17 states using a Wilcoxon signed rank test design to evaluate the effects of the Drug Effectiveness Review Project's report release and preferred drug list implementation on ACE inhibitor prescribing behavior at a state level. The primary outcome of interest was the percentage of ACE inhibitor prescriptions that are defined as differentiated' based on the content of the Drug Effectiveness Research Program report. Results: The use of differentiated ACE inhibitors increased significantly in states that participated in the Drug Effectiveness Research Program and subsequently implemented a preferred drug list (p < 0.05, one-tailed). However, there was no significant change in utilization in nonparticipating states or in states that participated but did not subsequently implement a preferred drug list. Conclusion: Although the publication of comparative effectiveness research findings may not directly influence practice, a preferred drug list can align utilization with clinical evidence. The states that participate in the Drug Effectiveness Review Project and use preferred drug lists have greater utilization of higher quality drugs, making the combination an effective strategy to translate comparative effectiveness research into practice. C1 [VanLare, Jordan M.; Worrall, Chris; Kelman, Jeffrey; Conway, Patrick H.] US Dept HHS, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [VanLare, Jordan M.; Wong, Hui-Hsing; Conway, Patrick H.] US Dept HHS, Off Secretary, Baltimore, MD USA. [VanLare, Jordan M.] Yale Univ, Dept Med, New Haven, CT 06520 USA. [Gibbs, Jonathan; Timp, Rolf; Whang, Stephanie] Acumen LLC, Burlingame, CA USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA. RP VanLare, JM (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. EM jordan.vanlare@cms.hhs.gov FU Department of Health and Human Services FX The Department of Health and Human Services supported this research. Acumen, LLC received compensation from the Department of Health and Human Services for the affiliated authors' contribution to the analysis. JM Van-Lare previously served on the board of the American Medical Association but was not serving at the time of submission. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. NR 24 TC 0 Z9 1 U1 0 U2 2 PU FUTURE MEDICINE LTD PI LONDON PA UNITEC HOUSE, 3RD FLOOR, 2 ALBERT PLACE, FINCHLEY CENTRAL, LONDON, N3 1QB, ENGLAND SN 2042-6305 EI 2042-6313 J9 J COMP EFFECT RES JI J. Comp. Eff. Res. PD NOV PY 2013 VL 2 IS 6 BP 541 EP 550 DI 10.2217/cer.13.74 PG 10 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 248KZ UT WOS:000326699700011 PM 24236793 ER PT J AU Du, DY McKean, S Kelman, J Laschinger, J Johnson, C Warnock, R Worrall, C MaCurdy, TE Izurieta, H AF Du, Dongyi McKean, Stephen Kelman, Jeffrey Laschinger, John Johnson, Chris Warnock, Rob Worrall, Chris MaCurdy, Thomas E. Izurieta, Hector TI Comparison of Early Mortality after Aortic Valve Replacement with Biological vs. Mechanical Prosthetic Valve among Medicare Beneficiaries SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Du, Dongyi; Izurieta, Hector] US FDA, CBER OBE, Rockville, MD 20857 USA. [McKean, Stephen; Johnson, Chris; Warnock, Rob; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Kelman, Jeffrey; Worrall, Chris] Ctr Medicare & Medicaid Serv, Washington, DC USA. [Laschinger, John] US FDA, CDRH ODE, White Oak, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD OCT PY 2013 VL 22 SU 1 SI SI MA 21 BP 11 EP 12 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA AF7EJ UT WOS:000334876100022 ER PT J AU Graham, DJ Calia, K Nelson, L Yang, J Bhattacharya, J MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Calia, Katlyn Nelson, Lorene Yang, Jeff Bhattacharya, Jay MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI A High-Performing, SEER-Validated Algorithm for Identifying Patients With Incident Cancer of the Esophagus or Cardia Using Medicare Claims Data SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Graham, David J.] US FDA, Off Epidemiol & Surveillance, Silver Spring, MD USA. [Calia, Katlyn; Yang, Jeff; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Nelson, Lorene; Bhattacharya, Jay; MaCurdy, Thomas E.] Stanford Univ, Palo Alto, CA 94304 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD OCT PY 2013 VL 22 SU 1 SI SI MA 477 BP 234 EP 235 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA AF7EJ UT WOS:000334876101047 ER PT J AU Cuckler, GA Sisko, AM Keehan, SP Smith, SD Madison, AJ Poisal, JA Wolfe, CJ Lizonitz, JM Stone, DA AF Cuckler, Gigi A. Sisko, Andrea M. Keehan, Sean P. Smith, Sheila D. Madison, Andrew J. Poisal, John A. Wolfe, Christian J. Lizonitz, Joseph M. Stone, Devin A. TI National Health Expenditure Projections, 2012-22: Slow Growth Until Coverage Expands And Economy Improves SO HEALTH AFFAIRS LA English DT Article AB Health spending growth through 2013 is expected to remain slow because of the sluggish economic recovery, continued increases in cost-sharing requirements for the privately insured, and slow growth for public programs. These factors lead to projected growth rates of near 4 percent through 2013. However, improving economic conditions, combined with the coverage expansions in the Affordable Care Act and the aging of the population, drive faster projected growth in health spending in 2014 and beyond. Expected growth for 2014 is 6.1 percent, with an average projected growth of 6.2 percent per year thereafter. Over the 2012-22 period, national health spending is projected to grow at an average annual rate of 5.8 percent. By 2022 health spending financed by federal, state, and local governments is projected to account for 49 percent of national health spending and to reach a total of $2.4 trillion. C1 [Cuckler, Gigi A.] Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD USA. RP Cuckler, GA (reprint author), Ctr Medicare & Medicaid Serv CMS, Off Actuary, Baltimore, MD USA. EM DNHS@cms.hhs.gov NR 14 TC 31 Z9 31 U1 1 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 OCT PY 2013 VL 32 IS 10 BP 1820 EP 1831 DI 10.1377/hlthaff.2013.0721 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 250GG UT WOS:000326837900019 PM 24047555 ER PT J AU Bindman, AB Blum, JD Kronick, R AF Bindman, Andrew B. Blum, Jonathan D. Kronick, Richard TI Medicare Payment for Chronic Care Delivered in a Patient-Centered Medical Home SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Bindman, Andrew B.; Kronick, Richard] US Dept HHS, Off Assistant Secretary Planning & Evaluat, Washington, DC 20201 USA. [Bindman, Andrew B.] Univ Calif San Francisco, Dept Med, San Francisco, CA 94118 USA. [Blum, Jonathan D.] US Dept HHS, Ctr Medicare Serv, Washington, DC 20201 USA. [Blum, Jonathan D.] US Dept HHS, Ctr Medicaid Serv, Washington, DC 20201 USA. RP Bindman, AB (reprint author), Univ Calif San Francisco, Dept Med, 3333 Calif St,Ste 265, San Francisco, CA 94118 USA. EM abindman@medsfgh.ucsf.edu NR 5 TC 8 Z9 8 U1 0 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD SEP 18 PY 2013 VL 310 IS 11 BP 1125 EP 1126 DI 10.1001/jama.2013.276525 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 219IU UT WOS:000324500300015 PM 23929029 ER PT J AU Polakowski, LL Sandhu, SK Martin, DB Ball, R MaCurdy, TE Franks, RL Gibbs, JM Kropp, GF Avagyan, A Kelman, JA Worrall, CM Sun, GY Kliman, RE Burwen, DR AF Polakowski, Laura L. Sandhu, Sukhminder K. Martin, David B. Ball, Robert MaCurdy, Thomas E. Franks, Riley L. Gibbs, Jonathan M. Kropp, Garner F. Avagyan, Armen Kelman, Jeffrey A. Worrall, Christopher M. Sun, Guoying Kliman, Rebecca E. Burwen, Dale R. TI Chart-Confirmed Guillain-Barre Syndrome After 2009 H1N1 Influenza Vaccination Among the Medicare Population, 2009-2010 SO AMERICAN JOURNAL OF EPIDEMIOLOGY LA English DT Article DE Fisher Syndrome; Guillain-Barre Syndrome; human influenza; vaccination ID SAFETY DATALINK PROJECT; UNITED-STATES; A H1N1; VACCINES; ASSOCIATION; RISK; SURVEILLANCE; CAMPAIGN; RECEIPT; PROGRAM AB Given the increased risk of Guillain Barre Syndrome (GBS) found with the 1976 swine influenza vaccine, both active surveillance and end of season analyses on chart-confirmed cases were performed across multiple US vaccine safety monitoring systems, including the Medicare system, to evaluate the association of GBS after 2009 monovalent H1N1 influenza vaccination. Medically reviewed cases consisted of H1N1-vaccinated Medicare beneficiaries who were hospitalized for GBS. These cases were then classified by using Brighton Collaboration diagnostic criteria. Thirty one persons had Brighton level 1, 2, or 3 GBS or Fisher Syndrome, with symptom onset 1-119 days after vaccination. Self controlled risk interval analyses estimated GBS risk within the 6 week period immediately following H1N1 vaccination compared with a later control period, with additional adjustment for seasonality. Our results showed an elevated risk of GBS with 2009 monovalent H1N1 vaccination (incidence rate ratio = 2.41, 95% confidence interval: 1.14, 5.11; attributable risk = 2.84 per million doses administered, 95% confidence interval: 0.21, 5.48).This observed risk was slightly higher than that seen with previous seasonal influenza vaccines; however, additional results that used a stricter case definition (Brighton level 1 or 2) were not statistically significant, and our ability to account for preceding respiratory gastrointestinal illness was limited. Furthermore, the observed risk was substantially lower than that seen with the 1976 swine influenza vaccine. C1 [Polakowski, Laura L.; Sandhu, Sukhminder K.; Martin, David B.; Ball, Robert; Sun, Guoying; Burwen, Dale R.] US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, Rockville, MD 20857 USA. [MaCurdy, Thomas E.; Franks, Riley L.; Gibbs, Jonathan M.; Kropp, Garner F.; Avagyan, Armen] Acumen LLC, Burlingame, CA USA. [Kelman, Jeffrey A.; Worrall, Christopher M.] Ctr Medicare & Medicaid Serv, Ctr Medicare, Baltimore, MD USA. [Kliman, Rebecca E.] Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP Polakowski, LL (reprint author), US PHS, US FDA, Room 327N,HFM-225,1401 Rockville Pike, Rockville, MD 20852 USA. EM laura.polakowski@fda.hhs.gov NR 43 TC 12 Z9 12 U1 0 U2 7 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 SEP 15 PY 2013 VL 178 IS 6 BP 962 EP 973 DI 10.1093/aje/kwt051 PG 12 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 227YC UT WOS:000325150600019 PM 23652165 ER PT J AU Sheffield, JS Munoz, FM Beigi, RH Rasmussen, SA Edwards, KM Read, JS Heine, RP Ault, KA Swamy, GK Jevaji, I Spong, CY Fortner, KB Patel, SM Nesin, M AF Sheffield, Jeanne S. Munoz, Flor M. Beigi, Richard H. Rasmussen, Sonja A. Edwards, Kathryn M. Read, Jennifer S. Heine, R. Phillips Ault, Kevin A. Swamy, Geeta K. Jevaji, Indira Spong, Catherine Y. Fortner, Kimberly B. Patel, Shital M. Nesin, Mirjana TI Research on vaccines during pregnancy: Reference values for vital signs and laboratory assessments SO VACCINE LA English DT Article DE Laboratory assessment; Toxicity grading scale; Maternal immunization AB The Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Diseases, National Institutes of Health organized a series of conferences, "Enrolling Pregnant Women in Clinical Trials of Vaccines and Therapeutics", to discuss enrollment and safety assessments of pregnant women in clinical trials of vaccines. Experts in obstetrics, maternal fetal medicine, infectious diseases, pediatrics, neonatology, genetics, vaccinology and clinical trial design were charged with identifying normal ranges for vital signs and laboratory assessments in pregnancy. A grading system for adverse events was then developed (C) 2013 Elsevier Ltd. All rights reserved. C1 [Sheffield, Jeanne S.] Univ Texas SW Med Ctr Dallas, Dept Obstet & Gynecol, Div Maternal Fetal Med, Dallas, TX 75390 USA. [Munoz, Flor M.] Baylor Coll Med, Dept Pediat Mol Virol & Microbiol, Houston, TX 77030 USA. [Beigi, Richard H.] Univ Pittsburgh, Med Ctr, Magee Womens Hosp, Dept Obstet Gynecol & Reprod Sci, Pittsburgh, PA 15213 USA. [Rasmussen, Sonja A.] Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. [Edwards, Kathryn M.] Vanderbilt Univ, Dept Pediat, Vanderbilt Vaccine Res Program, Nashville, TN 37232 USA. [Read, Jennifer S.] US Dept HHS, Natl Vaccine Program Off, Off Assistant Secretary Hlth, Off Secretary, Washington, DC 20201 USA. [Heine, R. Phillips; Swamy, Geeta K.] Duke Univ, Dept Obstet & Gynecol, Div Maternal Fetal Med, Durham, NC 27710 USA. [Ault, Kevin A.] Emory Univ, Sch Med, Dept Gynecol & Obstet, Atlanta, GA 30303 USA. [Ault, Kevin A.] Emory Univ, Sch Med, Emory Vaccine Ctr, Atlanta, GA 30303 USA. [Ault, Kevin A.] Emory Univ, Rollins Sch Publ Hlth, Hubert Dept Global Hlth, Atlanta, GA 30303 USA. [Jevaji, Indira] NIH, USA Div ESRD Populat & Community Hlth DEPCH, Ctr Medicare & Medicaid Serv CMS, Qual Improvement Grp,Ctr Clin Stand & Qual,Off Re, Bethesda, MD 20817 USA. [Spong, Catherine Y.] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, NIH, Bethesda, MD 20892 USA. [Fortner, Kimberly B.] Vanderbilt Univ, Dept Obstet & Gynecol, Div Maternal Fetal Med, Nashville, TN 37232 USA. [Patel, Shital M.] Baylor Coll Med, Dept Med Mol Virol & Microbiol, Houston, TX 77030 USA. [Nesin, Mirjana] NIAID, Div Microbiol & Infect Dis, NIH, Bethesda, MD 20817 USA. RP Nesin, M (reprint author), 5323 Harry Hines Blvd, Dallas, TX 75390 USA. EM jeanne.sheffield@utsouthwestern.edu NR 9 TC 14 Z9 14 U1 1 U2 3 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 SEP 13 PY 2013 VL 31 IS 40 BP 4264 EP 4273 DI 10.1016/j.vaccine.2013.07.031 PG 10 WC Immunology; Medicine, Research & Experimental SC Immunology; Research & Experimental Medicine GA 219MG UT WOS:000324510500002 PM 23906887 ER PT J AU Dodd, CN Romio, SA Black, S Vellozzi, C Andrews, N Sturkenboom, M Zuber, P Hua, W Bonhoeffer, J Buttery, J Crawford, N Deceuninck, G de Vries, C De Wals, P Gutierrez-Gimeno, MV Heijbel, H Hughes, H Hur, K Hviid, A Kelman, J Kilpi, T Chuang, SK Macartney, K Rett, M Lopez-Callada, VR Salmon, D Sanchez, FG Sanz, N Silverman, B Storsaeter, J Thirugnanam, U van der Maas, N Yih, K Zhang, T Izurieta, H AF Dodd, Caitlin N. Romio, Silvana A. Black, Steven Vellozzi, Claudia Andrews, Nick Sturkenboom, Miriam Zuber, Patrick Hua, Wei Bonhoeffer, Jan Buttery, Jim Crawford, Nigel Deceuninck, Genevieve de Vries, Corinne De Wals, Philippe Gutierrez-Gimeno, M. Victoria Heijbel, Harald Hughes, Hayley Hur, Kwan Hviid, Anders Kelman, Jeffrey Kilpi, Tehri Chuang, S. K. Macartney, Kristine Rett, Melisa Lopez-Callada, Vesta Richardson Salmon, Daniel Sanchez, Francisco Gimenez Sanz, Nuria Silverman, Barbara Storsaeter, Jann Thirugnanam, Umapathi van der Maas, Nicoline Yih, Katherine Zhang, Tao Izurieta, Hector CA Global H1N1 GBS Consortium TI International collaboration to assess the risk of Guillain Barre Syndrome following Influenza A (H1N1) 2009 monovalent vaccines SO VACCINE LA English DT Article DE Guillain Barre Syndrome (GBS); Monovalent H1N1 Vaccine (H1N1); Self-controlled case-series method (SCCS); International; Adjuvant; Adverse events following immunization (AEFI) ID CONTROLLED CASE SERIES; UNITED-KINGDOM; ADJUVANTED VACCINE; ADVERSE EVENTS; SAFETY; IMMUNIZATION; LICENSURE; SURVEILLANCE; ASSOCIATION; PROGRAM AB Background: The global spread of the 2009 novel pandemic influenza A (H1N1) virus led to the accelerated production and distribution of monovalent 2009 Influenza A (H1N1) vaccines (pH1N1). This pandemic provided the opportunity to evaluate the risk of Guillain-Barre syndrome (GBS), which has been an influenza vaccine safety concern since the swine flu pandemic of 1976, using a common protocol among high and middle-income countries. The primary objective of this project was to demonstrate the feasibility and utility of global collaboration in the assessment of vaccine safety, including countries both with and without an established infrastructure for vaccine active safety surveillance. A second objective, included a priori, was to assess the risk of GBS following pH1N1 vaccination. Methods: The primary analysis used the self-controlled case series (SCCS) design to estimate the relative incidence (RI) of GBS in the 42 days following vaccination with pH1N1 vaccine in a pooled analysis across databases and in analysis using a meta-analytic approach. Results: We found a relative incidence of GBS of 2.42(95% CI 1.58-3.72) in the 42 days following exposure to pH1N1 vaccine in analysis of pooled data and 2.09(95% CI 1.28-3.42) using the meta-analytic approach. Conclusions: This study demonstrates that international collaboration to evaluate serious outcomes using a common protocol is feasible. The significance and consistency of our findings support a conclusion of an association between 2009 H1N1 vaccination and GBS. Given the rarity of the event the relative incidence found does not provide evidence in contradiction to international recommendations for the continued use of influenza vaccines. (C) 2013 Elsevier Ltd. All rights reserved. C1 [Dodd, Caitlin N.] Cincinnati Childrens Hosp Med Ctr, Dept Biostat & Epidemiol, Cincinnati, OH 45229 USA. [Romio, Silvana A.; Sturkenboom, Miriam] Erasmus Univ, Med Ctr, Dept Med Informat, Rotterdam, Netherlands. [Black, Steven] Cincinnati Childrens Hosp Med Ctr, Dept Global Child Hlth, Cincinnati, OH 45229 USA. [Vellozzi, Claudia] Ctr Dis Control & Prevent, Atlanta, GA USA. [Andrews, Nick] Hlth Protect Agcy, London, England. [Zuber, Patrick] WHO, Dept Immunizat Vaccines & Biol IVB, CH-1211 Geneva, Switzerland. [Hua, Wei; Izurieta, Hector] US FDA, Ctr Biol Evaluat & Res, Off Biost & Epidemiol, Rockville, MD 20857 USA. [Bonhoeffer, Jan] Brighton Collaborat Fdn, Basel, Switzerland. [Bonhoeffer, Jan] Univ Childrens Hosp, Basel, Switzerland. [Buttery, Jim] Monash Univ, Dept Paediat, Murdoch Childrens Res Inst, Clayton, Vic 3800, Australia. [Crawford, Nigel] Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia. [Deceuninck, Genevieve; De Wals, Philippe] Quebec Univ Hosp, Res Ctr, Publ Hlth Res Unit, Quebec City, PQ, Canada. [de Vries, Corinne] Univ Bath, Dept Pharm & Pharmacol, Bath, Avon, England. [Gutierrez-Gimeno, M. Victoria] Ctr Publ Hlth Res CSISP FISABIO, Vaccine Dept, Valencia, Spain. [Heijbel, Harald] Swedish Inst Infect Dis, Lund, Sweden. [Hughes, Hayley] US Dept Def, Washington, DC 20305 USA. [Hur, Kwan] Hines Vet Affairs Hosp, Pharm Benefit Management Serv, Ctr Med Safety, Hines, IL USA. [Hviid, Anders] Statens Serum Inst, Dept Epidemiol Res, DK-2300 Copenhagen, Denmark. [Kelman, Jeffrey] Ctr Medicare Serv, Ctr Drug & Hlth Plan Choice, Baltimore, MD USA. [Kelman, Jeffrey] Ctr Medicaid Serv, Baltimore, MD USA. [Kilpi, Tehri] Natl Inst Hlth & Welf, Helsinki, Finland. [Chuang, S. K.] Ctr Hlth Protect, Dept Hlth, Hong Kong, Hong Kong, Peoples R China. [Macartney, Kristine] Childrens Hosp Westmead, Westmead, NSW, Australia. [Rett, Melisa; Yih, Katherine] Harvard Univ, Sch Med, Dept Populat Med, Boston, MA USA. [Rett, Melisa; Yih, Katherine] Harvard Pilgrim Hlth Care Inst, Boston, MA USA. [Lopez-Callada, Vesta Richardson] Natl Ctr Child & Adolescent Hlth, Mexico City, DF, Mexico. [Salmon, Daniel] US Dept Hlth & Human Serv, Off Assistant Secretary Hlth, Natl Vaccine Program Off, Washington, DC USA. [Salmon, Daniel] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA. [Salmon, Daniel] Johns Hopkins Bloomberg Sch Publ Hlth, Inst Vaccine Safety, Baltimore, MD USA. [Sanchez, Francisco Gimenez] Torrecardenas Hosp, Dept Pediat, Almeria, Spain. [Sanz, Nuria] Hosp Clin & Prov Barcelona SCReN, Barcelona, Spain. [Silverman, Barbara] Maccabi Healthcare Serv, Tel Aviv, Israel. [Storsaeter, Jann] Norwegian Inst Publ Hlth, Oslo, Norway. [Thirugnanam, Umapathi] Natl Neurosci Inst, Singapore, Singapore. [van der Maas, Nicoline] RIVM, Bilthoven, Netherlands. Fudan Univ, Dept Epidemiology, Sch Publ Hlth, Key Lab Publ Hlth Safety,Minist Educ, Shanghai 200433, Peoples R China. RP Dodd, CN (reprint author), Cincinnati Childrens Hosp Med Ctr, Dept Biostat & Epidemiol, Cincinnati, OH 45229 USA. EM c.dodd@erasmusmc.nl RI Bonhoeffer, Jan/E-5903-2014; Sammon, Cormac/B-7340-2015; Addis, Antonio/J-7894-2016; CPRD, CPRD/B-9594-2017; OI Sammon, Cormac/0000-0002-7921-4858; Addis, Antonio/0000-0003-0962-9959; Kulldorff, Martin/0000-0002-5284-2993; Clothier, Hazel Joanne/0000-0001-7594-0361; Silverman, Barbara/0000-0002-0337-4919; Cheng, Allen/0000-0003-3152-116X FU World Health Organization; US Food and Drug Administration FX Minimal funding was provided by the World Health Organization and by the US Food and Drug Administration for creation and maintenance of an online workspace as well as travel for group statisticians to conduct data analysis. No funding was provided to investigators for their participation. NR 46 TC 29 Z9 29 U1 8 U2 194 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 SEP 13 PY 2013 VL 31 IS 40 BP 4448 EP 4458 DI 10.1016/j.vaccine.2013.06.032 PG 11 WC Immunology; Medicine, Research & Experimental SC Immunology; Research & Experimental Medicine GA 219MG UT WOS:000324510500027 PM 23770307 ER PT J AU Barile, JP Thompson, WW Zack, MM Krahn, GL Horner-Johnson, W Bowen, SE AF Barile, John P. Thompson, William W. Zack, Matthew M. Krahn, Gloria L. Horner-Johnson, Willi Bowen, Sonya E. TI Multiple Chronic Medical Conditions and Health-Related Quality of Life in Older Adults, 2004-2006 SO PREVENTING CHRONIC DISEASE LA English DT Article ID FUNCTIONAL LIMITATIONS; DISABILITY; OUTCOMES; DISEASE AB Introduction Understanding longitudinal relationships among multiple chronic conditions, limitations in activities of daily living, and health-related quality of life is important for identifying potential opportunities for health promotion and disease prevention among older adults. Methods This study assessed longitudinal associations between multiple chronic conditions and limitations in activities of daily living on health-related quality of life among older adults (years) from 2004 through 2006, using data from the Medicare Health Outcomes Survey (N = 27,334). Results Using a longitudinal path model, we found the numbers of chronic conditions at baseline and 2-year follow-up were independently associated with more limitations in activities of daily living at 2-year follow-up. In addition, more limitations in activities of daily living at 2-year follow-up were associated with worse health-related quality of life during the follow-up time period. The association between multiple chronic conditions and indices of health-related quality of life was mediated by changes in limitations in activities of daily living. Conclusion Both baseline and new multiple chronic conditions led to worse health in terms of activities of daily living and health-related quality of life and should be considered important outcomes to intervene on for improved long-term health. In addition, public health practitioners should consider addressing classes of multiple chronic conditions by using interventions designed to reduce the emergence of multiple chronic conditions, such as physical activity, reductions in smoking rates, and improved and coordinated access to health care services. C1 [Barile, John P.] Univ Hawaii Manoa, Honolulu, HI 96822 USA. [Thompson, William W.; Zack, Matthew M.; Krahn, Gloria L.] Ctr Dis Control & Prevent, Atlanta, GA USA. [Horner-Johnson, Willi] Oregon Hlth & Sci Univ, Portland, OR 97201 USA. [Bowen, Sonya E.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Barile, JP (reprint author), Univ Hawaii Manoa, 2530 Dole St,Sakamaki Hall,C404, Honolulu, HI 96822 USA. EM Barile@Hawaii.edu RI Barile, John/F-9456-2015; OI Barile, John/0000-0003-4098-0640; Horner-Johnson, Willi/0000-0003-3568-1400 NR 29 TC 5 Z9 5 U1 3 U2 7 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1545-1151 J9 PREV CHRONIC DIS JI Prev. Chronic Dis. PD SEP PY 2013 VL 10 AR UNSP 120282 DI 10.5888/pcd10.120282 PG 11 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 285KS UT WOS:000329393500015 ER PT J AU Murray, CJL Abraham, J Ali, MK Alvarado, M Atkinson, C Baddour, LM Bartels, DH Benjamin, EJ Bhalla, K Birbeck, G Bolliger, I Burstein, R Carnahan, E Chen, HL Chou, D Chugh, SS Cohen, A Colson, KE Cooper, LT Couser, W Criqui, MH Dabhadkar, KC Dahodwala, N Danaei, G Dellavalle, RP Des Jarlais, DC Dicker, D Ding, EL Dorsey, R Duber, H Ebel, BE Engell, RE Ezzati, M Felson, DT Finucane, MM Flaxman, S Flaxman, AD Fleming, T Forouzanfar, MH Freedman, G Freeman, MK Gabriel, SE Gakidou, E Gillum, RF Gonzalez-Medina, D Gosselin, R Grant, B Gutierrez, HR Hagan, H Havmoeller, R Hoffman, H Jacobsen, KH James, SL Jasrasaria, R Jayaraman, S Johns, N Kassebaum, N Khatibzadeh, S Knowlton, LM Lan, Q Leasher, JL Lim, S Lin, JK Lipshultz, SE London, S Lozano, R Lu, Y MacIntyre, MF Mallinger, L McDermott, MM Meltzer, M Mensah, GA Michaud, C Miller, TR Mock, C Moffitt, TE Mokdad, AA Mokdad, AH Moran, AE Mozaffarian, D Murphy, T Naghavi, M Narayan, KMV Nelson, RG Olives, C Omer, SB Ortblad, K Ostro, B Pelizzari, PM Phillips, D Pope, CA Raju, M Ranganathan, D Razavi, H Ritz, B Rivara, FP Roberts, T Sacco, RL Salomon, JA Sampson, U Sanman, E Sapkota, A Schwebel, DC Shahraz, S Shibuya, K Shivakoti, R Silberberg, D Singh, GM Singh, D Singh, JA Sleet, DA Steenland, K Tavakkoli, M Taylor, JA Thurston, GD Towbin, JA Vavilala, MS Vos, T Wagner, GR Weinstock, MA Weisskopf, MG Wilkinson, JD Wulf, S Zabetian, A Lopez, AD AF Murray, Christopher J. L. Abraham, Jerry Ali, Mohammed K. Alvarado, Miriam Atkinson, Charles Baddour, Larry M. Bartels, David H. Benjamin, Emelia J. Bhalla, Kavi Birbeck, Gretchen Bolliger, Ian Burstein, Roy Carnahan, Emily Chen, Honglei Chou, David Chugh, Sumeet S. Cohen, Aaron Colson, K. Ellicott Cooper, Leslie T. Couser, William Criqui, Michael H. Dabhadkar, Kaustubh C. Dahodwala, Nabila Danaei, Goodarz Dellavalle, Robert P. Des Jarlais, Don C. Dicker, Daniel Ding, Eric L. Dorsey, Ray Duber, Herbert Ebel, Beth E. Engell, Rebecca E. Ezzati, Majid Felson, David T. Finucane, Mariel M. Flaxman, Seth Flaxman, Abraham D. Fleming, Thomas Forouzanfar, Mohammad H. Freedman, Greg Freeman, Michael K. Gabriel, Sherine E. Gakidou, Emmanuela Gillum, Richard F. Gonzalez-Medina, Diego Gosselin, Richard Grant, Bridget Gutierrez, Hialy R. Hagan, Holly Havmoeller, Rasmus Hoffman, Howard Jacobsen, Kathryn H. James, Spencer L. Jasrasaria, Rashmi Jayaraman, Sudha Johns, Nicole Kassebaum, Nicholas Khatibzadeh, Shahab Knowlton, Lisa Marie Lan, Qing Leasher, Janet L. Lim, Stephen Lin, John Kent Lipshultz, Steven E. London, Stephanie Lozano, Rafael Lu, Yuan MacIntyre, Michael F. Mallinger, Leslie McDermott, Mary M. Meltzer, Michele Mensah, George A. Michaud, Catherine Miller, Ted R. Mock, Charles Moffitt, Terrie E. Mokdad, Ali A. Mokdad, Ali H. Moran, Andrew E. Mozaffarian, Dariush Murphy, Tasha Naghavi, Mohsen Narayan, K. M. Venkat Nelson, Robert G. Olives, Casey Omer, Saad B. Ortblad, Katrina Ostro, Bart Pelizzari, Pamela M. Phillips, David Pope, C. Arden, III Raju, Murugesan Ranganathan, Dharani Razavi, Homie Ritz, Beate Rivara, Frederick P. Roberts, Thomas Sacco, Ralph L. Salomon, Joshua A. Sampson, Uchechukwu Sanman, Ella Sapkota, Amir Schwebel, David C. Shahraz, Saeid Shibuya, Kenji Shivakoti, Rupak Silberberg, Donald Singh, Gitanjali M. Singh, David Singh, Jasvinder A. Sleet, David A. Steenland, Kyle Tavakkoli, Mohammad Taylor, Jennifer A. Thurston, George D. Towbin, Jeffrey A. Vavilala, Monica S. Vos, Theo Wagner, Gregory R. Weinstock, Martin A. Weisskopf, Marc G. Wilkinson, James D. Wulf, Sarah Zabetian, Azadeh Lopez, Alan D. CA Us Burden Dis Collaborators TI The State of US Health, 1990-2010 Burden of Diseases, Injuries, and Risk Factors SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID BODY-MASS INDEX; ADJUSTED LIFE YEARS; GLOBAL BURDEN; SYSTEMATIC ANALYSIS; UNITED-STATES; PUBLIC-HEALTH; CARDIOVASCULAR-DISEASE; BUILT ENVIRONMENT; PHYSICAL-ACTIVITY; BLOOD-PRESSURE AB IMPORTANCE Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. OBJECTIVES To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. DESIGN We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. RESULTS US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. CONCLUSIONS AND RELEVANCE From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. C1 [Murray, Christopher J. L.; Alvarado, Miriam; Atkinson, Charles; Bolliger, Ian; Burstein, Roy; Carnahan, Emily; Chou, David; Colson, K. Ellicott; Dicker, Daniel; Duber, Herbert; Engell, Rebecca E.; Flaxman, Abraham D.; Gakidou, Emmanuela; Gonzalez-Medina, Diego; James, Spencer L.; Jasrasaria, Rashmi; Johns, Nicole; Lim, Stephen; MacIntyre, Michael F.; Mallinger, Leslie; Mokdad, Ali A.; Mokdad, Ali H.; Murphy, Tasha; Naghavi, Mohsen; Ortblad, Katrina; Phillips, David; Ranganathan, Dharani; Roberts, Thomas; Sanman, Ella; Vos, Theo; Wulf, Sarah] Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA. [Couser, William; Ebel, Beth E.; Kassebaum, Nicholas; Mock, Charles; Olives, Casey; Rivara, Frederick P.; Vavilala, Monica S.] Univ Washington, Seattle, WA 98195 USA. [Abraham, Jerry] Univ Texas San Antonio, Sch Med, San Antonio, TX USA. [Omer, Saad B.; Steenland, Kyle] Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. [Ali, Mohammed K.; Dabhadkar, Kaustubh C.; Narayan, K. M. Venkat; Zabetian, Azadeh] Emory Univ, Atlanta, GA 30322 USA. [Baddour, Larry M.; Gabriel, Sherine E.] Mayo Clin, Rochester, MN USA. [Danaei, Goodarz; Ding, Eric L.; Finucane, Mariel M.; Khatibzadeh, Shahab; Knowlton, Lisa Marie; Lin, John Kent; Lu, Yuan; Singh, Gitanjali M.; Tavakkoli, Mohammad; Weisskopf, Marc G.] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Bartels, David H.; Jayaraman, Sudha; Mozaffarian, Dariush] Harvard Univ, Sch Med, Boston, MA USA. [Bhalla, Kavi] Harvard Univ, Boston, MA 02115 USA. [Benjamin, Emelia J.] Boston Univ, Sch Med, Boston, MA 02118 USA. [Felson, David T.] Boston Univ, Boston, MA 02215 USA. [Birbeck, Gretchen] Michigan State Univ, E Lansing, MI USA. [Chen, Honglei; London, Stephanie] NIEHS, Res Triangle Pk, NC 27709 USA. [Lan, Qing] NCI, Occupat & Environm Epidemiol Branch, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA. [Grant, Bridget; Hoffman, Howard; Mensah, George A.] NIH, Bethesda, MD 20892 USA. [Nelson, Robert G.] Natl Inst Diabet & Digest & Kidney Dis, Bethesda, MD USA. [Wagner, Gregory R.] NIOSH, Baltimore, MD USA. [Chugh, Sumeet S.; Havmoeller, Rasmus] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Havmoeller, Rasmus] Karolinska Inst, Stockholm, Sweden. [Cohen, Aaron] Hlth Effects Inst, Boston, MA USA. [Cooper, Leslie T.] Loyola Univ, Sch Med, Chicago, IL 60611 USA. [Criqui, Michael H.] Univ Calif San Diego, La Jolla, CA 92093 USA. [Dahodwala, Nabila; Silberberg, Donald] Univ Penn, Philadelphia, PA 19104 USA. [Dellavalle, Robert P.] Denver VA Med Ctr, Denver, CO USA. [Des Jarlais, Don C.] Beth Israel Deaconess Med Ctr, New York, NY 10003 USA. [Dorsey, Ray; Shivakoti, Rupak] Johns Hopkins Univ, Baltimore, MD USA. [Ezzati, Majid] Univ London Imperial Coll Sci Technol & Med, Sch Publ Hlth, Dept Epidemiol & Biostatist, MRC HPA Ctr Environm & Hlth, London, England. [Flaxman, Seth] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA. [Gillum, Richard F.] Howard Univ, Coll Med, Washington, DC USA. [Gosselin, Richard] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Gutierrez, Hialy R.] Mailman Sch Publ Hlth, New York, NY USA. [Moran, Andrew E.] Columbia Univ, New York, NY USA. [Hagan, Holly; Thurston, George D.] NYU, New York, NY USA. [Jacobsen, Kathryn H.] George Mason Univ, Fairfax, VA 22030 USA. [Leasher, Janet L.] Nova SE Univ, Ft Lauderdale, FL 33314 USA. [Lipshultz, Steven E.; Sacco, Ralph L.; Wilkinson, James D.] Univ Miami, Miller Sch Med, Miami, FL 33136 USA. [Lopez, Alan D.] Univ Melbourne, Sch Populat & Global Hlth, Melbourne, Vic, Australia. [Lozano, Rafael] Inst Nacl Salud Publ, Ctr Invest Sistemas Salud, Cuernavaca, Morelos, Mexico. [McDermott, Mary M.] Northwestern Univ, Feinberg Sch Med, Evanston, IL USA. [Meltzer, Michele] Thomas Jefferson Univ, Philadelphia, PA 19107 USA. [Michaud, Catherine] China Med Board, Boston, MA USA. [Miller, Ted R.] Pacific Inst Res & Evaluat, Calverton, MD USA. [Moffitt, Terrie E.] Duke Univ, Durham, NC USA. [Mozaffarian, Dariush] Brigham & Womens Hosp, Boston, MA 02115 USA. [Ostro, Bart] Calif Environm Protect Agcy, Sacramento, CA USA. [Pelizzari, Pamela M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Pope, C. Arden, III] Brigham Young Univ, Provo, UT 84602 USA. [Raju, Murugesan] Univ Missouri, Mason Eye Inst, Columbia, MO 65211 USA. [Razavi, Homie] Ctr Dis Anal, Louisville, CO USA. [Ritz, Beate] Univ Calif Los Angeles, Los Angeles, CA USA. [Sampson, Uchechukwu] Vanderbilt Univ, Nashville, TN 37235 USA. [Sapkota, Amir] Univ Maryland, Sch Publ Hlth, College Pk, MD 20742 USA. [Schwebel, David C.; Singh, Jasvinder A.] Univ Alabama Birmingham, Birmingham, AL USA. [Shahraz, Saeid] Brandeis Univ, Waltham, MA USA. [Shibuya, Kenji] Univ Tokyo, Dept Global Hlth Policy, Tokyo, Japan. [Singh, David] Queens Med Ctr, Honolulu, HI USA. [Sleet, David A.] Natl Ctr Injury Prevent & Control, Atlanta, GA USA. [Taylor, Jennifer A.] Drexel Univ, Sch Publ Hlth, Philadelphia, PA 19104 USA. [Towbin, Jeffrey A.] Cincinnati Childrens Hosp, Cincinnati, OH USA. [Weinstock, Martin A.] Brown Univ, Providence, RI 02912 USA. RP Murray, CJL (reprint author), Inst Hlth Metr & Evaluat, 2301 5th Ave,Ste 600, Seattle, WA 98121 USA. EM cjlm@uw.edu RI Lopez, Alan D/F-1487-2010; Dellavalle, Robert/L-2020-2013; Salomon, Joshua/D-3898-2009; Moffitt, Terrie/D-5295-2011; Narayan, K.M. Venkat /J-9819-2012; Ritz, Beate/E-3043-2015; Sapkota, Amir/A-5968-2011; Bolliger, Ian/C-4207-2016; Jacobsen, Kathryn/B-5857-2008 OI London, Stephanie/0000-0003-4911-5290; Chen, Honglei/0000-0003-3446-7779; Lopez, Alan D/0000-0001-5818-6512; Mock, Charles/0000-0002-0564-568X; Ding, Eric/0000-0002-5881-8097; singh, jasvinder/0000-0003-3485-0006; Johns, Nicole/0000-0003-4513-4582; Mensah, George/0000-0002-0387-5326; Benjamin, Emelia/0000-0003-4076-2336; Miller, Ted/0000-0002-0958-2639; Dellavalle, Robert/0000-0001-8132-088X; Salomon, Joshua/0000-0003-3929-5515; Pelizzari, Pamela/0000-0002-6992-9462; Ranganathan, Dharani/0000-0001-6506-2825; Moffitt, Terrie/0000-0002-8589-6760; Narayan, K.M. Venkat /0000-0001-8621-5405; Bolliger, Ian/0000-0001-8055-297X; Jacobsen, Kathryn/0000-0002-4198-6246 FU National Institutes of Health, the National Institute of Environmental Health Sciences; Bill and Melinda Gates Foundation FX This study is supported in part by the Intramural Program of the National Institutes of Health, the National Institute of Environmental Health Sciences, and in part by the Bill and Melinda Gates Foundation. NR 81 TC 551 Z9 556 U1 39 U2 250 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD AUG 14 PY 2013 VL 310 IS 6 BP 591 EP 608 DI 10.1001/jama.2013.13805 PG 18 WC Medicine, General & Internal SC General & Internal Medicine GA 200HI UT WOS:000323058400015 PM 23842577 ER PT J AU Agrawal, S Tarzy, B Hunt, L Taitsman, J Budetti, P AF Agrawal, Shantanu Tarzy, Bruce Hunt, Lauren Taitsman, Julie Budetti, Peter TI Expanding Physician Education in Health Care Fraud and Program Integrity SO ACADEMIC MEDICINE LA English DT Article ID WASTE AB Program integrity (PI) spans the entire spectrum of improper payments from fraud to abuse, errors, and waste in thehealth care system. Few physicians will perpetrate fraud or abuse during their careers, but nearly all will contribute to the remaining spectrum of improper payments, making preventive education in this area vital. Despite the enormous impact that PI issues have on government-sponsored and private insurance programs, physicians receive little formal education in this area. Physicians' lack of awareness of PI issues not only makes them more likely to submit inappropriate claims, generate orders that other providers and suppliers will use to submit inappropriate claims, and document improperly in the medical record but also more likely to become victims of fraud schemes themselves. In this article, the authors provide an overview of the current state of PI issues in general, and fraud in particular, as well as a description of the state of formal education for practicing physicians, residents, and fellows. Building on the lessons from pilot programs conducted by the Centers for Medicare and Medicaid Services and partner organizations, the authors then propose a model PI education curriculum to be implemented nationwide for physicians at all levels. They recommend that various stakeholder organizations take part in the development and implementationprocess to ensure that all perspectives are included. Educating physicians is an essential step in establishing a broader culture of compliance and improved integrity in the health care system, extending beyond Medicare and Medicaid. C1 [Agrawal, Shantanu; Hunt, Lauren; Budetti, Peter] Ctr Medicare & Medicaid Serv, Ctr Program Integr, Baltimore, MD USA. [Tarzy, Bruce] Calif Dept Hlth Care Serv, Med Review Branch, Sacramento, CA USA. [Taitsman, Julie] US Dept HHS, Off Inspector Gen, Washington, DC 20201 USA. RP Agrawal, S (reprint author), CMS Ctr Program Integr, 7500 Secur Blvd,Mail Stop AR 18-50, Baltimore, MD 21244 USA. EM shantanu.agrawal@cms.hhs.gov NR 28 TC 2 Z9 2 U1 1 U2 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1040-2446 EI 1938-808X J9 ACAD MED JI Acad. Med. PD AUG PY 2013 VL 88 IS 8 BP 1081 EP 1087 DI 10.1097/ACM.0b013e318299f5cf PG 7 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA 235FO UT WOS:000325702400020 PM 23807100 ER PT J AU Wei, II Lloyd, JT Shrank, WH AF Wei, Iris I. Lloyd, Jennifer T. Shrank, William H. TI The Relationship Between the Low-Income Subsidy and Cost-Related Nonadherence to Drug Therapies in Medicare Part D SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE cost and adherence to medication; Part D drug benefit; low-income subsidy; autoenrollment; Medicare CAHPS survey ID HEALTH; ADHERENCE; SENIORS; IMPLEMENTATION; BENEFICIARIES; MEDICATIONS; DISPARITIES; COVERAGE; BENEFITS; BURDEN AB OBJECTIVES: To examine the relationship between receiving the Medicare Part D low-income subsidy (LIS) and cost-related medication nonadherence (CRN). DESIGN: Cross-sectional. SETTING: Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collected in spring 2007. PARTICIPANTS: Part D-enrolled Medicare beneficiaries who responded to the CAHPS survey. MEASUREMENTS: Respondents were categorized into three LIS groups: deemed LIS (Medicare and Medicaid dual-eligible and individuals receiving Supplemental Security Income), LIS applicants (other low-income individuals who applied for and received LIS), and non-LIS. Adjusted logistic models were used to assess the likelihood of CRN according to LIS status. Sample weights were applied in all analyses to account for complex sampling design. RESULTS: Of 171,573 Part D-enrolled respondents (weighted N = 14,572,827; response rate 48%), 17.2% reported CRN. Specifically, 14.7% of non-LIS respondents, 22.2% of deemed-LIS respondents, and 24.0% of LIS applicants reported CRN. LIS groups had higher unadjusted odds of CRN than the non-LIS respondents, but fully adjusted odds of CRN were lower in the deemed-LIS (adjusted odds ratio = 0.66, 95% confidence interval = 0.59, 0.74) than the LIS applicants or the non-LIS respondents. Subgroup analyses revealed that sociodemographic and health-related characteristics were associated with higher CRN in all three groups. CONCLUSION: The lower adjusted odds of CRN in deemed-LIS is reassuring, suggesting that autoenrollment provides meaningful assistance in removing cost-related barriers to medication use, but certain sociodemographic characteristics were associated with higher odds of CRN. Efforts to improving outreach to these subgroups and tracking of CRN are warranted. C1 [Wei, Iris I.; Lloyd, Jennifer T.; Shrank, William H.] Ctr Medicare & Medicaid Innovat, Ctr Medicare & Medicaid Serv, Res & Rapid Cycle Evaluat Grp, Baltimore, MD 21244 USA. RP Wei, II (reprint author), Ctr Medicare & Medicaid Innovat, Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mailstop WB-06-05, Baltimore, MD 21244 USA. EM wei.iris.999@gmail.com FU Aetna; CVS Caremark; Teva; Lilly; National Association of Chain Drug Stores FX WS has previously received unrestricted research funding from Aetna, CVS Caremark, Teva, Lilly, and the National Association of Chain Drug Stores. NR 27 TC 8 Z9 8 U1 1 U2 5 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD AUG PY 2013 VL 61 IS 8 BP 1315 EP 1323 DI 10.1111/jgs.12364 PG 9 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 198ZY UT WOS:000322964500009 PM 23889465 ER PT J AU Rajkumar, R Kesselheim, AS AF Rajkumar, Rahul Kesselheim, Aaron S. TI Balancing Access and Innovation India's Supreme Court Rules on Imatinib SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Rajkumar, Rahul] US Dept HHS, Ctr Medicare Serv, Baltimore, MD USA. [Rajkumar, Rahul] US Dept HHS, Ctr Medicaid Serv, Baltimore, MD USA. [Kesselheim, Aaron S.] Brigham & Womens Hosp, Dept Med, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02115 USA. [Kesselheim, Aaron S.] Harvard Univ, Sch Med, Boston, MA 02120 USA. RP Kesselheim, AS (reprint author), Harvard Univ, Sch Med, Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon,Dept Med, 1620 Tremont St,Ste 3030, Boston, MA 02120 USA. EM akesselheim@partners.org FU AHRQ HHS [K08HS18465-01] NR 7 TC 1 Z9 1 U1 0 U2 6 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 17 PY 2013 VL 310 IS 3 BP 263 EP 264 DI 10.1001/jama.2013.7336 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 183RU UT WOS:000321835700010 PM 23824051 ER PT J AU Lawson, EH Hall, BL Louie, R Ettner, SL Zingmond, DS Han, L Rapp, M Ko, CY AF Lawson, Elise H. Hall, Bruce Lee Louie, Rachel Ettner, Susan L. Zingmond, David S. Han, Lein Rapp, Michael Ko, Clifford Y. TI Association Between Occurrence of a Postoperative Complication and Readmission Implications for Quality Improvement and Cost Savings SO ANNALS OF SURGERY LA English DT Article DE complications; cost savings; postoperative; quality improvement; readmission ID PROFILING HOSPITAL PERFORMANCE; COLORECTAL SURGERY; HEART-FAILURE; RISK-FACTORS; CLAIMS DATA; CANCER; RATES; DISCHARGE; REGISTRY; PROGRAM AB Objective: To estimate the effect of preventing postoperative complications on readmission rates and costs. Background: Policymakers are targeting readmission for quality improvement and cost savings. Little is known regarding mutable factors associated with postoperative readmissions. Methods: Patient records (2005-2008) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient claims. Risk factors, procedure, and 30-day postoperative complications were determined from ACS-NSQIP. The 30-day postoperative readmission and costs were determined from Medicare. Occurrence of a postoperative complication included surgical site infections and cardiac, pulmonary, neurologic, and renal complications. Multivariate regression models predicted the effect of reducing complication rates on risk-adjusted readmission rates and costs by procedure. Results: The 30-day postoperative readmission rate was 12.8%. Complication rates for readmitted and nonreadmitted patients were 53% and 16% (P < 0.001). Patients with a postoperative complication had higher predicted probability of readmission and cost of readmission than patients without a complication. For the 20 procedures accounting for the greatest number of readmissions, reducing ACS-NSQIP complication rates by a relative 5% could result in prevention of 2092 readmissions per year and a savings to Medicare of $31.0 million per year. Preventing all ACS-NSQIP complications for these procedures could result in prevention of 41,846 readmissions per year and a savings of $620.3 million per year. Conclusions: This study provides substantial evidence that efforts to reduce postoperative readmissions should begin by focusing on postoperative complications that can be reliably and validly measured. Such an approach will not eliminate all postoperative readmissions but will likely have a major effect on readmission rates. C1 [Lawson, Elise H.; Ko, Clifford Y.] Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, Los Angeles, CA 90095 USA. [Louie, Rachel; Ettner, Susan L.; Zingmond, David S.] Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90095 USA. [Lawson, Elise H.; Hall, Bruce Lee; Ko, Clifford Y.] Amer Coll Surg, Div Res & Optimal Patient Care, Chicago, IL USA. [Lawson, Elise H.; Ko, Clifford Y.] VA Greater Los Angeles Healthcare Syst, Los Angeles, CA USA. [Hall, Bruce Lee] Washington Univ, Sch Med, Dept Surg, St Louis, MO 63110 USA. [Hall, Bruce Lee] Barnes Jewish Hosp, St Louis, MO 63110 USA. [Hall, Bruce Lee] Washington Univ, Ctr Hlth Policy, St Louis, MO USA. [Hall, Bruce Lee] Washington Univ, Olin Business Sch, St Louis, MO USA. [Hall, Bruce Lee] John Cochran Vet Affairs Med Ctr, Dept Surg, St Louis, MO USA. [Han, Lein; Rapp, Michael] Ctr Medicare Serv, Baltimore, MD USA. [Han, Lein; Rapp, Michael] Ctr Medicaid Serv, Baltimore, MD USA. [Rapp, Michael] George Washington Univ, Sch Med & Hlth Sci, Dept Emergency Med, Washington, DC 20052 USA. RP Lawson, EH (reprint author), Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, 10833 Le Conte Ave,72-215 CHS, Los Angeles, CA 90095 USA. EM elawson@mednet.ucla.edu FU VA Health Services Research and Development program [RWJ 65-020]; American College of Surgeons through the Robert Wood Johnson Foundation Clinical Scholars Program; CMS FX E.H.L.'s time was supported by the VA Health Services Research and Development program (RWJ 65-020) and the American College of Surgeons through the Robert Wood Johnson Foundation Clinical Scholars Program. This study was partially funded by a contract from the CMS. For the remaining authors, none were declared. The views expressed in this article represent the authors' views and do not necessarily represent official policy or opinions of the Department of Health and Human Services, the CMS. The authors declare no conflicts of interest. NR 27 TC 91 Z9 91 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-4932 EI 1528-1140 J9 ANN SURG JI Ann. Surg. PD JUL PY 2013 VL 258 IS 1 BP 10 EP 18 DI 10.1097/SLA.0b013e31828e3ac3 PG 9 WC Surgery SC Surgery GA 300JO UT WOS:000330460400011 PM 23579579 ER PT J AU Gupta, N Cannon, M Srinivasan, A AF Gupta, Neil Cannon, Marjory Srinivasan, Arjun CA Working Grp Fed Steering Comm TI National Agenda for Prevention of Healthcare-Associated Infections in Dialysis Centers SO SEMINARS IN DIALYSIS LA English DT Article ID BLOOD-STREAM INFECTIONS; OUTPATIENT HEMODIALYSIS CENTER; UNITED-STATES; SURVEILLANCE; OUTBREAK AB Healthcare-associated infections (HAIs) are among the leading causes of morbidity and mortality in dialysis patients. To coordinate HAI prevention efforts, the U.S. Department of Health and Human Services established the National Action Plan to Prevent Healthcare Associated Infections in End-Stage Renal Disease Facilities. This comprehensive plan prioritizes HAI prevention practices and 5-year evaluation targets based on the burden of disease, level of scientific evidence, and anticipated impact from the recommended intervention. As such, the Plan focuses primarily on interventions to reduce vascular access-related complications and infections with hepatitis B and hepatitis C virus. Over the last decade, there have been several efforts to expand HAI surveillance and prevention efforts, including coordination of HAI reporting metrics across multiple national agencies, changes in financial incentives by the Centers for Medicare & Medicaid Services (CMS), and federal funding for expansion of state-based HAI prevention programs. As a result, a paradigm shift in HAI prevention has developed. Public health officials have assumed greater responsibility in reducing the burden of HAIs and healthcare providers have become more involved in HAI prevention. Since the Plan was initially drafted, several collaborative efforts in dialysis facilities have reported a reduction in HAIs through implementation of these interventions. These early successes highlight the potential impact of coordinated action to combat HAIs in dialysis settings and this National Action Plan provides evidence-based strategies on how best to achieve this. C1 [Gupta, Neil] Ctr Dis Control & Prevent, Epidem Intelligence Serv, Atlanta, GA USA. [Gupta, Neil; Srinivasan, Arjun] Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Atlanta, GA USA. [Cannon, Marjory] Ctr Medicare Serv, Qual Improvement Grp Ctr Clin Stand & Qual, Baltimore, MD USA. [Cannon, Marjory] Ctr Medicaid Serv, Qual Improvement Grp Ctr Clin Stand & Qual, Baltimore, MD USA. RP Gupta, N (reprint author), 1600 Clifton Rd NE,MS E-92, Atlanta, GA 30333 USA. EM NGupta1@cdc.gov NR 29 TC 2 Z9 2 U1 1 U2 5 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0894-0959 J9 SEMIN DIALYSIS JI Semin. Dial. PD JUL PY 2013 VL 26 IS 4 BP 376 EP 383 DI 10.1111/sdi.12091 PG 8 WC Urology & Nephrology SC Urology & Nephrology GA 184LV UT WOS:000321892200004 PM 23682791 ER PT J AU Pradhan, R Weech-Maldonado, R Harman, JS Laberge, A Hyer, K AF Pradhan, Rohit Weech-Maldonado, Robert Harman, Jeffrey S. Laberge, Alex Hyer, Kathryn TI Private equity ownership and nursing home financial performance SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article DE financial performance; nursing homes; private equity ID FREE CASH FLOW; LEVERAGED BUYOUTS; AGENCY COSTS; CARE; QUALITY; REIMBURSEMENT AB Background: Private equity has acquired multiple large nursing home chains within the last few years; by 2009, it owned nearly 1,900 nursing homes. Private equity is said to improve the financial performance of acquired facilities. However, no study has yet examined the financial performance of private equity nursing homes, ergo this study. Purpose: The primary purpose of this study is to understand the financial performance of private equity nursing homes and how it compares with other investor-owned facilities. It also seeks to understand the approach favored by private equity to improve financial performancefor instance, whether they prefer to cut costs or maximize revenues or follow a mixed approach. Methodology/Approach: Secondary data from Medicare cost reports, the Online Survey, Certification and Reporting, Area Resource File, and Brown University's Long-term Care Focus data set are combined to construct a longitudinal data set for the study period 2000-2007. The final sample is 2,822 observations after eliminating all not-for-profit, independent, and hospital-based facilities. Dependent financial variables consist of operating revenues and costs, operating and total margins, payer mix (census Medicare, census Medicaid, census other), and acuity index. Independent variables primarily reflect private equity ownership. The study was analyzed using ordinary least squares, gamma distribution with log link, logit with binomial family link, and logistic regression. Findings: Private equity nursing homes have higher operating margin as well as total margin; they also report higher operating revenues and costs. No significant differences in payer mix are noted. Practice Implications: Results suggest that private equity delivers superior financial performance compared with other investor-owned nursing homes. However, causes for concern remain particularly with the long-term financial sustainability of these facilities. C1 [Pradhan, Rohit; Weech-Maldonado, Robert] Univ Alabama Birmingham, Dept Hlth Serv Adm, Birmingham, AL 35294 USA. [Harman, Jeffrey S.] Univ Florida, Dept Hlth Serv Res, Gainesville, FL USA. [Laberge, Alex] Ctr Medicare & Medicaid Serv, Woodlawn, MA USA. [Hyer, Kathryn] Univ S Florida, Sch Aging Studies, Tampa, FL USA. RP Pradhan, R (reprint author), Univ Alabama Birmingham, Dept Hlth Serv Adm, Birmingham, AL 35294 USA. EM rpradhan@uab.edu; rweech@uab.edu; jharman@phhp.ufl.edu; alexandre.laberge@cms.hhs.gov; khyer@cas.usf.edu NR 39 TC 1 Z9 1 U1 0 U2 7 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0361-6274 J9 HEALTH CARE MANAGE R JI Health Care Manage. Rev. PD JUL-SEP PY 2013 VL 38 IS 3 BP 224 EP 233 DI 10.1097/HMR.0b013e31825729ab PG 10 WC Health Policy & Services SC Health Care Sciences & Services GA 168IF UT WOS:000320698400005 PM 22609748 ER PT J AU Conway, PH Mostashari, F Clancy, C AF Conway, Patrick H. Mostashari, Farzad Clancy, Carolyn TI The Future of Quality Measurement for Improvement and Accountability SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Conway, Patrick H.; Mostashari, Farzad; Clancy, Carolyn] Dept Hlth & Human Serv, Washington, DC USA. [Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Mostashari, Farzad] Off Natl Coordinator Hlth Informat Technol, Washington, DC USA. [Clancy, Carolyn] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Conway, PH (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mailstop S3-02-01, Baltimore, MD 21244 USA. EM patrick.conway@cms.hhs.gov NR 5 TC 39 Z9 39 U1 1 U2 6 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 5 PY 2013 VL 309 IS 21 BP 2215 EP 2216 DI 10.1001/jama.2013.4929 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 156YC UT WOS:000319859200022 PM 23736730 ER PT J AU Lee, JS Nsa, W Hausmann, LR Trivedi, AN Bratzler, DW Auden, D Goodrich, K Larbi, FM Fine, MJ AF Lee, Jonathan S. Nsa, Wato Hausmann, Leslie R. Trivedi, Amal N. Bratzler, Dale W. Auden, Dana Goodrich, Kate Larbi, Fiona M. Fine, Michael J. TI NATIONAL TRENDS IN PROCESSES AND OUTCOMES OF CARE FOR ELDERLY PATIENTS HOSPITALIZED FOR PNEUMONIA SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 36th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 24-27, 2013 CL Denver, CO SP Soc Gen Internal Med C1 [Lee, Jonathan S.; Hausmann, Leslie R.; Fine, Michael J.] Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA. [Nsa, Wato; Auden, Dana] Oklahoma Fdn Med Qual, Oklahoma City, OK USA. [Hausmann, Leslie R.; Fine, Michael J.] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA. [Trivedi, Amal N.] Brown Univ, Alpert Med Sch, Providence, RI 02912 USA. [Bratzler, Dale W.] Univ Oklahoma, Hlth Sci Ctr, Oklahoma City, OK USA. [Goodrich, Kate; Larbi, Fiona M.] 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 ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2013 VL 28 SU 1 BP S126 EP S127 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA AB6ZP UT WOS:000331939301062 ER PT J AU Lee, JS Nsa, W Hausmann, LR Trivedi, AN Bratzler, DW Auden, D Goodrich, K Larbi, FM Fine, MJ AF Lee, Jonathan S. Nsa, Wato Hausmann, Leslie R. Trivedi, Amal N. Bratzler, Dale W. Auden, Dana Goodrich, Kate Larbi, Fiona M. Fine, Michael J. TI ASSOCIATIONS BETWEEN PROCESSES OF CARE AND MORTALITY IN A NATIONAL COHORT OF ELDERLY PATIENTS HOSPITALIZED FOR PNEUMONIA SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 36th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 24-27, 2013 CL Denver, CO SP Soc Gen Internal Med C1 [Lee, Jonathan S.; Hausmann, Leslie R.; Fine, Michael J.] Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA. [Nsa, Wato; Auden, Dana] Univ Pittsburgh, Med Ctr, Oklahoma City, OK USA. [Hausmann, Leslie R.; Fine, Michael J.] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA. [Trivedi, Amal N.] Brown Univ, Alpert Med Sch, Providence, RI 02912 USA. [Bratzler, Dale W.] Univ Oklahoma, Hlth Sci Ctr, Oklahoma City, OK USA. [Goodrich, Kate; Larbi, Fiona M.] 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 ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2013 VL 28 SU 1 BP S28 EP S28 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA AB6ZP UT WOS:000331939300067 ER PT J AU Trivedi, AN Nsa, W Hausmann, LR Lee, JS Ma, A Bratzler, DW Goodrich, K Larbi, FM Fine, MJ AF Trivedi, Amal N. Nsa, Wato Hausmann, Leslie R. Lee, Jonathan S. Ma, Allen Bratzler, Dale W. Goodrich, Kate Larbi, Fiona M. Fine, Michael J. TI TRENDS IN THE QUALITY OF CARE AND RACIAL/ETHNIC DISPARITIES IN US HOSPITALS, 2005-2010 SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract CT 36th Annual Meeting of the Society-of-General-Internal-Medicine CY APR 24-27, 2013 CL Denver, CO SP Soc Gen Internal Med C1 [Trivedi, Amal N.] Providence VA Med Ctr, Providence, RI USA. [Trivedi, Amal N.] Brown Univ, Alpert Med Sch, Providence, RI 02912 USA. [Nsa, Wato; Ma, Allen; Bratzler, Dale W.] Oklahoma Fdn Med Qual, Oklahoma City, OK USA. [Fine, Michael J.] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA. [Hausmann, Leslie R.; Lee, Jonathan S.; Goodrich, Kate; Larbi, Fiona M.] Ctr Medicare Serv, Baltimore, MD USA. [Hausmann, Leslie R.; Lee, Jonathan S.; Goodrich, Kate; Larbi, Fiona M.] Ctr Medicaid Serv, Baltimore, MD 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 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUN PY 2013 VL 28 SU 1 BP S228 EP S228 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA AB6ZP UT WOS:000331939301298 ER PT J AU Clark, NM Lachance, LL Benedict, MB Doctor, LJ Gilmore, L Kelly, CS Krieger, J Lara, M Meurer, J Milanovich, AF Nicholas, E Song, PXK Rosenthal, M Stoll, SC Awad, DF Wilkin, M AF Clark, Noreen M. Lachance, Laurie L. Benedict, M. Beth Doctor, Linda Jo Gilmore, Lisa Kelly, Cynthia S. Krieger, James Lara, Marielena Meurer, John Milanovich, Amy Friedman Nicholas, Elisa Song, Peter X. K. Rosenthal, Michael Stoll, Shelley C. Awad, Daniel F. Wilkin, Margaret TI Improvements in Health Care Use Associated With Community Coalitions: Long-Term Results of the Allies Against Asthma Initiative SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID UNITED-STATES; CHILDREN; OUTCOMES; POLICY AB Objectives. We assessed changes in asthma-related health care use by low-income children in communities across the country where 6 Allies Against Asthma coalitions (Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA) mobilized stakeholders to bring about policy changes conducive to asthma control. Methods. Allies intervention zip codes were matched with comparison communities by median household income, asthma prevalence, total population size, and race/ethnicity. Five years of data provided by the Center for Medicare and Medicaid Services on hospitalizations, emergency department (ED) use, and physician urgent care visits for children were analyzed. Intervention and comparison sites were compared with a stratified recurrent event analysis using a Cox proportional hazard model. Results. In most of the assessment years, children in Allies communities were significantly less likely (P < .04) to have an asthma-related hospitalization, ED visit, or urgent care visit than children in comparison communities. During the entire period, children in Allies communities were significantly less likely (P < .02) to have such health care use. Conclusions. Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities. C1 [Clark, Noreen M.; Lachance, Laurie L.; Milanovich, Amy Friedman; Stoll, Shelley C.; Awad, Daniel F.; Wilkin, Margaret] Univ Michigan, Ctr Managing Chron Dis, Ann Arbor, MI 48109 USA. [Benedict, M. Beth] Ctr Medicare, Baltimore, MD USA. [Benedict, M. Beth] Ctr Medicaid Serv Hlth & Human Serv, Baltimore, MD USA. [Doctor, Linda Jo] WK Kellogg Fdn, Battle Creek, MI USA. [Gilmore, Lisa] DC Asthma Coalit, Washington, DC USA. [Kelly, Cynthia S.] Kings Daughters, Childrens Hosp, Eastern Virginia Med Sch, Norfolk, VA USA. [Krieger, James] Seattle & King Cty, Publ Hlth, Seattle, WA USA. [Krieger, James] Univ Washington, Sch Publ Hlth, Dept Hlth Serv, Seattle, WA 98195 USA. [Lara, Marielena] RAND Hlth, Santa Monica, CA USA. [Meurer, John] Med Coll Wisconsin, Milwaukee, WI 53226 USA. [Meurer, John] Childrens Hosp & Hlth Syst, Milwaukee, WI USA. [Nicholas, Elisa] Childrens Clin, Long Beach, CA USA. [Song, Peter X. K.] Univ Michigan, Dept Biostat, Ann Arbor, MI 48109 USA. [Rosenthal, Michael] Christiana Care Hlth Syst, Dept Family & Community Med, Wilmington, DE USA. RP Clark, NM (reprint author), Univ Michigan, Ctr Managing Chron Dis, 1415 Washington Hts, Ann Arbor, MI 48109 USA. EM nmclark@umich.edu FU Robert Wood Johnson Foundation; W.K. Kellogg Foundation FX This study was supported by multiple grants from the Robert Wood Johnson Foundation, and additional support was provided by the W.K. Kellogg Foundation. NR 12 TC 9 Z9 9 U1 0 U2 5 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 800 I STREET, NW, WASHINGTON, DC 20001-3710 USA SN 0090-0036 EI 1541-0048 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD JUN PY 2013 VL 103 IS 6 BP 1124 EP 1127 DI 10.2105/AJPH.2012.300983 PG 4 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA AA3FI UT WOS:000330977900047 PM 23597384 ER PT J AU Yang, YT Gimm, G AF Yang, Y. Tony Gimm, Gilbert TI Caring for Elder Parents: A Comparative Evaluation of Family Leave Laws SO JOURNAL OF LAW MEDICINE & ETHICS LA English DT Article ID MEDICAL LEAVE; CAREGIVERS; HEALTH; CARE; EMPLOYMENT; MEMBERS AB As the baby boomer generation ages, the need for laws to enhance quality of life for the elderly and meet the increasing demand for family caregivers will continue to grow. This paper reviews the national family leave laws of nine major OECD countries (Canada, Denmark, France, Germany, Italy, Japan, Netherlands, Spain, and the United Kingdom) and provides a state-by-state analysis within the U.S. We find that the U.S. has the least generous family leave laws among the nine OECD countries. With the exception of two states (California and New Jersey), the U.S. federal Family Medical Leave Act of 1993 provides no right to paid family leave for eldercare. We survey the current evidence from the literature on how paid leave can impact family caregivers' employment and health outcomes, gender equality, and economic arguments for and against such laws. We argue that a generous and flexible family leave law, financed through social insurance, would not only be equitable, but also financially sustainable. C1 [Yang, Y. Tony; Gimm, Gilbert] George Mason Univ, Dept Hlth Adm & Policy, Coll Hlth & Human Serv, Fairfax, VA 22030 USA. [Gimm, Gilbert] Mathemat Policy Res, Ctr Medicare Serv, Washington, DC USA. [Gimm, Gilbert] Mathemat Policy Res, Ctr Medicaid Serv, Washington, DC USA. RP Yang, YT (reprint author), George Mason Univ, Dept Hlth Adm & Policy, Coll Hlth & Human Serv, Fairfax, VA 22030 USA. FU Borchard Foundation FX This paper is supported by a grant from the Borchard Foundation. NR 34 TC 6 Z9 6 U1 2 U2 22 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1073-1105 J9 J LAW MED ETHICS JI J. Law Med. Ethics PD SUM PY 2013 VL 41 IS 2 SI SI BP 501 EP 513 DI 10.1111/jlme.12058 PG 13 WC Ethics; Law; Medical Ethics; Medicine, Legal SC Social Sciences - Other Topics; Government & Law; Medical Ethics; Legal Medicine GA 171MR UT WOS:000320934000010 PM 23802900 ER PT J AU Miles, PV Conway, PH Pawlson, G AF Miles, Paul V. Conway, Patrick H. Pawlson, Gregory TI Physician Professionalism and Accountability: The Role of Collaborative Improvement Networks SO PEDIATRICS LA English DT Article DE physician professionalism; maintenance of certification; collaborative improvement networks ID QUALITY; CARE AB The medical profession is facing an imperative to deliver more patient-centered care, improve quality, and reduce unnecessary costs and waste. With significant unexplained variation in resource use and outcomes, even physicians and health care organizations with "the best" reputations cannot assume they always deliver the best care possible. Going forward, physicians will need to demonstrate professionalism and accountability in a different way: to their peers, to society in general, and to individual patients. The new accountability includes quality and clinical outcomes but also resource utilization, appropriateness and patient-centeredness of recommended care, and the responsibility to help improve systems of care. The pediatric collaborative improvement network model represents an important framework for helping transform health care. For individual physicians, participation in a multisite network offers the opportunity to demonstrate accountability by measuring and improving care as part of an approach that addresses the problems of small sample size, attribution, and unnecessary variation in care by pooling patients from individual practices and requiring standardization of care to participate. For patients and families, the model helps ensure that they are likely to receive the current best evidence-based recommendation. Finally, this model aligns with payers' goals of purchasing value-based care, rewarding quality and improvement, and reducing unnecessary variation around current best evidenced-based, effective, and efficient care. In addition, within the profession, the American Board of Pediatrics recognizes participation in a multisite quality improvement network as one of the most rigorous and meaningful approaches for a diplomate to meet practice performance maintenance of certification requirements. C1 [Miles, Paul V.] Amer Board Pediat Inc, Chapel Hill, NC 27514 USA. [Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Washington, DC USA. [Pawlson, Gregory] Stevens & Lee, Lancaster, PA USA. RP Miles, PV (reprint author), Amer Board Pediat Inc, 111 Silver Cedar Court, Chapel Hill, NC 27514 USA. EM pvm@abpeds.org FU American Board of Pediatrics Foundation; Children's Hospital Association; James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center; pediatric Center for Education and Research on Therapeutics; Agency for Healthcare Research and Quality [U19HS021114] FX The conference on which the articles in this supplement were based was funded by the American Board of Pediatrics Foundation, the National Association of Children's Hospitals and Related Institutions (now the Children's Hospital Association), the James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center, and the pediatric Center for Education and Research on Therapeutics, supported by cooperative agreement U19HS021114 from the Agency for Healthcare Research and Quality. NR 10 TC 3 Z9 3 U1 0 U2 10 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 JUN PY 2013 VL 131 SU 4 BP S204 EP S209 DI 10.1542/peds.2012-3786G PG 6 WC Pediatrics SC Pediatrics GA 181NR UT WOS:000321674900004 PM 23729761 ER PT J AU Dembosky, JW Haviland, AM Elliott, MN Kallaur, P Edwards, CA Sekscenski, E Zaslavsky, AM Brown, JA AF Dembosky, Jacob W. Haviland, Amelia M. Elliott, Marc N. Kallaur, Paul Edwards, Carol A. Sekscenski, Edward Zaslavsky, Alan M. Brown, Julie A. TI DOES NAMING THE FOCAL PLAN IN A CAHPS SURVEY OF HEALTH CARE QUALITY AFFECT RESPONSE RATES AND BENEFICIARY EVALUATIONS? SO PUBLIC OPINION QUARTERLY LA English DT Article ID SURVEY PARTICIPATION; MEDICARE BENEFICIARIES; MAILED QUESTIONNAIRES; PATIENT RESPONSES; NONRESPONSE; RELIABILITY; KNOWLEDGE; CHOICES; SCORES; BIAS AB The recently enacted Patient Protection and Affordable Care Act makes collecting information on patients' health care experiences a national priority. The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey is the largest survey of Medicare beneficiaries about their care experiences. Each year, a nationally representative random sample of beneficiaries enrolled in Medicare Advantage plans receive a mail survey, followed by a telephone follow-up of nonrespondents. The mail survey lists the respondent's plan name at the beginning and repeats the plan name in several of the questions. However, some beneficiaries may not recognize their plan name, potentially affecting their level of engagement with the survey and, in turn, unit and item response rates. An alternative approach is to use a generic survey in which the plan name appears only once, on the back of the survey booklet. This manuscript reports the results of a 2010 experiment in which a random subsample of beneficiaries were mailed a generic survey. Differences in unit and item response rates, as well as evaluations of care experiences, between beneficiaries who received a generic survey and those who received a customized survey were compared. The use of a generic survey did not appear to affect either unit or item response rates, and did not appear to affect the ways in which beneficiaries evaluate various aspects of their care experiences. These results suggest that generic mail surveys may be preferable to customized surveys, especially since they entail lower printing and mailing costs. C1 [Dembosky, Jacob W.; Haviland, Amelia M.; Elliott, Marc N.; Edwards, Carol A.; Brown, Julie A.] RAND Corp, Santa Monica, CA 90407 USA. [Haviland, Amelia M.] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA. [Kallaur, Paul] Ctr Studies Serv, Washington, DC USA. [Sekscenski, Edward] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Zaslavsky, Alan M.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St, Santa Monica, CA 90407 USA. EM Elliott@rand.org NR 31 TC 0 Z9 0 U1 0 U2 2 PU OXFORD UNIV PRESS PI OXFORD PA GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND SN 0033-362X EI 1537-5331 J9 PUBLIC OPIN QUART JI Public Opin. Q. PD SUM PY 2013 VL 77 IS 2 BP 455 EP 473 DI 10.1093/poq/nft011 PG 19 WC Communication; Political Science; Social Sciences, Interdisciplinary SC Communication; Government & Law; Social Sciences - Other Topics GA 173CK UT WOS:000321055500002 ER PT J AU Bensley, RP Schermerhorn, ML Hurks, R Sachs, T Boyd, CA O'Malley, AJ Cotterill, P Landon, BE AF Bensley, Rodney P. Schermerhorn, Marc L. Hurks, Rob Sachs, Teviah Boyd, Christopher A. O'Malley, A. James Cotterill, Philip Landon, Bruce E. TI Risk of Late-Onset Adhesions and Incisional Hernia Repairs after Surgery SO JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS LA English DT Article ID AORTIC-ANEURYSM; READMISSIONS; OBSTRUCTION; POPULATION; RECURRENCE; MORTALITY AB BACKGROUND: Long-term adhesion-related complications and incisional hernias after abdominal surgery are common and costly. There are few data on the risk of these complications after different abdominal operations. STUDY DESIGN: We identified Medicare beneficiaries who underwent endovascular repair of an abdominal aortic aneurysm from 2001-2008 who presumably are not at risk for laparotomy-related complications. We identified all laparoscopic and open operations involving the abdomen, pelvis, or retroperitoneum and categorized them into 5 groups according to invasiveness. We then identified laparotomy-related complications for up to 5 years after the index operation and compared these with the baseline rate of complications in a control group of patients who did not undergo an abdominal operation. RESULTS: We studied 85,663 patients, 7,513 (8.8%) of which underwent a laparotomy, including 2,783 major abdominal operations, 709 minor abdominal operations, 963 ventral hernia repairs, 493 retroperitoneal/pelvic operations, and 2,565 laparoscopic operations. Mean age was 76.7 years and 82.0% were male. Major abdominal operations carried the highest risk for adhesion-related complications (14.3% and 25.0% at 2 and 5 years compared with 4.0% and 7.8% for the control group; p < 0.001) and incisional hernias (7.8% and 12.0% compared with 0.6% and 1.2% for the control group; p < 0.001). Laparoscopic operations (4.6% and 10.7% for adhesions, 1.9% and 3.2% for incisional hernias) carried the lowest risk. CONCLUSIONS: Late-onset laparotomy-related complications are frequent and their risk extends through 5 years beyond the perioperative period. With the advancement and expansion of laparoscopic techniques and its attendant lower risk for long-term complications, these results can alter the risk-to-benefit profile of various types of abdominal operations and can also strengthen the rationale for additional development of laparoscopic approaches to abdominal operations. (J Am Coll Surg 2013; 216: 1159-1167. (C) 2013 by the American College of Surgeons) C1 [Bensley, Rodney P.; Schermerhorn, Marc L.; Hurks, Rob; Sachs, Teviah; Boyd, Christopher A.] Beth Israel Deaconess Med Ctr, Dept 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 Serv, Baltimore, MD USA. [Cotterill, Philip] Ctr Medicaid Serv, Baltimore, MD USA. RP Schermerhorn, ML (reprint author), Beth Israel Deconess Med Ctr, Dept Surg, 110 Francis St,Suite 5B, Boston, MA 02215 USA. EM mscherm@bidmc.harvard.edu FU NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant [HL007734]; NIH [1RC4MH092717-01] FX This work was supported by the NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant HL007734 and NIH grant 1RC4MH092717-01 for comparative effectiveness research. NR 16 TC 15 Z9 15 U1 0 U2 3 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1072-7515 J9 J AM COLL SURGEONS JI J. Am. Coll. Surg. PD JUN PY 2013 VL 216 IS 6 BP 1159 EP + DI 10.1016/j.jamcollsurg.2013.01.060 PG 21 WC Surgery SC Surgery GA 145TG UT WOS:000319039900017 PM 23623220 ER PT J AU Mintz, P Menis, M McKean, S Izurieta, HS Ovanesov, MV Liang, Y Gondalia, R Warnock, R Johnson, C Worrall, CM MaCurdy, TE Kelman, J AF Mintz, P. Menis, M. McKean, S. Izurieta, H. S. Ovanesov, M., V Liang, Y. Gondalia, R. Warnock, R. Johnson, C. Worrall, C. M. MaCurdy, T. E. Kelman, J. TI THROMBOTIC EVENT OCCURRENCE AMONG THE ELDERLY US MEDICARE BENEFICIARIES TRANSFUSED IN THE INPATIENT SETTING, AS RECORDED IN LARGE ADMINISTRATIVE DATABASES DURING 2007-2011 SO VOX SANGUINIS LA English DT Meeting Abstract C1 [Mintz, P.; Menis, M.; Izurieta, H. S.; Ovanesov, M., V; Liang, Y.] US FDA, Rockville, MD 20857 USA. [McKean, S.; Gondalia, R.; Warnock, R.; Johnson, C.; MaCurdy, T. E.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0042-9007 J9 VOX SANG JI Vox Sang. PD JUN PY 2013 VL 105 SU 1 SI SI BP 275 EP 275 PG 1 WC Hematology SC Hematology GA 148FH UT WOS:000319228100746 ER PT J AU Loring, Z Canos, DA Selzman, K Herz, ND Silverman, H MaCurdy, TE Worrall, CM Kelman, J Ritchey, ME Pina, IL Strauss, DG AF Loring, Zak Canos, Daniel A. Selzman, Kimberly Herz, Naomi D. Silverman, Henry MaCurdy, Thomas E. Worrall, Christopher M. Kelman, Jeffrey Ritchey, Mary E. Pina, Ileana L. Strauss, David G. TI Left Bundle Branch Block Predicts Better Survival in Women Than Men Receiving Cardiac Resynchronization Therapy Long-Term Follow-Up of similar to 145,000 Patients SO JACC-HEART FAILURE LA English DT Article DE cardiac resynchronization therapy; left bundle branch block; sex AB Objectives The goal of this study was to test the hypothesis that in recipients of cardiac resynchronization therapy defibrillators (CRT-D), conventional left bundle branch block (LBBB) diagnosis predicts better survival in women than in men. Background New York Heart Association class I and II patients without LBBB do not benefit from CRT-D, and women have better survival after CRT-D than men. Separate analysis suggests that QRS duration thresholds for LBBB diagnosis differ according to sex, and conventional LBBB electrocardiographic criteria are falsely positive in men more frequently than in women. Methods We analyzed Medicare records from 144,642 CRT-D recipients between 2002 and 2008 that were followed up for up to 90 months. Medicare billing data were used to determine age, sex, race, and comorbidities. Hazard ratios (HRs) were calculated to assess if conventional LBBB diagnosis had different prognostic significance according to sex. Results In univariate analysis, LBBB was associated with a 31% reduction in death in women (HR: 0.69 [95% confidence interval (CI): 0.67 to 0.71]) but only a 16% reduction in death in men (HR: 0.84 [95% CI: 0.82 to 0.85]). In multivariable analyses controlling for comorbidities, LBBB was associated with a 26% reduction in death in women (HR: 0.74 [95% CI: 0.71 to 0.77]) and a 15% reduction in death in men (HR: 0.85 [95% CI: 0.83 to 0.87]). A significant interaction (p < 0.0001) between sex and LBBB was seen. Conclusions LBBB diagnosis is associated with greater survival in women than in men receiving CRT-D, and this discrepancy is not explained by differences in measured comorbidities. Possible explanations for this difference include that LBBB may have different prognostic significance according to sex or that LBBB diagnosis is more often false-positive in men compared with women. (c) 2013 by the American College of Cardiology Foundation C1 [Loring, Zak; Canos, Daniel A.; Selzman, Kimberly; Herz, Naomi D.; Ritchey, Mary E.; Pina, Ileana L.; Strauss, David G.] US FDA, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [Loring, Zak] Duke Univ, Sch Med, Durham, NC USA. [Selzman, Kimberly] Univ Utah, Dept Internal Med, Sch Med, Div Cardiol, Salt Lake City, UT 84112 USA. [Silverman, Henry; MaCurdy, Thomas E.] Acumen LLC, SafeRx, Burlingame, CA USA. [Worrall, Christopher M.; Kelman, Jeffrey] Ctr Med Serv, Baltimore, MD USA. [Worrall, Christopher M.; Kelman, Jeffrey] Ctr Medicaid Serv, Baltimore, MD USA. [Pina, Ileana L.] Albert Einstein Coll Med, Div Cardiol, Bronx, NY 10467 USA. RP Strauss, DG (reprint author), Ctr Devices & Radiol Hlth, 10903 New Hampshire Ave,WO 62-1126, Silver Spring, MD 20993 USA. EM david.strauss@fda.hhs.gov NR 29 TC 14 Z9 14 U1 0 U2 0 PU ELSEVIER SCI LTD PI OXFORD PA THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, OXON, ENGLAND SN 2213-1779 EI 2213-1787 J9 JACC-HEART FAIL JI JACC-Heart Fail. PD JUN PY 2013 VL 1 IS 3 BP 237 EP 244 DI 10.1016/j.jchf.2013.03.005 PG 8 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA V41GU UT WOS:000209535500009 PM 24621876 ER PT J AU Agrawal, S Brennan, N Budetti, P AF Agrawal, Shantanu Brennan, Niall Budetti, Peter TI The Sunshine Act - Effects on Physicians SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Agrawal, Shantanu; Budetti, Peter] Ctr Medicare & Medicaid Serv, Ctr Program Integr, Baltimore, MD USA. [Brennan, Niall] Ctr Medicare & Medicaid Serv, Off Informat Prod & Data Analyt, Baltimore, MD USA. RP Agrawal, S (reprint author), Ctr Medicare & Medicaid Serv, Ctr Program Integr, Baltimore, MD USA. NR 5 TC 47 Z9 47 U1 0 U2 1 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD MAY 30 PY 2013 VL 368 IS 22 BP 2054 EP 2057 DI 10.1056/NEJMp1303523 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 153AT UT WOS:000319574200003 PM 23718163 ER PT J AU Koh, H Tavenner, M AF Koh, Howard Tavenner, Marilyn TI Connecting to Health Insurance Coverage SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID AFFORDABLE CARE ACT C1 [Koh, Howard] US Dept HHS, Washington, DC 20201 USA. [Tavenner, Marilyn] US Dept HHS, Ctr Medicare Serv, Washington, DC 20201 USA. [Tavenner, Marilyn] US Dept HHS, Ctr Medicaid Serv, Washington, DC 20201 USA. RP Koh, H (reprint author), US Dept HHS, 200 Independence Ave SW,Ste 716-G, Washington, DC 20201 USA. EM howard.koh@hhs.gov NR 5 TC 4 Z9 4 U1 0 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 8 PY 2013 VL 309 IS 18 BP 1893 EP 1894 DI 10.1001/jama.2013.3469 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 138AZ UT WOS:000318481900020 PM 23588385 ER PT J AU Clemans-Cope, L Long, SK Coughlin, TA Yemane, A Resnick, D AF Clemans-Cope, Lisa Long, Sharon K. Coughlin, Teresa A. Yemane, Alshadye Resnick, Dean TI The Expansion of Medicaid Coverage under the ACA: Implications for Health Care Access, Use, and Spending for Vulnerable Low-income Adults SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article DE Medicaid; uninusured; access to care; health care use; health care spending; vulnerable adults ID MENTAL-HEALTH; INSURANCE; EXPENDITURES; SERVICES; COST AB The expansion of Medicaid coverage under the Affordable Care Act offers the potential for significant increases in health care access, use, and spending for vulnerable nonelderly adults who are uninsured. Using pooled data from the Medical Expenditure Panel Survey, this study estimates the potential effects of Medicaid, controlling for individual and local community characteristics. Our findings project significant gains in health care access and use for uninsured adults who enroll in Medicaid coverage and have chronic health conditions and mental health conditions. With that increased use, annual per capita health care spending for those newly insured individuals (excluding out-of-pocket spending) is projected to grow from $2,677 to $6,370 in 2013 dollars, while their out-of-pocket spending would drop by $921. It is expected that these increases in spending would be offset at least in part by reductions in uncompensated care and charity care. C1 [Clemans-Cope, Lisa; Long, Sharon K.; Coughlin, Teresa A.; Resnick, Dean] Urban Inst, Washington, DC 20037 USA. [Yemane, Alshadye] Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Clemans-Cope, L (reprint author), Urban Inst, Ctr Hlth Policy, 2100 M St NW, Washington, DC 20037 USA. EM LClemans@urban.org FU Kaiser Family Foundation's Commission on Medicaid and the Uninsured FX The author(s) received the following financial support for the research, authorship, and/or publication of this article: This research was completed as part of a project for the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. NR 28 TC 6 Z9 6 U1 1 U2 4 PU BLUE CROSS BLUE SHIELD ASSOC PI ROCHESTER PA 150 EAST MAIN ST, ROCHESTER, NY 14647 USA SN 0046-9580 EI 1945-7243 J9 INQUIRY-J HEALTH CAR JI Inquiry-J. Health Care Organ. Provis. Financ. PD MAY PY 2013 VL 50 IS 2 BP 135 EP 149 DI 10.1177/0046958013513675 PG 15 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 298OR UT WOS:000330334400005 PM 24574131 ER PT J AU Shoemaker, JS Davidoff, A Stuart, B Zuckerman, IH Onukwugha, E Powers, CA AF Shoemaker, J. S. Davidoff, A. Stuart, B. Zuckerman, I. H. Onukwugha, E. Powers, C. A. TI THE ROLE OF HEALTH SHOCKS IN LATE PART D ENROLLMENT SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Shoemaker, J. S.] PhRMA, Washington, DC USA. [Davidoff, A.] AHRQ, Rockville, MD USA. [Stuart, B.; Zuckerman, I. H.; Onukwugha, E.] Univ Maryland, Sch Pharm, Baltimore, MD 21201 USA. [Powers, C. A.] Ctr Medicare Serv, Baltimore, MD USA. [Powers, C. A.] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2013 VL 16 IS 3 BP A262 EP A262 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 144CE UT WOS:000318916402314 ER PT J AU Halfon, N Conway, PH AF Halfon, Neal Conway, Patrick H. TI The Opportunities and Challenges of a Lifelong Health System SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Halfon, Neal] Univ Calif Los Angeles, Ctr Healthier Children Families & Communities, Los Angeles, CA 90024 USA. [Halfon, Neal] UCLA David Geffen Sch Med, Dept Pediat, Los Angeles, CA USA. [Halfon, Neal] UCLA Fielding Sch Publ Hlth, Dept Hlth Policy & Management, Los Angeles, CA USA. [Halfon, Neal] UCLA Luskin Sch Publ Affairs, Dept Publ Policy, Los Angeles, CA USA. [Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD USA. [Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA. RP Halfon, N (reprint author), Univ Calif Los Angeles, Ctr Healthier Children Families & Communities, Los Angeles, CA 90024 USA. NR 4 TC 13 Z9 13 U1 0 U2 6 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 APR 25 PY 2013 VL 368 IS 17 BP 1569 EP 1571 DI 10.1056/NEJMp1215897 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 130YK UT WOS:000317956300004 PM 23614582 ER PT J AU Lochner, KA Cox, CS AF Lochner, Kimberly A. Cox, Christine S. TI Prevalence of Multiple Chronic Conditions Among Medicare Beneficiaries, United States, 2010 SO PREVENTING CHRONIC DISEASE LA English DT Article AB Introduction The increase in chronic health conditions among Medicare beneficiaries has implications for the Medicare system. The objective of this study was to use the US Department of Health and Human Services Strategic Framework on multiple chronic conditions as a basis to examine the prevalence of multiple chronic conditions among Medicare beneficiaries. Analysis We analyzed Centers for Medicare and Medicaid Services administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program in 2010. We included approximately 31 million Medicare beneficiaries and examined 15 chronic conditions. A beneficiary was considered to have a chronic condition if a Medicare claim indicated that the beneficiary received a service or treatment for the condition. We defined the prevalence of multiple chronic conditions as having 2 or more chronic conditions. Results Overall, 68.4% of Medicare beneficiaries had 2 or more chronic conditions and 36.4% had 4 or more chronic conditions. The prevalence of multiple chronic conditions increased with age and was more prevalent among women than men across all age groups. Non-Hispanic black and Hispanic women had the highest prevalence of 4 or more chronic conditions, whereas Asian or Pacific Islander men and women, in general, had the lowest. Summary The prevalence of multiple chronic conditions among the Medicare fee-for-service population varies across demographic groups. Multiple chronic conditions appear to be more prevalent among women, particularly non-Hispanic black and Hispanic women, and among beneficiaries eligible for both Medicare and Medicaid benefits. Our findings can help public health researchers target prevention and management strategies to improve care and reduce costs for people with multiple chronic conditions. C1 [Lochner, Kimberly A.] Off Reg Administrator, Ctr Medicare Serv, Atlanta, GA 30303 USA. [Lochner, Kimberly A.] Off Reg Administrator, Ctr Medicaid Serv, Atlanta, GA 30303 USA. [Cox, Christine S.] Ctr Medicare Serv, Baltimore, MD USA. [Cox, Christine S.] Ctr Medicaid Serv, Baltimore, MD USA. RP Lochner, KA (reprint author), Off Reg Administrator, Ctr Medicare Serv, 61 Forsyth St SW,Ste 4T20, Atlanta, GA 30303 USA. EM Kimberly.Lochner@cms.hhs.gov NR 10 TC 20 Z9 20 U1 1 U2 3 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1545-1151 J9 PREV CHRONIC DIS JI Prev. Chronic Dis. PD APR PY 2013 VL 10 AR UNSP 120137 DI 10.5888/pcd10.120137 PG 10 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 285JS UT WOS:000329390700015 ER PT J AU Capoccia, V Croze, C Cohen, M O'Brien, JP AF Capoccia, Victor Croze, Colette Cohen, Martin O'Brien, John P. TI Sustaining Enrollment in Health Insurance for Vulnerable Populations: Lessons From Massachusetts SO PSYCHIATRIC SERVICES LA English DT Article ID MEDICAID COVERAGE; INTERRUPTIONS AB Objective: Since 2008 Massachusetts has had universal health insurance with an individual mandate. As a result, only about 3% of the population is uninsured. However, patients who use behavioral health services are uninsured at much higher rates. This 2011 study sought to understand reasons for the discrepancy and identify approaches to reduce disenrollment and sustain coverage. Methods: The qualitative study was based on structured interviews and focus groups. Structured interviews were conducted with 15 policy makers, consumer advocates, and chief executive officers of provider organizations, and three focus groups were held with 33 patient volunteers. Results: The interviews and focus groups identified several disenrollment opportunities, all of which contribute to "churn" (the process by which disenrolled persons who remain eligible are reenrolled in the same or a different plan): missing and incomplete documentation, acute and chronic conditions and long-term disabilities that interfere with a patient's ability to respond to program communications, and lack of awareness among beneficiaries of the consequences of changes that trigger termination and the need to transfer to another program. Although safeguards are built into the system to avoid some disenrollments, the policies and procedures that drive the system are built on a default assumption of ineligibility or disenrollment until the individual establishes eligibility and completes requirements. Practices that can sustain enrollment include real-time Web-based prepopulated enrollment and redetermination processes, redetermination flexibility for designated chronic illnesses, and standardized performance metrics for churn and associated costs. Conclusions: Changes in the information system infrastructure and in outreach, enrollment, disenrollment, and reenrollment procedures can improve continuity and retention of health insurance coverage. C1 [Croze, Colette] Croze Consulting, Middletown, DE USA. [Cohen, Martin] Metro West Community Hlth Fdn, Framingham, MA USA. [O'Brien, John P.] Ctr Medicare Serv, Baltimore, MD USA. [O'Brien, John P.] Ctr Medicaid Serv, Baltimore, MD USA. RP Capoccia, V (reprint author), 41 Channing Rd, Watertown, MA 02472 USA. EM vcapoccia@gmail.com FU Substance Abuse and Mental Health Services Administration [HHSS283200700017I/HHSS28300001T TO HHSS28300002T] FX The study on which this article is based was supported by prime contract HHSS283200700017I/HHSS28300001T TO HHSS28300002T from the Substance Abuse and Mental Health Services Administration to Deloitte Consulting LLP. NR 15 TC 4 Z9 4 U1 0 U2 5 PU AMER PSYCHIATRIC PUBLISHING, INC PI ARLINGTON PA 1000 WILSON BOULEVARD, STE 1825, ARLINGTON, VA 22209-3901 USA SN 1075-2730 EI 1557-9700 J9 PSYCHIAT SERV JI Psychiatr. Serv. PD APR PY 2013 VL 64 IS 4 BP 360 EP 365 DI 10.1176/appi.ps.201200155 PG 6 WC Health Policy & Services; Public, Environmental & Occupational Health; Psychiatry SC Health Care Sciences & Services; Public, Environmental & Occupational Health; Psychiatry GA 255VL UT WOS:000327268100018 PM 23319011 ER PT J AU Elliott, MN Brown, JA Lehrman, WG Beckett, MK Hambarsoomian, K Giordano, LA Goldstein, EH AF Elliott, Marc N. Brown, Julie A. Lehrman, William G. Beckett, Megan K. Hambarsoomian, Katrin Giordano, Laura A. Goldstein, Elizabeth H. TI A Randomized Experiment Investigating the Suitability of Speech-Enabled IVR and Web Modes for Publicly Reported Surveys of Patients' Experience of Hospital Care SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE speech-enabled IVR; web surveys; patient satisfaction; HCAHPS ID INTERACTIVE VOICE RESPONSE; HCAHPS SURVEY; MAIL SURVEY; TELEPHONE; NONRESPONSE; INTERNET; SYSTEMS; RATES; BIAS AB The HCAHPS Survey obtains hospital patients' experiences using four modes: Mail Only, Phone Only, Mixed (mail/phone follow-up), and Touch-Tone (push-button) Interactive Voice Response with option to transfer to live interviewer (TT-IVR/Phone). A new randomized experiment examines two less expensive modes: Web/Mail (mail invitation to participate by Web or request a mail survey) and Speech-Enabled IVR (SE-IVR/Phone; speaking to a voice recognition system; optional transfer to an interviewer). Web/Mail had a 12% response rate (vs. 32% for Mail Only and 33% for SE-IVR/Phone); Web/Mail respondents were more educated and less often Black than Mail Only respondents. SE-IVR/Phone respondents (who usually switched to an interviewer) were less often older than 75 years, more often English-preferring, and reported better care than Mail Only respondents. Concerns regarding inconsistencies across implementations, low adherence to primary modes, or low response rate may limit the applicability of the SE-IVR/Phone and Web/Mail modes in HCAHPS and similar standardized environments. C1 [Elliott, Marc N.; Brown, Julie A.; Beckett, Megan K.; Hambarsoomian, Katrin] RAND Corp, Santa Monica, CA 90407 USA. [Lehrman, William G.; Goldstein, Elizabeth H.] Ctr Medicare Serv, Baltimore, MD USA. [Lehrman, William G.; Goldstein, Elizabeth H.] Ctr Medicaid Serv, Baltimore, MD USA. [Giordano, Laura A.] Hlth Serv Advisory Grp, Phoenix, AZ USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St, Santa Monica, CA 90407 USA. EM elliott@rand.org FU CMS [HHSM-500-2008-A29THC]; Agency for Healthcare Research and Quality [U18 HS016980] FX The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by CMS Contract HHSM-500-2008-A29THC to HSAG. Elliott and Hambarsoomian had access to all study data and take responsibility for its integrity and the accuracy of the data analysis. Elliott and Brown were supported in part by a cooperative agreement from the Agency for Healthcare Research and Quality U18 HS016980. NR 35 TC 3 Z9 3 U1 0 U2 6 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD APR PY 2013 VL 70 IS 2 BP 165 EP 184 DI 10.1177/1077558712464907 PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 138QK UT WOS:000318523300003 PM 23132892 ER PT J AU Shrank, W AF Shrank, William TI The Center For Medicare And Medicaid Innovation's Blueprint For Rapid-Cycle Evaluation Of New Care And Payment Models SO HEALTH AFFAIRS LA English DT Article AB The Affordable Care Act established the Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models. The goal is to reduce program expenditures while preserving or improving the quality of care provided to beneficiaries of Medicare, Medicaid, and the Children's Health Insurance Program. Central to the success of the Innovation Center is a new, rapid-cycle approach to evaluation. This article describes that approach-setting forth how the Rapid Cycle Evaluation Group aims to deliver frequent feedback to providers in support of continuous quality improvement, while rigorously evaluating the outcomes of each model tested. This article also describes the relationship between the group's work and that of the Office of the Actuary at the Centers for Medicare and Medicaid Services, which plays a central role in the assessment of new models. C1 [Shrank, William] Ctr Medicare Serv, Ctr Medicare & Medicaid Innovat, Rapid Cycle Evaluat Grp, Baltimore, MD USA. [Shrank, William] Ctr Medicaid Serv, Ctr Medicare & Medicaid Innovat, Rapid Cycle Evaluat Grp, Baltimore, MD USA. RP Shrank, W (reprint author), Ctr Medicare Serv, Ctr Medicare & Medicaid Innovat, Rapid Cycle Evaluat Grp, Baltimore, MD USA. EM William.Shrank@cms.hhs.gov NR 0 TC 17 Z9 17 U1 0 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 APR PY 2013 VL 32 IS 4 BP 807 EP 812 DI 10.1377/hlthaff.2013.0216 PG 6 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 131UU UT WOS:000318023100022 PM 23535630 ER PT J AU Sorace, J Millman, M Bounds, M Collier, M Wong, HH Worrall, C Kelman, J MaCurdy, T AF Sorace, James Millman, Michael Bounds, Mallory Collier, Michael Wong, Hui-Hsing Worrall, Chris Kelman, Jeffrey MaCurdy, Thomas TI Temporal Variation in Patterns of Comorbidities in the Medicare Population SO POPULATION HEALTH MANAGEMENT LA English DT Article ID CLINICAL-RESEARCH CONCEPTS AB It is widely accepted that Medicare beneficiaries with multiple comorbidities (ie, patients with combinations of more than 1 disease) account for a disproportionate amount of mortality and expenditures. The authors previously studied this phenomenon by analyzing Medicare claims data from 2008 to determine the pattern of disease combinations (DCs) for 32,220,634 beneficiaries. Their findings indicated that 22% of these individuals mapped to a long-tailed distribution of approximately 1 million DCs. The presence of so many DCs, each populated by a small number of individuals, raises the possibility that the DC distribution varies over time. Measuring this variability is important because it indicates the rate at which the health care system must adapt to the needs of new patients. This article analyzes Medicare claims data for 3 consecutive calendar years, using 2 algorithms based on the Centers for Medicare & Medicaid Services (CMS)-Hierarchical Conditions Categories (HCC) claims model. These algorithms make different assumptions regarding the degree to which the CMS-HCC model could be disaggregated into its underlying International Classification of Diseases, Ninth Revision, Clinical Modification codes. The authors find that, although a large number of beneficiaries belong to a set of DCs that are nationally stable across the 3 study years, the number of DCs in this set is large (in the range of several hundred thousand). Furthermore, the small number of beneficiaries associated with the larger number of variable DCs (ie, DCs that were not constantly populated in all 3 study years) represents a disproportionally high level of expenditures and death. (Population Health Management 2013;16:120-124) C1 [Sorace, James; Millman, Michael; Wong, Hui-Hsing] Off Sci & Data Policy, Washington, DC 20201 USA. [Bounds, Mallory; Collier, Michael; MaCurdy, Thomas] Acumen LLC, Burlingame, CA USA. [Worrall, Chris] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Kelman, Jeffrey] Ctr Medicare & Medicaid Serv, Washington, DC USA. [MaCurdy, Thomas] Stanford Univ, Stanford, CA 94305 USA. RP Sorace, J (reprint author), Off Sci & Data Policy, Hubert Humphrey Bldg,Room 443E,200 Independence A, Washington, DC 20201 USA. EM james.sorace@hhs.gov FU Department of Health and Human Services [HHSM-500-2006-00006I]; Acumen LLC. [HHSM-500-2006-00006I] FX This work was supported by contract HHSM-500-2006-00006I between the Department of Health and Human Services and Acumen LLC. NR 16 TC 3 Z9 3 U1 0 U2 0 PU MARY ANN LIEBERT INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1942-7891 J9 POPUL HEALTH MANAG JI Popul. Health Manag. PD APR PY 2013 VL 16 IS 2 BP 120 EP 124 DI 10.1089/pop.2012.0045 PG 5 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 122XG UT WOS:000317351300008 PM 23113637 ER PT J AU Graham, DJ Williams, JR Hsueh, YH Calia, K Levenson, M Pinheiro, SP MaCurdy, TE Shih, D Worrall, C Kelman, JA AF Graham, David J. Williams, James R. Hsueh, Ya-Hui Calia, Katlyn Levenson, Mark Pinheiro, Simone P. MaCurdy, Thomas E. Shih, David Worrall, Chris Kelman, Jeffrey A. TI Cardiovascular and mortality risks in Parkinson's disease patients treated with entacapone SO MOVEMENT DISORDERS LA English DT Article DE entacapone; Parkinson's disease; acute myocardial infarction; stroke; mortality ID ACUTE MYOCARDIAL-INFARCTION; POSITIVE PREDICTIVE-VALUE; ADMINISTRATIVE DATA; CODING ACCURACY; DEATH; COHORT; STROKE; DIAGNOSIS; SURVIVAL; ONTARIO AB The controlled trial Stalevo Reduction in Dyskinesia Evaluation in Parkinson's Disease (STRIDE-PD) reported an unexpected increase in acute myocardial infarction (AMI) with entacapone use in patients with Parkinson's disease (PD). The authors investigated whether entacapone increased cardiovascular and mortality risk compared with the use of a non-levodopa dopamine agonist (DA) or a selective monoamine oxidase type-B inhibitor (MAOBI). Using national Medicare data, a new-user cohort of elderly patients with PD treated with entacapone was propensity score (PS) matched with new users of either DA or MAOBI. The PS model included variables for sociodemographics, cardiovascular disease, medications, prior PD treatment, and comorbidities. Cox proportional hazards regression was used to compare on-therapy time to event for AMI, stroke, and death with DA-MAOBI as a reference. Study cohorts included 8681 entacapone-treated and 17,362 DA-MAOBI-treated initators who were followed for 2569 and 5385 person-years, respectively. Cohorts were closely balanced for all covariates. During follow-up, there were 106 AMIs, 89 strokes, and 201 deaths. The hazard ratio (HR) and 95% confidence interval (CI) associated with entacapone use was 0.86 (95% CI, 0.571.30) for AMI, 0.85 (95% CI, 0.541.35) for stroke, and 0.79 (95% CI, 0.581.07) for death. The risk was unchanged for treatment of6 months' and>6 months' duration and was unaffected by adjustment for time-varying levodopa use during follow-up. The risk of each endpoint was not differentially affected by diabetes, ischemic heart disease, or kidney failure status. However, the risk of stroke was modified by the presence (HR, 2.09; 95% CI, 0.984.45) or absence (HR, 0.51; 95% CI, 0.270.95) of advanced PD-related morbidities (P value for interaction=0.004). Entacapone was not associated with an increased risk of AMI, stroke, or death in elderly patients with PD. (c) 2013 Movement Disorder Society C1 [Graham, David J.; Williams, James R.; Pinheiro, Simone P.; Shih, David] US FDA, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, Silver Spring, MD 20993 USA. [Hsueh, Ya-Hui; Levenson, Mark] US FDA, Off Biostat, Ctr Drug Evaluat & Res, Silver Spring, MD 20993 USA. [Calia, Katlyn; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Dept Econ, Palo Alto, CA 94304 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare Serv, Washington, DC USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicaid Serv, Washington, DC USA. RP Graham, DJ (reprint author), US FDA, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, 10903 New Hampshire Ave,Bldg 22,Room 4314, Silver Spring, MD 20993 USA. EM david.graham1@fda.hhs.gov FU Centers for Medicare & Medicaid Services (CMS); Food and Drug Administration (FDA) under an intra-agency agreement FX This study was funded by the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration (FDA) under an intra-agency agreement. NR 28 TC 4 Z9 4 U1 0 U2 8 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0885-3185 J9 MOVEMENT DISORD JI Mov. Disord. PD APR PY 2013 VL 28 IS 4 BP 490 EP 497 DI 10.1002/mds.25351 PG 8 WC Clinical Neurology SC Neurosciences & Neurology GA 123CO UT WOS:000317366100018 PM 23443994 ER PT J AU Koller, EA Chin, JS Conway, PH AF Koller, Elizabeth A. Chin, Joseph S. Conway, Patrick H. TI Diabetes Prevention and the Role of Risk Factor Reduction in the Medicare Population SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID LIFE-STYLE INTERVENTION; IMPAIRED GLUCOSE-TOLERANCE; AFRICAN-AMERICAN CHURCHES; OBSTRUCTIVE SLEEP-APNEA; SERVICES TASK-FORCE; LOOK-AHEAD TRIAL; WEIGHT-LOSS; CARDIOVASCULAR-DISEASE; GLYCEMIC CONTROL; PHYSICAL-ACTIVITY AB Medicare is keenly aware of the secular changes in weight gain and of the nearly parallel increases in both the incidence and prevalence of type 2 diabetes throughout the U. S. population. The Medicare population, however, differs from the population at large because of its advanced age and frequency of comorbid conditions and/or disability. These factors affect life span as well as participation in and potential benefit from lifestyle modification and risk-factor reduction activities. Further, macrovascular disease is the greatest burden for older beneficiaries with diabetes, and its risks may antedate the appearance of hyperglycemia. Both diabetes prevention and treatment must be considered in this context. Medicare benefits focus on reduction of cardiovascular risk and mitigation of more temporally immediate complications of weight gain and glucose elevation. These preventive services and interventions are described. (Am J Prev Med 2013;44(4S4):S307-S316) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine C1 [Koller, Elizabeth A.; Chin, Joseph S.; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Woodlawn, MD 21244 USA. [Conway, Patrick H.] Childrens Hosp, Med Ctr, Cincinnati, OH 45229 USA. RP Koller, EA (reprint author), Ctr Medicare & Medicaid Serv, Coverage & Anal Grp, 7500 Secur Blvd,S3-19-08, Woodlawn, MD 21244 USA. EM Elizabeth.Koller@cms.hhs.gov NR 82 TC 4 Z9 4 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 2013 VL 44 IS 4 SU 4 BP S307 EP S316 DI 10.1016/j.amepre.2012.12.019 PG 10 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 113NH UT WOS:000316674200004 PM 23498292 ER PT J AU Green, D Gee, RE Conway, PH AF Green, Daniel Gee, Rebekah E. Conway, Patrick H. TI Medicare and Medicaid Quality Programs SO OBSTETRICS AND GYNECOLOGY LA English DT Editorial Material C1 Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. Louisiana State Univ, Sch Publ Hlth, Dept Hlth Policy & Management, New Orleans, LA USA. Louisiana State Univ, Sch Publ Hlth, Dept Obstet & Gynecol, New Orleans, LA USA. Louisiana State Univ, Sch Med, Dept Hlth Policy & Management, New Orleans, LA USA. Louisiana State Univ, Sch Med, Dept Obstet & Gynecol, New Orleans, LA USA. RP Gee, RE (reprint author), 2020 Gravier St, New Orleans, LA 70112 USA. EM rgee@lsuhsc.edu NR 4 TC 1 Z9 1 U1 0 U2 3 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0029-7844 J9 OBSTET GYNECOL JI Obstet. Gynecol. PD APR PY 2013 VL 121 IS 4 BP 705 EP 708 DI 10.1097/AOG.0b013e3182883cdc PG 4 WC Obstetrics & Gynecology SC Obstetrics & Gynecology GA 112RJ UT WOS:000316610000003 PM 23635668 ER PT J AU Hamilton, TE AF Hamilton, Thomas E. TI Regulatory oversight in transplantation: are the patients really better off? SO CURRENT OPINION IN ORGAN TRANSPLANTATION LA English DT Review DE Centers for Medicare & Medicaid Services; outcomes; regulation; Scientific Registry of Transplant Recipients; transplantation ID ORGAN-TRANSPLANTATION; CENTER PERFORMANCE; UNITED-STATES AB Purpose of review This article conveys early findings with respect to changes in patient and graft survival since Centers for Medicare & Medicaid Services (CMS) regulations for Medicare coverage of solid organ transplantation became effective on 28 June 2007. Recent findings Programmes cited by CMS for subpar outcomes have strong incentives to improve performance and have risen to the challenge. Adult kidney programmes that entered into System Improvement Agreements or were approved for mitigating factors by CMS, for which there is a 2-year postsurvey tracking period (N = 15), improved their standardized mortality ratio (SMR) for 1-year posttransplant patient survival from 2.05 to 1.17 on average. Volume in some of those programmes tended to decline, whereas national volume increased. Nationally, average donor risk across U. S. adult kidney transplant programmes increased approximately 6% from CY2001 through CY2010. Average recipient risk also increased. Despite increased risk profiles, national survival rates for all organ types continued to increase from 2007 through 2010. Summary People who receive transplants from programmes cited by CMS for subpar outcomes tend to have much improved prospects for posttransplant survival. Individuals waitlisted in those programmes may face lower odds of receiving a transplant, at least temporarily, due to the tendency of such programmes to reduce volume as they regroup to improve their outcomes. C1 Ctr Medicare & Medicaid Serv, Survey & Certificat Grp, Baltimore, MD 21244 USA. RP Hamilton, TE (reprint author), Ctr Medicare & Medicaid Serv, Survey & Certificat Grp, Mailstop C2-21-12,7500 Secur Blvd, Baltimore, MD 21244 USA. EM thomas.hamilton@cms.hhs.gov NR 11 TC 6 Z9 6 U1 2 U2 2 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1087-2418 J9 CURR OPIN ORGAN TRAN JI Curr. Opin. Organ Transpl. PD APR PY 2013 VL 18 IS 2 BP 203 EP 209 DI 10.1097/MOT.0b013e32835f3fb4 PG 7 WC Transplantation SC Transplantation GA 107CK UT WOS:000316192100013 PM 23429659 ER PT J AU Martino, SC Weinick, RM Kanouse, DE Brown, JA Haviland, AM Goldstein, E Adams, JL Hambarsoomian, K Klein, DJ Elliott, MN AF Martino, Steven C. Weinick, Robin M. Kanouse, David E. Brown, Julie A. Haviland, Amelia M. Goldstein, Elizabeth Adams, John L. Hambarsoomian, Katrin Klein, David J. Elliott, Marc N. TI Reporting CAHPS and HEDIS Data by Race/Ethnicity for Medicare Beneficiaries SO HEALTH SERVICES RESEARCH LA English DT Article DE CAHPS; HEDIS; patient experience; public reporting; racial; ethnic differences ID QUALITY-OF-CARE; HEALTH-CARE; MANAGED CARE; ASSESSMENTS; CONSUMERS; DISPARITIES; RELIABILITY; IMPROVEMENT; HOSPITALS; RATINGS AB Objective To produce reliable and informative health plan performance data by race/ethnicity for the Medicare beneficiary population and to consider appropriate presentation strategies. Data Sources Patient experience data from the 20082009 Medicare Advantage (MA) and fee-for-service (FFS) CAHPS surveys and 20082009 HEDIS data (MA beneficiaries only). Study Design Mixed effects linear (and binomial) regression models estimated the reliability and statistical informativeness of CAHPS (HEDIS) measures. Principal Findings Seven CAHPS and seven HEDIS measures were reliable and informative for four racial/ethnic subgroupsWhites, Blacks, Hispanics, and Asian/Pacific Islandersat sample sizes of 100 beneficiaries (200 for prescription drug plans). Although many plans lacked adequate sample size for reporting group-specific data, reportable plans contained a large majority of beneficiaries from each of the four racial/ethnic groups. Conclusions Statistically reliable and valid information on health plan performance can be reported by race/ethnicity. Many beneficiaries may have difficulty understanding such reports, however, even with careful guidance. Thus, it is recommended that health plan performance data by subgroups be reported as supplemental data and only for plans meeting sample size requirements. C1 [Martino, Steven C.] RAND Corp, Pittsburgh, PA 15213 USA. [Weinick, Robin M.] RAND Corp, Arlington, VA USA. [Kanouse, David E.; Brown, Julie A.; Adams, John L.; Hambarsoomian, Katrin; Elliott, Marc N.] RAND Corp, Santa Monica, CA USA. [Haviland, Amelia M.] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA. [Goldstein, Elizabeth] Ctr Medicare Serv, Baltimore, MD USA. [Goldstein, Elizabeth] Ctr Medicaid Serv, Baltimore, MD USA. [Klein, David J.] Childrens Hosp, Boston, MA 02115 USA. RP Martino, SC (reprint author), RAND Corp, 4570 5th Ave,Suite 600, Pittsburgh, PA 15213 USA. EM martino@rand.org FU CMS [HHSM-500-2005-000281] FX This study was funded in full by CMS contract HHSM-500-2005-000281 to RAND. Although prior approval and notification by CMS is not required, CMS was provided with an advanced copy of the manuscript as a courtesy. The authors thank Carol A. Edwards for her assistance with programming and data management. NR 35 TC 7 Z9 7 U1 2 U2 15 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2013 VL 48 IS 2 BP 417 EP 434 DI 10.1111/j.1475-6773.2012.01452.x PN 1 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 106CW UT WOS:000316120200005 PM 23480716 ER PT J AU Braithwaite, S Friedman, B Mutter, R Handrigan, M AF Braithwaite, Sabina Friedman, Bernard Mutter, Ryan Handrigan, Michael TI Microsimulation of Financial Impact of Demand Surge on Hospitals: The H1N1 Influenza Pandemic of Fall 2009 SO HEALTH SERVICES RESEARCH LA English DT Article DE Microsimulation; H1N1; hospital preparedness; hospital finance ID UNITED-STATES; CAPACITY AB Objective Microsimulation was used to assess the financial impact on hospitals of a surge in influenza admissions in advance of the H1N1 pandemic in the fall of 2009. The goal was to estimate net income and losses (nationally, and by hospital type) of a response of filling unused hospital bed capacity proportionately and postponing elective admissions (a passive supply response). Methods Epidemiologic assumptions were combined with assumptions from other literature (e.g., staff absenteeism, profitability by payer class), Census data on age groups by region, and baseline hospital utilization data. Hospital discharge records were available from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Hospital bed capacity and staffing were measured with the American Hospital Association's (AHA) Annual Survey. Results Nationwide, in a scenario of relatively severe epidemiologic assumptions, we estimated aggregate net income of $119million for about 1 million additional influenza-related admissions, and a net loss of $37million for 52,000 postponed elective admissions. Implications Aggregate and distributional results did not suggest that a policy of promising additional financial compensation to hospitals in anticipation of the surge in flu cases was necessary. The analysis identified needs for better information of several types to improve simulations of hospital behavior and impacts during demand surges. C1 [Friedman, Bernard; Mutter, Ryan] US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD USA. [Braithwaite, Sabina] Univ Kansas, Dept Prevent Med & Publ Hlth, Wichita Sedgwick Cty EMS Syst Dept Emergency Med, Wichita, KS USA. [Handrigan, Michael] US Dept HHS, Ctr Medicare Serv, Arlington, VA USA. [Handrigan, Michael] US Dept HHS, Ctr Medicaid Serv, Arlington, VA USA. RP Friedman, B (reprint author), US Dept HHS, Agcy Healthcare Res & Qual, Rockville, MD USA. EM econobarry@gmail.com NR 25 TC 3 Z9 3 U1 1 U2 14 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD APR PY 2013 VL 48 IS 2 BP 735 EP 752 DI 10.1111/1475-6773.12041 PN 2 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 106CZ UT WOS:000316120600005 PM 23398540 ER PT J AU King, T Fleck, SB Estrella, E Reitz, SM AF King, Terris Fleck, Susan B. Estrella, Elisa Reitz, S. Maggie TI The Centers for Medicare & Medicaid Services Diabetes Health Disparities Reduction Program SO FAMILY & COMMUNITY HEALTH LA English DT Article DE collaboration; community-based; diabetes self-management education; expanded use of community health workers; underserved populations; vulnerable populations AB The Centers for Medicare & Medicaid Services has implemented 3 prevention interventions programs to bring diabetes self-management education to vulnerable populations via Medicare's Quality Improvement Organizations. The programs and the lessons derived from a Federal initiative geared to closing the health disparities gap are described. C1 [King, Terris; Estrella, Elisa] Ctr Medicare & Medicaid Serv, Off Informat Serv, Baltimore, MD 21244 USA. [Fleck, Susan B.] Ctr Medicare & Medicaid Serv, Hlth Dispar Program, Boston, MA USA. [Reitz, S. Maggie] Towson Univ, Dept Occupat Therapy & Occupat Sci, Towson, MD USA. RP Estrella, E (reprint author), Ctr Medicare & Medicaid Serv, Off Informat Serv, 7500 Security Blvd,N3-12-26, Baltimore, MD 21244 USA. EM Elisa.Estrella@cms.hhs.gov NR 12 TC 0 Z9 0 U1 2 U2 6 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0160-6379 J9 FAM COMMUNITY HEALTH JI Fam. Community Health PD APR-JUN PY 2013 VL 36 IS 2 BP 119 EP 124 DI 10.1097/FCH.0b013e3182834740 PG 6 WC Family Studies; Public, Environmental & Occupational Health SC Family Studies; Public, Environmental & Occupational Health GA 099VR UT WOS:000315651600005 PM 23455682 ER PT J AU Agrawal, S Taitsman, J Cassel, C AF Agrawal, Shantanu Taitsman, Julie Cassel, Christine TI Educating Physicians About Responsible Management of Finite Resources SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID CARE C1 [Agrawal, Shantanu] Ctr Program Integr, Ctr Medicare Serv, Baltimore, MD 21244 USA. [Agrawal, Shantanu] Ctr Program Integr, Ctr Medicaid Serv, Baltimore, MD 21244 USA. [Taitsman, Julie] Dept Hlth & Human Serv, Off Inspector Gen, Washington, DC USA. [Cassel, Christine] Amer Board Internal Med, Philadelphia, PA USA. RP Agrawal, S (reprint author), Ctr Program Integr, Ctr Medicare Serv, 7500 Secur Blvd,Mail Stop AR 18-50, Baltimore, MD 21244 USA. EM shantanu.agrawal@cms.hhs.gov NR 8 TC 14 Z9 14 U1 0 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAR 20 PY 2013 VL 309 IS 11 BP 1115 EP 1116 DI 10.1001/jama.2013.1013 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 108FF UT WOS:000316276500021 PM 23512056 ER PT J AU Taitsman, JK Grimm, CM Agrawal, S AF Taitsman, Julie K. Grimm, Christi Macrina Agrawal, Shantanu TI Protecting Patient Privacy and Data Security SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Taitsman, Julie K.; Grimm, Christi Macrina] US Dept HHS, Off Inspector Gen, Washington, DC 20201 USA. [Agrawal, Shantanu] Ctr Medicare Serv, Ctr Program Integr, Baltimore, MD USA. [Agrawal, Shantanu] Ctr Medicaid Serv, Ctr Program Integr, Baltimore, MD USA. RP Taitsman, JK (reprint author), US Dept HHS, Off Inspector Gen, Washington, DC 20201 USA. NR 4 TC 5 Z9 5 U1 0 U2 10 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 MAR 14 PY 2013 VL 368 IS 11 BP 977 EP 979 DI 10.1056/NEJMp1215258 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 104HF UT WOS:000315982100002 PM 23444980 ER PT J AU Blum, JD Conway, PH VanLare, JM AF Blum, Jonathan D. Conway, Patrick H. VanLare, Jordan M. TI Safety-Net Hospitals: Other Hospitals Score Similarly on Patient Experience SO JAMA INTERNAL MEDICINE LA English DT Letter C1 [Blum, Jonathan D.; Conway, Patrick H.; VanLare, Jordan M.] US Dept HHS, Ctr Medicare & Medicaid Serv CMS, Woodlawn, MD USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA. [VanLare, Jordan M.] Columbia Univ Coll Phys & Surg, New York, NY 10032 USA. RP VanLare, JM (reprint author), Ctr Medicare & Medicaid Serv, 7500 Security Blvd, Woodlawn, MD 21244 USA. EM jordan.vanlare@cms.hhs.gov NR 5 TC 0 Z9 0 U1 2 U2 6 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 2168-6106 J9 JAMA INTERN MED JI JAMA Intern. Med. PD MAR 11 PY 2013 VL 173 IS 5 BP 389 EP 390 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 153OY UT WOS:000319613100021 PM 23479105 ER PT J AU Errett, NA Barnett, DJ Thompson, CB Tosatto, R Austin, B Schaffzin, S Ansari, A Semon, NL Balicer, RD Links, JM AF Errett, Nicole A. Barnett, Daniel J. Thompson, Carol B. Tosatto, Rob Austin, Brad Schaffzin, Samuel Ansari, Armin Semon, Natalie L. Balicer, Ran D. Links, Jonathan M. TI Assessment of Medical Reserve Corps Volunteers' Emergency Response Willingness Using a Threat- and Efficacy-Based Model SO BIOSECURITY AND BIOTERRORISM-BIODEFENSE STRATEGY PRACTICE AND SCIENCE LA English DT Article ID PARALLEL PROCESS MODEL; WORKERS WILLINGNESS; PANDEMIC INFLUENZA; COMMUNICATION; PREPAREDNESS AB The goal of this study was to investigate the willingness of Medical Reserve Corps (MRC) volunteers to participate in public health emergency-related activities by assessing their attitudes and beliefs. MRC volunteers responded to an online survey organized around the Extended Parallel Process Model (EPPM). Respondents reported agreement with attitude/belief statements representing perceived threat, perceived efficacy, and personal/ organizational preparedness in 4 scenarios: a weather-related disaster, a pandemic influenza emergency, a radiological ("dirty bomb'') emergency, and an inhalational anthrax bioterrorism emergency. Logistic regression analyses were used to evaluate predictors of volunteer response willingness. In 2 response contexts (if asked and regardless of severity), self-reported willingness to respond was higher among those with a high perceived self-efficacy than among those with low perceived self-efficacy. Analyses of the association between attitude/belief statements and the EPPM profiles indicated that, under all 4 scenarios and with few exceptions, those with a perceived high threat/ high efficacy EPPM profile had statistically higher odds of agreement with the attitude/belief statements than those with a perceived low threat/ low efficacy EPPM profile. The radiological emergency consistently received the lowest agreement rates for the attitude/belief statements and response willingness across scenarios. The findings suggest that enrollment with an MRC unit is not automatically predictive of willingness to respond in these types of scenarios. While MRC volunteers' self-reported willingness to respond was found to differ across scenarios and among different attitude and belief statements, the identification of self-efficacy as the primary predictor of willingness to respond regardless of severity and if asked highlights the critical role of efficacy in an organized volunteer response context. C1 [Tosatto, Rob] US Dept HHS, Div Civilian Volunteer Med Reserve Corps, Rockville, MD USA. [Austin, Brad] US Dept HHS, Off Assistant Secretary Preparedness & Response, Ogdensburg, NY USA. [Schaffzin, Samuel] US Dept HHS, Ctr Medicare, Baltimore, MD USA. [Schaffzin, Samuel] US Dept HHS, Ctr Medicaid Serv, Baltimore, MD USA. [Ansari, Armin] Ctr Dis Control & Prevent, Atlanta, GA USA. [Balicer, Ran D.] Ben Gurion Univ Negev, Dept Epidemiol, Tel Aviv, Israel. RP Errett, NA (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, 624 N Broadway,Room 513, Baltimore, MD 21205 USA. EM nerrett@jhsph.edu FU OPHPR CDC HHS [1P01TP00288- 01]; PHS HHS [104264] NR 20 TC 9 Z9 9 U1 2 U2 12 PU MARY ANN LIEBERT INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1538-7135 J9 BIOSECUR BIOTERROR JI Biosecur. Bioterror. PD MAR PY 2013 VL 11 IS 1 BP 29 EP 40 DI 10.1089/bsp.2012.0047 PG 12 WC Public, Environmental & Occupational Health; International Relations SC Public, Environmental & Occupational Health; International Relations GA 116CO UT WOS:000316860400009 PM 23477632 ER PT J AU Agrawal, S Conway, PH AF Agrawal, Shantanu Conway, Patrick H. TI Integrating Emergency Care Into a Patient- and Outcome-Centered Health Care System SO ANNALS OF EMERGENCY MEDICINE LA English DT Editorial Material C1 [Agrawal, Shantanu] Ctr Medicare & Medicaid Serv, Ctr Program Integr, Baltimore, MD USA. [Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Ctr Clin Stand & Qual, Baltimore, MD USA. RP Agrawal, S (reprint author), Ctr Medicare & Medicaid Serv, Ctr Program Integr, Baltimore, MD USA. EM shantanu.agrawal@cms.hhs.gov NR 5 TC 1 Z9 1 U1 0 U2 3 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD MAR PY 2013 VL 61 IS 3 BP 301 EP 302 DI 10.1016/j.annemergmed.2012.10.023 PG 2 WC Emergency Medicine SC Emergency Medicine GA 106TL UT WOS:000316167500011 PM 23279963 ER PT J AU Goodrich, K Conway, PH AF Goodrich, Kate Conway, Patrick H. TI Affordable care act implementation: Implications for hospital medicine SO JOURNAL OF HOSPITAL MEDICINE LA English DT Editorial Material C1 [Goodrich, Kate; Conway, Patrick H.] Ctr Medicare Serv, Ctr Clin Stand & Qual, Baltimore, MD USA. [Goodrich, Kate; Conway, Patrick H.] Ctr Medicaid Serv, Ctr Clin Stand & Qual, Baltimore, MD USA. [Goodrich, Kate] George Washington Univ, Sch Med, Dept Med, Div Hosp Med, Washington, DC USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Div Hosp Med, Cincinnati, OH USA. RP Goodrich, K (reprint author), 7500 Secur Blvd,S3-02-01, Baltimore, MD 21244 USA. EM kate.goodrich@cms.hhs.gov NR 4 TC 1 Z9 1 U1 0 U2 6 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1553-5592 J9 J HOSP MED JI J. Hosp. Med. PD MAR PY 2013 VL 8 IS 3 BP 159 EP 161 DI 10.1002/jhm.2015 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 100UZ UT WOS:000315731000009 PM 23401481 ER PT J AU Lawson, EH Ko, CY Louie, R Han, L Rapp, M Zingmond, DS AF Lawson, Elise H. Ko, Clifford Y. Louie, Rachel Han, Lein Rapp, Michael Zingmond, David S. TI Linkage of a clinical surgical registry with Medicare inpatient claims data using indirect identifiers SO SURGERY LA English DT Article ID SURGERY; LINKING; NSQIP AB Background. A variety of data sources are available for measuring the quality of health care. Linking records from different sources can create unique and powerful databases that can be used to evaluate clinically relevant questions and direct health care policy. The objective of this study was to develop and validate a deterministic linkage algorithm that uses indirect patient identifiers to reliably match records from a surgical clinical registry with Medicare inpatient claims data. Methods. Patient records from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), years 2005-2008, were linked to claims data in the Medicare Provider Analysis and Review file (MedPAR) by the use of a deterministic linkage algorithm and the following indirect patient identifiers: hospital, age, sex, diagnosis, procedure and dates of admission, discharge, and procedure. We validated the linkage procedure by systematically reviewing subsets of matched and unmatched records and by determining agreement on patient-level coding of inpatient mortality. Results. Of the 150,454 records in ACS-NSQIP eligible for matching, 80.5% were linked to a MedPAR record. This percentage is within the expected match range given the estimated percentage of ACS-NSQIP patients likely to be Medicare beneficiaries. Systematic checks revealed no evidence of bias in the linkage procedure and there was excellent agreement on patient-level coding of mortality (kappa 0.969). The final linked database contained 121,070 patient records from 217 hospitals. Conclusion. This study demonstrates the feasibility and validity of a method for linking 2 data sources without direct personal identifiers. As clinical registries and other data sources continue to proliferate, linkage algorithms such as described here will be critical for quality measurement purposes. (Surgery 2013;153:423-30.) C1 [Lawson, Elise H.; Ko, Clifford Y.; Louie, Rachel; Zingmond, David S.] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA. [Lawson, Elise H.; Ko, Clifford Y.] Amer Coll Surg, Div Res & Optimal Patient Care, Chicago, IL USA. [Lawson, Elise H.; Ko, Clifford Y.] VA Greater Los Angeles Healthcare Syst, Los Angeles, CA USA. [Han, Lein; Rapp, Michael] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Lawson, EH (reprint author), Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, 10833 Le Conte Ave 72-215 CHS, Los Angeles, CA 90095 USA. EM elawson@mednet.ucla.edu FU Centers for Medicare & Medicaid Services (CMS); VA Health Services Research and Development program [RWJ 65-020]; American College of Surgeons through the Robert Wood Johnson Foundation Clinical Scholars Program FX Supported by a contract from the Centers for Medicare & Medicaid Services (CMS). In addition, Dr Lawson's time was supported by the VA Health Services Research and Development program (RWJ 65-020) and the American College of Surgeons through the Robert Wood Johnson Foundation Clinical Scholars Program. Dr Ko is an employee of the American College. of Surgeons. Dr Han and Dr Rapp are employees of CMS. NR 5 TC 24 Z9 24 U1 0 U2 3 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0039-6060 J9 SURGERY JI Surgery PD MAR PY 2013 VL 153 IS 3 BP 423 EP 430 DI 10.1016/j.surg.2012.08.065 PG 8 WC Surgery SC Surgery GA 101AQ UT WOS:000315748000019 PM 23122901 ER PT J AU Stefan, MS Pekow, PS Nsa, W Priya, A Miller, LE Bratzler, DW Rothberg, MB Goldberg, RJ Baus, K Lindenauer, PK AF Stefan, Mihaela S. Pekow, Penelope S. Nsa, Wato Priya, Aruna Miller, Lauren E. Bratzler, Dale W. Rothberg, Michael B. Goldberg, Robert J. Baus, Kristie Lindenauer, Peter K. TI Hospital Performance Measures and 30-day Readmission Rates SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE medicare; hospital readmission rates; process of care measurements; hospital compare ID ACUTE MYOCARDIAL-INFARCTION; CARE TRANSITIONS INTERVENTION; QUALITY-OF-CARE; HEART-FAILURE; CLINICAL-OUTCOMES; MORTALITY-RATES; ASSOCIATION; PROGRAM; TRIAL; CAPTOPRIL AB Lowering hospital readmission rates has become a primary target for the Centers for Medicare & Medicaid Services, but studies of the relationship between adherence to the recommended hospital care processes and readmission rates have provided inconsistent and inconclusive results. To examine the association between hospital performance on Medicare's Hospital Compare process quality measures and 30-day readmission rates for patients with acute myocardial infarction (AMI), heart failure and pneumonia, and for those undergoing major surgery. We assessed hospital performance on process measures using the 2007 Hospital Inpatient Quality Reporting Program. The process measures for each condition were aggregated in two separate measures: Overall Measure (OM) and Appropriate Care Measure (ACM) scores. Readmission rates were calculated using Medicare claims. Risk-standardized 30-day all-cause readmission rate was calculated as the ratio of predicted to expected rate standardized by the overall mean readmission rate. We calculated predicted readmission rate using hierarchical generalized linear models and adjusting for patient-level factors. Among patients aged a parts per thousand yen 66 years, the median OM score ranged from 79.4 % for abdominal surgery to 95.7 % for AMI, and the median ACM scores ranged from 45.8 % for abdominal surgery to 87.9 % for AMI. We observed a statistically significant, but weak, correlation between performance scores and readmission rates for pneumonia (correlation coefficient R = 0.07), AMI (R = 0.10), and orthopedic surgery (R = 0.06). The difference in the mean readmission rate between hospitals in the 1st and 4th quartiles of process measure performance was statistically significant only for AMI (0.25 percentage points) and pneumonia (0.31 percentage points). Performance on process measures explained less than 1 % of hospital-level variation in readmission rates. Hospitals with greater adherence to recommended care processes did not achieve meaningfully better 30-day hospital readmission rates compared to those with lower levels of performance. C1 [Stefan, Mihaela S.; Rothberg, Michael B.; Lindenauer, Peter K.] Baystate Med Ctr, Div Gen Internal Med, Springfield, MA 01199 USA. [Stefan, Mihaela S.; Rothberg, Michael B.; Lindenauer, Peter K.] Tufts Univ, Sch Med, Boston, MA 02111 USA. [Stefan, Mihaela S.] Tufts Univ, Sackler Sch Grad Biomed Sci, Program Clin & Translat Res, Boston, MA 02111 USA. [Stefan, Mihaela S.; Pekow, Penelope S.; Priya, Aruna; Rothberg, Michael B.; Lindenauer, Peter K.] Baystate Med Ctr, Ctr Qual Care Res, Springfield, MA USA. [Pekow, Penelope S.] Univ Massachusetts, Dept Publ Hlth, Div Biostat & Epidemiol, Amherst, MA 01003 USA. [Nsa, Wato; Miller, Lauren E.] Oklahoma Fdn Med Qual, Oklahoma City, OK USA. [Bratzler, Dale W.] Univ Oklahoma, Hlth Sci Ctr, Coll Publ Hlth, Oklahoma City, OK USA. [Goldberg, Robert J.] Univ Massachusetts, Dept Quantitat Hlth Sci, Worcester, MA 01605 USA. [Baus, Kristie] Ctr Medicare & Medicaid Serv, Qual Measures Hlth Assessment Grp, Baltimore, MD USA. RP Stefan, MS (reprint author), Baystate Med Ctr, Div Gen Internal Med, 756 Chestnut St, Springfield, MA 01199 USA. EM Mihaela.stefan@bhs.org OI Stefan, Mihaela/0000-0002-7947-4932 FU Centers for Medicare & Medicaid Services, an agency of the Department of Health Human Services [HHSM-500-2008-OK9THC]; Baystate Health Incubator fund; internal Center for Quality of Care departmental funds; National Cancer Institute (NCI) [KM1 CA156726]; National Center for Research Resources [UL1 RR025752] FX The analyses upon which this publication is based were performed under Contract Number HHSM-500-2008-OK9THC, entitled "Utilization and Quality Control Peer Review Organization for the State Oklahoma," sponsored by the Centers for Medicare & Medicaid Services, an agency of the Department of Health & Human Services. The contents of this publication does not necessarily reflect the views or policies of the Department of Health & Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U. S. government. The authors assume full responsibility of the accuracy and completeness of the ideas presented. 4-1399-OK-0212; This study was also supported by a Baystate Health Incubator fund and internal Center for Quality of Care departmental funds.; Dr. Stefan is supported by KM1 CA156726 from the National Cancer Institute (NCI) and by the National Center for Research Resources (UL1 RR025752). The content of this publication is solely the responsibility of the authors and does not represent the official views of NIH, NCRR or NCI. NR 37 TC 32 Z9 32 U1 1 U2 36 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 MAR PY 2013 VL 28 IS 3 BP 377 EP 385 DI 10.1007/s11606-012-2229-8 PG 9 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 096WA UT WOS:000315434200013 PM 23070655 ER PT J AU Bindman, AB Blum, JD Kronick, R AF Bindman, Andrew B. Blum, Jonathan D. Kronick, Richard TI Medicare's Transitional Care Payment - A Step toward the Medical Home SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Bindman, Andrew B.; Kronick, Richard] US Dept HHS, Off Assistant Secretary Planning & Evaluat, Washington, DC 20201 USA. [Blum, Jonathan D.] US Dept HHS, Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. [Bindman, Andrew B.] Univ Calif San Francisco, Dept Med, San Francisco, CA USA. RP Bindman, AB (reprint author), US Dept HHS, Off Assistant Secretary Planning & Evaluat, Washington, DC 20201 USA. NR 5 TC 18 Z9 20 U1 0 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 FEB 21 PY 2013 VL 368 IS 8 BP 692 EP 694 DI 10.1056/NEJMp1214122 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 092CG UT WOS:000315095800002 PM 23425161 ER PT J AU Krumholz, HM Lin, ZQ Keenan, PS Chen, J Ross, JS Drye, EE Bernheim, SM Wang, Y Bradley, EH Han, LF Normand, SLT AF Krumholz, Harlan M. Lin, Zhenqiu Keenan, Patricia S. Chen, Jersey Ross, Joseph S. Drye, Elizabeth E. Bernheim, Susannah M. Wang, Yun Bradley, Elizabeth H. Han, Lein F. Normand, Sharon-Lise T. TI Relationship Between Hospital Readmission and Mortality Rates for Patients Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID PERFORMANCE; CARE; QUALITY; SYSTEM; URBAN AB Importance The Centers for Medicare & Medicaid Services publicly reports hospital 30-day, all-cause, risk-standardized mortality rates (RSMRs) and 30-day, all-cause, risk-standardized readmission rates (RSRRs) for acute myocardial infarction, heart failure, and pneumonia. The evaluation of hospital performance as measured by RSMRs and RSRRs has not been well characterized. Objective To determine the relationship between hospital RSMRs and RSRRs overall and within subgroups defined by hospital characteristics. Design, Setting, and Participants We studied Medicare fee-for-service beneficiaries discharged with acute myocardial infarction, heart failure, or pneumonia between July 1, 2005, and June 30, 2008 (4506 hospitals for acute myocardial infarction, 4767 hospitals for heart failure, and 4811 hospitals for pneumonia). We quantified the correlation between hospital RSMRs and RSRRs using weighted linear correlation; evaluated correlations in groups defined by hospital characteristics; and determined the proportion of hospitals with better and worse performance on both measures. Main Outcome Measures Hospital 30-day RSMRs and RSRRs. Results Mean RSMRs and RSRRs, respectively, were 16.60% and 19.94% for acute myocardial infarction, 11.17% and 24.56% for heart failure, and 11.64% and 18.22% for pneumonia. The correlations between RSMRs and RSRRs were 0.03 (95% CI, -0.002 to 0.06) for acute myocardial infarction, -0.17 (95% CI, -0.20 to -0.14) for heart failure, and 0.002 (95% CI, -0.03 to 0.03) for pneumonia. The results were similar for subgroups defined by hospital characteristics. Although there was a significant negative linear relationship between RSMRs and RSRRs for heart failure, the shared variance between them was only 2.9% (r(2)=0.029), with the correlation most prominent for hospitals with RSMR <11%. Conclusion and Relevance Risk-standardized mortality rates and readmission rates were not associated for patients admitted with an acute myocardial infarction or pneumonia and were only weakly associated, within a certain range, for patients admitted with heart failure. JAMA. 2013;309(6):587-593 www.jama.com C1 [Krumholz, Harlan M.; Drye, Elizabeth E.] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Ross, Joseph S.] Yale Univ, Sch Med, Dept Internal Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06510 USA. [Ross, Joseph S.; Bernheim, Susannah M.] Yale Univ, Sch Med, Dept Internal Med, Gen Internal Med Sect, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Lin, Zhenqiu; Ross, Joseph S.; Drye, Elizabeth E.; Bernheim, Susannah M.; Wang, Yun] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Krumholz, Harlan M.; Keenan, Patricia S.; Bradley, Elizabeth H.] Yale Univ, Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06510 USA. [Wang, Yun; Normand, Sharon-Lise T.] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Han, Lein F.] Ctr Medicare Serv, Baltimore, MD USA. [Han, Lein F.] Ctr Medicaid Serv, Baltimore, MD USA. [Chen, Jersey] Yale Univ, Dept Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, 1 Church St,Ste 200, New Haven, CT 06510 USA. EM harlan.krumholz@yale.edu FU National Heart, Lung, and Blood Institute [U01 HL105270-03]; Agency for Healthcare Research and Quality [K08 HS018781-03]; National Institute on Aging [K08 AG032886-05]; American Federation for Aging Research through the Paul B. Beeson Career Development Award Program; CMS, an agency of the US Department of Health and Human Services [HHSM-500-2008-0025I/HHSM-500-T0001, 000007]; Medtronic through Yale University; CMS FX All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Krumholz and Ross report that they are recipients of a research grant from Medtronic through Yale University. Dr Krumholz chairs a cardiac scientific advisory board for United-Health. Dr Ross is a member of a scientific advisory board for FAIR Health. Dr Normand reports being a member of the Board of Directors of Frontier Science & Technology Research Foundation. Drs Drye, Krumholz, Lin, Bernheim, Wang, and Normand report that they receive contract funding from CMS to develop and maintain quality measures. No other disclosures were reported.; Dr Krumholz is supported by grant U01 HL105270-03 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. Dr Chen is supported by Career Development Award K08 HS018781-03 from the Agency for Healthcare Research and Quality. Dr Ross is supported by grant K08 AG032886-05 from the National Institute on Aging and by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program. The analyses on which this publication is based were performed under contract HHSM-500-2008-0025I/HHSM-500-T0001, Modification No. 000007, entitled "Measure Instrument Development and Support," funded by CMS, an agency of the US Department of Health and Human Services. NR 23 TC 113 Z9 115 U1 2 U2 29 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD FEB 13 PY 2013 VL 309 IS 6 BP 587 EP 593 DI 10.1001/jama.2013.333 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 087PH UT WOS:000314773700031 PM 23403683 ER PT J AU Kesselheim, AS Misono, AS Shrank, WH Greene, JA Doherty, M Avorn, J Choudhry, NK AF Kesselheim, Aaron S. Misono, Alexander S. Shrank, William H. Greene, Jeremy A. Doherty, Michael Avorn, Jerry Choudhry, Niteesh K. TI Variations in Pill Appearance of Antiepileptic Drugs and the Risk of Nonadherence SO JAMA INTERNAL MEDICINE LA English DT Article ID MEDICATION ADHERENCE; BRAND-NAME; HEALTH; LABEL; PHARMACEUTICALS; METAANALYSIS; ORGANIZERS; COVERAGE; EPILEPSY AB Background: Generic prescription drugs are bioequivalent to brand-name versions but may not have consistent color or shape, which can cause confusion and lead to interruptions in medication use. We sought to determine whether switching among different-appearing antiepileptic drugs (AEDs) is associated with increased rates of medication nonpersistence, which can have serious medical, financial, and social consequences. Methods: We designed a nested case-control study of commercially insured patients in the United States who initiated an AED. Cases were patients who became nonpersistent, defined as failure to fill a prescription within 5 days of the elapsed days supplied. Controls had no delay in refilling and were matched by sex, age, number of refills, and the presence of a seizure disorder diagnosis. We evaluated the 2 refills preceding nonpersistence and determined whether pill color and/or shape matched ("concordant") or did not match ("discordant"). We compared the odds of discordance among cases and controls using multivariate conditional logistic regression, adjusting for baseline characteristics, and drug type. We repeated our analysis among patients with a seizure diagnosis. Results: The AEDs dispensed had 37 colors and 4 shapes. A total of 11 472 patients with nonpersistence were linked to 50 050 controls. Color discordance preceded 136 cases (1.20%) but only 480 controls (0.97%) (adjusted odds ratio [OR], 1.27 [95% CI, 1.04-1.55]). Shape discordance preceded 18 cases (0.16%) and 54 controls (0.11%) (OR, 1.47 [95% CI, 0.85-2.54]). Within the seizure disorder diagnosis subgroup, the risk of nonpersistence after changes in pill color was also significantly elevated (OR, 1.53 [95%, CI 1.07-2.18]). Conclusions: Changes in pill color significantly increase the odds of nonpersistence; this may have important clinical implications. Our study supports a reconsideration of current regulatory policy that permits wide variation in the appearance of bioequivalent drugs. JAMA Intern Med. 2013; 173(3):202-208 Published online December 31, 2012. doi:10.1001/2013.jamainternmed.997 C1 [Kesselheim, Aaron S.; Misono, Alexander S.; Shrank, William H.; Greene, Jeremy A.; Doherty, Michael; Avorn, Jerry; Choudhry, Niteesh K.] Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon, Dept Med, Boston, MA 02120 USA. [Kesselheim, Aaron S.; Misono, Alexander S.; Shrank, William H.; Greene, Jeremy A.; Doherty, Michael; Avorn, Jerry; Choudhry, Niteesh K.] Harvard Univ, Sch Med, Boston, MA USA. [Greene, Jeremy A.] Harvard Univ, Dept Hist & Sci, Cambridge, MA 02138 USA. [Shrank, William H.] Ctr Medicare Serv, Baltimore, MD USA. [Shrank, William H.] Ctr Medicaid Serv, Baltimore, MD USA. RP Kesselheim, AS (reprint author), Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon, Dept Med, 1620 Tremont St,Ste 3030, Boston, MA 02120 USA. EM akesselheim@partners.org FU CVS Caremark, Aetna; Commonwealth Fund; Robert Wood Johnson Foundation; Teva; Lilly; National Association of Chain Drug Stores; Agency for Healthcare Research Quality [K08HS18465-01]; Robert Wood Johnson Foundation Investigator Award in Health Policy Research FX Dr Choudhry has received unrestricted research grants from CVS Caremark, Aetna, the Commonwealth Fund, and the Robert Wood Johnson Foundation to study medication adherence. Dr Shrank has received unrestricted research funding from CVS Caremark, Aetna, Teva, Lilly, and the National Association of Chain Drug Stores.; Dr Kesselheim's work is supported by a career development award from the Agency for Healthcare Research & Quality (K08HS18465-01), and a Robert Wood Johnson Foundation Investigator Award in Health Policy Research. NR 46 TC 30 Z9 30 U1 0 U2 10 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 2168-6106 J9 JAMA INTERN MED JI JAMA Intern. Med. PD FEB 11 PY 2013 VL 173 IS 3 BP 202 EP 208 DI 10.1001/2013.jamainternmed.997 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 121JV UT WOS:000317240400012 PM 23277164 ER PT J AU Morefield, B Patel, A Lucas, K Harrison, ZN Plotzke, M AF Morefield, Brant Patel, Anjana Lucas, Katherine Zinnia Ng Harrison Plotzke, Michael TI Hospice Cost Reports: Benchmarks and Trends SO JOURNAL OF PAIN AND SYMPTOM MANAGEMENT LA English DT Meeting Abstract CT Annual Assembly of the American-Academy-of-Hospice-and-Palliative-Medicine and the Hospice-and-Palliative-Nurses-Association CY MAR 13-16, 2013 CL New Orleans, LA SP Amer Acad Hosp and Palliat Med, Hosp and Palliat Nurses Assoc C1 [Morefield, Brant; Plotzke, Michael] Abt Associates Inc, Durham, NC USA. [Patel, Anjana; Lucas, Katherine; Zinnia Ng Harrison] Ctr Medicare & Medicaid Serv, Baltimore, MD 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 0885-3924 J9 J PAIN SYMPTOM MANAG JI J. Pain Symptom Manage. PD FEB PY 2013 VL 45 IS 2 BP 443 EP 444 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal; Clinical Neurology SC Health Care Sciences & Services; General & Internal Medicine; Neurosciences & Neurology GA 100GE UT WOS:000315684600213 ER PT J AU Plotzke, M Patel, A Lucas, K Harrison, ZN AF Plotzke, Michael Patel, Anjana Lucas, Katherine Zinnia Ng Harrison TI Impact of the Face-to-Face Physician Visit Requirement on Recertifications and Discharge Status SO JOURNAL OF PAIN AND SYMPTOM MANAGEMENT LA English DT Meeting Abstract CT Annual Assembly of the American-Academy-of-Hospice-and-Palliative-Medicine and the Hospice-and-Palliative-Nurses-Association CY MAR 13-16, 2013 CL New Orleans, LA SP Amer Acad Hosp and Palliat Med, Hosp and Palliat Nurses Assoc C1 [Plotzke, Michael] Abt Associates Inc, Cambridge, MA USA. [Patel, Anjana; Lucas, Katherine; Zinnia Ng Harrison] Ctr Medicare & Medicaid Serv, Baltimore, MD 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 0885-3924 J9 J PAIN SYMPTOM MANAG JI J. Pain Symptom Manage. PD FEB PY 2013 VL 45 IS 2 BP 446 EP 446 PG 1 WC Health Care Sciences & Services; Medicine, General & Internal; Clinical Neurology SC Health Care Sciences & Services; General & Internal Medicine; Neurosciences & Neurology GA 100GE UT WOS:000315684600217 ER PT J AU Pozniak, A Patel, A Lucas, K Harrison, ZN Plotzke, M AF Pozniak, Alyssa Patel, Anjana Lucas, Katherine Zinnia Ng Harrison Plotzke, Michael TI Analysis of Trends In General Inpatient Care (GIP) Utilization SO JOURNAL OF PAIN AND SYMPTOM MANAGEMENT LA English DT Meeting Abstract CT Annual Assembly of the American-Academy-of-Hospice-and-Palliative-Medicine and the Hospice-and-Palliative-Nurses-Association CY MAR 13-16, 2013 CL New Orleans, LA SP Amer Acad Hosp and Palliat Med, Hosp and Palliat Nurses Assoc C1 [Pozniak, Alyssa] Abt Associates Cambridge, Cambridge, MA USA. [Patel, Anjana; Lucas, Katherine; Zinnia Ng Harrison] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Plotzke, Michael] Abt Associates Inc, Cambridge, 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 0885-3924 J9 J PAIN SYMPTOM MANAG JI J. Pain Symptom Manage. PD FEB PY 2013 VL 45 IS 2 BP 447 EP 448 PG 3 WC Health Care Sciences & Services; Medicine, General & Internal; Clinical Neurology SC Health Care Sciences & Services; General & Internal Medicine; Neurosciences & Neurology GA 100GE UT WOS:000315684600219 ER PT J AU Cai, LM AF Cai, Liming TI The Cost of an Additional Disability-Free Life Year for Older Americans: 1992-2005 SO HEALTH SERVICES RESEARCH LA English DT Article DE Value of spending; population aging; health care spending; multistate life table; microsimulation ID US HEALTH-CARE; UNITED-STATES; REGIONAL-VARIATIONS; TRENDS; EXPECTANCY; DECLINE; DISEASE; COMPRESSION; LONGEVITY; MORTALITY AB Objective To estimate the cost of an additional disability-free life year for older Americans in 19922005. Data Source This study used 19922005 Medicare Current Beneficiary Survey, a longitudinal survey of Medicare beneficiaries with a rotating panel design. Study Design This analysis used multistate life table model to estimate probabilities of transition among a discrete set of health states (nondisabled, disabled, and dead) for two panels of older Americans in 1992 and 2002. Health spending incurred between annual health interviews was estimated by a generalized linear mixed model. Health status, including death, was simulated for each member of the panel using these transition probabilities; the associated health spending was cross-walked to the simulated health changes. Principal Findings Disability-free life expectancy (DFLE) increased significantly more than life expectancy during the study period. Assuming that 50 percent of the gains in DFLE between 1992 and 2005 were attributable to increases in spending, the average discounted cost per additional disability-free life year was $71,000. There were small differences between gender and racial/ethnic groups. Conclusions The cost of an additional disability-free life year was substantially below previous estimates based on mortality trends alone. C1 Ctr Medicare & Medicaid Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD 21244 USA. RP Cai, LM (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, Natl Hlth Stat Grp, Mail Stop N3-02-02,7500 Secur Blvd, Baltimore, MD 21244 USA. EM liming.cai@cms.hhs.gov NR 48 TC 1 Z9 1 U1 0 U2 18 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD FEB PY 2013 VL 48 IS 1 BP 218 EP 235 DI 10.1111/j.1475-6773.2012.01432.x PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 066WT UT WOS:000313253100012 PM 22670874 ER PT J AU Brock, J Mitchell, J Irby, K Stevens, B Archibald, T Goroski, A Lynn, J AF Brock, Jane Mitchell, Jason Irby, Kimberly Stevens, Beth Archibald, Traci Goroski, Alicia Lynn, Joanne CA Care Transitions Project Team TI Association Between Quality Improvement for Care Transitions in Communities and Rehospitalizations Among Medicare Beneficiaries SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID TRIAL; INTERVENTIONS; PROGRAM; SERVICE; ELDERS; ERRORS AB Importance Medicare beneficiaries experience errors during transitions among care settings, yielding harms that include unnecessary rehospitalizations. Objective To evaluate whether implementation of improved care transitions for patients with Medicare fee-for-service (FFS) insurance is associated with reduced rehospitalizations and hospitalizations in geographic communities. Design, Setting, and Participants Quality improvement initiative for care transitions by health care and social services personnel and Medicare Quality Improvement Organization staff in defined geographic areas, with monitoring by community-specific and aggregate control charts and evaluation with pre-post comparison of performance differences for 14 intervention communities and 50 comparison communities from before (2006-2008) and during (2009-2010) implementation. Intervention communities had between 22 070 and 90 843 Medicare FFS beneficiaries. Intervention Quality Improvement Organizations facilitated community-wide quality improvement activities to implement evidence-based improvements in care transitions by community organizing, technical assistance, and monitoring of participation, implementation, effectiveness, and adverse effects. Main Outcome Measures The primary outcome measure was all-cause 30-day rehospitalizations per 1000 Medicare FFS beneficiaries; secondary outcome measures were all-cause hospitalizations per 1000 Medicare FFS beneficiaries and all-cause 30-day rehospitalizations as a percentage of hospital discharges. Results The mean rate of 30-day all-cause rehospitalizations per 1000 beneficiaries per quarter was 15.21 in 2006-2008 and 14.34 in 2009-2010 in the 14 intervention communities and was 15.03 in 2006-2008 and 14.72 in 2009-2010 in the 50 comparison communities, with the pre-post between-group difference showing larger reductions in rehospitalizations in intervention communities (by 0.56/1000 per quarter; 95% CI, 0.05-1.07; P=.03). The mean rate of hospitalizations per 1000 beneficiaries per quarter was 82.27 in 2006-2008 and 77.54 in 2009-2010 in intervention communities and was 82.09 in 2006-2008 and 79.48 in 2009-2010 in comparison communities, with the pre-post between-group difference showing larger reductions in hospitalizations in intervention communities (by 2.12/1000 per quarter; 95% CI, 0.47-3.77; P=.01). Mean community-wide rates of rehospitalizations as a percentage of hospital discharges in the intervention communities were 18.97% in 2006-2008 and 18.91% in 2009-2010 and were 18.76% in 2006-2008 and 18.91% in 2009-2010 in the comparison communities, with no significant difference in the pre-post between-group differences (0.22%; 95% CI, -0.08% to 0.51%; P=.14). Process control charts signaled onset of improvement coincident with initiating intervention. Conclusions and Relevance Among Medicare beneficiaries in intervention communities, compared with those in uninvolved communities, all-cause 30-day rehospitalization and all-cause hospitalization declined. However, there was no change in the rate of all-cause 30-day rehospitalizations as a percentage of hospital discharges. JAMA. 2013; 309(4): 381-391 C1 [Brock, Jane; Mitchell, Jason; Irby, Kimberly; Stevens, Beth; Goroski, Alicia; Lynn, Joanne] Colorado Fdn Med Care, Englewood, CO USA. [Archibald, Traci; Lynn, Joanne] Ctr Medicare Serv, Baltimore, MD USA. [Archibald, Traci; Lynn, Joanne] Ctr Medicaid Serv, Baltimore, MD USA. RP Lynn, J (reprint author), Altarum Inst, Ctr Elder Care & Adv Illness, 2000 M St NW,Ste 400, Washington, DC 20036 USA. EM joanne.lynn@altarum.org FU CMS FX This project was funded through the CMS. NR 39 TC 79 Z9 79 U1 0 U2 42 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 23 PY 2013 VL 309 IS 4 BP 381 EP 391 DI 10.1001/jama.2012.216607 PG 11 WC Medicine, General & Internal SC General & Internal Medicine GA 074FT UT WOS:000313799000026 PM 23340640 ER PT J AU Reid, RO Deb, P Howell, BL Shrank, WH AF Reid, Rachel O. Deb, Partha Howell, Benjamin L. Shrank, William H. TI Association Between Medicare Advantage Plan Star Ratings and Enrollment SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID CHOICE SET SIZE; DECISION-MAKING; QUALITY INFORMATION; HEALTH-INSURANCE; REPORT CARDS; LESSONS; PROGRAM; FUTURE; MARKET AB Importance The US Centers for Medicare & Medicaid Services publishes star ratings reflecting Medicare Advantage plan quality to inform enrollment decisions. Objective To assess the association between publicly reported Medicare Advantage plan quality ratings and enrollment. Design, Setting, and Participants Cross-sectional study of 2011 Medicare Advantage enrollments among 952 352 first-time enrollees and 322 699 enrollees switching plans. Main Outcome Measure Association between star ratings and enrollment was modeled using conditional logit regression, controlling for beneficiary and plan characteristics. Results Among the 952 352 included first-time enrollees, a 1-star higher rating was associated with a 9.5 (95% CI, 9.3-9.6) percentage-point increase in likelihood to enroll. The highest rating available to a beneficiary was associated with a 1.9 (95% CI, 1.8-2.1) percentage-point increase in likelihood to enroll. Among the 322 699 enrollees switching plans, a 1-star higher rating was associated with a 4.4 (95% CI, 4.24.7) percentage-point increase in likelihood to enroll. A rating at least as high as a beneficiary's prior plan was associated with a 6.3 (95% CI, 6.0-6.6) percentage-point increase in likelihood to enroll. Star ratings were less strongly associated with enrollment for black, rural, low-income, and the youngest beneficiaries. Conclusion and Relevance Medicare's 5-star rating program for Medicare Advantage is associated with beneficiaries' enrollment decisions. JAMA. 2013;309(3):267-274 www.jama.com C1 [Shrank, William H.] Ctr Medicare Serv, Ctr Medicare & Medicaid Innovat, Rapid Cycle Evaluat Grp, Baltimore, MD USA. Ctr Medicaid Serv, Ctr Medicare & Medicaid Innovat, Rapid Cycle Evaluat Grp, Baltimore, MD USA. RP Shrank, WH (reprint author), Ctr Medicare Serv, Ctr Medicare & Medicaid Innovat, Rapid Cycle Evaluat Grp, 7500 Secur Blvd,Mailstop WB 06-05, Baltimore, MD USA. EM william.shrank@cms.hhs.gov FU CVS Caremark; Aetna; Express Scripts FX The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Shrank reported serving as a consultant to United Healthcare; and receiving grant support from CVS Caremark, Aetna, and Express Scripts. The other authors did not report any disclosures. NR 33 TC 26 Z9 26 U1 0 U2 9 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JAN 16 PY 2013 VL 309 IS 3 BP 267 EP 274 DI 10.1001/jama.2012.173925 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 070XG UT WOS:000313546800027 PM 23321765 ER PT J AU Ling, SM Bonner, AF McMullen, TL AF Ling, Shari M. Bonner, Alice F. McMullen, Tara L. TI Discontinuation of Risperidone in Alzheimer's Disease SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter ID METAANALYSIS; ADULTS C1 [Ling, Shari M.; Bonner, Alice F.; McMullen, Tara L.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Ling, SM (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. EM shari.ling@cms.hhs.gov NR 5 TC 0 Z9 0 U1 1 U2 3 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JAN 10 PY 2013 VL 368 IS 2 BP 187 EP 187 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 066RO UT WOS:000313238100017 PM 23301740 ER PT J AU Bonner, A AF Bonner, Alice TI Response to the Commentary: Advances in Nonpharmacological Interventions, 2011-2012 SO RESEARCH IN GERONTOLOGICAL NURSING LA English DT Editorial Material C1 [Bonner, Alice] Ctr Medicare & Medicaid Serv, Div Nursing Homes, Survey & Certificat Grp, Washington, DC USA. RP Bonner, A (reprint author), US Dept HHS, Div Nursing Homes, Survey & Certificat Grp, Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mailstop C2-21-16, Baltimore, MD 21244 USA. EM alice.bonner@cms.hhs.gov NR 0 TC 1 Z9 1 U1 0 U2 0 PU SLACK INC PI THOROFARE PA 6900 GROVE RD, THOROFARE, NJ 08086 USA SN 1940-4921 J9 RES GERONTOL NURS JI Res. Gerontol. Nurs. PD JAN PY 2013 VL 6 IS 1 BP 9 EP 9 DI 10.3928/19404921-20121206-02 PG 1 WC Nursing SC Nursing GA 173TX UT WOS:000321104600003 PM 23327596 ER PT J AU Hartman, M Martin, AB Benson, J Catlin, A AF Hartman, Micah Martin, Anne B. Benson, Joseph Catlin, Aaron CA Natl Hlth Expenditure Accounts Tea TI National Health Spending In 2011: Overall Growth Remains Low, But Some Payers And Services Show Signs Of Acceleration SO HEALTH AFFAIRS LA English DT Article AB In 2011 US health care spending grew 3.9 percent to reach $2.7 trillion, marking the third consecutive year of relatively slow growth. Growth in national health spending closely tracked growth in nominal gross domestic product (GDP) in 2010 and 2011, and health spending as a share of GDP remained stable from 2009 through 2011, at 17.9 percent. Even as growth in spending at the national level has remained stable, personal health care spending growth accelerated in 2011 (from 3.7 percent to 4.1 percent), in part because of faster growth in spending for prescription drugs and physician and clinical services. There were also divergent trends in spending growth in 2011 depending on the payment source: Medicaid spending growth slowed, while growth in Medicare, private health insurance, and out-of-pocket spending accelerated. Overall, there was relatively slow growth in incomes, jobs, and GDP in 2011, which raises questions about whether US health care spending will rebound over the next few years as it typically has after past economic downturns. C1 [Hartman, Micah] 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 21 TC 60 Z9 60 U1 0 U2 10 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 PY 2013 VL 32 IS 1 BP 87 EP 99 DI 10.1377/hlthaff.2012.1206 PG 13 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 077KH UT WOS:000314026100012 PM 23297275 ER PT J AU Brock, JA Jensen, TS Jacques, LB AF Brock, Janet Anderson Jensen, Tamara Syrek Jacques, Louis B. TI CMS National Coverage Determinations For Devices SO HEALTH AFFAIRS LA English DT Letter C1 [Brock, Janet Anderson; Jensen, Tamara Syrek; Jacques, Louis B.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Brock, JA (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 1 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 PY 2013 VL 32 IS 1 BP 192 EP 192 DI 10.1377/hlthaff.2012.1317 PG 1 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 077KH UT WOS:000314026100024 PM 23297286 ER PT J AU Brady, PW Muething, S Kotagal, U Ashby, M Gallagher, R Hall, D Goodfriend, M White, C Bracke, TM DeCastro, V Geiser, M Simon, J Tucker, KM Olivea, J Conway, PH Wheeler, DS AF Brady, Patrick W. Muething, Stephen Kotagal, Uma Ashby, Marshall Gallagher, Regan Hall, Dawn Goodfriend, Marty White, Christine Bracke, Tracey M. DeCastro, Victoria Geiser, Maria Simon, Jodi Tucker, Karen M. Olivea, Jason Conway, Patrick H. Wheeler, Derek S. TI Improving Situation Awareness to Reduce Unrecognized Clinical Deterioration and Serious Safety Events SO PEDIATRICS LA English DT Article DE patient safety; situation awareness; rapid response systems; clinical deterioration; quality improvement; high-reliability organizations; hospital medicine ID MEDICAL EMERGENCY TEAM; RAPID RESPONSE SYSTEM; HOSPITAL CARDIAC-ARREST; CARDIOPULMONARY ARRESTS; DYNAMIC-SYSTEMS; CARE; IMPLEMENTATION; PATIENT; MORTALITY; CHILDREN AB BACKGROUND AND OBJECTIVE: Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized patients. We designed a system to identify, mitigate, and escalate patient risk by using principles of high-reliability organizations. We hypothesized that our novel care system would decrease transfers determined to be unrecognized situation awareness failures events (UNSAFE). These were defined as any transfer from an acute care floor to an ICU where the patient received intubation, inotropes, or >= 3 fluid boluses in first hour after arrival or before transfer. METHODS: The setting for our observational time series study was a quaternary care children's hospital. Before initiating tests of change, 2 investigators reviewed recent serious safety events (SSEs) and floor-to-ICU transfers. Collectively, 5 risk factors were associated with each event: family concerns, high-risk therapies, presence of an elevated early warning score, watcher/clinician gut feeling, and communication concerns. Using the model for improvement, an intervention was developed and tested to reliably and proactively identify patient risk and mitigate that risk through unit-based huddles. A 3-times daily inpatient huddle was added to ensure risks were escalated and addressed. Later, a "robust" and explicit plan for at-risk patients was developed and spread. RESULTS: The rate of UNSAFE transfers per 10 000 non-ICU inpatient days was significantly reduced from 4.4 to 2.4 over the study period. The days between inpatient SSEs also increased significantly. CONCLUSIONS: A reliable system to identify, mitigate, and escalate risk was associated with a near 50% reduction in UNSAFE transfers and SSEs. Pediatrics 2013; 131:e298-e308 C1 [Brady, Patrick W.; Muething, Stephen; White, Christine; Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Hosp Med, Cincinnati, OH 45229 USA. [Gallagher, Regan; Hall, Dawn; Wheeler, Derek S.] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Crit Care Med, Cincinnati, OH 45229 USA. [Goodfriend, Marty] Cincinnati Childrens Hosp Med Ctr, Div Family Relat, Cincinnati, OH 45229 USA. [Brady, Patrick W.; Muething, Stephen; Kotagal, Uma; Ashby, Marshall; Bracke, Tracey M.; Olivea, Jason; Wheeler, Derek S.] Cincinnati Childrens Hosp Med Ctr, James M Anderson Ctr Hlth Syst Excellence, Cincinnati, OH 45229 USA. [Goodfriend, Marty; DeCastro, Victoria; Tucker, Karen M.] Cincinnati Childrens Hosp Med Ctr, Dept Patient Serv, Cincinnati, OH 45229 USA. [Simon, Jodi] Akron Childrens Hosp, Div Qual Serv, Akron, OH USA. [Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. RP Brady, PW (reprint author), Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Hosp Med, ML 9016,3333 Burnet Ave, Cincinnati, OH 45229 USA. EM patrick.brady@cchmc.org FU Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services [T32 HP10027]; Agency for Healthcare Research and Quality [U19 HS021114] FX Dr Brady was supported by funds from the Bureau of Health Professions, Health Resources and Services Administration, Department of Health and Human Services, under grant T32 HP10027. Portions of this project were supported by cooperative agreement number U19 HS021114 from the Agency for Healthcare Research and Quality. NR 33 TC 20 Z9 20 U1 1 U2 27 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 JAN PY 2013 VL 131 IS 1 BP E298 EP E308 DI 10.1542/peds.2012-1364 PG 11 WC Pediatrics SC Pediatrics GA 063PO UT WOS:000313012400036 PM 23230078 ER PT J AU Lim, SS Vos, T Flaxman, AD Danaei, G Shibuya, K Adair-Rohani, H Amann, M Anderson, HR Andrews, KG Aryee, M Atkinson, C Bacchus, LJ Bahalim, AN Balakrishnan, K Balmes, J Barker-Collo, S Baxter, A Bell, ML Blore, JD Blyth, F Bonner, C Borges, G Bourne, R Boussinesq, M Brauer, M Brooks, P Bruce, NG Brunekreef, B Bryan-Hancock, C Bucello, C Buchbinder, R Bull, F Burnett, RT Byers, TE Calabria, B Carapetis, J Carnahan, E Chafe, Z Charlson, F Chen, HL Chen, JS Cheng, ATA Child, JC Cohen, A Colson, KE Cowie, BC Darby, S Darling, S Davis, A Degenhardt, L Dentener, F Des Jarlais, DC Devries, K Dherani, M Ding, EL Dorsey, ER Driscoll, T Edmond, K Ali, SE Engell, RE Erwin, PJ Fahimi, S Falder, G Farzadfar, F Ferrari, A Finucane, MM Flaxman, S Fowkes, FGR Freedman, G Freeman, MK Gakidou, E Ghosh, S Giovannucci, E Gmel, G Graham, K Grainger, R Grant, B Gunnell, D Gutierrez, HR Hall, W Hoek, HW Hogan, A Hosgood, HD Hoy, D Hu, H Hubbell, BJ Hutchings, SJ Ibeanusi, SE Jacklyn, GL Jasrasaria, R Jonas, JB Kan, HD Kanis, JA Kassebaum, N Kawakami, N Khang, YH Khatibzadeh, S Khoo, JP Kok, C Laden, F Lalloo, R Lan, Q Lathlean, T Leasher, JL Leigh, J Li, Y Lin, JK Lipshultz, SE London, S Lozano, R Lu, Y Mak, J Malekzadeh, R Mallinger, L Marcenes, W March, L Marks, R Martin, R McGale, P McGrath, J Mehta, S Mensah, GA Merriman, TR Micha, R Michaud, C Mishra, V Hanafiah, KM Mokdad, AA Morawska, L Mozaffarian, D Murphy, T Naghavi, M Neal, B Nelson, PK Nolla, JM Norman, R Olives, C Omer, SB Orchard, J Osborne, R Ostro, B Page, A Pandey, KD Parry, CDH Passmore, E Patra, J Pearce, N Pelizzari, PM Petzold, M Phillips, MR Pope, D Pope, CA Powles, J Rao, M Razavi, H Rehfuess, EA Rehm, JT Ritz, B Rivara, FP Roberts, T Robinson, C Rodriguez-Portales, JA Romieu, I Room, R Rosenfeld, LC Roy, A Rushton, L Salomon, JA Sampson, U Sanchez-Riera, L Sanman, E Sapkota, A Seedat, S Shi, PL Shield, K Shivakoti, R Singh, GM Sleet, DA Smith, E Smith, KR Stapelberg, NJC Steenland, K Stockl, H Stovner, LJ Straif, K Straney, L Thurston, GD Tran, JH Van Dingenen, R van Donkelaar, A Veerman, JL Vijayakumar, L Weintraub, R Weissman, MM White, RA Whiteford, H Wiersma, ST Wilkinson, JD Williams, HC Williams, W Wilson, N Woolf, AD Yip, P Zielinski, JM Lopez, AD Murray, CJL Ezzati, M AF Lim, Stephen S. Vos, Theo Flaxman, Abraham D. Danaei, Goodarz Shibuya, Kenji Adair-Rohani, Heather Amann, Markus Anderson, H. Ross Andrews, Kathryn G. Aryee, Martin Atkinson, Charles Bacchus, Loraine J. Bahalim, Adil N. Balakrishnan, Kalpana Balmes, John Barker-Collo, Suzanne Baxter, Amanda Bell, Michelle L. Blore, Jed D. Blyth, Fiona Bonner, Carissa Borges, Guilherme Bourne, Rupert Boussinesq, Michel Brauer, Michael Brooks, Peter Bruce, Nigel G. Brunekreef, Bert Bryan-Hancock, Claire Bucello, Chiara Buchbinder, Rachelle Bull, Fiona Burnett, Richard T. Byers, Tim E. Calabria, Bianca Carapetis, Jonathan Carnahan, Emily Chafe, Zoe Charlson, Fiona Chen, Honglei Chen, Jian Shen Cheng, Andrew Tai-Ann Child, Jennifer Christine Cohen, Aaron Colson, K. Ellicott Cowie, Benjamin C. Darby, Sarah Darling, Susan Davis, Adrian Degenhardt, Louisa Dentener, Frank Des Jarlais, Don C. Devries, Karen Dherani, Mukesh Ding, Eric L. Dorsey, E. Ray Driscoll, Tim Edmond, Karen Ali, Suad Eltahir Engell, Rebecca E. Erwin, Patricia J. Fahimi, Saman Falder, Gail Farzadfar, Farshad Ferrari, Alize Finucane, Mariel M. Flaxman, Seth Fowkes, Francis Gerry R. Freedman, Greg Freeman, Michael K. Gakidou, Emmanuela Ghosh, Santu Giovannucci, Edward Gmel, Gerhard Graham, Kathryn Grainger, Rebecca Grant, Bridget Gunnell, David Gutierrez, Hialy R. Hall, Wayne Hoek, Hans W. Hogan, Anthony Hosgood, H. Dean, III Hoy, Damian Hu, Howard Hubbell, Bryan J. Hutchings, Sally J. Ibeanusi, Sydney E. Jacklyn, Gemma L. Jasrasaria, Rashmi Jonas, Jost B. Kan, Haidong Kanis, John A. Kassebaum, Nicholas Kawakami, Norito Khang, Young-Ho Khatibzadeh, Shahab Khoo, Jon-Paul Kok, Cindy Laden, Francine Lalloo, Ratilal Lan, Qing Lathlean, Tim Leasher, Janet L. Leigh, James Li, Yang Lin, John Kent Lipshultz, Steven E. London, Stephanie Lozano, Rafael Lu, Yuan Mak, Joelle Malekzadeh, Reza Mallinger, Leslie Marcenes, Wagner March, Lyn Marks, Robin Martin, Randall McGale, Paul McGrath, John Mehta, Sumi Mensah, George A. Merriman, Tony R. Micha, Renata Michaud, Catherine Mishra, Vinod Hanafiah, Khayriyyah Mohd Mokdad, Ali A. Morawska, Lidia Mozaffarian, Dariush Murphy, Tasha Naghavi, Mohsen Neal, Bruce Nelson, Paul K. Miquel Nolla, Joan Norman, Rosana Olives, Casey Omer, Saad B. Orchard, Jessica Osborne, Richard Ostro, Bart Page, Andrew Pandey, Kiran D. Parry, Charles D. H. Passmore, Erin Patra, Jayadeep Pearce, Neil Pelizzari, Pamela M. Petzold, Max Phillips, Michael R. Pope, Dan Pope, C. Arden, III Powles, John Rao, Mayuree Razavi, Homie Rehfuess, Eva A. Rehm, Juergen T. Ritz, Beate Rivara, Frederick P. Roberts, Thomas Robinson, Carolyn Rodriguez-Portales, Jose A. Romieu, Isabelle Room, Robin Rosenfeld, Lisa C. Roy, Ananya Rushton, Lesley Salomon, Joshua A. Sampson, Uchechukwu Sanchez-Riera, Lidia Sanman, Ella Sapkota, Amir Seedat, Soraya Shi, Peilin Shield, Kevin Shivakoti, Rupak Singh, Gitanjali M. Sleet, David A. Smith, Emma Smith, Kirk R. Stapelberg, Nicolas J. C. Steenland, Kyle Stoeckl, Heidi Stovner, Lars Jacob Straif, Kurt Straney, Lahn Thurston, George D. Tran, Jimmy H. Van Dingenen, Rita van Donkelaar, Aaron Veerman, J. Lennert Vijayakumar, Lakshmi Weintraub, Robert Weissman, Myrna M. White, Richard A. Whiteford, Harvey Wiersma, Steven T. Wilkinson, James D. Williams, Hywel C. Williams, Warwick Wilson, Nicholas Woolf, Anthony D. Yip, Paul Zielinski, Jan M. Lopez, Alan D. Murray, Christopher J. L. Ezzati, Majid TI A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 SO LANCET LA English DT Article ID CORONARY-HEART-DISEASE; LUNG-CANCER RISK; FINE PARTICULATE MATTER; ASIA-PACIFIC REGION; LONG-TERM EXPOSURE; BODY-MASS INDEX; RANDOMIZED CONTROLLED-TRIAL; CARDIOVASCULAR-DISEASE; BLOOD-PRESSURE; AIR-POLLUTION AB Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. Methods We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. Findings In 2010, the three leading risk factors for global disease burden were high blood pressure (7.0% [95% uncertainty interval 6.2-7.7] of global DALYs), tobacco smoking including second-hand smoke (6.3% [5.5-7.0]), and alcohol use (5.5% [5.0-5.9]). In 1990, the leading risks were childhood underweight (7.9% [6.8-9.4]), household air pollution from solid fuels (HAP; 7.0% [5.6-8.3]), and tobacco smoking including second-hand smoke (6.1% [5.4-6.8]). Dietary risk factors and physical inactivity collectively accounted for 10.0% (95% UI 9.2-10.8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0.9% (0.4-1.6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. Interpretation Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. C1 [Lim, Stephen S.; Flaxman, Abraham D.; Andrews, Kathryn G.; Atkinson, Charles; Carnahan, Emily; Colson, K. Ellicott; Engell, Rebecca E.; Freedman, Greg; Freeman, Michael K.; Gakidou, Emmanuela; Jasrasaria, Rashmi; Lozano, Rafael; Mallinger, Leslie; Mokdad, Ali A.; Murphy, Tasha; Naghavi, Mohsen; Roberts, Thomas; Rosenfeld, Lisa C.; Sanman, Ella; Straney, Lahn; Murray, Christopher J. L.] Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA. [Kassebaum, Nicholas] Univ Washington, Dept Anesthesiol & Pain Med, Seattle, WA 98121 USA. [Baxter, Amanda; Ferrari, Alize; Khoo, Jon-Paul; Whiteford, Harvey] Univ Queensland, Queensland Ctr Mental Hlth Res, Brisbane, Qld, Australia. [Vos, Theo; Blore, Jed D.; Charlson, Fiona; Norman, Rosana; Page, Andrew; Lopez, Alan D.] Univ Queensland, Sch Populat Hlth, Brisbane, Qld, Australia. [McGrath, John] Univ Queensland, Inst Brain, Brisbane, Qld, Australia. [Finucane, Mariel M.] Harvard Univ, Dept Biostat, Boston, MA 02115 USA. [Khatibzadeh, Shahab] Harvard Univ, Dept Epidemiol, Boston, MA 02115 USA. [Danaei, Goodarz; Ding, Eric L.; Giovannucci, Edward; Laden, Francine; Lin, John Kent; Micha, Renata; Mozaffarian, Dariush; Rao, Mayuree; Salomon, Joshua A.; Singh, Gitanjali M.; White, Richard A.] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Mozaffarian, Dariush] Harvard Univ, Sch Med, Boston, MA 02115 USA. [Shibuya, Kenji] Univ Tokyo, Dept Global Hlth Policy, Tokyo, Japan. [Balmes, John] Univ Calif Berkeley, Sch Publ Hlth, Berkeley, CA 94720 USA. [Amann, Markus] Int Inst Appl Syst Anal, A-2361 Laxenburg, Austria. [Anderson, H. Ross] Univ London, London, England. [Hanafiah, Khayriyyah Mohd] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Aryee, Martin] Johns Hopkins Univ, Sch Med, Baltimore, MD USA. [Bacchus, Loraine J.; Child, Jennifer Christine; Devries, Karen; Edmond, Karen; Falder, Gail; Mak, Joelle; Pearce, Neil; Stoeckl, Heidi] London Sch Hyg & Trop Med, London WC1, England. [Balakrishnan, Kalpana; Ghosh, Santu] Sri Ramachandra Univ, Chennai, Tamil Nadu, India. [Barker-Collo, Suzanne] Univ Auckland, Auckland 1, New Zealand. [Bell, Michelle L.] Yale Univ, New Haven, CT USA. [Leigh, James] Univ Sydney, Sch Publ Hlth, Sydney, NSW 2006, Australia. [Smith, Emma] Univ Sydney, No Clin Sch, Dept Rheumatol, Sydney, NSW 2006, Australia. [Chen, Jian Shen; March, Lyn; Sanchez-Riera, Lidia; Wilson, Nicholas] Univ Sydney, Inst Bone & Joint Res, Sydney, NSW 2006, Australia. [Borges, Guilherme] Natl Inst Psychiat, Mexico City, DF, Mexico. [Borges, Guilherme] Univ Nacl Autonoma Mexico, Mexico City 04510, DF, Mexico. [Bourne, Rupert] Anglia Ruskin Univ, Vis & Eye Res Unit, Cambridge, England. [Brauer, Michael] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada. [Weintraub, Robert] Univ Melbourne, Dept Pediat, Melbourne, Vic, Australia. [Degenhardt, Louisa] Univ Melbourne, Ctr Hlth Policy Programs & Econ, Melbourne, Vic, Australia. [Room, Robin] Univ Melbourne, Sch Populat Hlth, Melbourne, Vic, Australia. [Bruce, Nigel G.; Dherani, Mukesh; Pope, Dan] Univ Liverpool, Liverpool L69 3BX, Merseyside, England. [Brunekreef, Bert] Univ Utrecht, Insititute Risk Assessment Sci, Utrecht, Netherlands. [Bryan-Hancock, Claire; Lathlean, Tim] Flinders Univ S Australia, Adelaide, SA 5001, Australia. [Calabria, Bianca; Degenhardt, Louisa; Nelson, Paul K.] Univ New S Wales, Natl Drug & Alcohol Res Ctr, Sydney, NSW, Australia. [Buchbinder, Rachelle] Cabrini Inst, Malvern, Vic, Australia. [Buchbinder, Rachelle; Hoy, Damian] Monash Univ, Melbourne, Vic 3004, Australia. [Carapetis, Jonathan] Univ Western Australia, Telethon Inst Child Hlth Res, Ctr Child Hlth Res, Perth, WA 6009, Australia. [Burnett, Richard T.; Zielinski, Jan M.] Hlth Canada, Ottawa, ON K1A 0L2, Canada. [Byers, Tim E.] Colorado Sch Publ Hlth, Aurora, CO USA. [Chen, Honglei; London, Stephanie] NIEHS, Res Triangle Pk, NC 27709 USA. 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[Gmel, Gerhard] Addict Info Switzerland, Lausanne, Switzerland. [Graham, Kathryn; Rehm, Juergen T.; Shield, Kevin] Ctr Addict & Mental Hlth, Toronto, ON, Canada. [Grainger, Rebecca; Merriman, Tony R.] Univ Otago, Dunedin, New Zealand. [Lan, Qing] NCI, Occupat & Environm Epidemiol Branch, Div Canc Epidemiol & Genet, NIH, Bethesda, MD 20892 USA. [Gunnell, David] Univ Bristol, Bristol, Avon, England. [Weissman, Myrna M.] Columbia Univ, Coll Phys & Surg, New York, NY USA. [Gutierrez, Hialy R.; Weissman, Myrna M.] Columbia Univ, Mailman Sch Publ Hlth, New York, NY USA. [Hoek, Hans W.] Parnassia Psychiat Inst, The Hague, Netherlands. [Hogan, Anthony] Australian Natl Univ, Canberra, ACT, Australia. [Hosgood, H. Dean, III] Yeshiva Univ, Albert Einstein Coll Med, New York, NY 10033 USA. [Hu, Howard] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada. [Hubbell, Bryan J.] US EPA, Washington, DC 20460 USA. [Hutchings, Sally J.; Rushton, Lesley; Ezzati, Majid] Univ London Imperial Coll Sci Technol & Med, Sch Publ Hlth, Dept Epidemiol & Biostat, MRC HPA Ctr Environm & Hlth, London, England. [Ibeanusi, Sydney E.] Univ Port Harcourt, Port Harcourt, Nigeria. [Jonas, Jost B.] Heidelberg Univ, Med Fac Mannheim, Dept Ophthalmol, Heidelberg, Germany. [Kan, Haidong] Fudan Univ, Shanghai 200433, Peoples R China. [Kanis, John A.] Univ Sheffield, Sheffield, S Yorkshire, England. [Khang, Young-Ho] Univ Ulsan, Coll Med, Dept Prevent Med, Seoul, South Korea. [Kok, Cindy] Spinal Cord Injury Network, Glebe, New Zealand. [Lalloo, Ratilal] Griffith Univ, Sch Dent & Oral Hlth, Brisbane, Qld 4111, Australia. [Lalloo, Ratilal] Griffith Univ, Populat & Social Hlth Res Program, Brisbane, Qld 4111, Australia. [Leasher, Janet L.] Nova SE Univ, Ft Lauderdale, FL 33314 USA. [Li, Yang] George Inst Global Hlth, Crit Care & Trauma Div, Sydney, NSW, Australia. [Lipshultz, Steven E.; Wilkinson, James D.] Univ Miami, Miller Sch Med, Miami, FL 33136 USA. [Marcenes, Wagner] Queen Mary Univ London, London, England. [Martin, Randall; van Donkelaar, Aaron] Dalhousie Univ, Halifax, NS, Canada. [Mehta, Sumi] Global Alliance Clean Cookstoves, Washington, DC USA. [Mensah, George A.] Univ Cape Town, Dept Med, ZA-7925 Cape Town, South Africa. [Micha, Renata] Agr Univ Athens, Athens, Greece. [Michaud, Catherine] China Med Board, Boston, MA USA. [Mishra, Vinod] United Nations Populat Div, New York, NY USA. [Morawska, Lidia] Queensland Univ Technol, Brisbane, Qld 4001, Australia. [Miquel Nolla, Joan] Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge, Dept Rheumatol, Barcelona, Spain. [Omer, Saad B.; Steenland, Kyle] Emory Univ, Sch Publ Hlth, Atlanta, GA USA. [Omer, Saad B.] Emory Univ, Sch Med, Atlanta, GA USA. [Osborne, Richard] Deakin Univ, Melbourne, Vic, Australia. [Ostro, Bart] Calif Environm Protect Agcy, Sacramento, CA USA. [Pandey, Kiran D.] World Bank, Washington, DC 20433 USA. [Parry, Charles D. H.] S African MRC, Cape Town, South Africa. [Patra, Jayadeep] St Michaels Hosp, Toronto, ON M5B 1W8, Canada. [Pelizzari, Pamela M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Petzold, Max] Univ Gothenburg, Sahlgrenska Acad, Ctr Appl Biostat, Gothenburg, Sweden. [Phillips, Michael R.] Shanghai Jiao Tong Univ, Sch Med, Shanghai Mental Hlth Ctr, Shanghai 200030, Peoples R China. [Pope, C. Arden, III] Brigham Young Univ, Provo, UT 84602 USA. [Razavi, Homie] Ctr Dis Anal, Louisville, CO USA. [Rehfuess, Eva A.] Univ Munich, Munich, Germany. [Ritz, Beate] Univ Calif Los Angeles, Los Angeles, CA USA. [Robinson, Carolyn] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Rodriguez-Portales, Jose A.] Pontificia Univ Catolica Chile, Santiago, Chile. [Romieu, Isabelle; Straif, Kurt] Int Agcy Res Canc, F-69372 Lyon, France. [Room, Robin] Turning Point Alcohol & Drug Ctr, Ctr Alcohol Policy Res, Fitzroy, SA, Australia. [Roy, Ananya] Univ Med & Dent New Jersey, Newark, NJ 07103 USA. [Sampson, Uchechukwu] Vanderbilt Univ, Nashville, TN USA. [Sapkota, Amir] Univ Maryland, Sch Publ Hlth, Baltimore, MD 21201 USA. [Seedat, Soraya] Univ Stellenbosch, ZA-7600 Stellenbosch, South Africa. [Sleet, David A.] Ctr Dis Control & Prevent, Natl Ctr Injury Prevent & Control, Baltimore, MD USA. [Stovner, Lars Jacob] Norwegian Univ Sci & Technol, Dept Neurosci, N-7034 Trondheim, Norway. [Thurston, George D.] NYU, New York, NY USA. [Vijayakumar, Lakshmi] Voluntary Hlth Serv, Chennai, Tamil Nadu, India. [Weintraub, Robert] Royal Childrens Hosp, Melbourne, Vic, Australia. [Weintraub, Robert] Murdoch Childrens Res Inst, Melbourne, Vic, Australia. [Williams, Hywel C.] Univ Nottingham, Nottingham NG7 2RD, England. [Williams, Warwick] Natl Acoust Labs, Sydney, NSW, Australia. [Woolf, Anthony D.] Royal Cornwall Hosp, Truro, England. [Yip, Paul] Univ Hong Kong, Ctr Suicide Res & Prevent, Hong Kong, Hong Kong, Peoples R China. RP Lim, SS (reprint author), Univ Washington, Inst Hlth Metr & Evaluat, 2301 5th Ave,Suite 600, Seattle, WA 98121 USA. EM stevelim@uw.edu RI Balakrishnan, Kalpana/B-6653-2015; Lopez, Alan/F-1487-2010; Hall, Wayne/A-3283-2008; Stockwell, Tim/B-6662-2012; Baxter, Amanda/E-5449-2011; Ritz, Beate/E-3043-2015; Charlson, Fiona/F-5290-2011; Whiteford, Harvey/A-4840-2009; Boussinesq, Michel/J-7256-2016; Bacchus, Loraine/J-9996-2016; Lalloo, Ratilal/O-5624-2014; Salomon, Joshua/D-3898-2009; Pope, Daniel/C-3054-2014; Sapkota, Amir/A-5968-2011; McGrath, John/G-5493-2010; Stovner, Lars/D-5025-2014; Orchard, Jessica/E-2078-2013; NORMAN, ROSANA/F-2774-2010; Buchbinder, Rachelle/G-2952-2011; Degenhardt, Louisa/D-4515-2012; Bull, Fiona/G-4148-2012; Veerman, Lennert/A-9973-2011; Lathlean, Tim/K-3653-2013; Parry, Charles/A-2906-2009; Martin, Randall/C-1205-2014; OI Jacklyn, Gemma/0000-0002-4814-3241; Devries, Karen/0000-0001-8935-2181; Weissman, Myrna/0000-0003-3490-3075; Hoek, Hans/0000-0001-6353-5465; Borges, Guilherme/0000-0002-3269-0507; London, Stephanie/0000-0003-4911-5290; Khang, Young-Ho/0000-0002-9585-8266; brunekreef, bert/0000-0001-9908-0060; Powles, John/0000-0002-0766-7989; Stockl, Heidi/0000-0002-0907-8483; Hu, Howard/0000-0002-3676-2707; Balakrishnan, Kalpana/0000-0002-5905-1801; Cowie, Benjamin/0000-0002-7087-5895; O'donnell, Colm/0000-0002-8004-450X; Malekzadeh, Reza/0000-0003-1043-3814; Mensah, George/0000-0002-0387-5326; Lopez, Alan/0000-0001-5818-6512; Hall, Wayne/0000-0003-1984-0096; Baxter, Amanda/0000-0001-8198-9022; Charlson, Fiona/0000-0003-2876-5040; Whiteford, Harvey/0000-0003-4667-6623; Boussinesq, Michel/0000-0001-6312-0681; Bacchus, Loraine/0000-0002-9966-8208; Lalloo, Ratilal/0000-0001-5822-1269; Salomon, Joshua/0000-0003-3929-5515; Ghosh, Santu/0000-0003-1358-3471; McGrath, John/0000-0002-4792-6068; Orchard, Jessica/0000-0002-5702-7277; NORMAN, ROSANA/0000-0002-9742-1957; Degenhardt, Louisa/0000-0002-8513-2218; Veerman, Lennert/0000-0002-3206-8232; Parry, Charles/0000-0001-9787-2785; Martin, Randall/0000-0003-2632-8402; Brauer, Michael/0000-0002-9103-9343; Merriman, Tony/0000-0003-0844-8726; Chen, Honglei/0000-0003-3446-7779; Osborne, Richard/0000-0002-9081-2699 FU Lundbeck; Prana Biotechnology; Abbott; Amgen; AstraZeneca; George Clinical; GlaxoSmithKline; Novartis; PepsiCo; Pfizer; Pharmacy Guild of Australia; Roche; Sanofi-Aventis; Seervier; Tanabe; Australian Food and Grocery Council; Bupa Australia; Johnson and Johnson; Merck Schering-Plough; Servier; United Healthcare Group; Imperial College London (as PI) from the European Chemical Industry Council; CONCAWE; USEPA; Shell Foundation; Fight for Sight; Australian National Health and Medical Research Council; Monash University; Cabrini Health; Health Effects Institute; William and Flora Hewlett Foundation; Cancer Research UK; Safework Australia; Johns Hopkins Vaccine Initiative Scholarship; WHO; Parnassia Psychiatric Institute, The Hague, Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Netherlands; World Mental Health Japan; Grant for Research on Psychiatric and Neurological Diseases and Mental Health from the Japan Ministry of Health, Labour, and Welfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]; Intramural Research Program of the NIH (National Cancer Institute); Division of Intramural Research, National Institute of Environmental Health Sciences, USA; Australian Research Council Future Fellowship; National Health and Medical Research Council of Australia Senior Research Fellowship; Munich Centre of Health Sciences; Foundation for Alcohol Research and Education; Victorian Department of Health; Burke Global Health Fellowship; Harold Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation; Vanderbilt Clinical and Translational Scholars Award; Spanish Society of Rheumatology; South African Research Chairs Initiative; National Research Foundation; National Institute of Environmental Health Sciences [ES00260]; UK Medical Research Council (MRC); National Institute for Health Research Comprehensive Biomedical research Centre at Imperial College Healthcare NHS Trust; Nutrition Impact Model Study (NIMS); Bill & Melinda Gates Foundation; Spanish Rheumatology Association; Institute of Bone and Joint Research; University of Sydney FX A Davis is employed by the NHS on works for the UK Dept of Health as lead adviser on audiology. E R Dorsey has been a consultant for Medtronic and Lundbeck and has received grant support from Lundbeck and Prana Biotechnology. M Ezzati chaired a session and gave a talk at the World Cardiology Congress (WCC), with travel cost reimbursed by the World Heart Federation. At the WCC, he also gave a talk at a session organised by Pepsico with no financial remuneration. G A Mensah is a former employee of PepsiCo. D Mozaffarian has received: ad hoc travel reimbursement and/or honoraria for one-time specific presentations on diet and cardiometabolic diseases from Nutrition Impact (9/10), the International Life Sciences Institute (12/10), Bunge (11/11), Pollock Institute (3/12), and Quaker Oats (4/12; modest); and Unilever's North America Scientific Advisory Board (modest). B Neal is the Chair of the Australian Division of World Action on Salt and Health. He has consulted to Roche and Takeda. He has received lecture fees, travel fees, or reimbursements from Abbott, Amgen, AstraZeneca, George Clinical, GlaxoSmithKline, Novartis, PepsiCo, Pfizer, Pharmacy Guild of Australia, Roche, Sanofi-Aventis, Seervier, and Tanabe. He holds research support from the Australian Food and Grocery Council, Bupa Australia, Johnson and Johnson, Merck Schering-Plough, Roche, Servier, and United Healthcare Group. He is not employed by a commercial entity and has no equity ownership or stock options, patents or royalties, or any other financial or non-financial support that might be viewed as a conflict of interest. L Rushton received honorarium for board membership of the European Centre for Ecotoxicology and Toxicology of Chemicals and research grants to Imperial College London (as PI) from the European Chemical Industry Council and CONCAWE.; We thank the countless individuals who have contributed to the Global Burden of Disease Study 2010 in various capacities. We specifically acknowledge the important contribution to this work from multiple staff members of the World Health Organization. We also thank the following organisations that hosted consultations during the final stages of the analytical process, providing valuable feedback about the results and the data to improve the study's findings overall: Pan American Health Organization; Eastern Mediterranean Regional Office of WHO; UNAIDS; Ministry of Health, Brazil; China Centers for Disease Control; and the University of Zambia. We thank Regina Guthold, Jordis Ott, Annette Pruss-Ustun, and Gretchen A Stevens for their collaboration and input into the analyses and estimates. Finally, we acknowledge the extensive support from all staff members at the Institute for Health Metrics and Evaluation and specifically thank: James Bullard, Andrew Ernst, and Serkan Yalcin for their tireless support of the computational infrastructure required to produce the results; Linda A Ettinger for her expert administrative support to facilitate communication and coordination amongst the authors; Peter Speyer, Abigail McLain, Katherine Leach-Kemon, and Eden Stork for their persistent and valuable work to gain access to and catalogue as much data as possible to inform the estimates; and Erin C Mullany for her systematic efforts in organising drafts of papers, formatting correspondence with expert groups, and preparing the final manuscript. J Balmes, Z Chafe, and K R Smith acknowledge that their aspects of the research were also supported by USEPA and the Shell Foundation, neither of which had any role in design, data collection, analysis, interpretation, or decisions related to publication. R Bourne acknowledges Institutional Support: Vision & Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, UK. Funding support: Fight for Sight (Dr Hans and Mrs Gertrude Hirsch award). R Buchbinder was partially supported by an Australian National Health and Medical Research Council Practitioner Fellowship, Monash University, and Cabrini Health. A J Cohen received support from the Health Effects Institute and The William and Flora Hewlett Foundation. S Darby was supported by Cancer Research UK. L Degenhardt was supported by an Australian National Health and Medical Research Council Senior Research Fellowship. T Driscoll was supported in part by funding from the National Occupational Health and Safety Commission (now Safework Australia). K M Hanafiah's work for the GBD hepatitis C prevalence study was funded partly by Johns Hopkins Vaccine Initiative Scholarship and partly by WHO. H W Hoek acknowledges the support of: the Parnassia Psychiatric Institute, The Hague, Netherlands; the Department of Psychiatry, University Medical Center Groningen, University of Groningen, Netherlands; and the Department of Epidemiology, Columbia University, New York, USA. D Hoy was supported by the Bill & Melinda Gates Foundation and the Australian National Health and Medical Research Council. N Kawakami notes that data used in the study was collected through support from the following grants: The World Mental Health Japan is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour, and Welfare. He thanks staff members, filed coordinators, and interviewers of the WMH Japan 2002-2004 Survey.; Q Lan was supported in part by the Intramural Research Program of the NIH (National Cancer Institute). S London is supported by the Division of Intramural Research, National Institute of Environmental Health Sciences, USA. T R Merriman acknowledges the Health Research Council of New Zealand. B Neal was supported in his contribution to this work by an Australian Research Council Future Fellowship and a National Health and Medical Research Council of Australia Senior Research Fellowship. C Olives was supported in his contribution to this work by an Australian Research Council Future Fellowship and a National Health and Medical Research Council of Australia Senior Research Fellowship. E A Rehfuess acknowledges financial support from the Munich Centre of Health Sciences. R Room's position at the University of Melbourne and Turning Point Alcohol and Drug Centre is funded by the Foundation for Alcohol Research and Education and the Victorian Department of Health. J A Salomon received support from the Burke Global Health Fellowship while working on this study. U Sampson was supported in part by: The Harold Amos Medical Faculty Development Award of the Robert Wood Johnson Foundation; The Vanderbilt Clinical and Translational Scholars Award. L Sanchez-Riera acknowledges the Spanish Society of Rheumatology for their funds. S Seedat is supported by the South African Research Chairs Initiative, hosted by the Department of Science and Technology and the National Research Foundation. G D Thurston was supported in part by grant ES00260 from the National Institute of Environmental Health Sciences. J M Zielinski acknowledges institutional support from: Health Canada, University of Ottawa, and WHO (International Radon Project). M Ezzati's research is supported by a Strategic Award from the UK Medical Research Council (MRC) and by the National Institute for Health Research Comprehensive Biomedical research Centre at Imperial College Healthcare NHS Trust. Work on micronutrient deficiencies was supported by the Nutrition Impact Model Study (NIMS) funded by the Bill & Melinda Gates Foundation. The GBD Osteoporosis Expert Group was supported by the Spanish Rheumatology Association, Institute of Bone and Joint Research, University of Sydney. The GBD Osteoporosis Expert Group also acknowledges the contributions made by Professor Philip Sambrook who passed away in April, 2012. NR 192 TC 2676 Z9 2777 U1 203 U2 1287 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0140-6736 EI 1474-547X J9 LANCET JI Lancet PD DEC 15 PY 2012 VL 380 IS 9859 BP 2224 EP 2260 PG 37 WC Medicine, General & Internal SC General & Internal Medicine GA 055AL UT WOS:000312387000017 PM 23245609 ER PT J AU Lawson, EH Louie, R Zingmond, DS Brook, RH Hall, BL Han, L Rapp, M Ko, CY AF Lawson, Elise H. Louie, Rachel Zingmond, David S. Brook, Robert H. Hall, Bruce L. Han, Lein Rapp, Michael Ko, Clifford Y. TI A Comparison of Clinical Registry Versus Administrative Claims Data for Reporting of 30-Day Surgical Complications SO ANNALS OF SURGERY LA English DT Article DE Administrative claims; clinical registry; complications; postoperative; quality measurement; surgery ID QUALITY IMPROVEMENT PROGRAM; POSTOPERATIVE ADVERSE EVENTS; NSQIP AB Objectives: To compare the recording of 30-day postoperative complications between a national clinical registry and Medicare inpatient claims data and to determine whether the addition of outpatient claims data improves concordance with the clinical registry. Background: Policymakers are increasingly discussing use of postoperative complication rates for value-based purchasing. There is debate regarding the optimal data source for such measures. Methods: Patient records (2005-2008) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient and outpatient claims data sets. We assessed the ability of (1) Medicare inpatient claims and (2) Medicare inpatient and outpatient claims to detect a core set of ACS-NSQIP 30-day postoperative complications: superficial surgical site infection (SSI), deep/organ-space SSI, any SSI (superficial and/or deep/organ-space), urinary tract infection, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, venous thromboembolism (DVT and/or pulmonary embolism), and myocardial infarction. Agreement of patient-level complications by ACS-NSQIP versus Medicare was assessed by. statistics. Results: A total of 117,752 patients from more than 200 hospitals were studied. The sensitivity of inpatient claims data for detecting ACS-NSQIP complications ranged from 0.27 to 0.78; the percentage of false-positives ranged from 48% to 84%. Addition of outpatient claims data improved sensitivity slightly but also greatly increased the percentage of false-positives. Agreement was routinely poor between clinical and claims data for patient-level complications. Conclusions: This analysis demonstrates important differences between ACS-NSQIP and Medicare claims data sets for measuring surgical complications. Poor accuracy potentially makes claims data suboptimal for evaluating surgical complications. These findings have meaningful implications for performance measures currently being considered. C1 [Lawson, Elise H.; Louie, Rachel; Zingmond, David S.; Brook, Robert H.; Ko, Clifford Y.] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA. [Brook, Robert H.] RAND Corp, Santa Monica, CA USA. [Brook, Robert H.] Univ Calif Los Angeles, Jonathan & Karin Fielding Sch Publ Hlth, Los Angeles, CA 90095 USA. [Hall, Bruce L.; Ko, Clifford Y.] Amer Coll Surg, Div Res & Optimal Patient Care, Chicago, IL USA. [Hall, Bruce L.] Washington Univ, Sch Med, St Louis, MO USA. [Hall, Bruce L.] Washington Univ, Barnes Jewish Hosp, St Louis Vet Affairs Med Ctr, St Louis, MO USA. [Hall, Bruce L.] Washington Univ, Ctr Hlth Policy, St Louis, MO USA. [Hall, Bruce L.] Washington Univ, Olin Business Sch, St Louis, MO USA. [Han, Lein; Rapp, Michael] Ctr Medicare Serv, Baltimore, MD USA. [Han, Lein; Rapp, Michael] Ctr Medicaid Serv, Baltimore, MD USA. [Rapp, Michael] George Washington Univ, Sch Med & Hlth Sci, Dept Emergency Med, Washington, DC 20052 USA. [Ko, Clifford Y.] VA Greater Los Angeles Healthcare Syst, Los Angeles, CA USA. RP Lawson, EH (reprint author), Univ Calif Los Angeles, David Geffen Sch Med, 10833 Le Conte Ave,72-215 CHS, Los Angeles, CA 90095 USA. EM elawson@mednet.ucla.edu FU VA Health Services Research and Development program [RWJ 65-020]; American College of Surgeons through the Robert Wood Johnson Foundation Clinical Scholars Program; Centers for Medicare & Medicaid Services (CMS) FX E.H.L.'s time was supported by the VA Health Services Research and Development program (RWJ 65-020) and the American College of Surgeons through the Robert Wood Johnson Foundation Clinical Scholars Program. This study was funded by a contract from the Centers for Medicare & Medicaid Services (CMS). None of the remaining authors had any conflicts of interests to declare. The views expressed in this article represent the authors' views and do not necessarily represent official policy or opinions of the Department of Health and Human Services, the Centers for Medicare & Medicaid Services. NR 15 TC 106 Z9 106 U1 0 U2 9 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 DEC PY 2012 VL 256 IS 6 BP 973 EP 981 DI 10.1097/SLA.0b013e31826b4c4f PG 9 WC Surgery SC Surgery GA 053HC UT WOS:000312261000022 PM 23095667 ER PT J AU Carlin, CS Christianson, JB Keenan, P Finch, M AF Carlin, Caroline S. Christianson, Jon B. Keenan, Patricia Finch, Michael TI Chronic Illness and Patient Satisfaction SO HEALTH SERVICES RESEARCH LA English DT Article DE Chronic disease; patient assessment/satisfaction; LISREL ID QUALITY-OF-CARE; HEALTH-CARE; MEDICAL CONDITIONS; COMPLEX PATIENTS; THE-LITERATURE; PERFORMANCE; MULTIMORBIDITY; RATINGS; COMMUNICATION; INFORMATION AB Objective To examine how the relationship between patient characteristics, patient experience with the health care system, and overall satisfaction with care varies with illness complexity. Data Sources/Study Setting Telephone survey in 14 U.S. geographical areas. Study Design Structural equation modeling was used to examine how relationships among patient characteristics, three constructs representing patient experience with the health care system, and overall satisfaction with care vary across patients by number of chronic illnesses. Data Collection/Extraction Methods Random digital dial telephone survey of adults with one or more chronic illnesses. Principal Findings Patients with more chronic illnesses report higher overall satisfaction. The total effects of better patientprovider interaction and support for patient self-management are associated with higher satisfaction for all levels of chronic illness. The latter effect increases with illness burden. Older, female, or insured patients are more satisfied; highly educated patients are less satisfied. Conclusions Providers seeking to improve their patient satisfaction scores could do so by considering patient characteristics when accepting new patients or deciding who to refer to other providers for treatment. However, our findings suggest constructive actions that providers can take to improve their patient satisfaction scores without selection on patient characteristics. C1 [Carlin, Caroline S.] Med Res Inst, Minneapolis, MN 55440 USA. [Christianson, Jon B.] Univ Minnesota, Div Hlth Policy & Management, Minneapolis, MN USA. [Keenan, Patricia] Ctr Medicare Serv, Bethesda, MD USA. [Keenan, Patricia] Ctr Medicaid Serv, Bethesda, MD USA. [Finch, Michael] Finch & King Inc, Minneapolis, MN USA. RP Carlin, CS (reprint author), Med Res Inst, Mail Route CW295,POB 9310, Minneapolis, MN 55440 USA. EM caroline.car-lin@medica.com OI Carlin, Caroline/0000-0003-0813-3433 FU Robert Wood Johnson Foundation FX This research was supported by a grant from the Robert Wood Johnson Foundation for the evaluation of its Aligning Forces for Quality initiative. NR 43 TC 6 Z9 6 U1 2 U2 23 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2012 VL 47 IS 6 BP 2250 EP 2272 DI 10.1111/j.1475-6773.2012.01412.x PG 23 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 035WL UT WOS:000310983100010 PM 22515159 ER PT J AU VanLare, JM Blum, JD Conway, PH AF VanLare, Jordan M. Blum, Jonathan D. Conway, Patrick H. TI Linking Performance With Payment Implementing the Physician Value-Based Payment Modifier SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [VanLare, Jordan M.; Blum, Jonathan D.; Conway, Patrick H.] US Dept HHS, Ctr Medicare Serv, Woodlawn, MD 21244 USA. [VanLare, Jordan M.; Blum, Jonathan D.; Conway, Patrick H.] US Dept HHS, Ctr Medicaid Serv, Woodlawn, MD 21244 USA. [VanLare, Jordan M.] Columbia Univ, Columbia Coll Phys & Surg, New York, NY USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA. RP VanLare, JM (reprint author), US Dept HHS, Ctr Medicare Serv, 7500 Secur Blvd, Woodlawn, MD 21244 USA. EM jordan.vanlare@cms.hhs.gov NR 6 TC 25 Z9 25 U1 0 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 515 N STATE ST, CHICAGO, IL 60654-0946 USA SN 0098-7484 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD NOV 28 PY 2012 VL 308 IS 20 BP 2089 EP 2090 DI 10.1001/jama.2012.14834 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 043IV UT WOS:000311537200020 PM 23198298 ER PT J AU Donovan, S AF Donovan, S. TI MEDICARE-MEDICAID COORDINATION OFFICE OVERVIEW SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Donovan, S.] Ctr Medicare Serv, Baltimore, MD USA. [Donovan, S.] 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 J9 GERONTOLOGIST JI Gerontologist PD NOV PY 2012 VL 52 SU 1 BP 15 EP 15 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 061ZG UT WOS:000312888201075 ER PT J AU Smith, L Reilly, K Kissam, S Rokoske, FS Zheng, N Wiseman, CA AF Smith, L. Reilly, K. Kissam, S. Rokoske, F. S. Zheng, N. Wiseman, C. A. TI MDS 3.0 QUALITY MEASURES: SHORT-STAY AND LONG-STAY PRESSURE ULCERS SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Smith, L.; Reilly, K.; Kissam, S.; Rokoske, F. S.; Zheng, N.] RTI Int, Waltam, MA USA. [Wiseman, C. A.] 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 J9 GERONTOLOGIST JI Gerontologist PD NOV PY 2012 VL 52 SU 1 BP 422 EP 422 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 061ZG UT WOS:000312888203262 ER PT J AU Kissam, S Reilly, K Smith, L Rokoske, FS Zheng, N Wiseman, CA AF Kissam, S. Reilly, K. Smith, L. Rokoske, F. S. Zheng, N. Wiseman, C. A. TI MDS 3.0 QUALITY MEASURE: DEPRESSIVE SYMPTOMS (LONG-STAY) SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Kissam, S.; Reilly, K.; Smith, L.; Rokoske, F. S.; Zheng, N.] RTI Int, Waltam, MA USA. [Wiseman, C. A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 1 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 NOV PY 2012 VL 52 SU 1 BP 423 EP 423 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 061ZG UT WOS:000312888203264 ER PT J AU Rokoske, FS Reilly, K Smith, L Kissam, S Zheng, N Wiseman, CA AF Rokoske, F. S. Reilly, K. Smith, L. Kissam, S. Zheng, N. Wiseman, C. A. TI MDS 3.0 QUALITY MEASURE (QM): FALLS WITH MAJOR INJURY (LONG-STAY (LS)) SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Rokoske, F. S.; Reilly, K.; Smith, L.; Kissam, S.; Zheng, N.] RTI Int, Waltam, MA USA. [Wiseman, C. A.] 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 J9 GERONTOLOGIST JI Gerontologist PD NOV PY 2012 VL 52 SU 1 BP 423 EP 423 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 061ZG UT WOS:000312888203263 ER PT J AU Zheng, N Reilly, K Smith, L Kissam, S Rokoske, FS Wiseman, CA AF Zheng, N. Reilly, K. Smith, L. Kissam, S. Rokoske, F. S. Wiseman, C. A. TI MDS 3.0 QUALITY MEASURES (QMS): SELF-REPORTED PAIN PREVALENCE (SHORT-STAY (SS) AND LONG-STAY (LS)) SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Zheng, N.; Reilly, K.; Smith, L.; Kissam, S.; Rokoske, F. S.] RTI Int, Waltam, MA USA. [Wiseman, C. A.] 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 J9 GERONTOLOGIST JI Gerontologist PD NOV PY 2012 VL 52 SU 1 BP 423 EP 423 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 061ZG UT WOS:000312888203265 ER PT J AU Carrier, E Dowling, MK Pham, HH AF Carrier, Emily Dowling, Marisa K. Pham, Hoangmai H. TI Care Coordination Agreements: Barriers, Facilitators, and Lessons Learned SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article ID PERFORMANCE; PHYSICIANS; MEDICARE AB Background: With growing pressure to improve the quality and coordination of care, physicians feel a need to streamline their relationships with other practitioners around shared care for patients. Some physicians have developed written agreements that articulate the respective responsibilities of 2 or more parties for coordination of patient care, ie, care coordination agreements (CCAs). Objectives: To describe how CCAs are formed and explore facilitators and barriers to adoption of effective CCAs, the extent to which CCAs may be replicable in different market contexts, and the implications for policies and programs that aim to improve the coordination of care. Study Design: Qualitative study of primary care physicians participating in CCAs and representatives of their specialist, hospital, or communitybased partners. Methods: Semi-structured interviews with participating providers and national thought leaders in care coordination were reviewed to develop key themes. Results: Agreements that address referral and access processes were considered useful by all practices that had implemented them. Practices that implemented agreements including guidance on shared management of specific clinical conditions (comanagement) also found them useful. CCAs were most successful in settings where both parties to the agreement already had stable communication pathways (such as an electronic health record [EHR], designated staff) and strong working relationships. Conclusions: Policy changes (such as shifts in reimbursement to favor collaborative care or clarification of laws governing such collaborations) can help to support the development and implementation of CCAs, and can address factors that currently make some markets less supportive of coordination. (Am J Manag Care. 2012;18(11):e398-e404) C1 [Carrier, Emily; Dowling, Marisa K.] Ctr Studying Hlth Syst Change, Washington, DC 20002 USA. [Pham, Hoangmai H.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Carrier, E (reprint author), Ctr Studying Hlth Syst Change, 1100 1st St NE,12th Floor, Washington, DC 20002 USA. EM ecarrier@hschange.org FU Commonwealth Fund FX This study was funded by the Commonwealth Fund. NR 11 TC 2 Z9 2 U1 2 U2 8 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 NOV PY 2012 VL 18 IS 11 PG 6 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 052VM UT WOS:000312226900008 ER PT J AU Gargis, AS Kalman, L Berry, MW Bick, DP Dimmock, DP Hambuch, T Lu, F Lyon, E Voelkerding, KV Zehnbauer, BA Agarwala, R Bennett, SF Chen, B Chin, ELH Compton, JG Das, S Farkas, DH Ferber, MJ Funke, BH Furtado, MR Ganova-Raeva, LM Geigenmuller, U Gunselman, SJ Hegde, MR Johnson, PLF Kasarskis, A Kulkarni, S Lenk, T Liu, CSJ Manion, M Manolio, TA Mardis, ER Merker, JD Rajeevan, MS Reese, MG Rehm, HL Simen, BB Yeakley, JM Zook, JM Lubin, IM AF Gargis, Amy S. Kalman, Lisa Berry, Meredith W. Bick, David P. Dimmock, David P. Hambuch, Tina Lu, Fei Lyon, Elaine Voelkerding, Karl V. Zehnbauer, Barbara A. Agarwala, Richa Bennett, Sarah F. Chen, Bin Chin, Ephrem L. H. Compton, John G. Das, Soma Farkas, Daniel H. Ferber, Matthew J. Funke, Birgit H. Furtado, Manohar R. Ganova-Raeva, Lilia M. Geigenmueller, Ute Gunselman, Sandra J. Hegde, Madhuri R. Johnson, Philip L. F. Kasarskis, Andrew Kulkarni, Shashikant Lenk, Thomas Liu, C. S. Jonathan Manion, Megan Manolio, Teri A. Mardis, Elaine R. Merker, Jason D. Rajeevan, Mangalathu S. Reese, Martin G. Rehm, Heidi L. Simen, Birgitte B. Yeakley, Joanne M. Zook, Justin M. Lubin, Ira M. TI Assuring the quality of next-generation sequencing in clinical laboratory practice SO NATURE BIOTECHNOLOGY LA English DT Letter C1 [Gargis, Amy S.; Kalman, Lisa; Zehnbauer, Barbara A.; Chen, Bin; Lubin, Ira M.] Ctr Dis Control & Prevent, Div Lab Sci & Stand, Atlanta, GA 30333 USA. [Berry, Meredith W.; Lu, Fei] SeqWright Inc, Houston, TX USA. [Bick, David P.; Dimmock, David P.] Med Coll Wisconsin, Dept Pediat, Div Genet, Milwaukee, WI 53226 USA. [Hambuch, Tina] Illumina Clin Serv, San Diego, CA USA. [Lyon, Elaine; Voelkerding, Karl V.] Univ Utah, Dept Pathol, Salt Lake City, UT USA. [Lyon, Elaine; Voelkerding, Karl V.] ARUP Labs, Inst Clin & Expt Pathol, Salt Lake City, UT USA. [Agarwala, Richa] NIH, Natl Ctr Biotechnol Informat, Natl Lib Med, Bethesda, MD 20892 USA. [Bennett, Sarah F.] Ctr Medicare & Medicaid Serv, Div Lab Serv, Baltimore, MD USA. [Chin, Ephrem L. H.; Hegde, Madhuri R.] Emory Univ, Sch Med, Dept Human Genet, Atlanta, GA USA. [Compton, John G.] GeneDx Inc, Gaithersburg, MD USA. [Das, Soma] Univ Chicago, Dept Human Genet, Chicago, IL 60637 USA. [Farkas, Daniel H.] Sequenom Ctr Mol Med Inc, Grand Rapids, MI USA. [Ferber, Matthew J.] Mayo Clin, Dept Lab Med & Pathol, Rochester, MN USA. [Funke, Birgit H.; Rehm, Heidi L.] Partners Healthcare Ctr Personalized Genet Med, Mol Med Lab, Cambridge, MA USA. [Funke, Birgit H.; Rehm, Heidi L.] Harvard Univ, Sch Med, Dept Pathol, Boston, MA 02115 USA. [Furtado, Manohar R.] Life Technol, Foster City, CA USA. [Ganova-Raeva, Lilia M.] Ctr Dis Control & Prevent, Natl Ctr HIV Viral Hepatitis STD & TB Prevent, Atlanta, GA USA. [Geigenmueller, Ute] Correlagen Diagnost Inc, Waltham, MA USA. [Gunselman, Sandra J.] Kailos Genet Inc, Huntsville, AL USA. [Johnson, Philip L. F.] Emory Univ, Dept Biol, Atlanta, GA 30322 USA. [Kasarskis, Andrew] Pacific Biosci, Menlo Pk, CA USA. [Kulkarni, Shashikant] Washington Univ, Sch Med, Dept Genet, St Louis, MO 63110 USA. [Kulkarni, Shashikant] Washington Univ, Sch Med, Dept Pediat, St Louis, MO 63110 USA. [Kulkarni, Shashikant] Washington Univ, Sch Med, Dept Pathol & Immunol, St Louis, MO 63110 USA. [Lenk, Thomas] Celera Corp, Alameda, CA USA. [Liu, C. S. Jonathan; Manion, Megan] Softgenet LLC, State Coll, PA USA. [Manolio, Teri A.] NHGRI, NIH, Bethesda, MD 20892 USA. [Mardis, Elaine R.] Washington Univ, Genome Ctr, St Louis, MO USA. [Mardis, Elaine R.] Washington Univ, Dept Genet & Mol Microbiol, St Louis, MO USA. [Merker, Jason D.] Stanford Univ, Dept Pathol, Stanford, CA 94305 USA. [Rajeevan, Mangalathu S.] Ctr Dis Control & Prevent, Natl Ctr Emerging & Zoonot Infect Dis, Atlanta, GA USA. [Reese, Martin G.] Omica Inc, Emeryville, CA USA. [Simen, Birgitte B.] A Roche Co, Life Sci 454, Branford, CT USA. [Yeakley, Joanne M.] Illumina Inc, San Diego, CA USA. [Zook, Justin M.] Natl Inst Stand & Technol, Gaithersburg, MD 20899 USA. RP Gargis, AS (reprint author), Ctr Dis Control & Prevent, Div Lab Sci & Stand, Atlanta, GA 30333 USA. EM ILubin@cdc.gov RI Zook, Justin/B-7000-2008; Dimmock, David/I-7913-2015 OI Zook, Justin/0000-0003-2309-8402; Dimmock, David/0000-0001-6690-2523 FU NHGRI NIH HHS [R44 HG006579] NR 4 TC 180 Z9 183 U1 0 U2 30 PU NATURE PUBLISHING GROUP PI NEW YORK PA 75 VARICK ST, 9TH FLR, NEW YORK, NY 10013-1917 USA SN 1087-0156 J9 NAT BIOTECHNOL JI Nat. Biotechnol. PD NOV PY 2012 VL 30 IS 11 BP 1033 EP 1036 DI 10.1038/nbt.2403 PG 4 WC Biotechnology & Applied Microbiology SC Biotechnology & Applied Microbiology GA 037FL UT WOS:000311087500014 PM 23138292 ER PT J AU Robb, MA Racoosin, JA Worrall, C Chapman, S Coster, T Cunningham, FE AF Robb, Melissa A. Racoosin, Judith A. Worrall, Chris Chapman, Summer Coster, Trinka Cunningham, Francesca E. TI Active Surveillance of Postmarket Medical Product Safety in the Federal Partners' Collaboration SO MEDICAL CARE LA English DT Article DE FDA; Sentinel; safety monitoring; adverse events; surveillance ID VACCINATION; POPULATION AB After half a century of monitoring voluntary reports of medical product adverse events, the Food and Drug Administration (FDA) has launched a long-term project to build an adverse events monitoring system, the Sentinel System, which can access and evaluate electronic health care data to help monitor the safety of regulated medical products once they are marketed. On the basis of experience gathered through a number of collaborative efforts, the Federal Partners' Collaboration pilot project, involving FDA, the Centers for Medicare & Medicaid Services, the Department of Veteran Affairs, and the Department of Defense, is already enabling FDA to leverage the power of large public health care databases to assess, in near real time, the utility of analytical tools and methodologies that are being developed for use in the Sentinel System. Active medical product safety surveillance is enhanced by use of these large public health databases because specific populations of exposed patients can be identified and analyzed, and can be further stratified by key variables such as age, sex, race, socioeconomic status, and basis for eligibility to examine important subgroups. C1 [Robb, Melissa A.; Racoosin, Judith A.] Food & Drug Adm, Ctr Drug Evaluat & Res, Off Med Policy, Silver Spring, MD 20993 USA. [Worrall, Chris] Ctr Medicare & Medicaid Serv CMS, Ctr Medicare, Baltimore, MD USA. [Chapman, Summer; Cunningham, Francesca E.] Ctr Medicat Safety, Pharm Benefits Management Serv, Dept Vet Affairs, Hines, IL USA. [Coster, Trinka] US Army Off Surgeon Gen, Pharmacovigilance Ctr, Silver Spring, MD USA. RP Robb, MA (reprint author), Food & Drug Adm, Ctr Drug Evaluat & Res, Off Med Policy, 10903 New Hampshire Ave,Bldg 51,Room 6360, Silver Spring, MD 20993 USA. EM melissa.robb@fda.hhs.gov NR 21 TC 6 Z9 6 U1 0 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 NOV PY 2012 VL 50 IS 11 BP 948 EP 953 DI 10.1097/MLR.0b013e31826c874d PG 6 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 022OL UT WOS:000309968600008 PM 23047784 ER PT J AU McClellan, AC Luthi, JC Lynch, JR Soucie, JM Kulkarni, R Guasch, A Huff, ED Gilbertson, D McClellan, WM DeBaun, MR AF McClellan, Ann C. Luthi, Jean-Christophe Lynch, Janet R. Soucie, J. Michael Kulkarni, Roshni Guasch, Antonio Huff, Edwin D. Gilbertson, David McClellan, William M. DeBaun, Michael R. TI High one year mortality in adults with sickle cell disease and end-stage renal disease SO BRITISH JOURNAL OF HAEMATOLOGY LA English DT Article DE sickle cell disease; kidney disease; end-stage renal disease; mortality; disparities ID HEMODIALYSIS-PATIENTS; RISK-FACTORS; CHILDREN; DEATH; US AB Adequate pre-dialysis care reduces mortality among end-stage renal disease (ESRD) patients.We tested thehypothesis that individuals with ESRD due to sickle cell disease (SCDESRD) receiving pre-ESRD care have lower mortality compared to individuals without pre-ESRD care.We examined the association between mortality and pre-ESRD care in incident SCDESRD patients who started haemodialysis between 1 June, 2005 and 31 May, 2009using data provided by the Centers for Medicare and MedicaidServices (CMS).SCDESRD was reported for 410 (0.1%) of 442017 patients. One year after starting dialysis, 108 (26.3%) patients with incident ESRD attributed to SCD died; the hazard ratio (HR) for mortality among patients with SCDESRD compared to those without SCD as the primary cause of renal failure was 2.80 (95% confidence interval [CI] 2.313.38). Patients with SCDESRD receiving pre-dialysis nephrology care had a lower death rate than those with SCDESRD who did not receive pre-dialysis nephrology care (HR=0.67, 95% CI 0.450.99). The one-year mortality rate following an ESRD diagnosis was almost three times higher in individuals with SCD when compared to those without SCD but with ESRD and could be attenuated by pre-dialysis nephrology care. C1 [DeBaun, Michael R.] Vanderbilt Univ, Dept Pediat, Div Hematol Oncol, Nashville, TN 37232 USA. [Gilbertson, David] USRDS, Minneapolis, MN USA. [Huff, Edwin D.] Ctr Medicare Serv, Boston, MA USA. [Huff, Edwin D.] Ctr Medicaid Serv, Boston, MA USA. [Kulkarni, Roshni] Michigan State Univ, E Lansing, MI 48824 USA. [Lynch, Janet R.] Midatlantic Renal Coalit, Richmond, VA USA. [Luthi, Jean-Christophe] CHU Vaudois, Inst Social & Prevent Med IUMSP, Epalinges, Switzerland. [Luthi, Jean-Christophe] Univ Lausanne, CH-1066 Epalinges, Switzerland. [Luthi, Jean-Christophe; Guasch, Antonio; McClellan, William M.] Emory Univ, Atlanta, GA 30322 USA. [McClellan, Ann C.] Oak Ridge Inst Sci & Educ, Oak Ridge, TN USA. [McClellan, Ann C.; Soucie, J. Michael; Kulkarni, Roshni] Ctr Dis Control & Prevent, Atlanta, GA USA. RP DeBaun, MR (reprint author), Vanderbilt Univ, Dept Pediat, Div Hematol Oncol, 2200 Childrens Way,DOT 11206, Nashville, TN 37232 USA. EM m.debaun@vanderbilt.edu FU Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services" [HHSM-500-2010-005C] FX The analyses upon which this publication is based were performed under Contract Number HHSM-500-2010-005C, entitled 'End Stage Renal Disease Networks Organization Number 5", sponsored by the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services." This article is a direct result of the Health Care Quality Improvement Program initiated by CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. This research was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention, Division of Blood Disorders administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U. S. Department of Energy and the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. We thank Dr. Steven Embury and Mrs. Deborah Jones for reviewing and editing the manuscript. NR 13 TC 28 Z9 28 U1 0 U2 3 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0007-1048 J9 BRIT J HAEMATOL JI Br. J. Haematol. PD NOV PY 2012 VL 159 IS 3 BP 360 EP 367 DI 10.1111/bjh.12024 PG 8 WC Hematology SC Hematology GA 019DO UT WOS:000309717500012 PM 22967259 ER PT J AU Lee, GM Kleinman, K Soumerai, SB Tse, A Cole, D Fridkin, SK Horan, T Platt, R Gay, C Kassler, W Goldmann, DA Jernigan, J Jha, AK AF Lee, Grace M. Kleinman, Ken Soumerai, Stephen B. Tse, Alison Cole, David Fridkin, Scott K. Horan, Teresa Platt, Richard Gay, Charlene Kassler, William Goldmann, Donald A. Jernigan, John Jha, Ashish K. TI Effect of Nonpayment for Preventable Infections in US Hospitals SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Article ID CARE-ASSOCIATED INFECTIONS; PAY-FOR-PERFORMANCE; URINARY-TRACT-INFECTIONS; QUALITY-OF-CARE; SAFETY-NET HOSPITALS; HEALTH-CARE; MEDICARE POLICY; PAYMENT POLICY; UNINTENDED CONSEQUENCES; ACQUIRED CONDITIONS AB Background In October 2008, the Centers for Medicare and Medicaid Services (CMS) discontinued additional payments for certain hospital-acquired conditions that were deemed preventable. The effect of this policy on rates of health care-associated infections is unknown. Methods Using a quasi-experimental design with interrupted time series with comparison series, we examined changes in trends of two health care-associated infections that were targeted by the CMS policy (central catheter-associated bloodstream infections and catheter-associated urinary tract infections) as compared with an outcome that was not targeted by the policy (ventilator-associated pneumonia). Hospitals participating in the National Healthcare Safety Network and reporting data on at least one health care-associated infection before the onset of the policy were eligible to participate. Data from January 2006 through March 2011 were included. We used regression models to measure the effect of the policy on changes in infection rates, adjusting for base-line trends. Results A total of 398 hospitals or health systems contributed 14,817 to 28,339 hospital unit-months, depending on the type of infection. We observed decreasing secular trends for both targeted and nontargeted infections long before the policy was implemented. There were no significant changes in quarterly rates of central catheter-associated bloodstream infections (incidence-rate ratio in the postimplementation vs. preimplementation period, 1.00; P = 0.97), catheter-associated urinary tract infections (incidence-rate ratio, 1.03; P = 0.08), or ventilator-associated pneumonia (incidence-rate ratio, 0.99; P = 0.52) after the policy implementation. Our findings did not differ for hospitals in states without mandatory reporting, nor did it differ according to the quartile of percentage of Medicare admissions or hospital size, type of ownership, or teaching status. Conclusions We found no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates in U.S. hospitals. (Funded by the Agency for Healthcare Research and Quality.) C1 [Lee, Grace M.] Harvard Pilgrim Hlth Care Inst, Dept Populat Med, Ctr Child Hlth Care Studies, Boston, MA 02215 USA. [Lee, Grace M.] Harvard Univ, Sch Med, Div Infect Dis, Boston, MA USA. [Lee, Grace M.] Boston Childrens Hosp, Dept Lab Med, Boston, MA USA. [Kassler, William] Harvard Univ, Sch Publ Hlth, Ctr Medicare Serv, Boston, MA 02115 USA. [Kassler, William] Harvard Univ, Sch Publ Hlth, Ctr Medicaid Serv, Boston, MA 02115 USA. [Goldmann, Donald A.] Harvard Univ, Sch Publ Hlth, Inst Healthcare Improvement, Boston, MA 02115 USA. [Jha, Ashish K.] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA. [Fridkin, Scott K.; Horan, Teresa; Jernigan, John] Ctr Dis Control & Prevent, Div Healthcare Qual & Promot, Atlanta, GA USA. RP Lee, GM (reprint author), Harvard Pilgrim Hlth Care Inst, Dept Populat Med, Ctr Child Hlth Care Studies, 133 Brookline Ave,6th Fl, Boston, MA 02215 USA. EM grace.lee@childrens.harvard.edu FU Agency for Healthcare Research and Quality [5R01HS018414-03] FX Supported by a grant from the Agency for Healthcare Research and Quality (5R01HS018414-03, to Dr. Lee). NR 53 TC 94 Z9 98 U1 3 U2 18 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 OCT 11 PY 2012 VL 367 IS 15 BP 1428 EP 1437 DI 10.1056/NEJMsa1202419 PG 10 WC Medicine, General & Internal SC General & Internal Medicine GA 018ID UT WOS:000309652700009 PM 23050526 ER PT J AU Burwen, DR Sandhu, SK MaCurdy, TE Kelman, JA Gibbs, JM Garcia, B Markatou, M Forshee, RA Izurieta, HS Ball, R AF Burwen, Dale R. Sandhu, Sukhminder K. MaCurdy, Thomas E. Kelman, Jeffrey A. Gibbs, Jonathan M. Garcia, Bruno Markatou, Marianthi Forshee, Richard A. Izurieta, Hector S. Ball, Robert CA Safety Surveillance Working Grp TI Surveillance for Guillain-Barre Syndrome After Influenza Vaccination Among the Medicare Population, 2009-2010 SO AMERICAN JOURNAL OF PUBLIC HEALTH LA English DT Article ID ADVERSE EVENTS; UNITED-STATES; 2009-JANUARY 2010; SAFETY; VACCINES; ASSOCIATION; COVERAGE; RECEIPT; HUMANS; SYSTEM AB Objectives. We implemented active surveillance for Guillain Barre syndrome (GBS) following seasonal or H1N1 influenza vaccination among the Medicare population during the 2009-2010 influenza season. Methods. We used weekly Medicare claims data to monitor vaccinations and subsequent hospitalizations with principal diagnosis code for GBS within 42 days. Group sequential testing assessed whether the observed GBS rate exceeded a critical limit based on the expected rate from 5 previous years adjusted for claims delay. We evaluated the lag between date of service and date of claims availability and used it for adjustment. Results. By July 30, 2010 (after 26 interim surveillance tests), 14.0 million seasonal and 3.3 million H1N1 vaccinations had accrued. Taking into account claims delay appropriately lowered the critical limit during early monitoring. The observed GBS rate was below the critical limit throughout the surveillance. Conclusions. Medicare data contributed rapid safety monitoring among millions of 2009-2010 influenza vaccine recipients. Adjustment for claims delay facilitates early detection of potential safety issues. Although limited by lack of medical record review to confirm cases, this claims-based surveillance did not indicate a statistically significant elevated GBS rate following seasonal or H1N1 influenza vaccination. (Am J Public Health. 2012;102:1921-1927. doi:10.2105/AJPH.2011.300510) C1 [Burwen, Dale R.; Sandhu, Sukhminder K.; Forshee, Richard A.; Izurieta, Hector S.; Ball, Robert] US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, Rockville, MD 20857 USA. [Markatou, Marianthi] IBM Corp, TJ Watson Res Ctr, Hawthorne, NY USA. [MaCurdy, Thomas E.; Gibbs, Jonathan M.; Garcia, Bruno] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Stanford, CA 94305 USA. [Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv CMS, Ctr Medicare, Baltimore, MD USA. RP Burwen, DR (reprint author), NIH, 6701 Rockledge Dr,Room 9186,Rockledge 2,MSC 7913, Bethesda, MD 20892 USA. EM dale.burwen@nih.gov FU FDA; CMS; National Vaccine Program Office, US Department of Health and Human Services FX This work was funded by the FDA, CMS, and National Vaccine Program Office, US Department of Health and Human Services. NR 41 TC 21 Z9 21 U1 0 U2 2 PU AMER PUBLIC HEALTH ASSOC INC PI WASHINGTON PA 800 I STREET, NW, WASHINGTON, DC 20001-3710 USA SN 0090-0036 J9 AM J PUBLIC HEALTH JI Am. J. Public Health PD OCT PY 2012 VL 102 IS 10 BP 1921 EP 1927 DI 10.2105/AJPH.2011.300510 PG 7 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 015GU UT WOS:000309435200020 PM 22970693 ER PT J AU Schermerhorn, ML Bensley, RP Giles, KA Hurks, R O'Malley, AJ Cotterill, P Chaikof, E Landon, BE AF Schermerhorn, Marc L. Bensley, Rodney P. Giles, Kristina A. Hurks, Rob O'Malley, A. James Cotterill, Philip Chaikof, Elliot Landon, Bruce E. TI Changes in Abdominal Aortic Aneurysm Rupture and Short-Term Mortality, 1995-2008 SO ANNALS OF SURGERY LA English DT Article DE abdominal aortic aneurysm; endovascular aortic aneurysm repair; mortality; rupture ID RANDOMIZED CONTROLLED-TRIAL; ENDOVASCULAR REPAIR; UNITED-STATES; POPULATION; EPIDEMIOLOGY; TRENDS; TRANSPORT; SURGERY; FUTURE; MEN AB Objective: To examine the modern epidemiology of abdominal aortic aneurysm (AAA) rupture and short-term AAA-related mortality after the introduction of endovascular aneurysm repair (EVAR). Background: Previous epidemiologic studies have demonstrated stable rates of AAA repair, repair mortality, and AAA rupture. Recently, EVAR has been introduced as a less invasive treatment method, and its use has expanded to more than 75% of elective AAA repairs. Methods: We identified Medicare beneficiaries undergoing AAA repair and those hospitalized with a ruptured AAA during the period 1995 to 2008 and calculated standardized annual rates of AAA-related deaths due to either elective repair or rupture. Results: A total of 338,278 patients underwent intact AAA repair during the study period. There were 69,653 patients with AAA rupture, of whom 47,524 underwent repair. Intact repair rates increased substantially in those older than 80 years (57.7-92.3 per 100,000, P < 0.001) but decreased in those 65 to 74 years old (81.8-68.9, P < 0.001). Adecline in ruptures with andwithout repair was seen in all age groups. By 2008, 77% of all intact repairs and 31% of all rupture repairs were performed with EVAR (P < 0.001). Operative mortality declined during the study period for both intact (4.9%-2.4%, P < 0.001) and ruptured (44.1%-36.3%, P < 0.001) AAA repair. Short-term AAA-related deaths decreased by more than half (26.1-12.1 per 100,000, P < 0.001), with the greatest decline occurring in those older than 80 years (53.7-27.3, P < 0.001). Conclusions: A recent decline in AAA rupture and short-term AAA-related mortality is demonstrated and likely related in part to the introduction and expansion of EVAR. This is due to decreased deaths from ruptures (with and without repair) and decreased mortality with intact repairs, particularly in patients older than 80 years. C1 [Schermerhorn, Marc L.; Bensley, Rodney P.; Giles, Kristina A.; Hurks, Rob; Chaikof, Elliot] Beth Israel Deaconess Med Ctr, Dept Surg, 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. [Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA. RP Schermerhorn, ML (reprint author), Beth Israel Deaconess Med Ctr, Dept Surg, 110 Francis St,Suite 5B, Boston, MA 02215 USA. EM mscherm@bidmc.harvard.edu FU NIH T32 Harvard-Longwood Research Training in Vascular Surgery [HL007734]; NIH grant [1RC4MH092717-01]; NHLBI R01 grant [HL105453] FX Supported by the NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant HL007734, the NIH grant 1RC4MH092717-01 for comparative effectiveness research, and the NHLBI R01 grant HL105453. NR 33 TC 57 Z9 60 U1 0 U2 1 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 OCT PY 2012 VL 256 IS 4 BP 651 EP 658 DI 10.1097/SLA.0b013e31826b4f91 PG 8 WC Surgery SC Surgery GA 007VX UT WOS:000308917600015 PM 22964737 ER PT J AU Conway, PH Cassel, CK AF Conway, Patrick H. Cassel, Christine K. TI Engaging Physicians and Leveraging Professionalism A Key to Success for Quality Measurement and Improvement SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Conway, Patrick H.] Ctr Medicare Serv, Baltimore, MD 21224 USA. [Conway, Patrick H.] Ctr Medicaid Serv, Baltimore, MD 21224 USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA. [Cassel, Christine K.] Amer Board Internal Med, Philadelphia, PA USA. RP Conway, PH (reprint author), Ctr Medicare Serv, 7500 Secur Blvd, Baltimore, MD 21224 USA. EM patrick.conway@cms.hhs.gov NR 5 TC 11 Z9 11 U1 1 U2 2 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD SEP 12 PY 2012 VL 308 IS 10 BP 979 EP 980 DI 10.1001/jama.2012.9844 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 003AA UT WOS:000308579300018 PM 22968884 ER PT J AU Lyder, CH Wang, Y Metersky, M Curry, M Kliman, R Verzier, NR Hunt, DR AF Lyder, Courtney H. Wang, Yun Metersky, Mark Curry, Maureen Kliman, Rebecca Verzier, Nancy R. Hunt, David R. TI Hospital-Acquired Pressure Ulcers: Results from the National Medicare Patient Safety Monitoring System Study SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE pressure ulcer; adverse events; hospital-acquired pressure ulcer; patient safety; medical events ID CARE; QUALITY; RISK AB Objectives To determine the national and state incidence levels of newly hospital-acquired pressure ulcers (PUs) in Medicare beneficiaries and to describe the clinical and demographic characteristics and outcomes of these individuals. Design Retrospective secondary analysis of the national Medicare Patient Safety Monitoring System (MPSMS) database. Setting Medicare-eligible hospitals across the United States and select territories. Participants Fifty-one thousand eight hundred forty-two randomly selected hospitalized fee-for-service Medicare beneficiaries discharged from the hospital between January 1, 2006, and December 31, 2007. Measurements Data were abstracted from the MPSMS, which collects information on multiple hospital adverse events. Results Of the 51,842 individuals in the MPSMS 2006/07 sample, 2,313 (4.5%) developed at least one new PU during their hospitalization. The mortality riskadjusted odds ratios were 2.81 (95% confidence interval (CI) = 2.443.23) for in-hospital mortality, 1.69 (95% CI = 1.611.77) for mortality within 30 days after discharge, and 1.33 (95% CI = 1.231.45) for readmission within 30 days. The hospital riskadjusted main length of stay was 4.8 days (95% CI = 4.75.0 days) for individuals who did not develop PUs and 11.2 days (95% CI = 10.1911.4) for those with hospital-acquired PUs (P < .001). The Northeast region and Missouri had the highest incidence rates (4.6% and 5.9%, respectively). Conclusion Individuals who developed PUs were more likely to die during the hospital stay, have generally longer hospital lengths of stay, and be readmitted within 30 days after discharge. C1 [Lyder, Courtney H.] Univ Calif Los Angeles, Sch Nursing, Los Angeles, CA 90095 USA. [Lyder, Courtney H.] Univ Calif Los Angeles, Hlth Syst Patient Safety Inst, Los Angeles, CA 90095 USA. [Wang, Yun; Metersky, Mark; Curry, Maureen; Verzier, Nancy R.] Qualidigm, Middletown, CT USA. [Wang, Yun] Yale Univ, Ctr Outcomes Res, New Haven, CT USA. [Wang, Yun] Yale Univ, Ctr Evaluat, New Haven, CT USA. [Wang, Yun] Yale New Haven Hlth, New Haven, CT USA. [Metersky, Mark] Univ Connecticut, Sch Med, Div Pulm & Crit Care Med, Farmington, CT USA. [Kliman, Rebecca] Ctr Medicare Serv, Off Clin Stand & Qual, Baltimore, MD USA. [Kliman, Rebecca] Ctr Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. [Hunt, David R.] Off Natl Coordinator Hlth IT, Off Hlth Informat Technol Adopt, Washington, DC USA. RP Lyder, CH (reprint author), Univ Calif Los Angeles, Los Angeles Sch Nursing, 700 Tiverton Ave,Factor Bldg 2-256, Los Angeles, CA 90095 USA. EM clyder@sonnet.ucla.edu FU CMS, Department of Health and Human Services [500-2006-CToo2C] FX The analyses upon which this publication is based were performed under Contract 500-2006-CToo2C, entitled Utilization Quality Control: Quality Improvement Organization for the State of Connecticut, sponsored by CMS, Department of Health and Human Services. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by CMS, which has encouraged identification of quality improvement projects derived from analyses of patterns of care and therefore required no special funding on the part of the contractor. Ideas and contributions to the authors concerning experience and engaging with issues presented are welcomed. The authors would like to thank the MPSMS team at Qualidigm for its support and contributions. We specifically thank Nancy Verzier, RN, MSN, CPHQ, and Michael Pineau, RN, MS, for their excellent management of the project and Nancy Morse for manuscript preparation. NR 18 TC 66 Z9 75 U1 0 U2 4 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD SEP PY 2012 VL 60 IS 9 BP 1603 EP 1608 DI 10.1111/j.1532-5415.2012.04106.x PG 6 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 008ER UT WOS:000308940700001 PM 22985136 ER PT J AU Meisel, ZF Carr, BG Conway, PH AF Meisel, Zachary F. Carr, Brendan G. Conway, Patrick H. TI From Comparative Effectiveness Research to Patient-Centered Outcomes Research: Integrating Emergency Care Goals, Methods, and Priorities SO ANNALS OF EMERGENCY MEDICINE LA English DT Article ID HEALTH-CARE; REGIONALIZATION; MORTALITY; NETWORK AB Federal legislation placed comparative effectiveness research and patient-centered outcomes research at the center of current and future national investments in health care research. The role of this research in emergency care has not been well described. This article proposes an agenda for researchers and health care providers to consider comparative effectiveness research and patient-centered outcomes research methods and results to improve the care for patients who seek, use, and require emergency care. This objective will be accomplished by (1) exploring the definitions, frameworks, and nomenclature for comparative effectiveness research and patient-centered outcomes research; (2) describing a conceptual model for comparative effectiveness research in emergency care; (3) identifying specific opportunities and examples of emergency care-related comparative effectiveness research; and (4) categorizing current and planned funding for comparative effectiveness research and patient-centered outcomes research that can include emergency care delivery. [Ann Emerg Med. 2012;60:309-316.] C1 [Meisel, Zachary F.; Carr, Brendan G.] Univ Penn, Dept Emergency Med, Perelman Sch Med, Philadelphia, PA 19104 USA. [Carr, Brendan G.] Univ Penn, Ctr Biostat & Epidemiol, Perelman Sch Med, Philadelphia, PA 19104 USA. [Meisel, Zachary F.; Carr, Brendan G.] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA. [Conway, Patrick H.] US Dept HHS, Ctr Medicare Serv, Baltimore, MD USA. [Conway, Patrick H.] US Dept HHS, Ctr Medicaid Serv, Baltimore, MD USA. RP Meisel, ZF (reprint author), Univ Penn, Dept Emergency Med, Perelman Sch Med, Philadelphia, PA 19104 USA. EM zfm@wharton.upenn.edu FU National Institutes of Health (NIH) [1KM1CA156715-01]; Robert Wood Johnson Foundation Clinical Scholars Program FX By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This study was supported in part by the National Institutes of Health (NIH), from whom Dr. Meisel received an NIH Comparative Effectiveness Research Career Development Award (1KM1CA156715-01), and by the Robert Wood Johnson Foundation Clinical Scholars Program (Dr. Meisel). Dr. Meisel reports serving in a staff position and Dr. Conway reports serving as executive director for the US Department of Health and Human Services Federal Coordinating Council on Comparative Effectiveness Research. NR 34 TC 10 Z9 10 U1 0 U2 1 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-0644 J9 ANN EMERG MED JI Ann. Emerg. Med. PD SEP PY 2012 VL 60 IS 3 BP 309 EP 316 DI 10.1016/j.annemergmed.2012.03.021 PG 8 WC Emergency Medicine SC Emergency Medicine GA 003OF UT WOS:000308620500012 PM 22520987 ER PT J AU Menis, M Izurieta, HS Anderson, SA Kropp, G Holness, L Gibbs, J Erten, T Worrall, CM MaCurdy, TE Kelman, JA Ball, R AF Menis, Mikhail Izurieta, Hector S. Anderson, Steven A. Kropp, Garner Holness, Leslie Gibbs, Jonathan Erten, Tugce Worrall, Christopher M. MaCurdy, Thomas E. Kelman, Jeffrey A. Ball, Robert TI Outpatient transfusions and occurrence of serious noninfectious transfusion-related complications among US elderly, 2007-2008: utility of large administrative databases in blood safety research SO TRANSFUSION LA English DT Article ID ACUTE LUNG INJURY; RBC STORAGE VARIABLES; ADDITIVE SOLUTION; CELL; TRANSPLANTATION; LEUKOREDUCTION; PATHOGENESIS; IRRADIATION; EXPERIENCE; COMPONENTS AB BACKGROUND: Transfusion-related acute lung injury (TRALI) and hemolytic transfusion reactions account for significant transfusion-related morbidity and mortality in the United States. Our study evaluated types and quantities of transfused components as well as occurrence of TRALI, ABO, and Rh incompatibilities among the US elderly in the institutional outpatient setting during 2007 to 2008. STUDY DESIGN AND METHODS: This retrospective claims-based study utilized the Centers for Medicare & Medicaid Services' large administrative databases. Transfusions were identified by recorded procedure and revenue center codes, while complications were ascertained via ICD-9-CM diagnosis codes. The study quantified blood use based on revenue center units. RESULTS: Among 26,054,242 and 25,662,864 Medicare elderly in 2007 and 2008, a total of 241,055 (0.9%) and 251,284 (1.0%) had outpatient transfusions. Leukoreduced red blood cells (LR-RBCs) was the most frequently transfused single blood component (60.1 and 61.3%, respectively) each year. Likewise, LR-RBCs and LR pheresis platelets (LR-PLTs) was the most frequent component combination (2.4 and 2.6%, respectively). TRALI rate comparison for RBCs and PLTs versus RBCs only showed higher rate for RBCs and PLTs (p = 0.033). In 2007 and 2008, ABO incompatibility rate comparison for irradiated (IR) LR-RBCs versus LR-RBCs showed higher rates for IR LR-RBCs (rate ratio [RR] 37.4, 95% confidence interval [CI] 10.6-132.6; and RR 31.3, 95% CI 11.6-84.4, respectively). CONCLUSION: This study shows potential usefulness of Medicare databases in assessment of blood utilization, transfusion-related complications, and risk factors among US elderly in the outpatient setting. It suggests limitations (e.g., need for several years of data to better assess rare complications) and importance of databases as hypothesis-generating tool to supplement blood safety research. C1 [Menis, Mikhail] US FDA, Analyt Epidemiol Branch, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, Rockville, MD 20852 USA. Acumen LLC, Burlingame, CA USA. Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Menis, M (reprint author), US FDA, Analyt Epidemiol Branch, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, 1401 Rockville Pike,HFM 225, Rockville, MD 20852 USA. EM Mikhail.Menis@fda.hhs.gov FU internal FDA funds FX This research was supported through internal FDA funds. NR 53 TC 9 Z9 10 U1 0 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 J9 TRANSFUSION JI Transfusion PD SEP PY 2012 VL 52 IS 9 BP 1968 EP 1976 DI 10.1111/j.1537-2995.2011.03535.x PG 9 WC Hematology SC Hematology GA 000OY UT WOS:000308397400017 PM 22313096 ER PT J AU Menis, M Anderson, SA Holness, L Kropp, G Wang, EL Johnson, C Worrall, CM Kelman, JA Ball, R Izurieta, H AF Menis, M. Anderson, S. A. Holness, L. Kropp, G. Wang, E. L. Johnson, C. Worrall, C. M. Kelman, J. A. Ball, R. Izurieta, H. TI Transfusion-Associated Circulatory Overload (TACO) Among Inpatient US Elderly as Recorded in Medicare Administrative Databases During 2011 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting and CTTXPO CY OCT 06-09, 2012 CL Boston, MA SP AABB, CTTXPO C1 [Menis, M.; Anderson, S. A.; Holness, L.; Ball, R.; Izurieta, H.] US FDA, Ctr Biol Evaluat & Res, Rockville, MD 20857 USA. [Kropp, G.; Wang, E. L.; Johnson, C.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare Serv, Baltimore, MD USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicaid Serv, Baltimore, MD USA. EM Mikhail.Menis@fda.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 J9 TRANSFUSION JI Transfusion PD SEP PY 2012 VL 52 SU 3 SI SI BP 169A EP 169A PG 1 WC Hematology SC Hematology GA 000PH UT WOS:000308398600412 ER PT J AU Menis, M Izurieta, H Anderson, SA Kropp, G Johnson, C Wang, EL Golding, B Worrall, CM Forshee, R Kelman, JA AF Menis, M. Izurieta, H. Anderson, S. A. Kropp, G. Johnson, C. Wang, E. L. Golding, B. Worrall, C. M. Forshee, R. Kelman, J. A. TI Use of Immune Globulins Among the US Elderly as Recorded in Medicare Databases During a Five-Year Period, 2007-2011 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting and CTTXPO CY OCT 06-09, 2012 CL Boston, MA SP AABB, CTTXPO C1 [Menis, M.; Izurieta, H.; Anderson, S. A.; Golding, B.; Forshee, R.] US FDA, Ctr Biol Evaluat & Res, Rockville, MD 20857 USA. [Kropp, G.; Johnson, C.; Wang, E. L.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare Serv, Baltimore, MD USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicaid Serv, Baltimore, MD USA. EM Mikhail.Menis@fda.hhs.gov NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0041-1132 J9 TRANSFUSION JI Transfusion PD SEP PY 2012 VL 52 SU 3 SI SI BP 193A EP 193A PG 1 WC Hematology SC Hematology GA 000PH UT WOS:000308398600475 ER PT J AU Graham, DJ Williams, JR Hsueh, YH Calia, K Levenson, M Pinheiro, SP MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Williams, James R. Hsueh, Ya-Hui Calia, Katlyn Levenson, Mark Pinheiro, Simone P. MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Risk of Acute Myocardial Infarction (AMI), Stroke, and Death in Parkinson's Disease (PD) Patients Treated with Entacapone (Entac) or Other Adjunctive Therapies (AT) SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Graham, David J.; Williams, James R.; Hsueh, Ya-Hui; Levenson, Mark; Pinheiro, Simone P.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Calia, Katlyn; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Palo Alto, CA 94304 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 1 PU WILEY PERIODICALS, INC PI SAN FRANCISCO PA ONE MONTGOMERY ST, SUITE 1200, SAN FRANCISCO, CA 94104 USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2012 VL 21 SU 3 SI SI MA 47 BP 24 EP 24 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 996YU UT WOS:000308131701047 ER PT J AU Graham, DJ Ding, X Saneinejad, S Zhou, EH Calia, K Levenson, M Gelperin, K Rose, M Hammad, TA MaCurdy, TE Worrall, C Kelman, JA AF Graham, David J. Ding, Xiao Saneinejad, Shahin Zhou, Esther H. Calia, Katlyn Levenson, Mark Gelperin, Kate Rose, Martin Hammad, Tarek A. MaCurdy, Thomas E. Worrall, Chris Kelman, Jeffrey A. TI Cardiovascular Risk of Olmesartan (Olm) Compared with Other Angiotensin-II Receptor Blockers (ARBs) SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Graham, David J.; Ding, Xiao; Zhou, Esther H.; Levenson, Mark; Gelperin, Kate; Rose, Martin; Hammad, Tarek A.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Saneinejad, Shahin; Calia, Katlyn; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas E.] Stanford Univ, Palo Alto, CA 94304 USA. [Worrall, Chris; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Washington, DC USA. NR 0 TC 1 Z9 1 U1 0 U2 0 PU WILEY PERIODICALS, INC PI SAN FRANCISCO PA ONE MONTGOMERY ST, SUITE 1200, SAN FRANCISCO, CA 94104 USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2012 VL 21 SU 3 SI SI MA 345 BP 162 EP 162 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 996YU UT WOS:000308131701333 ER PT J AU Zornberg, GL Senior, JR Graham, DJ Kim, C Wernecke, M Seeff, LB Racoosin, JA Avigan, MI Reichman, ME MaCurdy, TE Lam, C Southworth, MR Houstoun, M Levenson, M Shoaibi, A Wu, E Worrall, C Kelman, JA AF Zornberg, Gwen L. Senior, John R. Graham, David J. Kim, Clara Wernecke, Michael Seeff, Leonard B. Racoosin, Judy A. Avigan, Mark I. Reichman, Marsha E. MaCurdy, Thomas E. Lam, Chelsea Southworth, Mary Ross Houstoun, Monika Levenson, Mark Shoaibi, Azadeh Wu, Eileen Worrall, Chris Kelman, Jeffrey A. TI Severe Liver Injury (SLI) among Dronedarone, Amiodarone or Sotalol Initiators SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Zornberg, Gwen L.; Senior, John R.; Graham, David J.; Seeff, Leonard B.; Avigan, Mark I.; Reichman, Marsha E.; Houstoun, Monika; Wu, Eileen] US FDA, Off Surveillance & Epidemiol, Ctr Drug Evaluat Res, Silver Spring, MD USA. [Kim, Clara; Levenson, Mark] US FDA, Off Biometr, OTS, Ctr Drug Evaluat Res, Silver Spring, MD USA. [Wernecke, Michael; MaCurdy, Thomas E.; Lam, Chelsea] Acumen LLC, Burlingame, CA USA. [Racoosin, Judy A.; Southworth, Mary Ross] US FDA, Off New Drugs, Ctr Drug Evaluat Res, Silver Spring, MD USA. [MaCurdy, Thomas E.] Stanford Univ, Stanford, CA 94305 USA. [Shoaibi, Azadeh] US FDA, Off Med Policy, Ctr Drug Evaluat Res, Silver Spring, MD USA. [Worrall, Chris; Kelman, Jeffrey A.] CMS SafeRx, Ctr Medicare Medicaid Serv, Washington, DC USA. NR 0 TC 0 Z9 0 U1 0 U2 3 PU WILEY PERIODICALS, INC PI SAN FRANCISCO PA ONE MONTGOMERY ST, SUITE 1200, SAN FRANCISCO, CA 94104 USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2012 VL 21 SU 3 SI SI MA 557 BP 261 EP 262 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 996YU UT WOS:000308131701538 ER PT J AU Jain, SH Conway, PH Berwick, DM AF Jain, Sachin H. Conway, Patrick H. Berwick, Donald M. TI A Public-Private Strategy to Advance the Use of Clinical Registries SO ANESTHESIOLOGY LA English DT Editorial Material C1 [Jain, Sachin H.] Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA. [Conway, Patrick H.] Harvard Univ, Sch Business, Inst Strategy & Competitiveness, Boston, MA 02163 USA. [Berwick, Donald M.] Ctr Medicare Serv, Baltimore, MD USA. [Berwick, Donald M.] Ctr Medicaid Serv, Baltimore, MD USA. RP Jain, SH (reprint author), Brigham & Womens Hosp, Dept Med, 75 Francis St, Boston, MA 02115 USA. EM shjain@post.harvard.edu NR 0 TC 2 Z9 2 U1 0 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0003-3022 J9 ANESTHESIOLOGY JI Anesthesiology PD AUG PY 2012 VL 117 IS 2 BP 227 EP 229 DI 10.1097/ALN.0b013e318259a9ed PG 3 WC Anesthesiology SC Anesthesiology GA 981RG UT WOS:000306986600002 PM 22584537 ER PT J AU Concannon, TW Meissner, P Grunbaum, JA McElwee, N Guise, JM Santa, J Conway, PH Daudelin, D Morrato, EH Leslie, LK AF Concannon, Thomas W. Meissner, Paul Grunbaum, Jo Anne McElwee, Newell Guise, Jeanne-Marie Santa, John Conway, Patrick H. Daudelin, Denise Morrato, Elaine H. Leslie, Laurel K. TI A New Taxonomy for Stakeholder Engagement in Patient-Centered Outcomes Research SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE stakeholders; research; guidance ID CLINICAL-TRIALS; HEALTH; IMPROVE; CARE; MINORITY; QUALITY; ROUTE; RISK; NEED AB Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach. C1 [Concannon, Thomas W.; Daudelin, Denise; Leslie, Laurel K.] Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA 02111 USA. [Meissner, Paul] Montefiore Med Ctr, Albert Einstein Coll Med, Off Med Director Res, Bronx, NY 10467 USA. [Grunbaum, Jo Anne] Ctr Dis Control & Prevent, Prevent Res Ctr Program, Atlanta, GA USA. [McElwee, Newell] Merck & Co Inc, US Outcomes Res, N Wales, PA USA. [Guise, Jeanne-Marie] Oregon Hlth & Sci Univ, Portland, OR 97201 USA. [Santa, John] Consumer Reports, Hlth Ratings Ctr, Yonkers, NY USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Cincinnati, OH USA. [Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Morrato, Elaine H.] Univ Colorado, Sch Med, Colorado Hlth Outcomes Program, Aurora, CO USA. [Morrato, Elaine H.] Univ Colorado, Colorado Sch Publ Hlth, Dept Hlth Syst Management & Policy, Aurora, CO USA. [Concannon, Thomas W.; Daudelin, Denise; Leslie, Laurel K.] Tufts Univ, Sch Med, Boston, MA 02111 USA. RP Concannon, TW (reprint author), Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, 800 Washington St 063, Boston, MA 02111 USA. EM tconcannon@tuftsmedicalcenter.org RI Concannon, Thomas/A-1610-2013 FU National Center for Research Resources (NCRR), National Institutes of Health (NIH) [UL1 RR025752]; Agency for Healthcare Research and Quality [K01 HS017726, K12HS019464] FX This project was funded in whole or in part with federal funds from the National Center for Research Resources (NCRR), National Institutes of Health (NIH), through the Clinical and Translational Science Awards Program (CTSA), part of the Roadmap Initiative, Re-Engineering the Clinical Research Enterprise. This publication was supported by grant no. UL1 RR025752 from the National Center for Research Resources (NCRR), National Institutes of Health (NIH). Dr. Concannon was supported by grant no. K01 HS017726 from the Agency for Healthcare Research and Quality. Dr. Morrato's effort was supported by grant no. K12HS019464 from the Agency for Healthcare Research and Quality. NR 44 TC 45 Z9 45 U1 2 U2 24 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 AUG PY 2012 VL 27 IS 8 BP 985 EP 991 DI 10.1007/s11606-012-2037-1 PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 974LB UT WOS:000306435500016 PM 22528615 ER PT J AU Elliott, MN Lehrman, WG Beckett, MK Goldstein, E Hambarsoomian, K Giordano, LA AF Elliott, Marc N. Lehrman, William G. Beckett, Megan K. Goldstein, Elizabeth Hambarsoomian, Katrin Giordano, Laura A. TI Gender Differences in Patients' Perceptions of Inpatient Care SO HEALTH SERVICES RESEARCH LA English DT Article DE Patient experience; CAHPS; hospitals; gender; sex differences in health and health care ID CAHPS(R) HOSPITAL SURVEY; MANAGED CARE; NONRESPONSE RATES; HCAHPS SURVEY; HEALTH-CARE; SATISFACTION; QUALITY; BIAS; METAANALYSIS; EXPERIENCE AB Objective To examine gender differences in inpatient experiences and how they vary by dimensions of care and other patient characteristics. Data Source A total of 1,971,632 patients (medical and surgical service lines) discharged from 3,830 hospitals, July 2007June 2008, and completing the HCAHPS survey. Study Design We compare the experiences of male and female inpatients on 10 HCAHPS dimensions using multiple linear regression, adjusting for survey mode and patient mix. Additional models add additional patient characteristics and their interactions with patient gender. Principal Findings We find generally less positive experiences for women than men, especially for Communication about Medicines, Discharge Information, and Cleanliness. Gender differences are similar in magnitude to previously reported HCAHPS differences by race/ethnicity. The gender gap is generally larger for older patients and for patients with worse self-reported health status. Gender disparities are largest in for-profit hospitals. Conclusions Targeting the experiences of women may be a promising means of improving overall patient experience scores (because women comprise a majority of all inpatients); the experiences of older and sicker women, and those in for-profit hospitals, may merit additional examination. C1 [Elliott, Marc N.; Beckett, Megan K.; Hambarsoomian, Katrin] RAND Corp, Santa Monica, CA 90407 USA. [Lehrman, William G.; Goldstein, Elizabeth] Ctr Medicare Serv, Div Consumer Assessment & Plan Performance, Baltimore, MD USA. [Lehrman, William G.; Goldstein, Elizabeth] Ctr Medicaid Serv, Baltimore, MD USA. [Giordano, Laura A.] Res & Anal Hlth Serv Advisory Grp, Phoenix, AZ USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St,POB 2138, Santa Monica, CA 90407 USA. EM elliott@rand.org NR 35 TC 27 Z9 27 U1 1 U2 19 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD AUG PY 2012 VL 47 IS 4 BP 1482 EP 1501 DI 10.1111/j.1475-6773.2012.01389.x PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 970OL UT WOS:000306141500006 PM 22375827 ER PT J AU VanLare, JM Conway, PH AF VanLare, Jordan M. Conway, Patrick H. TI Value-Based Purchasing - National Programs to Move from Volume to Value SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [VanLare, Jordan M.; Conway, Patrick H.] Ctr Medicare, Baltimore, MD USA. [VanLare, Jordan M.; Conway, Patrick H.] Ctr Medicaid Sev, Baltimore, MD USA. [VanLare, Jordan M.] Columbia Univ, Coll Physicians & Surg, New York, NY USA. [Conway, Patrick H.] Cincinnati Childrens Hosp, Med Ctr, Cincinnati, OH USA. RP VanLare, JM (reprint author), Ctr Medicare, Baltimore, MD USA. NR 5 TC 100 Z9 100 U1 4 U2 18 PU MASSACHUSETTS MEDICAL SOC PI WALTHAM PA WALTHAM WOODS CENTER, 860 WINTER ST,, WALTHAM, MA 02451-1413 USA SN 0028-4793 EI 1533-4406 J9 NEW ENGL J MED JI N. Engl. J. Med. PD JUL 26 PY 2012 VL 367 IS 4 BP 292 EP 295 DI 10.1056/NEJMp1204939 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 978KD UT WOS:000306738300002 PM 22830460 ER PT J AU Goodrich, K Krumholz, HM Conway, PH Lindenauer, P Auerbach, AD AF Goodrich, Kate Krumholz, Harlan M. Conway, Patrick H. Lindenauer, Peter Auerbach, Andrew D. TI Hospitalist utilization and hospital performance on 6 publicly reported patient outcomes SO JOURNAL OF HOSPITAL MEDICINE LA English DT Article ID ACUTE MYOCARDIAL-INFARCTION; CAUSE READMISSION RATES; 30-DAY MORTALITY-RATES; QUALITY-OF-CARE; HEART-FAILURE; PNEUMONIA CARE; PHYSICIANS; SERVICE; CALIFORNIA AB BACKGROUND: The increase in hospitalist-provided inpatient care may be accompanied by an expectation of improvement on patient outcomes. To date, the association between utilization of hospitalists and the publicly reported patient outcomes is unknown. OBJECTIVE: Assess the relationship between hospitalist utilization and performance on 6 publicly reported patient outcomes. DESIGN: Cross-sectional study. PARTICIPANTS: Representatives of 598 hospitals in the United States with direct knowledge of inpatient service models. INTERVENTION: Survey of hospital personnel with knowledge of hospitalist use and hospitalist programs. MEASUREMENTS: Six publicly reported quality outcome measures across 3 medical conditions: acute myocardial infarction (AMI), congestive heart failure (HF), and pneumonia. Using multivariable regression models, we assessed the relationship between presence of hospitalists and performance on each outcome measure; we further assessed the relationship between the percentage of patients admitted by hospitalists and each outcome measure. RESULTS: Of 598 respondents, 429 (72%) reported the use of hospitalist services. In the comparison of hospitals with and without hospitalists, there was no statistically significant difference on any of the mortality or readmissions measures with the exception of the risk-stratified readmission rate for heart failure. For hospitals that used hospitalists, there was no significant change in any of the outcome measures with increasing percentage of patients admitted by hospitalists. CONCLUSIONS: The presence of hospitalists is not an independent predictor of performance on publicly reported mortality and readmissions measures for AMI, HF, or pneumonia. It is likely that broader system or organizational interventions are required to improve performance on patient outcomes. Journal of Hospital Medicine 2012; (C) 2012 Society of Hospital Medicine C1 [Goodrich, Kate; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD 21244 USA. [Goodrich, Kate] George Washington Univ, Sch Med, Dept Med, Div Hosp Med, Washington, DC USA. [Krumholz, Harlan M.] Yale Univ, Sch Publ Hlth, Ctr Outcomes Res & Evaluat, Sect Hlth Policy & Adm,Yale New Haven Hosp, New Haven, CT USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06510 USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Div Hosp Med, Cincinnati, OH USA. [Lindenauer, Peter] Baystate Med Ctr, Ctr Qual Care Res, Springfield, MA USA. [Lindenauer, Peter] Tufts Univ, Sch Med, Dept Med, Springfield, MA 01199 USA. [Auerbach, Andrew D.] Univ Calif San Francisco, Dept Med, Div Hosp Med, San Francisco, CA USA. RP Goodrich, K (reprint author), Ctr Medicare & Medicaid Serv, Off Clin Stand & Qual, 7500 Secur Blvd,S3-02-01, Baltimore, MD 21244 USA. EM kate.goodrich@cms.hhs.gov FU Robert Wood Johnson Clinical Scholars Program; California Healthcare Foundation [15763]; National Heart, Lung, and Blood Institute (NHLBI) [1U01HL105270-02]; Medtronic through Yale University FX Disclosures: Work on this project was supported by the Robert Wood Johnson Clinical Scholars Program (K. G.); California Healthcare Foundation grant 15763 (A. D. A.); and a grant from the National Heart, Lung, and Blood Institute (NHLBI), study 1U01HL105270-02 (H. M. K.). Dr Krumholz is the chair of the Cardiac Scientific Advisory Board for United Health and has a research grant with Medtronic through Yale University; Dr Auerbach has a grant through the National Heart, Lung, and Blood Institute (NHLBI). The authors have no other disclosures to report. NR 26 TC 7 Z9 7 U1 1 U2 8 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1553-5592 J9 J HOSP MED JI J. Hosp. Med. PD JUL-AUG PY 2012 VL 7 IS 6 BP 482 EP 488 DI 10.1002/jhm.1943 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 982NW UT WOS:000307053200005 PM 22689448 ER PT J AU Hakim, RB Babish, JD Davis, AC AF Hakim, Rosemarie B. Babish, J. Daniel Davis, A. Conan TI State of Dental Care Among Medicaid-Enrolled Children in the United States SO PEDIATRICS LA English DT Article DE children; access to dental care; health insurance; Medicaid; oral health ID DISPARITIES; HEALTH AB OBJECTIVE: To evaluate the prevalence of dental care visits (DCV) in 2007 in the United States among Medicaid-enrolled children from birth to age 18 and measure progress since 2002. METHODS: By using Medicaid research files and information from the Centers for Medicare & Medicaid Services 416 Early Periodic Screening, Diagnostic, and Treatment forms, we calculated the prevalence of DCV in 50 states and the District of Columbia, stratifying by age, race, type of health plan, and Children's Health Insurance Program status. RESULTS: The prevalence of having DCV ranged from 12% depending on age, to 49% with a median value of 33% but did not exceed 50% in any state. The median percent change between 2002 and 2007 was 16%. DCV among toddlers and infants were low in all but 3 states and in most states peaked at age of school entry to >60% in some states. In most states, there were few racial differences in the prevalence of DCV. Children enrolled in Primary Care Case Management tended to have the highest DCV, the effect of Children's Health Insurance Program enrollment on the number of DCV was generally positive. CONCLUSIONS: To our knowledge, this is the first study to evaluate the prevalence of dental care by using paid Medicaid claims. Consistent with other reports, levels of DCV were low; but when the number of DCV was stratified by age and type plan, striking patterns emerged suggesting that a combination of school programs and having a medical home may have a positive impact on dental care. Pediatrics 2012; 130: 5-14 C1 [Hakim, Rosemarie B.; Babish, J. Daniel] Off Clin Stand & Qual, Ctr Medicare Serv, Baltimore, MD 21244 USA. [Hakim, Rosemarie B.; Babish, J. Daniel] Ctr Medicaid Serv, Baltimore, MD 21244 USA. [Davis, A. Conan] Univ Alabama Birmingham, Sch Dent, Dept Gen Dent Sci, Birmingham, AL 35294 USA. RP Hakim, RB (reprint author), Off Clin Stand & Qual, Ctr Medicare Serv, 7500 Secur Blvd, Baltimore, MD 21244 USA. EM rosemarie.hakim@cms.hhs.gov NR 15 TC 14 Z9 14 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 2012 VL 130 IS 1 BP 5 EP 14 DI 10.1542/peds.2011-2800 PG 10 WC Pediatrics SC Pediatrics GA 967KH UT WOS:000305905900037 PM 22665418 ER PT J AU Stevens, JA Ballesteros, MF Mack, KA Rudd, RA DeCaro, E Adler, G AF Stevens, Judy A. Ballesteros, Michael F. Mack, Karin A. Rudd, Rose A. DeCaro, Erin Adler, Gerald TI Gender Differences in Seeking Care for Falls in the Aged Medicare Population SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID OLDER-ADULTS; RISK-FACTORS; PREVENTION; PREDICTORS; COMMUNITY; INJURIES; HEALTH; HOME AB Background: One third of adults aged >= 65 years fall annually, and women are more likely than men to be treated for fall injuries in hospitals and emergency departments. Purpose: The aim of this study was to examine how men and women differed in seeking medical care for falls and in the information about falls they received from healthcare providers. Methods: This study, undertaken in 2010, analyzed population-based data from the 2005 Medicare Current Beneficiary Survey (MBCS), the most recent data available in 2010 from this survey. A sample of 12,052 community-dwelling Medicare beneficiaries aged >= 65 years was used to examine male-female differences among 2794 who reported falling in the previous year, sought medical care for falls and/or discussed fall prevention with a healthcare provider. Multivariable logistic regression analyses were conducted to determine the factors associated with falling for men and women. P-values <= 0.05 were considered significant. Results: Nationally, an estimated seven million Medicare beneficiaries (22%) fell in the previous year. Among those who fell, significantly more women than men talked with a healthcare provider about falls and also discussed fall prevention (31.2% [95% CI = 28.8%, 33.6%] vs 24.3% [95% CI = 21.6%, 27.0%]). For both genders, falls were most strongly associated with two or more limitations in activities of daily living and often feeling sad or depressed. Conclusions: Women were significantly more likely than men to report falls, seek medical care, and/or discuss falls and fall prevention with a healthcare provider. Providers should consider asking all older patients about previous falls, especially older male patients who are least likely to seek medical attention or discuss falls with their doctors. (Am J Prev Med 2012;43(1):59-62) (C) 2012 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine C1 [Stevens, Judy A.; Ballesteros, Michael F.; Mack, Karin A.; Rudd, Rose A.] CDC, Natl Ctr Injury Prevent & Control, Atlanta, GA 30333 USA. [DeCaro, Erin] Univ Alabama, Dept Anthropol, Tuscaloosa, AL USA. [Adler, Gerald] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Stevens, JA (reprint author), 4770 Buford Highway NE,Mailstop F-62, Atlanta, GA 30341 USA. EM jas2@cdc.gov RI Mack, Karin/A-3263-2012 OI Mack, Karin/0000-0001-9274-3001 FU CDC FX This study was funded by the CDC; data were provided by the Centers for Medicaid and Medicare Services. NR 18 TC 34 Z9 34 U1 0 U2 5 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 JUL PY 2012 VL 43 IS 1 BP 59 EP 62 DI 10.1016/j.amepre.2012.03.008 PG 4 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 959VJ UT WOS:000305344000009 PM 22704747 ER PT J AU Edwards, ST Schermerhorn, M O'Malley, AJ Bensley, RP Hurks, R Cotterill, P Landon, BE AF Edwards, Samuel T. Schermerhorn, Marc O'Malley, A. James Bensley, Rodney P. Hurks, Rob Cotterill, Philip Landon, Bruce E. TI COMPARATIVE EFFECTIVENESS OF ENDOVASCULAR VERSUS OPEN REPAIR OF RUPTURED ABDOMINAL AORTIC ANEURYSM IN THE MEDICARE POPULATION SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Meeting Abstract C1 [Edwards, Samuel T.; Schermerhorn, Marc; Bensley, Rodney P.; Hurks, Rob; Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA. [O'Malley, A. James; Landon, Bruce E.] Harvard Univ, Sch Med, Boston, MA USA. [Cotterill, Philip] Ctr Medicare & Medicaid Serv, Bethesda, MD USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU SPRINGER PI NEW YORK PA 233 SPRING ST, NEW YORK, NY 10013 USA SN 0884-8734 EI 1525-1497 J9 J GEN INTERN MED JI J. Gen. Intern. Med. PD JUL PY 2012 VL 27 SU 2 BP S145 EP S146 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA V35IG UT WOS:000209142900114 ER PT J AU Weech-Maldonado, R Laberge, A Pradhan, R Johnson, CE Yang, Z Hyer, K AF Weech-Maldonado, Robert Laberge, Alex Pradhan, Rohit Johnson, Christopher E. Yang, Zhou Hyer, Kathryn TI Nursing home financial performance: The role of ownership and chain affiliation SO HEALTH CARE MANAGEMENT REVIEW LA English DT Article DE chain affiliation; financial performance; for-profit; nursing homes ID QUALITY-OF-CARE; MEDICAID REIMBURSEMENT; COSTS; INDUSTRY; SYSTEMS; PROFIT; MARKET; IMPACT AB Background: The nursing home industry serves one of the most vulnerable populations, and its financial sustainability is a matter of public concern. However, limited empirical evidence exists on the impact of ownership and chain affiliation on nursing home financial performance. Purposes: The aim of this study was to examine the joint effects of ownership and chain affiliation on the financial performance of the nursing home industry for the study period 1999-2004 on a national sample of 11,236 nursing homes per year. Methodology/Approach: Data included the Medicare Cost Reports; the Online Survey, Certification, and Reporting file; and the Area Resource File. Dependent variables included operating and total margins. Independent variables included four ownership/chain affiliation combinations: for-profit chain, for-profit independent, not-for-profit chain, and not-for-profit independent. Random effects generalized least square regressions were performed. Findings: Results show that for-profit nursing homes delivered better financial performance than not-for-profit facilities did across both operating and total margins. However, the relationship between chain affiliation and financial performance was more nuanced. In the case of operating margin, chain-affiliated facilities delivered superior financial performance irrespective of ownership type; however, in the case of total margin, independents outperformed chain-affiliated facilities among for-profits. Practice Implications: Our findings show an interactive effect of ownership and chain affiliation on nursing home financial performance, suggesting the pursuit of different organizational strategies by different ownership/chain affiliation subgroups (for-profit chain, for-profit independent, not-for-profit chain, and not-for-profit independent), with implications for financial performance. For-profit independent nursing homes managed to be the top performing group in terms of overall financial despite the operating financial advantage of for-profit chain-affiliated nursing homes. Similarly, not-for-profit independent nursing homes and not-for-profit chain homes had comparable overall financial performance despite the operating financial advantage of chain homes. C1 [Weech-Maldonado, Robert; Pradhan, Rohit] Univ Alabama Birmingham, Dept Hlth Serv Adm, Birmingham, AL 35294 USA. [Laberge, Alex] Ctr Medicare & Medicaid Serv, Woodlawn, MD USA. [Johnson, Christopher E.] Texas A&M Univ Syst Hlth Sci Ctr, MHA Program, Dept Hlth Policy & Management, Sch Rural Publ Hlth, College Stn, TX USA. [Yang, Zhou] Emory Univ, Dept Hlth Policy & Management, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA. [Hyer, Kathryn] Univ S Florida, Sch Aging Studies, Florida Policy Exchange Ctr Aging, Tampa, FL USA. RP Weech-Maldonado, R (reprint author), Univ Alabama Birmingham, Dept Hlth Serv Adm, Birmingham, AL 35294 USA. EM rweech@uab.edu; Alexandre.Laberge@cms.hhs.gov; rpradhan@uab.edu; cejohnson@srph.tamhsc.edu; zyang26@sph.emory.edu; Khyer@cas.usf.edu FU NIADDK NIH HHS [90AM2750/02] NR 46 TC 10 Z9 10 U1 1 U2 9 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0361-6274 J9 HEALTH CARE MANAGE R JI Health Care Manage. Rev. PD JUL-SEP PY 2012 VL 37 IS 3 BP 235 EP 245 DI 10.1097/HMR.0b013e31823dfe13 PG 11 WC Health Policy & Services SC Health Care Sciences & Services GA 956HX UT WOS:000305081800005 PM 22261667 ER PT J AU Berwick, DM AF Berwick, Donald M. TI To Isaiah SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Berwick, Donald M.] Inst Healthcare Improvement, Boston, MA USA. [Berwick, Donald M.] Ctr Medicare Serv, Boston, MA USA. [Berwick, Donald M.] Ctr Medicaid Serv, Boston, MA USA. [Berwick, Donald M.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. EM donberwick1@gmail.com NR 0 TC 5 Z9 5 U1 0 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 27 PY 2012 VL 307 IS 24 BP 2597 EP 2599 DI 10.1001/jama.2012.6911 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 964KF UT WOS:000305692600027 PM 22735428 ER PT J AU Parker, TF Straube, BM Nissenson, A Hakim, RM Steinman, TI Glassock, RJ AF Parker, Thomas F., III Straube, Barry M. Nissenson, Allen Hakim, Raymond M. Steinman, Theodore I. Glassock, Richard J. TI Dialysis at a Crossroads-Part II: A Call for Action SO CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Editorial Material ID INCIDENT HEMODIALYSIS-PATIENTS; CHRONIC KIDNEY-DISEASE; EARLY INTERVENTION; PRACTICE PATTERNS; VASCULAR ACCESS; MORTALITY; HOSPITALIZATION; OUTCOMES; MORBIDITY; ULTRAFILTRATION AB A previous commentary pointed out that the renal community has led American healthcare in the development and continuous improvement of quality outcomes. However, survival, hospitalization, and quality of life for US dialysis patients is still not optimal. This follow-up commentary examines the obstacles, gaps, and metrics that characterize this unfortunate state of affairs. It posits that current paradigms are essential contributors to quality outcomes but are no longer sufficient to improve quality. New strategies are needed that arise from a preponderance of evidence, in addition to beyond a reasonable doubt standard. This work offers an action plan that consists of new pathways of care that will lead to improved survival, fewer hospitalizations and rehospitalizations, and better quality of life for patients undergoing dialysis therapy. Nephrologists in collaboration with large and small dialysis organizations and other stakeholders, including the Centers for Medicare and Medicaid Services, can implement these proposed new pathways of care and closely monitor their effectiveness. We suggest that our patients deserve nothing less and must receive even more. Clin J Am Soc Nephrol 7: 1026-1032, 2012. doi: 10.2215/CJN.11381111 C1 [Parker, Thomas F., III] Univ Texas SW, Dept Med, Sch Med, Dallas, TX USA. [Parker, Thomas F., III] Renal Ventures Management, Lakewood, CO USA. [Straube, Barry M.] Marwood Grp, New York, NY USA. [Straube, Barry M.] Univ Calif Los Angeles, David Geffen Sch Med, Ctr Medicare & Medicaid Serv, Los Angeles, CA 90095 USA. [Nissenson, Allen] Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, Los Angeles, CA 90095 USA. [Nissenson, Allen] DaVita, El Segundo, CA USA. [Hakim, Raymond M.] Fresenius Med Care N Amer, Clin & Sci Affairs, Brentwood, TN USA. [Steinman, Theodore I.] Harvard Univ, Dept Med, Sch Med, Beth Israel Deaconess Med Ctr, Boston, MA USA. [Steinman, Theodore I.] Brigham & Womens Hosp, Boston, MA 02115 USA. [Glassock, Richard J.] Univ Calif Los Angeles, David Geffen Sch Med, Laguna Niguel, CA USA. RP Parker, TF (reprint author), 100 Highland Pk Village,Suite 200, Dallas, TX 75205 USA. EM tfparker3rd@yahoo.com; tsteinma@bidmc.harvard.edu NR 50 TC 12 Z9 13 U1 0 U2 1 PU AMER SOC NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1555-9041 J9 CLIN J AM SOC NEPHRO JI Clin. J. Am. Soc. Nephrol. PD JUN PY 2012 VL 7 IS 6 BP 1026 EP 1032 DI 10.2215/CJN.11381111 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA 954VE UT WOS:000304975100021 PM 22498499 ER PT J AU Marcotte, L Seidman, J Trudel, K Berwick, DM Blumenthal, D Mostashari, F Jain, SH AF Marcotte, Leah Seidman, Joshua Trudel, Karen Berwick, Donald M. Blumenthal, David Mostashari, Farzad Jain, Sachin H. TI Achieving Meaningful Use of Health Information Technology A Guide for Physicians to the EHR Incentive Programs SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article C1 [Marcotte, Leah] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA. [Mostashari, Farzad] US Dept HHS, Off Natl Coordinator Hlth Informat Technol, Washington, DC 20201 USA. [Seidman, Joshua] US Dept HHS, Meaningful Use Div, Washington, DC 20201 USA. [Trudel, Karen] Off Informat Serv, Baltimore, MD USA. [Berwick, Donald M.] Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. [Jain, Sachin H.] Brigham & Womens Hosp, Boston, MA 02115 USA. [Blumenthal, David] Harvard Univ, Sch Med, Boston, MA USA. RP Seidman, J (reprint author), Switzer Bldg,Ste 1100,330 C St SW, Washington, DC 20201 USA. EM Joshua.Seidman@hhs.gov NR 12 TC 40 Z9 40 U1 3 U2 22 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 MAY 14 PY 2012 VL 172 IS 9 BP 731 EP 736 PG 6 WC Medicine, General & Internal SC General & Internal Medicine GA 941ZF UT WOS:000304007800011 PM 22782203 ER PT J AU Kulkarni, VT Shah, SJ Bernheim, SM Wang, YF Normand, SLT Han, LF Rapp, MT Drye, EE Krumholz, HM AF Kulkarni, Vivek T. Shah, Sachin J. Bernheim, Susannah M. Wang, Yongfei Normand, Sharon-Lise T. Han, Lein F. Rapp, Michael T. Drye, Elizabeth E. Krumholz, Harlan M. TI Regional Associations Between Medicare Advantage Penetration and Administrative Claims-based Measures of Hospital Outcomes SO MEDICAL CARE LA English DT Article DE acute MI; heart failure; Medicare; mortality; outcomes assessment; pneumonia; readmissions; risk adjustment ID ACUTE MYOCARDIAL-INFARCTION; CAUSE READMISSION RATES; 30-DAY MORTALITY-RATES; HEART-FAILURE; PERFORMANCE AB Background: Risk-standardized measures of hospital outcomes reported by the Centers for Medicare and Medicaid Services include Medicare fee-for-service (FFS) patients and exclude Medicare Advantage (MA) patients due to data availability. MA penetration varies greatly nationwide and seems to be associated with increased FFS population risk. Whether variation in MA penetration affects the performance on the Centers for Medicare and Medicaid Service measures is unknown. Objective: To determine whether the MA penetration rate is associated with outcomes measures based on FFS patients. Research Design: In this retrospective study, 2008 MA penetration was estimated at the Hospital Referral Region (HRR) level. Risk-standardized mortality rates and risk-standardized readmission rates for heart failure, acute myocardial infarction, and pneumonia from 2006 to 2008 were estimated among HRRs, along with several markers of FFS population risk. Weighted linear regression was used to test the association between each of these variables and MA penetration among HRRs. Results: Among 304 HRRs, MA penetration varied greatly (median, 17.0%; range, 2.1%-56.6%). Although MA penetration was significantly (P < 0.05) associated with 5 of the 6 markers of FFS population risk, MA penetration was insignificantly (P >= 0.05) associated with 5 of 6 hospital outcome measures. Conclusion: Risk-standardized mortality rates and risk-standardized readmission rates for heart failure, acute myocardial infarction, and pneumonia do not seem to differ systematically with MA penetration, lending support to the widespread use of these measures even in areas of high MA penetration. C1 [Kulkarni, Vivek T.] Yale Univ, Sch Med, New Haven, CT USA. [Shah, Sachin J.] Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA. [Bernheim, Susannah M.; Wang, Yongfei; Drye, Elizabeth E.; Krumholz, Harlan M.] Yale New Haven Hosp Ctr Outcomes Res & Evaluat, New Haven, CT USA. [Wang, Yongfei; Drye, Elizabeth E.; Krumholz, Harlan M.] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. [Han, Lein F.; Rapp, Michael T.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Rapp, Michael T.] George Washington Univ, Sch Med & Hlth Sci, Dept Emergency Med, Washington, DC 20052 USA. [Krumholz, Harlan M.] Robert Wood Johnson Clin Scholars Program, New Haven, CT USA. RP Bernheim, SM (reprint author), Yale YNHH Ctr Outcomes Res & Evaluat CORE, 1 Church St,Suite 200, New Haven, CT 06510 USA. EM susannah.bernheim@yale.edu FU Ruth L. Kirchstein National Research Service Award from the National Institutes of Health [5T35 HL07649-24]; (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute [U01 HL 105270-01] FX V.T.K. was supported by a Ruth L. Kirchstein National Research Service Award (5T35 HL07649-24) from the National Institutes of Health. H. M. K. is supported by grant U01 HL 105270-01 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. Each of the other authors reports no support received for this work. NR 16 TC 1 Z9 1 U1 0 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 MAY PY 2012 VL 50 IS 5 BP 406 EP 409 DI 10.1097/MLR.0b013e318245a0f9 PG 4 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 083IH UT WOS:000314456400008 PM 22456113 ER PT J AU Lee, GM Hartmann, CW Graham, D Kassler, W Linn, MD Krein, S Saint, S Goldmann, DA Fridkin, S Horan, T Jernigan, J Jha, A AF Lee, Grace M. Hartmann, Christine W. Graham, Denise Kassler, William Linn, Maya Dutta Krein, Sarah Saint, Sanjay Goldmann, Donald A. Fridkin, Scott Horan, Teresa Jernigan, John Jha, Ashish TI Perceived impact of the Medicare policy to adjust payment for health care-associated infections SO AMERICAN JOURNAL OF INFECTION CONTROL LA English DT Article DE Non-payment for preventable complications; Unintended consequences; Organizational culture; Organizational resources ID URINARY-TRACT-INFECTION; QUALITY IMPROVEMENT; UNITED-STATES; PERFORMANCE; PAY; REIMBURSEMENT; NONPAYMENT; PREVENTION; OUTCOMES; CONTEXT AB Background: In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts. Methods: A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010. Results: Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0-5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3-0.8; P = .005). Conclusion: Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear. Copyright (C) 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. C1 [Lee, Grace M.; Linn, Maya Dutta] Harvard Pilgrim Hlth Care Inst, Dept Populat Med, Boston, MA USA. [Lee, Grace M.; Linn, Maya Dutta] Harvard Univ, Sch Med, Boston, MA 02215 USA. [Lee, Grace M.] Childrens Hosp, Dept Lab Med, Boston, MA 02115 USA. [Lee, Grace M.] Childrens Hosp, Div Infect Dis, Boston, MA 02115 USA. [Hartmann, Christine W.] Bedford VA Med Ctr, Ctr Hlth Qual Outcomes & Econ Res, Bedford, MA USA. [Hartmann, Christine W.] Boston Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA. [Graham, Denise] Assoc Profess Infect Control & Epidemiol, Washington, DC USA. [Kassler, William] Ctr Medicare Serv, Boston, MA USA. [Kassler, William] Ctr Medicaid Serv, Boston, MA USA. [Krein, Sarah; Saint, Sanjay] Ann Arbor VA Med Ctr, Ann Arbor, MI USA. [Krein, Sarah; Saint, Sanjay] Univ Michigan, Sch Med, Ann Arbor, MI USA. [Goldmann, Donald A.] Inst Healthcare Improvement, Cambridge, MA USA. [Fridkin, Scott; Horan, Teresa; Jernigan, John] Ctr Dis Control & Prevent, Div Healthcare Qual & Promot, Atlanta, GA USA. [Jha, Ashish] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA. RP Lee, GM (reprint author), Harvard Pilgrim Hlth Care, Dept Populat Med, 133 Brookline Ave,6th Floor, Boston, MA 02215 USA. EM grace.lee@childrens.harvard.edu RI Krein, Sarah/E-2742-2014 OI Krein, Sarah/0000-0003-2111-8131 FU National Institute of Allergy and Infectious Diseases [R21AI083888] FX The project was funded by award number R21AI083888 (to G.M.L.) from the National Institute of Allergy and Infectious Diseases, which did not play a role in the design, conduct of the study, collection, management, analysis, data interpretation, preparation, review, or approval of the manuscript. NR 37 TC 16 Z9 16 U1 1 U2 4 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0196-6553 J9 AM J INFECT CONTROL JI Am. J. Infect. Control PD MAY PY 2012 VL 40 IS 4 BP 314 EP 319 DI 10.1016/j.ajic.2011.11.003 PG 6 WC Public, Environmental & Occupational Health; Infectious Diseases SC Public, Environmental & Occupational Health; Infectious Diseases GA 934CJ UT WOS:000303418400008 PM 22541855 ER PT J AU Howell, BL Powers, CA Weinhandl, ED St Peter, WL Frankenfield, DL AF Howell, Benjamin L. Powers, Christopher A. Weinhandl, Eric D. St Peter, Wendy L. Frankenfield, Diane L. TI Sources of Drug Coverage among Medicare Beneficiaries with ESRD SO JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article ID STAGE RENAL-DISEASE; PART-D; ADHERENCE; COST; GAP; NONADHERENCE; INSURANCE; DIALYSIS; HEALTH AB Despite extensive use of prescription medications in ESRD, relatively little is known about the participation of Medicare ESRD beneficiaries in the Part D program. Here, we quantitated the sources of drug coverage among ESRD beneficiaries and explored the Part D plan preferences of ESRD beneficiaries with regard to deductibles, coverage gaps, and monthly premiums. We obtained data on beneficiary sources of creditable coverage, characteristics of Part D plans, demographics, and residence from the Centers for Medicare and Medicaid Chronic Condition Data Warehouse and identified beneficiaries with ESRD from the US Renal Data System. We found that a substantial proportion (17.0%) of ESRD beneficiaries lacked a known source of creditable drug coverage in 2007 and 64.3% were enrolled in Part D. Of those enrolled, 72% received the Medicare Part D low-income subsidy. ESRD beneficiaries who enrolled in standalone Part D plans without the assistance of the low-income subsidy tended to prefer more comprehensive coverage options. In conclusion, more outreach is needed to ensure that beneficiaries who lack coverage obtain the coverage they need and that ESRD beneficiaries join the best plans for managing their disease and accompanying comorbid conditions. C1 [Howell, Benjamin L.; Frankenfield, Diane L.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Baltimore, MD 21244 USA. [Powers, Christopher A.] Ctr Medicare & Medicaid Serv, Strateg Planning, Baltimore, MD 21244 USA. [Weinhandl, Eric D.; St Peter, Wendy L.] Minneapolis Med Res Fdn Inc, US Renal Data Syst, Minneapolis, MN USA. [St Peter, Wendy L.] Univ Minnesota, Coll Pharm, Minneapolis, MN 55455 USA. RP Howell, BL (reprint author), Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, 7500 Secur Blvd,Mailstop C3-21-28, Baltimore, MD 21244 USA. EM Benjamin.Howell@CMS.hhs.gov OI St Peter, Wendy/0000-0002-2201-3019 NR 22 TC 2 Z9 2 U1 1 U2 3 PU AMER SOC 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 MAY PY 2012 VL 23 IS 5 BP 959 EP 965 DI 10.1681/ASN.2011070740 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA 937DA UT WOS:000303638000022 PM 22402802 ER PT J AU Straube, BM AF Straube, Barry M. TI Condition-Specific Disease Treatment in Dialysis Patients: Utilization, Costs, and Guideline and Policy Imperatives SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Editorial Material C1 [Straube, Barry M.] Marwood Grp, New York, NY 10017 USA. [Straube, Barry M.] Ctr Medicare Serv, Washington, DC USA. [Straube, Barry M.] Ctr Medicaid Serv, Washington, DC USA. RP Straube, BM (reprint author), Marwood Grp, 733 3rd Ave,11th Floor, New York, NY 10017 USA. EM barry.straube@gmail.com NR 2 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 J9 AM J KIDNEY DIS JI Am. J. Kidney Dis. PD MAY PY 2012 VL 59 IS 5 BP 595 EP 597 DI 10.1053/j.ajkd.2012.02.003 PG 3 WC Urology & Nephrology SC Urology & Nephrology GA 926XH UT WOS:000302864700002 PM 22507647 ER PT J AU Frankenfield, DL Weinhandl, ED Powers, CA Howell, BL Herzog, CA St Peter, WL AF Frankenfield, Diane L. Weinhandl, Eric D. Powers, Christopher A. Howell, Benjamin L. Herzog, Charles A. St Peter, Wendy L. TI Utilization and Costs of Cardiovascular Disease Medications in Dialysis Patients in Medicare Part D SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE Dialysis; Medicare Part D; cardiovascular medications; utilization; cost; low income subsidy ID CHRONIC-HEMODIALYSIS PATIENTS; CONVERTING ENZYME-INHIBITORS; PLACEBO-CONTROLLED TRIAL; STAGE RENAL-DISEASE; MANAGED CARE PLANS; ANGIOTENSIN RECEPTOR BLOCKERS; RANDOMIZED CONTROLLED-TRIAL; ACUTE MYOCARDIAL-INFARCTION; CORONARY-ARTERY-DISEASE; ISCHEMIC-HEART-DISEASE AB Background: Cardiovascular disease (CVD) is a major source of mortality and morbidity in dialysis patients. Population-level descriptions of CVD medication use are lacking in this population. Study Design: Retrospective cohort study. Setting & Participants: Adult dialysis patients in the United States, alive on December 31, 2006, with Medicare Parts A and B and enrollment in Medicare Part D continuously in 2007. Predictor: CVDs and demographic characteristics. Outcome: >= 1 prescription fill during follow-up (2007). Measurements: Average out-of-pocket costs per user per month and average total drug costs per member per month were calculated. Results: Of 225,635 dialysis patients who met inclusion criteria during the entry period, 70% (n = 158,702) had continuous Part D coverage during follow-up. Of these, 76% received the low-income subsidy. beta-Blockers were the most commonly used CVD medication (64%), followed by renin-angiotensin system inhibitors (52%), calcium channel blockers (51%), lipid-lowering agents (44%), and alpha-agonists (23%). Use varied by demographics, geographic region, and low-income subsidy status. For CVD medications, mean out-of-pocket costs per user per month were $3.44 and $49.59 and mean total costs per member per month were $124.02 and $110.32 for patients with and without the low-income subsidy, respectively. Limitations: Information was available for only filled prescriptions under the Part D benefit; information for clinical contraindications was lacking, information for over-the-counter medications was unavailable, and medication adherence and persistence were not examined. Conclusions: Most Medicare dialysis patients in 2007 were enrolled in Part D, and most enrollees received the low-income subsidy. beta-Blockers were the most used CVD medication. Total costs of CVD medications were modestly higher for low-income subsidy patients, but out-of-pocket costs were much higher for patients not receiving the subsidy. Further study is warranted to delineate sources of variation in the use and costs of CVD medications across subgroups. Am J Kidney Dis. 59(5): 670-681. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is a US Government Work. There are no restrictions on its use. C1 [Frankenfield, Diane L.; Howell, Benjamin L.] Ctr Medicare & Medicaid Innovat, Ctr Medicare Serv, Baltimore, MD USA. [Frankenfield, Diane L.; Howell, Benjamin L.] Ctr Medicare & Medicaid Innovat, Ctr Medicaid Serv, Baltimore, MD USA. [Herzog, Charles A.] Minneapolis Med Res Fdn Inc, US Renal Data Syst, Cardiovasc Special Studies Ctr, Minneapolis, MN USA. [Powers, Christopher A.] Ctr Strateg Planning, Ctr Medicare Serv, Baltimore, MD USA. [Powers, Christopher A.] Ctr Strateg Planning, Ctr Medicaid Serv, Baltimore, MD USA. [Herzog, Charles A.] Univ Minnesota, Dept Med, Div Cardiol, Minneapolis, MN 55455 USA. [St Peter, Wendy L.] Univ Minnesota, Coll Pharm, Minneapolis, MN 55455 USA. RP Frankenfield, DL (reprint author), CMS Ctr Medicare & Medicaid Innovat, 7500 Secur Blvd,Mailstop C3-21-28, Baltimore, MD 21244 USA. EM diane.frankenfield@cms.hhs.gov OI St Peter, Wendy/0000-0002-2201-3019 FU National Institute of Diabetes and Digestive and Kidney Diseases, NIH [HHSN267200715003C] FX This study was performed by employees of the CMS and USRDS. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy, interpretation, or opinion of the CMS, the National Institutes of Health (NIH), or the US government. This study was performed as a deliverable under contract no. HHSN267200715003C (National Institute of Diabetes and Digestive and Kidney Diseases, NIH). NR 82 TC 13 Z9 13 U1 2 U2 4 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 MAY PY 2012 VL 59 IS 5 BP 670 EP 681 DI 10.1053/j.ajkd.2011.10.047 PG 12 WC Urology & Nephrology SC Urology & Nephrology GA 926XH UT WOS:000302864700014 PM 22206743 ER PT J AU Shrank, WH Choudhry, NK AF Shrank, William H. Choudhry, Niteesh K. TI THERAPY Affect and affirmations-a 'basic' approach to promote adherence SO NATURE REVIEWS CARDIOLOGY LA English DT Editorial Material ID HYPERTENSIVE AFRICAN-AMERICANS; RANDOMIZED CONTROLLED-TRIAL; MEDICATION ADHERENCE; INTERVENTIONS C1 [Shrank, William H.] Ctr Medicare Serv, Rapid Cycle Evaluat Grp, Ctr Medicare & Medicaid Innovat, Baltimore, MD 21244 USA. [Shrank, William H.] Ctr Medicaid Serv, Rapid Cycle Evaluat Grp, Ctr Medicare & Medicaid Innovat, Baltimore, MD 21244 USA. [Choudhry, Niteesh K.] Brigham & Womens Hosp, Dept Med, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02120 USA. [Choudhry, Niteesh K.] Harvard Univ, Sch Med, Boston, MA 02120 USA. RP Shrank, WH (reprint author), Ctr Medicare Serv, Rapid Cycle Evaluat Grp, Ctr Medicare & Medicaid Innovat, 7205 Windsor Blvd, Baltimore, MD 21244 USA. EM william.shrank@cms.hhs.gov NR 10 TC 1 Z9 1 U1 0 U2 0 PU NATURE PUBLISHING GROUP PI NEW YORK PA 75 VARICK ST, 9TH FLR, NEW YORK, NY 10013-1917 USA SN 1759-5002 J9 NAT REV CARDIOL JI Nat. Rev. Cardiol. PD MAY PY 2012 VL 9 IS 5 BP 263 EP 265 DI 10.1038/nrcardio.2012.35 PG 4 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 927MF UT WOS:000302911000005 PM 22411288 ER PT J AU Karikari-Martin, P McCann, JJ Hebert, LE Haffer, SC Phillips, M AF Karikari-Martin, Pauline McCann, Judith J. Hebert, Liesi E. Haffer, Samuel C. Phillips, Marcia TI Do Community and Caregiver Factors Influence Hospice Use at the End of Life Among Older Adults With Alzheimer Disease? SO JOURNAL OF HOSPICE & PALLIATIVE NURSING LA English DT Article DE adult day care; Alzheimer disease; caregivers; hospice; Hospice Use Model ID CANCER-PATIENTS; UNITED-STATES; CARE; DEMENTIA; SERVICES; PATIENT; ACCESS; HEALTH AB Hospice is an underused service among people with Alzheimer disease. This study used the Hospice Use Model to examine community, care recipient, and caregiver characteristics associated with hospice use before death among 145 community-dwelling care recipients with Alzheimer disease and their caregivers. Secondary analysis using logistic regression modeling indicated that older age, male gender, black race, and better functional health of care recipients with Alzheimer disease were associated with a decreased likelihood of using hospice (model chi(2)(5) = 23.5, P = .0003). Moreover, care recipients recruited from an Alzheimer clinic were more likely to use hospice than those recruited from adult day-care centers. Caregiver factors were not independent predictors of hospice use. However, there was a significant interaction between hours of care provided each week and recruitment site. Among care recipients from the Alzheimer clinic, the probability of hospice use increased as caregiving intensity increased. This relationship was reversed in care recipients from day-care centers. Results suggest that adult day-care centers need to partner with hospice programs in the community. In conclusion, care recipient and community service factors influence hospice use in individuals with Alzheimer disease. C1 [McCann, Judith J.] Rush Univ, Coll Nursing, Med Ctr, Rush Inst Hlth Aging, Chicago, IL 60612 USA. [Karikari-Martin, Pauline] US PHS, Rockville, MD USA. [Karikari-Martin, Pauline; Haffer, Samuel C.] Ctr Medicare Serv, Baltimore, MD USA. [Karikari-Martin, Pauline; Haffer, Samuel C.] Ctr Medicaid Serv, Baltimore, MD USA. RP Karikari-Martin, P (reprint author), Rush Univ, Coll Nursing, 6152 Camelback Ln, Columbia, MD 21045 USA. EM pauline_karikari-martin@Rush.edu FU Longitudinal Study of Day Care in Alzheimer's Disease [R01 AG10315] FX This study was supported by the Longitudinal Study of Day Care in Alzheimer's Disease (R01 AG10315). NR 34 TC 6 Z9 6 U1 0 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1522-2179 J9 J HOSP PALLIAT NURS JI J. Hosp. Palliat. Nurs. PD MAY PY 2012 VL 14 IS 3 BP 225 EP 237 DI 10.1097/NJH.0b013e3182433a15 PG 13 WC Nursing SC Nursing GA 925OH UT WOS:000302770200008 ER PT J AU Fick, D Semla, T Beizer, J Dombrowski, R Brandt, N DuBeau, CE Flanagan, N Hanlon, J Hollmann, P Linnebur, S Nau, D Rehm, B Sandhu, S Steinman, M AF Fick, Donna Semla, Todd Beizer, Judith Dombrowski, Robert Brandt, Nicole DuBeau, Catherine E. Flanagan, Nina Hanlon, Joseph Hollmann, Peter Linnebur, Sunny Nau, David Rehm, Bob Sandhu, Satinderpal Steinman, Michael CA Amer Geriatrics Soc 2012 Beers TI American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE Beers list; medications; Beers Criteria; drugs; older adults ID ADVERSE DRUG-REACTIONS; EXPLICIT CRITERIA; CLINICAL-TRIALS; OUTPATIENTS; POPULATION; EVENTS; SCALE; AGE C1 [Amer Geriatrics Soc 2012 Beers] Amer Geriatr Soc, New York, NY USA. [Fick, Donna] Penn State Univ, Sch Nursing, University Pk, PA 16802 USA. [Fick, Donna] Penn State Univ, Coll Med, Dept Psychiat, University Pk, PA 16802 USA. [Semla, Todd] Natl Pharm Benefits Management Serv, US Dept Vet Affairs, Chicago, IL USA. [Semla, Todd] Northwestern Univ, Chicago, IL 60611 USA. [Beizer, Judith] St Johns Univ, New York, NY USA. [Brandt, Nicole] Univ Maryland, Baltimore, MD 21201 USA. [Dombrowski, Robert] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [DuBeau, Catherine E.] Univ Massachusetts, Sch Med, Worcester, MA USA. [Flanagan, Nina] Binghamton Univ, Dunmore, PA USA. [Hanlon, Joseph] Univ Pittsburgh, Sch Med, Dept Med Geriatr Med, Pittsburgh, PA USA. [Hanlon, Joseph] Vet Adm Hlth Syst, Geriatr Educ & Res & Clin Ctr, Pittsburgh, PA USA. [Hollmann, Peter] Blue Cross Blue Shield Rhode Isl, Cranston, RI USA. [Linnebur, Sunny] Univ Colorado, Sch Pharm & Pharmaceut Sci, Aurora, CO USA. [Nau, David] Pharm Qual Alliance Inc, Baltimore, MD USA. [Rehm, Bob] Natl Comm Qual Assurance, Washington, DC USA. [Sandhu, Satinderpal] MetroHlth Med Ctr, Cleveland, OH USA. [Sandhu, Satinderpal] Case Western Reserve Univ, Sch Med, Cleveland, OH USA. [Steinman, Michael] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Steinman, Michael] San Francisco VA Med Ctr, San Francisco, CA USA. RP Fick, D (reprint author), Care of Campanelli CM, Amer Geriatr Soc, 40 Fulton St,18th Floor, New York, NY 10038 USA. FU John A. Hartford Foundation; Talyst; Econometrics; Health Resources and Services Administration; State of Maryland Office of Health Care Quality; National Institute of Health (NIH) for National Institute of Nursing Research [R01 NR011042, R01NR012242]; National Institute on Aging [R01AG027017, P30AG024827, T32 AG021885, K07AG033174, R01AG034056]; National Institute of Nursing Research [R01 NR010135]; Agency for Healthcare Research and Quality [R01 HS017695, R01HS018721] FX Sue Radcliff, Independent Researcher, Denver, Colorado, provided research services. Susan E. Aiello, DVM, ELS, provided editorial services. Christine Campanelli and Elvy Ickowicz, MPH, provided additional research and administrative support. The development of this paper was supported in part by an unrestricted grant from the John A. Hartford Foundation.; Drs. Dombrowski, Flanagan, Hanlon, Hollmann, Rehm, Sandhu, and Steinman indicated no conflicts of interest. Dr. Beizer is an author and editor for LexiComp, Inc. She is on the Pharmacy and Therapeutics Committee for Part D at Medco Health Solutions. Dr. Brandt is on the Pharmacy and Therapeutics Committees at Omnicare and receives grants from Talyst (research grant), Econometrics (research grant), Health Resources and Services Administration (educational grant), and the State of Maryland Office of Health Care Quality (educational grant). Dr. Dubeau serves as a consultant for Pfizer, Inc. (urinary incontinence) and the New England Research Institute (nocturia). Dr. Fick is partially supported by the National Institute of Health (NIH) for National Institute of Nursing Research grants R01 NR011042 and R01NR012242. Dr. Hanlon is supported in part by National Institute on Aging grants and contracts (R01AG027017, P30AG024827, T32 AG021885, K07AG033174, R01AG034056), a National Institute of Nursing Research grant (R01 NR010135), and Agency for Healthcare Research and Quality grants (R01 HS017695, R01HS018721). Dr. Linnebur receives an honorarium for serving as a member of the Pharmacy and Therapeutics NR 35 TC 436 Z9 463 U1 4 U2 48 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 EI 1532-5415 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD APR PY 2012 VL 60 IS 4 BP 616 EP 631 DI 10.1111/j.1532-5415.2012.03923.x PG 16 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 923MR UT WOS:000302623900004 ER PT J AU Lilly, MP Lynch, JR Wish, JB Huff, ED Chen, SC Armistead, NC McClellan, WM AF Lilly, Michael P. Lynch, Janet R. Wish, Jay B. Huff, Edwin D. Chen, Shu-Cheng Armistead, Nancy C. McClellan, William M. TI Prevalence of Arteriovenous Fistulas in Incident Hemodialysis Patients: Correlation With Patient Factors That May Be Associated With Maturation Failure SO AMERICAN JOURNAL OF KIDNEY DISEASES LA English DT Article DE Hemodialysis access; arteriovenous fistula; vascular access ID CHRONIC KIDNEY-DISEASE; VASCULAR ACCESS; PRACTICE PATTERNS; DIALYSIS OUTCOMES; CANNULATION; FACILITIES; INCREASES; CHOICE; DOPPS AB Background: Lok et al previously reported a risk equation for arteriovenous fistula (AVF) maturation failure. It is unclear whether this model or a more comprehensive model correlates with incident AVF use in the US hemodialysis population. Study Design: Cross-sectional study. Setting & Participants: 195,756 adult patients initiating outpatient hemodialysis therapy in the United States between July 1, 2005, and December 31, 2009, with 6 months or more prior nephrology care. Predictor: Patient characteristics (age, peripheral vascular disease, coronary artery disease, and race) populating the AVF maturation failure risk equation and other demographic and clinical variables from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (CMS 2728). Outcomes & Measurements: AVF use at first outpatient dialysis treatment as recorded on the CMS 2728. Results: Using the risk categories defined by Lok et al, AVF use varied from 19.0% (very high risk) to 25.6% (low risk). In a model using only these risk categories, logistic regression showed lower ORs for moderate-, 0.90 (95% CI, 0.88-0.93); high-, 0.80 (95% CI, 0.78-0.83); and very high-risk patients, 0.68 (95% CI, 0.63-0.73) compared with low risk. In the expanded model, odds were lower for women, blacks, Hispanics, age older than 85 years, diabetes, peripheral vascular disease, congestive heart failure, other cardiac disease, and underweight. Odds were higher for hypertension, overweight, obesity, 12 months or more nephrologist care, most insurance types, and each successive year after 2005. Despite associations, the C statistic for the expanded model was 0.64. Limitations: This analysis is limited by lack of access creation history before dialysis therapy initiation and minimal external validation of CMS 2728 data. Conclusions: Clinical risk factors identified by Lok and expanded in this analysis have limited ability to predict incident AVF use. Even patients judged at highest risk can have successful AVF construction and initiate dialysis therapy through a functioning AVF. Am J Kidney Dis. 59(4): 541-549. (C) 2012 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. C1 [Lilly, Michael P.] Univ Maryland, Sch Med, Baltimore, MD 21201 USA. [Lynch, Janet R.; Armistead, Nancy C.] Mid Atlantic Renal Coalit, Richmond, VA USA. [Wish, Jay B.] Case Western Reserve Univ, Cleveland, OH 44106 USA. [Huff, Edwin D.] Boston Reg Off, Ctr Medicare Serv, Boston, MA USA. [Huff, Edwin D.] Boston Reg Off, Ctr Medicaid Serv, Boston, MA USA. [Chen, Shu-Cheng] Minneapolis Med Res Fdn Inc, Chron Dis Res Grp, Minneapolis, MN USA. [McClellan, William M.] Emory Univ, Sch Med, Atlanta, GA USA. RP Lilly, MP (reprint author), Univ Maryland Hosp, Div Vasc Surg, Rm S10B03,22 S Greene St, Baltimore, MD 21201 USA. EM mlilly@smail.umaryland.edu FU CMS, Department of Health and Human Services [500-2010-NW005C] FX The analyses upon which this publication is based were performed under contract 500-2010-NW005C entitled ESRD Network Organization for the District of Columbia, Maryland, Virginia, and West Virginia, sponsored by the CMS, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. This article is a direct result of the Health Care Quality Improvement Program initiated by the CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care and therefore required no special funding on the part of this contractor. NR 41 TC 30 Z9 32 U1 0 U2 2 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 2012 VL 59 IS 4 BP 541 EP 549 DI 10.1053/j.ajkd.2011.11.038 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 916QE UT WOS:000302117500324 PM 22342212 ER PT J AU Sonnenfeld, N Pitts, SR Schappert, SM Decker, SL AF Sonnenfeld, Nancy Pitts, Stephen R. Schappert, Susan M. Decker, Sandra L. TI Emergency Department Volume and Racial and Ethnic Differences in Waiting Times in the United States SO MEDICAL CARE LA English DT Article DE emergency department; race/ethnicity; visit volume; waiting time ID HOSPITAL EMERGENCY; CARE; ASSOCIATION; RACE/ETHNICITY; PERFORMANCE; DISPARITIES AB Background: Racial and ethnic differences in emergency department (ED) waiting times have been observed previously. Objectives: We explored how adjusting for ED attributes, particularly visit volume, affected racial/ethnic differences in waiting time. Research Design: We constructed linear models using generalized estimating equations with 2007-2008 National Hospital Ambulatory Medical Care Survey data. Subjects: We analyzed data from 54,819 visits to 431 US EDs. Measures: Our dependent variable was waiting time, measured from arrival to time seen by physician, and was log transformed because it was skewed. Primary independent variables were individual race/ethnicity (Hispanic and non-Hispanic white, black, other) and ED race/ethnicity composition (covariates for percentages of Hispanics, blacks, and others). Covariates included patient age, triage assessment, arrival by ambulance, payment source, volume, region, and teaching hospital. Results: Geometric mean waiting times were 27.3, 37.7, and 32.7 minutes for visits by white, black, and Hispanic patients. Patients waited significantly longer at EDs serving higher percentages of black patients; per 25 point increase in percent black patients served, waiting times increased by 23% (unadjusted) and 13% (adjusted). Within EDs, black patients waited 9% (unadjusted) and 4% (adjusted) longer than whites. The ED attribute most strongly associated with waiting times was visit volume. Waiting times were about half as long at low-volume compared with high-volume EDs (P<0.001). For Hispanic patients, differences were smaller and less robust to model choice. Conclusions: Non-Hispanic black patients wait longer for ED care than whites primarily because of where they receive that care. ED volume may explain some across-ED differences. C1 [Sonnenfeld, Nancy; Schappert, Susan M.; Decker, Sandra L.] Natl Ctr Hlth Stat, Div Hlth Care Stat, Hyattsville, MD 20782 USA. [Pitts, Stephen R.] Emory Univ, Dept Emergency Med, Atlanta, GA 30322 USA. RP Sonnenfeld, N (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. EM nancy.sonnenfeld@cms.hhs.gov NR 27 TC 15 Z9 16 U1 0 U2 6 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 2012 VL 50 IS 4 BP 335 EP 341 DI 10.1097/MLR.0b013e318245a53c PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 907SH UT WOS:000301437600010 PM 22270097 ER PT J AU Kowalczyk, KJ Levy, JM Caplan, CF Lipsitz, SR Yu, HY Gu, XM Hu, JC AF Kowalczyk, Keith J. Levy, Jesse M. Caplan, Craig F. Lipsitz, Stuart R. Yu, Hua-yin Gu, Xiangmei Hu, Jim C. TI Temporal National Trends of Minimally Invasive and Retropubic Radical Prostatectomy Outcomes from 2003 to 2007: Results from the 100% Medicare Sample SO EUROPEAN UROLOGY LA English DT Article DE Prostate cancer; Radical prostatectomy; Complications; Medicare ID ASSISTED PROSTATECTOMY; 30-DAY MORTALITY; LEARNING-CURVE; APGAR SCORE; MORBIDITY; COMPLICATIONS; RISK AB Background: Although the use of minimally invasive radical prostatectomy (MIRP) has increased, there are few comprehensive population-based studies assessing temporal trends and outcomes relative to retropubic radical prostatectomy (RRP). Objective: Assess temporal trends in the utilization and outcomes of MIRP and RRP among US Medicare beneficiaries from 2003 to 2007. Design, setting, and participants: A population-based retrospective study of 19 594 MIRP and 58 638 RRP procedures was performed from 2003 to 2007 from the 100% Medicare sample, composed of almost all US men >= 65 yr of age. Intervention: MIRP and RRP. Measurements: We measured 30-d outcomes (cardiac, respiratory, vascular, genitourinary, miscellaneous medical, miscellaneous surgical, wound complications, blood transfusions, and death), cystography utilization within 6wk of surgery, and late complications (anastomotic stricture, ureteral complications, rectourethral fistulae, lymphocele, and corrective incontinence surgery). Results and limitations: From 2003 to 2007, MIRP increased from 4.9% to 44.5% of radical prostatectomies while RRP decreased from 89.4% to 52.9%. MIRP versus RRP subjects were younger (p < 0.001) and had fewer comorbidities (p < 0.001). Decreased MIRP genitourinary complications (6.2-4.1%; p = 0.002), miscellaneous surgical complications (4.7-3.7%; p = 0.030), transfusions (3.5-2.2%; p = 0.005), and postoperative cystography utilization (40.3-34.1%; p < 0.001) were observed over time. Conversely, overall RRP perioperative complications increased (27.4-32.0%; p < 0.001), including an increase in perioperative mortality (0.5-0.8%, p = 0.009). Late RRP complications increased, with the exception of fewer anastomotic strictures (10.2-8.8%; p = 0.002). In adjusted analyses, RRP versus MIRP was associated with increased 30-d mortality (odds ratio [OR]: 2.67; 95% confidence interval [CI], 1.55-4.59; p < 0.001) and more perioperative (OR: 1.60; 95% CI, 1.45-1.76; p < 0.001) and late complications (OR: 2.52; 95% CI, 2.20-2.89; p < 0.001). Limitations include the inability to distinguish MIRP with versus without robotic assistance and also the lack of pathologic information. Conclusions: From 2003 to 2007, there were fewer MIRP transfusions, genitourinary complications, and miscellaneous surgical complications, whereas most RRP perioperative and late complications increased. RRP versus MIRP was associated with more postoperative mortality and complications. (C) 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved. C1 [Kowalczyk, Keith J.] Georgetown Univ Hosp, Dept Urol, Washington, DC 20007 USA. [Levy, Jesse M.; Caplan, Craig F.] Ctr Medicare Serv, Baltimore, MD USA. [Levy, Jesse M.; Caplan, Craig F.] Ctr Medicaid Serv, Baltimore, MD USA. [Lipsitz, Stuart R.; Gu, Xiangmei; Hu, Jim C.] Harvard Univ, Brigham & Womens Hosp, Ctr Surg & Publ Hlth, Sch Med, Boston, MA 02130 USA. [Hu, Jim C.] Harvard Univ, Div Urol Surg, Brigham & Womens Hosp, Faulkner Hosp,Med Sch, Boston, MA 02130 USA. RP Hu, JC (reprint author), Harvard Univ, Div Urol Surg, Brigham & Womens Hosp, Faulkner Hosp,Med Sch, 1153 Ctr St,Suite 4420, Boston, MA 02130 USA. EM jhu2@partners.org FU Department of Defense Physician Training [W81XWH-08-1-0283] FX I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Jim C. Hu receives salary support from Department of Defense Physician Training Award W81XWH-08-1-0283. The other authors have nothing to disclose. NR 34 TC 53 Z9 54 U1 0 U2 0 PU ELSEVIER SCIENCE BV PI AMSTERDAM PA PO BOX 211, 1000 AE AMSTERDAM, NETHERLANDS SN 0302-2838 J9 EUR UROL JI Eur. Urol. PD APR PY 2012 VL 61 IS 4 BP 803 EP 809 DI 10.1016/j.eururo.2011.12.020 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA 899TB UT WOS:000300838000045 PM 22209053 ER PT J AU Baron, RJ AF Baron, Richard J. TI New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS SO ANNALS OF FAMILY MEDICINE LA English DT Article DE primary health care; administration; management of health care; health care delivery; health services research; health policy research; health policy; health care economics and organizations; Center for Medicare & Medicaid Innovation; Agency for Health Care Research and Quality ID BENIGN PROSTATIC HYPERPLASIA; MEDICAL HOME AB Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide. C1 [Baron, Richard J.] Ctr Medicare & Medicaid Serv, Innovat Ctr, Baltimore, MD USA. RP Baron, RJ (reprint author), CMS, Mail Stop WB-06-05,7500 Secur Blvd, Baltimore, MD 21244 USA. EM Richard.Baron@cms.hhs.gov NR 14 TC 4 Z9 4 U1 1 U2 7 PU ANNALS FAMILY MEDICINE PI LEAWOOD PA 11400 TOMAHAWK CREEK PARKWAY, LEAWOOD, KS 66211-2672 USA SN 1544-1709 J9 ANN FAM MED JI Ann. Fam. Med. PD MAR-APR PY 2012 VL 10 IS 2 BP 152 EP 155 DI 10.1370/afm.1366 PG 4 WC Primary Health Care; Medicine, General & Internal SC General & Internal Medicine GA 915AX UT WOS:000301996400009 PM 22412007 ER PT J AU Simons, K Connolly, RP Bonifas, R Allen, PD Bailey, K Downes, D Galambos, C AF Simons, Kelsey Connolly, Robert P. Bonifas, Robin Allen, Priscilla D. Bailey, Kathleen Downes, Deirdre Galambos, Colleen TI Psychosocial Assessment of Nursing Home Residents via MDS 3.0: Recommendations for Social Service Training, Staffing, and Roles in Interdisciplinary Care SO JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION LA English DT Article DE Psychosocial assessment; social work; MDS 3.0; nursing home quality ID HEALTH-CARE; DEPRESSION; DIRECTORS; SYMPTOMS; DEMENTIA; DELIRIUM; WORK; MANAGEMENT; SCALE; TEAMS AB The Minimum Data Set 3.0 has introduced a higher set of expectations for assessment of residents' psychosocial needs, including new interviewing requirements, new measures of depression and resident choice, and new discharge screening procedures. Social service staff are primary providers of psychosocial assessment and care in nursing homes; yet, research demonstrates that many do not possess the minimum qualifications, as specified in federal regulations, to effectively provide these services given the clinical complexity of this client population. Likewise, social service caseloads generally exceed manageable levels. This article addresses the need for enhanced training and support of social service and interdisciplinary staff in long term care facilities in light of the new Minimum Data Set 3.0 assessment procedures as well as new survey and certification guidelines emphasizing quality of life. A set of recommendations will be made with regard to training, appropriate role functions within the context of interdisciplinary care, and needs for more realistic staffing ratios. Copyright (C) 2012 - American Medical Directors Association, Inc. C1 [Simons, Kelsey] Univ Toronto, Factor Inwentash Fac Social Work, Kunin Lunenfeld Appl & Evaluat Res Unit, Baycrest, Toronto, ON M6A 2E1, Canada. [Bonifas, Robin] Arizona State Univ, Sch Social Work, Phoenix, AZ USA. [Allen, Priscilla D.] Louisiana State Univ, Sch Social Work, LSU Life Course & Aging Ctr, Baton Rouge, LA 70803 USA. [Bailey, Kathleen] Bridgewater State Univ, Sch Social Work, Bridgewater, MA USA. [Downes, Deirdre] Jewish Home Lifecare, New York, NY USA. [Galambos, Colleen] Univ Missouri, Sch Social Work, Columbia, MO USA. [Connolly, Robert P.] Ctr Medicare & Med Serv, Ellicott City, MD USA. RP Simons, K (reprint author), Univ Toronto, Factor Inwentash Fac Social Work, Kunin Lunenfeld Appl & Evaluat Res Unit, Baycrest, 3560 Bathurst St, Toronto, ON M6A 2E1, Canada. EM ksimons@klaru-baycrest.on.ca NR 43 TC 1 Z9 1 U1 1 U2 11 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1525-8610 EI 1538-9375 J9 J AM MED DIR ASSOC JI J. Am. Med. Dir. Assoc. PD FEB PY 2012 VL 13 IS 2 DI 10.1016/j.jamda.2011.07.005 PG 7 WC Geriatrics & Gerontology SC Geriatrics & Gerontology GA 898HX UT WOS:000300733600028 ER PT J AU Agrawal, S Budetti, P AF Agrawal, Shantanu Budetti, Peter TI Physician Medical Identity Theft SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 Ctr Program Integr, Ctr Medicare Serv, Baltimore, MD USA. Ctr Program Integr, Ctr Medicaid Serv, Baltimore, MD USA. RP Agrawal, S (reprint author), CMS Ctr Program Integr, 7500 Secur Blvd,Mail Stop AR-18-50, Baltimore, MD 21244 USA. EM shantanu.agrawal1@cms.hhs.gov NR 8 TC 4 Z9 4 U1 0 U2 5 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD FEB 1 PY 2012 VL 307 IS 5 BP 459 EP 460 DI 10.1001/jama.2012.78 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 884SH UT WOS:000299728000023 PM 22298674 ER PT J AU Drye, EE Normand, SLT Wang, Y Ross, JS Schreiner, GC Han, L Rapp, M Krumholz, HM AF Drye, Elizabeth E. Normand, Sharon-Lise T. Wang, Yun Ross, Joseph S. Schreiner, Geoffrey C. Han, Lein Rapp, Michael Krumholz, Harlan M. TI Comparison of Hospital Risk-Standardized Mortality Rates Calculated by Using In-Hospital and 30-Day Models: An Observational Study With Implications for Hospital Profiling SO ANNALS OF INTERNAL MEDICINE LA English DT Article ID HEART-FAILURE; PERFORMANCE; OUTCOMES; LENGTH; TRENDS; STAY AB Background: In-hospital mortality measures, which are widely used to assess hospital quality, are not based on a standardized follow-up period and may systematically favor hospitals with shorter lengths of stay (LOSs). Objective: To assess the agreement between performance measures of U.S. hospitals by using risk-standardized in-hospital and 30-day mortality rates. Design: Observational study. Setting: Nonfederal acute care hospitals in the United States with at least 30 admissions for acute myocardial infarction (AMI), heart failure (HF), and pneumonia from 2004 to 2006. Patients: Medicare fee-for-service patients admitted for AMI, HF, or pneumonia from 2004 to 2006. Measurements: The primary outcomes were in-hospital and 30-day risk-standardized mortality rates (RSMRs). Results: Included patients comprised 718 508 admissions to 3135 hospitals for AMI, 1 315 845 admissions to 4209 hospitals for HF, and 1 415 237 admissions to 4498 hospitals for pneumonia. The hospital-level mean patient LOS varied across hospitals for each condition, ranging from 2.3 to 13.7 days for AMI, 3.5 to 11.9 days for HF, and 3.8 to 14.8 days for pneumonia. The mean RSMR differences (30-day RSMR minus in-hospital RSMR) were 5.3% (SD, 1.3) for AMI, 6.0% (SD, 1.3) for HF, and 5.7% (SD, 1.4) for pneumonia; distributions varied widely across hospitals. Performance classifications differed between the in-hospital and 30-day models for 257 hospitals (8.2%) for AMI, 456 (10.8%) for HF, and 662 (14.7%) for pneumonia. Hospital mean LOS was positively correlated with in-hospital RSMRs for all 3 conditions. Limitation: Medicare claims data were used for risk adjustment. Conclusion: In-hospital mortality measures provide a different assessment of hospital performance than 30-day mortality and are biased in favor of hospitals with shorter LOSs. C1 [Drye, Elizabeth E.] Yale Univ, Sch Med, Ctr Outcomes Res & Evaluat, Yale New Haven Hosp, New Haven, CT 06510 USA. Harvard Univ, Sch Med, Boston, MA USA. Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. Dartmouth Med Sch, Hanover, NH 03755 USA. Ctr Medicare Serv, Baltimore, MD USA. Ctr Medicaid Serv, Baltimore, MD USA. George Washington Univ, Sch Med & Hlth Sci, Washington, DC 20052 USA. RP Drye, EE (reprint author), Yale Univ, Sch Med, Ctr Outcomes Res & Evaluat, Yale New Haven Hosp, 1 Church St,Suite 200, New Haven, CT 06510 USA. EM Elizabeth.Drye@yale.edu FU CMS [HHSM-500-2008-0025I, T0001]; National Heart, Lung, and Blood Institute [U01-HL105270-02] FX By the CMS (contract HHSM-500-2008-0025I, task order T0001) and the National Heart, Lung, and Blood Institute (award U01-HL105270-02). NR 23 TC 69 Z9 70 U1 1 U2 11 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD JAN 3 PY 2012 VL 156 IS 1 BP 19 EP U66 DI 10.7326/0003-4819-156-1-201201030-00004 PN 1 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 872VK UT WOS:000298837600003 PM 22213491 ER PT J AU Andrawis, MA Rehm, SJ AF Andrawis, Mary A. Rehm, Susan J. TI Health-system pharmacists' role in improving immunization rates SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Editorial Material ID INFLUENZA VACCINATION; CARE WORKERS; PROGRAM; DISEASE C1 [Andrawis, Mary A.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. [Andrawis, Mary A.] Amer Soc Hlth Syst Pharmacists, Bethesda, MD USA. [Rehm, Susan J.] Cleveland Clin, Dept Infect Dis, Cleveland, OH 44106 USA. [Rehm, Susan J.] Natl Fdn Infect Dis, Pneumococcal Dis Advisory Board, Bethesda, MD USA. RP Andrawis, MA (reprint author), Ctr Medicare & Medicaid Serv, 7500 Secur Blvd,Mail Stop S3-13-05, Baltimore, MD 21244 USA. EM mary.andrawis@gmail.com NR 24 TC 2 Z9 2 U1 2 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 JAN 1 PY 2012 VL 69 IS 1 BP 74 EP 76 DI 10.2146/ajhp110257 PG 3 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 943LJ UT WOS:000304123200014 PM 22180557 ER PT J AU Martin, AB Lassman, D Washington, B Catlin, A AF Martin, Anne B. Lassman, David Washington, Benjamin Catlin, Aaron CA Natl Hlth Expenditure Accounts TI Growth In US Health Spending Remained Slow In 2010; Health Share Of Gross Domestic Product Was Unchanged From 2009 SO HEALTH AFFAIRS LA English DT Article AB Medical goods and services are generally viewed as necessities. Even so, the latest recession had a dramatic effect on their utilization. US health spending grew more slowly in 2009 and 2010-at rates of 3.8 percent and 3.9 percent, respectively-than in any other years during the fifty-one-year history of the National Health Expenditure Accounts. In 2010 extraordinarily slow growth in the use and intensity of services led to slower growth in spending for personal health care. The rates of growth in overall US gross domestic product (GDP) and in health spending began to converge in 2010. As a result, the health spending share of GDP stabilized at 17.9 percent. C1 [Martin, Anne B.] Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD USA. RP Martin, AB (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD USA. EM anne.martin@cms.hhs.gov NR 21 TC 96 Z9 97 U1 1 U2 9 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 PY 2012 VL 31 IS 1 BP 208 EP 219 DI 10.1377/hlthaff.2011.1135 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 879DD UT WOS:000299309000026 PM 22232112 ER PT J AU VanLare, JM Moody-Williams, J Conway, PH AF VanLare, Jordan M. Moody-Williams, Jean Conway, Patrick H. TI Value-Based Purchasing For Hospitals SO HEALTH AFFAIRS LA English DT Letter C1 [VanLare, Jordan M.; Moody-Williams, Jean; Conway, Patrick H.] Ctr Medicare & Medicaid Serv, Woodlawn, MD USA. RP VanLare, JM (reprint author), Ctr Medicare & Medicaid Serv, Woodlawn, MD USA. NR 0 TC 2 Z9 2 U1 0 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 JAN PY 2012 VL 31 IS 1 BP 249 EP 249 DI 10.1377/hlthaff.2011.1317 PG 1 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 879DD UT WOS:000299309000035 PM 22232116 ER PT J AU Chen, J Ross, JS Carlson, MDA Lin, ZQ Normand, SLT Bernheim, SM Drye, EE Ling, SM Han, LF Rapp, MT Krumholz, HM AF Chen, Jersey Ross, Joseph S. Carlson, Melissa D. A. Lin, Zhenqiu Normand, Sharon-Lise T. Bernheim, Susannah M. Drye, Elizabeth E. Ling, Shari M. Han, Lein F. Rapp, Michael T. Krumholz, Harlan M. TI Skilled Nursing Facility Referral and Hospital Readmission Rates after Heart Failure or Myocardial Infarction SO AMERICAN JOURNAL OF MEDICINE LA English DT Article DE Acute myocardial infarction; Health services research; Heart failure; Hospitals; Readmission; Skilled nursing facilities ID 30-DAY MORTALITY-RATES; POST-ACUTE CARE; MEDICARE BENEFICIARIES; OUTCOMES; DISCHARGE AB BACKGROUND: Substantial hospital-level variation in the risk of readmission after hospitalization for heart failure (HF) or acute myocardial infarction (AMI) has been reported. Prior studies have documented considerable state-level variation in rates of discharge to skilled nursing facilities (SNFs), but evaluation of hospital-level variation in SNF rates and its relationship to hospital-level readmission rates is limited. METHODS: Hospital-level 30-day all-cause risk-standardized readmission rates (RSRRs) were calculated using claims data for fee-for-service Medicare patients hospitalized with a principal diagnosis of HF or AMI from 2006-2008. Medicare claims were used to calculate rates of discharge to SNF following HF-specific or AMI-specific admissions in hospitals with >= 25 HF or AMI patients, respectively. Weighted regression was used to quantify the relationship between RSRRs and SNF rates for each condition. RESULTS: Mean RSRR following HF admission among 4101 hospitals was 24.7%, and mean RSRR after AMI admission among 2453 hospitals was 19.9%. Hospital-level SNF rates ranged from 0% to 83.8% for HF and from 0% to 77.8% for AMI. No significant relationship between RSRR after HF and SNF rate was found in adjusted regression models (P = .15). RSRR after AMI increased by 0.03 percentage point for each 1 absolute percentage point increase in SNF rate in adjusted regression models (P = .001). Overall, HF and AMI SNF rates explained <1% and 4% of the variation for their respective RSRRs. CONCLUSION: SNF rates after HF or AMI hospitalization vary considerably across hospitals, but explain little of the variation in 30-day all-cause readmission rates for these conditions. (C) 2012 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2012) 125, 100.e1-100.e9 C1 [Chen, Jersey; Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, New Haven, CT 06520 USA. [Ross, Joseph S.; Bernheim, Susannah M.] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06520 USA. [Carlson, Melissa D. A.] Mt Sinai Sch Med, Brookdale Dept Geriatr & Palliat Med, New York, NY USA. [Lin, Zhenqiu; Bernheim, Susannah M.; Drye, Elizabeth E.; Krumholz, Harlan M.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Ling, Shari M.; Han, Lein F.; Rapp, Michael T.] Ctr Medicare Serv, Baltimore, MD USA. [Ling, Shari M.; Han, Lein F.; Rapp, Michael T.] Ctr Medicaid Serv, Baltimore, MD USA. [Krumholz, Harlan M.] Robert Wood Johnson Clin Scholars Program, Dept Med, New Haven, CT USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Sect Hlth Policy & Adm, Sch Publ Hlth, New Haven, CT USA. RP Chen, J (reprint author), Yale Univ, Sch Med, Dept Med, Sect Cardiovasc Med, 333 Cedar St, New Haven, CT 06520 USA. EM jersey.chen@yale.edu FU Agency for Healthcare Research and Quality [1K08HS018781-01]; National Institute on Aging [K08 AG032886]; American Federation of Aging Research; National Heart Lung Blood Institute Cardiovascular Outcomes Center [1U01HL105270-01]; CMS, Department of Health and Human Services; [HHSM-500-2008-0025I (0001)] FX Dr Chen is supported by an Agency for Healthcare Research and Quality Career Development Award (1K08HS018781-01). Dr Ross is supported by the National Institute on Aging (K08 AG032886) and by the American Federation of Aging Research through the Paul B. Beeson Career Development Award. Dr Krumholz is supported by a National Heart Lung Blood Institute Cardiovascular Outcomes Center Award (1U01HL105270-01). The analyses on which this publication is based were performed under Contract No. HHSM-500-2008-0025I (0001), entitled "Measure and Instrument Development and Support (MIDS)-Development and Re-evaluation of the CMS [Centers for Medicare & Medicaid Services] Hospital Outcomes and Efficiency Measures," and HHSM-500-2008-00020I (0001), entitled "Production and Implementation of Hospital Outcome and Efficiency Measures" funded by the CMS, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services. The authors assume full responsibility for the accuracy and completeness of the ideas presented. NR 15 TC 10 Z9 11 U1 0 U2 8 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 JAN PY 2012 VL 125 IS 1 AR 100.e1 DI 10.1016/j.amjmed.2011.06.011 PG 9 WC Medicine, General & Internal SC General & Internal Medicine GA 866IF UT WOS:000298373300027 PM 22195535 ER PT J AU Menis, M Anderson, SA Izurieta, HS Kumar, S Burwen, DR Gibbs, J Kropp, G Erten, T MaCurdy, TE Worrall, CM Kelman, JA Walderhaug, MO AF Menis, Mikhail Anderson, Steven A. Izurieta, Hector S. Kumar, Sanjai Burwen, Dale R. Gibbs, Jonathan Kropp, Garner Erten, Tugce MaCurdy, Thomas E. Worrall, Christopher M. Kelman, Jeffrey A. Walderhaug, Mark O. TI Babesiosis among Elderly Medicare Beneficiaries, United States, 2006-2008 SO EMERGING INFECTIOUS DISEASES LA English DT Article ID TRANSFUSION AB We used administrative databases to assess babesiosis among elderly persons in the United States by year, sex, age, race, state of residence, and diagnosis months during 2006 2008. The highest babesiosis rates were in Connecticut, Rhode Island, New York, and Massachusetts, and findings suggested babesiosis expansion to other states. C1 [Menis, Mikhail] US FDA, Analyt Epidemiol Branch, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res,Div Epidemiol, Rockville, MD 20852 USA. [Gibbs, Jonathan; Kropp, Garner; Erten, Tugce; MaCurdy, Thomas E.] Acumen LLC, Burlingame, CA USA. [Worrall, Christopher M.; Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Menis, M (reprint author), US FDA, Analyt Epidemiol Branch, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res,Div Epidemiol, 1401 Rockville Pike,HFM-225, Rockville, MD 20852 USA. EM mikhail.menis@fda.hhs.gov FU Food and Drug Administration FX The research was supported through internal Food and Drug Administration funds. NR 15 TC 8 Z9 8 U1 0 U2 2 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1080-6040 J9 EMERG INFECT DIS JI Emerg. Infect. Dis PD JAN PY 2012 VL 18 IS 1 BP 128 EP 131 DI 10.3201/eid1801.110305 PG 4 WC Immunology; Infectious Diseases SC Immunology; Infectious Diseases GA 874QK UT WOS:000298973000024 PM 22257500 ER PT J AU Clauser, S Haffer, C Ambs, A Hays, R Malinoff, R Giordano, L AF Clauser, Steven Haffer, Chris Ambs, Anita Hays, Ron Malinoff, Rochelle Giordano, Laura TI Using the SEER-MHOS Database to Evaluate the HRQOL of Medicare Advantage Beneficiaries with and without Cancer SO QUALITY OF LIFE RESEARCH LA English DT Meeting Abstract C1 [Clauser, Steven; Ambs, Anita] NCI, Bethesda, MD 20892 USA. [Haffer, Chris] Ctr Medicare Serv, Baltimore, MD USA. [Haffer, Chris] Ctr Medicaid Serv, Baltimore, MD USA. [Hays, Ron] Univ Calif Los Angeles, Los Angeles, CA USA. [Malinoff, Rochelle; Giordano, Laura] Hlth Serv Advisory Grp, Phoenix, AZ USA. NR 0 TC 0 Z9 0 U1 1 U2 1 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 0962-9343 EI 1573-2649 J9 QUAL LIFE RES JI Qual. Life Res. PD JAN PY 2012 VL 20 SU 1 MA 386 BP 37 EP 37 PG 1 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA V38QV UT WOS:000209358800081 ER PT J AU Franzini, L Mikhail, OI Zezza, M Chan, I Shen, S Smith, JD AF Franzini, Luisa Mikhail, Osama I. Zezza, Mark Chan, Iris Shen, Sophie Smith, Jonathan D. TI Comparing Variation in Medicare and Private Insurance Spending in Texas SO AMERICAN JOURNAL OF MANAGED CARE LA English DT Article AB Objectives: A great deal of research has documented the wide variation in Medicare spending across different geographic regions in the United States. However, little research has been done on spending variation in the commercial sector. The objectives of this paper are (1) to compare variations in spending and inpatient utilization in the Blue Cross Blue Shield of Texas (BCBSTX) population and the Medicare population across 32 Texas regions and (2) to investigate if the pattern of widely varying Medicare spending but similar BCBSTX spending found in a previous analysis of El Paso and Hidalgo/McAllen exists across the state. Study Design: Retrospective study using 2008 BCBSTX and Medicare data. We used total spending per member/enrollee per month and inpatient admissions per 1000 members/enrollees. Methods: After adjusting BCBSTX and Medicare spending for price and adjusting BCBSTX spending and utilization for age and gender, we computed coefficients of variation, standard deviations from the Texas means, and kernel density estimates for standard deviations from the mean to compare variation in BCBSTX and Medicare spending and inpatient utilization. Results: Results indicated that variations across Texas in total spending and inpatient utilization are similar in BCBSTX and Medicare both in level and in direction, as the correlations between Medicare and commercial spending and inpatient utilization are positive after excluding the Hidalgo/McAllen regions. Conclusions: Over the state of Texas, regions of high Medicare spending also tend to be regions of high private insurance spending. McAllen appears to be an outlier for Medicare spending, but not for BCBSTX spending. (Am J Manag Care. 2011; 17(12): e488-e495) C1 [Franzini, Luisa] Univ Texas Sch Publ Hlth, Div Management Policy & Community Hlth, Houston, TX 77030 USA. [Zezza, Mark] Commonwealth Fund, New York, NY USA. [Chan, Iris; Shen, Sophie] Brookings Inst, Engelberg Ctr Hlth Care Reform, Washington, DC 20036 USA. [Smith, Jonathan D.] Ctr Medicare Serv, Baltimore, MD USA. [Smith, Jonathan D.] Ctr Medicaid Serv, Baltimore, MD USA. RP Franzini, L (reprint author), Univ Texas Sch Publ Hlth, Div Management Policy & Community Hlth, 1200 Pressler Dr, Houston, TX 77030 USA. EM Luisa.Franzini@uth.tmc.edu RI Shen, Sophie/D-8948-2011 NR 11 TC 5 Z9 5 U1 1 U2 2 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 DEC PY 2011 VL 17 IS 12 BP E488 EP E495 PG 8 WC Health Care Sciences & Services; Health Policy & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 868TN UT WOS:000298548700005 PM 22216873 ER PT J AU Landon, BE Reschovsky, JD O'Malley, AJ Pham, HH Hadley, J AF Landon, Bruce E. Reschovsky, James D. O'Malley, A. James Pham, Hoangmai H. Hadley, Jack TI The Relationship between Physician Compensation Strategies and the Intensity of Care Delivered to Medicare Beneficiaries SO HEALTH SERVICES RESEARCH LA English DT Article DE Physician payment; financial incentives; Medicare; costs of care ID FINANCIAL INCENTIVES; ORGANIZATIONS; CALIFORNIA; SERVICES; COST; RISK AB Objective. To examine the relationship between primary care physicians' (PCPs) payment arrangements and the total costs and intensity of care for specific episodes of care for Medicare beneficiaries. Data Sources/Study Setting. We combined data from the 2004 to 2005 Community Tracking Study Physician Survey on PCP compensation methods with administrative data from the Medicare program for beneficiaries to whom these physicians provided services over the time period 2004-2006. Study Design. Cross-sectional analysis of physician survey data linked to Medicare claims. Principal Findings. The 2,211 PCP respondents included 937 internists and 1,274 family or general physicians who were linked to more than 250,000 Medicare enrollees. Most physicians (62 percent) had been in practice for 11 or more years and 87 percent were board certified. The total spending models show that for both employed physicians and owners, those in highly capitated practice environments had the lowest risk adjusted spending per beneficiary, whereas those receiving just productivity payments had the highest spending. These physicians also had lower intensity of care for episodes of care. Conclusions. Physicians in highly capitated practices had the lowest total costs and intensity of care, suggesting that these physicians develop an overall approach to care that also applies to their FFS patients. C1 [Landon, Bruce E.] Harvard Univ, Sch Med, Div Gen Med, Boston, MA 02115 USA. [Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Boston, MA 02215 USA. [Reschovsky, James D.] Ctr Studying Hlth Syst Change, Washington, DC USA. [Landon, Bruce E.; O'Malley, A. James] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Pham, Hoangmai H.] Ctr Medicare, Baltimore, MD USA. [Pham, Hoangmai H.] Ctr Medicaid Serv, Baltimore, MD USA. [Hadley, Jack] George Mason Univ, Coll Hlth & Human Serv, Fairfax, VA 22030 USA. RP Landon, BE (reprint author), Harvard Univ, Sch Med, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA. EM landon@hcp.med.harvard.edu FU National Institutes of Aging [1R01AG027312] FX Joint Acknowledgment/Disclosure Statement: This work was supported by a grant from the National Institutes of Aging (1R01AG027312). We are indebted to Wilma Stahura for assistance with manuscript preparation, Rick McKellar for research assistance, Cynthia Saiontz-Martinez for expert statistical programming, and to Edward Bassin for input related to the use of Episode Treatment Groups software. NR 19 TC 9 Z9 9 U1 1 U2 6 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0017-9124 J9 HEALTH SERV RES JI Health Serv. Res. PD DEC PY 2011 VL 46 IS 6 BP 1863 EP 1882 DI 10.1111/j.1475-6773.2011.01294.x PN 1 PG 20 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 851BT UT WOS:000297244000010 PM 21790586 ER PT J AU Jain, SH AF Jain, Sachin H. TI Negotiating Authorship SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, Washington, DC 20201 USA. RP Jain, SH (reprint author), Ctr Medicare & Medicaid Serv, 200 Independence Ave,SW,Suite 351G-06, Washington, DC 20201 USA. EM shjain@post.harvard.edu NR 0 TC 1 Z9 1 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 DEC PY 2011 VL 26 IS 12 BP 1513 EP 1514 DI 10.1007/s11606-011-1754-1 PG 2 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 849ST UT WOS:000297146100021 PM 21656059 ER PT J AU O'Malley, AJ Cotterill, P Schermerhorn, ML Landon, BE AF O'Malley, A. James Cotterill, Philip Schermerhorn, Marc L. Landon, Bruce E. TI Improving Observational Study Estimates of Treatment Effects Using Joint Modeling of Selection Effects and Outcomes The Case of AAA Repair SO MEDICAL CARE LA English DT Article DE abdominal aortic aneurysm; bivariate probit; endovascular and open surgery; selection; volume-outcome relationship ID ABDOMINAL AORTIC-ANEURYSM; MORTALITY; VOLUME; POPULATION; TRIAL; CARE AB Background: When 2 treatment approaches are available, there are likely to be unmeasured confounders that influence choice of procedure, which complicates estimation of the causal effect of treatment on outcomes using observational data. Objective: To estimate the effect of endovascular (endo) versus open surgical (open) repair, including possible modification by institutional volume, on survival after treatment for abdominal aortic aneurysm, accounting for observed and unobserved confounding variables. Research Design: Observational study of data from the Medicare program using a joint model of treatment selection and survival given treatment to estimate the effects of type of surgery and institutional volume on survival. Patients: We studied 61,414 eligible repairs of intact abdominal aortic aneurysms during 2001 to 2004. Measures: The outcome, perioperative death, is defined as in-hospital death or death within 30 days of operation. The key predictors are use of endo, transformed endo and open volume, and endo-volume interactions. Results: There is strong evidence of nonrandom selection of treatment with potential confounding variables including institutional volume and procedure date, variables not typically adjusted for in clinical trials. The best fitting model included heterogeneous transformations of endo volume for endo cases and open volume for open cases as predictors. Consistent with our hypothesis, accounting for unmeasured selection reduced the mortality benefit of endo. Conclusions: The effect of endo versus open surgery varies nonlinearly with endo and open volume. Accounting for institutional experience and unmeasured selection enables better decision-making by physicians making treatment referrals, investigators evaluating treatments, and policy makers. C1 [O'Malley, A. James; Landon, Bruce E.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Cotterill, Philip] Off Res Dev & Informat, Ctr Medicare Serv, Baltimore, MD USA. [Cotterill, Philip] Off Res Dev & Informat, Ctr Medicaid Serv, Baltimore, MD USA. [Schermerhorn, Marc L.] Beth Israel Deaconess Med Ctr, Dept Surg, Boston, MA 02215 USA. [Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA. RP O'Malley, AJ (reprint author), Harvard Univ, Sch Med, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA. EM omalley@hcp.med.harvard.edu FU NIH [1RC4MH092717-01, 1R01-HL105453] FX This study was supported by NIH Grants 1RC4MH092717-01 and 1R01-HL105453 for comparative effectiveness research. NR 18 TC 3 Z9 3 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 DEC PY 2011 VL 49 IS 12 BP 1126 EP 1132 DI 10.1097/MLR.0b013e3182363d64 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 850TN UT WOS:000297222500013 PM 22011709 ER PT J AU Herrin, J Miller, LE Turkmani, DF Nsa, W Drye, EE Bernheim, SM Ling, SM Rapp, MT Han, LF Bratzler, DW Bradley, EH Nallamothu, BK Ting, HH Krumholz, HM AF Herrin, Jeph Miller, Lauren E. Turkmani, Dima F. Nsa, Wato Drye, Elizabeth E. Bernheim, Susannah M. Ling, Shari M. Rapp, Michael T. Han, Lein F. Bratzler, Dale W. Bradley, Elizabeth H. Nallamothu, Brahmajee K. Ting, Henry H. Krumholz, Harlan M. TI National Performance on Door-In to Door-Out Time Among Patients Transferred for Primary Percutaneous Coronary Intervention SO ARCHIVES OF INTERNAL MEDICINE LA English DT Article ID ELEVATION-MYOCARDIAL-INFARCTION; TO-BALLOON TIME; ST-ELEVATION; REGIONALIZATION PROGRAM; REPERFUSION THERAPY; UNITED-STATES; TIMELINESS; STRATEGIES; IMPROVE; SYSTEM AB Background: Delays in treatment time are commonplace for patients with ST-segment elevation acute myocardial infarction who must be transferred to another hospital for percutaneous coronary intervention. Experts have recommended that door-in todoor-out (DIDO) time (ie, time from arrival at the first hospital to transfer from that hospital to the percutaneous coronary intervention hospital) should not exceed 30 minutes. We sought to describe national performance in DIDO time using a new measure developed by the Centers for Medicare&Medicaid Services. Methods: We report national median DIDO time and examine associations with patient characteristics (age, sex, race, contraindication to fibrinolytic therapy, and arrival time) and hospital characteristics (number of beds, geographic region, location [rural or urban], and number of cases reported) using a mixed effects multivariable model. Results: Among 13 776 included patients from 1034 hospitals, only 1343 (9.7%) had a DIDO time within 30 minutes, and DIDO exceeded 90 minutes for 4267 patients (31.0%). Mean estimated times (95% CI) to transfer based on multivariable analysis were 8.9 (5.6-12.2) minutes longer for women, 9.1 (2.7-16.0) minutes longer for African Americans, 6.9 (1.6-11.9) minutes longer for patients with contraindication to fibrinolytic therapy, shorter for all age categories (except >75 years) relative to the category of 18 to 35 years, 15.3 (7.3-23.5) minutes longer for rural hospitals, and 14.4 (6.6-21.3) minutes longer for hospitals with 9 or fewer transfers vs 15 or more in 2009 (all P < .001). Conclusion: Among patients presenting to emergency departments and requiring transfer to another facility for percutaneous coronary intervention, the DIDO time rarely met the recommended 30 minutes. C1 [Herrin, Jeph; Drye, Elizabeth E.; Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Herrin, Jeph] Hlth Res & Educ Trust, Chicago, IL USA. [Miller, Lauren E.; Turkmani, Dima F.; Nsa, Wato; Bratzler, Dale W.] Oklahoma Fdn Med Qual, Oklahoma City, OK USA. [Turkmani, Dima F.] Taybah Healthcare Consulting, Dallas, TX USA. [Drye, Elizabeth E.; Bernheim, Susannah M.; Krumholz, Harlan M.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Ling, Shari M.; Rapp, Michael T.; Han, Lein F.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Rapp, Michael T.] George Washington Univ, Sch Med & Hlth Sci, Sect Emergency Med, Washington, DC 20052 USA. [Bratzler, Dale W.] Univ Oklahoma, Hlth Sci Ctr, Coll Publ Hlth, Oklahoma City, OK USA. [Bradley, Elizabeth H.; Krumholz, Harlan M.] Yale Univ, Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06510 USA. [Bradley, Elizabeth H.; Krumholz, Harlan M.] Yale Univ, Robert Wood Johnson Clin Scholars Program, Dept Internal Med, Sch Med, New Haven, CT 06510 USA. [Nallamothu, Brahmajee K.] Univ Michigan, Sch Med, Vet Affairs Ann Arbor Hlth Serv Res & Dev Ctr Exc, Ann Arbor, MI USA. [Nallamothu, Brahmajee K.] Univ Michigan, Sch Med, Div Cardiovasc Med, Ann Arbor, MI USA. [Nallamothu, Brahmajee K.] Univ Michigan, Sch Med, Ctr Healthcare Outcomes & Policy, Ann Arbor, MI USA. [Ting, Henry H.] Mayo Clin, Div Cardiovasc Dis, Knowledge & Encounter Res Unit, Rochester, MN USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, 1 Church St,Ste 200, New Haven, CT 06510 USA. EM harlan.krumholz@yale.edu FU Medtronic, Inc, through Yale University; federal government [HHSM-500-2008-00025I]; Center for Cardiovascular Outcomes Research at Yale University, National Heart, Lung, and Blood Institute [U01 HL105270-02] FX Dr Krumholz reports that he chairs a Cardiac Scientific Advisory Board for UnitedHealthcare and that he is the recipient of a research grant from Medtronic, Inc, through Yale University.; This work was conducted under a federal government contract with the CMS (HHSM-500-2008-00025I, Task Order T0001). This work was supported by grant U01 HL105270-02 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute (Dr Krumholz). NR 34 TC 24 Z9 24 U1 0 U2 1 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 NOV 28 PY 2011 VL 171 IS 21 BP 1879 EP 1886 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 853JV UT WOS:000297423000001 PM 22123793 ER PT J AU Conway, PH Berwick, DM AF Conway, Patrick H. Berwick, Donald M. TI Improving the Rules for Hospital Participation in Medicare and Medicaid SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Conway, Patrick H.; Berwick, Donald M.] Ctr Medicare Serv, Baltimore, MD 21244 USA. [Conway, Patrick H.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA. [Conway, Patrick H.; Berwick, Donald M.] Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Conway, PH (reprint author), Ctr Medicare Serv, Mailstop S3-02-01,7500 Secur Blvd, Baltimore, MD 21244 USA. EM Patrick.Conway@cms.hhs.gov NR 2 TC 2 Z9 2 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD NOV 23 PY 2011 VL 306 IS 20 BP 2256 EP 2257 DI 10.1001/jama.2011.1611 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 851GD UT WOS:000297255500025 PM 22008181 ER PT J AU Berwick, DM AF Berwick, Donald M. TI Making Good on ACOs' Promise - The Final Rule for the Medicare Shared Savings Program SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Berwick, Donald M.] Ctr Medicare Serv, Baltimore, MD USA. [Berwick, Donald M.] Ctr Medicaid Serv, Baltimore, MD USA. RP Berwick, DM (reprint author), Ctr Medicare Serv, Baltimore, MD USA. NR 0 TC 85 Z9 85 U1 0 U2 4 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 NOV 10 PY 2011 VL 365 IS 19 BP 1753 EP 1756 DI 10.1056/NEJMp1111671 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 844QQ UT WOS:000296762800001 PM 22013899 ER PT J AU Bonner, A AF Bonner, A. TI IMPROVING THE SAFETY OF RESIDENTS IN LONG-TERM CARE SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Bonner, A.] Ctr Medicare, Long Term Care Serv, Baltimore, MD USA. [Bonner, A.] Ctr Medicaid, Long Term Care 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 J9 GERONTOLOGIST JI Gerontologist PD NOV PY 2011 VL 51 SU 2 BP 111 EP 111 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 936PH UT WOS:000303602000502 ER PT J AU Kane, RA Kane, R Lee, PJ Clayton, K AF Kane, R. A. Kane, R. Lee, P. J. Clayton, K. TI QAPI FOR NURSING FACILITIES: A POSITIVE APPROACH TO QUALITY SO GERONTOLOGIST LA English DT Meeting Abstract C1 [Kane, R. A.; Kane, R.; Lee, P. J.] Univ Minnesota, Sch Publ Hlth, Minneapolis, MN USA. [Clayton, K.] Ctr Medicare & Medicaid Serv, Nursing Home Div, Survey & Certificat Grp, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 4 U2 10 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 NOV PY 2011 VL 51 SU 2 BP 119 EP 119 PG 1 WC Gerontology SC Geriatrics & Gerontology GA 936PH UT WOS:000303602000545 ER PT J AU Frieden, TR Berwick, DM AF Frieden, Thomas R. Berwick, Donald M. TI The "Million Hearts" Initiative - Preventing Heart Attacks and Strokes SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material ID DEATHS; US C1 [Frieden, Thomas R.] Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. [Berwick, Donald M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Frieden, TR (reprint author), Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. NR 5 TC 131 Z9 134 U1 0 U2 11 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 SEP 29 PY 2011 VL 365 IS 13 AR UNSP e27 DI 10.1056/NEJMP1110421 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 825YO UT WOS:000295318400004 PM 21913835 ER PT J AU Gutierrez, N AF Gutierrez, Nilsa TI Understanding Health Care Disparities in the US Territories SO ARCHIVES OF INTERNAL MEDICINE LA English DT Editorial Material C1 Ctr Medicare& Medicaid Serv, Dept Hlth & Human Serv, New York, NY 10278 USA. RP Gutierrez, N (reprint author), Ctr Medicare& Medicaid Serv, Dept Hlth & Human Serv, 26 Fed Plaza,Room 3811, New York, NY 10278 USA. EM Nilsa.Gutierrez@cms.hhs.gov NR 3 TC 0 Z9 0 U1 0 U2 0 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 26 PY 2011 VL 171 IS 17 BP 1579 EP 1581 PG 3 WC Medicine, General & Internal SC General & Internal Medicine GA 824RY UT WOS:000295221000014 PM 21709183 ER PT J AU Shrank, WH Choudhry, NK Swanton, K Jain, S Greene, JA Harlam, B Patel, KP AF Shrank, William H. Choudhry, Niteesh K. Swanton, Kellie Jain, Sachin Greene, Jeremy A. Harlam, Bari Patel, Kavita P. TI Variations in Structure and Content of Online Social Networks for Patients With Diabetes SO ARCHIVES OF INTERNAL MEDICINE LA English DT Letter ID QUALITY C1 [Shrank, William H.; Choudhry, Niteesh K.; Greene, Jeremy A.] Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon, Dept Med, Boston, MA 02120 USA. [Shrank, William H.; Choudhry, Niteesh K.; Greene, Jeremy A.] Harvard Univ, Sch Med, Boston, MA USA. [Shrank, William H.; Swanton, Kellie] Harvard Univ, Ctr Amer Polit Studies, Cambridge, MA 02138 USA. [Greene, Jeremy A.] Harvard Univ, Dept Hist Sci, Cambridge, MA 02138 USA. [Jain, Sachin] Ctr Medicare & Medicaid Innovat, Ctr Medicare & Medicaid Serv, Dept Hlth & Human Serv, Baltimore, MD USA. [Harlam, Bari] CVS Caremark Corp, Woonsocket, RI USA. [Patel, Kavita P.] Brookings Inst, Engelberg Ctr Improving Value Hlth Care, Washington, DC 20036 USA. RP Shrank, WH (reprint author), Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon, Dept Med, 1620 Tremont St,Ste 3030, Boston, MA 02120 USA. EM wshrank@partners.org FU NHLBI NIH HHS [K23HL090505-01] NR 9 TC 13 Z9 13 U1 0 U2 8 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 26 PY 2011 VL 171 IS 17 BP 1589 EP 1591 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 824RY UT WOS:000295221000019 PM 21949173 ER PT J AU Schenck, AP Klabunde, CN Warren, JL Jackson, E Peacock, S Lapin, P AF Schenck, Anna P. Klabunde, Carrie N. Warren, Joan L. Jackson, Eric Peacock, Sharon Lapin, Pauline TI Physician Visits and Colorectal Cancer Testing Among Medicare Enrollees in North Carolina and South Carolina, 2005 SO PREVENTING CHRONIC DISEASE LA English DT Article ID IOWA FAMILY PHYSICIANS; GEOGRAPHIC-VARIATION; PREVENTIVE SERVICES; CARE; DELIVERY; RECOMMENDATION; BENEFICIARIES; MAMMOGRAPHY; POPULATION; PATTERNS AB Introduction Many Medicare enrollees do not receive colorectal cancer tests at recommended intervals despite having Medicare screening coverage. Little is known about the physician visits of Medicare enrollees who are untested. Our study objective was to evaluate physician visits of enrollees who lack appropriate testing to identify opportunities to increase colorectal cancer testing. Methods We used North Carolina and South Carolina Medicare data to compare type and frequency of physician visits for Medicare enrollees with and without a colorectal cancer test in 2005. Type of physician visit was defined by the physician specialty as primary care, mixed specialty (more than 1 specialty, 1 of which was primary care), and nonprimary care. We used multivariate modeling to assess the influence of type and frequency of physician visits on colorectal cancer testing. Results Approximately half (46.5%) of enrollees lacked appropriate colorectal cancer testing. Among the untested group, 19.8% had no physician visits in 2005. Enrollees with primary care visits were more likely to be tested than those without a primary care visit. Many enrollees who had primary care visits remained untested. Enrollees with visits to all physician types had a greater likelihood of having colorectal cancer testing. Conclusions We identified 3 categories of Medicare enrollees without appropriate colorectal cancer testing: those with no visits, those who see primary care physicians only, and those with multiple visits to physicians with primary and nonprimary care specialties. Different strategies are needed for each category to increase colorectal cancer testing in the Medicare population. C1 [Schenck, Anna P.; Jackson, Eric; Peacock, Sharon] Carolinas Ctr Med Excellence, Cary, NC USA. [Klabunde, Carrie N.; Warren, Joan L.] NCI, Bethesda, MD 20892 USA. [Lapin, Pauline] Ctr Medicare Serv, Baltimore, MD USA. [Lapin, Pauline] Ctr Medicaid Serv, Baltimore, MD USA. RP Schenck, AP (reprint author), Univ N Carolina, Gillings Sch Global Publ Hlth, Campus Box 7469, Chapel Hill, NC 27599 USA. EM anna.schenck@unc.edu FU Centers for Medicare and Medicaid Services, Department of Health and Human Services [500-05-NC03]; National Cancer Institute [Y1-PC-8108-01] FX The analyses on which this publication is based were performed under contract no. 500-05-NC03, sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services, and the National Cancer Institute under interagency agreement no. Y1-PC-8108-01. This article is a result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. NR 34 TC 0 Z9 0 U1 0 U2 0 PU CENTERS DISEASE CONTROL PI ATLANTA PA 1600 CLIFTON RD, ATLANTA, GA 30333 USA SN 1545-1151 J9 PREV CHRONIC DIS JI Prev. Chronic Dis. PD SEP PY 2011 VL 8 IS 5 AR A112 PG 12 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 896JS UT WOS:000300562300022 PM 21843415 ER PT J AU Shaya, FT Gbarayor, CM Laird, A Winston, R Saunders, E AF Shaya, Fadia T. Gbarayor, Confidence M. Laird, Aurelia Winston, Reed Saunders, Elijah TI DIABETES KNOWLEDGE IN A HIGH RISK URBAN POPULATION SO ETHNICITY & DISEASE LA English DT Article DE Diabetes; Interventions; Diabetes Knowledge ID SELF-MANAGEMENT AB This study explored the impact of an intensive educational intervention to patients on their knowledge and understanding of diabetes. This study was a hypothesis-testing, prospective study, with an experimental two-by-two factorial design. The educational programs were offered to physicians only, patients only, or both patients and their physicians. In the fourth arm, neither patients nor their physicians received any education. Patients with uncontrolled diabetes were enrolled in the study. The outcome was the changes in the score of patients on the diabetes knowledge test. The knowledge test was administered at the Lime of enrollment and every six months thereafter. The study showed that a total of 622 (75%) patients took the diabetes knowledge test. The mean diabetes knowledge test score increased over time for both insulin and non-insulin users. The mean diabetes knowledge score in patients with patient education only was 11 points higher compared to those in the group of patients and their physicians without education (P=.0104). The study indicated that patients who are exposed to the educational program end up with better knowledge on all counts, than patients who just go through the health care system in the course of usual care for diabetes. (Ethn Dis. 2011;21(4):485-489) C1 [Shaya, Fadia T.] Univ Maryland, Sch Pharm, Ctr Drugs & Publ Policy, Baltimore, MD 21201 USA. [Gbarayor, Confidence M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Laird, Aurelia; Winston, Reed] Bon Secours Baltimore Hlth Syst, Baltimore, MD USA. [Saunders, Elijah] Univ Maryland, Sch Med, Baltimore, MD 21201 USA. RP Shaya, FT (reprint author), Univ Maryland, Sch Pharm, Ctr Drugs & Publ Policy, 515 W Lombard St,2nd Floor, Baltimore, MD 21201 USA. EM fshaya@rx.umaryland.edu FU [U01 HL79151] FX This study was conducted within the scope of the Baltimore Cardiovascular Partnership, grant #U01 HL79151. NR 10 TC 2 Z9 2 U1 0 U2 3 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 FAL PY 2011 VL 21 IS 4 BP 485 EP 489 PG 5 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 867FH UT WOS:000298439800015 PM 22428355 ER PT J AU Menis, M Izurieta, H Anderson, SA Holness, L Gibbs, JM Kropp, G Worrall, CM MaCurdy, T Kelman, JA Ball, R AF Menis, M. Izurieta, H. Anderson, S. A. Holness, L. Gibbs, J. M. Kropp, G. Worrall, C. M. MaCurdy, T. Kelman, J. A. Ball, R. TI TRALI Occurrence Trends Among the Inpatient US Elderly, as Recorded by Diagnosis Code in 2007-2010 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting and CTTXPO CY OCT 22-25, 2011 CL San Diego, CA SP AABB C1 [Menis, M.; Izurieta, H.; Anderson, S. A.; Holness, L.; Ball, R.] US FDA, CBER, Rockville, MD 20857 USA. [Gibbs, J. M.; Kropp, G.; MaCurdy, T.] Acumen LLC, Burlingame, CA USA. [Worrall, C. M.; Kelman, J. A.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. EM Mikhail.Menis@fda.hhs.gov 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 0041-1132 J9 TRANSFUSION JI Transfusion PD SEP PY 2011 VL 51 SU 3 SI SI BP 126A EP 127A PG 2 WC Hematology SC Hematology GA 822YC UT WOS:000295085500317 ER PT J AU Mast, DA Vaughan, W Busque, S Veale, JL Roberts, JP Straube, BM Flores, N Canari, C Levy, E Tietjen, A Hil, G Melcher, ML AF Mast, D. A. Vaughan, W. Busque, S. Veale, J. L. Roberts, J. P. Straube, B. M. Flores, N. Canari, C. Levy, E. Tietjen, A. Hil, G. Melcher, M. L. TI Managing Finances of Shipping Living Donor Kidneys for Donor Exchanges SO AMERICAN JOURNAL OF TRANSPLANTATION LA English DT Editorial Material DE CMS; financial analysis; live donor transplantation; paired donation; paired exchanges; standard acquisition charge; UNOS ID PAIRED DONATION; CHAIN; TRANSPLANTATION AB Kidney donor exchanges enable recipients with immunologically incompatible donors to receive compatible living donor grafts; however, the financial management of these exchanges, especially when an organ is shipped, is complex and thus has the potential to impede the broader implementation of donor exchange programs. Representatives from transplant centers that utilize the National Kidney Registry database to facilitate donor exchange transplants developed a financial model applicable to paired donor exchanges and donor chain transplants. The first tenet of the model is to eliminate financial liability to the donor. Thereafter, it accounts for the donor evaluation, donor nephrectomy hospital costs, donor nephrectomy physician fees, organ transport, donor complications and recipient inpatient services. Billing between hospitals is based on Medicare cost report defined costs rather than charges. We believe that this model complies with current federal regulations and effectively captures costs of the donor and recipient services. It could be considered as a financial paradigm for the United Network for Organ Sharing managed donor exchange program. C1 [Busque, S.; Melcher, M. L.] Stanford, Dept Surg, Stanford, CA 94305 USA. [Mast, D. A.] Stanford Univ, Med Ctr, Stanford, CA 94305 USA. [Veale, J. L.] Univ Calif Los Angeles, Dept Urol, Los Angeles, CA USA. [Vaughan, W.] Hlth Syst Concepts Inc, Longwood, FL USA. [Roberts, J. P.; Canari, C.; Levy, E.] UCSF, Dept Surg, San Francisco, CA USA. [Straube, B. M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Flores, N.] UCLA Med Ctr, Los Angeles, CA USA. [Tietjen, A.] St Barnabas Hosp, Livingston, NJ USA. [Hil, G.] Natl Kidney Registry, Babylon, NY USA. RP Melcher, ML (reprint author), Stanford, Dept Surg, Stanford, CA 94305 USA. EM melcherm@stanford.edu OI Melcher, Marc/0000-0002-7185-4383 NR 9 TC 9 Z9 9 U1 0 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1600-6135 EI 1600-6143 J9 AM J TRANSPLANT JI Am. J. Transplant. PD SEP PY 2011 VL 11 IS 9 BP 1810 EP 1814 DI 10.1111/j.1600-6143.2011.03690.x PG 5 WC Surgery; Transplantation SC Surgery; Transplantation GA 813IP UT WOS:000294360400009 PM 21831153 ER PT J AU Sachs, T Schermerhorn, M Pomposelli, F Cotterill, P O'Malley, J Landon, B AF Sachs, Teviah Schermerhorn, Marc Pomposelli, Frank Cotterill, Philip O'Malley, James Landon, Bruce TI Resident and fellow experiences after the introduction of endovascular aneurysm repair for abdominal aortic aneurysm SO JOURNAL OF VASCULAR SURGERY LA English DT Article; Proceedings Paper CT 37th Annual Meeting of the New-England-Society-for-Vascular-Surgery CY SEP 23-26, 2010 CL Rockport, ME SP New England Soc Vasc Surg ID RANDOMIZED CONTROLLED-TRIAL; MORTALITY; OUTCOMES; POPULATION; VOLUME AB Objectives: This study assessed trends in open and endovascular repair (EVAR) of intact and ruptured abdominal aortic aneurysm (AAA) in the Medicare population and evaluated recent trends in AAA repair at vascular fellowship training programs. Methods: We identified all Medicare beneficiaries with a diagnosis of AAA who underwent repair or had a primary diagnosis of rupture (1995-2008). Cohorts were compared by type of repair (open vs EVAR) and presentation (intact vs ruptured AAA). Demographics of age, sex, and race were evaluated. We used unique hospital identifier codes to compare trends and 30-day mortality between hospitals that participate in vascular surgery fellowship training and those that do not. American Council on Graduate Medical Education data, only available for the years 1999 to 2008, were further used to better understand the changes in number of EVAR and open repairs of AAA performed each year for vascular fellows and general surgery residents, over time. Results: We identified 449,122 patients (76% men), with 376,355 intact AAAs (84%) and 72,767 ruptured AAAs (16%). Mean age was 75.1 years. Use of EVAR for intact AAA rose to from 35% in 2001 to 63% in 2005 and comprised 78% of repairs by 2008. During the same period, the number of ruptured AAAs decreased by 40% overall, with nonoperative ruptured AAAs decreasing by 29% and EVAR increasing to 31% of rupture repairs. Hospitals training vascular fellows were quicker to adopt EVAR (2-year lag time) for intact AAA and had higher rates of EVAR for ruptured AAA (41.1% vs 29.2%; P = .001) than did hospitals without fellows. Mortality rates for open repairs of intact (4.0% vs 5.0%; P = .01) and ruptured AAA (34.1% vs 41.0%; P = .031) were lower at fellowship hospitals. The average number of open AAA repairs performed by vascular fellows dropped 50% (44.1 to 21.6/year) from 1999 to 2008. Conclusions: Contrary to the expectation of a plateau, use of EVAR for intact AAA continues to rise at fellowship and nonfellowship hospitals. Use of EVAR for rupture is being used more often at fellowship programs. The decline in open repairs performed by vascular fellows, and at fellowship and non-fellowship hospitals, may have important implications for future attending experience. (J Vasc Surg 2011;54:881-8.) C1 [Sachs, Teviah; Schermerhorn, Marc; Pomposelli, Frank] Beth Israel Deaconess Med Ctr, Div Vasc & Endovasc Surg, Boston, MA 02215 USA. [Cotterill, Philip] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [O'Malley, James; Landon, Bruce] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. RP Schermerhorn, M (reprint author), 110 Francis St,5th Fl, Boston, MA 02215 USA. EM mscherm@bidmc.harvard.edu FU NHLBI NIH HHS [R01 HL105453] NR 21 TC 40 Z9 40 U1 0 U2 0 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD SEP PY 2011 VL 54 IS 3 BP 881 EP 888 DI 10.1016/j.jvs.2011.03.008 PG 8 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA 815DC UT WOS:000294505300043 PM 21620615 ER PT J AU Carrier, ER Schneider, E Pham, HH Bach, PB AF Carrier, Emily R. Schneider, Eric Pham, Hoangmai H. Bach, Peter B. TI Association Between Quality of Care and the Sociodemographic Composition of Physicians' Patient Panels: A Repeat Cross-Sectional Analysis SO JOURNAL OF GENERAL INTERNAL MEDICINE LA English DT Article DE quality; disparities; payment incentives ID MEDICARE MANAGED CARE; PAY-FOR-PERFORMANCE; RACIAL DISPARITIES; HEALTH DISPARITIES; ACCURACY; CODES; WILL AB BACKGROUND: Pay-for-performance programs could worsen health disparities if providers who care for disadvantaged patients face systematic barriers to providing high-quality care. Risk adjustment that includes sociodemographic factors could mitigate the financial incentive to avoid disadvantaged patients. OBJECTIVE: To test for associations between quality of care and the composition of a physician's patient panel. DESIGN: Repeat cross-sectional analysis PARTICIPANTS: Nationally representative sample of US primary care physicians responding to a panel telephone survey in 2000-2001 and 2004-2005 MAIN MEASURES: Quality of primary care as measured by provision of eight recommended preventive services (diabetic monitoring [hemoglobin A1c testing, eye examinations, cholesterol testing and urine protein analysis], cancer screening [screening colonoscopy/sigmoidoscopy and mammography], and vaccinations against influenza and pneumococcus) documented in Medicare claims data and the association between quality and the sociodemographic composition of physicians' patient panels. KEY RESULTS: Across eight quality measures, physicians' quality of care was not consistently associated with the composition of their patient panel either in a single year or between time periods. For example, a substantial number (seven) of the eighteen significant associations seen between sociodemographic characteristics and the delivery of preventive services in the first time period were no longer seen in the second time period. Among sociodemographic characteristics, panel Medicaid eligibility was most consistently associated with differences in the delivery of preventive services between time points; among preventive services, the delivery of influenza vaccine was most likely to demonstrate disparities in both time points. CONCLUSIONS: In a Medicare pay-for-performance program, a better understanding of the effect of effect of patient panel composition on physicians' quality of care may be necessary before implementing routine statistical adjustment, since the association of quality and sociodemographic composition is small and inconsistent. In addition, we observed improvements between time periods among physicians with varying panel composition. C1 [Carrier, Emily R.] Ctr Studying Hlth Syst Change, Washington, DC 20024 USA. [Schneider, Eric] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Gen Med & Primary Care, Boston, MA 02115 USA. [Schneider, Eric] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA. [Pham, Hoangmai H.] Ctr Medicare Serv, Baltimore, MD USA. [Bach, Peter B.] Mem Sloan Kettering Canc Ctr, Ctr Hlth Policy & Outcomes, New York, NY 10021 USA. [Pham, Hoangmai H.] Ctr Medicaid Serv, Baltimore, MD USA. RP Carrier, ER (reprint author), Ctr Studying Hlth Syst Change, 600 Maryland Ave SW,Suite 550, Washington, DC 20024 USA. EM ecarrier@hschange.org OI Schneider, Eric/0000-0002-1132-5084 FU National Institutes of Health; Robert Wood Johnson Foundation FX This study was funded by the National Institutes of Health and the Robert Wood Johnson Foundation. NR 23 TC 5 Z9 5 U1 3 U2 5 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 SEP PY 2011 VL 26 IS 9 BP 987 EP 994 DI 10.1007/s11606-011-1740-7 PG 8 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 808WW UT WOS:000294013700011 PM 21557031 ER PT J AU Krumholz, HM Herrin, J Miller, LE Drye, EE Ling, SM Han, LF Rapp, MT Bradley, EH Nallamothu, BK Nsa, W Bratzler, DW Curtis, JP AF Krumholz, Harlan M. Herrin, Jeph Miller, Lauren E. Drye, Elizabeth E. Ling, Shari M. Han, Lein F. Rapp, Michael T. Bradley, Elizabeth H. Nallamothu, Brahmajee K. Nsa, Wato Bratzler, Dale W. Curtis, Jeptha P. TI Improvements in Door-to-Balloon Time in the United States, 2005 to 2010 SO CIRCULATION LA English DT Article DE balloon dilation; myocardial infarction; angioplasty; reperfusion ID ELEVATION MYOCARDIAL-INFARCTION; PERCUTANEOUS CORONARY INTERVENTION; ASSOCIATION TASK-FORCE; ST-ELEVATION; NATIONAL-REGISTRY; AMERICAN-COLLEGE; REPERFUSION; QUALITY; PERFORMANCE; STRATEGIES AB Background-Registry studies have suggested improvements in door-to-balloon times, but a national assessment of the trends in door-to-balloon times is lacking. Moreover, we do not know whether improvements in door-to-balloon times were shared equally among patient and hospital groups. Methods and Results-This analysis includes all patients reported by hospitals to the Centers for Medicare & Medicaid Services for inclusion in the time to percutaneous coronary intervention (acute myocardial infarction-8) inpatient measure from January 1, 2005, through September 30, 2010. For each calendar year, we summarized the characteristics of patients reported for the measure, including the number and percentage in each group, the median time to primary percutaneous coronary intervention, and the percentage with time to primary percutaneous coronary intervention within 75 minutes and within 90 minutes. Door-to-balloon time declined from a median of 96 minutes in the year ending December 31, 2005, to a median of 64 minutes in the 3 quarters ending September 30, 2010. There were corresponding increases in the percentage of patients who had times < 90 minutes (44.2% to 91.4%) and < 75 minutes (27.3% to 70.4%). The declines in median times were greatest among groups that had the highest median times during the first period: patients > 75 years of age (median decline, 38 minutes), women (35 minutes), and blacks (42 minutes). Conclusion-National progress has been achieved in the timeliness of treatment of patients with ST-segment-elevation myocardial infarction who undergo primary percutaneous coronary intervention. (Circulation. 2011; 124: 1038-1045.) C1 [Krumholz, Harlan M.; Herrin, Jeph; Drye, Elizabeth E.; Curtis, Jeptha P.] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Bradley, Elizabeth H.] Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, Dept Internal Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Drye, Elizabeth E.; Curtis, Jeptha P.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Krumholz, Harlan M.; Bradley, Elizabeth H.] Yale Univ, Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT 06510 USA. [Herrin, Jeph] Hlth Res & Educ Trust, Chicago, IL USA. [Miller, Lauren E.; Nsa, Wato] Oklahoma Fdn Med Qual, Oklahoma City, OK USA. [Bratzler, Dale W.] Univ Oklahoma, Hlth Sci Ctr, Coll Publ Hlth, Oklahoma City, OK USA. [Ling, Shari M.; Han, Lein F.; Rapp, Michael T.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Rapp, Michael T.] George Washington Univ, Sch Med & Hlth Sci, Sect Emergency Med, Washington, DC 20052 USA. [Nallamothu, Brahmajee K.] Univ Michigan, Sch Med, Vet Affairs Ann Arbor Hlth Serv Res & Dev Ctr Exc, Ann Arbor, MI USA. [Nallamothu, Brahmajee K.] Univ Michigan, Sch Med, Div Cardiovasc Med, Ann Arbor, MI USA. [Nallamothu, Brahmajee K.] Univ Michigan, Sch Med, Ctr Healthcare Outcomes & Policy, Ann Arbor, MI USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Sect Cardiovasc Med, 1 Church St,Ste 200, New Haven, CT 06510 USA. EM harlan.krumholz@yale.edu FU Centers for Medicare & Medicaid Services (CMS) [HHSM-500-2008-00025I]; federal government; National Heart, Lung, and Blood Institute [U01 HL105270] FX This work was conducted under a federal government contract with the Centers for Medicare & Medicaid Services (CMS), contract HHSM-500-2008-00025I, task order T0001. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. CMS staff fully participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and critical review of the manuscript. CMS staff reviewed and approved the use of CMS data for this work and approved submission of the manuscript. Drs Krumholz and Curtis are supported by grant U01 HL105270 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. NR 29 TC 123 Z9 125 U1 0 U2 4 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 0009-7322 J9 CIRCULATION JI Circulation PD AUG 30 PY 2011 VL 124 IS 9 BP 1038 EP U112 DI 10.1161/CIRCULATIONAHA.111.044107 PG 10 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 813BF UT WOS:000294340400014 PM 21859971 ER PT J AU Krulewitch, CJ Ritchey, MBE Cheng, H Marinac-Dabic, D Gross, T Gibbs, J Worrall, C Kelman, JA AF Krulewitch, Cara J. Ritchey, Mary Beth E. Cheng, Hong Marinac-Dabic, Danica Gross, Tom Gibbs, Jonathan Worrall, Christopher Kelman, Jeffery A. TI Medical Device Safety Surveillance: The Safety of Urogynecologic Surgical Mesh for Repair of Pelvic Organ Prolapse SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Krulewitch, Cara J.; Ritchey, Mary Beth E.; Cheng, Hong; Marinac-Dabic, Danica; Gross, Tom] US FDA, Ctr Devices & Radiologial Hlth, Silver Spring, MD USA. [Gibbs, Jonathan] Acumen LLC, Burlingame, CA USA. [Worrall, Christopher; Kelman, Jeffery A.] 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 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2011 VL 20 SU 1 MA 318 BP S138 EP S138 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 821AG UT WOS:000294946600307 ER PT J AU Racoosin, JA Mosholder, AE Young, S Wernecke, M MaCurdy, T Worrall, C Kelman, J AF Racoosin, Judith A. Mosholder, Andrew E. Young, Stephanie Wernecke, Michael MaCurdy, Thomas Worrall, Chris Kelman, Jeffrey TI Hemorrhage Following Concurrent Use of Warfarin and Oseltamivir by Medicare Beneficiaries SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Racoosin, Judith A.; Mosholder, Andrew E.] US FDA, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Young, Stephanie; Wernecke, Michael; MaCurdy, Thomas] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas] Stanford Univ, Stanford, CA 94305 USA. [Worrall, Chris; Kelman, Jeffrey] Ctr Medicare Serv, Baltimore, MD USA. [Worrall, Chris; Kelman, Jeffrey] 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 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2011 VL 20 SU 1 MA 339 BP S147 EP S148 PG 2 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 821AG UT WOS:000294946600327 ER PT J AU Zornberg, GL Hsu, L Dong, D Wernecke, M Kim, C Southworth, MR Houstoun, M MaCurdy, T Reichman, M Tracy, L Cunningham, F Coster, TS Moreschi, G Chen, A Karkowsky, AM Worrall, C Kelman, J AF Zornberg, Gwen L. Hsu, Lucy Dong, Diane Wernecke, Michael Kim, Clara Southworth, Mary Ross Houstoun, Monika MaCurdy, Thomas Reichman, Marsha Tracy, LaRee Cunningham, Francesca Coster, Trinka S. Moreschi, Gail Chen, Amy Karkowsky, Abraham M. Worrall, Chris Kelman, Jeffrey TI Dronedarone or Amiodarone and Risk of Heart Failure (HF): A Federal Partners Collaboration (FPC) SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Zornberg, Gwen L.; Kim, Clara; Southworth, Mary Ross; Houstoun, Monika; Reichman, Marsha; Tracy, LaRee; Moreschi, Gail; Chen, Amy; Karkowsky, Abraham M.] US FDA, Dept Hlth & Human Serv, Silver Spring, MD USA. [Hsu, Lucy; Coster, Trinka S.] USA, Ctr Hlth Promot, Dept Def, Silver Spring, MD USA. [Dong, Diane; Cunningham, Francesca] Dept Vet Affairs, Ctr Medicat Safety, Hines, IL USA. [Wernecke, Michael; MaCurdy, Thomas] Acumen, Burlingame, CA USA. [MaCurdy, Thomas] Stanford Univ, Stanford, CA 94305 USA. [Worrall, Chris; Kelman, Jeffrey] Dept Hlth & Human Serv, Ctr Medicare & Medicaid Serv, Washington, DC USA. NR 0 TC 1 Z9 1 U1 0 U2 1 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2011 VL 20 SU 1 MA 59 BP S26 EP S26 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 821AG UT WOS:000294946600059 ER PT J AU Buck, JA AF Buck, Jeffrey A. TI The Looming Expansion And Transformation Of Public Substance Abuse Treatment Under The Affordable Care Act SO HEALTH AFFAIRS LA English DT Article ID ADDICTION TREATMENT; UNITED-STATES; INFECTION; ALCOHOL; HEALTH AB Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and stand-alone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered. C1 Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Buck, JA (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. EM jeffrey.buck@cms.hhs.gov NR 34 TC 145 Z9 145 U1 1 U2 9 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 AUG PY 2011 VL 30 IS 8 BP 1402 EP 1410 DI 10.1377/hlthaff.2011.0480 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 803BW UT WOS:000293556100003 PM 21821557 ER PT J AU Keehan, SP Sisko, AM Truffer, CJ Poisal, JA Cuckler, GA Madison, AJ Lizonitz, JM Smith, SD AF Keehan, Sean P. Sisko, Andrea M. Truffer, Christopher J. Poisal, John A. Cuckler, Gigi A. Madison, Andrew J. Lizonitz, Joseph M. Smith, Sheila D. TI National Health Spending Projections Through 2020: Economic Recovery And Reform Drive Faster Spending Growth SO HEALTH AFFAIRS LA English DT Article AB In 2010, US health spending is estimated to have grown at a historic low of 3.9 percent, due in part to the effects of the recently ended recession. In 2014, national health spending growth is expected to reach 8.3 percent when major coverage expansions from the Affordable Care Act of 2010 begin. The expanded Medicaid and private insurance coverage are expected to increase demand for health care significantly, particularly for prescription drugs and physician and clinical services. Robust growth in Medicare enrollment, expanded Medicaid coverage, and premium and cost-sharing subsidies for exchange plans are projected to increase the federal government share of health spending from 27 percent in 2009 to 31 percent by 2020. This article provides perspective on how the nation's health care dollar will be spent over the coming decade as the health sector moves quickly toward its new paradigm of expanded insurance coverage. C1 [Keehan, Sean P.; Poisal, John A.] Ctr Medicare Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD 21244 USA. [Poisal, John A.] Ctr Medicaid Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD USA. RP Keehan, SP (reprint author), Ctr Medicare Serv, Off Actuary, Natl Hlth Stat Grp, Baltimore, MD 21244 USA. EM dnhs@cms.hhs.gov NR 19 TC 71 Z9 71 U1 2 U2 10 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 AUG PY 2011 VL 30 IS 8 BP 1594 EP 1605 DI 10.1377/hlthaff.2011.0662 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 803BW UT WOS:000293556100026 PM 21798885 ER PT J AU Sorace, J Wong, HH Worrall, C Kelman, J Saneinejad, S MaCurdy, T AF Sorace, James Wong, Hui-Hsing Worrall, Chris Kelman, Jeffrey Saneinejad, Shahin MaCurdy, Thomas TI The Complexity of Disease Combinations in the Medicare Population SO POPULATION HEALTH MANAGEMENT LA English DT Article ID HEALTH-CARE AB Developing systems of care that address the mortality, morbidity, and expenditures associated with Medicare beneficiaries with multiple diseases would benefit from a greater understanding of the complexity of disease combinations (DCs) found in the Medicare population. To develop estimates of the number of DCs, we performed an observational analysis on 32,220,634 beneficiaries in the Medicare Fee-for-Service claims database based on a set of records containing each beneficiary's Part A and B International Classification of Diseases, 9(th) Revision, Clinical Modification (ICD-9-CM) claims data for the year of 2008. We made 2 simplifying adjustments. First, we mapped the individual ICD-9-CM codes to the Centers for Medicare and Medicaid Services-Hierarchical Conditions Categories (HCC) model that was developed in 2004 to risk adjust capitation payments to private health care plans based on the health expenditure risk of their enrollees. Second, we aggregated beneficiaries with identical HCCs regardless of the temporal order of these findings within the 2008 claims year; thus the DC to which they are assigned represents the summation of their 2008 claims data. We defined 3 distinct populations at the HCC level. The first consisted of 35% of the beneficiaries who did not fall into any HCC category and accounted for 6% of expenditures. The second was represented by the 100 next most prevalent DCs that accounted for 33% of the beneficiaries and 15% of expenditures. The final population, accounting for 32% of the beneficiaries and 79% of expenses, was complex and consisted of over 2 million DCs. Our results indicate that the majority of expenditures are associated with a complex set of beneficiaries. (Population Health Management 2011; 14: 161-166) C1 [Sorace, James; Wong, Hui-Hsing] Off Sci & Data Policy, Washington, DC 20201 USA. [Worrall, Chris] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Kelman, Jeffrey] Ctr Drug & Hlth Plan Choice, Ctr Medicare & Medicaid Serv, Washington, DC USA. [Saneinejad, Shahin; MaCurdy, Thomas] Acumen LLC, Burlingame, CA USA. [MaCurdy, Thomas] Stanford Univ, Stanford, CA 94305 USA. RP Sorace, J (reprint author), Off Sci & Data Policy, Hubert Humphrey Bldg,Room 434E,200 Independence A, Washington, DC 20201 USA. EM james.sorace@hhs.gov FU Department of Health and Human Services [HHSM-500-2006-00006I]; Acumen LLC [HHSM-500-2006-00006I] FX This work was supported by contract HHSM-500-2006-00006I between the Department of Health and Human Services and Acumen LLC. NR 11 TC 12 Z9 12 U1 0 U2 5 PU MARY ANN LIEBERT INC PI NEW ROCHELLE PA 140 HUGUENOT STREET, 3RD FL, NEW ROCHELLE, NY 10801 USA SN 1942-7891 J9 POPUL HEALTH MANAG JI Popul. Health Manag. PD AUG PY 2011 VL 14 IS 4 BP 161 EP 166 DI 10.1089/pop.2010.0044 PG 6 WC Health Care Sciences & Services SC Health Care Sciences & Services GA 806QO UT WOS:000293825200002 PM 21241184 ER PT J AU Jain, SH Maxson, E AF Jain, Sachin H. Maxson, Emily TI More About Online Forums for Students and Faculty Reply SO ACADEMIC MEDICINE LA English DT Letter C1 [Jain, Sachin H.] Harvard Univ, Ctr Medicare & Medicaid Serv, Sch Med, Boston, MA 02115 USA. [Jain, Sachin H.; Maxson, Emily] Harvard Univ, Brigham & Womens Hosp, Sch Med, Boston, MA 02115 USA. RP Jain, SH (reprint author), Harvard Univ, Brigham & Womens Hosp, Sch Med, Boston, MA 02115 USA. EM shjain@post.harvard.edu RI liu, jing/D-9482-2012 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 1040-2446 J9 ACAD MED JI Acad. Med. PD AUG PY 2011 VL 86 IS 8 BP 921 EP 921 DI 10.1097/ACM.0b013e318222dbc5 PG 1 WC Education, Scientific Disciplines; Health Care Sciences & Services SC Education & Educational Research; Health Care Sciences & Services GA 798NK UT WOS:000293215200004 ER PT J AU Frankenfield, DL Howell, BL Wei, II Anderson, KK AF Frankenfield, Diane L. Howell, Benjamin L. Wei, Iris I. Anderson, Karyn K. TI Cost-related nonadherence to prescribed medication therapy among Medicare Part D beneficiaries with end-stage renal disease SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article DE Compliance; Costs; Data collection; Dialysis; Economics; Health-benefit programs; Kidney failure; Patients; Race; Sociology ID PERITONEAL-DIALYSIS PATIENTS; SELF-REPORT; HEALTH-CARE; CHRONICALLY ILL; UNITED-STATES; DRUG-BENEFIT; PRESCRIPTION NONCOMPLIANCE; TRANSPLANT RECIPIENTS; HEMODIALYSIS-PATIENTS; HOSPITAL QUALITY AB Purpose. Medication nonadherence due to cost issues among community-dwelling patients with end-stage renal disease (ESRD) enrolled in Medicare prescription drug plans was evaluated. Methods. Demographic and health status data were collected on 1329 patients with ESRD enrolled in Medicare Part D prescription drug plans who responded to a Centers for Medicare and Medicaid Services consumer survey in early 2007. The survey data were assessed for self-reported cost-related nonadherence (CRN), defined as delaying or not filling a prescription due to cost concerns. Multivariate logistic regression analysis was performed to evaluate CRN risk relative to patient demographic characteristics, socioeconomic status, other chronic conditions, health behaviors, and access to health care services. Results. Overall, survey respondents with ESRD were significantly more likely than those without ESRD to report CRN in the prior six months (unadjusted odds ratio [On 2.34; 95% confidence interval [CI], 2.00-2.75). After controlling for potential confounding factors such as other chronic conditions, the data analysis continued to show a significant association between ESRD and an increased risk of CRN (adjusted OR, 1.23; 95% CI, 1.07-1.41). Black race and receipt of Medicare Part D Low-Income Subsidy assistance were significant independent predictors of CRN for respondents with ESRD. Conclusion. In early 2007, 31% of survey respondents with ESRD enrolled in Medicare Part D drug plans reported CRN in the preceding six months. After adjusting for potential confounders, respondents with ESRD remained 23% more likely than respondents without ESRD to report CRN in the preceding six months. C1 [Frankenfield, Diane L.] Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Innovat Ctr, Baltimore, MD 21244 USA. RP Frankenfield, DL (reprint author), Ctr Medicare & Medicaid Serv, Ctr Medicare & Medicaid Innovat, Innovat Ctr, Mailstop C3-21-28, Baltimore, MD 21244 USA. EM diane.frankenfield@cms.hhs.gov NR 98 TC 12 Z9 12 U1 3 U2 10 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 JUL 15 PY 2011 VL 68 IS 14 BP 1339 EP 1348 DI 10.2146/ajhp100400 PG 10 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 858CN UT WOS:000297773600016 PM 21719594 ER PT J AU Blackwell, SA Baugh, DK Ciborowski, GM Montgomery, MA AF Blackwell, Steven A. Baugh, David K. Ciborowski, Gary M. Montgomery, Melissa A. TI National Study of Prescription Poisoning with Psychoactive and Nonpsychoactive Medications in Medicare/Medicaid Dual Enrollees Age 65 or Over SO JOURNAL OF PSYCHOACTIVE DRUGS LA English DT Article DE elderly; poisoning; safety ID OLDER-ADULTS; COMPARATIVE SAFETY; HEART-FAILURE; KNOWLEDGE AB The purpose of this study is to assess prescription medication poisoning among psychoactive and nonpsychoactive medications used by elderly (65 years or older) Medicare & Medicaid dual enrollees as well as examine contextual components associated with poisoning. Our primary research goal was to compare medication poisonings among psychoactive medications to nonpsychoactive medications. Our second research goal was to identify components influencing medication poisonings and how they interrelate. The approach used a cross-sectional retrospective review of calendar year 2003 Centers for Medicare & Medicaid Service's Medicaid Pharmacy claims data for elderly dual enrollees. Poisonings were identified based on ICD-9-CM categorizations. Poisonings associated with the psychoactive medications were proportionally over twice as high as compared to nonpsychoactive medications (14.3 per 100,000 enrollees and 6.6 per 100,000 enrollees, respectively). Additionally, the two contextual components of (a) use of many drugs and (b) familiarity with the medication have a direct, but competing impact on poisoning. The reasons behind unintentional poisoning in the elderly have been somewhat a mystery. This study is among the first to attempt to distinguish between poisoning events associated with psychoactive medications versus nonpsychoactive medications as well as assess the impact of differing contextual components on medication poisoning. C1 [Blackwell, Steven A.; Baugh, David K.; Ciborowski, Gary M.; Montgomery, Melissa A.] Ctr Medicare & Medicaid Serv CMS, Off Res Dev & Informat, Baltimore, MD USA. RP Blackwell, SA (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Mail Stop C3-21-28,7500 Secur Blvd, Baltimore, MD 21244 USA. EM sblackwell@cms.hhs.gov NR 27 TC 0 Z9 0 U1 0 U2 0 PU HAIGHT-ASHBURY PUBL PI SAN FRANCISCO PA 409 CLAYTON ST, SAN FRANCISCO, CA 94117 USA SN 0279-1072 J9 J PSYCHOACTIVE DRUGS JI J. Psychoact. Drugs PD JUL-SEP PY 2011 VL 43 IS 3 BP 229 EP 237 DI 10.1080/02791072.2011.605703 PG 9 WC Psychology, Clinical; Substance Abuse SC Psychology; Substance Abuse GA 833SL UT WOS:000295905100007 PM 22111406 ER PT J AU O'Connor, PJ Bodkin, NL Fradkin, J Glasgow, RE Greenfield, S Gregg, E Kerr, EA Pawlson, LG Selby, JV Sutherland, JE Taylor, ML Wysham, CH AF O'Connor, Patrick J. Bodkin, Noni L. Fradkin, Judith Glasgow, Russell E. Greenfield, Sheldon Gregg, Edward Kerr, Eve A. Pawlson, L. Gregory Selby, Joseph V. Sutherland, John E. Taylor, Michael L. Wysham, Carol H. TI Diabetes Performance Measures: Current Status and Future Directions SO DIABETES CARE LA English DT Article ID QUALITY-OF-CARE; GLYCEMIC CONTROL; CLINICAL-QUALITY; CARDIOTHORACIC SURGEONS; MEDICATION NONADHERENCE; UNINTENDED CONSEQUENCES; INTERMEDIATE OUTCOMES; TRANSLATING RESEARCH; SURGICAL MORTALITY; COST-EFFECTIVENESS C1 [O'Connor, Patrick J.] Hlth Partners Res Fdn, Minneapolis, MN 55440 USA. [Bodkin, Noni L.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Fradkin, Judith] NIDDK, Bethesda, MD USA. [Glasgow, Russell E.] NCI, Rockville, MD USA. [Greenfield, Sheldon] Univ Calif Irvine, Irvine, CA USA. [Gregg, Edward] Ctr Dis Control & Prevent, Atlanta, GA USA. [Kerr, Eve A.] Univ Michigan, Ann Arbor, MI 48109 USA. [Pawlson, L. Gregory] Natl Comm Qual Assurance, Washington, DC USA. [Selby, Joseph V.] Kaiser Permanente No Calif, Oakland, CA USA. [Sutherland, John E.] NE Iowa Med Educ Fdn, Waterloo, IA USA. [Taylor, Michael L.] Caterpillar Inc, Peoria, IL 61629 USA. [Wysham, Carol H.] Univ Washington, Sch Med, Spokane, WA USA. RP O'Connor, PJ (reprint author), Hlth Partners Res Fdn, Minneapolis, MN 55440 USA. EM patrick.j.oconnor@healthpartners.com RI Kerr, Eve/I-3330-2013 FU sanofi-aventis FX The consensus development conference was supported by an unrestricted grant from sanofi-aventis. The company had no input into the content of the report. No other potential conflicts of interest relevant to this article were reported. NR 93 TC 51 Z9 51 U1 3 U2 12 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 2011 VL 34 IS 7 BP 1651 EP 1659 DI 10.2337/dc11-0735 PG 9 WC Endocrinology & Metabolism SC Endocrinology & Metabolism GA 799CN UT WOS:000293261200041 PM 21709298 ER PT J AU Hartzema, AG Racoosin, JA MaCurdy, TE Gibbs, JM Kelman, JA AF Hartzema, Abraham G. Racoosin, Judith A. MaCurdy, Thomas E. Gibbs, Jonathan M. Kelman, Jeffrey A. TI Utilizing Medicare claims data for real-time drug safety evaluations: is it feasible? SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Article DE Medicare; active drug safety surveillance; real-time safety evaluation; claims adjudication; administrative claims data AB Purpose The Centers for Medicare & Medicaid Services claims comprise an administrative database of beneficiary-specific clinical information. This study evaluates the impacts of (i) claim information updates (claims adjudication) and (ii) delay in claim processing (claims delay) on real-time evaluation of health service and drug safety signals using the Medicare database. Methods Using Medicare claims data accumulated through May 2009 on health services rendered in 2006 and drugs dispensed in 2007, this study measures the frequency with which clinical information changes in the database as a result of (i) claims adjudication and (ii) claims delay. Results Over 85% of health services claims were processed within 8 weeks after the date of service, and 72% of drug claims were processed within 3 months after the dispense date. Clinical information changed for no more than 3% of unique claim groups in inpatient hospital, outpatient institutional, physician's office, and prescription drug Medicare claim settings. Conclusions Claims delay is consistent across time and is minimal. Claims adjudication does not substantially impact the content of clinical information in the Medicare claims database. Therefore, the Medicare claims database provides consistent information regarding health services and prescription drugs in a manner that is prompt enough to facilitate medical product safety evaluations in real time. Copyright (C) 2011 John Wiley & Sons, Ltd. C1 [Hartzema, Abraham G.] Univ Florida, Coll Pharm, HPNP, Dept Pharmaceut Outcomes & Policy, Gainesville, FL 32610 USA. [Racoosin, Judith A.] US FDA, Silver Spring, MD USA. [MaCurdy, Thomas E.] Stanford Univ, Stanford, CA 94305 USA. [MaCurdy, Thomas E.; Gibbs, Jonathan M.] Acumen LLC, Burlingame, CA USA. [Kelman, Jeffrey A.] Ctr Medicare & Medicaid Serv, Off Administrator, Ctr Beneficiary Choices, Washington, DC USA. RP Hartzema, AG (reprint author), Univ Florida, Coll Pharm, HPNP, Dept Pharmaceut Outcomes & Policy, Rm 3339,101 S Newell Dr,POB 100496, Gainesville, FL 32610 USA. EM Hartzema@ufl.edu FU HHS Office of the Assistant Secretary for Planning and Evaluation; Centers for Medicare & Medicaid Services (CMS); US Food and Drug Administration (FDA); Office of the Assistant Secretary for Planning and Evaluation (ASPE) FX We thank the HHS Office of the Assistant Secretary for Planning and Evaluation for their analytic and financial support of this project. With respect to financial support, the SafeRx Project is a joint initiative of the Centers for Medicare & Medicaid Services (CMS), US Food and Drug Administration (FDA), and the Office of the Assistant Secretary for Planning and Evaluation (ASPE). Acumen LLC is a contractor to CMS. NR 4 TC 12 Z9 12 U1 0 U2 1 PU WILEY-BLACKWELL PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 1053-8569 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD JUL PY 2011 VL 20 IS 7 BP 684 EP 688 DI 10.1002/pds.2143 PG 5 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 800PE UT WOS:000293374600002 PM 21847800 ER PT J AU Berwick, DM AF Berwick, Donald M. TI Preparing Nurses for Participation in and Leadership of Continual Improvement (Reprinted) SO JOURNAL OF NURSING EDUCATION LA English DT Reprint ID SAFETY EDUCATION; HEALTH-CARE; QUALITY C1 [Berwick, Donald M.] Inst Healthcare Improvement, Cambridge, MD USA. RP Berwick, DM (reprint author), US Dept HHS, Ctr Medicare & Medicaid Serv CMS, Washington, DC 20201 USA. NR 15 TC 4 Z9 4 U1 1 U2 2 PU SLACK INC PI THOROFARE PA 6900 GROVE RD, THOROFARE, NJ 08086 USA SN 0148-4834 J9 J NURS EDUC JI J. Nurs. Educ. PD JUN PY 2011 VL 50 IS 6 BP 322 EP 327 DI 10.3928/01484834-20110519-05 PG 6 WC Nursing SC Nursing GA 811YM UT WOS:000294254800005 PM 21634326 ER PT J AU McCannon, J Berwick, DM AF McCannon, Joseph Berwick, Donald M. TI A New Frontier in Patient Safety SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material ID BLOOD-STREAM INFECTIONS; CARE C1 [Berwick, Donald M.] US Dept HHS, Ctr Medicare Serv, Washington, DC 20201 USA. US Dept HHS, Ctr Medicaid Serv, Washington, DC 20201 USA. RP Berwick, DM (reprint author), US Dept HHS, Ctr Medicare Serv, 200 Independence Ave SW,Ste 314, Washington, DC 20201 USA. EM donald.berwick@cms.hhs.gov NR 8 TC 18 Z9 18 U1 0 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 1 PY 2011 VL 305 IS 21 BP 2221 EP 2222 DI 10.1001/jama.2011.742 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 770RN UT WOS:000291106300025 PM 21632485 ER PT J AU Hester, EJ McCrary, CDRMB AF Hester, Eva Jackson McCrary, C. D. R. Mercedes Benitez TI An Investigation of Health Literacy and Healthcare Communication Skills of African American Adults Across the Life Span SO JOURNAL OF MEDICAL SPEECH-LANGUAGE PATHOLOGY LA English DT Article DE health literacy; African Americans; healthcare communication AB Purpose: This study was conducted to obtain information on health literacy and healthcare communication skills of African American adults and to explore the relationship between these skills. Method: Self-reported measures were used to assess health literacy and healthcare communication skills of 101 African American adults ranging from 25 to 85 years of age. In addition, health literacy was directly assessed using the Short Test of Functional Health Literacy for Adults (STOFHLA). Participants' scores were analyzed using MANOVA and multiple regression analyses. Results: Significant differences in health literacy and healthcare communication skills emerged for age, education, and health status. However, adequate health literacy levels were identified across groups. Conversely, healthcare communication skills were found to be less than optimal across groups. Results of multiple regression indicated that healthcare communication is a predictor of health literacy skills. Conclusions: Contrary to frequent reports of low health literacy for African Americans, there is significant variation in this population and general intervention approaches may not be appropriate. However, the present findings support reports of healthcare communication difficulties in the population. Implications and suggestions for working with African American clients and families with speech and language disorders are discussed. C1 [Hester, Eva Jackson] Towson Univ, Dept Audiol Speech Language Pathol & Deaf Studies, Towson, MD 21252 USA. [McCrary, C. D. R. Mercedes Benitez] US PHS, Performance Management Div, Ctr Medicare Serv, Baltimore, MD USA. [McCrary, C. D. R. Mercedes Benitez] US PHS, Performance Management Div, Ctr Medicaid Serv, Baltimore, MD USA. RP Hester, EJ (reprint author), Towson Univ, Dept Audiol Speech Language Pathol & Deaf Studies, Towson, MD 21252 USA. EM ehester@towson.edu NR 69 TC 0 Z9 0 U1 0 U2 0 PU DELMAR CENGAGE LEARNING PI FLORENCE PA PO BOX 6904, FLORENCE, KY 41022-6904 USA SN 1065-1438 J9 J MED SPEECH-LANG PA JI J. Med. Speech-Lang. Pathol. PD JUN PY 2011 VL 19 IS 2 BP 11 EP 25 PG 15 WC Audiology & Speech-Language Pathology; Clinical Neurology SC Audiology & Speech-Language Pathology; Neurosciences & Neurology GA V34SS UT WOS:000209106600003 ER PT J AU Dowd, B Maciejewski, ML O'Connor, H Riley, G Geng, YS AF Dowd, Bryan Maciejewski, Matthew L. O'Connor, Heidi Riley, Gerald Geng, Yisong TI HEALTH PLAN ENROLLMENT AND MORTALITY IN THE MEDICARE PROGRAM SO HEALTH ECONOMICS LA English DT Article DE medicare; HMOs; mortality ID MANAGED CARE; STATISTICAL PROPERTIES; REGIONAL-VARIATIONS; BIASED SELECTION; HMOS; PERFORMANCE; OUTCOMES; QUALITY; BENEFICIARIES; ELASTICITIES AB Prior studies have found that Medicare health maintenance organization (HMO) enrollees have lower mortality (over a fixed observation period) than beneficiaries in traditional fee-for-service (FFS) Medicare. We use Medicare Current Beneficiary Survey (MCBS) data to compare 2-year predicted mortality for Medicare enrollees in the HMO and FFS sectors using a sample selection model to control for observed beneficiaries characteristics and unobserved confounders. The difference in raw, unadjusted mortality probabilities was 0.5% (HMO lower). Correcting for numerous observed confounders resulted in a difference of -0.6% (HMO higher). Further adjustment for unobserved confounders resulted in an estimated difference of 3.7 and 4.2% (HMO lower), depending on the specification of geographic-fixed effects. The latter result (4.2%) was statistically significant and consistent with prior studies that did not adjust for unobserved confounding. Our findings suggest there may be unobserved confounders associated with adverse selection in the HMO sector, which had a large effect on our mortality estimates among HMO enrollees. An important topic for further research is to identify such confounders and explore their relationship to mortality. The methods presented in this paper represent a promising approach to comparing outcomes between the HMO and FFS sectors, but further research is warranted. Copyright (C) 2010 John Wiley & Sons, Ltd. C1 [Dowd, Bryan; O'Connor, Heidi] Univ Minnesota, Sch Publ Hlth, Div Hlth Policy & Management, Minneapolis, MN 55455 USA. [Maciejewski, Matthew L.] Durham VA Med Ctr, Ctr Hlth Serv Res Primary Care, Durham, NC USA. [Maciejewski, Matthew L.] Duke Univ, Dept Med, Div Gen Internal Med, Durham, NC USA. [Riley, Gerald] Ctr Medicare, Baltimore, MD USA. [Riley, Gerald] Ctr Medicaid Serv, Baltimore, MD USA. [Geng, Yisong] ICF Macro, Atlanta, GA USA. RP Dowd, B (reprint author), Univ Minnesota, Sch Publ Hlth, Div Hlth Policy & Management, Box 729 MMC, Minneapolis, MN 55455 USA. EM dowdx001@umn.edu FU Centers for Medicare and Medicaid Services (CMS) FX The statements contained in this article are those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare and Medicaid Services. No part of this work has been submitted for publication elsewhere. The analysis uses only publicly available data. This research was funded in part by the Centers for Medicare and Medicaid Services (CMS). None of the authors have a conflict of interest in this research. NR 40 TC 4 Z9 4 U1 2 U2 10 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1057-9230 J9 HEALTH ECON JI Health Econ. PD JUN PY 2011 VL 20 IS 6 BP 645 EP 659 DI 10.1002/hec.1623 PG 15 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 748GY UT WOS:000289379500002 PM 20568081 ER PT J AU Jain, SH Rother, J AF Jain, Sachin H. Rother, John TI Are Patients Knights, Knaves, or Pawns? SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Editorial Material C1 [Jain, Sachin H.] Adm Off, Ctr Medicare, Washington, DC 20201 USA. [Jain, Sachin H.] Ctr Medicaid Serv, Washington, DC 20201 USA. [Rother, John] AARP, Washington, DC USA. RP Jain, SH (reprint author), Adm Off, Ctr Medicare, 200 Independence Ave SW,Ste 310, Washington, DC 20201 USA. EM shjain@post.harvard.edu NR 6 TC 3 Z9 3 U1 0 U2 1 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD MAY 25 PY 2011 VL 305 IS 20 BP 2112 EP 2113 DI 10.1001/jama.2011.694 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 768AC UT WOS:000290901700027 PM 21610245 ER PT J AU Clancy, CM Berwick, DM AF Clancy, Carolyn M. Berwick, Donald M. TI The Science of Safety Improvement: Learning While Doing SO ANNALS OF INTERNAL MEDICINE LA English DT Editorial Material ID QUALITY IMPROVEMENT; PATIENT SAFETY; RANDOMIZED-TRIAL; CARE; ORGANIZATIONS; HARM C1 [Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. [Berwick, Donald M.] Ctr Medicare, Washington, DC 20201 USA. [Berwick, Donald M.] Ctr Medicaid Serv, Washington, DC 20201 USA. RP Clancy, CM (reprint author), Agcy Healthcare Res & Qual, Rockville, MD 20850 USA. NR 22 TC 13 Z9 13 U1 0 U2 4 PU AMER COLL PHYSICIANS PI PHILADELPHIA PA INDEPENDENCE MALL WEST 6TH AND RACE ST, PHILADELPHIA, PA 19106-1572 USA SN 0003-4819 EI 1539-3704 J9 ANN INTERN MED JI Ann. Intern. Med. PD MAY 17 PY 2011 VL 154 IS 10 BP 699 EP + DI 10.7326/0003-4819-154-10-201105170-00013 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 764HK UT WOS:000290620300021 PM 21576540 ER PT J AU Blackwell, S Waldron, C Evans, M AF Blackwell, S. Waldron, C. Evans, M. TI ANALYSIS OF THE SIX PROTECTED MEDICATION CLASSES BASED ON PLAN TYPE AND LOW INCOME SUBSIDY STATUS SO VALUE IN HEALTH LA English DT Meeting Abstract C1 Ctr Medicare, Baltimore, MD USA. Ctr Medicaid Serv CMS, Baltimore, MD 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 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2011 VL 14 IS 3 BP A16 EP A16 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 876JY UT WOS:000299105000081 ER PT J AU Powers, CA Varghese, A Hsu, VD O'Donnell, J Schneider, K AF Powers, C. A. Varghese, A. Hsu, V. D. O'Donnell, J. Schneider, K. TI PRESCRIPTION DRUG COST AND USE IN THE MEDICARE PART D POPULATION - USES OF A NEW LIMITED DATA SET SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Powers, C. A.; Varghese, A.] Ctr Medicare Serv, Baltimore, MD USA. [Powers, C. A.; Varghese, A.] Ctr Medicaid Serv, Baltimore, MD USA. [Hsu, V. D.] Buccaneer, Owings Mills, MD USA. [O'Donnell, J.; Schneider, K.] Buccaneer, W Des Moines, IA 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 1098-3015 J9 VALUE HEALTH JI Value Health PD MAY PY 2011 VL 14 IS 3 BP A11 EP A11 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 876JY UT WOS:000299105000051 ER PT J AU Brechner, RJ Rosenfeld, PJ Babish, JD Caplan, S AF Brechner, Ross J. Rosenfeld, Philip J. Babish, J. Daniel Caplan, Stuart TI Pharmacotherapy for Neovascular Age-Related Macular Degeneration: An Analysis of the 100% 2008 Medicare Fee-For-Service Part B Claims File SO AMERICAN JOURNAL OF OPHTHALMOLOGY LA English DT Article ID INTRAVITREAL BEVACIZUMAB AVASTIN; OCCULT CHOROIDAL NEOVASCULARIZATION; PHOTODYNAMIC THERAPY; ELDERLY AMERICANS; UNITED-STATES; SHORT-TERM; RANIBIZUMAB; SECONDARY; VERTEPORFIN; 6-MONTH AB PURPOSE: To describe the usage patterns of pharmacological treatments for neovascular age-related macular degeneration (AMD) in Medicare fee-for-service beneficiaries. DESIGN: Retrospective review of all Medicare fee-for-service Part B claims for neovascular AMD during 2008. METHODS: Medicare beneficiaries having undergone treatment were identified. The data collected for each visit for a given beneficiary included age, race, gender, Medicare region, state/zip code of residence, date of visit, whether or not the beneficiary had a treatment, the type and amount of drug, and dollars paid by Medicare. The main outcome measures were the number and rate of treatments, the types of drugs used for treatment, and the payments for these drugs. RESULTS: Of the 222 886 unique beneficiaries, 146 276 (64.4%) received bevacizumab and 80 929 (35.6%) received ranibizumab. A total of 824 525 injections were performed with 480 025 injections of bevacizumab (58%) and 336 898 injections of ranibizumab (41%). National rates of injections per 100 000 fee-for-service Part B Medicare beneficiaries for bevacizumab and ranibizumab were 1506 and 1057, respectively. Total payments by Medicare were $20 290 952 for bevacizumab and $536 642 693 for ranibizumab. In 39 out of 50 states, the rate of injection was higher for bevacizumab compared with ranibizumab. CONCLUSIONS: In 2008, bevacizumab was used at a higher rate than ranibizumab for the treatment of neovascular AMD. Even though bevacizumab accounted for 58% of all injections, Medicare paid $516 million more for ranibizumab than bevacizumab. These data suggest that despite its off-label designation, intravitreal bevacizumab is currently the standard-of-care treatment for neovascular AMD in the United States. (Am J Ophthalmol 2011;151:887-895. Published by Elsevier Inc.) C1 [Brechner, Ross J.; Babish, J. Daniel; Caplan, Stuart] Ctr Medicare, Woodlawn, MD 21244 USA. [Brechner, Ross J.; Babish, J. Daniel; Caplan, Stuart] Ctr Medicaid Serv, Woodlawn, MD 21244 USA. [Rosenfeld, Philip J.] Univ Miami Miller Sch Med, Bascom Palmer Eye Inst, Miami, FL USA. RP Brechner, RJ (reprint author), Ctr Medicare, MS C-1-09,7500 Secur Blvd, Woodlawn, MD 21244 USA. EM ross.brechner@cms.hhs.gov FU Genentech FX THE AUTHORS INDICATE NO FUNDING SUPPORT. PREVIOUSLY, PHILIP J. ROSENFELD HAS RECEIVED CLINICAL RESEARCH grants from Genentech and payments for participating in Genentech's Advisory Boards and speaker's bureau program, but no support or payments have been received in the past 2 years. Involved in design and conduct of the study (R.J.B., P.J.R., J.D.B., S.C.); collection (R.J.B.), management (R.J.B.), analysis (R.J.B., P.J.R., J.D.B.), and interpretation of the data (R.J.B., P.J.R.); and preparation, review, or approval of the manuscript (R.J.B., P.J.R., J.D.B., S.C.). IRB approval for this non-trial public de-identified data is not applicable. The study has been approved by ethics committee at Centers for Medicare and Medicaid Services, Wood lawn, Maryland. NR 54 TC 66 Z9 67 U1 1 U2 10 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0002-9394 J9 AM J OPHTHALMOL JI Am. J. Ophthalmol. PD MAY PY 2011 VL 151 IS 5 BP 887 EP 895 DI 10.1016/j.ajo.2010.11.017 PG 9 WC Ophthalmology SC Ophthalmology GA 760WB UT WOS:000290353800021 PM 21310390 ER PT J AU Chavers, BM Solid, CA Sinaiko, A Daniels, FX Chen, SC Collins, AJ Frankenfield, DL Herzog, CA AF Chavers, Blanche M. Solid, Craig A. Sinaiko, Alan Daniels, Frank X. Chen, Shu-Cheng Collins, Allan J. Frankenfield, Diane L. Herzog, Charles A. TI Diagnosis of cardiac disease in pediatric end-stage renal disease SO NEPHROLOGY DIALYSIS TRANSPLANTATION LA English DT Article DE cardiac disease; end-stage renal disease; hypertension; maintenance hemodialysis; pediatric ID LEFT-VENTRICULAR HYPERTROPHY; CARDIOVASCULAR-DISEASE; DIALYSIS PATIENTS; KIDNEY-DISEASE; DUTCH COHORT; RISK-FACTORS; CHILDREN; HEMODIALYSIS; ADOLESCENTS; HYPERTENSION AB Background. Cardiac disease is a significant cause of morbidity and mortality in children with end-stage renal disease (ESRD). This study aimed to report the frequency of cardiac disease diagnostic methods used in US pediatric maintenance hemodialysis patients. Methods. A cross-sectional analysis of all US pediatric (ages 0.7-18 years, n = 656) maintenance hemodialysis patients was performed using data from the Centers for Medicare and Medicaid Services ESRD Clinical Performance Measures Project. Clinical and laboratory information was collected in 2001. Results were analysed by age, sex, race, Hispanic ethnicity, dialysis duration, body mass index (BMI), primary ESRD cause and laboratory data. Results. Ninety-two percent of the patients had a cardiovascular risk factor (63% hypertension, 38% anemia, 11% BMI > 94th percentile, 63% serum phosphorus > 5.5 mg/dL and 55% calcium-phosphorus product = 55 mg(2)/dL(2)). A diagnosis of cardiac disease was reported in 24% (n = 155) of all patients: left ventricular hypertrophy/enlargement 17%, congestive heart failure/pulmonary edema 8%, cardiomyopathy 2% and decreased left ventricular function 2%. Thirty-one percent of patients were not tested. Of those tested, the diagnostic methods used were chest X-rays in 60%, echocardiograms in 35% and electrocardiograms in 33%; left ventricular hypertrophy/enlargement was diagnosed using echocardiogram (72%), chest X-ray (20%) and electrocardiogram (15%). Conclusions. Although 92% of patients had cardiovascular risk factors, an echocardiography was performed in only one-third of the patients. Our study raises the question of why echocardiography, considered the gold standard for cardiac disease diagnosis, has been infrequently used in pediatric maintenance dialysis patients, a high-risk patient population. C1 [Chavers, Blanche M.; Sinaiko, Alan] Univ Minnesota, Dept Pediat, Amplatz Childrens Hosp, Minneapolis, MN 55455 USA. [Chavers, Blanche M.; Herzog, Charles A.] US Renal Data Syst, Cardiovasc Special Studies Ctr, Minneapolis, MN USA. [Collins, Allan J.; Herzog, Charles A.] Univ Minnesota, Dept Med, Minneapolis, MN 55455 USA. [Frankenfield, Diane L.] Off Res Dev & Informat, Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Chavers, BM (reprint author), Univ Minnesota, Dept Pediat, Amplatz Childrens Hosp, Minneapolis, MN 55455 USA. EM chave001@umn.edu FU National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA [HHSN267200715003C] FX This study was performed as a deliverable under Contract No. HHSN267200715003C (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA). The authors thank USRDS colleagues Beth Forrest for regulatory assistance, Shane Nygaard for manuscript preparation and submission assistance, and Nan Booth, MSW, MPH, for editorial assistance. NR 22 TC 13 Z9 14 U1 0 U2 4 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 MAY PY 2011 VL 26 IS 5 BP 1640 EP 1645 DI 10.1093/ndt/gfq591 PG 7 WC Transplantation; Urology & Nephrology SC Transplantation; Urology & Nephrology GA 757LN UT WOS:000290086600030 PM 20861193 ER PT J AU Metersky, ML Hunt, DR Kliman, R Wang, Y Curry, M Verzier, N Lyder, CH Moy, E AF Metersky, Mark L. Hunt, David R. Kliman, Rebecca Wang, Yun Curry, Maureen Verzier, Nancy Lyder, Courtney H. Moy, Ernest TI Racial Disparities in the Frequency of Patient Safety Events Results From the National Medicare Patient Safety Monitoring System SO MEDICAL CARE LA English DT Article DE healthcare disparities; safety; safety management; medical errors; quality improvement; quality indicators; healthcare ID CARE; QUALITY; OUTCOMES; RACE AB Background: Although there is extensive evidence of racial disparities in processes and outcomes of medical care, there has been limited investigation of disparities in patient safety. Objective: To determine whether there are racial disparities in the frequency of adverse events studied in the Medicare Patient Safety Monitoring System. Design and Subjects: Abstraction of 102,623 randomly selected charts from hospital discharges of non-Hispanic white and black Medicare patients between January 1, 2004 and December 31, 2007 to assess frequency of patient safety events in 4 domains: general (pressure ulcers and falls), selected nosocomial infections, selected procedure-related adverse events, and adverse drug events due to anticoagulants and hypoglycemic agents. Measures: Racial disparities in risk of patient safety events, and differences in adverse event rates among hospital groups stratified by percentage of black patients. Results: Blacks had higher adjusted risk than whites of suffering one of the measured nosocomial infections (1.34; 95% confidence interval, 1.17-1.55; P < 0.001) and one of the measured adverse drug events (1.29; 95% confidence interval, 1.19-1.40; P < 0.001). After adjustment for patient and hospital factors, patients in hospitals with the highest percentages of black patients were at increased risk of experiencing one of the measured nosocomial infections (1.9% vs. 1.5%; P < 0.001) and adverse drug events (8.7% vs. 7.8%; P < 0.01). Conclusions: Hospitalized blacks are at higher risk than whites of experiencing certain patient safety events. In addition, hospitals serving high percentages of black patients have higher risk-adjusted rates of selected patient safety events. C1 [Metersky, Mark L.] Univ Connecticut, Ctr Hlth, Div Pulm & Crit Care Med, Sch Med, Farmington, CT 06030 USA. [Metersky, Mark L.; Wang, Yun; Curry, Maureen; Verzier, Nancy] Qualidigm, New Haven, CT USA. [Hunt, David R.] Off Natl Coordinator Hlth IT, Off Hlth Informat Technol Adopt, Washington, DC USA. [Kliman, Rebecca] Ctr Medicare Serv, Off Clin Stand & Qual, Baltimore, MD USA. [Kliman, Rebecca] Ctr Medicaid Serv, Off Clin Stand & Qual, Baltimore, MD USA. [Wang, Yun] Yale Univ, Ctr Outcomes Res & Evaluat, New Haven, CT USA. [Wang, Yun] Yale New Haven Med Ctr, New Haven, CT 06504 USA. [Lyder, Courtney H.] Univ Calif Los Angeles, Sch Nursing, Los Angeles, CA 90024 USA. [Moy, Ernest] Agcy Healthcare Res & Qual, Ctr Qual Improvement & Patient Safety, Rockville, MD USA. RP Metersky, ML (reprint author), Univ Connecticut, Ctr Hlth, Div Pulm & Crit Care Med, Sch Med, 263 Farmington Ave, Farmington, CT 06030 USA. EM Metersky@nso.uchc.edu FU Centers for Medicare & Medicaid Services, Department of Health and Human Services [500-2006-CT002C] FX The analyses upon which this publication is based were performed under Contract Number 500-2006-CT002C, entitled "Utilization and Quality Control: Quality Improvement Organization for the State of Connecticut" sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. NR 26 TC 13 Z9 13 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 MAY PY 2011 VL 49 IS 5 BP 504 EP 510 DI 10.1097/MLR.0b013e31820fc218 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 750MQ UT WOS:000289551800011 PM 21494115 ER PT J AU Mann, C AF Mann, Cindy TI A New Era for State Medicaid and Children's Health Insurance Programs SO ACADEMIC PEDIATRICS LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, Ctr Medicaid CHIP & Survey & Certificat, Baltimore, MD 21224 USA. RP Mann, C (reprint author), Ctr Medicare & Medicaid Serv, Ctr Medicaid CHIP & Survey & Certificat, 7500 Secur Blvd,MS S2-26-12, Baltimore, MD 21224 USA. EM Jennifer.Ryan@cms.hhs.gov NR 3 TC 3 Z9 3 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1876-2859 J9 ACAD PEDIATR JI Acad. Pediatr. PD MAY-JUN PY 2011 VL 11 IS 3 SU S BP S95 EP S96 PG 2 WC Pediatrics SC Pediatrics GA 768IX UT WOS:000290928700014 PM 21570025 ER PT J AU Berwick, DM AF Berwick, Donald M. TI Launching Accountable Care Organizations - The Proposed Rule for the Medicare Shared Savings Program SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Berwick, DM (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD USA. NR 4 TC 109 Z9 109 U1 2 U2 11 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 APR 21 PY 2011 VL 364 IS 16 DI 10.1056/NEJMp1103602 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 752VH UT WOS:000289722700005 PM 21452999 ER PT J AU Bratzler, DW Normand, SLT Wang, Y O'Donnell, WJ Metersky, M Han, LF Rapp, MT Krumholz, HM AF Bratzler, Dale W. Normand, Sharon-Lise T. Wang, Yun O'Donnell, Walter J. Metersky, Mark Han, Lein F. Rapp, Michael T. Krumholz, Harlan M. TI An Administrative Claims Model for Profiling Hospital 30-Day Mortality Rates for Pneumonia Patients SO PLOS ONE LA English DT Article ID QUALITY-OF-CARE; COMMUNITY-ACQUIRED PNEUMONIA; ACUTE MYOCARDIAL-INFARCTION; PERFORMANCE-MEASURES; ELDERLY-PATIENTS; HEART-FAILURE; US HOSPITALS; OUTCOMES; ISSUES AB Background: Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings: Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998-2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998-2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25(th), 50(th), and 75(th) percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). Conclusions/Significance: An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model. C1 [Bratzler, Dale W.] Oklahoma Fdn Med Qual, Oklahoma City, OK 73134 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Wang, Yun; Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Wang, Yun; Krumholz, Harlan M.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [O'Donnell, Walter J.] Massachusetts Gen Hosp, Pulm & Crit Care Unit, Boston, MA 02114 USA. [Metersky, Mark] Univ Connecticut, Sch Med, Div Pulm & Crit Care Med, Farmington, CT USA. [Rapp, Michael T.] George Washington Univ, Sch Med & Hlth Sci, Dept Emergency Med, Washington, DC 20052 USA. [Han, Lein F.; Rapp, Michael T.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Sch Publ Hlth, Sect Hlth Policy & Adm, New Haven, CT USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Dept Internal Med, Sch Publ Hlth,Robert Wood Johnson Clin Scholars P, New Haven, CT 06510 USA. RP Bratzler, DW (reprint author), Oklahoma Fdn Med Qual, Oklahoma City, OK 73134 USA. EM harlan.krumholz@yale.edu FU Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services [500-02-OK-03, 500-05-CO01]; National Heart, Lung, and Blood Institute [U01 HL105270-01]; Massachusetts Department of Public Health FX The analyses upon which this publication is based were performed in part under Contract Numbers 500-02-OK-03 and Subcontract #500-05-CO01, funded by the Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services. The content of this publication does not necessarily reflect the views of policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. (025_HQMSS_OK0402_0407) CMS reviewed and approved the use of its data for this work and approved submission of the manuscript. The funder had no role in study design, data collection and analysis, or manuscript preparation. Dr. Krumholz reports that he is a consultant to UnitedHealthcare, and that he is supported by grant U01 HL105270-01 from the National Heart, Lung, and Blood Institute. Dr. Normand reports that she is funded by the Massachusetts Department of Public Health to monitor the quality of care following cardiac surgery or percutaneous coronary intervention. The other authors report no conflicts. NR 24 TC 61 Z9 61 U1 0 U2 4 PU PUBLIC LIBRARY SCIENCE PI SAN FRANCISCO PA 185 BERRY ST, STE 1300, SAN FRANCISCO, CA 94107 USA SN 1932-6203 J9 PLOS ONE JI PLoS One PD APR 12 PY 2011 VL 6 IS 4 AR e17401 DI 10.1371/journal.pone.0017401 PG 7 WC Multidisciplinary Sciences SC Science & Technology - Other Topics GA 748QE UT WOS:000289404700004 PM 21532758 ER PT J AU Honore, PA Wright, D Berwick, DM Clancy, CM Lee, P Nowinski, J Koh, HK AF Honore, Peggy A. Wright, Donald Berwick, Donald M. Clancy, Carolyn M. Lee, Peter Nowinski, Juleigh Koh, Howard K. TI Creating A Framework For Getting Quality Into The Public Health System SO HEALTH AFFAIRS LA English DT Article ID CARE AB The US health care system has undertaken concerted efforts to improve the quality of care that Americans receive, using well-documented strategies and new incentives found in the Affordable Care Act of 2010. Applying quality concepts to public health has lagged these efforts, however. This article describes two reports from the Department of Health and Human Services: Consensus Statement on Quality in the Public Health System and Priority Areas for Improvement of Quality in Public Health. These reports define what is meant by public health quality, establish quality aims, and highlight priority areas needing improvement. We describe how these developments relate to the Affordable Care Act and serve as a call to action for ensuring a better future for population health. We present real-world examples of how a framework of quality concepts can be applied in the National Vaccine Safety Program and in a state office of minority health. C1 [Honore, Peggy A.] Dept Hlth & Human Serv HHS, Publ Hlth Syst Finance & Qual Program, Off Healthcare Qual, Off Assistant Secretary Hlth, Washington, DC USA. [Berwick, Donald M.] Ctr Medicare Serv, Baltimore, MD USA. [Berwick, Donald M.] Ctr Medicaid Serv, Baltimore, MD USA. [Clancy, Carolyn M.] Agcy Healthcare Res & Qual, Rockville, MD USA. RP Honore, PA (reprint author), Dept Hlth & Human Serv HHS, Publ Hlth Syst Finance & Qual Program, Off Healthcare Qual, Off Assistant Secretary Hlth, Washington, DC USA. EM peggy.honore@hhs.gov NR 46 TC 34 Z9 34 U1 0 U2 7 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 APR PY 2011 VL 30 IS 4 BP 737 EP 745 DI 10.1377/hlthaff.2011.0129 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 746HE UT WOS:000289233400027 PM 21471496 ER PT J AU Boja, ES Jortani, SA Ritchie, J Hoofnagle, AN Tezak, Z Mansfield, E Keller, P Rivers, RC Rahbar, A Anderson, NL Srinivas, P Rodriguez, H AF Boja, Emily S. Jortani, Saeed A. Ritchie, James Hoofnagle, Andrew N. Tezak, Zivana Mansfield, Elizabeth Keller, Penny Rivers, Robert C. Rahbar, Amir Anderson, N. Leigh Srinivas, Pothur Rodriguez, Henry TI The Journey to Regulation of Protein-Based Multiplex Quantitative Assays SO CLINICAL CHEMISTRY LA English DT Article ID BIOMARKER DISCOVERY; MASS-SPECTROMETRY; VALIDATION; QUANTIFICATION; ACTIVATION; ENRICHMENT; MODELS; PLASMA; SERUM AB BACKGROUND: Clinical proteomics presents great promise in biology and medicine because of its potential for improving our understanding of diseases at the molecular level and for detecting disease-related biomarkers for diagnosis, prognosis, and prediction of therapeutic responses. To realize its full potential to improve clinical outcome for patients, proteomic studies have to be well designed, from biosample cohorts to data and statistical analyses. One key component in the biomarker development pipeline is the understanding of the regulatory science that evaluates diagnostic assay performance through rigorous analytical and clinical review criteria. CONTENT: The National Cancer Institute's Clinical Proteomic Technologies for Cancer (CPTC) initiative has proposed an intermediate preclinical "verification" step to close the gap between protein-based biomarker discovery and clinical qualification. In collaboration with the US Food and Drug Administration (FDA), the CPTC network investigators recently published 2 mock submission review documents, first-of-their-kind educational materials that may help the scientific community interested in developing products for the clinic in understanding the likely analytical evaluation requirements for multiplex protein technology-based diagnostic tests. CONCLUSIONS: Building on this momentum, the CPTC continues with this report its collaboration with the FDA, as well as its interactions with the AACC and the Centers for Medicare and Medicaid Services, to further the understanding of regulatory requirements for approving multiplex proteomic platform-based tests and analytically validating multiple analytes.(C) 2011 American Association for Clinical Chemistry C1 [Boja, Emily S.; Rivers, Robert C.; Rahbar, Amir; Rodriguez, Henry] NCI, Off Canc Clin Prote Res, NIH, Bethesda, MD 20892 USA. [Jortani, Saeed A.] Univ Louisville, Dept Pathol & Lab Med, Louisville, KY 40292 USA. [Ritchie, James] Emory Univ, Sch Med, Atlanta, GA USA. [Hoofnagle, Andrew N.] Univ Washington, Dept Lab Med, Seattle, WA 98195 USA. [Tezak, Zivana; Mansfield, Elizabeth] US FDA, Off In Vitro Diagnost Device Evaluat & Safety, Ctr Devices & Radiol Hlth, Silver Spring, MD USA. [Keller, Penny] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Anderson, N. Leigh] Plasma Proteome Inst, Washington, DC USA. [Srinivas, Pothur] NHLBI, NIH, Bethesda, MD 20892 USA. RP Boja, ES (reprint author), NCI, Off Canc Clin Prote Res, NIH, Bethesda, MD 20892 USA. EM bojae@mail.nih.gov FU Waters FX A.N. Hoofnagle, Waters. NR 21 TC 25 Z9 26 U1 0 U2 10 PU AMER ASSOC CLINICAL CHEMISTRY PI WASHINGTON PA 2101 L STREET NW, SUITE 202, WASHINGTON, DC 20037-1526 USA SN 0009-9147 EI 1530-8561 J9 CLIN CHEM JI Clin. Chem. PD APR PY 2011 VL 57 IS 4 BP 560 EP 567 DI 10.1373/clinchem.2010.156034 PG 8 WC Medical Laboratory Technology SC Medical Laboratory Technology GA 741HE UT WOS:000288854000008 PM 21300740 ER PT J AU Krumholz, HM Lin, ZQ Drye, EE Desai, MM Han, LF Rapp, MT Mattera, JA Normand, SLT AF Krumholz, Harlan M. Lin, Zhenqiu Drye, Elizabeth E. Desai, Mayur M. Han, Lein F. Rapp, Michael T. Mattera, Jennifer A. Normand, Sharon-Lise T. TI An Administrative Claims Measure Suitable for Profiling Hospital Performance Based on 30-Day All-Cause Readmission Rates Among Patients With Acute Myocardial Infarction SO CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES LA English DT Article DE myocardial infarction; health policy; quality of health care ID COOPERATIVE CARDIOVASCULAR PROJECT; RANDOMIZED CONTROLLED-TRIAL; QUALITY-OF-CARE; STATISTICAL-MODELS; HEALTH-CARE; REHABILITATION; INTERVENTION AB Background-National attention has increasingly focused on readmission as a target for quality improvement. We present the development and validation of a model approved by the National Quality Forum and used by the Centers for Medicare & Medicaid Services for hospital-level public reporting of risk-standardized readmission rates for patients discharged from the hospital after an acute myocardial infarction. Methods and Results-We developed a hierarchical logistic regression model to calculate hospital risk-standardized 30-day all-cause readmission rates for patients hospitalized with acute myocardial infarction. The model was derived using Medicare claims data for a 2006 cohort and validated using claims and medical record data. The unadjusted readmission rate was 18.9%. The final model included 31 variables and had discrimination ranging from 8% observed 30-day readmission rate in the lowest predictive decile to 32% in the highest decile and a C statistic of 0.63. The 25th and 75th percentiles of the risk-standardized readmission rates across 3890 hospitals were 18.6% and 19.1%, with fifth and 95th percentiles of 18.0% and 19.9%, respectively. The odds of all-cause readmission for a hospital 1 SD above average were 1.35 times that of a hospital 1 SD below average. Hospital-level adjusted readmission rates developed using the claims model were similar to rates produced for the same cohort using a medical record model (correlation, 0.98; median difference, 0.02 percentage points). Conclusions-This claims-based model of hospital risk-standardized readmission rates for patients with acute myocardial infarction produces estimates that are excellent surrogates for those produced from a medical record model. (Circ Cardiovasc Qual Outcomes. 2011;4:243-252.) C1 [Krumholz, Harlan M.; Drye, Elizabeth E.] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, Dept Internal Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Desai, Mayur M.] Yale Univ, Sch Med, Sch Publ Hlth, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Lin, Zhenqiu; Drye, Elizabeth E.; Mattera, Jennifer A.] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Han, Lein F.; Rapp, Michael T.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Rapp, Michael T.] George Washington Univ, Sch Med & Hlth Sci, Dept Emergency Med, Washington, DC 20052 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Sect Cardiovasc Med, 1 Church St,Ste 200, New Haven, CT 06510 USA. EM harlan.krumholz@yale.edu FU Centers for Medicare & Medicaid Services, US Department of Health and Human Services; National Heart, Lung, and Blood Institute [R01 HL081153-03, U01 HL105270-01]; Agency for Healthcare Research and Quality [R01 HS016929-02]; United Health Foundation; Commonwealth Fund [20070407] FX The analyses upon which this publication is based were performed under contract number HHSM-500-2005-CO001C, entitled "Utilization and Quality Control Quality Improvement Organization for the State (Commonwealth) of Colorado," funded by the Centers for Medicare & Medicaid Services, an agency of the US Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services nor does the mention of trade names, commercial products, or organizations imply endorsement by the US government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.; Dr Krumholz is supported by grants R01 HL081153-03 and U01 HL105270-01 from the National Heart, Lung, and Blood Institute; grant R01 HS016929-02 from the Agency for Healthcare Research and Quality and the United Health Foundation; and grant 20070407 from The Commonwealth Fund. NR 24 TC 118 Z9 118 U1 2 U2 14 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1941-7705 J9 CIRC-CARDIOVASC QUAL JI Circ.-Cardiovasc. Qual. Outcomes PD MAR PY 2011 VL 4 IS 2 BP 243 EP 252 DI 10.1161/CIRCOUTCOMES.110.957498 PG 10 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 734WN UT WOS:000288372200018 PM 21406673 ER PT J AU Schermerhorn, ML Giles, KA Sachs, T Bensley, RP O'Malley, AJ Cotterill, P Landon, BE AF Schermerhorn, Marc L. Giles, Kristina A. Sachs, Teviah Bensley, Rodney P. O'Malley, A. James Cotterill, Philip Landon, Bruce E. TI Defining Perioperative Mortality after Open and Endovascular Aortic Aneurysm Repair in the US Medicare Population SO JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS LA English DT Article ID QUALITY IMPROVEMENT PROGRAM; HIGH-RISK PATIENTS; RANDOMIZED-TRIAL; UNITED-STATES; OUTCOMES; PERFORMANCE; VOLUME AB BACKGROUND: Perioperative mortality is reported after abdominal aortic aneurysm (AAA) repair, but there is no agreed upon standard definition. Often, 30-day mortality is reported because in-hospital mortality may be biased in favor of endovascular repair given the shorter length of stay. However, the duration of increased risk of death after aneurysm repair is unknown. STUDY DESIGN: We used propensity score modeling to create matched cohorts of US Medicare beneficiaries undergoing endovascular (n = 22,830) and open (n = 22,830) AAA repair from 2001 to 2004. We calculated perioperative mortality using several definitions including in-hospital, 30-day, and combined 30-day and in-hospital mortality. We determined the relative risk (RR) of death after open compared with endovascular repair as well as the absolute mortality difference. To define the duration of increased risk we calculated biweekly interval death rates for 12 months. RESULTS: In-hospital, 30-day, and combined 30-day and in-hospital mortality for open and endovascular repair were 4.6% versus 1.1%, 4.8% versus 1.6%, and 5.3% versus 1.7%, respectively. The absolute differences in mortality were similar, at 3.5%, 3.2%, and 3.7%. The RRs of death (95% confidence interval) were 4.2 (3.6 to 4.8), 3.1 (2.7 to 3.4), and 3.2 (2.8 to 3.5). Biweekly interval death rates were highest during the first month after endovascular repair (0.6%) and during the first 2.5 months (0.5% to 2.1%) after open repair. After 2.5 months, rates were similar for both repairs (< 0.5%) and stabilized after 3 months. The 90-day mortality rates for open and endovascular repair were 7.0% and 3.2%, respectively. CONCLUSIONS: In-hospital mortality comparisons overestimate the benefit of endovascular repair compared with 30-day or combined 30-day and in-hospital mortality. The total mortality impact of AAA repair is not realized until 3 months after repair and the duration of highest mortality risk extends longer for open repair. (J Am Coll Surg 2011;212:349-355. (c) 2011 by the American College of Surgeons) C1 [Schermerhorn, Marc L.; Giles, Kristina A.; Sachs, Teviah; Bensley, Rodney P.; Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Dept Surg, Boston, MA 02215 USA. [Schermerhorn, Marc L.; Giles, Kristina A.; Sachs, Teviah; Bensley, Rodney P.; 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 Serv, Boston, MA USA. [Cotterill, Philip] Ctr Medicaid Serv, Boston, MA USA. RP Schermerhorn, ML (reprint author), Beth Israel Deaconess Med Ctr, Dept Surg, 110 Francis St, Boston, MA 02215 USA. EM mscherm@bidmc.harvard.edu FU Gore Unrestricted Educational Grant; NIH [HL007734] FX Dr Schermerhorn received a Gore Unrestricted Educational Grant as a consultant for Gore; a consulting fee from Endologix Data Safety and Monitoring Board, and a consulting fee from Medtronic. Dr Landon received a Gore Unrestricted Educational Grant as a consultant for Gore. All other authors have nothing to disclose.; This work was supported by the NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant HL007734. NR 24 TC 22 Z9 22 U1 1 U2 1 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1072-7515 J9 J AM COLL SURGEONS JI J. Am. Coll. Surg. PD MAR PY 2011 VL 212 IS 3 BP 349 EP 355 DI 10.1016/j.jamcollsurg.2010.12.003 PG 7 WC Surgery SC Surgery GA 748XW UT WOS:000289427400010 PM 21296011 ER PT J AU Sommers, AS Abraham, JM Spicer, L Mikow, A Spaulding-Bynon, M AF Sommers, Anna S. Abraham, Jean Marie Spicer, Laura Mikow, Asher Spaulding-Bynon, Mari TI Small Group Employer Participation in New Mexico's State Coverage Insurance Program: Lessons for Federal Reform SO HEALTH SERVICES RESEARCH LA English DT Article DE Small employers; federal reform; subsidized health insurance; state health policy ID HEALTH-INSURANCE AB Objective To identify factors associated with small group employer participation in New Mexico's State Coverage Insurance (SCI) program. Data Sources Telephone surveys of employers participating in SCI (N=269) and small employers who inquired about SCI (N=148) were fielded September 2008-January 2009. Study Design Descriptive and multivariate analyses investigated differences between employer samples, including employer characteristics, concerns that applied to the business when deciding whether to participate in SCI, prior offerings of insurance to workers, and perceived affordability of the program. Data Collection/Extraction Methods Unweighted employer samples yielded 88 and 75 percent response rates for the participating and inquiring employers, respectively. Principal Findings The administrative issue most commonly selected by inquiring employers as applying to their business was difficulty understanding how eligibility requirements applied to their business and its employees (53.5 percent). Inquiring businesses were significantly more likely to report concern about affording to pay the premiums in the first month (35.6 versus 18.7 percent) and the cost to the business over the long run (46.5 versus 26.6 percent) relative to participating employers. From the model results, businesses with the fewest full-time employees (zero to two) were 19 percentage points less likely to participate relative to businesses with six or more full-time employees. Conclusions Administrative and cost barriers to participation in SCI reported by employers suggest that the tax credit offered to small businesses under new federal provisions, which merely offsets the employer portion of premium, could be more effective if accompanied by additional supports to businesses. C1 [Sommers, Anna S.] Ctr Studying Hlth Syst Change, Washington, DC 20024 USA. [Abraham, Jean Marie] Univ Minnesota, Sch Publ Hlth, Div Hlth Policy & Management, Minneapolis, MN USA. [Spicer, Laura] Univ Maryland, Hilltop Inst, Baltimore, MD 21201 USA. [Mikow, Asher] US Dept HHS, DHHS CMS OA CMCS FMG DRSF, Ctr Medicare Serv, Baltimore, MD USA. [Mikow, Asher] US Dept HHS, DHHS CMS OA CMCS FMG DRSF, Ctr Medicaid Serv, Baltimore, MD USA. [Spaulding-Bynon, Mari] Blue Cross Blue Shield New Mexico, Legal Dept, NE, Albuquerque, NM USA. RP Sommers, AS (reprint author), Ctr Studying Hlth Syst Change, 600 Maryland Ave SW,Suite 550, Washington, DC 20024 USA. EM asommers@hschange.org FU Robert Wood Johnson Foundation SHARE Initiative; Hilltop Institute at the University of Maryland; Baltimore County (UMBC) FX The study was conducted in partnership with the New Mexico HSD with partial funding by the Robert Wood Johnson Foundation SHARE Initiative. The Hilltop Institute at the University of Maryland, Baltimore County (UMBC) led the evaluation under subcontract to HSD. Review of this manuscript by HSD was limited to ensuring accurate factual content about the SCI program. We would like to acknowledge Michael Davern, formerly with SHADAC, for assistance with the sampling and weighting methods; Susan DeGrand, HSD, who extracted the administrative data; and Ann Volpel, formerly with The Hilltop Institute, who led the May 2008 site visit. The study protocol was approved by the UMBC Institutional Review Board, protocol #Y08AS36185. NR 17 TC 1 Z9 1 U1 1 U2 2 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 FEB PY 2011 VL 46 IS 1 BP 268 EP 284 DI 10.1111/j.1475-6773.2010.01216.x PN 2 PG 17 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 701QX UT WOS:000285838500004 PM 21143477 ER PT J AU Nyweide, DJ Anthony, DL Chang, CH Goodman, D AF Nyweide, David J. Anthony, Denise L. Chang, Chiang-Hua Goodman, David TI Seniors' Perceptions Of Health Care Not Closely Associated With Physician Supply SO HEALTH AFFAIRS LA English DT Article ID QUALITY-OF-CARE; REGIONAL-VARIATIONS; WORKFORCE; PREFERENCES; INTENSITY; ACCESS; TRENDS AB We conducted a national random survey of Medicare beneficiaries to better understand the association between the supply of physicians and patients' perceptions of their health care. We found that patients living in areas with more physicians per capita had perceptions of their health care that were similar to those of patients in regions with fewer physicians. In addition, there were no significant differences between the groups of patients in terms of numbers of visits to their personal physician in the previous year; amount of time spent with a physician; or access to tests or specialists. Our results suggest that simply training more physicians is unlikely to lead to improved access to care. Instead, focusing health policy on improving the quality and organization of care may be more beneficial. C1 [Nyweide, David J.] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. [Anthony, Denise L.] Dartmouth Coll, Dept Sociol, Hanover, NH 03755 USA. [Chang, Chiang-Hua] Dartmouth Inst Hlth Policy & Clin Practice, Ctr Hlth Policy Res, Lebanon, NH USA. [Goodman, David] Dartmouth Inst, Ctr Hlth Policy Res, Hanover, NH USA. RP Nyweide, DJ (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. EM david.nyweide@cms.hhs.gov FU National Institute on Aging [PO1 AG19783]; Robert Wood Johnson Foundation FX This research was supported in part by the National Institute on Aging (PO1 AG19783) and the Robert Wood Johnson Foundation. David Nyweide conducted this research while at the Dartmouth Institute for Health Policy and Clinical Practice, before joining the Centers for Medicare and Medicaid Services. NR 36 TC 4 Z9 4 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 FEB PY 2011 VL 30 IS 2 BP 219 EP 227 DI 10.1377/hlthaff.2010.0602 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 715KR UT WOS:000286883900006 PM 21289342 ER PT J AU Mark, TL Levit, KR Vandivort-Warren, R Buck, JA Coffey, RM AF Mark, Tami L. Levit, Katharine R. Vandivort-Warren, Rita Buck, Jeffrey A. Coffey, Rosanna M. TI Changes In US Spending On Mental Health And Substance Abuse Treatment, 1986-2005, And Implications For Policy SO HEALTH AFFAIRS LA English DT Article ID EXPENDITURE PANEL SURVEY; INSURANCE; ILLNESS; TRENDS; CARE AB The United States invests a sizable amount of money on treatments for mental health and substance abuse: $135 billion in 2005, or 1.07 percent of the gross domestic product. We provide treatment spending estimates from the period 1986-2005 to build understanding of past trends and consider future possibilities. We find that the growth rate in spending on mental health medications-a major driver of mental health expenditures in prior years-declined dramatically. As a result, mental health and substance abuse spending grew at a slightly slower rate than gross domestic product in 2004 and 2005, and it continued to shrink as a share of all health spending. Of note, we also find that Medicaid's share of total spending on mental health grew from 17 percent in 1986 to 27 percent in 2002 to 28 percent in 2005. The recent recession, the full implementation of federal parity law, and such health reform-related actions as the planned expansion of Medicaid all have the potential to improve access to mental health and substance abuse treatment and to alter spending patterns further. Our spending estimates provide an important context for evaluating the effect of those policies. C1 [Mark, Tami L.; Coffey, Rosanna M.] Thomson Reuters, Healthcare & Sci Div, Washington, DC USA. [Vandivort-Warren, Rita] Subst Abuse & Mental Hlth Serv Adm, Ctr Subst Abuse Treatment, Div Serv Improvement, Rockville, MD USA. [Buck, Jeffrey A.] Ctr Medicare & Medicaid Serv, Ctr Strateg Planning, Baltimore, MD USA. RP Mark, TL (reprint author), Thomson Reuters, Healthcare & Sci Div, Washington, DC USA. EM tami.mark@thomsonreuters.com FU US Department of Health and Human Services [HHS-270-2006-000 23C] FX A version of this article was presented at the Substance Abuse and Mental Health Services Administration (SAMHSA) Block Grant Conference, Washington, D. C., June 24, 2010. This report was prepared by Thomson Reuters (Healthcare) for SAMHSA, US Department of Health and Human Services (contract HHS-270-2006-000 23C). It is the result of substantial contributions by numerous people and organizations. Ellen Bouchery of the Lewin Group produced the specialty facility estimates. Edward King of Actuarial Research Corporation produced the estimates for other providers, as well as the final total estimates. David McKusick of Actuarial Research Corporation developed the methods used to estimate the nonspecialty organizations. Tami Mark, Elizabeth Stranges, Rosanna Coffey, Katharine Levit, Cheryl Kassed, and Katheryn Ryan of Thomson Reuters provided coordination, monitored the results, and drafted the report. Rita Vandivort-Warren of SAMHSA and Jeffrey Buck of the Centers for Medicare and Medicaid Services guided the work and provided many helpful comments and suggestions. Experts in mental health and substance abuse treatment spending provided insights on the policy relevance of the results. NR 20 TC 51 Z9 52 U1 0 U2 11 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 FEB PY 2011 VL 30 IS 2 BP 284 EP 292 DI 10.1377/hlthaff.2010.0765 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 715KR UT WOS:000286883900013 PM 21289350 ER PT B AU Pracilio, VP Reifsnyder, J Nash, DB Fabius, RJ AF Pracilio, Valerie P. Reifsnyder, JoAnne Nash, David B. Fabius, Raymond J. BA Nash, DB Reifsnyder, J Fabius, RJ Pracilio, VP BF Nash, DB Reifsnyder, J Fabius, RJ Pracilio, VP TI THE POPULATION HEALTH MANDATE SO POPULATION HEALTH: CREATING A CULTURE OF WELLNESS LA English DT Article; Book Chapter ID CARE C1 [Reifsnyder, JoAnne] Thomas Jefferson Univ, Jefferson Sch Populat Hlth, Masters Program Chron Care Management 1, Philadelphia, PA USA. [Fabius, Raymond J.] Walgreen, Hlth & Wellness Div, Deerfield, IL USA. [Fabius, Raymond J.] Ab3Health LLC, Philadelphia, PA USA. [Fabius, Raymond J.] HealthNEXT, Unionville, PA USA. [Fabius, Raymond J.] I Trax AMEX DMX CHD Meridian, Nashville, TN USA. [Fabius, Raymond J.] Gen Elect, Fairfield, CT USA. [Reifsnyder, JoAnne] ExcelleRx Inc, Philadelphia, PA USA. [Reifsnyder, JoAnne] Ethos Consulting Grp LLC, Haddon Hts, NJ USA. [Reifsnyder, JoAnne] Samaritan Hosp, Patient Serv, Marlton, NJ USA. [Reifsnyder, JoAnne] Univ Penn, Sch Nursing, Philadelphia, PA 19104 USA. [Reifsnyder, JoAnne] Pennsylvania Hosp Network, Philadelphia, PA USA. [Reifsnyder, JoAnne] Visiting Nurse Assoc Greater Philadelphia, Hosp Program, Philadelphia, PA USA. [Nash, David B.] Off Hlth Policy, Washington, DC USA. [Nash, David B.] NQF Tech Advisory Panel, Washington, DC USA. [Nash, David B.] Board Comm Qual & Safety, Bangor, Gwynedd, Wales. [Nash, David B.] Main Line Hlth, Philadelphia, PA USA. [Nash, David B.] Humana, Louisville, KY USA. [Nash, David B.] Robert Wood Johnson Fdn, Princeton, NJ USA. RP Pracilio, VP (reprint author), Ctr Medicare & Medicaid Serv, Phys Qual Reporting Initiat Measures, Baltimore, MD 21244 USA. EM valerie.pracilio@jefferson.edu; joanne.reffsnyder@yahoo.com; david.nash@jefferson.edu; raymond.fabius@thomsonreuters.com; david.nash@jefferson.edu; joanne.reffsnyder@yahoo.com; raymond.fabius@thomsonreuters.com; valerie.pracilio@jefferson.edu NR 35 TC 5 Z9 5 U1 1 U2 1 PU JONES & BARTLETT PUBLISHERS PI SUDBURY PA 40 TALL PINE DRIVE, SUDBURY, MA 01776 USA BN 978-0-7637-8043-2 PY 2011 BP XXXV EP LII PG 18 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA BYM65 UT WOS:000299368900001 ER PT J AU Howell, JR Berenson, R Volland, PJ AF Howell, Julianne R. Berenson, Robert Volland, Patricia J. BE Schraeder, C Shelton, P TI Financing and payment SO COMPREHENSIVE CARE COORDINATION FOR CHRONICALLY ILL ADULTS LA English DT Article; Book Chapter ID TRANSITIONAL CARE; ACCOUNTABLE CARE; CONTROLLED-TRIAL; MEDICAL HOMES; QUALITY; MANAGEMENT; IMPROVE; PERFORMANCE; STRATEGY; DONT C1 [Howell, Julianne R.] Ctr Medicare Serv, Baltimore, MD 21244 USA. [Howell, Julianne R.] Ctr Medicaid Serv, Baltimore, MD USA. [Berenson, Robert] Urban Inst, Washington, DC 20037 USA. [Volland, Patricia J.] New York Acad Med, New York, NY USA. [Volland, Patricia J.] Social Work Leadership Inst, New York, NY USA. RP Howell, JR (reprint author), Ctr Medicare Serv, Baltimore, MD 21244 USA. NR 48 TC 0 Z9 0 U1 0 U2 0 PU BLACKWELL SCIENCE PUBL PI OXFORD PA OSNEY MEAD, OXFORD OX2 0EL, ENGLAND BN 978-0-8138-1194-9 PY 2011 BP 167 EP 189 D2 10.1002/9781118785775 PG 23 WC Health Policy & Services; Nursing SC Health Care Sciences & Services; Nursing GA BA1JO UT WOS:000332648300009 ER PT J AU Martin, A Lassman, D Whittle, L Catlin, A AF Martin, Anne Lassman, David Whittle, Lekha Catlin, Aaron CA Natl Hlth Expenditure Accounts Tea TI Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades SO HEALTH AFFAIRS LA English DT Article AB In 2009, US health care spending grew 4.0 percent-a historically low rate of annual increase-to $2.5 trillion, or $8,086 per person. Despite the slower growth, the share of the gross domestic product devoted to health spending increased to 17.6 percent in 2009 from 16.6 percent in 2008. The growth rate of health spending continued to outpace the growth of the overall economy, which experienced its largest drop since 1938. The recession contributed to slower growth in private health insurance spending and out-of-pocket spending by consumers, as well as a reduction in capital investments by health care providers. The recession also placed increased burdens on households, businesses, and governments, which meant that fewer financial resources were available to pay for health care. Declining federal revenues and strong growth in federal health spending increased the health spending share of total federal revenue from 37.6 percent in 2008 to 54.2 percent in 2009. C1 [Martin, Anne] Ctr Medicare Serv, Off Actuary, Baltimore, MD USA. [Martin, Anne] Ctr Medicaid Serv, Off Actuary, Baltimore, MD USA. RP Martin, A (reprint author), Ctr Medicare Serv, Off Actuary, Baltimore, MD USA. EM anne.martin@cms.hhs.gov NR 27 TC 58 Z9 58 U1 0 U2 4 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 PY 2011 VL 30 IS 1 BP 11 EP 22 DI 10.1377/hlthaff.2010.1032 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 702VK UT WOS:000285923800003 PM 21209433 ER PT J AU Roebuck, MC Liberman, JN Gemmill-Toyama, M Brennan, TA AF Roebuck, M. Christopher Liberman, Joshua N. Gemmill-Toyama, Marin Brennan, Troyen A. TI Medication Adherence Leads To Lower Health Care Use And Costs Despite Increased Drug Spending SO HEALTH AFFAIRS LA English DT Article ID ECONOMIC CONSEQUENCES; LONGITUDINAL COHORT; OLDER POPULATION; NONADHERENCE; DISEASE; HOSPITALIZATION; PREDICTORS; MANAGEMENT; ICD-9-CM; OUTCOMES AB Researchers have routinely found that improved medication adherence-getting people to take medicine prescribed for them-is associated with greatly reduced total health care use and costs. But previous studies do not provide strong evidence of a causal link. This article employs a more robust methodology to examine the relationship. Our results indicate that although improved medication adherence by people with four chronic vascular diseases increased pharmacy costs, it also produced substantial medical savings as a result of reductions in hospitalization and emergency department use. Our findings indicate that programs to improve medication adherence are worth consideration by insurers, government payers, and patients, as long as intervention costs do not exceed the estimated health care cost savings. C1 [Roebuck, M. Christopher] CVS Caremark, Hlth Econ & Strateg Res, Hunt Valley, MD USA. [Liberman, Joshua N.] CVS Caremark, Strateg Res Analyt & Outcomes, Hunt Valley, MD USA. [Gemmill-Toyama, Marin] Ctr Medicare Serv, Baltimore, MD USA. [Gemmill-Toyama, Marin] Ctr Medicaid Serv, Baltimore, MD USA. [Brennan, Troyen A.] CVS Caremark, Woonsocket, RI USA. RP Roebuck, MC (reprint author), CVS Caremark, Hlth Econ & Strateg Res, Hunt Valley, MD USA. EM chris.roebuck@caremark.com NR 23 TC 151 Z9 152 U1 1 U2 15 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 PY 2011 VL 30 IS 1 BP 91 EP 99 DI 10.1377/hlthaff.2009.1087 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 702VK UT WOS:000285923800014 PM 21209444 ER PT J AU Cylus, J Hartman, M Washington, B Andrews, K Catlin, A AF Cylus, Jonathan Hartman, Micah Washington, Benjamin Andrews, Kimberly Catlin, Aaron TI Pronounced Gender And Age Differences Are Evident In Personal Health Care Spending Per Person SO HEALTH AFFAIRS LA English DT Article AB This paper examines differences in national health care spending by gender and age. Our research found significant variations in per person spending by gender across age groups, health services, and types of payers. For example, in 2004 per capita health care spending for females was 32 percent more than for males. Per capita differences were most pronounced among the working-age population, largely because of spending for maternity care. Except for children, total spending for and by females was greater than that for and by males, for most services and payers. The gender difference in total spending was most pronounced in the elderly, as a result of the longer life expectancy of women. C1 [Cylus, Jonathan] Ctr Medicare Serv CMS, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD USA. [Cylus, Jonathan] Ctr Medicaid Serv CMS, Natl Hlth Stat Grp, Off Actuary, Baltimore, MD USA. EM Micah.Hartman@cms.hhs.gov NR 25 TC 26 Z9 26 U1 0 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 PY 2011 VL 30 IS 1 BP 153 EP 160 DI 10.1377/hlthaff.2010.0216 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 702VK UT WOS:000285923800021 PM 21148180 ER PT J AU Giles, KA Landon, BE Cotterill, P O'Malley, AJ Pomposelli, FB Schermerhorn, ML AF Giles, Kristina A. Landon, Bruce E. Cotterill, Philip O'Malley, A. James Pomposelli, Frank B. Schermerhorn, Marc L. TI Thirty-day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries SO JOURNAL OF VASCULAR SURGERY LA English DT Article ID RANDOMIZED CONTROLLED-TRIAL; OUTCOMES; POPULATION; EUROSTAR AB Objectives: Late survival is similar after open and endovascular abdominal aortic aneurysm (AAA) repair (EVAR), despite a perioperative benefit with EVAR. AAA-related reinterventions are more common after EVAR., whereas laparotomy-related reinterventions are more common after open repair. The effect of reinterventions on survival, however, is unknown. We therefore evaluated the rate of reinterventions and readmission after initial AAA repair, 30-day mortality, and the effect on long-term survival. Methods: We identified AAA-related and laparotomy-related reinterventions for propensity score-matched cohorts of 45,652 Medicare beneficiaries undergoing EVAR and open repair from 2001 to 2004. Follow-up was up to 6 years. Hospitalizations for ruptured AAA without repair and for bowel obstruction or ventral hernia without abdominal surgery were also recorded. Event rates were calculated per year and are presented through 6 years of follow-up as events per 100 person-years. Thirty-day mortality was calculated for each reintervention or readmission. Results: Through 6 years, overall reinterventions or readmissions were similar between repair methods but slightly more common after EVAR (7.6 vs 7.0/100 person-years; relative risk [RR], 1.1; P <.001). Overall 30-day mortality with any reintervention or readmission was 9.1%. EVAR patients had more ruptures (0.50 vs 0.09 [RR, 5.7; P <.001]), with a mortality of 28%, but these were uncommon. EVAR patients also had more AAA-related reinterventions through 6 years (3.7 vs 0.9 [RR, 4.0; P <.001]; mortality, 5.6%), most of which were minor endovascular reinterventions (2.4 vs 0.2 [RR, 11.4; P <.001]), with a 30-day mortality of 3.0%. However, minor open (0.8 vs 0.5 [RR, 1.4; P<.001]; mortality, 6.9%) and major reinterventions (0.4 vs 0.2 [RR, 2.4; P <.001]; mortality, 12.1%) were also more common after EVAR than open repair. Conversely, EVAR patients had fewer laparotomy-related reinterventions than open patients (1.4 vs 3.0 [RR, 0.5; P <.001]; mortality, 8.1%) and readmissions without surgery (2.0 vs 2.7 [RR, 0.7; P<.0011; mortality 10.9%). Overall, reinterventions or readmission accounted for 9.6% of all EVAR deaths and 7.6% of all open repair deaths in the follow-up period (P <.001). Conclusions: Reintervention and readmission are slightly higher after EVAR. Survival is negatively affected by reintervention or readmission after EVAR and open surgery, which likely contributes to the erosion of the survival benefit of EVAR over time. ( J Vasc Surg 2011;53:6-13.) C1 [Giles, Kristina A.; Pomposelli, Frank B.; Schermerhorn, Marc L.] Beth Israel Deaconess Med Ctr, Div Vasc & Endovasc Surg, Boston, MA 02215 USA. [Landon, Bruce E.; O'Malley, A. James] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Cotterill, Philip] Ctr Medicare, Baltimore, MD USA. [Cotterill, Philip] Ctr Medicaid Serv, Baltimore, MD USA. RP Schermerhorn, ML (reprint author), Beth Israel Deaconess Med Ctr, Div Vasc & Endovasc Surg, 110 Francis St,Ste 5B, Boston, MA 02215 USA. EM mscherm@bidmc.harvard.edu FU National Institutes of Health [HL007734] FX This work was supported by the National Institutes of Health T32 Harvard-Longwood Research Training in Vascular Surgery grant HL007734.; Dr Schermcrhorn has received an unrestricted educational grant from Gore, is on the DSMB for Endologix, and is a consultant for Medtronic. Dr Landon has received an unrestricted educational grant from Gore. NR 14 TC 50 Z9 56 U1 0 U2 3 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD JAN PY 2011 VL 53 IS 1 BP 6 EP 13 DI 10.1016/j.jvs.2010.08.051 PG 8 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA 704WB UT WOS:000286085200002 PM 21030195 ER PT J AU Foster, J Greer, J Thorbecke, E AF Foster, James Greer, Joel Thorbecke, Erik TI The Foster-Greer-Thorbecke (FGT) poverty measures: 25 years later SO JOURNAL OF ECONOMIC INEQUALITY LA English DT Article DE Axioms; Decomposability; FGT measures; Income distribution; Poverty; Stochastic dominance; Subgroup consistency ID STATISTICAL-INFERENCE; STOCHASTIC-DOMINANCE; INEQUALITY MEASURES; UNEQUAL INEQUALITIES; INCOME INEQUALITY; RELATIVE POVERTY; UNITED-STATES; ROBUST; INDEXES; ALLEVIATION AB Twenty-five years ago, the FGT class of decomposable poverty measures was introduced in Foster, Greer, and Thorbecke (Econometrica 52:761-776, 1984). The present study provides a retrospective view of the FGT paper and the subsequent literature, as well as a brief discussion of future directions. We identify three categories of contributions: to measurement, to axiomatics, and to application. A representative subset of the literature generated by the FGT methodology is discussed and grouped according to this taxonomy. We show how the FGT paper has played a central role in several thriving literatures and has contributed to the design, implementation, and evaluation of prominent development programs; the breadth of its impact is evidenced by the many topics beyond poverty to which its methodology has been applied. We conclude with a selection of prospective research topics. C1 [Thorbecke, Erik] Cornell Univ, Dept Econ, Ithaca, NY 14853 USA. [Thorbecke, Erik] Cornell Univ, Div Nutr Sci, Ithaca, NY 14853 USA. [Foster, James] George Washington Univ, Elliott Sch Int Affairs, Washington, DC 20052 USA. [Foster, James] George Washington Univ, Dept Econ, Washington, DC 20052 USA. [Foster, James] Univ Oxford, Oxford Poverty & Human Dev Initiat, Oxford Dept Int Dev, Oxford OX1 3TB, England. [Greer, Joel] Ctr Medicare Serv, Dept Hlth & Human Serv, Baltimore, MD 21244 USA. [Greer, Joel] Ctr Medicaid Serv, Dept Hlth & Human Serv, Baltimore, MD 21244 USA. RP Thorbecke, E (reprint author), Cornell Univ, Dept Econ, B-16 MVR, Ithaca, NY 14853 USA. EM fosterje@gwu.edu; et17@cornell.edu NR 142 TC 21 Z9 22 U1 2 U2 21 PU SPRINGER PI DORDRECHT PA VAN GODEWIJCKSTRAAT 30, 3311 GZ DORDRECHT, NETHERLANDS SN 1569-1721 J9 J ECON INEQUAL JI J. Econ. Inequal. PD DEC PY 2010 VL 8 IS 4 BP 491 EP 524 DI 10.1007/s10888-010-9136-1 PG 34 WC Economics SC Business & Economics GA 669OZ UT WOS:000283361400007 ER PT J AU Baldwin, LM Chan, L Andrilla, CHA Huff, ED Hart, LG AF Baldwin, Laura-Mae Chan, Leighton Andrilla, C. Holly A. Huff, Edwin D. Hart, L. Gary TI Quality of Care for Myocardial Infarction in Rural and Urban Hospitals SO JOURNAL OF RURAL HEALTH LA English DT Article DE Medicare; myocardial infarction; quality of care; rural hospitals ID COOPERATIVE CARDIOVASCULAR PROJECT; MEDICARE PATIENTS; UNITED-STATES; GUIDELINES; BENEFICIARIES; ASSOCIATION; PROGRAM; HEALTH; VOLUME AB Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776 Medicare beneficiaries with AMI from 2000-2001, unadjusted and logistic regression analysis compared receipt of 5 recommended treatments between admissions to urban, large rural, small rural, and isolated small rural hospitals as defined by Rural Urban Commuting Area codes. Results: Substantial proportions of hospital admissions in all areas did not receive guideline-recommended treatments (eg, 17.0% to 23.6% without aspirin within 24 hours of admission, 30.8% to 46.6% without beta-blockers at arrival/discharge). Admissions to small rural and isolated small rural hospitals were least likely to receive most treatments (eg, 69.2% urban, 68.3% large rural, 59.9% small rural, 53.4% isolated small rural received discharge beta-blocker prescriptions). Adjusted analyses found no treatment differences between admissions to large rural and urban area hospitals, but admissions to small rural and isolated small rural hospitals had lower rates of discharge prescriptions such as aspirin and beta-blockers than urban hospital admissions. Conclusions: Many simple guidelines that improve AMI outcomes are inadequately implemented, regardless of geographic location. In small rural and isolated small rural hospitals, addressing barriers to prescription of beneficial discharge medications is particularly important. The best quality improvement practices should be identified and translated to the broadest range of institutions and providers. C1 [Baldwin, Laura-Mae; Andrilla, C. Holly A.] Univ Washington, Sch Med, Dept Family Med, WWAMI Rural Hlth Res Ctr, Seattle, WA 98195 USA. [Chan, Leighton] NIH, Dept Rehabil Med, Bethesda, MD 20892 USA. [Huff, Edwin D.] Ctr Medicare & Medicaid Serv, Boston Reg Off, Div Qual Improvement, Boston, MA USA. [Hart, L. Gary] Univ Arizona Mel & Enid Zuckerman, Coll Publ Hlth, Rural Hlth Off, Tucson, AZ USA. RP Baldwin, LM (reprint author), Univ Washington, Sch Med, Dept Family Med, WWAMI Rural Hlth Res Ctr, Box 354982, Seattle, WA 98195 USA. EM lmb@u.washington.edu FU Office of Rural Health Policy; Health Resources and Services Administration; Department of Health and Human Services; National Institutes of Health FX This study was funded by the federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services, and by the Intramural Research Program of the National Institutes of Health. The Centers for Medicare & Medicaid Services provided the de-identified study database linked to Rural Urban Commuting Area Codes. The authors thank Shelli Beaver, MS, from the Centers for Medicare & Medicaid Services and Richard F. Maclehose, PhD, from the National Institute of Environmental Health Sciences for serving as resources in the use of the Medicare Quality Improvement Organization data, and Beth Jackson, PhD, for her help in developing the database used in this study. NR 23 TC 11 Z9 11 U1 2 U2 4 PU WILEY-BLACKWELL PUBLISHING, INC PI MALDEN PA COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA SN 0890-765X J9 J RURAL HEALTH JI J. Rural Health PD WIN PY 2010 VL 26 IS 1 BP 51 EP 57 DI 10.1111/j.1748-0361.2009.00265.x PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 540EJ UT WOS:000273313500008 PM 20105268 ER PT J AU Elliott, MN Lehrman, WG Goldstein, EH Giordano, LA Beckett, MK Cohea, CW Cleary, PD AF Elliott, Marc N. Lehrman, William G. Goldstein, Elizabeth H. Giordano, Laura A. Beckett, Megan K. Cohea, Christopher W. Cleary, Paul D. TI Hospital Survey Shows Improvements In Patient Experience SO HEALTH AFFAIRS LA English DT Article ID QUALITY-OF-CARE; HEALTH-CARE; NONRESPONSE RATES; UNITED-STATES; PERFORMANCE; IMPACT; HCAHPS; BIAS AB Hospitals are improving the inpatient care experience. A government survey that measures patients' experiences with a range of issues from staff responsiveness to hospital cleanliness-the Hospital Consumer Assessment of Healthcare Providers and Systems survey-is showing modest but meaningful gains. Using data from the surveys reported in March 2008 and March 2009, we present the first comprehensive national assessment of changes in patients' experiences with inpatient care since public reporting of the results began. We found improvements in all measures of patient experience, except doctors' communication. These improvements were fairly uniform across hospitals. The largest increases were in measures related to staff responsiveness and the discharge information that patients received. C1 [Elliott, Marc N.; Beckett, Megan K.] RAND Corp, Santa Monica, CA USA. [Lehrman, William G.] Ctr Medicare Serv CMS, Div Consumer Assessment & Plan Performance, Baltimore, MD USA. [Lehrman, William G.] Ctr Medicaid Serv CMS, Baltimore, MD USA. [Giordano, Laura A.; Cohea, Christopher W.] Hlth Serv Advisory Grp, Phoenix, AZ USA. [Cleary, Paul D.] Yale Univ, Sch Publ Hlth, New Haven, CT USA. RP Elliott, MN (reprint author), RAND Corp, Santa Monica, CA USA. EM elliott@rand.org FU Centers for Medicare and Medicaid Services (CMS) through Health Services Advisory Group and RAND [HHSM-500-2008-A29THC] FX The Centers for Medicare and Medicaid Services (CMS) provided support for the preparation of this paper through a contract with Health Services Advisory Group and RAND (Contract no. HHSM-500-2008-A29THC). The authors thank Jacquelyn Chou for assistance in preparing the manuscript. The opinions expressed are those of the authors and do not necessarily reflect the opinions of CMS. NR 27 TC 42 Z9 42 U1 0 U2 8 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 PY 2010 VL 29 IS 11 BP 2061 EP 2067 DI 10.1377/hlthaff.2009.0876 PG 7 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 673MX UT WOS:000283668700015 PM 21041749 ER PT J AU Soran, OZ Feldman, AM Pina, IL Lamas, GA Kelsey, SF Selzer, F Pilotte, J Lave, JR AF Soran, Ozlem Z. Feldman, Arthur M. Pina, Ileana L. Lamas, Gervasio A. Kelsey, Sheryl F. Selzer, Faith Pilotte, John Lave, Judith R. TI Cost of Medical Services in Older Patients With Heart Failure: Those Receiving Enhanced Monitoring Using a Computer-Based Telephonic Monitoring System Compared With Those in Usual Care: The Heart Failure Home Care Trial SO JOURNAL OF CARDIAC FAILURE LA English DT Article DE Heart failure; disease management programs; cost ID RANDOMIZED CLINICAL-TRIAL; DISEASE-MANAGEMENT PROGRAM; ELDERLY-PATIENTS; RESOURCE USE; INTERVENTION; OUTCOMES; MULTIDISCIPLINARY; READMISSION AB Background Prior studies suggest that disease management programs may be effective in improving clinical and economic outcomes in patients with heart failure Whether these types of programs can lower health care cost and be adapted to the primary care setting is unknown This study was designed to assess the impact of a home-based disease management program, the Alere DayLink HF Monitoring System (HFMS) on the clinical and economic outcomes of Medicare beneficiaries recently hospitalized for heart failure who received the care from a community based primary care practitioner Methods and Results The Heart Failure Home Care trial was a multicenter randomized controlled trial of sophisticated monitoring of heart failure patients with an interactive program versus standard heart failure care with enhanced patient education and follow-up (SC) in Medicare-eligible patients The study end points included cardiovascular death or rehospitalization for heart failure length of hospital stay, total patient cost and cost to Medicare at 6 months of enrollment A total of 315 patients age >= 65 years old were randomized 160 to the HFMS and 155 to SC There were no significant statistical differences between the groups in regards to 6-month cardiac mortality rehospitalizations for heart failure or length of hospital stay Of those, 304 patients had their Medicare data available The information from the Medicare claims data was used to determine the cost Information from the trial was used to determine costs of out-patient drugs and the interventions The 6 month mean Medicare costs were estimated to be $17 837 and $13 886 for the HFMS and the SC groups respectively We found that overall medical costs of medicare patients were significantly higher for patients who were randomized to the HFMS arm than they were for the patients randomized to the SC arm 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 and less costly in patients who are elderly and receive the care from a community-based primary care practitioner (J Cardiac Fail 2010 16 859-866) C1 [Soran, Ozlem Z.] Univ Pittsburgh, Med Ctr, Cardiovasc Inst, Pittsburgh, PA 15213 USA. [Kelsey, Sheryl F.; Selzer, Faith] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA 15213 USA. [Feldman, Arthur M.] Thomas Jefferson Univ, Jefferson Med Coll, Dept Med, Philadelphia, PA 19107 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. [Pilotte, John] Ctr Medicare, Baltimore, MD USA. [Pilotte, John] Ctr Med Serv, Baltimore, MD USA. [Lave, Judith R.] Univ Pittsburgh, Dept Hlth Policy & Management, Grad Sch Publ Hlth, Pittsburgh, PA 15213 USA. RP Soran, OZ (reprint author), Univ Pittsburgh, Cardiovasc Inst, UPMC Presbyterian Hosp PUH, 200 Lothrop St,F-748, Pittsburgh, PA 15213 USA. FU Centers for Medicare & Medicaid Services Baltimore MD FX Grant Support Centers for Medicare & Medicaid Services Baltimore MD NR 28 TC 13 Z9 13 U1 3 U2 8 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 2010 VL 16 IS 11 BP 859 EP 866 DI 10.1016/j.cardfail.2010.05.028 PG 8 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 680PT UT WOS:000284247600002 PM 21055649 ER PT J AU Gordon, WJ Polansky, JM Boscardin, WJ Fung, KZ Steinman, MA AF Gordon, William J. Polansky, Jesse M. Boscardin, W. John Fung, Kathy Z. Steinman, Michael A. 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 Article; Proceedings Paper CT 32nd Annual Meeting of the Society-of-General-Internal-Medicine CY MAY 13-16, 2009 CL Miami, FL SP Soc Gen Internal Med DE risk assessment; cholesterol; heart diseases; practice guidelines as topic; prognosis ID ISCHEMIC-HEART-DISEASE; TREATMENT PANEL-III; CARDIOVASCULAR RISK; PRIMARY PREVENTION; CHOLESTEROL; GUIDELINES; PREDICTION; STATINS; SCORE; RECLASSIFICATION AB BACKGROUND: US cholesterol guidelines use original and simplified versions of the Framingham model to estimate future coronary risk and thereby classify patients into risk groups with different treatment strategies. We sought to compare risk estimates and risk group classification generated by the original, complex Framingham model and the simplified, point-based version. METHODS: We assessed 2,543 subjects age 20-79 from the 2001-2006 National Health and Nutrition Examination Surveys (NHANES) for whom Adult Treatment Panel III (ATP-III) guidelines recommend formal risk stratification. For each subject, we calculated the 10-year risk of major coronary events using the original and point-based Framingham models, and then compared differences in these risk estimates and whether these differences would place subjects into different ATP-III risk groups (<10% risk, 10-20% risk. or >20% risk). Using standard procedures, all analyses were adjusted for survey weights, clustering, and stratification to make our results nationally representative. RESULTS: Among 39 million eligible adults, the original Framingham model categorized 71% of subjects as having "moderate" risk (<10% risk of a major coronary event in the next 10 years), 22% as having "moderately high" (10-20%) risk, and 7% as having "high" (>20%) risk. Estimates of coronary risk by the original and point-based models often differed substantially. The point-based system classified 15% of adults (5.7 million) into different risk groups than the original model, with 10% (3.9 million) misclassified into higher risk groups and 5% (1.8 million) into lower risk groups, for a net impact of classifying 2.1 million adults into higher risk groups. These risk group misclassifications would impact guideline-recommended drug treatment strategies for 25-46% of affected subjects. Patterns of misclassifications varied significantly by gender. age. and underlying CHD risk. CONCLUSIONS: Compared to the original Framingham model, the point-based version misclassifies millions of Americans into risk groups for which guidelines recommend different treatment strategies. C1 [Fung, Kathy Z.; Steinman, Michael A.] San Francisco VA Med Ctr, San Francisco, CA 94121 USA. [Gordon, William J.] Weill Cornell Med Coll, New York, NY USA. [Gordon, William J.; Steinman, Michael A.] Med Student Training Aging Res Program, San Francisco, CA USA. [Polansky, Jesse M.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Boscardin, W. John; Fung, Kathy Z.; Steinman, Michael A.] Univ Calif San Francisco, Div Geriatr, San Francisco, CA 94143 USA. [Boscardin, W. John] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA. RP Steinman, MA (reprint author), San Francisco VA Med Ctr, 4150 Clement St,Box 181G, San Francisco, CA 94121 USA. EM mike.steinman@ucsf.edu FU NIA NIH HHS [K23 AG030999, K23-AG030999] NR 38 TC 7 Z9 7 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 NOV PY 2010 VL 25 IS 11 BP 1145 EP 1151 DI 10.1007/s11606-010-1454-2 PG 7 WC Health Care Sciences & Services; Medicine, General & Internal SC Health Care Sciences & Services; General & Internal Medicine GA 672YN UT WOS:000283624000005 PM 20824362 ER PT J AU Gorman, G Neu, A Fivush, B Frankenfield, D Furth, S AF Gorman, Gregory Neu, Alicia Fivush, Barbara Frankenfield, Diane Furth, Susan TI Hospitalization rates and clinical performance measures in U.S. adolescent hemodialysis patients SO PEDIATRIC NEPHROLOGY LA English DT Article DE Hemodialysis; Pediatrics; Guidelines; Outcomes ID MORTALITY; TARGETS; OUTCOMES AB The Centers for Medicare and Medicaid Services' End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project monitors clinical measure attainment in pediatric hemodialysis (HD) patients. Targets include hemoglobin a parts per thousand yen11 g/dL, albumin a parts per thousand yen3.5/3.2 g/dL (bromcresol green/purple), single-pooled Kt/V a parts per thousand yen1.2, and the use of subcutaneous access. We hypothesized that the achievement of multiple targets by adolescent HD patients is associated with decreased morbidity. Data on patients aged 12-18 years included in the ESRD CPM Project from 2000 to 2004 with Medicare as primary payer were linked to the U.S. Renal Data System data from October 1, 1999 to December 31, 2004. Hospitalization rates by number of targets achieved were determined with Poisson regression analysis adjusted for dialysis vintage, short stature, and race. A total of 1534 patients with 1774 patient-years of follow-up, with 580 hospitalizations, were included in the analysis. In their first year in the ESRD CPM Project, 22% of the patients achieved four targets, with 34 and 28% achieving three and two targets, respectively. Subcutaneous access was least frequently attained target; spKt/V a parts per thousand yenaEuro parts per thousand 1.2 was the most frequently attained target. After adjustment, there was decreased hospitalization risk with increasing target attainment (incidence rate ratio 0.74, 95% confidence interval 0.67-0.80, p < 0.001). Based on this analysis, meeting adult-defined targets is associated with decreases in the hospitalization rate of adolescent HD patients. Tracking adult-defined HD measures is appropriate for assessing hospitalization risk in adolescent patients, although no evidence for a cause-and-effect relationship exists. C1 [Gorman, Gregory] Uniformed Serv Univ Hlth Sci, Dept Pediat, Bethesda, MD 20814 USA. [Gorman, Gregory] Natl Naval Med Ctr, Sect Pediat Nephrol, Walter Reed Army Med Ctr, Washington, DC USA. [Neu, Alicia; Fivush, Barbara; Furth, Susan] Johns Hopkins Med Inst, Div Pediat Nephrol, Baltimore, MD 21205 USA. [Frankenfield, Diane] Ctr Medicare & Medicaid Serv, Res & Evaluat Grp, Off Res Dev & Informat, Baltimore, MD USA. [Furth, Susan] Childrens Hosp Philadelphia, Div Nephrol, Philadelphia, PA 19104 USA. RP Gorman, G (reprint author), Uniformed Serv Univ Hlth Sci, Dept Pediat, 4301 Jones Bridge Rd, Bethesda, MD 20814 USA. EM ggorman@usuhs.mil FU National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland [R21 DK64313] FX This study was supported by grant R21 DK64313 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland. This study was presented at the American Society of Nephrology in Philadelphia, PA in October 2005 and at the American Society of Pediatric Nephrology meeting in San Francisco on April 30, 2006. NR 17 TC 3 Z9 3 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 NOV PY 2010 VL 25 IS 11 BP 2335 EP 2341 DI 10.1007/s00467-010-1597-8 PG 7 WC Pediatrics; Urology & Nephrology SC Pediatrics; Urology & Nephrology GA 648WN UT WOS:000281725200016 PM 20668886 ER PT J AU Schaefer, MK Dahl, M Perz, JF AF Schaefer, Melissa K. Dahl, Marilyn Perz, Joseph F. TI Ambulatory Surgical Centers and Infection Control Reply SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Letter C1 [Schaefer, Melissa K.; Perz, Joseph F.] Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. [Dahl, Marilyn] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Schaefer, MK (reprint author), Ctr Dis Control & Prevent, Atlanta, GA 30333 USA. EM mschaefer@cdc.gov NR 5 TC 0 Z9 0 U1 0 U2 0 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD OCT 13 PY 2010 VL 304 IS 14 BP 1557 EP 1557 DI 10.1001/jama.2010.1444 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 662OE UT WOS:000282816500018 ER PT J AU Burwen, DR Ball, R Bryan, WW Izurieta, HS La Voie, L Gibbs, NA Kliman, R Braun, MM AF Burwen, Dale R. Ball, Robert Bryan, Wilson W. Izurieta, Hector S. La Voie, Lawrence Gibbs, Neville A. Kliman, Rebecca Braun, M. Miles TI Evaluation of Guillain-Barre Syndrome Among Recipients of Influenza Vaccine in 2000 and 2001 SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID UNITED-STATES; EPIDEMIOLOGIC FEATURES; IMMUNIZATION-PROGRAM; ASSOCIATION; SURVEILLANCE; POPULATION; CRITERIA; SAFETY; SWEDEN; GREECE AB Background: The 1976-1977 swine influenza vaccine was associated with an elevated risk of Guillain-Barre Syndrome (GBS), especially within 6 weeks after vaccination. A 2004 IOM report concluded that evidence was inadequate to accept or reject a causal relationship between subsequent influenza vaccine formulations and GBS. Studies published after the IOM report have been limited by passively reported data or lack of validation of coded diagnoses. Purpose: To evaluate whether influenza vaccine is associated with GBS. Methods: Controlled observational study using national data from the Medicare program, which ensures a predominantly elderly population. People included had a Medicare claim for influenza vaccination during September-December in 2000 or 2001. Medical records were reviewed to classify definite, probable, or possible GBS (or not a case) using a standardized case definition. In a risk interval design, the incidence rate of GBS during Weeks 0-6 after vaccination (exposed period) was compared to Weeks 9-14 after vaccination (comparison period). Data collection occurred during 2003-2007, and analysis was conducted during 2007-2009. Results: Primary analysis included 22.2 million vaccinees, among whom 164 definite or probable GBS cases with onset during Weeks 0-6 or 9-14 were identified. The incidence rate ratio (IRR [95% CIs]) based on the GBS rate in the vaccine-exposed versus comparison periods, was 1.04 (0.76, 1.43) for combined years; 0.86 (0.52, 1.41) among people vaccinated in 2000; and 1.21 (0.79, 1.86) among people vaccinated in 2001. Secondary analysis additionally included 74 possible GBS cases; results were similar. Conclusions: Overall, the results do not support an association between influenza vaccine receipt and GBS among the elderly for the years studied (2000-2001 and 2001-2002 formulations). (Am J Prev Med 2010;39(4):296-304) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine C1 [Burwen, Dale R.; Ball, Robert; Izurieta, Hector S.; Braun, M. Miles] US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, Rockville, MD 20852 USA. [Bryan, Wilson W.; Gibbs, Neville A.] US FDA, Off New Drugs, Ctr Drug Evaluat & Res, Silver Spring, MD USA. [Kliman, Rebecca] Ctr Medicare, Qual Improvement Grp, Off Clin Stand & Qual, Baltimore, MD USA. [Kliman, Rebecca] Ctr Medicaid Serv, Qual Improvement Grp, Off Clin Stand & Qual, Baltimore, MD USA. [La Voie, Lawrence] Ctr Medicare, Kansas City Reg Off, Kansas City, MO USA. [La Voie, Lawrence] Ctr Medicare, Kansas City Reg Off, Kansas City, MO USA. RP Burwen, DR (reprint author), US FDA, Off Biostat & Epidemiol, Ctr Biol Evaluat & Res, 1401 Rockville Pike,HFM 222,Suite 200S, Rockville, MD 20852 USA. EM dale.burwen@fda.hhs.gov FU National Vaccine Program Office, USDHHS FX We thank Benjamin Robertson of CMS for assistance with project coordination, and Tina Khoie, MD, MPH, Azra Dobardzic, MD, MSc, PhD, and Manette Niu, MD, FDA, for contributions to data acquisition. We also thank Tamar Lasky, PhD, University of Rhode Island, and A. Marshall McBean, MD, MSc, University of Minnesota, for sharing some unpublished materials from prior studies. This work was supported in part by funding from the National Vaccine Program Office, USDHHS. NR 40 TC 19 Z9 19 U1 0 U2 2 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 OCT PY 2010 VL 39 IS 4 BP 296 EP 304 DI 10.1016/j.amepre.2010.05.022 PG 9 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 650QY UT WOS:000281867100002 PM 20837279 ER PT J AU Sachs, T Landon, B Pomposelli, F Cotterill, P O'Malley, J Schermerhorn, M AF Sachs, Teviah Landon, Bruce Pomposelli, Frank Cotterill, Philip O'Malley, James Schermerhorn, Marc TI Continued Expansion of EVAR for Intact and Ruptured Abdominal Aortic Aneurysm in the Medicare Population, 1995-2008 SO JOURNAL OF VASCULAR SURGERY LA English DT Meeting Abstract C1 [Sachs, Teviah; Pomposelli, Frank; Schermerhorn, Marc] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA. [Landon, Bruce; O'Malley, James] Harvard Univ, Sch Med, Boston, MA USA. [Cotterill, Philip] Ctr Medicare Serv, Baltimore, MD USA. [Cotterill, Philip] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 1 Z9 2 U1 0 U2 0 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD OCT PY 2010 VL 52 IS 4 BP 1115 EP 1115 DI 10.1016/j.jvs.2010.06.115 PG 1 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA 660RF UT WOS:000282660300048 ER PT J AU Landon, BE O'Malley, AJ Giles, K Cotterill, P Schermerhorn, ML AF Landon, Bruce E. O'Malley, A. James Giles, Kristina Cotterill, Philip Schermerhorn, Marc L. TI Volume-Outcome Relationships and Abdominal Aortic Aneurysm Repair SO CIRCULATION LA English DT Article DE aneurysm; peripheral vascular disease; surgery; survival ID MORTALITY; TRIAL AB Background-There is a well-established literature relating procedure volume to outcomes, but incorporating such information into clinical decision making is problematic when there is >1 treatment option for a condition. Methods and Results-We used data from the Medicare program to investigate the relationship between institutional volume for open and endovascular abdominal aortic aneurysm (AAA) repair and outcomes, examine trends in volume, and explore the implications for physicians making referrals for AAA repair. Trends in institutional volume were measured for the time period 2001-2006, whereas outcomes were assessed with the use of a previously assembled propensity score-matched cohort covering the time period 2001-2004. Between 2001 and 2006, there were a total of 230 736 repairs of either an intact or ruptured AAA for traditional Medicare beneficiaries. During this time, the proportion of endovascular cases increased from approximate to 22% in 2001 to >50% of AAA repairs in 2006, but there was little shift in procedure volume to high-volume institutions. For endovascular repair, adjusted mortality by quintile showed a marked decrease between the first and second quintile, with continued smaller decreases over quintiles 3 to 5. For open repair, adjusted mortality showed a steady decrease across the quintiles of volume. Conclusions-We found a steady increase in survival with increasing volume of open repair but relatively little improvement after reaching a relatively low threshold for endovascular repair. Because hospital experience with one repair method does not translate into improved outcomes for the alternative method, referring clinicians must consider both treatment options when making referral decisions. (Circulation. 2010;122:1290-1297.) C1 [Landon, Bruce E.; O'Malley, A. James] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02215 USA. [Landon, Bruce E.] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA. [Giles, Kristina; Schermerhorn, Marc L.] Beth Israel Deaconess Med Ctr, Dept Surg, Boston, MA 02215 USA. [Cotterill, Philip] Ctr Medicare Serv, Baltimore, MD USA. [Cotterill, Philip] Ctr Medicaid Serv, Baltimore, MD USA. RP Landon, BE (reprint author), Harvard Univ, Sch Med, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02215 USA. EM landon@hcp.med.harvard.edu FU National Heart, Lung, and Blood Institute [5 T32 HL007734] FX The work of Dr Giles is funded by a training grant from the National Heart, Lung, and Blood Institute (5 T32 HL007734). NR 15 TC 27 Z9 28 U1 1 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 28 PY 2010 VL 122 IS 13 BP 1290 EP 1297 DI 10.1161/CIRCULATIONAHA.110.949172 PG 8 WC Cardiac & Cardiovascular Systems; Peripheral Vascular Disease SC Cardiovascular System & Cardiology GA 655FJ UT WOS:000282232300016 PM 20837892 ER PT J AU Ayello, EA Levine, JM Roberson, S AF Ayello, Elizabeth A. Levine, Jeffrey M. Roberson, Sharon TI CMS Updates on MDS 3.0 Section M: Skin Conditions-Change in Coding of Blister Pressure Ulcers SO ADVANCES IN SKIN & WOUND CARE LA English DT Article C1 [Ayello, Elizabeth A.] Excelsior Coll, Sch Nursing, Albany, NY USA. [Levine, Jeffrey M.] Beth Israel Deaconess Med Ctr, Wound Care Ctr, New York, NY 10003 USA. [Roberson, Sharon] Ctr Medicare & Medicaid Serv, Boston, MA USA. RP Ayello, EA (reprint author), Excelsior Coll, Sch Nursing, Albany, NY USA. NR 2 TC 4 Z9 4 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1527-7941 J9 ADV SKIN WOUND CARE JI Adv. Skin Wound Care PD SEP PY 2010 VL 23 IS 9 BP 394 EP 397 DI 10.1097/01.ASW.0000383214.03535.6a PG 3 WC Dermatology; Nursing; Surgery SC Dermatology; Nursing; Surgery GA 832YW UT WOS:000295847900002 PM 20729643 ER PT J AU Bernheim, SM Grady, JN Lin, ZQ Wang, Y Wang, YF Savage, SV Bhat, KR Ross, JS Desai, MM Merrill, AR Han, LF Rapp, MT Drye, EE Normand, SLT Krumholz, HM AF Bernheim, Susannah M. Grady, Jacqueline N. Lin, Zhenqiu Wang, Yun Wang, Yongfei Savage, Shantal V. Bhat, Kanchana R. Ross, Joseph S. Desai, Mayur M. Merrill, Angela R. Han, Lein F. Rapp, Michael T. Drye, Elizabeth E. Normand, Sharon-Lise T. Krumholz, Harlan M. TI National Patterns of Risk-Standardized Mortality and Readmission for Acute Myocardial Infarction and Heart Failure Update on Publicly Reported Outcomes Measures Based on the 2010 Release SO CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES LA English DT Article DE mortality; myocardial infarction; heart failure; performance measurement; readmission ID PROFILING HOSPITAL PERFORMANCE; RATES; TRIAL; CARE AB Background-Patient outcomes provide a critical perspective on quality of care. The Centers for Medicare and Medicaid Services (CMS) is publicly reporting hospital 30-day risk-standardized mortality rates (RSMRs) and risk-standardized readmission rates (RSRRs) for patients hospitalized with acute myocardial infarction (AMI) and heart failure (HF). We provide a national perspective on hospital performance for the 2010 release of these measures. Methods and Results-The hospital RSMRs and RSRRs are calculated from Medicare claims data for fee-for-service Medicare beneficiaries, 65 years or older, hospitalized with AMI or HF between July 1, 2006, and June 30, 2009. The rates are calculated using hierarchical logistic modeling to account for patient clustering, and are risk-adjusted for age, sex, and patient comorbidities. The median RSMR for AMI was 16.0% and for HF was 10.8%. Both measures had a wide range of hospital performance with an absolute 5.2% difference between hospitals in the 5th versus 95th percentile for AMI and 5.0% for HF. The median RSRR for AMI was 19.9% and for HF was 24.5% (3.9% range for 5th to 95th percentile for AMI, 6.7% for HF). Distinct regional patterns were evident for both measures and both conditions. Conclusions-High RSRRs persist for AMI and HF and clinically meaningful variation exists for RSMRs and RSRRs for both conditions. Our results suggest continued opportunities for improvement in patient outcomes for HF and AMI. (Circ Cardiovasc Qual Outcomes. 2010; 3:459-467.) C1 [Bernheim, Susannah M.; Grady, Jacqueline N.; Lin, Zhenqiu; Wang, Yun; Wang, Yongfei; Savage, Shantal V.; Bhat, Kanchana R.; Desai, Mayur M.; Drye, Elizabeth E.; Krumholz, Harlan M.] Yale New Haven Hlth Serv Corp, Ctr Outcomes Res & Evaluat, New Haven, CT USA. [Desai, Mayur M.] Yale Univ, Sch Publ Hlth, Sect Chron Dis Epidemiol, New Haven, CT USA. [Wang, Yun; Wang, Yongfei; Drye, Elizabeth E.; Krumholz, Harlan M.] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT USA. [Krumholz, Harlan M.] Robert Wood Johnson Clin Scholars Program, New Haven, CT USA. [Ross, Joseph S.] Mt Sinai Sch Med, Dept Geriatr, New York, NY USA. [Ross, Joseph S.] Mt Sinai Sch Med, Dept Adult Dev & Med, New York, NY USA. [Ross, Joseph S.] James J Peters Vet Adm Med Ctr, HSR&D Targeted Res Enhancement Program, Bronx, NY USA. [Ross, Joseph S.] James J Peters Vet Adm Med Ctr, Geriatr Res Educ & Clin Ctr, Bronx, NY USA. [Merrill, Angela R.] Math Policy Res Inc, Cambridge, MA USA. [Han, Lein F.; Rapp, Michael T.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Rapp, Michael T.] George Washington Univ, Sch Med & Hlth Sci, Sect Emergency Med, Washington, DC 20052 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. RP Bernheim, SM (reprint author), Yale YNHH Ctr Outcomes Res & Evaluat, 1 Church St,Suite 200, New Haven, CT 06510 USA. EM susannah.bernheim@yale.edu FU CMS, Department of Health and Human Services [HHSM-500-2008-0025I (0001), HHSM-500-2008-00020I (0001)]; National Institute on Aging [K08 AG032886]; American Federation of Aging Research; CMS FX The analyses on which this publication is based were performed under Contract No. HHSM-500-2008-0025I (0001), entitled "Measure and Instrument Development and Support (MIDS)-Development and Re-evaluation of the CMS Hospital Outcomes and Efficiency Measures," and HHSM-500-2008-00020I (0001), entitled " Production and Implementation of Hospital Outcome and Efficiency Measures" funded by the CMS, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services. The authors assume full responsibility for the accuracy and completeness of the ideas presented. Dr Ross is currently supported by the National Institute on Aging (K08 AG032886) and by the American Federation of Aging Research through the Paul B. Beeson Career Development Award.; Dr Bernheim, Jacqueline Grady, Zhenqiu Lin, Yun Wang, Yongfei Wang, Shantal V. Savage, Kanchana R. Bhat, Elizabeth Drye, and Harlan Krumholz all work under contract with CMS to develop and maintain performance measures. Dr Merrill works under contract with CMS to produce and implement the outcomes measures. Dr Han and Dr Rapp are employed by CMS. NR 17 TC 98 Z9 99 U1 1 U2 11 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1941-7713 J9 CIRC-CARDIOVASC QUAL JI Circ.-Cardiovasc. Qual. Outcomes PD SEP PY 2010 VL 3 IS 5 BP 459 EP 467 DI 10.1161/CIRCOUTCOMES.110.957613 PG 9 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 680UW UT WOS:000284262100006 PM 20736442 ER PT J AU Suh, DC Powers, CA Barone, JA Shin, H Kwon, J Goodin, S AF Suh, Dong-Churl Powers, Christopher A. Barone, Joseph A. Shin, HyunChul Kwon, Jinweon Goodin, Susan TI Full costs of dispensing and administering fluorouracil chemotherapy for outpatients: A microcosting study SO RESEARCH IN SOCIAL & ADMINISTRATIVE PHARMACY LA English DT Article DE Chemotherapy cost; Chemotherapy administration; Time-and-motion study; Microcosting method; Pharmacy dispensing cost AB Background: Although full costs (including direct and indirect costs) that incurred during the process of chemotherapy administration should be measured, many studies estimate only direct labor and medication costs associated with various chemotherapy delivery systems. Objectives: To estimate the total costs for dispensing and administration of fluorouracil when administered with leucovorin, by intravenous infusion or bolus, using a microcosting approach from the perspective of a provider or health system. Methods: A time-and-motion study was used to measure the time spent by (1) pharmacy staff in the handling, admixture, and dispensing of fluorouracil and (2) patients in the clinic. The study was performed at The Cancer Institute of New Jersey for an 8-month period. Costs of dispensing and administering fluorouracil were calculated per patient visit on the basis of resources used in the processing of fluorouracil and time spent by pharmacy staff and patient. All costs were standardized to 2005 dollars. Results: A total of 275 observations were made, and 74 (26.9%) of these were associated with fluorouracil-based chemotherapy. Pharmacy staff spent an average of 11 minutes for bolus fluorouracil with leucovorin infusion (fluorouracil/LCV-IV) and 8 minutes for bolus fluorouracil with bolus leucovorin (fluorouracil/LCV-B). Patients who received fluorouracil/LCV-IV spent an average of 203 minutes in the clinic, whereas patients who received fluorouracil/LCV-B spent 110 minutes. The average cost of administering fluorouracil/LCV-IV was $933, which comprised drug costs ($279), dispensing costs ($189), and administration costs ($465). The average cost of fluorouracil/LCV-B was $474, which comprised drug costs ($65), dispensing costs ($141), and administration costs ($268). Conclusions: This is the first study to formally demonstrate the high cost of administering the injectable form of fluorouracil chemotherapy with leucovorin, despite relatively low drug acquisition cost. Therefore, reimbursement rates for fluorouracil should be calculated in such a way that covers all costs, including overhead costs for the department. (C) 2010 Elsevier Inc. All rights reserved. C1 [Suh, Dong-Churl; Barone, Joseph A.; Shin, HyunChul; Kwon, Jinweon; Goodin, Susan] Rutgers State Univ, Ernest Mario Sch Pharm, Piscataway, NJ 08854 USA. [Suh, Dong-Churl; Goodin, Susan] Canc Inst New Jersey, New Brunswick, NJ USA. [Powers, Christopher A.] US Dept HHS, Ctr Medicare Serv, Baltimore, MD 21244 USA. [Powers, Christopher A.] US Dept HHS, Ctr Medicaid Serv, Baltimore, MD 21244 USA. [Shin, HyunChul] Korea Hlth Insurance Review Agcy, Seoul 137927, South Korea. [Goodin, Susan] Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Med, Div Med Oncol, New Brunswick, NJ 08901 USA. RP Suh, DC (reprint author), Rutgers State Univ, Ernest Mario Sch Pharm, Piscataway, NJ 08854 USA. EM dsuh@rci.rutgers.edu FU NCI NIH HHS [P30 CA072720, P30 CA72720-01-03, R03 CA133902, R03 CA121391] NR 39 TC 2 Z9 2 U1 0 U2 2 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 1551-7411 J9 RES SOC ADMIN PHARM JI Res. Soc. Adm. Pharm. PD SEP PY 2010 VL 6 IS 3 BP 246 EP 256 DI 10.1016/j.sapharm.2009.07.004 PG 11 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA V29HG UT WOS:000208738900008 PM 20813337 ER PT J AU Menis, M Burwen, DR Izurieta, H Anderson, SA Sholley, C Erten, T Holness, LG MaCurdy, T Kelman, J Ball, R AF Menis, M. Burwen, D. R. Izurieta, H. Anderson, S. A. Sholley, C. Erten, T. Holness, L. G. MaCurdy, T. Kelman, J. Ball, R. TI Outpatient Transfusions and Occurrence of Transfusion-Related Acute Lung Injury (TRALI) Among US Elderly, 2007-2008 SO TRANSFUSION LA English DT Meeting Abstract CT AABB Annual Meeting 2010 CY OCT 09-12, 2010 CL Baltimore, MD SP AABB C1 [Menis, M.; Burwen, D. R.; Izurieta, H.; Anderson, S. A.; Ball, R.] US FDA, CBER OBE, Rockville, MD 20857 USA. [Sholley, C.; Erten, T.; MaCurdy, T.] Acumen LLC, Burlingame, CA USA. [Holness, L. G.] US FDA, CBER OBRR, Rockville, MD 20857 USA. [Kelman, J.] Ctr Medicare, Baltimore, MD USA. [Kelman, J.] Ctr Medicaid Serv, Baltimore, MD USA. EM mikhail.menis@fda.hhs.gov 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 0041-1132 J9 TRANSFUSION JI Transfusion PD SEP PY 2010 VL 50 SU 2 BP 135A EP 135A PG 1 WC Hematology SC Hematology GA 649JM UT WOS:000281764900336 ER PT J AU Blumenthal, D Tavenner, M AF Blumenthal, David Tavenner, Marilyn TI The "Meaningful Use" Regulation for Electronic Health Records SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Blumenthal, David] US Dept HHS, Washington, DC 20201 USA. [Tavenner, Marilyn] Ctr Medicare & Medicaid Serv, Washington, DC USA. RP Blumenthal, D (reprint author), US Dept HHS, Washington, DC 20201 USA. NR 0 TC 795 Z9 801 U1 8 U2 66 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 5 PY 2010 VL 363 IS 6 BP 501 EP 504 DI 10.1056/NEJMp1006114 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 634BB UT WOS:000280552700001 PM 20647183 ER PT J AU Burwen, D Sandhu, S MaCurdy, T Kelman, J Gibbs, J Garcia, B Markatou, M Forshee, R Gullet, R Izurieta, H Worrall, C Ball, R AF Burwen, D. Sandhu, S. MaCurdy, T. Kelman, J. Gibbs, J. Garcia, B. Markatou, M. Forshee, R. Gullet, R. Izurieta, H. Worrall, C. Ball, R. TI Surveillance for Guillain-Barre Syndrome after Influenza Vaccination among the Medicare Population, 2009-2010 SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Burwen, D.; Sandhu, S.; Markatou, M.; Forshee, R.; Izurieta, H.; Ball, R.] US FDA, Rockville, MD 20857 USA. [MaCurdy, T.; Gibbs, J.; Garcia, B.; Gullet, R.] Acumen LLC, Burlingame, CA USA. [Kelman, J.; Worrall, C.] Ctr Medicare & Medicaid Serv CMS, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 1053-8569 EI 1099-1557 J9 PHARMACOEPIDEM DR S JI Pharmacoepidemiol. Drug Saf. PD AUG PY 2010 VL 19 SU 1 MA 34 BP S15 EP S15 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA V45OP UT WOS:000209826200034 ER PT J AU Graham, DJ Ouellet-Hellstrom, R MaCurdy, TE Ali, F Sholley, C Worrall, C Kelman, JA AF Graham, David J. Ouellet-Hellstrom, Rita MaCurdy, Thomas E. Ali, Farzana Sholley, Christopher Worrall, Christopher Kelman, Jeffrey A. TI Risk of Acute Myocardial Infarction, Stroke, Heart Failure, and Death in Elderly Medicare Patients Treated With Rosiglitazone or Pioglitazone SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID POSITIVE PREDICTIVE-VALUE; CARDIOVASCULAR OUTCOMES; ADMINISTRATIVE DATA; CODING ACCURACY; UNITED-STATES; DATABASE; DISEASE; EVENTS; COHORT; THIAZOLIDINEDIONES AB Context Studies have suggested that the use of rosiglitazone may be associated with an increased risk of serious cardiovascular events compared with other treatments for type 2 diabetes. Objective To determine if the risk of serious cardiovascular harm is increased by rosiglitazone compared with pioglitazone, the other thiazolidinedione marketed in the United States. Design, Setting, and Patients Nationwide, observational, retrospective, inception cohort of 227 571 Medicare beneficiaries aged 65 years or older (mean age, 74.4 years) who initiated treatment with rosiglitazone or pioglitazone through a Medicare Part D prescription drug plan from July 2006-June 2009 and who underwent follow-up for up to 3 years after thiazolidinedione initiation. Main Outcome Measures Individual end points of acute myocardial infarction (AMI), stroke, heart failure, and all-cause mortality (death), and composite end point of AMI, stroke, heart failure, or death, assessed using incidence rates by thiazolidinedione, attributable risk, number needed to harm, Kaplan-Meier plots of time to event, and Cox proportional hazard ratios for time to event, adjusted for potential confounding factors, with pioglitazone as reference. Results A total of 8667 end points were observed during the study period. The adjusted hazard ratio for rosiglitazone compared with pioglitazone was 1.06 (95% confidence interval [CI], 0.96-1.18) for AMI; 1.27 (95% CI, 1.12-1.45) for stroke; 1.25 (95% CI, 1.16-1.34) for heart failure; 1.14 (95% CI, 1.05-1.24) for death; and 1.18 (95% CI, 1.12-1.23) for the composite of AMI, stroke, heart failure, or death. The attributable risk for this composite end point was 1.68 (95% CI, 1.27-2.08) excess events per 100 person-years of treatment with rosiglitazone compared with pioglitazone. The corresponding number needed to harm was 60 (95% CI, 48-79) treated for 1 year. Conclusion Compared with prescription of pioglitazone, prescription of rosiglitazone was associated with an increased risk of stroke, heart failure, and all-cause mortality and an increased risk of the composite of AMI, stroke, heart failure, or all-cause mortality in patients 65 years or older. JAMA. 2010;304(4):411-418 www.jama.com C1 [Graham, David J.; Ouellet-Hellstrom, Rita] US FDA, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, Silver Spring, MD 20993 USA. [MaCurdy, Thomas E.] Stanford Univ, Stanford, CA 94305 USA. [MaCurdy, Thomas E.; Ali, Farzana; Sholley, Christopher] Acumen LLC, Burlingame, CA USA. [Worrall, Christopher; Kelman, Jeffrey A.] Ctr Medicare Serv, Washington, DC USA. [Worrall, Christopher; Kelman, Jeffrey A.] Ctr Medicaid Serv, Washington, DC USA. RP Graham, DJ (reprint author), US FDA, Off Surveillance & Epidemiol, Ctr Drug Evaluat & Res, 10903 New Hampshire Ave,Bldg 22,Room 4314, Silver Spring, MD 20993 USA. EM david.graham1@fda.hhs.gov FU Office of the Assistant Secretary for Planning and Evaluation (ASPE); Centers for Medicare & Medicaid Services (CMS); US Food and Drug Administration (FDA); Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services FX This study was funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), the Centers for Medicare & Medicaid Services (CMS), and the US Food and Drug Administration (FDA).; We thank the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services for scientific contributions and financial support of this study and the SafeRx Project. We also extend special thanks to Mark Levenson, PhD, and Stephine Keeton, PhD (both with the FDA Office of Biostatistics), for providing statistical advice and to Pallavi Mukherji, MSc, Richard Domurat, BS, Jonathan Gibbs, BA, and Konrad Turski, MSc ( all with Acumen LLC), for assistance with programming and data analysis. These individuals are salaried employees of their respective organizations and received no additional compensation related to their contributions to this study. NR 39 TC 271 Z9 286 U1 0 U2 11 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUL 28 PY 2010 VL 304 IS 4 BP 411 EP 418 DI 10.1001/jama.2010.920 PG 8 WC Medicine, General & Internal SC General & Internal Medicine GA 631MA UT WOS:000280350100024 PM 20584880 ER PT J AU Sheikh, K AF Sheikh, Kazim TI Statins and risk of incident diabetes SO LANCET LA English DT Letter C1 [Sheikh, Kazim] US Dept HHS, Ctr Medicare, Kansas City, MO 64106 USA. [Sheikh, Kazim] US Dept HHS, Ctr Medicaid Serv, Kansas City, MO 64106 USA. RP Sheikh, K (reprint author), US Dept HHS, Ctr Medicare, Kansas City, MO 64106 USA. EM kazim.sheikh@cms.hhs.gov NR 1 TC 2 Z9 2 U1 0 U2 0 PU ELSEVIER SCIENCE INC PI NEW YORK PA 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA SN 0140-6736 J9 LANCET JI Lancet PD JUN 19 PY 2010 VL 375 IS 9732 BP 2139 EP 2140 DI 10.1016/S0140-6736(10)60987-7 PG 2 WC Medicine, General & Internal SC General & Internal Medicine GA 617BF UT WOS:000279255100015 PM 20609943 ER PT J AU Schaefer, MK Jhung, M Dahl, M Schillie, S Simpson, C Llata, E Link-Gelles, R Sinkowitz-Cochran, R Patel, P Bolyard, E Sehulster, L Srinivasan, A Perz, JF AF Schaefer, Melissa K. Jhung, Michael Dahl, Marilyn Schillie, Sarah Simpson, Crystal Llata, Eloisa Link-Gelles, Ruth Sinkowitz-Cochran, Ronda Patel, Priti Bolyard, Elizabeth Sehulster, Lynne Srinivasan, Arjun Perz, Joseph F. TI Infection Control Assessment of Ambulatory Surgical Centers SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID HEPATITIS-C VIRUS; BLOOD-STREAM INFECTIONS; B VIRUS; OUTBREAK; CONTAMINATION; TRANSMISSION AB Context More than 5000 ambulatory surgical centers (ASCs) in the United States participate in the Medicare program. Little is known about infection control practices in ASCs. The Centers for Medicare & Medicaid Services (CMS) piloted an infection control audit tool in a sample of ASC inspections to assess facility adherence to recommended practices. Objective To describe infection control practices in a sample of ASCs. Design, Setting, and Participants All State Survey Agencies were invited to participate. Seven states volunteered; 3 were selected based on geographic dispersion, number of ASCs each state committed to inspect, and relative cost per inspection. A stratified random sample of ASCs was selected from each state. Sample size was based on the number of inspections each state estimated it could complete between June and October 2008. Sixty-eight ASCs were assessed; 32 in Maryland, 16 in North Carolina, and 20 in Oklahoma. Surveyors from CMS, trained in use of the audit tool, assessed compliance with specific infection control practices. Assessments focused on 5 areas of infection control: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment. Main Outcome Measures Proportion of facilities with lapses in each infection control category. Results Overall, 46 of 68 ASCs (67.6%; 95% confidence interval [CI], 55.9%-77.9%) had at least 1 lapse in infection control; 12 of 68 ASCs (17.6%; 95% CI, 9.9%-28.1%) had lapses identified in 3 or more of the 5 infection control categories. Common lapses included using single-dose medication vials for more than 1 patient (18/64; 28.1%; 95% CI, 18.2%-40.0%), failing to adhere to recommended practices regarding reprocessing of equipment (19/67; 28.4%; 95% CI, 18.6%-40.0%), and lapses in handling of blood glucose monitoring equipment (25/54; 46.3%; 95% CI, 33.4%-59.6%). Conclusion Among a sample of US ASCs in 3 states, lapses in infection control were common. JAMA. 2010; 303(22): 2273-2279 C1 [Schaefer, Melissa K.; Jhung, Michael; Schillie, Sarah; Llata, Eloisa; Link-Gelles, Ruth; Sinkowitz-Cochran, Ronda; Patel, Priti; Bolyard, Elizabeth; Sehulster, Lynne; Srinivasan, Arjun; Perz, Joseph F.] Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Emerging & Zoonot Infect Dis Proposed, Atlanta, GA 30333 USA. [Schaefer, Melissa K.; Schillie, Sarah; Llata, Eloisa] Ctr Dis Control & Prevent, Epidem Intelligence Serv, Off Workforce Career Dev, Atlanta, GA 30333 USA. [Dahl, Marilyn; Simpson, Crystal] Ctr Medicare & Medicaid Serv, Ctr Medicaid & State Operat, Survey & Certificat Grp, Baltimore, MD USA. RP Schaefer, MK (reprint author), Ctr Dis Control & Prevent, Div Healthcare Qual Promot, Natl Ctr Emerging & Zoonot Infect Dis Proposed, 1600 Clifton Rd NE,Mailstop A-31, Atlanta, GA 30333 USA. EM mschaefer@cdc.gov FU Centers for Medicare & Medicaid Services FX Funding for the pilot ASC inspections was provided by the Centers for Medicare & Medicaid Services. NR 25 TC 46 Z9 46 U1 0 U2 3 PU AMER MEDICAL ASSOC PI CHICAGO PA 330 N WABASH AVE, STE 39300, CHICAGO, IL 60611-5885 USA SN 0098-7484 EI 1538-3598 J9 JAMA-J AM MED ASSOC JI JAMA-J. Am. Med. Assoc. PD JUN 9 PY 2010 VL 303 IS 22 BP 2273 EP 2279 DI 10.1001/jama.2010.744 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 607IY UT WOS:000278496800026 PM 20530781 ER PT J AU Levine, JM Roberson, S Ayello, EA AF Levine, Jeffrey M. Roberson, Sharon Ayello, Elizabeth A. TI Essentials of MDS 3.0 Section M: Skin Conditions SO ADVANCES IN SKIN & WOUND CARE LA English DT Article AB PURPOSE: To provide information about the impending changes in the Minimum Data Set (MDS) Section M on skin conditions and its implications for practice. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Compare section M of MDS version 2.0 to MDS version 3.0. 2. Apply the complexities of the MDS 3.0 section M for coding. 3. Demonstrate accurate and complete documentation of wounds as per MDS 3.0 section M. C1 [Levine, Jeffrey M.] St Vincents Hosp, Wound Care Ctr, New York, NY USA. [Roberson, Sharon] Ctr Medicare Serv, Boston, MA USA. [Roberson, Sharon] Ctr Medicaid Serv, Boston, MA USA. [Ayello, Elizabeth A.] Excelsior Coll, Sch Nursing, Albany, NY USA. RP Levine, JM (reprint author), St Vincents Hosp, Wound Care Ctr, New York, NY USA. FU Agency for Healthcare Research and Quality; Boston University FX Dr Levine has disclosed that he has no significant relationships with or financial interest regarding this educational activity. MsRoberson has disclosed that she has no significant relationships with or financial interest regarding this educational activity. Dr Ayello has disclosed that she is/was a recipient of grant/research funding from the Agency for Healthcare Research and Quality and Boston University; is/was a consultant advisor to KCI, Coloplast, Molnlycke, Hill-Rom, and Medline; was a consultant/advisor to Baxter; is a consultant/advisor to Gaymar; is/was a member of the speaker's bureau for 3M, Smith & Nephew, Healthpoint, Hill-Rom, MEDLINE, and Coloplast; is a member of the speaker's bureau for Huntleigh and PharAmerica; other: New Jersey Hospital Association; was the developer of the educational slides and presenter for Centers for Medicare & Medicaid Services (CMS) on Section M Skin Conditions for CMS Train the Trainer Programs on MDS 3.0. Acknowledgment: Drs Levine and Ayello recently published a book on pressure ulcer identification that includes some of the information presented in this article. NR 11 TC 8 Z9 8 U1 0 U2 0 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1527-7941 J9 ADV SKIN WOUND CARE JI Adv. Skin Wound Care PD JUN PY 2010 VL 23 IS 6 BP 273 EP 284 DI 10.1097/01.ASW.0000363555.60973.bc PG 12 WC Dermatology; Nursing; Surgery SC Dermatology; Nursing; Surgery GA 832YQ UT WOS:000295847200005 PM 20489382 ER PT J AU Rudolph, NV Montgomery, MA AF Rudolph, Noemi V. Montgomery, Melissa A. TI Low-Income Medicare Beneficiaries and their Experiences with the Part D Prescription Drug Benefit SO INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING LA English DT Article ID KNOWLEDGE; PROGRAM AB This study seeks to understand how much beneficiaries knew about the Medicare prescription drug benefit (Part D) and low-income subsidy (US) programs and what their experiences were with the programs. Part D enrollees who automatically qualified for the US were less likely to report awareness that they could switch among different plans, had lower knowledge scores, and were more likely to have medications not covered by the plan compared to beneficiaries who applied for the US and others who enrolled in Part D but did not receive the US. Communication efforts to the US population, particularly for beneficiaries deemed automatically eligible for the US, need to continually make them aware of their benefits and protections in Part D. C1 [Rudolph, Noemi V.; Montgomery, Melissa A.] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Rudolph, NV (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Mail Stop C3-21-28,7500 Security Blvd, Baltimore, MD 21244 USA. EM Noemi.Rudolph@cms.hhs.gov NR 11 TC 3 Z9 3 U1 0 U2 4 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 SUM PY 2010 VL 47 IS 2 BP 162 EP 172 DI 10.5034/inquiryjrnl_47.02.162 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 637ZD UT WOS:000280857000007 PM 20812464 ER PT J AU Sachs, T Landon, B Pomposelli, F Cotterill, P O'Malley, J Schermerhorn, ML AF Sachs, Teviah Landon, Bruce Pomposelli, Frank Cotterill, Philip O'Malley, James Schermerhorn, Marc L. TI Continued Expansion of EVAR for Intact and Ruptured Abdominal Aortic Aneurysm in the Medicare Population 1995-2008 SO JOURNAL OF VASCULAR SURGERY LA English DT Meeting Abstract CT Vascular Annual Meeting/Society-for-Vascular Surgery CY JUN 10-13, 2010 CL Boston, MA SP Soc Vasc Surg C1 [Sachs, Teviah; Pomposelli, Frank; Schermerhorn, Marc L.] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA. [Landon, Bruce; O'Malley, James] Harvard Univ, Sch Med, Dept Hlth Policy, Boston, MA 02115 USA. [Cotterill, Philip] Ctr Medicare, Baltimore, MD USA. [Cotterill, Philip] Ctr Medicaid Serv, Baltimore, MD USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU MOSBY-ELSEVIER PI NEW YORK PA 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA SN 0741-5214 J9 J VASC SURG JI J. Vasc. Surg. PD JUN PY 2010 VL 51 SU S BP 22S EP 23S PG 2 WC Surgery; Peripheral Vascular Disease SC Surgery; Cardiovascular System & Cardiology GA 601EA UT WOS:000278039700044 ER PT J AU Roberson, S Ayello, EA Levine, J AF Roberson, Sharon Ayello, Elizabeth A. Levine, Jeffrey TI Clarification of Pressure Ulcer Staging in Long-term Care under MDS 2.0 SO ADVANCES IN SKIN & WOUND CARE LA English DT Article C1 [Roberson, Sharon] NE Consortia, Ctr Medicare, Boston, MA USA. [Roberson, Sharon] NE Consortia, Ctr Medicaid Serv, Boston, MA USA. [Ayello, Elizabeth A.] Excelsior Coll, Sch Nursing, Albany, NY USA. [Levine, Jeffrey] St Vincents Hosp Wound Care Ctr, New York, NY USA. RP Roberson, S (reprint author), NE Consortia, Ctr Medicare, Boston, MA USA. NR 12 TC 3 Z9 3 U1 1 U2 1 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1527-7941 J9 ADV SKIN WOUND CARE JI Adv. Skin Wound Care PD MAY PY 2010 VL 23 IS 5 BP 206 EP 210 DI 10.1097/01.ASW.0000363539.21070.7a PG 4 WC Dermatology; Nursing; Surgery SC Dermatology; Nursing; Surgery GA 832YO UT WOS:000295847000002 PM 20407294 ER PT J AU Frankenfield, DL Wei, II Anderson, KK Howell, BL Waldo, D Sekscenski, E AF Frankenfield, Diane L. Wei, Iris I. Anderson, Karyn K. Howell, Benjamin L. Waldo, Daniel Sekscenski, Edward TI Prescription Medication Cost-Related Non-adherence among Medicare CAHPS Respondents: Disparity by Hispanic Ethnicity SO JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED LA English DT Article DE Disparities; Hispanic; ethnicity; race; minority; cost-related non-adherence; Medicare ID OLDER MEXICAN-AMERICANS; OF-THE-LITERATURE; HEALTH-INSURANCE-COVERAGE; SPANISH-SPEAKING PATIENTS; UNITED-STATES; PART-D; DRUG COVERAGE; RACIAL/ETHNIC DISPARITIES; EMERGENCY-DEPARTMENT; LANGUAGE BARRIERS AB Purpose. We examined whether there was disparity in prescription medication cost-related non-adherence (CRN) by Hispanic ethnicity among Medicare enrollees. Methods. Multivariate logistic regression, adjusting for race, other socio-demographic variables, health status, health care utilization, and patient rating of their personal physician, was used to examine association of Hispanic ethnicity with CRN using cross-sectional data from Medicare's Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey (data collected in Spring 2007). Results. Hispanic respondents constituted 6.9% (unweighted n=22,304) of the analytic sample (unweighted n=272,701; response rate = 48%). Overall, 13.4% of respondents reported CRN; among Hispanics and non-Hispanics, 20.3% and 12.9% reported CRN, respectively, p<.0001. Adjusted odds ratio (95% CI) of reporting CRN in the past six months was 1.18 (1.08, 1.29) for Hispanic compared with non-Hispanic respondents. Conclusions. Hispanic ethnicity was significantly associated with CRN. More research is needed to understand interventions to eliminate the disparity for this minority group. C1 [Frankenfield, Diane L.] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. [Howell, Benjamin L.] Ctr Medicare & Medicaid Serv, Hlth Serv Researcher, Baltimore, MD 21244 USA. [Sekscenski, Edward] Ctr Medicare & Medicaid Serv, Div Consumer Assessment Healthcare Surveys, Baltimore, MD 21244 USA. RP Frankenfield, DL (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, 7500 Secur Blvd,Mailstop C3-21-28, Baltimore, MD 21244 USA. EM diane.frankenfield@cms.hhs.gov NR 134 TC 11 Z9 11 U1 7 U2 11 PU JOHNS HOPKINS UNIV PRESS PI BALTIMORE PA JOURNALS PUBLISHING DIVISION, 2715 NORTH CHARLES ST, BALTIMORE, MD 21218-4363 USA SN 1049-2089 J9 J HEALTH CARE POOR U JI J. Health Care Poor Underserved PD MAY PY 2010 VL 21 IS 2 BP 518 EP 543 PG 26 WC Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 594GC UT WOS:000277523200010 PM 20453354 ER PT J AU Polinski, JM Bhandari, A Saya, UY Schneeweiss, S Shrank, WH AF Polinski, Jennifer M. Bhandari, Aman Saya, Uzaib Y. Schneeweiss, Sebastian Shrank, William H. TI Medicare Beneficiaries' Knowledge of and Choices Regarding Part D, 2005 to the Present SO JOURNAL OF THE AMERICAN GERIATRICS SOCIETY LA English DT Article DE Medicare Part D; systematic review; choice; knowledge ID PRESCRIPTION DRUG BENEFIT; OLDER-ADULTS; D ENROLLMENT; COVERAGE; INFORMATION; SAVINGS AB In the months before and years since Medicare Part D's implementation in January 2006, many have been concerned with beneficiaries' ability to benefit from the complex program. A systematic review of published Medline and gray literature from January 1, 2005, to August 20, 2009, was undertaken to evaluate Medicare beneficiaries' knowledge about Part D and how this knowledge informed decisions regarding enrollment and plan choice. Thirty articles that reported original results describing seniors' knowledge of the Part D benefit, decision to enroll, or selection of plans; results from patient surveys addressing these issues; or results that analyzed enrollment data or plan selection patterns were included. Of these 30 articles, 10 described beneficiaries' knowledge, 12 described enrollment and plan choices, and eight described knowledge and choice. Across studies and years, beneficiaries' knowledge of the Part D program and benefit structure and design was poor, particularly with regard to the coverage gap and the low-income subsidy. Beneficiaries had great difficulty choosing the lowest-cost Part D plans and were disinclined to switch plans to improve their benefits. Knowledge deficits, enrollment problems, and plan choice difficulties were most pronounced during Part D implementation in early 2006 but persisted in subsequent years of the benefit. Beneficiaries' knowledge and choices should be monitored on an ongoing basis to inform potential changes to the Part D program. C1 [Polinski, Jennifer M.; Saya, Uzaib Y.; Schneeweiss, Sebastian; Shrank, William H.] Brigham & Womens Hosp, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02120 USA. [Bhandari, Aman] US Dept HHS, Div Res Hlth Plans & Drugs, Res & Evaluat Grp, Off Res Dev & Informat,Ctr Medicare, Baltimore, MD USA. [Bhandari, Aman] US Dept HHS, Div Res Hlth Plans & Drugs, Res & Evaluat Grp, Off Res Dev & Informat,Ctr Med 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 RI Schneeweiss, Sebastian/C-2125-2013 FU National Institute on Aging [T32 AG000158]; National Institute of Mental Health [R01 5U01MH079175-02]; National Heart Lung and Blood Institute [K23 HL-090505] FX Grant Support: National Institute on Aging T32 AG000158 (Ms. Polinski), National Institute of Mental Health R01 5U01MH079175-02 (Dr. Schneeweiss), National Heart Lung and Blood Institute K23 HL-090505 (Dr. Shrank).; The views expressed in this paper are those of the authors and not necessarily those of the U.S. Department of Health and Human Services.; Opinions expressed here are only those of the authors and not necessarily those of the agencies or sponsors.; Conflict of interest: Dr. Schneeweiss is a paid member of the Scientific Advisory Board of HealthCore and a consultant to HealthCore, WHISCON, and RTI. Dr. Schneeweiss is Principal Investigator of the Brigham and Women's Hospital DEcIDE Center on Comparative Effectiveness Research funded by the Agency for Healthcare Research and Quality and of the Harvard-Brigham Drug Safety and Risk Management Research Center funded by Food and Drug Administration. Within the past 5 years, Dr. Schneeweiss was funded by an investigator-initiated grant from Pfizer that has ended. Dr. Shrank is the principal investigator for and has research funding from CVS/Caremark and Express Scripts. Dr. Schneeweiss is a co-investigator on and receives research funding from the CVS/Caremark grant.; Author Contributions: Jennifer Polinski: study design, acquisition of data, analysis, and preparation of the manuscript. Aman Bhandari: study concept and design, acquisition of data, and preparation of the manuscript. Uzaib Saya: acquisition of data, analysis, and preparation of the manuscript. Sebastian Schneeweiss: study concept and design, analysis, and preparation of the manuscript. William Shrank: study concept and design, acquisition of data, analysis, and preparation of the manuscript.; Sponsor's Role: The sponsor had no role in the design or analysis of the study or in preparation of the manuscript. NR 44 TC 12 Z9 13 U1 0 U2 2 PU WILEY-BLACKWELL PI HOBOKEN PA 111 RIVER ST, HOBOKEN 07030-5774, NJ USA SN 0002-8614 EI 1532-5415 J9 J AM GERIATR SOC JI J. Am. Geriatr. Soc. PD MAY PY 2010 VL 58 IS 5 BP 950 EP 966 DI 10.1111/j.1532-5415.2010.02812.x PG 17 WC Geriatrics & Gerontology; Gerontology SC Geriatrics & Gerontology GA 592XE UT WOS:000277414400023 PM 20406313 ER PT J AU Blackwell, S Waldron, C AF Blackwell, S. Waldron, C. TI ASSESSING TRENDS IN UTILIZATION AND COST OF THE SIX PROTECTED MEDICATION CLASSES IN THE PART D PROGRAM SO VALUE IN HEALTH LA English DT Meeting Abstract C1 [Blackwell, S.; Waldron, C.] 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 2010 VL 13 IS 3 BP A86 EP A86 DI 10.1016/S1098-3015(10)72406-2 PG 1 WC Economics; Health Care Sciences & Services; Health Policy & Services SC Business & Economics; Health Care Sciences & Services GA 589CJ UT WOS:000277121900423 ER PT J AU Riley, GF Lubitz, JD AF Riley, Gerald F. Lubitz, James D. TI Long-Term Trends in Medicare Payments in the Last Year of Life SO HEALTH SERVICES RESEARCH LA English DT Article DE End-of-life care; Medicare; health care costs; elderly ID TREATMENT INTENSITY; CARE; END; BENEFICIARIES; COSTS; EXPENDITURES; VISITS AB Objective To update research on Medicare payments in the last year of life. Data Sources Continuous Medicare History Sample, containing annual summaries of claims data on a 5 percent sample from 1978 to 2006. Study Design Analyses were based on elderly beneficiaries in fee for service. For each year, Medicare payments were assigned either to decedents (persons in their last year) or to survivors (all others). Results The share of Medicare payments going to persons in their last year of life declined slightly from 28.3 percent in 1978 to 25.1 percent in 2006. After adjustment for age, sex, and death rates, there was no significant trend. Conclusions Despite changes in the delivery of medical care over the last generation, the share of Medicare expenditures going to beneficiaries in their last year has not changed substantially. C1 [Riley, Gerald F.] Ctr Medicare Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. [Riley, Gerald F.] Ctr Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Riley, GF (reprint author), Ctr Medicare Serv, Off Res Dev & Informat, 7500 Secur Blvd,Mail Stop C3-21-28, Baltimore, MD 21244 USA. EM gerald.riley@cms.hhs.gov NR 33 TC 144 Z9 144 U1 2 U2 16 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 APR PY 2010 VL 45 IS 2 BP 565 EP 576 DI 10.1111/j.1475-6773.2010.01082.x PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 565YT UT WOS:000275335900013 PM 20148984 ER PT J AU Truffer, CJ Keehan, S Smith, S Cylus, J Sisko, A Poisal, JA Lizonitz, J Clemens, MK AF Truffer, Christopher J. Keehan, Sean Smith, Sheila Cylus, Jonathan Sisko, Andrea Poisal, John A. Lizonitz, Joseph Clemens, M. Kent TI Health Spending Projections Through 2019: The Recession's Impact Continues SO HEALTH AFFAIRS LA English DT Article AB The economic recession and rising unemployment-plus changing demographics and baby boomers aging into Medicare-are among the factors expected to influence health spending during 2009-2019. In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent-the largest single-year increase since 1960. Average public spending growth rates for hospital, physician and clinical services, and prescription drugs are expected to exceed private spending growth in the first four years of the projections. As a result, public spending is projected to account for more than half of all U. S. health care spending by 2012. C1 [Truffer, Christopher J.] Ctr Medicare Serv, Off Actuary, Baltimore, MD USA. [Truffer, Christopher J.] Ctr Medicaid Serv, Off Actuary, Baltimore, MD USA. RP Truffer, CJ (reprint author), Ctr Medicare Serv, Off Actuary, Baltimore, MD USA. EM DNHS@cms.hhs.gov NR 17 TC 86 Z9 86 U1 0 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 MAR-APR PY 2010 VL 29 IS 3 BP 522 EP 529 DI 10.1377/hlthaff.2009.1074 PG 8 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 562EC UT WOS:000275031300026 PM 20133357 ER PT J AU Harman, JS Scholle, SH Ng, JH Pawlson, LG Mardon, RE Haffer, SC Shih, S Bierman, AS AF Harman, Jeffrey S. Scholle, Sarah Hudson Ng, Judy H. Pawlson, L. Gregory Mardon, Russell E. Haffer, Samuel C. (Chris) Shih, Sarah Bierman, Arlene S. TI Association of Health Plans' Healthcare Effectiveness Data and Information Set (HEDIS) Performance With Outcomes of Enrollees With Diabetes SO MEDICAL CARE LA English DT Article DE Medicare; aged; managed care programs; outcome and process assessment (health care); hierarchical linear models ID MEDICARE MANAGED CARE; QUALITY-OF-CARE; SF-36; DISEASE; DEATH; LIFE AB Background: Few quality of care evaluations examine the relationship between clinical processes and patient outcomes. Objective: To determine the association between health plan performance on Healthcare Effectiveness Data and Information Set (HEDIS) clinical processes and intermediate outcome measures and Health Outcomes Survey (HOS) self-reported physical and mental health scores among Medicare plan enrollees with diabetes. Research Design: Secondary data analysis of 2002 HEDIS and 2001-2003 HOS data. Subjects: This study focused on Medicare plan enrollees with self-reported diabetes (N = 8184). Measures: Plan-level HEDIS diabetes care measures for 2002 and longitudinal, patient-level 2001-2003 HOS physical and mental health outcomes scores. Hierarchical linear models estimated the relationship between plan HEDIS performance on diabetes process of care and intermediate outcome measures and 2-year changes in enrollee HOS physical and mental health scores. Results: Each 10% point improvement in plan performance on HEDIS intermediate outcomes (ie, the proportion of well-controlled diabetes) was related to significant positive increase in the probability of being healthy as measured by both enrollee physical health scores (7 percentage point increase, P < 0.05) and mental health scores (11 percentage point increase, P < 0.01). Similar increases in plan process of care measures were associated with increases in the probability of being healthy as measured by enrollee mental health scores (11 percentage point increase, P < 0.001). Conclusions: This study represents one of the first attempts to link plan HEDIS performance to changes in enrollee health. The results suggest that improved quality of care, as measured by process and intermediate outcomes measures for diabetes, can result in better health among patients with diabetes. Further research should address whether this relationship exists in other quality measures, clinical conditions, and populations. C1 [Scholle, Sarah Hudson; Ng, Judy H.; Pawlson, L. Gregory] Natl Comm Qual Assurance, Washington, DC 20005 USA. [Harman, Jeffrey S.] Univ Florida, Dept Hlth Serv Res Management & Policy, Coll Publ Hlth & Hlth Profess, Gainesville, FL USA. [Mardon, Russell E.] WESTAT Corp, Rockville, MD 20850 USA. [Haffer, Samuel C. (Chris)] Ctr Medicare, Baltimore, MD USA. [Haffer, Samuel C. (Chris)] Ctr Med Serv, Baltimore, MD USA. [Shih, Sarah] New York City Dept Hlth, New York, NY 10013 USA. [Bierman, Arlene S.] Univ Toronto, Li Ka Shing Knowledge Inst, Toronto, ON, Canada. RP Scholle, SH (reprint author), Natl Comm Qual Assurance, 1100 13th St NW,Suite 1000, Washington, DC 20005 USA. EM scholle@ncqa.org FU Centers for Medicare and Medicaid Services, US Department of Health and Human Services FX Supported by the Centers for Medicare and Medicaid Services, US Department of Health and Human Services. NR 33 TC 16 Z9 16 U1 0 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 MAR PY 2010 VL 48 IS 3 BP 217 EP 223 DI 10.1097/MLR.0b013e3181ca3fe6 PG 7 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 564FH UT WOS:000275198200005 PM 20125042 ER PT J AU Giordano, LA Elliott, MN Goldstein, E Lehrman, WG Spencer, PA AF Giordano, Laura A. Elliott, Marc N. Goldstein, Elizabeth Lehrman, William G. Spencer, Patrice A. TI Development, Implementation, and Public Reporting of the HCAHPS Survey SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE health care surveys; quality of inpatient health care; patient satisfaction; patient experiences of care; CAHPS; implementation; public reporting ID CAHPS(R) HOSPITAL SURVEY; QUALITY-OF-CARE; HEALTH-CARE; CARDIAC-SURGERY; PATIENT-CARE; IMPACT; EQUIVALENCE; NONRESPONSE; INFORMATION; RESPONSES AB The authors describe the history and development of the CAHPS Hospital Survey (also known as HCAHPS) and its associated protocols. The randomized mode experiment, vendor training, and "dry runs" that set the stage for initial public reporting are described. The rapid linkage of HCAHPS data to annual payment updates ("pay for reporting") is noted, which in turn led to the participation of approximately 3,900 general acute care hospitals (about 90% of all such United States hospitals). The authors highlight the opportunities afforded by this publicly reported data on hospital inpatients' experiences and perceptions of care. These data, reported on www.hospitalcompare.hhs.gov, facilitate the national comparison of patients' perspectives of hospital care and can be used alone or in conjunction with other clinical and outcome measures. Potential benefits include increased transparency, improved consumer decision making, and increased incentives for the delivery of high-quality health care. C1 [Giordano, Laura A.; Spencer, Patrice A.] Hlth Serv Advisory Grp, Phoenix, AZ USA. [Elliott, Marc N.] RAND Corp, Santa Monica, CA USA. [Goldstein, Elizabeth; Lehrman, William G.] Ctr Medicare Serv, Baltimore, MD USA. [Goldstein, Elizabeth; Lehrman, William G.] Ctr Medicaid Serv, Baltimore, MD USA. RP Elliott, MN (reprint author), 1776 Main St, Santa Monica, CA 90407 USA. EM elliott@rand.org NR 34 TC 117 Z9 117 U1 1 U2 21 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD FEB 10 PY 2010 VL 67 IS 1 BP 27 EP 37 DI 10.1177/1077558709341065 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 537RA UT WOS:000273129800002 PM 19638641 ER PT J AU Lehrman, WG Elliott, MN Goldstein, E Beckett, MK Klein, DJ Giordano, LA AF Lehrman, William G. Elliott, Marc N. Goldstein, Elizabeth Beckett, Megan K. Klein, David J. Giordano, Laura A. TI Characteristics of Hospitals Demonstrating Superior Performance in Patient Experience and Clinical Process Measures of Care SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE health care surveys; quality of inpatient health care; patient satisfaction; hospital characteristics ID QUALITY-OF-CARE; UNITED-STATES; CASE-MIX; SAFETY AB Prior research suggests hospital quality of care is multidimensional. In this study, the authors jointly examine patient experience of care and clinical care measures from 2,583 hospitals based on inpatients discharged in 2006 and 2007. The authors use multinomial logistic regression to identify key characteristics of hospitals that perform in the top quartile on both, either, and neither dimension of quality. Top performers on both quality measures tend to be small (<100 beds), large (>200 beds) and rural, located in the New England or West North Central Census divisions, and nonprofit. Top performers in patient experience only are most often small and rural, located in the East South Central division, and government owned. Top performers in clinical care only are most often medium to large and urban, located in the West North Central division, and non-government owned. These findings provide an overview of how these dimensions of quality vary across hospitals. C1 [Lehrman, William G.] Ctr Medicare Serv, Baltimore, MD USA. [Lehrman, William G.] Ctr Medicaid Serv, Baltimore, MD USA. [Elliott, Marc N.; Beckett, Megan K.] RAND Corp, Santa Monica, CA USA. [Goldstein, Elizabeth] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Klein, David J.] Childrens Hosp Boston, Boston, MA USA. [Giordano, Laura A.] Hlth Serv Advisory Grp, Phoenix, AZ USA. RP Elliott, MN (reprint author), 1776 Main St,POB 2138, Santa Monica, CA 90401 USA. EM elliott@rand.org FU Center for Medicare & Medicaid Services (CMS) [HHSM-500-2008-A29THC] FX Support for preparation of this manuscript for this research comes from the Center for Medicare & Medicaid Services (CMS) through a contract with Health Services Advisory Group and RAND (contract number HHSM-500-2008-A29THC). The authors would like to thank Jacquelyn Chou for assistance with the preparation of the manuscript and data entry as well as Katrin Hambarsoomians for statistical assistance. The opinions expressed are those of the authors and do not necessarily reflect the opinions of CMS. Please address correspondence to Marc N. Elliott, RAND, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90401; e-mail: elliott@rand.org. NR 34 TC 56 Z9 56 U1 3 U2 11 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD FEB 10 PY 2010 VL 67 IS 1 BP 38 EP 55 DI 10.1177/1077558709341323 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 537RA UT WOS:000273129800003 PM 19638640 ER PT J AU Elliott, MN Lehrman, WG Goldstein, E Hambarsoomian, K Beckett, MK Giordano, LA AF Elliott, Marc N. Lehrman, William G. Goldstein, Elizabeth Hambarsoomian, Katrin Beckett, Megan K. Giordano, Laura A. TI Do Hospitals Rank Differently on HCAHPS for Different Patient Subgroups? SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE health care surveys; quality of inpatient health care; patient satisfaction; patient subgroup differences ID MEDICAID MANAGED CARE; BENCHMARKING DATA 1.0; CASE-MIX ADJUSTMENT; HEALTH-CARE; CONSUMER ASSESSMENTS; PATIENTS EXPERIENCES; DISPARITIES; PLANS; QUALITY; RACE/ETHNICITY AB Prior research documents differences in patient-reported experiences by patient characteristics. Using nine measures of patient experience from 1,203,229 patients discharged in 2006-2007 from 2,684 acute and critical access hospitals, the authors find that adjusted hospital scores measure distinctions in quality for the average patient with high reliability. The authors also find that hospital "ranks" (the relative scores of hospitals for patients of a given type) vary substantially by patient health status and race/ethnicity/language, and moderately by patient education and age (p<.05 for almost all measures). Quality improvement efforts should examine hospital performance with both sicker and healthier patients, because many hospitals that do well with one group (relative to other hospitals) may not do well with another. The experiences of American Indians/Alaska Natives should also receive particular attention. As HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) data accumulate, reports that drill down to hospital performance for patient subtypes (especially by health status) may be valuable. C1 [Elliott, Marc N.; Hambarsoomian, Katrin; Beckett, Megan K.] RAND Corp, Santa Monica, CA 90401 USA. [Lehrman, William G.; Goldstein, Elizabeth] Ctr Medicare Serv, Baltimore, MD USA. [Lehrman, William G.; Goldstein, Elizabeth] Ctr Medicaid Serv, Baltimore, MD USA. [Giordano, Laura A.] Hlth Serv Advisory Grp, Phoenix, AZ USA. RP Elliott, MN (reprint author), RAND Corp, 1776 Main St,POB 2138, Santa Monica, CA 90401 USA. EM elliott@rand.org FU Centers for Medicare & Medicaid Services (CMS) [HHSM-500-2008-A29THC] FX Support for preparation of this manuscript for this research comes from the Centers for Medicare & Medicaid Services (CMS) through a contract with Health Services Advisory Group and RAND (Contract number HHSM-500-2008-A29THC). The authors would like to thank Jacquelyn Chou for assistance with the preparation of the manuscript. The opinions expressed are those of the authors and do not necessarily reflect the opinions of CMS. Please address correspondence to Marc N. Elliott, RAND, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401; e-mail: elliott@rand.org. NR 34 TC 33 Z9 33 U1 0 U2 10 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD FEB 10 PY 2010 VL 67 IS 1 BP 56 EP 73 DI 10.1177/1077558709339066 PG 18 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 537RA UT WOS:000273129800004 PM 19605621 ER PT J AU Goldstein, E Elliott, MN Lehrman, WG Hambarsoomian, K Giordano, LA AF Goldstein, Elizabeth Elliott, Marc N. Lehrman, William G. Hambarsoomian, Katrin Giordano, Laura A. TI Racial/Ethnic Differences in Patients' Perceptions of Inpatient Care Using the HCAHPS Survey SO MEDICAL CARE RESEARCH AND REVIEW LA English DT Article DE health care surveys; quality of inpatient health care; patient satisfaction; racial/ethnic disparities ID CAHPS(R) HOSPITAL SURVEY; MEDICAID MANAGED CARE; HEALTH-CARE; UNITED-STATES; RACIAL DISPARITIES; ETHNIC-DIFFERENCES; NONRESPONSE RATES; ASSESSMENTS; PERFORMANCE; RATINGS AB Using HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems, also known as the CAHPS Hospital Survey) data from 2,684 hospitals, the authors compare the experiences of Hispanic, African American, Asian/Pacific Islander, American Indian/Alaska Native, and multiracial inpatients with those of non-Hispanic White inpatients to understand the roles of between- and within-hospital differences in patients' perspectives of hospital care. The study finds that, on average, non-Hispanic White inpatients receive care at hospitals that provide better experiences for all patients than the hospitals more often used by minority patients. Within hospitals, patient experiences are more similar by race/ethnicity, though some disparities do exist, especially for Asians. This research suggests that targeting hospitals that serve predominantly minority patients, improving the access of minority patients to better hospitals, and targeting the experiences of Asians within hospitals may be promising means of reducing disparities in patient experience. C1 [Goldstein, Elizabeth; Lehrman, William G.] Ctr Medicare Serv, Baltimore, MD USA. [Goldstein, Elizabeth; Lehrman, William G.] Ctr Medicaid Serv, Baltimore, MD USA. [Elliott, Marc N.; Hambarsoomian, Katrin] RAND Corp, Santa Monica, CA USA. [Giordano, Laura A.] Hlth Serv Advisory Grp, Phoenix, AZ USA. RP Elliott, MN (reprint author), 1776 Main St, Santa Monica, CA 90407 USA. EM elliott@rand.org NR 42 TC 52 Z9 52 U1 1 U2 12 PU SAGE PUBLICATIONS INC PI THOUSAND OAKS PA 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA SN 1077-5587 J9 MED CARE RES REV JI Med. Care Res. Rev. PD FEB 10 PY 2010 VL 67 IS 1 BP 74 EP 92 DI 10.1177/1077558709341066 PG 19 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 537RA UT WOS:000273129800005 PM 19652150 ER PT J AU Rochester, CD Leon, N Dombrowski, R Haines, ST AF Rochester, Charmaine D. Leon, Nicholas Dombrowski, Robert Haines, Stuart T. TI Collaborative drug therapy management for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus SO AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY LA English DT Article DE Ambulatory care; Antidiabetic agents; Clinical pharmacists; Clinical pharmacy; Department of Veterans Affairs; Diabetes mellitus; Dosage; Insulin; Insulins; Patient information; Pharmaceutical services; Protocols ID DISEASE-STATE MANAGEMENT; QUALITY-OF-CARE; CLINICAL-OUTCOMES; GLYCEMIC CONTROL; BASAL INSULIN; PHARMACIST; PROGRAM; RISK; COMPLICATIONS; IMPACT AB Purpose. Collaborative drug therapy management (CDTM) by pharmacists for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus in a Veterans Affairs Health Care System (VAHCS) is described. Summary. During 2003-04, the Veterans Affairs Maryland Health Care System (VAMHCS) at Baltimore reported that 24% of its patients with diabetes had a glycosylated hemoglobin (HbA(1c)) value of >9% or no recently documented HbA(1c) and that 91% of its patients with an HbA(1c) value of >9% were treated with oral antihyperglycemic agents alone. To address this issue, clinical pharmacists at VAMHCS at Baltimore developed the insulin initiation clinic. The primary goal of VAMHCS at Baltimore insulin initiation clinic was to provide an appropriate infrastructure to address the needs of patients with poorly controlled type 2 diabetes who required insulin therapy. Patients could be referred to the clinic if they had an HbA(1c) value of >9% on two occasions at least three months apart and were taking two oral antidiabetic medications whose dose was at least 50% of the maximal dose. The participating pharmacists mutually agreed to follow an insulin dosing protocol to help guide their therapeutic decision-making. Patients received comprehensive education during the initial visit regarding self-management skills, self-monitoring of blood glucose levels, treatment of hypoglycemia, insulin injection administration, and lifestyle modifications. Patients were discharged to their primary care provider if they attained an HbA(1c) value of <7.5% or after six months, whichever came first, during January 2005 and July 2008. Conclusion. Use of a preplanned insulin initiation and titration protocol by pharmacists resulted in the successful implementation of an insulin initiation clinic through CDTM and improved patients' glycemic control. C1 [Rochester, Charmaine D.; Haines, Stuart T.] Univ Maryland, Sch Pharm, Dept Pharm Practice & Sci, Baltimore, MD 21201 USA. [Rochester, Charmaine D.] Thomas Jefferson Univ, Dept Pharm Practice & Sci, Philadelphia, PA 19107 USA. [Leon, Nicholas] Thomas Jefferson Univ, Jefferson Sch Pharm, Dept Pharm Practice, Philadelphia, PA 19107 USA. [Dombrowski, Robert] Ctr Medicare Serv, Baltimore, MD USA. [Dombrowski, Robert] Ctr Medicaid Serv, Baltimore, MD USA. RP Rochester, CD (reprint author), Univ Maryland, Sch Pharm, Dept Pharm Practice & Sci, Room 449,20 N Pine St, Baltimore, MD 21201 USA. EM crochest@rx.umaryland.edu OI Haines, Stuart/0000-0001-8217-1871 FU Novo Nordisk FX The editorial assistance of Caroline Pettigrew of Bioscript Stirling Ltd., which was funded by Novo Nordisk, is acknowledged. The assistance of Angela L. Gipprich-Shenfield, Pharm.D., in the development of the insulin initiation protocol is also acknoweldged. NR 40 TC 12 Z9 13 U1 0 U2 4 PU AMER SOC HEALTH-SYSTEM PHARMACISTS PI BETHESDA PA 7272 WISCONSIN AVE, BETHESDA, MD 20814 USA SN 1079-2082 EI 1535-2900 J9 AM J HEALTH-SYST PH JI Am. J. Health-Syst. Pharm. PD JAN 1 PY 2010 VL 67 IS 1 BP 42 EP 48 DI 10.2146/ajhp080706 PG 7 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 538KE UT WOS:000273182200013 PM 20044368 ER PT J AU Hartman, M Martin, A Nuccio, O Catlin, A AF Hartman, Micah Martin, Anne Nuccio, Olivia Catlin, Aaron CA Natl Hlth Expenditure Accounts Tea TI Health Spending Growth At A Historic Low In 2008 SO HEALTH AFFAIRS LA English DT Article AB In 2008, U. S. health care spending growth slowed to 4.4 percent-the slowest rate of growth over the past forty-eight years. The deceleration was broadly based for nearly all payers and health care goods and services, as growth in both price and nonprice factors slowed amid the recession. Despite the slowdown, national health spending reached $2.3 trillion, or $7,681 per person, and the health care portion of gross domestic product (GDP) grew from 15.9 percent in 2007 to 16.2 percent in 2008. These developments reflect the general pattern that larger increases in the health spending share of GDP generally occur during or just after periods of economic recession. Despite the overall slowdown in national health spending growth, increases in this spending continue to outpace growth in the resources available to pay for it. C1 [Hartman, Micah] Ctr Medicare Serv, Off Actuary, Baltimore, MD USA. [Hartman, Micah] Ctr Medicaid Serv, Off Actuary, Baltimore, MD USA. RP Hartman, M (reprint author), Ctr Medicare Serv, Off Actuary, Baltimore, MD USA. EM micah.hartman@cms.hhs.gov NR 32 TC 44 Z9 44 U1 0 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 2010 VL 29 IS 1 BP 147 EP 155 DI 10.1377/hlthaff.2009.0839 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 539JZ UT WOS:000273251500022 PM 20048374 ER PT J AU Dickersin, K Fredman, L Flegal, KM Scott, J Crawley, B AF Dickersin, Kay Fredman, Lisa Flegal, Katherine M. Scott, Jane Crawley, Barbara TI Female editorship is an important indicator of gender imbalance SO JOURNAL OF THE ROYAL SOCIETY OF MEDICINE LA English DT Letter ID EDITORIAL-BOARDS; WOMEN; JOURNALS C1 [Dickersin, Kay] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. [Fredman, Lisa] Boston Univ, Sch Publ Hlth, Boston, MA USA. [Flegal, Katherine M.] Ctr Dis Control & Prevent, Natl Ctr Hlth Stat, Hyattsville, MD 20782 USA. [Scott, Jane] NHLBI, NIH, Bethesda, MD 20892 USA. [Crawley, Barbara] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Dickersin, K (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA. EM kdickers@jhsph.edu RI Flegal, Katherine/A-4608-2013; OI Flegal, Katherine/0000-0002-0838-469X NR 6 TC 2 Z9 2 U1 0 U2 1 PU ROYAL SOC MEDICINE PRESS LTD PI LONDON PA 1 WIMPOLE STREET, LONDON W1G 0AE, ENGLAND SN 0141-0768 J9 J ROY SOC MED JI J. R. Soc. Med. PD JAN PY 2010 VL 103 IS 1 BP 5 EP 5 DI 10.1258/jrsm.2009.09k071 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 550XZ UT WOS:000274169100002 PM 20056662 ER PT J AU Shortliffe, EH AF Shortliffe, Edward H. GP Natl Res Council TI Context SO PRELIMINARY OBSERVATIONS ON INFORMATION TECHNOLOGY NEEDS AND PRIORITIES AT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES: AN INTERIM REPORT LA English DT Article; Book Chapter C1 Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. RP Shortliffe, EH (reprint author), Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU NATL ACADEMIES PRESS PI WASHINGTON PA 2101 CONSTITUTION AVE, WASHINGTON, DC 20418 USA BN 978-0-309-17693-4 PY 2010 BP 1 EP 3 PG 3 WC Computer Science, Hardware & Architecture; Medical Informatics SC Computer Science; Medical Informatics GA BC4IC UT WOS:000352541100002 ER PT J AU Shortliffe, EH AF Shortliffe, Edward H. GP Natl Res Council TI Emerging Requirements Driving Multilayered Transformation SO PRELIMINARY OBSERVATIONS ON INFORMATION TECHNOLOGY NEEDS AND PRIORITIES AT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES: AN INTERIM REPORT LA English DT Article; Book Chapter C1 Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. RP Shortliffe, EH (reprint author), Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. NR 6 TC 0 Z9 0 U1 0 U2 0 PU NATL ACADEMIES PRESS PI WASHINGTON PA 2101 CONSTITUTION AVE, WASHINGTON, DC 20418 USA BN 978-0-309-17693-4 PY 2010 BP 4 EP 8 PG 5 WC Computer Science, Hardware & Architecture; Medical Informatics SC Computer Science; Medical Informatics GA BC4IC UT WOS:000352541100003 ER PT J AU Shortliffe, EH AF Shortliffe, Edward H. GP Natl Res Council TI Preliminary Observations on Information Technology Needs and Priorities at the Centers for Medicare and Medicaid Services An Interim Report Preface SO PRELIMINARY OBSERVATIONS ON INFORMATION TECHNOLOGY NEEDS AND PRIORITIES AT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES: AN INTERIM REPORT LA English DT Editorial Material; Book Chapter C1 Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. RP Shortliffe, EH (reprint author), Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. NR 0 TC 0 Z9 0 U1 0 U2 0 PU NATL ACADEMIES PRESS PI WASHINGTON PA 2101 CONSTITUTION AVE, WASHINGTON, DC 20418 USA BN 978-0-309-17693-4 PY 2010 BP VII EP VIII PG 2 WC Computer Science, Hardware & Architecture; Medical Informatics SC Computer Science; Medical Informatics GA BC4IC UT WOS:000352541100001 ER PT J AU Shortliffe, EH AF Shortliffe, Edward H. GP Natl Res Council TI Challenges in Transforming Enterprise Technology and Data Management SO PRELIMINARY OBSERVATIONS ON INFORMATION TECHNOLOGY NEEDS AND PRIORITIES AT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES: AN INTERIM REPORT LA English DT Article; Book Chapter C1 Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. RP Shortliffe, EH (reprint author), Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. NR 6 TC 0 Z9 0 U1 0 U2 0 PU NATL ACADEMIES PRESS PI WASHINGTON PA 2101 CONSTITUTION AVE, WASHINGTON, DC 20418 USA BN 978-0-309-17693-4 PY 2010 BP 9 EP 11 PG 3 WC Computer Science, Hardware & Architecture; Medical Informatics SC Computer Science; Medical Informatics GA BC4IC UT WOS:000352541100004 ER PT J AU Shortliffe, EH AF Shortliffe, Edward H. GP Natl Res Council TI Organizational, Administrative, and Cultural Challenges SO PRELIMINARY OBSERVATIONS ON INFORMATION TECHNOLOGY NEEDS AND PRIORITIES AT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES: AN INTERIM REPORT LA English DT Article; Book Chapter C1 Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. RP Shortliffe, EH (reprint author), Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU NATL ACADEMIES PRESS PI WASHINGTON PA 2101 CONSTITUTION AVE, WASHINGTON, DC 20418 USA BN 978-0-309-17693-4 PY 2010 BP 12 EP 14 PG 3 WC Computer Science, Hardware & Architecture; Medical Informatics SC Computer Science; Medical Informatics GA BC4IC UT WOS:000352541100005 ER PT J AU Shortliffe, EH AF Shortliffe, Edward H. GP Natl Res Council TI Preliminary Observations on Information Technology Needs and Priorities at the Centers for Medicare and Medicaid Services An Interim Report Concluding Observations SO PRELIMINARY OBSERVATIONS ON INFORMATION TECHNOLOGY NEEDS AND PRIORITIES AT THE CENTERS FOR MEDICARE AND MEDICAID SERVICES: AN INTERIM REPORT LA English DT Editorial Material; Book Chapter C1 Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. RP Shortliffe, EH (reprint author), Ctr Medicare & Medicaid Serv, Comm Future Informat Architectures Proc & Strateg, Baltimore, MD 21244 USA. NR 1 TC 0 Z9 0 U1 0 U2 0 PU NATL ACADEMIES PRESS PI WASHINGTON PA 2101 CONSTITUTION AVE, WASHINGTON, DC 20418 USA BN 978-0-309-17693-4 PY 2010 BP 15 EP 15 PG 1 WC Computer Science, Hardware & Architecture; Medical Informatics SC Computer Science; Medical Informatics GA BC4IC UT WOS:000352541100006 ER PT J AU Guessous, I Dash, C Lapin, P Doroshenk, M Smith, RA Klabunde, CN AF Guessous, Idris Dash, Chiranjeev Lapin, Pauline Doroshenk, Mary Smith, Robert A. Klabunde, Carrie N. CA Natl Colorectal Canc Roundtable Sc TI Colorectal cancer screening barriers and facilitators in older persons SO PREVENTIVE MEDICINE LA English DT Article; Proceedings Paper CT 31st Annual Meeting of the Society-of-General-Internal-Medicine CY APR 09-12, 2008 CL Pittsburgh, PA SP Soc Gen Internal Med DE Colorectal cancer; Screening; Older persons; Barriers; Facilitators ID SERVICES TASK-FORCE; ELDERLY-PATIENTS; UNITED-STATES; COLON-CANCER; RECOMMENDATIONS; PARTICIPATION; DISPARITIES; COLONOSCOPY; AMERICANS; COVERAGE AB Background. This systematic review identifies factors that are most consistently mentioned as either barriers to or facilitators of colorectal cancer (CRC) screening in older persons. Methods. A systematic literature search (1995-2008) was conducted to identify studies that reported barriers to or facilitators of CRC screening uptake, compliance or adherence specifically for older persons (>= 65 years). Information on study characteristics and barriers and facilitators related to subjects; healthcare providers; policies; and screening tests were then abstracted and analyzed. Results. Eighty-three studies met the eligibility criteria. Low level of education, African American race, Hispanic ethnicity, and female gender were the most frequently reported barriers, whereas being married or living with a partner was the most frequently reported facilitator. The most cited barrier related to healthcare providers was lack of screening recommendation by a physician; having a usual source of care was a commonly reported facilitator. Lack of health insurance, and dual coverage with Medicare and Medicaid were the most frequently reported barriers, whereas Medicare's coverage of screening colonoscopy was consistently reported as a facilitator. Conclusions. Barriers to, and facilitators of, CRC screening among older persons are reported. Particular attention should be paid to modifiable factors that could become the focus of interventions aimed at increasing CRC screening participation in older persons. (C) 2009 Elsevier Inc. All rights reserved. C1 [Guessous, Idris; Dash, Chiranjeev] Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA. [Guessous, Idris] Univ Hosp Geneva, Unit Populat Epidemiol, Div Primary Care Med, Dept Community Med & Primary Care, Geneva, Switzerland. [Lapin, Pauline] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Doroshenk, Mary] Amer Canc Soc, Washington, DC USA. [Smith, Robert A.] Amer Canc Soc, Canc Control Sci Dept, Atlanta, GA 30329 USA. [Klabunde, Carrie N.] NCI, Div Canc Control & Populat Sci, Appl Res Program, Hlth Serv & Econ Branch, Bethesda, MD 20892 USA. RP Guessous, I (reprint author), Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA. EM iguesso@sph.emory.edu FU NCCDPHP CDC HHS [U50/DP424071] NR 28 TC 71 Z9 71 U1 0 U2 8 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 JAN-FEB PY 2010 VL 50 IS 1-2 BP 3 EP 10 DI 10.1016/j.ypmed.2009.12.005 PG 8 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 565GU UT WOS:000275278700001 PM 20006644 ER PT J AU McClellan, WM Casey, MT Hughley, J Freund, E AF McClellan, William M. Casey, Mary Teresa Hughley, JoVonn Freund, Eugene TI Population-Based Interventions To Reduce Socioeconomic Disparities in Chronic Kidney Disease SO SEMINARS IN NEPHROLOGY LA English DT Review DE ESRD; poverty; quality improvement; SES; CKD ID STAGE RENAL-DISEASE; UNITED-STATES; HEALTH-CARE; ATHEROSCLEROSIS RISK; NATIONAL-HEALTH; FAMILY-HISTORY; ESRD; RACE; PREVALENCE; DIALYSIS C1 [McClellan, William M.] Emory Univ, Dept Med, Atlanta, GA 30322 USA. [McClellan, William M.] Emory Univ, Dept Epidemiol, Atlanta, GA 30322 USA. [McClellan, William M.; Hughley, JoVonn] Georgia Med Care Fdn, Atlanta, GA USA. [Casey, Mary Teresa; Freund, Eugene] Ctr Medicare & Medicaid Serv, Div Qual Improvement Policy Chron & Ambulatory Ca, Baltimore, MD USA. RP McClellan, WM (reprint author), Emory Univ, Dept Med, 1518 Clifton Rd, Atlanta, GA 30322 USA. EM wmcclel@sph.emory.edu NR 51 TC 4 Z9 4 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 0270-9295 J9 SEMIN NEPHROL JI Semin. Nephrol. PD JAN PY 2010 VL 30 IS 1 BP 33 EP 41 DI 10.1016/j.semnephrol.2009.10.011 PG 9 WC Urology & Nephrology SC Urology & Nephrology GA 617CF UT WOS:000279257700007 PM 20116646 ER PT J AU Nyweide, DJ Weeks, WB Gottlieb, DJ Casalino, LP Fisher, ES AF Nyweide, David J. Weeks, William B. Gottlieb, Daniel J. Casalino, Lawrence P. Fisher, Elliott S. TI Relationship of Primary Care Physicians' Patient Caseload With Measurement of Quality and Cost Performance SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID HEALTH-CARE; PROSPECTS AB Context Sufficient numbers of patients are necessary to generate statistically reliable measurements of physicians' quality and cost performance. Objective To determine whether primary care physicians in the same physician practice collectively see enough Medicare patients annually to detect meaningful differences between practices in ambulatory quality and cost measures. Design, Setting, and Patients Primary care physicians in the United States were linked to their physician practices using the Healthcare Organization Services database maintained by IMS Health. Patients who visited primary care physicians in the 2005 Medicare Part B 20% sample were used to estimate Medicare caseloads per practice. Caseloads necessary to detect 10% relative differences in costs and quality were calculated using national mean ambulatory Medicare spending, rates of mammography for women 66 to 69 years, and hemoglobin A(1c) testing for 66-to 75-year-olds with diabetes, preventable hospitalization rate, and 30-day readmission rate after discharge for congestive heart failure (CHF). Main Outcome Measures Percentage of primary care physician practices with a sufficient number of eligible patients to detect a 10% relative difference in each performance measure. Results Primary care physician practices had annual median caseloads of 260 Medicare patients (interquartile range [IQR], 135-500), 25 women eligible for mammography (IQR, 10-50), 30 patients with diabetes eligible for hemoglobin A1c testing (IQR, 15-55), and 0 patients hospitalized for CHF. For ambulatory costs, mammography rate, and hemoglobin A1c testing rate, the percentage of primary care physician practices with sufficient caseloads to detect 10% relative differences in performance ranged from less than 10% of practices with fewer than 11 primary care physicians to 100% of practices with more than 50 primary care physicians. None of the primary care physician practices had sufficient caseloads to detect 10% relative differences in preventable hospitalization or 30-day readmission after discharge for CHF. Conclusion Relatively few primary care physician practices are large enough to reliably measure 10% relative differences in common measures of quality and cost performance among fee-for-service Medicare patients. JAMA. 2009; 302(22): 2444-2450 C1 [Nyweide, David J.] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. [Weeks, William B.; Gottlieb, Daniel J.; Fisher, Elliott S.] Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH USA. [Casalino, Lawrence P.] Weill Cornell Med Coll, Dept Publ Hlth, New York, NY USA. RP Nyweide, DJ (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, 7500 Secur Blvd,C3-21-28, Baltimore, MD 21244 USA. EM david.nyweide@cms.hhs.gov RI Weeks, William/G-7436-2014 FU Commonwealth Fund [20070129]; National Institute on Aging [PO1 AG19783] FX This research was funded by grant 20070129 from The Commonwealth Fund and grant PO1 AG19783 from the National Institute on Aging; access to data were provided by the Healthcare Organization Services database from IMS Health; Dr Nyweide reports completion of this research with support from the National Institute on Aging prior to becoming an employee at the Centers for Medicare & Medicaid Services, and he reports receiving reimbursement from IMS Health for expenses associated with a research meeting in August 2008. NR 28 TC 31 Z9 31 U1 1 U2 5 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 DEC 9 PY 2009 VL 302 IS 22 BP 2444 EP 2450 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 529MD UT WOS:000272520500023 PM 19996399 ER PT J AU Riley, GF Levy, JM Montgomery, MA AF Riley, Gerald F. Levy, Jesse M. Montgomery, Melissa A. TI Adverse Selection In The Medicare Prescription Drug Program SO HEALTH AFFAIRS LA English DT Article ID RISK ADJUSTMENT; PART-D; EXPENDITURES; BENEFICIARIES; COVERAGE; PAYMENTS; BENEFIT; MCBS AB The Medicare Part D drug benefit created choices for beneficiaries among many prescription drug plans with varying levels of coverage. As a result, Medicare enrollees with high prescription drug costs have strong incentives to enroll in Part D, especially in plans with more comprehensive coverage. To measure this potential problem of "adverse selection," which could threaten plans' finances, we compared baseline characteristics among groups of beneficiaries with various drug coverage arrangements in 2006. We found some significant differences. For example, enrollees in stand-alone prescription drug plans, especially in plans offering benefits in the coverage gap, or "doughnut hole," had higher baseline drug costs and worse health than enrollees in Medicare Advantage prescription drug plans. Although risk-adjusted payments and other measures have been put in place to account for selection, these patterns could adversely affect future Medicare costs and should be watched carefully. [Health Aff (Millwood). 2009;28(6):1826-37] C1 [Riley, Gerald F.; Levy, Jesse M.; Montgomery, Melissa A.] Ctr Medicare & Medicaid Serv Off Res Dev & Inform, Baltimore, MD USA. RP Riley, GF (reprint author), Ctr Medicare & Medicaid Serv Off Res Dev & Inform, Baltimore, MD USA. EM gerald.riley@cms.hhs.gov NR 16 TC 9 Z9 9 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 NOV-DEC PY 2009 VL 28 IS 6 BP 1826 EP 1837 DI 10.1377/hlthaff.28.6.1826 PG 12 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 517NR UT WOS:000271622300027 PM 19887424 ER PT J AU Blackwell, SA Montgomery, MA Waldo, D Baugh, DK Ciborowski, GM Gibson, D AF Blackwell, Steven A. Montgomery, Melissa A. Waldo, Dan Baugh, David K. Ciborowski, Gary M. Gibson, David TI National study of medications associated with injury in elderly Medicare/Medicaid dual enrollees during 2003 SO JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION LA English DT Article DE Elderly; safety; prescribing patterns ID ADVERSE DRUG-REACTIONS; BEERS CRITERIA; OUTPATIENTS; EVENTS AB Objectives: To address the association between inappropriate prescribing for the elderly and adverse outcomes and to identify the magnitude of the cost of medication-associated injury in this population. Design: Cross sectional. Setting: United States, 2003. Patients: 5,412,678 dually eligible Medicare/Medicaid enrollees aged 65 years or older. Intervention: Beers and non-Beers medications with potential central nervous system adverse effects of dizziness/vertigo, drowsiness, and/or fainting were assessed. Emergency department (ED) visits with admitting diagnoses pertaining to injuries for elderly enrollees dually eligible for Medicare and Medicaid during the calendar year were linked to prescriptions filled during the 90 days preceding the visit. Main outcome measure: For each drug, the proportion of ED-related fills and the Medicare average revenue charge per injury-related ED visit were calculated. Results: Several drugs not currently on the Beers list were found to be associated with high proportions of ED-related fills: methadone had the highest proportion of any of the drugs studied (12.3 per 1,000 fills), and bethanechol (7.8 per 1,000 fills) had the highest proportion among genitourinary products. Regarding narcotic analgesics, propoxyphene (7.7 per 1,000 fills) had a higher association with injury than morphine (6.6 per 1,000 fills) or tramadol (6.5 per 1,000 fills). For cardiovascular agents, clonidine (4.7 per 1,000 fills) and doxazosin (3.6 per 1,000 fills) had higher associations with injury than nifedipine (3.3 per 1,000 fills). Fentanyl, a non-Beers medication, was associated with the most expensive injury-related ED visits ($1,263 average revenue charge). Conclusion: Beers medications are associated with high injury-related ED visit rates for the elderly, and a number of drugs not currently on the Beers list also pose an apparent risk for injury-related visits. C1 [Blackwell, Steven A.; Montgomery, Melissa A.; Waldo, Dan; Baugh, David K.; Ciborowski, Gary M.; Gibson, David] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD 21244 USA. RP Blackwell, SA (reprint author), Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Mail Stop C3-21-28,7500 Secur Blvd, Baltimore, MD 21244 USA. EM sblackwell@cms.hhs.gov FU Centers for Medicare & Medicaid Services FX Centers for Medicare & Medicaid Services. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of the CMS. NR 29 TC 4 Z9 4 U1 4 U2 6 PU AMER PHARMACEUTICAL ASSOC PI WASHINGTON PA 2215 CONSTITUTION AVE NW, WASHINGTON, DC 20037 USA SN 1544-3191 J9 J AM PHARM ASSOC JI J. Am. Pharm. Assoc. PD NOV-DEC PY 2009 VL 49 IS 6 BP 751 EP 759 DI 10.1331/JAPhA.2009.08102 PG 9 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 521QO UT WOS:000271937700006 PM 19926555 ER PT J AU Wolff, JL Meadow, A Boyd, CM Weiss, CO Leff, B AF Wolff, Jennifer L. Meadow, Ann Boyd, Cynthia M. Weiss, Carlos O. Leff, Bruce TI Physician Evaluation and Management of Medicare Home Health Patients SO MEDICAL CARE LA English DT Article DE physicians; home care; Medicare ID RANDOMIZED CONTROLLED-TRIAL; OLDER-ADULTS; PRIMARY-CARE; HOUSE CALLS; GUIDED CARE; TRANSITIONS; INPATIENT; SERVICES; OUTCOMES; QUALITY AB Objective: The Medicare home health benefit is predicated on physician referral and involvement. In this study, we investigated (1) the frequency and (2) implications of home health patients' evaluation and management by community physicians. Methods: The 2005 and 2006 Medicare 5% Standard Analytic Files were linked to the Outcome and Assessment Information Set to examine physician visits among 74,462 fee-for service Medicare beneficiaries with a home health episode of care between July 1, 2005 and December 1, 2006. We examined whether receipt of community physician evaluation and management visits by home health patients was associated with subsequent discharge disposition, comparing discharge from the agency as opposed to inpatient facility transfer. Results: More than one-third (34.6%) of patients did not receive physician evaluation and management visits during their home health episode. Home health patients most commonly incurred physician office visits exclusively (51.5%) or in combination with consultations (6.8%) or house call visits (2.2%), as well as house call visits exclusively (3.3%). Patients who incurred physician evaluation and management visits during their episode of care were more likely to be discharged from home health agencies than their counterparts who did not (77.9% vs. 70.6%, respectively). The association between physician visits and home health discharge was statistically significant in both simple regression models (odds ratio = 1.47; 95% confidence interval [CI], 1.42-1.52) and in multivariate analyses accounting for socio-demographic factors, health, and functioning (odds ratio = 1.45; 95% CI, 1.40-1.51). Conclusions: More systematic integration of physicians in home care processes may reduce subsequent hospital and other inpatient facility use among home health patients. C1 [Wolff, Jennifer L.; Boyd, Cynthia M.; Leff, Bruce] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Lipitz Ctr Integrated Hlth Care, Baltimore, MD 21205 USA. [Wolff, Jennifer L.; Boyd, Cynthia M.; Weiss, Carlos O.; Leff, Bruce] Johns Hopkins Univ, Sch Med, Dept Med, Div Geriatr Med & Gerontol, Baltimore, MD 21205 USA. [Wolff, Jennifer L.; Meadow, Ann] Ctr Medicare Serv, Off Res Dev & Informat, Baltimore, MD USA. [Wolff, Jennifer L.; Meadow, Ann] Ctr Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Wolff, JL (reprint author), Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Lipitz Ctr Integrated Hlth Care, 624 N Broadway,Room 692, Baltimore, MD 21205 USA. EM jwolff@jhsph.edu NR 38 TC 2 Z9 2 U1 1 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 NOV PY 2009 VL 47 IS 11 BP 1147 EP 1155 PG 9 WC Health Care Sciences & Services; Health Policy & Services; Public, Environmental & Occupational Health SC Health Care Sciences & Services; Public, Environmental & Occupational Health GA 515DM UT WOS:000271447000006 PM 19786916 ER PT J AU Johnson, ML Petersen, LA Sundaravaradan, R Byrne, MM Hasche, JC Osemene, NI Wei, II Morgan, RO AF Johnson, Michael L. Petersen, Laura A. Sundaravaradan, Raji Byrne, Margaret M. Hasche, Jennifer C. Osemene, Nora I. Wei, Iris I. Morgan, Robert O. TI The Association of Medicare Drug Coverage with Use of Evidence-Based Medications in the Veterans Health Administration SO ANNALS OF PHARMACOTHERAPY LA English DT Article DE managed care; Medicare; pharmacy; veterans ID ACUTE MYOCARDIAL-INFARCTION; ACCESS; VA; IDENTIFICATION; POPULATIONS; PREVALENCE; OUTCOMES; HMOS; CARE AB BACKGROUND: Veterans with Medicare managed-care plans have access to pharmacy benefits outside the Veterans Health Administration (VA), but how this coverage affects use of medications for specific disease conditions within the VA is unclear. OBJECTIVE: To examine patterns of pharmacotherapy among patients with diabetes mellitus, ischemic heart disease, and chronic heart failure enrolled in fee-for-service (FFS) or managed-care (HMO) plans and to test whether pharmacy benefit coverage within Medicare is associated with the receipt of evidence-based medications in the VA. METHODS: A retrospective analysis of veterans dually enrolled in the VA and Medicare healthcare systems was conducted. We used VA and Medicare administrative data from 2002 in multivariable logistic regression analysis to determine the unique association of enrollment in Medicare FFS or managed-care plans on the use of medications, after adjusting for sociodemographic, geographic, and patient clinical factors. RESULTS: A total of 369,697 enrollees met inclusion criteria for diabetes, ischemic heart disease, or chronic heart failure. Among patients with diabetes, adjusted odds ratios (ORs) of receiving angiotensin-converting enzyme (ACE) inhibitors and oral hypoglycemics in the FFS group were, respectively, 0.86 and 0.80 (p < 0.001). Among patients with ischemic heart disease, FFS patients were generally less likely to receive beta-blockers, antianginals, and statins. Among patients with chronic heart failure, adjusted ORs of receiving ACE inhibitors, angiotensin-receptor blockers, and statins in the FFS group were, respectively, 0.90, 0.78, and 0.79 (all p < 0.05). There were few systematic differences within HMO coverage levels. CONCLUSIONS: FFS-enrolled veterans were generally less likely to be receiving condition-related medications from the VA, compared with HMO-enrolled veterans with lower levels of prescription drug coverage. Pharmacy prescription coverage within Medicare affects the use of evidence-based medications for specific disease conditions in the VA. C1 [Johnson, Michael L.] Univ Houston, Coll Pharm, Dept Clin Sci & Adm, Houston, TX 77030 USA. [Johnson, Michael L.; Petersen, Laura A.; Sundaravaradan, Raji; Hasche, Jennifer C.; Morgan, Robert O.] Michael E DeBakey Vet Affairs Med Ctr, Houston Ctr Qual Care & Utilizat Studies, Houston, TX USA. [Petersen, Laura A.] Baylor Coll Med, Sect Hlth Serv Res, Houston, TX 77030 USA. [Byrne, Margaret M.] Univ Miami, Sch Med, Dept Epidemiol & Publ Hlth, Miami, FL USA. [Osemene, Nora I.] Texas So Univ, Coll Pharm & Hlth Sci, Houston, TX 77004 USA. [Wei, Iris I.] Ctr Medicare Serv, Off Res Dev & Informat, Res & Evaluat Grp, Div Res Hlth Plans & Drugs, Baltimore, MD USA. [Wei, Iris I.] Ctr Medicaid Serv, Off Res Dev & Informat, Res & Evaluat Grp, Div Res Hlth Plans & Drugs, Baltimore, MD USA. RP Johnson, ML (reprint author), 1441 Moursund St, Houston, TX 77030 USA. EM mikejohnson@uh.edu NR 30 TC 2 Z9 2 U1 0 U2 0 PU HARVEY WHITNEY BOOKS CO PI CINCINNATI PA PO BOX 42696, CINCINNATI, OH 45242 USA SN 1060-0280 J9 ANN PHARMACOTHER JI Ann. Pharmacother. PD OCT PY 2009 VL 43 IS 10 BP 1565 EP 1575 DI 10.1345/aph.1L606 PG 11 WC Pharmacology & Pharmacy SC Pharmacology & Pharmacy GA 503YR UT WOS:000270579100001 PM 19706740 ER PT J AU Iglehart, JK Wilensky, G AF Iglehart, John K. Wilensky, Gail TI Reform, Regulation, and Research - An Interview with Gail Wilensky SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Editorial Material C1 [Wilensky, Gail] Ctr Medicaid Serv, Baltimore, MD USA. [Wilensky, Gail] Medicare Payment Advisory Commiss, Washington, DC USA. NR 5 TC 1 Z9 1 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 SEP 10 PY 2009 VL 361 IS 11 BP 1038 EP 1040 DI 10.1056/NEJMp0907415 PG 4 WC Medicine, General & Internal SC General & Internal Medicine GA 492LP UT WOS:000269659400003 ER PT J AU Krumholz, HM Merrill, AR Schone, EM Schreiner, GC Chen, J Bradley, EH Wang, Y Wang, YF Lin, Z Straube, BM Rapp, MT Normand, SLT Drye, EE AF Krumholz, Harlan M. Merrill, Angela R. Schone, Eric M. Schreiner, Geoffrey C. Chen, Jersey Bradley, Elizabeth H. Wang, Yun Wang, Yongfei Lin, Zhenqiu Straube, Barry M. Rapp, Michael T. Normand, Sharon-Lise T. Drye, Elizabeth E. TI Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission SO CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES LA English DT Article DE health policy; myocardial infarction; heart failure; equality of health care ID QUALITY-OF-CARE; RATES; OUTCOMES; SUPPORT AB Background-In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures. Methods and Results-We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics, there were high and low hospital performers among all types of hospitals. Conclusions-In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high. (Circ Cardiovasc Qual Outcomes. 2009;2:407-413.) C1 [Krumholz, Harlan M.; Schreiner, Geoffrey C.; Chen, Jersey; Wang, Yun; Wang, Yongfei; Drye, Elizabeth E.] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, Dept Internal Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Bradley, Elizabeth H.] Yale Univ, Sch Med, Sect Hlth Policy & Adm, Sch Publ Hlth, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Wang, Yun; Lin, Zhenqiu] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Merrill, Angela R.; Schone, Eric M.] Math Policy Res Inc, Cambridge, MA USA. [Straube, Barry M.; Rapp, Michael T.] Ctr Medicare, Baltimore, MD USA. [Straube, Barry M.; Rapp, Michael T.] Ctr Medicaid Serv, Baltimore, MD USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Sect Cardiovasc Med, 1 Church St,Suite 200, New Haven, CT 06510 USA. EM harlan.krumholz@yale.edu FU Production and Implementation of Hospital Outcome and Efficiency Measures [HHSM-500-2008-00020I (0001)]; Development and Re-Evaluation of the CMS Hospital Outcomes and Efficiency Measures [HHSM-500-2008-00025I (0001)]; CMS; Department of Health and Human Services FX The analyses on which this publication is based were performed under contract HHSM-500-2008-00020I (0001), entitled "Production and Implementation of Hospital Outcome and Efficiency Measures," and contract HHSM-500-2008-00025I (0001), entitled " Development and Re-Evaluation of the CMS Hospital Outcomes and Efficiency Measures," both sponsored by CMS, Department of Health and Human Services. The views expressed in this article are those of the authors and do not necessarily reflect the official position of CMS or the US Department of Health and Human Services. NR 17 TC 204 Z9 207 U1 2 U2 19 PU LIPPINCOTT WILLIAMS & WILKINS PI PHILADELPHIA PA 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA SN 1941-7713 J9 CIRC-CARDIOVASC QUAL JI Circ.-Cardiovasc. Qual. Outcomes PD SEP PY 2009 VL 2 IS 5 BP 407 EP 413 DI 10.1161/CIRCOUTCOMES.109.883256 PG 7 WC Cardiac & Cardiovascular Systems SC Cardiovascular System & Cardiology GA 575PA UT WOS:000276078200004 PM 20031870 ER PT J AU Smith, S Newhouse, JP Freeland, MS AF Smith, Sheila Newhouse, Joseph P. Freeland, Mark S. TI Income, Insurance, And Technology: Why Does Health Spending Outpace Economic Growth? SO HEALTH AFFAIRS LA English DT Article ID MEDICAL-CARE; COST CONTAINMENT; INDUSTRY AB A broad consensus holds that increased medical capability-technology-is the primary driver of health spending growth. However, technology does not expand independently of historical context; it is fueled by rising incomes and more generous insurance coverage. We estimate that medical technology explains 27-48 percent of health spending growth since 1960-a smaller percentage than earlier estimates. Income ( gross domestic product, or GDP) growth plays a critical role, primarily through the actions of governments and employers on behalf of pools of consumers. The contribution of insurance is likely to differ, with less of a push from increasing generosity of coverage and more of a push from changes in provider payment. [ Health Aff (Millwood). 2009; 28(5):1276-84; 10.1377/hlthaff.28.5.1276] C1 [Smith, Sheila; Freeland, Mark S.] Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD USA. [Newhouse, Joseph P.] Harvard Univ, Boston, MA 02115 USA. RP Smith, S (reprint author), Ctr Medicare & Medicaid Serv, Off Actuary, Baltimore, MD USA. EM ssmith2@cms.hhs.gov NR 26 TC 58 Z9 58 U1 1 U2 7 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 2009 VL 28 IS 5 BP 1276 EP 1284 DI 10.1377/hlthaff.28.5.1276 PG 9 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 492HP UT WOS:000269646100006 PM 19738242 ER PT J AU Straube, B Blum, JD AF Straube, Barry Blum, Jonathan D. TI The Policy On Paying For Treating Hospital-Acquired Conditions: CMS Officials Respond SO HEALTH AFFAIRS LA English DT Article AB Policies that decline payment in the event of hospital-acquired conditions have generated considerable public attention. Although the projected payment reductions are not large, small payment penalties have been effective in changing human behavior and ultimately in improving the hospital care experience for patients. Many state Medicaid programs and commercial payers have adopted similar policies. Medicare payment reductions for hospital-acquired conditions are only one component of several efforts to reduce their incidence. The Centers for Medicare and Medicaid Services (CMS) will refine these policies as appropriate. Other CMS strategies to reduce hospital-acquired conditions include public reporting, quality improvement initiatives, value-based purchasing, quality metrics and guidelines development, and national coverage decisions. [Health Aff (Millwood). 2009;28(5):1494-97; 10.1377/hlthaff.28.5.1494] C1 [Straube, Barry] Ctr Medicare Serv, Baltimore, MD USA. [Straube, Barry] Ctr Medicaid Serv, Baltimore, MD USA. RP Straube, B (reprint author), Ctr Medicare Serv, Baltimore, MD USA. EM barry.straube@cms.hhs.gov NR 4 TC 12 Z9 12 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 SEP-OCT PY 2009 VL 28 IS 5 BP 1494 EP 1497 DI 10.1377/hlthaff.28.5.1494 PG 4 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 492HP UT WOS:000269646100033 PM 19738268 ER PT J AU Buczko, W AF Buczko, William TI Ventilator-Associated Pneumonia among Elderly Medicare Beneficiaries in Long-Term Care Hospitals SO HEALTH CARE FINANCING REVIEW LA English DT Article ID EPIDEMIOLOGY; LEVEL AB Ventilator-associated pneumonia (VAP) is a complication of ventilator care that produces excess, avoidable resource use and treatment costs. Control of VAP is an important aspect of quality of care improvement for long-term care hospitals (LTCHs) since they provide post-acute ventilator care for many Medicare beneficiaries. Data for Medicare patients discharged from LTCHs during CY 2004 who received continuous mechanical ventilation are examined (N=13,759). Nearly 25% of Medicare LTCH ventilator patients acquired VAP Despite having lower mortality and less co-morbidity than non-VAP patients, length of stay (LOS) and total charges were both higher for VAP patients. Some of this excess is avoidable. C1 [Buczko, William] Ctr Medicare Serv, ORDI, Baltimore, MD 21244 USA. [Buczko, William] Ctr Medicaid Serv, Baltimore, MD 21244 USA. RP Buczko, W (reprint author), Ctr Medicare Serv, ORDI, Mail Stop C3-19-07,7500 Secur Blvd, Baltimore, MD 21244 USA. EM WBuczko@cms.hhs.gov NR 16 TC 1 Z9 1 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 2009 VL 31 IS 1 BP 1 EP 10 PG 10 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 538MU UT WOS:000273189400001 ER PT J AU Thomas, F Caplan, C Levy, JM Cohen, M Leonard, J Caldis, T Mueller, C AF Thomas, Fred Caplan, Craig Levy, Jesse M. Cohen, Marty Leonard, James Caldis, Todd Mueller, Curt TI Clinician Feedback on Using Episode Groupers with Medicare Claims Data SO HEALTH CARE FINANCING REVIEW LA English DT Article AB CMS is investigating techniques that might help identify costly physician practice patterns. One method presently under evaluation is to compare resource use for certain episodes of care using commercially available episode grouping software. Although this software has been used by the private sector to classify insured individuals' medical claims into episodes of care, it has never been used with fee-for-service Medicare claims except in the studies by the Medicare Payment Advisory Commission (MedPAC) and CMS. This study reviews and reports on clinician feedback on the most obvious and important decisions that must be faced by Medicare to use grouped claims data as the foundation for a physician performance measurement system. The panel reactions show the importance of bringing persons with clinical knowledge into the development process. The clinician feedback confirms that additional research is needed. C1 [Thomas, Fred; Caplan, Craig; Levy, Jesse M.; Mueller, Curt] Ctr Medicare Serv, Baltimore, MD 21224 USA. [Thomas, Fred; Caplan, Craig; Levy, Jesse M.; Mueller, Curt] Ctr Medicaid Serv, Baltimore, MD 21224 USA. RP Thomas, F (reprint author), Ctr Medicare Serv, 7500 Secur Blvd,Mail Stop C3-21-28, Baltimore, MD 21224 USA. EM fred.thomas@cms.hhs.gov NR 7 TC 1 Z9 1 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 2009 VL 31 IS 1 BP 51 EP 61 PG 11 WC Health Care Sciences & Services; Health Policy & Services SC Health Care Sciences & Services GA 538MU UT WOS:000273189400005 ER PT J AU McGuinness, KM Perez, JT Coady, JA AF McGuinness, Kevin M. Perez, Jon T. Coady, Jeff A. TI Redefining the Mission: The Mercy Model as a Leadership Approach for Public Health Systems and Population-Based Programs SO PUBLIC HEALTH REPORTS LA English DT Editorial Material C1 [McGuinness, Kevin M.] US Hlth Resources & Serv Adm, Bur Clinician Recruitment & Serv, Div Site & Clinician Recruitment, State & Community Initiat Branch, Rockville, MD 20857 USA. [Perez, Jon T.] Indian Hlth Serv, Rockville, MD USA. [Coady, Jeff A.] Ctr Medicare & Medicaid Serv, Chicago, IL USA. RP McGuinness, KM (reprint author), US Hlth Resources & Serv Adm, Bur Clinician Recruitment & Serv, Div Site & Clinician Recruitment, State & Community Initiat Branch, 5600 Fishers Ln,Room 8A-08, Rockville, MD 20857 USA. EM kevinmcg@gwmail.gwu.edu NR 3 TC 0 Z9 0 U1 0 U2 0 PU ASSOC SCHOOLS PUBLIC HEALTH PI WASHINGTON PA 1101 15TH ST NW, STE 910, WASHINGTON, DC 20005 USA SN 0033-3549 J9 PUBLIC HEALTH REP JI Public Health Rep. PD SEP-OCT PY 2009 VL 124 IS 5 BP 625 EP 628 PG 4 WC Public, Environmental & Occupational Health SC Public, Environmental & Occupational Health GA 482VV UT WOS:000268918600004 PM 19753940 ER PT J AU Krumholz, HM Wang, Y Chen, J Drye, EE Spertus, JA Ross, JS Curtis, JP Nallamothu, BK Lichtman, JH Havranek, EP Masoudi, FA Radford, MJ Han, LF Rapp, MT Straube, BM Normand, SLT AF Krumholz, Harlan M. Wang, Yun Chen, Jersey Drye, Elizabeth E. Spertus, John A. Ross, Joseph S. Curtis, Jeptha P. Nallamothu, Brahmajee K. Lichtman, Judith H. Havranek, Edward P. Masoudi, Frederick A. Radford, Martha J. Han, Lein F. Rapp, Michael T. Straube, Barry M. Normand, Sharon-Lise T. TI Reduction in Acute Myocardial Infarction Mortality in the United States Risk-Standardized Mortality Rates From 1995-2006 SO JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION LA English DT Article ID QUALITY-OF-CARE; NATIONAL REGISTRY; HOSPITAL MORTALITY; TRENDS; MEDICARE; IMPROVEMENT; ELEVATION; COMMUNITY; OUTCOMES; PROGRAM AB Context During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. Objective To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Design, Setting, and Patients Observational study using administrative data and a validated risk model to evaluate 3 195 672 discharges in 2 755 370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Main Outcome Measure Hospital-specific 30-day all-cause RSMR. Results At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Conclusion Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation. JAMA. 2009;302(7):767-773 C1 [Krumholz, Harlan M.; Wang, Yun; Chen, Jersey; Drye, Elizabeth E.; Curtis, Jeptha P.] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06510 USA. [Krumholz, Harlan M.] Yale Univ, Sch Med, Sect Hlth Policy & Adm, Sch Publ Hlth, New Haven, CT 06510 USA. [Lichtman, Judith H.] Yale Univ, Sch Med, Sect Chron Dis Epidemiol, Sch Publ Hlth, New Haven, CT 06510 USA. [Krumholz, Harlan M.; Wang, Yun] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA. [Spertus, John A.] Univ Missouri Kansas City, Sch Med, Kansas City, MO USA. [Spertus, John A.] Mid Amer Heart Inst, Kansas City, MO USA. [Ross, Joseph S.] Mt Sinai Sch Med, Dept Geriatr & Adult Dev, New York, NY USA. [Ross, Joseph S.] James J Peters VA Med Ctr, Ctr Geriatr Res Educ & Clin, Bronx, NY USA. [Ross, Joseph S.] Hlth Serv Res Enhancement Award Program, Bronx, NY USA. [Nallamothu, Brahmajee K.] Univ Michigan, Sch Med, Hlth Serv Res & Dev Ctr Excellence, Ann Arbor VA Med Ctr, Ann Arbor, MI USA. [Nallamothu, Brahmajee K.] Univ Michigan, Sch Med, Div Cardiovasc Dis, Dept Internal Med, Ann Arbor, MI USA. [Havranek, Edward P.; Masoudi, Frederick A.] Univ Colorado, Hlth Sci Ctr, Denver, CO USA. [Havranek, Edward P.; Masoudi, Frederick A.] Denver Hlth Med Ctr, Denver, CO USA. [Radford, Martha J.] NYU, Sch Med, New York, NY USA. [Han, Lein F.; Rapp, Michael T.; Straube, Barry M.] Ctr Medicare, Baltimore, MD USA. [Han, Lein F.; Rapp, Michael T.; Straube, Barry M.] Ctr Medicaid Serv, Baltimore, MD USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA. [Normand, Sharon-Lise T.] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. RP Krumholz, HM (reprint author), Yale Univ, Sch Med, Sect Cardiovasc Med, 1 Church St,Ste 200, New Haven, CT 06510 USA. EM harlan.krumholz@yale.edu FU Centers for Medicare & Medicaid Services (CMS); US Department of Health and Human Services; [HHSM-500-2005-CO001C] FX The analyses on which this article is based were performed under contract HHSM-500-2005-CO001C, "Utilization and Quality Control Quality Improvement Organization for the State (commonwealth) of Colorado," funded by the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. NR 21 TC 125 Z9 129 U1 0 U2 2 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 AUG 19 PY 2009 VL 302 IS 7 BP 767 EP 773 PG 7 WC Medicine, General & Internal SC General & Internal Medicine GA 484UT UT WOS:000269073800025 PM 19690309 ER PT J AU Chavers, BM Solid, CA Daniels, FX Chen, SC Collins, AJ Frankenfield, DL Herzog, CA AF Chavers, Blanche M. Solid, Craig A. Daniels, Frank X. Chen, Shu-Cheng Collins, Allan J. Frankenfield, Diane L. Herzog, Charles A. TI Hypertension in Pediatric Long-term Hemodialysis Patients in the United States SO CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY LA English DT Article ID STAGE RENAL-DISEASE; LEFT-VENTRICULAR HYPERTROPHY; CHRONIC KIDNEY-DISEASE; BLOOD-PRESSURE; CARDIOVASCULAR-DISEASE; PERITONEAL-DIALYSIS; DUTCH COHORT; RISK-FACTORS; CHILDREN; MORTALITY AB Background and objectives: Data are limited regarding BP distribution and the prevalence of hypertension in pediatric long-term dialysis patients. This study aimed to examine BP distribution in U.S. pediatric long-term hemodialysis patients. Design, setting, participants, & measurements: This cross-sectional study of all U.S. pediatric (aged 0-< 18 yr, n = 624) long-term hemodialysis patients was performed as part of the Centers for Medicare & Medicaid Services End-Stage Renal Disease (ESRD) Clinical Performance Measures Project. BP and clinical information were collected monthly in October, November, and December 2001. Hypertension was defined as the mean of pre- and postdialysis systolic or diastolic BP above the 95th percentile for age, height, and sex, or anti hypertensive medication use. Results were calculated by age, sex, race, ethnicity, ESRD duration, body mass index percentile, primary cause of ESRD, and laboratory data. Results: Hypertension was present in 79% of patients; 62% used antihypertensive medication. Five percent of patients were prehypertensive (mean BP at 90th to 95th percentile). Hypertension was uncontrolled in 74% of treated patients. Characteristics associated with hypertension included acquired kidney disease, shorter duration of ESRD, and lower mean hemoglobin and calcium values. Characteristics associated with uncontrolled hypertension were younger age and shorter duration of ESRD. Conclusions: Hypertension is common in U.S. pediatric long-term hemodialysis patients, uncontrolled in 74% of treated patients, and untreated in 21% of hypertensive patients. It is concluded that a more aggressive approach to treatment of hypertension is warranted in pediatric long-term hemodialysis patients. Clin J Am Soc Nephrol 4: 1363-1369, 2009. doi: 10.2215/CJN.01440209 C1 [Chavers, Blanche M.] Univ Minnesota, Dept Pediat, Minneapolis, MN 55455 USA. [Chavers, Blanche M.; Herzog, Charles A.] US Renal Data Syst, Cardiovasc Special Studies Ctr, Minneapolis, MN USA. [Collins, Allan J.; Herzog, Charles A.] Univ Minnesota, Dept Med, Minneapolis, MN 55455 USA. [Frankenfield, Diane L.] Ctr Medicare & Medicaid Serv, Off Res Dev & Informat, Baltimore, MD USA. RP Chavers, BM (reprint author), Univ Minnesota, Dept Pediat, Mayo Mail Code 491,420 Delaware St SE, Minneapolis, MN 55455 USA. EM chave001@umn.edu FU National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD [HHSN267200715003C] FX This study was performed as a deliverable under Contract No. HHSN267200715003C (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD). The authors have no competing financial interests. The authors thank Dr. Alan Sinaiko for comments and United States Renal Data System colleagues Beth Forrest for regulatory assistance; Shane Nygaard for manuscript preparation and submission assistance; and Nan Booth, MSW, MPH, for editorial assistance. NR 30 TC 31 Z9 33 U1 0 U2 4 PU AMER SOC NEPHROLOGY PI WASHINGTON PA 1725 I ST, NW STE 510, WASHINGTON, DC 20006 USA SN 1555-9041 J9 CLIN J AM SOC NEPHRO JI Clin. J. Am. Soc. Nephrol. PD AUG PY 2009 VL 4 IS 8 BP 1363 EP 1369 DI 10.2215/CJN.01440209 PG 7 WC Urology & Nephrology SC Urology & Nephrology GA 479RJ UT WOS:000268678300012 PM 19556378 ER PT J AU Sandhu, SK Burwen, D MaCurdy, T Gibbs, J Rusev, E Garcia, B Sholley, C Marston, D Elmo, K Izurieta, H Ball, R AF Sandhu, S. K. Burwen, D. MaCurdy, T. Gibbs, J. Rusev, E. Garcia, B. Sholley, C. Marston, D. Elmo, K. Izurieta, H. Ball, R. TI Comparison of Alpha-Spending Plans for Influenza Vaccine Safety Surveillance SO PHARMACOEPIDEMIOLOGY AND DRUG SAFETY LA English DT Meeting Abstract C1 [Sandhu, S. K.; Burwen, D.; Izurieta, H.; Ball, R.] US FDA, Rockville, MD 20857 USA. [MaCurdy, T.; Gibbs, J.; Rusev, E.; Garcia, B.; Sholley, C.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. [Marston, D.; Elmo, K.] Acumen LLC, Burlingame, CA 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 2009 VL 18 BP S35 EP S35 PG 1 WC Public, Environmental & Occupational Health; Pharmacology & Pharmacy SC Public, Environmental & Occupational Health; Pharmacology & Pharmacy GA 483YQ UT WOS:000269009900080 ER PT J AU Straube, BM McGann, PE Rapp, MT AF Straube, Barry M. McGann, Paul E. Rapp, Michael T. TI Rehospitalizations among Patients in the Medicare Fee-for-Service Program SO NEW ENGLAND JOURNAL OF MEDICINE LA English DT Letter C1 [Straube, Barry M.; McGann, Paul E.; Rapp, Michael T.] Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. RP Straube, BM (reprint author), Ctr Medicare & Medicaid Serv, Baltimore, MD 21244 USA. EM ocsqbox@cms.hhs.gov NR 2 TC 0 Z9 0 U1 0 U2 2 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 JUL 16 PY 2009 VL 361 IS 3 BP 311 EP 311 PG 1 WC Medicine, General & Internal SC General & Internal Medicine GA 470LL UT WOS:000267976100032 PM 19610165 ER PT J AU Schenck, AP Peacock, SC Klablinde, CN Lapin, P Coan, JF Brown, ML AF Schenck, Anna P. Peacock, Sharon C. Klablinde, Carrie N. Lapin, Pauline Coan, Jim F. Brown, Martin L. TI Trends in Colorectal Cancer Test Use in the Medicare Population, 1998-2005 SO AMERICAN JOURNAL OF PREVENTIVE MEDICINE LA English DT Article ID SCREENING PROCEDURES; PREVENTIVE SERVICES; UNITED-STATES; COLON-CANCER; BENEFICIARIES; DISPARITIES; REIMBURSEMENT; COLONOSCOPY; GUIDELINES; ENROLLEES AB Background: Colorectal cancer (CRC) screening has been covered under the Medicare program since 1998. No prior study has addressed the question of the completeness of CRC screening in the entire Medicare cohort. Methods: In 2008, CRC test-use rates were analyzed for the national fee-for-service Medicare population using Medicare enrollment and claims data from 1998 through 2005. Annual test-use rates were calculated for fecal occult blood testing, sigmoidoscopy, barium enema, and colonoscopy for each year by the demographic characteristics of enrollees. A current-in-Medicare rate was calculated to assess the percentage of enrollees with CRC testing according to recommended intervals. Results: Colonoscopy rates have increased every year since the introduction of CRC screening coverage. Test-use rates for all other test modalities have steadily decreased. The percentage of Medicare enrollees receiving appropriate tests has slowly increased. In 2005, 47% of enrollees aged >= 65 years and 33% of enrollees aged 50-64 years had claims indicating that they had been tested according to recommended intervals. Conclusions: CRC test-use rates in the Medicare population are low. Disparities are apparent by age, race/ethnicity, gender, disability, income, and geographic residence. Much work remains to be done to increase testing to acceptable levels. (Am J Prev Med 2009;37(1):1-7) (C) 2009 American Journal of Preventive Medicine C1 [Schenck, Anna P.; Peacock, Sharon C.] Carolinas Ctr Med Excellence, Cary, NC 27518 USA. [Klablinde, Carrie N.; Brown, Martin L.] NCI, Hlth Serv & Econ Branch, Appl Res Program, Div Canc Control & Populat Sci, Bethesda, MD 20892 USA. [Lapin, Pauline; Coan, Jim F.] Ctr Medicare & Medicaid Serv, Baltimore, MD USA. RP Schenck, AP (reprint author), Carolinas Ctr Med Excellence, 100 Regency Forest,Suite 200, Cary, NC 27518 USA. EM aschenck@ncqio.sdps.org FU Centers for Medicare & Medicaid Services (CMS) [500-02-NC03]; National Cancer Institute (NCI) [YI-PC-1007] FX The analyses on which this publication is based were performed under Contract No. 500-02-NC03 (Utilization and Quality Control Peer Review Organization for the State of North Carolina), sponsored by the Centers for Medicare & Medicaid Services (CMS) with collaboration from the National Cancer Institute (NCI) under inter-agency agreement #YI-PC-1007. The content of this publication does not necessarily reflect the views or policies of CMS, NCI, or The Carolinas Center for Medical Excellence. The opinions expressed in this paper are those of the authors. NR 31 TC 67 Z9 67 U1 0 U2 2 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 JUL PY 2009 VL 37 IS 1 BP 1 EP 7 DI 10.1016/j.amepre.2009.03.009 PG 7 WC Public, Environmental & Occupational Health; Medicine, General & Internal SC Public, Environmental & Occupational Health; General & Internal Medicine GA 462IE UT WOS:000267343800001 PM 19423273 ER EF