Influenza vaccinations of Washington State Medicare beneficiaries seen by physiatrists in the outpatient setting in 1994

PURPOSE: A shift in outpatient oncology care from the physician’s office to hospital outpatient settings has generated interest in the effect of practice setting on outcomes. Our objective was to examine whether medical oncologists’ prescribing of drugs and services for older adult patients with advanced cancer is used more in physicians’ offices compared with hospital outpatient departments. METHODS: This was a retrospective comparative study. SEER-Medicare data (2004 to 2011) were used to identify Medicare beneficiaries diagnosed with advanced breast, colon, esophagus, non–small-cell lung, pancreatic, or stomach cancer. Between physicians’ offices and hospital outpatient departments, we compared use of selected likely low-value supportive drugs, low-value therapeutic drugs, chemotherapy-related hospitalizations, and hospice. We used hierarchical modeling to assess differences between settings to account for correlation within physicians. RESULTS: Compared with patients treated in a hospital outpatient department, those treated in a physician’s office setting were more likely to receive erythropoiesis-stimulating agents (odds ratio, 1.72; 95% CI, 1.53 to 1.94) and granulocyte colony–stimulating factors (odds ratio, 1.28; 95% CI, 1.18 to 1.38). For combination chemotherapy and nanoparticle albumin-bound–paclitaxel in patients with breast cancer, there was a trend toward higher use in physicians’ offices, although this was not statistically significant. Chemotherapy-related hospitalizations and hospice did not vary by setting. CONCLUSION: We found somewhat higher use of several drugs for patients with advanced cancer in physicians’ office settings compared with hospital outpatient departments. Findings support research to dissect the mechanisms through which setting might influence physicians’ behavior.

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Heart Failure Practice Improvement Effort in the Outpatient Setting: A Health Care Financing Administration Initiative to Improve the Care of Medicare Beneficiaries with Heart Failure

Congestive Heart Failure ◽

10.1111/j.1527-5299.2001.00235.x ◽

2001 ◽

Vol 7 (2) ◽

pp. 105-108

Author(s):

Jane P. Taylor ◽

Christine L. Mulgrew ◽

Risa Hayes ◽

Diana L. Ordin ◽

Edward P. Havranek

Keyword(s):

Heart Failure ◽

Health Care ◽

Health Care Financing ◽

Outpatient Setting ◽

Medicare Beneficiaries ◽

Health Care Financing Administration ◽

Practice Improvement ◽

Improvement Effort

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Abstract 5921: Medicare Beneficiaries with Mild to Severe Heart Failure See 15–23 Different Providers Annually

Circulation ◽

10.1161/circ.118.suppl_18.s_1030-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Robert L Page ◽

Christopher Hogan ◽

Kara Strongin ◽

Roger Mills ◽

JoAnn Lindenfeld

Keyword(s):

Heart Failure ◽

Severe Heart Failure ◽

The United States ◽

Outpatient Setting ◽

Fiscal Year ◽

Hospital Inpatient ◽

Medicare Beneficiaries ◽

Improvement Program ◽

Data Set ◽

Mild Disease

In fiscal year 2003, Medicare beneficiaries with heart failure (HF) accounted for 37% of all Medicare spending and nearly 50% of all hospital inpatient costs. On average, each beneficiary had 10.3 outpatient and 2 inpatient visits specifically for HF. Despite significant improvements in medical care for HF, mortality and hospital admissions remain high. No data exist regarding the number of providers ordering and providing care for this population. An analysis of fiscal year 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. Three cohorts were defined according to mild, moderate, severe HF employing the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model and Chronic Care Improvement Program definitions. HMO enrollees, persons without Part A and Part B coverage, and those outside the United States were excluded. We identified physicians by using the unique physician identification number of performing physicians. Based on inclusion criteria, 173,863 beneficiaries were identified. The average number of providers providing care in all sites were 15.9, 18.6, 23.1 for beneficiaries with mild, moderate, and severe HF, respectively; and 10.1, 11.5, and 12.1 in the outpatient setting, respectively. The average number of providers ordering care in all sites consisted of 8.3, 9.6, and 11.2 for beneficiaries with mild, moderate, and severe HF, respectively; and 6.5,7.3, and 7.8 in the outpatient setting, respectively. For beneficiaries with mild disease, only 10% of all office visits were specifically for HF, while those with moderate or severe disease, only 20% were specifically for HF. Medicare beneficiaries with HF, even those with mild disease, have a large number of providers ordering and providing care. These data highlight the importance for developing systems and processes of coordinated care for this population.

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Abstract 281: Contemporary Epidemiology of Atrial Fibrillation Among Medicare Beneficiaries, 2004-2013

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.281 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Joshua Parker ◽

Rohan Khera ◽

Ambarish Pandey ◽

Daniel Cheeran ◽

Colby Ayers ◽

...

Keyword(s):

Atrial Fibrillation ◽

Black Men ◽

White Men ◽

National Sample ◽

Outpatient Setting ◽

Relative Increase ◽

Racial Groups ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Men And Women

Background: Atrial fibrillation (AF) is the most common dysrhythmia in clinical practice, and is a significant contributor to morbidity and mortality. Prior reports have projected a large increase in AF burden over time. A contemporary assessment of epidemiology is needed to assess if an emphasis of prevention strategies over the last decade has been effective in alleviating this risk. Methods: We used a 5% national sample of all Medicare beneficiaries in the US from 2002 through 2013 to construct a longitudinal cohort of 2.3 million fee-for-service Medicare beneficiaries administratively followed for ≥2 years using claims data. Trends in incident and prevalent AF were assessed for 2004 through 2013. Using ICD-9 codes, encounters with AF were identified from inpatient, outpatient, and physician claims. AF during the first 2 years of entry into the cohort was defined as pre-existing AF. Incident AF was defined as having either 1 inpatient claim with a diagnosis of AF or 2 outpatient or physician claims with AF. Calendar-year prevalence comprised pre-existing and incident AF for the respective years as well as those with incident AF in preceding years. Age-adjusted time trends were assessed using Poisson regression. Results: Between 2002 and 2013, 219,570 patients had incident AF. At incidence, mean age was 79 years, 55% were women, and 92% and 5% were white and black, respectively. Age-adjusted AF incidence decreased by 0.4/1000 per year between 2004 (20/1000) and 2013 (17/1000). While incidence declined for white men and women (P<.05), it has remained unchanged for black men and women (Figure). Proportion of incident events in the outpatient setting increased from 26% to 40%. One-year mortality was 9%, and remained unchanged throughout the study period. Over this period, the overall prevalence of AF decreased by 0.9/1000 per year (p<.05), however, there was a relative increase in AF prevalence among black men. Conclusions: Between years 2004 and 2013, the overall incidence and prevalence of AF among a 5% sample of Medicare beneficiaries stabilized. There were, however, differences across racial groups, with a slight decline in incidence among white men and women, which was not observed in black men and women.

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Acute Kidney Injury Requiring Dialysis and Incident Dialysis Patient Outcomes in US Outpatient Dialysis Facilities

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.18311120 ◽

2021 ◽

pp. CJN.18311120

Author(s):

Claudia Dahlerus ◽

Jonathan Segal ◽

Kevin He ◽

Wenbo Wu ◽

Shu Chen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Race And Ethnicity ◽

Proportional Hazards ◽

Kidney Injury ◽

Patient Characteristics ◽

Outpatient Setting ◽

Cox Proportional Hazards ◽

Medicare Beneficiaries ◽

Dialysis Patients ◽

Dialysis Facilities

Background and Objectives: About 30% of patients with acute kidney injury (AKI) may require ongoing dialysis in the outpatient setting after hospital discharge. A 2017 CMS policy change allows Medicare beneficiaries with AKI requiring dialysis to receive outpatient treatment in dialysis facilities. Outcomes for these patients have not been reported. We compare patient characteristics and mortality among AKI dialysis patients and non-AKI incident dialysis patients. Design, setting, participants, and measurements: Retrospective cohort design, using 2017 Medicare Claims to follow outpatient AKI dialysis patients and non-AKI incident dialysis patients up to 365 days. Outcomes are unadjusted and adjusted mortality using Kaplan-Meier estimation for unadjusted survival probability, Poisson regression for monthly mortality, and Cox proportional hazards modeling for adjusted mortality. Results: 10,821 of 401,973 (3%) Medicare dialysis patients had at least one AKI claim, and 52,626 patients were Medicare non-AKI incident dialysis patients. AKI dialysis patients were more likely to be White (76% vs 70%), non-Hispanic (92% vs 87%), and age 60 or greater (82% vs 72%) compared to non-AKI incident dialysis patients. Unadjusted mortality was markedly higher for AKI dialysis patients compared to non-AKI incident dialysis patients. Adjusted mortality differences between both cohorts persisted through month 4 of the follow-up period (all P<0.01) then declined and were no longer statistically significant. Adjusted monthly mortality stratified by Black and other race between AKI dialysis patients vs non-AKI incident dialysis patients was lower throughout month 4 (1.5 v .60, 1.20 v 0.84, 1.00 v 0.80, 0.95 v 0.74, all P<0.001 which persisted through month 7. Overall adjusted mortality risk was 22% higher for AKI dialysis patients (1.22, CI 1.17, 1.27). Conclusions: In fully adjusted analyses AKI dialysis patients had higher early mortality compared to non-AKI incident dialysis patients, but these differences declined after several months. Differences were also observed by age, race and ethnicity within both patient cohorts.

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Patterns of palliative symptom management (PSM) medication use at end-of-life (EoL) among Medicare beneficiaries with advanced lung cancer (advLC).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.130 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 130-130

Author(s):

Amy J. Davidoff ◽

Elizabeth Horn Prsic ◽

Maureen Saphire ◽

Maureen Canavan ◽

Shi-Yi Wang ◽

...

Keyword(s):

Rural Areas ◽

Symptom Relief ◽

Medication Use ◽

Symptom Burden ◽

Poor Quality ◽

Outpatient Setting ◽

Advanced Lung Cancer ◽

Medicare Beneficiaries ◽

Pain Medications ◽

Poor Access

130 Background: Patients with advLC experience high symptom burden; undertreatment may result in poor quality of life for patients and caregivers. Hospice enrollment often happens late or not at all, yet little is known about EoL outpatient PSM medication use in the non-hospice setting. Methods: Using SEER-Medicare linked registry and claims data, we selected decedents diagnosed with advLC between 2008-2013 who survived ≥6 months (death between 2008-2014). Using non-hospice claims, we identified receipt of oral and parenteral medications to manage symptoms such as pain (any pain medications, any opioids), nausea/ vomiting and dyspnea at 6 (EoL-6) and 1 (EoL-1) months prior to death. Antiemetics were excluded if concurrent with chemotherapy (CTx). T-tests compared sample proportions receiving PSM between EoL-6 and EoL-1. Logistic regression estimated associations between PSM medication receipt at EoL-1 and patient demographic characteristics, comorbidity, and ongoing CTx or radiation. Results: We identified 16,246 decedents: mean age 77 years, 50% male, and 81% non-Hispanic white. PSM medication for individual symptom areas increased from EoL-6 to EoL-1 [Table]. Adjusted results indicate that pain medication receipt was higher for females, and patients with multimorbidity, dual Medicare/Medicaid, higher poverty, living in rural areas, and receiving concurrent radiation but lower among those with increasing age and for non-white race/ethnicity groups. We saw similar trends for PSM using opioids, and for emotional distress, and dyspnea. Conclusions: Among patients with advLC at EoL, medication use for symptom relief was common and increasing toward EoL-1. Lower use by males, older adults, and non-whites may reflect poor access or poor patient-provider communication. Further research is needed to assess adequacy of PSM in the outpatient setting. [Table: see text]

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Connecting Culture and Community: Washington State University Builds Partnerships With Northwest Tribes

ASHA Leader ◽

10.1044/leader.ftr1.10162005.1 ◽

2005 ◽

Vol 10 (16) ◽

pp. 1-21

Author(s):

Ella Inglebret

Keyword(s):

Washington State ◽

State University ◽

Washington State University

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Lingual Strengthening: Success in an Outpatient Setting

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd24.2.71 ◽

2015 ◽

Vol 24 (2) ◽

pp. 71-74

Author(s):

Ali Meier

Keyword(s):

Oropharyngeal Dysphagia ◽

Patient Discharge ◽

Outpatient Setting ◽

Oral Performance ◽

Exercise Protocol ◽

Anterior Position ◽

Tongue Position ◽

Bolus Propulsion ◽

Posterior Position

In the last decade or more, dysphagia research has investigated the effect of lingual strengthening on oropharyngeal dysphagia with promising results. Much of this research has utilized strengthening devices such as the Iowa Oral Performance Instrument (IOPI) or the Madison Oral Strengthening Therapeutic (MOST) Device. Patients are often given a device to use, and are able to complete an exercise protocol daily or multiple times per day. This case study was completed to determine the effectiveness of using the IOPI in an outpatient clinic where therapy was conducted two to three times per week. The patient was seen post tongue resection due to oropharyngeal cancer. From initiation of IOPI use to patient discharge, the patient demonstrated a 71% increase in lingual strength at the anterior position, a 61% increase at the posterior position, and a 314% increase at the base of tongue position. His diet advanced from NPO to general based on gains in lingual strength and bolus propulsion.

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