972 Predictors and Outcomes of Readmission for Clostridium difficile in a National Sample of Medicare Beneficiaries

Abstract Hospitalization is associated with accelerated cognitive decline for persons with Alzheimer’s disease and related dementia (ADRD), which disproportionately impacts women. Persons with ADRD are also at higher risk for 30-day rehospitalization, which may compound the impact of hospitalization-related exposures that precipitate decline. Evidence surrounding the intersections between gender and rehospitalization risk among diverse, representative populations with ADRD are lacking. This retrospective cohort study used a 100% national sample of Medicare beneficiaries with a diagnosis of ADRD and qualifying index hospitalization in 2014 (n= 1,033,144 unique beneficiaries and 1,672,238 unique stays). The primary outcome was rate of 30-day rehospitalization by gender and race. Within each racial group, men have higher rehospitalization rates than women: 2.6% higher among white men, 1.7% among African American men, and 2.6% higher among other racial/ethnic minorities. Findings highlight the importance of elucidating mechanisms underlying gender differences in hospital utilization and subsequent impact on cognitive decline.

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National Rates of Warfarin Use in Medicare Patients with Atrial Fibrillation: Results from the National Stroke Project

Stroke ◽

10.1161/str.32.suppl_1.328-a ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 328-328

Author(s):

David S Nilasena ◽

Timothy F Kresowik ◽

Anton F Piskac ◽

Rebecca A Hemann ◽

Marian A Brenton ◽

...

Keyword(s):

Atrial Fibrillation ◽

Warfarin Therapy ◽

District Of Columbia ◽

National Sample ◽

The State ◽

Medicare Beneficiaries ◽

Medicare Patients ◽

Project Data ◽

Demographic Subgroups ◽

Univariate Analyses

66 Background: The National Stroke Project is a HCFA initiative to improve stroke related hospital care for Medicare beneficiaries. As part of the evaluation of these efforts, HCFA is measuring performance on a set of quality indicators at the state and national levels. We report the baseline results for a key quality indicator for this project: warfarin at discharge for patients with atrial fibrillation (AF). Methods: Project data were abstracted from a national sample of Medicare inpatient charts with a principal or secondary diagnosis of AF (ICD-9-CM 427.31) and discharged between 4/98 and 3/99. All U.S. states, the District of Columbia, and Puerto Rico were sampled using a systematic random approach. Eligible patients were required to have physician confirmation of AF during the hospitalization and at discharge, or intermittent AF. The main outcome measure was a prescription or physician documented plan for warfarin at discharge. Results: Of 38,925 cases reviewed, 12,303 met the inclusion criteria. Many of the cases (38.3%) were excluded due to a history or current finding of hemorrhage. Nationwide, 6,633 (unadjusted rate, 53.9%) patients were prescribed warfarin at discharge or had a plan to start warfarin after discharge. The state-specific rates ranged from 30.7% to 65.3%. Univariate analyses showed that warfarin was prescribed less frequently (p<0.002) for adults 85 years of age and older (rate=39.9%, OR=0.47, 95% CI=0.43–0.51) and women (rate=52.0%, OR=0.83, 95% CI=0.78–0.90). African-Americans (rate=47.2%, OR=0.76 95% CI=0.63–0.90) and Asians (n=108, rate=37.0%, OR=0.50, 95% CI=0.34–0.74) were also found to have lower warfarin therapy rates. Conclusions: The results from this large national sample confirm the findings from other reports that there is substantial under-utilization of warfarin therapy for stroke prevention among Medicare patients with AF. This is particularly true for demographic subgroups at high risk for stroke. Quality improvement efforts are currently underway through HCFA’s National Stroke Project (AF topic) to increase warfarin use in appropriate AF patients.

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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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PMH2 RISK OF HOSPITALIZATION FOR PNEUMONIA ASSOCIATED WITH THE USE OF ATYPICAL VERSUS TYPICAL ANTIPSYCHOTICS IN A NATIONAL SAMPLE OF MEDICARE BENEFICIARIES

Value in Health ◽

10.1016/j.jval.2011.02.1026 ◽

2011 ◽

Vol 14 (3) ◽

pp. A185

Author(s):

S.H. Dharmarajan ◽

Y. Yang ◽

A.S. Athavale ◽

J.P. Bentley ◽

K.D. Null ◽

...

Keyword(s):

National Sample ◽

Medicare Beneficiaries ◽

Typical Antipsychotics

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Mortality, Hospital Costs, Payments, and Readmissions Associated With Clostridium difficile Infection Among Medicare Beneficiaries

Infectious Diseases in Clinical Practice ◽

10.1097/ipc.0000000000000299 ◽

2015 ◽

Vol 23 (6) ◽

pp. 318-323 ◽

Cited By ~ 12

Author(s):

Edward M. Drozd ◽

Timothy J. Inocencio ◽

Shamonda Braithwaite ◽

Dayo Jagun ◽

Hemal Shah ◽

...

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Hospital Costs ◽

Medicare Beneficiaries

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Inpatient Rehabilitation Outcomes in a National Sample of Medicare Beneficiaries With Hip Fracture

Journal of Applied Gerontology ◽

10.1177/0733464814541325 ◽

2014 ◽

Vol 35 (1) ◽

pp. 62-83 ◽

Cited By ~ 9

Author(s):

Michael P. Cary ◽

Elizabeth I. Merwin ◽

M. Norman Oliver ◽

Ishan C. Williams

Keyword(s):

Hip Fracture ◽

Inpatient Rehabilitation ◽

National Sample ◽

Medicare Beneficiaries ◽

Rehabilitation Outcomes

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Treatment utilization patterns of newly initiated oral anticancer agents in a national sample of Medicare beneficiaries

Journal of Managed Care & Specialty Pharmacy ◽

10.18553/jmcp.2021.27.10.1457 ◽

2021 ◽

Vol 27 (10) ◽

pp. 1457-1468

Author(s):

Jalpa A Doshi ◽

Jordan Jahnke ◽

Swathi Raman ◽

Justin T Puckett ◽

Victoria T Brown ◽

...

Keyword(s):

Anticancer Agents ◽

National Sample ◽

Treatment Utilization ◽

Medicare Beneficiaries ◽

Utilization Patterns ◽

Oral Anticancer Agents

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Abstract 236: Trends in Hospitalization for Digoxin Toxicity and Subsequent Outcomes Among Medicare Beneficiaries in the United States, 1999-2011

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.236 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Sudhakar V Nuti ◽

Frederick A Masoudi ◽

James V Freeman ◽

Karthik Murugiah ◽

Nihar R Desai ◽

...

Keyword(s):

United States ◽

Hospital Mortality ◽

The United States ◽

National Sample ◽

Digoxin Toxicity ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Annual Change ◽

Hospital Discharge Diagnosis ◽

Annual Decline

Objective: To characterize changes in rates of hospitalization for digoxin toxicity and trends in the associated mortality and readmission among older adults over a 12-year period in the United States. Methods: We studied 33,952,331 Medicare fee-for-service beneficiaries 65 years or older with a hospital discharge diagnosis of digoxin toxicity in the United States from 1999 to 2011. Outcome measures were rates of hospitalization for digoxin toxicity; in-hospital mortality; 30-day mortality; and 30-day readmission. Results: There were 20,957 hospitalizations for a principal or secondary diagnosis of digoxin toxicity between 1999 and 2011. The rate declined significantly from 15.2 per 100,000 person-years (95% confidence interval [CI]: 14.7-15.7) in 1999 to 2.1 per 100,000 person-years (95% CI: 1.9-2.3) in 2011 (p<0.001), representing an adjusted annual decline of 17.0% (95% CI: 16.2-17.0) (Figure 1). Between 1999 and 2011, the observed in-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity declined significantly, from 6.0% (95% CI: 5.2-6.8) to 3.3% (95% CI: 2.0-5.1) (p<0.01) and 14.0% (95% CI: 13.0-15.2) to 10.6% (95% CI: 8.2-13.4) (p<0.05), respectively, representing an annual decline for in-hospital mortality of 5.0% (95% CI: 3.7-7.2) and for 30-day mortality of 4.0% (95% CI: 3.1-5.7). The overall observed 30-day readmission rate declined significantly from 23.5% (95% CI: 22.1-24.9) in 1999 to 18.9% (95% CI: 15.6-22.3) in 2011 (p<0.05), but there was no significant decline in the adjusted annual change in 30-day readmission (1.0%, 95% CI: 0.0-1.7). Conclusions: In a national sample of Medicare beneficiaries, the rate of hospitalization for digoxin toxicity and subsequent mortality declined significantly between 1999 and 2011.

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Patterns of Statin Use in Older Medicare Beneficiaries With Traumatic Brain Injury

Journal of Pharmacy Technology ◽

10.1177/8755122517710671 ◽

2017 ◽

Vol 33 (4) ◽

pp. 156-166

Author(s):

Bilal Khokhar ◽

Linda Simoni-Wastila ◽

Julia F. Slejko ◽

Eleanor Perfetto ◽

Min Zhan ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

National Sample ◽

Pharmacological Therapy ◽

Medicare Beneficiaries ◽

Future Studies ◽

Factors Associated ◽

The Impact ◽

Statin Use

Background: In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins’ potential to reduce mortality, there is limited research regarding statin use among older adults. Objective: To characterize and investigate factors associated with statin use among older adults with TBI. Methods: A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. Results: Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). Conclusions: This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.

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