scholarly journals 2219. Evaluation of Medicare Claims to Assess Burden of Pertussis Disease in Persons Aged ≥65 Years

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S757-S757
Author(s):  
Fiona Havers ◽  
Xiyuan Wu ◽  
Michael Wernecke ◽  
Jeffrey A Kelman ◽  
Michael Spiller ◽  
...  
Keyword(s):  
Older Adults ◽  
Laboratory Testing ◽  
Claims Data ◽  
The United States ◽  
Age Group ◽  
Medicare Beneficiaries ◽  
Limited Information ◽  
Diagnostic Codes ◽  
Inpatient Hospitalizations ◽  
Public Health Authorities

Abstract Background Pertussis in adults may be underdiagnosed and underreported; there is limited information on the incidence and severity of pertussis in older adults. We compared pertussis diagnoses identified using medical claims data with national surveillance data to examine the use of claims data as a source for disease burden estimates. Methods We examined claims data in persons aged ≥65 years in the United States enrolled in Medicare A and B from January 1, 2008 to December 31, 2017. We identified provider-diagnosed pertussis through pertussis-related ICD9/ICD10 diagnostic codes (033.XX, 484.3, A37.XX). We examined whether any were categorized as inpatient claims and if there were claims for laboratory tests within 30 days of the initial pertussis claim. We estimated claims-based pertussis incidence using person-time for all Medicare A/B enrollees and compared incidence estimates to those reported by the Nationally Notifiable Diseases Surveillance System (NNDSS) for the same period and age group. Results Among 27,269,361 Medicare beneficiaries, 24,355 (0.09%) had claims with pertussis diagnostic codes. Of these, 1,875 (7.7%) had claims associated with inpatient hospitalizations; 7,964 (33%) had laboratory testing performed. The mean annual incidence of claims-based pertussis was 11.5/100,000 person-years (range: 9.37 to 14.3/100,000 person-years) (figure). In contrast, 6,722 pertussis cases in persons aged ≥65 years were reported to NNDSS. Among the 5,101 cases whose hospitalization status was known, 783 (15%) were hospitalized. Mean annual reported pertussis incidence was 1.5/100,000 person-years (0.67 cases to 2.63 cases/100,000 person-years) in this age group. Conclusion Many more Medicare beneficiaries with pertussis-related claims were identified than pertussis cases in persons ≥65 years reported to public health authorities, suggesting pertussis is likely diagnosed more frequently in older adults than national incidence estimates indicate. A smaller proportion of Medicare beneficiaries with pertussis-related claims were hospitalized compared with reported cases and a majority did not have laboratory testing performed. It is unknown what proportion of pertussis-associated claims represent true pertussis disease. Disclosures All authors: No reported disclosures.

scholarly journals Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. 31-40
Keyword(s):  
Older Adults ◽  
Claims Data ◽  
The United States ◽  
Prescription Opioid ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

Telehealth Music Therapy Services in the United States With Older Adults: A Descriptive Study

2022 ◽  
Author(s):  
Lindsey Wilhelm ◽  
Kyle Wilhelm
Keyword(s):  
United States ◽  
Older Adults ◽  
Music Therapy ◽  
Response Rate ◽  
Descriptive Study ◽  
The United States ◽  
Age Group ◽  
Music Therapists ◽  
Therapy Services ◽  
Therapy Sessions

Abstract In response to the COVID-19 pandemic, many music therapists in the United States turned to telehealth music therapy sessions as a strategy to continue services with older adults. However, the nature and perception of telehealth music therapy services for this age group are unknown. The purpose of this study was to describe music therapy telehealth practices with older adults in the United States including information related to session implementation, strengths and challenges, and adaptations to clinical practice. Of the 110 participants in the United States who responded to the survey (25.2% response rate), 69 reported implementing telehealth music therapy services with older adults and responded to a 32-item survey. Quantitative and qualitative analyses were conducted. Results indicated that while all participants had provided telehealth music therapy for no more than 6 months, their experiences with telehealth varied. Based on participant responses, telehealth session structure, strengths, challenges, and implemented changes are presented. Overall, 48% of music therapists reported that they planned to continue telehealth music therapy with older adults once pandemic restrictions are lifted. Further study on the quality, suitability, and acceptability of telehealth services with older adults is recommended.

scholarly journals Driving Status and Transportation Disadvantage Among Medicare Beneficiaries

2018 ◽  
Vol 39 (9) ◽  
pp. 935-943 ◽  
Author(s):  
Miriam Ryvicker ◽  
Evan Bollens-Lund ◽  
Katherine A. Ornstein
Keyword(s):  
United States ◽  
Older Adults ◽  
Well Being ◽  
The United States ◽  
Community Dwelling ◽  
Medicare Beneficiaries ◽  
Coordination Strategies ◽  
Representative Study ◽  
Nationally Representative ◽  
Community Dwelling Older Adults

Transportation disadvantage may have important implications for the health, well-being, and quality of life of older adults. This study used the 2015 National Health Aging Trends Study, a nationally representative study of Medicare beneficiaries aged 65 and over ( N = 7,498), to generate national estimates of transportation modalities and transportation disadvantage among community-dwelling older adults in the United States. An estimated 10.8 million community-dwelling older adults in the United States rarely or never drive. Among nondrivers, 25% were classified as transportation disadvantaged, representing 2.3 million individuals. Individuals with more chronic medical conditions and those reliant on assistive devices were more likely to report having a transportation disadvantage ( p < .05). Being married resulted in a 50% decreased odds of having a transportation disadvantage ( p < .01). Some individuals may be at higher risk for transportation-related barriers to engaging in valued activities and accessing care, calling for tailored interventions such as ride-share services combined with care coordination strategies.

scholarly journals Estimating Older Adult Mortality From COVID-19

2020 ◽  
Author(s):  
Andy Sharma
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Body Mass ◽  
Positive Association ◽  
The United States ◽  
Epidemiological Studies ◽  
Adult Mortality ◽  
Age Group ◽  
Worst Case ◽  
Interview Survey

Abstract Objectives The purpose of this study was to employ simulations to model the probability of mortality from COVID-19 (i.e., coronavirus) for older adults in the United States given at best and at worst cases. Methods This study first examined current epidemiological reports to better understand the risk of mortality from COVID-19. Past epidemiological studies from severe acute respiratory syndrome were also examined given similar virology. Next, at best and at worst mortality cases were considered with the goal of estimating the probability of mortality. To accomplish this for the general population, microdata from the National Health Interview Survey pooled sample (2016, 2017, and 2018 public-use NHIS with a sample of 34,881 adults at least 60 years of age) were utilized. Primary measures included age and health status (diabetes, body mass index, and hypertension). A logit regression with 100,000 simulations was employed to derive the estimates and probabilities. Results Age exhibited a positive association for the probability of death with an odds ratio (OR) of 1.22 (p &lt; .05, 95% confidence interval [CI]: 1.05–1.42). A positive association was also found for body mass index (BMI) (OR 1.03, p &lt; .01, 95% CI: 1.02–1.04) and hypertension (OR 1.36, p &lt; .01, 95% CI: 1.09–1.66) for the at best case. Diabetes was significant but only for the at best case. Discussion This study found mortality increased with age and was notable for the 74–79 age group for the at best case and the 70–79 age group of the at worst case. Obesity was also important and suggested a higher risk for mortality. Hypertension also exhibited greater risk but the increase was minimal. Given the volume of information and misinformation, these findings can be applied by health professionals, gerontologists, social workers, and local policymakers to better inform older adults about mortality risks and, in the process, reestablish public trust.

scholarly journals 1544. Sexually Transmitted Infection Laboratory Testing and Education Trends Among Physician Office Visits in the United States, 2009-2016

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S771-S771
Author(s):  
Amina R Zeidan ◽  
Kelly R Reveles
Keyword(s):  
United States ◽  
Laboratory Testing ◽  
The United States ◽  
Age Group ◽  
The South ◽  
Transmitted Infection ◽  
Sti Prevention ◽  
Prevention Education ◽  
Sexually Transmitted ◽  
Sti Testing

Abstract Background Rates of sexually transmitted infections (STIs) have been rising in the United States (US). Physician offices play an important role in providing both STI prevention and education, as well as STI laboratory testing options for patients who present at risk. However, few studies have documented the extent to which physician’s offices have contributed to prevention and testing efforts. We address this gap by evaluating STI testing and education provided in US physician offices from 2009 to 2016. Methods This was a cross-sectional study of the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey (NAMCS) from 2009 to 2016. Data weights were applied to extrapolate sample data to national estimates. Testing for HIV, HPV, Chlamydia (2009 – 2016) and Hepatitis and Gonorrhea (2014 – 2016) were presented as testing visits per 1,000 total visits. Subgroup analyses were performed for age group, sex, and geographical region by individual STI test and receipt of STI prevention education. Results A total of 7.6 billion visits were included for analysis, of which 0.6% included an STI test. Testing rates increased over the study period for Chlamydia (R2=0.27), HPV (R2=0.28), and HIV (R2=0.51). Peak testing occurred in 2015 for all tests. STI prevention education was provided to 0.5% of patients. Females were tested at a higher rate for all STIs (4.2%) compared to males (0.4%). Females also received more STI prevention education overall (0.6% versus 0.4%, respectively). While the age group 25 – 24 accounted for highest Hepatitis (15.9%) and HPV (11.3%) testing rates, the 15 – 24 age group had the highest overall testing rate (9.4%). STI testing was highest in the South region (Figure 1). Conclusion STI testing in US physician offices increased in recent years. Females accounted for the majority of STI testing and STI prevention education. Testing was more frequent among patients 15 – 24 years old and those seen in the South region. Further research should be conducted to determine reasons for differences in testing and education amongst sex, age group, and geographic region. Disclosures All Authors: No reported disclosures

Abstract WMP58: Blacks Have Higher Risk of 1-Year Recurrent Ischemic Stroke: An Analysis of White and Black Medicare Beneficiaries 1999-2013

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Karen C Albright ◽  
Lei Huang ◽  
Justin Blackburn ◽  
George Howard ◽  
Michael Mullen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Racial Differences ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
The United States ◽  
Stroke Recurrence ◽  
Fee For Service ◽  
Age Group ◽  
Medicare Beneficiaries ◽  
Risk Of Death

Introduction: Blacks have a higher incidence of stroke compared with whites. Most stroke survivors in the United States are 65 years and older but few data are available on racial differences in recurrent stroke risk in this age group. Methods: We conducted a retrospective cohort of Medicare beneficiaries in the 5% sample from 1999-2013 to compare 1-year recurrent stroke risk in older black and white Americans following hospitalization for ischemic stroke. We studied beneficiaries with Medicare fee-for-service coverage for 182 days before the index stroke hospitalization with no claims for stroke-related events. Patients were divided into two age groups (66-74, 75 years and above) and stratified into 3 calendar periods (1999-2001, 2002-2006, 2007-2013) allowing for implementation of secondary stroke prevention trial findings (PROGRESS, 2001; SPARCL, 2006). Hazard ratios for recurrent ischemic stroke comparing blacks to whites were calculated with adjustment for demographics, risk factors, and the competing risk of death. Results: Of 128,789 ischemic stroke patients (mean age 80 years [SD 8], 11.1% black, 60.4% male), 7.8% of whites and 11.0% of blacks had a recurrent ischemic stroke overall (Table 1). For each time period, blacks had a higher risk of recurrent stroke compared with whites (Figure 1). This disparity increased over time among patients age 66-74 years (p=0.038) but no trend was present for those 75 years and above (p=0.301). Conclusion: The risk of stroke recurrence among older Americans hospitalized for ischemic stroke is higher for blacks than whites, regardless of age group.

scholarly journals Global Unbiased Determination Of Comorbidity (GUDC) In U.S. Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 841-842
Author(s):  
Beth Hogans ◽  
Leslie Katzel ◽  
Bernadette Siaton ◽  
Raya Kheirbek ◽  
John Sorkin
Keyword(s):  
Older Adults ◽  
Primary Objective ◽  
Comorbid Condition ◽  
Medicare Beneficiaries ◽  
Diagnostic Codes ◽  
Hiv Management ◽  
Clinical Complexity ◽  
Icd 10 ◽  
Potential Applications ◽  
And Gender

Abstract With age, many adults develop multiple comorbid conditions; and resulting clinical complexity increases markedly so that identifying how specific conditions effect others remains important. Here, our primary objective was rapid unbiased appraisal of pair-wise condition-specific comorbidity; our second objective was identification of common conditions with highest and lowest rates of such comorbidity. In 2016, utilization of ICD-10 codes became mandatory for providers rendering care to Medicare beneficiaries. Universal adoption of ICD-10 coding ensued and concomitantly, all patients had ICD-9 codes replaced with new codes, so that 2017 data represent an opportunity to examine massive amounts of ‘freshly’ coded patient claims data. Evaluating ICD-10 coding data at individual and population levels, we appraised how often two codes were utilized together, i.e. estimated pair-specific comorbidity. Expanding this computationally, we determined the extent to which any given condition was co-coded with all other utilized diagnostic codes, i.e., estimated global, unbiased pair-wise comorbidity. We term this metric the global unbiased dyadic comorbidity (GUDC) value. Based on 40 million claims for a representative sample of 1.5 million older adults across the U.S., GUDC values varied with age and gender but were highly stable across varying comorbid condition prevalence, e.g., common (&gt;1%) vs. less common (1/1000-1/100) prevalence. GUDC values for HIV in older adults were modest, compared to high values for ARDS, we infer substantive progress in HIV management among older adults. We discuss the interpretation and potential applications of GUDC and conclude that access to comorbidity appraisals may advance geriatric care, more study is needed.

scholarly journals Influenza Vaccination and the Risk of COVID-19 Infection and Severe Illness in Older Adults in the United States

2020 ◽  
Author(s):  
Kelly Huang ◽  
Shu-Wan Lin ◽  
Wang-Huei Sheng ◽  
Chi-Chuan Wang
Keyword(s):  
Older Adults ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Claims Data ◽  
The United States ◽  
Cross Sectional Study ◽  
Severe Illness ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Database

Abstract The COVID-19 pandemic is an urgent threat worldwide with no vaccine available. It is important to evaluate whether influenza vaccination can reduce the risk of COVID-19 infection. This is a retrospective cross-sectional study with claims data from Symphony Health database from July 1, 2019, to June 30, 2020. Participants were adults aged 65 years old or older who had received the influenza vaccine between September 1 and December 31 of 2019. The objective was to measure the odds of COVID-19 infection and severe COVID-19 illness after January 15, 2020 among vaccinated and unvaccinated older adults. The adjusted odds ratio (aOR) of COVID-19 infection risk between the influenza-vaccination group and no-influenza-vaccination group was 0.76 (95% confidence interval (CI), 0.75–0.77). Among COVID-19 patients, the aOR of developing severe COVID-19 illness was 0.72 (95% CI, 0.68–0.76) between the influenza-vaccination group and the no-influenza-vaccination group. When the influenza-vaccination group and the other-vaccination group were compared, the aOR of COVID-19 infection was 0.95 (95% CI, 0.93–0.97), and the aOR of developing a severe COVID-19 illness was 0.95 (95% CI, 0.80–1.13). In conclusion, the influenza vaccine may marginally protect people from COVID-19 infection.

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