scholarly journals Pharmacogenomic and drug interaction risk associations with hospital length of stay among Medicare Advantage members with COVID-19

2021 ◽  
Author(s):  
Kristine Ashcraft ◽  
Chad Moretz ◽  
Chantelle Schenning ◽  
Susan Rojahn ◽  
Kae Vines Tanudtanud ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Length Of Stay ◽  
Drug Interactions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Administrative Database ◽  
Insurance Company ◽  
Medicare Advantage ◽  
Lengths Of Stay ◽  
Pharmacy Claims

Importance: COVID-19 has severely impacted older populations and strained healthcare resources, with many patients requiring long periods of hospitalization. Reducing the hospital length of stay (LOS) reduces patient and hospital burden. Given that adverse drug reactions are known to prolong LOS, unmanaged pharmacogenomic risk and drug interactions among COVID-19 patients may be a risk factor for longer hospital stays. Objective: The objective of this study was to determine if pharmacogenomic and drug interaction risks were associated with longer lengths of stay among high-risk patients hospitalized with COVID-19. Design: Retrospective cohort study of medical and pharmacy claims Setting: Administrative database from a large U.S. health insurance company Participants: Medicare Advantage members with a first COVID-19 hospitalization between January 2020 and June 2020, who did not die during the stay. Exposures: (1) Pharmacogenetic interaction probability (PIP) of ≤25% (low), 26%-50% (moderate), or >50% (high), which indicate the likelihood that one or more clinically actionable gene-drug or gene-drug-drug interactions would be identified with testing; (2) drug-drug interaction (DDI) severity of minimal, minor, moderate, major, or contraindicated, which indicate the severity of an interaction between two or more active medications. Main Outcomes and Measures: The primary outcome was hospital length of stay. Results were stratified by hierarchical condition categories (HCC) counts and chronic conditions. Results: A total of 6,025 patients hospitalized with COVID-19 were included in the study. Patients with moderate or high PIP were hospitalized for 9% (CI: 4%-15%; p < 0.001) and 16% longer (CI: 8%-24%; p < 0.001), respectively, compared to those with low PIP, whereas RAF score was not associated with LOS. High PIP was significantly associated with 12%-22% longer lengths of stay compared to low PIP in patients with hypertension, hyperlipidemia, diabetes, or COPD. Finally, among patients with 2 or 3 HCCs, a 10% longer length of stay was observed among patients with moderate or more severe DDI compared to minimal or minor DDI. Conclusions and Relevance: Proactively mitigating pharmacogenomic risk has the potential to reduce length of stay in patients hospitalized with COVID-19 especially those with COPD, diabetes, hyperlipidemia, and hypertension.

scholarly journals Unmanaged Pharmacogenomic and Drug Interaction Risk Associations with Hospital Length of Stay among Medicare Advantage Members with COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 11 (11) ◽  
pp. 1192
Author(s):  
Kristine Ashcraft ◽  
Chad Moretz ◽  
Chantelle Schenning ◽  
Susan Rojahn ◽  
Kae Vines Tanudtanud ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Chronic Conditions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Chronic Obstructive ◽  
Medicare Advantage ◽  
Obstructive Pulmonary Disease ◽  
Lengths Of Stay ◽  
Pharmacy Claims ◽  
Or Gene

Unmanaged pharmacogenomic and drug interaction risk can lengthen hospitalization and may have influenced the severe health outcomes seen in some COVID-19 patients. To determine if unmanaged pharmacogenomic and drug interaction risks were associated with longer lengths of stay (LOS) among patients hospitalized with COVID-19, we retrospectively reviewed medical and pharmacy claims from 6025 Medicare Advantage members hospitalized with COVID-19. Patients with a moderate or high pharmacogenetic interaction probability (PIP), which indicates the likelihood that testing would identify one or more clinically actionable gene–drug or gene–drug–drug interactions, were hospitalized for 9% (CI: 4–15%; p < 0.001) and 16% longer (CI: 8–24%; p < 0.001), respectively, compared to those with low PIP. Risk adjustment factor (RAF) score, a commonly used measure of disease burden, was not associated with LOS. High PIP was significantly associated with 12–22% longer LOS compared to low PIP in patients with hypertension, hyperlipidemia, diabetes, or chronic obstructive pulmonary disease (COPD). A greater drug–drug interaction risk was associated with 10% longer LOS among patients with two or three chronic conditions. Thus, unmanaged pharmacogenomic risk was associated with longer LOS in these patients and managing this risk has the potential to reduce LOS in severely ill patients, especially those with chronic conditions.

scholarly journals Association of daily copayments with use of hospital care among medicare advantage enrollees

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
John P. McHugh ◽  
Laura Keohane ◽  
Regina Grebla ◽  
Yoojin Lee ◽  
Amal N. Trivedi
Keyword(s):  
Length Of Stay ◽  
Cost Sharing ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Matched Control ◽  
Hospital Length Of Stay ◽  
Inpatient Cost ◽  
Medicare Advantage ◽  
Lengths Of Stay ◽  
Percentage Points

Abstract Background While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007–2010 period. Results The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI − 1.8 to − 0.9), 6.9 inpatient days/100 enrollees (95% CI − 10.1 to − 3.8) and 0.7 percentage points in the probability of hospital admission (95% CI − 1.0 to − 0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI − 8.4 to 1.4), 31.1 days/100 (95% CI − 75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI − 3.8 to − 0.6) in intervention plans relative to control plans. Conclusions Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

scholarly journals PCV39: IMPACT OF ANEMIA ON HF HOSPITAL LENGTH OF STAY: LONGITUDINAL ANALYSIS OF A LARGE ADMINISTRATIVE DATABASE

2003 ◽  
Vol 6 (3) ◽  
pp. 321
Author(s):  
RJ Nordyke ◽  
M Shaw ◽  
GA Goldberg ◽  
RM Vendiola ◽  
D Batra ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Longitudinal Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Administrative Database

scholarly journals The Impact of Drug Interactions in Patients with Community-Acquired Pneumonia on Hospital Length of Stay

Geriatrics ◽  
2022 ◽  
Vol 7 (1) ◽  
pp. 11
Author(s):  
Johannes Peter Schmitt ◽  
Andrea Kirfel ◽  
Marie-Therese Schmitz ◽  
Hendrik Kohlhof ◽  
Tobias Weisbarth ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Drug Interactions ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Hospital Length ◽  
Community Acquired Pneumonia ◽  
Assessment Tools ◽  
Hospital Length Of Stay ◽  
Increased Risk ◽  
The Impact

(1) Background: An aging society is frequently affected by multimorbidity and polypharmacy, which, in turn, leads to an increased risk for drug interaction. The aim of this study was to evaluate the influence of drug interactions on the length of stay (LOS) in hospitals. (2) Methods: This retrospective, single-centre study is based on patients treated for community-acquired pneumonia in the hospital. Negative binomial regression was used to analyse the association between drug interactions and the LOS in the hospital. (3) Results: The total cohort contained 503 patients, yet 46 inpatients (9%) that died were not included in the analyses. The mean age was 74 (±15.3) years, 35% of patients older than 65 years were found to have more than two drug interactions, and 55% had a moderate, severe, or contraindicated adverse drug reaction. The regression model revealed a significant association between the number of drug interactions (rate ratio (RR) 1.02; 95%-CI 1.01–1.04) and the severity of drug interactions (RR 1.22; 95%-CI 1.09–1.37) on the LOS for the overall cohort as well as for the subgroup of patients aged 80 years and older. (4) Conclusion: Drug interactions are an independent risk factor for prolonged hospitalisation. Standardised assessment tools to avoid drug interactions should be implemented in clinical routines.

scholarly journals Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees

2019 ◽  
Author(s):  
John McHugh ◽  
Laura Keohane ◽  
Regina Grebla ◽  
Yoojin Lee ◽  
Amal Trivedi
Keyword(s):  
Length Of Stay ◽  
Cost Sharing ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Matched Control ◽  
Hospital Length Of Stay ◽  
Inpatient Cost ◽  
Medicare Advantage ◽  
Lengths Of Stay ◽  
Percentage Points

Abstract Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period. Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans. Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

scholarly journals Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees

2019 ◽  
Author(s):  
John McHugh ◽  
Laura Keohane ◽  
Regina Grebla ◽  
Yoojin Lee ◽  
Amal Trivedi
Keyword(s):  
Length Of Stay ◽  
Cost Sharing ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Matched Control ◽  
Hospital Length Of Stay ◽  
Inpatient Cost ◽  
Medicare Advantage ◽  
Lengths Of Stay ◽  
Percentage Points

Abstract Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period. Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans. Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

scholarly journals Mortality and Length of Stay Trends Following Implementation of a Rapid Response System and Real-Time Automated Clinical Deterioration Alerts

2016 ◽  
Vol 32 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Marin H. Kollef ◽  
Kevin Heard ◽  
Yixin Chen ◽  
Chenyang Lu ◽  
Nelda Martin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Real Time ◽  
General Medicine ◽  
Hospital Length ◽  
Rapid Response ◽  
Clinical Deterioration ◽  
Hospital Length Of Stay ◽  
Rapid Response System ◽  
Response System ◽  
Lengths Of Stay

A study was performed to determine the potential influence of a rapid response system (RRS) employing real-time clinical deterioration alerts (RTCDAs) on patient outcomes involving 8 general medicine units. Introduction of the RRS occurred in 2006 with staged addition of the RTCDAs in 2009. Statistically significant year-to-year decreases in mortality were observed through 2014 ( r = −.794; P = .002). Similarly, year-to-year decreases in the number of cardiopulmonary arrests (CPAs; r = −.792; P = .006) and median lengths of stay ( r = −.841; P = .001) were observed. There was a statistically significant year-to-year increase in the number of RRS activations for these units ( r = .939; P < .001) that was inversely correlated with the occurrence of CPAs ( r = −.784; P = .007). In this single-institution retrospective study, introduction of a RRS employing RTCDAs was associated with lower hospital mortality, CPAs, and hospital length of stay.

scholarly journals Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees

2019 ◽  
Author(s):  
John McHugh ◽  
Laura Keohane ◽  
Regina Grebla ◽  
Yoojin Lee ◽  
Amal Trivedi
Keyword(s):  
Length Of Stay ◽  
Cost Sharing ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Matched Control ◽  
Hospital Length Of Stay ◽  
Inpatient Cost ◽  
Medicare Advantage ◽  
Lengths Of Stay ◽  
Percentage Points

Abstract Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period. Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans. Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

scholarly journals Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees

2019 ◽  
Author(s):  
John McHugh ◽  
Laura Keohane ◽  
Regina Grebla ◽  
Yoojin Lee ◽  
Amal Trivedi
Keyword(s):  
Length Of Stay ◽  
Cost Sharing ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Matched Control ◽  
Hospital Length Of Stay ◽  
Inpatient Cost ◽  
Medicare Advantage ◽  
Lengths Of Stay ◽  
Percentage Points

Abstract Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period. Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans. Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

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