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

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.

scholarly journals The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States

2020 ◽  
Author(s):  
Robert D. Becher ◽  
Brent Vander Wyk ◽  
Linda Leo-Summers ◽  
Mayur M. Desai ◽  
Thomas M. Gill
Keyword(s):  
United States ◽  
Older Persons ◽  
Cumulative Risk ◽  
The United States ◽  
Community Living ◽  
Major Surgery ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal

ABSTRACTImportanceAs the population of the United States (US) ages, there is considerable interest in ensuring safe and high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of major surgery in the geriatric population are sparse.ObjectiveTo estimate the incidence and cumulative risk of major surgery in older persons over a 5-year period and evaluate how these estimates differ according to demographic and geriatric characteristics.DesignProspective longitudinal study.SettingContinental US from 2011 to 2016.Participants5,571 community-living fee-for-service Medicare beneficiaries, aged 65+, from the National Health and Aging Trends Study (NHATS).Main Outcomes and MeasuresMajor surgeries were identified through linkages with data from the Centers for Medicare & Medicaid Services. Data on frailty and dementia were obtained from the baseline NHATS assessment.ResultsThe nationally-representative incidence of major surgery per 100 person-years was 8.8 (95% confidence interval [CI], 8.2-9.5), with estimates of 5.2 (95% CI, 4.7-5.7) and 3.7 (95% CI, 3.3-4.1) for elective and non-elective surgeries. The adjusted incidence of major surgery peaked at 10.8 (95% CI, 9.4-12.4) in persons 75-79 years, increased from 6.6 (95% CI, 5.8-7.5) in the non-frail group to 10.3 (95% CI, 8.9-11.9) in the frail group, and was similar by sex (males 8.6 [95% CI, 7.7-9.6]; females 8.3 [95% CI, 7.5-9.1]) and dementia (no 8.6 [95% CI, 7.9-9.3]; possible 7.8 [95% CI, 6.3-9.6]; probable 8.1 [95% CI, 6.7-9.9]). The 5-year cumulative risk of major surgery was 13.8% (95% CI, 12.2%-15.5%), representing nearly 5 million unique older persons (4,958,048 [95% CI, 4,345,342-5,570,755]), including 12.1% (95% CI, 9.5%-14.6%) in persons 85-89 years, 9.1% (95% CI, 7.2%-11.0%) in those ≥90 years, 12.1% (95% CI, 9.9%-14.4%) in those with frailty, and 12.4% (95% CI, 9.8%-15.0%) in those with probable dementia.Conclusions and RelevanceMajor surgery is a common event in the lives of community-living older persons, including high-risk vulnerable subgroups such as the oldest old, those with frailty or dementia, and those undergoing non-elective surgery. The burden of major surgery in older Americans will add to the challenges ahead for the US health care system in our aging society.KEY POINTSQuestionWhat is the incidence and cumulative risk of major surgery in older persons in the United States?FindingsIn this prospective longitudinal study, data from 5,571 community-living fee-for-service Medicare beneficiaries were used to calculate nationally-representative estimates for the incidence and cumulative risk of major surgery over a 5-year period. Nearly 9 major surgeries were performed annually for every 100 older persons, and more than 1 in 7 Medicare beneficiaries underwent a major surgery over 5 years, representing nearly 5 million unique older persons.MeaningMajor surgery is a common event in the lives of community-living older persons.

scholarly journals Declining Utilization and Inflation-Adjusted Expenditures for Epidural Procedures in Chronic Spinal Pain in the Medicare Population

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. 1-15
Keyword(s):  
United States ◽  
Spinal Pain ◽  
The United States ◽  
National Sample ◽  
Fee For Service ◽  
Epidural Injections ◽  
Medicare Population ◽  
Adjusted Rate ◽  
Caudal Epidural ◽  
Chronic Spinal Pain

BACKGROUND: Despite epidurals being one of the most common interventional pain procedures for managing chronic spinal pain in the United States, expenditure analysis lacks assessment in correlation with utilization patterns. OBJECTIVES: This investigation was undertaken to assess expenditures for epidural procedures in the fee-for-service (FFS) Medicare population from 2009 to 2018. STUDY DESIGN: The present study was designed to assess expenditures in all settings, for all providers in the FFS Medicare population from 2009 to 2018 in the United States. In this manuscript: • A patient was described as receiving epidural procedures throughout the year. • A visit was considered to include all regions treated during the visit. • An episode was considered as one treatment per region utilizing primary codes only. • Services or procedures were considered as all procedures including bilateral and multiple levels. A standard 5% national sample of the Centers for Medicare and Medicaid Services (CMS) physician outpatient billing claims data for those enrolled in the FFS Medicare program from 2009 to 2018 was utilized. All the expenditures were presented with allowed costs and adjusted to inflation to 2018 US dollars. RESULTS: Total expenditures were $723,981,594 in 2009, whereas expenditures of 2018 were $829,987,636, with an overall 14.6% increase, or an annual increase of 1.5%. However, the inflation-adjusted rate was $847,058,465 in 2009, compared to $829,987,636 in 2018, a reduction overall of 2% and an annual reduction of 0.2%. Inflation-adjusted per patient annual costs decreased from $988.93 in 2009 to $819.27 in 2018 with a decrease of 17.2% or an annual decline of 2.1%. In addition, inflation-adjusted costs per procedure decreased from $399.77 to $377.94, or 5.5% overall and 0.6% annually. Per procedure, episode, visit, and patient expenses were higher for transforaminal epidural procedures than lumbar interlaminar/caudal epidural procedures. Overall, costs of transforaminal epidurals increased 27.6% or 2.7% annually, whereas lumbar interlaminar and caudal epidural injections cost were reduced 2.7%, or 0.3% annually. Inflation-adjusted costs for transforaminal epidurals increased 9.1% or 1.0% annually and declined 16.9 or 2.0% annually for lumbar interlaminar and caudal epidural injections. LIMITATIONS: Expenditures for epidural procedures in chronic spinal pain were assessed only in the FFS Medicare population. This excluded over 30% of the Medicare population, which is enrolled in Medicare Advantage plans. CONCLUSIONS: After adjusting for inflation, there was a decrease of expenditures for epidural procedures of 2%, or 0.2% annually, from 2009 to 2018. However, prior to inflation, the increases were noted at 14.6% and 1.5%. Inflation-adjusted costs per patient, per visit, and per procedure also declined. The proportion of Medicare patients per 100,000 receiving epidural procedures decreased 9.1%, or 1.1% annually. However, assessment of individual procedures showed higher costs for transforaminal epidural procedures compared to lumbar interlaminar and caudal epidural procedures. KEY WORDS: Chronic spinal pain, epidural procedures, caudal epidural, lumbar interlaminar epidural, cervical interlaminar epidural, thoracic interlaminar epidural, lumbar transforaminal epidural procedures, Medicare expenditures

scholarly journals Association of Socioeconomic Disadvantage With Mortality and Readmissions Among Older Adults Hospitalized for Pulmonary Embolism in the United States

2021 ◽  
Author(s):  
Rishi K. Wadhera ◽  
Eric A. Secemsky ◽  
Yun Wang ◽  
Robert W. Yeh ◽  
Samuel Z. Goldhaber
Keyword(s):  
United States ◽  
Older Adults ◽  
Pulmonary Embolism ◽  
The United States ◽  
Mortality Rates ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Socioeconomically Disadvantaged ◽  
Vein Thrombosis ◽  
Advanced Therapies

Background In the United States, hospitalizations for pulmonary embolism (PE) are increasing among older adults insured by Medicare. Although efforts to reduce health disparities have intensified, it remains unclear whether clinical outcomes differ between socioeconomically disadvantaged and nondisadvantaged Medicare beneficiaries hospitalized with PE. Methods and Results In this study, there were 53 386 Medicare fee‐for‐service beneficiaries age ≥65 years hospitalized for PE between October 2015 and January 2017. Of these, 5494 (10.3%) were socioeconomically disadvantaged and 47 892 (89.7%) were nondisadvantaged. Socioeconomically disadvantaged adults were of similar age as nondisadvantaged adults (77.1 versus 77.0), more likely to be female (68.5% versus 54.2%), and less likely to receive advanced therapies (11.0% versus 12.1%). After adjustment for demographics, 90‐day all‐cause mortality rates were similar between disadvantaged and nondisadvantaged adults. In contrast, 1‐year mortality rates were higher among socioeconomically disadvantaged adults (hazard ratio [HR], 1.16; 95% CI, 1.10–1.22), although these differences were partially attenuated after additional adjustments for comorbidities and PE severity (HR, 1.09; 95% CI, 1.02–1.16). Risk‐adjusted 30‐day and 90‐day all‐cause readmission rates were substantially higher among socioeconomically disadvantaged patients (30‐day HR, 1.14 [95% CI, 1.06–1.22]; 90‐day HR, 1.18 [95% CI, 1.12–1.25]). In addition, 90‐day readmissions attributed to PE, deep vein thrombosis, and/or bleeding were higher among socioeconomically disadvantaged patients (HR, 1.16; 95% CI, 1.02–1.32). Conclusions Socioeconomically disadvantaged older adults hospitalized with PE have higher 1‐year mortality rates compared with their nondisadvantaged counterparts. Nearly 1 in 3 socioeconomically disadvantaged older adults was readmitted within 90 days of a hospitalization for PE. Targeted strategies are needed to improve transitional and ambulatory care for this vulnerable population.

scholarly journals Geographic and Demographic Variability in Transcatheter Aortic Valve Replacement Dispersion in the United States

2021 ◽  
Author(s):  
Michael N. Young ◽  
Stephen Kearing ◽  
David Malenka ◽  
Philip P. Goodney ◽  
Jonathan Skinner ◽  
...  
Keyword(s):  
United States ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
The United States ◽  
Disruptive Technology ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Transcatheter Aortic Valve

Background Transcatheter aortic valve replacement (TAVR) has transformed the management of aortic valve stenosis. However, little national data are available characterizing the geographic and demographic dispersion of this disruptive technology relative to surgical aortic valve replacement (SAVR). Methods and Results In this US claims‐based study, we analyzed a 100% sample of fee‐for‐service Medicare beneficiaries from 2012 to 2017 and examined national rates of TAVR versus SAVR. Procedure rates were compared across years as a function of age, sex, race, and geography for TAVR and SAVR beneficiaries. There was significant growth in TAVR from 15.4 beneficiaries/100 000 enrollees in 2012 to 90.6 in 2017 ( P <0.001). SAVR rates declined from 92.8 beneficiaries/100 000 enrollees in 2012 to 63.5 in 2017 ( P <0.001). The growth of TAVR varied as a function of age ( P <0.0001). While TAVR was the dominant strategy among beneficiaries ≥85 and 75 to 84 years old, SAVR was more common among beneficiaries 65 to 74 years old. TAVR was also used more frequently than SAVR among women ( P <0.001). While TAVR increased among all races, it was less commonly used among non‐White beneficiaries ( P <0.001). Contemporary use of TAVR relative to SAVR varied significantly by geographic location, with a TAVR:SAVR ratio in 2017 of 1.24 in the Midwest and 1.68 in the Northeast ( P <0.001). Conclusions In 2017, the number of Medicare beneficiaries receiving TAVR exceeded SAVR for the first time in the United States. There is significant variation, however, in the geographic expansion of TAVR and in patient demographics relative to SAVR.

scholarly journals Utilization and Expenditures of Vertebral Augmentation Continue to Decline: An Analysis in Fee-For-Service (FFS) Recipients from 2009 to 2018

2021 ◽  
Vol 24 (6) ◽  
pp. 401-415
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Compression Fracture ◽  
The United States ◽  
National Sample ◽  
Annual Rate ◽  
Vertebral Compression Fractures ◽  
Vertebral Augmentation ◽  
Fee For Service ◽  
Medicare Population ◽  
Relative Utilization ◽  
Annual Decline

BACKGROUND: Despite the high prevalence of vertebral compression fractures (VCFs) associated with refractory pain, deformity, or progressive neurological symptoms, minimally invasive vertebral augmentation procedures, including vertebroplasty and kyphoplasty, have been declining in their relative utilization, along with expenditures. OBJECTIVES: This investigation was undertaken to assess utilization and expenditures for vertebral augmentation procedures, including vertebroplasty and kyphoplasty, in the fee-for-service (FFS) Medicare population from 2009 to 2018. STUDY DESIGN: The present study was designed to assess utilization and expenditures in all settings, for all providers in the FFS Medicare population from 2009 to 2018 in the United States. In this manuscript: • A patient was described as receiving vertebral augmentation over the course of the year. • An episode was considered as one treatment per region per day utilizing primary codes only. • Services or procedures were considered to be procedures including multiple levels. A standard 5% national sample of the Centers for Medicare and Medicaid Services (CMS) physician outpatient billing claims data for those enrolled in the FFS Medicare program from 2009 to 2018 was utilized. All the expenditures were presented with allowed costs and adjusted for inflation to 2018 US dollars. RESULTS: In 2009, there were 76,860 episodes of vertebral augmentation with a rate of 168 per 100,000 Medicare population, which declined to 58,760, or 99 per 100,000 population for a total decline of 41%, or an annual rate of decline of 5.7% per 100,000 Medicare population. Vertebroplasty interventions declined more dramatically than kyphoplasty from 2009. Total episodes of vertebroplasty were 27,380 with an annual rate of 60 per 100,000 Medicare population, decreasing to 9,240, or 16 per 100,000 Medicare population, a 66% decline in episodes and a 74% decline in overall rate with an annual decline of 11.4% and 13.9%. In contrast, kyphoplasty interventions were 49,480, for a rate per 100,000 population of 108 in 2009 compared to 49,520 in 2018 with a rate of 83, for a decrease of 23% and 2.9% annual decrease. Evaluation of expenditures showed a net decrease of $30,102,809, or 8%, from $378,758,311 in 2009 to $348,655,502 in 2018. However, inflation-adjusted expenditures decreased overall by 21% and 3% annually from $443,147,324 in 2009 to $345,655,502 in 2018. In addition, inflation-adjusted total expenditures per 100,000 Medicare population decreased from $967,549 to $584,992, for an overall decrease of 40%, or an annual decrease of 5%. Per patient expenditures decreased 2% overall with 0% decrease per year. LIMITATIONS: Vertebral augmentation procedures were assessed only in the FFS Medicare service population. This excluded over 30% of the Medicare population, which is enrolled in Medicare Advantage plans. CONCLUSIONS: This study shows a significant decline in relative utilization patterns of vertebroplasty and kyphoplasty procedures, along with reductions in overall expenditures. The inflation-adjusted total expenditures of kyphoplasty and vertebroplasty decreased 21% with an annual decline of 3%. The inflation-adjusted expenditures per 100,000 of Medicare population decreased 40% overall and 5% per year. In addition, vertebroplasty has seen substantial declines in utilization and expenditure patterns compared to kyphoplasty procedures, which showed trends of decline. KEY WORDS: Osteoporosis, osteoporotic compression fracture, vertebroplasty, kyphoplasty, vertebral augmentation, expenditures, inflation-adjusted, utilization

scholarly journals Stroke Hospitalizations Before and During COVID-19 Pandemic Among Medicare Beneficiaries in the United States

Stroke ◽  
2021 ◽  
Author(s):  
Quanhe Yang ◽  
Xin Tong ◽  
Sallyann Coleman King ◽  
Benjamin S. Olivari ◽  
Robert K. Merritt
Keyword(s):  
United States ◽  
Patient Characteristics ◽  
The United States ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Percent Reduction ◽  
Stroke Patients ◽  
Race Ethnicity ◽  
National Emergency

Background and Purpose: Emergency department visits and hospitalizations for stroke declined significantly following declaration of coronavirus disease 2019 (COVID-19) as a national emergency on March 13, 2020, in the United States. This study examined trends in hospitalizations for stroke among Medicare fee-for-service beneficiaries aged ≥65 years and compared characteristics of stroke patients during COVID-19 pandemic to comparable weeks in the preceding year (2019). Methods: For trend analysis, we examined stroke hospitalizations from week 1 in 2019 through week 44 in 2020. For comparison of patient characteristics, we estimated percent reduction in weekly stroke hospitalizations from 2019 to 2020 during weeks 10 through 23 and during weeks 24 through 44 by age, sex, race/ethnicity, and state. Results: Compared to weekly numbers of hospitalizations for stroke reported during 2019, stroke hospitalizations in 2020 decreased sharply during weeks 10 through 15 (March 1–April 11), began increasing during weeks 16 through 23, and remained at a level lower than the same weeks in 2019 from weeks 24 through 44 (June 7–October 31). During weeks 10 through 23, stroke hospitalizations decreased by 22.3% (95% CI, 21.4%–23.1%) in 2020 compared with same period in 2019; during weeks 24 through 44, they decreased by 12.1% (95% CI, 11.2%–12.9%). The magnitude of reduction increased with age but similar between men and women and among different race/ethnicity groups. Reductions in stroke hospitalizations between weeks 10 through 23 varied by state ranging from 0.0% (95% CI, −16.0%–1.7%) in New Hampshire to 36.2% (95% CI, 24.8%–46.7%) in Montana. Conclusions: One-in-5 fewer stroke hospitalizations among Medicare fee-for-service beneficiaries occurred during initial weeks of the COVID-19 pandemic (March 1–June 6) and weekly stroke hospitalizations remained at a lower than expected level from June 7 to October 31 in 2020 compared with 2019. Changes in stroke hospitalizations varied substantially by state.

scholarly journals Christian Nationalism and Views of Immigrants in the United States: Is the Relationship Stronger for the Religiously Inactive?

2021 ◽  
Vol 7 ◽  
pp. 237802312098511
Author(s):  
Samuel Stroope ◽  
Heather M. Rackin ◽  
Paul Froese
Keyword(s):  
United States ◽  
The United States ◽  
National Sample ◽  
Religious Communities ◽  
Religious Nationalism ◽  
Religious Service ◽  
Religious Service Attendance ◽  
The Relationship ◽  
Christian Nationalism ◽  
Service Attendance

Previous research has shown that Christian nationalism is linked to nativism and immigrant animus, while religious service attendance is associated with pro-immigrant views. The findings highlight the importance of distinguishing between religious ideologies and practices when considering how religion affects politics. Using a national sample of U.S. adults, we analyze immigrant views by measuring levels of agreement or disagreement that undocumented immigrants from Mexico are “mostly dangerous criminals.” We find that Christian nationalism is inversely related to pro-immigrant views for both the religiously active and inactive. However, strongly pro-immigrant views are less likely and anti-immigrant views are more likely among strong Christian nationalists who are religiously inactive compared with strong Christian nationalists who are religiously active. These results illustrate how religious nationalism can weaken tolerance and heighten intolerance most noticeably when untethered from religious communities.

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