scholarly journals Prevalence and Geographic Variations of Polypharmacy Among West Virginia Medicaid Beneficiaries

2017 ◽  
Vol 51 (11) ◽  
pp. 981-989 ◽  
Author(s):  
Xue Feng ◽  
Xi Tan ◽  
Brittany Riley ◽  
Tianyu Zheng ◽  
Thomas K. Bias ◽  
...  
Keyword(s):  
Logistic Regression ◽  
West Virginia ◽  
Healthcare Utilization ◽  
Chronic Conditions ◽  
Negative Binomial ◽  
Spatial Association ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Geographic Variations ◽  
Medicaid Beneficiaries

Background: West Virginia (WV) residents are at high risk for polypharmacy given its considerable chronic disease burdens. Objective: To evaluate the prevalence, correlates, outcomes, and geographic variations of polypharmacy among WV Medicaid beneficiaries. Methods: In this cross-sectional study, we analyzed 2009-2010 WV Medicaid fee-for-service (FFS) claims data for adults aged 18-64 (N=37,570). We defined polypharmacy as simultaneous use of drugs from five or more different drug classes on a daily basis for at least 60 consecutive days in one year. Multilevel logistic regression was used to explore the individual- and county-level factors associated with polypharmacy. Its relationship with healthcare utilization was assessed using negative binomial regression and logistic regression. The univariate local indicators of spatial association method was applied to explore spatial patterns of polypharmacy in WV. Results: The prevalence of polypharmacy among WV Medicaid beneficiaries was 44.6%. High-high clusters of polypharmacy were identified in southern WV, indicating counties with above-average prevalence surrounded by counties with above-average prevalence. Polypharmacy was associated with being older, female, eligible for Medicaid due to cash assistance or medical eligibility, having any chronic conditions or more chronic conditions, and living in a county with lower levels of education. Polypharmacy was associated with more hospitalizations, emergency department visits, and outpatient visits, as well as higher non-drug medical expenditures. Conclusions: Polypharmacy was prevalent among WV Medicaid beneficiaries and was associated with substantial healthcare utilization and expenditures. The clustering of high prevalence of polypharmacy in southern WV may suggest targeted strategies to reduce polypharmacy burden in these areas.

scholarly journals Younger Dual-Eligibles Who Use Federally Qualified Health Centers Have More Preventable Emergency Department Visits, but Some Have Fewer Hospitalizations

2016 ◽  
Vol 8 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Andrew J. Potter ◽  
Amal N. Trivedi ◽  
Brad Wright
Keyword(s):  
Emergency Department ◽  
Fixed Effects ◽  
Negative Binomial ◽  
Care Service ◽  
Emergency Department Visits ◽  
Health Centers ◽  
Fee For Service ◽  
Federally Qualified Health Centers ◽  
Dual Eligibles ◽  
Ed Visits

Objective: To determine whether younger dual-eligibles receiving care at federally qualified health centers (FQHCs) have lower rates of ambulatory care sensitive (ACS) hospitalization and emergency department (ED) visits. Data Sources: We used the 100% Medicare Part A and Part B institutional claims from 2007 to 2010 for dual-eligibles younger than 65 years, enrolled in traditional fee-for-service Medicare, who received care at an FQHC or lived in a primary care service area with an FQHC. Methods: Our cross-sectional analysis used negative binomial regressions to model ACS hospitalizations and ED visits as a function of prior year FQHC use. The model adjusted for beneficiary age, gender, race, and chronic diseases, as well as county fixed effects, time trends, and race-FQHC use interactions. Results: FQHC use is associated with a decrease in ACS hospitalization rates for whites (2.8 per 1000 persons), but an increase among blacks (2.5 per 1000 persons). FQHC use is also associated with an increase in ACS ED visits, from 27 to 33 more visits per 1000 persons per year, depending on patient race. Conclusions: ACS hospital use is higher for FQHC users than nonusers, but white FQHC users have fewer ACS hospitalizations. More research is needed to understand how this relationship varies within and between centers.

Association of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, and Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden

2020 ◽  
pp. 107755872095258
Author(s):  
Sungchul Park ◽  
Brent A. Langellier ◽  
Robert E. Burke ◽  
Jose F. Figueroa ◽  
Norma B. Coe
Keyword(s):  
Emergency Department ◽  
Chronic Conditions ◽  
Emergency Department Visits ◽  
Multiple Chronic Conditions ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Readmission Rates ◽  
Comorbidity Burden ◽  
Capita Spending ◽  
Per Capita

Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. We assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. We also examined whether the association between MA growth and per capita spending in FFS varied in beneficiaries with specific chronic conditions. MA growth was associated with decreased FFS spending and emergency department visits only among beneficiaries with six or more chronic conditions. MA growth was associated with decreased FFS spending among beneficiaries with 11 of the 20 chronic conditions. This suggests that MA growth may drive improvements in efficiency of health care delivery for high-need, high-cost beneficiaries.

scholarly journals Environmental Influences of Extreme Heat on the Health of Older Adults: A Retrospective Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 280-280
Author(s):  
Mei Liu ◽  
Carol Buller ◽  
Barbara Polivka ◽  
Terri Woodburn ◽  
Mark Jakubauskas ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Environmental Influence ◽  
Emergency Department Visits ◽  
Extreme Heat ◽  
Extreme Weather Events ◽  
Study Cohort ◽  
Outpatient Visits ◽  
Extreme Heat Event ◽  
Heat Event

Abstract Studies have suggested that extreme weather events have differential effects by age. By leveraging electronic medical records, we aim to analyze the environmental influence of extreme heat on the health of older adults. From our healthcare system’s de-identified data warehouse, we extracted a retrospective cohort of 108,192 patients who were ≥65 years of age as of 1/1/2018 with pre-existing chronic conditions including diabetes, COPD, cardiovascular disease, or kidney disease. Extreme heat event period was defined as 5/1/2018 to 9/1/2018 (79 days with temperature ≥90o; 15 days of moderately poor/poor air quality index (AQI) [≥75] values) and the comparison period was defined as 5/1/2019 to 9/1/2019 (51 days with temperature ≥90o; 0 days with moderately poor/poor AQI values) in the Kansas City area. We randomly partitioned the study cohort into two sets and demonstrated the two patient sets were statistically similar (p>0.05) with respect to their demographic and underlying health conditions. Finally, we compared the respiratory, cardiovascular, and renal health outcomes between the 2018 and the 2019 cohorts. Most patients were Caucasians, female and had comorbid conditions. Results showed significantly higher number of all-cause emergency department visits (p=0.04) and outpatient visits (p=<.001) during the extreme heat event period in 2018. Analyses also showed significantly higher number of outpatient visits due to upper respiratory diseases (p=0.008) and acute renal failure (p=0.01) in 2018. In conclusion, extreme heat increased use of healthcare services in older adults with chronic conditions.

scholarly journals Older Adults’ Adoption of Mobility Devices: Interplay of Predisposing Factors and Precipitating Health Events

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 484-485
Author(s):  
Farhanaz Sharmin ◽  
Laura Sands
Keyword(s):  
Older Adults ◽  
Logistic Regression ◽  
Chronic Conditions ◽  
High School Education ◽  
Living Alone ◽  
Mobility Limitations ◽  
Chi Square ◽  
Health Events ◽  
Mobility Devices ◽  
History Of

Abstract Existing mobility limitations and chronic conditions increase likelihood of adopting mobility-related devices such as canes and walkers. Prior research has not considered how recent acute events such as falls and hospitalizations contribute to the adoption of mobility devices. We studied 4,592 older adults who responded to the 2015 and 2016 National Health and Aging Trends Study surveys, and classified adoption of mobility devices as: (i) Never users (did not use mobility devices either year) and (ii) New users (started using mobility devices in 2016). We determined through chi-square tests, that predisposing characteristics from 2015 that were significantly associated with being a New User in 2016 were: being female, aged 80+, minority race, having a high-school education or lower, living alone, being obese, and having a history of dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P’s<0.05). We used logistic regression to determine the contribution of recent precipitating events on the adoption of mobility devices among older adults after controlling for 2015 characteristics that were significantly associated with being a New user. Precipitating events were significantly associated with being a New user of mobility equipment. Specifically, older adults who, between the 2015 and 2016 interviews, experienced a fall (OR=1.7; 95% CI=1.1-2.9), hospitalization (OR=3.7; 95% CI=2.3-5.9) or increase in mobility difficulties (OR=3.7; 95% CI=2.3-5.9) were more likely to be New users. Study findings reveal the importance precipitating events on the adoption of mobility devices, signaling the importance of assessing for need for mobility devices after these events.

Huntington’s Disease in Israel: A Population-based Study Using 20 Years of Routinely-Collected Healthcare Data

2021 ◽  
pp. 1-9
Author(s):  
Natalie Gavrielov-Yusim ◽  
Yael Barer ◽  
Michael Martinec ◽  
Athanasios Siadimas ◽  
Spyros Roumpanis ◽  
...  
Keyword(s):  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Healthcare Utilization ◽  
Behavioral Problems ◽  
Clinical Manifestations ◽  
Population Based ◽  
Emergency Department Visits ◽  
Study Cohort ◽  
Population Based Study ◽  
Healthcare Data

Background: Huntington’s disease (HD) is a rare, genetic, neurodegenerative disease. Obtaining population-level data on epidemiology and disease management is challenging. Objective: To investigate the epidemiology, clinical manifestations, treatment, and healthcare utilization of patients with HD in Israel. Methods: Retrospective population-based cohort study, including 20 years of routinely collected data from Maccabi Healthcare Services, an insurer and healthcare provider for one-quarter of the Israeli population. Results: The study cohort included 109 adult patients (aged ≥18 years) diagnosed with HD, with mean age of 49.9 years and 56%females. The most common HD-related conditions were anxiety (40%), behavioral problems (34%), sleep disorders (21%), and falls (13%). Annual incidence rates for HD ranged from 0.17 to 1.34 per 100,000 from 2000 to 2018; the 2018 crude prevalence in adults was 4.36 per 100,000. Median survival from diagnosis was approximately 12 years (95%CI: 10.4–15.3). The most frequent symptomatic treatments were antidepressants (69%), antipsychotics (63%), and tetrabenazine (63%), the only drug approved for the treatment of HD chorea in Israel during the examined period. Patterns of healthcare utilization changed as disease duration increased, reflected by increased frequency of emergency department visits and home visits. Conclusion: This retrospective population-based study provides insights into the prevalence, incidence, clinical profile, survival, and resource utilization of patients with HD in ethnically diverse Israel. The findings in this study are generally consistent with the international literature and demonstrate the value of routinely collected healthcare data as a complementary resource in HD research.

scholarly journals Social and Medical Determinants of Cardiometabolic Health: The Big Picture

2015 ◽  
Vol 25 (4) ◽  
pp. 521 ◽  
Author(s):  
Gary A. Puckrein ◽  
Brent M. Egan
Keyword(s):  
Emergency Department ◽  
Health Disparities ◽  
Social Determinants ◽  
The United States ◽  
Emergency Department Visits ◽  
Cardiometabolic Health ◽  
Years Of Life Lost ◽  
Fee For Service ◽  
Cardiometabolic Diseases ◽  
Mean Cost

<p class="Pa7">Cardiometabolic diseases, including diabetes and heart disease, account for &gt;12 million years of life lost annually among Black adults in the United States. Health disparities are geographically localized, with ~80% of health disparities occurring within ~6000 (16%) of all 38,000 US ZIP codes. Socio-economic status (SES), behavioral and environmental fac­tors (social determinants) account for ~80% of variance in health outcomes and cluster geographically. Neighborhood SES is inversely associated with prevalent diabetes and hyper­tension, and Blacks are four times more likely than Whites to live in lowest SES neighbor­hoods. In ZIP code 48235 (Detroit, 97% Black, 16.2% unemployed, income/capita $18,343, 23.6% poverty), 1082 Medicare fee-for service (FFS) beneficiaries received care for type 2 diabetes (T2D) and coronary artery disease (CAD) in 2012. Collectively, these beneficiaries had 1082 inpatient admissions and 839 emergency department visits, mean cost $27,759/beneficiary and mortality 2.7%. Nationally in 2011, 236,222 Black Medicare FFS beneficiaries had 213,715 inpatient admissions, 191,346 emergency department visits, mean cost $25,580/beneficiary and 2.4% mortality. In addition to more prevalent hypertension and T2D, Blacks appear more susceptible to clinical complications of risk fac­tors than Whites, including hypertension as a contributor to stroke. Cardiometabolic health equity in African Americans requires interven­tions on social determinants to reduce excess risk prevalence of risk factors. Social-medical interventions to promote timely access to, delivery of and adherence with evidence-based medicine are needed to counterbal­ance greater disease susceptibility. Place-based interventions on social and medical determi­nants of health could reduce the burden of life lost to cardiometabolic diseases in Blacks. <em>Ethn Dis. </em>2015;25(4):521-524; doi:10.18865/ ed.25.4.521</p>

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