scholarly journals Trends in antipsychotic prescribing for approved and unapproved indications to Medicaid-enrolled youth in Philadelphia, Pennsylvania between 2014 and 2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Molly Candon ◽  
Siyuan Shen ◽  
Oluwatoyin Fadeyibi ◽  
Joseph L Smith ◽  
Aileen Rothbard
Keyword(s):  
Bipolar Disorder ◽  
Foster Care ◽  
Treatment Duration ◽  
Claims Data ◽  
Quality Monitoring ◽  
Administrative Claims ◽  
Prior Authorization ◽  
Policy Initiatives ◽  
Monitoring Programs ◽  
Antipsychotic Prescribing

Abstract Background Antipsychotic prescribing to Medicaid-enrolled youth has been the target of numerous policy initiatives, including prior authorization and quality monitoring programs, which often target specific populations. Whether these efforts have changed the level or composition of antipsychotic prescribing is unclear. Methods Using 2014–2018 administrative claims data for Medicaid enrollees aged 21 years and under in Philadelphia, Pennsylvania, we measured antipsychotic prescription fills overall and for youth without an approved indication (autism, bipolar disorder, or psychosis). We then assessed whether trends differed for populations that have been targeted by policy initiatives, including younger children and foster care-enrolled youth. We also identified the most common approved and unapproved indications and examined whether the treatment duration of antipsychotic prescriptions differed based on whether the youth had an approved or unapproved indication. Results Overall, the number of Medicaid youth with an antipsychotic prescription fill halved between 2014 and 2018. Youth aged 17 years and under and foster care-enrolled youth, who were targeted by prior authorization and quality improvement efforts, experienced larger declines. Roughly half of prescriptions were for unapproved indications in both 2014 and 2018; the most common unapproved indication was ADHD, and the treatment duration was shorter for unapproved indications compared to approved indications. Conclusions Antipsychotic prescribing to Medicaid-enrolled youth is declining, particularly among populations that have been targeted by policy initiatives like prior authorization and quality monitoring programs. Despite the fact that these initiatives often assess diagnostic criteria, half of antipsychotic prescriptions were for unapproved indications in both 2014 and 2018. More research is needed to gauge whether this prescribing is appropriate.

scholarly journals Dental visits in Medicaid-enrolled youth with mental illness: an analysis of administrative claims data

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Erica L. Stockbridge ◽  
Eleena Dhakal ◽  
Stacey B. Griner ◽  
Abiah D. Loethen ◽  
Joseph F. West ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Oral Health ◽  
Dental Care ◽  
Service Use ◽  
Claims Data ◽  
The United States ◽  
Administrative Claims ◽  
Dental Visits ◽  
Administrative Claims Data

Abstract Background State Medicaid plans across the United States provide dental insurance coverage to millions of young persons with mental illness (MI), including those with attention deficit hyperactivity disorder (ADHD), depression, anxiety, bipolar disorder, and schizophrenia. There are significant oral health challenges associated with MI, and providing dental care to persons with MI while they are young provides a foundation for future oral health. However, little is known about the factors associated with the receipt of dental care in young Medicaid enrollees with MI. We aimed to identify mental and physical health and sociodemographic characteristics associated with dental visits among this population. Methods We retrospectively analyzed administrative claims data from a Medicaid specialty health plan (September 2014 to December 2015). All enrollees in the plan had MI and were ≥ 7 years of age; data for enrollees aged 7 to 20 years were analyzed. We used two-level, mixed effects regression models to explore the relationships between enrollee characteristics and dental visits during 2015. Results Of 6564 Medicaid-enrolled youth with MI, 29.0% (95% CI, 27.9, 30.1%) had one or more visits with a dentist or dental hygienist. Within youth with MI, neither anxiety (Adjusted odds ratio [AOR] = 1.15, p = 0.111), post-traumatic stress disorder (AOR = 1.31, p = 0.075), depression (AOR = 1.02, p = 0.831), bipolar disorder (AOR = 0.97, p = 0.759), nor schizophrenia (AOR = 0.83, p = 0.199) was associated with dental visits in adjusted analyses, although having ADHD was significantly associated with higher odds of dental visits relative to not having this condition (AOR = 1.34, p < 0.001). Age, sex, race/ethnicity, language, and education were also significantly associated with visits (p < 0.05 for all). Conclusions Dental utilization as measured by annual dental visits was lower in Medicaid-enrolled youth with MI relative to the general population of Medicaid-enrolled youth. However, utilization varied within the population of Medicaid-enrolled youth with MI, and we identified a number of characteristics significantly associated with the receipt of dental services. By identifying these variations in dental service use this study facilitates the development of targeted strategies to increase the use of dental care in – and consequently improve the current and long-term wellbeing of – the vulnerable population of Medicaid-enrolled youth with MI.

Variations in inpatient stays for non-metastatic HER2- breast cancer (BC), non-small cell lung cancer (NSCLC), and colorectal cancer (CRC) in a real world setting.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18099-e18099
Author(s):  
Jennifer Malin ◽  
Stacey DaCosta Byfield ◽  
Benjamin Chastek ◽  
Stephanie Korrer ◽  
Thomas Horstman ◽  
...  
Keyword(s):  
Clinical Data ◽  
Claims Data ◽  
Administrative Claims ◽  
Cancer Type ◽  
Prior Authorization ◽  
Inpatient Stay ◽  
Her2 Breast Cancer ◽  
Real World Setting ◽  
End Of Treatment ◽  
The Impact

e18099 Background: We aim to compareprevalence and duration of inpatient stays during the most commonly used chemotherapy regimens for BC, NSCLC, and CRC in a commercially insured population. Methods: This analysis used clinical data obtained from a prior authorization program for chemotherapy linked with administrative claims data from 6/1/2015 to 5/31/2016. Clinical data included cancer type, stage at diagnosis, relevant biomarkers, and evidence of progression/relapse. Eligible patients included commercially insured members with a prior authorization request for one of the most commonly used NCCN recommended regimens for BC, NSCLC and CRC. Outcomes, including percent of patients experiencing an inpatient stay and number of inpatient days were tracked from the first claim for chemotherapy until end of treatment due to discontinuation, death or change in treatment, with remaining patients censored at 5/31/2016 or end of enrollment. Results: There were 1612 HER2- BC, 237 NSCLC, and 386 CRC patients who completed therapy during the study period. Incidence and inpatient stay days per 100 patient months for the most common regimens for each cancer are summarized in the table. Conclusions: The rates and duration of inpatient stays varied substantially across the most commonly used therapies for BC, NSCLC and CRC. These data show the importance of systematically incorporating the impact of hospitalizations alongside other clinical outcomes in treatment choice in routine clinical practice. As the database grows over time, these data will help clinicians and patients better evaluate regimen choices for various cancers. [Table: see text]

Variations in cost for non-metastatic HER2- breast cancer (BC), non-small cell lung cancer (NSCLC), and colorectal cancer (CRC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18106-e18106
Author(s):  
Jennifer Malin ◽  
Stacey DaCosta Byfield ◽  
Benjamin Chastek ◽  
Stephanie Korrer ◽  
Thomas Horstman ◽  
...  
Keyword(s):  
Clinical Data ◽  
Claims Data ◽  
Administrative Claims ◽  
Cancer Type ◽  
Prior Authorization ◽  
Her2 Breast Cancer ◽  
End Of Treatment ◽  
Relative Value ◽  
Time Table ◽  
Care Costs

e18106 Background: We aim to quantify economic outcomes of the most commonly used chemotherapy regimens for BC, NSCLC, and CRC in a commercially insured population. Methods: This analysis used clinical data from a prior authorization program for chemotherapy regimens linked with administrative claims data from 6/1/2015 to 5/31/2016. Clinical data included cancer type, stage at diagnosis, and biomarkers. Eligible patients were commercially insured members with a prior authorization request for one of the most commonly used NCCN recommended regimens for BC, NSCLC and CRC. Outcomes, including total healthcare cost and cost of chemotherapy were tracked from first claim for chemotherapy until end of treatment due to discontinuation, death or change in treatment. Patients were censored at 5/31/2016 or end of enrollment. Results: There were 1612 BC, 237 NSCLC, and 386 CRC non-censored patients who received therapy during the study period. Mean (SD) total and monthly drug costs and total health care costs for the most common regimens by cancer are summarized in the table. Conclusions: The relative value of the most common therapies for BC, NSCLC, and CRC varied significantly depending on the metric used underscoring the importance of comparing total healthcare costs when assessing the value of therapies. Information on these and other regimens will increase as the database grows over time. [Table: see text]

Methodological Approaches to Organization of Drinking Water Quality Monitoring Programs

2020 ◽  
pp. 4-8
Author(s):  
Yu.A. Novikova ◽  
I.O. Myasnikov ◽  
A.A. Kovshov ◽  
N.A. Tikhonova ◽  
N.S. Bashketova
Keyword(s):  
Water Quality ◽  
Drinking Water ◽  
Water Supply ◽  
Cold Water ◽  
Water Quality Monitoring ◽  
Drinking Water Quality ◽  
Quality Monitoring ◽  
Water Supply Systems ◽  
Monitoring Programs ◽  
Supply Systems

Summary. Introduction: Drinking water is one of the most important environmental factors sustaining life and determining human health. The goal of the Russian Federal Clean Water Project is to improve drinking water quality through upgrading of water treatment and supply systems using advanced technologies, including those developed by the military-industrial complex. The most informative and reliable sources of information for assessing drinking water quality are the results of systematic laboratory testing obtained within the framework of socio-hygienic monitoring (SGM) and production control carried out by water supply organizations. The objective of our study was to formulate approaches to organizing quality monitoring programs for centralized cold water supply systems. Materials and methods: We reviewed programs and results of drinking water quality laboratory tests performed by Rospotrebnadzor bodies and institutions within the framework of SGM in 2017–2018. Results: We established that drinking water quality monitoring in the constituent entities of the Russian Federation differs significantly in the number of monitoring points (566 in the Krasnoyarsk Krai vs 10 in Sevastopol) and measured indicators, especially sanitary and chemical ones (53 inorganic and organic substances in the Kemerovo Region vs one indicator in the Amur Region). Discussion: For a more complete and objective assessment of drinking water quality in centralized cold water supply systems, monitoring points should be organized at all stages of water supply with account for the coverage of the maximum number of people supplied with water from a particular network. Thus, the number of points in the distribution network should depend, inter alia, on the size of population served. In urban settlements with up to 10,000 inhabitants, for example, at least 4 points should be organized while in the cities with more than 3,000,000 inhabitants at least 80 points are necessary. We developed minimum mandatory lists of indicators and approaches to selecting priority indices to be monitored at all stages of drinking water supply.

scholarly journals Characterization of bariatric surgery and outcomes using administrative claims data in the research network of a nationwide commercial health plan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qinli Ma ◽  
Michael Mack ◽  
Sonali Shambhu ◽  
Kathleen McTigue ◽  
Kevin Haynes
Keyword(s):  
Bariatric Surgery ◽  
Health Systems ◽  
Comparative Effectiveness ◽  
Claims Data ◽  
Research Network ◽  
Hospital Death ◽  
Administrative Claims ◽  
Administrative Claims Data ◽  
Abdominal Operations

Abstract Background The supplementation of electronic health records data with administrative claims data may be used to capture outcome events more comprehensively in longitudinal observational studies. This study investigated the utility of administrative claims data to identify outcomes across health systems using a comparative effectiveness study of different types of bariatric surgery as a model. Methods This observational cohort study identified patients who had bariatric surgery between 2007 and 2015 within the HealthCore Anthem Research Network (HCARN) database in the National Patient-Centered Clinical Research Network (PCORnet) common data model. Patients whose procedures were performed in a member facility affiliated with PCORnet Clinical Research Networks (CRNs) were selected. The outcomes included a 30-day composite adverse event (including venous thromboembolism, percutaneous/operative intervention, failure to discharge and death), and all-cause hospitalization, abdominal operation or intervention, and in-hospital death up to 5 years after the procedure. Outcomes were classified as occurring within or outside PCORnet CRN health systems using facility identifiers. Results We identified 4899 patients who had bariatric surgery in one of the PCORnet CRN health systems. For 30-day composite adverse event, the inclusion of HCARN multi-site claims data marginally increased the incidence rate based only on HCARN single-site claims data for PCORnet CRNs from 3.9 to 4.2%. During the 5-year follow-up period, 56.8% of all-cause hospitalizations, 31.2% abdominal operations or interventions, and 32.3% of in-hospital deaths occurred outside PCORnet CRNs. Incidence rates (events per 100 patient-years) were significantly lower when based on claims from a single PCORnet CRN only compared to using claims from all health systems in the HCARN: all-cause hospitalization, 11.0 (95% Confidence Internal [CI]: 10.4, 11.6) to 25.3 (95% CI: 24.4, 26.3); abdominal operations or interventions, 4.2 (95% CI: 3.9, 4.6) to 6.1 (95% CI: 5.7, 6.6); in-hospital death, 0.2 (95% CI: 0.11, 0.27) to 0.3 (95% CI: 0.19, 0.38). Conclusions Short-term inclusion of multi-site claims data only marginally increased the incidence rate computed from single-site claims data alone. Longer-term follow up captured a notable number of events outside of PCORnet CRNs. The findings suggest that supplementing claims data improves the outcome ascertainment in longitudinal observational comparative effectiveness studies.

scholarly journals Attribution of Adverse Events Following Coronary Stent Placement Identified Using Administrative Claims Data

2020 ◽  
Vol 9 (4) ◽  
Author(s):  
Sanket S. Dhruva ◽  
Craig S. Parzynski ◽  
Ginger M. Gamble ◽  
Jeptha P. Curtis ◽  
Nihar R. Desai ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stent Placement ◽  
Claims Data ◽  
Coronary Stent ◽  
Administrative Claims ◽  
Administrative Claims Data

Validation of diabetes case definitions using administrative claims data

2011 ◽  
Vol 28 (4) ◽  
pp. 424-427 ◽  
Author(s):  
S. Amed ◽  
S. E. Vanderloo ◽  
D. Metzger ◽  
J.-P. Collet ◽  
K. Reimer ◽  
...  
Keyword(s):  
Claims Data ◽  
Administrative Claims ◽  
Case Definitions ◽  
Administrative Claims Data ◽  
Diabetes Case
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