scholarly journals Hospitalized patients co-diagnosed with infective endocarditis and opioid drug dependence in Florida, 2015-2018

2021 ◽  
Vol 10 (4) ◽  
pp. 26
Author(s):  
Alexander Litvintchouk ◽  
Lori Bilello ◽  
Carmen Smotherman ◽  
Katryn Lukens Bull
Keyword(s):  
Infective Endocarditis ◽  
Financial Burden ◽  
The United States ◽  
Population Characteristics ◽  
Opioid Use ◽  
Discharge Disposition ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Using Data ◽  
Total Charges

Objective: As the opioid addiction epidemic continues to grow, other serious health issues regarding drug use has also increased. This study examines the trends in admissions and population characteristics of those who experience infective endocarditis with opioid drug dependence.Methods: We used ICD-9-CM and ICD-10-CM codes to identify patients admitted to a hospital with infective endocarditis and with a secondary diagnosis of opioid use related disorders using data released by the Florida Agency for Health Care Administration (AHCA). Data included age, gender, ethnicity, race, discharge disposition, admission type, payer status, total charges, and zip code of patients’ residence.Results: During the four-year period, the percent of patients diagnosed with infective endocarditis and a diagnosis code associated with opioid abuse or dependence doubled (4.48% to 8.52%). Of the patients dually diagnosed, the mean age was 37.47 and the majority were white (90.78%), non-Hispanic (91.96%), and female (58.55%). Nearly 47% of the patients did not have health insurance. The percentage of patients with both diagnosis codes living in urban counties was 91.37%. Median length of stay was 10 days and median total charges for patients was $101,604.Conclusions: With the increasing incidence of opioid dependence and addiction within the United States, there is a rise in infective endocarditis, a costly and debilitating disease. Our analysis provides the framework for hospital systems to identify patients who may benefit from addiction services, which through downstream effects will cause less of a health and financial burden.

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

scholarly journals Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

2021 ◽  
pp. 002204262110063
Author(s):  
Brian King ◽  
Ruchi Patel ◽  
Andrea Rishworth
Keyword(s):  
Age Groups ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Policy Recommendations ◽  
Opioid Use ◽  
Fentanyl Analogs ◽  
Measure Change ◽  
Using Data ◽  
At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

scholarly journals 1337. Medically Attended (MA) Illness Due to Respiratory Syncytial Virus (RSV) Infection among Infants in the United States during the 2016–17, 2017–18, 2018–19, and 2019–20 RSV Seasons: The Need for All-Infant Protection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S756-S756
Author(s):  
Jason Gantenberg ◽  
Nicole Zimmerman ◽  
Andrew R Zullo ◽  
Brendan Limone ◽  
Clarisse Demont ◽  
...  
Keyword(s):  
Claims Data ◽  
The United States ◽  
Research Support ◽  
Term Infants ◽  
Material Support ◽  
Diagnosis Codes ◽  
Icd 10 ◽  
Ibm Watson ◽  
Syncytial Virus ◽  
Research Grant

Abstract Background RSV-associated lower respiratory tract infection (LRTI) is the leading cause of infant hospitalization. Most studies of RSV have focused on infants with underlying comorbidities, including prematurity. The purpose of this analysis is to describe the burden of RSV LRTI across all medical settings and in all infants experiencing their first RSV season. Methods Using de-identified claims data from two commercial (MarketScan Commercial, MSC; Optum Clinformatics, OC) and one public (MarketScan Medicaid, MSM) insurance database, we estimated the prevalence of MA RSV LRTI among infants born between April 1, 2016 and June 30, 2019 in their first RSV season. Estimates were made by gestational age, presence/absence of comorbidities, and setting (inpatient, emergency department and outpatient). Due to limited laboratory testing, we defined MA RSV LRTI using two sets of ICD-10-CM diagnosis codes: a specific definition (identifying RSV explicitly) and a sensitive definition that included unspecified bronchiolitis. The first specific diagnosis triggered a search for another MA RSV LRTI diagnosis (either specific or sensitive) within the next 7 days. In the sensitive analysis, the first diagnosis was allowed to meet the sensitive definition. Setting was recorded as the highest level of care attached to a MA RSV LRTI diagnosis within this 7-day period. Results Using the specific (sensitive) definitions, 4.2% (12.2%), 6.8% (16.8%), and 2.7% (7.2%) of newborns had an MA RSV LRTI diagnosis during their first respiratory season across the MSC, MSM, and OC datasets (Table 1). Term infants without comorbidities accounted for 77% (83%), 79% (86%), and 80 (81%) of all MA RSV LRTI, and 21% (10%), 19% (10%), and 21% (10%) of all infants with MA RSV LRTI had an inpatient hospital stay (Table 2). Term infants without comorbidities accounted for 69% (68%), 67% (79%), and 73% (73%) of all MA RSV LRTI inpatients (Table 2). Conclusion In commercial and public claims data, during their first RSV season, term infants without comorbidities accounted for a sizable majority of inpatient, emergency room, and outpatient encounters for RSV LRTI in the US. To address the burden of RSV LRTI, future RSV prevention efforts should target all infants. Funding Sanofi Pasteur, AstraZeneca Disclosures Jason Gantenberg, MPH, Sanofi Pasteur (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support) Nicole Zimmerman, MS, IBM Watson Health (Employee, Nicole Zimmerman is an employee of IBM, which was compensated by Sanofi to complete this work.)Sanofi (Other Financial or Material Support, Nicole Zimmerman is an employee of IBM, which was compensated by Sanofi to complete this work.) Andrew R. Zullo, PharmD, PhD, ScM, Sanofi Pasteur (Grant/Research Support, Research Grant or Support) Brendan Limone, PharmD, PharmD, Sanofi Pasteur (Other Financial or Material Support, IBM was contracted by Sanofi to perform analysis) Clarisse Demont, n/a, Sanofi Pasteur (Employee, Shareholder) Sandra S. Chaves, MD, MSc, Sanofi Pasteur (Employee) William V. La Via, MD, AstraZeneca (Shareholder)Sanofi Pasteur (Employee) Christopher Nelson, PhD, Epidemiology, Sanofi Pasteur (Employee) Christopher Rizzo, MD, Sanofi (Employee) David A. Savitz, PhD, Sanofi Pasteur (Grant/Research Support) Robertus Van Aalst, MSc, Sanofi Pasteur (Employee, Shareholder)

scholarly journals The Financial Burden of Opioid-Related Abuse among Surgical and Non-Surgical Patients in Florida: A Longitudinal Study

2021 ◽  
Vol 18 (17) ◽  
pp. 9127
Author(s):  
Jing Xu ◽  
Nazik M. A. Zakari ◽  
Hanadi Y. Hamadi ◽  
Sinyoung Park ◽  
Donald Rob Haley ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Financial Burden ◽  
Opioid Abuse ◽  
Opioid Use ◽  
Retrospective Case ◽  
Discharge Data ◽  
Hospital Administrators ◽  
Icd 10 ◽  
Longitudinal Study Design ◽  
Insight Into

Florida is one of the eight states labeled as a high-burden opioid abuse state and is an epicenter for opioid use and misuse. The aim of our study was to measure multi-year total room charges and costs billed for opioid abuse-related events and to compare the costs of inpatient opioid abusers and non-opioid abusers for Florida hospitals from 2011 to 2017. We constructed a retrospective case-control longitudinal study design on inpatient administrative discharge data across 173 hospitals. Opioid abuse was defined using both ICD-9-CM and ICD-10-CM systems. We found a statistically significant association between opioid abuse diagnosis and total room charge. On average, opioid abuse status increased the room charges by 8.1%. We also noticed year-to-year variations in opioid abuse had a remarkable influence on hospital finances. We showed that since 2015, the differences significantly increased from 4–5% to 13–14% for both room charges and cost, which indicates the financial burden due to opioid abuse becoming more frequent. These findings are important to policymakers and hospital administrators because they provide crucial insight into Florida’s opioid crisis and its economic burden on hospitals.

Intercapitalist Maneuvers and the ICD-10 Transition: The Instrumental Role of the State in the Corporate Governance of U.S. Health Care

2019 ◽  
Vol 49 (3) ◽  
pp. 457-475 ◽  
Author(s):  
Mary Bugbee
Keyword(s):  
Health Care ◽  
Corporate Governance ◽  
Financial Burden ◽  
Health Sector ◽  
The United States ◽  
The State ◽  
Coding System ◽  
Role Of The State ◽  
Icd 10

In 2015, the United States transitioned to the ICD-10-CM/PCS, a comprehensive updated coding system for medical reimbursement. This transition was part of a larger move toward value-based reimbursement in U.S. health care and required nearly 2 decades of planning. As an unfunded mandate from Congress, it created a substantial financial burden for many groups within the health sector. This article traces the ICD-10 transition using the concept of the corporate governance of health care, attending to the role the state plays in mediating intercapitalist maneuvers. The ICD-10 was not a simple top-down declaration originating in a neutral state. Rather, it was produced and modified through lobbying efforts on the part of various stakeholders who, along with their competitors, would be affected by the transition in differential ways. The health information technology industry, in particular, stood to gain the most from this transition, at the expense of other capitalist players. An examination of the intercapitalist maneuevers behind the ICD-10 transition demonstrates that even when corporate powers govern U.S. health care, the role of the state should not be written off as inconsequential but rather interrogated and analyzed in relation to the corporate interests with which it is entangled.

Abstract TMP119: Incidence, Presentation and Outcomes of Brain Arteriovenous Malformations in Adult Population in United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Vamshi Balasetti ◽  
Wei Huang ◽  
Nitish Kumar ◽  
Iryna Lobanova ◽  
Farhan Siddiq ◽  
...  
Keyword(s):  
United States ◽  
Hospital Admissions ◽  
Adult Population ◽  
The United States ◽  
Severe Disability ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Diagnostic Code ◽  
Discharge Disposition ◽  
Icd 10

Background: Data regarding national estimates of brain arteriovenous malformation (BAVM) among adults in United States data are scant, often biased by limitations of single center and regional studies. Identification of such patients in nationally representative datasets was not possible until recently due to a new specific ICD-10 code. Objective: To characterize inpatient burden, expenditures, associated comorbidities (including intracerebral hemorrhages and seizures) and treatments of BAVM among adults in United States. Methods: Patients with BAVM were identified from the Nationwide Inpatient Sample (NIS) database for the year 2016 using ICD-10 diagnostic code (Q28.2). The primary outcome was to determine the prevalence of BAVM in the adult (18 and above) in-patient population in the United States. Secondary outcomes included determining inpatient mortality, morbidity, comorbidities, hospital length of stay (LOS) and total hospital charges. Outcome was classified by discharge disposition into none to minimal and moderate to severe disability. Results: Of the total 7,135,090 reported hospital discharges in 2016, an estimated 1733 (0.02%) had the diagnosis of BAVM; 1547 were adults with ages 18 or greater (mean age [SD] 54 (18); 783 (50.6%) were men). Patients with BAVM were whites (n= 921, 59.5%), African-Americans (n=224, 14.4%) and Hispanic (n=212, 13.7%). Underlying hypertension was identified in 677 (43.1%) patients. Clinical presentation was intracerebral hemorrhage (n=260, 16.8%), seizures (n=234, 15.1%) and subarachnoid hemorrhage (n=75, 4.8%). Endovascular treatment was performed in 272 (17.5%) patients and surgical treatment was performed in 45 (2.9%) patients. None to minimal disability was seen in 1023 (66.1%) and moderate to severe disability was seen in 469 (30.3%) of the patients. In hospital mortality was 2.59% (n=40). Average LOS (SD) was 4 days (8.6) with mean hospitalization charges (SD) of $121,186 (153553.1). Conclusion: There are 1547 hospital admissions for BAVM among adults in United States every year. The overall outcomes were good with high rates of none to minimal disability but the hospitalization charges were higher than expected and may be important for resource allocation.

scholarly journals Trends in diagnostic prevalence and treatment patterns of male and female ankylosing spondylitis patients in the United States, 2006–2016

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Jessica Walsh ◽  
Theresa Hunter ◽  
Krista Schroeder ◽  
David Sandoval ◽  
Rebecca Bolce
Keyword(s):  
United States ◽  
Ankylosing Spondylitis ◽  
The United States ◽  
Epidemiological Studies ◽  
Treatment Patterns ◽  
Opioid Use ◽  
Biologic Dmards ◽  
Male And Female ◽  
Pharmacy Claims ◽  
Diagnosis Codes

Abstract Background There has been much variation between epidemiological studies that report the prevalence of ankylosing spondylitis (AS). This study aimed to analyze the diagnostic prevalence rates and treatment patterns of male and female AS patients in the United States adult insured population from 2006 to 2016. Methods Trends in AS prevalence were calculated for the 11-year period covering January 1, 2006 to December 31, 2016. Adult (18+ years old) AS patients were included in this retrospective analysis of medical and pharmacy claims data from the IBM Marketscan Commercial, Medicaid and Medicare-Supplemental Claims database. Prevalence was determined as having ≥1 AS diagnostic codes (ICD-9:720.0; ICD-10:M45.x). Trends in treatment patterns were also analyzed and stratified by gender. Results The AS prevalence increased from 0.04 to 0.09% from 2006 to 2016. The mean age between 2006 and 2016 ranged from 49.52–50.00 years. In 2006, approximately 40% of AS patients were female, while in 2016 over 47% of AS patients were female. Rates of use of TNF inhibitors and oral glucocorticoids increased, while NSAIDs and non-biologic DMARDs (sulfasalazine & methotrexate) rates decreased. Opioid use rates were stable. In 2016, males were more likely to be prescribed biologics, while females were more likely to be prescribed methotrexate, sulfasalazine, NSAIDs, muscle relaxants, anticonvulsants, opioids, and glucocorticoids. Conclusions The prevalence of AS diagnosis codes more than doubled between 2006 and 2016, but the very low prevalence suggests that AS continues to be underdiagnosed and under-addressed in routine clinical practice. Despite the increase in female AS patients, females were less likely to be prescribed biologics compared to male AS patients.

scholarly journals 197. Infective Endocarditis Over a Five-Year Period in an Academic Teaching Center: The Validity of ICD Codes vs. Manual Chart Review

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S117-S118
Author(s):  
Michael Haden ◽  
Mohammad Mahdee Sobhanie ◽  
Courtney Hebert ◽  
Clara Castillejo Becerra ◽  
Abigail N Turner
Keyword(s):  
Substance Abuse ◽  
Infective Endocarditis ◽  
Chart Review ◽  
The United States ◽  
Infectious Complications ◽  
Diagnosis Codes ◽  
Icd Codes ◽  
Infectious Disease Service ◽  
Epidemiological Trends ◽  
Overdose Deaths

Abstract Background Opioid dependence and overdose are at epidemic levels in the United States. Ohio has the third highest rate of opioid-related overdose deaths. Infectious complications of intravenous drug use (IDU) include increased acquisition of hepatitis C, HIV and infective endocarditis. In this study, we aimed to characterize cases of infective endocarditis admitted to our healthcare system over a five-year period. We additionally sought to determine the validity of using ICD codes to identify infective endocarditis cases and IDU. Methods Patients with ICD-9 or 10 discharge diagnosis codes for infective endocarditis were identified from our institution’s electronic health record. ICD codes pertaining to substance abuse were used to classify patients according to IDU status. Readmissions during the same episode of infective endocarditis were excluded. We compared chart review to ICD code for the identification of infective endocarditis and IDU in a random sample of 296 of 1590 cases. Results Of 296 charts reviewed, 133 (44.9%) were excluded because they did not meet criteria for definite infective endocarditis by modified Duke’s criteria or because the episode was a readmission. A total of 163 (55.1%) cases met inclusion criteria, all of whom were seen in consultation by the inpatient Infectious Disease service. Of these, 52 (31.9%) had ICD 9 or 10 codes linked to substance abuse. Following manual chart review, we established that in fact 86 of these 163 cases (52.8%) had evidence of substance abuse. Conclusion Misclassification due to use of ICD codes is a well-established challenge to epidemiological research. However, the extent of misclassification in this analysis was greater than expected. If prior research on IDU and infective endocarditis has relied on medical record data alone without verification through manual chart review, the observed epidemiological trends may not be accurate. Disclosures All authors: No reported disclosures.

scholarly journals Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study

2020 ◽  
Author(s):  
Joshua A Barocas ◽  
Golnaz Eftekhari Yazdi ◽  
Alexandra Savinkina ◽  
Shayla Nolen ◽  
Caroline Savitzky ◽  
...  
Keyword(s):  
United States ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Population Level ◽  
Risk Groups ◽  
The United States ◽  
Published Data ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Behavior Profiles

Abstract Background The expansion of the US opioid epidemic has led to significant increases in infections, such as infective endocarditis (IE), which is tied to injection behaviors. We aimed to estimate the population-level IE mortality rate among people who inject opioids and compare the risk of IE death against the risks of death from other causes. Methods We developed a microsimulation model of the natural history of injection opioid use. We defined injection behavior profiles by both injection frequency and injection techniques. We accounted for competing risks of death and populated the model with primary and published data. We modeled cohorts of 1 million individuals with different injection behavior profiles until age 60 years. We combined model-generated estimates with published data to project the total expected number of IE deaths in the United States by 2030. Results The probabilities of death from IE by age 60 years for 20-, 30-, and 40-year-old men with high-frequency use with higher infection risk techniques compared to lower risk techniques for IE were 53.8% versus 3.7%, 51.4% versus 3.1%, and 44.5% versus 2.2%, respectively. The predicted population-level attributable fraction of 10-year mortality from IE among all risk groups was 20%. We estimated that approximately 257 800 people are expected to die from IE by 2030. Conclusions The expected burden of IE among people who inject opioids in the United States is large. Adopting a harm reduction approach, including through expansion of syringe service programs, to address injection behaviors could have a major impact on decreasing the mortality rate associated with the opioid epidemic.

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