Emergency department increased use of observation care for elderly medicare patients

Background: Over the past decade, a growing number of older Medicare beneficiaries visit the emergency department (ED) and have been placed in observation care. We investigated and compared the prevalence and factors associated with patients age ≥ 65 years with Medicare insurance who are placed in the hospital, observation care, or discharged following an ED visit.Methods: We conducted a retrospective cohort study using data from a nationally representative 5% sample of Medicare patients age ≥ 65 years during the year 2013. We performed multiple generalized estimating equation (GEE) logistic regression analyses to assess the relationship between placement in a hospital vs. discharge, observation care vs. discharge, and observation care vs. admission.Results: Of 537,455 Medicare beneficiaries age ≥ 65 years who visited an ED in 2013, 48.0% (N = 258,083) were discharged, 10.5% (N = 56,184) placed in observation care, and 41.5% (N = 223,188) were admitted to the inpatient service following the ED visit. The top 2 diagnoses associated with placement in the hospital vs. discharge were ischemic heart disease and renal disease. Patients with symptomatic diagnoses such as chest pain and dizziness were more likely to be placed in observation care following an ED visit as compared to admission to the hospital.Conclusions: Compared to prior studies, we found a greater number of older Medicare ED patients placed in observation care and a lower number admitted to the hospital. Most common diagnoses of placement in observation care were symptom-based as compared to being admitted to the hospital which were disease-based.

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Who Has an Unsuccessful Observation Care Stay?

Healthcare ◽

10.3390/healthcare6040138 ◽

2018 ◽

Vol 6 (4) ◽

pp. 138 ◽

Cited By ~ 1

Author(s):

Gelareh Gabayan ◽

Brian Doyle ◽

Li-Jung Liang ◽

Kwame Donkor ◽

David Huang ◽

...

Keyword(s):

Estimating Equation ◽

Generalized Estimating Equation ◽

Inpatient Service ◽

Intestinal Infections ◽

Sample Data ◽

Medicare Patients ◽

Prolonged Observation ◽

Nationally Representative ◽

The Relationship ◽

Successful Observation

Background: With the recent increase use of observation care, it is important to understand the characteristics of patients that utilize this care and either have a prolonged observation care stay or require admission. Methods: We a conducted a retrospective cohort study utilizing 5% sample data from Medicare patients age ≥65 years that was nationally representative in the year 2013. We performed a generalized estimating equation (GEE) logistic regression analysis to evaluate the relationship between an unsuccessful observation stay (defined as either requiring an inpatient admission from observation or having a prolonged observation stay) compared to having successful observation care. Observation cut offs of “successful” vs. “unsuccessful” were based on the CMS 2 midnight rule. Results: Of 154,756 observation stays in 2013, 19 percent (n = 29,604) were admitted to the inpatient service and 34,275 (22.2%) had a prolonged observation stay. The two diagnoses most likely to have an unsuccessful observation stay were intestinal infections (OR 1.56, 95% CI 1.32–1.83) and pneumonia (OR 1.26, 95% CI 1.13–1.41). Conclusion: We found patients placed in observation care with intestinal infections and pneumonia to have the highest odds of either being admitted from observation or having a prolonged observation stay.

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Functional Hearing Loss and Social Engagement Among Medicare Beneficiaries

The Journals of Gerontology Series B ◽

10.1093/geronb/gbz094 ◽

2019 ◽

Vol 76 (1) ◽

pp. 195-200 ◽

Cited By ~ 1

Author(s):

Aishwarya Shukla ◽

Thomas K M Cudjoe ◽

Frank R Lin ◽

Nicholas S Reed

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Social Engagement ◽

Social Activity ◽

Medicare Beneficiaries ◽

Cross Sectional ◽

The Past ◽

Hearing Ability ◽

Nationally Representative ◽

Using Data

Abstract Objectives Hearing loss is common in older adults and limits communication. We investigated the independent association between functional hearing loss and social engagement in a nationally representative sample of older adults. Methods Using data from the 2015 Medicare Current Beneficiaries Survey, we modeled the cross-sectional association between self-reported hearing ability and limitation in social activity over the past month using multivariable logistic regression. Results The majority of the study population was female (54.8%) and non-Hispanic white (74.3%). Participants (40.4%) reported “a little trouble” hearing and 7.4% reported “a lot of trouble” hearing. Those who reported any trouble hearing had higher odds of limited social engagement in the past month. After adjustment for demographic, clinical, and functional covariates, those who reported “a lot of trouble” hearing had 37% higher odds of limited social activity in the past month compared to those with normal hearing. Discussion These results suggest that hearing loss may be an important risk factor for limited social engagement and downstream negative health consequences, independent of other disability and health conditions.

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Vascular Neurologists’ Involvement in the Care of Medicare Patients With Ischemic Stroke

The Neurohospitalist ◽

10.1177/1941874420902951 ◽

2020 ◽

Vol 10 (3) ◽

pp. 181-187

Author(s):

Daniel C. Sacchetti ◽

Ajay Gupta ◽

Caroline D. Chung ◽

Abhinaba Chatterjee ◽

Yi Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

Diagnostic Testing ◽

Heart Rhythm ◽

The United States ◽

Medicare Beneficiaries ◽

Intracranial Vessel ◽

Vessel Imaging ◽

Medicare Patients ◽

Nationally Representative ◽

The Relationship

Background and Purpose: We sought to determine the proportion of patients with ischemic stroke evaluated by vascular neurologists in the United States. Methods: Using 2009 to 2015 claims from a 5% nationally representative sample of Medicare beneficiaries, we identified patients ≥65 years of age who were hospitalized for ischemic stroke. We ascertained the proportion of patients evaluated during the hospitalization or within 90 days of discharge by nonvascular and vascular neurologists. We assessed the relationship between county-level socioeconomic status and the likelihood of neurologist evaluation and between neurologist evaluation and diagnostic testing. Results: Among 66 989 patients with ischemic stroke, 37 820 (56.5%) were evaluated by a nonvascular neurologist and 11 700 (17.5%) by a board-certified vascular neurologist. Across increasing quartiles of county socioeconomic advantage, the proportion of patients evaluated by a vascular neurologist was 12.2%, 16.5%, 19.8%, and 23.0%. Relative to evaluation by a nonvascular neurologist, evaluation by a vascular neurologist was associated with a higher likelihood of postdischarge heart rhythm monitoring (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.6-1.9), echocardiography (OR, 1.4; 95% CI, 1.3-1.4), cervical vessel imaging (OR, 1.3; 95% CI, 1.2-1.3), and intracranial vessel imaging (OR, 2.1; 95% CI, 2.0-2.2). Conclusions: In a nationally representative cohort of Medicare beneficiaries, we found that about three quarters of patients with ischemic stroke were evaluated by a neurologist, and about one-sixth were evaluated by a vascular neurologist. Patients who were evaluated by a vascular neurologist were significantly more likely to undergo diagnostic testing.

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Partners’ Educational Pairings and Fertility Intentions in the United States: Evidence from 2015–2017 National Survey of Family Growth

Social Currents ◽

10.1177/2329496520906515 ◽

2020 ◽

Vol 7 (4) ◽

pp. 299-309

Author(s):

Danielle Xiaodan Morales

Keyword(s):

National Survey ◽

Estimating Equation ◽

The United States ◽

Fertility Intentions ◽

Generalized Estimating Equation ◽

Highly Educated ◽

Family Growth ◽

Nationally Representative ◽

The Difference ◽

The Relationship

In light of the ongoing educational shift from favoring men to favoring women, this study contributes to the literature on fertility by investigating the relationship between educational pairings and fertility intentions. To test two competing hypotheses, nationally representative data from the latest wave (2015–2017) of the National Survey of Family Growth were used, and four generalized estimating equation models were estimated. Results indicate that women’s intentions for additional children were influenced by educational pairings. Specifically, when highly educated women had a highly educated partner, their fertility intentions were higher than lower-educated women, but this difference disappeared if those women were in hypogamous relationships; when lower-educated women had lower- or medium-educated partners, their intentions for additional children were significantly lower than highly educated women, but the difference disappeared when she had a highly educated partner. Findings from this study provide new insights into fertility intentions by taking into account both partners’ education.

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Openness and Self-enhancement are predictors of cultural and economic beliefs: an analysis of European countries across 15 years

10.31234/osf.io/q2s35 ◽

2019 ◽

Author(s):

Gabriela Czarnek ◽

Małgorzata Kossowska

Keyword(s):

Cultural Context ◽

Cultural Beliefs ◽

European Social Survey ◽

European Countries ◽

Political Beliefs ◽

Economic Beliefs ◽

Nationally Representative ◽

Self Transcendence ◽

Using Data ◽

The Relationship

In this study, we investigate the relationship between values and political beliefs and how it varies as a function of cultural context and time. In particular, we analyzed the effects of Conservation vs. Openness to change and Self-transcendence vs. Self-enhancement for cultural and economic political beliefs using data from nationally representative samples of citizens from 34 European countries from eight rounds of the European Social Survey (data spans the 2002–2016 period). We found that the effects of values on political beliefs are moderated by the Western vs. Eastern cultural context and that there is a modest round-to-round variation in the effects of values on beliefs. The relationship between Openness and cultural beliefs was negative and largely consistent across the Western and Eastern countries. Similarly, the effects of Self-enhancement were positive across these Western and Eastern countries. In contrast, the effects of Openness on economic beliefs were positive for the Eastern countries but largely weak and inconsistent for the Western countries. Finally, the effects of Self-enhancement on cultural beliefs are weak for both cultural contexts.

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The Authoritarian Dynamic During the COVID-19 Pandemic: Effects on Nationalism and Anti-Immigrant Sentiment

Social Psychological and Personality Science ◽

10.1177/1948550620978023 ◽

2021 ◽

pp. 194855062097802

Author(s):

Todd K. Hartman ◽

Thomas V. A. Stocks ◽

Ryan McKay ◽

Jilly Gibson-Miller ◽

Liat Levita ◽

...

Keyword(s):

Social Order ◽

Situational Factors ◽

Right Wing ◽

Right Wing Authoritarianism ◽

The United Kingdom ◽

The Social ◽

Political Outcomes ◽

Nationally Representative ◽

Using Data ◽

The Relationship

Research has demonstrated that situational factors such as perceived threats to the social order activate latent authoritarianism. The deadly COVID-19 pandemic presents a rare opportunity to test whether existential threat stemming from an indiscriminate virus moderates the relationship between authoritarianism and political attitudes toward the nation and out-groups. Using data from two large nationally representative samples of adults in the United Kingdom ( N = 2,025) and Republic of Ireland ( N = 1,041) collected during the initial phases of strict lockdown measures in both countries, we find that the associations between right-wing authoritarianism (RWA) and (1) nationalism and (2) anti-immigrant attitudes are conditional on levels of perceived threat. As anxiety about the COVID-19 pandemic increases, so too does the effect of RWA on those political outcomes. Thus, it appears that existential threats to humanity from the COVID-19 pandemic moderate expressions of authoritarianism in society.

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The relationship between remission and health-related quality of life in a cohort of SLE patients

Rheumatology ◽

10.1093/rheumatology/key349 ◽

2018 ◽

Vol 58 (4) ◽

pp. 628-635 ◽

Cited By ~ 8

Author(s):

Michel W P Tsang-A-Sjoe ◽

Irene E M Bultink ◽

Maaike Heslinga ◽

Lilian H van Tuyl ◽

Ronald F van Vollenhoven ◽

...

Keyword(s):

Quality Of Life ◽

Global Assessment ◽

Short Form ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

The Relationship

Abstract Objective To investigate the relationship between remission and health-related quality of life (HRQoL) in patients with SLE in a longitudinal observational cohort. Methods HRQoL was measured at cohort visits using the physical and mental component score (PCS and MCS, respectively) of the Short Form 36 questionnaire. Definitions of Remission in SLE remission categories (no remission/remission on therapy/remission off therapy) were applied. Determinants of PCS and MCS were identified with simple linear regression analyses. Association between remission and HRQoL was assessed using generalized estimating equation models. Results Data from 154 patients with 2 years of follow-up were analysed. At baseline 60/154 (39.0%) patients were in either form of remission. Patients in remission had higher Short Form 36 scores in all subdomains compared with patients not in remission. PCS was positively associated with remission and employment, and negatively associated with SLICC damage index, ESR, medication, patient global assessment and BMI. MCS was positively associated with Caucasian ethnicity and negatively associated with patient global assessment. In generalized estimating equation analysis, a gradual and significant increase of PCS was observed from patients not in remission (mean PCS 36.0) to remission on therapy (41.8) to remission off therapy (44.8). No significant difference in MCS was found between remission states. Conclusion we show a strong and persistent association between remission and PCS, but not MCS. These results support the relevance (construct validity) of the Definition of Remission in SLE remission definitions and the further development of a treat-to-target approach in SLE.

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1083. Risk Factors Associated with Treatment of Asymptomatic Bacteriuria in the Emergency Department: A Multi-Hospital Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.947 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S384-S385

Author(s):

Lindsay A Petty ◽

Valerie M Vaughn ◽

Twisha S Patel ◽

Anurag N Malani ◽

Jason M Pogue ◽

...

Keyword(s):

Emergency Department ◽

Asymptomatic Bacteriuria ◽

Altered Mental Status ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Medical Patients ◽

Positive Urine Culture ◽

Factors Associated ◽

Patient Variables ◽

Antibiotic Dose

Abstract Background Antimicrobial stewardship interventions to decrease testing and treatment of asymptomatic bacteriuria (ASB) have primarily focused on inpatient clinicians, however emergency medicine (EM) clinicians also test and treat ASB. We identified testing attributable to EM clinicians and patient-level factors associated with EM treatment of ASB. Methods Between November 2017 and March 2019, data were abstracted from medical records of adult non-ICU medical patients at 43 Michigan hospitals admitted through the Emergency Department (ED) with a positive urine culture (Ucx) collected on day 1 or 2 of hospitalization. Exclusions included pregnancy, urologic surgery or abnormality, immune-compromise, severe sepsis, or concomitant infection. ASB was defined as a positive Ucx without signs or symptoms of a urinary tract infection (UTI). The treatment group included patients receiving ≥1 antibiotic dose ordered by an EM clinician. Patient factors associated with ASB treatment by EM clinicians vs. no treatment were evaluated using logistic generalized estimating equation models. Results Of 1,778 patients with ASB, 74.7% (N = 1328) had a Ucx ordered by an EM clinician (Figure 1), and 74.4% (N = 1323) were treated with antibiotics (Figure 2). Of those treated for ASB, 64.3% (851/1328) had the first dose ordered by an EM clinician (Figure 2). Patient variables associated with EM treatment included nonambulatory status, incontinence, presence of a urinary catheter, acutely altered mental status (AMS), leukocytosis, and positive urinalysis (Table 1). When EM initiated treatment, most patients (80%) remained on antibiotics for ≥3 days (Figure 3), with a median treatment duration of 6 days [IQR 4–9]. Conclusion Among patients with ASB admitted through the ED with a Ucx collected on day 1 or 2 of hospitalization, most were treated with antibiotics. The majority of testing and initial treatment for ASB was by EM clinicians. The strongest predictors of EM treatment of ASB were positive urinalysis and AMS. Once started by EM, patients often received a full course for UTI. Given the burden of ASB testing and treatment, expanding stewardship into the ED is critical and should start with addressing interpretation of urinalyses in patients without specific urinary symptoms. Disclosures All authors: No reported disclosures.

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The moderating effect of sociodemographic factors on the predictive power of self-rated health for mortality in Canada

Canadian Studies in Population ◽

10.25336/p64c7p ◽

2017 ◽

Vol 44 (1-2) ◽

pp. 77

Author(s):

James Falconer ◽

Amélie Quesnel-Vallée

Keyword(s):

Sex Education ◽

Predictive Power ◽

Estimating Equation ◽

Sociodemographic Factors ◽

Moderating Effect ◽

Social Characteristics ◽

Generalized Estimating Equation ◽

Self Rated Health ◽

Using Data ◽

Effect Of Age

Self-rated health is a reliable predictor for mortality, but its predictive power varies depending on social characteristics. This study tests the moderating effect of age, sex, education, and income on the power of self-rated health to predict mortality in Canada using data from the National Population Health Survey. Predictive power trajectories are modelled using time-series generalized estimating equation logistic regression. Findings show that self-rated health is a predictor for mortality up to 14 years prior to death in Canada, and is weakly moderated by income and education, and age/sex interactions. Self-rated health remains reliable across population sub-groups in Canada.La santé auto-évaluée est un prédicteur fiable de la mortalité, mais son pouvoir prédictif varie en fonction des caractéristiques sociales. Cette étude examine l'effet modérateur de l'âge, du sexe, de l'éducation, et du revenu sur le pouvoir de la santé auto-évaluée pour prédire la mortalité au Canada utilisant des données de l'Enquête nationale sur la santé de la population. Les trajectoires de puissance prédictive sont modélisées avec une régression logistique de l'équation d'estimation généralisée. Les résultats montrent que la santé auto-évaluée est un prédicteur de la mortalité jusqu'à 14 ans avant le décès au Canada, et est faiblement modérée par le revenu, l'éducation, et les interactions entre l'âge et le sexe. La santé auto-évaluée demeure valide parmi les sous-groupes de la population du Canada.

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Tying Knots With Communities

Nonprofit and Voluntary Sector Quarterly ◽

10.1177/0899764016634892 ◽

2016 ◽

Vol 45 (6) ◽

pp. 1113-1129 ◽

Cited By ~ 4

Author(s):

Young-Il Kim ◽

Sung Joon Jang ◽

Byron R. Johnson

Keyword(s):

Civic Engagement ◽

Youth Development ◽

Community Involvement ◽

Structural Equation ◽

Equation Modeling ◽

Adult Males ◽

American Adult ◽

Nationally Representative ◽

Using Data ◽

The Relationship

Using data from a nationally representative sample of American adult males ( N = 2,512), this study examines (a) whether duration of membership in the Boy Scouts of America is associated with adult civic engagement and (b) whether five characteristics of positive youth development (confidence, competence, connection, character, and caring) account for the relationship between duration of Scouting membership and adult civic engagement. The results from structural equation modeling indicate that duration of participation in Scouting is positively associated with four indicators of civic engagement: community involvement, community volunteering, community activism, and environmental activism. Among the five positive characteristics, confidence and competence were found to fully mediate the effects of Scouting on all four types of civic engagement, whereas the other three only to partly mediate the effects.

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