The effects of expanding public insurance to rural low-income childless adults
The effects of expanding public insurance to rural low-income childless adults
In this study, Marguerite Burns et al. used insurance claims and Medicaid enrollment files to measure the change in health care use by rural, low-income childless adults after enrollment into a new public insurance program. The investigators found that public insurance enrollment led to substantial increases in outpatient visits, including preventive visits, but not mental health visits. It also led to increases in inpatient stays but it was inconclusive whether it led to increased ED visits.
Patient demographic and tumor characteristics influencing oncologist follow-up frequency in older breast cancer survivors
Patient demographic and tumor characteristics influencing oncologist follow-up frequency in older breast cancer survivors
Dr. Heather Neuman et al. studied current patterns of oncologist breast cancer follow-up to determine the association between patient and tumor characteristics and follow-up frequency. Using SEER-Medicare data, the authors found young age, positive nodes, estrogen/progesterone receptor positivity, and increasing treatment intensity were most strongly associated with more frequent follow-up. Number and types of oncologists also were associated with different follow-up frequencies.
Division of primary care services between physicians, PAs, and NPs for older patients with diabetes
Division of primary care services between physicians, PAs, and NPs for older patients with diabetes
Using Medicare claims and EHR data from a large physician group, Christine Everett et al. looked at how to incorporate physician assistants and nurse pracitioners (PA/NPs) into primary care teams. This article describes the division of patients and services between PCPs for older diabetes patients on panels with varying levels of PA/NP involvement. Panels with PA/NP providers had higher proportions of patients with Medicaid, disability, and depression.
Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities
Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities
Annual lipid testing is recommended to reduce morbidity and mortality for patients with rheumatoid arthritis and comorbid cardiovascular disease, diabetes, or hyperlipidemia. Dr. Christie Bartels et al. used Chronic Conditions Warehouse data to examine the extent to which lipid testing was performed among patients over 65 years old with rheumatoid arthritis and found that although 90% of the patients had cardiovascular disease, 64% had hyperlipidemia, and 46% had diabetes, annual lipid testing was only performed in 63% of the patients. Additionally, 30% of patients saw a primary care provider less than once per year, and those patients were 16% less likely to have lipid testing. Patients who were older, had higher complexity scores, more hospitalizations, and lived in a large town were also less likely to receive lipid testing.
5 year colorectal cancer outcomes in a large negative CT colonography screening cohort
5 year colorectal cancer outcomes in a large negative CT colonography screening cohort
In this study co-authored by Dr. Jennifer Weiss, the authors examined the 5-year incidence of clinically presenting colorectal cancers following a negative CT colonography (CTC) screening. The study found that clinically presenting cancers are rare in the 5 years following a negative CTC screening, a 6mm polyp size threshold is safe, and a 5-year CTC screening interval is appropriate. The results indicate that the current strategies for CTC screening for colorectal cancer are appropriate.
Monitoring diabetes in patients with and without rheumatoid arthritis
Monitoring diabetes in patients with and without rheumatoid arthritis
Diabetes mellitus is an important predictor of mortality in patients with rheumatoid arthritis (RA), and both diseases increase the risk of cardiovascular disease. In this study, Dr. Christie Bartels et al. identified patients 65 years or older who had diabetes and examined whether they had comorbid RA and whether they received guideline recommended A1c and lipid testing. They found that among the patients with diabetes, 2% had RA, and those with comorbid RA were more likely to have baseline cardiovascular disease, diabetes-related complications, lower extremity ulcers, and peripheral vascular disease. The patients with RA were less likely to receive recommended A1c testing, but were slightly more likely to receive lipid testing.
Mortality by stage for right vs. left-sided colon cancer
Mortality by stage for right vs. left-sided colon cancer
In this article by Dr. Jennifer Weiss et al., the authors used SEER-Medicare data to predict all-cause 5-year mortality by colon cancer stage and location. There was no significant difference in 5-year mortality between right- and left-sided cancers for all stages combined or for stage I cancers. Right-sided cancers had a lower 5-year mortality in stage II and higher mortality in stage III.
Low frequency of primary lipid screening among Medicare patients with rheumatoid arthritis
Low frequency of primary lipid screening among Medicare patients with rheumatoid arthritis
Dr. Christie Bartels et al. examined the performance of primary lipid screening in rheumatoid arthritis patients. The retrospective cohort study examined a 5% Medicare sample and found that primary lipid screening was performed in fewer than half of eligible RA patients highlighting a key target for cardiovascular disease risk reduction efforts. Half of RA patients saw their rheumatologist as often or more often than they saw a primary care provider, illustrating the need for optimal partnerships betweeen PCPs and rheumatologists for screening patients for CVD risks.
For-profit hospital status and rehospitalizations at different hospitals: an analysis of Medicare data
For-profit hospital status and rehospitalizations at different hospitals: an analysis of Medicare data
Dr. Amy Kind and co-authors examined predictors of and payments for rehospitalization at a different hospital among a 5% random national sample of Medicare patients with rehospitalizations within 30 days of discharge. They found rehospitalizations at different hospitals are common for Medicare patients. Rehospitalizations are more likely among those initially hospitalized at a for-profit hospital, and are related to increased overall payments without improved mortality.
Insurance disruption due to spousal Medicare transitions
Insurance disruption due to spousal Medicare transitions
In this study, researchers looked at the care of married women under age 65 from the Wisconsin Longitudinal Study. The authors found that despite consistent insurance coverage, the insurance disruption that accompanies a spouse's Medicare transition has adverse access and health care utilization consequences for women, including a greater probability of experiencing a change in usual clinic/provider, delaying filling medications or taking fewer medications than prescribed because of cost, going to the emergency room, and having lower average mental health scores than women who did not experience an insurance disruption.