BackgroundAddressing COVID-19 is a pressing health and social concern. To date, many epidemic projections and policies addressing COVID-19 have been designed without seroprevalence data to inform epidemic parameters. We measured the... more
BackgroundAddressing COVID-19 is a pressing health and social concern. To date, many epidemic projections and policies addressing COVID-19 have been designed without seroprevalence data to inform epidemic parameters. We measured the seroprevalence of antibodies to SARS-CoV-2 in a community sample drawn from Santa Clara County.MethodsOn April 3-4, 2020, we tested county residents for antibodies to SARS-CoV-2 using a lateral flow immunoassay. Participants were recruited using Facebook ads targeting a sample of individuals living within the county by demographic and geographic characteristics. We estimate weights to adjust our sample to match the zip code, sex, and race/ethnicity distribution within the county. We report both the weighted and unweighted prevalence of antibodies to SARS-CoV-2. We also adjust for test performance characteristics by combining data from 16 independent samples obtained from manufacturer’s data, regulatory submissions, and independent evaluations: 13 samples...
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While SARS-CoV-2 serologic testing is used to measure cumulative incidence of COVID-19, appropriate signal-to-cut off (S/Co) thresholds remain unclear. We demonstrate S/Co thresholds based on known negative samples significantly increases... more
While SARS-CoV-2 serologic testing is used to measure cumulative incidence of COVID-19, appropriate signal-to-cut off (S/Co) thresholds remain unclear. We demonstrate S/Co thresholds based on known negative samples significantly increases seropositivity and more accurately estimates cumulative incidence of disease compared to manufacturer-based thresholds.
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6502Background: Rising cancer costs demand models that safely lower expenditures and improve patients’ experiences and outcomes. In response, we developed a risk-stratified proactive symptom assess...
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203 Background: Cancer-related deaths are often preceded by high utilization of non-beneficial care that may contribute to poor quality of life, adverse symptoms, and high costs. Over the past several years, there is increased attention... more
203 Background: Cancer-related deaths are often preceded by high utilization of non-beneficial care that may contribute to poor quality of life, adverse symptoms, and high costs. Over the past several years, there is increased attention on palliative care to limit these challenges. Yet, rates of palliative care referral at the end of life remain low, and there are few studies that evaluate why. Our objective is to study whether one potentially important factor among patients with advanced cancer, advance directives, influence referral to palliative care among patients with advanced cancer. Methods: We conducted a retrospective chart review of all patients diagnosed with Stage III and IV cancers and treated at the Veterans Administration Palo Alto Healthcare System (VAPAHCS) in Fiscal Year 2012-2013. Chi-squared tests estimated differences in receipt of palliative care by individual- and clinical-factors. Logistic regression models estimated odds of receipt of palliative care after a...
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Russia experienced an extreme spike in death rates in the immediate aftermath of the break-up of the Soviet Union. Jay Bhattacharya, Christina Gathmann and Grant Miller write that while this has typically been explained using political... more
Russia experienced an extreme spike in death rates in the immediate aftermath of the break-up of the Soviet Union. Jay Bhattacharya, Christina Gathmann and Grant Miller write that while this has typically been explained using political and economic arguments, the real cause of Russia’s mortality crisis may have been the end of Mikhail Gorbachev’s anti-alcohol campaign. Using a series of statistical tests they illustrate that Russian death rates fell significantly during the campaign, with the hardest drinking regions experiencing a larger spike in death rates after the fall of the Soviet Union.
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The authors thank Adrienne Jones of the National Center for Health Statistics for assistance in accessing restricted-use NHIS data for the analysis. This project was supported with a grant from the University of Kentucky Center for... more
The authors thank Adrienne Jones of the National Center for Health Statistics for assistance in accessing restricted-use NHIS data for the analysis. This project was supported with a grant from the University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Economic Research Service and the Food and Nutrition Service, Agreement Number 58-5000-3-0066. The opinions and conclusions expressed herein are solely those of the authors and should not be construed as representing the opinions or policies of the sponsoring agencies.
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Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for... more
Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Cohort study of patients starting dialysis in the United States in the 3 years before and the 3 years after payment reform. We conducted difference-in-difference analyses comparing patients with traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Patients with traditional Medicare coverage experienced a 0.7% (95% CI, 0.2%-1.1%; P = .003) reduction in the absolute probability of home dialysis use following ...
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ABSTRACT
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Research Interests: Engineering, Genetics, Chemistry, Biology, Carotenoids, and 15 moreMedicine, Logistic Regression, Association study, Humans, Effect size, Chronic Disease, Disease Control, Body Mass Index, Cross Section, Health surveys, Logistic Regression Model, Environment, Fasting blood sugar, Cohort Studies, and Environmental factor
Research Interests: Obesity, Adolescent, Medicine, Applied Economics, Humans, and 12 moreSocial Science Research Network, Developing Country, United States, National Disability Insurance Scheme, Health Status, Aged, Middle Aged, Adult, Public health systems and services research, Health affairs, Disabled Persons, and National Health Interview Survey
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We have benefited from discussions with Steve Garber, Michael Grossman, Jim Hosek, David Loughran, John Romley, Neeraj Sood, Eric Talley, and participants at the Spring 2003 NBER Health Economics ProgramMeeting. Lakdawalla is grateful for... more
We have benefited from discussions with Steve Garber, Michael Grossman, Jim Hosek, David Loughran, John Romley, Neeraj Sood, Eric Talley, and participants at the Spring 2003 NBER Health Economics ProgramMeeting. Lakdawalla is grateful for the financial support of ...
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There is substantial variation in the generosity of public assistance programs that affect HIV+ patients, and these differences should affect the economic outcomes associated with HIV infection. This article uses data from a nationally... more
There is substantial variation in the generosity of public assistance programs that affect HIV+ patients, and these differences should affect the economic outcomes associated with HIV infection. This article uses data from a nationally representative sample of HIV+ patients to assess how differences across states in Medicaid and AIDS Drug Assistance Programs (ADAP) affect costs and labor market outcomes for HIV+ patients in care in that state. Making ADAP programs more generous in terms of drug coverage would reduce per patient total monthly costs, mainly through a reduction in hospitalization costs. In contrast, expanding ADAP eligibility by increasing the income threshold would increase the total cost of care. Expanding eligibility for Medicaid through the medically needy program would increase per patient total costs, but full-time employment would increase and so would monthly earnings. The authors conclude that more generous state policies toward HIV+ patients--especially those designed to provide access to efficacious treatment--could improve the economic outcomes associated with HIV.
Research Interests: Public Health, Health Policy, Humans, Business and Management, United States, and 15 moreFemale, Male, Care, Medical Care, Medicaid, Aged, Middle Aged, Adult, Medical Assistance, Public health systems and services research, Drug Costs, Combination drug therapy, Health Care Costs, Database, and HIV infections
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Use of direct-acting oral anticoagulants (DOACs) is increasing, but little is known about the associated risks in patients undergoing colonoscopy with polypectomy. We aimed to determine the risk of post-polypectomy complications in... more
Use of direct-acting oral anticoagulants (DOACs) is increasing, but little is known about the associated risks in patients undergoing colonoscopy with polypectomy. We aimed to determine the risk of post-polypectomy complications in patients prescribed DOACs. We performed a retrospective analysis using the Clinformatics Data Mart Database (a de-identified administrative database from a large national insurance provider) to identify adults who underwent colonoscopy with polypectomy or endoscopic mucosal resection (EMR) from January 1, 2011, through December 31, 2015. We collected data from 11,504 patients prescribed antithrombotic agents (1590 DOAC, 3471 warfarin, and 6443 clopidogrel) and 599,983 patients not prescribed antithrombotics of interest (controls). We compared 30-day post-polypectomy complications, including gastrointestinal bleeding (GIB), cerebrovascular accident (CVA), myocardial infarction (MI), and hospital admissions, of patients prescribed DOACs, warfarin, or clopidogrel vs controls. Post-polypectomy complications were uncommon but occurred in a significantly higher proportion of patients receiving any antithrombotic vs controls (P<0.001). The percentage of patients in the DOAC group with GIB was 0.63% (95% CI, 0.3%-1.2%) vs 0.2% (95% CI, 0.2%-0.3%) in controls. The percentage of patients with CVA in the DOAC group was 0.06% (95% CI, 0.01%-0.35%) vs 0.04% (95% CI, 0.04%-0.05%) in controls. After we adjusted for bridge anticoagulation, EMR, Charlson comorbidity index (CCI), and CHADS (congestive heart failure, hypertension, age over 75, diabetes, stroke [double weight]) score, patients prescribed DOACs no longer had a statistically significant increase in the odds of GIB (odds ratio [OR], 0.90; 95% CI, 0.44-1.85), CVA (OR, 0.45; 95% CI, 0.06-3.28), MI (OR, 1.07; 95% CI, 0.14-7.72), or hospital admission (OR, 0.86; 95% CI, 0.64-1.16). Clopidogrel, warfarin, bridge anticoagulation, higher CHADS, CCI, and EMR were associated with increased odds of complications. In our retrospective analysis of a large national dataset, we found that patients prescribed DOACs did not have significantly increased adjusted odds of post-polypectomy GIB, MI, CVA, or hospital admission. Bridge anticoagulation, higher CHADS score, CCI, and EMR were risk factors for GIB, MI, CVA, and hospital admissions. Studies are needed to determine the optimal peri-procedural dose for high-risk patients.
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INTRODUCTION: Despite advancements in cancer care, persistent gaps remain in the delivery of high-value end-of-life cancer care. The aim of this study was to examine views of health care payer organization stakeholders on approaches to... more
INTRODUCTION: Despite advancements in cancer care, persistent gaps remain in the delivery of high-value end-of-life cancer care. The aim of this study was to examine views of health care payer organization stakeholders on approaches to the redesign of end-of-life cancer care delivery strategies to improve care. METHODS: We conducted semistructured interviews with 34 key stakeholders (eg, chief medical officers, medical directors) in 12 health plans and 22 medical group organizations across the United States. We recorded, transcribed, and analyzed interviews using the constant comparative method of qualitative analysis. RESULTS: Participants endorsed strategies to redesign end-of-life cancer care delivery to improve end-of-life care. Participants supported the use of nonprofessionals to deliver some cancer services through alternative formats (eg, telephone, Internet) and delivery of services in nonclinical settings. Participants reported that using nonprofessional providers to offer...
Although lay health workers (LHWs) improve cancer screening and treatment adherence, evidence on whether they can enhance other aspects of care is limited. To determine whether an LHW program can increase documentation of patients'... more
Although lay health workers (LHWs) improve cancer screening and treatment adherence, evidence on whether they can enhance other aspects of care is limited. To determine whether an LHW program can increase documentation of patients' care preferences after cancer diagnosis. Randomized clinical trial conducted from August 13, 2013, through February 2, 2015, among 213 patients with stage 3 or 4 or recurrent cancer at the Veterans Affairs Palo Alto Health Care System. Data analysis was by intention to treat and performed from January 15 to August 18, 2017. Six-month program with an LHW trained to assist patients with establishing end-of-life care preferences vs usual care. The primary outcome was documentation of goals of care. Secondary outcomes were patient satisfaction on the Consumer Assessment of Health Care Providers and Systems "satisfaction with provider" item (on a scale of 0 [worst] to 10 [best possible]), health care use, and costs. Among the 213 participants ran...
Retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment six months prior to and 12 months following the initial visit. To determine whether provider specialty influences patterns of opiate... more
Retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment six months prior to and 12 months following the initial visit. To determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis. Patients with low back pain present to a variety of providers and receive a spectrum of treatments, including opiate medications. The impact of initial provider type on opiate use in this population is uncertain. We performed a retrospective analysis of opiate-naïve adult patients in the United States with newly diagnosed low back or lower extremity pain. We estimated the risk of early opiate prescription (≤ 14 days from diagnosis) and long-term opiate use (≥ six prescriptions in 12 months) based on the provider type at initial diagnosis using multivariable logistic regression, adjusting for patient demographics and comorbidities. We identified 478,981 newly diagnosed opiate-naïve patients. Of these, 40.4% recei...
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To examine whether market competition is associated with improved health outcomes in hemodialysis. Secondary analysis of data from a national dialysis registry between 2001 and 2011. We conducted one- and two-part linear regression... more
To examine whether market competition is associated with improved health outcomes in hemodialysis. Secondary analysis of data from a national dialysis registry between 2001 and 2011. We conducted one- and two-part linear regression models, using each hospital service area (HSA) as its own control, to examine the independent associations among market concentration and health outcomes. We selected cohorts of patients receiving in-center hemodialysis in the United States at the start of each calendar year. We used information about dialysis facility ownership and the location where patients received dialysis to measure an index of market concentration-the Hirschman-Herfindahl Index (HHI)-for HSA and year, which ranges from near zero (perfect competition) to one (monopoly). An average reduction in HHI by 0.2 (one standard deviation in 2011) was associated with 2.9 fewer hospitalizations per 100 patient-years (95 percent CI, 0.4 to 5.4). If these findings were generalized to the entire i...
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Better identification of at-risk groups could benefit HIV-1 care programmes. We systematically identified HIV-1 risk factors in two nationally representative cohorts of women in the Demographic and Health Surveys. We identified and... more
Better identification of at-risk groups could benefit HIV-1 care programmes. We systematically identified HIV-1 risk factors in two nationally representative cohorts of women in the Demographic and Health Surveys. We identified and replicated the association of 1415 social, economic, environmental, and behavioral factors with HIV-1 status. We used the 2007 and 2013-2014 surveys conducted among 5715 and 15 433 Zambian women, respectively (688 shared factors). We used false discovery rate criteria to identify factors that are strongly associated with HIV-1 in univariate and multivariate models of the entire population, as well as in subgroups stratified by wealth, residence, age, and past HIV-1 testing. In the univariate analysis, we identified 102 and 182 variables that are associated with HIV-1 in the two surveys, respectively (79 factors were associated in both). Factors that were associated with HIV-1 status in full-sample analyses and in subgroups include being formerly married (...
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Visual dysfunction and poor cognition are highly prevalent among older adults; however, the relationship is not well defined. To evaluate the association of measured and self-reported visual impairment (VI) with cognition in older US... more
Visual dysfunction and poor cognition are highly prevalent among older adults; however, the relationship is not well defined. To evaluate the association of measured and self-reported visual impairment (VI) with cognition in older US adults. Cross-sectional analysis of 2 national data sets: the National Health and Nutrition Examination Survey (NHANES), 1999-2002, and the National Health and Aging Trends Study (NHATS), 2011-2015. The NHANES was composed of a civilian, noninstitutionalized community, and the NHATS comprised Medicare beneficiaries in the contiguous United States. Vision was measured at distance, near, and by self-report in the NHANES and by self-report alone in the NHATS. Sample weights were used to ensure result generalizability. The NHANES measured Digit Symbol Substitution Test (DSST) score and relative DSST impairment (DSST score ≤28, lowest quartile in study cohort), and the NHATS measured probable or possible dementia, classified per NHATS protocol. The NHANES comprised 2975 respondents aged 60 years and older who completed the DSST measuring cognitive performance. Mean (SD) age was 72 (8) years, 52% of participants were women (n = 1527), and 61% were non-Hispanic white (n = 1818). The NHATS included 30 202 respondents aged 65 years and older with dementia status assessment. The largest proportion (40%; n = 12 212) were between 75 and 84 years of age. Fifty-eight percent were women (n = 17 659), and 69% were non-Hispanic white (n = 20 842). In the NHANES, distance VI (β = -5.1; 95% CI, -8.6 to -1.6; odds ratio [OR], 2.8; 95% CI, 1.1-6.7) and subjective VI (β = -5.3; 95% CI, -8.0 to -2.6; OR, 2.7; 95% CI, 1.6-4.8) were both associated with lower DSST scores and higher odds of DSST impairment after full adjustment with covariates. Near VI was associated with lower DSST scores but not higher odds of DSST impairment. The NHATS data corroborated these results, with all vision variables associated with higher odds of dementia after full adjustment (distance VI: OR, 1.9; 95% CI, 1.6-2.2; near VI: OR, 2.6; 95% CI, 2.2-3.1; either distance or near VI: OR, 2.1; 95% CI, 1.8-2.4). In a nationally representative sample of older US adults, vision dysfunction at distance and based on self-reports was associated with poor cognitive function. This was substantiated by a representative sample of US Medicare beneficiaries using self-reported visual function, reinforcing the value of identifying patients with visual compromise. Further study of longitudinal interactions between vision and cognition is warranted.
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In response to rising Medicare costs, Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act in 2015. The law fundamentally changes the way that health care providers are reimbursed by... more
In response to rising Medicare costs, Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act in 2015. The law fundamentally changes the way that health care providers are reimbursed by implementing a pay for performance system that rewards providers for high-value health care. As of the beginning of 2017, providers will be evaluated on quality and in later years, cost as well. High-quality, cost-efficient providers will receive bonuses in reimbursement, and low-quality, expensive providers will be penalized financially. The Centers for Medicare and Medicaid Services will evaluate provider costs through episodes of care, which are currently in development, and alternative payment models. Although dialysis-specific alternative payment models have already been implemented, current models do not address the transition of patients from CKD to ESRD, a particularly vulnerable time for patients. Nephrology providers have an opportunity to develop cost-efficient ways to care for patients during these transitions. Efforts like these, if successful, will help ensure that Medicare remains solvent in coming years.
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Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation... more
Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of social contacts and network) and loneliness (positive response to three-item loneliness scale) as predictors of subsequent Medicare spending. In multivariable regression adjusting for health and demographics, we determined marginal differences in Medicare expenditures. Secondary outcomes included spending by setting, and mortality. Results: Objective isolation predicts greater spending, US$1,644 ( p < .001) per beneficiary annually, whereas loneliness predicts reduced spending, −US$768 ( p < .001). Increased spending concentrated in inpatient and nursing home (skilled nursing facilities [SNFs]) care; despite more health care, objectively isolated beneficiaries had 31% ( p < .001) greater risk of death. Loneliness did no...
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In 2004, the Centers for Medicare &amp; Medicaid Services changed reimbursement for physicians and advanced practitioners caring for patients receiving hemodialysis from a capitated to a tiered fee-for-service system, encouraging... more
In 2004, the Centers for Medicare &amp; Medicaid Services changed reimbursement for physicians and advanced practitioners caring for patients receiving hemodialysis from a capitated to a tiered fee-for-service system, encouraging increased face-to-face visits. This early version of a pay-for-performance initiative targeted a care process: more frequent provider visits in hemodialysis. Although more frequent provider visits in hemodialysis are associated with fewer hospitalizations and rehospitalizations, it is unknown whether encouraging more frequent visits through reimbursement policy also yielded these benefits. We used a retrospective cohort interrupted time-series study design to examine whether the 2004 nephrologist reimbursement reform led to reduced hospitalizations and rehospitalizations. We also used published data to estimate a range of annual economic costs associated with more frequent visits. Medicare beneficiaries in the United States receiving hemodialysis in the 2 years prior to and following reimbursement reform. The 2 years following nephrologist reimbursement reform. Odds of hospitalization and 30-day hospital readmission for all causes and fluid overload; US dollars. We found no significant change in all-cause hospitalization or rehospitalization and slight reductions in fluid overload hospitalization and rehospitalization following reimbursement reform; the estimated economic cost associated with additional visits ranged from $13 to $87 million per year, depending on who (physicians or advanced practitioners) spent additional time visiting patients and how much additional effort was involved. Due to limited information about how much additional time providers spent seeing patients after reimbursement reform, we could only examine a range of potential economic costs associated with the reform. A Medicare reimbursement policy designed to encourage more frequent visits during outpatient hemodialysis may have been costly. The policy was associated with fewer hospitalizations and rehospitalizations for fluid overload, but had no effect on all-cause hospitalizations or rehospitalizations.
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Noninvasive testing and coronary angiography are used to evaluate patients who present to the emergency department (ED) with chest pain, but their effects on outcomes are uncertain. To determine whether cardiovascular testing-noninvasive... more
Noninvasive testing and coronary angiography are used to evaluate patients who present to the emergency department (ED) with chest pain, but their effects on outcomes are uncertain. To determine whether cardiovascular testing-noninvasive imaging or coronary angiography-is associated with changes in the rates of coronary revascularization or acute myocardial infarction (AMI) admission in patients who present to the ED with chest pain without initial findings of ischemia. This retrospective cohort analysis used weekday (Monday-Thursday) vs weekend (Friday-Sunday) presentation as an instrument to adjust for unobserved case-mix variation (selection bias) between 2011 and 2012. National claims data (Truven MarketScan) was used. The data included a total of 926 633 privately insured patients ages 18 to 64 years who presented to the ED with chest pain without initial diagnosis consistent with acute ischemia. Noninvasive testing or coronary angiography within 2 days or 30 days of presentati...
Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. To evaluate changes in breast cancer stage at diagnosis after enactment of breast... more
Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. Using a difference-in-differences analysis, we examined changes in stage at diagnosis among women with breast cancer in Connecticut, the first state to enact legislation, compared to changes among women in control states. We used data from the Surveillance, Epidemiology, and End Results Program (SEER) registry, 2005-2013. Women ages 40-74 with breast cancer. Breast density notification legislation, enacted in Connecticut in October of 2009. Breast cancer stage at diagnosis. Our study included 466,930 women, 25,592 of whom lived in Connecticut. Legislation was associated with a 1.38-percentage-point (95 % CI 0.12 to 2.63) increase in the proportion of women in Connecticut versus control states who had localized invasive...
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OBJECTIVE Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious... more
OBJECTIVE Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS policy's effect on rates of targeted orthopedic SSIs among the Medicare population. DESIGN We examined SSI rates following orthopedic procedures among the Medicare population before and after policy implementation compared to a similarly aged control group. Using the Nationwide Inpatient Sample database for 2000-2013, we estimated rate ratios (RRs) of orthopedic SSIs among Medicare and non-Medicare patients using a difference-in-differences approach. RESULTS Following policy implementation, SSIs significantly decreased among both the Medicare and non-Medicare populations (RR, 0.7; 95% confidence interval [CI], 0.6-0.8) and RR, 0.8l; 95% CI...
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Evaluate self-reported adherence to diabetic retinopathy screening exams among diabetics DESIGN: Retrospective, population-based cross-sectional study. Medical Expenditures Panel Survey (MEPS) consolidated full year and prescribed drugs... more
Evaluate self-reported adherence to diabetic retinopathy screening exams among diabetics DESIGN: Retrospective, population-based cross-sectional study. Medical Expenditures Panel Survey (MEPS) consolidated full year and prescribed drugs data from 2002-2013 were reviewed; multivariable logistic regression was used to identify patient characteristics as potential barriers to receiving exams. Of 13,299 persons in the MEPS sample, only 39.62% (CI 38.56-40.67%) reported receiving annual dilated eye exams, and 90.31% (CI 89.70-90.91%) reported ever having received an eye exam. Significant factors related to ever receiving an eye exam included completed high school (OR=1.53; CI, 1.33-1.75), bachelor's degree or higher (OR=1.94; CI, 1.56-2.41), private health insurance (OR=2.07; CI, 1.70-2.52), public insurance (OR=1.90; CI, 1.56-2.31), household income >400% of the poverty threshold (OR=1.75; CI, 1.36-2.25), prescribed diabetes medication (OR=1.45; CI, 1.27-1.65), diabetic kidney di...
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The ESRD Prospective Payment System introduced two incentives to increase home dialysis use: bundling injectable medications into a single payment for treatment and paying for home dialysis training. We evaluated the effects of the ESRD... more
The ESRD Prospective Payment System introduced two incentives to increase home dialysis use: bundling injectable medications into a single payment for treatment and paying for home dialysis training. We evaluated the effects of the ESRD Prospective Payment System on home dialysis use by patients starting dialysis in the United States from January 1, 2006 to August 31, 2013. We analyzed data on dialysis modality, insurance type, and comorbidities from the United States Renal Data System. We estimated the effect of the policy on home dialysis use with multivariable logistic regression and compared the effect on Medicare Parts A/B beneficiaries with the effect on patients with other types of insurance. The ESRD Prospective Payment System associated with a 5.0% (95% confidence interval [95% CI], 4.0% to 6.0%) increase in home dialysis use by the end of the study period. Home dialysis use increased by 5.8% (95% CI, 4.3% to 6.9%) among Medicare beneficiaries and 4.1% (95% CI, 2.3% to 5.4%...
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Prior sepsis studies evaluating antibiotic timing have shown mixed results. To evaluate the association between antibiotic timing and mortality among sepsis patients receiving antibiotics within 6 hours of emergency department... more
Prior sepsis studies evaluating antibiotic timing have shown mixed results. To evaluate the association between antibiotic timing and mortality among sepsis patients receiving antibiotics within 6 hours of emergency department registration. Retrospective study of 35,000 randomly selected sepsis inpatients treated at 21 emergency departments between 2010 and 2013 in Northern California. The primary exposure was antibiotics given within six hours of emergency department registration. The primary outcome was adjusted in-hospital mortality. We used detailed physiologic data to quantify severity of illness within 1 hour of registration and logistic regression to estimate the odds of hospital mortality based on antibiotic timing and patient factors. The median time to antibiotic administration was 2.1 hours (interquartile range: 1.4-3.1 hours). The adjusted odds ratio for hospital mortality based on each hour of delay in antibiotics after registration was 1.09 (95% CI, 1.05-1.13) for each...