Local Population Characteristics and Hemoglobin A1c Testing Rates among Diabetic Medicare Beneficiaries

PloS One
Yasaitis LC, Bubolz T, Skinner JS, Chandra A

Proposed payment reforms in the US healthcare system would hold providers accountable for the care delivered to an assigned patient population. Annual hemoglobin A1c (HbA1c) tests are recommended for all diabetics, but some patient populations may face barriers to high quality healthcare that are beyond providers’ control. The magnitude of fine-grained variations in care for diabetic Medicare beneficiaries, and their associations with local population characteristics, are unknown.

Prescription Opioid Use Among Disabled Medicare Beneficiaries: Intensity, Trends and Regional Variation

Medical Care
Morden NE, Munson JC, Colla CH, Skinner JS, Bynum JPW, Zhou, W, Meara E

Prescription opioid use and overdose deaths are increasing in the United States. Among disabledMedicare beneficiaries under the age of 65, the rise in musculoskeletal conditions as qualifying diagnoses suggests that opioid analgesic use may be common and increasing, raising safety concerns.

Spirometry, Exacerbations, And Bronchodilator Use Among COPD Patients Initiating Inhaled Corticosteroid Therapy

COPD Exacerbations: Precipitating Factors, Prevention, and Outcomes
Jeffrey C. Munson, Donald A. Mahler, Jeremy Smith, Nancy E. Morden, Jonathan S. Skinner

Inhaled corticosteroids have been shown to reduce exacerbation frequency in select patients with COPD; however, they are also associated with adverse effects and high costs. Careful patient selection is therefore important. This study aimed to evaluate the extent to which clinicians target inhaled steroid therapy to patients most likely to benefit.

Association of Statin Use With the Risk of Subarachnoid Hemorrhage in Medicare Patients With Unruptured Cerebral Aneurysms

Stroke
Kimon Bekelis, Jeremy Smith, Weiping Zhou, David Roberts, Jonathan Skinner, and Nancy Morden

Animal studies have demonstrated that statins decrease cerebral aneurysm progression and the risk of subarachnoid hemorrhage (SAH). A protective effect has also been observed in human studies of abdominal aortic aneurysms. We investigated the association between statin use and SAH in Medicare beneficiaries.

Fragmentation of Care and the Use of Head Computed Tomography in patients with Ischemic Stroke

Circulation: Cardiovascular Quality and Outcomes
Kimon Bekelis, David W. Roberts, Weiping Zhou, and Jonathan S. Skinner

Computed tomographic (CT) scans are central diagnostic tests for ischemic stroke. Their inefficient use is a negative quality measure tracked by the Centers for Medicare and Medicaid Services. We performed a retrospective analysis of Medicare fee-for-service claims data for adults admitted for ischemic stroke from 2008 to 2009, with 1-year follow-up. The outcome measures were risk-adjusted rates of high-intensity CT use (≥4 head CT scans) and risk- and price-adjusted Medicare expenditures in the year after admission. The average number of head CT scans in the year after admission, for the 327 521 study patients, was 1.94, whereas 11.9% had ≥4. Risk-adjusted rates of high-intensity CT use ranged from 4.6% (Napa, CA) to 20.0% (East Long Island, NY). These rates were 2.6% higher for blacks than for whites (95% confidence interval, 2.1%–3.1%), with considerable regional variation. Higher fragmentation of care (number of different doctors seen) was associated with high-intensity CT use. Patients living in the top quintile regions of fragmentation experienced a 5.9% higher rate of high-intensity CT use, with the lowest quintile as reference; the corresponding odds ratio was 1.77 (95% confidence interval, 1.71–1.83). Similarly, 1-year risk- and price-adjusted expenditures exhibited considerable regional variation, ranging from $31 175 (Salem, MA) to $61 895 (McAllen, TX). Regional rates of high-intensity CT scans were positively associated with 1-year expenditures (r=0.56; P<0.01).

A Population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims

British Medical Journal
Wennberg, DE, Sharp SM, Bevaan, G, Skinner JS, Gottlieb D

Per capita medical spending and utilization varies extensively among healthcare regions, as reported in the Dartmouth Atlas of Healthcare, the NHS Atlas of Variation, and the Spanish Atlas of Variability. These variations have raised major concerns about the effectiveness and equitable distribution of healthcare services, and led naturally to an important question: “To what extent can variations be explained by differences in illness of the regions’ populations?”