2022

Benefits and harms of oral anticoagulants for atrial fibrillation in nursing home residents with advanced dementia

Journal of the American Geriatrics Society

Gregory M. Ouellet, John R. O'Leary, Christopher G. Leggett, Jonathan Skinner, Mary E. Tinetti, Andrew B. Cohen

Although the potential benefits of anticoagulation for AF diminish as individuals with dementia develop more profound cognitive and functional loss, guidelines currently provide little guidance about when to consider discontinuation. This study provides valuable information to clinicians and surrogate decision-makers as they discuss whether to continue anticoagulation in patients with advanced dementia, who have high dementia-related mortality and for whom the primary goal is most frequently comfort.

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The association between beta-blockers and outcomes in patients with heart failure and concurrent Alzheimer's disease and related dementias

Journal of the American Geriatrics

Lauren Gilstrap, Andrew Cohen, Gregory M. Ouellet, Parag Goyal, Barbara Gladders, Danette Flint, Jonathan Skinner

Background Contemporary patients with heart failure with reduced ejection fraction
(HFrEF) are older and have a higher prevalence of cognitive impairment than those
studied in trials. The risk/benefit trade-off of routine beta-blocker (BB) use in patients …

Geographical Variation in Health Spending Across the US Among Privately Insured Individuals and Enrollees in Medicaid and Medicare

JAMA Network

Zack Cooper, Olivia Stiegman, Chima D. Ndumele, Becky Staiger, Jonathan Skinner

Little is known about small-area variations in health care spending and utilization across the 3 major funders of health care in the US: Medicare, Medicaid, and private insurers.

To measure regional health spending and utilization across Medicare, Medicaid, and the privately insured; to observe whether there are regions that are simultaneously low spending for all 3 payers; and to determine what factors are correlated with regional spending and utilization by payer.

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Improving Efficiency in Medical Diagnosis

JAMA

Leila Agha, Jonathan Skinner, David Chan

The US health care system experiences wide variation in diagnosis rates forcommonconditions,muchof which is drivenby differences indiagnostic practice rather than byunderlyingpatient health.1 Diagnosis-related errors are common, and a report from 2014 estimated that 12 million patientsmayexperienceanoutpatient diagnostic error each year.2 To improve health outcomes and reduce unnecessaryspending,theUShealthsystemshouldmove toward greater efficiency in medical diagnosis.

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Geographic Variation in Apical Support Procedures for Pelvic Organ Prolapse

Obstet Gynecol

Kristen A. Gerjevic, Helen Newton, Christopher Leggett, Jonathan Skinner, Elisabeth Erekson, Kris Strohbehn

To measure geographic variation in rates of apical support procedures for the treatment of pelvic organ prolapse (POP) among female Medicare beneficiaries.

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Advance Care Planning and Treatment Intensity Before Death Among Black, Hispanic, and White Patients Hospitalized with COVID-19

Journal General Internal Medicine

Amber E. Barnato, Gregory R. Johnson, John D. Birkmeyer, Jonathan S. Skinner, Alistair James O’Malley, Nancy J. O. Birkmeyer

Black and Hispanic people aremore likely to contract COVID-19, require hospitalization, and die thanWhite people due to differences in exposures, comorbidity risk, and healthcare access.

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Trends in Mortality Rates Among Medicare Enrollees With Alzheimer Disease and Related Dementias Before and During the Early Phase of the COVID-19 Pandemic

JAMA Neurology

Lauren Gilstrap, Weiping Zhou, Marcella Alsan, Anoop Nanda, Jonathan S. Skinner

Mortality rates from March through December 2020 were compared with those from March through December 2019. Excess mortality was calculated by comparing mortality rates in 2020 with rates in 2019 for specific, predetermined groups. Means were compared using t tests, and 95% CIs were estimated using the delta method.

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Complications and Mortality Following CRT-D Versus ICD Implants in Older Medicare Beneficiaries With Heart Failure

J A C C : Heart Failure

Emily P. Zeitler, Andrea M. Austin, Christopher G. Leggett, Lauren Gilstrap, Daniel J. Friedman, Jonathan S. Skinner, Sana M. Al-Khatib

Heart failure (HF) remains a fast-growing cardiovascular disease affecting the Medicare population in large numbers (1,2). Increasingly, HF is managed as a chronic disease, in part because of the incremental improvements achieved with medical and device-based therapies. Despite the large proportion of older patients with HF, clinical trials designed to assess HF interventions rarely include an adequate number of older patients...

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Treatment Intensity and Mortality Among COVID-19 Patients With Dementia: A Retrospective Observational Study

Journal of the American Geriatrics Society

Amber E. Barnato, John D. Birkmeyer, Jonathan S. Skinner, A. James O’Malley, Nancy J.O. Birkmeyer

Older adults are at elevated risk for severe illness and death from COVID-19. Those living in nursing homes, including patients with dementia, have been severely affected.1 National vital statistics data is likely an underestimate of the mortality impacts of COVID-19 in dementia populations, for whom non-COVID-19 attributed excess mortality increased significantly during the 2020 Spring and Summer surges.2 Many nursing home residents received end-of-life palliation in place, electing to avoid hospital transfer,3 consistent with preferences to avoid lifesustaining treatments.4–8 However, among patients with dementia who were hospitalized, many of whom may have been community dwelling, little is known about their treatment intensity and outcomes.

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