Abstract

In 2006, the Centers for Medicare & Medicaid Services, which administers the Medicare program in the United States, launched the Chronic Condition Data Warehouse (CCW). The CCW contains all Medicare fee-for-service (FFS) institutional and non-institutional claims, nursing home and home health assessment data, and enrollment/eligibility information from January 1, 1999 forward for a random 5% sample of Medicare beneficiaries (and 100% of the Medicare population from 2000 forward). Twenty-one predefined chronic condition indicator variables are coded within the CCW, to facilitate research on chronic conditions.

The current article describes this new data source, and the authors demonstrate the utility of the CCW in describing the extent of chronic disease among Medicare beneficiaries. Medicare claims were analyzed to determine the prevalence, utilization, and Medicare program costs for some common and high cost chronic conditions in the Medicare FFS population in 2005. Chronic conditions explored include diabetes, chronic obstructive pulmonary disease (COPD), heart failure, cancer, chronic kidney disease (CKD), and depression.

Fifty percent of Medicare FFS beneficiaries were receiving care for one or more of these chronic conditions. The highest prevalence is observed for diabetes, with nearly one-fourth of the Medicare FFS study cohort receiving treatment for this condition (24.3 percent). The annual number of inpatient days during 2005 is highest for CKD (9.51 days) and COPD (8.18 days). As the number of chronic conditions increases, the average per beneficiary Medicare payment amount increases dramatically. The annual Medicare payment amounts for a beneficiary with only one of the chronic conditions is $7,172. For those with two conditions, payment jumps to $14,931, and for those with three or more conditions, the annual Medicare payments per beneficiary is $32,498.

The CCW data files have tremendous value for health services research. The longitudinal data and beneficiary linkage within the CCW are features of this data source which make it ideal for further studies regarding disease prevalence and progression over time. As additional years of administrative data are accumulated in the CCW, the expanded history of beneficiary services increases the value of this already rich data source.

Adequate health services are critical to the success of efforts to maintain persons with mental retardation in the community, yet information concerning the health status of this population is in short supply. This paper presents the results of a survey of 333 mentally retarded persons randomly selected from a population of 1,333 such individuals living in community settings. Almost twothirds had chronic conditions requiring medical intervention. The top five conditions in terms of prevalence were neurologic, ophthalmologic, dermatologic, psychiatric-emotional, and orthopedic. The

In September 2015, a Wyoming woman was admitted to a local hospital with a 5-day history of progressive weakness, ataxia, dysarthria, and dysphagia. Because of respiratory failure, she was transferred to a referral hospital in Utah, where she developed progressive encephalitis. On day 8 of hospitalization, the patient's family told clinicians they recalled that, 1 month before admission, the woman had found a bat on her neck upon waking, but had not sought medical care. The patient's husband subsequently had contacted county invasive species authorities about the incident, but he was not advised to seek health care for evaluation of his wife's risk for rabies. On October 2, CDC confirmed the patient was infected with a rabies virus variant that was enzootic to the silver-haired bat (Lasionycteris noctivagans). The patient died on October 3. Public understanding of rabies risk from bat contact needs to be improved; cooperation among public health and other agencies can aid in referring persons with possible bat exposure for assessment of rabies risk.

No abstract

SEver since the demonstration of the "swan-neck" lesion (shortening and narrowing of the neck of the proximal renal tubule) in cystinosis by nephron microdissection, it has been a source of speculation. The prenatal or postnatal onset of the lesion and its role in the pathogenesis of cystine storage have been debated. To study this problem, renal function tests, kidney biopsies, and renal tissue amino acid analyses were performed on two cystinotic infants at six and 12 months of age. At six months, the infants showed a generalized aminoaciduria, proteinuria and glucosuria but not hypophosphatemia, hypokalemia or polyuria; and they were pitressin responsive. Renal biopsies did not show the "swan-neck" lesion by light microscopy or nephron microdissection. However, electron microscopy revealed vacuolization and previously undescribed ultramicroscopic crystals in the epithelial cells of the neck region of the proximal tubule. The unbound cystine concentration in the kidney biopsies was threefold greater than in controls. At 12 months of age the infants exhibited hypokalemia, hypophosphatemia, polyuria and subnormal pitressin responses. Typical "swan-neck" lesions were demonstrated by nephron microdissection. The unbound cystine concentration was ten times normal levels. These studies indicate the "swan-neck" lesion in cystinosis is an acquired rather than congenital defect and it follows rather than precedes cystine storage.Paramedical personnel in evaluating children with renal disease. DEBBIE DEAN, BARBARA PETERS, and GEORGE A. RICHARD. Univ. Fla. Coll. Med., Gainesville, Fla. (Intr. by G. L. Schiebler). During the past four years we have utilized the Clinical Laboratory Patient Service Assistant to help us evaluate children with renal disease. She arranges, conducts and calculates all studies, except for performing the renal biopsy. This has permitted us to evaluate 450 children with renal disease, including 2,000 complete series of renal function studies and 300 renal biopsies.Previously, this diagnostic work-up required 5.5 hospital days. The Clinical Lab. Patient Service Assisiant has permitted us to evaluate each patient in the outpatient dept. in 7 hours (overnight hospitalization required for renal biopsy). The studies include two 12-hour urine collections in the recumbent and ambulatory positions (done prior to coming to the hospital), concentrating and diluting capacity, urine culture and urinalysis, creatinine and urea clearance, tubular resorption of phosphate, blood gases, appropriate serological studies and blood chemistries, and a water load test. An intravenous pyelogram and voiding cystogram can be done before and after the studies are completed, respectively.The Clinical Laboratory Patient Service Assistant has permitted us to decrease hospitalization time, decrease expenses to the family for lodging, decrease cost to the insurance carrier and the time of confinement in the hospital. She represents a familiar friend to the children with renal disease whom we follow. of Calif., San Francis...