Context Total hip arthroplasty (THA) is a common surgical procedure but little is known about longitudinal trends. Objective To examine demographics and outcomes of patients undergoing primary and revision THA between 1991 and 2008. Design, Setting, and Participants Observational cohort of 1,453,493 Medicare beneficiaries who underwent primary THA and 348,596 who underwent revision THA. Outcomes Changes in patient demographics and comorbidity; hospital length of stay (LOS); mortality; discharge disposition; and all-cause readmission rates. Results Between 1991 and 2008 the mean age for primary THA increased from 74.1 (95% CI, 74.0-74.1) years to 75.1 (95% CI, 75.1-75.2)(P=0.01) and 75.8 (95% CI, 75.7-75.9) to 77.3 (95% CI, 77.2-77.4) for revision THA (P<.001). The mean number of comorbid illnesses per patient increased from 1.0 (95% CI, 1.0-1.0) to 2.0 (95% CI, 2.0-2.0) for primary and 1.1 (95% CI, 1.1-1.1) to 2.3 (95% CI, 2.3-2.3) for revision THA (P<.001 for both). For primary THA, LOS decreased from 9.1 days (95% CI, 9.1-9.2) in 1991–1992 to 3.7 days (95% CI, 3.7-3.7) in 2007–2008 (P=0.002); unadjusted in-hospital and 30-day mortality decreased from 0.5% (95% CI, 0.5%-0.5%) to 0.2% (95% CI, 0.2%-0.2%)(P< 0.001) and 0.7% (95% CI, 0.7%-0.7%) to 0.4% respectively (95% CI, 0.4%-0.4%)(P< 0.001). The proportion of primary THA patients discharged home declined from 68.0% (95% CI, 67.8%-68.3%) to 48.2% (95% CI, 48.0%-48.4%)(P<.001); the proportion discharged to skilled care increased from 17.8% (95% CI, 17.6%-18.1%) to 34.3% (95% CI, 34.1%-34.5%) (P<.001); 30-day all-cause readmission increased from 5.9% (95% CI, 5.8%-6.1%) to 8.5% (95% CI, 8.4%-8.6%) (P<.001). For revision THA similar trends were observed in hospital LOS, in-hospital mortality, discharge disposition, and hospital readmission rates. Conclusions Among Medicare beneficiaries who underwent primary and revision hip arthroplasty between 1991 and 2008, there was a decrease in hospital LOS, but an increase in the rates of post-acute care and readmission.

Previous research has shown that, compared to white patients, black patients more frequently undergo surgery at low-quality hospitals. In this paper, we assess the extent to which racial segregation and geographic proximity to low–quality hospitals contributes to this disparity. To determine the role of proximity, we used national Medicare data to measure distances between patient residence and high- and low-quality surgical hospitals. To examine the role of racial segregation, we evaluated the likelihood that blacks living in regions with low, medium, and high degrees of residential segregation would undergo surgery in lower quality hospitals. Despite living closer to higher-quality hospitals, black patients were 25% to 58% more likely to undergo surgery at low-quality hospitals. We found a strong relationship between racial segregation and the likelihood that blacks underwent surgery at low quality hospitals. Policy efforts aimed at helping referring physicians overcome these entrenched referral patterns and programs to improve care at the low quality hospitals are needed.

This study contributes to the understanding of early Blue Button adoption and use of this feature for patient-initiated sharing of health information. Educational efforts are needed to raise awareness of the Blue Button and to address usability issues that hinder adoption.

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After adjustment for patient characteristics and hospital volume, the specialty orthopaedic hospitals had better patient outcomes, as measured by Medicare administrative data, than did the general hospitals.

BACKGROUND Atrial fibrillation (AF) is associated with an increased risk of stroke and death. Uniform utilization of appropriate therapies for AF may help reduce those risks. OBJECTIVE We sought to determine whether significant race and sex differences exist in the treatment of newly diagnosed AF in Medicare beneficiaries. METHODS We used administrative encounter data for Medicare beneficiaries to identify patients with newly diagnosed AF during 2010–2011. Services received after initial AF diagnosis were cataloged, including visits with a cardiologist or electrophysiolo-gist, catheter ablation procedures, and use of oral anticoagulants, rate control agents, and antiarrhythmic drugs. RESULTS Overall, 517,941 patients met study criteria, of whom 452,986 (87%) were white, 36,425 (7%) black, and 28,530 (6%) Hispanic. Male patients comprised 209,788 (41%) of the cohort. In multivariate analysis, there were statistically significant differences in the use of AF-related services by both race and sex, with white patients and male patients receiving the most care. The most notable disparities were for catheter ablation (Hispanic vs white: adjusted hazard ratio [AHR] 0.70; 95% confidence interval [CI] 0.63–0.79; P < .001; female vs male: AHR 0.65; 95% CI 0.63–0.68; P < .001) and receipt of oral anticoagulation (black vs white: AHR 0.94; 95% CI 0.92–0.95; P < .001; Hispanic vs white: AHR 0.94; 95% CI 0.93–0.97; P < .001; female vs male: AHR 0.93; 95% CI 0.93–0.94; P < .001). CONCLUSION Race and sex appear to have a significant effect on the health care provided to this cohort of Medicare beneficiaries diagnosed with AF. Possible explanations include racial differences in access, patient preferences, treatment bias, and unmeasured clinical characteristics.

IMPORTANCE Randomized clinical trials have yielded conflicting results about the effects of remdesivir therapy on survival and length of hospital stay among people with COVID-19. OBJECTIVE To examine associations between remdesivir treatment and survival and length of hospital stay among people hospitalized with COVID-19 in routine care settings. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Veterans Health Administration (VHA) to identify adult patients in 123 VHA hospitals who had a first hospitalization with laboratory-confirmed COVID-19 from May 1 to October 8, 2020. Propensity score matching of patients initiating remdesivir treatment to control patients who had not initiated remdesivir treatment by the same hospital day was used to create the analytic cohort. EXPOSURES Remdesivir treatment. MAIN OUTCOMES AND MEASURES Time to death within 30 days of remdesivir treatment initiation (or corresponding hospital day for matched control individuals) and time to hospital discharge with time to death as a competing event. Associations between remdesivir treatment and these outcomes were assessed using Cox proportional hazards regression in the matched cohort.RESULTS The initial cohort included 5898 patients admitted to 123 hospitals, 2374 (40.3%) of whom received remdesivir treatment (2238 men [94.3%]; mean [SD] age, 67.8 [12.8] years) and 3524 (59.7%) of whom never received remdesivir treatment (3302 men [93.7%]; mean [SD] age, 67.0 [14.4] years). After propensity score matching, the analysis included 1172 remdesivir recipients and 1172 controls, for a final matched cohort of 2344 individuals. Remdesivir recipients and matched controls were similar with regard to age (mean [SD], 66.6 [14.2] years vs 67.5 [14.1] years), sex (1101 men [93.9%] vs 1101 men [93.9%]), dexamethasone use (559 [47.7%] vs 559 [47.7%]), admission to the intensive care unit (242 [20.7%] vs 234 [19.1%]), and mechanical ventilation use (69 [5.9%] vs 45 [3.8%]). Standardized differences were less than 10% for all measures. Remdesivir treatment was not associated with 30-day mortality (143 remdesivir recipients [12.2%] vs 124 controls [10.6%]; log rank P = .26; adjusted hazard ratio [HR], 1.06; 95% CI, 0.83-1.36). Results were similar for people receiving vs not receiving dexamethasone at remdesivir initiation (dexamethasone recipients:

Black patients admitted to hospitals with and without coronary revascularization services are less likely to receive coronary revascularization. The higher long-term mortality of black patients may reflect the lower use of revascularization or other aspects of AMI care.