Introduction/Background Frailty identifies patients that have vulnerability to stress. Acute illness and hospitalization are stressors that may result in delirium and further accelerate the negative consequences of frailty. Purpose The purpose of this study was to determine whether frailty, identified at hospital admission and as measured by a frailty index, is associated with incident delirium. Methods A retrospective, observational, cohort study was done at a Veterans hospital between January 2013 and March 2014. English-speaking patients over 55 years were eligible. Exclusion criteria included inability to complete baseline assessments due to pre-existing cognitive impairment, emergent surgery; and/or admission from a nursing home, pre-existing delirium, and those with psychiatric disease or substance use disorder. Main Outcomes and Measures Frailty index (FI) variables included cognitive screening, physical function and comorbidities. The FI was calculated as a proportion of possible deficits (range 0 to 1; higher scores indicate increased frailty). Incident delirium was measured daily by an expert clinician interview. Results A total of 247 patients were admitted and 218 met inclusion/exclusion criteria, with a mean age of 71.54 years (SD = 9.53 years) and were predominantly white (92.7%) and male (91.7%). Participants were grouped using FI ranges as non-frail (FI <0.25, n=56 (26%)), pre-frail (FI =0.25–0.35, n=86 (39%)), and frail (FI >0.35, n=76 (35%)). Pre-frailty and frailty were associated with incident delirium (non-frail: 3.6% vs pre-frail: 20.9% vs frail: 29.3%, p =0.001) and total delirium days (mean day =non-frail 0.04 vs pre-frail 0.35 vs frail 0.57, p =0.003). After adjustment for sociodemographic factors, pre-frail (adjusted OR=5.64, 95% CI: 1.23, 25.99) and frail status (adjusted OR=6.80, 95% CI: 1.38, 33.45) were independently associated with delirium. Conclusion This study demonstrates that a frailty index is independently associated with incident delirium and suggests that admission assessments for frailty may identify patients at high risk of developing delirium.
Count: 250Keywords: comparative effectiveness research, methods guides, consensus document Running head: Comparative effectiveness methods guides 2 Key Points• A systematic literature review identified nine CER methods guidance documents.• These documents present more than three hundred individual methods recommendations, covering topics such as study design, bias, and statistical analysis.• Categories of shared methods recommendations were assembled which embodies a consensus of recommendations for CER methods.• All nine documents recommended transparency and adaptation for relevant stakeholders in the interpretation and dissemination of results.• Other shared recommendations identified in at least seven documents included transparent operational definitions allowing for replication, assessment of data and study measure validity, inclusion of clinically meaningful and objectively measured outcomes, and focusing on gap in knowledge that are relevant for decision-makers.
of commercially insured patients aged < 65 years and one of Medicare enrolleeswe identified all adult patients (≥ 18 years) with schizophrenia (ICD-9-CM 295. XX) initiating treatment with asenapine versus OBAP between 2009 and 2012. All patients were required to be continuously enrolled for the 6-month periods before and after the date of the first prescription claim for asenapine or OBAP (this was deemed the "index date"). We used propensity-score matching to control for differences between the groups. Changes in HRU and costs (2012 dollars) between the 6 month pre-and post-index periods were calculated within each group and then compared across groups. RESULTS: A total of 259 asenapine patients were propensity matched to an equal number of OBAP patients; matched groups were similar in terms of age (mean: 39.9 years for asenapine patients vs. 41.8 years for OBAP patients, p= 0.19), gender (58.7% vs. 56.8% female; p= 0.66); and Charlson comorbidity index (mean: 0.47 vs. 0.52, p= 0.65). Differences in HRU between the preand post-index periods nominally favored asenapine patients, including greater reductions in admissions (mean: -0.49 for asenapine patients vs. -0.40 for OBAP patients, p= 0.38) and emergency room visits (-0.19 vs. -0.08, p= 0.26); decreases in total healthcare costs also favored asenapine patients ($-7,609 vs. $-5,585, p= 0.45). While pharmacy costs increased in both groups, the increase was significantly lower among asenapine patients ($922 vs. $1,707, p< 0.05). CONCLUSIONS: Initiation of asenapine for schizophrenia is associated with significantly lower pharmacy costs than OBAP, and nominally greater decreases in levels of HRU and total healthcare costs.
A245 objectives. Adult patients with type 2 diabetes mellitus (T2DM) newly initiating treatment between January 1, 2010, and December 31, 2011, with either saxagliptin or sitagliptin were identified. A 1:1 propensity-matched sample of saxagliptin and sitagliptin patients was created to reduce any potential confounding. Propensity scores were generated based on demographic characteristics, comorbidities, disease severity and treatment patterns before the index date. Patients were required to have ≥ 6 months of continuous eligibility before (baseline period) and after (followup period) treatment initiation. All outcomes were assessed based on an intent-totreat analysis in the 6-month follow-up period. Both overall and diabetes-specific charges were computed; breakdowns of medical and overall (medical plus pharmacy) charges were compared. Appropriate univariate statistical tests were applied to the propensity-matched sample to examine differences in resource utilization outcomes. Results: A total of 8,438 and 23,155 patients initiated treatment with saxagliptin and sitagliptin, respectively. After matching, each cohort consisted of 7,700 patients. Compared with sitagliptin, during the follow-up period, saxagliptin was associated with significantly lower (all p values ≤ 0.
Frailty is an accumulation of deficits that helps identify patients who are vulnerable to stressors. Acute illness and hospitalization are stressors that may result in delirium. Delirium is significant in older adults, resulting in increased hospital stays, institutionalization, morbidity, and mortality. This study aimed to determine if a frailty index (FI), calculated on hospital admission, was associated with the development of incident delirium. An FI was built on an accumulation of deficits model which included assessments of cognition, physical function, and medical comorbidities for a cohort of 218 patients admitted to a Veteran Affairs medical facility. The FI was calculated as a proportion of possible deficits (range 0-1; higher scores indicate increased frailty). Delirium was assessed daily by expert clinician interview. Participants were, on average, 71 years (SD=9.53), white (92.7%), and male (91.7%). Participants were grouped using FI ranges as non-frail (FI<0.25; 26%), pre-frail (FI=0.25-0.35; 39%), and frail (FI>0.35; 35%). Incident delirium was more likely to occur in those who were frail (29.3%, p=0.001), compared to those who were pre-frail (20.9%) or non-frail (3.6%). The association of FI and incident delirium remained after adjustment for age, education, and other demographics (pre-frail: adjusted OR=5.64, 95%CI; 1.23, 25.99; frail: adjusted OR=6.80, 95%CI; 1.38, 33.45). Continued data analysis will include an AUC model to demonstrate robustness of the FI. The results from this study support the use of frailty assessments at hospital admission to identify patients at high risk of delirium and in need of additional clinical support and interdisciplinary resources.
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