Context Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether excess admissions in dementia might be potentially preventable. Objective To determine whether dementia onset is associated with higher rates or different reasons for hospitalization, particularly for ambulatory care sensitive conditions (ACSCs) for which proactive outpatient care might prevent the need for a hospital stay. Design, Setting, and Participants We conducted a retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of initially non-demented adults aged 65 and older enrolled in an integrated healthcare system. Automated data were used to identify all hospitalizations from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned from February 1, 1994 to December 31, 2007. Main Outcome Measures Hospital admission rates for dementia and dementia-free groups, for all causes, by type of admission, and for ACSCs. Results Four hundred ninety-four cognitively normal individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained dementia free and 1478 (59%) were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admits per 1000 person-years vs. 200 admits/1000 in the dementia-free group. After adjustment for age, gender, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23 to 1.61; P<.0001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38 to 2.31; P<.0001). Adjusted admission rates classified by body system were significantly higher in the demented group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia. Conclusions Among patients aged 65 years and older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs.

Background Women screened with digital mammography may experience false-positive and false-negative results and subsequent additional imaging and biopsies. It is unclear how these outcomes vary by age, time since last screening, and individual risk factors. Objective To determine factors associated with false-positive and false-negative digital mammography results, additional imaging, and biopsies among a general population of women screened for breast cancer. Design Analysis of registry data. Setting Participating facilities at five U.S. Breast Cancer Surveillance Consortium breast imaging registries with linkages to pathology databases and tumor registries. Patients 405,191 women aged 40–89 years screened with digital mammography between 2003–2011; 2,963 were diagnosed with invasive cancer or ductal carcinoma in situ within 12 months of screening. Measurements Rates of false-positive and false-negative results and recommendations for additional imaging and biopsies from a single screening round, and comparisons by age, time since last screening, and risk factors. Results Rates of false-positive results (121.2/1,000 women; 95% CI 105.6 to 138.7) and recommendations for additional imaging (124.9/1,000; 95% CI 109.3 to 142.3) were highest among women aged 40–49 years and decreased with age; rates of false-negative results (1.0 to 1.5/1,000) and recommendations for biopsy (5.6 to 17.5/1,000) did not differ greatly by age. Results did not differ by time since last screening. All rates were higher for women with risk factors, particularly family history of breast cancer, previous benign breast biopsy, high breast density, and low body mass index for younger women. Limitations Additional factors were not examined, including numbers of first- and second-degree relatives with breast cancer and diagnoses of previous benign biopsies. Conclusions False-positive results and additional imaging are common, particularly for younger women and those with risk factors, while biopsies occur less often. Rates of false-negative results are low.

Background Upgrade rates of high-risk breast lesions after screening mammography were examined. Study design The Breast Cancer Surveillance Consortium registry was used to identify all BI-RADS 4 assessments followed by needle biopsies with high-risk lesions. Follow-up was performed for all women. Results High-risk lesions were found in 957 needle biopsies, with excision documented in 53%. Most (N=685) were atypical ductal hyperplasia (ADH), 173 were lobular neoplasia, and 99 were papillary lesions. Upgrade to cancer varied with type of lesion (18% in ADH, 10% in lobular neoplasia and 2% in papillary). In premenopausal women with ADH, upgrade was associated with family history. Cancers associated with ADH were mostly (82%) ductal carcinoma in situ, those associated with lobular neoplasia were mostly (56%) invasive. During further 2 years of follow-up, cancer was documented in 1% of women with follow-up surgery and in 3% with no surgery. Conclusion Despite low rates of surgery, low rates of cancer were documented during follow-up. Benign papillary lesions diagnosed on BI-RADS 4 mammograms among asymptomatic women do not justify surgical excision.

Background Medicare claims data may be a fruitful data source for research or quality measurement in mammography. However, it is uncertain whether claims data can accurately distinguish screening from diagnostic mammograms, particularly when claims are not linked with cancer registry data. Objectives To validate claims-based algorithms that can identify screening mammograms with high positive predictive value (PPV) in claims data with and without cancer registry linkage. Research Design Development of claims-derived algorithms using classification and regression tree analyses within a random half-sample of bilateral mammogram claims with validation in the remaining half-sample. Subjects Female fee-for-service Medicare enrollees age 66 years and older who underwent bilateral mammography from 1999 to 2005 within Breast Cancer Surveillance Consortium (BCSC) registries in four states (CA, NC, NH, and VT), enabling linkage of claims and BCSC mammography data (N=383,730 mammograms obtained by 146,346 women). Measures Sensitivity, specificity, and PPV of algorithmic designation of a “screening” purpose of the mammogram using a BCSC-derived reference standard. Results In claims data without cancer registry linkage, a three-step claims derived algorithm identified screening mammograms with 97.1% sensitivity, 69.4% specificity, and a PPV of 94.9%. In claims that are linked to cancer registry data, a similar three-step algorithm had higher sensitivity (99.7%), similar specificity (62.7%), and higher PPV (97.4%). Conclusions Simple algorithms can identify Medicare claims for screening mammography with high predictive values in Medicare claims alone and in claims linked with cancer registry data.