Association Between Changes in CMS Reimbursement Policy and Drug Labels for Erythrocyte-Stimulating Agents With Outcomes for Older Patients Undergoing Hemodialysis Covered by Fee-for-Service Medicare

Wang, Cunlin; Kane, Robert C.; Levenson, Mark; Kelman, Jeffrey A.; Wernecke, Michael; Lee, Joo-Yeon; Kozlowski, Steven; Dekmezian, Carmen; Zhang, Zhiwei; Thompson, Aliza; Smith, Kimberly A.; Wu, Yue; Wei, Yuqin; Chillarige, Yoganand; Ryan, Qin; Worrall, Chris; MaCurdy, Thomas; Graham, David J.

doi:10.1001/jamainternmed.2016.6520

Cited by 36 publications

(46 citation statements)

References 24 publications

(46 reference statements)

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“…They found no difference in cardiovascular outcomes among White fee-for-service Medicare patients on dialysis 66 years or older during the 2-year period before and after the PPS and ESA changes while an 18% reduction in cardiovascular events was observed in Black patients. Such findings suggest that different target ESA and Hb levels may be appropriate for Black dialysis patients (37).…”

Section: Anemiamentioning

confidence: 94%

Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society

Norris

Williams

Rhee

et al. 2017

Seminars in Dialysis

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End-stage renal disease (ESRD) is one of the starkest examples of racial/ethnic disparities in health. Racial/ethnic minorities are 1.5 to nearly 4 times more likely than their non-Hispanic White counterparts to require renal replacement therapy (RRT), with African Americans suffering from the highest rates of ESRD. Despite improvements over the last 25 years, substantial racial differences persistence in dialysis quality measures such as RRT modality options, dialysis adequacy, anemia, mineral and bone disease, vascular access, and pre-ESRD care. This report will outline the current status of racial disparities in key ESRD quality measures and explore the impact of race. While the term race represents a social construct, its association with health is more complex. Multiple individual and community level social determinants of health are defined by the social positioning of race in the U.S., while biologic differences may reflect distinct epigenetic changes and linkages to ancestral geographic origins. Together these factors conspire to influence dialysis outcomes among African Americans with ESRD.

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Section: Anemiamentioning

confidence: 94%

Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society

Norris

Williams

Rhee

et al. 2017

Seminars in Dialysis

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“…Awareness of these reimbursement changes and their possible influence on provider practices are critical when conducting studies to address a specific clinical question. In fact, designing and conducting studies that take advantage of such policy changes can often provide compelling information regarding the effectiveness and/or safety of therapeutic interventions 22,23…”

Section: Factors To Consider When Using Medicare Data For Researchmentioning

confidence: 99%

“…If approved, CMS enters into a Data Use Agreement (DUA) with the researcher. These data have been used to describe patterns of morbidity2 and mortality3 and burden of disease,4,5 compare the effectiveness of pharmacologic therapies,6–9 examine the cost of care,10–13 evaluate the effects of provider practices on the delivery of care,14–17 and explore the effects of important policy changes on physician practices and patient outcomes 18–23. The use of the Medicare databases as sources for epidemiologic and health outcomes research has increased substantially over time (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Use of the Medicare database in epidemiologic and health services research: a valuable source of real-world evidence on the older and disabled populations in the US

Mues¹,

Liede²,

Liu³

et al. 2017

CLEP

171

129

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Medicare is the federal health insurance program for individuals in the US who are aged ≥65 years, select individuals with disabilities aged <65 years, and individuals with end-stage renal disease. The Centers for Medicare and Medicaid Services grants researchers access to Medicare administrative claims databases for epidemiologic and health outcomes research. The data cover beneficiaries’ encounters with the health care system and receipt of therapeutic interventions, including medications, procedures, and services. Medicare data have been used to describe patterns of morbidity and mortality, describe burden of disease, compare effectiveness of pharmacologic therapies, examine cost of care, evaluate the effects of provider practices on the delivery of care and patient outcomes, and explore the health impacts of important Medicare policy changes. Considering that the vast majority of US citizens ≥65 years of age have Medicare insurance, analyses of Medicare data are now essential for understanding the provision of health care among older individuals in the US and are critical for providing real-world evidence to guide decision makers. This review is designed to provide researchers with a summary of Medicare data, including the types of data that are captured, and how they may be used in epidemiologic and health outcomes research. We highlight strengths, limitations, and key considerations when designing a study using Medicare data. Additionally, we illustrate the potential impact that Centers for Medicare and Medicaid Services policy changes may have on data collection, coding, and ultimately on findings derived from the data.

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“…Recently, two major trends in anemia management have evolved. 27 In contrast, a broad trend has generally favored more restrictive transfusion use, manifested by increased tolerance for lower hemoglobin levels before transfusion administration. 1 Declines in ESA use were followed by an approximately10% increase in transfusion use during this same time period.…”

Section: Discussionmentioning

confidence: 99%

“…1 Declines in ESA use were followed by an approximately10% increase in transfusion use during this same time period. 27 In contrast, a broad trend has generally favored more restrictive transfusion use, manifested by increased tolerance for lower hemoglobin levels before transfusion administration. Such an approach is formally recommended by the AABB, based in large measure on the results of cardinal randomized controlled trials (RCTs).…”

Section: Discussionmentioning

confidence: 99%

Association of hospital transfusion use and infection‐related rehospitalizations among patients receiving hemodialysis: A retrospective cohort study

Liu

Dluzniewski

et al. 2019

Hemodialysis International

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Introduction: Red blood cell transfusions have been associated with infection risk. We investigated whether hospital transfusions are associated with infections in maintenance hemodialysis patients requiring transfusions for chronic anemia.Methods: In this retrospective cohort study, hemodialysis patients who experienced an incident hospitalization during 2012-2013 were identified from the Medicare end-stage renal disease database. Hospital transfusions were first categorized into one of five groups based on adjusted likelihood of administering red blood cell transfusions during inpatient hospital stays that occurred over the previous year (2011) among the general Medicare cohort. Next, in a patient-level analysis, patients were categorized according to transfusion use at the incident hospitalization hospital. Outcomes were infection-related rehospitalization and a composite of infection-related hospitalization and all-cause mortality during the 60 days following hospital discharge. We estimated adjusted rate ratios for the association between hospital transfusion use and risk of rehospitalization or the composite endpoint using Poisson regression models. Findings:The study included 1578 hospitals and 61,455 hemodialysis patients. Patient characteristics were balanced across hospital transfusion use groups. The overall transfusion rate was 16.0%. The overall 30-day infection-related hospitalization rate (95% confidence interval) per 100 patientmonths was 8.8 (8.6-9.1); rates did not differ by transfusion use group. Rate ratios for infectionrelated rehospitalization were 1.00 (0.91-1.10) over 30 days and 0.98 (0.91-1.05) over 60 days comparing the lowest and highest transfusion use groups.Discussion: We found no differences in risk of infection-related rehospitalization for patients receiving maintenance hemodialysis across the varying blood transfusion rates of US hospitals.

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Association Between Changes in CMS Reimbursement Policy and Drug Labels for Erythrocyte-Stimulating Agents With Outcomes for Older Patients Undergoing Hemodialysis Covered by Fee-for-Service Medicare

Cited by 36 publications

References 24 publications

Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society

Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society

Use of the Medicare database in epidemiologic and health services research: a valuable source of real-world evidence on the older and disabled populations in the US

Association of hospital transfusion use and infection‐related rehospitalizations among patients receiving hemodialysis: A retrospective cohort study

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