Chronic Disease Score as a Predictor of Hospitalization

Putnam, Kathleen; Buist, Diana S.M.; Fishman, Paul; Andrade, Susan E.; Boles, Myde; Chase, Gary A.; Goodman, Michael J.; Gurwitz, Jerry H.; Platt, Richard; Raebel, Marsha A.; Chan, K. Arnold

doi:10.1097/00001648-200205000-00016

Cited by 85 publications

(61 citation statements)

References 25 publications

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“…51 CDS is a well-validated, pharmacy-based riskadjustment tool that uses pharmacy fill data to identify patient risk in different patient populations. [52][53][54][55][56][57][58][59][60][61][62] We refer to this measure as the risk score.…”

Section: Study Design and Study Samplementioning

confidence: 99%

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

et al. 2013

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BACKGROUND:Although the Medicare Part D coverage gap phase-out should reduce cost-related nonadherence (CRN) among seniors with diabetes, preferential generic prescribing may have already decreased CRN, while smaller numbers of patients using more costly branded oral antidiabetic (OAD) medications remain vulnerable to CRN. OBJECTIVE: To estimate the effects of cost sharing in the Part D standard (non-LIS) benefit on adherence to different OAD classes, comparing two classes dominated by inexpensive generic medications and two by more costly branded medications. DESIGN AND PATIENTS: Retrospective cohort study using dispensed prescription data for elderly non-LIS (N= 81,047) and LIS (low-income subsidy) (N=150,359) beneficiaries using same class OAD(s) in 2008 and 2009. Logistic regression modeled non-LIS likelihood; LIS and non-LIS patients matched using propensity outcome (N= 38,054). Logistic regression, controlling for demographic and health status characteristics, modeled effects of non-LIS coverage on 2009 OAD class adherence. MAIN MEASURES: Main outcome measures were within-class OAD coverage year adherence, with patients considered adherent when days supplied to calendar days ratio at least 0.8. KEY RESULTS: Non-LIS patients had 0.52 and 0.57 times the odds of branded-only DPP-4 Inhibitor (N= 1,812; 95 % CI: 0.43, 0.63; P<0.001) and Thiazolidinedione (TZD) (N=6,290; 95 % CI: 0.52, 0.63; P<0.001) adherence. Most patients (N=32,510; 82 %) used OADs in primarily generic classes, where we found no significant (Biguanides; N=21,377) or small differences (Sulfonylureas/Glinides [N=19,240; OR: 0.91; 95 % CI: 0.86, 0.97; P =0.002]) in adherence odds. Crude adherence rates were sub-optimal when CRN was not a factor (Non-LIS/LIS: Biguanides: 65 %/65 %; Sulfonylureas/Glinides: 66 %/ 68 %; LIS: DPP-4 Inhibitors: 66 %; TZDs: 67 %). CONCLUSIONS: Gap elimination would not affect generic, but should reduce branded OAD CRN. Branded copayments may continue to lead to CRN. Policy initiatives and benefit changes targeting both cost deterrents for patients with more complex disease and non-cost generic OAD underuse are recommended.

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Section: Study Design and Study Samplementioning

confidence: 99%

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

et al. 2013

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“…Other covariates included sex, the number of comorbidities by the day of the ARI visit, the number of different classes of prescribed medications, and the number of visits within the year before the ARI visit. [36][37][38] As changes in drug use could vary by age; the study also tested for an interaction between year and age category.…”

Section: British Journal Of General Practice October 2009 E323mentioning

confidence: 99%

Reduced antibiotic prescribing for acute respiratory infections in adults and children

2009

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Resistance to antibacterial medications among community-acquired pathogens is a growing public health threat. [1][2][3][4][5] Key drivers are the volume and type of antibacterials used in ambulatory settings. [6][7][8] Antibacterials are often prescribed for acute nonspecific respiratory infections (ARIs), which they are unlikely to benefit. 9,10 Reducing such use can slow, or even reverse resistance rates. British Journal of General Practice, October 2009 e321 Reduced antibiotic prescribing for acute respiratory infections in adults and children Sharon B Meropol, Zhen Chen and Joshua P Metlay SB Meropol, Z Chen and JP Metlay ABSTRACT BackgroundRecent public health efforts, including in the UK and US, have targeted decreasing unnecessary antibiotic use. In the US, prescribing for acute non-specific respiratory infections (ARIs) has decreased, but broadspectrum antibacterial prescribing has soared. AimTo assess recent trends in antibacterial prescribing for ARIs in the UK. Design of studyRetrospective cohort. SettingThe Health Improvement Network database. MethodOutpatient ARI visits from 1 January 1990 to 31 December 2004 were selected. Outcomes were antibacterial and broad-spectrum antibacterial prescriptions per thousand person-years, and the probability of receiving an antibacterial and broadspectrum prescription conditional on an ARI visit. ResultsFrom 1990 to 2004, antibacterial prescribing rates for ARIs decreased from 55.0 to 30.3 prescriptions/1000 person-years for adults and from 124.8 to 46.3 prescriptions/1000 person-years for children (P = 0.001). The probability of receiving an antibacterial prescription after an ARI visit decreased from 70.8% to 59.5% for adults and from 46.1% to 30.8% for children (P = 0.003 and 0.007, respectively). Antibacterial prescribing declined faster for younger than for older adults. Broad-spectrum antibacterial prescribing rates decreased from 3.8 to 2.9 prescriptions/1000 personyears for adults and from 5.2 to 2.2 prescriptions/1000 person years for children (P = 0.005 and 0.003, respectively). The probability of broad-spectrum prescribing did not demonstrate a significant linear trend for adults (P = 0.16), and decreased for children (P = 0.01). ConclusionUK antibacterial prescribing for ARIs has declined, similar to US trends, but there was no concomitant increase in low broad-spectrum prescribing. The success of UK strategies for limiting antimicrobial use has implications for programmes in other countries.

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“…These covariates included age, sex, baseline use or cost (as appropriate), a previously validated, pharmacy-based measure of chronic disease burden (RxRisk) (18,19), comorbidities derived from ICD-9-CM codes from outpatient problem lists, and a preventive services index. Members who use other preventive services (colon cancer screening, a screening mammogram, prostate cancer screening, an influenza vaccine, or a pneumococcal vaccine) may be more likely to participate in SS, so we adjusted for prior preventive service use to account for self-selection of health-oriented individuals into SS participation (13,14).…”

Section: Data Sourcesmentioning

confidence: 99%

Health Care Use and Costs Associated With Use of a Health Club Membership Benefit in Older Adults with Diabetes

et al. 2008

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OBJECTIVE -The purpose of this study was to determine whether elective use of a health plan-sponsored health club membership had an impact on health care use and costs among older adults with diabetes.RESEARCH DESIGN AND METHODS -Administrative claims for 2,031 older adults with diabetes enrolled in a Medicare Advantage plan were obtained for this retrospective cohort study. Participants (n ϭ 618) in the plan-sponsored health club benefit (Silver Sneakers [SS]) and control subjects (n ϭ 1,413) matched on SS enrollment index date were enrolled in the plan for at least 1 year before the index date. Two-year health care use and costs of SS participants and control subjects were estimated in regressions adjusting for baseline differences.RESULTS -SS participants were more likely to be male, had a lower chronic disease burden, used more preventive services, and had a lower prevalence of arthritis (P Յ 05). SS participants had lower adjusted total health care costs than control subjects in the first year after enrollment (Ϫ$1,633 [95% CI Ϫ$2,620 to Ϫ$646], P ϭ 0.001), and adjusted total costs in year 2 trended lower (Ϫ$1,230 [Ϫ$2,494 to $33], P ϭ 0.06). Participants who made on average Ն2 SS visits/week in year 1 had lower total costs in year 2 ($2,141 [Ϫ$3,877 to Ϫ$405], P ϭ 0.02) than participants who made Ͻ2 visits/week.CONCLUSIONS -Use of a health club benefit by older adults with diabetes was associated with slower growth in total health care costs over 2 years; greater use of the benefit was actually associated with declines in total costs.

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Chronic Disease Score as a Predictor of Hospitalization

Abstract: The Chronic Disease Score predicts hospitalization and therefore may be a useful indicator of baseline comorbidity for control of confounding.

Cited by 85 publications

References 25 publications

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

Reduced antibiotic prescribing for acute respiratory infections in adults and children

Health Care Use and Costs Associated With Use of a Health Club Membership Benefit in Older Adults with Diabetes

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