Costs Associated With Progression of Mildly Reduced Kidney Function Among Medicare Advantage Enrollees.

Rationale & Objective: The prevalence of early chronic kidney disease (CKD) in older adults has increased in the past 2 decades, yet CKD disease progression, overall, is variable. It is unclear whether health care costs differ by progression trajectory. The purpose of this study was to estimate the trajectories of CKD progression and examine Medicare Advantage (MA) health care costs of each trajectory over a 3-year period in a large cohort of MA enrollees with mildly reduced kidney function.

Developing a quality measure to assess use of antibiotic medications for respiratory conditions.

Objective: Antibiotics are essential medications for treating life-threatening infections. However, incorrect prescribing can lead to adverse events and contribute to antibiotic resistance. We sought to develop a utilization quality measure that could be used by health insurance plans to track overall prescribing for respiratory conditions.

Association Between a National Insurer's Pay-for-Performance Program for Oncology and Changes in Prescribing of Evidence-Based Cancer Drugs and Spending.

Purpose: Cancer drug prescribing by medical oncologists accounts for the greatest variation in practice and the largest portion of spending on cancer care. We evaluated the association between a national commercial insurer's ongoing pay-for-performance (P4P) program for oncology and changes in the prescribing of evidence-based cancer drugs and spending.

Methods: We conducted an observational difference-in-differences study using administrative claims data covering 6.

Association of Utilization Management Policy With Uptake of Hypofractionated Radiotherapy Among Patients With Early-Stage Breast Cancer.

Importance: Breast cancer accounts for the largest portion of cancer-related spending in the United States. Although hypofractionated radiotherapy after breast-conserving surgery is a cost-effective and convenient treatment strategy for patients with early-stage breast cancer, less than 40% of eligible women received hypofractionated radiotherapy in 2013.

Objective: To assess the association of a large commercial payer's utilization management policy with the use of hypofractionated radiotherapy among women with early-stage breast cancer and its associated cost.

Use of Optimal Evidence-Based Anticancer Drug Regimens in Physician Offices Versus Hospital Outpatient Facilities.

Purpose: Cancer care has increasingly shifted from physician offices (MDOs) to hospital-based outpatient departments (HOPDs). This study compared the proportion of patients receiving optimal, evidence-based anticancer drug regimens and the cost of care when administered in these sites.

Methods: Patients with breast, lung, or colorectal cancer were identified from a large health insurance database.

Association between early-childhood antibiotic exposure and subsequent asthma in the US Medicaid population.

Background: Although socioeconomically disadvantaged children have an increased risk of asthma, the association between early-childhood antibiotics and the incidence of asthma among such children has had limited study.

Objective: To examine the association between antibiotic fills in the first 2 years of life and risk of developing asthma among children enrolled in Medicaid plans.

Methods: This retrospective cohort study of children with continuous medical and pharmacy coverage from birth to 2.

Using claims data to attribute patients with breast, lung, or colorectal cancer to prescribing oncologists.

Background: Alternative payment models frequently require attribution of patients to individual physicians to assign cost and quality outcomes. Our objective was to examine the performance of three methods for attributing a patient with cancer to the likeliest physician prescriber of anticancer drugs for that patient using administrative claims data.

Methods: We used the HealthCore Integrated Research Environment to identify patients who had claims for anticancer medication along with diagnosis codes for breast, lung, or colorectal lung cancer between July 2013 and September 2017.

Validation of a claims-based algorithm identifying eligible study subjects in the ADAPTABLE pragmatic clinical trial.

Objective: Validate an algorithm that uses administrative claims data to identify eligible study subjects for the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) pragmatic clinical trial (PCT).

Materials And Methods: This study used medical records from a random sample of patients identified as eligible for the ADAPTABLE trial. The inclusion criteria for ADAPTABLE were a history of acute myocardial infarction (AMI) or percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), or other coronary artery disease (CAD), plus at least one of several risk-enrichment factors.

Risk of Developing Dementia at Older Ages in the United States.

Dementia is increasingly recognized as a major source of disease burden in the United States, yet little research has evaluated the lifecycle implications of dementia. To address this research gap, this article uses the Aging, Demographics, and Memory Study (ADAMS) to provide the first nationally representative, longitudinal estimates of the probability that a dementia-free person will develop dementia later in life. For the 1920 birth cohort, the average dementia-free 70-year-old male had an estimated 26.

Association between Objectively Measured Physical Activity and Mortality in NHANES.

Purpose: We examined total activity, light activity, and moderate-to-vigorous physical activity (MVPA) as predictors of mortality in a nationally representative sample of older adults. Then we explored the theoretical consequences of replacing sedentary time with the same duration of light activity or MVPA.

Methods: Using accelerometer-measured activity, the associations between total activity, light activity (100-2019 counts per minute), and MVPA (>2019 counts per minute) counts and mortality were examined in adults age 50 to 79 yr in the National Health and Nutrition Examination Survey, 2003-2006 (n = 3029), with mortality follow-up through December 2011.

Effects of categorization and self-report bias on estimates of the association between obesity and mortality.

Purpose: The health consequences of obesity are often assessed using categorical, self-reported data on body mass index (BMI). This article investigates the combined effects of categorization and self-report bias on the estimated association between obesity and mortality.

Methods: We used the National Health and Nutrition Examination Survey (1988-2008) linked to death records through 2011.

Incident Diabetes and Mobility Limitations: Reducing Bias Through Risk-set Matching.

Background: Increased prevalence of diabetes in the U.S. population could contribute substantially to increases in disability at older ages.

A novel endoscopic delivery system for placement of a duodenal-jejunal implant for the treatment of obesity and type 2 diabetes.

The EndoBarrier Delivery System is a unique product capable of reliably delivering an implant into the small intestine. Further improvements to the product can likely be made to facilitate tracking and improved navigation through the small bowel. This unique system and its related technology may have additional applications where access to the small bowel is desired such as drug delivery, diagnostic and therapeutic endoscopy and small bowel stent delivery.