Identification of patients with arthritis and arthritis-related functional limitation using administrative data.

Objective: To develop algorithms on the basis of administrative data to identify patients with arthritis and arthritis-related functional limitation (AFL).

Study Design And Setting: In this retrospective study, 361 enrollees of a health plan underwent a clinical examination to confirm arthritis and assessment of functional limitation on the basis of responses to the health assessment questionnaire. Administrative data were obtained on these subjects and included arthritis drugs dispensed, as well as outpatient and emergency department diagnoses and procedures (including radiographic studies, arthritis procedures, and laboratory tests).

Antipsychotic therapy and short-term serious events in older adults with dementia.

Background: Antipsychotic therapy is widely used to treat behavioral problems in older adults with dementia. Cohort studies evaluating the safety of antipsychotic therapy generally focus on a single adverse event. We compared the rate of developing any serious event, a composite outcome defined as an event serious enough to lead to an acute care hospital admission or death within 30 days of initiating antipsychotic therapy, to better estimate the overall burden of short-term harm associated with these agents.

Administrative data used to identify patients with irritable bowel syndrome.

Objective: To assess the usefulness of health plan administrative data for identifying patients with irritable bowel syndrome (IBS).

Study Design And Setting: In this retrospective study of 442 medical records of patients in nine U.S.

Costs associated with developing and implementing a computerized clinical decision support system for medication dosing for patients with renal insufficiency in the long-term care setting.

A team of physicians, pharmacists, and informatics professionals developed a CDSS added to a commercial electronic medical record system to provide prescribers with patient-specific maximum dosing recommendations based on renal function. We tracked the time spent by team members and used US national averages of relevant hourly wages to estimate costs. The team required 924.

Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D.

Context: Cost-related medication nonadherence (CRN) has been a persistent problem for individuals who are elderly and disabled in the United States. The impact of Medicare prescription drug coverage (Part D) on CRN is unknown.

Objective: To estimate changes in CRN and forgoing basic needs to pay for drugs following Part D implementation.

The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review.

Context: Computerized physician order entry (CPOE) with clinical decision support (CDS) has been promoted as an effective strategy to prevent the development of a drug injury defined as an adverse drug event (ADE).

Objective: To systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure.

Data Sources: PUBMED versions of MEDLINE (from inception through March 2007) were searched to identify relevant studies.

Medicare beneficiaries and free prescription drug samples: a national survey.

Background: New policies regulating physician/pharmaceutical company relationships propose to eliminate access to free prescription drug samples. Little is known about the prevalence of patient activity in requesting or receiving free prescription drug samples, or the characteristics of patients who access drug samples.

Objective: To determine the prevalence of free sample access and to examine demographic, clinical, and insurance characteristics of Medicare beneficiaries who access free samples.

Reliability of new measures of cost-related medication nonadherence.

Background: Although several national studies have attempted to measure medication nonadherence due to cost in cross-sectional studies of the elderly and disabled, little information exists on the psychometric properties of these measures over time.

Objectives: Examine the test-retest reliability of several recently published measures of cost-related medication nonadherence, among elderly community.

Methods: We developed a questionnaire and tested the reliability of measures of cost-related medication nonadherence and general cost-reduction strategies in a sample of 185 elderly in eastern Massachusetts surveyed twice (1-2 months apart).

Changing trends (1986-2003) in the use of lipid lowering medication in patients hospitalized with acute myocardial infarction: a community-based perspective.

Objectives: The objectives of this community-wide observational study were to describe nearly two decade long (1986-2003) trends in the use of lipid lowering therapy in patients hospitalized with acute myocardial infarction (AMI) and clinical and demographic factors associated with underutilization of this treatment regimen.

Methods: A total of 9429 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 10 annual periods between 1986 and 2003 comprised the study population. Hospital medical records were reviewed to ascertain the prescribing of lipid lowering agents during hospitalization for AMI.

Cluster randomized trials: opportunities and barriers identified by leaders of eight health plans.

Background: Cluster randomized trials (CRTs) offer unique advantages over standard randomized controlled clinical trials (RCTs) and observational methodologies, and may provide a cost-efficient alternative for answering questions about the best treatments for common conditions.

Objectives: To describe health plan leaders' views on CRTs, identify barriers to conducting CRTs, and solicit recommendations for increasing the acceptability of CRTs.

Research Design: Qualitative in-depth telephone interviews with leaders from 8 health plans.

Early detection of adverse drug events within population-based health networks: application of sequential testing methods.

Purpose: Active surveillance of population-based health networks may improve the timeliness of detection of adverse drug events (ADEs). Active monitoring requires sequential analysis methods. Our objectives were to (1) evaluate the utility of automated healthcare claims data for near real-time drug adverse event surveillance and (2) identify key methodological issues related to the use of healthcare claims data for real-time drug safety surveillance.

Patient education about anticoagulant medication: is narrative evidence or statistical evidence more effective?

Objective: To determine the relative impact of incorporating narrative evidence, statistical evidence or both into patient education about warfarin, a widely used oral anticoagulant medication.

Methods: 600 patients receiving anticoagulant therapy were randomly assigned to view one of three versions of a video depicting a physician-patient encounter where anticoagulation treatment was discussed, or usual care (no video). The videos differed in whether the physician used narrative evidence (patient anecdotes), statistical evidence, or both to highlight key information.

Computerized physician order entry with clinical decision support in long-term care facilities: costs and benefits to stakeholders.

Nursing homes are the setting of care for growing numbers of our nation's older people, and adverse drug events are an increasingly recognized safety and quality concern in this population. Health information technology, including computerized physician/provider order entry (CPOE) with clinical decision support (CDS), has been proposed as an important systems-based approach for reducing medication errors and preventable drug-related injuries. This article describes the costs and benefits of CPOE with CDS for the various stakeholders involved in long-term care (LTC), including nurses, physicians, the pharmacy, the laboratory, the payer (e.

Comparative effectiveness of beta-adrenergic antagonists (atenolol, metoprolol tartrate, carvedilol) on the risk of rehospitalization in adults with heart failure.

Placebo-controlled randomized trials have demonstrated the efficacy of selected beta blockers on outcomes in chronic heart failure (HF), but the relative effectiveness of different beta blockers in usual clinical care is poorly understood. We compared 12-month risk of rehospitalization for HF associated with receipt of different beta blockers in 7,883 adults hospitalized for HF within 2 large health plans between January 1, 2001 and December 31, 2002. Beta-blocker use was ascertained from electronic pharmacy databases and readmissions within 12 months were identified from hospital discharge databases.

Antipsychotic drug use and mortality in older adults with dementia.

Background: Antipsychotic drugs are widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety.

Objective: To examine the association between treatment with antipsychotics (both conventional and atypical) and all-cause mortality.

Design: Population-based, retrospective cohort study.

The safety of warfarin therapy in the nursing home setting.

Purpose: We examined the preventability of adverse warfarin-related events and potential adverse warfarin-related events ("near misses") in the nursing home setting.

Methods: We performed a cohort study of all long-term care residents of 25 nursing homes (bed size range, 90-360) in Connecticut during a 12-month observation period. The total number of residents in these facilities ranged from 2946 to 3212 per quarter.

Depression and cost-related medication nonadherence in Medicare beneficiaries.

Context: Treatment for depression can be expensive and depression can affect the use of other medical services, yet there is little information on how depression affects the prevalence of cost-related medication nonadherence (CRN) in elderly patients and patients with disabilities.

Objective: To quantify the presence of CRN in depressed and nondepressed elderly Medicare beneficiaries and nonelderly Medicare beneficiaries with disabilities prior to the implementation of the Medicare Drug Benefit.

Design And Setting: 2004 Medicare Current Beneficiary Survey.

Variation in nursing home antipsychotic prescribing rates.

Background: Excessive prescribing of antipsychotic therapy is a concern owing to their potential to cause serious adverse events. We explored variation in the use of antipsychotic therapy across nursing homes in Ontario, Canada, and determined if prescribing decisions were based on clinical indications.

Methods: A point-prevalence study of antipsychotic therapy use in 47 322 residents of 485 provincially regulated nursing homes in December 2003.

Patients at-risk for cost-related medication nonadherence: a review of the literature.

Objective: Up to 32% of older patients take less medication than prescribed to avoid costs, yet a comprehensive assessment of risk factors for cost-related nonadherence (CRN) is not available. This review examined the empirical literature to identify patient-, medication-, and provider-level factors that influence the relationship between medication adherence and medication costs.

Design: We conducted searches of four databases (MEDLINE, CINAHL, Sciences Citations Index Expanded, and EconLit) from 2001 to 2006 for English-language original studies.

Adverse drug events resulting from patient errors in older adults.

Objectives: To characterize the types of patient-related errors that lead to adverse drug events (ADEs) and identify patients at high risk of such errors.

Design: A subanalysis within a cohort study of Medicare enrollees.

Setting: A large multispecialty group practice.

Effect of New York State regulatory action on benzodiazepine prescribing and hip fracture rates.

Background: Medicare Part D excludes benzodiazepines from coverage, and numerous state government policies limit use of benzodiazepines. No data indicate that such policies have decreased the incidence of hip fracture.

Objective: To assess whether a statewide policy that decreased the use of benzodiazepines among elderly persons by more than 50% has decreased the incidence of hip fracture.

Racial differences in tumor stage and survival for colorectal cancer in an insured population.

Background: Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients.

Methods: This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems.

Statin therapy and risks for death and hospitalization in chronic heart failure.

Context: Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear.

Objective: To evaluate the association between initiation of statin therapy and risks for death and hospitalization among adults with chronic heart failure.

Design, Setting, And Patients: Propensity-adjusted cohort study of adults diagnosed with heart failure who were eligible for lipid-lowering therapy but had no previous known statin use, within an integrated health care delivery system in northern California between January 1, 1996, and December 31, 2004.