Geographic and facility variation in inpatient stroke rehabilitation: multilevel analysis of functional status.

Objective: To examine geographic and facility variation in cognitive and motor functional outcomes after postacute inpatient rehabilitation in patients with stroke.

Design: Retrospective cohort design using Centers for Medicare and Medicaid Services (CMS) claims files. Records from 1209 rehabilitation facilities in 298 hospital referral regions (HRRs) were examined.

The effect of postoperative beam, implant, and combination radiation therapy on GI and bladder toxicities in female Medicare beneficiaries with stage I uterine cancer.

OBJECTIVE: Determine the risk of late gastrointestinal (GI) and bladder toxicities in women treated for Stage I uterine cancer with postoperative beam, implant, or combination radiation. METHODS: The Surveillance, Epidemiology, and End Results (SEER) tumor registry and Medicare claims were used to estimate the risk of developing late GI and bladder toxicities by type of radiation received. Bladder and GI diagnoses were identified 6-60 months after cancer diagnosis.

Socioeconomic status and chemotherapy use for melanoma in older people.

The study objective was to examine the association, among older persons with cutaneous melanoma, between areal socioeconomic status (SES) and receiving chemotherapy. SEER-Medicare-linked database (1,239 white men and women aged ≥ 66, with invasive melanoma [regional and distant stages]; 1991-1999) was used. SES was measured by census tract poverty level (average of 1990 and 2000 Census data).

Atrial fibrillation and stroke associated with intravenous bisphosphonate therapy in older patients with cancer.

Purpose: Recent studies have linked the use of intravenous and orally administered bisphosphonates with subsequent development of atrial fibrillation. Patients with cancer who receive intravenous bisphosphonate therapy may be at particular risk for this adverse event because they receive higher doses of these drugs than do patients treated for other indications. We examined the association of intravenous bisphosphonates with atrial fibrillation, all classifications of supraventricular tachycardia (SVT), and stroke among older patients with cancer.

Outpatient follow-up visit and 30-day emergency department visit and readmission in patients hospitalized for chronic obstructive pulmonary disease.

Background: Readmissions in patients with chronic obstructive pulmonary disease (COPD) are common and costly. We examined the effect of early follow-up visit with patient's primary care physician (PCP) or pulmonologist following acute hospitalization on the 30-day risk of an emergency department (ER) visit and readmission.

Methods: We conducted a retrospective cohort study of fee-for-service Medicare beneficiaries with an identifiable PCP who were hospitalized for COPD between 1996 and 2006.

Dissecting racial disparities in the treatment of patients with locoregional pancreatic cancer: a 2-step process.

Background: Previous studies have demonstrated that black patients with pancreatic cancer are less likely to undergo resection and have worse overall survival compared with white patients. The objective of this study was to determine whether these disparities occur at the point of surgical evaluation or after evaluation has taken place.

Methods: The authors used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data (1992-2002) to compare black patients and white patients with locoregional pancreatic cancer in univariate models.

Readmission after pancreatectomy for pancreatic cancer in Medicare patients.

Objective: The objective of this study was to use a population-based dataset to evaluate the number of readmissions and reasons for readmission in Medicare patients undergoing pancreatectomy for pancreatic cancer.

Methods: We used Surveillance, Epidemiology, and End Results-Medicare linked data (1992-2003) to evaluate the initial hospitalization, readmission rates within 30 days (early), and between 30 days and 1 year (late) after initial discharge and reasons for readmission in patients 66 years and older undergoing pancreatectomy.

Results: We identified 1,730 subjects who underwent pancreatectomy for pancreatic cancer.

Continuity of outpatient and inpatient care by primary care physicians for hospitalized older adults.

Context: Little is known about the extent of continuity of care across the transition from outpatient care to hospitalization.

Objectives: To describe continuity of care in older hospitalized patients, change in continuity over time, and factors associated with discontinuity.

Design, Setting, And Participants: A retrospective cohort study of 3,020,770 hospital admissions between 1996 and 2006 using enrollment and claims data for a 5% national sample of Medicare beneficiaries older than 66 years.

Correlates of bacterial pneumonia hospitalizations in elders, Texas border.

Background: Immunization preventable bacterial pneumonia is an Agency for Healthcare Research and Quality (AHRQ) prevention quality indicator of health care. This study explored associations of individual and county correlates with bacterial pneumonia hospitalization rates for elders residing in 32 Texas counties bordering Mexico.

Methods: We estimated baseline rates from Texas Health Care Information Collection's hospital discharge data for 1999-2001, and population counts from the 2000 U.

Growth in the care of older patients by hospitalists in the United States.

Background: National and population-based information on the increase in patient care by hospitalists in the United States is lacking.

Methods: Using a 5% sample of Medicare beneficiaries in 1995, 1997, 1999, and the period from 2001 through 2006, we identified 120,226 physicians in general internal medicine who were providing care to older patients in 5800 U.S.

Ethnic differences in in-hospital place of death among older adults in California: effects of individual and contextual characteristics and medical resource supply.

Background: : Substantial ethnic differences have been reported in the probability that death will occur in a hospital setting rather than at home, in a hospice, or in a nursing home. To date, no study has investigated the role of both individual characteristics and contextual characteristics, including local health care environments, to explain ethnic differentials in end-of-life care.

Objectives: : The study purpose is to examine ethnic differences in the association between death as a hospital in-patient and individual and contextual characteristics, as well as medical resource supply.

Risk of subsequent dementia diagnoses does not vary by types of adjuvant chemotherapy in older women with breast cancer.

Objective: Little is known about long-term cognitive side effects of adjuvant chemotherapy for breast cancer. We thus examined incidence of dementia diagnoses in older women diagnosed with breast cancer, stratified by types of chemotherapy regimen.

Methods: We identified patients with incident dementia diagnoses through Medicare claims linked to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry data.

Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care.

Background: Preexisting dementia affects cancer care. Knowledge of how dementia affects survival after a cancer diagnosis may help guide cancer care decisions. We therefore examined the associations between preexisting diagnoses of dementia and survival from breast, colon, and prostate cancer.

672 patients with acinar cell carcinoma of the pancreas: a population-based comparison to pancreatic adenocarcinoma.

Background: Acinar cell carcinoma (ACC) is a rare cancer of the pancreas accounting for approximately 1% of nonendocrine tumors. Because no large series of patients with ACC exist, our understanding of this disease comes mainly from small retrospective reports and anecdotal experience.

Objective: Our goal was to evaluate a large population-based cohort of patients with ACC and compare their demographic factors and outcomes to those of patients with pancreatic adenocarcinoma (PA).

Outcomes following pancreatic resection: variability among high-volume providers.

Background: A strong volume-outcome relationship has been demonstrated for pancreatic resection, and regionalization of care to high-volume centers (>11 resections/year) has been recommended. However, it is unclear if volume alone should be the sole criteria for regionalization. The objective of this study is to evaluate variability in outcomes among high-volume hospitals (>11 resections/year).

Reducing the effects of lead-time bias, length bias and over-detection in evaluating screening mammography: a censored bivariate data approach.

Measuring the benefit of screening mammography is difficult due to lead-time bias, length bias and over-detection. We evaluated the benefit of screening mammography in reducing breast cancer mortality using observational data from the SEER-Medicare linked database. The conceptual model divided the disease duration into two phases: preclinical (T(0)) and symptomatic (T(1)) breast cancer.

Survival advantage in Medicare patients receiving drug-eluting stents compared with bare metal stents: real or artefactual?

Background: Concerns have been raised regarding late mortality, particularly from late stent thrombosis, from drug-eluting stents (DES). Randomized clinical trials have shown that DES decrease restenosis but do not decrease mortality compared with bare metal stents (BMS). These studies utilized well-defined clinical and angiographic subsets.

Characteristics of urologists predict the use of androgen deprivation therapy for prostate cancer.

Purpose: We previously have reported wide variations among urologists in the use of androgen deprivation for prostate cancer. Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we examined how individual urologist characteristics influenced the use of androgen deprivation therapy.

Methods: Participants included 82,375 men with prostate cancer who were diagnosed from January 1, 1992, through December 31, 2002, and the 2,080 urologists who provided care to them.

Mammography use among older Mexican-American women: correcting for over-reports of breast cancer screening.

Objectives: To determine the accuracy of self-reported mammography use and generate a correction factor that adjusts for reporting errors among Mexican-American women.

Design: Self-reported mammography use was compared with a medical chart review.

Participants: A random sample of 199 Mexican-American women aged 50-74 in southeast Texas.

The influence of marital status on stage at diagnosis and survival of older persons with melanoma.

Background: Melanoma incidence and mortality had a sustained increase in the last 3 decades in the United States, especially among white older men. Little is known about the relationship between marital status and melanoma outcomes in older people. The objective of this study was to determine the association between marital status and stage at diagnosis and survival of older persons with cutaneous melanoma.

Trends and disparities in regionalization of pancreatic resection.

Background: The current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually.

Objective: To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at high-volume centers (>10 cases/year) in Texas.

Methods: Using the Texas Hospital Inpatient Discharge Public Use Data File, we evaluated trends in the percentage of patients undergoing pancreatic resection at high-volume centers (>10 cases/year) from 1999 to 2004 and determined the factors that independently predicted resection at high-volume centers.

Evaluating health care performance: strengths and limitations of multilevel analysis.

An increasing number of health services researchers are using multilevel analysis for evaluating health care performance. This method has the distinct advantage of accounting for within-provider correlation among patients. Alternatively, in a similar manner, estimators based on cluster sampling can also adjust for within-provider correlation.

Intravenous bisphosphonate therapy and inflammatory conditions or surgery of the jaw: a population-based analysis.

Background: Recent reports have identified an association between osteonecrosis of the jaw or facial bones and treatment with nitrogen-containing intravenous bisphosphonates. We investigated this association by use of data from the Surveillance, Epidemiology, and End Results (SEER) program linked to Medicare claims.

Methods: We identified 16,073 cancer patients who were diagnosed between January 1, 1986, and December 31, 2002, and were treated intravenously with the bisphosphonates pamidronate and/or zoledronic acid between January 1, 1995, and December 31, 2003.

Incidence of additional primary cancers in patients with invasive intraductal papillary mucinous neoplasms and sporadic pancreatic adenocarcinomas.

Background: Recent small studies have reported an incidence of 23% to 39% for additional primary cancers in patients with intraductal papillary mucinous neoplasms (IPMN) of the pancreas. There have been no population-based studies evaluating this incidence rate.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (1983 to 1991), we identified all patients with primary pancreatic cancers (sporadic and adenocarcinomas arising in IPMNs).