A care coordination program to support patients with hepatitis B virus at Kaiser Permanente Mid-Atlantic States.

Background: Eliminating hepatitis B virus (HBV) is a significant worldwide challenge requiring innovative approaches for vaccination, screening, disease management, and the prevention of related conditions. Programs that support patients in accessing needed clinical services can help optimize access to preventive services and treatment resources for hepatitis B.

Methods: Here, we outline a coordinator-supported program (HBV Pathway) that connects patients infected with HBV to laboratory testing, imaging, and specialty care for treatment initiation and/or liver cancer surveillance (screening of high-risk patients for liver cancer).

Time to Second-line Treatment and Subsequent Relative Survival in Older Patients With Relapsed Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma.

Background: Novel targeted therapies offer excellent short-term outcomes in patients with chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL). However, there is disagreement over how widely these therapies should be used in place of standard chemo-immunotherapy (CIT). We investigated whether stratification on the length of the interval between first-line (T1) and second-line (T2) treatments could identify a subgroup of older patients with relapsed CLL/SLL with an expectation of normal overall survival, and for whom CIT could be an acceptable treatment choice.

Updating survival estimates in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL) based on treatment-free interval length.

We hypothesized that the length of treatment-free survival following (a) initial diagnosis and (b) first-line treatment would be associated with improved subsequent five-year relative survival (RS5) in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL). 19,879 patients incident CLL/SLL cases (median age = 76 years) were identified from SEER-Medicare. RS5 improved from 0.

Geographic variation in the use of adjuvant therapy among elderly patients with resected non-small cell lung cancer.

Objectives: The purpose of this study was to assess to what extent geographic variation in adjuvant treatment for non-small cell lung cancer (NSCLC) patients would remain, after controlling for patient and area-level characteristics.

Materials And Methods: A retrospective cohort of 18,410 Medicare beneficiaries with resected, stage I-IIIA NSCLC was identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Adjuvant therapies were classified as adjuvant chemotherapy (ACT), postoperative radiation therapy (PORT), or no adjuvant therapy.

Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care: Analysis of Surveillance, Epidemiology and End Results-Medicare Data.

Background: Evidence suggests that high-volume facilities achieve better rectal cancer outcomes.

Methods: Logistic regression was used to evaluate association of facility type with treatment after adjusting for patient demographics, stage, and comorbidities. SEER-Medicare beneficiaries who were diagnosed with stage II/III rectal adenocarcinoma at age ≥66 years from 2005 to 2009 and had Parts A/B Medicare coverage for ≥1 year prediagnosis and postdiagnosis plus a claim for cancer-directed surgery were included.

Treatment of diffuse large B-cell lymphoma in the elderly: regimens without anthracyclines are common and not futile.

Anthracycline-containing regimens (ACRs) are recommended for patients with diffuse large B-cell lymphoma (DLBCL). However, over 40% of elderly patients do not receive ACRs, possibly due to expected toxicities. We characterized treatment choices and compared the 3-year overall survival (OS) rates of 8262 Medicare beneficiaries diagnosed with DLBCL in 2000-2006 identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.

Beyond comorbidity: expanding the definition and measurement of complexity among older adults using administrative claims data.

Background: Studies of patients with multiple chronic conditions using claims data are often missing important determinants of treatments and outcomes, such as function status and disease severity. We sought to identify and evaluate a class of function-related indicators (FRIs) from administrative claims data.

Population: The study cohort comprised US Medicare beneficiaries aged 65 years or older with Parts A and B fee-for-service and Part D coverage, with a hospitalization for acute myocardial infarction during 2007.

Personal health records: a randomized trial of effects on elder medication safety.

Purpose: To examine the impact of a personal health record (PHR) on medication-use safety among older adults.

Background: Online PHRs have potential as tools to manage health information. We know little about how to make PHRs accessible for older adults and what effects this will have.

Development and initial assessment of the medication user self-evaluation (MUSE) tool.

Background: Using patient-reported data to supplement claims-based indicators may be helpful in identifying Medicare beneficiaries likely to benefit from medication therapy management (MTM) services.

Objective: Our objective was to develop and initially assess a patient medication user self-evaluation (MUSE) tool to identify Medicare Part D beneficiaries who would benefit from a comprehensive medication review.

Methods: A random sample of 225 patient medication profiles was created from a survey of Medicare beneficiaries; the survey also included demographic characteristics, responses to adherence questions, and reported symptoms.

Standardizing Medicare payment information to support examining geographic variation in costs.

Objectives: Examination of efficiency in health care requires that cost information be normalized. Medicare payments include both geographic and policy-based facility type differentials (e.g.

Survival implications associated with variation in mastectomy rates for early-staged breast cancer.

Despite a 20-year-old guideline from the National Institutes of Health (NIH) Consensus Development Conference recommending breast conserving surgery with radiation (BCSR) over mastectomy for woman with early-stage breast cancer (ESBC) because it preserves the breast, recent evidence shows mastectomy rates increasing and higher-staged ESBC patients are more likely to receive mastectomy. These observations suggest that some patients and their providers believe that mastectomy has advantages over BCSR and these advantages increase with stage. These beliefs may persist because the randomized controlled trials (RCTs) that served as the basis for the NIH guideline were populated mainly with lower-staged patients.

Diffuse large B-cell lymphoma in the elderly: diffusion of treatment with rituximab and survival advances with and without anthracyclines.

Anthracycline-based chemotherapy (ABC) is the most effective therapy for diffuse large B-cell lymphoma (DLBCL). The addition of rituximab to ABC in controlled trials has demonstrated superior survival, yet ABC is inconsistently utilized in elderly patients, and little is known about the penetrance or impact of rituximab with other treatments. We analyzed the treatment and survival patterns of 7559 patients with DLBCL over age 66 diagnosed from 1992 to 2002 using a linked Surveillance, Epidemiology and End Results (SEER)-Medicare database.

Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries.

Background: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.

Methods: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD).

Outcomes following local therapy for early-stage breast cancer in non-trial populations.

Recent studies suggest trends toward more mastectomies for primary breast cancer treatment. We assessed survival after mastectomy and breast-conserving surgery (BCS) with radiation for early-stage breast cancer among non-selected populations of women and among women similar to those in clinical trials. Using population-based data from Surveillance Epidemiology, and End Results cancer registries linked with Medicare administrative data from 1992 to 2005, we conducted propensity score analysis of survival following primary therapy for early-stage breast cancer, including BCS with radiation, BCS without radiation, mastectomy with radiation, and mastectomy without radiation.

Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries.

Background: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

Methods: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.

Continuity of care with a primary care physician and mortality in older adults.

Background: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

Methods: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans.

The aftermath of hip fracture: discharge placement, functional status change, and mortality.

The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993-2005. There were 495 postbaseline hip fractures among 5,511 respondents aged >or=69 years.

Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults.

Objectives: To determine the association between inappropriate medication use and self-reported adverse drug effects (ADEs).

Design: Prospective cohort study with three annual mailed surveys.

Setting: Population-based sample of Iowa Medicare beneficiaries.

A 12-year prospective study of stroke risk in older Medicare beneficiaries.

Background: 5.8 M living Americans have experienced a stroke at some time in their lives, 780K had either their first or a recurrent stroke this year, and 150K died from strokes this year. Stroke costs about $66B annually in the US, and also results in serious, long-term disability.

Recent hospitalization and the risk of hip fracture among older Americans.

Background: We identified hip fracture risks in a prospective national study.

Methods: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare.

Emergency department utilization patterns among older adults.

Background: We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them.

Methods: A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older.

The use of chiropractors by older adults in the United States.

Background: In a nationally representative sample of United States Medicare beneficiaries, we examined the extent of chiropractic use, factors associated with seeing a chiropractor, and predictors of the volume of chiropractic use among those having seen one.

Methods: We performed secondary analyses of baseline interview data on 4,310 self-respondents who were 70 years old or older when they first participated in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). The interview data were then linked to their Medicare claims.

An interpersonal continuity of care measure for Medicare Part B claims analyses.

Objectives: This article presents an interpersonal continuity of care measure.

Methods: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals.

Hospital episodes and physician visits: the concordance between self-reports and medicare claims.

Background: Health services use typically is examined using either self-reports or administrative data, but the concordance between the 2 is not well established.

Objective: We evaluated the concordance of hospital and physician utilization data from self-reports and claims data, and identified factors associated with disagreement.

Methods: We performed a secondary analysis on linked observational and administrative data.