Medicare Enrollment and Spending Among Patients Initiating Dialysis After the Affordable Care Act.

Importance: Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. Medicare enrollment may have slowed for patients with incident ESKD who gained access to new private insurance options with the 2014 passage of the Affordable Care Act (ACA) and introduction of the ACA Marketplace.

Objective: To describe trends in public and private insurance coverage and dialysis spending among patients with incident ESKD from 2012 to 2017.

Defining key deprescribing measures from electronic health data: A multisite data harmonization project.

Background: Stopping or reducing risky or unneeded medications ("deprescribing") could improve older adults' health. Electronic health data can support observational and intervention studies of deprescribing, but there are no standardized measures for key variables, and healthcare systems have differing data types and availability. We developed definitions for chronic medication use and discontinuation based on electronic health data and applied them in a case study of benzodiazepines and Z-drugs in five diverse US healthcare systems.

The Social Risk ACTIONS Framework: Characterizing Responses to Social Risks by Health Care Delivery Organizations.

Social risks refer to individuals' social and economic conditions shaped by underlying social determinants of health. Health care delivery organizations increasingly screen patients for social risks given their potential impact on health outcomes. However, it can be challenging to meaningfully address patients' needs.

A comparison of time-varying propensity score vs sequential stratification approaches to longitudinal matching with a time-varying treatment.

Background: Methods for matching in longitudinal cohort studies, such as sequential stratification and time-varying propensity scores, facilitate causal inferences in the context of time-dependent treatments that are not randomized where patient eligibility or treatment status changes over time. The tradeoffs in available approaches have not been compared previously, so we compare two methods using simulations based on a retrospective cohort of patients eligible for weight loss surgery, some of whom received it.

Methods: This study compares matching completeness, bias, coverage, and precision among three approaches to longitudinal matching: (1) time-varying propensity scores (tvPS), (2) sequential stratification that matches exactly on all covariates used in tvPS (SS-Full) and (3) sequential stratification that exact matches on a subset of covariates (SS-Selected).

Outcomes of Community-Acquired Acute Kidney Injury: A Cohort Study of US Veterans.

Background: Community-acquired acute kidney injury (CA-AKI) occurs outside of the hospital and is the most common form of AKI. CA-AKI is not well understood, which hinders efforts to prevent, identify, and manage CA-AKI.

Objective: Examine 30-day outcomes following CA-AKI using national administrative and lab data from the Veterans Health Administration (VA).

Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients.

Background: Social risks (individual social and economic conditions) have been implicated as playing a major role in the opioid epidemic and may be more prevalent in the most medically vulnerable patients. However, the extent to which specific social risks and other patient factors are associated with opioid use among high-risk patients has not been comprehensively assessed.

Objective: To identify patient-reported and electronic health record (EHR)-derived demographic, social, behavioral/psychological, and clinical characteristics associated with opioid use in Veterans Affairs (VA) patients at high risk for hospitalization or death.

Patient education and extracorporeal membrane oxygenation preferences of patients and providers in COVID care.

Background: Extracorporeal membrane oxygenation (ECMO) represents an important but limited treatment for patients with severe COVID-19. We assessed the effects of an educational intervention on a person's ECMO care preference and examined whether patients and providers had similar ECMO preferences.

Methods: In the Video+Survey group, patients watched an educational video about ECMO's purpose, benefits, and risks followed by an assessment of ECMO knowledge and care preferences in seven scenarios varying by hypothetical patient age, function, and comorbidities.

The association between social risks and days at home for older veterans.

Background: Many health systems are trying to support the ability of older adults to remain in their homes for as long as possible. Little is known about the relationship between patient-reported social risks and length of time spent at home. We assessed how social risks were associated with days at home for a cohort of older Veterans at high risk for hospitalization and mortality.

Regional variation in financial hardship among US veterans during the COVID-19 pandemic.

Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform.

Generalizability of Randomized Clinical Trial Outcomes for Diabetes Control Resulting From Bariatric Surgery.

Objective: To assess the external validity of randomized controlled trials (RCTs) of bariatric surgical treatment on diabetes control.

Background: Multisite RCTs provide the strongest evidence supporting clinical treatments and have the greatest internal validity. However, characteristics of trial participants may not be representative of patients receiving treatment in the real world.

Association between a national behavioral weight management program and real-world weight change.

Objective: In a national cohort of Veterans, weight change was compared between participants in a US Department of Veterans Affairs (VA) behavioral weight management program (MOVE!) and matched non-participants, and between high-intensity and low-intensity participants.

Methods: Retrospective cohort study of Veterans with 1 + MOVE! visits in 2008-2017 were matched to MOVE! non-participants via sequential stratification. Percent weight change up to two years after MOVE! initiation of participants and non-participants was modeled using generalized additive mixed models, and 1-year weight change of high-intensity or low-intensity participants was also compared.

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries.

Background: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive medication review (CMR) to all beneficiaries who qualify, and provides a platform to reduce PIM use. The objective of this study was to assess the impact of CMR on PIM discontinuation in Medicare beneficiaries and whether this differed by race or ethnicity.

Health Expenditures After Bariatric Surgery: A Retrospective Cohort Study.

Objective: To compare expenditures between surgical and matched nonsurgical patients in a retrospective cohort study.

Background: Bariatric surgery leads to substantial improvements in weight and weight-related conditions, but prior literature on postsurgical health expenditures is equivocal.

Methods: In a retrospective study, total outpatient, inpatient, and medication expenditures 3 years before and 5.

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure.

Importance: Comprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourage the use of CMRs.

Objective: To examine trends in CMR completion rates before and after 2016 and whether racial, ethnic, and socioeconomic disparities in CMR completion changed.

Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection.

Importance: Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations-that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings.

Objective: To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans.

Hospital response to a new case-based payment system in China: the patient selection effect.

Providers have intended and unintended responses to payment reforms, such as China's new case-based payment system, i.e. Diagnosis-Intervention Packet (DIP) under global budget, that classified patients based on the combination of principal diagnosis and procedures.