Trends and predictors of leaving before medically advised in US emergency departments from 2016 to 2021.

Background: Leaving before medically advised (BMA) is a significant issue in the US healthcare system, leading to adverse health outcomes and increased costs. Despite previous research, multi-year studies using up-to-date nationwide emergency department (ED) data, are limited. This study examines factors associated with leaving BMA from EDs and trends over time, before and during the COVID-19 pandemic.

Why wasn't mirabegron chosen for the first year of the CMS negotiation program?

Importance: The most used overactive bladder (OAB) medications are anticholinergics, which professional societies recommend avoiding in older patients given dementia risk. Cost prevents patients from switching to preferred beta-3 agonists. Mirabegron was the only beta-3 agonist eligible for the Centers for Medicare/Medicaid Services (CMS) 2023 Drug Negotiation Program (DNP).

A Comprehensive Approach to Reducing Patient Safety Indicators (PSI-90).

Background: PSI-90, a composite measure comprising ten indicators, reflects the quality of care during hospital stays. The Hospital-Acquired Condition Reduction Program (HACRP), a Centers for Medicare and Medical Services (CMS) program, assesses hospital performance based on quality measures, including PSI-90, with financial implications for poor performers.

Objectives: To evaluate PSI events, establish workflows for accurate documentation, and foster collaboration across clinical and administrative teams, with the ultimate objective of reducing PSI events.

Impact of Academic Medical Centers on Surgical Outcomes of Neighboring Non-Academic Medical Centers.

Introduction: We aimed to investigate the geographic variation of Academic Medical Centers (AMCs) across different healthcare markets and the impact on surgical outcomes in nearby non-AMCs.

Methods: Patients who underwent major surgery between 2016 and 2021 were identified from the Medicare Standard Analytic Files. Healthcare markets were delineated using Dartmouth Atlas hospital referral regions.

'Screening should not be based on ability to pay': Australian healthcare providers' and consumers' perspectives on public funding for non-invasive prenatal testing.

Background: Non-invasive prenatal testing (NIPT) does not receive any Medicare rebate. This study investigated the views of Australian healthcare providers and consumers on public funding of NIPT.

Materials And Methods: Two anonymous online, cross-sectional surveys were conducted from September 2022 to January 2023.

Association Between Positive Airway Pressure Therapy and Healthcare Costs Among Older Adults with Comorbid Obstructive Sleep Apnea and Common Chronic Conditions: An Actuarial Analysis.

Study Objectives: To determine the association between adherence to positive airway pressure and healthcare costs among a national sample of older adults with comorbid OSA and common chronic conditions.

Methods: Our data source was a random sample of Medicare administrative claims for years 2016-2019. Inclusion criteria included age >65 years and new diagnosis of OSA.

Impact of pericarditis on cardiovascular complications and healthcare utilization in patients with inflammatory bowel disease: a National Inpatient Sample study.

Background: Inflammatory bowel disease (IBD), which affects over 2.3 million people in the USA, involves chronic gut inflammation and can lead to cardiovascular complications, including pericarditis. Whether pericarditis in IBD patients is caused by medication, or by the disease itself, remains unclear.

A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty.

Background: Total joint arthroplasty (TJA) represents the single largest procedural cost for the Centers for Medicare & Medicaid Services. Discharge to a skilled nursing facility (SNF) remains a primary driver of post-acute care costs. The COVID-19 pandemic led to a decrease in number of discharges to SNFs.

Colorectal Cancer and Quality of Life: A Medicare Advantage Study by Race, Ethnicity, and Language.

Background And Methods: Colorectal cancer (CRC) treatment can influence health-related quality of life (HRQOL). This study examined HRQOL among older adults undergoing CRC treatment, and the conditional effects of race, ethnicity, and primary language. We conducted a retrospective cohort study of Medicare Advantage enrollees ≥ 65 years old who completed the Medicare Health Outcomes Survey (MHOS) (2016-2020).

Interhospital Variability in 180-day Infections Following Cardiac Surgery.

Objective: This study sought to: (1) evaluate hospital-level variation in infections following cardiac surgery and (2) develop and evaluate a 180-day infection quality metric.

Methods: This study evaluated Medicare claims that were merged with institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database files among patients undergoing cardiac surgery across 33 Michigan centers. The primary outcome was an infection within 180 days of surgery.

Methodological standards for comparative effectiveness research: considerations for evidentiary review for medicare drug price negotiation.

Introduction: The 2022 Inflation Reduction Act (IRA) is expected to result in lower drug prices for Medicare beneficiaries in the United States (US). The Centers for Medicare & Medicaid Services (CMS) released the most recent draft guidance for the Medicare Drug Price Negotiation (DPN) program in May 2024.

Areas Covered: In August 2023, the list of 10 drugs selected for the DPN were published and the first round of negotiations are now complete.

Predictors of dilation difficulty in gender-affirming vaginoplasty.

A necessary component of postoperative care in gender-affirming vaginoplasty is the dilation of the neovaginal canal. Difficulty with dilation can cause patient pain and distress, often decreasing compliance and leading to partial or complete closure of the neovaginal canal. This study sought to evaluate the sociodemographic, operative, and comorbid characteristics that contribute to patient difficulty with neovaginal dilation.

The Cost-Effectiveness of CDK4/6 Inhibitors in Treating HR+/HER2- Metastatic Breast Cancer Patients in the USA: When Non-medication Expenses are Considered.

Background And Objective: Cyclin-dependent kinase (CDK)4/6 inhibitors in combination with endocrine therapy (ET) significantly enhance progression-free survival and overall survival in patients diagnosed with HR+/HER2- metastatic breast cancer (MBC). However, they are highly expensive, and their economic impact has not been fully evaluated. This is a retrospective secondary analysis evaluating the cost effectiveness of these drugs, differentiating between medication-related and non-medication costs from a healthcare perspective.

Variations in Revascularization Strategies for Chronic Limb-Threatening Ischemia: A Nationwide Analysis of Medicare Beneficiaries.

Background: Recent data support both surgical-first and endovascular-first revascularization approaches for chronic limb-threatening ischemia (CLTI), but hospital-based practices are poorly described.

Objectives: This aim of this study was to characterize contemporary variations and outcomes associated with each strategy among U.S.

Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: new user cohort study.

Objective: To compare the effectiveness and safety of budesonide-glycopyrrolate-formoterol, a twice daily metered dose inhaler, and fluticasone-umeclidinium-vilanterol, a once daily dry powder inhaler, in patients with chronic obstructive pulmonary disease (COPD) treated in routine clinical practice.

Design: New user cohort study.

Setting: Longitudinal commercial US claims data.

Segregation in hospital care for Medicare beneficiaries by race and ethnicity and dual-eligible status from 2013 to 2021.

Objective: To examine the extent of segregation between hospitals for Medicare beneficiaries by race, ethnicity, and dual-eligible status over time.

Data Sources And Study Setting: We used Medicare inpatient hospital provider data for fee-for-service (FFS) beneficiaries, and the Dartmouth Atlas of Health Care from 2013 to 2021 nationwide, for hospital referral regions (HRRs), and for and hospital service areas (HSAs).

Study Design: We conducted time trend analysis with dissimilarity indices (DIs) for Black (DI-Black), Hispanic (DI-Hispanic), non-White (including Black, Hispanic, and other non-White) (DI-non-White), and dual-eligible (DI-Dual) beneficiaries.

Clinical features associated with self-reported food insecurity in people with cystic fibrosis.

Background: Food insecurity (FI) is more prevalent in people with cystic fibrosis (PwCF) than the reported national prevalence, but there are limited data on the relationship between FI and health outcomes in PwCF. The objective of this study was to analyze the relationship between FI in PwCF and pulmonary and nutritional status.

Methods: We leveraged an electronic cross-sectional survey that ascertained FI status and gave participants the option to link their survey data to their records in the Cystic Fibrosis Foundation Patient Registry (CFFPR).

Location of Primary Tumor Impacts Survival After Pulmonary Metastasectomy for Colorectal Cancer.

Background: The benefit of pulmonary metastasectomy (PM) in patients with colorectal cancer (CRC) with isolated lung metastases remains unclear and failure to separate colon from rectal cancer may contribute. Utilizing a large national database, we investigate whether PM is associated with survival benefits in patients presenting with CRC with synchronous lung metastases based upon primary tumor location.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 was queried to identify patients with stage IV CRC with isolated synchronous lung metastases at initial diagnosis.

Advanced therapies in US veterans with rheumatoid arthritis-associated interstitial lung disease: a retrospective, active-comparator, new-user, cohort study.

Background: Uncertainty exists regarding patient outcomes when using TNF inhibitors versus other biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis-associated interstitial lung disease (ILD). We compared survival and respiratory hospitalisation outcomes following initiation of TNF-inhibitor or non-TNF inhibitor biological or targeted synthetic DMARDs for treatment of rheumatoid arthritis-associated ILD.

Methods: We did a retrospective, active-comparator, new-user, observational cohort study with propensity score matching following the target trial emulation framework using US Department of Veterans Affairs (VA) electronic and administrative health records.

Hospital Medicare Spending per Beneficiary: A Longitudinal Study.

Goal: While studies have examined quality and health outcomes related to the Centers for Medicare & Medicaid Services' (CMS's) Hospital Value-Based Purchasing (HVBP) Program, a significant gap exists in the literature regarding the relationship between pay-for-performance initiatives and hospital financial performance in the program's Efficiency and Cost Reduction domain. This study examined the association between hospitals' cost inefficiency and participation in the HVBP Program by estimating the probability and magnitude of improvement or achievement in the program's Efficiency and Cost Reduction domain.

Methods: The 2014-2019 Efficiency and Cost Reduction domain data were obtained from CMS and merged with the American Hospital Association's Annual Survey Database.

Novel Leech Antimicrobial Peptides, Hirunipins: Real-Time 3D Monitoring of Antimicrobial and Antibiofilm Mechanisms Using Optical Diffraction Tomography.

Antimicrobial peptides (AMPs) are promising agents for treating antibiotic-resistant bacterial infections. Although discovering novel AMPs is crucial for combating multidrug-resistant bacteria and biofilm-related infections, their clinical potential relies on precise, real-time evaluation of efficacy, toxicity, and mechanisms. Optical diffraction tomography (ODT), a label-free imaging technology, enables real-time visualization of bacterial morphological changes, membrane damage, and biofilm formation over time.

Health information technology to advance care in accountable care organizations: Implications for Medicare patients.

Background: Prior research has explored the link between health information technology (HIT) and performance of accountable care organizations (ACOs). However, the challenges of HIT use in ACOs for the management of chronic diseases among Medicare beneficiaries remain less examined.

Purpose: Given the high costs of implementing HIT and the occurrence of multiple chronic conditions (MCC) among elderly individuals, it is important to understand the extent to which HIT capabilities enable chronic disease management among the Medicare population.

Use of and Steering to Pharmacies Owned by Insurers and Pharmacy Benefit Managers in Medicare.

Importance: The prevalence of pharmacies owned by integrated insurers and pharmacy benefit managers (PBMs), or insurer-PBMs, is of growing regulatory concern. However, little is known about the role of these pharmacies in Medicare, in which pharmacy network protections may influence market dynamics.

Objective: To evaluate the prevalence of insurer-PBM-owned pharmacies and the extent to which insurer-PBMs steer patients to pharmacies they own in Medicare.

Medicaid Unwinding Experiences in Dual-Eligible Older Adults.

Importance: Dual-eligible older adults rely on Medicaid to pay for Medicare premiums and cost sharing in addition to supplemental services including dental and long-term care. However, the unique experiences of dual-eligible older adults with Medicaid unwinding remain unknown.

Objective: To assess the awareness and experiences of dual-eligible older adults with Medicaid redetermination.

High-Cost Cancer Drug Use in Medicare Advantage and Traditional Medicare.

Importance: Medicare Advantage (MA) plans are designed to incentivize the use of less expensive drugs through capitated payments, formulary control, and preauthorizations for certain drugs. These conditions may reduce spending on high-cost therapies for conditions such as cancer, a condition that is among the most expensive to treat.

Objective: To determine whether patients insured by MA plans receive less high-cost drugs than those insured by traditional Medicare (TM).