Leveraging Administrative Data for Program Evaluations: A Method for Linking Data Sets Without Unique Identifiers.

In community-based wellness programs, Social Security Numbers (SSNs) are rarely collected to encourage participation and protect participant privacy. One measure of program effectiveness includes changes in health care utilization. For the 65 and over population, health care utilization is captured in Medicare administrative claims data.

An overview of measurement activities in the partnership for patients.

The Partnership for Patients, launched in April 2011, is a national quality improvement initiative from the Department of Health and Human Services that has set ambitious goals for U.S. providers to improve patient safety and care transitions.

Cumulative expenditures under the DI, SSI, Medicare, and Medicaid programs for a cohort of disabled working-age adults.

Objective: To estimate cumulative DI, SSI, Medicare, and Medicaid expenditures from initial disability benefit award to death or age 65.

Data Sources: Administrative records for a cohort of new CY2000 DI and SSI awardees aged 18-64.

Study Design: Actual expenditures were obtained for 2000-2006/7.

Leveraging the big-data revolution: CMS is expanding capabilities to spur health system transformation.

As the largest single payer for health care in the United States, the Centers for Medicare and Medicaid Services (CMS) generates enormous amounts of data. Historically, CMS has faced technological challenges in storing, analyzing, and disseminating this information because of its volume and privacy concerns. However, rapid progress in the fields of data architecture, storage, and analysis--the big-data revolution--over the past several years has given CMS the capabilities to use data in new and innovative ways.

Development of a clinical registry-based 30-day readmission measure for coronary artery bypass grafting surgery.

Background: Reducing readmissions is a major healthcare reform goal, and reimbursement penalties are imposed for higher-than-expected readmission rates. Most readmission risk models and performance measures are based on administrative rather than clinical data.

Methods And Results: We examined rates and predictors of 30-day all-cause readmission following coronary artery bypass grafting surgery by using nationally representative clinical data (2008-2010) from the Society of Thoracic Surgeons National Database linked to Medicare claims records.

Racial segregation and maternal smoking during pregnancy: a multilevel analysis using the racial segregation interaction index.

Drawing from both the place stratification and ethnic enclave perspectives, we use multilevel modeling to investigate the relationships between women's race/ethnicity (i.e., non-Hispanic white, non-Hispanic black, Asian, and Hispanic) and maternal smoking during pregnancy, and examine if these relationships are moderated by racial segregation in the continental United States.

National trends in patient safety for four common conditions, 2005-2011.

Background: Changes in adverse-event rates among Medicare patients with common medical conditions and conditions requiring surgery remain largely unknown.

Methods: We used Medicare Patient Safety Monitoring System data abstracted from medical records on 21 adverse events in patients hospitalized in the United States between 2005 and 2011 for acute myocardial infarction, congestive heart failure, pneumonia, or conditions requiring surgery. We estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations.

Oral antibiotics at discharge for children with acute osteomyelitis: a rapid cycle improvement project.

Background: Substantial evidence demonstrates comparable cure rates for oral versus intravenous therapy for routine osteomyelitis. Evidence adoption is often slow and in our centre virtually all patients with osteomyelitis were discharged on intravenous therapy.

Objective: For patients with acute osteomyelitis admitted to the hospital medicine service, we aimed to increase the proportion of cases discharged on oral antibiotics to at least 70%.

Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population.

Objective: Endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries.

Methods: We examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008.

The relationship between the low-income subsidy and cost-related nonadherence to drug therapies in Medicare Part D.

Objectives: To examine the relationship between receiving the Medicare Part D low-income subsidy (LIS) and cost-related medication nonadherence (CRN).

Design: Cross-sectional.

Setting: Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collected in spring 2007.

Prevalence of multiple chronic conditions among Medicare beneficiaries, United States, 2010.

Introduction: The increase in chronic health conditions among Medicare beneficiaries has implications for the Medicare system. The objective of this study was to use the US Department of Health and Human Services Strategic Framework on multiple chronic conditions as a basis to examine the prevalence of multiple chronic conditions among Medicare beneficiaries.

Analysis: We analyzed Centers for Medicare and Medicaid Services administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program in 2010.

The Center For Medicare And Medicaid Innovation's blueprint for rapid-cycle evaluation of new care and payment models.

The Affordable Care Act established the Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models. The goal is to reduce program expenditures while preserving or improving the quality of care provided to beneficiaries of Medicare, Medicaid, and the Children's Health Insurance Program. Central to the success of the Innovation Center is a new, rapid-cycle approach to evaluation.

Diabetes prevention and the role of risk factor reduction in the Medicare population.

Medicare is keenly aware of the secular changes in weight gain and of the nearly parallel increases in both the incidence and prevalence of type 2 diabetes throughout the U.S. population.

National health spending in 2011: overall growth remains low, but some payers and services show signs of acceleration.

In 2011 US health care spending grew 3.9 percent to reach $2.7 trillion, marking the third consecutive year of relatively slow growth.

Medicare readmission rates showed meaningful decline in 2012.

Objective: Descriptive analysis of 30-day, all-cause hospital readmission rate patterns from 2007-2012.

Population: Medicare FFS beneficiaries experiencing at least one acute inpatient hospital stay.

Methods: Using Chronic Condition Data Warehouse claims, we estimate unadjusted, monthly, readmission rates for the nation, within the Dartmouth Hospital Referral Regions (HRR), and compare participating and non-participating hospitals in the Partnership for Patients (P4P) program (overall and by number of inpatient beds at each facility).

National health expenditure projections: modest annual growth until coverage expands and economic growth accelerates.

For 2011-13, US health spending is projected to grow at 4.0 percent, on average--slightly above the historically low growth rate of 3.8 percent in 2009.