Zobrazení zdroje stránky Lausenwaters0067

6% experienced fracture at 24 months (women vs men 12 months, 4.8% vs 2.5%; 24 months, 8.3% vs 4.4%; both P less then .01). At 12 months, recent fracture conferred approximately 3-fold-higher fracture risk (vs no recent fracture). Older age, white race, female sex, osteoporosis-related screening/diagnosis/medication, antidepressant/antipsychotic/sedative hypnotic/muscle relaxant medications, history of falls, fracture history, and respiratory conditions also increased risk (all P less then .0001). The simplified model (recent fracture, age, sex, race, falls, antidepressant/antipsychotic/sedative hypnotic/muscle relaxant medications) performed well (C statistic = 0.71). CONCLUSIONS Recent fracture, older age, female sex, white race, falls, and antidepressant/antipsychotic/sedative hypnotic/muscle relaxant medications predict imminent fracture risk in an older-adult Medicare Advantage population. Imminent fracture risk can be assessed using 6 easily quantified factors.OBJECTIVES Hospitals have begun designing programs tailored to patients with intellectual disabilities to address their specific healthcare needs and social determinants of health. This study aimed to determine whether these programs improve hospital outcomes for patients with intellectual disabilities. STUDY DESIGN This cross-sectional, retrospective study analyzed data for patients with a primary or secondary diagnosis of intellectual disability and/or autism who were discharged from 5 hospitals participating in Vizient's Clinical Data Base/Resource Manager between January 2010 and September 2018. METHODS Generalized linear regression models were constructed to test the association between tailored program status and length of stay, cost, and cost per day, and a binary logistic regression model was constructed to test the association between tailored program status and 30-day readmission. A secondary analysis stratified patients by 3M All Patient Refined Diagnosis Related Groups grouper (the standard for inpatient classification) admission severity of illness (ASOI) score. RESULTS Of the 6618 patients included in the study, 29% were treated at hospitals with tailored programs. After controlling for patient demographic characteristics and clinical factors, patients treated at hospitals without programs had higher total costs (relative risk [RR], 1.06; P = .038) and cost per day (RR, 1.11; P less then .001). Patients with an extreme ASOI score who were treated at hospitals without programs had significantly longer stays (RR, 1.38; P = .001), higher total cost (RR, 1.42; P less then .001), and higher cost per day (RR, 1.10; P = .025) than patients treated at hospitals with programs. CONCLUSIONS Providing tailored programs for patients with intellectual disabilities is a promising strategy for improving inpatient care for this population.OBJECTIVES Cost-effectiveness estimates are useful to a health plan when they are specific to a utilization management policy question. To help inform a step therapy policy decision, this study assessed the 3-year cost-effectiveness of adding a sodium-glucose cotransporter 2 (SGLT2) inhibitor versus switching to a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in patients with type 2 diabetes who are on metformin and a dipeptidyl peptidase-4 (DPP-4) inhibitor from both private and public payer perspectives in the United States. STUDY DESIGN Cost-effectiveness analysis. METHODS A decision-analytic model was built incorporating goal glycated hemoglobin (A1C) achievement as the effectiveness measure, as well as adverse effect and discontinuation rates from clinical trial data. One-way, scenario, and probabilistic sensitivity analyses were performed. RESULTS In a cohort of 1000 patients, adding an SGLT2 inhibitor led to $3.9 million more in spending and 93 more patients reaching goal A1C compared with switching from a DPP-4 inhibitor to a GLP-1 RA. This resulted in an incremental cost-effectiveness ratio (ICER) of $42,125&nbsp;per patient to achieve goal A1C from the private payer perspective. Using a public payer perspective led to an ICER of $103,829. These results were most sensitive to changes in drug costs and the proportion of patients achieving A1C goal or discontinuing. CONCLUSIONS Assuming a $50,000 willingness-to-pay threshold, adding an SGLT2 inhibitor was cost-effective compared with switching from a DPP-4 inhibitor to a GLP-1 RA from a private payer perspective but not from a public payer perspective. This study highlights how differences in payer reimbursement rates for medications can lead to contrasting results.OBJECTIVES To examine the effects of MD-Value in Prevention (MDVIP) enrollment on Medicare expenditures and utilization among fee-for-service (FFS) beneficiaries with diabetes over a 5-year period. STUDY DESIGN We obtained participating physician and beneficiary enrollment lists from MDVIP and Medicare FFS claims data through the Virtual Research Data Center to compare changes in outcomes, before and after enrollment dates, with those of nonenrolled beneficiaries receiving primary care in the same local market. METHODS We employed propensity score matching to identify comparison beneficiaries similar in observed characteristics and preenrollment trends. [https://www.selleckchem.com/products/VX-765.html selleck inhibitor] Individual fixed effects were used to control for time-consistent differences between treatment and comparison populations. RESULTS We found that enrollment is statistically associated with reductions in outpatient expenditures, Medicare expenditures in year 5, emergency department (ED) utilization, and unplanned inpatient admissions, accompanied by significant increases in evaluation and management visits and expenditures. Total Medicare expenditures over the 5-year period, as well as all inpatient admissions, were not statistically different between the MDVIP and comparison groups. CONCLUSIONS Our finding of reduced unplanned inpatient admissions and ED utilization supports the previous findings regarding MDVIP enrollees. We did not find significant changes in overall third-party expenditures, although savings were estimated in year 5, the last year of observation, and may occur later. Our approach, however, strengthens controls for baseline characteristics of the population and uses a comparison population drawn from the same markets who do not experience the loss of their primary care physician at the time of enrollment.