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Enrollment Files (enrollment + file)
Selected AbstractsHow Much Is Postacute Care Use Affected by Its Availability?HEALTH SERVICES RESEARCH, Issue 2 2005Melinda Beeuwkes Buntin Objective. To assess the relative impact of clinical factors versus nonclinical factors,such as postacute care (PAC) supply,in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. Data Sources and Study Setting. Medicare acute hospital, IRF, and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data. Study Design. We used multinomial logit models to predict PAC use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements. Data Collection/Extraction Methods. A file was constructed linking acute and postacute utilization data for all medicare patients hospitalized in 1999. Principal Findings. PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there. Conclusions. We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes,or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes. [source] Effect of an Expenditure Cap on Low-Income Seniors' Drug Use and Spending in a State Pharmacy Assistance ProgramHEALTH SERVICES RESEARCH, Issue 3 2009Christine E. Bishop Objective. To estimate the impact of a soft cap (a ceiling on utilization beyond which insured enrollees pay a higher copayment) on low-income elders' use of prescription drugs. Data Sources and Setting. Claims and enrollment files for the first year ( June 2002 through May 2003) of the Illinois SeniorCare program, a state pharmacy assistance program, and Medicare claims and enrollment files, 2001 through 2003. SeniorCare enrolled non-Medicaid-eligible elders with income less than 200 percent of Federal Poverty Level. Minimal copays increased by 20 percent of prescription cost when enrollee expenditures reached $1,750. Research Design. Models were estimated for three dependent variables: enrollees' average monthly utilization (number of prescriptions), spending, and the proportion of drugs that were generic rather than brand. Observations included all program enrollees who exceeded the cap and covered two periods, before and after the cap was exceeded. Principle Findings. On average, enrollees exceeding the cap reduced the number of drugs they purchased by 14 percent, monthly expenditures decreased by 19 percent, and the proportion generic increased by 4 percent, all significant at p<.01. Impacts were greater for enrollees with greater initial spending, for enrollees without one of five chronic illness diagnoses in the previous calendar year, and for enrollees with lower income. Conclusions. Near-poor elders enrolled in plans with caps or coverage gaps, including Part D plans, may face sharp declines in utilization when they exceed these thresholds. [source] Do Hierarchical Condition Category Model Scores Predict Hospitalization Risk in Newly Enrolled Medicare Advantage Participants as Well as Probability of Repeated Admission Scores?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2009David G. Mosley MHA OBJECTIVES: To compare how well hierarchical condition categories (HCC) and probability of repeated admission (PRA) scores predict hospitalization. DESIGN: Longitudinal cohort study with 12-month follow-up. SETTING: A Medicare Advantage (MA) plan. PARTICIPANTS: Four thousand five hundred six newly enrolled beneficiaries. MEASUREMENT: HCC scores were identified from enrollment files. The PRA tool was administered by mail and telephone. Inpatient admissions were based on notifications. The Mann-Whitney test was used to compare HCC scores of PRA responders and nonresponders. The receiver operating characteristic curve provided the area under the curve (AUC) for each score. Admission risk in the top 5% of scores was evaluated using logistic regression. RESULTS: Within 60 days of enrollment, 45.1% of the 3,954 beneficiaries with HCC scores completed the PRA tool. HCC scores were lower for the 1,783 PRA respondents than the 2,171 nonrespondents (0.71 vs 0.81, P<.001). AUCs predicting hospitalization with regard to HCC and PRA were similar (0.638, 95% confidence interval (CI)=0.603,0.674; 0.654, 95% CI=0.618,0.690). Individuals identified in the top 5% of scores using both tools, using HCC alone, or using PRA alone had higher risk for hospitalization than those below the 95th percentile (odds ratio (OR)=8.5, 95% CI=3.7,19.4, OR=3.8, 95% CI=2.3,6.3, and OR=3.9, 95% CI=2.3,6.4, respectively). CONCLUSION: HCC scores provided to MA plans for risk adjustment of revenue can also be used to identify hospitalization risk. Additional studies are required to evaluate whether a hybrid approach incorporating administrative and self-reported models would further optimize risk stratification efforts. [source] Assessment and Interpretation of Comorbidity Burden in Older Adults with CancerJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2009Siran M. Koroukian PhD OBJECTIVES: To evaluate the associations between comorbidities, functional limitations, geriatric syndromes, treatment patterns, and outcomes in a population-based cohort of older patients diagnosed with colorectal cancer and receiving home health care. DESIGN: Retrospective study. SETTING: Data from the Ohio Cancer Incidence Surveillance System, Medicare claims and enrollment files, and the home health care Outcome and Assessment Information Set. PARTICIPANTS: Ohio residents diagnosed with incident colorectal cancer in 1999 to 2001 and receiving home health care in the 30 days before or after cancer diagnosis (N=957). MEASUREMENTS: Outcome measures included receipt of cancer treatment and survival through 2005. RESULTS: Not having surgery was associated negatively with comorbidities but positively with functional limitations and geriatric syndromes. Receipt of chemotherapy was negatively associated with comorbidities and functional limitations. The presence of two or more geriatric syndromes was significantly associated with unfavorable survival outcomes when analyzing overall survival and disease-specific survival (DSS). Having limitations in two or more activities of daily living was associated with unfavorable overall survival but not with DSS. Comorbity was associated with favorable DSS at borderline level of statistical significance but not with overall survival. CONCLUSION: The findings highlight the importance of incorporating functional limitations and geriatric syndrome data in geriatric oncology outcomes studies. [source] Multimorbidity and Survival in Older Persons with Colorectal CancerJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006Cary P. Gross MD OBJECTIVES: To ascertain the effect of common chronic conditions on mortality in older persons with colorectal cancer. DESIGN: Retrospective cohort study. SETTING: Population-based cancer registry. PARTICIPANTS: Patients in the Surveillance Epidemiology and End Results,Medicare linked database who were aged 67 and older and had a primary diagnosis of Stage 1 to 3 colorectal cancer during 1993 through 1999. MEASUREMENTS: Chronic conditions were identified using claims data, and vital status was determined from the Medicare enrollment files. After estimating the adjusted hazard ratios for mortality associated with each condition using a Cox model, the population attributable risk (PAR) was calculated for the full sample and by age subgroup. RESULTS: The study sample consisted of 29,733 patients, 88% of whom were white and 55% were female. Approximately 9% of deaths were attributable to congestive heart failure (CHF; PAR =9.4%, 95% confidence interval (CI) =8.4,10.5%), more than 5% were attributable to chronic obstructive pulmonary disease (COPD; PAR =5.3%, 95% CI=4.7,6.6%), and nearly 4% were attributable to diabetes mellitus (PAR =3.9%, 95% CI=3.1,4.8%). The PAR associated with CHF increased with age, from 6.3% (95% CI=4.4,8.8%) in patients aged 67 to 70 to 14.5% (95% CI=12.0,17.5%) in patients aged 81 to 85. Multiple conditions were common. More than half of the patients who had CHF also had diabetes mellitus or COPD. The PAR associated with CHF alone (4.29%, 95% CI=3.68,4.94%) was similar to the PAR for CHF in combination with diabetes mellitus (3.08, 95% CI=2.60,3.61%) or COPD (3.93, 95% CI=3.41,4.54%). CONCLUSION: A substantial proportion of deaths in older persons with colorectal cancer can be attributed to CHF, diabetes mellitus, and COPD. Multimorbidity is common and exerts a substantial effect on colorectal cancer survival. [source] | ||||||||||