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Medical Claims (medical + claim)
Selected AbstractsAmbulatory Use of Ticlopidine and Clopidogrel in Association with Percutaneous Coronary Revascularization Procedures in a National Managed Care OrganizationJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2002DEBORAH SHATIN PH.D. The aim of this study was to quantify ambulatory use of ticlopidine and clopidogrel in association -with percutaneous coronary revascularization procedures (PTCA, atherectomy, stent) in a national managed care organization. Retrospective administrative claims data over a 3-year period (1996,1998) from 12 UnitedHealth Group-affiliated health plans in four geographic regions were collected. Pharmacy and medical claims data were used to determine the patients exposed to ticlopidine and clopidogrel between January 1, 1996 and December 31, 1998, the duration of use, prescriptions within 2 weeks of a coronary procedure, and stent patients prescribed either drug within 2 weeks of stent placement in 1998. Substantial short-term use of ticlopidine and clopidogrel was found. The percentage of members with duration of use , 30 days ranged from 50.4% in 1996 to 56.9% in 1998 for ticlopidine and was 52.7% for clopidogrel. In 1998, 46% and 33% of ticlopidine and clopidogrel users, respectively, had a medical claim for a coronary procedure that fell within 2 weeks of a prescription. The rate was lower for Medicare beneficiaries. In 1998, 78% of stent patients filled a prescription for either drug within 2 weeks of stent implantation. Although little difference was found overall in the use of these agents across geographic regions, a higher proportion of stent patients in the Southeast were prescribed ticlopidine within this timeframe. The findings suggest that during the study time period ticlopidine and clopidogrel are frequently used off-label in association with percutaneous coronary revascularization procedures. These results were important in considering the overall benefit-risk profile. [source] Somnolence effects of antipsychotic medications and the risk of unintentional injury,,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Qayyim Said PhD Abstract Purpose This study examined the relationship between antipsychotic medications, categorized by published somnolence effects, and unintentional injury (UI). Methods The study population included patients of 18,64 years of age in a healthcare insurance database with claims from 2001 to 2004 and diagnoses of schizophrenia or affective disorder. A nested case-control design was used with cases defined by an E-code claim (a specified external cause of injury) for selected UIs. For cases, the index date referred to the first injury. For controls, the "control index date" was the date of claim if there was only a single medical claim; for patients with ,2 claims, one was selected at random as the "control index date." Both groups had a prescription for a first-generation antipsychotic (FGA) or second-generation antipsychotic (SGA) overlapping the index date. Potential somnolence effects were defined as: low (referent) , aripiprazole/ziprasidone; medium , risperidone; high , olanzapine/quetiapine: or any single FGA. Logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI) for UI, adjusted for gender, age, concomitant drug, and psychiatric diagnosis. Results Among 648 cases and 5214 controls, high-somnolence SGAs were associated with an OR of 1.41 95%CI (1.03,1.93) for risk of UI, while medium-somnolence SGAs, and FGAs had ORs of 1.17 95%CI (0.83,1.64) and 1.17 95%CI (0.79,1.74), respectively. When quetiapine and olanzapine were disaggregated, ORs were 1.61 95%CI (1.15,2.25) and 1.25 95%CI (0.89,1.74), respectively. Conclusions High-somnolence SGAs may lead to UI among patients. When prescribing antipsychotics, clinicians should consider potential somnolence. Copyright © 2008 John Wiley & Sons, Ltd. [source] The impact of publishing medical specialty society guidelines on subsequent adoption of best practices: a case study with type 2 diabetesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2010E. A. Huang Summary Aims:, Our goal was to determine the effect of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus algorithm for the initiation and adjustment of type 2 diabetes (T2D) therapy, published in 2006, on the incidence of early metformin monotherapy (EMM), defined as the prescription of metformin and no other antidiabetic medications within 30 days of initial T2D diagnosis. Methods:, The incidence of EMM in the United States (US) from January 2005 to December 2007 was estimated using data from the i3 InVisionÔ Data Mart, an integrated database of enrolment dates, inpatient and outpatient medical claims, pharmaceutical claims, and laboratory results from a diverse group of US health plans. The trend in the incidence of EMM was analysed using joinpoint regression modelling. Results:, A statistically significant joinpoint was found in July 2006 (p < 0.05). From January 2005 to July 2006, EMM increased at an annualised rate of 15.6%. From July 2006 to December 2007, EMM increased at an annualised rate of 66.0%. Conclusions:, Our findings suggest that publication of the ADA/EASD algorithm caused a significant acceleration in the incidence of EMM. [source] Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan membersINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2007Ronald C. Kessler Abstract The validity of the six-question World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener was assessed in a sample of subscribers to a large health plan in the US. A convenience subsample of 668 subscribers was administered the ASRS Screener twice to assess test-retest reliability and then a third time in conjunction with a clinical interviewer for DSM-IV adult ADHD. The data were weighted to adjust for discrepancies between the sample and the population on socio-demographics and past medical claims. Internal consistency reliability of the continuous ASRS Screener was in the range 0.63,0.72 and test-retest reliability (Pearson correlations) in the range 0.58,0.77. A four-category version The ASRS Screener had strong concordance with clinician diagnoses, with an area under the receiver operating characteristic curve (AUC) of 0.90. The brevity and ability to discriminate DSM-IV cases from non-cases make the six-question ASRS Screener attractive for use both in community epidemiological surveys and in clinical outreach and case-finding initiatives. Copyright © 2007 John Wiley & Sons, Ltd. [source] Pneumonia and Influenza Hospitalizations in Elderly People with DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2009Elena N. Naumova PhD OBJECTIVES: To compare the demographic and geographic patterns of pneumonia and influenza (P&I) hospitalizations in older adults with dementia with those of the U.S. population and to examine the relationship between healthcare accessibility and P&I. DESIGN: Observational study using historical medical claims from the Centers for Medicare and Medicaid Services (CMS) and CMS records supplemented with information derived from other large national sources. SETTING: Retrospective analysis of medical records uniformly collected over a 5-year period with comprehensive national coverage. PARTICIPANTS: A study population representative of more than 95% of all people aged 65 and older residing in the continental United States. MEASUREMENTS: Six million two hundred seventy-seven thousand six hundred eighty-four records of P&I between 1998 and 2002 were abstracted, and county-specific outcomes for hospitalization rates of P&I, mean length of hospital stay, and percentage of deaths occurring in a hospital setting were estimated. Associations with county-specific elderly population density, percentage of nursing home residents, median household income per capita, and rurality index were assessed. RESULTS: Rural and poor counties had the highest rate of P&I and percentage of influenza. Patients with dementia had a lower frequency of influenza diagnosis, a shorter length of hospital stay, and 1.5 times as high a rate of death as the national average. CONCLUSION: The results suggest strong disparities in healthcare practices in rural locations and vulnerable populations; infrastructure, proximity, and access to healthcare are significant predictors of influenza morbidity and mortality. These findings have important implications for influenza vaccination, testing, and treatment policies and practices targeting the growing fraction of patients with cognitive impairment. [source] Accuracy and validity of using medical claims data to identify episodes of hospitalizations in patients with COPD,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 1 2006Amir Abbas Tahami Monfared PhD Abstract Purpose In Quebec, MED-ECHO database can be used to estimate inhospital length of stay (LOS) and number of hospitalizations (NOH) both accurately and reliably. However, access to MED-ECHO database is time-consuming. Quebec medical claims database (RAMQ) can be used as an alternative source to estimate these measures. Considering MED-ECHO as the ,gold standard,' this study examined the validity of using RAMQ medical claims to estimate LOS and NOH. Methods We used a cohort of 3768 elderly patients with chronic obstructive pulmonary disease (COPD) between 1990 and 1996 and identified those with inhospital claims. Inhospital LOS was defined as the total number of days with inhospital claims. Various grace periods (1,15 days) between consecutive claims were considered for the estimation of LOS and NOH. RAMQ and MED-ECHO databases were linked using unique patient identifiers. Estimates obtained from RAMQ data were compared to those from MED-ECHO using various measures of central tendency and predictive error estimates. Results Overall, 32.7% of patients were hospitalized at least once during the study period based on RAMQ claims, as compared to 32.0% in MED-ECHO ( p -value,=,0.51). The best estimates [mean (p -value)] were found to be those obtained when using a 7-day grace period. RAMQ versus MED-ECHO estimates were: 12.2 versus 13.5 days (<,0.001) for LOS and 3.6 versus 3.7 times (0.36) for NOH. Conclusions RAMQ medical claims can be used as a reliable source to estimate LOS and NOH, particularly when time and resources are restricted. RAMQ, however, should be used with caution since slight underestimations may occur. Copyright © 2005 John Wiley & Sons, Ltd. 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