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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 11 of 11 Research Studies Displayed
Wu SS, Bellantoni m, Weiner JP
Geriatric syndrome risk factors among hospitalized postacute Medicare patients.
The purpose of this study was to assess the association of geriatric syndrome risk factors with postacute utilization among hospitalized Medicare patients (both Medicare Advantage [MA] and fee-for-service [FFS] cohorts) and to examine patterns of postacute care for MA and FFS cohorts with high geriatric syndrome risk. The investigators found that geriatric syndrome risk factors not only play a role in postacute care and inpatient utilization in MA and FFS cohorts but also explain different utilizations between MA and FFS cohorts.
Citation: Wu SS, Bellantoni m, Weiner JP . Geriatric syndrome risk factors among hospitalized postacute Medicare patients. Am J Manag Care 2020 Oct;26(10):e319-e26. doi: 10.37765/ajmc.2020.88505..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Medicare, Risk, Healthcare Utilization, Hospitalization
Khera R, Kondamudi N, Zhong L
Temporal trends in heart failure incidence among Medicare
This retrospective, national cohort study looked at temporal trends in heart failure (HF) incidence among Medicare beneficiaries from 2011 to 2016. There had been a decline in claims during that time period. Five percent of all fee-for-service Medicare beneficiaries with no prior HF diagnosis were followed up from 2011-2016. Annual trends were examined in HF incidence among groups with and without primary HF risk factors (hypertension, diabetes, and obesity) and predisposing cardiovascular conditions (acute myocardial infarction (MI) and atrial fibrillation (AF). Of the approximately 1.8 million Medicare beneficiaries at risk for HF, 249,832 had a new diagnosis of HF. The prevalence of all 5 risk factors had increased during the 5-year study period. There was a relative decline in HF incidence among beneficiaries with primary HF risk factors, but incidence increased among individuals with acute MI and AF.
Citation: Khera R, Kondamudi N, Zhong L . Temporal trends in heart failure incidence among Medicare JAMA Netw Open 2020 Oct;3(10):e2022190. doi: 10.1001/jamanetworkopen.2020.22190.
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medicare, Risk, Elderly, Mortality
Hoffman GJ, Tinetti ME, Ha J
Prehospital and posthospital fall injuries in older US adults.
Investigators estimated the risk of older adult fall injury within and across discrete periods during a 12-month care episode anchored by an acute hospitalization using national data from 2006 to 2014. Participants in this cohort study included Medicare fee-for-service beneficiaries aged 65 and older from the Health and Retirement Study. The investigators found that an episode-based assessment of fall injury illustrated substantial variability in period-specific risks over an extended period including an anchor hospitalization. Risk transitions between periods included sizable increases just before hospitalization that do not fully subside after hospital discharge. Financial incentives to coordinate hospital and posthospital care for patients at risk for fall injury are needed.
Citation: Hoffman GJ, Tinetti ME, Ha J . Prehospital and posthospital fall injuries in older US adults. JAMA Netw Open 2020 Aug 3;3(8):e2013243. doi: 10.1001/jamanetworkopen.2020.13243..
Keywords: Elderly, Falls, Injuries and Wounds, Risk, Hospitalization, Medicare
Wu S, Mulcahy J, Kasper JD
Comparing survey-based frailty assessment to Medicare claims in predicting health outcomes and utilization in Medicare beneficiaries.
The purpose of this study was to assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric risk measures among Medicare fee-for-service beneficiaries aged 65 years and above. Outcomes of hospitalizations, death, and functional help were investigated for participants in the 2011 National Health and Aging Trends Study.
Citation: Wu S, Mulcahy J, Kasper JD . Comparing survey-based frailty assessment to Medicare claims in predicting health outcomes and utilization in Medicare beneficiaries. J Aging Health 2020 Aug-Sep;32(7-8):764-77. doi: 10.1177/0898264319851995..
Keywords: Elderly, Medicare, Healthcare Utilization, Risk
Goldstone AB, Chiu P, Baiocchi M
Interfacility transfer of Medicare beneficiaries with acute type a aortic dissection and regionalization of care in the United States.
Researchers investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. Operative mortality and long-term survival were compared for Medicare beneficiaries diagnosed with an acute type A aortic dissection who were transferred versus not transferred, underwent surgery at high-volume versus low-volume hospitals, and were rerouted versus not rerouted to a high-volume hospital for treatment. The researchers found that, despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% absolute risk reduction in operative mortality. They recommended that policymakers evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.
Citation: Goldstone AB, Chiu P, Baiocchi M . Interfacility transfer of Medicare beneficiaries with acute type a aortic dissection and regionalization of care in the United States. Circulation 2019 Oct 8;140(15):1239-50. doi: 10.1161/circulationaha.118.038867..
Keywords: Transitions of Care, Medicare, Heart Disease and Health, Cardiovascular Conditions, Patient-Centered Outcomes Research, Risk, Evidence-Based Practice, Mortality, Hospitals
Kundi H, Popma JJ, Valsdottir LR
The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure.
The goals of this study were to identify nontraditional risk factors coded in administrative claims data and to evaluate their ability to improve prediction of long-term mortality in patients undergoing percutaneous mitral valve repair. Patients undergoing transcatheter mitral valve repair using MitraClip implantation were identified among Medicare fee-for-service beneficiaries; researchers used nested Cox regression models to identify claims codes predictive of long-term mortality. Four groups of variables were introduced: cardiac, noncardiac, and nontraditional risk factors, and presentation characteristics. The authors conclude that risk-prediction models, which include nontraditional risk factors as identified in claims data, can be used to predict long-term mortality risk more accurately in patients who have undergone MitraClip procedures.
Citation: Kundi H, Popma JJ, Valsdottir LR . The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure. Can J Cardiol 2018 Dec;34(12):1648-54. doi: 10.1016/j.cjca.2018.10.002..
Keywords: Cardiovascular Conditions, Elderly, Mortality, Heart Disease and Health, Medicare, Risk, Surgery
Randolph AC, Lin YL, Volpi E
Tricyclic antidepressant and/or gamma-aminobutyric acid-analog use is associated with fall risk in diabetic peripheral neuropathy.
This study invested whether tricyclic antidepressant and/or gamma-aminobutyric acid-analog (TCA/GABA) use is associated fall risk in older diabetic peripheral neuropathy (DPN) patients. A nationally representative 5% Medicare sample between the years 2008 and 2010 were used, and 5,550 patients with TCA/GABA prescriptions were compared to 22,200 patients without a TCA/GABA prescription. Patients were followed until there was an incidence of a fall or first incidence of a fracture during the follow-up period of up to 5 years. After covariate adjustment, there was a statistically significant increase in falls and fractures for patients using TCAs or GABA-analogs.
Citation: Randolph AC, Lin YL, Volpi E . Tricyclic antidepressant and/or gamma-aminobutyric acid-analog use is associated with fall risk in diabetic peripheral neuropathy. J Am Geriatr Soc 2019 Jun;67(6):1174-81. doi: 10.1111/jgs.15779..
Keywords: Medication, Diabetes, Elderly, Falls, Injuries and Wounds, Medicare, Risk
Zhang Y, Johnson P, Jeng PJ
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
This study examined the association between a first opioid prescription and high-risk opioid use in the 18 months following the first prescription. A retrospective cohort study was conducted using data from a large commercial insurance claims database for patients aged 18-64 and also Medicare Advantage patients aged 65 or older for 2011-2014. The patients initially had not used opioids. The features the researchers were looking for were: 1) opioid or benzodiazepine prescriptions overlapping 7 days or more, 2) opioid prescriptions overlapping for 7 days or more; 3) three or more prescribers of opioids; and 4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription. All of those features were strongly associated with high-risk use.
Citation: Zhang Y, Johnson P, Jeng PJ . First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults. J Gen Intern Med 2018 Dec;33(12):2156-62. doi: 10.1007/s11606-018-4628-y..
Keywords: Opioids, Substance Abuse, Medication, Risk, Medicare, Health Insurance
Dubberke ER, Olsen MA, Stwalley D
Identification of Medicare recipients at highest risk for Clostridium difficile infection in the US by population attributable risk analysis.
This study determined the population attributable risk percent (PAR%) for Clostridium difficile infection (CDI) in various subpopulations in the Medicare 5% random sample. It found that small and identifiable subpopulations that account for relatively large proportions of CDI cases in the elderly were identified. These data can be used to target specific subpopulations for CDI prevention interventions.
Citation: Dubberke ER, Olsen MA, Stwalley D . Identification of Medicare recipients at highest risk for Clostridium difficile infection in the US by population attributable risk analysis. PLoS One 2016 Feb 9;11(2):e0146822. doi: 10.1371/journal.pone.0146822.
Keywords: Medicare, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Risk
Chaudhry SI, Khan RF, Chen J
National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010.
The investigators evaluated changes in the incidence of 1-year recurrent acute myocardial infarction (AMI) hospitalization and mortality. In a national sample of Medicare beneficiaries hospitalized for AMI from 1999 to 2010, they found that hospitalization for recurrent AMI decreased, as did subsequent mortality, albeit to a lesser extent. The risk of recurrent AMI hospitalization declined less in black patients than in whites, increasing observed racial disparities by the end of the study period.
Citation: Chaudhry SI, Khan RF, Chen J . National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010. J Am Heart Assoc 2014 Oct;3(5):e001197. doi: 10.1161/jaha.114.001197.
Keywords: Hospitalization, Medicare, Mortality, Heart Disease and Health, Risk
Thacker EL, Muntner P, Zhao H
Claims-based algorithms for identifying Medicare beneficiaries at high estimated risk for coronary heart disease events: a cross-sectional study.
The researchers sought to develop claims-based algorithms to identify individuals at high risk for coronary artery disease (CHD) and to identify low-density lipoprotein (LDL) cholesterol among statin users at high risk for CHD events. They found that despite low sensitivity, the high predictive value of their algorithm for high risk for CHD events supports the use of claims to identify Medicare beneficiaries at high risk for CHD events.
Citation: Thacker EL, Muntner P, Zhao H . Claims-based algorithms for identifying Medicare beneficiaries at high estimated risk for coronary heart disease events: a cross-sectional study. BMC Health Serv Res. 2014 Apr 29;14:195. doi: 10.1186/1472-6963-14-195..
Keywords: Comparative Effectiveness, Medicare, Risk, Cardiovascular Conditions, Chronic Conditions