All-payer Claims Database Research Articles

Outcomes of patients undergoing single-level arthroplasty versus anterior lumbar interbody fusion.

Compared to vertebral body fusion, artificial discs are thought to lessen the risks of adjacent segment disease and the need for additional surgery by maintaining spinal mobility as they mimic the intervertebral disc structure. No studies have compared the rates of postoperative complications and the requirement for secondary surgery at adjacent segments among patients who have undergone anterior lumbar interbody fusions (ALIF) versus those undergoing lumbar arthroplasty. An all-payer claims database identified 11,367 individuals who underwent single-level ALIF and lumbar arthroplasty for degenerative disc disease (DDD) between January 2010 and October 2020. Rates of complications following surgery, the need for additional lumbar surgeries, length of stay (LOS), and postoperative opioid utilization were assessed in matched cohorts based on logistic regression models. Kaplan-Meyer plots were created to model the probability of additional surgery. Following 1:1 exact matching, 846 records of patients who had undergone ALIF or lumbar arthroplasty were analyzed. All-cause readmission within 30-30days following surgery was significantly higher in patients undergoing ALIF versus arthroplasty (2.6% vs. 0.71%, p = 0.02). LOS was significantly lower among the patients who had undergone ALIF (1.043 ± 0.21 vs. 2.17 ± 1.7, p < .001). ALIF and lumbar arthroplasty procedures are equally safe and effective in treating DDD. Our findings do not support that single-level fusions may biomechanically necessitate revisional surgeries.

Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City.

This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.

Tiered network health plans and changes in physician practice intensity.

To examine whether physicians in tiered physician networks where tier assignments are based on "intensity" of care, which is the quantity of resources used per-episode of care, change their intensity after learning detailed information about how their intensity compares to their peers. Administrative data on intensity and quality at the physician-episode level for all physicians included in a tiered physician network offered through the Massachusetts Group Insurance Commission (GIC) in 2010-2015. Data on physicians' share of revenue from GIC patients from the 2012 Massachusetts All-Payer Claims Database. For 21,086 physicians in seven specialties, we estimate the impact of the dissemination of detailed intensity performance information in 2014 on physician intensity per episode of care overall and decomposed into physician services, facility, and pharmaceutical subcomponents. Intensity outcomes were measured using a standardized price schedule. Using a difference-in-differences regression, we compared physicians with high exposure to the tiered network via a large share of their revenue coming from GIC patients ("GIC share") to physicians who were less exposed. Measures of intensity of care and GIC share were log-transformed, and models controlled for physician-episode type fixed effects. We linked GIC share to administrative data using National Provider Identifier. There were no statistically significant differences in total intensity of care with the informational intervention for physicians in procedure-based specialties (-0.12 elasticity of intensity per episode with respect to GIC patient share, 95% CI -0.30 to 0.06) or in relationship-based specialties (0.09, 95% CI -0.15 to 0.33). There were also no differences in intensity of subcomponents of care following the intervention. Tiered network incentives had no detectable impact on intensity of care that physicians provided to patients.

A real-world evidence analysis of the impact of switching from factor VIII to emicizumab prophylaxis in patients with hemophilia A without inhibitors

ABSTRACT Background This study retrospectively compared annualized billed bleed rates (ABRb) in people with hemophilia A (PwHA) without inhibitors who switched from factor VIII (FVIII) prophylaxis to emicizumab. Research design and methods A real-world comparison study was performed on the effect of switching from FVIII to emicizumab prophylaxis in male, non-inhibitor patients on ABRb using an all-payer claims database (APCD) dataset from 1 January 2014, to 31 March 2021. The identification period was from 1 November 2017, to 30 September 2020. Results One hundred and thirty-one patients were included with a total of 82 and 45 bleeds in the pre- and post-switch periods, respectively. The average follow-up period pre-switch was 978.37 days (SD 555.03), whereas the average follow-up period post-switch was 522.26 days (SD 191.36). No significant differences in mean ABRb were observed pre-/post-switch (0.25 and 0.20, respectively; P = 0.4456). Conclusions The results of this study demonstrate no significant reduction in ABRb, suggesting that switching from FVIII to emicizumab may not deliver incremental benefits to PwHA receiving prophylactic care.

Rising Racial Disparities in Opioid Mortality and Undertreatment of Opioid Use Disorder and Mental Health Comorbidities in Virginia

There were more than 100,000 fatal drug overdoses in the U.S. in 2021 alone. In recent years, there has been a shift in opioid mortality from predominantly White rural communities to Black urban communities. This study aimed to identify the Virginia communities disproportionately affected by the overdose crisis and to better understand the systemic factors contributing to disparities in opioid mortality. Using the state all-payer claims database, state mortality records, and census data, we created a multivariate model to examine the community-level factors contributing to racial disparities in opioid mortality. We used generalized linear mixed models to examine the associations between socioecologic factors and fatal opioid overdoses, opioid use disorder diagnoses, opioid-related emergency department visits, and mental health diagnoses. Between 2015 and 2020, racial disparities in mortality widened. In 2020, Black males were 1.5 times more likely to die of an opioid overdose than White males (47.3 vs 31.6 per 100,000; p<0.001). The rate of mental health disorders strongly correlated with mortality (β=0.53, p<0.001). Black individuals are not more likely to be diagnosed with opioid use disorder (β=0.01, p=0.002) or with mental health disorders (β= -0.12, p<0.001), despite higher fatal opioid overdoses. There are widening racial disparities in opioid mortality. Untreated mental health disorders are a major risk factor for opioid mortality. Findings show pathways to address inequities, including early linkage to care for mental health and opioid use disorders. This analysis shows the use of comprehensive socioecologic data to identify the precursors to fatal overdoses, which could allow earlier intervention and reallocation of resources in high-risk communities.

Access to Neurology Healthcare Professionals in the United States Among Medicaid Patients with Epilepsy (P6-9.009)

<h3>Objective:</h3> Examine provider access restrictions among adults with epilepsy enrolled under Medicaid. <h3>Background:</h3> Patients with epilepsy may not receive the antiseizure medications (ASMs) they need due to limited access to neurology healthcare professionals (HCPs). <h3>Design/Methods:</h3> Adults with ≥1 epilepsy diagnosis or ≥2 diagnoses for unspecified convulsions on different days (within 12 months) were identified in the all-payer claims database (January 1, 2014–May 31, 2021). Medicaid patients prescribed ≥1 ASM on/after initial diagnosis (date of first ASM prescription=index date) with continuous medical and pharmacy benefits for ≥12 months pre-and post-index date were included. Demographic characteristics at index and clinical characteristics within the 12-months pre-index were captured. Proximity to a neurology HCP for epilepsy-related care (defined as availability of a neurologist/neuropsychiatrist within the patient’s zip-3 location), and patient utilization of neurology HCPs during 12-months post-index were assessed. <h3>Results:</h3> 24,722 patients (mean age 43.3 years; 62.4% female) met all selection criteria. Most patients were white (80.4%), non-Hispanic (67.7%), and resided in an urban area (91.1%). The most common comorbidities (≥20% of patients) were unspecified convulsions (48.9%), anxiety (34.5%), and depression (28.8%). Most patients were prescribed index ASMs by non-neurology HCPs; 25.0% received their index ASM prescription from a neurology HCP. Nationwide, 92.2% of patients (60.2% rural, 95.4% urban) utilized a neurology HCP to access ASM treatment during index or follow-up; however, only 28.7% (12.6% rural, 30.3% urban) lived within proximity of a neurology HCP. <h3>Conclusions:</h3> Most Medicaid patients with epilepsy had low access to neurology HCPs in proximity to home and were prescribed their first ASM by a non-neurology HCP. The majority of patients utilized neurology HCPs within 12 months of index, showing a high need for specialist care. <b>Disclosure:</b> Mr. Peeples has received personal compensation for serving as an employee of UCB. Mr. Dieyi has received personal compensation for serving as an employee of STATinMED. Ms. Maughn has received personal compensation for serving as an employee of STATinMED. Ms. Achter has received personal compensation for serving as an employee of STATinMED.

No Difference in 30-day Mortality Between Patients Undergoing Bilateral Simultaneous Total Knee Arthroplasty With Technology Assistance Compared to Conventional Instrumentation.

Background: Bilateral simultaneous total knee arthroplasty (BSTKA) has decreased in frequency due to concerns about higher rates of early mortality and complications than unilateral or staged surgeries. Purpose: We sought to evaluate whether technology assistance (encompassing robotics and computer assistance) decreases early mortality following BSTKA. Methods: We conducted a retrospective cohort study using a national all-payer claims database. Patients who underwent BSTKA from October 2015 to December 2020 were identified. Univariate and multivariable analyses were conducted to compare outcomes in patients who underwent BSTKA with technology assistance compared to conventional instrumentation. The primary outcome was 30-day postoperative mortality. Secondary outcomes were respiratory failure and fat embolism. A post-hoc analysis was performed to evaluate length of stay, readmission, and other medical complications. Results: A total of 14,870 patients who underwent BSTKA were included in this study. Of these, 860 patients underwent technology-assisted BSTKA, and 14,010 patients underwent BSTKA without technology assistance. After a multivariable analysis, patients who underwent technology-assisted BSTKA had equivalent odds of 30-day mortality compared to those who underwent BSTKA without technology assistance. Technology assistance was not protective against the development of acute respiratory failure or fat embolism. Conclusion: This retrospective cohort study found no differences in the rates of 30-day mortality, respiratory failure, or fat embolism after technology-assisted BSTKA compared to conventional BSTKA. On the post-hoc analysis, technology use was associated with a decreased length of stay, lower readmission risk, and decreased rates of deep vein thrombosis, pulmonary embolism, and blood transfusion.

Postoperative Opioid Use Among Opioid-Naive Cannabis Users Following Single-Level Lumbar Fusions

As the literature grows on opioid use, the impact of simultaneous cannabis use has hitherto been mostly unexplored. In this study, we assessed the effects of cannabis use on postoperative opioid utilization in opioid-naive patients undergoing single level fusions of the lumbar spine. Using an all-payer claims database, the medical records of 91 million patients were analyzed to identify patients who had undergone single level lumbar fusions between January 2010 and October 2020. Rates of opioid utilization at 6months following index procedure (morphine milligram equivalents/day), the development of opioid use disorder (OUD), and the rates of opioid overuse were assessed. Following examination of 87,958 patient records, 454 patients were matched and distributed equally into cannabis user and noncannabis user cohorts. At 6months following index procedure, cannabis users were equal to nonusers in their rates of prescribed opioid utilization (49.78%, P > 0.99). Cannabis users used smaller daily dosages compared to nonusers (51.1±35.05 vs. 59.72±41, P= 0.003). On the other hand, the proportion of patients diagnosed with OUD was found to be significantly higher among patients using cannabis (18.94% vs. 3.96%, P < 0.0001). Compared to noncannabis users, opioid-naive patients who are cannabis users undergoing lumbar spinal fusions are at a higher risk of developing opioid dependence following surgery, despite having decreased daily dosages of opioids overall. Further studies should explore the factors associated with the development of OUD and the details of concurrent marijuana use to effectively treat pain while limiting the potential for abuse.

215 Relationships between geospatial factors and adverse outcomes in Medicaid-enrolled children with asthma

OBJECTIVES/GOALS: To determine the relationship between race/ethnicity, geospatial (place-based) social determinants of health (SDOH; rurality and child opportunity index (COI)), and asthma-related adverse events (AAE: hospitalizations, emergency department (ED) visits) among children with asthma in Arkansas. METHODS/STUDY POPULATION: Using the Arkansas All-Payer Claims Database, we conducted a retrospective analysis of children (5-18 years). Medicaid-enrolled children with, 1 asthma diagnosis (ICD-10 J45.xx) for any type of medical event in 2019 were included. Race/ethnicity were self-reported (non-Hispanic White, non-Hispanic Black, Hispanic/Latino). Due to small sample size, all other racial/ethnic groups were classified as Other. Rural-Urban Commuting Area (RUCA) codes were used to determine rural-urban designation using 4-category classification by zip code. COI level was determined by zip code (scale: very low- to very-high opportunity). AAEs were identified using 2019 medical claims. RESULTS/ANTICIPATED RESULTS: The cohort (n=25,198) included 38.7% White, 32.9% Black, 6.0% Hispanic, 5.1% Other, and 17.3% Missing race/ethnicity children. Overall, 61.2% live in rural and 38.8% live in urban areas. Among rural children, 33.1% were in very-low, 34.4% low, 20.8% moderate, 11.6% high, and 0.1% very-high opportunity areas. Among urban children, 32.6% were in very-low, 12.4% low, 17.5% moderate, 19.5% high, and 18.0% very-high opportunity areas. Overall, Black children more frequently lived in very-low or low opportunity areas (75.4%). Among rural children, 9.3% had an AAE. White children had highest rates of AAE. Overall, AAE rates were variable by rurality/urbanity and COI level. DISCUSSION/SIGNIFICANCE: Differences in asthma outcomes by race/ethnicity, rurality, and COI level were unexpected, with similar rates of poor outcomes across the cohort. These finding underscore the complexity of the relationships between race/ethnicity, geospatial SDOH, and asthma outcomes.

Abstract P472: Matching Young Adult Strokes in a Claims Database to the Clinical Get With the Guidelines-Stroke Registry

Background: Due to its lower incidence, strokes in young adults, studies have difficulty answering why there are more women than men less than 35 with incident strokes. The goal of this study is to link claims and registry data to create a new longitudinal and clinical cohort of strokes in young adults. Methods: Colorado mandates reporting of commercial and public insurance (Medicaid and Medicare) claims to the All Payer Claims Database (APCD). We identified all first-time stroke admissions using ICD-9 /10 codes between 2012 to 2018 in young adults (18-55). Get with the Guidelines (GWTG) Stroke registry has stroke cases from 41 hospitals in Colorado since 2010. Matching was based on exact birthdate, sex and +/- 1day in admission/discharge dates. Confirmation of match was based on comparing the admitting hospital between the two databases. Cardiovascular(CV) and non-CV risk factors occurring from enrollment until 1 day prior to stroke date in the APCD were included. Student’s T-test, and Z-tests were used to test differences between men and women. Results: We identified 3032 stroke cases in the APCD. Of these, 1455 (48.0%) matched to an admission in the GWTG-Stroke registry. Of these, 1303 (89.6%) also matched based on the admitting hospital (Table). The final cohort contained 51% women, 11.3% &lt;35, 35.2% between 35-45, and 63.5% between 45-55. The most common CV risk factors were hypertension, hyperlipidemia, and tobacco use in men, and hypertension, tobacco use, and obesity in women. The most common non-CV risk factors were migraines, renal failure, thrombophilia in men and migraines, malignancy, and thrombophilia in women. The prevalence of cardiovascular risk factors was higher in men, while the prevalence of non-cardiovascular risk factors was higher in women. There was no difference in the severity of strokes between men and women. Conclusions: Clinical registries such as GWTG-Stroke can be used to supplement longitudinal administrative cohorts of young adults with stroke to get richer data on stroke etiology and severity.

Association of Medicaid Expansion With Postpartum Depression Treatment in Arkansas

Postpartum depression affects approximately 1 in every 8 postpartum individuals in the US. Antidepressant medication can effectively treat postpartum depression. However, gaps in postpartum insurance coverage after the end of Medicaid pregnancy coverage at 60 days postpartum may limit treatment uptake and decrease continuity of postpartum depression treatment. To examine the association of Medicaid expansion in Arkansas with postpartum antidepressant prescription fills and antidepressant continuation and supply during the first 6 months postpartum. Cohort study with a difference-in-differences analysis comparing persons with Medicaid and commercially financed childbirth using Arkansas' All-Payer Claims Database (2013-2016). Analysis was completed between July 2021 and June 2022. Medicaid-paid childbirth after January 1, 2014. Antidepressant medication prescription fills and the number of days of antidepressant supply in the early (first 60 days after childbirth) and the late (61 days to 6 months after childbirth) postpartum periods. In this cohort study with a difference-in-differences analysis of 60 990 childbirths (mean [SD] birthing parent's age, 27 [5.3] years; 22% Black, 7% Hispanic, 67% White individuals), 72% of births were paid for by Medicaid and 28% were paid for by a commercial payer. Before expansion, 4.2% of people with a Medicaid-paid birth filled an antidepressant prescription in the later postpartum period. Medicaid expansion was associated with a 4.6 percentage point (95% CI, 2.9-6.3) increase in the likelihood, or a relative change of 110%, in this outcome. Before expansion, among people with postpartum depression in the early postpartum period with a Medicaid-paid birth, 32.7% filled an antidepressant prescription in the later postpartum period, and had an average of 23 days of antidepressant prescription supply during the later postpartum period. Among people with early postpartum depression, Medicaid expansion increased the continuity of antidepressant treatment by 20.5 percentage points (95% CI, 14.1-26.9) and the number of days with antidepressant supply in the later postpartum period by 14.1 days (95% CI, 7.2-20.9). Medicaid expansion in Arkansas was associated with an increase in postpartum antidepressant prescription fills, and an increase in antidepressant treatment continuity and medication supply in the period after Medicaid pregnancy-related eligibility ended.

Preinjury Social Determinants of Health Disparities Predict Postinjury Psychosocial Conditions in Adult Traumatic Brachial Plexus Injuries.

Adult traumatic brachial plexus injuries (TBPIs) are life-altering events that can have detrimental effects on a patient's quality of life. To examine how social determinants of health (SDOH) disparities influence the risk of developing new psychosocial conditions after TBPIs in previously psychiatric-naïve patients. Between January 2010 and June 2019, a retrospective analysis was performed using PearlDiver's Mariner, an all-payer claims database, to create 3 cohorts: TBPI disparity cohort: patients with TBPI and presence of at least 1 SDOH disparity before injury, TBPI without disparity cohort: patients with TBPI and the absence of any SDOH disparity, and control cohort: patients without TBPIs. The matched population analyzed in this study consisted of 1176 patients who were equally represented in the TBPI disparity cohort (n = 392, 33.33%), TBPI without disparity cohort (n = 392, 33.33%), and control cohort (n = 392, 33.33%). A total of 301 patients developed any psychosocial condition with 4 years of their injury. Patients in the TBPI disparity cohort had significantly higher rates of developing any psychosocial condition (31.12%, P < .0005), depression (22.70%, P = .0032), anxiety (18.62%, P = .0203), drug abuse (7.91%, P = .0060), and alcohol abuse (4.85%, P = .03499) when compared with the other cohorts. Furthermore, the disparity cohort carried a significantly increased risk of developing any psychosocial condition (hazard ratio 1.42, 95% CI 1.09-1.86). The rates of suicide attempt, post-traumatic stress disorder, and divorce did not significantly differ between groups. TBPI patients with SDOH disparities are at increased risk of developing new-onset psychosocial conditions, such as depression, anxiety, drug abuse, and alcohol abuse. Level of Evidence: Prognostic Level III.

Abstract TP201: The Role Cardiovascular And Non-cardiovascular Risk Factors In The Development Of Strokes Among Young Adults

Background: We examined the effect of CV and non-CV risk factors on the development of strokes in young adults 18-55 years old. Methods: This case-control study, using the Colorado All Payer Claims Database (APCD), identified young adults with index stroke admissions and assigned them(1:3) to controls matched on age/sex/insurance type(commercial or public)/enrollment duration. Controls were assigned a proxy stroke date based on their matched case. CV and non-CV risk factors occurring from enrollment until 1 day prior to stroke date were included. Pregnancy, postpartum, and oral contraceptives were separated from other non-CV risk factors in women. To assess whether there was a differential effect of the risk factors by age in each sex, conditional logistic regression models were fit separately for men and women with an interaction between age and risk factor. Results: Between 2012-2018, 2735 index stroke admissions were identified (52.3% women) and matched to 8,178 controls. In men with stroke, 53.4% and 27.7% had at least one CV and non-CV risk factor, respectively. In women with stroke, 57.6%, 41.0%, and 12.1% had at least one CV, non-CV and hormonal risk factor, respectively. The most common CV risk factors were hypertension(27.8%), hyperlipidemia(26.8%), tobacco use(20.9%) in men and hypertension(25.5%), tobacco use(22.9%), obesity(22.6%) in women. The most common non-CV risk factors were migraines (14.3%), renal failure(6.9%), thrombophilia(6.1%) in men and migraines(29.1%), malignancy(9.5%), thrombophilia(6.7%) in women. Having one or more CV or non-CV risk factors significantly contributed to the development of strokes(Figure). Controlling for CV risk factors, having at least one non-CV risk factor had the highest risk among men and women &lt;45. Hormonal risk factors significantly contribute to strokes in women ≥35. Conclusions: Non-CV risk factors play a significant role in the development of strokes among young adults and warrants further study.

Public Insurance Is Associated With Decreased Rates of Surgical Management for Glenohumeral Instability: An Analysis of the Rhode Island All-Payers Claims Database.

Socioeconomic status has been shown to influence patients' ability to access health care. To evaluate the socioeconomic status and/or insurance provider of patients and to determine whether these differences influence the management of shoulder instability. Descriptive epidemiology study. The Rhode Island All-Payers Claims Database (APCD) was used to identify all patients between the ages of 5 and 64 years who made an insurance claim related to a shoulder instability event between January 1, 2011, and December 31, 2019. Chi-square analysis and multivariate logistic regression were utilized to determine whether insurance status, social deprivation index (SDI), or median income by zip code were significant predictors of treatment methodology and recurrent instability. Kaplan-Meier failure analysis and Cox regression were used to assess for variation in the cumulative rates of surgical intervention and recurrent instability over 20-year age groups (5-24, 25-44, and 45-64 years). There were 3310 patients from the APCD query included in the analysis. Bivariate analysis demonstrated significant variation in the rates of surgical stabilization between patients with public and commercial insurance providers (P < .001). Patients with public insurance received surgery 1.8% of the time compared with 5.8% of the time in patients with commercial insurance. After controlling for recurrent instability, age, instability type (subluxation or dislocation) and directionality, and sex, patients with public insurance were 79% less likely to receive surgery within 30 days (P = .035) and 64% less likely to receive surgery within 1 year (P = .002). This disparity was most notable in the 5- to 24-year (hazard ratio [HR] = 0.28; 95% CI, 0.13-0.61) and 25- to 44-year (HR = 0.26; 95% CI, 0.08-0.89) age groups. Neither SDI quartile nor income quartile based on patient primary zip code had a clinically significant influence on rates of surgery or recurrent instability. These data demonstrate that patients with public insurance have a decreased likelihood of undergoing surgical stabilization to address glenohumeral instability compared with patients with commercial insurance.

Polycystic Ovary Syndrome and Risk of Adverse Pregnancy Outcomes: A Registry Linkage Study From Massachusetts

ABSTRACT Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women, affecting approximately 6% to 15% of reproductive-aged women. Polycystic ovarian syndrome is associated with obesity, metabolic syndrome, impaired glucose tolerance, insulin resistance, adverse pregnancy outcomes, and infertility. Previous meta-analyses and reviews have suggested that women with PCOS are at an increased risk of pregnancy complications, although many of the studies included are small and may not be generalizable. This population-based study aimed to investigate whether women with a previous history of PCOS had greater risk of adverse maternal and pregnancy outcomes compared with women without a diagnosis of PCOS accounting for potential confounding factors. Data were obtained from 3 sources: the Massachusetts Pregnancy to Early Life Longitudinal Data System, the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, and the Massachusetts All-Payers Claims Database. Maternal outcomes investigated included gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, and placental abnormalities. Neonatal outcomes investigated were size for gestational age, low birth weight, prematurity, prolonged delivery, and hospital stay. Infant conditions and diagnoses during the first year of life were also investigated. Deliveries were classified into groups of noninfertile, subfertile/infertile, or assisted reproductive technology. The relative risks (RRs) and 95% confidence intervals (CIs) of adverse outcomes were estimated with a log-link and Poisson distribution, and multivariable models were a priori adjusted for potential confounding factors. A total of 3552 deliveries to women with a history of PCOS and 88,273 deliveries to women without a diagnosis of PCOS were included. When adjusting for maternal age, prepregnancy body mass index (BMI), education, race/ethnicity, plurality, birth year, and history of hypertension and diabetes, women with a history of PCOS had a 51% greater risk of gestational diabetes (RR, 1.51; 95% CI, 1.38–1.65). Women with a history of PCOS were also at a greater risk of pregnancy-induced hypertension, preeclampsia, and eclampsia (RR, 1.25; 95% CI, 1.15–1.35) and higher risk of cesarean delivery (RR, 1.07; 95% CI, 1.02–1.11). Women with a history of PCOS were more likely to deliver prematurely (RR, 1.17; 95% CI, 1.06–1.29), and infants born to mothers with a history of PCOS were more likely to have a prolonged neonatal hospital stay (RR, 1.23; 95% CI, 1.01–1.19). Among women with a BMI &lt;30 kg/m2, PCOS was associated with a greater risk of gestational diabetes (RR, 1.60; 95% CI, 1.42–1.80) than among those with a BMI &gt;30 kg/m2 (gestational diabetes: RR, 1.37; 95% CI, 1.21–1.57). The results of this study demonstrate that women with a history of PCOS were more likely to experience gestational diabetes, hypertensive disorders of pregnancy, and cesarean delivery, and their neonates were more likely to be born premature and have a prolonged neonatal hospital stay.

Consistency Between State's Cancer Registry and All-Payer Claims Database in Documented Radiation Therapy Among Patients Who Received Breast Conservative Surgery.

Arkansas is one of only four known states that have linked All-Payer Claims Database (APCD) to state's cancer registry (Arkansas Cancer Registry [ACR]). We evaluated the reporting consistency of radiation therapy (RT) between the two sources. Women age ≥ 18 years diagnosed in 2013-2017 with early-stage hormone receptor-positive breast cancer who received breast-conserving surgery were identified. Patients must have continuous insurance coverage (any private plans, Medicaid, and Medicare) in the 13 months (month of diagnosis and 12 months after). Receipt of RT was identified independently from ACR and APCD. We calculated sensitivity, specificity, positive predictive value, and negative predictive value for receipt of RT coded by the registry compared with APCD billing claims as the gold standard. We assessed the degree of concordance between the data sources by Cohen's kappa statistics. The final sample included 2,695 patients who were in both databases and satisfied our inclusion/exclusion criteria. Using APCD as the gold standard, there were high sensitivity (88.1%) and positive predictive value (87.7%) and moderate specificity (71.1%) and negative predictive value (71.8%). The overall agreement between the two sources was 83.0%, with a kappa statistic of 0.59 (95% CI, 0.56 to 0.63). Consistency measures varied by age, stage, and insurance type with Medicare fee-for-service coverage only having the best and private insurance only the worse consistency. In patients with early-stage hormone receptor-positive breast cancer who received breast-conserving surgery, recording of RT receipt was moderately consistent between Arkansas APCD and ACR. Future studies are needed to identify factors affecting reporting consistency to better use this unique resource in addressing population health problems.

Use of population health data to promote equitable recruitment for a primary care practice implementation trial addressing unhealthy alcohol use.

Recruiting underrepresented people and communities in research is essential for generalizable findings. Ensuring representative participants can be particularly challenging for practice-level dissemination and implementation trials. Novel use of real-world data about practices and the communities they serve could promote more equitable and inclusive recruitment. We used a comprehensive primary care clinician and practice database, the Virginia All-Payers Claims Database, and the HealthLandscape Virginia mapping tool with community-level socio-ecological information to prospectively inform practice recruitment for a study to help primary care better screen and counsel for unhealthy alcohol use. Throughout recruitment, we measured how similar study practices were to primary care on average, mapped where practices' patients lived, and iteratively adapted our recruitment strategies. In response to practice and community data, we adapted our recruitment strategy three times; first leveraging relationships with residency graduates, then a health system and professional organization approach, followed by a community-targeted approach, and a concluding approach using all three approaches. We enrolled 76 practices whose patients live in 97.3% (1844 of 1907) of Virginia's census tracts. Our overall patient sample had similar demographics to the state for race (21.7% vs 20.0% Black), ethnicity (9.5% vs 10.2% Hispanic), insurance status (6.4% vs 8.0% uninsured), and education (26.0% vs 32.5% high school graduate or less). Each practice recruitment approach uniquely included different communities and patients. Data about primary care practices and the communities they serve can prospectively inform research recruitment of practices to yield more representative and inclusive patient cohorts for participation.

Concordance of opioid exposure in all-payer claims databases with prescription drug monitoring program database using Arkansas as a case example.

To assess the concordance between and benefit of adding prescription drug monitoring program (PDMP) data to all-payer claims database (APCD) data for identifying and classifying opioid exposure among insured individuals. Arkansas APCD and PDMP. Enrollees in APCD were classified as (1) true positives: if they received opioids in both databases, (2) false positives: if they only received opioids in APCD, (3) true negatives: if they had no opioid exposure in both databases, (4) false negatives: if they only received opioids in the PDMP database. Specificity, sensitivity, negative, and positive predictive values were calculated using PDMP as the "gold standard" database source. Subjects were also categorized as those who received any opioid, chronic opioid, high-dose opioid, or high-risk opioid therapies. Arkansas residents continuously enrolled with pharmacy coverage in 2016 were included. APCD and PDMP were linked using an encrypted enrollee identifier, gender, and year of birth. The degree of concordance in opioid exposure between the two databases among 1,411,565 enrollees was high (sensitivity=92.67%, specificity=96.13%, positive predictive value=91.60%, negative predictive value=96.65%). Enrollees classified as having any opioid (APCD: 31.64% vs. PDMP: 31.26% vs. APCD+PDMP: 33.93%), chronic opioid (APCD: 7.81% vs. PDMP: 7.54% vs. APCD+PDMP: 8.24%), high-dose opioid (APCD: 10.60% vs. PDMP: 9.62% vs. APCD+PDMP: 11.33%), or high-risk opioid (APCD: 5.28% vs. PDMP: 5.33% vs. APCD+PDMP: 6.20%) therapies, were similar using only APCD versus PDMP versus the combined APCD and PDMP data sources. Claims data sources, such as APCDs, are fairly accurate in identifying opioid exposure and the level of opioid exposure among persons with continuous pharmacy coverage.

FREQUENT CAUSES OF 30-DAY READMISSION FOLLOWING A FIRST EPISODE OF HEART FAILURE IN OLDER ADULTS

Abstract Older adults with heart failure (HF) have a greater propensity to experience poor clinical outcomes, hospital readmission, and functional decline. It is important that healthcare workers are aware of the comorbidities that may lead to poor outcomes. A deeper understanding of potential causes of readmission will help in adequate prevention. Employing an all-payers claims database, we aimed to examine the diagnoses related to 30-day readmission in patients aged 65-75 with an Elixhauser-Comorbidity Index score &amp;lt; 4 upon the first episode of HF. Exclusion criteria included in-hospital death, readmissions for the same condition, and discharge against medical advice. Using ICD codes 9-10, a cohort of 323,678 patients (mean age: 70, SD: 3.22; male: 60%) with the first episode of HF between 2015-2019 were identified. We found 7,729 (2.4%) readmissions within 30 days and examined the frequency of 118 diagnoses as the primary cause. Cardiovascular etiologies including HF, hypertension, arrhythmias, and coronary artery disease were the most prevalent causes of readmission (40.64%), with HF being the most frequent (13.25%). Non-Cardiovascular causes included pulmonary (5.94%), sepsis (7%), renal (3.8%), and cerebrovascular (1.58%). Metabolic, liver, gastrointestinal diseases, and other infections accounted for 19.32%. Understanding the diagnoses related to readmissions in different populations is crucial for improving care, conducting research, and lowering costs. We focused on the first episode of HF in a relatively healthy older population to control for confounding factors. Further studies considering demographics, HF characteristics, and baseline comorbidities are needed.

A comparative analysis of public and private dental benefit payer types for the provision and outcomes of root canal therapy on permanent teeth of children and adolescents in Massachusetts

BackgroundDespite substantial increases in dental benefits and improvements in the use of dental services among children and adolescents in the United States, oral health disparities according to dental insurance payer type persist. MethodsThe authors used an all-payer claims (2013-2017) database to perform a comparative analysis of the provision and treatment outcomes of an endodontic procedure (root canal therapy) in the permanent teeth of a pediatric population aged 6 through 18 years, according to dental insurance payer type. Statistical analyses, including logistic regression, Cox proportional hazards regression, and the Kaplan-Meier method, were performed at person and tooth levels. ResultsCompared with privately insured children and adolescents, public-payer children and adolescent beneficiaries were more likely to have had root canal therapy (adjusted odds ratio, 1.91; 95% CI, 1.73 to 2.11) and had poorer treatment outcomes associated with the procedure (adjusted hazard ratio, 2.19; 95% CI, 1.53 to 3.14; P < .0001) during the study period. Those enrolled in private insurance were more likely to receive treatment from an endodontist (specialist in providing root canal therapy) (P < .0001). Amounts allowed and paid by the insurer were significantly higher for private payers (P < .001). ConclusionsThere were significant differences in the provision and outcomes of endodontic treatment between privately and publicly insured children and adolescents. Practical ImplicationsDespite ostensibly equal access to care, differences in the provision of oral health care exist between privately and publicly insured patients. These differences may be contributing to persisting oral health disparities.