Annual Research Meeting Research Articles

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research, University of Ghana

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research, University of Ghana

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Neglected Tropical Diseases

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Neglected Tropical Diseases

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Non-Communicable Diseases

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Non-Communicable Diseases

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Viral Infections

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Viral Infections

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Malaria Control and Elimination

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Malaria Control and Elimination

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Health Systems Research

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Health Systems Research

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Bacterial Infections and Antimicrobial Resistance

Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research: Bacterial Infections and Antimicrobial Resistance

JAMA Health Forum Highlights From the AcademyHealth Annual Research Meeting

JAMA Health Forum Highlights From the AcademyHealth Annual Research Meeting

Improving safety and preventing falls using an evidence-based, front-line staff huddling practice: protocol for a pragmatic trial to increase quality of care in State Veterans Homes

IntroductionFalls in nursing homes are a major cause for decreases in residents’ quality of life and overall health. This study aims to reduce resident falls by implementing the LOCK Falls...

Outline of the 2023 Annual Research Meeting of Chugoku Chapter of the Architectural Institute of Japan

Outline of the 2023 Annual Research Meeting of Chugoku Chapter of the Architectural Institute of Japan

XXXVI Annual Research Meeting 2022 from the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez

Annual Research Meeting 2022 from the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez

British Society of Urogynaecology Abstracts: Annual Research Meeting November 2021.

British Society of Urogynaecology Abstracts: Annual Research Meeting November 2021.

XXXV Annual Research Meeting 2021 of the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez

XXXV Annual Research Meeting 2021 of the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez

British Society of Urogynaecology Abstracts: Annual Research Meeting November 2020.

British Society of Urogynaecology Abstracts: Annual Research Meeting November 2020.

AcademyHealth Annual Research Meeting (ARM): A Selection of Abstracts Accepted for Oral Presentation, 2021.

Research ObjectiveTo investigate the extent to which telehealth visits mitigated COVID‐19 pandemic‐related impacts on in‐person outpatient visits among Medicare beneficiaries, including those who are high‐cost high‐need. High‐cost high‐need patients were defined as those 65 years or older and with 2 or higher Hierarchical Condition Categories (HCC) scores.Study DesignA difference‐in‐difference design was used to estimate the change in outpatient in‐person and telehealth utilization for the COVID‐19 pandemic cohort compared to the control cohort in the prior year.Population StudiedMedicare patients from an Accountable Care Organization (ACO) were used as the study sample. The pandemic cohort was defined as those enrolled in the ACO in 2019–2020 (N = 21,361). The control cohort was defined as those enrolled in the ACO in 2018–2019 (N = 20,028). The study period was defined as April–September 2020 for the pandemic cohort and the same months in 2019 for the control cohort, with the preceding 12 months used as the baseline periods, respectively. Over 740,000 patient‐month records were analyzed using logistic and negative binomial regressions. The models were adjusted for patient‐level characteristics, including HCC scores, which reflect the complexity of patient health conditions and risk for future healthcare costs.Principal FindingsThe total number of outpatient encounters (in‐person and telehealth) in both primary and specialty care decreased by 41.5% in April 2020 compared to the pre‐pandemic period. Telehealth comprised 78% of all outpatient encounters in April 2020 but declined to 22% by the end of September 2020. Only about 40% of all patients had at least one telehealth encounter between April–September 2020. Compared to the control cohort, the pandemic cohort experienced a monthly average of 113 fewer primary care encounters per 1000 patients (OR: 0.75, 95% CI: [0.73, 0.77]) and 49 fewer specialty care encounters (OR: 0.82, 95% CI: [0.80, 0.85]) over the six‐month study period. This represented a decline of 25.6% and 17.3% in primary care and specialty encounters, respectively, among high‐cost high‐need patients. High‐cost high‐need patients or those with disabilities were more likely to use telehealth and experienced a lesser reduction in outpatient care utilization than other Medicare beneficiaries (OR: 1.20 and 1.06). Medicare beneficiaries with dual Medicaid coverage, those of non‐white race/ethnic groups, and those living in rural/suburban areas were less likely to use telehealth and experienced a greater reduction in total outpatient care (OR: 0.86, 0.96 and 0.90).ConclusionsWhile there was a substantial significant increase in telehealth use in April 2020, utilization declined significantly during the six‐month study period, and did not fully mitigate the decline in in‐person outpatient visits resulting from the COVID‐19 pandemic. While high‐cost high‐need Medicare patients and those with disabilities were more likely to use telehealth, disparities in telehealth usage and reductions in outpatient care remain among low‐income, non‐white, and rural Medicare beneficiaries.Implications for Policy or PracticeOlder patients insured by Medicare, including those with high‐cost high‐need or disabilities were able to make use of telehealth services for outpatient visits during the COVID‐19 pandemic. Health policies and interventions should target improving telehealth access and delivery for advancing sustainability and equity among Medicare beneficiaries.Primary Funding SourcePatient‐Centered Outcomes Research Institute.

Effect of relaxing hepatitis C treatment restrictions on direct-acting antiviral use in a Medicaid program: an interrupted time series analysis.

BACKGROUND: Although direct-acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C virus (HCV), many state Medicaid programs have limited coverage because of their expense. In 2015, the Centers for Medicare & Medicaid Services (CMS) notified states about the legality of Medicaid coverage limitations, particularly within managed care programs. OBJECTIVES: To (1) examine how relaxation and alignment of hepatitis C policies within the Oregon Medicaid program affected DAA utilization and (2) describe changes in DAA coverage policies and patient characteristics of treated individuals over time. METHODS: We manually collected DAA Medicaid drug policies in the state of Oregon before and after the CMS notification was released. After categorizing DAA policies into 2 groups based on baseline prior authorization criteria (restrictive and permissive), we evaluated how changes in these DAA policies affected utilization over 3 time periods (pre-CMS period, post-CMS period, and fibrosis policy alignment). Immediate and gradual changes in trend were assessed using an interrupted time series regression model. Finally, we examined patient characteristics and liver disease complications over time as policy restrictions were removed and aligned with one another. RESULTS: From 2014 to 2018, Oregon's coordinated care organizations and fee-for-service drug policies relaxed liver fibrosis and substance abstinence coverage criteria leading to immediate increases in DAA use in 2016 (0.62 prescriptions per 10,000 enrollees per month; 95% CI = 0.17 to 1.08) and 2018 (1.07 prescriptions per 10,000 enrollees per month; 95% CI = 0.63 to 1.51) among more restrictive coordinated care organizations at baseline. This was followed by a decrease in trend after the 2016 and 2018 impact (-0.05; 95% CI = -0.11 to -0.001 and -0.07; 95% CI = -0.13 to -0.02, respectively). Over the 3 periods, there was a decrease in treated individuals with liver-related complications (P < 0.0001) and an increase in those with a substance use diagnosis (P = 0.0013). CONCLUSIONS: Reducing coverage limitations resulted in treatment of patients with fewer liver-related complications and more substance use disorders. Expanding access to treatment did not result in sustained increases in utilization, and additional interventions may be necessary to meet HCV elimination goals. DISCLOSURES: This study was funded in part by AbbVie Pharmaceuticals, which did not have any role in the study design, collection, analysis and interpretation of data, writing the report, or the decision to submit the report for publication. Hartung received support for his work on this study via a grant from AbbVie Pharmaceuticals. The other authors did not receive any financial support for their contributions to this study. The authors have no other financial disclosures to report. This study was presented at the Academy Health Annual Research Meeting in Washington, DC, on June 3, 2019.

Direct medical costs of obesity in the United States and the most populous states.

BACKGROUND: After a dramatic increase in prevalence over several decades, obesity has become a major public health crisis in the United States. Research to date has consistently demonstrated a correlation between obesity and higher medical costs for a variety of U.S. subpopulations and specific categories of care. However, by examining associations rather than causal effects, previous studies likely underestimated the effect of obesity on medical expenditures. OBJECTIVE: To estimate the causal effect of obesity on direct medical care costs at the national and state levels. METHODS: This study is a pooled cross-sectional analysis of retrospective data from the 2001-2016 Medical Expenditure Panel Surveys. Adults aged 20-65 years with a biological child living in the household were included in the study sample. Primary outcomes were individual-level medical expenditures due to obesity, overall, as well as separately by type of payer and category of medical care. Results were reported at the national level and separately for the 20 most populous states. The expenditure estimates were obtained from 2-part models of instrumental variables in which the respondent's body mass index (BMI) was instrumented using the BMI of their biological child. RESULTS: Adults with obesity in the United States compared with those with normal weight experienced higher annual medical care costs by $2,505 or 100%, with costs increasing significantly with class of obesity, from 68.4% for class 1 to 233.6% for class 3. The effects of obesity raised costs in every category of care: inpatient, outpatient, and prescription drugs. Increases in medical expenditures due to obesity were higher for adults covered by public health insurance programs ($2,868) than for those having private health insurance ($2,058). In 2016, the aggregate medical cost due to obesity among adults in the United States was $260.6 billion. The increase in individual-level expenditures due to obesity varied considerably by state (e.g., 24.0% in Florida, 66.4% in New York, and 104.9% in Texas). CONCLUSIONS: The 2-part models of instrumental variables, which estimate the causal effects of obesity on direct medical costs, showed that the effect of obesity is greater than suggested by previous studies, which estimated only correlations. Much of the aggregate national cost of obesity-$260.6 billion-represents external costs, providing a rationale for interventions to prevent and reduce obesity. DISCLOSURES: Novo Nordisk financed the development of the study design, analysis, and interpretation of data, as well as writing support of the manuscript. Cawley, Biener, and Meyerhoefer received financial support from Novo Nordisk to conduct the research study on which this manuscript is based. Smolarz and Ramasamy are employees of Novo Nordisk. Ding and Zvenyach have no conflicts to declare. Our research has been presented as a poster at the 2020 Academy Health Annual Research Meeting (Virtual), July 28-August 6, 2020.

Advancing oral health policy through persuasive messaging and effective research measures.

Oral health is often excluded from broad health policy discussions, addressed only in a policy silo. There is a paucity of research to guide policymaking as it relates to oral health. In response, AcademyHealth's Oral Health Interest Group organized a meeting during the 2019 AcademyHealth Annual Research Meeting to promote transdisciplinary dialog on the current state of oral health policy and the steps necessary to improve the oral health of Americans. This article summarizes the two main themes that emerged from the proceedings of the Oral Health Interest Group meeting: a) recommendations for advocating the inclusion of oral health in policy discussions and b) critical research topics and measures needed for effective oral health policies in the future.

Trends in Gabapentin Prescribing in a Commercially Insured U.S. Adult Population, 2009-2016.

Gabapentin is prescribed for a variety of conditions and is often used off label. It is important to understand the prevalence of gabapentin prescribing and the characteristics of individuals who are prescribed gabapentin, given increasing concern regarding its potential for misuse. To (a) examine state- and region-level prevalence and trends in gabapentin prescribing from 2009 to 2016 and (b) characterize demographic and clinical characteristics of individuals prescribed gabapentin in a nationwide population of commercially insured adults. This retrospective, longitudinal study examined trends in gabapentin prescribing from 2009 to 2016. The study population included individuals aged 18-64 years who were enrolled in a commercial insurance plan at any point from 2009 to 2016. Individuals who were prescribed gabapentin were defined as beneficiaries with at least 1 gabapentin prescription claim in a calendar year (CY). A cross-sectional descriptive analysis was performed to examine differences in demographic and clinical characteristics of individuals prescribed or not prescribed gabapentin in CY 2016. The prevalence of gabapentin prescribing nearly doubled from 2009 to 2016. During this time, gabapentin prescribing increased in every state (range: 44%-179%). State-specific prevalence rates in 2016 varied from 12.7 to 43.9 per 1,000 beneficiaries. Overall, 2.7% of beneficiaries filled ≥ 1 gabapentin prescription in 2016. Individuals prescribed gabapentin were more likely to fill opioid prescriptions (60.8% vs. 16.5%, P < 0.01); reside in the South (53.7% vs. 47%, P < 0.01); be female (62.5% vs. 52.3%, P < 0.01); and be aged 55-64 years (41.7% vs. 21.2%, P < 0.01) compared with the comparator. Individuals who were prescribed gabapentin also had significantly higher rates of seizure disorders, neuropathic pain, mental health disorders, substance use disorders, and diabetes. The prevalence of gabapentin prescribing among a U.S. privately insured population has increased steadily in recent years. Additional research should examine coprescribing of gabapentin in the context of the opioid epidemic. The project described in this study was supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998. This study was also partially supported by grant number 2017-PM-BX-K026 (Data-Driven Responses to Prescription Drug Misuse in Kentucky) awarded by the Bureau of Justice Assistance. Viewpoints or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice or the official views of the NIH. The authors do not have any conflicts of interest to report. Portions of this study have been previously presented in poster presentations at the 2019 Academy Health Annual Research Meeting; June 2-4, 2019; Washington, DC, and the 2019 University of Kentucky Substance Use Research Day; March 3, 2019; Lexington, KY.

Noninitiation of Discharge Medications After Revascularization.

Timely initiation of medication therapy after a cardiovascular event is vital to achieve optimal patient outcomes, yet there is a lack of insight on the frequency and predictors of discharge medications that are delayed or never initiated. To (a) describe how frequently patients do not fill newly prescribed discharge medications within 30 days after revascularization and (b) identify predictors of patients who did not fill their new medications. A single-center, retrospective analysis was conducted of patients discharged after percutaneous coronary intervention or coronary artery bypass grafting. Discharge prescriptions were linked to pharmacy claims data to identify medications that were not filled within 30 days of discharge. 1,206 patients and their 5,253 discharge medications were included for study. More than one third of patients did not fill at least 1 discharge medication within 30 days (466/1,206, 38.6%); nearly 1 in 10 (116/1,206, 9.6%) did not fill any of their discharge prescriptions. Significant predictors of nonadherence included longer length of stay and higher number of prescribed discharge medications (both P values < 0.05). The largest classes of unfilled medications included insulin, factor Xa inhibitors, and narcotic analgesics. Noninitiation is a common issue among patients after cardiac revascularization. These patients may be at a higher risk of not filling their medications if they experience longer lengths of stay or are prescribed a higher number of medications at discharge. This work was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod). The sponsor had no connection with Surescripts and no role in the study design, data analysis, interpretation of results, or development of this manuscript. Glasgow reports personal fees from Burroughs Group, outside the submitted work. The other authors have nothing to disclose. Preliminary results from this work were presented as a poster presentation at the 2018 AcademyHealth Annual Research Meeting; June 24-26, 2018; Seattle, WA.