Hospital Claims Research Articles

Hospitalizations in people with down syndrome across age groups: a population-based cohort study in Switzerland.

People with Down syndrome suffer from multiple associated diseases. However, knowledge on rates and causes of hospitalizations is limited. This population-based cohort study used national hospital claims data in Switzerland between January 1, 2012 and December 31, 2020. Included were hospitalizations of people aged 0-90 years. People with Down syndrome were identified using ICD-10-GM code Q90 and were compared to the general population. The primary outcome was the hospitalization rate. Secondary outcomes were the primary reasons for hospitalizations, secondary diagnoses, and in-hospital outcomes. Analyses were stratified by three age groups: neonates and infants (0-12 months), children and adolescents (1-17 years), and adults (18-90 years). We calculated incidence rates, risk ratios (RR), and regression coefficients with corresponding 95% confidence intervals (CI). Among 9,992,538 hospitalizations, 5697 were identified for people with Down syndrome. Hospitalization rate for people with Down syndrome was highest in the first two years of life. In the total general population, it was highest in adults beyond 60 years. Primary reasons for hospitalization among people with Down syndrome were classified as diagnoses of the circulatory system (neonates and infants: RR 13.3 [95% CI 12.0-14.6], children and adolescents: RR 3.3 [95% CI 2.7-3.9]), and infectious diseases (adults: RR 4.0 [95% CI 3.7-4.2]). At birth, individuals with Down syndrome typically had an average of six diagnoses, a number that the general population reaches, on average, by the age of 69. People with Down syndrome experienced worse in-hospital outcomes, including longer stays in both the hospital and intensive care unit by a factor of 1.7 and a higher all-cause in-hospital mortality by an overall rate difference of 1.9%. The findings underscore the medical complexity of hospitalized people with Down syndrome and emphasize the need for a comprehensive, age-inclusive approach to improve in-hospital outcomes and anticipate emergency hospitalizations across age groups. Kantonsspital Aarau AG.

P-1010. Clinical and Economic Burden of Changing Initial Antifungal Regimens in Invasive Aspergillosis: A Hospital Perspective

Abstract Background Initial antifungal (AF) regimens (AFR) for Invasive Aspergillosis (IA) are often changed due to treatment failure, intolerability, or drug-drug interactions. We compared outcomes among IA patients who did and did not change their initial IA AFR.Table 1.Adjusted Baseline Characteristics of Patients Who Changed or Did Not Change Their IA Antifungal Regimen*CCI=Charlson comorbidity index; COPD=chronic obstructive pulmonary disease; IA= invasive Aspergillosis; SD=standard deviation*The following covariates were used to calculate propensity scores for Inverse probability of treatment weighting: age group, geographic region, payer type, year of index, asthma, autoimmune conditions, bacteremia, COPD, pneumonia, immunodeficiencies, myelodysplastic syndrome, transplant history, immunosuppressants, cancer, neutropenia, and total healthcare costs.||All covariates were well balanced as indicated by an SMD <0.1 except corticosteroids which was marginally imbalanced with an SMD of 0.108†Solid organ or hematopoietic cell transplant#Partial years data available in IQVIA New Data Warehouse⁋Azathioprine, cyclophosphamide, cyclosporine, methotrexate, mycophenolate, tacrolimus, voclosporin Methods This retrospective cohort study identified US adults with an index hospitalization for IA (ICD-10: B44.0, B44.1, B44.7) between Oct 2015 and Nov 2022 in IQVIA’s New Data Warehouse (pharmacy, outpatient and hospital claims). Patients were placed into two cohorts based on whether they changed AFRs, defined as starting a new AFR with or without discontinuing initial therapy at any subsequent point. Inverse probability of treatment weighting minimized confounding due to baseline differences between patients who changed vs. did not change their AFR. Inpatient length of stay (LOS), all-cause costs (in 2023 US$) and all-cause mortality in IA patients who did and did not change their initial AFR were reported as medians with interquartile ranges (IQR) or frequencies and compared.Table 2.Adjusted* Outcomes of Patients Who Changed or Did Not Change Their IA Antifungal RegimenLOS=length of stay; IA= invasive Aspergillosis; ICU=intensive care unit; IQR=interquartile range; SD=standard deviation*Inverse probability of treatment weighted Results Among 1,192 IA patients, 707 (59.3%) changed their initial AFR (Table 1). Most patients started therapy on an -azole (87% among those who changed vs 95% in those who did not change regimens). Duration of initial AFR for those who did and did not change their regimen was a median of 5 days (IQR=7) vs. 11 days (IQR=24), respectively. Hospital and ICU LOS were longer in the AFR change than the no change cohort (Table 2). Median costs associated with the index hospitalization, including pharmacy costs, were also significantly higher for those who changed AFR compared with those who did not. No statistical difference was seen in inpatient mortality during the index hospitalization between cohorts. Conclusion In this large contemporary cohort of patients with IA, most patients changed AFRs, with many doing so within 1-2 weeks of treatment initiation. Changing regimens was associated with significantly longer hospital and ICU LOS as well as higher inpatient costs. Further study is needed to understand reasons for changing AFRs and to understand changes that might be avoided. New and improved AFs that reduce the need for regimen changes offer the opportunity to reduce the economic and clinical burden associated with changing AFRs. Disclosures Barbara D. Alexander, MD, Basilea: Advisor/Consultant|F2G: Advisor/Consultant|F2G: Grant/Research Support|HealthTrackRx: Advisor/Consultant|HealthTrackRx: Board Member|Scynexis: Grant/Research Support|TFF Pharmaceuticals: Advisor/Consultant Mark Bresnik, MD, F2G Ltd: Employee Ruthwik Anupindi, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Lia Pizzicato, MPH, F2G Ltd: Grant/Research Support|IQVIA: Employee Mitchell DeKoven, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Belinda Lovelace, PharmD, MS, MJ, F2G, Inc.: Employee Craig I. Coleman, PharmD, F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties

P-1011. Real-World Antifungal Therapy Patterns in US Patients with Invasive Aspergillosis: It’s Complicated

Abstract Background The complexity of antifungal therapy (AFT) in Invasive Aspergillosis (IA) can complicate care. We sought to better understand AFT changes that occur in IA across both in- and outpatient settings of care.Table 1.Baseline Characteristics of Patients Who Changed or Did Not Change Their Invasive Aspergillosis Antifungal Therapy* CCI=Charlson comorbidity index; COPD=chronic obstructive pulmonary disease; IA= invasive Aspergillosis †Partial years data were available in IQVIA New Data Warehouse #Solid organ or hematopoietic cell transplant ¶Azathioprine, cyclophosphamide, cyclosporine, methotrexate, mycophenolate, tacrolimus, voclosporin *The following covariates were used to calculate propensity scores for Inverse probability of treatment weighting: age group, geographic region, payer type, year of index, asthma, autoimmune conditions, bacteremia, COPD, pneumonia, immunodeficiencies, myelodysplastic syndrome, transplant history, immunosuppressants, cancer, neutropenia, and total healthcare costs. ∥All covariates were well balanced as indicated by an SMD <0.1 except corticosteroids which was marginally imbalanced with an SMD of 0.108 Methods This retrospective study was performed using the IQVIA New Data Warehouse (hospital, outpatient, and prescription claims) from Oct 2015-Nov 2022. The index inpatient stay was identified by IA ICD-10 codes. Patients were followed from index hospitalization until end of the study period (Dec 31, 2022), lack of medical or pharmacy activity in the database, or death (whichever occurred first). Patients were stratified by whether they ‘changed’ (defined as discontinuation with restart of a non-first line (L) AFT, switch or modification) or ‘did not change’ their AFT during the post-index period. Inverse probability of treatment weighting was used to minimize confounding due to baseline differences between the change and no change cohorts. Data were reported as frequencies or median with interquartile range.Figure 1.Sankey Diagram of IA Patients Who Required Changes in Antifungal Therapy Results Among 1,192 IA adults, 707 (59.3%) experienced changes to their AFT (60% modified existing AFT, 22.1% stopped 1L AFT and initiated AFT for 2L, and 18% directly switched to a different AFT) (Table 1). Among those who changed AFT, mold active azole use predominated, with voriconazole the most used across all AFT lines (37.3-49.3%), followed by isavuconazole (19.3-26.7%) (Figure 1). Echinocandin use varied between 25.3%-33.6% over 1-4L and amphotericin B use steadily increased over the lines of therapy (13.4-20.7%). Among the 485 (40.6%) patients that completed AFT with no changes, most received azole (62.8% voriconazole, 15.2% isavuconazole) monotherapy. Patients who changed AFT had shorter time on treatment for 1-3L (5-8 days) than those who did not change (11-21 days) (p< 0.047). Conclusion Based on this snapshot of IA treatment patterns, managing AFT for patients with IA is complicated. Most patients require changes to their AFT. Future studies should examine challenges associated with IA treatment and which factors contribute to AFT changes, such as drug toxicities or interactions and refractory infection. Novel oral antifungals that reduce the need for AFT changes when IA patients have limited options are needed. Disclosures Barbara D. Alexander, MD, Basilea: Advisor/Consultant|F2G: Advisor/Consultant|F2G: Grant/Research Support|HealthTrackRx: Advisor/Consultant|HealthTrackRx: Board Member|Scynexis: Grant/Research Support|TFF Pharmaceuticals: Advisor/Consultant Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties Mark Bresnik, MD, F2G Ltd: Employee Ruthwik Anupindi, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Lia Pizzicato, MPH, F2G Ltd: Grant/Research Support|IQVIA: Employee Mitchell DeKoven, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Belinda Lovelace, PharmD, MS, MJ, F2G, Inc.: Employee Craig I. Coleman, PharmD, F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support

P-911. Antifungal Treatment Patterns, Healthcare Utilization, Costs and Mortality in Coccidioidal Meningitis Patients: A Descriptive Analysis of United States Nationwide Claims Database

Abstract Background Coccidioidal meningitis (CM) patients require lifelong antifungal therapy (AFT) to reduce morbidity and mortality. This study sought to identify CM patients and characterize their AFT patterns, healthcare utilization, costs, and mortality.Table 1.Baseline Characteristics of Patients with Coccidioidal Meningitis*Partial years data utilized†Baseline period was defined as the 6 months prior to, but not including the date of coccidioidal meningitis diagnosis (index date) Methods A retrospective study was performed in the United States (US) using data from IQVIA’s New Data Warehouse (hospital, outpatient and prescription claims) for 2015-2022. We identified CM patients at time of diagnosis (index date). AFT use patterns were captured for up to 4 lines of therapy per patient. Subsequent lines began upon discontinuation and restart, switch or modification of first line AFT. Healthcare utilization and treatment costs were depicted as per person per year (PPPY). Results were reported as frequencies or medians (25%, 75% ranges).Figure 1.Antifungal Treatment Patterns in Patients Diagnosed with Coccidioidal MeningitisA=amphotericin B; F=fluconazole; OA=other azole Results In total, 626 CM patients were identified with a follow up of 23 (9, 50) months. Median age was 57 (42, 68) years, 56.4% were men, 83.4% from the Western US and 70.8% had commercial insurance (Table 1). Common comorbidities included diabetes, obesity and pneumonia. In total, 70.9% of patients initiated first line AFT, for which 10 unique treatment courses accounted for 82.0% of patients (Figure 1). Azoles were used as first line AFT in 98.4% of patients, with 83.8% receiving fluconazole monotherapy. Polyenes were used in 7.2% of patients as first line AFT, with 1.6% as monotherapy. First line AFT lasted 31 (7, 224) days. Second, third- and fourth-line AFT was observed in 257, 182 and 129 patients, respectively. Azoles continued to be used often over subsequent lines of AFT (96.9-97.7% of patients), with 66.5-77.5% of azole use being fluconazole monotherapy. Polyene use increased (peaking at 13.2% of patients in line 3), often administered with azoles (55.6-79.2%). Patients experienced 0.81 (0.37, 2.28) hospitalizations and 5 (1, 12) outpatient physician office visits PPPY after the index diagnosis encounter. Total all-cause costs were $28,664 ($9,912, $89,460) PPPY. All-cause death occurred in 5.4% of patients (time to death=79 (9, 418) days). Conclusion This study demonstrates the complexity of treating CM in routine practice. CM is responsible for a substantial clinical and economic burden in the US. Disclosures Fariba Donovan, MD, PhD, F2G: Advisor/Consultant|F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support|F2G Ltd: Honoraria Mark Bresnik, MD, F2G Ltd: Employee Lia Pizzicato, MPH, F2G Ltd: Grant/Research Support|IQVIA: Employee Ruthwik Anupindi, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Mitchell DeKoven, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Belinda Lovelace, PharmD, MS, MJ, F2G, Inc.: Employee Craig I. Coleman, PharmD, F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support

P-1534. The Impact of Broad-spectrum Antimicrobials in Patients with Community-onset Pneumonia at Low Risk of Drug-resistant Pathogens: A Historical Cohort Study

Abstract Background The administration of broad-spectrum antimicrobials has prevailed in the clinical management of community-onset pneumonia (COP). Growing evidence suggests that the use of unnecessary broad-spectrum antimicrobials for patients with COP leads to adverse events and poor outcomes. This study aims to understand the impact of broad-spectrum antipseudomonal β-lactam use on clinical outcomes and resource utilization in patients hospitalized for COP with a low risk for drug-resistant pathogens (DRPs). Methods This historical cohort study analyzed the hospital claims database in Japan from January to December 2018. The study includes patients aged 20 or older hospitalized with COP having intravenous antimicrobial therapy administration and excludes patients with a high risk for DRPs. Patients were selected into a broad-spectrum (antipseudomonal β-lactam therapy) and a narrow-spectrum (non-antipseudomonal β-lactam therapy) group based on the initial antimicrobial regimen. This study evaluates 30-day mortality as a primary outcome by inverse probability of treatment weighting (IPTW)and healthcare resource utilization as one of the secondary outcomes. Results A total of 15,617 patients met the inclusion criteria. This target population was divided into two groups: 2,627 patients in the broad-spectrum and 12,990 in the narrow-spectrum group. In the first group, the most commonly used antimicrobials were Piperacillin / Tazobactam (68%), and the 30-day mortality was 10.6 in contrast with 5.3% in the second group. Thus, the broad-spectrum group was associated with an increased 30-day mortality rate in contrast with the narrow-spectrum group after IPTW weighting (adjusted odds ratio 1.77, 95% confidence interval [1.52 to 2.06], < 0.001). This trend was observed regardless of pneumonia severity. The average inpatient cost was $6,139 USD for the broad-spectrum group against $5,184 USD for the narrow-spectrum group, with respective length of stay (LOS) figures of 23.1 and 19.8 days. Conclusion This study shows that the initial use of antipseudomonal β-lactams for COP with a low risk for DRPs is associated with higher poor outcomes, including death and higher healthcare resource utilization. Judicious selection of initial antimicrobials is warranted in the management of COP. Disclosures Junichi Hirayama, n/a, bioMerieux Japan: employee of bioMerieux, salary Rie Ueno, MD., BioMérieux Japan Ltd.: Employee of BioMérieux Japan Ltd. Hiroshi Mukae, M.D., Ph.D., AstraZeneca: Lecture fees|Gilead Sciences: Lecture fees|GSK: Lecture fees|MSD: Advisor/Consultant|MSD: Lecture fees|Pfizer: Lecture fees|Shionogi & Co., Ltd.: Advisor/Consultant|Shionogi & Co., Ltd.: Grant/Research Support|Shionogi & Co., Ltd.: Lecture fees

Impact of Uterine Leiomyomas on Cardiovascular Disease Risk in Young Reproductive-Aged Women: A Nationwide Population-Based Cohort Study.

Background/Objectives: Uterine leiomyomas are the most common benign gynecological tumors in women of reproductive age and are often associated with localized symptoms. However, emerging evidence suggests a link between uterine leiomyomas and systemic conditions such as cardiovascular disease (CVD), particularly myocardial infarction (MI) and ischemic stroke (IS). This study aimed to investigate the relationship between uterine leiomyomas and the risk of CVD events in young women aged 20-39 years using a large, nationwide, population-based cohort. Methods: This retrospective cohort study analyzed data from the National Health Insurance Service database of South Korea of 2,581,700 women aged 20-39 years who underwent health screening between 2009 and 2012. Uterine leiomyomas were identified using International Code of Disease, 10th Edition codes. CVD events (MI and IS) were defined according to hospital claims and radiological data. Multivariate hazard ratios (HRs) were calculated to evaluate the association between leiomyomas and CVD after adjusting for confounders (age, lifestyle factors, comorbidities, and body mass index). Results: In all, 58,812 were diagnosed with uterine leiomyomas, and 25,063 underwent surgical treatment. During the follow-up period, MI occurred in 115 women (0.21%) and IS in 82 women (0.15%) in the leiomyoma group, compared with 3107 cases of MI (0.12%) and 2240 cases of IS (0.09%) in the non-leiomyoma group. The leiomyoma group demonstrated a higher incidence rate of CVD (IR: 0.63 vs. 0.39 per 1000 person-years). After adjusting for confounding factors such as age, lifestyle, comorbidities, and body mass index (BMI), the hazard ratio (HR) for MI was 1.32, indicating a statistically significant increase in cardiovascular risk. The risk of CVD was lower in women who underwent surgical treatment; however, when specifically analyzing the occurrence of MI and IS, no statistically significant differences were observed between the two groups. Conclusions: Uterine leiomyomas are associated with an increased risk of MI and IS in young women. Surgical treatment itself may be associated with additional cardiovascular risks. Further research is needed to develop strategies to mitigate these risks and elucidate the underlying mechanisms.

Increase in prevalence and costs of cirrhosis in the Netherlands: a nationwide hospital diagnosis data analysis.

Due to the rising incidence of patients with cirrhosis and its accompanied extensive management, there is an increasing burden of cirrhosis patients on healthcare resources and costs. However, exact data on Dutch cirrhosis epidemiology and associated costs are lacking. We aimed to determine the year-prevalence of adults (aged ≥18 years) with cirrhosis registered as active patients in Dutch hospitals (2017-2021) using the Dutch hospital claims database. Next, we assessed average reimbursed annual healthcare costs. The prevalence of patients with cirrhosis registered as an active patient in Dutch hospitals increased by 54% from 48.7 patients per 100 000 in 2017 to 75.2 per 100 000 in 2021. There were regional differences and prevalence for cirrhosis was at highest of 105.6 patients per 100 000. The yearly incidence of patients for which hospitals requested claims was n = 3725 in 2018, n = 3840 in 2019 (+3%), n = 3749 in 2020 (-2%), and n = 3695 in 2021 (-1%). Total number of hospital admissions increased by 19% from 2443 in 2017 to 2899 in 2021. The annual reported costs for patients with cirrhosis increased by 120% from €35 million in 2017 to €78 million in 2021. Adjusted for inflation this increase was 143% to €85 million. The prevalence of patients with cirrhosis registered as a patient in Dutch hospitals increased by more than 50 percent from 2017 to 2021, with regional differences. Consequently, total healthcare costs for Dutch patients with cirrhosis more than doubled in less than 5 years.

Comparative adherence and persistence of single-inhaler and multiple-inhaler triple therapies among patients with chronic obstructive pulmonary disease in Japan: a retrospective cohort study

ObjectivesTo evaluate and compare medication adherence and persistence for patients newly initiating single-inhaler triple therapy (SITT) and multiple-inhaler triple therapy (MITT) for chronic obstructive pulmonary disease (COPD) in Japan.DesignRetrospective, new-user,...

Excess Diagnosis Coding In Medicare Advantage: Evidence From Skilled Nursing Facility Clinical Assessments.

Some research suggests that risk adjustment plays a substantial role in explaining the high levels of government spending on Medicare Advantage (MA). We studied whether the reliance on diagnosis codes to risk-adjust payments to MA plans leads to the inflation of submitted diagnoses. Our approach relied on a comparison among diagnoses included in hospital claims, health status measures from similarly timed health assessments completed by skilled nursing facility (SNF) clinicians, and short-term mortality data. SNF assessments are completed for both MA and traditional Medicare enrollees and, in contrast to diagnoses in claims, cannot be directly manipulated by MA plans or inform their payments. We found that among patients with the same assessment-based health status discharged to the same SNF, claims-based disease scores were 4.1percent higher for MA enrollees, on average, relative to traditional Medicare enrollees. However, short-term mortality risk was, on average, 8.8percent lower for MA enrollees. About 60percent of the payer-based difference in disease scores was attributable to MA chart review updates to diagnoses, and additional codes from chart reviews were unrelated to assessment-based health status. Given the growth of MA and current spending on the program, which reached $321billion in 2021, this evidence of potential coding inflation may have large fiscal implications.

Identification of Chronic Hypertension in Pregnancy in Three Administrative Data Sources Among Medicaid-Funded Births in California.

Administrative data sources are used to describe the epidemiology of chronic hypertension in pregnancy and its consequences. Differences in identification across sources may affect research estimates. We compared identification of chronic hypertension in birth certificate records, hospital discharge records, and Medi-Cal claims in the same individuals. We used data from 820 140 2016-2020 California Medi-Cal covered births. We identified chronic hypertension on birth certificates using the prepregnancy hypertension check box and in hospital discharge records and Medi-Cal claims using ICD codes. We compared the prevalence of chronic hypertension and identified predictors of agreement. We also compared absolute and relative estimates of racial/ethnic disparities in chronic hypertension and associations with neonatal outcomes. The prevalence of chronic hypertension was 0.7% in birth records, 2.1% in hospital discharge records, and 3.9% in Medi-Cal claims. There was low to fair agreement between birth certificate records and hospitalization records (kappa = 0.36) and Medi-Cal claims (kappa = 0.25). Characteristics associated with the worst agreement were eligibility for Women Infant and Children benefits, US-born, and normal body mass index. Estimates of the relative risk for racial/ethnic disparities and associations with preterm birth and SGA age at delivery were similar across sources. Estimates of risk differences were larger in hospitalization and Medi-Cal claims data. Reliance on birth certificate data may contribute to underestimated prevalence estimates and biased causal estimates. Epidemiologic research and public health surveillance of chronic hypertension and its consequences should incorporate data from multiple data sources to improve validity of estimates.

Association Between Pre-Hip Fracture Antidepressant Use and Post-Hip Fracture Length of Hospital Stay in Medicare Beneficiaries and Assessing Sex Differences

Antidepressants are the first-line treatment for depression among older adults. While antidepressants are associated with increased risk of falls and fractures in older adults, their effect on outcomes after fall-related injuries such as hip fracture, and whether these effects differ by sex, is unknown. Thus, the purpose of this study was to examine the association between prefracture antidepressant use and hospital length of stay (LOS) among hip fracture survivors, and related sex differences. Participants included 17,936 community-dwelling Medicare fee-for-service beneficiaries with depression and hospitalization claim for hip fracture surgery between 2010 and 2017. Ordinal logistic regression estimated the association between prefracture antidepressant use and hospital LOS in days, categorized into three groups (1-4, 5-8, and 8+ days) during the 30-day postfracture period, adjusting for demographic, medical, facility, and geographic factors. A sex-by-antidepressant use interaction term was included to examine effect heterogeneity by sex. Prefracture antidepressant users (47%, n = 8,350) were more likely to be younger, White females. The adjusted ordinal logistic regression showed beneficiaries who used antidepressants had 8% higher odds of being in a shorter hospital LOS category compared to non-users (OR = 1.08; 95% CI = 1.02, 1.14; p=0.01). The sex-by-antidepressant use interaction was not statistically significant (p=0.92). Among older adults with depression who subsequently experienced a hip fracture, antidepressant use of >30 days in the 6 months prior to fracture was associated with a shorter hospital LOS. These findings indicate that use of antidepressants does not prolong early recovery from hip fracture and may be protective.

Analysis of the implementation of the s-claim application system in the context of the implementation of BPJS claim standards in Charitas Belitang hospital in 2024

Background: The S-claim application is an application designed by the ICT team of Charitas hospital palembang to be used by the internal Charitas hospital group. This S-claim application is used by the service unit and the internal verifier of the casemix team at the hospital to make it easier to verify the completeness of the patient's file based on his diagnosis before being claimed to BPJS Kesehatan Objectives: to make efforts to improve the completeness of the claim file on the S-claim Application so that it is effective and efficient. Research method: This type of research is qualitative descriptive with data collection methods of interviews, observations and FGDs on 30 informants. Results: Based on the results of the study, it is known that the cause of the delay in BPJS Kesehatan claims is based on the input factor of the number of human resources that are not in accordance with the Job description, based on mathematical factors, namely incomplete hospitalization claim files such as medical resumes. Based on the Process factor, it is a Form Checklist of the completeness of the s-claim file that has not been running optimally in the authorized units.

Emergency Department Utilization for Postpartum Behavioral Health Problems and Assault Injury During the COVID-19 Pandemic.

Objective: Distinctive stressors facing pregnant and postpartum individuals during the COVID-19 pandemic may have affected their emergency department (ED) care-seeking for behavioral health concerns and violence victimization. We tested whether the incidence of postpartum behavioral health and assault injury ED visits differed for individuals according to their months of postpartum pandemic exposure. Methods: We used statewide, longitudinally linked hospital and ED administrative claims data from California to classify all individuals with hospital deliveries between January 1, 2016, and December 31, 2020, according to their months of postpartum pandemic exposure. Outcomes comprised 12-month incidence of any ED visit for a psychiatric disorder, drug use disorder/overdose, alcohol use disorder/intoxication, or assault injury, defined using International Classification of Diseases-Clinical Modification, version 10 codes. Risk ratios compared the incidence of each outcome among people with 1-12 months of postpartum pandemic exposure to those with 0 months of exposure. Results: Compared to people with 0 months of postpartum pandemic exposure (n = 1,163,215), delivering people with 1-12 month' exposure (range: n = 26,836 to n = 273,561) were approximately equally likely to have a postpartum ED visit for a psychiatric disorder, drug use disorder, or alcohol use disorder, after adjusting for demographic differences (most p > 0.10). The incidence of assault injury was significantly lower among delivering individuals with 11 or 12 months of pandemic exposure (RRadj = 0.70 and 0.91, respectively; both p < 0.01) compared to those with 0 months. Conclusions: Contrary to expectations, the pandemic did not appear to have affected ED utilization for most behavioral health conditions among postpartum individuals, but assault injury ED visits declined.

Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study

Abstract Background The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care. Methods In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses. Results Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021. Conclusions Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics. Key messages • Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care. • This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.

Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis

BackgroundIn adults aged 50 + years, vaccine-preventable diseases (VPDs) pose a significant health burden and can lead to additional ‘downstream effects’ of infection beyond the acute phase e.g., increasing the risk for non-communicable disease and exacerbating chronic conditions. The aim was to understand and quantify the burden of VPD downstream effects in hospitalised adults in the United States.MethodsThis retrospective observational study analysed hospitalisation claims data (2016–2019) with 1-year follow-up, in adults with a VPD diagnosis versus matched controls (using Optum’s de-identified Clinformatics Data Mart Database). Outcomes included mortality; increase in Charlson Comorbidity Index (CCI) score; new diagnosis of comorbidities; and loss of independence (defined by need for home health/home care and/or move to long-term facility).ResultsMortality was significantly increased in VPD cases versus controls at 30-day (risk ratio [RR] of 4.08 [95% CI 3.98–4.18]) and 1-year follow-up (RR 2.76 [2.73–2.80]). Over a 1-year follow-up period, morbidity increased following VPD hospitalisation: 65–86% of VPD cases had new comorbidities diagnosed (versus 13–41% of controls); with a significantly higher mean increase in CCI score versus baseline (3.23 in VPD cases versus 0.89 in controls, p < 0.001). Adults were observed to experience a worsening of their health status and were less likely to return to their original health state. In addition, 41% of VPD cases had a loss of independence following hospitalisation versus 12% of controls; as seen by an increased need for home assistance (in 25% versus 9% of controls) and/or a move to a long-term care facility (in 29% versus 6% of controls).ConclusionsThis analysis suggests that VPD hospitalised cases suffer significantly worse clinical outcomes than controls, with downstream effects that include increased mortality and morbidity, and greater loss of independence. Evidence on potential downstream effects of infection is relatively new, and this additional burden is generally not considered in vaccine decision-making. More research is needed to disentangle the effect of VPDs on new comorbidities versus the natural course of the condition. Increasing awareness among adults, healthcare providers and decision makers could help to increase adult vaccination coverage, and reduce the clinical burden of VPDs.

Navigating the aftermath: Risk factors of recurrence following coronary bypass surgery in Indonesia.

Coronary heart disease (CHD) remains a leading cause of mortality in Indonesia, and coronary artery bypass graft (CABG) surgery is frequently employed to manage arterial blockages. Despite its efficacy, the recurrence of heart disease post-surgery is a significant concern, highlighting the need for a deeper understanding of its influencing factors. The aim of this study was to examine the factors associated with the incidence of heart disease recurrence after coronary bypass surgery. This study employed a prospective observational design, analyzing hospital claim data from Indonesia's Social Security Agency for Health, known as Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, from 2017 to 2022. The analysis included 5,947 patients who survived CABG surgery. Multivariable logistic regression was utilized to assess the relationship between patient demographics, comorbidities, socioeconomic status, and compliance with follow-up visits, as well as their impact on the recurrence of cardiovascular disease. The study found that 24.1% of patients experienced hospitalization recurrence. Patients with irregular follow-ups were less likely to experience recurrence (adjusted odds ratio (AOR): 0.63; 95%CI: 0.51-0.78). Other significant risk factors for recurrence included being self-employed (AOR: 2.09; 95%CI: 1.72-2.55), having comorbid conditions such as disorders of fluid, electrolyte, and acid-base balance (AOR: 3.55; 95%CI: 2.97-4.24), and experiencing cerebral infarction or stroke (AOR: 10.85; 95%CI: 8.24-14.29). In contrast, older age (AOR: 0.89; 95%CI: 0.88-0.91) and the presence of non-insulin-dependent diabetes mellitus (AOR: 0.35; 95%CI: 0.29-0.42) were associated with a lower risk of recurrence. Sex did not significantly influence the risk of recurrence (AOR: 1.18; 95%CI: 0.86-1.62). In conclusion, the study indicates a considerable rate of cardiovascular disease recurrence post-CABG in Indonesia, highlighting several key risk factors. Tailored postoperative management and strict adherence to follow-up protocols are essential for mitigating recurrence. These findings offer crucial insights for improving post-CABG health management strategies in Indonesia.

Postpartum Emergency Care Visits Among North Carolina Medicaid Beneficiaries, 2013-2019.

Objective: To describe the rate, timing, and primary diagnosis codes for emergency care visits up to 8 weeks (56 days) after live birth among Medicaid beneficiaries in North Carolina (NC). Materials and Methods: Using a linked dataset of Medicaid hospital claims and certificates of live birth, which included Medicaid beneficiaries who had a live-born infant in NC between January 1, 2013, and November 4, 2019, and met inclusion criteria (n = 321,879), we estimated week-specific visit rates for emergency care visits that did not result in hospital admission (outpatient) and those that did (inpatient). We assessed the 10 leading diagnosis code categories for emergency care visits and described the characteristics of people with 0, 1, or ≥2 outpatient emergency care visits. Results: One in eight (12.4%) Medicaid beneficiaries had an emergency care visit that did not result in inpatient hospital admission during the first 8 weeks postpartum. Visit rates peaked in postpartum week 2. Diagnosis codes for nonspecific symptoms and substance use were the two leading diagnosis code categories for outpatient emergency care visits. Respiratory concerns and gastrointestinal concerns were the two leading diagnosis code categories for inpatient emergency care visits. Compared with those with zero outpatient emergency care visits, a greater proportion of people with ≥2 visits had less than a high school education, used tobacco during pregnancy, had Medicaid insurance outside of pregnancy, had mental health as a medical comorbidity, and/or had ≥2 medical comorbidities. Conclusions: These findings support scheduling health care visits early in the postpartum period, when emergency care visits are most frequent, and point to unmet needs for substance use support.

Characteristics and real-world medication persistence of people living with HIV treated with DTG/3TC or BIC/FTC/TAF: a hospital claims database study in Japan.

As the life expectancy of people living with human immunodeficiency virus (HIV) (PLWH) has improved, chronic disease burden and polypharmacy have increased in PLWH. Simplification of the antiretroviral therapy (ART) regimen for PLWH has become crucial. The real-world treatment patterns and medication persistence of the 2-drug single-tablet regimen (STR), dolutegravir/lamivudine (DTG/3TC), compared to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) prescribed were investigated. This retrospective, database study extracted data from a hospital-based medical claims database in Japan. The changes in ART distributions by year during the identification period between January 1, 2018 and December 31, 2021 were observed. Patients with disease record of HIV-1 infection and prescribed DTG/3TC or BIC/FTC/TAF as the first prescription of STR during the identification period were divided into two cohorts; DTG/3TC cohort and BIC/FTC/TAF cohort, respectively. Patient without medication records more than 3 months and no future data more than 6 months were excluded. Patients' characteristics were compared between the DTG/3TC cohort and the BIC/FTC/TAF cohort by Mantel-Haenszel test to adjust for age. Medication persistence was compared between the two cohorts by evaluating the continuation rates using Kaplan-Meier methods, using the log-rank test to assess the difference between the Kaplan-Meier curves. The median time-to-first prescription was compared between the two cohorts by Kaplan-Meier methods. Prescriptions of DTG/3TC and BIC/FTC/TAF increased steadily from 2019 to 2021 after the release year of each STR. There was no significant difference in the time-to-first prescription (p = 0.3). A total of 959 patients were included, with 120 patients and 839 patients on DTG/3TC and BIC/FTC/TAF, respectively. The proportion of dyslipidemia at baseline was significantly higher in the DTG/3TC cohort than in the BIC/FTC/TAF cohort after adjusting for mean age (p = 0.002). There was no significant difference in medication persistence between the two cohorts (p = 0.91). This study showed that DTG/3TC was likely to be selected for elderly patients and those with chronic disease in real-world clinical practice, which seems in accordance with the treatment strategy recommended by guidelines. Comparable medication persistence was observed with both regimens, aligning with findings from other countries. The 2-drug single-tablet regimen DTG/3TC may be an important ART regimen for PLWH with multiple morbidities and polypharmacy in an aging society. Due to the limitations of the database, further research to assess viral loads, emergence of resistance and adverse events will be encouraged.

Recent Medicare Billing Trends of Hospitals and Surgeons for Revision Hip and Knee Total Joint Arthroplasty: Is the Value of a Surgeon’s Work Decreasing?

BackgroundRevision hip and knee total joint arthroplasty (TJA) is associated with higher health care costs and work burden than primary TJAs. However, previous studies demonstrated a decrease in the value of reimbursements for revision TJA, causing concerns for hospitals and surgeons regarding the financial sustainability of these resource-expensive procedures. This study aimed to investigate the Medicare billing trends of hospitals and surgeons for revision TJA between 2017 and 2022. MethodsMedicare claims and payments for revision TJA were identified from the Centers for Medicare and Medicaid Services Part A and B databases. Hospital claims for revision TJA were identified through Diagnostic-Related Groups (467, 468). Surgeon claims were identified using Current Procedural Terminology codes for revision hip (27134, 27137, 27138) and knee (27486, 27487) TJA. Yearly charges, reimbursements, and markup ratios (MR = charge/reimbursement) were analyzed. All monetary values were adjusted to the 2022 U.S. dollars. ResultsA total of 43,125 surgeons and 152,974 hospital claims were included in this study. From 2017 to 2022, the total volume of revision TJA decreased by 19.4%. Hospital reimbursements remained relatively unchanged, with a decrease of 1.4%, while hospital charges increased by 11.8%, resulting in a 13.3% increase in the MR. For surgeons, reimbursements decreased by 13.8%, and charges decreased by 11.0%, leading to a 3.3% increase in the MR. The proportion of surgeon reimbursement to hospital reimbursement decreased from 8.5 to 7.5%. ConclusionsThe comparison of the billing trends of hospitals and surgeons showed the relatively stable value of hospital reimbursement while the value of surgeon reimbursement continued to decline, implying the decreasing fiscal value of physicians’ work. The study suggests the need for sustainable financial incentives for surgeons performing revision TJA and strategies to control hospital charges to alleviate financial burdens and improve patient access to revision TJA.

Association between pre-hip fracture depression and days at home after fracture and assessing sex differences.

Hip fracture and depression are important public health issues among older adults, but how pre-fracture depression impacts recovery after hip fracture is unknown, especially among males who often experience greater depression severity. Days at home (DAH), or the days spent outside a hospital or healthcare facility, is a novel, patient-centered outcome that can capture meaningful aspects of fracture recovery. How pre-fracture depression impacts DAH after fracture, and related sex differences, remains unclear. Participants included 63,618 Medicare fee-for-service beneficiaries aged 65+ years, with a hospitalization claim for hip fracture surgery between 2010 and 2017. The primary exposure was a diagnosis of depression at hospital admission, and the primary outcome was total DAH over 12 months post-discharge. Longitudinal associations between pre-fracture depression and the count of DAH among beneficiaries were estimated using Poisson regression models after adjustment for covariates; sex-by-depression interactions were also assessed. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) reflecting relative differences were estimated from these models. Overall, beneficiaries with depression were younger, White females, and spent 11 fewer average DAH compared to counterparts without depression when demographic factors (age and sex) (IRR = 0.91; 95% CI = 0.90, 0.92; p < 0.0001) and social determinants of health (race, Medicaid dual eligibility, and poverty) were adjusted for (IRR = 0.92; 95% CI = 0.91, 0.93; p < 0.0001), but this association attenuated after adjusting for medical complexities (IRR = 0.99; 95% CI = 0.98, 1.01; p = 0.41) and facility and geographical factors (IRR = 1.0037; 95% CI = 0.99, 1.02; p = 0.66). There was no evidence of effect modification by sex. The comorbidity burden of preexisting depression may impact DAH among both male and female Medicare beneficiaries with hip fracture. Results suggest a holistic health approach and secondary prevention of depressive symptoms after hip fracture.