Inpatient Claims Research Articles

Relative Effectiveness of Coronavirus Disease 2019 Vaccination and Booster Dose Combinations Among 18.9 Million Vaccinated Adults During the Early Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Period-United States, 1 January 2022 to 31 March 2022.

Small sample sizes have limited prior studies' ability to capture severe COVID-19 outcomes, especially among Ad26.COV2.S vaccine recipients. This study of 18.9 million adults aged ≥18 years assessed relative vaccine effectiveness (rVE) in three recipient cohorts: (1) primary Ad26.COV2.S vaccine and Ad26.COV2.S booster (2 Ad26.COV2.S), (2) primary Ad26.COV2.S vaccine and mRNA booster (Ad26.COV2.S+mRNA), (3) two doses of primary mRNA vaccine and mRNA booster (3 mRNA). We analyzed two de-identified datasets linked using privacy-preserving record linkage (PPRL): insurance claims and retail pharmacy COVID-19 vaccination data. We assessed the presence of COVID-19 diagnosis during January 1-March 31, 2022 in: (1) any claim, (2) outpatient claim, (3) emergency department (ED) claim, (4) inpatient claim, and (5) inpatient claim with intensive care unit (ICU) admission. rVE for each outcome comparing three recipient cohorts (reference: two Ad26.COV2.S doses) was estimated from adjusted Cox proportional hazards models. Compared with two Ad26.COV2.S doses, Ad26.COV2.S+mRNA and three mRNA doses were more effective against all COVID-19 outcomes, including 57% (95% CI: 52-62) and 62% (95% CI: 58-65) rVE against an ED visit; 44% (95% CI: 34-52) and 54% (95% CI: 48-59) rVE against hospitalization; and 48% (95% CI: 22-66) and 66% (95% CI: 53-75) rVE against ICU admission, respectively. This study demonstrated that Ad26.COV2.S + mRNA doses were as good as three doses of mRNA, and better than two doses of Ad26.COV2.S. Vaccination continues to be an important preventive measure for reducing the public health impact of COVID-19.

The epidemiology and healthcare costs of community-acquired pneumonia in Ontario, Canada: a population-based cohort study

ObjectivesThe aim of the present study was to determine incidence-based short- and long-term healthcare costs attributable to community-acquired pneumonia (CAP) from the healthcare payer perspective in Ontario, Canada.MethodsWe conducted a retrospective population-based matched cohort study of residents in Ontario, Canada using health administrative data. We identified subjects with an incident episode of CAP (exposed subjects) between 1 January 2012 and 31 December 2014. The index date of each episode was based on the first inpatient or outpatient claim for pneumonia. Exposed subjects were matched without replacement to unexposed subjects from the general population using hard and propensity score matching on age, sex, income quintile, rural residence, comorbidities, and healthcare costs prior to index date. Attributable costs represented the mean difference in costs between the exposed subjects and their matched pairs.ResultsWe identified 692,090 subjects with at least one episode of CAP between 1 January 2012 and 31 December 2014. Adults aged 65 years and older had the highest annual incidence rate of 50.1 episodes per 1,000 person-years, while adults aged 18–64 years and children (aged 0–17) had incidence rates of 12.9 and 24.7 episodes per 1,000 person-years, respectively. The majority of episodes involved care exclusively in the outpatient setting (92.6%), with most of these episodes involving a single physician visit. The mean attributable costs were $1,595 (95% CI: $1,572–$1,616) per outpatient CAP episode and $12,576 (95% CI: $12.392–$12,761) per inpatient CAP episode. Attributable costs were significantly higher for adult subjects and those with time spent in the intensive care unit. Alternative case definitions yielded different results, although demonstrated the same overall trends across groups.ConclusionCAP is associated with substantially increased acute and long-term healthcare costs compared to unexposed subjects. This study highlights the burden of CAP in both the inpatient and outpatient setting, and will serve to inform strategic healthcare planning for future interventions and healthcare programs.

Abstract TP48: Acute Ischemic Stroke Transfer Networks: Low Volume Ed-hospital Connections Are Common

Background: Emergency Department (ED) transfers to tertiary centers are a critical component of stroke systems of care, yet little is known about the status of the transfer networks used to execute this process. Our objective is to characterize these transfer networks and assess rates of acute treatments among transfers to identify potential targets for improving organization of stroke systems of care. Methods: Using the 2017 US Centers of Medicare and Medicaid Inpatient and Outpatient Fee-for-Service files, we captured patients with inpatient ischemic stroke claims based on ICD 10 codes. We defined ED-hospital transfers as: 1) any outpatient ED claim ≤48 hrs prior to the inpatient stroke claim, 2) ED discharge status indicating an acute care hospital, and 3) originating and receiving facilities with different NPI numbers. We characterized the structure of transfer networks and acute treatment rates (based on ICD 10 codes and DRGs for thrombolysis and thrombectomy) using descriptive statistics. Results: We identified 225,177 patients with inpatient stroke claims. Of these, 7,907 (3.5%) had an ED-hospital transfer, involving 2083 different acute care hospitals. Amongst EDs that transferred a patient, the median number of receiving hospitals was 1 (IQR 1; range [1,7]) and the median volume of transferred patients was 3 (IQR 5; range [1,53]). Amongst hospitals that had stroke patients transfer in, the median number of originating EDs was 2 (IQR 5; range [1,28]) and the median volume of transferred patients was 5 [IQR 14; 1-158]. Amongst all ED-hospital transfer pairs, the median volume of transferred patients was 2 (IQR 2; range[1,53]). Amongst transferred patients, 60% received thrombolysis and 16% received mechanical thrombectomy. Conclusions: We found wide variation in the volumes of ED-hospital transfers for acute stroke, with a large number of these transfers occurring between hospitals with low transfer volumes. Given that high volume centers generally have better outcomes and the majority of identified transfers received acute therapies, a better understanding of the clinical circumstances driving these low-volume transfer connections is needed.

Abstract WP132: Cerebral Amyloid Angiopathy And Risk Of Ischemic And Hemorrhagic Stroke

Introduction: Cerebral amyloid angiopathy (CAA), a condition characterized by beta amyloid deposition in the cerebral vasculature, is a common cause of intracerebral hemorrhage (ICH) in elderly patients. Radiographic features of CAA such as white matter hyperintensities and cerebral microbleeds are also associated with an increased risk of ischemic stroke. However, there are limited population-based data regarding the risk of incident ischemic and hemorrhagic stroke associated with clinically diagnosed CAA. Methods: We performed a retrospective cohort study using inpatient and outpatient claims from 2016 to 2018 from a nationally representative 5% sample of Medicare beneficiaries. The study exposure was a diagnosis of CAA identified using ICD-10-CM code I68.0. Participants with prevalent stroke were excluded. The primary outcome was any stroke (ischemic or hemorrhagic), and secondary outcomes were ICH, subarachnoid hemorrhage (SAH), and ischemic stroke, assessed separately. These outcomes were identified using validated ICD-10-CM diagnosis codes. Cox proportional hazards regression was used to determine the association between CAA and outcomes after adjustment for demographics and vascular comorbidities. Results: Of the 1.3 million Medicare beneficiaries included, 436 had clinically documented CAA without a prior or concurrent stroke. During a median follow-up of 3.0 years (IQR, 2.3-3.0), incident ischemic stroke occurred in 29,545 patients (2.28%), SAH in 3,340 (0.26%), and ICH in 4,338 (0.34%). In adjusted Cox models, CAA was significantly associated with an increased risk of any stroke (HR, 3.4; 95% CI, 2.5-4.7), ICH (HR, 17.1; 95% CI, 11.1-26.3), and SAH (HR, 6.2; 95% CI, 2.7-13.9). There was a nonsignificant association with ischemic stroke (HR, 1.4; 95% CI, 0.8-2.4). Conclusions: In a nationally representative cohort of Medicare beneficiaries, CAA was associated with a significantly increased risk of future ICH and SAH, but was not significantly associated with an increased risk of future ischemic stroke.

Abstract 78: Neighborhood Socioeconomic Deprivation Is Associated With Increased 30-day Mortality After Stroke: Results From A Nationwide Study Of 755,899 Medicare Patients

Introduction: The relationship between neighborhood socioeconomic deprivation- a reflection of the general economic and environmental conditions of a neighborhood- and outcomes after stroke is not known. Methods: We performed a retrospective study of 100% nationwide Medicare inpatient claims from 2017-2019. We categorized admissions for cerebrovascular diseases using principal ICD-10-CM codes as follows: Ischemic Stroke (I63), Subarachnoid Hemorrhage (I60), Intracerebral Hemorrhage other than SAH (I61 and I62); Transient Ischemic Attack (G45); Precranial stenosis without ischemia (I65). The primary outcomes of interest were 30-day mortality and 30-day unplanned readmission (per CMS definition). The exposure of interest was the Area Deprivation Index (ADI), calculated at the census block group level. Adjustment covariates included beneficiary demographics (age, sex, and race), Medicaid-dual eligibility status (as a proxy for individual SES), end-stage renal disease status, discharge year, and the 29 Elixhauser index comorbid conditions. Generalized estimating equation methods were used to estimate logistic regression models. Results: A total of 755,899 patients were included (mean age 79.4 years (SD 8.3), 47.1% male, 18.9% dually eligible for both Medicare and Medicaid) and the median Elixhauser comorbidity index was 17.0 (SD 14.1). After multivariable adjustment, a strong, dose-dependent association was observed between neighborhood deprivation and 30-day mortality for all conditions studied (Figure). No adjusted association was observed between ADI and 30-day unplanned readmission. Conclusions: For the first time, we show that neighborhood socioeconomic deprivation is associated with increased 30-day mortality for patients admitted with common cerebrovascular disorders, potentially in a dose-dependent fashion, after adjusting for age, sex, race, comorbidity burden and individual socioeconomic status.

Abstract TMP50: Increased Pre-stroke Emergency Department Visits And Post-stroke Readmissions For Mexican-Americans Compared To Non-hispanic Whites In The Brain Attack Surveillance In Corpus Christi (BASIC) Study

Introduction: Mexican Americans (MAs) use less preventative healthcare than NHWs and this may result in in more emergency department (ED) visits or readmissions. We sought to explore ethnic differences in ED and hospital utilization immediately before and after stroke. Methods: BASIC is a stroke epidemiologic study in Corpus Christi TX. We performed probabilistic matching to identify hospital claims for all BASIC-identified index strokes (ischemic or ICH) from 2010-2020 continuously enrolled in Medicare fee-for-service (FFS). Matching was performed using demographics (including date of birth), stroke admission/discharge dates, vascular risk factors, comorbidities, and in-hospital procedures. All emergency department (ED) visits and hospital readmissions within 90 days before and after the index stroke were identified using Medicare claims. Logistic regression models were used to determine the association of MA ethnicity (compared to NHWs) with prior ED/inpatient visits and cox regression models were used to estimate the associations with subsequent ED visits/readmissions (censoring at death), adjusting for patient age, sex, stroke severity, and stroke type. Results: We identified 1,180 incident BASIC strokes that could be matched with Medicare FFS inpatient claims: 84% with ischemic stroke, 46.2% NHWs vs 45.7% MAs, mean age 76.4, median (IQR) NIHSS 5 (2-13). Both ED visits and hospitalizations were relatively common before and after stroke (Table). Compared to NHWs, MAs were more likely to have ED visits before stroke than NHWs (OR 1.5, 95%CI [1.1-2.1]) and hospitalizations after stroke (HR 1.3, [1.1-1.7], but no ethinc differences were observed in pre-stroke hospitalizations or post-stroke ED visits. ( Table ) Conclusion: The increased rate of pre-stroke ED visits in MAs suggests the potential for missed opportunities to prevent stroke may exist and merits further scrutiny.

Association of Participation in the Maryland Primary Care Program With COVID-19 Outcomes Among Medicare Beneficiaries

Advanced primary care is a team-based approach to providing higher-quality primary care. The association of advanced primary care and COVID-19 outcomes is unknown. To evaluate the association of advanced primary care with COVID-19 outcomes, including vaccination, case, hospitalization, and death rates during the first 2 years of the COVID-19 pandemic. This retrospective cohort study used Medicare claims data from January 1, 2020, through January 31, 2022, and Maryland state vaccination data. All Part A and B Medicare claims for Maryland Medicare beneficiaries were included. The study population was divided into beneficiaries attributed to Maryland Primary Care Program (MDPCP) practices and a matched cohort of beneficiaries not attributed to MDPCP practices but who met the eligibility criteria for study participation from January 1, 2020, through December 31, 2021. Eligibility criteria for both groups included fee-for-service Medicare beneficiaries who were eligible for attribution to the MDPCP. A forced-match design was used to match both groups in the study population by age category, sex, race and ethnicity, Medicare-Medicaid dual eligibility status, COVID-19 Vulnerability Index score, Maryland county of residence, and primary care practice participation. Primary care practice participation in the MDPCP. Primary outcome variables included rate of vaccination, monoclonal antibody infusion uptake, and telehealth claims. Secondary outcomes included rates of COVID-19 diagnosis, COVID-19 inpatient claims, COVID-19 emergency department claims, COVID-19 deaths, and median COVID-19 inpatient admission length of stay. Claims measures were assessed from January 1, 2020, through October 31, 2021. Vaccination measures were assessed from January 1, 2020, through March 31, 2022. After matching, a total of 208 146 beneficiaries in the MDPCP group and 37 203 beneficiaries in the non-MDPCP group were included in this study, comprising 60.10% women and 39.90% men with a median age of 76 (IQR, 71-82) years. Most participants (78.40% and 78.38%, respectively) were White. There were no significant demographic nor risk measure baseline differences between the 2 groups. The MDPCP beneficiaries had more favorable primary COVID-related outcomes than non-MDPCP beneficiaries: 84.47% of MDPCP beneficiaries were fully vaccinated, compared with 77.93% of nonparticipating beneficiaries (P < .001). COVID-19-positive beneficiaries in MDPCP also received monoclonal antibody treatment more often (8.45% vs 6.11%; P < .001) and received more care via telehealth (62.95% vs 54.53%; P < .001) compared with nonparticipating counterparts. In terms of secondary outcomes, beneficiaries in the MDPCP had lower rates of COVID-19 cases (6.55% vs 7.09%; P < .001), lower rates of COVID-19 inpatient admissions (1.81% vs 2.06%; P = .001), and lower rates of death due to COVID-19 (0.56% vs 0.77%; P < .001) compared with nonparticipating beneficiaries. These findings suggest that participation in the MDPCP was associated with lower COVID-19 case, hospitalization, and death rates, and advanced primary care and COVID-19 response strategies within the MDPCP were associated with improved COVID-19 outcomes for attributed beneficiaries.

Incidence, Severity, and Mortality of Influenza During 2010-2020 in Korea: A Nationwide Study Based on the Population-Based National Health Insurance Service Database.

The epidemiology of influenza is commonly used to understand and establish relevant health policies for emerging respiratory infections, including coronavirus disease 2019 (COVID-19). However, Korea has no confirmed nationwide data on influenza incidence, severity, and mortality rate. We conducted a cross-sectional study to obtain epidemic data on influenza at the national level using National Health Insurance claims data during 2010 to 2020. Influenza cases were defined as 90-day timeframe episodes based on all inpatient and outpatient claims data with disease code J09, J10, and J11. Influenza incidence, severity, and mortality rate were calculated, and logistic regressions were performed to assess the associations of demographic characteristics and comorbidity with influenza-related hospitalization, severe illness, and death. There were 0.4-5.9% influenza cases in the population from 2010 to 2020, with 9.7-18.9%, 0.2-0.9%, and 0.03-0.08% hospitalized, used in the intensive care unit, and dead, respectively. Age-standardized incidence and mortality rates were 424.3-6847.4 and 0.2-1.9 per 100,000 population, respectively. While more than half of the influenza cases occurred in populations aged younger than 20 years, deaths in older than 60 years accounted for more than two-thirds of all deaths. This study provided the simplest but most important statistics regarding Korean influenza epidemics as a reference. These can be used to understand and manage other new acute respiratory diseases, including COVID-19, and establish influenza-related policies.

Trends in the Stage Distribution of Colorectal Cancer During the COVID-19 Pandemic in Japan: A Nationwide Hospital-claims Data Analysis.

The coronavirus disease 2019 (COVID-19) pandemic has affected cancer care. The aim of this study was to clarify the trend of colorectal cancer (CRC) stage distribution in Japan during the COVID-19 pandemic. In this retrospective study, we used an inpatient medical claims database established at approximately 400 acute care hospitals. From the database, we searched patients who were identified as having the main disease (using International Classification of Diseases, 10th revision codes [C18.0-C20]) between January 2018 and December 2020. A multivariate logistic regression analysis was used to determine the impact of the pandemic on CRC stage distribution each month, and the odds ratio (OR) for late-stage cancer was calculated. We analyzed 99,992 CRC patients. Logistic regression analysis, including the interaction term between increased late-stage CRC effect during the pandemic period and by each individual month, showed that the OR for late-stage CRC was highest in July during the pandemic, at 1.31 (95% confidence interval [CI], 1.13-1.52) and also significantly higher in September at 1.16 (95% CI, 1.00-1.35). We investigated the trend of CRC stage distribution during the COVID-19 pandemic using a nationwide hospital-claims database in Japan and found that the proportion of early-stage cancers tended to decrease temporarily after the state of emergency declaration due to the COVID-19 pandemic, but the effect was only temporary.

Real-World Evaluation of Demographics, Treatment Pattern, and Economic Burden of Heart Failure and Kidney Disease in Type 2 Diabetes Mellitus Patient Population in Dubai, United Arab Emirates

Aims: The current study evaluated the demographics, clinical characteristics, treatment patterns, and economic burden of patients with type 2 diabetes mellitus (T2DM) with comorbidities (heart failure [HF], chronic kidney disease [CKD], and cardiovascular disease [CVD] without HF) in Dubai, United Arab Emirates (UAE). Methods: This observational, retrospective study collected data from January 01, 2014, to December 31, 2019, from the Dubai Real-World Claims Database (adults ≥18 years; at least 1 T2DM diagnosis claim). Patients were stratified into 5 cohorts: T2DM alone (cohort 1), T2DM and CKD (cohort 2), T2DM and CVD without CKD and HF (cohort 3), T2DM and HF (cohort 4), and T2DM with HF and CKD (cohort 5). An evaluation of demographics and clinical characteristics during pre-index period, as well as treatment patterns, healthcare resource utilization, and costs during the post-index period was conducted. Results: The sample had 374,271 patients with T2DM (age 43–56 years; male [72–84%]). Patients in cohorts 4 and 5 had Deyo-Charlson Comorbidity Index scores of 4.4 and 5.8, respectively. General practitioners (GPs) routinely prescribed biguanides for patients in cohorts 1–4 (24–38%), and insulin to patients in cohort 5 (27.7%). Prescription rates of novel antihyperglycemic drugs, such as glucagon-like peptide-1 (GLP-1 RA), were very low (∼2–8%) even in cohorts with cardiovascular and renal comorbidities (cohorts 2–5). A similar observation was noted with prescribing rates (0.6–4.4%) of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in cohorts 2–5. Endocrinologists preferred to prescribe GLP-1 RA and SGLT2i to T2DM patients with comorbidities. During the 5-year study period, median outpatient claims were the highest in cohort 5 (8.0 [range, 1.0–168.0]), followed by cohort 2 (5.5 [range, 1.0–52.0]). The median cost for inpatient claims was higher in cohort 5 (16,429 [range, 3,732–29,126] AED) compared to other cohorts. The median cost for drugs and procedures was highest in cohort 5 (4,525 [range, 38–31,546] AED and 2,297 [range, 56–105,074] AED, respectively). Conclusion: Continued and increased usage of drugs such as SGLT2i and GLP-1 RA with proven cardiorenal benefits could improve long-term outcomes and reduce associated healthcare costs in patients with T2DM and comorbidities in Dubai, UAE.

Changes in inpatient healthcare utilization at public hospitals during the Covid-19 pandemic

Objective: Public hospitals play an important role in reducing health inequality among socially marginalized groups and local communities. The objective of this study was to investigate changes in healthcare utilization at public hospitals during the COVID-19 pandemic in Korea.Methods: The unit of analysis was public hospitals. This study adopted a retrospective longitudinal study design and used inpatient health insurance claim data from January 1, 2019 to December 31, 2020. In total, 206 public hospitals were analyzed. For statistical analysis, a generalized linear model using the number of health insurance claims was constructed.Results: The total number of patients who received COVID-19-related care was 44,949, with a length of stay (LOS) of 657,717 days. After controlling for hospital covariates, healthcare utilization at public hospitals decreased by 22.5% (relative risk [RR], 0.775; p=0.029) and 16.8% (RR, 0.832; p=0.045) for the actual number and total LOS of national health insurance patients, respectively. For beneficiaries of the Medical Aid program, the actual number and total LOS were reduced by 29.6% (RR, 0.704; p=0.001) and 35.8% (RR, 0.642; p=0.001), respectively. Interestingly, most of this reduction occurred at public hospitals providing general healthcare services.Conclusion: Despite significant changes in healthcare utilization, public hospitals played a critical role in providing healthcare regarding COVID-19. Healthcare policymakers need to pay more attention to the role of public hospitals in the next infectious disease pandemic.

Ambulance use and subsequent fragmented hospital readmission among older adults.

Interhospital care fragmentation, when a patient is readmitted to a different hospital than they were originally discharged from, occurs in 20%-25% of readmissions. Mode of transport to the hospital, specifically ambulance use, may be a risk factor for fragmented readmissions. Our study seeks to further understand the relationship between ambulance transport and fragmented readmissions in older adults, a population that is at increased risk for poor outcomes following fragmented readmissions. We analyzed inpatient claims from Medicare beneficiaries in 2018 who had a hospital admission for select Hospital Readmission Reduction Program Conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia) as well as dehydration, syncope, urinary tract infection, or behavioral issues. We evaluated the associations between ambulance transport and a fragmented readmission using logistic regression models adjusted for demographic, clinical, and hospital characteristics. The study included 1,186,600 30-day readmissions. Of these, 46.8% (n=555,847) required ambulance transport. In fully adjusted models, taking an ambulance to the readmission hospital increased the odds of a fragmented readmission by 38% (95% CI 1.32, 1.44). When this association was examined by readmission major diagnostic category (MDC), the strongest associations were seen for Factors Influencing Health Status and Other Contacts with Health Services (i.e., rehabilitation, aftercare) (AOR 3.66, 95% CI 3.11, 4.32), Mental Diseases and Disorders (AOR 2.69, 95% CI 2.44, 2.97), and Multiple Significant Trauma (AOR 2.61, 95% CI 1.56, 4.35). When the model was stratified by patient origin, ambulance use remained associated with fragmented readmissions across all locations. Ambulance use is associated with increased odds of a fragmented readmission, though the strength of the association varies by readmission diagnosis and origin. Patient-, hospital-, and system-level interventions should be developed, implemented, and evaluated to address this modifiable risk factor.

2163. RSV-related hospitalization and outpatient palivizumab use in very preterm (born at &amp;lt; 29 wGA) infants: 2003-2020

Abstract Background Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in children under one year and the leading cause of infant hospitalization. Palivizumab was approved by the FDA in 1998 as RSV immunoprophylaxis (RSV-IP) to prevent severe RSV disease in children with specific health conditions and those born at &amp;lt; 35 weeks gestational age (wGA). Though RSV-IP recommendations have changed over time, RSV-IP has been consistently recommended in very preterm infants (&amp;lt; 29 wGA) since palivizumab approval. This study's objective is to compare RSV-related hospitalization (RSVH) and RSVH characteristics in very preterm and term ( &amp;gt; 37 wGA) infants. Methods Using the MarketScan Commercial and Multi-State Medicaid administrative claims databases, very preterm and term infants born between 7/1/2003 and 6/30/2020 were identified and classified as very preterm or term using diagnosis codes. Infants with evidence of health conditions such as congenital heart disease and cystic fibrosis were excluded. During 2003-2020 RSV seasons (November to March), claims incurred by infants while they were &amp;lt; 12 months old were evaluated for outpatient administration of palivizumab and RSVH. RSVH was identified in infants with an inpatient claim with an RSV diagnosis. Rate of RSVH during the first 12 months of life was calculated and compared in very preterm and term infants; the proportion of very preterm infants with an outpatient administration of palivizumab was also calculated. Results The study included 40,123 very preterm infants and 4,421,942 term infants. Rate of RSVH in very preterm infants ranged 1.5-3.8 per 100 infant seasons in Commercially insured infants and 3.5-8.4 in Medicaid insured infants. Relative risk of RSVH in very preterm was 3-4 times higher than term infants and was inversely related to wGA at birth (Figure 1). ICU admissions and mechanical ventilation were more common during RSVH in very preterm infants (Table 1); these outcomes were less common in very preterm infants with outpatient palivizumab administration (Table 2). Figure 1.Relative risk of RSVH in very preterm vs. term infantsTable 1.RSVH characteristics of term and very preterm infants by payerTable 2.RSVH characteristics of very preterm infants by palivizumab use and payer Conclusion Rates of RSVH are significantly higher and RSVH is more severe in very preterm infants than in term infants. Among very preterm infants, RSVH was less severe in infants with outpatient palivizumab administration. Disclosures Elizabeth Packnett, MPH, IBM Watson Health: Employee|Sobi: Contracted IBM Watson Health to conduct the study. Isabelle Winer, MPH, IBM Watson Health: employee|Sobi: contracted IBM Watson Health to conduct study David R. Diakun, BS, Sanofi: Employed by IBM Watson Health which was contracted by Sanofi to perfom outcomes research|Sobi: Employed by IBM Watson Health which was contracted by Sobi to conduct the study Abiola Oladapo, PhD, Sobi Inc: Employee Tara L. Gonzales, MD, Sobi, NA: Employee Matthew Wojdyla, PharmD, Sobi: Employee.

Bridging Data Pasien Rawat Inap Dengan INA-CBG’s (Indonesian Case Base Groups’s)

Abstract— Integration and acceleration of data transactions is a very important issue to be discussed in the era of integrated information technology development. This problem is the reason for making the system interact with each other quickly. Indonesian Case Base Groups (INA-CBG's) is an application used to process claims for National Health Insurance (JKN) participants from the Hospital. Every hospital is required to send patient data through INACBG's. However, current data claims for inpatients are still done manually. This manual process will make officers enter patient data into the main system and INACBG's. This results in the efficiency of work performed by hospital staff. In addition, the data entered is not automatic because there is a delay when entering data into the main system and INACBG's. Development of an Inpatient Information System that is integrated with INA-CBG's using JavaScript Object Notation (JSON). This format can send inpatient claim data to the INACBG's application in the form of an array. The JSON format does not have a standard format for writing, so it can be faster and more flexible in sending data. With an integrated system between the main system and INACBG's, it can increase the efficiency of processing data claims to INACBG's.&#x0D;

A Simple and Interpretable Mortality-Based Value Metric for Condition- or Procedure-Specific Hospital Performance Reporting

ObjectiveTo develop a simple, interpretable value metric (VM) to assess the value of care of hospitals for specific procedures or conditions by operationalizing the value equation: Value = Quality/Cost. Patients and MethodsThe present study was conducted on a retrospective cohort from 2015 to 2018 drawn from the 100% US sample of Medicare inpatient claims. The final cohort comprised 637,341 consecutive inpatient encounters with a cancer-related Medicare Severity-Diagnosis Related Grouping and 13,307 consecutive inpatient encounters with the International Classification of Diseases, Ninth Revision or International Classification of Diseases, Tenth Revision procedure code for partial or total gastrectomy. Claims-based demographic and clinical variables were used for risk adjustment, including age, sex, year, dual eligibility, reason for Medicare entitlement, and binary indicators for each of the Elixhauser comorbidities used in the Elixhauser mortality index. Risk-adjusted 30-day mortality and risk-adjusted encounter-specific costs were combined to form the VM, which was calculated as follows: number needed to treat = 1/(Mortalitynational − Mortalityhospital), and VM = number needed to treat × risk-adjusted cost per encounter. ResultsAmong hospitals with better-than-average 30-day cancer mortality rates, the cost to prevent 1 excess 30-day mortality for an inpatient cancer encounter ranged from $71,000 (best value) to $1.4 billion (worst value), with a median value of $543,000. Among hospitals with better-than-average 30-day gastrectomy mortality rates, the cost to prevent 1 excess 30-day mortality for an inpatient gastrectomy encounter ranged from $710,000 (best value) to $95 million (worst value), with a median value of $1.8 million. ConclusionThis simple VM may have utility for interpretable reporting of hospitals’ value of care for specific conditions or procedures. We found substantial inter- and intrahospital variation in value when defined as the costs of preventing 1 excess cancer or gastrectomy mortality compared with the national average, implying that hospitals with similar quality of care may differ widely in the value of that care.

Evidence of hospital‐based HIT infrastructure and reduced Medicare payment and racial and ethnic disparities among ADRD patients

AbstractBackgroundUnderstanding the potential cost‐saving or cost‐enhancing of HIT adoptions can help policymakers understand the capacity of HIT investment for population health and racial and ethnic groups. The objective of the study is to examine access to the hospital‐based HIT infrastructure and its association with Medicare payments by Alzheimer’s disease and related dementia (ADRD) patients’ racial and ethnic groups. ADRD is one of the most expensive health conditions in the Unites States and substantial racial and ethnic disparities are observed.MethodWe used 2017 Medicare Beneficiary Summary File, inpatient claims, and the American Hospital Annual survey. Generalized linear models were used for the payment regressions.ResultsThe adjusted total Medicare payment and acute inpatient Medicare payment per person per year were higher for ADRD beneficiaries treated in hospitals with telehealth‐post discharge functions (e.g., an incremental increase of $542 in total payment). However, it relates to a significant reduction of Medicare payments to Black ADRD patients (approximately a reduction of $1,104). The finding suggested that telehealth‐post discharge might be cost‐enhancing at the population level; however it is cost‐saving to Black patients with ADRD. The cost‐saving of Black patients exceeded the incremental cost of the adoption of HIT‐post discharge. Similar findings were found for the telehealth‐treatment, which was associated with a significant reduction of payments among Black and Hispanic ADRD patients.ConclusionsResults suggested that personalized HIT utilization and provisions (telehealth‐post‐discharge for Black and telehealth‐treatment for Black and Hispanic ADRD patients) are critical components of receiving high‐quality ADRD treatment for minority patients.

Racial and Ethnic Disparities in Measures of Consumer Assessment of Healthcare Providers and Systems among ADRD Patients

AbstractBackgroundThis study examines the consumer reported health care quality and racial and ethnic disparities among ADRD patients.MethodThe main datasets included 2017 Medicare inpatient claims data, Medicare Beneficiary Summary File, and the Medicare Shared Savings Program ACO data. Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores were used to measure the quality of physician‐patient relationship among ADRD patients enrolled in ACOs.ResultWhites reported higher CAHPS total score compared to Black, Hispanic, and Asian ADRD patients, and social determinants of health explained 11% ‐13% of disparities between White vs. Black and White vs. Hispanic. Compared to Whites, Black, Hispanic, and Asian ADRD patients reported significantly lower CAHPS measures on access, communication, and rating, Hispanics reported higher scores on the measure of health promotion, and Hispanics and Asians reported higher scores on shared decision making.ConclusionOur results demonstrated significant variations of CAHPS score by race and ethnicity among ADRD patients who were enrolled in ACOs.

Strengthening the Public Health Partnership and Telehealth Infrastructure to Reduce Health Care Disparities.

The COVID-19 pandemic has underscored the urgency to focus on the essential value of public health systems (PHSs) in fostering health equity across the US health care delivery system. PHS integration and care coordination can be successfully achieved through health information technology systems. The objective of the study was to examine the association between PHS partnerships (PHSPs), telehealth postdischarge, and racial and ethnic disparities in health care. The analysis used 2017 Centers for Medicare and Medicaid Services Medicare 100% inpatient claims data, the Medicare Beneficiary Summary File, the American Hospital Association Annual Survey, and the American Community Survey. Results showed that compared with those treated in hospitals with neither PHSP nor telehealth postdischarge services, beneficiaries treated in hospitals with PHSP encountered significantly lower Medicare payment and inpatient and readmission rates. Black patients experienced significantly lower cost, inpatient visits, and readmission rates when treated in hospitals with PHSP and telehealth postdischarge services (coefficient = -0.051, P < 0.001; incidence rate ratio [IRR] = 0.982, P = 0.007; IRR = 0.891, P = 0.003). The results of the study demonstrated the importance of combining PHSP and telehealth postdischarge services to improve the efficiency of the health care delivery system and health equity. It is urgent to ensure that PHSs have adequate funding and telehealth infrastructure to support population health.

Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis

BackgroundCervical artery dissection and subsequent ischemic stroke is the most serious safety concern associated with cervical spinal manipulation.MethodsWe evaluated the association between cervical spinal manipulation and cervical artery dissection among older Medicare beneficiaries in the United States. We employed case-control and case-crossover designs in the analysis of claims data for individuals aged 65+, continuously enrolled in Medicare Part A (covering hospitalizations) and Part B (covering outpatient encounters) for at least two consecutive years during 2007–2015. The primary exposure was cervical spinal manipulation; the secondary exposure was a clinical encounter for evaluation and management for neck pain or headache. We created a 3-level categorical variable, (1) any cervical spinal manipulation, 2) evaluation and management but no cervical spinal manipulation and (3) neither cervical spinal manipulation nor evaluation and management. The primary outcomes were occurrence of cervical artery dissection, either (1) vertebral artery dissection or (2) carotid artery dissection. The cases had a new primary diagnosis on at least one inpatient hospital claim or primary/secondary diagnosis for outpatient claims on at least two separate days. Cases were compared to 3 different control groups: (1) matched population controls having at least one claim in the same year as the case; (2) ischemic stroke controls without cervical artery dissection; and (3) case-crossover analysis comparing cases to themselves in the time period 6–7 months prior to their cervical artery dissection. We made each comparison across three different time frames: up to (1) 7 days; (2) 14 days; and (3) 30 days prior to index event.ResultsThe odds of cervical spinal manipulation versus evaluation and management did not significantly differ between vertebral artery dissection cases and any of the control groups at any of the timepoints (ORs 0.84 to 1.88; p > 0.05). Results for carotid artery dissection cases were similar.ConclusionAmong Medicare beneficiaries aged 65 and older who received cervical spinal manipulation, the risk of cervical artery dissection is no greater than that among control groups.

The evolution of private medical expenses for civil servants in Germany

In this study we analyse private medical insurance data with respect to civil servants in Germany. This data is applied to pricing purposes in the market and may therefore be deemed as useful. In particular, we discuss average health care expenditure per capita by age over time. Thereby, we analyse inpatient and outpatient benefits as well as hospital cash and dental insurance. In essence, we observe an effect that we call the rectangularisation of the cumulative health care expenditure curve. In line with this finding, we note that the modal age (at which total medical expenses for in force business are highest) has increased by 10 years of age over the last decade with respect to inpatient benefits. Moreover, we apply a linear regression model based on mortality rates as regressor. We use the Siegel test for comparing different expenditure profiles and judging goodness of fit. As a result, we find that steepening of private medical expenses by age over time is prevalent for three out of four benefit types in certain age bands. As for outpatient claims provided to male civil servants, medicalisation dominates the evolution of the average claim amount by attained age over time. On the other hand, compression is of relatively high importance for inpatient claims.