Medical Claims Research Articles

Disparities in Mental Health and the Social Determinants of Health Among Privately Insured Transgender Patients in the United States

Abstract Objectives The purpose of this study was to examine disparities in mental health and the social determinants of health (SDoH) among privately insured transgender and gender minority (TGM) patients in the United States. Methods Data came from FAIR Health, a repository of private health insurance claims data covering over 150 million individuals in the United States. TGM patients (n = 274,479) were identified with medical claims that included a diagnosis for gender dysphoria or gender identity disorder. A random 5% selection of cisgender patients (n = 7,456,823) was used as a comparison group. We estimated descriptive statistics and used multivariable logistic regression models to compare health outcomes between TGM and cisgender patients. Results TGM patients were more likely to have anxiety (odds ratio [OR]=7.02; 95% confidence interval [CI]=6.94-7.09), depression (OR = 9.27; 95% CI = 9.16-9.37), post-traumatic stress disorder (OR = 9.03; 95% CI = 8.86-9.21), and substance use disorder (OR = 2.93; 95% CI = 2.86-3.00) compared to their cisgender peers. TGM patients were also more likely to have problems with education and literacy (OR = 5.95; 95% CI = 5.64-6.28), employment (OR = 3.67; 95% CI = 3.44-3.92), economic circumstances (OR = 5.74; 95% CI = 5.39-6.12), and social exclusion (OR = 7.35; 95% CI = 6.91-7.81). Compared to TGM patients living in states with transphobic policy environments, TGM patients in states with comprehensive protections from discrimination fared better. Conclusions We found wide disparities in mental health and the SDoH among privately insured TGM. More research is critically needed to better understand the health and social needs of TGM populations. Meanwhile, policymakers should consider enacting policies that would prohibit discrimination against TGM people throughout the SDoH -- or the conditions where we live, learn, work, play, and age. Health care providers should also receive education on the unique health needs of TGM patients to advance health equity.

Patient journey from the appearance of red flags to the diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) in Japan: a nationwide retrospective study using a medical claims database

Abstract Introduction Transthyretin amyloid cardiomyopathy (ATTR-CM) is an under-recognized cause of common cardiovascular conditions in the elderly, with relatively high rates among patients diagnosed with heart failure (HF) with preserved ejection fraction. In addition to cardiac symptoms such as HF, extracardiac symptoms such as carpal tunnel syndrome (CTS) and lumbar spinal stenosis (LSS) are also red flags for ATTR-CM. Tafamidis is currently the only disease-modifying therapy approved for the treatment of patients with ATTR-CM and is likely to be more effective in the earlier stage. Patients with ATTR-CM often undergo a long and difficult diagnostic journey because of the nonspecificity of clinical manifestations, resulting in delays in establishing the correct diagnosis. Purpose To identify the timing of appearance of comorbidities in patients with ATTR-CM during diagnosis. Methods In this retrospective, non-interventional, observational study using a claims database (dataset period: April 1, 2014–August 31, 2021), adult patients with a diagnosis of ATTR-CM or prescription for tafamidis 80 mg were included. The index date was defined as the first date of recording ATTR-CM diagnosis or the prescription of tafamidis 80 mg, whichever was earlier. The baseline period was defined as the period between the index date and 6 months before the index date. The onset date was defined as the first date of recording diagnosis of the first red-flags that was suspicious for ATTR-CM. Results Of 11,101,578 patients in the database, 246 patients with ATTR-CM met the inclusion criteria. A total of 239 patients were included, of whom 139 had received tafamidis 80 mg. The median (range) age at the index date was 79.0 (46.0–95.0) years, and 79.9% (191/239) were male. The most frequently reported comorbidity defined as onset of ATTR-CM was conduction disorders (88.7%) followed by atrial fibrillation/atrial flutter (50.6%), hypertensive heart disease (19.7%), aortic stenosis (15.9%), and hypertrophic cardiomyopathy (11.7%), with the median (interquartile range [IQR]) time to the index date being 15.5 (5.0–24.5), 14.0 (5.0–22.0), 9.0 (2.0–18.0), 5.0 (2.0–16.0), and 12.0 (6.5–21.5) months, respectively (Fig. 1). LSS (23.9%), neuropathy (13.0%), and CTS (7.5%) were frequently observed as extracardiac symptoms at baseline, and the median (IQR) time from appearance to the index date was 19 (9.0–28.0), 5.0 (1.0–16.0), and 18.0 (14.0–25.0) months, respectively (Fig. 2). Conclusions This study elucidated the time lag between the appearance of cardiac and extracardiac complications of ATTR-CM and its diagnosis in real-world clinical settings. These novel findings highlight the potential for earlier detection of ATTR-CM.

Leveraging Telemedicine for Disaster Response: Longitudinal Study on Return-to-Work Programs During the COVID-19 Crisis.

Since COVID-19, Indonesia has legalized telemedicine in medical services, including Return to Work (RTW). RTW programs help occupational injury-disabled workers return to work. This research examines how telemedicine supports RTW for employees with occupational injuries. The study used Interrupted Time Series Analysis (ITSA) to find patterns and trends in RTW program telemedicine case numbers and claim settlements over time. A total of 1 314 data were obtained from the Indonesian National Social Security Agency on Employment (BPJS Ketenagakerjaan) from July 1, 2015, to December 2022. Telemedicine reduces the frequency of recurrent occupational injuries in persons with impairments (Relative Risk [RR] = 0.59). In addition, the integration of telemedicine into health care practices exhibits promising prospects in terms of mitigating the financial burden on social security programs. This is supported by a robust RR (0.6). Telemedicine reduced the number of repeat cases and optimized medical claims cost in the RTW program during the COVID-19 pandemic. The results will contribute to policy and assist health care professionals and employers in improving RTW outcomes for disabled people.

Validation Study of the Claims-Based Algorithm Using the International Classification of Diseases Codes to Identify Patients With Coronavirus Disease in Japan From 2020 to 2022: The VENUS Study.

We validated claims-based algorithms using the International Classification of Diseases, Tenth Revision (ICD-10) to identify patients with the first-ever coronavirus disease (COVID-19) onset between May 2020 and August 2022. The study cohort was comprised of residents of one municipality enrolled in a public insurance program. This study used data provided by the municipality, including residents' insurer-based medical claims data linked to the Health Center Real-time Information-Sharing System (HER-SYS). The HER-SYS data included positive results from COVID-19 tests and were used as reference standards. Claims-based algorithms #1 and #2 were U07.1, B34.2, with and without suspicious diagnoses, respectively. Claims-based algorithms #3 and #4 were U07.1 with and without suspicious diagnoses, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each algorithm. The study cohort included 165 038 residents, including 13 402 residents were the reference standard. For the entire period, the sensitivity, specificity, PPV, and NPV were 55.7% (95% confidence interval: 54.8%-56.5%), 65.4% (65.2%-65.6%), 11.5% (11.3%-11.8%), and 98.9% (98.8%-99.0%) for Algorithm #1, and 67.0% (66.2%-67.8%), 88.1% (87.9%-88.3%), 31.6% (31.1%-32.2%), and 97.8% (97.7%-97.8%) for Algorithm #2, and 52.9% (52.0%-53.7%), 67.1% (66.9%-67.3%), 11.5% (11.2%-11.8%), and 98.3% (98.3%-98.4%) for Algorithm #3, 62.6% (61.8%-63.4%), 88.5% (88.3%-88.7%), 30.9% (30.3%-31.4%), and 97.3% (97.2%-97.4%) for Algorithm #4, respectively. Our study showed that the validity of claims-based algorithms consisting of COVID-19-related ICD-10 codes to identify patients with first-onset COVID-19 is limited.

Implementing Loss Prevention by Identifying Trends and Insights to Help Policyholders Mitigate Risks and Reduce Claims

Loss prevention is a critical focus for both insurers and policyholders, as rising claim volumes lead to increased premiums and financial losses. This paper explores the implementation of loss prevention strategies through the identification of trends and insights derived from historical data, predictive analytics, and emerging technologies. By leveraging these insights, insurers can recommend proactive risk mitigation measures to policyholders, reducing the occurrence of claims and overall risks. The study begins by analyzing historical data trends across various sectors such as auto, property, and health insurance, identifying key factors that drive claims. Predictive analytics is then applied to forecast future risks, allowing insurers to develop personalized strategies for mitigating those risks. Emerging technologies like Internet of Things (IoT) devices and artificial intelligence (AI) are highlighted for their role in providing real-time data and early warning systems, which help to prevent incidents before they escalate into claims. This paper also outlines practical loss prevention strategies for policyholders, such as installing smart home devices to monitor potential hazards, encouraging safe driving habits through telematics, and promoting health and wellness programs to lower medical claims. These risk mitigation strategies are shown to provide significant return on investment (ROI) for policyholders by reducing claims frequency and severity. Through case studies and data analysis, the paper demonstrates that proactive loss prevention not only benefits policyholders by lowering their risk exposure but also helps insurers reduce claims costs and enhance profitability. In conclusion, this research highlights the importance of trend identification, predictive analytics, and emerging technologies in the future of loss prevention, offering a path forward for insurers and policyholders to work collaboratively in mitigating risks.

Respiratory syncytial virus (RSV) vaccine effectiveness against RSV-associated hospitalisations and emergency department encounters among adults aged 60 years and older in the USA, October, 2023, to March, 2024: a test-negative design analysis

Respiratory syncytial virus vaccines first recommended for use during 2023 were efficacious against lower respiratory tract disease in clinical trials. Limited real-world data regarding respiratory syncytial virus vaccine effectiveness are available. To inform vaccine policy and address gaps in evidence from the clinical trials, we aimed to assess the effectiveness against respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years. We conducted a test-negative design analysis in an electronic health records-based network in eight states in the USA, including hospitalisations and emergency department encounters with respiratory syncytial virus-like illness among adults aged at least 60 years who underwent respiratory syncytial virus testing from Oct 1, 2023, to March 31, 2024. Respiratory syncytial virus vaccination status at the time of the encounter was derived from electronic health record documentation, state and city immunisation registries, and, for some sites, medical claims. Vaccine effectiveness was estimated by immunocompromise status, comparing the odds of vaccination among respiratory syncytial virus-positive case patients and respiratory syncytial virus-negative control patients, and adjusting for age, race and ethnicity, sex, calendar day, social vulnerability index, number of underlying non-respiratory medical conditions, presence of respiratory underlying medical conditions, and geographical region. Among 28 271 hospitalisations for respiratory syncytial virus-like illness among adults aged at least 60 years without immunocompromising conditions, vaccine effectiveness was 80% (95% CI 71-85) against respiratory syncytial virus-associated hospitalisations, and vaccine effectiveness was 81% (52-92) against respiratory syncytial virus-associated critical illness (ICU admission or death, or both). Among 8435 hospitalisations for respiratory syncytial virus-like illness among adults with immunocompromising conditions, vaccine effectiveness was 73% (48-85) against associated hospitalisation. Among 36 521 emergency department encounters for respiratory syncytial virus-like illness among adults aged at least 60 years without an immunocompromising condition, vaccine effectiveness was 77% (70-83) against respiratory syncytial virus-associated emergency department encounters. Vaccine effectiveness estimates were similar by age group and product type. Respiratory syncytial virus vaccination was effective in preventing respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years in the USA during the 2023-24 respiratory syncytial virus season, which was the first season after respiratory syncytial virus vaccine was approved. The Centers for Disease Control and Prevention.

Association Between Medical Marijuana Cardholder Status and Antiemetic Overuse.

Introduction: The conscientious prescribing of antiemetics by chemotherapy-induced nausea and vomiting (CINV) risk was highlighted in the American Society of Clinical Oncology (ASCO) "Choosing Wisely" recommendations. The pharmacologic properties of medical marijuana (MMJ) may allow for decreased incidence of CINV; however, little is known about the effects of MMJ on the use of antiemetics. This study aimed to determine if MMJ cardholder status, which enables access to MMJ, is associated with antiemetic overuse among patients with cancer. Materials and Methods: This population-based secondary data analysis examined a retrospective cohort derived from the linked Arkansas All Payers Claims Database (2013-2020) and MMJ cardholder registry (2013-2019). The cohort consisted of 20,558 patients with cancer aged 18 and older with a chemotherapy claim in an outpatient setting within 12 months of a cancer diagnosis. Exposure was a registration to receive an MMJ card that permitted access to MMJ. The primary outcome of interest was antiemetic overuse, as characterized by the ASCO recommendation. Antiemetic use associated with chemotherapy was identified through filled prescriptions and medical claims. Multivariable logistic regression, adjusted for baseline demographic and prescription characteristics, was used to calculate the adjusted odds ratios (aOR) of antiemetic overuse among MMJ cardholders compared with non-MMJ cardholders. Results: Among 20,558 eligible patients, 436 (2.1%) had an MMJ card at some point in the study period. Antiemetic overuse was identified in 7.5% of chemotherapy cycles. Compared with non-MMJ cardholders, MMJ cardholders were less likely to experience antiemetics overuse (aOR: 0.76, p < 0.001). Patients with fewer chemotherapy cycles and younger in age had higher odds of antiemetic overuse compared with those with more chemotherapy cycles. The risk of antiemetic overuse did not differ based on gender and rurality of residency. Route of chemotherapy administration, CINV risk category, and type of cancer also impacted the odds of antiemetic overuse. Discussion: The findings indicate that MMJ cardholders are significantly less likely to experience antiemetic overuse than non-MMJ cardholders. Further investigation into the use, effectiveness, and safety of cannabis for CINV mitigation is needed to inform patient and provider decision-making.

Obstetrician-Gynecologists' Telehealth Provision at the Beginning, During, and Latter Stages of the COVID-19 Pandemic.

Objective: This study aims to determine how obstetrician-gynecologists provided telehealth from January 2020 to December 2022 in the United States, using de-identified commercial insurance data from FAIR Health. It also explores the trends in telehealth provision by physicians' age, gender, and by state policies on telehealth payment parity. Methods: Aggregated, de-identified data derived from medical claims containing 450,588 physician-quarter observations during 2020 to 2022 were analyzed using descriptive methods to examine the total number of telehealth services to pregnant individuals provided, the number of obstetrician-gynecologists that provided telehealth, and the mean number of telehealth services provided per quarter. Results: Obstetrician-gynecologists' telehealth provision increased rapidly after the onset of the COVID-19 pandemic, reaching its peak during the winter 2020 wave (fourth quarter) during which 4,663 obstetrician-gynecologists provided 13,846 telehealth visits. This was followed by a drop in subsequent quarters and during the fourth quarter of 2022, about 9,500 visits were provided by 2,800 obstetrician-gynecologists. Mean number of telehealth visits per physician was higher among older obstetrician-gynecologists and among those that practiced in states that adapted telehealth payment parity policies. Conclusions: Physician sex, age, and the state of practice location impacted their telehealth provision during the COVID-19 pandemic. Future policies aimed at ensuring telehealth access for pregnant people should consider these factors.

Effects of SGLT2 inhibitors on the onset of esophageal varices and extrahepatic cancer in type 2 diabetic patients with suspected MASLD: a nationwide database study in Japan.

SGLT2 inhibitors (SGLT2i) improve hepatic steatosis in patients with type 2 diabetes mellitus (T2DM) and MASLD. We aimed to investigate the impact of SGLT2i on the incidence of liver-related events and extrahepatic cancer compared to DPP4 inhibitors (DPP4i) in patients with T2DM and suspected MASLD using a medical claims database in Japan. We conducted a retrospective study using a Japanese medical claims database. Among patients with T2DM who were prescribed SGLT2i or DPP4i (n = 1,628,656), patients with suspected MASLD were classified into SGLT2i (n = 4204) and DPP4i (n = 4204) groups. Effects of SGLT2i on the following outcomes were compared to DPP4i: (1) changes in HbA1c and ALT levels after 6months, (2) changes in hepatic fibrosis index, and (3) the incidence of liver-related events/extrahepatic cancer over 12months. After 6months, DPP4i significantly decreased HbA1c levels compared to SGLT2i. In contrast, SGLT2i significantly decreased ALT levels compared to DPP4i. SGLT2i significantly decreased FIB-4 index compared to DPP4i over 12months. Although no significant difference was observed in the incidence of overall liver-related events between the two groups, SGLT2i significantly reduced the incidence of esophageal varices (HR 0.12, 95%CI 0.01-0.95, P = 0.044). Moreover, SGLT2i significantly suppressed the incidence of extrahepatic cancer (HR 0.50, 95%CI 0.30-0.84, P = 0.009) compared to DPP4i. SGLT2i was more beneficial than DPP4i in improving the hepatic inflammation and fibrosis indices. Moreover, SGLT2i suppressed the incidence of esophageal varices and extrahepatic cancer compared to DPP4i. SGLT2i may suppress life-threatening events in patients with T2DM and suspected MASLD.

Risk Retention and Management Implications of Medical Malpractice in the Italian Health Service

This work provides an economic exploration of the multifaceted world of medical malpractice risk. Third party liability insurance plays a central role in protecting healthcare providers and public care institutions from the financial consequences of medical malpractice claims, although in recent years, the industry landscape has been characterised by periods of distress for this type of protection, with rising litigations and reimbursement costs, resulting in a peculiarly complex market. For the Italian context, the study focuses on the financial repercussions for healthcare institutions of the growing trend towards risk retention practises, legally empowered by the introduction of Law No. 24/2017. The analysis employs Generalised Linear Models for the regressive approach to incorporate the structural and organisational characteristics of hospitals and uses quantitative simulations to explore different scenarios at a regional aggregate level. Due to the limited existing literature and data on the topic, this research aims to provide new methods for effectively understanding and managing this type of risk, thereby supporting decision-making processes in the healthcare sector.

6903 The Treatment May Be Worse Than The Disease: The Real-World Clinical Burden Of Disease And Treatment In Congenital Adrenal Hyperplasia

Abstract Disclosure: W. Huang: Consulting Fee; Self; Spruce Biosciences. Research Investigator; Self; Spruce Biosciences. R. Charlton: Employee; Self; Spruce Biosciences. S. Sile: Employee; Self; Spruce Biosciences. C. Dieyi: Employee; Self; STATinMED. S. Adams: Employee; Self; STATinMED. J. Maynard: Employee; Self; STATinMED. C.N. Barnes: Employee; Self; Spruce Biosciences. A.H. Hamrahian: Consulting Fee; Self; Spruce Biosciences. Research Investigator; Self; Spruce Biosciences. Background and Aims: Classic congenital adrenal hyperplasia (CAH) is a group of autosomal recessive conditions that affects the production of adrenal hormones, leading to deficiencies in cortisol and aldosterone, and excess in adrenal androgens. Current treatment includes mineralocorticoids and oral glucocorticoids (GCs) for physiologic cortisol replacement and hypothalamic-pituitary-adrenal (HPA) axis suppression to control androgen levels. The health impacts of hyperandrogenemia include accelerated skeletal maturation leading to adult short stature, precocious puberty, acne, hirsutism, male pattern baldness, adrenal rest tumors, and infertility. There are also serious adverse events due to the long-term use of supraphysiologic doses of GCs. The aim of this study was to explore the risks associated with CAH diagnosis and treatment. Methods: This cross-sectional study used medical administrative claims data within 2014-2021 from RWD Insights®, an all-payer claims database in the US. Adult patients were required to have a diagnosis of CAH (ICD-9/10-CM: 255.9, E25.0, E25.9) and continuous use of oral GCs (defined as a proportion of days covered of 75% or more in any given calendar year). Patients were further required to receive an average daily GC dose of ≥10mg/day hydrocortisone equivalent and be free of pituitary disorders. Non-CAH controls were also selected if they did not have a CAH diagnosis or any GC use. Demographic characteristics and comorbidity rates were compared between patients with and without CAH during the study period. For comorbidity rate comparisons, rate ratios (RR) and 95% confidence intervals (CI) were computed. Results: A total of 1,532,141 (CAH: 2,033; Non-CAH: 1,530,108) were eligible for the study. A lower proportion of the CAH cohort was elderly (i.e., 65+ years; 11% vs. 26%), and there were more females (67% vs. 57%), as compared to the non-CAH cohort. After propensity score matching (PSM) on demographic characteristics, there were 2,019 and 8,076 patients in the CAH and non-CAH cohort, respectively, and patient characteristics were balanced. There were higher rates of comorbidities in the CAH cohort. Some notable differences, RR (95%CI), include GC related comorbidities such as osteoporosis/necrosis, 3.48 (3.36, 3.60) and fractures, 2.14 (1.90, 2.39); metabolic disorders, 2.20 (2.08, 2.33), obesity, 1.35 (1.26-1.44), type 2 diabetes, 1.27 (1.18,1.36), and cardiovascular disorders, 1.24 (1.16, 1.33); and CAH related comorbidities, hirsutism, 11.70 (11.34, 12.06) and testicular hypofunction, 5.48 (5.24, 5.71). Conclusions: This study suggests the association of several comorbidities with CAH, highlighting the burden of both the disease and treatment. Novel, non-steroidal treatments that improve hormonal balance in CAH could ameliorate the systemic risks associated with hyperandrogenemia and chronic overexposure to GCs. Presentation: 6/1/2024

6374 Prevalence and risk factor of complications in patients with adult growth hormone deficiency: A retrospective database study

Abstract Disclosure: H. Fukuoka: None. S. Fujio: None. T. Endo: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk. S. Tsuboi: Employee; Self; Novo Nordisk. Stock Owner; Self; Novo Nordisk. Though adult growth hormone deficiency (AGHD) is known to lead to increased prevalence of complications, large database studies on AGHD have not been conducted. We investigated the clinical characteristics and prevalence of AGHD-related complications in Japanese patients. We identified 8,809 GH-untreated patients with AGHD from Medical Data Vision claims database between April 2008 and September 2022. In 2020, 3,420 AGHD patients were identified, and their prevalence of complications adjusted for sex and age was higher than that of Japanese general population, 9.3% vs 3.6% for diabetes mellitus (DM), 4.8% vs 1.3% for osteoporosis, and especially 22.0% vs 3.9% for dyslipidemia. We explored the risk factors for the onset of complications using Cox proportional hazard model. Age was significant risk factor for most complications and being female was significant risk factor for osteoporosis. DM was a significant risk factor for dyslipidemia, ischemic heart disease, cerebrovascular disease, and all cause death. AGHD increases the overall risk of metabolic complications, risk factors of these complications were similar to those in general population. Comprehensive treatment approach needs to be considered to alleviate the risk of complications. Presentation: 6/3/2024

7459 Predictors of a Second Fracture in Men With Osteoporosis-related Fractures

Abstract Disclosure: R.H. Lee: None. Y. Wang: Employee; Self; Radius Health, Inc. S.A. Williams: Employee; Self; Star Biopharma, LLC. N. Pyrih: Employee; Self; Cobbs Creek Healthcare. B.H. Mitlak: Employee; Self; Radius Health, Inc. J.R. Curtis: Consulting Fee; Self; Amgen Inc, Eli Lilly &amp; Company, Radius Health, Inc, UCB. Grant Recipient; Self; Amgen Inc, Eli Lilly &amp; Company, Radius Health, Inc, UCB. Background: Management of osteoporosis (OP)-related fractures in men is suboptimal. Real-world evidence suggests that, after men sustain a first fracture, they experience a higher risk for subsequent fracture and greater mortality compared to women. There is limited knowledge regarding absolute risk and predictors of second fractures in men and fracture risk assessment tools may be less accurate in men (Vilaca et al 2022). The objective of this study was to develop a model to identify risk factors for a second fracture in men in the year following an initial fracture. Methods: Anonymized patient-level medical and pharmacy claims data from Symphony Health PatientSource® were used. The study criteria included males ≥40 years with a case-qualifying OP-related fracture between January 1, 2017 to May 31, 2021 based on a claims-based validated algorithm (Wright et al 2019). Logistic regression models with a binary outcome of a second fracture versus no second fracture within one year of index fracture were created to predict second fracture occurrence. The study built upon a previous model (Williams et al 2021) developed for OP-related fractures for both men and women incorporating additional variables relevant to men based on the current literature. A separate model to identify risk factors for a secondary nonvertebral fracture (NVF) in men was also developed. Results: Of 956,828 men identified with an index fracture (677,047 commercial; 279,781 Medicare Advantage), 13% (126,106) experienced a second fracture within 1 year following the index fracture. More than two thirds of secondary fractures were NVFs. Multivariable logistic regression showed that patients with an index fracture at the spine (OR [95% CI] 1.71 [1.68, 1.74]) or hip (OR [95% CI] 1.79 [1.75, 1.82]) were the most likely to have a second fracture within a year of index fracture. An index clinical spine fracture was not associated with an increased risk of secondary NVFs. Nonfracture spinal cord injury was included among the predictors with the greatest magnitude of estimate for NVF (OR [95% CI] 1.21 [1.08, 1.36]). In addition to fracture history, advanced age, history of falls, use of medications that increase fall risk, OP diagnosis, treatment with OP medication, low body weight, and excessive alcohol use were significant and the numerically largest predictors for a second fracture. Type 2 diabetes, but not GLP-1 use, also increased risk of secondary fracture. Variables negatively associated with future fractures included treatment history with alpha blockers (beta blockers in the Medicare cohort) and diuretics. Conclusion: Predictors of fracture in men were overall consistent with the literature (and risk factors identified in the FRAX risk calculator). Regardless of gender, recent fracture is always the highest risk factor for a secondary fracture. Presentation: 6/3/2024

Serum Lipoprotein(a) Levels and Their Association with Atherosclerotic Cardiovascular Disease in Japan.

To investigate the distribution of lipoprotein(a) (Lp(a)) and its association with atherosclerotic cardiovascular disease (ASCVD) in Japanese patients at high risk for ASCVD using a health insurance database. Between July 2013 and June 2021, patients eligible for ASCVD prevention according to the 2017 Japan Atherosclerosis Society (JAS) guidelines with documented Lp(a) test results were extracted from the Medical Data Vision claims database and divided into three groups: primary prevention high-risk (Group I), secondary prevention (Group II) and secondary prevention high-risk (Group III). Data on lipid levels, cardiovascular morbidity risk factors and lipid-lowering treatments were extracted. Of 700,580 patients with documented low-density lipoprotein cholesterol (LDL-C), 2,967 (0.42%) were tested for Lp(a). In 2,170 eligible patients, the median [interquartile range] serum concentration of Lp(a) was 13.9 [7.5-24.6] mg/dL, with 151 patients (7.0%) above the recommended risk threshold of ≥ 50 mg/dL. Lp(a) levels increased with risk across all prevention groups. Being in the highest Lp(a) quintile (Q5) was associated with an increased frequency of ASCVD (28.9% versus 18.9% in the lowest quintile (Q1) for unstable angina; 18.7% versus 10.1% for myocardial infarction; 27.9% versus 17.0% for ischemic stroke). In the secondary prevention groups, the proportion of patients meeting an LDL-C target of ＜70 mg/dL decreased from 30.2% in Q1 to 19.0% in Q5 for Group II and from 32.9% to 16.3% for Group III. Despite a high prevalence of Lp(a) ≥ 50mg/dL in Japanese patients at high risk for ASCVD, it found that the Lp(a) testing rate was very low.

A-236 Rapid multiplexed PCR (polymerase chain reaction) tests for respiratory disease improve process and time to diagnosis versus laboratory-based molecular testing

Abstract Background The Infectious Disease Society of America recommends molecular testing for symptomatic patients suspected of having COVID-19. Molecular tests can be performed at the point of care or in a centralized laboratory, using different methodologies, and can be singleplex or multiplex. Limited data are available examining the use of these tests in clinical practice and impact of different test types on patient outcomes; however, common antiviral treatments for both COVID-19 and influenza are more effective when taken earlier and are not indicated for use more than 5 and 2 days after symptom onset, respectively. The aim of this study was to describe the diagnostic journey for non-inpatients who received molecular testing for respiratory pathogens in the laboratory versus those who received testing using a rapid, multiplexed real-time RT-PCR test that can be performed at the point of care. Methods De-identified administrative claims were analyzed from July 1, 2020 through September 30, 2022 for commercially insured and Medicare Advantage enrollees in the Optum Labs Data Warehouse. Patients with ≥1 medical claim for a non-inpatient visit with a procedure code for testing for SARS-CoV-2 were identified; patients who received antigen testing at index were excluded. Patients were followed for up to 90 days. Two patient groups were selected for the final study sample: 1) Patients with ≥1 claim with CPT code 0240U or 0241U with a point-of-care or laboratory place of service on the index date (proprietary laboratory analyses codes for Xpert® Xpress CoV-2/Flu/RSV, or “Xpert Xpress”); and 2) Patients with other laboratory-based molecular testing on the index date. Standardized difference of &amp;gt;0.10 or &amp;lt;-0.10 was considered a significant imbalance in proportions or means. Results In total, 51,602 patients received testing with Xpert Xpress while 317,192 received laboratory testing. Patients who were tested with Xpert Xpress were significantly older (mean 49.82 vs 42.19, SD 0.3), had a higher Charlson Comorbidity Index (mean 0.7 vs 0.35, SD 0.29), and were more likely to have a respiratory risk factor (6.09% vs 2.38%, SD 0.19). On average, patients who were tested with Xpert Xpress had significantly fewer tests for SARS-CoV-2 on the index date (mean 1.2 vs 1.58, SD -0.55), and fewer tests for SARS-CoV-2, influenza, or RSV on the index date and through the end of the 90-day fixed follow-up period (mean 1.64 vs 2.57, SD -0.45). They were also significantly more likely to be diagnosed with COVID-19 on the index date (23.31% vs 16.53%, SD 0.17). Among patients with a diagnosis for COVID-19, mean time to diagnosis was significantly shorter among patients tested with Xpert Xpress (4.85 vs 8.86 days, SD -0.27; median 0 vs 4 days). This finding was also consistent for influenza (4.05 vs 20.28 days, SD -0.74; median 0 vs 5 days). Conclusions Testing with Xpert Xpress at index resulted in fewer total tests and faster diagnosis compared to testing in the laboratory. Rapid, multiplex PCR testing provides a faster time to diagnosis and may support more appropriate and effective treatment.

Quantifying corticosteroid burden in chronic rhinosinusitis with nasal polyps: A retrospective US database study

BackgroundReal-world burden data on systemic corticosteroid (SCS) use in chronic rhinosinusitis with nasal polyps (CRSwNP) are limited. ObjectiveThis study's objective was to describe the real-world burden of SCS in CRSwNP. MethodsThis retrospective cohort study included commercial/Medicare Advantage with Part D health plan members from the Optum Research Database with a first medical claim (index) for CRSwNP (January 2015 to July 2020). Primary outcomes/variables included SCS use, healthcare resource utilization (HCRU) and costs during the 12-month follow-up period. Outcomes were analyzed overall (N=21,172) and stratified by baseline comorbid asthma status and sinus surgeries during follow-up. ResultsOverall, 64.7% and 41.0% of patients used all-cause and CRSwNP-related SCS respectively, and 36.0% had ≥1 oral corticosteroid (OCS) burst (≥20 mg for 3–28 days); SCS use was higher in patients with asthma and those with a NP-related surgery (1, 2, ≥3) versus without. The mean (SD) all-cause cumulative OCS dose was 303.3 (675.0) mg/year and 23.5% had a cumulative annual dose ≥400 mg; these values were higher (p<0.001) in patients with versus without comorbid asthma (514.9 [956.1] vs. 247.5 [567.0]; 36.9% vs. 19.9%). All-cause and CRSwNP HCRU and costs increased with increasing number of surgeries; mean (SD) all-cause total medical costs were $14,472 (38,915), $26,909 (40,800), $29,816 (41,677), and $31,558 (37,143) with 0, 1, 2, and ≥3 surgeries, respectively. ConclusionThese data highlight the significant burden of SCS use in CRSwNP, particularly in patients with comorbid asthma and suggest a need to reduce SCS exposure.

Effect of an oncology care management program on ED visits in a rural Medicaid population.

175 Background: Optum’s Cancer Support Program (CSP) provides care management to members with cancer diagnoses facing healthcare barriers. CSP nurses educate members on symptom management, palliative care and advance care planning, address psychosocial needs and close gaps in care. Improving health equity and outcomes is a program priority. In 2023, Optum analyzed outpatient claims for 24,221 Medicaid members with cancer and found that rural members visit emergency departments (ED) 31% more than urban members. As part of a CSP quality and outcomes assessment, we aimed to understand CSP’s impact on ED utilization within a high-risk rural Medicaid population. Methods: Beginning 1/1/23, Medicaid members in rural zip codes with an active cancer diagnosis were stratified as high- or low-risk based on diagnosis and clinical factors. High-risk members were invited to participate in CSP and receive individualized telephonic care management. 2023 outpatient medical claims were evaluated, and rural ED visit rates were compared for high-risk CSP participants and non-participants for approximately 4 months (average CSP engagement) after CSP enrollment or identification (non-participants). Population demographics were tested via a Mood's median test; ED visits per thousand members per year (PTMPY)—engaged, non-engaged, and difference in means—was tested via a 10,000-iteration bootstrap. Results: The study population included 421 members stratified as high-risk. Of those, 38% (161) enrolled in CSP. Reasons for non-enrollment included inability to reach the member (61%) and member refused (39%). There were no statistically significant differences between the groups’ demographic composition (all variables had p ≥ 0.05). Under a 10,000-iteration bootstrap, there were 2,696 ED visits PTMPY, 80% CI [2,258, 3,150] in the participant group and 3,427 ED visits PTMPY, 80% CI [2,904, 3,974] in the non-participant group. The difference in means between the groups was 730 ED visits PTMPY, 80% CI [52, 1,421]. Conclusions: Rural Medicaid members enrolled in CSP experienced lower ED visit rates, suggesting that care management may be effective at reducing ED utilization within rural populations that lack access to wraparound oncology services. Limitations of this study include small sample size and potential enrollment bias. Further analysis is underway to increase the study sample size and identify other factors that may be impacted by care management, thereby improving healthcare equity.

A nationwide survey of changes in nutritional management after gastrointestinal cancer surgery over a 12-year period using medical claims database

A nationwide survey of changes in nutritional management after gastrointestinal cancer surgery over a 12-year period using medical claims database

Optimal Pediatric Outpatient Antibiotic Prescribing

In the US, 50% of all pediatric outpatient antibiotics prescribed are unnecessary or inappropriate. Less is known about the appropriateness of pediatric outpatient antibiotic prescribing. To identify the overall percentage of outpatient antibiotic prescriptions that are optimal according to guideline recommendations for first-line antibiotic choice and duration. This cross-sectional study obtained data on any clinical encounter for a patient younger than 20 years with at least 1 outpatient oral antibiotic, intramuscular ceftriaxone, or penicillin prescription filled in the state of Tennessee from January 1 to December 31, 2022, from IQVIA's Longitudinal Prescription Claims and Medical Claims databases. Each clinical encounter was assigned a single diagnosis corresponding to the lowest applicable tier in a 3-tier antibiotic tier system. Antibiotics prescribed for tier 1 (nearly always required) or tier 2 (sometimes required) diagnoses were compared with published national guidelines. Antibiotics prescribed for tier 3 (rarely ever required) diagnoses were considered to be suboptimal for both choice and duration. Primary outcome was the percentage of optimal antibiotic prescriptions consistent with guideline recommendations for first-line antibiotic choice and duration. Secondary outcomes were the associations of optimal prescribing by diagnosis, suboptimal antibiotic choice, and patient- and clinician-level factors (ie, age and Social Vulnerability Index) with optimal antibiotic choice, which were measured by odds ratios (ORs) and 95% CIs calculated using a multivariable logistic regression model. A total of 506 633 antibiotics were prescribed in 488 818 clinical encounters (for 247 843 females [50.7%]; mean [SD] age, 8.36 [5.5] years). Of these antibiotics, 21 055 (4.2%) were for tier 1 diagnoses, 288 044 (56.9%) for tier 2 diagnoses, and 197 660 (39.0%) for tier 3 diagnoses. Additionally, 194 906 antibiotics (38.5%) were optimal for antibiotic choice, 259 786 (51.3%) for duration, and 159 050 (31.4%) for both choice and duration. Acute otitis media (AOM) and pharyngitis were the most common indications, with 85 635 of 127 312 (67.3%) clinical encounters for AOM and 42 969 of 76 865 (55.9%) clinical encounters for pharyngitis being optimal for antibiotic choice. Only 257 of 4472 (5.7%) antibiotics prescribed for community-acquired pneumonia had a 5-day duration. Optimal antibiotic choice was more likely in patients who were younger (OR, 0.98; 95% CI, 0.98-0.98) and were less socially vulnerable (OR, 0.84; 95% CI, 0.82-0.86). This cross-sectional study found that less than one-third of antibiotics prescribed to pediatric outpatients in Tennessee were optimal for choice and duration. Four stewardship interventions may be targeted: (1) reduce the number of prescriptions for tier 3 diagnoses, (2) increase optimal prescribing for AOM and pharyngitis, (3) provide clinician education on shorter antibiotic treatment courses for community-acquired pneumonia, and (4) promote optimal antibiotic prescribing in resource-limited settings.

Associations of hypothetical early intensive in-hospital rehabilitation with activities of daily living after hip fracture surgery in patients with and without dementia: Emulating a randomized controlled trial using medical claims data

To investigate the impact of early intensive in-hospital rehabilitation, initiated within 2 days of surgery and lasting up to 7 days, on the recovery of activities of daily living in patients with and without dementia. Medical claims data from 925 hospitals in Japan were analyzed. We enrolled patients aged ≥50 years who underwent hip fracture surgery within 2 days of admission between April 1, 2018 and December 31, 2019. Low- (20 min per day starting on day 2), highest- (60 min per day starting on day 1), and gradually increasing (20 min on day 1, 40 min on days 2-4, and 60 min per day thereafter) intensity regimens were used as exposures. The outcomes were Barthel Index (BI) scores at 14 and 30 days postoperatively. For per-protocol analysis, a target trial emulation framework with the sequential doubly robust estimator was used. Among patients without dementia (N = 11,461), no significant differences in BI scores were observed at 14 days postoperatively across regimens. At 30 days postoperatively, significant differences in BI scores were noted between highest- and low-intensity regimens and between gradually increasing intensity and low-intensity regimens, with additive BI scores of 15.2 (95% confidence interval [CI], 10.7-19.7) and 14.7 (95% CI, 9.2-20.2), respectively. In patients with dementia (N = 14,302), significant differences in BI scores were noted at 14 days postoperatively between highest- and low-intensity regimens and between gradually increasing intensity and low-intensity regimens, with additive BI scores of 8.7 (95% CI, 5.2-12.2) and 10.7 (95% CI, 5.8-15.6), respectively. At 30 days postoperatively, a significant difference in BI scores was observed between gradually increasing intensity and low-intensity regimens, with an additive BI score of 17.9 (95% CI, 11.3-24.5). Early intensive in-hospital rehabilitation is highly relevant and beneficial for dementia patients.