Use of Medicare Data to Identify Team-based Primary Care: Is it Possible?

BACKGROUND: It is unclear whether Medicare data can be used to identify type and degree of collaboration between primary care providers (PCPs) [medical doctors (MDs), nurse practitioners, and physician assistants] in a team care model. METHODS: We surveyed 63 primary care practices in Texas and linked the survey results to 2015 100% Medicare data. We identified PCP dyads of 2 providers in Medicare data and compared the results to those from our survey. Sensitivity, specificity, and positive predictive value (PPV) of dyads in Medicare data at different threshold numbers of shared patients were reported. We also identified PCPs who work in the same practice by Social Network Analysis (SNA) of Medicare data and compared the results to the surveys. RESULTS: With a cutoff of sharing at least 30 patients, the sensitivity of identifying dyads was 27.8%, specificity was 91.7%, and PPV 72.2%. The PPV was higher for MD-nurse practitioner/physician assistant pairs (84.4%) than for MD-MD pairs (61.5%). At the same cutoff, 90% of PCPs identified in a practice from the survey were also identified by SNA in the corresponding practice. In 5 of 8 surveyed practices with at least 3 PCPs, about ≤20% PCPs identified in the practices by SNA of Medicare data were not identified in the survey. CONCLUSIONS: Medicare data can be used to identify shared care with low sensitivity and high PPV. Community discovery from Medicare data provided good agreement in identifying members of practices. Adapting network analyses in different contexts needs more validation studies.

Associations between positive emotion and recovery of functional status following stroke.

OBJECTIVE: Accumulating evidence indicates the beneficial effects of positive emotion on health and general well-being in older age. Less evidence is available on whether positive emotion supports improvement in functional status after an acute medical event such as stroke. This study examined the association between positive emotion at discharge from inpatient medical rehabilitation and functional status 3 months later in persons with stroke. METHODS: A longitudinal study using information from the Stroke Recovery in Underserved Patients database. The study included 823 persons aged 55 years or older with stroke and admitted to an inpatient medical rehabilitation facility. Information was collected during inpatient medical rehabilitation stay and approximately 3 months after discharge. RESULTS: The mean age of the sample was 72.8 years (SD = 9.5), 51.5% were women and 53.8% were married. The sample was mostly non-Hispanic white (79.2%), followed by non-Hispanic black (15.0%) and Hispanic (5.8%). The average length of stay was 20.1 day (SD = 10.1). In multivariate regression analyses, discharge positive emotion score was significantly associated with higher overall functional status (b = 0.70, SE = 0.21, p = .001) as well as with higher motor (b = 0.37, SE = 0.17, p = .003) and cognitive (b = 0.30, SE = 0.05, p = .0001) status at 3-month follow-up after adjustment for relevant risk factors. CONCLUSIONS: Our results indicate positive emotion is associated with gains in functional status after stroke. Findings have implications for stroke recovery programs and suggest the need to include measures of positive emotion inpatient assessments.

Androgen treatment and muscle strength in elderly men: A meta-analysis.

OBJECTIVES: To review published, randomized trials examining the effect of androgen treatment on muscle strength in older men. DESIGN: Systematic review using meta-analysis procedures. SETTING: Computerized and manual searches. PARTICIPANTS: MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched for trials. Key words included testosterone, androgen, sarcopenia, muscle loss, aged, aging, elderly, older, geriatric, randomized controlled trials, and controlled clinical trials. Sixty-five nonoverlapping studies were found. Meta-analysis methods were used to evaluate the 11 randomized, double-blind trials. INTERVENTION: Testosterone or dihydrotestosterone (DHT) replacement therapy in healthy men aged 65 and older. MEASUREMENTS: Tests of muscle strength. RESULTS: The studies included 38 statistical comparisons. The mean g-index (g(i)) adjusted for sample size was 0.53 (95% confidence interval (CI) = 0.21-0.86). Subanalyses revealed larger effects for measures of lower extremity muscle strength (g(i) = 0.63, 95% CI = 0.03-1.28) than for upper extremity muscle strength (g(i) = 0.47, 95% CI = 0.12-0.84). A larger mean g-index was found for injected (g(i) = 0.95, 95% CI = 0.33-1.58) than topical (g(i) = 0.26, 95% CI = 0.08-0.42) or oral (g(i) = -0.21, 95% CI = -1.40-1.02) administration of testosterone/DHT. Effect sizes were related to study characteristics such as subject attrition and design-quality ratings. Sensitivity analyses revealed that the elimination of one study reduced the mean g-index from 0.53 to 0.23. CONCLUSION: The results suggest that testosterone/DHT therapy produced a moderate increase in muscle strength in men participating in 11 randomized trials. One study influenced the mean effect size.

Test-retest reliability of a psychological well-being scale in hospitalized older adults.

BACKGROUND AND AIMS: To examine the reliability of a 6-domain psychological well-being instrument in older patients admitted to an acute care hospital unit. METHODS: A prospective reliability study was conducted using a convenience sample of 40 hospitalized patients aged 65 or older. The main measure was a 6-domain psychological well-being instrument including self-acceptance, positive relations with others, autonomy, environmental mastery, purpose of life, and personal growth. RESULTS: The mean age was 76.3 years [standard deviation (SD)=6.1], 72.5% were white and 57.5% were men. The mean length of stay was 4.9 days (SD=3.1). Test-retest (admission and discharge) intraclass correlation (ICC) values for the six domains were self-acceptance (0.79), positive relations with others (0.72), autonomy (0.79), environmental mastery (0.66), purpose in life (0.79), and personal growth (0.78). CONCLUSIONS: The 6-domain psychological well-being instrument demonstrated good reliability among a sample of hospitalized older patients. This instrument may be useful in a clinical setting to predict outcomes related to patient health and recovery.