Hospital-based Health Information Technology Infrastructure: Evidence of Reduced Medicare Payments and Racial Disparities Among Patients With ADRD.

BACKGROUND: Alzheimer disease and related dementia (ADRD) is one of the most expensive health conditions in the United States. Understanding the potential cost-savings or cost-enhancements of Health Information Technology (HIT) can help policymakers understand the capacity of HIT investment to promote population health and health equity for patients with ADRD. OBJECTIVES: This study examined access to hospital-based HIT infrastructure and its association with racial and ethnic disparities in Medicare payments for patients with ADRD. RESEARCH DESIGN: We used the 2017 Medicare Beneficiary Summary File, inpatient claims, and the American Hospital Association Annual Survey. Our study focused on community-dwelling Medicare fee-for-service beneficiaries who were diagnosed with ADRD. Our study focused on hospital-based telehealth-postdischarge (eg, remote patient monitoring) and telehealth-treatment (eg, psychiatric and addiction treatment) services. RESULTS: Results showed that hospital-based telehealth postdischarge services were associated with significantly higher total Medicare payment and acute inpatient Medicare payment per person per year among patients with ADRD on average. The associations between hospital-based telehealth-treatment services and payments were not significant. However, the association varied by patient's race and ethnicity. The reductions of the payments associated with telehealth postdischarge and treatment services were more pronounced among Black patients with ADRD. Telehealth-treatment services were associated with significant payment reductions among Hispanic patients with ADRD. CONCLUSION: Results showed that having hospital-based telehealth services might be cost-enhancing at the population level but cost-saving for Black and Hispanic patients with ADRD. Results suggested that personalized HIT services might be necessary to reduce the cost associated with ADRD treatment for racial and ethnic minority groups.

An HIT-Supported Care Coordination Framework for Reducing Structural Racism and Discrimination for Patients With ADRD.

Black and Latinx Americans are disproportionately at greater risk for having Alzheimer's disease and related dementias (ADRD) than White Americans. Such differences in risk for ADRD are arguably explained through health disparities, social inequities, and historical policies. Structural racism and discrimination (SRD), defined as "macro-level conditions that limit opportunities, resources, and well-being of less privileged groups," have been linked with common comorbidities of ADRD, including hypertension, obesity, diabetes, depression. Given the historical impact of SRD-including discriminatory housing policies resulting in racial residential segregation that has been shown to limit access to education, employment, and healthcare-Black and Latinx populations with ADRD are directly or indirectly negatively affected by SRD in terms of access, quality and cost for healthcare. Emerging studies have brought to light the value of structural-level hospital and public health collaboration on care coordination for improving healthcare quality and access, and thus could serve as a macro-level mechanism for addressing disparities for minoritized racial and ethnic populations with ADRD. This paper presents a conceptual framework delineating how care coordination can successfully be achieved through health information technology (HIT) systems and ultimately address SRD. To address health inequities, it is therefore critical that policy initiatives invest in HIT capacities and infrastructures to promote care coordination, identify patient needs and preferences, and promote engagement of patients with ADRD and their caregivers.

Suicide Among Adults Age 55 and Older, 2021.

Suicide is a leading cause of mortality in the United States, with an ageadjusted rate of 14.1 deaths per 100,000 population in 2021 (1). Older adults tend to have higher rates of suicide, although they represent a low percentage of the total number of suicides (2). Factors that specifically affect older adults can include declines in physical and cognitive functioning, changes in mental health, and other factors often associated with getting older, like bereavement, loneliness, and lack of social connectedness (3-8). This report presents suicide rates for adults age 55 and older by sex and mechanism of suicide.

Repetitive Strain Injuries in Adults in the Past 3 Months: United States, 2021.

Objectives-This report describes the percentage of adults aged 18 and over who reported injuries from repetitive strain in the past 3 months by selected sociodemographic characteristics, including age, sex, race and Hispanic origin, and family income. The impacts of these injuries-limitation of usual activity for at least 24 hours and whether a medical professional was consulted for the injuries-are also examined. Methods-Data from the 2021 National Health Interview Survey were used to estimate the percentage of adults who had repetitive strain injuries in the past 3 months by sociodemographic characteristics. Among those who had a repetitive strain injury in the past 3 months, 24-hour limitation of activity and consultation of a medical professional are also examined by sociodemographic characteristics. Results-In 2021, for adults aged 18 and over in the United States, 9.0% had repetitive strain injuries in the past 3 months. Adults aged 35-49 (10.3%) and 50-64 (11.6%), White non-Hispanic adults (subsequently, White; 9.5%), and adults with family income at 400% or more of the federal poverty level (9.8%) tended to have higher percentages. For those who had repetitive strain injuries, 44.2% limited their activities for at least 24 hours, with the highest percentages among White adults (47.0%), women (47.1%), and adults with a family income less than 200% of the federal poverty level (51.0%). For those who limited their activity for at least 24 hours due to a repetitive strain injury, 51.4% consulted a doctor or medical professional, with the highest percentages among women (56.3%) and Black non-Hispanic adults (66.2%).

Co-involvement of Opioids in Drug Overdose Deaths Involving Cocaine and Psychostimulants, 2011-2021.

Drug overdose deaths involving cocaine and psychostimulants with abuse potential (that is, drugs such as methamphetamine, amphetamine, and methylphenidate) have risen in the past several years (1-4). A recent report highlighted that drug overdose deaths involving cocaine rose 22% and drug overdose deaths involving psychostimulants rose 33% from 2020 through 2021 (1). By the end of 2021, the report counted 24,486 drug overdose deaths involving cocaine and 32,537 drug overdose deaths involving psychostimulants (1,5). This report presents trends from 2011 through 2021 in death rates involving cocaine and psychostimulants, with and without opioid co-involvement, and by U.S. Census region in 2021.

National Hospital Care Survey Demonstration Projects:Mortality Following Nonfatal Opioid Overdose Visits to the Emergency Department.

Objective-This report provides a descriptive analysis of a sample of adult patients who visited the emergency department (ED) for nonfatal opioid overdose (NOO), using restricted-use 2016 National Hospital Care Survey data linked to the 2016-2017 National Death Index and the 2016-2017 Drug-Involved Mortality data from the National Center for Health Statistics.

Unintentional Fall Deaths Among Adults Aged 65 and Over: United States, 2020.

Unintentional fall injuries occur most frequently among people in older age groups, with over 2 million fall events treated in emergency departments each year among adults aged 65 and over (1,2). A variety of factors contribute to the risk of falling, including difficulties in seeing, walking, and balance; disabilities; medication effects; and environmental walking obstacles, among other factors (3-6). Deaths due to unintentional falls are a leading cause of unintentional injury deaths among adults aged 65 and over (7). Reducing unintentional fall-related deaths among older adults is a key objective for Healthy People 2030 (8). This report presents unintentional fall death rates for adults aged 65 and over, by demographic characteristics.

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.

Drug Overdose Deaths in the United States, 2001-2021.

Drug overdose deaths have been rising over the past 2 decades in the United States (1-4). This report uses the most recent data from the National Vital Statistics System (NVSS) to update statistics on deaths from drug overdose in the United States, showing rates by demographic groups and by the types of drugs involved (specifically, opioids and stimulants), with a focus on changes from 2020 through 2021.

Urban-Rural Differences in Drug Overdose Death Rates, 2020.

Drug overdose death rates, which have been rising over the past decade, differ by urban and rural counties across the United States (1-4). A previous report demonstrated higher drug overdose death rates in urban counties by various demographic and geographic characteristics (4). This report uses the most recent final mortality data from the National Vital Statistics System (NVSS) to describe urban and rural differences in drug overdose death rates in 2020 by sex, race and Hispanic origin, and selected types of opioids and stimulants.

Psychological distress and the risk of drug overdose death.

BACKGROUND: Previous research has shown an association between psychological distress and overdose death among specific populations. However, few studies have examined this relationship in a large US population-based cohort. METHODS: Data from the 2010-2018 NHIS were linked to mortality data from the National Death Index through 2019. Psychological distress was measured using the Kessler 6 scale. Drug overdose deaths were examined, and deaths from all other causes were included as a comparison group. Cox proportional hazards regression was used to estimate mortality risk by psychological distress level. RESULTS: The study population included 272,561 adults. Adjusting for demographic covariates and using no psychological distress as the reference, distress level was positively associated with the risk of overdose death: low (HR = 1.8, 95 % CI = 1.1-2.8), moderate (HR = 4.1, 95 % CI = 2.5-6.7), high (HR = 10.3, 95 % CI = 6.5-16.1). A similar pattern was observed for deaths from all other causes: low (HR = 1.2, 95 % CI = 1.1-1.2), moderate (HR = 1.9, 95 % CI = 1.7-2.0), high (HR = 2.6, 95 % CI = 2.4-2.8). LIMITATIONS: Limited substance use information prevented adjustment for this potentially important covariate. DISCUSSION: Adults with psychological distress were at greater risk of drug overdose death, relative to those without psychological distress. Adults with psychological distress were also at increased risk of death due to other causes, though the association was not as strong.

Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019.

Drug overdose death rates continue to rise in the United States (1-3), with significant urban-rural differences in rates by sex, age, and types of drugs involved (4). This report uses the most recent mortality data from the National Vital Statistics System (NVSS) to examine urban-rural differences in drug overdose death rates for all drugs and by selected types of opioids and stimula.

Urban-rural Differences in Unintentional Injury Death Rates Among Children Aged 0-17 Years: United States, 2018-2019.

Unintentional injuries are the leading cause of death among children aged 0-17 years (1). In 2018-2019, 14% of children in the United States aged 0-17 years resided in rural areas but accounted 24% of all childhood injury deaths (1). Urban-rural differences in injury mortality have been associated with a variety of factors, including differences in types of activities, use of safety equipment, practice of safety-related behaviors, built environments, and access to care (2-9). This report presents rates of unintentional injury death among children aged 0-17 for 2018-2019, highlighting the differences in rates by mechanism of injury and urban-rural status.

Drug Overdose Deaths in the United States, 1999-2020.

Deaths from drug overdose continue to contribute to overall mortality and the lowering of life expectancy in the United States (1-4). This report uses the most recent data from the National Vital Statistics System (NVSS) to update statistics on deaths from drug overdose in the United States, showing rates by demographic group and by specific types of drugs involved (such as opioids or stimulants), with a focus on changes from 2019 to 2020.

Rates of Alcohol-induced Deaths Among Adults Aged 25 and Over in Urban and Rural Areas: United States, 2000-2018.

Excessive alcohol consumption is a well-known risk factor for mortality and has been causally linked to many diseases, conditions and injuries, including alcohol-attributable cancer, liver cirrhosis, and alcohol poisonings (1). Alcohol-induced deaths, or deaths from dependent and nondependent use of alcohol, as well as accidental poisoning by alcohol (2), have been increasing in the United States since 1999 with differences by sex, age, urban-rural classification, and other demographic characteristics (3,4). This Data Brief focuses on alcohol-induced deaths among adults aged 25 and over, which account for more than 99% of the alcohol-induced deaths in the United States. The report presents trends from 2000 through 2018 by sex and urbanization level of county of residence.

Increase in Drug Overdose Deaths Involving Cocaine: United States, 2009-2018.

Deaths from drug overdose continue to contribute to mortality in the United States. The rate of drug overdose deaths involving cocaine has increased in recent years (1-3). This Data Brief provides additional information on drug overdose deaths involving cocaine by examining trends in rates by sex, age group, race and Hispanic origin, and by concurrent involvement of opioids from 2009 through 2018. Rates by urbanicity and census region in 2018 are also examined.