Comparative Analysis of Hospital Length of Stay and Discharge Status of Two Contemporary Primary Total Knee Systems.

This study compares the differences in hospital length of stay (LOS), operating room time (ORT), discharge status, and total hospital costs among primary total knee arthroplasty (TKA) patients implanted with one of two contemporary primary total knee systems. A retrospective cohort analysis of elective inpatient, primary, unilateral TKA patients in the United States from 2013 to 2014 was conducted using the Premier Perspective® hospital billing database. The included patients had a diagnosis for osteoarthritis and received an ATTUNE® Knee (Gradually Reducing Radius Knee) or Triathlon™ (Single Radius Knee) from a hospital where both devices were used. Patient, provider, and procedure characteristics were included in generalized estimating equation (GEE) models to explore the impact of device on LOS, ORT, discharge status, and costs accounting for clustering within hospitals. A 1:1 propensity score-matched sensitivity analysis was also conducted. There were 1,178 patients who received gradually reducing radius knee and 5,707 patients who received single radius knee. GEE models indicated that the adjusted mean LOS and ORT for patients who received gradually reducing radius knee were significantly shorter than those who received single radius knee (p < 0.001). The adjusted odds ratios for gradually reducing radius knee patients being discharged to a skilled nursing facility (SNF) or other facility were 39% lower than that for single radius knee patients (odds ratio = 0.61; 95% confidence interval: 0.50-0.75; p < 0.001). The adjusted mean costs for gradually reducing radius knee patients were significantly lower than the single radius knee patients ($12,824 [1,813] vs. $18,713 [1,505]; p < 0.01). Findings were similar in the propensity-matched cohort of 2,044 patients, which was balanced on baseline covariates between devices (standardized differences were ≤ 8%). Patients who received gradually reducing radius knee had a shorter LOS and ORT, were less likely to be discharged to a SNF or other facility, and had lower total hospital cost than those who received single radius knee. These outcomes are increasingly relevant as hospitals bear the financial burden for episodes of care, and will require optimization to achieve success under the Centers for Medicare and Medicaid Services' Comprehensive Care for Joint Replacement model.

Evaluation of specialized medication packaging combined with medication therapy management: adherence, outcomes, and costs among Medicaid patients.

BACKGROUND: This study evaluates the effect of a program combing specialized medication packaging and telephonic medication therapy management on medication adherence, health care utilization, and costs among Medicaid patients. RESEARCH DESIGN: A retrospective cohort design compared Medicaid participants who voluntarily enrolled in the program (n = 1007) compared with those who did not (n = 13,614). Main outcome measures were medication adherence at 12 months, hospital admissions and emergency department visits at 6 and 12 months, and total paid claim costs at 6 and 12 months. Multivariate regression models were used to adjust for the effect of age, sex, race, comorbidities, and 12-month preenrollment health care utilization. RESULTS: Measures of medication adherence were significantly improved in the program cohort compared with the usual care cohort. At 6 months, adjusted all-cause hospitalization was marginally less in the program cohort compared with the usual care cohort [odds ratio = 0.73, 95% confidence interval (CI), 0.54-1.0, P = 0.05]. No statistically significant differences were observed between the 2 cohorts for any of the other adjusted utilization endpoints at 6 or 12 months. Adjusted total cost at 6 and 12 months were higher in the program cohort (6-month cost ratio = 1.76, 95% CI,1.65-1.89; 12-month cost ratio = 1.84, 95% CI,1.72-1.97), primarily because of an increase in prescription costs. Emergency department visits and hospitalization costs did not differ between groups. CONCLUSIONS: : The program improved measures of medication adherence, but the effect on health care utilization and nonpharmacy costs at 6 and 12 months was not different from the usual care group. Reasons for these findings may reflect differences in the delivery of the specialized packaging and the medication therapy management program, health care behaviors in this Medicaid cohort, unadjusted confounding, or time required for the benefit of the intervention to manifest.

Misclassification associated with measurement error in the assessment of dietary intake.

OBJECTIVE: Dietary assessment has been used for certification to receive food supplements or other nutrition services and to provide feedback for educational purposes. The proportion of individuals correctly certified as eligible is a function of the amount of error that exists in the dietary measures and the level of dietary intake used to establish eligibility. Whether individuals are correctly counselled to increase or decrease the consumption of selected foods or nutrients is a function of the same factors. It is not clear, however, what percentage of individuals would be correctly classified under what circumstances. The objective of this study is to demonstrate the extent to which measurement error and eligibility criteria affect the accuracy of classification. DESIGN: Hypothetical distributions of dietary intake were generated with varying degrees of measurement error. Different eligibility criteria were applied and the expected classification rates were determined using numerical methods. SETTING AND SUBJECTS: Simulation study. RESULTS: Cut points of dietary intake at decreasing levels below the 50th percentile of true intake were associated with lower sensitivity and predictive value positive rates, but higher specificity and predictive value negative rates. The correct classification rates were lower when two cut points of dietary intake were used. Using a single cut point that was higher than the targeted true consumption resulted in higher sensitivity but lower predictive value positive, and lower specificity but higher predictive value negative. CONCLUSIONS: Current methods of dietary assessment may not be reliable enough to attain acceptable levels of correct classification. Policy-makers and educators must consider how much misclassification error they are willing to accept and determine whether more intensive methods are necessary.

Children's dietary fat intake and fat practices vary by meal and day.

OBJECTIVE: This research examined the relationship between the dietary fat intake and fat practices of children by meal, day of week, and weekend day vs weekday. DESIGN: Cross-sectional study. SUBJECTS/SETTING: Fourth- to sixth-grade students (n = 520; 25% African-American, 32% white, 33% Mexican-American, 10% Asian/other, 58% girls) attending 8 parochial schools in Houston, Texas. MAIN MEASURES: Students completed daily food records in the classroom for 7 days. Food records were hand-coded for high-fat (eg, frying foods, adding fat) and low-fat (eg, removing meat fat, drinking low-fat milk) practices, and percent energy from fat. STATISTICAL ANALYSES: Descriptive statistics, Spearman correlation coefficients, and analysis of variance on fat intake and fat practices by demographic variables and weekend vs weekday. RESULTS: Students consumed 36% of total energy from fat, reported 0.59 low-fat practices, and 6.3 high-fat practices per day. Only 13% consumed 30% or less energy from fat. Significant correlations were found between percent energy from fat and high-fat practices and low-fat practices (r = 0.27, P < .001 and r = -0.15, P < .01, respectively). APPLICATIONS/CONCLUSIONS: Intervention programs targeting children's dietary fat behaviors should include teaching skills that enable children to ask for low-fat foods like fruit, vegetables, low-fat snacks and dairy foods. These foods should be made available in the home to encourage children to practice low-fat dietary behaviors, which may differ depending on meal, day, and meal source.

Fat practices and consumption among African-American adolescent Boy Scouts: the impact of meal source.

This study investigated the fat consumption and dietary fat practices of 183 African-American Boy Scouts, members of urban (low socioeconomic status [SES]) and church-affiliated (middle SES) troops by meal source. The scouts completed 2 24-hour dietary recalls. Total kilocalories (kcal), % kcal from fat and saturated fat, and high and low fat practices were calculated by meal location (home, school, restaurant). About 50% of all meals were eaten at home, 35% at school, and 15% in restaurants. Scouts consumed greater than the recommended amounts of total kcal from fat and saturated fat at all meal locations. Low SES scouts reported more school meals, and fewer home and restaurant meals compared with middle SES scouts. For all scouts, restaurant meals were associated with less healthy dietary fat behaviors and higher kcal consumption. Scouts consuming 2 school meals reported more low fat practices compared to those eating one school meal. Interventions targeting African-American adolescents should focus on building skills for choosing low-fat foods at all meal locations, particularly restaurants.