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1.
Sr Care Pharm ; 35(7): 331, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32600512

RESUMO

The Centers for Medicare & Medicaid Services (CMS) and other federal agencies are busy churning out regulations and guidance documents in response to the COVID-19 crisis. CMS now requires plans to waive cost sharing for COVID-19-related immunizations, testing, and treatment and suspend utilization review requirements related to drug-supply limits unless these limits are related to patient safety.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Medicaid/organização & administração , Medicare/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Betacoronavirus , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Uso de Medicamentos , Humanos , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Estados Unidos
2.
Pediatr Dent ; 42(3): 203-207, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32522323

RESUMO

Purpose: The purpose of this study was to examine national data for trends in pediatric patient visits to dentists and physicians that may inform future interprofessional practice. Methods: Data for 95,677 children, aged zero to 17 years, captured between 2011 and 2012 from the National Survey of Children's Health were examined to compare the number of visits made to dentists and physicians at each year of age. Results: The average age was 8.9±5.2 (standard deviation) years; 28.6 percent were receiving Medicaid. Comparisons showed that, while physician visits were more common than dentist visits at younger ages, children aged nine years and older had more dentist visits than physician visits per year (P<0.001). Stratified analyses showed similar patterns in the frequency of physician and dentist visits within boys (P<0.001), girls (P<0.001), English speakers (P<0.001), and non-English speakers (P<0.001). Conclusions: Physicians have an opportunity to address oral health in younger children, and dentists have an opportunity to address systemic health for older children. For five-year-olds and younger, physicians should incorporate oral health evaluations and dentist-referrals. For nine-year-olds and older, dentists should provide counseling on healthy weight, nutrition, and human papillomavirus (HPV) vaccination; monitoring for diabetes and asthma; and screening for smoking, vaping, and sleep apnea.


Assuntos
Odontólogos , Médicos , Adolescente , Criança , Pré-Escolar , Aconselhamento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Medicaid , Encaminhamento e Consulta , Estados Unidos
4.
J Neurol Sci ; 414: 116930, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32460041

RESUMO

BACKGROUND: The COVID-19 pandemic mandated rapid transition from face-to-face encounters to teleneurology visits. While teleneurology is regularly used in acute stroke care, its application in other branches of neurology was limited. Here we review how the recent pandemic has created a paradigm shift in caring for patients with chronic neurological disorders and how academic institutions have responded to the present need. METHOD: Literature review was performed to examine the recent changes in health policies. Number of outpatient visits and televisits in the Department of Neurology was reviewed from Yale University School of Medicine and Johns Hopkins School of Medicine to examine the road to transition to televisit. RESULTS: The federal government and the insurance providers extended their supports during the COVID-19 pandemic. Several rules and regulations regarding teleneurology were revised and relaxed to address the current need. New technologies for video conferencing were incorporated. The transition to televisits went smoothly in both the institutions and number of face-to-face encounters decreased dramatically along with a rapid rise in televisits within 2 weeks of the declaration of national emergency. CONCLUSION AND RELEVANCE: The need for "social distancing" during the COVID-19 pandemic has created a major surge in the number of teleneurology visits, which will probably continue for the next few months. It may have initiated a more permanent transition to virtual technology incorporated medical care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Doenças do Sistema Nervoso/terapia , Neurologia/tendências , Pandemias , Pneumonia Viral , Telemedicina/tendências , Doença Crônica , Humanos , Internet , Licenciamento em Medicina , Medicaid , Medicare , Doenças do Sistema Nervoso/economia , Exame Neurológico , Neurologia/economia , Neurologia/métodos , Quarentena , Telemedicina/economia , Telemedicina/legislação & jurisprudência , Estados Unidos , Comunicação por Videoconferência/tendências
5.
South Med J ; 113(5): 254-260, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358621

RESUMO

OBJECTIVES: Hospitalized patients with acute and chronic pancreatitis (AP and CP) are prone to frequent readmissions to different hospitals. The rate of care fragmentation and its impact on important outcomes are unknown. The aims of this study were to evaluate the rate and predictors of care fragmentation in patients hospitalized with AP and CP using a nationally representative sample, and to analyze the impact of care fragmentation on mortality, cost, and hospital readmissions. METHODS: We identified all adult hospitalizations with a primary diagnosis of AP or CP in the 2010-2014 National Readmissions Database, which captures statewide readmissions. We calculated 30- and 90-day readmission and care fragmentation rates. Readmission to a nonindex hospital was considered care fragmentation. Logistic regression was used to determine hospital and patient factors independently associated with 30-day care fragmentation. Patients readmitted within 30 days were followed for 60 days postdischarge from the first readmission. Mortality during the first readmission, hospitalization costs, and rates of 60-day readmission were compared between those with and without care fragmentation. RESULTS: There were 479,427 admissions with AP and 25,513 with CP. The rates of 30- and 90-day readmissions were 13.5% and 22.9% for AP and 26.9% and 44.7%% for CP. The rates of 30- and 90-day care fragmentation were 28% and 32% for AP and 33% and 38% for CP. Younger age (younger than 45 y), male patients, length of stay <5 days, ≥4 Elixhauser comorbidities, and self-pay or Medicaid insurance were associated with increased risk of 30-day care fragmentation. Large hospital size, routine discharge, and metropolitan location were associated with lower risk. Patients who had the first readmission to a nonindex hospital had a higher mortality (2% vs 1.6%, P = 0.005), length of stay (6.5 vs 5.6 days, P < 0.0001), mean hospitalization cost ($16,731 vs $13,368, P < 0.0001), and 60-day readmission (48.4% vs 42.9%) compared with those readmitted to the index hospital. CONCLUSIONS: In patients with AP and CP, one-third of 90-day readmissions occur at a nonindex hospital. Care fragmentation is associated with increased mortality, readmissions, and cost of care.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Pancreatite Crônica/terapia , Pancreatite/terapia , Readmissão do Paciente/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Comorbidade , Feminino , Tamanho das Instituições de Saúde , Hospitalização , Hospitais Urbanos , Humanos , Modelos Logísticos , Masculino , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Fatores Sexuais , Estados Unidos , Adulto Jovem
7.
Am Surg ; 86(3): 195-199, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223797

RESUMO

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion (P = 0.56). Statewide data similarly demonstrated no change (P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients' decision to seek breast cancer screening and care.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/economia , Custos de Cuidados de Saúde , Medicaid/economia , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Neoplasias da Mama/economia , Neoplasias da Mama/mortalidade , Bases de Dados Factuais , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Ohio , Patient Protection and Affordable Care Act , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Estados Unidos
9.
J Surg Oncol ; 121(8): 1191-1200, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32227342

RESUMO

BACKGROUND AND OBJECTIVES: A previous analysis of breast cancer care after the 2014 Medicaid expansion in Kentucky demonstrated delays in treatment despite a 12% increase in insurance coverage. This study sought to identify factors associated with treatment delays to better focus efforts for improved breast cancer care. METHODS: The Kentucky Cancer Registry was queried for adult women diagnosed with invasive breast cancer between 2010 and 2016 who underwent up-front surgery. Demographic, tumor, and treatment characteristics were assessed to identify factors independently associated with treatment delays. RESULTS: Among 6225 patients, treatment after Medicaid expansion (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.874-2.535, P < .001), urban residence (OR = 1.362, 95% CI = 1.163-1.594, P < .001), treatment at an academic center (OR = 1.988, 95% CI = 1.610-2.455, P < .001), and breast reconstruction (OR = 3.748, 95% CI = 2.780-5.053, P < .001) were associated with delay from diagnosis to surgery. Delay in postoperative chemotherapy was associated with older age (OR = 1.155,95% CI = 1.002-1.332, P = .0469), low education level (OR = 1.324, 95% CI = 1.164-1.506, P < .001), hormone receptor positivity (OR = 1.375, 95% CI = 1.187-1.593, P < .001), and mastectomy (OR = 1.312, 95% CI = 1.138-1.513, P < .001). Delay in postoperative radiation was associated with younger age (OR = 1.376, 95% CI = 1.370-1.382, P < .001), urban residence (OR = 1.741, 95% CI = 1.732-1.751, P < .001), treatment after Medicaid expansion (OR = 2.007, 95% CI = 1.994-2.021, P < .001), early stage disease (OR = 5.661, 95% CI = 5.640-5.682, P < .001), and mastectomy (OR = 1.884, 95% CI = 1.870-1.898, P < .001). CONCLUSIONS: Patient, tumor, and socioeconomic factors influence the timing of breast cancer treatment. Improving timeliness of treatment will likely require improvements in outreach, education, and healthcare infrastructure.


Assuntos
Neoplasias da Mama/terapia , Medicaid/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Fatores Etários , Idoso , Neoplasias da Mama/economia , Neoplasias da Mama/epidemiologia , Quimioterapia Adjuvante , Estudos de Coortes , Feminino , Acesso aos Serviços de Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Kentucky/epidemiologia , Modelos Logísticos , Mastectomia , Mastectomia Segmentar , Pessoa de Meia-Idade , Radioterapia Adjuvante , Sistema de Registros , Estados Unidos
10.
Sr Care Pharm ; 35(5): 237, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32340661

RESUMO

The decision of the Centers for Medicare & Medicaid Services to suspend routine surveys in favor of focused inspections targeted at infection control is the first signal that long-term care will be at the epicenter of federal oversight.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Assistência de Longa Duração , Medicare , Pandemias , Pneumonia Viral , Centers for Medicare and Medicaid Services, U.S. , Humanos , Medicaid , Estados Unidos
11.
Am J Nurs ; 120(5): 16, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332348

RESUMO

Changed rules may limit services under Medicare, Medicaid, and Title X.


Assuntos
Assistência à Saúde , Acesso aos Serviços de Saúde , Reabilitação , Saúde Reprodutiva , Anticoncepção , Assistência à Saúde/economia , Humanos , Medicaid , Medicare , Estados Unidos
15.
JAMA ; 323(9): 854-862, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32125403

RESUMO

Importance: Most studies that have examined drug prices have focused on list prices, without accounting for manufacturer rebates and other discounts, which have substantially increased in the last decade. Objective: To describe changes in list prices, net prices, and discounts for branded pharmaceutical products for which US sales are reported by publicly traded companies, and to determine the extent to which list price increases were offset by increases in discounts. Design, Setting, and Participants: Retrospective descriptive study using 2007-2018 pricing data from the investment firm SSR Health for branded products available before January 2007 with US sales reported by publicly traded companies (n = 602 drugs). Net prices were estimated by compiling company-reported sales for each product and number of units sold in the US. Exposures: Calendar year. Main Outcomes and Measures: Outcomes included list and net prices and discounts in Medicaid and other payers. List prices represent manufacturers' price to wholesalers or direct purchasers but do not account for discounts. Net prices represent revenue per unit of the product after all manufacturer concessions are accounted for (including rebates, coupon cards, and any other discount). Means of outcomes were calculated each year for the overall sample and 6 therapeutic classes, weighting each product by utilization and adjusting for inflation. Results: From 2007 to 2018, list prices increased by 159% (95% CI, 137%-181%), or 9.1% per year, while net prices increased by 60% (95% CI, 36%-84%), or 4.5% per year, with stable net prices between 2015 and 2018. Discounts increased from 40% to 76% in Medicaid and from 23% to 51% for other payers. Increases in discounts offset 62% of list price increases. There was large variability across classes. Multiple sclerosis treatments (n = 4) had the greatest increases in list (439%) and net (157%) prices. List prices of lipid-lowering agents (n = 11) increased by 278% and net prices by 95%. List prices of tumor necrosis factor inhibitors (n = 3) increased by 166% and net prices by 73%. List prices of insulins (n = 7) increased by 262%, and net prices by 51%. List prices of noninsulin antidiabetic agents (n = 10) increased by 165%, and net prices decreased by 1%. List price increases were lowest (59%) for antineoplastic agents (n = 44), but discounts only offset 41% of list price increases, leading to 35% increase in net prices. Conclusions and Relevance: In this analysis of branded drugs in the US from 2007 to 2018, mean increases in list and net prices were substantial, although discounts offset an estimated 62% of list price increases with substantial variation across classes.


Assuntos
Custos de Medicamentos/tendências , Honorários Farmacêuticos/tendências , Custos e Análise de Custo , Honorários Farmacêuticos/legislação & jurisprudência , Medicaid/economia , Estudos Retrospectivos , Estados Unidos
16.
Am J Surg ; 219(4): 571-577, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32147020

RESUMO

INTRODUCTION: Bariatric surgery is an effective treatment for obesity resulting in both sustained weight loss and reduction in obesity-related comorbidities. It is uncertain how sociodemographic factors affect postoperative outcomes. METHODS: The National Inpatient Sample was queried for patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2005 to 2014. Factors associated with selection of SG over RYGB, increased postoperative length of stay (LOS) greater than 3 days, and inpatient mortality were compared by race, insurance status, and other clinical and hospital factors. RESULTS: The database captured 781,413 patients, of which 525,986 had a RYGB and 255,428 had SG. There was an increase in the incidence of SG over RYGB over time. Among the self-pay/uninsured, the increased incidence began several years earlier than other groups. Black patients had greater odds of increased postoperative LOS (OR 1.40) and in-hospital mortality (OR 2.11). CONCLUSION: Sociodemographic factors are associated with differences in temporal trends in the adoption of SG versus RYGB for surgical weight loss.


Assuntos
Gastrectomia/tendências , Derivação Gástrica/tendências , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Comorbidade , Grupos de Populações Continentais/estatística & dados numéricos , Conjuntos de Dados como Assunto , Feminino , Financiamento Pessoal/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Setor Privado , Fatores Raciais , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto Jovem
18.
Am J Cardiol ; 125(7): 1063-1068, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32146925

RESUMO

Medicaid expansion in terms of its eligibility and federal funding has led to improved healthcare access in previously uninsured individuals. However, proposed lower Medicaid rates have unintentionally led to lower utilization of substantial life-saving therapies and poor outcomes compared with private insurance. We examined heart failure (HF) management, in-hospital mortality, and resource utilization in Medicaid and privately insured individuals hospitalized with HF. The authors screened the National Inpatient Sample from January 2012 to September 2015 for HF hospitalizations with Medicaid or private insurance as the primary payer. The authors identified a total of 226,265 and 292,070 patients with HF hospitalizations with Medicaid and private insurance, respectively. In propensity-matched cohort of 155,790 hospitalizations in each group, Medicaid beneficiaries with HF hospitalization had lower rates of intra-aortic balloon pump/left ventricular assist device/extracorporeal membrane oxygenation utilization (0.6 vs 0.9%; odds ratio [OR] 0.64; 95% confidence interval [CI] 0.59 to 0.69), heart transplantation (0.15 vs 0.44%; OR 0.35; 95% CI 0.30 to 0.40), implantable cardioverter-defibrillator/cardiac resynchronization therapy/permanent pacemaker (3.3 vs 3.9%; OR 0.84; 95% CI 0.81 to 0.87), and had higher rates of in-hospital mortality (1.9 vs 1.7%; OR 1.12; 95% CI 1.07 to 1.19) compared with privately insured individuals (p <0.001 for both). In conclusion, Medicaid recipients with HF hospitalizations had a lower rate of device utilization, heart transplantation, and a higher rate of in-hospital mortality compared with the privately insured sector. Further studies are needed to explore and understand the variation in the outcomes of HF hospitalizations stratified by insurance status.


Assuntos
Gerenciamento Clínico , Disparidades em Assistência à Saúde , Insuficiência Cardíaca/terapia , Hospitalização/economia , Cobertura do Seguro , Seguro Saúde/economia , Medicaid/economia , Feminino , Seguimentos , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
19.
PLoS One ; 15(3): e0229787, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32126120

RESUMO

OBJECTIVE: To identify the geographic, organisational, and payment correlates of buprenorphine and methadone treatment among substance abuse treatment (SAT) providers. METHODS: Secondary analyses of the National Survey of Substance Abuse Treatment Services (NSSATS) from 2007-16 were conducted. We provide bivariate descriptive statistics regarding substance abuse treatment services which offered buprenorphine and methadone treatment from 2007-16. Using multiple logistic regression, we regressed geographic, organisational, and payment correlates on buprenorphine and methadone treatment. RESULTS: Buprenorphine is increasingly offered at SAT facilities though uptake remains comparatively low outside of the northeast. SAT facilities run by tribal governments or Indian Health Service which offer buprenorphine remain low compared to privately operated SAT facilities (AOR = 0.528). The odds of offering buprenorphine among facilities offering free or no charge treatment (AOR = 0.838) or a sliding fee scale (AOR = 0.464) was lower. SAT facilities accepting Medicaid payments showed higher odds of offering methadone treatment (AOR = 2.035). CONCLUSIONS: Greater attention towards the disparities in provision of opioid agonist therapies is warranted, especially towards the reasons why uptake has been moderate among civilian providers. Additionally, the care needs of Native Americans facing opioid-related use disorders bears further scrutiny.


Assuntos
Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/reabilitação , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Analgésicos Opioides/efeitos adversos , Buprenorfina/economia , Buprenorfina/uso terapêutico , Efeitos Psicossociais da Doença , Geografia , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Medicaid/economia , Medicaid/estatística & dados numéricos , Metadona/economia , Metadona/uso terapêutico , Antagonistas de Entorpecentes/economia , Tratamento de Substituição de Opiáceos/economia , Tratamento de Substituição de Opiáceos/tendências , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Centros de Tratamento de Abuso de Substâncias/economia , Centros de Tratamento de Abuso de Substâncias/organização & administração , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos/epidemiologia
20.
JAMA ; 323(10): 961-969, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32154858

RESUMO

Importance: Medicare beneficiaries who are also enrolled in Medicaid (dually enrolled beneficiaries) have drawn the attention of policy makers because they comprise the poorest subset of the Medicare population; however, it is unclear how their outcomes have changed over time compared with those only enrolled in Medicare (nondually enrolled beneficiaries). Objective: To evaluate annual changes in all-cause mortality, hospitalization rates, and hospitalization-related mortality among dually enrolled beneficiaries and nondually enrolled beneficiaries. Design, Setting, and Participants: Serial cross-sectional study of Medicare fee-for-service beneficiaries aged 65 years or older between January 2004 and December 2017. The final date of follow-up was September 30, 2018. Exposures: Dual vs nondual enrollment status. Main Outcomes and Measures: Annual all-cause mortality rates; all-cause hospitalization rates; and in-hospital, 30-day, 1-year hospitalization-related mortality rates. Results: There were 71 017 608 unique Medicare beneficiaries aged 65 years or older (mean age, 75.6 [SD, 9.2] years; 54.9% female) enrolled in Medicare for at least 1 month from 2004 through 2017. Of these beneficiaries, 11 697 900 (16.5%) were dually enrolled in Medicare and Medicaid for at least 1 month. After adjusting for age, sex, and race, annual all-cause mortality rates declined from 8.5% (95% CI, 8.45%-8.56%) in 2004 to 8.1% (95% CI, 8.05%-8.13%) in 2017 among dually enrolled beneficiaries and from 4.1% (95% CI, 4.08%-4.13%) in 2004 to 3.8% (95% CI, 3.76%-3.79%) in 2017 among nondually enrolled beneficiaries. The difference in annual all-cause mortality between dually and nondually enrolled beneficiaries increased between 2004 (adjusted odds ratio, 2.09 [95% CI, 2.08-2.10]) and 2017 (adjusted odds ratio, 2.22 [95% CI, 2.21-2.23]) (P < .001 for interaction between dual enrollment status and time). All-cause hospitalizations per 100 000 beneficiary-years declined from 49 888 in 2004 to 41 121 in 2017 among dually enrolled beneficiaries (P < .001) and from 29 000 in 2004 to 22 601 in 2017 among nondually enrolled beneficiaries (P < .001); however, the difference between these groups widened between 2004 (adjusted risk ratio, 1.72 [95% CI, 1.71-1.73]) and 2017 (adjusted risk ratio, 1.83 [95% CI, 1.82-1.83]) (P < .001 for interaction). Among hospitalized beneficiaries, the risk-adjusted 30-day mortality rates declined from 10.3% (95% CI, 10.22%-10.33%) in 2004 to 10.1% (95% CI, 10.02%-10.20%) in 2017 among dually enrolled beneficiaries and from 8.5% (95% CI, 8.50%-8.56%) in 2004 to 8.1% (95% CI, 8.06%-8.13%) in 2017 among nondually enrolled beneficiaries. In contrast, 1-year mortality increased among hospitalized beneficiaries from 23.1% (95% CI, 23.05%-23.20%) in 2004 to 26.7% (95% CI, 26.58%-26.84%) in 2017 among dually enrolled beneficiaries and from 18.1% (95% CI, 18.11%-18.17%) in 2004 to 20.3% (95% CI, 20.21%-20.31%) in 2017 among nondually enrolled beneficiaries. The difference in hospitalization-related outcomes between dually and nondually enrolled beneficiaries persisted during the study period. Conclusions and Relevance: Among Medicare fee-for-service beneficiaries aged 65 years or older, dually enrolled beneficiaries had higher annual all-cause mortality, all-cause hospitalizations, and hospitalization-related mortality compared with nondually enrolled beneficiaries. Between 2004 and 2017, these differences did not decrease.


Assuntos
Planos de Pagamento por Serviço Prestado , Hospitalização/estatística & dados numéricos , Medicaid , Medicare , Mortalidade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Estados Unidos/epidemiologia
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