Elizabeth Bass

Rehospitalization After Hip Fracture: Predictors and Prognosis from a National Veterans Study

OBJECTIVES: To estimate the risk and long‐term prognostic significance of 30‐day readmission postdischarge of a 4‐year cohort of elderly veterans first admitted to Medicare hospitals for treatment of hip fractures (HFx), controlling for comorbidities.

A National Perspective of Medicare Expenditures for Elderly Veterans with Hip Fractures

INTRODUCTIONnThe Centers for Medicare and Medicaid Services (CMS) recently announced that beginning in October 2008, Medicare will no longer reimburse hospitals for the costs of treating injuries from several preventable conditions, including inpatient falls resulting in hip fracture. If hospitals try to shift this care to other payers, elderly veterans who are dually eligible for care in Medicare and Veterans Health Administration (VHA) facilities may be adversely affected. As health care provided for a hip fracture can be substantial, the goal of this research was to calculate Medicare payments for a national cohort of elderly veterans with hip fractures, beginning with the first inpatient admission and continuing through one year.nnnMETHODSnThis was a retrospective, secondary data analysis of national VHA-eligible Medicare beneficiaries. The study population was 43,104 veterans with a hip fracture first admitted to a Medicare-eligible facility during 1999-2002. The estimation method was an ordinary least squares regression model of Medicare payments to providers for hip fracture patients over 4 time periods, up to 1 year after discharge, controlling for age, gender, inpatient length of stay, 1-year mortality, and selected Elixhauser comorbidities.nnnRESULTSnMedicare reimbursed providers for nearly

Understanding recent estimates of PTSD and TBI from Operations Iraqi Freedom and Enduring Freedom.

3 billion of health care for hip fracture patients the first year of injury. Approximately 71.4% (

Central nervous system and musculoskeletal medication profile of a veteran cohort with blast-related injuries

49,544) of the total annual Medicare payments (for all services) occurred within the first 30 days of hospital admission. Inpatient and carrier (physician) providers received the majority of the payments. The average annual payment per individual was

Rehabilitation Outcomes for Veterans with Polytrauma Treated at the Tampa VA

69,389 (99% confidence interval:

The Enigma of Higher Income Immigrants With Lower Rates of Health Insurance Coverage in the United States

68,539-

Exploring the Link between Ambulatory Care and Avoidable Hospitalizations at the Veteran Health Administration

70,239). Almost 7 in 10 hip fracture patients obtained care in a skilled nursing facility (SNF) during the year, with these providers comprising only 12% of total annual Medicare payments. In this elderly veteran cohort, hip fracture patients with renal failure, diabetes, lymphoma, and metastatic cancer generated the highest payments.nnnCONCLUSIONnThis analysis provides proxy cost estimates for hip fracture patients useful for the forthcoming CMS reimbursement policy changes for inpatient fall-related injuries. The VHA and dually eligible elderly veterans could be disproportionately exposed to the economic consequences of the new CMS policy change.

Benchmark Data on the Utilization and Acquisition Costs of Central Nervous System and Muscular Skeletal Drugs among Veterans with Combat-Related Injuries

As of late summer 2009, some 5,000 U.S. troops had died and 35,000 had been wounded in action during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) in Afghanistan. The fraction of wounded troops who survive their injuries is higher than in previous conflicts, such as Vietnam [1-2]. Enhanced survival is a desirable outcome; however, many policy makers and commentators have expressed concerns about the ensuing healthcare needs of wounded servicemembers and veterans. In particular, much attention has recently focused on mild traumatic brain injuries (TBIs), posttraumatic stress disorder (PTSD), and other mental health conditions. Some 80 percent of TBI diagnoses stemming from OIF/OEF have been associated with closed (as opposed to penetrating) head injuries, suggesting that many more TBIs may have gone undiagnosed. (1) Servicemembers who survive gunshot wounds, explosions, or other kinetic events may suffer PTSD but so too may many others who do not receive physical injuries and, again, are not identified. Although individuals who develop PTSD symptoms or sustain mild TBIs (concussions) often regain normal function without treatment, others recover only after medical intervention. To date, no definitive count is available of service-members and veterans who were ever deployed to the conflicts in Iraq or Afghanistan and are impaired by PTSD or TBI. Nonetheless, the specter of large numbers of servicemembers and veterans suffering--undiagnosed and requiring treatment--has been raised by a number of researchers and embraced by the popular press. For an excellent overview of scholarly publications on PTSD and TBI prevalence, see Ramchand et al. [3]. Understanding the scope of these problems helps decision makers effectively allocate scarce healthcare resources; conversely, reliance on incorrect prevalence rates can result in oversupply of medical personnel and equipment in some areas, while other medical services suffer from shortages and excessive waiting times. As recently indicated in an article by Colonel Charles Hoge (Director of the Division of Psychiatry and Neuroscience at Walter Reed Army Institute of Research) and his colleagues, the presage of large numbers of servicemembers with debilitating TBI and PTSD may fuel undesirable clinical and budgetary consequences: unproductive and time-consuming testing, inappropriate treatment and medication, and reinforcement of patients negative perceptions [4]. There are three main problems with relying on extant studies to estimate the prevalence rates of TBI and PTSD in the full OIF/OEF population. First, the studies generally report the percentage of servicemembers who screen positive for TBI or PTSD, not those who have been diagnosed with the condition by an appropriately trained medical provider. Second, the study samples are not representative of the entire ever-deployed military population. Third, the degree of impairment for servicemembers who have or have had TBI or PTSD is unknown. Although studies often estimate rates of TBI and PTSD with a screening questionnaire, those tools do not replace a clinician-determined diagnosis. For one, screening tools are not comprehensive--typically they do not survey respondents regarding all the symptoms and conditions necessary for a diagnosis. Further, for conditions in which the underlying prevalence in the population is relatively low, screening tools are likely to overestimate the number of cases, particularly when the tool is designed to capture as many potential cases as possible. For example, suppose that 90 percent of people with a certain disease screen positive (sensitivity = 0.90) and 5 percent of those without the disease also screen positive (specificity = 0.95). If the true population prevalence is 10 percent and 1,000 people are screened, a total of 135 people (13.5%) would be expected to test positive: 90 percent of the 100 people (90) who have the disease and 5 percent of the 900 people (45) who do not (false positives). …

Expanding participation in Alzheimer's association Safe Return by improving enrollment.

Little is known about the utilization of central nervous system (CNS) and musculoskeletal (MS) medications in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with blast-related injuries (BRIs). We followed prescription drug use among a cohort of 133 OIF/OEF veterans with BRIs by using the Joint Theatre Trauma Registry, the Tampa Polytrauma Registry, and electronic medical records. We extracted 12 months of national medication records from the Veterans Health Administration Decision Support System and analyzed them with descriptive statistics. Over the 12-month period (fiscal year 2007), CNS medications comprised 27.9% (4,225/15,143) of total prescriptions dispensed to 90.2% (120/133) of our cohort. Approximately one-half (48.9%) of the 133 patients were treated with opioid analgesics. Nearly 60% received antidepressants. More than one-half (51.1%) of patients were treated with anticonvulsants. Benzodiazepines and antipsychotics were dispensed to 17.3% and 15.8%, respectively. For MS medicines, 804 were prescribed for 48.1% (64/133) of veterans. Nearly one-fourth (24.8%) were treated with skeletal muscle relaxants. The CNS and MS medications, in general, were continuously prescribed over the 12-month study period. This study provides insight into the complex medical management involved in the care of veterans with BRIs.

Risk-adjusted mortality rates of elderly veterans with hip fractures

&NA; Returning soldiers from Iraq and Afghanistan who have sustained polytrauma have a combination of complex physical and mental morbidities that require extensive therapy and rehabilitation. This study examined the effect of rehabilitation on 116 polytrauma patients with service‐connected injuries treated at the Tampa VA; improvements in functional and cognitive abilities were measured using the Functional Independence Measure (FIM™) scores and healthcare costs for rehabilitation treatment were also assessed. Intensive rehabilitation therapy increased functional ability in this cohort with an average improvement in total FIM scores of 23 points. Total inpatient costs for these patients exceeded