J. Bradford Rice

The incidence of peripheral nerve injury in extremity trauma.

Taylor CA, Braza D, Rice JB, Dillingham T: The incidence of peripheral nerve injury in extremity trauma. Am J Phys Med Rehabil 2008;87:381–385. Objective:To examine the incidence of peripheral nerve injury within 90 days of a limb trauma diagnosis in patients who have presented to the hospital or outpatient clinic. Design:This study is a retrospective, descriptive study that uses the 1998 MarketScan Commercial Claims and Encounters Database (The MEDSTAT Group) to track peripheral nerve injuries in extremity trauma. We selected our sample by using ICD9 codes for limb trauma during the first 9 mos of 1998. Nerve injuries within 90 days after limb trauma were the main outcome measure. Finally, we report how the rates of trauma and accompanying nerve injuries were contrasted by gender and age group, using univariate and bivariate statistics. All data analyses were conducted using Stata 9.0 statistical software. Results:Out of 16 million insureds in the database, 220,593 (1.4%) were diagnosed with limb trauma. Eighty-three percent of the patients were less than 55 yrs old, and 50% were male. The total incidence of nerve injuries within 90 days of upper- or lower-limb trauma was 1.64%. The type of extremity trauma with the highest incidence of nerve injury within 90 days of the diagnosis was a crush injury at 1.9%. Approximately 50% of our sample was selected because of a dislocation, which had an associated nerve injury prevalence of 1.46%. Conclusions:When looking at the population sampled, rates for peripheral nerve injury in people incurring limb trauma are low. Crush injuries seem to have the highest rate of associated nerve injury. Further studies are needed to observe outcomes for people with nerve damage after trauma.

Burden of Diabetic Foot Ulcers for Medicare and Private Insurers

OBJECTIVE To estimate the annual, per-patient incremental burden of diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS DFU patients and non-DFU patients with diabetes (controls) were selected using two deidentified databases: ages 65+ years from a 5% random sample of Medicare beneficiaries (Standard Analytical Files, January 2007–December 2010) and ages 18–64 years from a privately insured population (OptumInsight, January 2007–September 2011). Demographics, comorbidities, resource use, and costs from the payer perspective incurred during the 12 months prior to a DFU episode were identified. DFU patients were matched to controls with similar pre-DFU characteristics using a propensity score methodology. Per-patient incremental clinical outcomes (e.g., amputation and medical resource utilization) and health care costs (2012 U.S. dollars) during the 12-month follow-up period were measured among the matched cohorts. RESULTS Data for 27,878 matched pairs of Medicare and 4,536 matched pairs of privately insured patients were analyzed. During the 12-month follow-up period, DFU patients had more days hospitalized (+138.2% Medicare, +173.5% private), days requiring home health care (+85.4% Medicare, +230.0% private), emergency department visits (+40.6% Medicare, +109.0% private), and outpatient/physician office visits (+35.1% Medicare, +42.5% private) than matched controls. Among matched patients, 3.8% of Medicare and 5.0% of privately insured DFU patients received lower limb amputations. Increased utilization resulted in DFU patients having

Burden of venous leg ulcers in the United States

11,710 in incremental annual health care costs for Medicare, and

Sources of prescription opioids among diagnosed opioid abusers

16,883 for private insurance, compared with matched controls. Privately insured matched DFU patients incurred excess work-loss costs of

Nerve injury in patients after hip and knee arthroplasties and knee arthroscopy.

3,259. CONCLUSIONS These findings document that DFU imposes substantial burden on public and private payers, ranging from

Electrodiagnostic services in the United States

9–13 billion in addition to the costs associated with diabetes itself.

A comparative analysis of Medicaid long-term care policies and their effects on elderly dual enrollees

Abstract Objective: To estimate the annual incremental per-patient and overall payer burden (2012USD) of venous leg ulcers (VLU) in the US. Methods: Beneficiaries with and without VLU were identified using two de-identified insurance claims databases: aged 65+ from a 5% random sample of Medicare beneficiaries (2007–2010: n ∼ 2.3 million); and aged 18–64 from a privately-insured population (2007–2011: n ∼ 8.4 million). The index date was selected as the date of a VLU claim with no other VLU diagnoses in the preceding 12 months for the VLU cohort and as the date of a random medical claim for the non-VLU patients. These groups were matched using propensity scores to account for differences in demographics, comorbidities, resource utilization, and costs in the 12 month pre-index period. Medical resource use and costs incurred during the 12 month follow-up period were calculated for both payers. Drug costs and indirect work-loss due to disability and medically-related absenteeism were estimated for the privately-insured sample only. Annual VLU incidence rates were also estimated for both payers. Results: Data for 58,672 matched VLU/non-VLU pairs of Medicare and 22,476 matched pairs of privately-insured patients were analyzed. Relative to matched non-VLU patients, VLU patients used more medical resources and incurred annual incremental medical costs of

The Economic Burden of Diagnosed Opioid Abuse Among Commercially Insured Individuals

6391 in Medicare (

Stability and changes in living arrangements: Relationship to nursing home admission and timing of placement

18,986 vs

Economic outcomes among Medicare patients receiving bioengineered cellular technologies for treatment of diabetic foot ulcers.

12,595), and