Jess J. Behrens

An evaluation of recurrent diabetic ketoacidosis, fragmentation of care, and mortality across Chicago, Illinois

OBJECTIVE A portion of patients with diabetes are repeatedly hospitalized for diabetic ketoacidosis (DKA), termed recurrent DKA, which is associated with poorer clinical outcomes. This study evaluated recurrent DKA, fragmentation of care, and mortality throughout six institutions in the Chicago area. RESEARCH DESIGN AND METHODS A deidentified Health Insurance Portability and Accountability Act–compliant data set from six institutions (HealthLNK) was used to identify 3,615 patients with DKA (ICD-9 250.1x) from 2006 to 2012, representing 5,591 inpatient admissions for DKA. Demographic and clinical data were queried. Recurrence was defined as more than one DKA episode, and fragmentation of health care was defined as admission at more than one site. RESULTS Of the 3,615 patients, 780 (21.6%) had recurrent DKA. Patients with four or more DKAs (n = 211) represented 5.8% of the total DKA group but accounted for 26.3% (n = 1,470) of the encounters. Of the 780 recurrent patients, 125 (16%) were hospitalized at more than one hospital. These patients were more likely to recur (odds ratio [OR] 2.96; 95% CI 1.99, 4.39; P < 0.0001) and had an average of 1.88-times the encounters than nonfragmented patients. Although only 13.6% of patients died of any cause during the study period, odds of death increased with age (OR 1.06; 95% CI 1.05, 1.07; P < 0.001) and number of DKA encounters (OR 1.28; 95% CI 1.04, 1.58; P = 0.02) after adjustment for age, sex, insurance, race, fragmentation, and DKA visit count. This study was limited by lack of medical record–level data, including comorbidities without ICD-9 codes. CONCLUSIONS Recurrent DKA was common and associated with increased fragmentation of health care and increased mortality. Further research is needed on potential interventions in this unique population.

Variation in Ophthalmologist Use of Antivascular Endothelial Growth Factor Therapy Among Medicare Beneficiaries

Variation in Ophthalmologist Use of Antivascular Endothelial Growth Factor Therapy Among Medicare Beneficiaries Antivascular endothelial growth factor (anti-VEGF) drugs used for ophthalmic conditions account for more than

Geographic association of liquor licenses and gunshot wounds in Chicago.

6 billion in Part B Medicare costs.1 Recent research2,3 has shown that bevacizumab may be equally as effective as the more-expensive agents (aflibercept and ranibizumab) for some but not all retinal vascular diseases. Using provider-level billing data for Medicare beneficiaries, we analyzed geographic trends in antiVEGF therapy to identify whether the use of lower-cost drugs increased among ophthalmologists from calendar years 2012 to 2013.