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Article ; Online: Applying Hospital Readmissions to Oncology: A Square Peg in a Round Hole?

Hong, Arthur S / Halm, Ethan A

2021 Volume 18, Issue 1, Page(s) 7–10

MeSH term(s)	Humans ; Medical Oncology ; Patient Readmission
Language	English
Publishing date	2021-08-06
Publishing country	United States
Document type	Editorial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	3028198-2
ISSN	2688-1535 ; 2688-1527
ISSN (online)	2688-1535
ISSN	2688-1527
DOI	10.1200/OP.21.00320
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Article ; Online: Association of medical tests use with care continuity in primary care service: evidence from the Department of Veterans Affairs.

Akunna, Adebola A / Ahuja, Vishal / Halm, Ethan A / Alvarez, Carlos A

Family practice

2023 Volume 40, Issue 2, Page(s) 338–344

Abstract: Background: Continuity of care (CoC) is an important component of health care delivery that can have cost implications and improve patient outcomes. We analysed data obtained from the Department of Veterans Affairs to examine the relationship between ... ...

Abstract	Background: Continuity of care (CoC) is an important component of health care delivery that can have cost implications and improve patient outcomes. We analysed data obtained from the Department of Veterans Affairs to examine the relationship between CoC and use of image-oriented diagnostic tests in patients with comorbid chronic conditions. Methods: A longitudinal, retrospective cohort study involving participants ≥18 years old, with comorbid diabetes and chronic kidney disease. We used a multivariate linear regression model to test whether greater care continuity, measured using a care continuity index (CCI), is associated with less frequent use of diagnostic tests. Results: Total of 267,442 patients and 8,142,036 tests were included. Of the diagnostic tests we chose to evaluate, the 4 most frequently ordered tests were X-ray (45.6%), electrocardiogram (EKG, 16.8%), computerized tomography (CT, 13.4%), and magnetic resonance imaging (MRI, 3.4%). Overall, greater CCI was associated with fewer use of tests (P < 0.001). A 1 standard deviation (SD, 0.27) increase in CCI was associated with 4.2% decrease (P < 0.001) in number of tests. But a mixed pattern existed. For X-ray and EKG, greater continuity was associated with less testing, 6.2% (P < 0.001) and 3.3% (P < 0.05) reductions, respectively. Whereas, for CT and MRI, greater continuity was associated with more testing, 2.3% (P < 0.001) and 1.4% increases (P < 0.01), respectively. Conclusion: Overall, greater CoC was associated with fewer use of tests, representing a greater presumed efficiency of care. This has implications for designing health care delivery.
MeSH term(s)	Humans ; Adolescent ; Retrospective Studies ; Veterans ; Continuity of Patient Care ; Diabetes Mellitus/diagnosis ; Diabetes Mellitus/epidemiology ; Comorbidity
Language	English
Publishing date	2023-02-17
Publishing country	England
Document type	Journal Article
ZDB-ID	605939-9
ISSN	1460-2229 ; 0263-2136
ISSN (online)	1460-2229
ISSN	0263-2136
DOI	10.1093/fampra/cmac099
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Article ; Online: Evaluating Different Approaches for Calculating Adenoma Detection Rate: Is Screening Colonoscopy the Gold Standard?

Corley, Douglas A / Jensen, Christopher D / Chubak, Jessica / Schottinger, Joanne E / Halm, Ethan A / Udaltsova, Natalia

Gastroenterology

2023 Volume 165, Issue 3, Page(s) 784–787.e4

MeSH term(s)	Humans ; Colonoscopy ; Colonic Polyps/diagnosis ; Adenoma/diagnosis ; Early Detection of Cancer ; Colorectal Neoplasms/diagnosis
Language	English
Publishing date	2023-05-30
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2023.05.025
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Article ; Online: Place of care in the last three years of life for Medicare beneficiaries.

Lin, Haiqun / Grafova, Irina B / Zafar, Anum / Setoguchi, Soko / Roy, Jason / Kobylarz, Fred A / Halm, Ethan A / Jarrín, Olga F

BMC geriatrics

2024 Volume 24, Issue 1, Page(s) 91

Abstract: Background: Most older adults prefer aging in place; however, patients with advanced illness often need institutional care. Understanding place of care trajectory patterns may inform patient-centered care planning and health policy decisions. The ... ...

Abstract	Background: Most older adults prefer aging in place; however, patients with advanced illness often need institutional care. Understanding place of care trajectory patterns may inform patient-centered care planning and health policy decisions. The purpose of this study was to characterize place of care trajectories during the last three years of life. Methods: Linked administrative, claims, and assessment data were analyzed for a 10% random sample cohort of US Medicare beneficiaries who died in 2018, aged fifty or older, and continuously enrolled in Medicare during their last five years of life. A group-based trajectory modeling approach was used to classify beneficiaries based on the proportion of days of institutional care (hospital inpatient or skilled nursing facility) and skilled home care (home health care and home hospice) used in each quarter of the last three years of life. Associations between group membership and sociodemographic and clinical predictors were evaluated. Results: The analytic cohort included 199,828 Medicare beneficiaries. Nine place of care trajectory groups were identified, which were categorized into three clusters: home, skilled home care, and institutional care. Over half (59%) of the beneficiaries were in the home cluster, spending their last three years mostly at home, with skilled home care and institutional care use concentrated in the final quarter of life. One-quarter (27%) of beneficiaries were in the skilled home care cluster, with heavy use of skilled home health care and home hospice; the remaining 14% were in the institutional cluster, with heavy use of nursing home and inpatient care. Factors associated with both the skilled home care and institutional care clusters were female sex, Black race, a diagnosis of dementia, and Medicaid insurance. Extended use of skilled home care was more prevalent in southern states, and extended institutional care was more prevalent in midwestern states. Conclusions: This study identified distinct patterns of place of care trajectories that varied in the timing and duration of institutional and skilled home care use during the last three years of life. Clinical, socioregional, and health policy factors influenced where patients received care. Our findings can help to inform personal and societal care planning.
MeSH term(s)	United States/epidemiology ; Humans ; Aged ; Female ; Male ; Medicare ; Independent Living ; Medicaid ; Nursing Homes ; Skilled Nursing Facilities
Language	English
Publishing date	2024-01-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-023-04610-w
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Article ; Online: Reply to Comment on: The Clinical Course After Long-Term Acute Care Hospital Admission Among Older Medicare Beneficiaries.

Makam, Anil N / Nguyen, Oanh Kieu / Halm, Ethan A

Journal of the American Geriatrics Society

2020 Volume 68, Issue 3, Page(s) 667–668

MeSH term(s)	Aged ; Fee-for-Service Plans ; Health Facilities ; Hospitalization ; Humans ; Medicare ; United States
Language	English
Publishing date	2020-01-06
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.16317
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Article ; Online: A Multicomponent Intervention to Reduce Readmissions Among People With HIV.

Nijhawan, Ank E / Zhang, Song / Chansard, Matthieu / Gao, Ang / Jain, Mamta K / Halm, Ethan A

Journal of acquired immune deficiency syndromes (1999)

2022 Volume 90, Issue 2, Page(s) 161–169

Abstract: Background: Hospital readmissions are common, costly, and potentially preventable, including among people with HIV (PWH). We present the results of an evaluation of a multicomponent intervention aimed at reducing 30-day readmissions among PWH.: ... ...

Abstract	Background: Hospital readmissions are common, costly, and potentially preventable, including among people with HIV (PWH). We present the results of an evaluation of a multicomponent intervention aimed at reducing 30-day readmissions among PWH. Methods: Demographic, socioeconomic, and clinical variables were collected from the electronic health records of PWH or those with cellulitis (control group) hospitalized at an urban safety-net hospital before and after (from September 2012 to December 2016) the implementation of a multidisciplinary HIV transitional care team. After October 2014, hospitalized PWH could receive a medical HIV consultation ± a transitional care nurse intervention. The primary outcome was readmission to any hospital within 30 days of discharge. Multivariate logistic regression and propensity score analyses were conducted to compare readmissions before and after intervention implementation in PWH and people with cellulitis. Results: Overall, among PWH, 329 of the 2049 (16.1%) readmissions occurred before and 329 of the 2023 (16.3%) occurred after the transitional care team intervention. After including clinical and social predictors, the adjusted odds ratio of 30-day readmissions for postintervention for PWH was 0.81 (95% confidence interval: 0.66 to 0.99, P= 0.04), whereas little reduction was identified for those with cellulitis (adjusted odds ratio 0.91 (95% confidence interval: 0.81 to 1.02, P= 0.10). A dose-response effect was not observed for receipt of different HIV intervention components. Conclusions: A multicomponent intervention reduced the adjusted risk of 30-day readmissions in PWH, although no dose-response effect was detected. Additional efforts are needed to reduce overall hospitalizations and readmissions among PWH including increasing HIV prevention, early diagnosis and engagement in care, and expanding the availability and spectrum of transitional care services.
MeSH term(s)	Cellulitis ; HIV Infections ; Humans ; Patient Discharge ; Patient Readmission ; Transitional Care
Language	English
Publishing date	2022-01-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000002938
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Article ; Online: Statins and renal disease progression, ophthalmic manifestations, and neurological manifestations in veterans with diabetes: A retrospective cohort study.

Mansi, Ishak A / Chansard, Matheu / Lingvay, Ildiko / Zhang, Song / Halm, Ethan A / Alvarez, Carlos A

PloS one

2022 Volume 17, Issue 7, Page(s) e0269982

Abstract: Background: Statins increase insulin resistance, which may increase risk of diabetic microvascular complications. Little is known about the impact of statins on renal, ophthalmologic, and neurologic complications of diabetes in practice. The objective ... ...

Abstract	Background: Statins increase insulin resistance, which may increase risk of diabetic microvascular complications. Little is known about the impact of statins on renal, ophthalmologic, and neurologic complications of diabetes in practice. The objective of this study was to examine the association of statins with renal disease progression, ophthalmic manifestations, and neurological manifestations in diabetes. Methods: This is a retrospective cohort study, new-user active comparator design, that included a national Veterans Health Administration (VA) patients with diabetes from 2003 to 2015. Patients were age 30 years or older and were regular users of the VA with data encompassing clinical encounters, demographics, vital signs, laboratory tests, and medications. Patients were divided into statin users or nonusers (active comparators). Statin users initiated statins and nonusers initiated H2-blockers or proton pump-inhibitors (H2-PPI) as an active comparator. Study outcomes were: 1) Composite renal disease progression outcome; 2) Incident diabetes with ophthalmic manifestations; and 3) Incident diabetes with neurological manifestations. Results: Out of 705,774 eligible patients, we propensity score matched 81,146 pairs of statin users and active comparators. Over a mean (standard deviation) of follow up duration of 4.8 (3) years, renal disease progression occurred in 9.5% of statin users vs 8.3% of nonusers (odds ratio [OR]: 1.16; 95% confidence interval [95%CI]: 1.12-1.20), incident ophthalmic manifestations in 2.7% of statin users vs 2.0% of nonusers (OR: 1.35, 95%CI:1.27-1.44), and incident neurological manifestations in 6.7% of statin users vs 5.7% of nonusers (OR: 1.19, 95%CI:1.15-1.25). Secondary, sensitivity, and post-hoc analyses were consistent and demonstrated highest risks among the healthier subgroup and those with intensive lowering of LDL-cholesterol. Conclusions: Statin use in patients with diabetes was associated with modestly higher risk of renal disease progression, incident ophthalmic, and neurological manifestations. More research is needed to assess the overall harm/benefit balance for statins in the lower risk populations with diabetes and those who receive intensive statin therapy.
MeSH term(s)	Adult ; Diabetes Complications/drug therapy ; Diabetes Mellitus/chemically induced ; Diabetes Mellitus/drug therapy ; Diabetes Mellitus/epidemiology ; Disease Progression ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Kidney Diseases/drug therapy ; Propensity Score ; Retrospective Studies ; Veterans
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	English
Publishing date	2022-07-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0269982
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Article ; Online: Is Statin Use Associated With Risk of Thyroid Diseases? Results of a Retrospective Cohort Study.

Trivedi, Lakshya U / Femnou Mbuntum, Laurette / Halm, Ethan A / Mansi, Ishak

The Annals of pharmacotherapy

2021 Volume 55, Issue 9, Page(s) 1110–1119

Abstract: Background: Given the ubiquity of statin use and prevalence of thyroid diseases, such as thyroid cancer, hyperthyroidism, and thyroiditis, understanding their association deserves further attention.: Objective: To examine the association between ... ...

Abstract	Background: Given the ubiquity of statin use and prevalence of thyroid diseases, such as thyroid cancer, hyperthyroidism, and thyroiditis, understanding their association deserves further attention. Objective: To examine the association between statin use and thyroid cancer, thyrotoxicosis, goiter, and thyroiditis. Methods: Using Tricare data, 2 propensity score (PS)-matched cohorts of statin users and nonusers were formed: (1) a PS-matched general cohort (all patients aged 30-85 years) and (2) a PS-matched healthy cohort (excluded patients with cardiovascular diseases or severe comorbidities). Outcomes were thyroid cancer, thyrotoxicosis, goiter, and thyroiditis. Odds ratios (ORs) and 95% CIs of outcomes were estimated using conditional regression analysis. Results: Of 43 438 patients, the PS-matched general cohort matched 6342 statin users to 6342 nonusers. The OR of thyroid cancer was 0.62 (95% CI = 0.39-0.996). There was no significant difference between statin users and nonusers in risk of thyrotoxicosis (OR = 0.88; 95% CI = 0.71-1.09), goiter (OR = 0.9; 95% CI = 0.77-1.03), or thyroiditis (OR = 0.78; 95% CI = 0.53-1.15). In the PS-matched healthy cohort (3351 statin users to 3351 nonusers), there was no difference between statin users and nonusers in any outcome. Limitations of the study include its retrospective observational design and use of administrative codes in outcomes ascertainment. Conclusion and relevance: This study did not demonstrate any association of statins with harmful effects on thyroid diseases, which offers assurance to clinicians and patients. Furthermore, statin use appears to be associated with a decreased risk of thyroid cancer, but more studies are needed.
MeSH term(s)	Cohort Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Odds Ratio ; Propensity Score ; Retrospective Studies ; Risk Factors ; Thyroid Diseases/chemically induced ; Thyroid Diseases/epidemiology
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	English
Publishing date	2021-01-07
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1101370-9
ISSN	1542-6270 ; 1060-0280
ISSN (online)	1542-6270
ISSN	1060-0280
DOI	10.1177/1060028020986552
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Article ; Online: Shortcomings of Research Regarding Long-term Acute Care Hospitals and Skilled Nursing Facilities-Reply.

Makam, Anil N / Nguyen, Oanh Kieu / Halm, Ethan A

JAMA internal medicine

2018 Volume 178, Issue 6, Page(s) 866–867

MeSH term(s)	Health Facilities ; Hospitals ; Research ; Skilled Nursing Facilities
Language	English
Publishing date	2018-06-01
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2018.1757
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Article ; Online: Carotid stenting at the crossroads: practice makes perfect, but some may be practicing too much (and not enough).

Halm, Ethan A

JAMA

2011 Volume 306, Issue 12, Page(s) 1378–1380

MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Atherosclerosis/mortality ; Atherosclerosis/therapy ; Carotid Stenosis/mortality ; Carotid Stenosis/therapy ; Clinical Competence ; Health Policy ; Hospital Mortality ; Humans ; Medicare/statistics & numerical data ; Physicians/standards ; Stents/utilization ; Stroke/prevention & control ; United States
Language	English
Publishing date	2011-09-28
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2011.1384
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