@article {11216, title = {Identifying cohabiting couples in administrative data: evidence from Medicare address data}, journal = {Health Services and Outcomes Research Methodology}, volume = {21}, year = {2021}, pages = {238-247}, abstract = {Marital status is recognized as an important social determinant of health, income, and social support, but is rarely available in administrative data. We assessed the feasibility of using exact address data and zip code history to identify cohabiting couples using the 2018 Medicare Vital Status file and ZIP codes in the 2011{\textendash}2014 Master Beneficiary Summary Files. Medicare beneficiaries meeting our algorithm displayed characteristics consistent with assortative mating and resembled known married couples in the Health and Retirement Study linked to Medicare claims. Address information represents a promising strategy for identifying cohabiting couples in administrative data including healthcare claims and other data types.}, keywords = {Cohabitation, Couples, Marriage, Medicare}, isbn = {1572-9400}, doi = {10.1007/s10742-020-00229-1}, author = {Matta, Sasmira and Joanne W. Hsu and Theodore J Iwashyna and Micah Y. Baum and Kenneth M. Langa and Lauren Hersch Nicholas} } @article {8928, title = {Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia.}, journal = {Health Affairs}, volume = {33}, year = {2014}, month = {2014 Apr}, pages = {667-74}, abstract = {

The number of older adults with cognitive impairment is increasing, and such adults often require a surrogate to make decisions about health care. However, little is known about the aggressiveness of end-of-life care for these people, especially those who reside in the community. We found that cognitive impairment is common among older adults approaching the end of life, whether they live in the community or in a nursing home, and that nearly 30 percent of patients with severe dementia remained in the community until death. Among those patients, having an advance directive in the form of a living will was associated with significantly less aggressive care at the end of life, compared to similar patients without an advance directive-as measured by Medicare spending ($11,461 less per patient), likelihood of in-hospital death (17.9 percentage points lower), and use of the intensive care unit (9.4 percentage points lower). In contrast, advance directives were not associated with differences in care for people with normal cognition or mild dementia, whether they resided in the community or in a nursing home. Timely advance care planning after a diagnosis of cognitive impairment may be particularly important for older adults who reside in the community.

}, keywords = {Advance directives, Dementia, Disabilities, End-of-life care, Nursing homes, Older Adults}, issn = {1544-5208}, doi = {10.1377/hlthaff.2013.1258}, author = {Lauren Hersch Nicholas and Julie P W Bynum and Theodore J Iwashyna and David R Weir and Kenneth M. Langa} } @article {7712, title = {Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions.}, journal = {Am J Respir Crit Care Med}, volume = {185}, year = {2012}, note = {Iwashyna, Theodore J Netzer, Giora Langa, Kenneth M Cigolle, Christine K08 AG031837/AG/NIA NIH HHS/ K08 HL091249/HL/NHLBI NIH HHS/ K12 RR023250/RR/NCRR NIH HHS/ P30-AG028747/AG/NIA NIH HHS/ P60 DK-20572/DK/NIDDK NIH HHS/ R01 AG030155/AG/NIA NIH HHS/ U01 AG09740/AG/NIA NIH HHS/ UL1RR024986/RR/NCRR NIH HHS/ Am J Respir Crit Care Med. 2012 Apr 15;185(8):835-41. Epub 2012 Feb 9.}, month = {2012 Apr 15}, pages = {835-41}, publisher = {185}, abstract = {

RATIONALE: Survivors of critical illness suffer significant limitations and disabilities.

OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.

METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors{\textquoteright} own pre-sepsis levels assessed before hospitalization, or survivors{\textquoteright} own pre-sepsis trajectory.

MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients{\textquoteright} pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.

CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Chronic pain, Cohort Studies, Comorbidity, Critical Illness, Disabled Persons, disease progression, Female, Geriatric Assessment, Hearing Disorders, Hospitalization, Humans, Incidence, Male, Musculoskeletal Diseases, Prognosis, Retrospective Studies, Risk Assessment, Sepsis, Survival Analysis, Survivors, Thinness, Time, Treatment Outcome, Urinary incontinence, Vision Disorders}, issn = {1535-4970}, doi = {10.1164/rccm.201109-1660OC}, author = {Theodore J Iwashyna and Netzer, Giora and Kenneth M. Langa and Christine T Cigolle} } @article {7687, title = {Regional variation in the association between advance directives and end-of-life Medicare expenditures.}, journal = {JAMA}, volume = {306}, year = {2011}, month = {2011 Oct 05}, pages = {1447-53}, publisher = {112}, abstract = {

CONTEXT: It is unclear if advance directives (living wills) are associated with end-of-life expenditures and treatments.

OBJECTIVE: To examine regional variation in the associations between treatment-limiting advance directive use, end-of-life Medicare expenditures, and use of palliative and intensive treatments.

DESIGN, SETTING, AND PATIENTS: Prospectively collected survey data from the Health and Retirement Study for 3302 Medicare beneficiaries who died between 1998 and 2007 linked to Medicare claims and the National Death Index. Multivariable regression models examined associations between advance directives, end-of-life Medicare expenditures, and treatments by level of Medicare spending in the decedent{\textquoteright}s hospital referral region.

MAIN OUTCOME MEASURES: Medicare expenditures, life-sustaining treatments, hospice care, and in-hospital death over the last 6 months of life.

RESULTS: Advance directives specifying limits in care were associated with lower spending in hospital referral regions with high average levels of end-of-life expenditures (-$5585 per decedent; 95\% CI, -$10,903 to -$267), but there was no difference in spending in hospital referral regions with low or medium levels of end-of-life expenditures. Directives were associated with lower adjusted probabilities of in-hospital death in high- and medium-spending regions (-9.8\%; 95\% CI, -16\% to -3\% in high-spending regions; -5.3\%; 95\% CI, -10\% to -0.4\% in medium-spending regions). Advance directives were associated with higher adjusted probabilities of hospice use in high- and medium-spending regions (17\%; 95\% CI, 11\% to 23\% in high-spending regions, 11\%; 95\% CI, 6\% to 16\% in medium-spending regions), but not in low-spending regions.

CONCLUSION: Advance directives specifying limitations in end-of-life care were associated with significantly lower levels of Medicare spending, lower likelihood of in-hospital death, and higher use of hospice care in regions characterized by higher levels of end-of-life spending.

}, keywords = {Advance directives, Aged, Aged, 80 and over, Data collection, Female, Health Expenditures, Hospice Care, Hospital Mortality, Hospitals, Humans, Kidney Failure, Chronic, Male, Medicare, Palliative care, Prospective Studies, Regression Analysis, Terminal Care, United States}, issn = {1538-3598}, doi = {10.1001/jama.2011.1410}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2590187421andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Lauren Hersch Nicholas and Kenneth M. Langa and Theodore J Iwashyna and David R Weir} }