TY - JOUR T1 - Utilization of rehabilitation services in stroke: A study utilizing the Health and Retirement Study with linked Medicare claims data. JF - Arch Phys Med Rehabil Y1 - 2019 A1 - Keptner, Karen M A1 - Kathleen A Smyth A1 - Siran M Koroukian A1 - Mark Schluchter A1 - Furlan, Anthony KW - Health Services Utilization KW - Medicare linkage KW - Medicare/Medicaid/Health Insurance KW - Stroke AB -

OBJECTIVES: To describe Medicare fee-for-service beneficiaries who utilized post-stroke rehabilitation services and identifies the strongest predictors of utilization after the initial stroke care episode.

DESIGN: Pooled, cross-sectional design using data from 1998-2010 from the Health and Retirement Study (HRS) with linked Medicare claims data.

SETTING: NA PARTICIPANTS: Stroke survivors who were Medicare fee-for-service beneficiaries and participated in the Health and Retirement Study (HRS) were included (n=515).

MAIN OUTCOME MEASURE: Utilization of rehabilitation services up to 10 years following stroke was the primary outcome with logistic regression used to predict utilization. Covariates included demographic factors, baseline functional status, health conditions, personal lifestyle factors and social support.

RESULTS: Rehabilitation service utilization was 21.6%, 6.8%, 15.8%, 16.5%, and <16% in years 2, 4, 6, 8, and 10 respectively. Age was the primary factor predicting use of rehabilitation in the first 10 years post-stroke (OR: 1.14; p=0.001). Recurrent stroke (OR: 1.64; p=0.051) was also significantly associated with utilization while unspecified incident stroke at incident trended towards significance (OR:2.17; p=0.077). None of the other factors was a significant predictor of participation in rehabilitation services in this period.

CONCLUSION: A small number of Medicare fee-for-service beneficiaries who are stroke survivors utilize rehabilitation services in the first 10 years post-stroke. Of those who do, age is the primary driver of utilization. We analyzed a multitude of factors that might influence utilization, but other factors not available in these data also need to be explored.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/31421093?dopt=Abstract ER - TY - JOUR T1 - Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer. JF - J Geriatr Oncol Y1 - 2017 A1 - Siran M Koroukian A1 - Nicholas K Schiltz A1 - David F Warner A1 - Charles W Given A1 - Mark Schluchter A1 - Owusu, Cynthia A1 - Nathan A. Berger KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Emergency Service, Hospital KW - Female KW - Health Surveys KW - Hospices KW - Hospital Mortality KW - Humans KW - Logistic Models KW - Male KW - multimorbidity KW - Neoplasms KW - Population Surveillance KW - Quality of Health Care KW - Risk Factors KW - Socioeconomic factors KW - Terminal Care AB -

OBJECTIVE: Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care.

METHODS: From the linked 1991-2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age ≥66years who died from cancer (n=835). MM was defined as the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Aggressive care was based on claims-derived measures of receipt of cancer-directed treatment in the last two weeks of life; admission to the hospital and/or emergency department (ED) within the last month; and in-hospital death. We also identified patients enrolled in hospice. In multivariable logistic regression models, we analyzed the associations of interest, adjusting for potential confounders.

RESULTS: While 61.2% of the patients enrolled in hospice, 24.6% underwent cancer-directed treatment; 55.1% were admitted to the hospital and/or ED; and 21.7% died in the hospital. We observed a U-shaped distribution between income and in-hospital death. Chronic conditions and geriatric syndromes were associated with some outcomes, but not with others.

CONCLUSIONS: To improve quality end-of-life care and curtail costs incurred by dying patients, relevant interventions need to account for social determinants of health and MM in a nuanced fashion.

VL - 8 UR - http://linkinghub.elsevier.com/retrieve/pii/S1879406816301229http://api.elsevier.com/content/article/PII:S1879406816301229?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1879406816301229?httpAccept=text/plain IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28029586?dopt=Abstract JO - Journal of Geriatric Oncology ER - TY - JOUR T1 - Multimorbidity and racial disparities in use of hospice by older patients dying from cancer. JF - Journal of Clinical Oncology Y1 - 2014 A1 - Siran M Koroukian A1 - Nicholas K Schiltz A1 - Warner, David A1 - Charles W Given A1 - Owusu, Cynthia A1 - Mark Schluchter A1 - Nathan A. Berger KW - Cancer KW - Death KW - multimorbidity KW - National Death Index KW - race KW - race difference KW - race-ethnicity AB - 9542 Background: While previous studies have documented lower use of hospice by Non-Hispanic Blacks (NHBs) than by Non-Hispanic Whites (NHWs), racial variations have not been examined in the context of multimorbidity (MM), which affects minority patients disproportionately. We sought to determine the impact of MM severity on NHBs’ use of hospice in a U.S. representative sample of older adults. Methods: We used data from the linked 1991-2008 Health and Retirement Study (HRS), Medicare data, and the National Death Index (NDI). From the NDI, we identified fee-for-service patients ≥65 years of age who died from cancer (n=812), and retrieved their demographic data, presence of comorbidities (COM), functional limitations (FL), and geriatric syndromes (GS) from their last HRS interview. We characterized severity of MM by 3 levels: none or only one of COM, FL, or GS (MM0/1); presence of two of COM, FL, or GS (MM2); or presence of all three of COM, FL, and GS (MM3). Hospice use was identified from Medicare claims data. We developed multivariable logistic regression models to analyze the association between race and hospice use, adjusting for MM and other patient covariates. Results: Nearly 12% of the study population was NHB; 61.3% of NHBs and 53.0% of NHWs were identified in MM3 (p=0.057). Overall, 61% of the patients received hospice care (63.7% in NHWs, and 43.0% in NHBs, p < 0.001). The distribution NHBs and NHWs by MM was similar across hospice users and non-users. Adjusting for MM and other confounders, NHBs were significantly less likely than NHWs to utilize hospice (Adjusted odds ratio: 0.42, 95% Confidence Interval: 0.27-0.66, p < 0.001). Conclusions: Despite the greater representation of NHBs in the highest severity of MM category, NHBs remain significantly less likely than NHWs to use hospice, even after adjusting for MM. The findings carry important implications with regard to disparities in providing optimal, and cost effective quality of end-of-life care. VL - 32 IS - 15_Suppl ER -