Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort

Objective: Insurance status is a predictor of drug-eluting stent (DES) usage. Our study sought to determine the effect of hospital and sociodemographic characteristics on utilization of DES in nationwide inpatient discharges with uniform insurance (Medicare). Methods: We linked data from the 2011 to...

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Autores principales:	Tushar A Tuliani, Maithili Shenoy, Milind Parikh, Mauricio G Cohen, Cindy Grines, Kenneth Jutzy, Anthony Hilliard
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2017
Materias:	drug-eluting stent utilization medicare sociodemographic factors Medicine R
Acceso en línea:	https://doaj.org/article/5d2c6f6919ff48dcaa08d38cd797ff48
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spelling	oai:doaj.org-article:5d2c6f6919ff48dcaa08d38cd797ff482021-12-02T16:24:58ZImpact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort2231-07702249-446410.4103/2231-0770.197509https://doaj.org/article/5d2c6f6919ff48dcaa08d38cd797ff482017-01-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.4103/2231-0770.197509https://doaj.org/toc/2231-0770https://doaj.org/toc/2249-4464Objective: Insurance status is a predictor of drug-eluting stent (DES) usage. Our study sought to determine the effect of hospital and sociodemographic characteristics on utilization of DES in nationwide inpatient discharges with uniform insurance (Medicare). Methods: We linked data from the 2011 to 2012 Medicare discharges, 2011 Medicare hospital referral region (HRR) report (racial composition of each HRR), American Hospital Association (number of beds, rural/urban location, public/private status, and academic affiliation of hospitals), and American Community Survey 2011 (median income using zip code). We analyzed diagnosis-related group (DRG) codes 249 (bare metal stent without complications), 246, and 247 (DES with and without complications, respectively). Univariate and multivariable logistic regression was conducted to determine odds ratios (OR) for utilization of DES. Results: There were 322,002 discharges with DRG codes 246 (54,279), 247 (209,365), and 249 (58,358) in our database. Higher odds of DES usage was observed in Hispanic dominant HRR(s) (OR: 1.37, 95% confidence interval [CI]: 1.33-1.42, P < 0.001) compared to Caucasian dominant HRR(s). DES utilization was similar in African-American and Caucasian dominant HRR (s). Higher odds of DES use was observed in median household income groups ≥$20,001 (OR: 1.07, 95% CI: 1.01-1.13, P - 0.03). Lower DES usage was observed in hospitals with higher total stent volume (quartile 4 vs. quartile 1: OR: 0.66, 95% CI: 0.63-0.69, P < 0.001) and for-profit hospitals (OR: 0.88, 95% CI: 0.85-0.92, P < 0.001). Conclusions: Our study findings suggest that there are significant differences in DES utilization in a national cohort of individuals with uniform insurance.Tushar A TulianiMaithili ShenoyMilind ParikhMauricio G CohenCindy GrinesKenneth JutzyAnthony HilliardThieme Medical and Scientific Publishers Pvt. Ltd.articledrug-eluting stent utilizationmedicaresociodemographic factorsMedicineRENAvicenna Journal of Medicine, Vol 07, Iss 01, Pp 17-22 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	drug-eluting stent utilization medicare sociodemographic factors Medicine R
spellingShingle	drug-eluting stent utilization medicare sociodemographic factors Medicine R Tushar A Tuliani Maithili Shenoy Milind Parikh Mauricio G Cohen Cindy Grines Kenneth Jutzy Anthony Hilliard Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort
description	Objective: Insurance status is a predictor of drug-eluting stent (DES) usage. Our study sought to determine the effect of hospital and sociodemographic characteristics on utilization of DES in nationwide inpatient discharges with uniform insurance (Medicare). Methods: We linked data from the 2011 to 2012 Medicare discharges, 2011 Medicare hospital referral region (HRR) report (racial composition of each HRR), American Hospital Association (number of beds, rural/urban location, public/private status, and academic affiliation of hospitals), and American Community Survey 2011 (median income using zip code). We analyzed diagnosis-related group (DRG) codes 249 (bare metal stent without complications), 246, and 247 (DES with and without complications, respectively). Univariate and multivariable logistic regression was conducted to determine odds ratios (OR) for utilization of DES. Results: There were 322,002 discharges with DRG codes 246 (54,279), 247 (209,365), and 249 (58,358) in our database. Higher odds of DES usage was observed in Hispanic dominant HRR(s) (OR: 1.37, 95% confidence interval [CI]: 1.33-1.42, P < 0.001) compared to Caucasian dominant HRR(s). DES utilization was similar in African-American and Caucasian dominant HRR (s). Higher odds of DES use was observed in median household income groups ≥$20,001 (OR: 1.07, 95% CI: 1.01-1.13, P - 0.03). Lower DES usage was observed in hospitals with higher total stent volume (quartile 4 vs. quartile 1: OR: 0.66, 95% CI: 0.63-0.69, P < 0.001) and for-profit hospitals (OR: 0.88, 95% CI: 0.85-0.92, P < 0.001). Conclusions: Our study findings suggest that there are significant differences in DES utilization in a national cohort of individuals with uniform insurance.
format	article
author	Tushar A Tuliani Maithili Shenoy Milind Parikh Mauricio G Cohen Cindy Grines Kenneth Jutzy Anthony Hilliard
author_facet	Tushar A Tuliani Maithili Shenoy Milind Parikh Mauricio G Cohen Cindy Grines Kenneth Jutzy Anthony Hilliard
author_sort	Tushar A Tuliani
title	Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort
title_short	Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort
title_full	Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort
title_fullStr	Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort
title_full_unstemmed	Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort
title_sort	impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 medicare cohort
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2017
url	https://doaj.org/article/5d2c6f6919ff48dcaa08d38cd797ff48
work_keys_str_mv	AT tusharatuliani impactofhospitalandsociodemographicfactorsonutilizationofdrugelutingstentsin20112012medicarecohort AT maithilishenoy impactofhospitalandsociodemographicfactorsonutilizationofdrugelutingstentsin20112012medicarecohort AT milindparikh impactofhospitalandsociodemographicfactorsonutilizationofdrugelutingstentsin20112012medicarecohort AT mauriciogcohen impactofhospitalandsociodemographicfactorsonutilizationofdrugelutingstentsin20112012medicarecohort AT cindygrines impactofhospitalandsociodemographicfactorsonutilizationofdrugelutingstentsin20112012medicarecohort AT kennethjutzy impactofhospitalandsociodemographicfactorsonutilizationofdrugelutingstentsin20112012medicarecohort AT anthonyhilliard impactofhospitalandsociodemographicfactorsonutilizationofdrugelutingstentsin20112012medicarecohort
_version_	1718384053883764736

Impact of hospital and sociodemographic factors on utilization of drug-eluting stents in 2011-2012 Medicare cohort

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