Abstract:
OBJECTIVES:Medicare value-based payment programs evaluate physicians' performance on their patients' annual Medicare costs and clinical outcomes. However, little is known about how geriatricians, who disproportionately provide care for medically complex older adults, perform on these measures. DESIGN:A retrospective study using multivariable regression methods to estimate the association of geriatric risk factors with annualized Medicare costs and preventable hospitalization rates and to compare geriatricians' performance on these outcomes to other primary care physicians (PCPs) under standard Medicare risk adjustment and after adding additional adjustment for geriatric risk factors. SETTING:Eight years (2006-2013) of cohort data from the Medicare Current Beneficiary Survey. PARTICIPANTS:Medicare beneficiaries, aged 65 years and older, with primary care services contributing 27 027 person-years of data. MEASUREMENTS:Outcomes were costs and preventable hospitalization rates; geriatric risk factors were patient frailty, long-term institutionalization, dementia, and depression. RESULTS:Geriatricians were more likely to care for patients with frailty (22.8% vs 14.1%), long-term institutionalization (12.0% vs 4.7%), dementia (21.6% vs 10.2%), and depression (23.6% vs 17.4%) than other PCPs (P < .001 for each). Under standard Medicare risk adjustment, geriatricians performed more poorly on costs compared to other PCPs (observed-expected [O-E] ratio = 1.24 vs 0.99) and preventable hospitalizations (O-E ratio = 1.16 vs 0.98). Adding frailty, institutionalization, dementia, and depression to risk adjustment improved geriatricians' performance on costs by 25% and on preventable hospitalization rates by 35%, relative to other PCPs. Concurrent-year risk prediction that removed the influence of unpredictable acute events further improved geriatricians' performance vs other PCPs (O-E ratio = 0.99 vs 1.00). CONCLUSION:Medicare should consider risk adjusting for frailty, long-term institutionalization, dementia, and depression to avoid inappropriately penalizing geriatricians who care for vulnerable older adults. J Am Geriatr Soc 68:297-304, 2020.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Johnston KJ,Wen H,Joynt Maddox KEdoi
10.1111/jgs.16297subject
Has Abstractpub_date
2020-02-01 00:00:00pages
297-304issue
2eissn
0002-8614issn
1532-5415journal_volume
68pub_type
杂志文章abstract:BACKGROUND/OBJECTIVES:Delirium is common in older adults, especially following hospitalization. Because low vitamin D levels may be associated with increased delirium risk, we aimed to determine the prognostic value of blood vitamin D levels, extending our previous genetic analyses of this relationship. DESIGN:Prospec...
journal_title:Journal of the American Geriatrics Society
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更新日期:2020-10-05 00:00:00
abstract::There is accumulating evidence that interactions between beta-amyloid and copper, iron, and zinc are associated with the pathophysiology of Alzheimer's disease (AD). A significant dyshomeostasis of copper, iron, and zinc has been detected, and the mismanagement of these metals induces beta-amyloid precipitation and ne...
journal_title:Journal of the American Geriatrics Society
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更新日期:2003-08-01 00:00:00
abstract:OBJECTIVES:To describe factors associated with provider-ordered influenza testing in hospitalized older adults. DESIGN:Information on participant demographics, symptoms, and provider-ordered influenza testing were collected by questionnaire and chart review. We conducted prospective laboratory-based surveillance using...
journal_title:Journal of the American Geriatrics Society
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更新日期:2018-03-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.2005.53356.x
更新日期:2005-07-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.1985.tb07121.x
更新日期:1985-04-01 00:00:00
abstract:OBJECTIVES:To examine whether arterial stiffness is a risk factor for falls in community-dwelling older people. DESIGN:Prospective cohort study. SETTING:Community population, Sydney, Australia. PARTICIPANTS:Community-dwelling older adults (mean age 79.8±4.4, 52.2% female; N=481). MEASUREMENTS:Carotid-femoral pulse ...
journal_title:Journal of the American Geriatrics Society
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doi:10.1111/jgs.12931
更新日期:2014-08-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.1982.tb07102.x
更新日期:1982-04-01 00:00:00
abstract:OBJECTIVES:To determine whether a distance coaching course on improving nursing home incontinence care could be replicated and brought to scale with a larger group of nursing homes without sacrificing outcomes. DESIGN:The study collected descriptive and comparative data. SETTING:Fourteen nursing homes in the original...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2012.03939.x
更新日期:2012-06-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
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更新日期:2019-11-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2002-02-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:To explore the opinion of the Dutch general public and of physicians regarding euthanasia in patients with advanced dementia. DESIGN:A cross-sectional survey. SETTING:The Netherlands. PARTICIPANTS:Random samples of 1,965 citizens (response = 1,965/2,641 [75%]) and 1,147 physicians (response = 1...
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doi:10.1111/jgs.16692
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journal_title:Journal of the American Geriatrics Society
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更新日期:2020-11-02 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1978.tb03332.x
更新日期:1978-11-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:2002-01-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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doi:10.1046/j.1532-5415.2002.50458.x
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journal_title:Journal of the American Geriatrics Society
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更新日期:2019-11-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
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更新日期:2009-07-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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更新日期:2017-03-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1998.tb02756.x
更新日期:1998-08-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2004.52456.x
更新日期:2004-10-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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更新日期:2020-03-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
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更新日期:2006-06-01 00:00:00
abstract:OBJECTIVES:Patients undergoing hip fracture surgery have a 10 times increased risk of stroke compared with the general population. We aimed to evaluate the association between the CHA2 DS2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke/TIA [transient ischemic attack]/systemic em...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:2020-08-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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更新日期:2012-03-01 00:00:00
abstract:OBJECTIVES:To examine the relationship between cognitive function and self-reported oral health-related quality of life (HRQoL) in community-dwelling older adults. DESIGN:Cross-sectional. SETTING:Community in West Virginia. PARTICIPANTS:Two hundred twenty-six community-dwelling older adults. MEASUREMENTS:Oral HRQoL...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.12402
更新日期:2013-09-01 00:00:00