Abstract:
Background:Medicare uses the Centers for Medicare & Medicaid Services Hierarchical Condition Category (CMS-HCC) model to predict patients' annualized Medicare costs in value-based payment programs. The CMS-HCC model does not include measures of frailty, and prior research shows that it systematically underpredicts costs for frail Medicare beneficiaries. Objective:To determine whether a claims-based frailty index can improve Medicare cost prediction. Design:Retrospective cohort study. Setting:Medicare Current Beneficiary Survey linked to Medicare claims, 2006 to 2013. Participants:16 535 community-dwelling, fee-for-service beneficiaries representing 26 705 patient-years. Measurements:Patient frailty status was classified using a validated claims-based frailty index. The association between the frailty index and annualized Medicare costs was examined, and regression methods were used to compare observed Medicare costs versus predictions based on the standard CMS-HCC model with and without the frailty index. Results:Mean costs were $5724 for the 8910 patients classified as robust (46.4% of patient-years), $12 462 for the 8405 prefrail patients (41.6%), $26 239 for the 2215 mildly frail patients (9.6%), and $44 586 for the 593 patients classified as moderately to severely frail (2.5%). The frailty index addition to the CMS-HCC model predicted on average an additional $2712, $7915, and $16 449 in costs for prefrail, mildly frail, and moderately to severely frail patients, respectively, beyond the CMS-HCC model alone. On average, the model with the frailty index addition resulted in more accurate predictions of costs for patients at all 4 levels of frailty. However, observed costs remained more widely distributed than predictions from the enhanced model at all levels of frailty. Limitation:The claims-based index is a proxy for frailty and is likely less accurate than an in-person examination. Conclusion:The CMS-HCC model with the frailty index addition is an improvement over current Medicare cost prediction. Primary Funding Source:None.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Johnston KJ,Wen H,Joynt Maddox KEdoi
10.7326/M19-3261subject
Has Abstractpub_date
2020-04-21 00:00:00pages
533-540issue
8eissn
0003-4819issn
1539-3704pii
2764240journal_volume
172pub_type
杂志文章abstract::We prospectively studied the evaluation of dementia in 107 unselected outpatients; 83 had so-called "irreversible" dementias, including 74 who had an Alzheimer-type dementia. Fifteen patients had potentially reversible dementias, of which hypothyroidism and drug toxicity were the commonest causes. Distinguishing featu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-3-417
更新日期:1984-03-01 00:00:00
abstract:BACKGROUND:Health care-associated infections from invasive medical devices in the intensive care unit (ICU) are a major threat to patient safety. Most published studies of ICU-acquired infections have come from industrialized western countries. In a Centers for Disease Control and Prevention (CDC) National Nosocomial I...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-145-8-200610170-00007
更新日期:2006-10-17 00:00:00
abstract::The new knowledge of the regulation of cell growth and the genetic and biochemical changes that lead to malignancy have created many new opportunities for cancer drug discovery. These new targets include oncogenes, growth factors and their receptors, signal transduction pathways, and cell differentiation signals. Atte...
journal_title:Annals of internal medicine
pub_type: 评论,杂志文章,评审
doi:10.7326/0003-4819-118-8-199304150-00011
更新日期:1993-04-15 00:00:00
abstract:OBJECTIVE:To determine whether concurrent treatment with acetaminophen and zidovudine impairs clearance of zidovudine, thereby increasing the risk for zidovudine-induced hematologic toxicity. DESIGN:Dose escalation, drug interaction study. SETTING:University clinical research center. PATIENTS:Patients with the acqui...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-114-11-937
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:The clinical significance of asymptomatic deep venous thrombosis that develops after joint arthroplasty and the value of screening tests to detect thrombi are uncertain. OBJECTIVES:To determine 1) the rate of symptomatic deep venous thrombosis or pulmonary embolism occurring after hospitalization for joint ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-127-6-199709150-00004
更新日期:1997-09-15 00:00:00
abstract:BACKGROUND:Growing evidence indicates that peripheral neuropathy (PN) is common even in the absence of diabetes. However, the clinical sequelae of PN have not been quantified in the general population. OBJECTIVE:To assess the associations of PN with all-cause and cardiovascular mortality in the general adult populatio...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-1340
更新日期:2020-12-08 00:00:00
abstract::The insulin-like growth factor (IGF) family of peptides, binding proteins, and receptors are ubiquitous and important for normal human growth and development. Modern techniques including specific radioimmunoassays, radioreceptor assays and recombinant DNA technology have improved our understanding of the role of IGFs ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-116-10-854
更新日期:1992-05-15 00:00:00
abstract::Barrett's esophagus denotes the presence of columnar epithelium in the esophagus instead of the usual stratified squamous epithelium. Barrett's esophagus had been thought to represent a mediastinal extension of the stomach in patients with a congenital short esophagus. Subsequent clinical and experimental data have es...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-97-1-103
更新日期:1982-07-01 00:00:00
abstract::As the third decade since AIDS was first recognized comes to an end, extraordinary advances have occurred in the understanding, treatment, and prevention of HIV infection and AIDS. As a result of these successes, it is now time to focus on future challenges. Paramount among these is reaching the goal of truly controll...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-154-11-201106070-00345
更新日期:2011-06-07 00:00:00
abstract:BACKGROUND:Few recent data are available on risk factors for perioperative supraventricular arrhythmia (SVA) after noncardiac surgery or on the effect of SVA on clinical outcomes. OBJECTIVE:To determine the incidence, clinical correlates, and effect on length of stay of perioperative SVA in patients having major nonca...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-129-4-199808150-00003
更新日期:1998-08-15 00:00:00
abstract:BACKGROUND:Many dispensing errors made in hospital pharmacies can harm patients. Some hospitals are investing in bar code technology to reduce these errors, but data about its efficacy are limited. OBJECTIVE:To evaluate whether implementation of bar code technology reduced dispensing errors and potential adverse drug ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-145-6-200609190-00006
更新日期:2006-09-19 00:00:00
abstract:Background:Little is known about whether insurance expansion affects the location and type of emergency department (ED) use. Understanding these changes can inform state-level decisions about the Medicaid expansion under the Patient Protection and Affordable Care Act (ACA). Objective:To investigate the effect of the 2...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/M16-0086
更新日期:2017-02-07 00:00:00
abstract:OBJECTIVE:To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN:A retrospective study using stored specimens. SETTING:A referral center and several priva...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-115-12-936
更新日期:1991-12-15 00:00:00
abstract:BACKGROUND:HIV-infected patients with sustained immunologic improvement from antiretroviral therapy may be able to discontinue chemoprophylaxis against Pneumocystis carinii pneumonia (PCP). OBJECTIVE:To compare PCP incidence in HIV-infected patients who had sustained CD4+ lymphocyte counts greater than 200 cells/mm3 a...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-132-3-200002010-00005
更新日期:2000-02-01 00:00:00
abstract::This guideline summarizes the current approaches for the diagnosis of venous thromboembolism. The importance of early diagnosis to prevent mortality and morbidity associated with venous thromboembolism cannot be overstressed. This field is highly dynamic, however, and new evidence is emerging periodically that may cha...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-146-6-200703200-00013
更新日期:2007-03-20 00:00:00
abstract:BACKGROUND:Few treatments exist for coronavirus disease 2019 (COVID-19). PURPOSE:To evaluate the effectiveness and harms of remdesivir for COVID-19. DATA SOURCES:Several databases, tables of contents of journals, and U.S. Food and Drug Administration and company websites were searched from 1 January through 31 August...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-5752
更新日期:2020-10-05 00:00:00
abstract:BACKGROUND:Screening can detect prostate cancer at earlier, asymptomatic stages, when treatments might be more effective. PURPOSE:To update the 2002 and 2008 U.S. Preventive Services Task Force evidence reviews on screening and treatments for prostate cancer. DATA SOURCES:MEDLINE (2002 to July 2011) and the Cochrane ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-155-11-201112060-00375
更新日期:2011-12-06 00:00:00
abstract::Three patients with the acquired immunodeficiency syndrome had biliary obstruction resulting from benign strictures of the biliary tract. Stenosis of the distal common bile duct with differing degrees of irregularity of the smaller intrahepatic and extrahepatic ducts was seen in association with either cryptosporidial...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-105-2-207
更新日期:1986-08-01 00:00:00
abstract::Wilson's disease is an inherited disorder of copper accumulation that is fatal if untreated. Because penicillamine, the established treatment, is toxic in a substantial number of patients, we studied the efficacy of zinc treatment. We induced a negative or neutral copper balance in five out of five patients with Wilso...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-99-3-314
更新日期:1983-09-01 00:00:00
abstract:OBJECTIVE:To compare trimethoprim-sulfamethoxazole (TMP-SMZ) and vancomycin regarding efficacy and safety in the therapy of serious Staphylococcus aureus infections. DESIGN:Randomized, double-blind comparative trial. SETTING:A tertiary-care hospital. PATIENTS:One hundred and one intravenous drug users hospitalized w...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-117-5-390
更新日期:1992-09-01 00:00:00
abstract:BACKGROUND:When deep venous thrombosis is suspected, objective testing is required to confirm or refute the diagnosis. OBJECTIVE:To determine whether the combination of a low clinical suspicion and a normal D -dimer result rules out deep venous thrombosis. DESIGN:Prospective cohort study. SETTING:Three tertiary care...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-135-2-200107170-00011
更新日期:2001-07-17 00:00:00
abstract:OBJECTIVE:To determine whether the quality of care for common ambulatory conditions is adversely affected when physicians are provided with incentives to limit the use of health services. DESIGN:Retrospective cohort study over a 2-year period. SETTING:Four group practices that cared for both fee-for-service patients ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-115-5-394
更新日期:1991-09-01 00:00:00
abstract:PURPOSE:To compare the diagnostic accuracy of computed tomography (CT) and positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) for mediastinal staging in patients with non-small-cell lung cancer and to determine whether test results are conditionally dependent (the sensitivity and specificity of FDG-PET...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/0003-4819-139-11-200311180-00013
更新日期:2003-12-02 00:00:00
abstract:OBJECTIVE:To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis. DESIGN:Case study. SETTING:Intensive care unit of a referral hospital. PATIENT:A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amox...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-117-6-476
更新日期:1992-09-15 00:00:00
abstract::The diagnostic and therapeutic value of the angiotensin converting enzyme inhibitor teprotide (SQ 20881) was assessed in 18 patients with hypertensive emergencies. Mean blood pressure fell 31 +/- 18 mm Hg in the 10 subjects who responded to 1 mg/kg body weight administered intravenously, whereas it fell 5 +/- 3 mm Hg ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-1-43
更新日期:1979-01-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the association between current non-aspirin nonsteroidal anti-inflammatory drug (NSAID) use and fatal peptic ulcers or upper gastrointestinal hemorrhage. DESIGN:Nested case control study using a linked Medicaid-death certificate database. SETTING:Tennessee Medicaid enrollees aged 60 and g...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-109-5-359
更新日期:1988-09-01 00:00:00
abstract:OBJECTIVE:To determine whether antimicrobial therapy for Helicobacter pylori infection accelerates the healing of duodenal ulcers. DESIGN:Single-blind, randomized, controlled trial. SETTING:Veterans Affairs hospital. PARTICIPANTS:One hundred and five patients with endoscopically verified duodenal ulcers. INTERVENTI...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-115-4-266
更新日期:1991-08-15 00:00:00
abstract::There has been considerable change in the practice of internal medicine in the past quarter century, including the rise of specialization, increasing time pressure, the hospitalist movement, and the rapidly changing responsibilities of internists in inpatient and outpatient settings. Training programs have not adequat...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-144-12-200606200-00010
更新日期:2006-06-20 00:00:00
abstract::An unusual cluster of 11 patients with Pneumocystis carinii pneumonia occurred in a 3-month period at Memorial Hospital, New York. Ten of the 11 patients had lymphoma or leukemia. In 7 patients, corticosteroid therapy was decreased or stopped shortly before pneumocystis pneumonia was diagnosed. The pediatric patients ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-82-6-722
更新日期:1975-06-01 00:00:00
abstract::Polysaccharide vaccines against diseases caused by Neisseria meningitidis serogroups A and C meningococci are now licensed in the United States. They are prepared as monovalent and as bivalent antigens. This statement summarizes available information on these antigen and offers guidance regarding their role in the con...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:
更新日期:1976-02-01 00:00:00