Dataset Information

Medical management patterns in a US commercial claims database following a nontraumatic fracture in postmenopausal women.

ABSTRACT: Among women ≥ 50 years with fracture, 76% had not received osteoporosis diagnosis or treatment at 6 months and only 14% underwent a DXA scan. Nearly half of all and 90% of hip fracture patients required surgery. Fractures cause substantial clinical burden and are not linked to osteoporosis diagnosis or treatment.

Purpose

Osteoporosis (OP) and OP-related fractures are a major public health concern, associated with significant economic burden. This study describes management patterns following a nontraumatic fracture for commercially insured patients.

Methods

This retrospective cohort study identified women aged ≥ 50 years having their first nontraumatic index fracture (IF) between January 1, 2015 and June 30, 2019, from IQVIA's PharMetrics® Plus claims database. Medical management patterns at month 6 and medication use patterns at months 6, 12, and 24 following the IF were described.

Results

Among 48,939 women (mean (SD) age: 62.7 (9.5) years), the most common fracture types were vertebral (30.6%), radius/ulna (24.9%), and hip (HF; 12.1%). By month 6, 76% of patients had not received an OP diagnosis or treatment, 13.6% underwent a DXA scan, and 11.2% received any OP treatment. Surgery was required in 43.1% of all patients and 90.0% of HF patients on or within 6 months of the fracture date. Among HF patients, 41.4% were admitted to a skilled nursing facility, 96.7% were hospitalized an average of 5.5 days, and 38.1% required durable medical equipment use. The 30-day all-cause readmission rate was 14.3% among those hospitalized for the IF. Overall, 7.4%, 9.9%, and 13.2% had a subsequent fracture at months 6, 12, and 24, respectively.

Conclusion

Our findings provide an overview of post-fracture management patterns using real-world data. OP was remarkably underdiagnosed and undertreated following the initial fracture. Nontraumatic fracture, particularly HF, resulted in substantial ongoing clinical burden.

SUBMITTER: Wang X

PROVIDER: S-EPMC9283183 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:This study examined the imminent risk of a future fracture within 1 and 2 years following a first fracture in women aged 50 years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures. INTRODUCTION:This study aims to determine the imminent risk of subsequent fractures within 1 and 2 years following a first fracture and to assess independent factors associated with subsequent fractures. METHODS:Retrospective, observational cohort study of women aged ≥ 50 years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24 months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis. RESULTS:Two hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12 months was 7.1% (95% confidence interval [CI], 6.9-7.2) and at 24 months was 12.0% (95% CI, 11.8-12.1). The rate of subsequent fractures was highest in the first month (~ 15 fractures per 1000 patient-years) and remained steady between 4 and 24 months (~ 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24 months, sub-distribution hazard ratio [HR], 3.07; p < 0.001 for women 80-89 years [reference 50-59 years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p < 0.001 over 12 months; HR, 2.23; p < 0.001 over 24 months). CONCLUSIONS:Our findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.

Project description:IntroductionNontraumatic intracranial hemorrhage (ICH) is a neurological emergency of research interest; however, unlike ischemic stroke, has not been well studied in large datasets due to the lack of an established administrative claims-based definition. We aimed to evaluate both explicit diagnosis codes and machine learning methods to create a claims-based definition for this clinical phenotype.MethodsWe examined all patients admitted to our tertiary medical center with a primary or secondary International Classification of Disease version 9 (ICD-9) or 10 (ICD-10) code for ICH in claims from any portion of the hospitalization in 2014-2015. As a gold standard, we defined the nontraumatic ICH phenotype based on manual chart review. We tested explicit definitions based on ICD-9 and ICD-10 that had been previously published in the literature as well as four machine learning classifiers including support vector machine (SVM), logistic regression with LASSO, random forest and xgboost. We report five standard measures of model performance for each approach.ResultsA total of 1830 patients with 2145 unique ICD-10 codes were included in the initial dataset, of which 437 (24%) were true positive based on manual review. The explicit ICD-10 definition performed best (Sensitivity = 0.89 (95% CI 0.85-0.92), Specificity = 0.83 (0.81-0.85), F-score = 0.73 (0.69-0.77)) and improves on an explicit ICD-9 definition (Sensitivity = 0.87 (0.83-0.90), Specificity = 0.77 (0.74-0.79), F-score = 0.67 (0.63-0.71). Among machine learning classifiers, SVM performed best (Sensitivity = 0.78 (0.75-0.82), Specificity = 0.84 (0.81-0.87), AUC = 0.89 (0.87-0.92), F-score = 0.66 (0.62-0.69)).ConclusionsAn explicit ICD-10 definition can be used to accurately identify patients with a nontraumatic ICH phenotype with substantially better performance than ICD-9. An explicit ICD-10 based definition is easier to implement and quantitatively not appreciably improved with the additional application of machine learning classifiers. Future research utilizing large datasets should utilize this definition to address important research gaps.

Project description:INTRODUCTION:This study describes characteristics of nonfatal self-inflicted injuries and incidence of repeat self-inflicted injuries among a large convenience sample of youth (aged 10-24 years) with Medicaid or commercial insurance. METHODS:In 2018, Truven Health MarketScan medical claims data were used to identify youth with a self-inflicted injury in 2013 (or index self-inflicted injury) diagnosed in any inpatient or outpatient setting. Patients with 2 years of healthcare claims data (1 year before/after index self-inflicted injury) were assessed. Patient and injury characteristics, repeat self-inflicted injuries ?1 year, time to repeat self-inflicted injury, and number of emergency department and urgent care facility visits per patient are reported. A regression model assessed factors associated with repeat self-inflicted injuries. RESULTS:Among 4,681 self-inflicted injury patients, 70% were female. More than 71% of patients were treated for comorbidities (50% for depression) ?1 year preceding the index self-inflicted injury. Poisoning was the most common index self-inflicted injury mechanism (60% of patients). Approximately 52% of patients had one or more emergency department visit and 1% had one or more urgent care facility visit, respectively, during the 2-year observation period. More than 11% of patients repeated self-inflicted injury ?1 year (and 3% ?7 days). Repeat self-inflicted injury was associated with younger patient age, being female, a self-inflicted injury event preceding the index self-inflicted injury, index self-inflicted injury treatment setting, and patient comorbidities. CONCLUSIONS:Approximately one in ten youth repeated self-inflicted injury within 1 year and nearly half of youth with clinically treated self-inflicted injuries never received care in hospitals or emergency departments. Physicians and families should be aware of risk factors for repeat self-inflicted injury, including mental health comorbidities. Multilevel strategies are needed to prevent youth self-inflicted injuries.

Project description:BackgroundSepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined.MethodsWe conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. We investigated the annual trend of medical costs during the study period. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to evaluate the association between the annual trend and medical costs.ResultsAmong 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017, whereas the total medical cost per hospitalization declined (rate = - $1075/year, p < 0.0001). While the survival rate of sepsis patients improved during the study period, the effective cost per survivor significantly decreased (rate = - $1806/year [95% CI - $2432 to - $1179], p = 0.001). In the subgroup analysis, the trend of decreasing medical cost per hospitalization remained consistent among the subpopulation of age, sex, and site of infection. After adjusting for age, sex (male), number of chronic diseases, site of infection, intensive care unit (ICU) admission, surgery, and length of hospital stay, the admission year was significantly associated with reduced medical costs.ConclusionsWe demonstrated an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. The annual trend of reduced costs was consistent after adjustment with the confounders altering hospital expenses.