Our Parents, Ourselves: Health Care for an Aging Population; A Report of the Dartmouth Atlas Project

The new Dartmouth Atlas, funded by The John A. Hartford Foundation, is a report card that analyzes Medicare data to show us where the United States is making progress in patient-centered, evidence-based care for Medicare beneficiaries and where improvement is still needed. It also offers insight into regional variations in care.Filling in the gaps in our knowledge about the state of care across the country will help health care providers, health systems, and patients and families work together to improve care for all older adults.This Dartmouth Atlas report looks at a number of measures from Medicare data, including:The number of days older adults spend in contact with the health care system;Use of high-risk medications;Cancer screening rates (and how they compare with recommendations);30-day hospital readmission rates;Annual Wellness Visit (AWV) rates;Late hospice referral; andThe number of days spent in intensive care.The report also offers a historical look at key practices, comparing data from 2003-05 and 2012

Improving Patient Decision-Making in Health Care

Outlines regional variations within Minnesota in rates of patients with similar conditions receiving elective surgery, the concept of shared decision making, treatment choices for eight conditions, and steps for ensuring patients make informed decisions

Modeling peer effect modification by network strength: The diffusion of implantable cardioverter defibrillators in the US hospital network

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154422/1/sim8466.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154422/2/sim8466_am.pd

Provider Specialty and the Use of Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among Older Adults in the 2005-2016 National Ambulatory Medical Care Survey

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172305/1/acr211406.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172305/2/acr211406_am.pd

State variation in antipsychotic and benzodiazepine prescribing among hospice beneficiaries in the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175463/1/jgs17992.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/175463/2/jgs17992_am.pd

Access to primary care and cognitive impairment: results from a national community study of aging Americans

Abstract Background Despite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear. Primary care manages risk causing conditions and risk reducing behaviors for dementia, so we examine the association between individual and area-level access to primary care and cognitive impairment in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Methods REGARDS participants with a cognitive assessment and vascular measurements at their baseline visit were included in this cross-sectional analysis. Cognitive impairment was defined as a Six-Item Screener (SIS) score < 5. Primary care supply, primary care utilization and emergency department (ED) utilization were measured at the primary care service area (PCSA) level based on participant’s address. Individual access to care was self-reported. Models were adjusted for confounding by demographics, socioeconomic status and behavioral risk factors. Results Among 25,563 adults, living in a PCSA with low primary care supply was associated with 25% higher odds of cognitive impairment (OR 1.25 CI 1.07-1.45). Not having a regular source of medical care was associated with 14% higher odds of cognitive impairment (OR 1.14 CI 1.02-1.28), and living in a PCSA with high emergency department utilization was associated with 12% higher odds of cognitive impairment (OR 1.12 CI 1.02-1.23). Conclusions Our results are an important first step in understanding how health care may prevent cognitive impairment. They highlight the importance of primary care and suggest future work clarifying its role in preventing cognitive decline is imperative.http://deepblue.lib.umich.edu/bitstream/2027.42/173554/1/12877_2021_Article_2545.pd

The Influence of Health Status, Age, and Race on Screening Mammography in Elderly Women

Background Screening mammography is controversial for elderly women because of an absence of efficacy data. Decisions to screen are based on individualized assessment of risks and benefits. Our objective was to determine how screening mammography varies by age and race when adjusted for propensity to die. Methods In a retrospective cohort study, rates of screening mammogram performed in 2000-2001 based on claims, adjusted for propensity to die in 2000, were determined for a nationally representative 5% random sample of female fee-for-service Medicare beneficiaries 65 years and older in (N = 722 310). Results The overall rate of screening was 39%. When stratified into quintiles by propensity to die, 2-year rates ranged from 61% in the lowest-risk group to 5% in the highest-risk group. In analyses stratified by age and adjusted for propensity to die, 42% of women aged 65 to 69 years were screened, declining to 26% of women 85 years and older (P<.001). Adjusted screening rates for white women, black women, and women of other races were 40%, 30%, and 25%, respectively (P<.001). Thus, among women with similar health status, the youngest women were 1.61 times more likely to be screened compared with the oldest; compared with black women and women of other races, white women were 1.38 and 1.60 times, respectively, more likely to be screened. Conclusions Decisions to screen for breast cancer are related not only to health status but also to age and race. Underuse and overuse of screening mammography likely occurs owing to age- and race-associated decision making. Assessment of life expectancy may more accurately identify women who could benefit from screening

Changes in medication use among long‐stay residents with dementia in Michigan during the pandemic

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168452/1/jgs17161.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168452/2/jgs17161_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168452/3/jgs17161-sup-0001-TableS1.pd