Incidence of Venous Thromboembolism in Nursing Home Residents

AbstractObjectiveVenous thromboembolism (VTE) is common in the elderly, but its epidemiology in nursing home residents remains unclear. This study estimated rates of VTE recorded on nursing home admission and incidence during residence.DesignRetrospective analysis of AnalytiCare long term care (LTC) database for the period January 2007 to June 2009.Setting181 nursing homes in 19 US states.ParticipantsEligible residents had 1 or more admission Minimum Data Set (MDS) 2.0 assessment(s) over the study period. All VTE cases were extracted if MDS indicated deep vein thrombosis or pulmonary embolism. The number of admissions and days at risk were estimated from a random sample (n = 1350) of all residents.MeasurementsThe earliest admission was identified as the admission index date. VTE cases were classified as either “On Admission” (VTE coded on admission index date) or “During Residence” (coded afterward). Residents were followed from admission index date until censoring.ResultsA total of 2144 VTE admission cases (3.7% of all admissions) were identified. A further 757 cases of VTE occurring during residence were identified, yielding an incidence of 3.68 cases of VTE per 100 person-years of postadmission residence. VTE admission rates were highest for residents younger than 50 years (4.8%, confidence interval [CI]: 3.9%–5.9%) and 50 to 64 years (5.1%, CI: 4.6%–5.7%) but similar for those aged 65 to 74 (3.6%, CI: 3.3%–4.0%), 75 to 84 (3.6%, CI: 3.3%–3.9%), and 85 years or older (3.1%, CI: 2.9%–3.4%). The incidence of VTE during residence was similar among these age strata.ConclusionApproximately 1 in 25 nursing home admissions had a VTE diagnosis. VTE incidence during residence was higher than reported in earlier nursing home studies. These incidence rates merit further investigation because diagnostic improvements may be driving greater recognition of VTE in LTC

Patient Experience-of-Care Is Associated With Adherence/Persistence to Cardiometabolic Disease Medications in an Ambulatory Setting

Background: We aimed to investigate associations between patient ratings of experience-of-care and medication adherence or persistence to cardiometabolic disease (CMD) medications in an ambulatory care setting. Methods: This retrospective study was conducted using electronic health records and administrative data from an ambulatory care network in Northern California. We included managed-care beneficiaries (≥ 18 years) with a prescription for a CMD medication between 2010 and 2014. CMD medications included antihyperglycemic, antihyperlipidemic and antihypertensive agents. Within each class, we chose the first medication prescribed within 14 days of an office encounter that was associated with a completed Press-Ganey patient-experience survey. Primary outcome measures were adherence (proportion of days covered ≥ 0.80) and persistence (no gap in pharmacy fills \u3e 1.5× of a day’s supply). The main predictor variables were experience-of-care domains, which comprised health care providers’ (a) explanation about problems or conditions; (b) effort to include patients in treatment decisions; (c) information about medications; and (d) information about follow-up care. Experience-of-care was rated on a scale of 1 (very poor) to 5 (very good). Multivariable logistic regression models were fitted to assess associations between adherence or persistence (yes/no) and ratings for each experience-of-care domain (dichotomized as 5 vs \u3c 5), with statistical adjustment for important patient, prescription and provider characteristics. Odds ratios (ORs) were generated. Results: Eligibility criteria were met by 5,045 patients. The majority of patients were ≥ 65 years old (61.8%); median of CMD medications was 2. Patients receiving antihyperglycemic medications had higher odds of adherence when they had better experience-of-care with “inclusion in treatment decisions” (OR: 1.64) and “information about follow-up care” (OR: 1.60). Patients receiving antihyperlipidemic medications had higher odds of persistence when they had better experiences-of-care within each domain (range of ORs: 1.38–1.57). Patients receiving antihypertensive medications had higher odds of persistence when they had better experiences-of-care with “inclusion in treatment decisions” (OR: 1.52) and “information about medications” (OR: 1.55). Conclusion: In an ambulatory care setting, better experience-of-care with a health care provider in making shared treatment decisions was consistently a positive predictor of adherence/persistence. The relationship between other domains of experience-of-care and adherence/persistence differed by therapeutic class. Improving adherence or persistence to CMD medications through better patient experiences with their health care providers will likely require tailored approaches