Browsing by Author "Davis-Ajami, Mary L."

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    CMS Practice Assessment Tool Validity for Alternative Payment Models
    (MJH Life Science, 2023-02) Boustani, Malaz A.; Perkins, Anthony J.; Davis-Ajami, Mary L.; Simon, Kosali I.; Chang, Chiang-Hua; Solid, Craig A.; Monahan, Patrick O.; Medicine, School of Medicine
    Objectives: To study the predictive validity of the CMS Practice Assessment Tool (PAT) among 632 primary care practices. Study Design: Retrospective observational study. Methods: The study included primary care physician practices recruited by the Great Lakes Practice Transformation Network (GLPTN), 1 of 29 CMS-awarded networks, and used data from 2015 to 2019. At enrollment, trained quality improvement advisers scored each of the PAT’s 27 milestones by its degree of implementation based on interviews with staff, review of documents, direct observation of practice activity, and professional judgment. The GLPTN also tracked each practice’s status regarding alternative payment model (APM) enrollment. Exploratory factor analysis (EFA) was used to identify summary scores; mixed-effects logistic regression was used to assess the relationship between derived scores with APM participation. Results: EFA revealed that the PAT’s 27 milestones could be summed into 1 overall score and 5 secondary scores. By the end of the 4-year project, 38% of practices were enrolled in an APM. A baseline overall score and 3 secondary scores were associated with increased odds of joining an APM (overall score: odds ratio [OR], 1.06; 95% CI, 0.99-1.12; P = .061; data-driven care quality score: OR, 1.11; 95% CI, 1.00-1.22; P = .040; efficient care delivery score: OR, 1.08; 95% CI, 1.03-1.13; P = .003; collaborative engagement score: OR, 0.88; 95% CI, 0.80-0.96; P = .005). Conclusions: These results demonstrate that the PAT has adequate predictive validity for APM participation.
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    Delivery of healthcare provider’s lifestyle advice and lifestyle behavioural change in adults who were overweight or obese in pre-diabetes management in the USA: NHANES (2013–2018)
    (BMJ, 2021) Davis-Ajami, Mary L.; Lu, Zhiqiang K.; Wu, Jun
    Objective: The purpose of this study is to examine the association between delivery of healthcare provider's advice about lifestyle management and lifestyle behavioural change in pre-diabetes management in adults who were overweight or obese. Design: This cross-sectional study included adults with body mass index (BMI) ≥25 kg/m2 and reporting pre-diabetes in USA. Outcomes included the prevalence of receiving provider's advice on lifestyle management and patterns of practicing lifestyle change. The association between delivery of provider's advice and lifestyle-related behavioural change in pre-diabetes management was examined. Setting: US Continuous National Health and Nutrition Examination Survey (2013-2018). Participants: A total of 1039 adults with BMI ≥25 kg/m2 reported pre-diabetes. Results: Of eligible adults with pre-diabetes, 76.8% received provider's advice about lifestyle change. The advice group showed higher proportions of ongoing lifestyle change than no advice group, including weight reduction/control (80.1% vs 70.9%, p=0.018), exercise (70.9% vs 60.9%, p=0.013) and diet modifications (83.8% vs 61.8%, p<0.001). After adjustment, those receiving provider's advice were more likely to increase exercise (OR 1.63, 95% CI 1.12 to 2.38) and modify diet (OR 3.0, 95% CI 1.82 to 4.96). Conclusion: Over 75% of US adults who were overweight or obese and reported pre-diabetes received healthcare provider's advice about reducing the risk of diabetes through lifestyle change. Provider's advice increased the likelihood of lifestyle-related behavioural change to exercise and diet.
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    Exploring home healthcare workforce in Alzheimer’s disease and related dementias: utilization and cost outcomes in US community dwelling older adults.
    (Elsevier, 2021-09) Davis-Ajami, Mary L.; Lu, Zihiqiang K.; Wu, Jun
    Objective This study assessed home health care use associated with Alzheimer's Disease and related dementias (ADRD) in US community dwelling older adults, including workforce, intensity, and cost outcomes. Materials and methods Medical Expenditure Panel Survey (2010–2018) household and home care event files were used to identify adults ≥ 65 years with ADRD. Outcomes included home health care provider type, intensity of care use, and annual direct home care cost. All analyses applied person weights for national estimates. Results Among the 20,443 eligible older adults, 4.2% (n = 843) reported ADRD. Among all professional and non-professional health care workers, nurse practitioners (NPs, 38.5%) and home health care aids (35.6%) were most used. Comparing ADRD vs non-ADRD: the annual per-person average number of days in home care was 110 vs. 64 (p<0.001) and home care costs accounted for 30.8% vs. 7.5% of total health care costs. After adjusting for participants' characteristics, those with ADRD were more likely to use home health care (OR = 4.32, 95% CI=3.29 – 5.68) and showed 229% (95% CI = 175% - 297%) higher associated costs than controls (p<0.001). Conclusion The study provides insight into the home care workforce. Of the professional workforce NPs were most often used and home care aides dominated the non-professional workforce. As expected, ADRD increased the likelihood and intensity of home health care utilization and associated direct home care costs significantly.
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    Hospital readmission and mortality associations to frailty in hospitalized patients with coronary heart disease
    (Elsevier, 2021) Davis-Ajami, Mary L.; Chang, Pei-Shuin; Wu, Jun
    Background: Frailty is associated with poor quality outcomes. Objective: To examine associations between frailty and hospital readmission or mortality in Coronary Heart Disease (CHD). Methods: Retrospectively assessed the 2016 US Nationwide Readmissions Database (NRD) including adults ≥ 65 years with pre-existing CHD. A validated Hospital Frailty Risk Score (HFRS) using ICD-10-CM codes identified frailty risk. Outcomes included: Readmission (30-day and subsequent readmission after index event) and in- hospital morality (during index event, readmission, and at 30-day readmission). Results: Among 1.1 million eligible patients, low, intermediate, and high frailty risk accounted for 48.9%, 46.7%, and 4.4% of the sample. Compared to low frailty risk, intermediate and high frailty risk showed significantly higher overall readmission rates (40.9% vs. 31.4%, 41.7% vs. 31.4%) and 30-day readmission rates (21.9% vs. 15.7%, 23.5% vs. 15.7%), respectively. After adjustment, higher in-hospital mortality and readmission rates were associated with higher frailty risk. The associations between in-hospital mortality and frailty depended on the presence of acute coronary syndrome. Conclusions: Readmission and mortality rates increased proportionally to the level of frailty risk in older adults with CHD. CHD, frailty risk, and older age profoundly negatively impact health outcomes and increases risk of death and readmission.
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    Impact of migraine on health care utilization and expenses in obese adults: A U.S. population-based study
    (Dove Press, 2018-12) Wu, Jun; Davis-Ajami, Mary L.; Lu, Zhiqiang K.
    Purpose: Migraine prevalence increases in people with obesity, and obesity may contribute to migraine chronicity. Yet, few studies examine the effect of comorbid migraine on health care utilization and expenses in obese US adults. This study aimed to identify risk factors for migraine and compare the use of health care services and expenses between migraineurs and non-migraineurs in obese US adults. Subjects and methods: This 7-year retrospective study used longitudinal panel data from 2006 to 2013 from the Household Component of the Medical Expenditure Panel Survey to identify obese adults reporting migraines. Outcomes compared in migraineurs vs non-migraineurs were as follows: annualized per-person medical care, prescription drug, and total health expenses. Results: In 23,596 obese adults, 4.7% reported migraine (n=1,025) approximating 3 million civilian noninstitutionalized US individuals. Logistic regression showed that the following sociodemographic characteristics increased migraine risk: age (18-45 years), females, White race, poor perceived health status, and greater Charlson comorbidity index. Migraineurs showed US$1,401 (P=0.007), US$813 (P<0.001), and US$2,213 (P=0.001) greater annual medical, prescription drug, and total health expenses than non-migraineurs, respectively. After adjustment, total health expenses increased by 31.6% in migraineurs vs non-migraineurs. Conclusion: In this US adult obese population, migraineurs showed greater total health care utilization and expenses than non-migraineurs. Treatment plans that address risk factors associated with migraine and comorbidities may help reduce the utilization of health care services and costs.
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    Telemedicine use in 2020 during the COVID-19 pandemic among community dwelling U.S. Medicare beneficiaries
    (SCIEDU, 2021-09-28) Davis-Ajami, Mary L.; Lu, Zhiqiang K.; Wu, Jun
    Objective: CMS reimbursement regulations for telemedicine changed after the onset of the COVID-19 pandemic. This study aimed to assess telemedicine utilization patterns offered by health care providers and used by Medicare beneficiaries during the COVID-19 pandemic during 2020. Methods: This study used the Fall 2020 Medicare Current Beneficiary Survey (MCBS) supplemental COVID-19 survey to identify Medicare beneficiaries (≥ 65 years) with a regular place for medical care that offered telemedicine during 2020. Major outcomes: prevalence for whether telemedicine was offered before and during the pandemic, telemedicine use, and digital access to telemedicine. Logistic regression identified the demographic factors associated with telemedicine use. Results: The study sample included 4,380 eligible individual Medicare beneficiaries ≥ 65 years. Of those, 42.9% made telemedicine visits during the pandemic. Approximately 60% of the telemedicine visits were conducted via telephone. Telemedicine was offered to 18% of the respondents before the pandemic vs. 64% during year 2020 of the pandemic. Among telemedicine users, 57.2%, 28.3%, and 14.5% used voice calls, video calls, and both voice and video calls for health care appointments, respectively. Overall telemedicine use varied by sex, race, and region. Individuals 65-74 years, female, living in a metropolitan area, with higher incomes were more likely to make video visits. Experience using telecommunications via the internet influenced telemedicine use significantly. Conclusions: Telemedicine offered to older Medicare beneficiaries increased dramatically after the onset of the COVID-19 pandemic. Yet, less than half used telemedicine and differences in utilization existed by demographic characteristics.