Digital Commons Network^™

Recurrent Clostridium Difficile Infection Among Medicare Patients In Nursing Homes: A Population-Based Cohort Study, Marya D. Zilberberg, Andrew F. Shorr, William M. Jesdale, Jennifer Tjia, Kate L. Lapane

Jennifer Tjia

We explored the epidemiology and outcomes of Clostridium difficile infection (CDI) recurrence among Medicare patients in a nursing home (NH) whose CDI originated in acute care hospitals. We conducted a retrospective, population-based matched cohort combining Medicare claims with Minimum Data Set 3.0, including all hospitalized patients age > /=65 years transferred to an NH after hospitalization with CDI 1/2011-11/2012. Incident CDI was defined as ICD-9-CM code 008.45 with no others in prior 60 days. CDI recurrence was defined as (within 60 days of last day of CDI treatment): oral metronidazole, oral vancomycin, or fidaxomicin for > /=3 days in part D file; …

Pain And Pharmacologic Pain Management In Long-Stay Nursing Home Residents, Jacob N. Hunnicutt, Christine M. Ulbricht, Jennifer Tjia, Kate L. Lapane

Jennifer Tjia

Prior studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set (MDS) 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after these important initiatives of: 1) prevalence and correlates of persistent pain; and 2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in United States NHs between 2011-2012 with 2 MDS assessments 90 days apart. Pain was categorized as persistent (pain …

Factors Associated With Ordering Laboratory Monitoring Of High-Risk Medications, Shira Fischer, Jennifer Tjia, George Reed, Daniel Peterson, Jerry Gurwitz, Terry Field

Jennifer Tjia

BACKGROUND: Knowledge about factors associated with provider ordering of appropriate testing is limited.

OBJECTIVE: To determine physician factors associated with ordering recommended laboratory monitoring tests for high-risk medications.

METHODS: Retrospective cohort study of patients prescribed a high-risk medication requiring laboratory monitoring in a large multispecialty group practice between 1 January 2008 and 31 December 2008. Analyses are based on administrative claims and electronic medical records. The outcome is a physician order for each recommended laboratory test for each prescribed medication. Key predictor variables are physician characteristics, including age, gender, specialty training, years since completing training, and prescribing volume. Additional variables …

Intervention To Reduce Adverse Outcomes Among Older Adults Discharged From Skilled Nursing Facilities To Home, Terry S. Field, Jessica Ogarek, Abir O. Kanaan, Jennifer L. Donovan, Peggy Preusse, Devi Sundaresan, Shawn J. Gagne, Lawrence D. Garber, Jennifer Tjia, Sarah L. Cutrona, Jerry H. Gurwitz

Jennifer Tjia

Background: Older adults may be at risk for adverse outcomes after discharge from skilled nursing facilities (SNF), but little research has focused on this transition.

Objective: To assess the impact of an alert system on the rates of adverse outcomes among older adults discharged from SNFs to home.

Methods: Within a multispecialty group practice, we tracked 30-day re-hospitalizations after SNF discharges during an intervention that provided discharge alerts to primary care physicians. We compared them to discharges from the pre-intervention period matched on age, gender and SNF. For the first 100 intervention discharges and their matches, we performed chart reviews …

Self-Reported Colorectal Cancer Screening Of Medicare Beneficiaries In Family Medicine Vs. Internal Medicine Practices In The United States: A Cross-Sectional Study, Angela (Young) Higgins, Anna R. B. Doubeni, Karon L. Phillips, Adeyinka O. Laiyemo, Becky A. Briesacher, Jennifer Tjia, Chyke A. Doubeni

Jennifer Tjia

BACKGROUND: The benefit of screening for decreasing the risk of death from colorectal cancer (CRC) has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs) vs. internal medicine (internists) physicians.

METHODS: Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey). The main …

Factors Associated With Ordering Laboratory Monitoring Of High-Risk Medications, Shira H. Fischer, Terry S. Field, Daniel J. Peterson, George Reed, Jerry H. Gurwitz, Jennifer Tjia

Jennifer Tjia

Background

Knowledge about factors associated with provider ordering of appropriate testing is limited.

Objective

To determine physician factors correlated with ordering of recommended laboratory monitoring tests for high-risk medications, accounting for patient characteristics.

Methods

Analysis of the administrative claims and electronic medical records of patients prescribed a high-risk medication requiring laboratory monitoring in a large multispecialty group practice between January 1, 2008 and December 31, 2008. The outcome is a physician order for each recommended laboratory test for each prescribed medication. Key predictor variables include physician characteristics, including age, gender, specialty training, years since completing training, and prescribing volume. We …

Healthcare Preferences Among Lesbians: A Focus Group Analysis, Margaret R. Seaver, Karen M. Freund, Leslie M. Wright, Jennifer Tjia, Susan M. Frayne

Jennifer Tjia

OBJECTIVE: The healthcare needs of lesbians are not well understood. We sought to characterize lesbians' experiences with, and preferences for, women's healthcare. METHODS: We conducted three age-stratified focus groups (18-29, 30-50, and >50 years) with a total of 22 participants using a semistructured interview guide to elicit lesbians' experiences and preferences. We analyzed transcripts of these audiotaped sessions using the constant comparative method of grounded theory. Community-dwelling women who self-identified as lesbian and responded to advertisements were selected on first-come basis. RESULTS: Participants voiced experiences and preferences for healthcare that emerged into three themes: desired models of care, desired processes …