Search PubMed⌕ Search

Biomedical subjects

S Kind

Publications and source records attributed to S Kind.

6 recordsLinked to original sources
PubMed2001

Hospice use in Medicare managed care and fee-for-service systems.

OBJECTIVE: To examine whether patterns of hospice use by older Medicare beneficiaries are consistent with the differing financial incentives in Medicare managed care (MC) and fee-for-service (FFS) settings. Specifically, are use patterns consistent with incentives that might encourage hospice use for MC enrollees and discourage hospice use for FFS enrollees? STUDY DESIGN: One-year study of hospice use by Medicare beneficiaries dying in 1996. PATIENTS AND METHODS: Medicare enrollment and hospice administrative data were used to examine hospice use before death for all elderly individuals residing in 100 US counties with high MC enrollment in 1996. Age-, sex-, and race-adjusted rate of hospice use and length of stay in hospice are compared between FFS and MC enrollees across and within (when possible) the 100 counties. RESULTS: Rates of hospice use were significantly higher for MC enrollees than for FFS enrollees (26.6 vs 17.0 per 100 deaths; P < .001). These differences persisted within age, sex, and race groups but were not related to area MC enrollment rate or the amount of money paid to managed care organizations. Age-, sex-, and race-adjusted differences were observed in 94 of 100 counties. Length of stay in hospice was marginally longer for MC enrollees than for FFS enrollees (median, 24 vs 21 days; P < .0001). CONCLUSIONS: System of care is an important determinant of hospice use in the elderly Medicare population.

Aged↗
PubMed2000

Geographic variation in hospice use prior to death.

OBJECTIVES: To examine national variation in use of the Medicare hospice benefit by older individuals before their death, and to identify individual characteristics and local market factors associated with hospice use. DESIGN: Retrospective analysis of Medicare administrative data. SETTING: Hospice care. PARTICIPANTS: Older Medicare enrollees who died in 1996. MEASUREMENTS: Rate of hospice use per 1,000 older Medicare beneficiary deaths. RESULTS: Overall, 155 of every 1,000 older Medicare beneficiaries who die use hospice before death. This rate is significantly higher among younger older persons (P < .001), non-blacks (P < .001), persons living in wealthier areas (P < .001), and persons in urban areas (P < .001). Areas with a higher proportion of non-cancer diagnoses among hospice users have higher rates of hospice use for both cancer and non-cancer reasons than areas with a majority of hospice users having cancer diagnoses (P < .001). Hospice use is higher in areas with fewer hospital beds per capita (P < .001), areas with lower in-hospital death rates (P < .001), and areas with higher HMO enrollment (P < .001). Rates of hospice use are also positively related to average reimbursements for health care (P < .001) and to physicians per capita (P < .001). In the largest metropolitan statistical areas (MSAs), rates of hospice use vary more than 11-fold from a low of 35.15 (Portland, ME) to a high of 397.2 per 1,000 deaths (Ft. Lauderdale, FL). CONCLUSIONS: The wide variation in hospice use suggests that there is great potential to increase the number of users of the Medicare hospice benefit.

Age Distribution↗
PubMed2000

Survival analysis using Medicare data: example and methods.

OBJECTIVE: To describe key methods and issues in conducting survival analyses, especially using Medicare (and other) administrative data. PRINCIPAL FINDINGS: Survival analyses are rich , informative, and underutilized methods for examining out comes whose timing is important . Medicare files contain the necessary information for conducting such analyses, including identification of cohorts, definition of events, censoring of observations, and adjustment for covariates. CONCLUSION: Survival analyses can readily be conducted using the information contained in administrative data files.

Aged↗
PubMed1999

Degradation of tryptophan in patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE), a progressive autoimmune disorder, is associated with chronic stimulation of various components of the immune system. Since cell-mediated immunity is also activated, we were interested to test for abnormalities in tryptophan metabolism in SLE which may result from activation of indoleamine 2,3-dioxygenase by cytokines released during the immune response. We measured serum tryptophan and kynurenine concentrations in 52 patients with SLE as well as serum neopterin as an indicator for the degree of immune activation. Compared to controls, we found significantly decreased tryptophan and increased kynurenine concentrations in SLE. The extent of tryptophan catabolism correlates with neopterin concentrations or with the disease activity index. Tryptophan depletion may be associated with neurologic/psychiatric disturbances in patients suffering from SLE.

Depression↗