Geographic Variation in Anticoagulant Use and Resident, Nursing Home, and County Characteristics Associated With Treatment Among US Nursing Home Residents.
Atrial fibrillation
anticoagulants
nursing homes
Journal
Journal of the American Medical Directors Association
ISSN: 1538-9375
Titre abrégé: J Am Med Dir Assoc
Pays: United States
ID NLM: 100893243
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
16
07
2020
revised:
01
10
2020
accepted:
04
10
2020
entrez:
28
12
2020
pubmed:
29
12
2020
medline:
1
7
2021
Statut:
ppublish
Résumé
To quantify geographic variation in anticoagulant use and explore what resident, nursing home, and county characteristics were associated with anticoagulant use in a clinically complex population. A repeated cross-sectional design was used to estimate current oral anticoagulant use on December 31, 2014, 2015, and 2016. Secondary data for United States nursing home residents during the period 2014-2016 were drawn from the Minimum Data Set 3.0 and Medicare Parts A and D. Nursing home residents (≥65 years) with a diagnosis of atrial fibrillation and ≥6 months of Medicare fee-for-service enrollment were eligible for inclusion. Residents in a coma or on hospice were excluded. Multilevel logistic models evaluated the extent to which variation in anticoagulant use between counties could be explained by resident, nursing home, and county characteristics and state of residence. Proportional changes in cluster variation (PCVs), intraclass correlation coefficients (ICCs), and adjusted odds ratios (aORs) were estimated. Among 86,736 nursing home residents from 11,860 nursing homes and 1694 counties, 45% used oral anticoagulants. The odds of oral anticoagulant use were 18% higher in 2016 than 2014 (aOR: 1.18; 95% confidence interval: 1.14-1.22). Most states had counties in the highest (51.3-58.9%) and lowest (31.1%-41.4%) deciles of anticoagulant use. Compared with the null model, adjustment for resident characteristics explained one-third of the variation between counties (PCV: 34.8%). The full model explained 65.5% of between-county variation. Within-county correlation was a small proportion (ICC < 2.2%) of total variation. In this older adult population at high risk for ischemic stroke, less than half of the residents received treatment with anticoagulants. Variation in treatment across counties was partially attributable to the characteristics of residents, nursing homes, and counties. Comparative evidence and refinement of predictive algorithms specific to the nursing home setting may be warranted.
Identifiants
pubmed: 33357746
pii: S1525-8610(20)30846-X
doi: 10.1016/j.jamda.2020.10.001
pmc: PMC8092949
mid: NIHMS1677336
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
164-172.e9Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL126911
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL137734
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL141434
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL136660
Pays : United States
Organisme : NIA NIH HHS
ID : R21 AG060529
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR001454
Pays : United States
Organisme : NIA NIH HHS
ID : K24 AG068300
Pays : United States
Organisme : NHLBI NIH HHS
ID : U54 HL143541
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL137794
Pays : United States
Informations de copyright
Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
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