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P OSTER
A BSTRACTS
Conclusion: The focus of incentives motivated clinic activity, but
the impact of care coordination incentives was greatest. Information
about which had greater effect on utilization, patient outcomes, and
clinic quality metrics is required to determine how to alter health policy.
C110
Person and Organizational Correlates of HEDIS High-Risk Drug
Utilization within Veteran’s Administration Nursing Homes.
D. M. Dosa, 2,1 O. Intrator, 2,1 G. Kochersberger, 3 P. Katz. 4 1. Medicine,
Brown University, Providence, RI; 2. Providence Research
Enhancement Award Program, Providence VA Medical Center,
Providence, RI; 3. Canandaigua VAMC, Rochester, NY; 4. Baycrest
Hospital, Toronto, ON, Canada.
Supported By: Veteran’s Administration
Objectives: A common error described in the literature is the
utilization of high risk medications in the elderly—a population most
likely to experience morbidity. This study evaluates the use of medications
classified by the Healthcare Effectiveness Data Information
Set (HEDIS) as high risk in VA Nursing Homes (NHs) and identifies
any patient/organizational correlates of high use.
Methods: Minimum Data Set (MDS) records from 2009 were
merged with VA Pharmacy Data to identify residents of VA NHs who
received at least one medication on the HEDIS high risk list. Utilizing
HEDIS medication use as a quality indicator (QI), the MDS was
then used to identify patient specific correlates of high use (e.g. demographics,
cognitive status, and functional status.) Organizational
practices within specific NHs were identified from a 2010 VA NH
medical director survey. Descriptive statistics (Chi- Square, t-tests)
were used to test associations between person level variables and a
Poisson Regression analysis was conducted to test associations of organizational
characteristics with the QI.
Results: Of 43,577 veterans residing in any of 132 NHs, 2666
(6.4%) received at least 1 HEDIS medication. Females were more
likely to receive a HEDIS drug (10.5 versus 5.9%). Those with better
cognition (7.1%) were more likely to receive a HEDIS drug compared
to those with intermediate(4.6%) or severe cognitive status (4.0%).
Conversely, residents were more likely to get a HEDIS medication as
their functional status declined on a 28-point scale. Among organizational
correlates, increased HEDIS medication use was noted at
homes with increased hospice care, short stay rehabilitation, low cognitive
impairment, and higher acuity. Decreased HEDIS use was associated
with the perception of greater physician supervision by the medical
director (Estimate: -0.69, 95% confidence interval (CI) -0.94 to
-0.43) and by the perception of better NH leadership (Estimate: -0.47;
95% CI: -0.73 to -0.21).All estimates were significant at less than 1%.
Conclusions: The HEDIS QI appears to be important in targeting
veterans receiving high risk medications in VA NHs. Certain subpopulations
are at higher risk for receiving HEDIS medications and
can be targeted for quality improvement efforts.
C111
Food Access in Aging Adults with Impaired Mobility.
D. L. Huang, 1,2 D. E. Rosenberg, 3 S. D. Petz, 4 B. Belza. 4,5 1. Veterans
Affairs Puget Sound Health Care System, Seattle, WA; 2. Division of
Gerontology and Geriatric Medicine, University of Washington,
Seattle, WA; 3. Group Health Research Institute, Seattle, WA; 4. School
of Nursing, University of Washington, Seattle, WA; 5. Health
Promotion Research Center, University of Washington, Seattle, WA.
Supported By: FUNDING: CDC Prevention Research Centers
Program, through a grant to the University of Washington Health
Promotion Research Center (cooperative agreement #U48-DP001911).
Dr. Huang receives salary support from the Department of Veterans
Affairs Advanced Fellowship in Geriatrics.
BACKGROUND: Food access is essential and may be difficult
for aging adults, especially those with impaired mobility. Many aging
adults may not live near locations where they can access food outside
their residence, such as grocery stores. The purpose of this study was
to determine where aging adults access food and built environment
factors affecting their ability to access food.
METHODS: Thirty-five older adults living in the Seattle, WA
metropolitan area who used assistive mobility devices completed
in-depth interviews focusing on built environment barriers and facilitators
in their neighborhood and wore a Global Positioning System
(GPS) device for 3 days. Qualitative data analysis of 20 interviews
to date was completed to date by 2 researchers using Atlas.ti
software.
RESULTS: Participants’ mean age was 66.8 years (range 50-86
years), 9 (25.7%) lived in low-income ( 80 years
old, but evidence-based guidelines specific to the elderly are scarce.
OBJECTIVES To correlate serious episodes of hypoglycemia
(blood sugar < 65 with symptoms) with patient-specific factors and
medication use. METHODS Prospectively designed retrospective
explicit electronic chart review of 140 patients randomly selected out
of a pool of 525 consecutive patients with diabetes that visited our
clinic 8/1-10/30/2010. We excluded subjects as follows: age < 65
(n=3), mislabeled as diabetics (n=6), no follow up visit
4/1–10/30/2011 (n=6), or no follow up HbA1c after enrollment
(n=8). Serious hypoglycemia was defined as blood sugar less than 65
with reported symptoms. Chi 2 and logistic regression techniques
were used to investigate the efficacy (levels of HbA1c, LDL) and
safety (serious hypoglycemia) of chosen medication classes and
achieved therapeutic goals. RESULTS The mean age was 78±8 years
(range 65-100). Other baseline characteristics and univariate results
are shown in table 1. 96% were on statins, yet only 32% had an LDL