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Purpose: To describe the use of chiropractic care by urban and rural residents in Washington state with musculoskeletal diagnoses, all of whom have insurance coverage for this care. The analyses investigate whether restricting the analyses to insured individuals attenuates previously reported differences in the prevalence of chiropractic use between urban and rural residents as well as whether differences in provider availability or patient cost-sharing explain the difference in utilization. Methods: Claims data from 237,500 claimants in 2 large insurance companies in Washington state for calendar year 2002 were analyzed, using adjusted clinical group risk adjustment for differences in disease burden and rural urban commuting area codes for rurality definition. Findings: The proportion of claimants using chiropractors was higher in rural than urban residents (44% vs 32%, P less than 0.001). Lack of conventional providers in rural areas did not completely explain this difference, nor did differences in patient cost-sharing or demographics. Among those who used chiropractors, those in urban areas had more chiropractic visits than users of chiropractic in rural areas. Conclusions: Among insured adults, use of chiropractic care was higher in rural than in urban areas. Reasons suggested for this difference in previous reports were not borne out in this data set.

Research use of insurance claims data presents unique challenges and requires a series of value judgments that are intended to improve the data quality. In this study, medical insurance claims [...]

Aortic-valve sclerosis is common in the elderly and can increase the risk of death from heart disease as well as the overall death rate. Aortic-valve sclerosis occurs when the aortic valve of the heart becomes thickened. If the valve is too thick, it can block the flow of blood from the heart. In a study of 5,621 men and women 65 years old or older, 31% had aortic-valve sclerosis. Only 2% had severe enough sclerosis to block blood flow. Aortic-valve sclerosis increased the risk of death from heart disease 66% in patients who had no other pre-existing heart disorder.

Falls in community-dwelling older adults are a complicated phenomenon that are attributed to sociodemographic characteristics, health conditions, functional problems, and environmental factors. The current cross-sectional and correlational study aimed to explore comprehensive risk factors for falls in community-dwelling older adults using a nationally representative data file (N = 5,930). Descriptive statistics were used and multiple logistic regression analyses were performed. Study findings showed that homebound or semi-homebound older adults were 50% more likely to experience a fall than non-homebound individuals. Impaired balance was the strongest predictor (odds ratio [OR] = 2.37, p < 0.001), followed by problems moving around in the home. Arthritis (OR = 1.39, p = 0.009) and depression or anxiety (OR = 1.28, p = 0.013) were additional risk factors. Community health or home health nurses need to assess these risk factors when planning fall intervention programs for older adults using evidence-based prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) screening is underutilized by Medicaid enrollees and the uninsured. Multiple national and state policies were enacted from 2010 to 2014 to increase access to Medicaid and to promote CRC screening among Medicaid enrollees. We aimed to determine the impact of these policies on screening initiation among newly enrolled Oregon Medicaid beneficiaries age-eligible for CRC screening.Methods: We identified national and state policies affecting Medicaid coverage and preventive services in Oregon during 2010-2014. We used Oregon Medicaid claims data from 2010 to 2015 to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening (a prevention milestone, and an age at which guideline-concordant screening can be assessed within a single year) during each year from 2010 to 2014. We calculated risk ratios to assess whether first year of Medicaid enrollment and/or year turned 50 was associated with CRC screening initiation.Results: We identified 14,576 Oregon Medicaid enrollees who turned 50 during 2010-2014; 2429 (17%) completed CRC screening within 12 months after turning 50. Individuals newly enrolled in Medicaid in 2013 or 2014 were 1.58 and 1.31 times more likely, respectively, to initiate CRC screening than those enrolled by 2010. A primary care visit in the calendar year, having one or more chronic conditions, and being Hispanic was also associated with CRC screening initiation.Discussion: The increased uptake of CRC screening in 2013 and 2014 is associated with the timing of policies such as Medicaid expansion, enhanced federal matching for preventive services offered to Medicaid enrollees without cost sharing, and formation of Medicaid accountable care organizations, which included CRC screening as an incentivized quality metric. [ABSTRACT FROM AUTHOR]

A lift team was implemented at an urban medical center in the Pacific Northwest to reduce employee injuries. The lift team consisted of a lift technician and a nursing assistant both trained in lifting techniques. The trial lasted 1 year. Data on employee injuries and day versus night injuries before and during lift team implementation are presented. Results do not show the same reduction in employee injuries described by previous authors. Possible explanations are related to the use of the lift team and policy development.

Background: Since 1996, Washington State law has required that private health insurance cover licensed complementary and alternative medicine (CAM) providers., Objective: To evaluate how insured people used CAM providers and what role this played in healthcare utilization and expenditures., Study Design: Cross-sectional analysis of insurance enrollees from western Washington in 2002., Methods: Analysis of insurance demographic data, claims files, benefit information, diagnoses, CAM and conventional provider utilization, and healthcare expenditures for 3 large health insurance companies., Results: Among more than 600,000 enrollees, 13.7% made CAM claims. This included 1.3% of enrollees with claims for acupuncture, 1.6% for naturopathy, 2.4% for massage, and 10.9% for chiropractic. Patients enrolled in preferred provider organizations and point-of-service products were notably more likely to use CAM than those with health maintenance organization coverage. The use of CAM was greater among women and among persons 31 to 50 years of age. The use of chiropractic was more frequent in less populous counties. The CAM provider visits usually focused on musculoskeletal complaints except for naturopathic physicians, who treated a broader array of problems. The median per-visit expenditures were 39.00 dollars for CAM care and 74.40 dollars for conventional outpatient care. The total expenditures per enrollee were 2589 dollars, of which 75 dollars(2.9%) was spent on CAM., Conclusions: The number of people using CAM insurance benefits was substantial; the effect on insurance expenditures was modest. Because the long-term trajectory of CAM cost under third-party payment is unknown, utilization of these services should be followed.