Ayse Akincigil

BACKGROUND HMG-CoA reductase inhibitors (statins) are well-established as an effective pharmacotherapy for dyslipidemia, a condition thought to trigger excess amyloid beta (Aβ) aggregation. Statins may therefore also offer prophylaxis against Alzheimer’s Disease and Related Dementias (ADRD). METHODS To assess associations between statin use and ADRD risk, we conducted a secondary analysis of United States Medicare Current Beneficiary Survey (MCBS) data from 2019-2020. Each respondent with ADRD was matched with two other persons based on key demographic characteristics to create cases and comparisons, making for a total of 3,468 Medicare beneficiaries included in the analysis. Beneficiary ADRD diagnosis statuses were identified using MCBS’s self-reported Health Status and Functioning Questionnaire and/or the Health Status section of the MCBS Facility Instrument. Prescription utilization data, as published in the MCBS PME module, was used to identify statin users and nonusers. Associations between statin use and ADRD diagnosis were assessed via Fisher’s exact tests. FINDINGS Statin utilization was associated with significantly reduced ADRD risk (OR 0.68; pCONCLUSIONS While statin use was found to correlate to significantly reduced ADRD risk, longitudinal research remains necessary to confirm that statins are indeed effective prophylactics against ADRD.

There is growing attention to community-based services for preventing adverse health care outcomes among people aging with dementia. We explored whether the availability of dementia-centered programming within older adult centers (ie, senior centers)—specifically, adult day services (ADS), social adult day centers (SADCs), memory cafes, and caregiver support—is associated with reduced hospitalization, emergency room use, and total Medicare costs for community-dwelling individuals ages 75 and older with Alzheimer's disease and related dementias (ADRD), and whether associations differ by the relative size of the local jurisdiction. We used a novel dataset that links Medicare claims data with data from an organizational census of municipally based Massachusetts older adult centers. Living in a community with an older adult center that facilitates access to ADS and/or SADCs was associated with reduced hospital utilization and costs among residents in smaller jurisdictions. We found no evidence for associations concerning memory cafes or support groups. These findings underscore the potential of older adult centers in curbing health care costs and acute care usage among individuals with ADRD, particularly in smaller communities with centers that provide access to ADS.

Objective This article employs a best-worst scaling (BWS) experiment to identify the claims-based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs in the United States. Data Sources Patients and relevant parties, with pediatric antipsychotic oversight and treatment experience, completed a BWS experiment, including policymakers (n = 31), foster care alumni (n = 28), caseworkers (n = 23), prescribing clinicians (n = 32), and caregivers (n = 18). Study Design Respondents received surveys with a scenario on antipsychotic monitoring programs and ranked 11 candidate claims-based outcomes as most and least important for program evaluation. Data Analysis Stratified by respondent group, best-worst scores were calculated to identify the relative importance of the claims-based outcomes. A conditional logit examined whether candidate outcomes for safety, quality, and unintended consequences were preferred over reduction in antipsychotic treatment, the outcome used most often to evaluate antipsychotic monitoring programs. Principal Findings Safety indicators (eg, antipsychotic co-pharmacy, cross-class polypharmacy, higher than recommended doses) ranked among the top three candidate outcomes across respondent groups and were an important complement to antipsychotic treatment reduction. Foster care alumni prioritized "antipsychotic treatment reduction" and "increased psychosocial treatment." Caseworkers, prescribers, and caregivers prioritized "increased follow-up after treatment initiation." Potential unintended consequences of an antipsychotic monitoring program ranked lowest, including increased use of other psychotropic medication classes (as a substitute), increased psychiatric hospital stays, and increased emergency room utilization. Results of the conditional logit model found only caregivers significantly preferred other indicators over antipsychotic treatment reduction, preferring improvements in follow-up care (5.78) and psychosocial treatment (4.53) and reduction in prescriptions of higher than recommended doses (3.64). Conclusions The BWS experiment supported rank ordering of candidate claims-based outcomes demonstrating the opportunity for future studies to align outcomes used in antipsychotic monitoring program evaluations with community preferences, specifically by diversifying metrics to include safety and quality indicators.

Background: Prior authorization of prescription medications is a policy tool that can potentially impact care quality and patient safety.Objective: To examine the effectiveness of a mandatory peer‐review program in reducing antipsychotic prescriptions among Medicaid‐insured children, accounting for secular trends that affected antipsychotic prescribing nationally.Data Source: Medicaid Analytical eXtracts (MAX) with administrative claims for health services provided between January 2006 and December 2011.Study Design: This retrospective, observational study examined prescription claims records from Washington State (Washington) and compared them to a synthetic control drawing from 20 potential donor states that had not implemented any antipsychotic prior authorization program or mandatory peer review for Medicaid‐insured children during the study period. This method provided a means to control for secular trends by simulating the antipsychotic use trajectory that the program state would have been expected to experience in the absence of the policy implementation.Principal Findings: Before the policy implementation, antipsychotic use prevalence closely tracked those of the synthetic control (6.17 per 1000 in Washington vs. 6.21 in the synthetic control group). Within two years after the policy was implemented, prevalence decreased to 4.04 in Washington and remained stable in the synthetic control group (6.47), corresponding to an approximately 38% decline.Conclusion: Prior authorization program designs and implementations vary widely. This mandatory peer‐review program, with an authorization window and two‐stage rollout, was effective in moving population level statistics toward safe and judicious use of antipsychotic medications in children.

Objectives: Drawing on insights from theorizing on cumulative dis/advantage (CDA), we aimed to advance understanding of educational attainment as a protective factor for later-life cognition by examining whether associations between obtaining a bachelor’s degree and later-life cognition differ according to individuals’ likelihood of completing college based on characteristics in adolescence.Methods: We conducted a propensity score analysis with data from the Wisconsin Longitudinal Study (WLS). Measures to predict college completion were assessed prospectively in adolescence, and a global measure of later-life cognition was based on cognitive assessments at age 65.Results: College completion by age 25 (vs high school only) was associated with better later-life cognition for both men and women. Among men specifically, associations were stronger for those who were less likely as adolescents to complete college.Discussion: Results indicate the utility of a CDA perspective for investigating the implications of interconnected early life risk and protective factors for later-life cognition, as well as ways in which college education can both contribute to, as well as mitigate, processes of CDA.

This study employs a mixed methods analysis of exit survey data gathered from public child welfare employees at their completion of a Title IV-E funded MSW program, distinct because it was initiated during a period of major reform and permitted students to continue employment during their studies. Findings suggest that opportunities for growth and manageable levels of stress were associated with intentions to stay and engagement with the work, reflected in respondents’ positive perceptions of their roles in the work environment and their retrospective assessments of the impact of their social work education.

Objectives:Despite high prevalence rates of depression in primary care, depressive symptoms are often undetected by physicians. Screening for depression is now recommended as a part of routine primary care; however, recent estimates of rates and patterns of depression screening are lacking in the literature. This study examined national rates and patterns of depression screening among visits to office-based primary care physicians.Methods:A secondary analysis of data from the 2012 and 2013 National Ambulatory Medical Care Survey was conducted. The sample consisted of 33,653 physician-patient encounters.Results:The overall rate of depression screening was 4.2%. African Americans were half as likely to be screened compared with whites, and elderly patients were half as likely to be screened compared with middle-aged patients. Patients with a chronic condition were more likely than patients without a chronic condition to receive depression screening, and the likelihood of being screened increased with each a...

Objective:The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector.Methods:Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484). The authors computed VA and MarketScan national means for seven process-based quality measures related to medication evaluation and management and estimated national-level performance by age and gender.Results:In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treat...

Clinical informatics, decision support for health professionals, electronic health records, and ehealth infrastructures.