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  • ISSN: 2378-9409
    Volume 2, Issue 3
    Short Communications
    Anil N. Makam, Oanh K. Nguyen, Jie Zhou, Kenneth J. Ottenbacher and Ethan A. Halm
    Objective: To assess regional trends in long-term acute care hospital (LTAC) use over time.
    Design, Setting, Participants: Retrospective study using 100% Texas Medicare data. Separate cohorts were created for each year from 2002-2011, which included all beneficiaries residing in 23 hospital referral regions (HRRs) with continuous enrollment in Parts A and B in the previous and current year, or until death.
    Measurements: LTAC utilization rate was defined as the number of individuals with a LTAC stay per 100,000 Medicare beneficiaries residing in the HRR. Baseline LTAC use at the HRR-level was categorized by tertiles of use in 2002.
    Results: Overall, LTAC use increased 35% from 2002-2011and coincided with major Medicare policy changes. However, there were marked regional differences in LTAC utilization trends. From 2002-2011, HRRs in the lowest tertile of baseline LTAC use, which included regions with 0 to 1 LTAC facilities in 2002, had an increase in utilization by 211%, from 190 to 591 individuals per 100,000 persons. In contrast, HRRs in the highest tertile of baseline LTAC use, which included some of the most densely LTAC-bedded regions in the country, experienced a 21% decline (915 to 719 individuals per 100,000 persons; p<0.001 for interaction of LTAC utilization and tertile of baseline use).
    Conclusion: These findings suggest substantial regional variation in the trends in LTAC use over time. Further research is needed to estimate how much of this variation is due to differences in clinical need due to increasing number of severely ill older adults versus regional market supply.
    Research Article
    Jen-Tzer Gau*, Osman Perez, Masato Nakazawa, Brian C Clark, Tzu-Cheg Kao
    Objectives: It is unclear whether the association between lower serum calcium and fracture risk is confounded by lower serum albumin. The purpose of this study is to determine the association between serum calcium levels and fracture risk in the consideration of potential confounders including albumin levels.
    Methods: A case-control study of hospitalized adults aged 50 years or older was conducted in a community hospital of Southeast Ohio between 2006 and 2012. Patients were excluded if they had keto acidosis, bicarbonate <16 mmol/L, calcium levels =11.0 mg/dL, creatinine =3.5 mg/dL, and fractures related to motor vehicle accidents. Cases (N=335: hip fractures=148, non-hip fractures=187) were those diagnosed with fracture(s) as identified by radiography. Controls (N=1,036) were patients without the diagnosis of new fracture, but admitted to the hospital during 2008.
    Results: Case and control groups had similar mean serum calcium levels (8.83±0.49 vs. 8.85±0.51 mg/dL). However, higher serum calcium level emerged as a significant negative risk factor for fractures of all types (adjusted odds ratio [OR] =0.58, 95% CI=0.40-0.85) when potential confounders (including albumin) were adjusted for. Higher calcium level remained significantly associated with a lower risk for hip fracture (adjusted OR=0.50, 95% CI=0.31-0.83), but was not significantly associated with non-hip fracture (adjusted OR=0.65, 95% CI=0.42-1.03) with adjustment of confounders.
    Conclusions: This case-control study suggested that lower serum calcium level was significantly associated with a higher risk for fractures of all types as well as for hip fractures independently of serum albumin levels after adjusting for other confounders among hospitalized adult patients.
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