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dc.contributor.advisorKate Lapane
dc.contributor.authorMack, Deborah Sara
dc.date2022-08-11T08:08:38.000
dc.date.accessioned2022-08-23T16:02:34Z
dc.date.available2022-08-23T16:02:34Z
dc.date.issued2020-08-27
dc.date.submitted2020-09-18
dc.identifier.doi10.13028/xbbq-0s68
dc.identifier.urihttp://hdl.handle.net/20.500.14038/31331
dc.description.abstractBackground: Statins have questionable benefits among older adults with life-limiting illness. Statin use is widespread among U.S. older adults, but little is known about use in nursing homes. This dissertation was designed to identify the prevalence and predictors of statin pharmacotherapy use and discontinuation in U.S. nursing homes. Methods: Data sources (2011-2016) included: Minimum Data Set 3.0, Medicare administrative claims data, Provider of Service files, and Dartmouth Atlas files. Analyses included: descriptive statistics, multilevel modeling, and proportional change in cluster variations with adjustments to reduce confounding and model misspecification. Results: Approximately 36% of older adults admitted to U.S. nursing homes between 2015 – 2016 were actively using statins at the time of admission. Among long-stay residents with life-limiting illness, 34% were on statins at one time (2016; aged 65-75 years: 44%, >75 years: 31%). Statin use varied significantly by hospital referral regions, with most variation in the >75 age group. Limiting the sample to statin users, 20% discontinued statins within 30 days of nursing home admission. While discontinuation was positively associated with severity of life-limiting condition, the majority of residents remained on statins 30 days post-admission, including those with a < 6-month prognosis. Conclusion: Statin use is pervasive across US nursing homes and persists with life-limiting illness. Geographic variation appeared to coincide with clinical uncertainty, especially among adults >75 with few national guidelines. More needs to be done to prioritize statin deprescribing in nursing homes with research that identifies ways to facilitate improved patient-provider awareness and engagement in the discontinuation process.
dc.language.isoen_US
dc.rightsCopyright is held by the author, with all rights reserved.
dc.subjectstatins
dc.subjectpharmacotherapy
dc.subjectpharmacoepidemiology
dc.subjectpolypharmacy
dc.subjectgeographic variation
dc.subjectdeprescribing
dc.subjectlong-term care
dc.subjectnursing home
dc.subjectolder adults
dc.subjectMedicare beneficiaries
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titleStatin Pharmacotherapy in U.S. Nursing Homes
dc.typeDoctoral Dissertation
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=2114&amp;context=gsbs_diss&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/gsbs_diss/1104
dc.legacy.embargo2022-09-18T00:00:00-07:00
dc.identifier.contextkey19449737
html.description.abstract<p><strong>Background: </strong>Statins have questionable benefits among older adults with life-limiting illness. Statin use is widespread among U.S. older adults, but little is known about use in nursing homes. This dissertation was designed to identify the prevalence and predictors of statin pharmacotherapy use and discontinuation in U.S. nursing homes.</p> <p><strong>Methods: </strong>Data sources (2011-2016) included: Minimum Data Set 3.0, Medicare administrative claims data, Provider of Service files, and Dartmouth Atlas files. Analyses included: descriptive statistics, multilevel modeling, and proportional change in cluster variations with adjustments to reduce confounding and model misspecification.</p> <p><strong>Results: </strong>Approximately 36% of older adults admitted to U.S. nursing homes between 2015 – 2016 were actively using statins at the time of admission. Among long-stay residents with life-limiting illness, 34% were on statins at one time (2016; aged 65-75 years: 44%, >75 years: 31%). Statin use varied significantly by hospital referral regions, with most variation in the >75 age group. Limiting the sample to statin users, 20% discontinued statins within 30 days of nursing home admission. While discontinuation was positively associated with severity of life-limiting condition, the majority of residents remained on statins 30 days post-admission, including those with a < 6-month prognosis.</p> <p><strong>Conclusion: </strong>Statin use is pervasive across US nursing homes and persists with life-limiting illness. Geographic variation appeared to coincide with clinical uncertainty, especially among adults >75 with few national guidelines. More needs to be done to prioritize statin deprescribing in nursing homes with research that identifies ways to facilitate improved patient-provider awareness and engagement in the discontinuation process.</p>
dc.identifier.submissionpathgsbs_diss/1104
dc.contributor.departmentPopulation and Quantitative Health Sciences
dc.description.thesisprogramClinical and Population Health Research
dc.identifier.orcid0000-0002-8619-0364


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