title: Few Disparities in Baseline Laboratory Testing After the Diuretic or Digoxin Initiation by Medicare Fee-For-Service Beneficiaries.
abstract: Despite the persistence of significant disparities, few evaluations examine disparities in laboratory testing by race/ethnicity, age, sex, Medicaid eligibility, and number of chronic conditions for Medicare fee-for-service beneficiaries' newly prescribed medications. In Medicare beneficiaries initiating diuretics or digoxin, this study examined disparities in guideline-appropriate baseline laboratory testing and abnormal laboratory values.
  
  
  
  To evaluate guideline-concordant testing for serum creatinine and serum potassium within 180 days before or 14 days after the index prescription fill date, we constructed retrospective cohorts from 10 states of 99 711 beneficiaries who had heart failure or hypertension initiating diuretic in 2011 and 8683 beneficiaries who had heart failure or atrial fibrillation initiating digoxin. Beneficiaries initiating diuretics were less likely to have testing if they were non-Hispanic Black (relative risk [RR], 0.99; 95% confidence interval [CI], 0.98-0.99) than non-Hispanic White. Beneficiaries initiating diuretics and beneficiaries initiating digoxin were more likely to have testing if they had multiple chronic conditions relative to 0 to 1 conditions. Beneficiaries initiating diuretics with laboratory values were more likely to have an abnormal serum creatinine value at baseline if they were non-Hispanic Black (RR, 2.57; 95% CI, 1.91-3.44), other race (RR, 2.11; 95% CI, 1.08-4.10), or male (RR, 2.75; 95% CI, 2.14-3.52) or an abnormal serum potassium value if they were aged ≥76 years (RR, 1.29; 95% CI, 1.09-1.51) or male (RR, 1.17; 95% CI, 1.03-1.33).
  
  
  
  Testing rates were consistently high, so there were negligible disparities in guideline-concordant testing of creatinine and potassium after the initiation of digoxin or diuretics by Medicare beneficiaries.
authors.affiliation: From the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC (M.L.M.); Division of General Internal Medicine, Department of Medicine (M.L.M., L.H.C.) and Duke Clinical Research Institute (X.M., L.H.C., B.G.H.), Duke University Medical Center, Durham, NC; National Committee for Quality Assurance, Washington, DC (J.N.); and Office of Minority Health, US Centers for Medicare and Medicaid Services, Baltimore, MD (S.C.H.). mlm34@duke.edu.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: From the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC (M.L.M.); Division of General Internal Medicine, Department of Medicine (M.L.M., L.H.C.) and Duke Clinical Research Institute (X.M., L.H.C., B.G.H.), Duke University Medical Center, Durham, NC; National Committee for Quality Assurance, Washington, DC (J.N.); and Office of Minority Health, US Centers for Medicare and Medicaid Services, Baltimore, MD (S.C.H.).
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Mi
authors.affiliation: From the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC (M.L.M.); Division of General Internal Medicine, Department of Medicine (M.L.M., L.H.C.) and Duke Clinical Research Institute (X.M., L.H.C., B.G.H.), Duke University Medical Center, Durham, NC; National Committee for Quality Assurance, Washington, DC (J.N.); and Office of Minority Health, US Centers for Medicare and Medicaid Services, Baltimore, MD (S.C.H.).
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: From the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC (M.L.M.); Division of General Internal Medicine, Department of Medicine (M.L.M., L.H.C.) and Duke Clinical Research Institute (X.M., L.H.C., B.G.H.), Duke University Medical Center, Durham, NC; National Committee for Quality Assurance, Washington, DC (J.N.); and Office of Minority Health, US Centers for Medicare and Medicaid Services, Baltimore, MD (S.C.H.).
authors.forename: Judy
authors.initials: J
authors.lastname: Ng
authors.affiliation: From the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC (M.L.M.); Division of General Internal Medicine, Department of Medicine (M.L.M., L.H.C.) and Duke Clinical Research Institute (X.M., L.H.C., B.G.H.), Duke University Medical Center, Durham, NC; National Committee for Quality Assurance, Washington, DC (J.N.); and Office of Minority Health, US Centers for Medicare and Medicaid Services, Baltimore, MD (S.C.H.).
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Haffer
authors.affiliation: From the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC (M.L.M.); Division of General Internal Medicine, Department of Medicine (M.L.M., L.H.C.) and Duke Clinical Research Institute (X.M., L.H.C., B.G.H.), Duke University Medical Center, Durham, NC; National Committee for Quality Assurance, Washington, DC (J.N.); and Office of Minority Health, US Centers for Medicare and Medicaid Services, Baltimore, MD (S.C.H.).
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis / Q000592:standards; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D004077:Digoxin / Q000009:adverse effects / Q000627:therapeutic use*; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods / Q000592:standards*; D018588:Fee-for-Service Plans / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D007342:Insurance Benefits / Q000592:standards*; D008297:Male; D006278:Medicare / Q000592:standards*; D016017:Odds Ratio; D011188:Potassium / Q000097:blood; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D044469:Racial Groups; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D004232:Diuretics; D004077:Digoxin; D003404:Creatinine; D011188:Potassium
keywords: Medicare; atrial fibrillation; creatinine; digoxin; heart failure; potassium; safety