Key PointsQuestionIs the concurrent receipt of 2 fracture-associated drugs associated with increased risk of hip fracture?FindingsIn this cohort study, 11 million person-years of Medicare data revealed that the receipt of multiple fracture-associated drugs was common among older US residents. Concurrent receipt of 2 or more such drugs was associated with a more than 2-fold increase in hip fracture risk, with some specific combinations appearing especially hazardous, including commonly prescribed drugs, such as opioids, antidepressants, and sedatives.MeaningIf confirmed, results of this cohort study suggest caution when combining fracture-associated medications, especially when use is discretionary, alternatives exist, or baseline fracture risk is high.

Associations between the hospital network measures and guideline adherence suggests new approaches to better disseminate clinical guidelines across health systems.

ObjectiveTo determine whether patients from the Vascular Quality Initiative (VQI) registry who are Medicare–Medicaid dual-eligible have outcomes after surgical intervention with medical devices such as stents for peripheral artery disease comparable to the outcomes of those eligible for Medicare alone.MethodsThe study cohort included fee-for-service Medicare beneficiaries from 2010 to 2015 who underwent peripheral vascular intervention as determined by the VQI. We performed propensity matching between the dual-eligible and non-dual-eligible cohorts. Postintervention use, including imaging, amputation and death, was determined using Medicare claims data.ResultsRates of major amputation were higher among dual-eligible patients (13.0% vs 10.5%, p<0.001), while time to amputation by disease severity was similar (p=0.443). For patients with more advanced disease (critical limb ischaemia (CLI) vs claudication), dual-eligible patients have significantly faster times to any amputation and death (p<0.001). For of postoperative imaging, 48.4% of dual-eligible patients receive at least one postoperative image, while the percentage for non-dual-eligible patients is 47.2% (p=0.187).ConclusionsPatients with mild forms of peripheral artery disease (PAD), such as claudication, demonstrated similar outcomes regardless of dual-eligibility status. However, those with severe PAD, such as CLI, who were also dual-eligible had both inferior overall survival and amputation-free survival. Minimal differences were observed in process-driven aspects of care between dual-eligible and non-dual-eligible patients, including postoperative imaging. These findings indicate that despite receiving similar care, dual-eligible patients with severe PAD have inferior long-term outcomes, suggesting the Medicaid safety net is not timely enough to benefit from long-term outcomes for these patients.

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