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Kazi DS, Elkind MSV, Deutsch A, Dowd WN, Heidenreich P, Khavjou O, Mark D, Mussolino ME, Ovbiagele B, Patel SS, Poudel R, Weittenhiller B, Powell-Wiley TM, Joynt Maddox KE. Forecasting the Economic Burden of Cardiovascular Disease and Stroke in the United States Through 2050: A Presidential Advisory From the American Heart Association. Circulation 2024; 150:e89-e101. [PMID: 38832515 DOI: 10.1161/cir.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Quantifying the economic burden of cardiovascular disease and stroke over the coming decades may inform policy, health system, and community-level interventions for prevention and treatment. METHODS We used nationally representative health, economic, and demographic data to project health care costs attributable to key cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia) and conditions (coronary heart disease, stroke, heart failure, atrial fibrillation) through 2050. The human capital approach was used to estimate productivity losses from morbidity and premature mortality due to cardiovascular conditions. RESULTS One in 3 US adults received care for a cardiovascular risk factor or condition in 2020. Annual inflation-adjusted (2022 US dollars) health care costs of cardiovascular risk factors are projected to triple between 2020 and 2050, from $400 billion to $1344 billion. For cardiovascular conditions, annual health care costs are projected to almost quadruple, from $393 billion to $1490 billion, and productivity losses are projected to increase by 54%, from $234 billion to $361 billion. Stroke is projected to account for the largest absolute increase in costs. Large relative increases among the Asian American population (497%) and Hispanic American population (489%) reflect the projected increases in the size of these populations. CONCLUSIONS The economic burden of cardiovascular risk factors and overt cardiovascular disease in the United States is projected to increase substantially in the coming decades. Development and deployment of cost-effective programs and policies to promote cardiovascular health are urgently needed to rein in costs and to equitably enhance population health.
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Freiman EC, Monuteaux MC, Michelson KA. Variation and Drivers of Costs for Emergency Department Visits Among Children in 8 States. Hosp Pediatr 2024; 14:258-264. [PMID: 38505934 PMCID: PMC11015896 DOI: 10.1542/hpeds.2023-007417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To describe variation in costs for emergency department (ED) visits among children and to assess hospital and regional factors associated with costs. METHODS Cross-sectional study of all ED encounters among children under 18 years in 8 states from 2014 to 2018. The primary outcome was each hospital's mean inflation-adjusted ED costs. We evaluated variability in costs between hospitals and determined factors associated with costs using hierarchical linear models at the state, region, and hospital levels. Models adjusted for pediatric case mix, regional wages, Medicaid share, trauma status, critical access status, ownership, and market competitiveness. RESULTS We analyzed 22.9 million ED encounters across 713 hospitals. The median ED-level cost was $269 (range 99-1863). There was a 5.1-fold difference in median ED-level costs between the lowest- and highest-cost regions (range 119-605). ED-level costs were associated with case mix index (+38% per 10% increase, 95% confidence interval [CI] 30 to 47); wages [+7% per 10% increase, 95% CI 5 to 9]); critical access (adjusted costs, +24%, 95% CI 13 to 35); for profit status (-20%, 95% CI -26 to -14) compared with nonprofit, lowest trauma designation (+17%, 95% CI 5 to 30); teaching hospital status (+7%, 95% CI 1 to 14); highest number of inpatient beds (+13%, 95% CI 4 to 23); and Medicaid share versus quarter (Q)1 (Q2: -12%, 95% CI -18 to -7; Q3: -13%, 95% CI -19 to -7; Q4: -11%, 95% CI -17 to -4). CONCLUSIONS Our results suggest nonclinical factors are important drivers of pediatric health care costs.
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Affiliation(s)
- Eli C Freiman
- Division of Emergency Medicine, Newton Wellesley Hospital, Newton, Massachusetts
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Kenneth A Michelson
- Division of Emergency Medicine, Lurie Children's Hospital of Chicago, Chicago, Illinois
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Hager K, Emanuel E, Mozaffarian D. Employer-Sponsored Health Insurance Premium Cost Growth and Its Association With Earnings Inequality Among US Families. JAMA Netw Open 2024; 7:e2351644. [PMID: 38227313 DOI: 10.1001/jamanetworkopen.2023.51644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Importance Costs of employer-sponsored health care benefits have increased faster than workers' wages for several decades, with important implications for disparities in earnings and wage stagnation. Objective To quantify how growth in employer-sponsored health insurance (ESI) premiums may have been associated with reduced annual wages, disparities in earnings by race and ethnicity and wage level, and wage stagnation among US families with ESI. Design, Setting, and Participants In this economic evaluation, serial cross-sectional analyses were performed of US families receiving ESI from 1988 to 2019 based on data from the Consumer Expenditure Survey, Kaiser Employer Health Benefits Survey, US Census Bureau's Current Population Survey, and federal payroll taxation rates. Statistical analysis was conducted from February 2022 to July 2023. Main Outcomes and Measures Percentage of annual compensation associated with health care premiums (after accounting for tax deductibility) and lost wages associated with growth in cost of premiums from 1989 to 2019 based on 1988 compensation. To assess disparities, analyses were stratified by race and ethnicity and wage level. Results In 1988, 44.7 million individuals (head of household: mean [SD] age, 43.3 [13.1] years; 30.1% were female; and 2.4% identified as Asian, 6.2% as Hispanic, 8.6% as non-Hispanic Black, and 82.8% as non-Hispanic White) were covered by ESI family plans; this number remained similar in 2019 at 44.8 million individuals (head of household: mean [SD] age, 47.1 [12.9] years; 41.3% were female; and 1.3% identified as Asian, 9.9% as Hispanic, 9.9% as non-Hispanic Black, and 78.9% as non-Hispanic White). In 1988, the mean (SD) household size was 3.3 (1.3) people, and in 2019, it was 3.4 (1.3) people. If ESI costs had remained at the same proportion of the 1988 average compensation package, then in 2019, the median US family with ESI could have earned $8774 (95% CI, $8354-$9195) more in annual wages. During all 32 years, health care premiums as a percentage of compensation were greater for non-Hispanic Black and Hispanic families than for non-Hispanic White families. By 2019, 13.8% (95% CI, 13.5%-14.1%) of compensation among non-Hispanic White families with ESI went to premium costs compared with 19.2% (95% CI, 18.8%-19.7%) among non-Hispanic Black families and 19.8% (19.3%-20.3%) among Hispanic families with ESI. In 2019, health care premiums as a percentage of compensation at the 95th percentile of earnings for families with ESI were 3.9% (95% CI, 3.8%-4.0%) compared with 28.5% (95% CI, 27.8%-29.2%) at the 20th percentile of earnings. From 1988 to 2019, the mean cumulative lost earnings associated with growth in health care premiums for the median US family with ESI was $125 340 (95% CI, $120 155-$130 525) in 2019 dollars, 4.7% of earnings over the 32-year period. Conclusions and Relevance This economic evaluation of US families receiving ESI suggests that 3 decades of increasing health care premiums were likely associated with reduced annual earnings and increased earnings inequality by race and ethnicity and wage level and were meaningfully associated with wage stagnation.
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Affiliation(s)
- Kurt Hager
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
- Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Ezekiel Emanuel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Wharton School, University of Pennsylvania, Philadelphia
| | - Dariush Mozaffarian
- Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
- Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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Kapinos KA, Peters RM, Murphy RE, Hohmann SF, Podichetty A, Greenberg RS. Inpatient Costs of Treating Patients With COVID-19. JAMA Netw Open 2024; 7:e2350145. [PMID: 38170519 PMCID: PMC10765267 DOI: 10.1001/jamanetworkopen.2023.50145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Importance With more than 6.2 million hospitalizations due to COVID-19 in the US, recognition of the average hospital costs to provide inpatient care during the pandemic is necessary to understanding the national medical resource use and improving public health readiness and related policies. Objective To examine the mean cost to provide inpatient care to treat COVID-19 and how it varied through the pandemic waves and by important sociodemographic patient characteristics. Design, Setting, and Participants This cross-sectional study used inpatient-level data from March 1, 2020, to March 31, 2022, extracted from a repository of clinical, administrative, and financial information covering 97% of academic medical centers across the US. Main Outcomes and Measures Cost to produce care for each stay was calculated using direct hospital costs to provide care adjusted for geographic differences in labor costs using area wage indices. Results The sample included 1 333 404 stays with a primary or secondary COVID-19 diagnosis from 841 hospitals. The cohort included 692 550 (52%) men, with mean (SD) age of 59.2 (17.5) years. The adjusted mean cost of an inpatient stay was $11 275 (95% CI, $11 252-$11 297) overall, increasing from $10 394 (95% CI, $10 228-$10 559) at the end of March 2020 to $13 072 (95% CI, $12 528-$13 617) by the end of March 2022. Patients with specific comorbidities had significantly higher mean costs than their counterparts: those with obesity incurred an additional $2924 in inpatient stay costs, and those with coagulation deficiency incurred an additional $3017 in inpatient stay costs. Stays during which the patient required extracorporeal membrane oxygenation (ECMO) had an adjusted mean cost of $36 484 (95% CI, $34 685-$38 284). Conclusions and Relevance In this cross-sectional study, an adjusted mean hospital cost to provide care for patients with COVID-19 increased more than 5 times the rate of medical inflation overall. This appeared to be explained partly by changes in the use of ECMO, which increased over time.
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Affiliation(s)
| | - Richard M. Peters
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Robert E. Murphy
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | | | - Ankita Podichetty
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | - Raymond S. Greenberg
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas
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Wong CH, Li D, Wang N, Gruber J, Lo AW, Conti RM. The estimated annual financial impact of gene therapy in the United States. Gene Ther 2023; 30:761-773. [PMID: 37935855 PMCID: PMC10678302 DOI: 10.1038/s41434-023-00419-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 11/09/2023]
Abstract
Gene therapy is a new class of medical treatment that alters part of a patient's genome through the replacement, deletion, or insertion of genetic material. While still in its infancy, gene therapy has demonstrated immense potential to treat and even cure previously intractable diseases. Nevertheless, existing gene therapy prices are high, raising concerns about its affordability for U.S. payers and its availability to patients. We assess the potential financial impact of novel gene therapies by developing and implementing an original simulation model which entails the following steps: identifying the 109 late-stage gene therapy clinical trials underway before January 2020, estimating the prevalence and incidence of their corresponding diseases, applying a model of the increase in quality-adjusted life years for each therapy, and simulating the launch prices and expected spending of all available gene therapies annually. The results of our simulation suggest that annual spending on gene therapies will be approximately $20.4 billion, under conservative assumptions. We decompose the estimated spending by treated age group as a proxy for insurance type, finding that approximately one-half of annual spending will on the use of gene therapies to treat non-Medicare-insured adults and children. We conduct multiple sensitivity analyses regarding our assumptions and model parameters. We conclude by considering the tradeoffs of different payment methods and policies that intend to ensure patient access to the expected benefits of gene therapy.
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Affiliation(s)
- Chi Heem Wong
- Research Affiliate, MIT Computer Science and Artificial Intelligence Laboratory & Department of Electrical Engineering and Computer Science, Cambridge, MA, 02139, USA
- MIT Sloan School of Management and Laboratory for Financial Engineering, Cambridge, MA, 02142, USA
| | - Dexin Li
- Graduate Student, Department of Economics, Princeton University, Princeton, NJ, 08544, USA
| | - Nina Wang
- Undergraduate Student, Laboratory for Financial Engineering, MIT, Cambridge, MA, 02142, USA
| | - Jonathan Gruber
- Ford Professor of Economics, Chair, Department of Economics, MIT, Cambridge, MA, 02142, USA
| | - Andrew W Lo
- Charles E. and Susan T. Harris Professor, Department of Finance, MIT Sloan School of Management, Director, Laboratory for Financial Engineering & CSAIL, MIT, Cambridge, MA, 02142, USA
| | - Rena M Conti
- Associate Professor and Dean's Scholar, Department of Markets, Public Policy and Law, Questrom School of Business, and Co-Director Technology Policy and Research Institute, Boston University, Boston, MA, 02115, USA.
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Marçal KE. Patterns and predictors of material hardship among poor families with children. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1901-1916. [PMID: 36511430 DOI: 10.1002/jcop.22978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/30/2022] [Accepted: 11/26/2022] [Indexed: 06/14/2023]
Abstract
Experiences of material hardship vary across poor families, but little is understood about this variability. The present study aimed to distinguish subtypes of material hardship as well as which characteristics predict subtypes. Latent class analysis with data from a large, longitudinal study of families with youth children investigated subtypes of material hardship as well as predictors of subtypes. Multinomial logistic regression then predicted class membership used on known housing risk factors maternal IPV victimization, depression, and substance use. Analyses identified three distinct subtypes of material hardship: "Housing Insecure," "Food Insecure," and "Cost-Burdened but Managing." Maternal IPV victimization and depression reduced likelihood of membership in the "Managing" class, but no predictors distinguished families who become food versus housing insecure. Findings suggest widespread financial stress and complex tradeoffs for low-income families, who struggle to afford basic needs. Maternal safety and mental health prove crucial to families' coping abilities. Increased systemic supports targeting specific circumstances may promote stability and prevent more severe hardship.
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Choi Y, Armstrong DP, Moore J. Characteristics of Public Health Registered Nurses and Advanced Practice Registered Nurses: Lessons Learned From the 2018 National Sample Survey of Registered Nurses. Public Health Rep 2023; 138:72S-77S. [PMID: 37226949 PMCID: PMC10226070 DOI: 10.1177/00333549231151877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES Little research has compared the demographic and practice characteristics of registered nurses (RNs) who work in public health (PH RNs) with other RNs and advanced practice registered nurses (APRNs) who work in public health (PH APRNs) with other APRNs. We examined differences in characteristics between PH RNs and other RNs and between PH APRNs and other APRNs. METHODS Using the 2018 National Sample Survey of Registered Nurses (N = 43 960), we examined demographic and practice characteristics, training needs, job satisfaction, and wages of PH RNs compared with other RNs and PH APRNs compared with other APRNs. We used independent sample t tests to determine significant differences between PH RNs and other RNs and between PH APRNs and other APRNs. RESULTS On average, PH RNs and PH APRNs earned significantly less than other RNs ($7082 difference) and APRNs ($16 362 difference) (both P < .001). However, their job satisfaction was comparable. PH RNs and PH APRNs were also significantly more likely than other RNs and APRNs to report the need for more training in social determinants of health (20 [P < .001] and 9 [P = .04] percentage points higher, respectively), working in medically underserved communities (25 and 23 percentage points higher, respectively [P < .001 for both]), population-based health (23 and 20 percentage points higher, respectively [P < .001 for both]), and mental health (13 and 8 percentage points higher, respectively [P < .001 for both]). CONCLUSIONS Efforts that expand public health infrastructure and workforce development must consider the value of a diverse public health nursing workforce to protect community health. Future studies should include more detailed analyses of PH RNs and PH APRNs and their roles.
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Affiliation(s)
- Yongjin Choi
- Health Workforce Technical Assistance Center, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David P Armstrong
- Health Workforce Technical Assistance Center, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Jean Moore
- Center for Health Workforce Studies, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
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Affiliation(s)
- Jonathan Skinner
- From the Department of Economics, Dartmouth College, Hanover, NH (J.S.); the National Bureau of Economic Research, Cambridge, MA (J.S.); New York University, New York (E.C.); and Stanford University (E.C.) and the Stanford Institute for Economic Policy Research (V.R.F.), Stanford, and the Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (V.R.F.) - all in California
| | - Eli Cahan
- From the Department of Economics, Dartmouth College, Hanover, NH (J.S.); the National Bureau of Economic Research, Cambridge, MA (J.S.); New York University, New York (E.C.); and Stanford University (E.C.) and the Stanford Institute for Economic Policy Research (V.R.F.), Stanford, and the Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (V.R.F.) - all in California
| | - Victor R Fuchs
- From the Department of Economics, Dartmouth College, Hanover, NH (J.S.); the National Bureau of Economic Research, Cambridge, MA (J.S.); New York University, New York (E.C.); and Stanford University (E.C.) and the Stanford Institute for Economic Policy Research (V.R.F.), Stanford, and the Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (V.R.F.) - all in California
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Ong CB, Krueger CA, Star AM. The Hospital Frailty Risk Score is Not an Accurate Predictor of Treatment Costs for Total Joint Replacement Patients in a Medicare Bundled Payment Population. J Arthroplasty 2021; 36:2658-2664.e2. [PMID: 33893001 DOI: 10.1016/j.arth.2021.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Medically complex patients require more resources and experience higher costs within total joint arthroplasty (TJA) bundled payment models. While risk adjustment would be beneficial for such patients, no tool currently exists which can reliably identify these patients preoperatively. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is a valid predictor of high-TJA treatment costs. METHODS Retrospective analysis was performed on patients who underwent primary TJA between 2015 and 2020 from a single large orthopedic practice. ICD-10 codes from an institutional database were used to calculate HFRS. Cost data including inpatient, postacute, and episode of care (EOC) costs were collected. Charlson comorbidity index, demographics, readmissions, and complications were analyzed. RESULTS 4936 patients had a calculable HFRS and those with intermediate and high scores experienced more frequent readmissions/complications after TJA, as well as higher EOC costs. However, HFRS did not reliably predict EOC costs, yielding a sensitivity of 49% and specificity of 66%. Multivariate analysis revealed that both patient age and sex are superior individual cost predictors when compared with HFRS. Secondary analyses indicated that HFRS more effectively predicts TJA complications and readmissions but is still nonideal for clinical applications. CONCLUSION HFRS has poor sensitivity as a predictor of high-EOC costs for TJA patients but has adequate specificity for predicting postoperative readmissions and complications. Further research is needed to develop a scale that can appropriately predict orthopedic cost outcomes.
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Affiliation(s)
- Christian B Ong
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Andrew M Star
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Unger JP, Morales I, De Paepe P, Roland M. Neo-Hippocratic healthcare policies: professional or industrial healthcare delivery? A choice for doctors, patients, and their organisations. BMC Health Serv Res 2020; 20:1067. [PMID: 33292193 PMCID: PMC7724692 DOI: 10.1186/s12913-020-05890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethical medical practice requires managing health services to promote professionalism and secure accessibility to care. Commercially financed and industrially managed services strain the physicians' clinical autonomy and ethics because the industry's profitability depends on commercial, clinical standardisation. Private insurance companies also reduce access to care whilst fragmenting and segmenting health systems. Against this background, given the powerful, symbolic significance of their common voice, physicians' and patients' organisations could effectively leverage together political parties and employers' organisations to promote policies favouring access to professional care. MAIN TEXT To provide a foundation for negotiations between physicians' and patients' organisations, we propose policy principles derived from an analysis of rights-holders and duty-bearers' stakes, i.e., patients, physicians and health professionals, and taxpayers. Their concerns are scrutinised from the standpoints of public health and right to health. Illustrated with post-WWII European policies, these principles are formulated as inputs for tentative action-research. The paper also identifies potential stumbling blocks for collective doctor/patient negotiations based on the authors' personal experience. The patients' concerns are care accessibility, quality, and price. Those of physicians and other professionals are problem-solving capacity, autonomy, intellectual progress, ethics, work environment, and revenue. The majority of taxpayers have an interest in taxes being progressive and public spending on health regressive. Mutual aid associations tend to under-estimate the physician's role in delivering care. Physicians' organisations often disregard the mission of financing care and its impact on healthcare quality. CONCLUSION The proposed physicians-patients' alliance could promote policies in tune with professional ethics, prevent European policies' putting industrial concerns above suffering and death, bar care financing from the ambit of international trade treaties, and foster international cooperation policies consistent with the principles that inspire the design of healthcare policies at home and so reduce international migration. To be credible partners in this alliance, physicians' associations should promote a public health culture amongst their members and a team culture in healthcare services. To promote a universal health system, patients' organisations should strive to represent universal health interests rather than those of patients with specific diseases, ethnic groups, or social classes.
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Affiliation(s)
- Jean-Pierre Unger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - Ingrid Morales
- Office de la Naissance et de l’Enfance, French Community of Belgium, Chaussée de Charleroi 95, B-1060 Brussels, Belgium
| | - Pierre De Paepe
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - Michel Roland
- Département de Médecine Générale, Université Libre de Bruxelles, Route de Lennik, 808, BP 612/1, B-1070 Brussels, Belgium
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Abstract
INTRODUCTION Anterior cervical discectomy and fusion (ACDF) remain an effective treatment option for multiple pathologies of the cervical spine. As the health care economic climate has changed, so have reimbursements with a concomitant push toward outpatient procedures. Certificate of Need (CON) programs were established in response to burgeoning health care costs which require states to demonstrate need before expansion of medical facilities. The impact of this program on spine surgery is largely unknown. The purpose of this study was to examine the impact of CON status on reimbursement and utilization trends of ACDF in both inpatient and outpatient settings. MATERIALS AND METHODS We queried a combined private payer and Medicare database from 2007 to 2015. All single-level ACDFs were identified. We then split each procedure into those performed in CON versus non-CON states. We then further split each group into the inpatient and outpatient settings. Compound annual growth rate (CAGR) was used to compare utilization and reimbursement trends. Reimbursement was adjusted for inflation using the United States Bureau of Labor Statistics consumer price index. RESULTS A total of 32,727 single-level ACDFs were identified, of which 28,441 were performed in the inpatient setting, and 4286 were performed in the outpatient setting. Reimbursement decreased across all settings, with the most pronounced decrease in the non-CON outpatient setting with an adjusted CAGR of -11.0%. Utilization increased across all groups, although the fastest growth was seen in the outpatient CON setting with a CAGR of 47.7%, and the slowest growth seen in the inpatient non-CON setting at a CAGR of 12.9%. CONCLUSIONS ACDF utilization increased most rapidly in the outpatient setting, and CON status did not appear to hinder growth. Reimbursement decreased across all settings, with the outpatient setting in non-CON states most affected. Surgeons should be aware of these trends in the changing health care environment.
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Mousavi B, Maftoon F, Soroush M, Mohammad K, Majdzadeh R. Health Care Utilization and Expenditure in War Survivors. ARCHIVES OF IRANIAN MEDICINE 2020; 23:S9-S15. [DOI: 10.34172/aim.2020.s3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/12/2019] [Indexed: 11/09/2022]
Abstract
Background: To describe the utilization and out-of-pocket (OOP) payments of war survivors receiving health care services and its determinants. Methods: A cross-sectional study was carried out by systematic random sampling at national level (n = 3079) on healthcare utilization in war survivors on their last received services. A validated questionnaire was used to gather the information of inpatient and outpatient healthcare services and OOP payment. The data were analyzed to indicate the determinants of health utilization and expenses. Results: Health care utilization was reported in 91.6% (n = 2822). The majority (82.5%) received one or two services in their last visits, mostly related to physician visits and medications (65.97%). Health care utilization was higher than general population annually, especially in physician visit (6.6 versus 4.89), medication (5.1 versus 3.6), and hospitalization (0.78 versus 0.15). About 20.2% (n = 599) of the study population paid out of their pocket for their last medical care services. The frequency of OOP payment was greater for physician visit and medication. Payment for hospitalization, imaging, and lab tests were more significantly associated with proceeding to reimburse the expenses (P<0.001). The median OOP payment was US$10.8 (interquartile range US$20.6). Gender (P=0.003), area of residence (P=0.01) and being war victims (P=0.005) were the significant determinants for both OOP payments and reclaiming the expenditure. Higher amount of payments (P<0.001) and more received health services (P=0.002) were also important factors in reclaiming the expenditure. Conclusion: Both outpatient services and hospital admission are more frequent among war survivors compared to the general Iranian population. Future studies should attempt to explore the reasons.
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Affiliation(s)
- Batool Mousavi
- Prevention Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, IR Iran
| | - Farzaneh Maftoon
- Population Health Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, IR Iran
| | | | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Community Based Participatory Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Carman KG, Liu J, White C. Accounting for the burden and redistribution of health care costs: Who uses care and who pays for it. Health Serv Res 2020; 55:224-231. [PMID: 31984503 PMCID: PMC7080400 DOI: 10.1111/1475-6773.13258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To measure the burden of financing health care costs and quantify redistribution among population groups. Data Sources A synthetic population using data combined from multiple sources, including the Survey of Income and Program Participation (SIPP), Medical Expenditure Panel Survey (MEPS), Kaiser Family Foundation (KFF)/Health Research Educational Trust (HRET) Employer Health Benefits Survey, American Community Survey (ACS), and National Health Expenditure Accounts (NHEA). Study Design We estimate two dollar amounts for each individual in the synthetic population: (a) payments to finance health care services, which includes all payments by a household and their employers to finance health care, including premiums, out‐of‐pocket payments, federal and state taxes, and other payments; and (b) the dollar value of health care services received, which equals the amount paid to providers for those services. Data Extraction Methods We linked the nationally representative survey data using statistical matching. We allocated health care expenditures from the NHEA to individuals and households based on expenditures reported in the MEPS. Principal Findings We show that higher‐income households pay the most to finance health care in dollar amounts, but the burden of payments as a share of income is greater among lower‐income households. Conclusions Accounting for all sources of payments provides a clear picture of the burden of financing health care costs, and how that burden is spread under our current financing system.
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Affiliation(s)
| | - Jodi Liu
- RAND Corporation, Santa Monica, California
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Does certificate-of-need status impact lumbar microdecompression reimbursement and utilization? A retrospective database review. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jacobs PD, Selden TM. Changes In The Equity Of US Health Care Financing In The Period 2005-16. Health Aff (Millwood) 2019; 38:1791-1800. [PMID: 31618081 DOI: 10.1377/hlthaff.2019.00625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spending on health care in the United States amounted to 17.9 percent of gross domestic product in 2017. Households paid for this care through out-of-pocket medical spending and a complex mix of out-of-pocket premiums, employer premium contributions, taxes, and subsidies that combined to finance private employer-sponsored insurance, nongroup insurance, and multiple public insurance programs. Our analysis examined the impact of this complex system of health care financing on households in the period 2005-16, tracking how economic and policy changes affected incidence-that is, the amount paid to finance health care, either directly or indirectly, by households as a share of their pretax income. Health care financing was regressive at the start of our study period, with households in the bottom 20 percent of income paying 26.8 percent of their income compared to about half that amount for those with income in the top 1 percent. By 2016 incidence had become approximately proportional (the same percentage across all income levels). In part, these results reflect increases in coverage through Medicaid and the Affordable Care Act Marketplaces, which are progressively financed through the federal tax system.
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Affiliation(s)
- Paul D Jacobs
- Paul D. Jacobs ( paul. jacobs@ahrq. hhs. gov ) is a senior fellow in the Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), in Rockville, Maryland
| | - Thomas M Selden
- Thomas M. Selden is director of the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, AHRQ
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Matsumoto AH. The 2019 Dotter Lecture: Patients and Patience: Why Interventional Radiologists Need Both. J Vasc Interv Radiol 2019; 30:1581-1585. [PMID: 31522980 DOI: 10.1016/j.jvir.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Alan H Matsumoto
- Department of Radiology and Medical Imaging, 1215 Lee Street, Box 800170, Room 1839, University of Virginia Health, Charlottesville, VA 22908.
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Collins B, Kypridemos C, Pearson-Stuttard J, Huang Y, Bandosz P, Wilde P, Kersh R, Capewell S, Mozaffarian D, Whitsel LP, Micha R, O'Flaherty M. FDA Sodium Reduction Targets and the Food Industry: Are There Incentives to Reformulate? Microsimulation Cost-Effectiveness Analysis. Milbank Q 2019; 97:858-880. [PMID: 31332837 PMCID: PMC6739614 DOI: 10.1111/1468-0009.12402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Policy Points The World Health Organization has recommended sodium reduction as a “best buy” to prevent cardiovascular disease (CVD). Despite this, Congress has temporarily blocked the US Food and Drug Administration (FDA) from implementing voluntary industry targets for sodium reduction in processed foods, the implementation of which could cost the industry around $16 billion over 10 years. We modeled the health and economic impact of meeting the two‐year and ten‐year FDA targets, from the perspective of people working in the food system itself, over 20 years, from 2017 to 2036. Benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, and the value of CVD‐related health gains and cost savings are together greater than the government and industry costs of reformulation.
Context The US Food and Drug Administration (FDA) set draft voluntary targets to reduce sodium levels in processed foods. We aimed to determine cost effectiveness of meeting these draft sodium targets, from the perspective of US food system workers. Methods We employed a microsimulation cost‐effectiveness analysis using the US IMPACT Food Policy model with two scenarios: (1) short term, achieving two‐year FDA reformulation targets only, and (2) long term, achieving 10‐year FDA reformulation targets. We modeled four close‐to‐reality populations: food system “ever” workers; food system “current” workers in 2017; and subsets of processed food “ever” and “current” workers. Outcomes included cardiovascular disease cases prevented and postponed as well as incremental cost‐effectiveness ratio per quality‐adjusted life year (QALY) gained from 2017 to 2036. Findings Among food system ever workers, achieving long‐term sodium reduction targets could produce 20‐year health gains of approximately 180,000 QALYs (95% uncertainty interval [UI]: 150,000 to 209,000) and health cost savings of approximately $5.2 billion (95% UI: $3.5 billion to $8.3 billion), with an incremental cost‐effectiveness ratio (ICER) of $62,000 (95% UI: $1,000 to $171,000) per QALY gained. For the subset of processed food industry workers, health gains would be approximately 32,000 QALYs (95% UI: 27,000 to 37,000); cost savings, $1.0 billion (95% UI: $0.7bn to $1.6bn); and ICER, $486,000 (95% UI: $148,000 to $1,094,000) per QALY gained. Because many health benefits may occur in individuals older than 65 or the uninsured, these health savings would be shared among individuals, industry, and government. Conclusions The benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, with the value of health gains and health care cost savings outweighing the costs of reformulation, although not for the processed food industry.
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Affiliation(s)
| | | | | | - Yue Huang
- Friedman School of Nutrition Science and Policy, Tufts University
| | - Piotr Bandosz
- University of Liverpool.,Medical University of Gdansk
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University
| | | | | | | | | | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University
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Unger JP, De Paepe P. Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency? INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2019; 49:431-456. [PMID: 31067137 PMCID: PMC6560522 DOI: 10.1177/0020731419847113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article evaluates the performance of 3 industrialized nations that have pursued market-based financing models, focusing on equity in access to care, care quality, health status, and efficiency. It then assesses the consistency of the findings with those of different research teams. Using secondary data obtained from a semi-structured review of articles from 2000 to 2017, we discuss the hypothesis that commercial health care insurance is detrimental to accessing professional health care and to population health status. The results show that in 2010 the unmet care needs of both poor and rich Americans exceeded those of the poor in several industrial countries. The number of Dutch adults experiencing financial obstacles to health care quadrupled between 2007 and 2013, and 22% of Swiss adults reported skipping needed care in a 2016 survey. The most negative impacts of "managed care" on care quality are its tight constraints on physicians' professional autonomy; a large reliance on the physicians' material motivation; health service fragmentation; and the tendency to apply evidence-based medicine too rigidly. Countries with a commercial insurance monopoly generally remained above the maternal, infant, and neonatal mortality rates versus the health-spending regression line. We conclude that the most inefficient system is where the insurance market has achieved its maximal development and that care industrialization contributes to the comparatively poor performance of the U.S., Dutch, and Swiss health systems.
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Affiliation(s)
- Jean-Pierre Unger
- Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerp, Belgium
| | - Pierre De Paepe
- Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerp, Belgium
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Lavigne JE, Brown J, Matzke GR. Population health and medicine: Policy and financial drivers. Am J Health Syst Pharm 2019; 74:1413-1421. [PMID: 28887343 DOI: 10.2146/ajhp161051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The financial and policy levers of population health and potential opportunities for pharmacists are described. SUMMARY Three long-standing problems drive the focus on population health: (1) the United States suffers far worse population health outcomes compared with those of other developed nations that spend significantly less on healthcare, (2) the U.S. healthcare system's focus on "sick care" fails to address upstream prevention and population health improvement, and (3) financial incentives for healthcare delivery are poorly aligned with improvements in population health outcomes. The Patient Protection and Affordable Care Act of 2010 (ACA) was arguably the first major healthcare legislation since 1965 and had 3 main strategies for improving population health: expand health insurance coverage, control healthcare costs, and improve the healthcare delivery system. Federal and state legislation as well as Medicare and Medicaid financing strategies have designated mechanisms to reward advances in population outcomes since the passage of the ACA. States are responsible for many of the factors that affect population health, and a bipartisan effort that builds upon state and federal collaboration will likely be needed to implement the necessary health policy initiative. Population health issues affect productivity in the United States; conversely, improvements in population health may increase productivity, helping to offset the rising federal debt. Employers are in a position to improve population health and consequently help reduce the federal debt by addressing lifestyle, chronic disease, poverty, and inequality. National pharmacy organizations, regulatory bodies, and journal editors need to collectively agree to a threshold of quality and rigor for publication and endorsement. CONCLUSION Knowledge of the policy and financial drivers of population health may both support pharmacists' efforts to improve population outcomes and identify opportunities for professional advancement.
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Affiliation(s)
- Jill E Lavigne
- Department of Pharmacy Practice and Administration, Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY.
| | - Jack Brown
- Department of Pharmacy Practice and Administration, Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY
| | - Gary R Matzke
- Virginia Commonwealth University School of Pharmacy, Richmond, VA
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Ayub S, Scali ST, Richter J, Huber TS, Beck AW, Fatima J, Berceli SA, Upchurch GR, Arnaoutakis D, Back MR, Giles KA. Financial implications of coding inaccuracies in patients undergoing elective endovascular abdominal aortic aneurysm repair. J Vasc Surg 2019; 69:210-218. [DOI: 10.1016/j.jvs.2018.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/03/2018] [Indexed: 11/24/2022]
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Sanderson J, Lonsdale C, Mannion R. What's Needed to Develop Strategic Purchasing in Healthcare? Policy Lessons from a Realist Review. Int J Health Policy Manag 2019; 8:4-17. [PMID: 30709098 PMCID: PMC6358649 DOI: 10.15171/ijhpm.2018.93] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/11/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In the context of serious concerns over the affordability of healthcare, various authors and international policy bodies advise that strategic purchasing is a key means of improving health system performance. Such advice is typically informed by theories from the economics of organization (EOO). This paper proposes that these theories are insufficient for a full understanding of strategic purchasing in healthcare, because they focus on safeguarding against poor performance and ignore the coordination and adaptation needed to improve performance. We suggest that insights from other, complementary theories are needed. METHODS A realist review method was adopted involving 3 steps: first, drawing upon complementary theories from the EOO and inter-organizational relationships (IOR) perspectives, a theoretical interpretation framework was developed to guide the review; second, a purposive search of scholarly databases to find relevant literature addressing healthcare purchasing; and third, qualitative analysis of the selected texts and thematic synthesis of the results focusing on lessons relevant to 3 key policy objectives taken from the international health policy literature. Texts were included if they provided relevant empirical data and met specified standards of rigour and robustness. RESULTS A total of 58 texts were included in the final analysis. Lessons for patient empowerment included: the need for clearly defined rights for patients and responsibilities for purchasers, and for these to be enacted through regular patientpurchaser interaction. Lessons for government stewardship included: the need for health strategy to contain specific targets to incentivise purchasers to align with national policy objectives, and for national government actors to build close, trusting relationships with purchasers to facilitate access to local knowledge about needs and priorities. Lessons for provider performance included: provider decision autonomy may drive innovation and efficient resource use, but may also create scope for opportunism, and interdependence likely to be the best power structure to incentivise collaboration needed to drive performance improvement. CONCLUSION Using complementary theories suggests a range of general policy lessons for strategic purchasing in healthcare, but further empirical work is needed to explore how far these lessons are a practically useful guide to policy in a variety of healthcare systems, country settings and purchasing process phases.
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Affiliation(s)
- Joe Sanderson
- Birmingham Business School, University of Birmingham, Birmingham, UK
| | - Chris Lonsdale
- Birmingham Business School, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Artino AR. Graduate Programs in Health Professions Education: Preparing Academic Leaders for Future Challenges. J Grad Med Educ 2018; 10:119-122. [PMID: 29686748 PMCID: PMC5901787 DOI: 10.4300/jgme-d-18-00082.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Bradley EH, Canavan M, Rogan E, Talbert-Slagle K, Ndumele C, Taylor L, Curry LA. Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09. Health Aff (Millwood) 2018; 35:760-8. [PMID: 27140980 DOI: 10.1377/hlthaff.2015.0814] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted.
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Affiliation(s)
- Elizabeth H Bradley
- Elizabeth H. Bradley is the Brady-Johnson Professor of Grand Strategy and a professor of public health at the Yale School of Public Health, in New Haven, Connecticut
| | - Maureen Canavan
- Maureen Canavan is an associate research scientist in health policy and management at the Yale School of Public Health
| | - Erika Rogan
- Erika Rogan is a doctoral candidate in health policy and management at the Yale School of Public Health
| | - Kristina Talbert-Slagle
- Kristina Talbert-Slagle is a senior scientific officer and lecturer of health policy and management at the Yale School of Public Health
| | - Chima Ndumele
- Chima Ndumele is an assistant professor of health policy and management at the Yale School of Public Health
| | - Lauren Taylor
- Lauren Taylor is a doctoral student at the Harvard Business School, in Boston, Massachusetts
| | - Leslie A Curry
- Leslie A. Curry is a senior research scientist at the Yale School of Public Health
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Burke LG, Wild RC, Orav EJ, Hsia RY. Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries. BMJ Open 2018; 8:e019357. [PMID: 29382680 PMCID: PMC5829666 DOI: 10.1136/bmjopen-2017-019357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE There has been concern that an increase in billing for high-intensity emergency care is due to changes in coding practices facilitated by electronic health records. We sought to characterise the trends in billing for high-intensity emergency care among Medicare beneficiaries and to examine the degree to which trends in high-intensity billing are explained by changes in patient characteristics and services provided in the emergency department (ED). DESIGN, SETTING AND PARTICIPANTS Observational study using traditional Medicare claims to identify ED visits at non-federal acute care hospitals for elderly beneficiaries in 2006, 2009 and 2012. OUTCOMES MEASURES Billing intensity was defined by emergency physician evaluation and management (E&M) codes. We tested for overall trends in high-intensity billing (E&M codes 99285, 99291 and 99292) and in services provided over time using linear regression models, adjusting for patient characteristics. Additionally, we tested for time trends in rates of admission to the hospital and to the intensive care unit (ICU). Next, we classified outpatient visits into 39 diagnosis categories and analysed the change in proportion of high-intensity visits versus the change in number of services. Finally, we quantified the extent to which trends in high-intensity billing are explained by changes in patient demographics and services provided in the ED using multivariable modelling. RESULTS High-intensity visits grew from 45.8% of 671 103 visits in 2006 to 57.8% of 629 010 visits in 2012 (2.0% absolute increase per year; 95% CI 1.97% to 2.03%) as did the mean number of services provided for admitted (1.28 to 1.41; +0.02 increase in procedures per year; 95% CI 0.018 to 0.021) and discharged ED patients (7.1 to 8.6; +0.25 increase in services per year; 95% CI 0.245 to 0.255). There was a reduction in hospital admission rate from 40.1% to 35.9% (-0.68% per year; 95% CI -0.71% to -0.65%; P<0.001), while the ICU rate of admission rose from 11.7% to 12.3% (+0.11% per year; 95% CI 0.09% to 0.12%; P<0.001). When we stratified by diagnosis category, there was a moderate correlation between change in visits billed as high intensity and the change in mean number of services provided per visit (r=0.38; 95% CI 0.07 to 0.63). Trends in patient characteristics and services provided accounted moderately for the trend in practice intensity for outpatient visits (pseudo R2 of 0.47) but very little for inpatient visits (0.051) and visits overall (0.148). CONCLUSIONS Increases in services provided in the ED moderately account for the trends in billing for high-intensity emergency care for outpatient visits.
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Affiliation(s)
- Laura G Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Cambridge, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115
| | - Robert C Wild
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - E John Orav
- Department of Biostatistics, Harvard T H Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Renee Y Hsia
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Philip R Lee Institute of Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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Trtovac D, Lee J. The Use of Technology in Identifying Hospital Malnutrition: Scoping Review. JMIR Med Inform 2018; 6:e4. [PMID: 29351894 PMCID: PMC5797288 DOI: 10.2196/medinform.7601] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 10/06/2017] [Accepted: 10/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Malnutrition is a condition most commonly arising from the inadequate consumption of nutrients necessary to maintain physiological health and is associated with the development of cardiovascular disease, osteoporosis, and sarcopenia. Malnutrition occurring in the hospital setting is caused by insufficient monitoring, identification, and assessment efforts. Furthermore, the ability of health care workers to identify and recognize malnourished patients is suboptimal. Therefore, interventions focusing on the identification and treatment of malnutrition are valuable, as they reduce the risks and rates of malnutrition within hospitals. Technology may be a particularly useful ally in identifying malnutrition due to scalability, timeliness, and effectiveness. In an effort to explore the issue, this scoping review synthesized the availability of technological tools to detect and identify hospital malnutrition. Objective Our objective was to conduct a scoping review of the different forms of technology used in addressing malnutrition among adults admitted to hospital to (1) identify the extent of the published literature on this topic, (2) describe key findings, and (3) identify outcomes. Methods We designed and implemented a search strategy in 3 databases (PubMed, Scopus, and CINAHL). We completed a descriptive numerical summary and analyzed study characteristics. One reviewer independently extracted data from the databases. Results We retrieved and reviewed a total of 21 articles. We categorized articles by the computerized tool or app type: malnutrition assessment (n=15), food intake monitoring (n=5), or both (n=1). Within those categories, we subcategorized the different technologies as either hardware (n=4), software (n=13), or both (n=4). An additional subcategory under software was cloud-based apps (n=1). Malnutrition in the acute hospital setting was largely an unrecognized problem, owing to insufficient monitoring, identification, and initial assessments of identifying both patients who are already malnourished and those who are at risk of malnourishment. Studies went on to examine the effectiveness of health care workers (nurses and doctors) with a knowledge base focused on clinical care and their ability to accurately and consistently identify malnourished geriatric patients within that setting. Conclusions Most articles reported effectiveness in accurately increasing malnutrition detection and awareness. Computerized tools and apps may also help reduce health care workers’ workload and time spent assessing patients for malnutrition. Hospitals may also benefit from implementing malnutrition technology through observing decreased length of stay, along with decreased foregone costs related to missing malnutrition diagnoses. It is beneficial to study the impact of these technologies to examine possible areas of improvement. A future systematic review would further contribute to the evidence and effectiveness of the use of technologies in assessing and monitoring hospital malnutrition.
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Affiliation(s)
- Dino Trtovac
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Joon Lee
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Christopher AS, Himmelstein DU, Woolhandler S, McCormick D. The Effects of Household Medical Expenditures on Income Inequality in the United States. Am J Public Health 2018; 108:351-354. [PMID: 29345995 DOI: 10.2105/ajph.2017.304213] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effect of households' outlays for medical expenditures on income inequality and changes since the implementation of the Affordable Care Act (ACA). METHODS We analyzed data from the US Current Population Surveys for calendar years 2010 through 2014. We calculated the Gini index of income inequality before and after subtracting households' medical outlays (including insurance premiums and out-of-pocket costs) from income, the financial burden of medical outlays for each income decile, and the number of individuals pushed below poverty by medical outlays. RESULTS In 2014, the Gini index was 47.84, which rose to 49.21 after medical outlays were subtracted, indicating that medical outlays effectively redistributed about 1.37% of total income from poorer to richer individuals, a slightly smaller redistribution compared with the years before the ACA. Medical outlays reduced the median income of the poorest decile by 47.6% versus 2.7% for the wealthiest decile and pushed 7.013 million individuals into poverty. CONCLUSIONS The way we finance medical care exacerbates income inequality and impoverishes millions of Americans. This regressive financing pattern improved minimally in the wake of the ACA.
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Affiliation(s)
- Andrea S Christopher
- Andrea S. Christopher is with the Department of Medicine, Boise Veterans Affairs Medical Center, Boise, ID, and the University of Washington School of Medicine, Seattle. David U. Himmelstein and Steffie Woolhandler are with the School of Urban Public Health, City University of New York at Hunter College, New York, NY, and the Department of Medicine, Harvard Medical School, Boston, MA. Danny McCormick is with the Department of Medicine, Harvard Medical School and Cambridge Health Alliance, Cambridge, MA
| | - David U Himmelstein
- Andrea S. Christopher is with the Department of Medicine, Boise Veterans Affairs Medical Center, Boise, ID, and the University of Washington School of Medicine, Seattle. David U. Himmelstein and Steffie Woolhandler are with the School of Urban Public Health, City University of New York at Hunter College, New York, NY, and the Department of Medicine, Harvard Medical School, Boston, MA. Danny McCormick is with the Department of Medicine, Harvard Medical School and Cambridge Health Alliance, Cambridge, MA
| | - Steffie Woolhandler
- Andrea S. Christopher is with the Department of Medicine, Boise Veterans Affairs Medical Center, Boise, ID, and the University of Washington School of Medicine, Seattle. David U. Himmelstein and Steffie Woolhandler are with the School of Urban Public Health, City University of New York at Hunter College, New York, NY, and the Department of Medicine, Harvard Medical School, Boston, MA. Danny McCormick is with the Department of Medicine, Harvard Medical School and Cambridge Health Alliance, Cambridge, MA
| | - Danny McCormick
- Andrea S. Christopher is with the Department of Medicine, Boise Veterans Affairs Medical Center, Boise, ID, and the University of Washington School of Medicine, Seattle. David U. Himmelstein and Steffie Woolhandler are with the School of Urban Public Health, City University of New York at Hunter College, New York, NY, and the Department of Medicine, Harvard Medical School, Boston, MA. Danny McCormick is with the Department of Medicine, Harvard Medical School and Cambridge Health Alliance, Cambridge, MA
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Comparing comparables: an approach to accurate cross-country comparisons of health systems for effective healthcare planning and policy guidance. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2015.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cook WA, Morrison ML, Eaton LH, Theodore BR, Doorenbos AZ. Quantity and Quality of Economic Evaluations in U.S. Nursing Research, 1997-2015: A Systematic Review. Nurs Res 2017; 66:28-39. [PMID: 27893648 PMCID: PMC5159252 DOI: 10.1097/nnr.0000000000000188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The United States has a complex healthcare system that is undergoing substantial reformations. There is a need for high-quality, economic evaluations of nursing practice. An updated review of completed economic evaluations relevant to the field of nursing within the U.S. healthcare system is timely and needed. OBJECTIVES The purpose of this study was to evaluate and describe the quantity and quality of economic evaluations in nursing-relevant research performed in the United States between 1997 and 2015. METHODS Four databases were searched. Titles, abstracts, and full-text content were reviewed to identify studies that analyzed both costs and outcomes, relevant to nursing, performed in the United States, and used the quality-adjusted life year to measure effectiveness. For included studies, data were extracted from full-text articles using criteria from U.S. Public Health Service's Panel on Cost-Effectiveness in Health and Medicine. RESULTS Twenty-eight studies met the inclusion criteria. Most (n = 25, 89%) were published in the last decade of the analysis, from 2006 to 2015. Assessment of quality, based on selected items from the panel guidelines, found that the evaluations did not consistently use the recommended societal perspective, use multiple resource utilization categories, use constant dollars, discount future costs and outcomes, use a lifetime horizon, or include an indication of uncertainty in results. The only resource utilization category consistently included across studies was healthcare resources. DISCUSSION Only 28 nursing-related studies meeting the inclusion criteria were identified as meeting robust health economic evaluation methodological criteria, and most did not include all important guideline items. Despite increases in absolute numbers of published studies over the past decade, economic evaluation has been underutilized in U.S. nursing-relevant research in the past two decades.
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Affiliation(s)
- Wendy A Cook
- Wendy A. Cook, PhD, RN, CCNS, is U.S. Navy Nurse Corps Nurse Scientist, Naval Medical Center San Diego, California, and Affiliate Assistant Professor, School of Nursing, University of Washington, Seattle. Megan L. Morrison, PhD, ARNP, FNP-BC, ACHPN, is Palliative and Supportive Care Attending Nurse Practitioner, Northwest Hospital and Medical Center, Seattle, Washington. Linda H. Eaton, PhD, RN, AOCN, is Project Director, Pain and Symptom Management in Rural Communities, School of Nursing, University of Washington, Seattle, and Post-Doctoral Research Fellow, University of Utah College of Nursing, Salt Lake City. Brian R. Theodore, PhD, is Research Assistant Professor, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle. Ardith Z. Doorenbos, PhD, RN, FAAN, is Professor, School of Nursing and School of Medicine, University of Washington, Seattle
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Holmes AV, Long M, Stallworth J. We Can Teach How to Bend the Cost Curve: Lessons in Pediatric High-Value Health Care. Pediatrics 2017; 139:peds.2016-4016. [PMID: 28196930 DOI: 10.1542/peds.2016-4016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alison Volpe Holmes
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; .,Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire.,The Dartmouth Institute, Lebanon, New Hampshire
| | - Michele Long
- Department of Pediatrics, School of Medicine, and.,UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; and
| | - James Stallworth
- Division of General Pediatrics, Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina
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Mehrotra A, Huckfeldt PJ, Haviland AM, Gascue L, Sood N. Patients Who Choose Primary Care Physicians Based On Low Office Visit Price Can Realize Broader Savings. Health Aff (Millwood) 2016; 35:2319-2326. [DOI: 10.1377/hlthaff.2016.0408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ateev Mehrotra
- Ateev Mehrotra ( ) is an associate professor in the Department of Health Care Policy at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center, both in Boston, Massachusetts
| | - Peter J. Huckfeldt
- Peter J. Huckfeldt is an assistant professor in the Division of Health Policy and Management, School of Public Health, at the University of Minnesota, in Minneapolis
| | - Amelia M. Haviland
- Amelia M. Haviland is an associate professor at the H. John Heinz III College of Public Policy and Management at Carnegie Mellon University, in Pittsburgh, Pennsylvania
| | - Laura Gascue
- Laura Gascue is a programmer and quantitative analyst at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, in Los Angeles
| | - Neeraj Sood
- Neeraj Sood is a professor at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California
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Abstract
Because of the increasing pressure to contain health-care-related costs, the number of spinal surgeries performed in the outpatient setting has significantly increased. The higher perioperative efficiency and greater predictability of associated costs offer significant incentives for payers and providers to move surgical procedures into the outpatient setting. Nonetheless, judicious patient selection is advised to optimize outcomes.
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Cedars AM, Burns S, Novak EL, Amin AP. Rehospitalization Is a Major Determinant of Inpatient Care Costs in Adult Congenital Heart Disease. J Am Coll Cardiol 2016; 67:1254-1255. [PMID: 26965547 DOI: 10.1016/j.jacc.2015.12.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/19/2015] [Accepted: 12/14/2015] [Indexed: 11/25/2022]
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Cedars AM, Burns S, Novak EL, Amin AP. Lesion-Specific Factors Contributing to Inhospital Costs in Adults With Congenital Heart Disease. Am J Cardiol 2016; 117:1821-5. [PMID: 27079214 DOI: 10.1016/j.amjcard.2016.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/17/2022]
Abstract
The population of adults with congenital heart disease (ACHD) in the United States is growing rapidly with concomitant increases in care costs. We sought to define the variables having the greatest influence on annual cost of inpatient care in patients with ACHD in the United States. To do so, we conducted a retrospective analysis of admissions in patients >18 years old with a 3-digit International Classification of Disease, Ninth Revision, code of 745 to 747 from the State Inpatient Databases of Arkansas (2008 to 2010), California (2003 to 2012), Florida (2005 to 2012), Hawaii (2006 to 2010), Nebraska (2003 to 2011), and New York (2005 to 2012). We selected variables we believed would have the greatest effect on care costs and built a series of multivariable regression models grouping patients by congenital lesion to examine the relative contribution of the specified variables to total annual inpatient cost. We analyzed a total of 68,314 patients aged 57 ± 18.6 years, 51% of whom were women. The multivariable regression model had an overall R(2) of 0.35. Readmission was responsible for 10.3% of annual inpatient cost among all patients with ACHD and had the greatest effect on inpatient care cost for each congenital lesion except Eisenmenger syndrome and conotruncal abnormalities, for both of which it was the second most significant contributor. Other major contributors to annual inpatient care costs included length of stay and operative procedures. In conclusion, rehospitalization is the most significant contributor to annual inpatient cost for individual patients with ACHD in the United States, regardless of underlying anatomy.
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Affiliation(s)
- Ari M Cedars
- Department of Cardiology, Baylor University Hospital, Dallas, Texas.
| | - Sara Burns
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric L Novak
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Amit P Amin
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
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Alghamdi K, Zocchi M, Frohna WJ, Pines JM. The 2013 Dip: Factors Influencing Falling Emergency Department Visits and Inpatient Admissions in District of Columbia and Maryland. J Emerg Med 2016; 50:897-901. [DOI: 10.1016/j.jemermed.2016.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/07/2016] [Accepted: 02/17/2016] [Indexed: 10/21/2022]
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Hebert PL, Liu CF, Wong ES, Hernandez SE, Batten A, Lo S, Lemon JM, Conrad DA, Grembowski D, Nelson K, Fihn SD. Patient-centered medical home initiative produced modest economic results for Veterans Health Administration, 2010-12. Health Aff (Millwood) 2015; 33:980-7. [PMID: 24889947 DOI: 10.1377/hlthaff.2013.0893] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2010 the Veterans Health Administration (VHA) began a nationwide initiative called Patient Aligned Care Teams (PACT) that reorganized care at all VHA primary care clinics in accordance with the patient-centered medical home model. We analyzed data for fiscal years 2003-12 to assess how trends in health care use and costs changed after the implementation of PACT. We found that PACT was associated with modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care-sensitive conditions and outpatient visits with mental health specialists. We estimated that these changes avoided $596 million in costs, compared to the investment in PACT of $774 million, for a potential net loss of $178 million in the study period. Although PACT has not generated a positive return, it is still maturing, and trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA.
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Affiliation(s)
- Paul L Hebert
- Paul L. Hebert is an investigator in the Veterans Affairs (VA) Health Services Research and Development Center for Veteran-Centered, Value-Driven Health, VA Puget Sound Health Care System, and a research associate professor in the Department of Health Services, School of Public Health, University of Washington, both in Seattle
| | - Chuan-Fen Liu
- Chuan-Fen Liu is an investigator in the VA Health Services Research and Development Center for Veteran-Centered, Value-Driven Health and a research professor in the Department of Health Services, School of Public Health, University of Washington
| | - Edwin S Wong
- Edwin S. Wong is an investigator in the VA Health Services Research and Development Center for Veteran-Centered, Value-Driven Health
| | - Susan E Hernandez
- Susan E. Hernandez is a doctoral candidate in the Department of Health Services, School of Public Health, University of Washington
| | - Adam Batten
- Adam Batten is a statistician in the VA Health Services Research and Development Center for Veteran-Centered, Value-Driven Health
| | - Sophie Lo
- Sophie Lo is a program analyst in the Veterans Health Administration Office of Analytics and Business Intelligence, in Bedford, Massachusetts
| | - Jaclyn M Lemon
- Jaclyn M. Lemon is a medical student at the University of Washington School of Medicine
| | - Douglas A Conrad
- Douglas A. Conrad is a professor of health services at the School of Public Health, University of Washington
| | - David Grembowski
- David Grembowski is a professor of health services at the University of Washington
| | - Karin Nelson
- Karin Nelson is an investigator in the VA Health Services Research and Development Center for Veteran-Centered, Value-Driven Health and an associate professor in the Department of Medicine, School of Medicine, University of Washington
| | - Stephan D Fihn
- Stephan D. Fihn is director of the VHA Office of Analytics and Business Intelligence, VA Puget Sound Health Care System, and a professor in the Department of Medicine, School of Medicine, University of Washington
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Abstract
In the USA, increasing attention is being paid to adopting a value-based framework for measuring and ultimately improving health care delivery. Value is defined as the benefit achieved relative to costs. The numerator of the value equation includes quality of care and outcomes achieved. The denominator includes costs, both financial costs and harms of treatment. Herein, we describe these elements of value as they pertain to head and neck cancer. A particular focus is to identify areas of the value equation where physicians have some control. We examine quality in each of three dimensions: structure, process, and outcomes. We also adopt Porter's three-tiered hierarchy of outcomes model, with specific outcomes relevant to patients with head and neck and thyroid cancer. Finally, we review issues related to costs and harms. We believe these findings can serve as a framework for further efforts to drive value-based delivery of head and neck cancer care.
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Affiliation(s)
- Benjamin R Roman
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,
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Buchan J, Twigg D, Dussault G, Duffield C, Stone PW. Policies to sustain the nursing workforce: an international perspective. Int Nurs Rev 2015; 62:162-70. [PMID: 25639942 DOI: 10.1111/inr.12169] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Examine metrics and policies regarding nurse workforce across four countries. BACKGROUND International comparisons inform health policy makers. METHODS Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored. RESULTS Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries. LIMITATIONS There are differences as well as variation in the overall impact of the global financial crisis in these countries. CONCLUSION Future supply of nurses in all four countries is vulnerable. IMPLICATIONS FOR NURSING AND HEALTH POLICY Work force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries.
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Affiliation(s)
- J Buchan
- School of Health, Queen Margaret University, Edinburgh, UK
| | - D Twigg
- Nursing and Health Services Management, Edith Cowan University, Perth, WA, Australia.,Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - G Dussault
- International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - C Duffield
- Nursing and Health Services Management, Edith Cowan University, Perth, WA, Australia.,Nursing and Health Services Management, University of Technology, Sydney, NSW, Australia
| | - P W Stone
- Columbia University School of Nursing, New York, NY, USA
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Goodnough LT, Shah N. The next chapter in patient blood management: real-time clinical decision support. Am J Clin Pathol 2014; 142:741-7. [PMID: 25389326 DOI: 10.1309/ajcp4w5ccfozujfu] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Blood transfusion was identified by the American Medical Association as one of the top five most frequently overused therapies. Utilization review has been required by accreditation agencies, but retrospective review has been ineffective due to labor-intense resources applied to only a sampling of transfusion events. Electronic medical records have allowed clinical decision support (CDS) to occur via a best practices alert at the critical decision point concurrently with physician order entry. METHODS We review emerging strategies for improving blood utilization. RESULTS Implementation of CDS at our institution decreased the percentage of transfusions in patients with a hemoglobin level of more than 8 g/dL from 60% to less than 30%. Annual RBC transfusions were reduced by 24%, despite concurrent increases in patient discharge volumes and case mix complexity. This resulted in acquisition costs savings (direct blood product purchase costs) of $6.4 million over 4 years. CONCLUSIONS We have been able to significantly reduce inappropriate blood transfusions and related costs through an educational initiative coupled with real-time CDS. In deriving increased value out of health care, CDS can be applied to a number of overuse measures in laboratory testing, radiology, and therapy such as antibiotics, as outlined by the American Board of Internal Medicine's Choosing Wisely campaign.
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Affiliation(s)
- Lawrence Tim Goodnough
- Department of Pathology, Stanford University, Stanford, CA
- Department of Medicine, Stanford University, Stanford, CA
| | - Neil Shah
- Department of Pathology, Stanford University, Stanford, CA
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40
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Myles IA. Fast food fever: reviewing the impacts of the Western diet on immunity. Nutr J 2014; 13:61. [PMID: 24939238 PMCID: PMC4074336 DOI: 10.1186/1475-2891-13-61] [Citation(s) in RCA: 186] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/23/2014] [Indexed: 02/08/2023] Open
Abstract
While numerous changes in human lifestyle constitute modern life, our diet has been gaining attention as a potential contributor to the increase in immune-mediated diseases. The Western diet is characterized by an over consumption and reduced variety of refined sugars, salt, and saturated fat. Herein our objective is to detail the mechanisms for the Western diet's impact on immune function. The manuscript reviews the impacts and mechanisms of harm for our over-indulgence in sugar, salt, and fat, as well as the data outlining the impacts of artificial sweeteners, gluten, and genetically modified foods; attention is given to revealing where the literature on the immune impacts of macronutrients is limited to either animal or in vitro models versus where human trials exist. Detailed attention is given to the dietary impact on the gut microbiome and the mechanisms by which our poor dietary choices are encoded into our gut, our genes, and are passed to our offspring. While today's modern diet may provide beneficial protection from micro- and macronutrient deficiencies, our over abundance of calories and the macronutrients that compose our diet may all lead to increased inflammation, reduced control of infection, increased rates of cancer, and increased risk for allergic and auto-inflammatory disease.
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Affiliation(s)
- Ian A Myles
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike Building 33, Room 2W10A, Bethesda, MD, 20892, Maryland.
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Smartphones for Cell and Biomolecular Detection. Ann Biomed Eng 2014; 42:2205-17. [DOI: 10.1007/s10439-014-1055-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Improvements in some treatment programs for multiple myeloma (MM) are increasing survival. As patients live longer with MM as a chronic disease, the personal financial effects of MM treatment become a serious concern. OBJECTIVE The objective of this study was to identify the personal financial effects of MM and its treatment in 5 areas: employment, disability, health/medical and life insurance, retirement, and out-of-pocket expenses. METHODS We mailed a questionnaire about financial issues to 1015 patients who had received intensive treatment for MM at the study site. Data analysis included descriptive statistics and comparisons using independent t tests. RESULTS Our sample (n = 762; mean age, 61 [SD, 9.26] years) experienced issues with employment (66% employed at diagnosis and treatment; 33% employed at questionnaire time), disability (35% applied), health/medical and life insurance (29% lost coverage and 8% changed coverage), retirement (13% retired during treatment), and out-of-pocket expenses (36% of income in first treatment year and 28% of income during most recent 12 months). CONCLUSIONS Issues of employment, disability, health insurance, retirement, and out-of-pocket costs for treatment are major challenges for patients. IMPLICATIONS FOR PRACTICE In the midst of assessing physical needs during clinical trials for chemotherapy and stem cell transplants, healthcare providers must keep sight of patients' personal financial needs so that we can intervene promptly with referrals to social work, rehabilitation therapy, and other healthcare professions to help patients decrease the personal financial effects of MM and its treatment.
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Trastek VF, Hamilton NW, Niles EE. Leadership models in health care - a case for servant leadership. Mayo Clin Proc 2014; 89:374-81. [PMID: 24486078 DOI: 10.1016/j.mayocp.2013.10.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/09/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022]
Abstract
Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients.
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Affiliation(s)
- Victor F Trastek
- Program in Professionalism and Ethics, Mayo Clinic, Phoenix, AZ.
| | | | - Emily E Niles
- University of St Thomas School of Law, Minneapolis, MN
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Lagoe R, Littau S. Improving Hospital Utilization and Outcomes: Health Economics at the Community Level. Health (London) 2014. [DOI: 10.4236/health.2014.69107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lluncor DE, Belongie S, Rullan P, Morhenn V. Regression and classification methods for nasolabial folds: a possible paradigm for computer-aided diagnosis of skin diseases. J Dermatol 2013; 41:92-7. [PMID: 24354417 DOI: 10.1111/1346-8138.12297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/22/2013] [Indexed: 11/25/2022]
Abstract
Classification of facial features, for example, nasolabial folds, still relies mainly on clinical assessment, resulting in significant costs because of high intra- and interrater variability. Further, diagnosing skin diseases, for example, malignant melanoma, also can present challenges. In an attempt to reduce cost of medical care in future, we determined the utility of methods in image processing and statistical analysis to automatically quantify, for example, the structure of nasolabial folds. To the best of our knowledge, this is the first report of the application of computer technology to grading of nasolabial folds. When classifying severity of wrinkles on a scale of 1-5, the computer achieved an accuracy of 87% compared to the dermatologist, taken as the gold standard. Further, the computer program's capacity to sort the order of wrinkles from least to most wrinkled was 98% as accurate as the clinician(s). We conclude that by using computer technology, nasolabial folds can be categorized almost as accurately as by using grading by dermatologists, suggesting that computer technology may be a useful tool to grade nasolabial folds because a computer is always consistent. We hypothesize that, after additional studies, this technology also may be a useful tool to aid in diagnosing skin diseases.
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Hardie JH, Landale NS. Profiles of Risk: Maternal Health, Socioeconomic Status, and Child Health. JOURNAL OF MARRIAGE AND THE FAMILY 2013; 75:651-666. [PMID: 23794751 PMCID: PMC3685849 DOI: 10.1111/jomf.12021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Child health is fundamental to well-being and achievement throughout the life course. Prior research has demonstrated strong associations between familial socioeconomic resources and children's health outcomes, with especially poor health outcomes among disadvantaged youth who experience a concentration of risks, yet little is known about the influence of maternal health as a dimension of risk for children. This research used nationally representative U.S. data from the National Health Interview Surveys in 2007 and 2008 (N = 7,361) to evaluate the joint implications of maternal health and socioeconomic disadvantage for youth. Analyses revealed that maternal health problems were present in a substantial minority of families, clustered meaningfully with other risk factors, and had serious implications for children's health. These findings support the development of health policies and interventions aimed at families.
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Affiliation(s)
- Jessica Halliday Hardie
- Department of Sociology, University of Missouri - Kansas City, 5100 Rockhill Rd., 208 Haag Hall, Kansas City, MO 64110 ( )
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Schul MW, King T, Kabnick LS. Inequalities of health insurance guidelines for the treatment of symptomatic varicose veins. Phlebology 2013; 29:236-46. [PMID: 23559591 DOI: 10.1177/0268355513479589] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The emerging model of US health-care delivery is aimed at reducing costs, standardizing care, and improving outcomes. Although it is necessary for health-care providers and insurance carriers to work together to achieve those goals, insurers have the added duty of assuring physicians and patients that they comprehend the medical evidence and, based on that understanding, construct policies. Are US insurers meeting that responsibility or are they simply creating policies to serve their own needs? METHODS The medical policies of several US health insurers were analysed. The goal was to see whether it could readily be determined if these carriers used evidence-based medicine consistently to create uniform policies for the treatment of patients with symptomatic varicose veins. The literature was also reviewed to determine whether increased insurance documentation requirements have affected cost reduction, standardization of care and/or improvement of outcomes related to chronic vein disease management. RESULTS There is a dramatic lack of uniformity among the insurance policies reviewed. Insurers appear to not choose important papers to create policy but use carefully chosen articles to reinforce what they want their policies to say. In so doing, conflicting policy criteria are being created. Complicating this inconsistency, rules for medical necessity are modified frequently, raising frustration levels among vein providers and their patients. What is clear is that costs are not being lowered, care is not being standardized and little is being done to prevent potential complications resulting from chronic vein disease. CONCLUSIONS Patients and physicians are increasingly ill-served by, and frustrated with, the clear lack of consistency in the medical policy criteria being created by US insurance carriers in covering the treatment of patients with symptomatic varicose veins. The contradictory coverage requirements, seemingly based on no understanding of evidence-based medicine guidelines, and total variability in reimbursement for various types of treatment options is particularly worrisome. Collaboration between venous treatment providers and insurance carriers, to create evidence-based standards of care, would be timely and beneficial in creating guidelines for optimal patient care.
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Affiliation(s)
- M W Schul
- Unity Healthcare, LLC, Lafayette, IN, USA
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48
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Agee MD, Gates Z. Lessons from game theory about healthcare system price inflation: evidence from a community-level case study. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:45-51. [PMID: 23329381 DOI: 10.1007/s40258-012-0003-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Game theory is useful for identifying conditions under which individual stakeholders in a collective action problem interact in ways that are more cooperative and in the best interest of the collective. The literature applying game theory to healthcare markets predicts that when providers set prices for services autonomously and in a noncooperative fashion, the market will be susceptible to ongoing price inflation. OBJECTIVES We compare the traditional fee-for-service pricing framework with an alternative framework involving modified doctor, hospital and insurer pricing and incentive strategies. While the fee-for-service framework generally allows providers to set prices autonomously, the alternative framework constrains providers to interact more cooperatively. METHODS We use community-level provider and insurer data to compare provider and insurer costs and patient wellness under the traditional and modified pricing frameworks. The alternative pricing framework assumes (i) providers agree to manage all outpatient claims; (ii) the insurer agrees to manage all inpatient clams; and (iii) insurance premiums are tied to patients' healthy behaviours. RESULTS AND CONCLUSIONS Consistent with game theory predictions, the more cooperative alternative pricing framework benefits all parties by producing substantially lower administrative costs along with higher profit margins for the providers and the insurer. With insurance premiums tied to consumers' risk-reducing behaviours, the cost of insurance likewise decreases for both the consumer and the insurer.
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Affiliation(s)
- Mark D Agee
- Department of Economics, Pennsylvania State University, Altoona, 16601, USA.
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Brody AA, Galvin JE. A review of interprofessional dissemination and education interventions for recognizing and managing dementia. GERONTOLOGY & GERIATRICS EDUCATION 2013; 34:225-56. [PMID: 23879387 PMCID: PMC4112072 DOI: 10.1080/02701960.2013.801342] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The number of individuals with dementia is expected to increase dramatically over the next 20 years. Given the complicated clinical, sociobehavioral, and caregiving skills that are needed to comprehensively assess and manage individuals with dementia, the gold standard of care requires involvement of interprofessional teams. This systematic review examined 4,023 abstracts, finding 18 articles from 16 studies where an interprofessional dissemination program was performed. Most studies found some improvement in clinician knowledge or confidence, or patient outcomes, though methods and patient and clinician populations were disparate. Although a significant evidence base for assessing and managing individuals with dementia has been developed, few studies have examined how to disseminate this research, and even fewer in an interprofessional manner. These findings suggest that greater emphasis needs to be placed on disseminating existing evidence-based care and ensuring that programs are interprofessional in nature so that excellent, patient-centered care is provided.
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Affiliation(s)
- Abraham A Brody
- New York University College of Nursing and the James J Peters Bronx VA Geriatric Research Education and Clinical Center, , 726 Broadway, 10 Floor, New York, NY 10003, USA, Tel: 212-992-7341; Fax 212-995-3143
| | - James E. Galvin
- New York University School of Medicine, Departments of Neurology, Psychiatry, Nutrition and Public Health, and the Alzheimer Disease Center,
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