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Wagle NS, Park S, Washburn D, Ohsfeldt R, Kum HC, Singal AG. Racial and Ethnic Disparities in Hepatocellular Carcinoma Treatment Receipt in the United States: A Systematic Review and Meta-Analysis. Cancer Epidemiol Biomarkers Prev 2024; 33:463-470. [PMID: 38252039 PMCID: PMC10990826 DOI: 10.1158/1055-9965.epi-23-1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Racial and ethnic disparities in hepatocellular carcinoma (HCC) prognosis exist, partly related to differential failures along the cancer care continuum. We characterized racial and ethnic disparities in treatment receipt among patients with HCC in the United States. METHODS We searched Medline, Embase, and CINAHL databases to identify studies published between January 2012 and March 2022 reporting HCC treatment receipt among adult patients with HCC, stratified by race or ethnicity. We calculated pooled odds ratios for HCC treatment using random effects models. RESULTS We identified 15 studies with 320,686 patients (65.8% White, 13.9% Black, 10.4% Asian, and 8.5% Hispanic). Overall, 33.2% of HCC patients underwent any treatment, and 22.7% underwent curative treatment. Compared with White patients, Black patients had lower odds of any treatment (OR 0.67, 95% CI 0.55-0.81) and curative treatment (OR 0.74, 95% CI 0.71-0.78). Similarly, Hispanic patients had lower pooled odds of curative treatment (OR 0.79, 95% CI 0.73-0.84). CONCLUSIONS There were significant racial and ethnic disparities in HCC treatment receipt, with Black patients having lower odds of receiving any and curative treatment while Hispanic patients having lower odds of curative treatment. IMPACT Racial and ethnic differences in treatment receipt serve as an intervention target to reduce disparities in HCC prognosis.
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Affiliation(s)
- Nikita Sandeep Wagle
- Population Informatics Lab, Texas A&M University, College Station, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M, Health Science Center, College Station, Texas
| | - Sulki Park
- Department of Health Policy and Management, School of Public Health, Texas A&M, Health Science Center, College Station, Texas
- Department of Industrial and Systems Engineering, Texas A&M University, College, Station, Texas
| | - David Washburn
- Population Informatics Lab, Texas A&M University, College Station, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M, Health Science Center, College Station, Texas
| | - Robert Ohsfeldt
- Population Informatics Lab, Texas A&M University, College Station, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M, Health Science Center, College Station, Texas
| | - Hye-Chung Kum
- Population Informatics Lab, Texas A&M University, College Station, Texas
- Department of Health Policy and Management, School of Public Health, Texas A&M, Health Science Center, College Station, Texas
- Department of Industrial and Systems Engineering, Texas A&M University, College, Station, Texas
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas
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2
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Vitko AS, Martin P, Zhang S, Johnston A, Ohsfeldt R, Zheng S, Liepa AM. Costs of breast cancer recurrence after initial treatment for HR+, HER2-, high-risk early breast cancer: estimates from SEER-Medicare linked data. J Med Econ 2024; 27:84-96. [PMID: 38059275 DOI: 10.1080/13696998.2023.2291266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To assess the costs of treated recurrence and survival in elderly patients with early breast cancer (EBC) at high risk of recurrence using Surveillance Epidemiology and End Results (SEER) registry-Medicare linked claims data. METHODS This retrospective study included patients aged ≥65 years with hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), node-positive EBC at high risk of recurrence. Treated recurrences were defined based on treatment events/procedure codes from claims. Primary outcomes were monthly total extra costs and cumulative extra costs of treated recurrence relative to patients with non/untreated recurrence. Costs were calculated using a Kaplan-Meier sampling average estimator method and inflated to 2021 US$. Secondary outcomes included analysis by recurrence type and overall survival (OS) after recurrence. Subgroup analysis evaluated costs in patients with Medicare Part D coverage. RESULTS Among 3,081 eligible patients [mean (SD) age at diagnosis was 74.5 (7.1) years], the majority were females (97.4%) and white (87.8%). Treated recurrence was observed in 964 patients (31.3%). The monthly extra cost of treated recurrence was highest at the beginning of the first treated recurrence episode, with 6-year cumulative cost of $117,926. Six-year cumulative extra costs were higher for patients with distant recurrences ($168,656) than for patients with locoregional recurrences ($96,465). Median OS was 4.34 years for all treated recurrences, 1.92 years for distant recurrence, and 6.78 years for locoregional recurrence. Similar cumulative extra cost trends were observed in the subgroup with Part D coverage as in the overall population. LIMITATIONS This study utilizes claims data to identify treated recurrence. Due to age constraints of the dataset, results may not extrapolate to a younger population where EBC is commonly diagnosed. CONCLUSION EBC recurrence in this elderly population has substantial costs, particularly in patients with distant recurrences. Therapies that delay or prevent recurrence may reduce long-term costs significantly.
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Affiliation(s)
- Alexandra S Vitko
- Value, Evidence, and Outcomes (VEO) - Oncology, Eli Lilly and Company, Indianapolis, IN, USA
| | - Pam Martin
- Medical Decision Modeling Inc, Indianapolis, IN, USA
| | - Sheng Zhang
- Medical Decision Modeling Inc, Indianapolis, IN, USA
| | - Adam Johnston
- Medical Decision Modeling Inc, Indianapolis, IN, USA
| | - Robert Ohsfeldt
- Medical Decision Modeling Inc, Indianapolis, IN, USA
- Texas A&M University, College Station, TX, USA
| | - Shen Zheng
- TechData Service Company, King of Prussia, PA, USA
| | - Astra M Liepa
- Value, Evidence, and Outcomes (VEO) - Oncology, Eli Lilly and Company, Indianapolis, IN, USA
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3
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Nguyen BT, Heyrana K, Ohsfeldt R, Johnston A, Summers K. Descriptive study of the real-world, long-term cost estimates and duration of use for hormonal and nonhormonal intrauterine devices using US commercial insurance claims. J Manag Care Spec Pharm 2023; 29:1303-1311. [PMID: 38058139 PMCID: PMC10776262 DOI: 10.18553/jmcp.2023.29.12.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND Intrauterine devices (IUDs) have comparable efficacy to permanent surgical contraceptive methods; however, long-term costs are infrequently considered. Existing estimates inconsistently account for costs outside of IUD insertion or removal, actual duration of use, or differences between hormonal and nonhormonal IUDs. OBJECTIVE To describe health care resource utilization and commercial payer costs that arise throughout hormonal and nonhormonal IUD use. METHODS In this retrospective cohort study, paid claims data (Merative, MarketScan) from a large US commercial claims database were evaluated between 2013 and 2019. Claims were included from individuals aged 12 to 45 years who had an IUD inserted in 2014, continuous insurance coverage for 1 year prior to insertion and throughout follow-up, and no insertion, removal, or reinsertion in the previous year. Procedures and services that could be IUD-related were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Edition codes. Duration of IUD use was evaluated by Kaplan-Meier analysis of time to IUD removal. Event rates were determined for identified procedures and services; costs were calculated as the sum of payer reimbursements per enrolled individual. All IUD types available during the study period were described: 2 hormonal IUDs (52-mg and 13.5-mg levonorgestrel-releasing [LNG]) and the nonhormonal (380-mm2 copper) IUD. RESULTS Of 195,009 individuals meeting the age requirement and receiving an IUD in 2014, 63,386 met the inclusion criteria and 53,744 had their IUD type on record-42,777 (67.5%) 52-mg LNG, 2,932 (4.6%) 13.5-mg LNG, and 8,035 (12.7%) nonhormonal IUD users. Despite differences in their indicated duration (13.5-mg LNG, 3 years; 52-mg LNG, 5 years; and nonhormonal, 10 years), most individuals had their IUD removed before its indicated full duration of use (13.5-mg LNG, 56.1%; 52-mg LNG, 61.3%; nonhormonal [at 5 years], 54.6%). The event rate per 100 individuals during the follow-up period was highest for abnormal uterine bleeding (16.2), ovarian cysts (9.3), and surgical management of uterine perforations (4.5). IUD insertion costs (mean ± SE) per enrolled individual for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $931 ± $9, $1,107 ± $4, and $897 ± $6, respectively. Cumulative mean ± SE 5-year postinsertion costs for the 13.5-mg LNG, 52-mg LNG, and nonhormonal IUDs were $2,892 ± $232, $1,514 ± $31, and $1,389 ± $97, respectively, among the remaining enrolled individuals. CONCLUSIONS In this descriptive study of commercially insured IUD users, at least half had their IUD removed before its indicated duration. IUD improvements that reduce the frequency of abnormal uterine bleeding, ovarian cysts, and uterine perforations may help reduce long-term IUD costs.
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Affiliation(s)
- Brian T. Nguyen
- Department of Clinical Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Katrina Heyrana
- Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert Ohsfeldt
- Texas A&M School of Public Health, College Station
- Medical Decision Modeling, Inc., Indianapolis, IN
| | | | - Kent Summers
- AlphaScientia, a Red Nucleus company, King of Prussia, PA
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Kassabian M, Calderwood MS, Ohsfeldt R. A Cost-Effectiveness Analysis of Fosfomycin: A Single-Dose Antibiotic Therapy for Treatment of Uncomplicated Urinary Tract Infection. Health Serv Insights 2022; 15:11786329221126340. [PMID: 36245475 PMCID: PMC9554122 DOI: 10.1177/11786329221126340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
Nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX) and fosfomycin are first-line therapeutics for uncomplicated urinary tract infections (uUTI). While fosfomycin is the most expensive, it is also attractive due to its effectiveness against most uUTI-causing bacteria, limited risk of cross-resistance with other drugs, and single-dose delivery. In light of these competing attributes, a cost-effectiveness analysis can provide useful, standardized information about tradeoffs between fosfomycin and treatment alternatives. This paper assessed cost-effectiveness via incremental cost-effectiveness ratios (ICERs) that represented a drug’s incremental cost per additional uUTI case resolved with initial course of antibiotic therapy. The study setting was New Hampshire, USA. Total cost of treatment was lowest with TMP-SMX and highest with fosfomycin. ICERs were $84.53 and $78.59 for nitrofurantoin and $2264.29 and $2260.89 for fosfomycin under a payer and societal perspective, respectively. While no standard benchmark for our measure of cost-effectiveness exists, the high national prevalence of antibiotic stewardship efforts suggests that willingness-to-pay to increase the number of people who are successfully treated with an initial course of therapy is non-zero. Ultimately, fosfomycin may currently be considered a cost-effective option for treating uUTI in the US. As a recently off-patent drug, increased competition in the generic market may improve its cost-effectiveness in the future.
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Affiliation(s)
- Morgan Kassabian
- Department of Health Policy & Management, Texas A&M School of Public Health, College Station, TX, USA,Morgan Kassabian, Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX 77843, USA.
| | | | - Robert Ohsfeldt
- Department of Health Policy & Management, Texas A&M School of Public Health, College Station, TX, USA
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5
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Ohsfeldt R, Kelton K, Klein T, Belger M, Mc Collam PL, Spiro T, Burge R, Ahuja N. Cost-Effectiveness of Baricitinib Compared With Standard of Care: A Modeling Study in Hospitalized Patients With COVID-19 in the United States. Clin Ther 2021; 43:1877-1893.e4. [PMID: 34732289 PMCID: PMC8487786 DOI: 10.1016/j.clinthera.2021.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
Purpose In the Phase III COV-BARRIER (Efficacy and Safety of Baricitinib for the Treatment of Hospitalised Adults With COVID-19) trial, treatment with baricitinib, an oral selective Janus kinase 1/2 inhibitor, in addition to standard of care (SOC), was associated with significantly reduced mortality over 28 days in hospitalized patients with coronavirus disease–2019 (COVID-19), with a safety profile similar to that of SOC alone. This study assessed the cost-effectiveness of baricitinib + SOC versus SOC alone (which included systemic corticosteroids and remdesivir) in hospitalized patients with COVID-19 in the United States. Methods An economic model was developed to simulate inpatients' stay, discharge to postacute care, and recovery. Costs modeled included payor costs, hospital costs, and indirect costs. Benefits modeled included life-years (LYs) gained, quality-adjusted life-years (QALYs) gained, deaths avoided, and use of mechanical ventilation avoided. The primary analysis was performed from a payor perspective over a lifetime horizon; a secondary analysis was performed from a hospital perspective. The base-case analysis modeled the numeric differences in treatment effectiveness observed in the COV-BARRIER trial. Scenario analyses were also performed in which the clinical benefit of baricitinib was limited to the statistically significant reduction in mortality demonstrated in the trial. Findings In the base-case payor perspective model, an incremental total cost of 17,276 US dollars (USD), total QALYs gained of 0.6703, and total LYs gained of 0.837 were found with baricitinib + SOC compared with SOC alone. With the addition of baricitinib, survival was increased by 5.1% and the use of mechanical ventilation was reduced by 1.6%. The base-case incremental cost-effectiveness ratios were 25,774 USD/QALY gained and 20,638 USD/LY gained; a “mortality-only” scenario analysis yielded similar results of 26,862 USD/QALY gained and 21,433 USD/LY gained. From the hospital perspective, combination treatment with baricitinib + SOC was more effective and less costly than was SOC alone in the base case, with an incremental cost of 38,964 USD per death avoided in the mortality-only scenario. Implications In hospitalized patients with COVID-19 in the United States, the addition of baricitinib to SOC was cost-effective. Cost-effectiveness was demonstrated from both the payor and the hospital perspectives. These findings were robust to sensitivity analysis and to conservative assumptions limiting the clinical benefits of baricitinib to the statistically significant reduction in mortality demonstrated in the COV-BARRIER trial.
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Affiliation(s)
- Robert Ohsfeldt
- Texas A&M University, College Station, Texas; Medical Decision Modeling Inc, Indianapolis, Indiana
| | - Kari Kelton
- Medical Decision Modeling Inc, Indianapolis, Indiana
| | - Tim Klein
- Medical Decision Modeling Inc, Indianapolis, Indiana
| | - Mark Belger
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, Indiana; University of Cincinnati, Cincinnati, Ohio.
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6
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Giannouchos TV, Kum HC, Gary J, Ohsfeldt R, Morrisey M. The Effect of the Medicaid Expansion on Frequent Emergency Department Use in New York. J Emerg Med 2021; 61:749-762. [PMID: 34518044 DOI: 10.1016/j.jemermed.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is limited evidence on the effect of the Affordable Care Act (ACA) on frequent emergency department (ED) use. OBJECTIVES To estimate the effect of the ACA Medicaid expansion on frequent ED use in New York. METHODS We used data from the Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases from 2011 to 2016. A consistent and unique patient identifier enabled us to identify ED visits by the same patient across different facilities within the state for each calendar year. Multivariate logistic regressions were used to quantify the policy's effect on frequent ED use (≥ 4 ED visits/year). We included in-state residents 18 to 64 years of age who were covered by Medicaid, private insurance, or were uninsured. Sensitivity analyses were conducted using alternative definitions of frequent use. To validate the findings, a falsification analysis was also conducted using only the 3 pre-expansion years. RESULTS Our study included 14.3 million ED patients with 23.8 million ED visits from 2011 to 2016. Frequent users (7.2%) accounted for 26.6% of all ED visits. The likelihood of frequent ED use declined by 4% among Medicaid beneficiaries (adjusted odds ratio [AOR] 0.96, 95% confidence intervals (CI) 0.95-0.97) and by 12% for the uninsured (AOR 0.88, 95% CI 0.86-0.89) in the post-expansion period, compared with the pre-expansion period. Private insurance enrollees were 9% more likely to exhibit frequent use in the post-expansion period (AOR 1.09, 95% CI 1.08-1.11). The sensitivity analyses yielded results similar to those of the main model. The falsification analyses revealed small and insignificant year-to-year changes in the 3 pre-expansion years. CONCLUSION The likelihood of frequent ED use decreased 3 years after New York implemented the ACA Medicaid expansion, particularly for Medicaid beneficiaries and the uninsured, highlighting the importance of expanding health insurance and provisions tailored at high-need populations.
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Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Population Informatics Lab
| | - Hye-Chung Kum
- Population Informatics Lab; Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Jodie Gary
- College of Nursing, Texas A&M University, Bryan, Texas
| | - Robert Ohsfeldt
- Population Informatics Lab; Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, Texas
| | - Michael Morrisey
- Population Informatics Lab; Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, Texas
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7
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Giannouchos T, Kum H, Ohsfeldt R, Gary J, Morrisey M. Medicaid Expansion Resulted in Decreased Odds of Frequent Emergency Department Use Among Medicaid Beneficiaries and the Uninsured in New York. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- T. Giannouchos
- College of Pharmacy University of Utah Salt Lake City UT United States
| | - H.‐C. Kum
- School of Public Health Texas A&M University College Station TX United States
| | - R. Ohsfeldt
- School of Public Health Texas A&M University College Station TX United States
| | - J. Gary
- Texas A&M College of Nursing Bryan TX United States
| | - M. Morrisey
- School of Public Health Texas A&M University College Station TX United States
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8
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Dick K, Briggs A, Ohsfeldt R, Sydendal Grand T, Buchs S. A quality-of-life mapping function developed from a grass pollen sublingual immunotherapy trial to a tree pollen sublingual immunotherapy trial. J Med Econ 2020; 23:64-69. [PMID: 31352853 DOI: 10.1080/13696998.2019.1649268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aims: Allergic rhinitis is caused by sensitivity to environmental allergens that can significantly impact quality-of-life. The objective of this analysis was to estimate health state utilities and quality-adjusted life days (QALDs) for a tree allergy immunotherapy trial, TT-04 (EudraCT No.2015-004821-15). Health-state utilities are a measure of patient preference for health states and are necessary to derive QALDs for cost-utility analysis. Preference-based utilities were not collected in the TT-04 trial, so a mapping algorithm was developed based on a similar grass allergy immunotherapy trial, GT-08 (EudraCT No. 2004-000083-27), to estimate utilities.Methods: A two-part model was developed to predict utilities for the GT-08 trial and applied to the TT-04 trial to estimate the difference in mean utility and QALDs between SQ tree sublingual immunotherapy (SLIT)-tablet and placebo.Results: Mean utility difference between SQ tree SLIT-tablet and placebo was 0.030 [95% CI = 0.015-0.046] during the birch pollen season (BPS), 0.019 [95% CI = 0.007-0.030] during the tree pollen season (TPS) and 0.018 [95% CI = 0.007-0.030] during the full trial. The treatment showed a QALD benefit of 1.26 [95% CI = 0.619-1.917] during the BPS, 1.90 [95% CI = 0.692-3.047] during the TPS, and 2.47 [95% CI = 0.930-4.101] during the full trial.Limitations: The generalizability of this algorithm is limited to allergy trials containing the same covariates as those present in the model. The analysis also assumes that grass and tree pollen allergy have the same relationship with EQ5D utilities, which is supported by the fact that both grass and tree pollen induce similar symptoms.Conclusions: Application of the mapping function enabled the calculation of QALDs associated with the treatment, with the caveat that data were extrapolated from grass seasonal allergy to tree seasonal allergy. The results showed a significant QALD benefit of the treatment over placebo in treatment of tree pollen-induced rhinoconjunctivitis.
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Affiliation(s)
| | - Andrew Briggs
- Avalon Health Economics, Morristown, NJ, USA
- Health Economics, University of Glasgow, Glasgow, UK
| | - Robert Ohsfeldt
- Avalon Health Economics, Morristown, NJ, USA
- Health Policy and Management, Texas A&M University School of Public Health, College Station, TX, USA
| | | | - Sarah Buchs
- ALK, Global Market Access, Hørsholm, Denmark
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9
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Phillips CD, Truong C, Kum HC, Nwaiwu O, Ohsfeldt R. The Effects of Chronic Disease on Ambulatory Care-Sensitive Hospitalizations for Children or Youth. Health Serv Insights 2019; 12:1178632919879422. [PMID: 31662605 PMCID: PMC6796197 DOI: 10.1177/1178632919879422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/27/2019] [Indexed: 11/23/2022] Open
Abstract
Considerable research has focused on hospitalizations for ambulatory
care–sensitive conditions (ACSHs), but little of that research has focused on
the role played by chronic disease in ACSHs involving children or youth (C/Y).
This research investigates, for C/Y, the effects of chronic disease on the
likelihood of an ACSH. The database included 699 473 hospital discharges for
individuals under 18 in Texas between 2011 and 2015. Effects of chronic disease,
individual, and contextual factors on the likelihood of a discharge involving an
ACSH were estimated using logistic regression. Contrary to the results for
adults, the presence of chronic diseases or a complex chronic disease among
children or youth was protective, reducing the likelihood of an ACSH for a
nonchronic condition. Results indicate that heightened ambulatory care received
by C/Y with chronic diseases is largely protective. Two of more chronic
conditions or at least one complex chronic condition significantly reduced the
likelihood of an ACSH.
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Affiliation(s)
- Charles D Phillips
- Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Chau Truong
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hye-Chung Kum
- Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Obioma Nwaiwu
- Department of Family Medicine, School of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert Ohsfeldt
- Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA
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10
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Affiliation(s)
- Obioma Nwaiwu
- Texas A&M Health Science Center, School of Public Health, College Station, Texas.,University of Arkansas for Medical Sciences, College of Medicine, Department of Family and Preventive Medicine, Fayetteville, Arkansas
| | - Charles Phillips
- Texas A&M Health Science Center, School of Public Health, College Station, Texas
| | - Robert Ohsfeldt
- Texas A&M Health Science Center, School of Public Health, College Station, Texas
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11
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Phillips CD, Truong C, Kum HC, Nwaiwu O, Ohsfeldt R. Post-acute Care for Children and Youth in Texas, 2011-2014. Clin Med Insights Pediatr 2018; 11:1179556517711445. [PMID: 29844709 PMCID: PMC5965663 DOI: 10.1177/1179556517711445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/26/2017] [Indexed: 11/16/2022]
Abstract
Little is known about services provided to children and youth (C/Y) discharged from an acute care facility. Recent research has provided a foundation for efforts to supplement or complement that early work. This research investigates post-acute care (PAC) in Texas. It focuses on what differentiates those discharges that receive PAC from those that do not and on what differentiates those C/Y who receive PAC in a health care facility from those who receive home health services. The results show that only 6.4% of discharges involving C/Y receive PAC and that many factors affected the 2 issues under investigation quite differently. These results clearly demonstrate the low prevalence of PAC use for C/Y and the clear preference of using PAC home health in this population.
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Affiliation(s)
- Charles D Phillips
- Department of Health Policy & Management, School of Public Health, Texas A&M Health Science Center, Texas A&M University, College Station, TX, USA
| | - Chau Truong
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Sciences Center, Houston, Texas
| | - Hye-Chung Kum
- Department of Health Policy & Management, School of Public Health, Texas A&M Health Science Center, Texas A&M University, College Station, TX, USA
| | - Obioma Nwaiwu
- Department of Family Medicine, School of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert Ohsfeldt
- Department of Health Policy & Management, School of Public Health, Texas A&M Health Science Center, Texas A&M University, College Station, TX, USA
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12
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Schneider JE, Ohsfeldt R, Li P, Miller TR, Scheibling C. Assessing the impact of state "opt-out" policy on access to and costs of surgeries and other procedures requiring anesthesia services. Health Econ Rev 2017; 7:10. [PMID: 28243888 PMCID: PMC5328901 DOI: 10.1186/s13561-017-0146-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/08/2017] [Indexed: 06/06/2023]
Abstract
In 2001, the U.S. government released a rule that allowed states to "opt-out" of the federal requirement that a physician supervise the administration of anesthesia by a nurse anesthetist. To date, 17 states have opted out. The majority of the opt-out states cited increased access to anesthesia care as the primary rationale for their decision. In this study, we assess the impact of state opt-out policy on access to and costs of surgeries and other procedures requiring anesthesia services. Our null hypothesis is that opt-out rule adoption had little or no effect on surgery access or costs. We estimate an inpatient model of surgeries and costs and an outpatient model of surgeries. Each model uses data from multiple years of U.S. inpatient hospital discharges and outpatient surgeries. For inpatient cost models, the coefficient of the opt-out variable was consistently positive and also statistically significant in most model specifications. In terms of access to inpatient surgical care, the opt-out rules did not increase or decrease access in opt-out states. The results for the outpatient access models are less consistent, with some model specifications indicating a reduction in access associated with opt-out status, while other model specifications suggesting no discernable change in access. Given the sensitivity of model findings to changes in model specification, the results do not provide support for the belief that opt-out policy improves access to outpatient surgical care, and may even reduce access to outpatient surgical care (among freestanding facilities).
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Affiliation(s)
- John E. Schneider
- Avalon Health Economics, LLC, 26 Washington Street, 3rd Fl, 07960 Morristown, NJ USA
| | - Robert Ohsfeldt
- Health Policy & Management, Texas A&M University, 212 Adriance Lab Rd, 1266 TAMU, 77843-1266 College Station, TX USA
| | - Pengxiang Li
- Division of General Internal Medicine, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104 USA
| | - Thomas R. Miller
- American Society of Anesthesiologists, 1061 American Lane, 60173-4973 Schaumburg, IL USA
| | - Cara Scheibling
- Avalon Health Economics, 26 Washington Street, 3rd Fl., 07960 Morristown, NJ USA
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13
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Phillips CD, Truong C, Kum HC, Nwaiwu O, Ohsfeldt R. Post-acute care for children with special health care needs. Disabil Health J 2017; 11:49-57. [PMID: 28918094 DOI: 10.1016/j.dhjo.2017.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Almost all studies of post-acute care (PAC) focus on older persons, frequently those suffering from chronic health problems. Some research is available on PAC for the pediatric population in general. However, very few studies focus on PAC services for children with special health care needs (SHCN). OBJECTIVE To investigate factors affecting the provision of PAC to children with SHCN. METHODS Pooled cross-sectional data from Texas Department of State Health Services hospital discharge database from 2011-2014 were analyzed. Publicly available algorithms identified chronic conditions, complex chronic conditions, and the principal problem leading to hospitalization. Analysis involved estimating two logistic regressions, with clustered robust standard errors, concerning the likelihood of receiving PAC and where that PAC was delivered. Models included patient characteristics and conditions, as well as hospital characteristics and location. RESULTS Only 5.8 percent of discharges for children with SHCN resulted in the provision of PAC. Two-thirds of PAC was provided in a health care facility (HCF). Severity of illness and the number of complex chronic conditions, though not the number of chronic problems, made PAC more likely. Patient demographics had no effect on PAC decisions. Hospital type and location also affected PAC decision-making. CONCLUSIONS PAC was provided to relatively few children with SHCN, which raises questions concerning the potential underutilization of PAC for children with SHCN. Also, the provision of most PAC in a HCF (66%) seems at odds with professional judgment and family preferences indicating that health care for children with SHCN is best provided in the home.
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Affiliation(s)
- Charles D Phillips
- Texas A&M Health Science Center, School of Public Health, Department of Health Policy and Management, USA.
| | - Chau Truong
- University of Texas, School of Public Health, Department of Management, Policy, and Community Health, USA
| | - Hye-Chung Kum
- Texas A&M Health Science Center, School of Public Health, Department of Health Policy and Management, USA
| | - Obioma Nwaiwu
- University of Arkansas for Medical Sciences, School of Medicine, Department of Family Medicine, USA
| | - Robert Ohsfeldt
- Texas A&M Health Science Center, School of Public Health, Department of Health Policy and Management, USA
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14
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Abstract
In a recent article, Susan Feigenbaum and Ronald Teeples (1983) highlight an important omission in the public-versus-private, production-efficiency literature. They note the possibility that differences in product quality might explain apparent differences in efficiency. They, however, fail at the more fundamental task of accurately measuring differences in economic costs in their study of public and private water utilities. More generally, Feigenbaum and Teeples's methodology is not well suited for an analysis of the relative efficiency issue.
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15
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Lee WC, Phillips C, Ohsfeldt R. Do rural and urban women experience differing rates of maternal rehospitalizations? Rural Remote Health 2015. [DOI: 10.22605/rrh3335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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16
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Pergolizzi JV, Labhsetwar SA, Puenpatom RA, Ben-Joseph R, Ohsfeldt R, Summers KH. Economic Impact of Potential Drug-Drug Interactions among Osteoarthritis Patients Taking Opioids. Pain Pract 2011; 12:33-44. [DOI: 10.1111/j.1533-2500.2011.00498.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Pergolizzi JV, Labhsetwar SA, Amy Puenpatom R, Ben-Joseph R, Ohsfeldt R, Summers KH. Economic impact of potential CYP450 pharmacokinetic drug-drug interactions among chronic low back pain patients taking opioids. Pain Pract 2011; 12:45-56. [PMID: 21923882 DOI: 10.1111/j.1533-2500.2011.00503.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chronic low back pain (cLBP) patients who take at least 1 CYP450-metabolized opioid analgesic agent concurrent with at least 1 other CYP450-metabolized medication experience a drug-drug exposure (DDE), which puts them at risk for a pharmacokinetic drug-drug interaction (PK DDI). This study compared utilization of healthcare resources and associated payments in cLBP patients with and without incident DDEs with the potential to cause PK DDIs. A retrospective database analysis examined the associated clinical events, healthcare utilization (measured in terms of claims for office visits, outpatient visits, emergency department visits, and hospitalization), and cost to the health plan, as defined as the sum of health plan payments for resources used. Patients were grouped into 2 cohorts by age (those under 65 and those 65 years and over). In the 6 months after exposure, total healthcare payments were significantly higher for DDE patients than those without DDEs (no-DDE), in both in the younger ($7,086, SD = $8,370) and $6,353, SD = $8,352, respectively, P < 0.001) and the older cohorts ($7,806 vs. $7,043, respectively, P = 0.013). Younger and older patients with DDE had significantly higher prescription payments than those without DDE ($2,041, SD = $2,706 vs. $1,565, SD = $2,349, respectively, P < 0.001 for younger and $2,482, SD = $2,481 vs. $2,286, SD = $2,521, respectively, P = 0.044 for older patients). Both older and younger patients with DDE had significantly more claims for office visits and higher associated payments than similar patients without DDE. Patients in the study who experienced DDEs that placed them at risk for PK DDIs had significantly greater utilization rates of healthcare resources and higher associated payments in the 6-month observation period following exposure.
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Affiliation(s)
- Joseph V Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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18
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Abstract
OBJECTIVE Patients managing chronic non-cancer pain with cytochrome P450 (CYP450)-metabolized opioid analgesics who concurrently take another CYP450-metabolized medication experience a drug-drug exposure (DDE), which puts them at risk for a pharmacokinetic drug-drug interaction (PK DDI). This study examined the economic impact of incident DDEs with the potential to cause PK DDIs compared to similar patients without such exposure. STUDY DESIGN This retrospective analysis used paid claims from a large, commercially insured population during January 1, 2004 through December 31, 2008. METHODS Propensity matching was used to control for baseline differences in comparisons between 85,043 exposed and 85,043 non-exposed patients. RESULTS Comparisons yielded mean total costs 6 months after the DDEs that were significantly higher in subjects with DDE versus matched subjects without DDE [$8165 (SD $11,357) vs. $7498 (SD $11,668), respectively, p<0.01] resulting in a difference of $667. This was driven by medical costs [$5520 (SD $10,505) vs. $5222 (SD $10,689), respectively, p<0.01] a $298 difference, and total prescription costs [$2646 (SD $3262) vs. $2276 (SD $3907), respectively, p<0.01] a $369 difference. LIMITATIONS The study design demonstrates associations only and cannot establish causal relationships. Further, relevant DDEs were not included if concurrent consumption occurred outside the index period and when CYP450 substances were consumed that are not reflected in pharmacy claims (herbals, over-the-counter medications). CONCLUSION Since concurrent exposure to DDEs with the potential to cause PK DDIs may be relatively common, policy decisions-makers should consider the use of long-acting opioids that are not metabolized through the CYP450 pathway.
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Affiliation(s)
- Kent H Summers
- Department of Health Outcomes and Pharmacoeconomics (HOPE), Endo Pharmaceuticals, 100 Endo Boulevard, Chadds Ford, PA 19317, USA.
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Balamurugan A, Ohsfeldt R, Hughes T, Phillips M. Diabetes self-management education program for Medicaid recipients: a continuous quality improvement process. Diabetes Educ 2007; 32:893-900. [PMID: 17102156 DOI: 10.1177/0145721706294787] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Diabetes self-management education (DSME) is the cornerstone in effective management of diabetes. The continuous quality improvement process was used to identify the problem, collect and analyze data, and develop and implement a DSME program for Medicaid recipients, and subsequently, the program was evaluated to assess its effectiveness. METHODS A DSME program consisting of a 1-hour initial assessment of individual needs followed by 12 hours of group education on nutrition and self-management was provided to 212 Arkansas Medicaid recipients over 1 year. Key clinical measures were assessed at the end of the period. RESULTS Over 1 year, mean HbA1c declined by 0.45% among the DSME participants who completed the full program. Multivariate analyses found that after controlling for age, gender, race, preperiod diabetes drug use, and preperiod costs, DSME participants were found to have fewer hospital admissions, emergency department visits, and outpatient visits. Changes from baseline clinical values for DSME participants were used to project changes in diabetes-related costs using the Gilmer model. An estimated savings in diabetes-related cost over 3 years was $415 per program completer. Over 10 years, completers were estimated to experience 12% fewer coronary heart disease events and 15% fewer microvascular disease events using the United Kingdom Prospective Diabetes Study risk models. CONCLUSIONS A DSME program for Medicaid recipients can reduce health care use among Medicaid recipients with diabetes within 1 year and over longer periods of time is likely to reduce costs associated with reduced use of health care. Plans are in place to explore the possibility of sustaining the program.
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Affiliation(s)
- Appathurai Balamurugan
- The Arkansas Department of Health and Human Services, Little Rock (Dr Balamurugan)
- Department of Epidemiology, University of Arkansas for Medical Sciences (UAMS) Fay W. Boozman College of Public Health, Little Rock (Dr Balamurugan)
| | - Robert Ohsfeldt
- The Department of Health Policy and Management, Texas A & M Health Sciences Center, College Station (Dr Ohsfeldt)
| | - Tom Hughes
- Eli Lilly and Company, Indianapolis, Indiana (Dr Hughes)
| | - Martha Phillips
- The Department of Psychiatry & Epidemiology, UAMS College of Medicine & College of Public Health, Little Rock (Dr Phillips)
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20
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Rautiainen RH, Ohsfeldt R, Sprince NL, Donham KJ, Burmeister LF, Reynolds SJ, Saarimäki P, Zwerling C. Cost of Compensated Injuries and Occupational Diseases in Agriculture in Finland. J Agromedicine 2005; 10:21-9. [PMID: 16537313 DOI: 10.1300/j096v10n03_03] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records. The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was 75 (Euros) per person in 1983, increasing to 215 in 1999. The total insurance cost in 1996 was 23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was 1340 for injuries and 6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs. Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.
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Affiliation(s)
- Risto H Rautiainen
- University of Iowa, College of Public Health, Department of Occupational and Environmental Health, Iowa City, IA, 52242-5000, USA.
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21
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Rautiainen RH, Ledolter J, Sprince NL, Donham KJ, Burmeister LF, Ohsfeldt R, Reynolds SJ, Phillips K, Zwerling C. Effects of premium discount on workers' compensation claims in agriculture in Finland. Am J Ind Med 2005; 48:100-9. [PMID: 16032738 DOI: 10.1002/ajim.20192] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to measure changes in injury claim rates after a premium discount program was implemented in the Finnish farmers' workers' compensation insurance. We focused on measures that could indicate whether the changes occurred in the true underlying injury rate, or only in claims reporting. METHODS Monthly injury claim rates were constructed at seven disability duration levels from January 1990 to December 2003. We conducted interrupted time series analyses to measure changes in the injury claim rates after the premium discount was implemented on July 1, 1997. Three additional policy change indicators were included in the analyses. RESULTS The overall injury claim rate decreased 10.2%. Decreases occurred at four severity levels (measured by compensated disability days): 0 days (16.3%), 1-6 days (14.1%), 7-13 days (19.5%), and 14-29 days (8.4%). No changes were observed at higher severity levels. Minor injuries had a seasonal pattern with higher rates in summer months while severe injuries did not have a seasonal pattern. CONCLUSIONS The premium discount decreased the overall claim rate. Decreases were observed in all categories up to 29 disability days. This pattern suggests that under-reporting contributes to the decrease but may not be the only factor. The value of the premium discount is lower than the value of a lost-time claim, so there was no financial reason to under-report lost-time injuries. Under-reporting would be expected to be greatest in the 0 day category, but that was not the case. These observations suggest that in addition to under-reporting, the premium discount may also have some preventive effect.
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Affiliation(s)
- Risto H Rautiainen
- Department of Occupational and Environmental Health, The University of Iowa, College of Public Health, Iowa City, Iowa 52242-5000, USA.
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22
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Cram P, Rosenthal GE, Ohsfeldt R, Wallace RB, Schlechte J, Schiff GD. Failure to Recognize and Act on Abnormal Test Results: The Case of Screening Bone Densitometry. Jt Comm J Qual Patient Saf 2005; 31:90-7. [PMID: 15791768 DOI: 10.1016/s1553-7250(05)31013-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Failure to follow up on abnormal test results is common. A model was developed to capture the reasons why providers did not take action on abnormal test results. METHODS A systematic review of the medical literature was conducted to identify why providers did not follow up on test results. The reasons were then synthesized to develop an operational model. The model was tested by reviewing electronic medical records of consecutive patients diagnosed with osteoporosis through a dual-energy x-ray absorptiometry (DXA) scan to determine whether: (1) the scan results had been reeviewed; (2) therapy was recommended; (3) the scan results were not reviewed and why this occurred. RESULTS Of the 48 newly diagnosed osteoporosis patients, 16 did not receive a recommendation to begin treatment. There was no evidence that the scan results wrere reviewed in 11 of the 16 cases (23% of all abnormal scans); the scan results of an additional 5 patients were reviewed but no treatment was recommended. DISCUSSION AND CONCLUSIONS A clinically significant ercentage of DXA scan results went unrecognized. As a long-term solution, direct patient notification could theoretically reduce the burden on providers, activate and empower patients, and create a back-up system for ensuring that patients are notified of their test results.
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Affiliation(s)
- Peter Cram
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, USA.
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23
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Wehby G, Ohsfeldt R, Murray J. Health Professionals' Assessment of Health Related Quality of Life Values for Oral Clefting by Age Using a Visual Analogue Scale Method. Cleft Palate Craniofac J 2005. [DOI: 10.1597/05-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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24
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Wakefield DS, Ward M, Miller T, Ohsfeldt R, Jaana M, Lei Y, Tracy R, Schneider J. Intensive care unit utilization and interhospital transfers as potential indicators of rural hospital quality. J Rural Health 2004; 20:394-400. [PMID: 15551857 DOI: 10.1111/j.1748-0361.2004.tb00054.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease-specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care processes. PURPOSE To evaluate the applicability of intensive care unit (ICU) utilization and interhospital transfers as potential indicators of quality in rural hospitals. METHODS Secondary data analysis of ICU utilization and interhospital transfer practices in Iowa's Critical Access (CAH), rural, rural referral, and urban hospitals. FINDINGS Rural hospitals have fewer resources, provide a more limited range of definitive care services, and rely to a greater extent on transferring patients to other hospitals capable of providing the required definitive care. Examining ICU utilization and interhospital transfer patterns we found (1) that lower percentages of patients receive ICU care in smaller facilities; (2) higher transfer rates for both ICU and non-ICU patients in CAH hospitals; (3) shorter average lengths of stay for ICU patients from smaller hospitals who were transferred; and (4) lower mortality rates for CAH and rural hospital ICU patients. CONCLUSIONS Examining ICU utilization and interhospital transfer patterns offers potential insights into rural hospital quality measurement and comparisons.
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Affiliation(s)
- Douglas S Wakefield
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa 52242, USA.
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25
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Phillips KT, Ohsfeldt R, Voigt M. Albumin versus crystalloid therapy in the management of hepatorenal syndrome: a model for using meta analysis in cost effectiveness studies and the design of clinical trials. AMIA Annu Symp Proc 2003; 2003:970. [PMID: 14728474 PMCID: PMC1480134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
We applied traditional methods of gathering, integrating and summarizing findings of current literature, with new approaches for assessing the cost effectiveness of two treatments for hepatorenal syndrome (HRS). Findings of this cost effectiveness study are used to form a proposal for a multi-center prospective clinical trial, to assess the economic and clinical benefits of albumen versus crystalloid therapy in the care of these patients. Our initial findings suggest that albumin therapy is superior to standard crystalloid therapy, in the treatment of HRS patients. The number of survival days appears to increase with this form of therapy per dollar cost, while patients await liver transplantation.
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Affiliation(s)
- Kirk T Phillips
- College of Public Health, University of Iowa, Iowa City, USA
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Capilouto E, Capilouto ML, Ohsfeldt R. A review of methods used to project the future supply of dental personnel and the future demand and need for dental services. J Dent Educ 1995; 59:237-57. [PMID: 7884073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- E Capilouto
- School of Public Health, University of Alabama at Birmingham
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27
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Capilouto E, Capilouto ML, Ohsfeldt R. A review of methods used to project the future supply of dental personnel and the future demand and need for dental services. J Dent Educ 1995. [DOI: 10.1002/j.0022-0337.1995.59.1.tb02919.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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