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Eaglehouse YL, Seabury SA, Aljehani M, Koehlmoos T, Lee JSH, Shriver CD, Zhu K. Chemotherapy Treatment Costs and Clinical Outcomes of Colon Cancer in the U.S. Military Health System's Direct and Private Sector Care Settings. Mil Med 2023; 188:e3439-e3446. [PMID: 37167011 DOI: 10.1093/milmed/usad132] [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] [Received: 01/10/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Identifying low-value cancer care may be an important step in containing costs associated with treatment. Low-value care occurs when the medical services, tests, or treatments rendered do not result in clinical benefit. These may be impacted by care setting and patients' access to care and health insurance. We aimed to study chemotherapy treatment and the cost paid by the Department of Defense (DoD) for treatment in relation to clinical outcomes among patients with colon cancer treated within the U.S. Military Health System's direct and private sector care settings to better understand the value of cancer care. MATERIALS AND METHODS A cohort of patients aged 18 to 64 years with primary colon cancer diagnosed between January 1, 1999, and December 31, 2014, were identified in the Military Cancer Epidemiology database. Multivariable time-dependent Cox proportional hazards regression models were used to assess the relationship between chemotherapy treatment and the cost paid by the DoD (in quartiles, Q) and the outcomes of cancer progression, cancer recurrence, and all-cause death modeled as adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). The Military Cancer Epidemiology data were approved for research by the Uniformed Services University of the Health Sciences' Institutional Review Board. RESULTS The study included 673 patients using direct care and 431 patients using private sector care. The median per patient chemotherapy costs in direct care ($111,202) were lower than in private sector care ($350,283). In direct care, higher chemotherapy costs were associated with an increased risk of any outcome but not with all-cause death. In private sector care, higher chemotherapy costs were associated with a higher risk of any outcome and with all-cause death (aHR, 2.67; 95% CI, 1.20-5.92 for Q4 vs. Q1). CONCLUSIONS The findings in the private sector may indicate low-value care in terms of the cost paid by the DoD for chemotherapy treatment and achieving desirable survival outcomes for patients with colon cancer in civilian health care. Comprehensive evaluations of value-based care among patients treated for other tumor types may be warranted.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Seth A Seabury
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA 90089, USA
| | - Mayada Aljehani
- Lawrence J. Ellison Institute for Transformative Medicine, Los Angeles, CA 90064, USA
| | - Tracey Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jerry S H Lee
- Lawrence J. Ellison Institute for Transformative Medicine, Los Angeles, CA 90064, USA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Chemical Engineering and Material Sciences, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Huckfeldt PJ, Yu JC, O'Leary PK, Harada ASM, Pajewski NM, Frenier C, Espeland MA, Peters A, Bancks MP, Seabury SA, Goldman DP. Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes. JAMA Intern Med 2023; 183:1071-1079. [PMID: 37578773 PMCID: PMC10425863 DOI: 10.1001/jamainternmed.2023.3283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/29/2023] [Indexed: 08/15/2023]
Abstract
Importance An intensive lifestyle intervention (ILI) has been shown to improve diabetes management and physical function. These benefits could lead to better labor market outcomes, but this has not been previously studied. Objective To estimate the association of an ILI for weight loss in type 2 diabetes with employment, earnings, and disability benefit receipt during and after the intervention. Design, Setting, and Participants This cohort study included participants with type 2 diabetes and overweight or obesity and compared an ILI with a control condition of diabetes support and education. Data for the original trial were accrued from August 22, 2001, to September 14, 2012. Trial data were linked with Social Security Administration records to investigate whether, relative to the control group, the ILI was associated with improvements in labor market outcomes during and after the intervention period. Difference-in-differences models estimating relative changes in employment, earnings, and disability benefit receipt between the ILI and control groups were used, accounting for prerandomization differences in outcomes for linked participants. Outcome data were analyzed from July 13, 2020, to May 17, 2023. Exposure The ILI consisted of sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists on a weekly basis in the first 6 months, decreasing to a monthly basis by the fourth year, designed to achieve and maintain at least 7% weight loss. The control group received group-based diabetes education sessions 3 times annually during the first 4 years, with 1 annual session thereafter. Main Outcomes and Measures Employment and receipt of federal disability benefits (Supplemental Security Income and Social Security Disability Insurance), earnings, and disability benefit payments from 1994 through 2018. Results A total of 3091 trial participants were linked with Social Security Administration data (60.1% of 5145 participants initially randomized and 97.0% of 3188 of participants consenting to linkage). Among the 3091 with fully linked data, 1836 (59.4%) were women, and mean (SD) age was 58.4 (6.5) years. Baseline clinical and demographic characteristics were similar between linked participants in the ILI and control groups. Employment increased by 2.9 (95% CI, 0.3-5.5) percentage points for the ILI group relative to controls (P = .03) with no significant relative change in disability benefit receipt (-0.9 [95% CI, -2.1 to 0.3] percentage points; P = .13). Conclusions and Relevance The findings of this cohort study suggest that an ILI to prevent the progression and complications of type 2 diabetes was associated with higher levels of employment. Labor market productivity should be considered when evaluating interventions to manage chronic diseases.
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Affiliation(s)
- Peter J Huckfeldt
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Jeffrey C Yu
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles
- Alexion Pharmaceuticals, Ltd, Boston, Massachusetts
| | - Paul K O'Leary
- Office of Retirement and Disability Policy, Social Security Administration
| | - Ann S M Harada
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Chris Frenier
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
- Yale University School of Public Health, New Haven, Connecticut
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anne Peters
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Seth A Seabury
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles
| | - Dana P Goldman
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- Sol Price School of Public Policy, University of Southern California, Los Angeles
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Bae-Shaaw YH, Shier V, Sood N, Seabury SA, Joyce G. Potentially Inappropriate Medication Use in Community-Dwelling Older Adults Living with Dementia. J Alzheimers Dis 2023; 93:471-481. [PMID: 37038818 DOI: 10.3233/jad-221168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: The Beers Criteria identifies potentially inappropriate medications (PIMs) that should be avoided in older adults living with dementia. Objective: The aim of this study was to provide estimates of the prevalence and persistence of PIM use among community-dwelling older adults living with dementia in 2011-2017. Methods: Medicare claims data were used to create an analytic dataset spanning from 2011 to 2017. The analysis included community-dwelling Medicare fee-for-service beneficiaries aged 65 and older who were enrolled in Medicare Part D plans, had diagnosis for dementia, and were alive for at least one calendar year. Dementia status was determined using Medicare Chronic Conditions Date Warehouse (CCW) Chronic Condition categories and Charlson Comorbidity Index. PIM use was defined as 2 or more prescription fills with at least 90 days of total days-supply in a calendar year. Descriptive statistics were used to report the prevalence and persistence of PIM use. Results: Of 1.6 million person-year observations included in the sample, 32.7% used one or more PIMs during a calendar year in 2011-2017. Breakdown by drug classes showed that 14.9% of the sample used anticholinergics, 14.0% used benzodiazepines, and 11.0% used antipsychotics. Conditional on any use, mean annual days-supply for all PIMs was 270.6 days (SD = 102.7). The mean annual days-supply for antipsychotic use was 302.7 days (SD = 131.2). Conclusion: Significant proportion of community-dwelling older adults with dementia used one or more PIMs, often for extended periods of time. The antipsychotic use in the community-dwelling older adults with dementia remains as a significant problem.
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Affiliation(s)
- Yuna H. Bae-Shaaw
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Victoria Shier
- University of Southern California Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Neeraj Sood
- University of Southern California Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Seth A. Seabury
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Geoffrey Joyce
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
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Gaudette É, Seabury SA, Temkin N, Barber J, DiGiorgio AM, Markowitz AJ, Manley GT. Employment and Economic Outcomes of Participants With Mild Traumatic Brain Injury in the TRACK-TBI Study. JAMA Netw Open 2022; 5:e2219444. [PMID: 35767257 PMCID: PMC9244609 DOI: 10.1001/jamanetworkopen.2022.19444] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Mild traumatic brain injury (mTBI) may impair the ability to work. Strategies to facilitate return to work are understudied. OBJECTIVE To assess employment and economic outcomes for employed, working-age adults with mTBI in the 12 months after injury and the association between return to work and employer assistance. DESIGN, SETTING, AND PARTICIPANTS Using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a cohort study of patients with mTBI presenting to emergency departments of 11 level I US trauma centers was performed. Patients with mTBI enrolled in the TRACK-TBI cohort study from February 26, 2014, to May 4, 2016, were followed up at 2 weeks and 3, 6, and 12 months after injury. Work status and income decline of participants were documented in the first year after injury. Associations between work status, injury characteristics, and offer of employer assistance and associations between follow-up care and employer assistance were investigated. Results were adjusted for unobserved outcomes using inverse probability weighting. Data were extracted July 12, 2020; analyses were completed March 24, 2021. Analyses included 435 participants aged 18 to 64 years who were working before the injury, had a Glasgow Coma Scale score of 13 to 15, and completed all postinjury follow-up surveys. MAIN OUTCOMES AND MEASURES Primary outcomes were work status (working or not working) at each study follow-up milestone. Employer assistance included sick leave, reduced hours, modified schedule, transfer to different tasks, assistive technology, and coaching offered during the first 3 months after injury. RESULTS Of 435 participants (147 [34%] female; 320 [74%] White; mean [SD] age 37.3 [12.9] years), 258 (59%) reported not working at 2 weeks after injury and 74 (17%) reported not working at 12 months after injury. More than one-fifth (92 [21%]) experienced a decline in annual income. Work status at 12 months was significantly associated with postconcussion symptoms experienced at 3 months after injury (73% of patients with 3 or more symptoms reported working at 12 months after injury vs 89% of patients with 2 or fewer symptoms; P < .001) but not with other injury characteristics. Participants offered employer assistance in the first 3 months after injury were more likely to report working after injury than those not offered such assistance (at 6 months: 88% vs 78%; P = .02; at 12 months: 86% vs 72%; P = .005). CONCLUSIONS AND RELEVANCE In this cohort study, mTBI was associated with substantial employment and economic consequences for some patients. Clinicians should systematically follow up with patients with mTBI and coordinate with employers to promote successful return to work.
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Affiliation(s)
- Étienne Gaudette
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Seth A. Seabury
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
- School of Pharmacy, University of Southern California, Los Angeles
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Anthony M. DiGiorgio
- Department of Neurological Surgery, University of California, San Francisco
- Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Amy J. Markowitz
- Department of Neurological Surgery, University of California, San Francisco
- Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
- Zuckerberg San Francisco General Hospital, San Francisco, California
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Li K, Yu T, Seabury SA, Dor A. Trends and Disparities in the Utilization of Influenza Vaccines Among Commercially Insured US Adults During the COVID-19 Pandemic. Vaccine 2022; 40:2696-2704. [PMID: 35370018 PMCID: PMC8960160 DOI: 10.1016/j.vaccine.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
Objectives Little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected influenza vaccine utilization and disparities. We sought to estimate changes in the likelihood of receiving an influenza vaccine across different demographic subgroups during the COVID-19 pandemic. Methods In this cohort study, we analyzed influenza vaccine uptake from 2019 to 2020 using Optum commercial insurance claims data. Eligible individuals were aged 18 or above in 2018 and continuously enrolled from 08/01/2018 through 12/31/2020. Multivariable logistic regressions were fitted for the individual-level influenza vaccine uptake. Adjusting for demographic factors and medical histories, we estimated probabilities of receiving influenza vaccines before and after the COVID-19 pandemic across demographic subgroups. Results From August to December 2019, unadjusted influenza vaccination rate was 42.3%, while in the same period of 2020, the vaccination rate increased to 45.9%. Females had a higher vaccination rate in 2019 (OR: 1.16, 95% CI 1.15–1.16), but the increase was larger for males. Blacks and Hispanics had lower vaccination rates relative to whites in both flu seasons. Hispanics showed a greater increase in vaccination rate, increasing by 7.8 percentage points (p < .001) compared to 4.4 (p < .001) for whites. The vaccination rate for Blacks increased by 5.2 percentage points (p < .001). All income groups experienced vaccination improvements, but poorer individuals had lower vaccination rates in both seasons. The most profound disparities occurred when educational cohort were considered. The vaccination rate increased among college-educated enrollees by 8.8 percentage points (p < .001) during the pandemic compared to an increase of 2.8 percentage points (p < .001) for enrollees with less than a 12th grade education. Past influenza infections or vaccination increased the likelihood of vaccination (p < .001). Conclusions The COVID-19 pandemic was associated with increased influenza vaccine utilization. Disparities persisted but narrowed with respect to gender and race but worsened with respect to income and educational attainment.
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Lopez J, Gange WS, Lung K, Xu BY, Seabury SA, Toy BC. Response to Comment on Gange et al. Incidence of Proliferative Diabetic Retinopathy and Other Neovascular Sequelae at 5 Years Following Diagnosis of Type 2 Diabetes. Diabetes Care 2021;44:2518-2526. Diabetes Care 2022; 45:e61-e62. [PMID: 35245351 PMCID: PMC8918259 DOI: 10.2337/dci21-0057] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jennifer Lopez
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - William S Gange
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Khristina Lung
- Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Benjamin Y Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Seth A Seabury
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Brian C Toy
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Lichtenstein GR, Shahabi A, Seabury SA, Lakdawalla DN, Espinosa OD, Green S, Brauer M, Baldassano RN. Increased Lifetime Risk of Intestinal Complications and Extraintestinal Manifestations in Crohn's Disease and Ulcerative Colitis. Gastroenterol Hepatol (N Y) 2022; 18:32-43. [PMID: 35505770 PMCID: PMC9053498] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patients with Crohn's disease (CD) or ulcerative colitis (UC) have high morbidity rates owing to debilitating intestinal complications and extraintestinal manifestations (EIMs). We retrospectively identified patients in the Truven MarketScan databases with an incident CD or UC diagnosis from January 2008 to September 2015 to quantify the incremental lifetime risk of experiencing an intestinal complication or EIM after CD or UC diagnosis. Seven intestinal complications and 13 categories of EIMs by site were identified, and lifetime risk of experiencing an intestinal complication or EIM from age at CD or UC diagnosis to end of life was estimated using parametric models. Results were compared with controls' propensity score matched by age, sex, health plan, and pre-index Charlson Comorbidity Index. The CD or UC incremental risk was calculated using the difference in rates between CD or UC patients and matched controls. A total of 34,692 CD patients and 48,196 UC patients with 1:1 matched controls were included. CD and UC patients had an increased lifetime risk of intestinal complications, which varied across ages, inflammatory bowel disease (IBD) types, and categories of intestinal complications and EIMs. CD and UC patients aged 0 to 11 years had the highest incremental lifetime risk for all 7 intestinal complications and the majority of EIMs, with blood EIMs associated with the highest incremental risk (CD: 32%; UC: 21%). CD and UC patients of all ages have a higher lifetime risk of experiencing intestinal complications and EIMs than patients without CD or UC. When evaluating the burden of disease on patients with IBD, it is important to include the burden of these intestinal complications and EIMs in the assessment.
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Affiliation(s)
- Gary R. Lichtenstein
- Department of Medicine, Center for Inflammatory Bowel Disease, Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ahva Shahabi
- Health Policy and Economics, Precision Health Economics, Los Angeles, California
| | - Seth A. Seabury
- Pharmaceutical and Health Economics, Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | - Darius N. Lakdawalla
- Pharmaceutical and Regulatory Innovation, Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California
| | | | - Sarah Green
- Health Policy and Economics, Precision Health Economics, Los Angeles, California
| | - Michelle Brauer
- Health Policy and Economics, Precision Health Economics, Los Angeles, California
| | - Robert N. Baldassano
- Center for Pediatric Inflammatory Bowel Disease, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Gange WS, Lopez J, Xu BY, Lung K, Seabury SA, Toy BC. Incidence of Proliferative Diabetic Retinopathy and Other Neovascular Sequelae at 5 Years Following Diagnosis of Type 2 Diabetes. Diabetes Care 2021; 44:2518-2526. [PMID: 34475031 PMCID: PMC8546279 DOI: 10.2337/dc21-0228] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the incidence and risk factors for developing proliferative diabetic retinopathy (PDR), tractional retinal detachment (TRD), and neovascular glaucoma (NVG) at 5 years after the initial diagnosis of type 2 diabetes. RESEARCH DESIGN AND METHODS Insured patients aged ≥18 years with newly diagnosed type 2 diabetes and 5 years of continuous enrollment were identified from a nationwide commercial claims database containing data from 2007 to 2015. The incidences of PDR, TRD, and NVG were computed at 5 years following the index diagnosis of type 2 diabetes. Associations between these outcomes and demographic, socioeconomic, and medical factors were tested with multivariable logistic regression. RESULTS At 5 years following the initial diagnosis of type 2 diabetes, 1.74% (1,249 of 71,817) of patients had developed PDR, 0.25% of patients had developed TRD, and 0.14% of patients had developed NVG. Insulin use (odds ratio [OR] 3.59, 95% CI 3.16-4.08), maximum HbA1c >9% or >75 mmol/mol (OR 2.10, 95% CI 1.54-2.69), renal disease (OR 2.68, 95% CI 2.09-3.42), peripheral circulatory disorders (OR 1.88, 95% CI 1.25-2.83), neurological disease (OR 1.62, 95% CI 1.24-2.11), and older age (age 65-74 years) at diagnosis (OR 1.62, 95% CI 1.28-2.03) were identified as risk factors for development of PDR at 5 years. Young age (age 18-23 years) at diagnosis (OR 0.46, 95% CI 0.29-0.74), Medicare insurance (OR 0.60, 95% CI 0.70-0.76), morbid obesity (OR 0.72, 95% CI 0.59-0.87), and smoking (OR 0.84, 95% CI 0.70-1.00) were identified as protective factors. CONCLUSIONS A subset of patients with type 2 diabetes develop PDR and other neovascular sequelae within the first 5 years following the diagnosis with type 2 diabetes. These patients may benefit from increased efforts for screening and early intervention.
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Affiliation(s)
- William S Gange
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jennifer Lopez
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Benjamin Y Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Khristina Lung
- Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Seth A Seabury
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Brian C Toy
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Dworsky M, Seabury SA, Broten N. The Frequency and Economic Impact of Musculoskeletal Disorders for California Firefighters: Trends and Outcomes over the Past Decade. Rand Health Q 2021; 9:4. [PMID: 34484876 PMCID: PMC8383844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Musculoskeletal disorders (MSDs) are the most common type of occupational injury or illness suffered by firefighters, so there is considerable interest among policymakers and stakeholders about how best to monitor, prevent, and treat firefighter MSDs. In this study, the authors update analyses from a 2010 RAND study on firefighters in California and consider the impacts of the 2013 workers' compensation reforms and the economic shocks of the late 2000s on outcomes for firefighters with MSDs. The California Department of Industrial Relations requested that the authors address a wide range of specific research questions on various aspects of firefighters' injury risk and outcomes in the workers' compensation system, from case mix and economic consequences to permanent disability rating and medical treatment patterns. The authors analyzed administrative data from the California workers' compensation system linked to data on earnings for workers injured between 2005 and 2015, with additional analyses to tailor the results to the new reforms. They compare firefighters with three groups of workers in broadly comparable occupations-police, other public-sector workers, and private-sector workers with job demands that resemble firefighting-and supplement the analysis using outside data. The authors found, among other things, that firefighters continue to face elevated risk of work-related MSDs and that earnings losses for firefighters worsened after the Great Recession of 2008-2009. Their findings will be of interest to policymakers in California and other states and to other audiences concerned with the occupational health and safety of firefighters.
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Mulligan K, Seabury SA, Dugel PU, Blim JF, Goldman DP, Humayun MS. Economic Value of Anti-Vascular Endothelial Growth Factor Treatment for Patients With Wet Age-Related Macular Degeneration in the United States. JAMA Ophthalmol 2021; 138:40-47. [PMID: 31725830 DOI: 10.1001/jamaophthalmol.2019.4557] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Anti-vascular endothelial growth factor (anti-VEGF) is a breakthrough treatment for wet age-related macular degeneration (wAMD), the most common cause of blindness in western countries. Anti-VEGF treatment prevents vision loss and has been shown to produce vision gains lasting as long as 5 years. Although this treatment is costly, the benefits associated with vision gains are large. Objective To estimate the economic value of benefits, costs for patients with wAMD, and societal value in the United States generated from vision improvement associated with anti-VEGF treatment. Design, Setting, and Participants This economic evaluation study used data from the published literature to simulate vision outcomes for a cohort of 168 820 patients with wAMD aged 65 years or older and to translate them into economic variables. Data were collected and analyzed from March 2018 to November 2018. Main Outcomes and Measures Main outcomes included patient benefits, costs, and societal value. Each outcome was estimated for a newly diagnosed cohort and the full population across 5 years, with a focus on year 3 as the primary outcome because data beyond that point may be less representative of the general population. Drug costs were the weighted mean across anti-VEGF therapies. Two current treatment scenarios were considered: less frequent injections (mean [SD], 8.2 [1.6] injections annually) and more frequent injections (mean [range], 10.5 [6.8-13.1] injections annually). The 2 treatment innovation scenarios, improved adherence and best case, had the same vision outcomes as the current treatment scenarios had but included more patients treated from higher initiation and lower discontinuation. Results The study population included 168 820 patients aged 65 years at the time of diagnosis with wAMD. The underlying clinical trials that were used to parameterize the model did not stratify visual acuity outcomes or treatment frequency by sex; therefore, the model parameters could not be stratified by sex. The current treatment scenario of less frequent injections generated $1.1 billion for the full population in year 1 and $5.1 billion in year 3, whereas the scenario of more frequent injections generated $1.6 billion (year 1) and $8.2 billion (year 3). Three-year benefits ranged from $7.3 billion to $11.4 billion in the improved adherence scenario and from $9.7 billion to $15.0 billion if 100% of the patients initiated anti-VEGF treatment and the discontinuation rates were 6% per year or equivalent to clinical trial discontinuation (best-case scenario). Societal value (patient benefits net of treatment cost) ranged from $0.9 billion to $3.0 billion across 3 years in the current treatment scenarios and from $0.9 billion to $4.3 billion in the treatment innovation scenarios. Conclusions and Relevance This study's findings suggest that improved vision associated with anti-VEGF treatment may provide economic value to patients and society if the outcomes match published outcomes data used in these analyses; however, future innovations that increase treatment utilization may result in added economic benefit.
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Affiliation(s)
- Karen Mulligan
- Sol Price School of Public Policy, University of Southern California, Los Angeles.,Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| | - Seth A Seabury
- School of Pharmacy, University of Southern California, Los Angeles.,Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| | - Pravin U Dugel
- Retinal Research Institute, LLC, Phoenix, Arizona.,Roski Eye Institute, University of Southern California, Los Angeles
| | - Jill F Blim
- American Society of Retina Specialists, Chicago, Illinois
| | - Dana P Goldman
- Sol Price School of Public Policy, University of Southern California, Los Angeles.,School of Pharmacy, University of Southern California, Los Angeles.,Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles
| | - Mark S Humayun
- Roski Eye Institute, University of Southern California, Los Angeles.,Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles
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11
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Heun-Johnson H, Menchine M, Axeen S, Lung K, Claudius I, Wright T, Seabury SA. Association Between Race/Ethnicity and Disparities in Health Care Use Before First-Episode Psychosis Among Privately Insured Young Patients. JAMA Psychiatry 2021; 78:311-319. [PMID: 33355626 PMCID: PMC7758828 DOI: 10.1001/jamapsychiatry.2020.3995] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Racial/ethnic disparities in health care use and clinical outcomes for behavioral health disorders, including psychosis, are well documented, but less is known about these disparities during the period leading up to first-episode psychosis (FEP). OBJECTIVE To describe the racial/ethnic disparities in behavioral health care use and prescription drug use of children and young adults before the diagnosis of FEP. DESIGN, SETTING, AND PARTICIPANTS An observational cohort study was conducted using medical and prescription drug claims from January 1, 2007, to September 30, 2015, obtained from Optum's deidentified Clinformatics Data Mart Database, a commercial claims database augmented with race/ethnicity and socioeconomic variables. Data analysis was performed from February 6, 2018, to October 10, 2020. First-episode psychosis was determined by the presence of psychosis diagnoses on claims for at least 1 hospitalization or 2 outpatient events, with a continuous enrollment requirement of at least 2 years before the first diagnosis. Participants included 3017 Black, Hispanic, or White patients who were continually enrolled in commercial insurance plans and received an FEP diagnosis between the ages of 10 and 21 years. MAIN OUTCOMES AND MEASURES Race/ethnicity was determined from a commercial claims database. Rates of inpatient admission, emergency department presentation, and outpatient visits (including psychotherapy), behavioral health disorder diagnoses, and antipsychotic/antidepressant prescription fills were determined for the year before FEP. Race/ethnicity was also obtained from Optum's claims database. With use of multivariable logistic regression, results were adjusted for covariates including estimated household income, age, sex, and geographic division in the US. RESULTS Of the 3017 patients with FEP, 643 Black or Hispanic patients (343 [53.3%] Black, 300 [46.7%] Hispanic, 324 [50.4%] male, mean [SD] age, 17.2 [2.76] years) were less likely than 2374 White patients (1210 [51.0%] male, mean age, 17.0 [2.72] years) to receive comorbid behavioral health disorder diagnoses in the year before the diagnosis of FEP (410 [63.8%] vs 1806 [76.1%], χ2 = 39.3; P < .001). Except for emergency care, behavioral health care use rates were lower in Black and Hispanic patients vs White patients (424 [65.9%] vs 1868 [78.7%]; χ2 = 45.0; P < .001), particularly for outpatient visits with behavioral health care professionals (232 [36.1%] vs 1236 [52.1%]; χ2 = 51.7; P < .001). After adjustment for socioeconomic covariates, behavioral health care use rates (68.9% vs 79.2%; P < .001), outpatient visits with behavioral health professionals (37.7% vs 51.2%; P < .001), and other outcomes remained significantly lower for Black and Hispanic patients vs White patients. CONCLUSIONS AND RELEVANCE The results of this study extend existing research findings of well-known racial/ethnic disparities in the population of patients who are diagnosed with FEP. These differences were apparent in young patients with continuous commercial health insurance and after controlling for household income. Providing equal access to preventive outpatient behavioral health care may increase opportunities for timely detection of psychotic symptoms and early intervention and improve differential outcomes after FEP.
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Affiliation(s)
- Hanke Heun-Johnson
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Michael Menchine
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Sarah Axeen
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Khristina Lung
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Ilene Claudius
- Department of Emergency Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Tyler Wright
- LAC+USC Medical Center, Los Angeles, California,University of Southern California, Los Angeles
| | - Seth A. Seabury
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles
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12
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Seabury SA, Axeen S, Pauley G, Tysinger B, Schlosser D, Hernandez JB, Heun-Johnson H, Zhao H, Goldman DP. Measuring The Lifetime Costs Of Serious Mental Illness And The Mitigating Effects Of Educational Attainment. Health Aff (Millwood) 2020; 38:652-659. [PMID: 30933598 DOI: 10.1377/hlthaff.2018.05246] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Serious mental illness (SMI) is a disabling condition that develops early in life and imposes substantial economic burden. There is a growing belief that early intervention for SMI has lifelong benefits for patients. However, assessing the cost-effectiveness of early intervention efforts is hampered by a lack of evidence on the long-term benefits. We addressed this by using a dynamic microsimulation model to estimate the lifetime burden of SMI for those diagnosed by age twenty-five. We estimated that the per patient lifetime burden of SMI is $1.85 million. We also found that a policy intervention focused on improving the educational attainment of people with SMI reduces the average per person burden of SMI by $73,600 (4.0 percent)-a change driven primarily by higher lifetime earnings-or over $8.9 billion in reduced burden per cohort of SMI patients. These findings provide a benchmark for the potential value of improving educational attainment for people with SMI.
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Affiliation(s)
- Seth A Seabury
- Seth A. Seabury is an associate professor in the Department of Pharmaceutical and Health Economics at the School of Pharmacy and the Leonard D. Schaeffer Center for Health Policy and Economics, both at the University of Southern California (USC), in Los Angeles
| | - Sarah Axeen
- Sarah Axeen ( ) is an assistant professor of research at the Keck School of Medicine and the Schaeffer Center, both at USC
| | - Gwyn Pauley
- Gwyn Pauley is a visiting assistant professor of economics at the University of Wisconsin-Madison
| | - Bryan Tysinger
- Bryan Tysinger is a research assistant professor at the Sol Price School of Public Policy and director of health policy microsimulation at the Schaeffer Center, both at USC
| | - Danielle Schlosser
- Danielle Schlosser is a senior clinical scientist at Verily Life Sciences LLC, in South San Francisco, California
| | - John B Hernandez
- John B. Hernandez is a research scientist at Google Health, in Mountain View, California
| | | | - Henu Zhao
- Henu Zhao is a senior quantitative analyst at the Schaeffer Center, USC
| | - Dana P Goldman
- Dana P. Goldman is the Leonard D. Schaeffer Chair and Distinguished Professor of Public Policy, Pharmacy, and Economics in the Sol Price School of Public Policy and School of Pharmacy, USC
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13
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Gange WS, Xu BY, Lung K, Toy BC, Seabury SA. Rates of Eye Care and Diabetic Eye Disease among Insured Patients with Newly Diagnosed Type 2 Diabetes. Ophthalmol Retina 2020; 5:160-168. [PMID: 32653554 DOI: 10.1016/j.oret.2020.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine rates of eye examinations and diabetic eye disease in the first 5 years after diagnosis of type 2 diabetes (DM2) among continuously insured adults. DESIGN Retrospective, longitudinal cohort study. PARTICIPANTS Insured patients aged 40 years or older with newly diagnosed DM2 (n = 42 684), and control patients without diabetes matched on age, sex, and race were identified from a nationwide commercial claims database containing data from 2007 to 2015. METHODS All patients were tracked for 6 years: 1 year before and 5 years after the index diabetes diagnosis. Receipt of eye care for individual patients was identified using International Classification of Diseases 9th edition (ICD-9) procedure codes or Current Procedural Terminology (CPT) codes indicating an eye examination, as well as encounters indicating the patient was seen by an ophthalmologist. A diagnosis of diabetic eye disease was determined by using ICD-9 codes. MAIN OUTCOME MEASURES Outcome measures included annual receipt of eye care and development of diabetic eye disease, namely, diabetic retinopathy (DR). Associations between these outcomes and demographic factors were tested with multivariable logistic regression. RESULTS Diabetic patients received more eye examinations than controls in each year, but no more than 40.4% of diabetic patients received an examination in any given year. Patients with Medicare Advantage received fewer eye examinations at 5 years (odds ratio [OR], 0.79; P < 0.01) than those with private insurance but were less likely to develop DR (OR, 0.71; P < 0.01). Hispanic patients had higher rates of DR (OR, 1.60; P < 0.01) and received fewer eye examinations (OR, 0.75; P < 0.01) at 5 years compared with White patients. Men received fewer eye examinations (OR, 0.84; P < 0.01) and were more likely to develop DR at 5 years (OR, 1.17; P < 0.01) than women. Patients with higher education were more likely to receive an eye examination and less likely to develop DR. CONCLUSIONS The majority of diabetic patients do not receive adequate eye care within the 5 years after initial diabetes diagnosis despite having insurance. Efforts should be made to improve adherence to screening guidelines, especially for vulnerable populations.
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Affiliation(s)
- William S Gange
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Benjamin Y Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Khristina Lung
- Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brian C Toy
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Seth A Seabury
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, California
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14
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Lichtenstein GR, Shahabi A, Seabury SA, Lakdawalla DN, Espinosa OD, Green S, Brauer M, Baldassano RN. Lifetime Economic Burden of Crohn's Disease and Ulcerative Colitis by Age at Diagnosis. Clin Gastroenterol Hepatol 2020; 18:889-897.e10. [PMID: 31326606 DOI: 10.1016/j.cgh.2019.07.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Understanding the burden of Crohn's disease (CD) and ulcerative colitis (UC) is important for measuring treatment value. We estimated lifetime health care costs incurred by patients with CD or UC by age at diagnosis. METHODS We collected data from 78,620 patients with CD, 85,755 with UC, and propensity score-matched control subjects from the Truven Health MarketScan insurance claims databases (2008‒2015). Total medical (inpatient, outpatient) and pharmacy costs were captured. Cost variations over a lifetime were estimated in cost-state Markov models by age at diagnosis, adjusted to 2016 U.S. dollars and discounted at 3% per annum. We measured lifetime total and lifetime incremental cost (the difference between costs of CD or UC patients vs matched controls). RESULTS For CD, the lifetime incremental cost was $707,711 among patients who received their diagnosis at 0‒11 years, and $177,614 for patients 70 years or older, averaging $416,352 for a diagnosis at any age. Lifetime total cost was $622,056, consisting of outpatient ($273,056), inpatient ($164,298), pharmacy ($163,722), and emergency room (ER) ($20,979) costs. For UC, the lifetime incremental cost was $369,955 among patients who received their diagnosis at 0‒11 years, and $132,396 for individuals 70 years or older, averaging $230,102 for a diagnosis at any age. Lifetime total cost was $405,496, consisting of outpatient ($163,670), inpatient ($123,190), pharmacy ($105,142), and ER ($13,493) costs. Therefore, the prevalent populations of patients with CD or UC in the United States in 2016 are expected to incur lifetime total costs of $498 billion and $377 billion, respectively. CONCLUSIONS Using a Markov model, we estimated lifetime costs for patients with CD or UC to exceed previously published estimates. Individuals who receive a diagnosis of CD or UC at an early age (younger than 11 years) incur the highest lifetime cost burden. Advancing management strategies may significantly improve patient outcomes and reduce lifetime health care spending.
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Affiliation(s)
- Gary R Lichtenstein
- Gastroenterology Division, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ahva Shahabi
- Precision Health Economics, Los Angeles, California
| | | | | | | | - Sarah Green
- Precision Health Economics, Los Angeles, California
| | | | - Robert N Baldassano
- Center for Pediatric Inflammatory Bowel Disease, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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15
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Nielson JL, Cooper SR, Seabury SA, Luciani D, Fabio A, Temkin NR, Ferguson AR. Statistical Guidelines for Handling Missing Data in Traumatic Brain Injury Clinical Research. J Neurotrauma 2020; 38:2530-2537. [PMID: 32008424 DOI: 10.1089/neu.2019.6702] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Missing data is a persistent and unavoidable problem in even the most carefully designed traumatic brain injury (TBI) clinical research. Missing data patterns may result from participant dropout, non-compliance, technical issues, or even death. This review describes the types of missing data that are common in TBI research, and assesses the strengths and weaknesses of the statistical approaches used to draw conclusions and make clinical decisions from these data. We review recent innovations in missing values analysis (MVA), a relatively new branch of statistics, as applied to clinical TBI data. Our discussion focuses on studies from the International Traumatic Brain Injury Research (InTBIR) initiative project: Transforming Research and Clinical Knowledge in TBI (TRACK-TBI), Collaborative Research on Acute TBI in Intensive Care Medicine in Europe (CREACTIVE), and Approaches and Decisions in Acute Pediatric TBI Trial (ADAPT). In addition, using data from the TRACK-TBI pilot study (n = 586) and the completed clinical trial assessing valproate (VPA) for the treatment of post-traumatic epilepsy (n = 379) we present real-world examples of typical missing data patterns and the application of statistical techniques to mitigate the impact of missing data in order to draw sound conclusions from ongoing clinical studies.
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Affiliation(s)
- Jessica L Nielson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota.,Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
| | - Shelly R Cooper
- Cognitive Control and Psychopathology Laboratory, Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Seth A Seabury
- Department of Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Davide Luciani
- Unit of Clinical Knowledge Engineering, Laboratory of Clinical Epidemiology, IRCCS-Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Anthony Fabio
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nancy R Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington
| | - Adam R Ferguson
- Brain and Spinal Injury Center (BASIC), Weill Institute for Neurosciences, Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
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16
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Frakes MD, Frank MB, Seabury SA. The effect of malpractice law on physician supply: Evidence from negligence-standard reforms. J Health Econ 2020; 70:102272. [PMID: 31911276 DOI: 10.1016/j.jhealeco.2019.102272] [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] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 01/08/2019] [Accepted: 12/07/2019] [Indexed: 06/10/2023]
Abstract
We explore whether the composition of the physician workforce is impacted by the clinical standards imposed on physicians under medical liability rules. Specifically, we explore whether the proportion of non-surgeons practicing in a region decreases-and thus whether the proportion of surgeons increases-when liability standards are modified so as to expect that physicians practice more intensively. For these purposes, we draw on a quasi-experiment made possible by states shifting from local to national customs as the basis for setting liability standards. Using data from the Area Health Resource File from 1977 to 2005, we find that the rate of non-surgeons among practicing physicians decreases by 2-2.4 log points (or by 1.4-1.7 percentage points) following the adoption of national-standard laws in initially low surgery-rate regions-i.e., following a change in the law that effectively expects physicians to increase their use of surgical approaches.
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Affiliation(s)
| | - Matthew B Frank
- Harvard University, Interfaculty Initiative in Health Policy, United States.
| | - Seth A Seabury
- University of Southern California, Department of Emergency Medicine and Leonard B. Schaeffer Center for Health Policy and Economics, United States.
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17
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Eaglehouse YL, Aljehani M, Georg MW, Castellanos O, Lee JSH, Seabury SA, Shriver CD, Zhu K. Contribution Of Care Source To Cancer Treatment Cost Variation In The US Military Health System. Health Aff (Millwood) 2019; 38:1335-1342. [PMID: 31381409 DOI: 10.1377/hlthaff.2019.00283] [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] [Indexed: 11/05/2022]
Abstract
The US Military Health System (MHS) provides universal access to health care for more than nine million eligible beneficiaries through direct care in military treatment facilities or purchased care in civilian facilities. Using information from linked cancer registry and administrative databases, we examined how care source contributed to cancer treatment cost variation in the MHS for patients ages 18-64 who were diagnosed with colon, female breast, or prostate cancer in the period 2003-14. After accounting for patient, tumor, and treatment characteristics, we found the independent contribution of care source to total variation in cost to be 8 percent, 12 percent, and 2 percent for colon, breast, and prostate cancer treatment, respectively. About 20-50 percent of the total cost variance remained unexplained and may be related to organizational and administrative factors.
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Affiliation(s)
- Yvonne L Eaglehouse
- Yvonne L. Eaglehouse is a health services researcher in the Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences (USUHS); is an assistant professor in the Department of Surgery at USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine, all in Bethesda, Maryland
| | - Mayada Aljehani
- Mayada Aljehani is a biostatistician in the Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California (USC), in Los Angeles
| | - Matthew W Georg
- Matthew W. Georg is a research associate in the Murtha Cancer Center Research Program, Department of Surgery, USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Olga Castellanos
- Olga Castellanos is a clinical research program manager in the Lawrence J. Ellison Institute for Transformative Medicine, USC
| | - Jerry S H Lee
- Jerry S. H. Lee is the chief science and innovation officer in the Lawrence J. Ellison Institute for Transformative Medicine, USC; is an associate professor in the Departments of Clinical Medicine and Chemical Engineering, both at USC; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Seth A Seabury
- Seth A. Seabury is the director of the Keck-Schaeffer Initiative for Population Health Policy at the Leonard D. Schaeffer Center for Health Policy and Economics and an associate professor in the Department of Pharmaceutical and Health Economics at the School of Pharmacy, both at USC
| | - Craig D Shriver
- Craig D. Shriver is the director of the Murtha Cancer Center Research Program, Department of Surgery, USUHS; director of the Murtha Cancer Center at Walter Reed National Military Medical Center; and a professor in the Department of Surgery at USUHS
| | - Kangmin Zhu
- Kangmin Zhu ( ) is the director of Military Epidemiology and Population Science in the Murtha Cancer Center Research Program, Department of Surgery, USUHS; is a professor in the Department of Preventive Medicine and Biostatistics at USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
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18
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Terp S, Wang B, Burner E, Connor D, Seabury SA, Menchine M. Civil Monetary Penalties Resulting From Violations of the Emergency Medical Treatment and Labor Act (EMTALA) Involving Psychiatric Emergencies, 2002 to 2018. Acad Emerg Med 2019; 26:470-478. [PMID: 30994255 DOI: 10.1111/acem.13710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective was to describe characteristics of civil monetary penalties levied by the Office of the Inspector General (OIG) related to violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies. METHODS Descriptions of EMTALA-related civil monetary penalty settlements from 2002 to 2018 were obtained from the OIG. Cases related to psychiatric emergencies were identified by inclusion of key words in settlement descriptions. Characteristics of settlements involving EMTALA violations related to psychiatric emergencies including date, amount, and nature of the allegation were described and compared with settlements not involving psychiatric emergencies. RESULTS Of 230 civil monetary penalty settlements related to EMTALA during the study period, 44 (19%) were related to psychiatric emergencies. The average settlement for psychiatric-related cases was $85,488, compared with $32,004 for non-psychiatric-related cases (p < 0.001). Five (83%) of the six largest settlements during the study period were related to cases involving psychiatric emergencies. The most commonly cited deficiencies for settlements involving psychiatric patients were failure to provide appropriate medical screening examination (84%) or stabilizing treatment (68%) or arrange appropriate transfer (30%). Failure to provide stabilizing treatment was more common among cases involving psychiatric emergencies (68% vs. 51%, p = 0.041). Among psychiatric-related settlements, 18 (41%) occurred in CMS Region IV (Southeast) and nine (20%) in Region VII (Central). CONCLUSIONS Nearly one in five civil monetary penalty settlements related to EMTALA violations involved psychiatric emergencies. Settlements related to psychiatric emergencies were more costly and more often associated with failure to stabilize than for nonpsychiatric emergencies. Administrators should evaluate and strengthen policies and procedures related to psychiatric screening examinations, stabilizing care of psychiatric patients boarding in EDs, and transfer policies. Recent large, notable settlements related to EMTALA violations suggest that there is considerable room to improve access to and quality of care for patients with psychiatric emergencies.
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Affiliation(s)
- Sophie Terp
- Keck School of Medicine University of Southern California Los Angeles CA
- Schaeffer Center for Health Policy & Economics, University of Southern California Los Angeles CA
| | - Brandon Wang
- New York University School of Medicine New York NY
| | - Elizabeth Burner
- Keck School of Medicine University of Southern California Los Angeles CA
| | | | - Seth A. Seabury
- Keck School of Medicine University of Southern California Los Angeles CA
- Schaeffer Center for Health Policy & Economics, University of Southern California Los Angeles CA
| | - Michael Menchine
- Keck School of Medicine University of Southern California Los Angeles CA
- Schaeffer Center for Health Policy & Economics, University of Southern California Los Angeles CA
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19
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Seabury SA, Dougherty JS, Sullivan J. Medication adherence as a measure of the quality of care provided by physicians. Am J Manag Care 2019; 25:78-83. [PMID: 30763038] [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: 06/09/2023]
Abstract
OBJECTIVES To assess the extent to which medication adherence in congestive heart failure (CHF) and diabetes may serve as a measure of physician-level quality. STUDY DESIGN A retrospective analysis of Medicare data from 2007 to 2009, including parts A (inpatient), B (outpatient), and D (pharmacy). METHODS For each disease, we assessed the correlation between medication adherence and health outcomes at the physician level. We controlled for selection bias by first regressing patient-level outcomes on a set of covariates including comorbid conditions, demographic attributes, and physician fixed effects. We then classified physicians into 3 levels of average patient medication adherence-low, medium, and high-and compared health outcomes across these groups. RESULTS There is a clear relationship between average medication adherence and patient health outcomes as measured at the physician level. Within the diabetes sample, among physicians with high average adherence and controlling for patient characteristics, 26.3 per 1000 patients had uncontrolled diabetes compared with 45.9 per 1000 patients among physicians with low average adherence. Within the CHF sample, also controlling for patient characteristics, the average rate of CHF emergency care usage among patients seen by physicians with low average adherence was 16.3% compared with 13.5% for doctors with high average adherence. CONCLUSIONS This study's results establish a physician-level correlation between improved medication adherence and improved health outcomes in the Medicare population. Our findings suggest that medication adherence could be a useful measure of physician quality, at least for chronic conditions for which prescription medications are an important component of treatment.
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Affiliation(s)
- Seth A Seabury
- USC Schaeffer Center, VPD Suite 414, Los Angeles, CA 90087.
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Axeen S, Seabury SA, Menchine M. Emergency Department Contribution to the Prescription Opioid Epidemic. Ann Emerg Med 2018; 71:659-667.e3. [DOI: 10.1016/j.annemergmed.2017.12.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 11/21/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
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Seabury SA, Gaudette É, Goldman DP, Markowitz AJ, Brooks J, McCrea MA, Okonkwo DO, Manley GT. Assessment of Follow-up Care After Emergency Department Presentation for Mild Traumatic Brain Injury and Concussion: Results From the TRACK-TBI Study. JAMA Netw Open 2018; 1:e180210. [PMID: 30646055 PMCID: PMC6324305 DOI: 10.1001/jamanetworkopen.2018.0210] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Mild traumatic brain injury (mTBI) affects millions of Americans each year. Lack of consistent clinical practice raises concern that many patients with mTBI may not receive adequate follow-up care. OBJECTIVE To characterize the provision of follow-up care to patients with mTBI during the first 3 months after injury. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data on patients with mTBI enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study between February 26, 2014, and August 25, 2016. We examined site-specific variations in follow-up care, the types of clinicians seen by patients receiving follow-up care, and patient and injury characteristics associated with a higher likelihood of receiving follow-up care. The TRACK-TBI study is a prospective, multicenter, longitudinal observational study of patients with TBI presenting to the emergency department of 1 of 11 level I US trauma centers. Study data included patients with head trauma who underwent a computed tomography (CT) scan within 24 hours of injury, had a Glasgow Coma Scale score of 13 to 15, were aged 17 years or older, and completed follow-up care surveys at 2 weeks and 3 months after injury (N = 831). MAIN OUTCOMES AND MEASURES Follow-up care was defined as hospitals providing TBI educational material at discharge, hospitals calling patients to follow up, and patients seeing a physician or other medical practitioner within 3 months after the injury. Unfavorable outcomes were assessed with the Rivermead Post Concussion Symptoms Questionnaire. RESULTS Of 831 patients (289 [35%] female; 483 [58%] non-Hispanic white; mean [SD] age, 40.3 [16.9] years), less than half self-reported receiving TBI educational material at discharge (353 patients [42%]) or seeing a physician or other health care practitioner within 3 months after injury (367 patients [44%]). Follow-up care varied by study site; adjusting for patient characteristics, the provision of educational material varied from 19% to 72% across sites. Of 236 patients with a positive finding on a CT scan, 92 (39%) had not seen a medical practitioner 3 months after the injury. Adjusting for injury severity and demographics, patient admission to the hospital ward or intensive care unit, patient income, and insurance status were not associated with the probability of seeing a medical practitioner. Among the patients with 3 or more moderate to severe postconcussive symptoms, only 145 of 279 (52%) reported having seen a medical practitioner by 3 months. CONCLUSIONS AND RELEVANCE There are gaps in follow-up care for patients with mTBI after hospital discharge, even those with a positive finding on CT or who continue to experience postconcussive symptoms.
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Affiliation(s)
- Seth A. Seabury
- Department of Ophthalmology and Leonard D. Schaeffer Center for Health Policy and Economics, Keck School of Medicine, University of Southern California, Los Angeles
| | - Étienne Gaudette
- Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, Los Angeles
| | - Dana P. Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, Los Angeles
- Leonard D. Schaeffer Center for Health Policy and Economics, Price School of Public Policy, University of Southern California, Los Angeles
| | | | - Jordan Brooks
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
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Affiliation(s)
- Dan P Ly
- Harvard Medical School, Boston, Massachusetts (D.P.L., A.B.J.)
| | - Seth A Seabury
- University of Southern California, Los Angeles, California (S.A.S.)
| | - Anupam B Jena
- Harvard Medical School, Boston, Massachusetts (D.P.L., A.B.J.)
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Yue JK, Winkler EA, Sharma S, Vassar MJ, Ratcliff JJ, Korley FK, Seabury SA, Ferguson AR, Lingsma HF, Deng H, Meeuws S, Adeoye OM, Rick JW, Robinson CK, Duarte SM, Yuh EL, Mukherjee P, Dikmen SS, McAllister TW, Diaz-Arrastia R, Valadka AB, Gordon WA, Okonkwo DO, Manley GT. Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome. Brain Inj 2017; 31:1820-1829. [DOI: 10.1080/02699052.2017.1351000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- John K. Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Ethan A. Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Sourabh Sharma
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Mary J. Vassar
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Jonathan J. Ratcliff
- Departments of Emergency Medicine and Neurology, Emory University, Atlanta, GA, USA
| | - Frederick K. Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Seth A. Seabury
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Hester F. Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Sacha Meeuws
- Department of Neurological Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Opeolu M. Adeoye
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan W. Rick
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Caitlin K. Robinson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Siena M. Duarte
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Esther L. Yuh
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Sureyya S. Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Ramon Diaz-Arrastia
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA
| | | | - Wayne A. Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
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Abstract
This Research Letter estimates weekly hours worked for married, dual-physician couples.
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Affiliation(s)
- Dan P Ly
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Seth A Seabury
- Department of Ophthalmology, University of Southern California, Los Angeles
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Desai S, Gruber PF, Eiting E, Seabury SA, Mack WJ, Voyageur C, Vasquez V, Kim HT, Terp S. The Effect of Utilization Review on Emergency Department Operations. Ann Emerg Med 2017; 70:623-631.e1. [PMID: 28559030 DOI: 10.1016/j.annemergmed.2017.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Increasingly, hospitals are using utilization review software to reduce hospital admissions in an effort to contain costs. Such practices have the potential to increase the number of unsafe discharges, particularly in public safety-net hospitals. Utilization review software tools are not well studied with regard to their effect on emergency department (ED) operations. We study the effect of prospectively used admission decision support on ED operations. METHODS In 2012, Los Angeles County + University of Southern California Medical Center implemented prospective use of computerized admission criteria. After implementation, only ED patients meeting primary review (diagnosis-based criteria) or secondary review (medical necessity as determined by an on-site emergency physician) were assigned inpatient beds. Data were extracted from electronic medical records from September 2011 through December 2013. Outcomes included operational metrics, 30-day ED revisits, and 30-day admission rates. Excluding a 6-month implementation period, monthly summary metrics were compared pre- and postimplementation with nonparametric and negative binomial regression methods. All adult ED visits, excluding incarcerated and purely behavioral health visits, were analyzed. The primary outcomes were disposition rates. Secondary outcomes were 30-day ED revisits, 30-day admission rate among return visitors to the ED, and estimated cost. RESULTS Analysis of 245,662 ED encounters was performed. The inpatient admission rate decreased from 14.2% to 12.8%. Increases in discharge rate (82.4% to 83.4%) and ED observation unit utilization (2.5% to 3.4%) were found. Thirty-day revisits increased (20.4% to 24.4%), although the 30-day admission rate decreased (3.2% to 2.8%). Estimated cost savings totaled $193.17 per ED visit. CONCLUSION The prospective application of utilization review software in the ED led to a decrease in the admission rate. This was tempered by a concomitant increase in ED observation unit utilization and 30-day ED revisits. Cost savings suggest that resources should be redirected to the more highly affected ED and ED observation unit, although more work is needed to confirm the generalizability of these findings.
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Affiliation(s)
- Shoma Desai
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA.
| | - Phillip F Gruber
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Erick Eiting
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Seth A Seabury
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA; Keck School of Medicine, and the Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Christian Voyageur
- Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
| | - Veronica Vasquez
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Hyung T Kim
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Sophie Terp
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA; Keck School of Medicine, and the Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
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Seabury SA, Frasco MA, van Eijndhoven E, Sison S, Zacker C. The impact of self- and physician-administered cancer treatment on work productivity and healthcare utilization. Res Social Adm Pharm 2017; 14:434-440. [PMID: 28559004 DOI: 10.1016/j.sapharm.2017.05.009] [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: 05/19/2017] [Accepted: 05/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lost productivity in the workplace represents a significant portion of the economic burden of cancer in the United States. Cancer treatments have historically been physician-administered, while recent innovations have led to the development of self-administered, usually oral, agents. Self-administered treatments have the potential to reduce healthcare utilization and time away from work, but the magnitude of these effects is unknown. OBJECTIVE To compare the effects of self- and physician-administered cancer treatment on work productivity and health care utilization. METHODS Cancer subtypes with self- and physician-administered treatment options were selected. Patients with female breast, or lung or bronchus cancer diagnosed in 2004-2013 were identified in the Truven Health Analytics Commercial Claims and Encounters and Health and Productivity Management databases. Using multivariate regression models, work productivity and healthcare utilization were compared for patients receiving self- versus physician-administered treatment in the 12 months after initial diagnosis. Work productivity outcomes included the number of sick days and short-term disability claims. RESULTS One month of self- versus physician-administered treatment significantly reduced cancer-related outpatient services, doctor visits, and infusions in the 12 months after initial diagnosis for both cancers of interest. In addition, breast and lung or bronchus cancer patients who received self-administered treatment were less likely to have short-term disability claims, and breast cancer patients with non-metastatic disease who received self-administered treatment had significantly fewer sick days. CONCLUSIONS Self-administered cancer treatment was associated with fewer cancer-related outpatient services and reduced time away from work compared to physician-administered cancer treatment.
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Affiliation(s)
- Seth A Seabury
- University of Southern California, USC Schaeffer Center, 635 Downey Way, VPD Suite 414C, Los Angeles, CA, 90089-3333, United States.
| | - Melissa A Frasco
- Precision Health Economics, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA, 90025, United States
| | - Emma van Eijndhoven
- Precision Health Economics, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA, 90025, United States
| | - Steve Sison
- Precision Health Economics, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA, 90025, United States
| | - Christopher Zacker
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, United States
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Schaffer AC, Jena AB, Seabury SA, Singh H, Chalasani V, Kachalia A. Rates and Characteristics of Paid Malpractice Claims Among US Physicians by Specialty, 1992-2014. JAMA Intern Med 2017; 177:710-718. [PMID: 28346582 PMCID: PMC5470361 DOI: 10.1001/jamainternmed.2017.0311] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although physician concerns about medical malpractice are substantial, national data are lacking on the rate of claims paid on behalf of US physicians by specialty. OBJECTIVE To characterize paid malpractice claims by specialty. DESIGN, SETTING, AND PARTICIPANTS A comprehensive analysis was conducted of all paid malpractice claims, with linkage to physician specialty, from the National Practitioner Data Bank from January 1, 1992, to December 31, 2014, a period including an estimated 19.9 million physician-years. All dollar amounts were inflation adjusted to 2014 dollars using the Consumer Price Index. The dates on which this analysis was performed were from May 1, 2015, to February 20, 2016, and from October 25 to December 16, 2016. MAIN OUTCOMES AND MEASURES For malpractice claims (n = 280 368) paid on behalf of physicians (in aggregate and by specialty): rates per physician-year, mean compensation amounts, the concentration of paid claims among a limited number of physicians, the proportion of paid claims that were greater than $1 million, severity of injury, and type of malpractice alleged. RESULTS From 1992-1996 to 2009-2014, the rate of paid claims decreased by 55.7% (from 20.1 to 8.9 per 1000 physician-years; P < .001), ranging from a 13.5% decrease in cardiology (from 15.6 to 13.5 per 1000 physician-years; P = .15) to a 75.8% decrease in pediatrics (from 9.9 to 2.4 per 1000 physician-years; P < .001). The mean compensation payment was $329 565. The mean payment increased by 23.3%, from $286 751 in 1992-1996 to $353 473 in 2009-2014 (P < .001). The increases ranged from $17 431 in general practice (from $218 350 in 1992-1996 to $235 781 in 2009-2014; P = .36) to $114 410 in gastroenterology (from $276 128 in 1992-1996 to $390 538 in 2009-2014; P < .001) and $138 708 in pathology (from $335 249 in 1992-1996 to $473 957 in 2009-2014; P = .005). Of 280 368 paid claims, 21 271 (7.6%) exceeded $1 million (4304 of 69 617 [6.2%] in 1992-1996 and 4322 of 54 081 [8.0%] in 2009-2014), and 32.1% (35 293 of 109 865) involved a patient death. Diagnostic error was the most common type of allegation, present in 31.8% (35 349 of 111 066) of paid claims, ranging from 3.5% in anesthesiology (153 of 4317) to 87.0% in pathology (915 of 1052). CONCLUSIONS AND RELEVANCE Between 1992 and 2014, the rate of malpractice claims paid on behalf of physicians in the United States declined substantially. Mean compensation amounts and the percentage of paid claims exceeding $1 million increased, with wide differences in rates and characteristics across specialties. A better understanding of the causes of variation among specialties in paid malpractice claims may help reduce both patient injury and physicians' risk of liability.
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Affiliation(s)
- Adam C Schaffer
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts3Department of Medicine, Massachusetts General Hospital, Boston4National Bureau of Economic Research, Cambridge, Massachusetts
| | - Seth A Seabury
- National Bureau of Economic Research, Cambridge, Massachusetts5Department of Ophthalmology, University of Southern California, Los Angeles6Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Harnam Singh
- US Health Resources and Services Administration, Rockville, Maryland
| | - Venkat Chalasani
- US Health Resources and Services Administration, Rockville, Maryland
| | - Allen Kachalia
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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28
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Terp S, Wang B, Raffetto B, Seabury SA, Menchine M. Individual Physician Penalties Resulting From Violation of Emergency Medical Treatment and Labor Act: A Review of Office of the Inspector General Patient Dumping Settlements, 2002-2015. Acad Emerg Med 2017; 24:442-446. [PMID: 28109011 DOI: 10.1111/acem.13159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/09/2017] [Accepted: 01/14/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to describe characteristics of civil monetary penalty settlements levied by the Office of the Inspector General (OIG) against individual physicians related to violation of the Emergency Medical Treatment and Labor Act (EMTALA). METHODS Descriptions of all civil monetary penalty settlements between 2002 and 2015 were obtained from the OIG. Characteristics of settlements against individual physicians related to EMTALA violations were described including settlement date, location, amount, whether there was an associated hospital settlement, the medical specialty of the physician involved, and the nature of the allegation. RESULTS Of 196 OIG civil monetary penalty settlements related to EMTALA, eight (4%) were levied against individual physicians, and 188 (96%) against facilities. Seven of the eight penalties against individual physicians were imposed upon on-call specialists, including six who failed to respond to evaluate and treat a patient in the emergency department (ED), and one who failed to accept appropriate transfer of a patient requiring higher level of care. The only penalty imposed on an emergency physician involved a case where a provider repeatedly failed to provide a medical screening examination to a pregnant teen based on the erroneous belief that a minor could not be evaluated or treated absent parental consent. Four of eight penalties against individual physicians were levied within the first 3 years of the 14-year study period. Half of all physician settlements were associated with a separate hospital civil monetary penalty settlement. CONCLUSIONS For emergency physicians, a civil monetary penalty is a feared consequence of EMTALA enforcement, as a physician can be held individually liable for fine of up to $50,000 not covered by malpractice insurance. Although EMTALA is an actively enforced law, and violation of the EMTALA statute often results in hospital citations and fines, and occasionally facility closure, we found that individual physicians are rarely penalized by the OIG following EMTALA violation. Individual physician penalties are far less common than hospital citations or fines related to EMTALA or malpractice claims or payments. The majority of penalties against individual physicians were levied upon on-call specialists who refused to evaluate and treat ED patients. Only one emergency physician was fined during the study period for a clear violation of the EMTALA statute. Physicians should be diligent to ensure appropriate patient care and that facilities are compliant with the EMTALA statute, but should be aware that settlements against individual physicians are a rare consequence of EMTALA enforcement.
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Affiliation(s)
- Sophie Terp
- Department of Emergency Medicine; Keck School of Medicine; Angeles CA
- Schaeffer Center for Health Policy and Economics; University of Southern California; Los Angeles CA
| | | | - Brian Raffetto
- Department of Emergency Medicine; Keck School of Medicine; Angeles CA
| | - Seth A. Seabury
- Department of Emergency Medicine; Keck School of Medicine; Angeles CA
- Schaeffer Center for Health Policy and Economics; University of Southern California; Los Angeles CA
| | - Michael Menchine
- Department of Emergency Medicine; Keck School of Medicine; Angeles CA
- Schaeffer Center for Health Policy and Economics; University of Southern California; Los Angeles CA
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29
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Abstract
Occupational injuries and illnesses lead to significant health care costs and productivity losses for millions of workers each year. This study used national survey data to test for differences between members of minority groups and non-Hispanic white workers in the risk of workplace injuries and the prevalence of work-related disabilities. Non-Hispanic black workers and foreign-born Hispanic workers worked in jobs with the highest injury risk, on average, even after adjustment for education and sex. These elevated levels of workplace injury risk led to a significant increase in the prevalence of work-related disabilities for non-Hispanic black and foreign-born Hispanic workers. These findings suggest that disparities in economic opportunities expose members of minority groups to increased risk of workplace injury and disability.
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Affiliation(s)
- Seth A Seabury
- Seth A. Seabury is a visiting associate professor of ophthalmology and director of the Keck-Schaeffer Initiative for Population Health Policy at the Keck School of Medicine and the Leonard D. Schaeffer Center for Health Policy and Economics, both at the University of Southern California, in Los Angeles. He is also a faculty research fellow at the National Bureau of Economic Research
| | - Sophie Terp
- Sophie Terp is an assistant professor of clinical emergency medicine at the Keck School of Medicine, University of Southern California
| | - Leslie I Boden
- Leslie I. Boden is a professor of environmental health at the School of Public Health, Boston University, in Massachusetts
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Shafrin J, Ganguli A, Gonzalez YS, Shim JJ, Seabury SA. Geographic Variation in the Quality and Cost of Care for Patients with Rheumatoid Arthritis. J Manag Care Spec Pharm 2016; 22:1472-1481. [PMID: 27882832 PMCID: PMC10398269 DOI: 10.18553/jmcp.2016.22.12.1472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is considerable push to improve value in health care by simultaneously increasing quality while lowering or containing costs. However, for diseases that are best treated with comparatively expensive treatments, such as rheumatoid arthritis (RA), there could be tension between these aims. In this study, we measured geographic variation in quality, access, and cost for patients with RA, a disease with effective but costly specialty treatments. OBJECTIVE To assess the geographic differences in the quality, access, and cost of care for patients with RA. METHODS Using large claims databases covering the period between 2008 and 2014, we measured quality of care metrics by metropolitan statistical areas (MSAs) for patients with RA. Quality measures included use of disease-modifying antirheumatic drugs (DMARDs) and tuberculosis (TB) screening before initiating biologic DMARD therapy. Access to care measures included measured detection and the share of patients with RA who visited a rheumatologist. Regression models were used to control for differences in patient demographics and health status across MSAs. RESULTS For the 501,376 patients diagnosed with RA, in the average MSA 64.1% of RA patients received a DMARD, and 29.6% of RA patients initiating a biologic DMARD appropriately received a TB screening. Only 17% (73/430) of MSAs comprised the top 2 Medicare Advantage star ratings for DMARD use. Measured detection was 0.59% (IQR = 0.47%-0.71%; CV = 0.355) on average, and 57.6% (IQR = 48%-69%; CV = 0.341) of RA patients visited a rheumatologist. MSAs with the highest DMARD use spent $26,724 (in 2015 U.S. dollars) annually treating patients with RA, $5,428 more (P < 0.001) than low DMARD-use MSAs, largely because of higher pharmacy cost ($5,090 vs. $7,610, P < 0.001). However, MSAs with higher DMARD use had lower RA-related inpatient cost ($1,890 vs. $2,342, P = 0.024). CONCLUSIONS There were significant geographic variations in the quality of care received by patients with RA, although quality was poor in most areas. Fewer than 1 in 5 MSAs could be considered high quality based on patient DMARD use. Access to specialist care may be an issue, since just over half of patients with RA visited a rheumatologist annually. Efforts to incentivize better quality of care holds promise in terms of unlocking value for patients, but for some diseases, this approach may result in higher costs. DISCLOSURES The research reported in this manuscript was supported by AbbVie through consulting fees paid to Precision Health Economics (PHE). AbbVie and PHE collaborated to develop the study design and protocol. AbbVie and PHE participated in the interpretation of data, review, and approval of the manuscript. Shafrin and Shim are employed by PHE. Ganguli and Sanchez Gonzalez are employed by AbbVie. Seabury reports consulting fees from PHE. The results from this study were presented in poster form at the Academy of Managed Care Pharmacy's 2015 Annual Meeting and Expo; April 7-10, 2015; San Diego, California, and at the Academy of Managed Care Pharmacy's 2016 Annual Meeting and Expo; April 19-22, 2016; San Francisco, California. Study concept and design were contributed primarily by Shafrin, along with Ganguli and Seabury. Shafrin and Shim took the lead in data collection, and data interpretation was performed by Ganguli, Sanchez Gonzalez, Seabury, and Shafrin. The manuscript was written primarily by Shafrin, along with Shim and Seabury, and revised primarily by Ganguli, along with Sanchez Gonzalez and Seabury.
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Affiliation(s)
- Jason Shafrin
- 1 Precision Health Economics, Los Angeles, California
| | | | | | - Jin Joo Shim
- 1 Precision Health Economics, Los Angeles, California
| | - Seth A Seabury
- 3 Keck School of Medicine, University of Southern California, Los Angeles
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31
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Abstract
DISCLOSURES Seabury reports receiving consulting fees from Precision Health Economics, a life sciences firm that provides consulting services to the pharmaceutical industry.
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Affiliation(s)
- Seth A Seabury
- 1 University of Southern California Keck School of Medicine
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Terp S, Seabury SA, Arora S, Eads A, Lam CN, Menchine M. Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014. Ann Emerg Med 2016; 69:155-162.e1. [PMID: 27496388 DOI: 10.1016/j.annemergmed.2016.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/15/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE We determine the incidence of and trends in enforcement of the Emergency Medical Treatment and Labor Act (EMTALA) during the past decade. METHODS We obtained a comprehensive list of all EMTALA investigations conducted between 2005 and 2014 directly from the Centers for Medicare & Medicaid Services (CMS) through a Freedom of Information Act request. Characteristics of EMTALA investigations and resulting citation for violations during the study period are described. RESULTS Between 2005 and 2014, there were 4,772 investigations, of which 2,118 (44%) resulted in citations for EMTALA deficiencies at 1,498 (62%) of 2,417 hospitals investigated. Investigations were conducted at 43% of hospitals with CMS provider agreements, and citations issued at 27%. On average, 9% of hospitals were investigated and 4.3% were cited for EMTALA violation annually. The proportion of hospitals subject to EMTALA investigation decreased from 10.8% to 7.2%, and citations from 5.3% to 3.2%, between 2005 and 2014. There were 3.9 EMTALA investigations and 1.7 citations per million emergency department (ED) visits during the study period. CONCLUSION We report the first national estimates of EMTALA enforcement activities in more than a decade. Although EMTALA investigations and citations were common at the hospital level, they were rare at the ED-visit level. CMS actively pursued EMTALA investigations and issued citations throughout the study period, with half of hospitals subject to EMTALA investigations and a quarter receiving a citation for EMTALA violation, although there was a declining trend in enforcement. Further investigation is needed to determine the effect of EMTALA on access to or quality of emergency care.
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Affiliation(s)
- Sophie Terp
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
| | - Seth A Seabury
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
| | - Andrew Eads
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
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Abstract
OBJECTIVES To estimate differences in annual income of physicians in the United States by race and sex adjusted for characteristics of physicians and practices. DESIGN Cross sectional survey study. SETTING Nationally representative samples of US physicians. PARTICIPANTS The 2000-13 American Community Survey (ACS) included 43 213 white male, 1698 black male, 15 164 white female, and 1252 black female physicians. The 2000-08 Center for Studying Health System Change (HSC) physician surveys included 12 843 white male, 518 black male, 3880 white female, and 342 black female physicians. MAIN OUTCOME MEASURES Annual income adjusted for age, hours worked, time period, and state of residence (from ACS data). Income was adjusted for age, specialty, hours worked, time period, years in practice, practice type, and percentage of revenue from Medicare/Medicaid (from HSC physician surveys). RESULTS White male physicians had a higher median annual income than black male physicians, whereas race was not consistently associated with median income among female physicians. For example, in 2010-13 in the ACS, white male physicians had an adjusted median annual income of $253 042 (95% confidence interval $248 670 to $257 413) compared with $188 230 ($170 844 to $205 616) for black male physicians (difference $64 812; P<0.001). White female physicians had an adjusted median annual income of $163 234 ($159 912 to 166 557) compared with $152 784 ($137 927 to $167 641) for black female physicians (difference $10 450; P=0.17). $100 000 is currently equivalent to about £69 000 (€89 000). Patterns were unaffected by adjustment for specialty and characteristics of practice in the HSC physician surveys. CONCLUSIONS White male physicians earn substantially more than black male physicians, after adjustment for characteristics of physicians and practices, while white and black female physicians earn similar incomes to each other, but significantly less than their male counterparts. Whether these differences reflect disparities in job opportunities is important to determine.
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Affiliation(s)
- Dan P Ly
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - Seth A Seabury
- Department of Emergency Medicine and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, VPD Suite 210, Los Angeles, CA 90089-3333, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA Department of Medicine, Massachusetts General Hospital, Boston, MA, USA National Bureau of Economic Research, Cambridge, MA, USA
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Seabury SA, Goldman DP, Gupta CN, Khan ZM, Chandra A, Philipson TJ, Lakdawalla DN. Quantifying Gains in the War on Cancer Due to Improved Treatment and Earlier Detection. Forum Health Econ Policy 2016; 19:141-156. [PMID: 31419891 DOI: 10.1515/fhep-2015-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There have been significant improvements in both treatment and screening efforts for many types of cancer over the past decade. However, the effect of these advancements on the survival of cancer patients is unknown, and many question the value of both new treatments and screening efforts. METHODS This study uses a retrospective analysis of SEER Registry data to quantify reductions in mortality rates for cancer patients diagnosed between 1997 and 2007. Using variation in trends in mortality rates by stage of diagnosis across cancer types, we use logistic regression to decompose separate survival gains into those attributable to advances in treatment versus advances in detection. We estimate the gains in survival due to gains in both treatment and detection overall and separately for 15 of the most common cancer types. RESULTS We estimate that 3-year cancer-related mortality of cancer patients fell 16.7% from 1997 to 2007. Overall, advances in treatment reduced mortality rates by approximately 12.2% while advances in early detection reduced mortality rates by 4.5%. The relative importance of treatment and detection varied across cancer types. Improvements in detection were most important for thyroid, prostate and kidney cancer. Improvements in treatment were most important for non-Hodgkins lymphoma, lung cancer and myeloma. CONCLUSION Both improved treatment options and better early detection have led to significant survival gains for cancer patients diagnosed from 1997 to 2007, generating considerable social value over this time period.
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Affiliation(s)
- Seth A Seabury
- University of Southern California - Department of Emergency Medicine and Leonard D. Schaeffer Center for Health Policy and Economics, 635 Downey Way Verna & Peter Dauterive Hall (VPD), 2nd Floor Los Angeles CA 90089-3333, USA
| | - Dana P Goldman
- University of Southern California - Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Charu N Gupta
- The Wharton School of the University of Pennsylvania - Health Care Management Department, PA, USA
| | - Zeba M Khan
- Celgene Corporation, Summit, New Jersey, USA
| | - Amitabh Chandra
- Harvard University - John F. Kennedy School of Government, Boston, MA, USA
| | - Tomas J Philipson
- University of Chicago - Irving B. Harris Graduate School of Policy Studies, Chicago, IL, USA
| | - Darius N Lakdawalla
- University of Southern California - Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
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Schwartz AL, Pesa J, Doshi D, Fastenau J, Seabury SA, Roberts ET, Grabowski DC. Medicaid managed care penetration and drug utilization for patients with serious mental illness. Am J Manag Care 2016; 22:346-353. [PMID: 27266436] [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: 06/06/2023]
Abstract
OBJECTIVES State Medicaid programs are under increasing pressure to contain pharmaceutical spending. Many states have attempted to limit spending through greater Medicaid managed care penetration, which rose nationally from 54.5% in 1999 to 74.9% in 2011. It is not clear how this expansion has affected beneficiaries with serious mental illness (SMI)-a vulnerable population that often has their drug spending "carved out" from their managed care benefit. We sought to assess the association between managed care penetration and pharmaceutical spending on drugs for SMIs in these states. STUDY DESIGN Retrospective cohort study. METHODS State-year observations were constructed to study the relationship between managed care penetration and pharmaceutical spending on drugs for SMIs over the period 1999 to 2011. We analyzed the relationship using both cross-sectional and panel-data methods. RESULTS Our cross-sectional analyses suggested that carve-out states with greater managed care penetration spend significantly less per enrollee on pharmaceuticals for the treatment of mental disorders: our panel data analyses did not generate statistically meaningful results. CONCLUSIONS Future studies should address whether any effects of managed care on mental health prescription utilization and spending reflect improved care coordination or worsening access to valuable care for the population with SMI.
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Affiliation(s)
| | | | | | | | | | | | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115. E-mail:
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Jena AB, Schoemaker L, Bhattacharya J, Seabury SA. Authors' reply to Barbieri and Kovarik, Mariani, and Waxman and Kanzaria. BMJ 2015; 351:h6774. [PMID: 26668033 DOI: 10.1136/bmj.h6774] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA; and Massachusetts General Hospital, Boston, MA, USA National Bureau of Economic Research, Cambridge, MA, USA
| | - Lena Schoemaker
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Jay Bhattacharya
- National Bureau of Economic Research, Cambridge, MA, USA Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Seth A Seabury
- National Bureau of Economic Research, Cambridge, MA, USA Department of Emergency Medicine and Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Abstract
STUDY QUESTION Is a higher use of resources by physicians associated with a reduced risk of malpractice claims? METHODS Using data on nearly all admissions to acute care hospitals in Florida during 2000-09 linked to malpractice history of the attending physician, this study investigated whether physicians in seven specialties with higher average hospital charges in a year were less likely to face an allegation of malpractice in the following year, adjusting for patient characteristics, comorbidities, and diagnosis. To provide clinical context, the study focused on obstetrics, where the choice of caesarean deliveries are suggested to be influenced by defensive medicine, and whether obstetricians with higher adjusted caesarean rates in a year had fewer alleged malpractice incidents the following year. STUDY ANSWER AND LIMITATIONS The data included 24,637 physicians, 154,725 physician years, and 18,352,391 hospital admissions; 4342 malpractice claims were made against physicians (2.8% per physician year). Across specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim. For example, among internists, the probability of experiencing an alleged malpractice incident in the following year ranged from 1.5% (95% confidence interval 1.2% to 1.7%) in the bottom spending fifth ($19,725 (£12,800; €17,400) per hospital admission) to 0.3% (0.2% to 0.5%) in the top fifth ($39,379 per hospital admission). In six of the specialties, a greater use of resources was associated with statistically significantly lower subsequent rates of alleged malpractice incidents. A principal limitation of this study is that information on illness severity was lacking. It is also uncertain whether higher spending is defensively motivated. WHAT THIS STUDY ADDS Within specialty and after adjustment for patient characteristics, higher resource use by physicians is associated with fewer malpractice claims. FUNDING, COMPETING INTERESTS, DATA SHARING This study was supported by the Office of the Director, National Institutes of Health (grant 1DP5OD017897-01 to ABJ) and National Institute of Aging (R37 AG036791 to JB). The authors have no competing interests or additional data to share.
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Affiliation(s)
- Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA; and Massachusetts General Hospital, Boston, MA, USA National Bureau of Economic Research, Cambridge, MA, USA
| | - Lena Schoemaker
- Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Jay Bhattacharya
- National Bureau of Economic Research, Cambridge, MA, USA Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Seth A Seabury
- National Bureau of Economic Research, Cambridge, MA, USA Department of Emergency Medicine and Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Seabury SA, Lakdawalla DN, Dougherty JS, Sullivan J, Goldman DP. Medication adherence and measures of health plan quality. Am J Manag Care 2015; 21:e379-e389. [PMID: 26247579] [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: 06/04/2023]
Abstract
OBJECTIVES Medication adherence is increasingly being considered as a measure for performance-based reimbursement contracts in healthcare systems. However, the association between health outcomes and adherence at the plan level is unknown. STUDY DESIGN Retrospective analysis of medical and pharmacy claims from a large private sector claims database from 2000 to 2009. METHODS We compared plan-level measures of medication adherence and health outcomes for patients with diabetes and congestive heart failure (CHF). Plan performance was based on average rates of disease complications. Medication adherence was calculated as the percent of patients having 80% of days covered for medications treating diabetes or CHF. Both adherence and outcomes were adjusted for patient differences using multivariate regression. Plans were stratified into low, moderate, and high adherence, based on adherence in the bottom quartile, middle 2 quartiles, and top quartile, respectively. RESULTS Average adherence varied significantly across plans. Plans with low adherence to diabetes medications had adjusted rates of uncontrolled diabetes admissions of 13.2 per 1000 patients, compared with 11.2 in moderate adherence plans and 8.3 in high adherence plans (P < .001). The adjusted rate of CHF-related hospitalization was 15.3% in low adherence plans, compared with 12.4% in moderate adherence plans and 12.2% in high adherence plans (P < .001). These patterns were consistent across different types of complications for both diabetes and CHF. CONCLUSIONS Private health plans vary considerably in average adherence to medications treating chronic diseases. Plans with higher average adherence had lower rates of disease complications, suggesting that medication adherence measures are potentially useful tools for improving the performance of health plans.
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Affiliation(s)
- Seth A Seabury
- University of Southern California, 3335 South Figueroa St, Unit A, Los Angeles, CA 90089-7273. E-mail:
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Abstract
IMPORTANCE Human papillomavirus (HPV) vaccination rates among US females remain low, in part because of concerns that HPV vaccination may promote unsafe sexual activity by lowering perceived risks of acquiring a sexually transmitted infection (STI). OBJECTIVE To study whether HPV vaccination of females is associated with increases in STI rates. DESIGN, SETTING, AND PARTICIPANTS Using a large, longitudinal insurance database of females aged 12 to 18 years insured from January 1, 2005, through December 31, 2010, in the United States, we examined whether HPV vaccination was associated with an increase in incident STIs among females who were vaccinated compared with those who were not. We defined STIs as one or more medical claims for any of the following infections in a given quarter: chlamydia, gonorrhea, herpes, human immunodeficiency virus or AIDS, or syphilis. We used difference-in-difference analysis to compare changes in STI rates among HPV-vaccinated females before and after vaccination (index quarter) to changes among age-matched nonvaccinated females before and after the index quarter. We analyzed whether effects varied according to age and prior contraceptive medication use. MAIN OUTCOMES AND MEASURES Rates of STIs. RESULTS The rates of STIs in the year before vaccination were higher among HPV-vaccinated females (94 of 21 610, 4.3 per 1000) compared with age-matched nonvaccinated females (522 of 186 501, 2.8 per 1000) (adjusted odds ratio, 1.37; 95% CI, 1.09-1.71; P = .007). The rates of STIs increased for the vaccinated (147 of 21 610, 6.8 per 1000) and nonvaccinated (781 of 186 501, 4.2 per 1000) groups in the year after vaccination (adjusted odds ratio, 1.50; 95% CI, 1.25-1.79; P < .001). The difference-in-difference odds ratio was 1.05 (95% CI, 0.80-1.38; P = .74), implying that HPV vaccination was not associated with an increase in STIs relative to growth among nonvaccinated females. Similar associations held among subgroups aged 12 through 14 years and aged 15 through 18 years and among females with contraceptive use in the index quarter. CONCLUSIONS AND RELEVANCE Human papillomavirus vaccination was not associated with increases in STIs in a large cohort of females, suggesting that vaccination is unlikely to promote unsafe sexual activity.
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Affiliation(s)
- Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts2Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts3National Bureau of Economic Research, Cambridge, Massachusetts
| | - Dana P Goldman
- National Bureau of Economic Research, Cambridge, Massachusetts4Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Seth A Seabury
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles5Department of Emergency Medicine, University of Southern California, Los Angeles
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Abstract
OBJECTIVES To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians. DESIGN Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13. SETTING United States. PARTICIPANTS 48,881 physicians, 10,086 dentists, 13,883 pharmacists, 159,044 nurses, 18,920 healthcare executives, 59,284 lawyers, and 6,339,310 other non-healthcare professionals. MAIN OUTCOME MEASURES Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence). RESULTS After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians. CONCLUSIONS Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable to a differential effect of hours worked on divorce.
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Affiliation(s)
- Dan P Ly
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Seth A Seabury
- Department of Emergency Medicine and Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA; Department of Medicine, Massachusetts General Hospital; and National Bureau of Economic Research, Cambridge, MA, USA
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Seabury SA, Helland E, Jena AB. Medical malpractice reform: noneconomic damages caps reduced payments 15 percent, with varied effects by specialty. Health Aff (Millwood) 2014; 33:2048-56. [PMID: 25339633 DOI: 10.1377/hlthaff.2014.0492] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of malpractice claims for the period 1985-2010, merged with information on state liability reforms, to estimate the impact of state noneconomic damages caps on average malpractice payment size for physicians overall and for ten different specialty categories. We then compared how the effects differed according to the restrictiveness of the cap ($250,000 versus $500,000). We found that, overall, noneconomic damages caps reduced average payments by $42,980 (15 percent), compared to having no cap at all. A more restrictive $250,000 cap reduced average payments by $59,331 (20 percent), and a less restrictive $500,000 cap had no significant effect, compared to no cap at all. The effect of the caps overall varied according to specialty, with the largest impact being on claims involving pediatricians and the smallest on claims involving surgical subspecialties and ophthalmologists.
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Affiliation(s)
- Seth A Seabury
- Seth A. Seabury is an associate professor at the Leonard D. Schaeffer Center for Health Policy and Economics and in the Keck School of Medicine, University of Southern California, in Los Angeles
| | - Eric Helland
- Eric Helland is a professor of economics at Claremont McKenna College, in Claremont, and the RAND Corporation in Santa Monica, both in California
| | - Anupam B Jena
- Anupam B. Jena is an assistant professor of health care policy and medicine at Harvard Medical School and a physician at Massachusetts General Hospital, both in Boston, Massachusetts
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Seabury SA, Scherer E, O'Leary P, Ozonoff A, Boden L. Using linked federal and state data to study the adequacy of workers' compensation benefits. Am J Ind Med 2014; 57:1165-73. [PMID: 25223516 PMCID: PMC5223776 DOI: 10.1002/ajim.22362] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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] [Accepted: 05/27/2014] [Indexed: 11/06/2022]
Abstract
Background We combined federal and state administrative data to study the long-term earnings losses associated with occupational injuries and assess the adequacy of workers’ compensation benefits. Methods We linked state data on workers’ compensation claims from New Mexico for claimants injured from 1994-2000 to federal earnings records from 1987-2007. We estimated earnings losses up to 10 years after injury and computed the fraction of losses replaced by benefits. Results Workers with lost-time injuries lost an average of 15% of their earnings over the 10 years after injury. On average, workers’ compensation income benefits replaced 16% of these losses. Men and women had similar losses and replacement rates. Workers with minor injuries had lower losses but also had lower replacement rates. Conclusion Earnings losses after an injury are highly persistent, even for comparatively minor injuries. Income benefits replace a smaller fraction of those losses than previously believed.
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Affiliation(s)
- Seth A. Seabury
- Department of Emergency Medicine and Schaeffer Center for Health Policy and Economics; University of Southern California; Los Angeles California
| | - Ethan Scherer
- Pardee RAND Graduate School; Santa Monica California
| | - Paul O'Leary
- U.S. Social Security Administration Office of Retirement and Disability Policy; Washington District of Columbia
| | - Al Ozonoff
- Center for Patient Safety and Quality Research; Boston Children's Hospital; Boston Massachusetts
| | - Leslie Boden
- Department of Environmental Health; Boston University, School of Public Health; Boston Massachusetts
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Seabury SA, Lakdawalla DN, Walter D, Hayes J, Gustafson T, Shrestha A, Goldman DP. Patient Outcomes and Cost Effects of Medicaid Formulary Restrictions on Antidepressants. ACTA ACUST UNITED AC 2014; 17:153-168. [DOI: 10.1515/fhep-2014-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Many state Medicaid programs have implemented policies designed to reduce spending on prescription drugs by restricting access to branded products. For patients with major depressive disorder, formulary restrictions could severely limit access to antidepressant therapies and disrupt care. We linked data on patient outcomes and spending from 24 state Medicaid programs to information on formulary restrictions from 2001 to 2008. Outcomes included frequency of MDD-related hospitalizations and ER visits per patient and total healthcare spending. We estimated the effect of the policies on patient outcomes and spending using a difference-and-difference approach. We found that restricting access to antidepressants increased the probability of an MDD-related hospitalization by 1.7 percentage points (16.6%). Furthermore, we found no evidence that these restrictions resulted in any net savings for Medicaid.
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Seabury SA, Gupta CN, Philipson TJ, Henkhaus LE. Understanding and overcoming barriers to medication adherence: a review of research priorities. J Manag Care Spec Pharm 2014; 20:775-83. [PMID: 25062070 PMCID: PMC10437805 DOI: 10.18553/jmcp.2014.20.8.775] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/05/2022]
Abstract
Improving medication adherence has been identified as a crucial step towards improving health outcomes for patients with chronic disease and has provided the motivation for many changes in our health care system. Despite the volume of research done on this topic, however, we still lack important basic information about how to improve adherence in a cost-effective way. There is a need for a better understanding of what areas of research are most likely to produce advances that could be used by policymakers, providers, payers, or other stakeholders to generate real improvements in medication adherence. To address this, we developed a set of research priorities designed to improve understanding about whom to target for adherence interventions and which particular interventions to employ for specific subpopulations. To produce this research agenda, we synthesized information from the existing literature with a series of stakeholder interviews and expert panel meetings. We identified 6 key areas for research: (1) predicting nonadherence, (2) behavioral factors affecting nonadherence, (3) measuring the impact of nonadherence on health and cost outcomes, (4) effectiveness of existing interventions, (5) misaligned incentives between payers and providers, and (6) provider training and coordination of care. We provide detailed descriptions and example topics within each area. As the health care system continues to embrace reforms designed to improve the value of care, more and better information is needed to guide efforts designed to improve medication adherence. Addressing the topic areas identified here will be an important step towards accomplishing this goal.
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Affiliation(s)
- Seth A. Seabury
- University of Southern California, Keck School of Medicine, Health Sciences Campus, GNH 1011, 9300, Los Angeles, CA 90089-9300.
| | - Charu N. Gupta
- University of Southern California, Keck School of Medicine, Health Sciences Campus, GNH 1011, 9300, Los Angeles, CA 90089-9300.
| | - Tomas J. Philipson
- University of Southern California, Keck School of Medicine, Health Sciences Campus, GNH 1011, 9300, Los Angeles, CA 90089-9300.
| | - Laura E. Henkhaus
- University of Southern California, Keck School of Medicine, Health Sciences Campus, GNH 1011, 9300, Los Angeles, CA 90089-9300.
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Affiliation(s)
- Seth A Seabury
- Department of Emergency Medicine and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Amitabh Chandra
- Harvard Kennedy School of Government, Harvard University, Cambridge, Massachusetts
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts4Department of Medicine, Massachusetts General Hospital, Boston
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Mangalmurti S, Seabury SA, Chandra A, Lakdawalla D, Oetgen WJ, Jena AB. Medical professional liability risk among US cardiologists. Am Heart J 2014; 167:690-6. [PMID: 24766979 DOI: 10.1016/j.ahj.2014.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 02/11/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical professional liability (MPL) remains a significant burden for physicians, in general, and cardiologists, in particular, as recent research has shown that average MPL defense costs are higher in cardiology than other specialties. Knowledge of the clinical characteristics and outcomes of lawsuits against cardiologists may improve quality of care and risk management. METHODS We analyzed closed MPL claims of 40,916 physicians and 781 cardiologists insured by a large nationwide insurer for ≥1 policy year between 1991 and 2005. RESULTS The annual percentage of cardiologists facing an MPL claim was 8.6%, compared with 7.4% among physicians overall (P < .01). Among 530 claims, 72 (13.6%) resulted in an indemnity payment, with a median size of $164,988. Mean defense costs for claims resulting in payment were $83,593 (standard deviation (s.d.) $72,901). The time required to close MPL claims was longer for claims with indemnity payment than claims without (29.6 versus 18.9 months; P < .001). More than half of all claims involved a patient's death (304; 57.4%), were based on inpatient care (379; 71.5%), or involved a primary cardiovascular condition (416; 78.4%). Acute coronary syndrome was the most frequent condition (234; 44.2%). Medical professional liability claims involving noncardiovascular conditions were common (66; 12.5%) and included falls or mechanical injuries had while under a cardiologist's care and a failure to diagnose cancer. CONCLUSIONS Rates of malpractice lawsuits are higher among cardiologists than physicians overall. A substantial portion of claims are noncardiovascular in nature.
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Seabury SA, Goldman DP, Kalsekar I, Sheehan JJ, Laubmeier K, Lakdawalla DN. Formulary restrictions on atypical antipsychotics: impact on costs for patients with schizophrenia and bipolar disorder in Medicaid. Am J Manag Care 2014; 20:e52-e60. [PMID: 24738555] [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: 06/03/2023]
Abstract
OBJECTIVES To measure the impact of state Medicaid formulary policies on costs for patients with schizophrenia and bipolar disorder. STUDY DESIGN Retrospective analysis of medical and pharmacy claims for patients diagnosed with schizophrenia or bipolar disorder in 24 state Medicaid programs. METHODS We combined information on formulary restrictions in Medicaid with the medical and pharmacy claims of 117,908 patients with schizophrenia and 170,596 patients with bipolar disorder in Medicaid who were single-eligible, and newly prescribed a second-generation antipsychotic from 2001 to 2008. We tested the impact of formulary restrictions on the medical costs and utilization of patients in the 12 months after the index prescription. To capture social costs in addition to medical expenditures in Medicaid, we estimated the incremental costs of incarcerating patients with schizophrenia and bipolar disorder associated with formulary restrictions. RESULTS Patients with schizophrenia subject to formulary restrictions were more likely to be hospitalized (odds ratio 1.13, P <.001), had 23% higher inpatient costs (P <.001), and 16% higher total costs (P <.001). Similar effects were observed for patients with bipolar disorder. Our estimates suggest restrictive formulary policies in Medicaid increased the number of prisoners by 9920 and incarceration costs by $362 million nationwide in 2008. CONCLUSIONS Applying formulary restrictions to atypical antipsychotics is associated with higher total medical expenditures for patients with schizophrenia and bipolar disorder in Medicaid. Combined with the other social costs such as an increase in incarceration rates, these formulary restrictions could increase state costs by $1 billion annually, enough to offset any savings in pharmacy costs.
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Affiliation(s)
- Seth A Seabury
- University of Southern California, Health Sciences Campus, GNH 1011, M/C 9300, Los Angeles, CA 90089-3900. E-mail:
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Seabury SA, Chandra A, Lakdawalla DN, Jena AB. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. Health Aff (Millwood) 2013; 32:111-9. [PMID: 23297278 DOI: 10.1377/hlthaff.2012.0967] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The US malpractice system is widely regarded as inefficient, in part because of the time required to resolve malpractice cases. Analyzing data from 40,916 physicians covered by a nationwide insurer, we found that the average physician spends 50.7 months-or almost 11 percent-of an assumed forty-year career with an unresolved, open malpractice claim. Although damages are a factor in how doctors perceive medical malpractice, even more distressing for the doctor and the patient may be the amount of time these claims take to be adjudicated. We conclude that this fact makes it important to assess malpractice reforms by how well they are able to reduce the time of malpractice litigation without undermining the needs of the affected patient.
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