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Biomedical subjects

D G Cave

Publications and source records attributed to D G Cave.

At least 19 recordsLinked to original sources
PubMed1999

Use of diagnostic cluster methodology for therapeutic costing and drug surveillance of HMG-CoA reductase-inhibitor therapy.

Diagnostic cluster methodology groups patients having similar medical conditions according to their International Classification of Diseases, 9th Revision codes. Episodes of care related to the diagnostic cluster can then be tracked from the claims data to determine the total charges associated with patient management. A retrospective claims analysis using an episode registry database was conducted to determine the 1-year (July 1, 1995, to June 30, 1996) covered charge for statin therapy, the overall cost of treating related cardiovascular (CV) disease, and the cost impact of coadministration of drugs that potentially compete for hepatic metabolism. The three statin treatment groups (lovastatin, pravastatin, and simvastatin) were similar with respect to age, gender, mean number of prescription refills, rate of refill compliance, and prevalence of the coadministration of potentially interacting agents. Before adjustment for severity of illness, there were no significant differences between groups in prescription drugs/services (statin Rx/Svc) or total CV charges. After adjustment for severity of illness, the pravastatin group had the lowest statin Rx/Svc and total CV charges. Within the group with the greatest severity of illness, statin Rx/Svc charges were significantly lower with pravastatin than with lovastatin and simvastatin. The statin Rx/Svc charges were not significantly different between lovastatin and simvastatin. Coadministration of a potentially interacting agent significantly increased both the statin Rx/Svc and total CV charges within the simvastatin-treated group but did not significantly influence costs in the lovastatin- or pravastatin-treated groups. The estimates of direct costs derived from this analysis are consistent with findings in the published literature and demonstrate that pravastatin has cost advantages compared with lovastatin and simvastatin. Diagnostic cluster methodology also generated valuable information regarding drug surveillance and the health care cost impact of potential drug-drug interactions with selected statins.

Cardiovascular Diseases↗
PubMed1998

Sinusitis.

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Adolescent↗
PubMed1998

Hypertension.

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Cost of Illness↗
PubMed1998

Glaucoma.

The routine, easiest-to-treat adult patients with glaucoma utilize 1.80 office visits, 3.34 prescriptions, and 2.02 medical/surgical procedures during the course of a year. Based on data from the PTE-Registry database, this patient group did not receive any hospital admissions or professional inpatient services. Eye surgery was performed at an average rate of 0.08 times per PTE. About 53.5% of all PTEs were treated without the use of prescription drugs. When a drug was prescribed, beta blockers were used most often. In fact, 74.1% of all PTEs treated with a single drug group used a beta blocker.

Adolescent↗
PubMed1998

Hemorrhoids.

The patients with routine, easiest-to-treat hemorrhoids average 1.25 office visits, 0.80 prescriptions, and 1.38 medical/surgical procedures during the course of a year. About 63.9% of all PTEs were treated without the use of prescription drugs. This patient group did not receive any hospital admissions or professional inpatient services. Hemorrhoid surgery was performed at an average rate of 1.37 times per PTE on an out-patient basis. Seventy-two percent of the overall medical charges for hemorrhoid treatment are direct surgical charges. Of the PTEs treated with a single drug group, only 1.5% are treated with a prescription laxative. However, the use of OTC stool softeners and laxatives were not measured in this analysis. Thus, an exact measurement of cost savings associated with appropriate use of softeners/laxatives for the prevention of recurrent hemorrhoids could not be determined. Considering the potential cost savings of using laxatives for prevention of hemorrhoids, further investigation of the prescribing patterns of this specialty may prove useful.

Adolescent↗
PubMed1998

Urinary tract infections.

Women between the ages of 18 years and 64 years with the easiest-to-treat UTIs average 1.07 office visits, 2.36 prescriptions, and 2.34 laboratory and pathology services per PTE. Laboratory services were performed an average of 2.27 times per PTE on an outpatient basis. This patient group did not receive a significant amount of hospital admissions or professional inpatient services. Approximately 71% of all PTEs were treated with pharmaceutical therapy. Of the overall charges for UTIs, 31% were for prescription drug therapy. Of those patients treated with a single drug group, almost 33% were treated with trimethoprim/sulfamethoxazole and 13.2% were treated with a fluoroquinolone. Considering the potential cost savings of encouraging adherence to clinical prescribing guidelines, further investigation of physician prescribing patterns for uncomplicated UTIs may prove valuable to health plans.

Adolescent↗
PubMed1998

Major depression.

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Adolescent↗
PubMed1998

Cataracts.

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Adolescent↗
PubMed1997

The role of Ureaplasma urealyticum in adverse pregnancy outcome.

We investigated Ureaplasma urealyticum genital tract colonization rates in an Australian population to determine whether colonization was associated with adverse pregnancy outcome. Women attending an antenatal clinic were evaluated for lower genital tract colonization at their first antenatal visit (162 women) and at 28 weeks' gestation (120 women). Placentas from 92 women were cultured. U. urealyticum was the predominant isolate from the lower (57.4%) and upper (17.4%) genital tract in this population of pregnant women. U. urealyticum was a persistent colonizer during mid-trimester of pregnancy (in 88% of women colonized) whereas M. hominis, G. vaginalis, and Group B streptococcus were present as transient flora of the lower genital tract. Lower genital tract colonization during pregnancy was not directly associated with adverse pregnancy outcome. However preterm delivery in afebrile, asymptomatic women, could possibly be associated with chorioamnionitis (4 of 16 preterm births). Screening of women with a history of preterm birth may prevent upper genital tract infections and preterm delivery.

Adult↗
PubMed1997

Challenges to identifying actual diabetes case-mix complexity and total treatment charges.

Patient management programs are being used to improve the quality of care and decrease charges for both high-cost and potential high-cost claimants. Adequate information is key to program development, planning, and implementation. Claims-based data are a ready source of valuable information, but without proper processing, true case-mix complexity and total charges for patients will not be identified.

Cluster Analysis↗
PubMed1997

Low back pain.

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Case Management↗
PubMed1997

Nonmigraine headaches.

The easiest-to-treat nonmigraine headaches for the 18-to-64 year old population have an average duration of 60 days. The most common diagnostic imaging test used is the computed tomography scan performed on the head or brain. Two out of 1,000 patients have a hospital admission. About 43% of the PTEs are treated without prescription. When a single prescription drug group is used, 56.7% of the prescriptions are for pain relief drugs. Nonsteroidal anti-inflammatory drugs are the most prescribed single drug group for this condition.

Adolescent↗
PubMed1997

Conjunctivitis.

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Adolescent↗
PubMed1997

Asthma.

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Adolescent↗
PubMed1995

Vertical integration models to prepare health systems for capitation.

Health systems will profit most under capitation if their vertical integration strategy provides operational stability, a strong primary care physician base, efficient delivery of medical services, and geographic access to physicians. Staff- and equity-based systems best meet these characteristics for success because they have one governance structure and a defined mission statement. Moreover, physician bonds are strong because these systems maximize physicians' income potential and control the revenue stream.

Capitation Fee↗
PubMed1995

Small-area variations in the treatment of prevalent medical conditions: a comparison of three cities in the Northeast.

This article presents a small-area variation study that examines utilization differences for primary care physicians (PCPs) in treating a homogeneous set of prevalent medical conditions. The study used secondary data collected over a 24-month period from a large, Northeastern region independent practice association. The diagnostic cluster methodology was used to examine geographic differences for PCPs in treating prevalent medical conditions. This methodology groups International Classification of Diseases, 9th revision (ICD-9), codes into diagnostic clusters based on clinical homogeneity with respect to generating a similar clinical response from the physician. For each diagnostic cluster, diagnostic episode clusters (DECs) were formulated. Each DEC links all services incurred in treating a patient's medical condition within a specific period of time. Differences in use rates across small areas were tested using t tests. The data showed little variation in the physician office visit rate across small areas. However, services generated from these office visits exhibited large rate variations. The most significant small-area differences were for hospital inpatient days and surgical procedures. Pattern-of-treatment differences exist across small areas for the homogeneous set of prevalent medical conditions treated by PCPs.

Age Factors↗