Biomedical subjects

Farrokh Alemi

Publications and source records attributed to Farrokh Alemi.

12 recordsLinked to original sources

PubMed2006

Costs and benefits of combining probation and substance abuse treatment.

AIMS OF THE STUDY: We compared seamless combination of probation and treatment (where the probation officer is co-located with treatment provider or is actively engaged in treatment) to traditional probation where treatment is left to the client's choice. METHODS: Clients were randomly assigned to either seamless or traditional probation. We used a decision analytic approach which had two advantages: First it separated estimation of probability of adverse events (e.g. hospitalization) from the daily cost of the adverse event, thereby allowing use of estimates of daily costs available within the literature. Second, the reliance on daily probability of various adverse events also had the benefit of reflecting both length of the event and its intermittent re-occurrence. Subjects were 272 clients on probation in Northern Virginia and Maryland in the United States. Clients were randomly assigned to seamless and traditional probation and were followed for an average of 2.75 years (arrest information was only available for 1 year); 77% of clients participated in the follow-up interviews. At baseline, there was no statistically significant difference among the clients. RESULTS: During the follow-up period, clients in the seamless probation had less recidivism but the cost savings from this component (dollar 2.31 per client per follow-up day) was not sufficient to overcome increased costs due to mental hospitalization of seamless clients (dollar 13.50 per client per follow-up day), cost of delivery of seamless probation (dollar 2.58 per client per follow-up day), more frequent use of jail/prison for clients in the seamless group (dollar 2.08 per client per follow-up day) and additional treatment costs (dollar 1.24 per client per follow-up day). The expected cost of seamless probation and its consequences was dollar 38.84 per follow-up day. The expected cost of traditional probation and its consequences was dollar 21.60 per follow-up day. Seamless probation was dollar 6,293 more expensive than traditional probation per client per year. DISCUSSION: Sensitivity analysis suggested that the analysis was not sensitive to small change in any single cost or probability estimate. Sensitivity analysis suggested that increased supervision intensity and use of sanctions had contributed to lower cost-effectiveness. IMPLICATIONS: One possible way of improving seamless probation is to improve the intensity of the substance abuse treatment while reducing the intensity of supervision to its traditional levels. This analysis was limited to 2.75 years follow-up period and does not address cost savings that might occur after this period.

Adult↗

PubMed2004

Statistical definition of relapse: case of family drug court.

At any point in time, a patient's return to drug use can be seen either as a temporary event or as a return to persistent use. There is no formal standard for distinguishing persistent drug use from an occasional relapse. This lack of standardization persists although the consequences of either interpretation can be life altering. In a drug court or regulatory situation, for example, misinterpreting relapse as return to drug use could lead to incarceration, loss of child custody, or loss of employment. A clinician who mistakes a client's relapse for persistent drug use may fail to adjust treatment intensity to client's needs. An empirical and standardized method for distinguishing relapse from persistent drug use is needed. This paper provides a tool for clinicians and judges to distinguish relapse from persistent use based on statistical analyses of patterns of client's drug use. To accomplish this, a control chart is created for time-in-between relapses. This paper shows how a statistical limit can be calculated by examining either the client's history or other clients in the same program. If client's time-in-between relapse exceeds the statistical limit, then the client has returned to persistent use. Otherwise, the drug use is temporary. To illustrate the method, it is applied to data from three family drug courts. The approach allows the estimation of control limits based on the client's as well as the court's historical patterns. The approach also allows comparison of courts based on recovery rates.

Child↗

PubMed2004

Time-between control charts for monitoring asthma attacks.

BACKGROUND: The monitoring of peak expiratory flow rate (PEFR) is crucial for effective management of asthma. Daily PEFR monitoring is recommended, yet the data are rarely used by patients to help them understand their progress or by clinicians to modify treatment plans. Time-between control charts, which have been shown to be specially suited for monitoring rare events, can be used to monitor asthma attacks. METHODS: Each patient is asked to record his or her PEFR value once a day, and these data are used to construct the control chart. PEFR data for three previously reported cases are presented and used to illustrate the control chart methodology. If duration of consecutive attacks is plotted and the observed duration exceeds the upper control limit (UCL), the patient is getting worse. If length of consecutive symptom-free days is plotted and the observed duration exceeds the UCL, the patient is getting better. In both circumstances, the clinician and the patient explore what brought about the prolonged recovery or periods of deterioration. The object is to increase time until the next attack. DISCUSSION: Using time-between control charts in monitoring asthma attacks has the advantage of providing a visual display of data that, unlike eyeballing of trends, clarifies when patients should seek additional clinical advice. The control limit allows clinicians and patients to ignore random variations and focus on real changes in underlying patterns of asthma attacks.

Asthma↗

PubMed2004

Experience with family drug courts in three cities.

The purpose of the study was to describe the following components of specialized Family Drug Courts: (1) children under court supervision; (2) parent(s) named in the petition; (3) services provided and court actions taken; and (4) relapse rates. Data were collected from the court records of 65 families in three courts in Florida, Kansas, and New York. Courts differed in type of clients, sanctions used, and length of time required between drug testing. Drug testing frequency varied depending on the parent's recovery and cooperation. Test results indicated a decline in drug use in the first four months and an increased risk for relapse between the 15th and 19th weeks. Specialized Family Drug Courts show promise for an improved way to address child abuse and neglect involving parental substance use. They can also provide a unique clinical training experience for health professionals.

Adolescent↗

PubMed2004

Activity based costing of probation with and without substance abuse treatment: a case study.

BACKGROUND: Since many offenders have drug problems, investigators have proposed that drug testing and treatment should be an integral part of probation. In 1994, the Office of National Drug Control Policy (ONDCP) funded a demonstration project designed to integrate drug treatment with traditional supervision services. As part of this demonstration a new procedure called 'seamless' probation was set up in which treatment providers were co-located with probation officers and probation officers coordinated offenders' participation in treatment. AIMS OF THE STUDY: This study examines the cost of providing substance abuse treatment coordination through probation agencies. METHODS: We used Activity Based Costing (ABC) to examine the cost of probation with and without treatment coordination in one probation agency. Agency budget was analyzed and allocated to various programs. A questionnaire was developed to assess probation officer's activities. The cost of coordinating treatment for one offender was calculated by dividing the total cost of the program by units of various activities done by the probation officers. RESULTS: Preliminary test of reliability of the instrument showed that it was accurately portraying the probation officers time allocation. Probation officers spent 6.9% of their time in seamless supervision and 83.3% time in traditional supervision (83.83%). The seamless probation officers had more group meetings and more phone contact with their offenders than traditional probation officers. The average cost per offender per day was 12 dollars for seamless probation and 7 dollars for traditional probation. DISCUSSION: This study is limited because it focuses on one agency at one point in time. Results may not be relevant to other agencies or to the same agency as it makes its operation more efficient. This study provides a method of allocating budget cost to per client costs using survey of probation officer's activities -- a tool developed in this study. Comparison of seamless and traditional supervision activities showed major differences in terms of the probation officers' activities and costs. IMPLICATIONS: There are significant costs associated with asking probation officers to coordinate treatment. Studies should be undertaken to examine the relative benefits that can be derived from this increased cost.

Budgets↗

PubMed2003

The Orientation of Social Support measure.

In this study we proposed and tested the theory that behavior is affected by the orientation of the members of one's social network. We collected data from 98 women (some drug users) with the Orientation of Social Support (OSS) scale and two other widely used measures: the Social Support Questionnaire (SSQ), and the Multidimensional Scale of Perceived Social Support (MSPSS). Drug use was measured with the Addiction Severity Index (ASI). Pairwise correlations showed that the OSS had no correlation with the SSQ or the MSPSS. Subjects' ASI scores were regressed on the three measures of support. The only variable that entered stepwise regression was the OSS scale. This study confirmed our theory that it is important to examine the orientation of and not just the extent of social support. The paper provides the questionnaire and the scoring procedures for measurement of extent of peer pressure.

Adult↗

PubMed2003

Evaluating Medicaid HMOs when encounter data are missing: case of developmentally delayed children.

In evaluating Medicaid Health Maintenance Organizations (HMOs), crucial information regarding severity of illness of patients is often missing--in part because encounter data are not available. If we assume that patients are either in the HMO or in fee-for-service (FFS) plans (i.e., no in or out migration); then severity of HMO patients can be deduced from encounters of FFS patients. We applied this approach to effectiveness of HMO services for developmentally delayed children. Data supported the assumption of a closed system. Data also showed that over 12 months, severity of FFS patients declined. Therefore, we inferred that the HMO was attracting sicker patients. The HMO was paid less than FFS plan, despite the fact that it attracted sicker patients.

Child↗

PubMed2002

Unit cost of counseling and patients length of stay in a residential drug treatment setting.

BACKGROUND: Many published reports on cost of counseling give a fixed cost per hour of service. These estimates may be flawed. AIMS OF THE STUDY: The purpose of this study is to show, by way of an example, how cost of an hour of counseling depends on the nature of the patient, in general, and length of the patient s stay, in particular. Even though the health care professional provides the same hour of work, the cost of the hour is different for short-stay and long-stay patients. METHODS: We identified 5-short and 5 long stay patients in a residential treatment program. For each group, we asked the counselors to review the medical records and measure the patients utilization of various service units. We estimated the cost of a unit of service by dividing cost of an average patient by the program utilization of short and long-stay patients. RESULTS: The cost of an hour of counseling for long stay patients was 2/3 less than the cost of short-stay patients. Similar large changes in unit cost of treatment were observed for cost of group counseling or other components of substance abuse treatment. DISCUSSION: Our data was limited to one case study and may not indicate similar patterns in other treatment programs. The paper suggests that methods of studying cost of treatment should be adjusted to reflect case mix of patients and their expected length of stay. IMPLICATIONS FOR HEALTH POLICIES: Our analysis shows that higher rates should be set for patients at risk for short stays; conversely lower rates should be set for patients likely to complete treatment. Without adjusting the rate for the case mix of patients, health care institutions have an incentive to avoid the difficult cases and concentrate on long stay cases. IMPLICATIONS FOR FURTHER RESEARCH: A number of instruments that measure severity of illness or difficulty of treatment can be used to anticipate patients length of stay. Then the rate for units of treatment can be set based on patients expected length of stay. This paper presents a questionnaire that can be used to collect cost data and estimate cost per unit of treatment adjusted for expected length of stay.

Counseling↗

PubMedDate not supplied

Tukey's control chart.

This article presents the idea of Tukey's Control Chart, a method of analyzing data based on the concepts developed by John Tukey for calculation of confidence intervals for medians. The procedure is simple to implement (no need to calculate averages or standard deviations); it does not assume any distribution of the data; it can be applied to small data sets; and it is robust and not affected by occasional unusual observations (outliers). The article provides examples of the application of Tukey's Control Chart to both patients' lifestyle management and business process improvement.

Data Interpretation, Statistical↗

PubMedDate not supplied

Simulated environment is not appropriate.

In the Spring 2005 issue of Quality Management in Health Care, Borckand et al examined the performance of Tukey's chart in a simulated environment. Unfortunately, the simulated environment does not reflect the type of settings where Tukey's chart has been proposed to be most effective. Tukey's charts are ideally used on relatively small data sets. In these data sets, we hypothesize that it is unlikely to have the high autocorrelations simulated in the Borckand et al study. Furthermore, Tukey's chart will perform well in data coming from non-Normal or non-Uniform distributions. The simulation study was based on random numbers generated with Uniform or Normal distributions. We encourage Borckand et al to examine the performance of Tukey's chart in the modified circumstances.

Computer Simulation↗

PubMedDate not supplied

A mathematical theory for identifying and measuring severity of episodes of care.

OBJECTIVES: We propose and test a method for constructing episodes of care from data within administrative databases and electronic health records. SUBJECTS: We created a measure for severity of episodes of illness for 565 randomly chosen developmentally delayed children who were enrolled in the Medicaid program. DESIGN: Regression analysis was conducted to test the percentage of variance explained by our proposed mathematical model in cost of care. DATA COLLECTION: Data included both hospitalizations and clinic visits obtained from Medicaid programs from one southeastern state. METHODS: For each patient, the likelihood that two diagnoses are part of the same episode is proportional to the similarity of the two diagnoses and to the short time interval between them. When this likelihood exceeds a preset cutoff, then the two diagnoses are part of the same episode. The cutoff is estimated by selecting number of days before two very similar diagnoses are considered to be part of separate episodes. The similarity between two diagnoses is assumed to be proportional to co-occurrence of the two diagnoses within a fixed period (usually 30 days). The severity of an episode was calculated using a Muliplicative Multiattribute Utility model, where severity of each diagnosis is aggregated to estimate the overall severity of the episode. Severity of each diagnosis was assumed to be proportional to average cost of a diagnosis-if patients do not die before care is delivered. The article includes an algorithm that can classify a patient's diagnosis into episodes of care and measure severity of the episodes from date of diagnoses, code for the diagnoses, and charges for the visit. To facilitate integration with existing database, the article includes a Standard Query Language computer program. To evaluate the method of constructing episodes of care, we regressed cost of care on the patient's number of episodes of care within the year, average severity of the episodes within the year, and the interaction between number and average severity of the episodes. RESULTS: The number of episodes (alpha = .001), the average severity of the episodes (alpha = .001), and the product of the two (alpha = .001) had statistically significant relationships to the average cost of the case. The 3 variables together explained 53% of variation in yearly cost of care. CONCLUSIONS: These data suggest that our proposed mathematical approach is reasonable and produces severity scores that are predictive of objective criteria such as cost of care.

Child, Preschool↗

PubMedDate not supplied

System thinking in a personal context to improve eating behaviors.

People can create positive environments so that their chances of relapse to poor habits are reduced and their likelihood of success is increased. Continuous quality improvement (CQI) suggests that this can be accomplished by making systemwide changes and deemphasizing personal effort. This article provides a 7-step approach to system thinking in a personal context. It offers a case study and other examples that show how to lose weight by making systemic changes in lifestyles. Learning about system thinking in a personal context also may help healthcare professionals understand the application of CQI within organizations.

Attitude to Health↗