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M C Hornbrook

Publications and source records attributed to M C Hornbrook.

At least 37 records · Page 2Linked to original sources
PubMed1995

Assessing relative health plan risk with the RAND-36 health survey.

Unbiased risk assessment models base health plan payments on enrollee health care needs. We explored the risk structure of employed adult health maintenance organization (HMO) members using the RAND-36 health survey. We used multivariate techniques to estimate risk weights on demographic and health status factors. The dependent variable was annual real total health plan expense for covered services for the year following the survey. Repeated random-split-sample validation techniques minimized outlier influences. Five scales improved prediction over simple demographic factors, but demographic factors still were required to achieve unbiased forecasts. Self-reported health status is a useful and powerful risk measure for adults.

Actuarial Analysis↗
PubMed1994

Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization.

OBJECTIVE: To estimate the cost-effectiveness and net medical care costs of programs for annual influenza vaccinations for the elderly in a health maintenance organization (HMO). DESIGN: Population-based, case-control study. SETTING: The Northwest Region of Kaiser Permanente, a prepaid group practice HMO in Portland, Oregon. PARTICIPANTS: Kaiser Permanente members 65 years of age and older who had at least 1 month of HMO eligibility during any of nine influenza seasons in the 1980s. MEASUREMENTS: The HMO's costs for providing medical care and conducting vaccination programs were estimated using accounting data. RESULTS: 32% of high-risk elderly persons and 22% of non-high-risk elderly persons received influenza vaccinations. Aggregate vaccine effectiveness in preventing pneumonia and influenza hospitalizations was 30% (95% CI, 17% to 42%) for high-risk and 40% (CI, 1% to 64%) for non-high-risk elderly persons. The net savings to the HMO per vaccination was $6.11 for high-risk elderly persons and $1.10 for all elderly persons. The HMO incurred a net cost of $4.82 per vaccination for non-high-risk elderly persons. CONCLUSIONS: Influenza vaccination rates in this HMO were relatively low for high-risk elderly persons. The medical care costs saved by preventing pneumonia and influenza through vaccination of high-risk elderly persons provide a compelling rationale to increase compliance with recommendations for annual influenza vaccination. Indirect benefits, such as prevention of suffering, incapacity, and lost wages, are likely to compensate for the small net cost of vaccinating non-high-risk elderly persons.

Aged↗
PubMed1994

Replicating the chronic disease score (CDS) from automated pharmacy data.

Michael Von Korff and colleagues at the Center for Health Studies, Group Health Cooperative (GHC) of Puget Sound created a measure of chronic disease status (CDS) using automated outpatient pharmacy data. They reported the measure appeared to provide a stable and valid measure of health status. The availability of such a measure could become a new tool for a variety of applications, including screening, resource allocation, and quality assurance. The measure was replicated for its reliability and construct and predictive validity in the KPNW membership using automated pharmacy data. Reliability and validity were tested using correlation and regression techniques. The CDS showed test-retest reliability over time. It showed construct validity with the RAND-36 instrument and the BSI-8 depression screener. It showed predictive validity with health care visits and hospitalizations. The results were similar to those at GHC. The findings indicated that the CDS can serve, with certain precautions, as a readily accessible low cost measure of health status.

Chronic Disease↗
PubMed1994

Preventing falls among community-dwelling older persons: results from a randomized trial.

A randomized trial of falls prevention program that addressed home safety, exercise, and behavioral risks was conducted with 3,182 independently living HMO members age 65 and older. The intervention decreased the odds of falling by 0.85, but only reduced the average number of falls among those who fell by 7%. The effect was strongest among men age 75 and older. The likelihood of avoiding falls requiring medical treatment was not significantly affected by the intervention. We conclude that the intervention dose was not of sufficient intensity or duration to have a marked protective effect on older persons. Future research should focus on more intensive intervention approaches because serious falls do not appear to be amendable to low-intensity environment/behavioral efforts.

Accidental Falls↗
PubMed1993

Development of the common data base for the FICSIT trials.

The eight FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) sites test different intervention strategies in selected target groups of older adults. To compare the relative potential of these interventions to reduce frailty and fall-related injuries, all sites share certain descriptive (risk-adjustment) measures and outcome measures. This article describes the shared measures, which are referred to as the FICSIT Common Data Base (CDB). The description is divided into four sections according to the four FICSIT committees responsible for the CDB: (1) psychosocial health and demographic measures; (2) physical health measures; (3) fall-related measures; and (4) cost and cost-effectiveness measures. Because the structure of the FICSIT trial is unusual, the CDB should expedite secondary analyses of various research questions dealing with frailty and falls.

Accidental Falls↗
PubMed1993

Seniors' Program for Injury Control and Education.

The Seniors' Program for Injury Control and Education (SPICE) examines the effects of exercise and physical fitness on falls and related injuries among older persons. The design is a two-group, randomized trial with 2 years of follow-up. The study is at Northwest Region of Kaiser Permanente (NWKP), a large hospital-based prepaid group practice HMO in Portland, OR. The participants are 1,323 community-living persons 65 years or older who are enrolled in NWKP and are at moderate risk of falling. A multifaceted intervention strategy uses a group approach to falls and injury prevention which includes moderate intensity endurance-building exercise (walking), strength and balance training, home safety improvements, and mental practice. Sessions of 20-25 participants are led by two nurses. Participants set their own realistic goals for exercising to accommodate to differing functional abilities and baseline conditioning. The control group receives usual care from the HMO. Participants report all falls for 2 years after randomization. Outcome measures include health status, physical functioning, falls, and fall-related medical care use and cost. If SPICE is effective, cost-effectiveness analysis will examine the relative efficiency of SPICE versus other successful FICSIT interventions. Thus far, recruitment and intervention compliance goals have been met from a population of frail elderly HMO members.

Accidental Falls↗
PubMed1985

The contribution of case-mix severity to the hospital cost-output relation.

Analyses of the cost-output relation of hospital care often omit diagnostic case mix from the analytic model. In this study, we examine the bias that arises from the use of either single-dimensional output volume or structural hospital capacity, but not case-mix severity, to analyze hospital costs and outputs. We found that hospitals with higher admission rates tend to admit less severe case mixes, other things equal, which implies that specialized facilities are relatively underutilized. Our finding provides a rationale for regionalization and sharing of costly specialized services and for reimbursement controls on the cost of capital. We conclude that public policy should focus on optimizing the mix of treatment services rather than on hospital size per se.

Costs and Cost Analysis↗