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Biomedical subjects

W B Stason

Publications and source records attributed to W B Stason.

At least 37 records · Page 2Linked to original sources
PubMed1991

Health-related quality of life among patients undergoing percutaneous transluminal coronary angioplasty.

A randomized clinical trial was recently conducted to investigate whether a new antiplatelet agent could prevent restenosis in patients who had undergone percutaneous transluminal coronary artery angioplasty (PTCA). Approximately 1,200 patients were enrolled at 13 separate clinical sites. To assess the impact of this intervention on health-related quality of life, a patient questionnaire for telephone administration was developed. This questionnaire focused attention on several specific dimensions likely to be important in this patient population: physical well-being, perceived health, emotional well-being, home management, work, recreation, and social and sexual functioning. This paper describes the instrument that was used in this trial and reports on its psychometric [corrected] properties based on completed interviews with approximately 500 patients at study entry and 1 month after PTCA.

Activities of Daily Living↗
PubMed1991

Opportunities to improve the cost-effectiveness of treatment for hypertension.

The cost-effectiveness of treatment for hypertension depends on the pretreatment level of blood pressure, age and sex of the patient, presence of other cardiovascular risk factors, long-term control of blood pressure, and the annual costs of treatment. Treatment of very mild hypertension (diastolic blood pressure, 90-94 mm Hg), even if the benefits do exceed the risks, does not appear to be particularly cost-effective. Opportunities to improve the cost-effectiveness of hypertension management lie in 1) avoidance of patient mislabeling by careful documentation of blood pressures on multiple occasions in the office and during usual activities outside the office before the diagnosis is made and treatment is begun; 2) efforts to increase adherence to scheduled visits and medication regimens; 3) attempts to step-down dosages or discontinue medications after periods of good blood pressure control; 4) explicit consideration of costs, as well as benefits, in decisions on the needed frequency of office visits, choice of medications, and use of laboratory tests; and 5) efforts to improve practice efficiency. Future practice guidelines for hypertension management should take these factors into account and should make trade-offs between benefits, risks, and costs explicit for specific types of patients.

Cost-Benefit Analysis↗
PubMed1990

Costs and benefits of risk factor reduction for coronary heart disease: insights from screening and treatment of serum cholesterol.

The principles of cost-effectiveness analysis are straightforward and can be applied to set priorities among competing uses for resources. This article examines the relationship between serum cholesterol and coronary heart disease (CHD) risk, drawing on information from a number of large intervention trials. The cost-effectiveness of treatment alternatives for elevated serum cholesterol, hypertension, and symptomatic CHD are compared. Concern is expressed that the guidelines issued by the National Cholesterol Education Program extend beyond the available evidence and do not adequately take into account problems with adherence to diet and drug regimens or the cost of widespread implementation. The cost-effectiveness of drug treatment for both high cholesterol and hypertension depends on the populations at which they are targeted.

Coronary Artery Bypass↗
PubMed1990

Learning by doing in CABG surgery.

This study provides empiric confirmation of the widely held belief that coronary artery bypass graft (CABG) surgery has become quicker over time as clinical and organizational improvements diffuse across hospitals. Based on a two-stage cluster sample of 74 hospitals performing CABG surgery in 1984, data on skin-to-skin procedure and pump times were analyzed for 2,784 Medicare-eligible cases over the 1972-84 period. Using multivariate regression analysis to adjust for patient characteristics and number of grafts, we found that CABG skin-to-skin times fell an average of 36.5% during the first 12 years of hospital experience while cardiopulmonary pump times fell 28.2%. Rates of decline averaged 4.5-5.4% annually initially, but tapered off to 1.5% by the twelfth year of experience. Extrapolating over a 20-year period, gains in skin-to-skin times are projected to reach 42%, resulting in nearly a halving of surgical times. Our findings have implications both for physician reimbursement and patient outcomes. Medicare CABG prevailing fees do not reflect these gains in efficiency and could be reduced substantially. Alternatively, efficient, high-volume hospitals could be identified for inclusion in a Medicare "CABG PPO" so that society might share in the productivity gains. Finally, recent research showing better outcomes in high-volume institutions may be partially explained by their shorter procedure times, which should reduce operative complications.

Aged↗
PubMed1989

Cost and quality trade-offs in the treatment of hypertension.

The cost-effectiveness of treatment for hypertension is positively related to the level of pretreatment blood pressure and to the level of success in achieving patient adherence to prescribed medical regimens. Opportunities to improve the cost-effectiveness of treatment include limiting treatment to patients with well-documented sustained increases in blood pressure, giving higher priority to the treatment of patients with diastolic blood pressures of 100 mm Hg and above, and relying on lower-cost medications if clinical responses to treatment permit. In patients with mild hypertension, a comparison of strategies for initiating pharmacological treatment that takes into account potential side effects as well as the costs of medications indicates a difference of $270/patient-yr between the least and most expensive alternatives. Whether the additional costs of more expensive treatment strategies are "worth it" depend on any additional health benefits actually conferred. Moreover, higher-cost strategies may have negative influences on patients' decisions to adhere to prescribed regimens or to continue in treatment. Cost is a particular problem for the treatment of chronic conditions like hypertension because of inadequate insurance coverage for medications, especially for the poor.

Antihypertensive Agents↗
PubMed1989

Using physician time and complexity to identify mispriced procedures.

Physician fees have come under increasing scrutiny as policymakers attempt to constrain Medicare outlays. Our study tests the hypothesis that relative fees can be explained in terms of the physician effort involved. Our regression results show that the majority of the variation in Medicare allowed charges can be justified in terms of the physician time involved and the complexity of the procedure. Nevertheless, some surgical procedures were identified as being "overpaid" relative to their reported time and complexity, while other services appeared "underpaid," especially visits. Our methodology provides a tool for identifying "mispriced" procedures, should Congress continue its current policy of making adjustments to individual fees.

Costs and Cost Analysis↗
PubMed1988

Determinants of acquisition of MR imaging units in an era of prospective payment.

A survey was undertaken to examine the impact of Medicare's Prospective Payment System (PPS) and other recent changes in the health care environment on providers' decisions regarding acquisition of high-cost technologic equipment. The survey group included 199 hospitals and freestanding imaging centers known to have acquired magnetic resonance (MR) imaging units, as well as a random sample of 400 hospitals whose acquisition decisions were unknown to the authors. Fifty-eight percent of the known adopters and 61% of the randomly selected hospitals responded to the survey. Nonadopters' decisions were dominated by economic considerations, including the high cost of MR imagers and concerns about Medicare's reimbursement policies. Competition and a desire to provide the highest quality of care are counterbalancing the retardant effects of PPS, however, and are stimulating widespread diffusion of MR imagers.

Costs and Cost Analysis↗
PubMed1987

Reproducibility and validity of self-reported menopausal status in a prospective cohort study.

The reproducibility and validity of self-reported menopausal status were evaluated among the 121,700 female US registered nurses aged 30-55 years in 1976 who are participants in the Nurses' Health Study, a prospective cohort study of diseases in women. When questioned in 1978, 6,591 of the women who were premenopausal in 1976 reported that their menses had ceased and provided their age at menopause. Two years later, in 1980, 98.8 per cent of the 6,591 women again reported that they were postmenopausal and again gave the reasons for menopause (natural or surgical). Among those women who reported surgical menopause during the 1976-1978 follow-up interval, age at menopause was reported to within one year on both the 1978 and 1980 questionnaires by 95 per cent of women. Among those reporting natural menopause during the 1976-1978 period, 82 per cent of women reported their age at menopause to within one year on the two follow-up questionnaires. A random sample of 255 women reporting surgical menopause between 1982 and 1984 was identified and medical records were obtained for 200. For all but two women, there was complete agreement between self-report and medical record for details of hysterectomy and extent of ovarian surgery. The reproducibility of self-reported age at menopause was assessed among 31,405 women who were menopausal in 1976. Reported age at menopause on consecutive questionnaires showed increasing within-person variance with increasing duration since menopause.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model.

A computer simulation model was developed to project the future mortality, morbidity, and cost of coronary heart disease (CHD) in the United States population. The model contains a demographic-epidemiologic (DE) submodel, which stimulates the distribution of coronary risk factors and the conditional incidence of CHD in a demographically evolving population; a "bridge" submodel, which determines the outcome of the initial CHD event; and a disease history (DH) submodel, which simulates subsequent events in persons with a previous CHD event. The user of the model may simulate the effects of interventions, either preventive (i.e., risk factor modification) or therapeutic, upon mortality, morbidity, and cost for up to a 30-year period. If there were no future changes in risk factors or the efficacy of therapies after 1980, baseline projections indicate that the aging of the population, and especially the maturation of the post-World War II baby-boom generation, would increase CHD prevalence and annual incidence, mortality, and costs by about 40-50 per cent by the year 2010. Unprecedented reductions in risk factors would be required to offset these demographic effects on the absolute incidence of CHD. The specific forecasts could be inaccurate, however, as a consequence of erroneous assumptions or misestimated baseline data, and the model awaits validation based on actual future data.

Adult↗
PubMed1987

Packaging physician services: alternative approaches to Medicare Part B reimbursement.

More than a quarter of the rapid growth in physician expenditures since the advent of the Medicare program can be ascribed to greater service intensity, generally through unpackaging of physician services, procedure inflation, and the involvement of multiple physicians. One way to achieve effective cost control is to restrain prices and the number of services simultaneously through redefining the payment unit from a narrow procedure to a comprehensive package of services. In this paper, we explore five means of packaging physician services: collapsed procedure, office visit, special procedure, ambulatory condition, and inpatient condition packages. While three packages hold promise for reining in the costs of physician services in the Medicare program, two raise important policy considerations that would have to be addressed before they could be given further consideration.

Ambulatory Care↗
PubMed1987

Economics in hypertension management: cost and quality trade-offs.

Hypertension is a pervasive public health problem with enormous economic as well as medical consequences. Progress in developing more effective, safer and more convenient medications has been remarkable. Similarly, progress in focusing public and professional attention on hypertension has led to earlier treatment and undoubtedly contributed significantly to reduced stroke and cardiovascular mortality rates. Challenges in the next decade will be to resolve residual uncertainties about the balance of benefits and risk of treatment in mild diastolic hypertension and isolated systolic hypertension, and to develop incentives for maximizing the cost-effectiveness of treatment in those for whom treatment is, on balance, beneficial. Quality-of-life parameters will play prominent roles in clinical and policy decisions with respect to each of these challenges.

Cost-Benefit Analysis↗
PubMed1986

Opportunities for improving the cost-effectiveness of antihypertensive treatment.

Hypertension is an extremely important public health problem, both medically and economically. The cost burden of treatment may significantly compromise care for the individual patient, while in aggregate the direct costs of antihypertensive treatment in the United States approach $8 billion a year. Improved insurance coverage and efforts to control the costs of antihypertensive treatment are needed. Efforts to reduce the costs of care, with minimal or no reduction in its quality, should focus on the following: limiting treatment to patients with sustained diastolic hypertension; improving the efficiency of the delivery process; and emphasizing "low-cost prescribing strategies." The uncertainty that remains over the risk-benefit ratio of pharmacologic treatment for patients with very mild hypertension (90 to 94 mm Hg diastolic) raises additional questions. Even if treatment of mild hypertension is effective, it is without doubt less cost-effective than treatment of moderate and severe hypertension. Is this cost worthwhile? Such trade-offs of cost and benefits will increasingly have to be confronted in the face of limited health care resources.

Antihypertensive Agents↗