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PubMed2006

The economic impact of children dispensed asthma medications without an asthma diagnosis.

OBJECTIVE: To compare the resource utilization and healthcare costs of children with a diagnosis of asthma, children dispensed asthma medications but without a diagnosis of asthma, and control children. STUDY DESIGN: Children 0 to 17 years old were identified from an integrated managed-care database during calendar year 2001. They were compared on the basis of the presence of a medical claim for asthma (Dx cohort); a prescription for an asthma controller or reliever medication (excluding oral corticosteroids) but without an asthma diagnosis (Rx cohort), and control children. Using medical and pharmacy claims, resource utilization and costs were compared across cohorts. RESULTS: Children in both the Dx and Rx cohorts had significantly greater nonasthma and total all-cause annual healthcare costs compared with control children. The Dx and Rx cohorts had higher rates of nonasthma emergency department visits and hospitalizations. The risk of an oral corticosteroid dispensed was 14-fold and 7-fold greater for the Dx and Rx cohorts, respectively, compared with the control children. These findings were consistent in infant, toddler, school-age, and adolescent groups. CONCLUSIONS: Children dispensed asthma medications but lacking an asthma diagnosis have considerable morbidity and incur high healthcare resource utilization. This study suggests that better recognition of pediatric asthma is warranted.

Adolescent↗
PubMed2005

Is gastric electrical stimulation superior to standard pharmacologic therapy in improving GI symptoms, healthcare resources, and long-term health care benefits?

CONTEXT: Severe upper gastrointestinal (GI) motor disorders, including gastroparesis (GP), can consume significant health care resources. Many patients are refractory to traditional drug therapy. OBJECTIVE: To compare symptoms, healthcare resource utilization and costs in two groups of patients with the symptoms of GP: those treated via gastric electrical stimulation (GES) and those treated with traditional pharmacological agents in an intensive outpatient program (MED). DESIGN: A long-term comparison of patients with devices (n = 9) vs intensive medical therapy (n = 9). SETTING AND PATIENTS: A total of 18 eligible patients with the symptoms of GP reported for 1-year baseline and long-term treatment for 3 years. INTERVENTIONS: Patients with the symptoms of GP were treated by a GES or intensive medical therapy (MED). MAIN OUTCOME MEASURES: GP Symptoms, healthcare resource utilization using investigator-derived independent outcome measure score (IDIOMS) and total hospital (inpatient and outpatient) billing costs. RESULTS: Gastrointestinal symptoms were significantly different from baseline (F = 3.03, P < 0.017) with GP patients treated via GES showing more sustained improvement over 36 months than those treated via MED. Healthcare resource usage, measured via the IDIOMS, significantly improved at 12, 24 and 36 month follow-up for GES patients (F = 10.49, P < 0.001), compared with patients receiving medical therapy, who demonstrated further deterioration. GP patients treated via GES also proved superior to medical therapy at 24 and 36 months with regard to decreased costs (F = 4.85, P < 0.001). Within group comparisons indicated significantly reduced hospital days for both patient groups; however, no statistical differences were noted between groups in terms of hospital days. Three of nine patients in the MED group died primarily from i.v. access related problems; none of the GES patients died. CONCLUSION: We conclude that GES is more effective in improving long-term GI symptoms and costs, and decreasing use of healthcare resources than intensive medical therapy, in this sample of patients with the symptoms of GP followed for 3 years. Certain patients with GP form a high-risk group in terms of costs, quality of life, morbidity and mortality.

Adult↗
PubMed2004

Preference and resource utilization in elderly patients: InnoLet versus vial/syringe.

InnoLet is a disposable insulin injection device with a large easy-to-read dial, large push button for injection, and audible clicks for each unit injected. This clinical trial assessed patient preference, satisfaction, and utilization of healthcare resources (estimated nursing care) for InnoLet and vial/syringe. Patients with diabetes mellitus (N=79, mean age 68.2+/-8.6 years, duration of diabetes 16.5+/-10.9 years) having visual and/or motor disabilities and having difficulty (or required caregiver assistance) for previous injections by vial/syringe were randomized to use of either InnoLet or vial/syringe for 6 weeks, then switched to the alternate regimen for 6 weeks. At the end of the study, utilization of healthcare resources was assessed in terms of the caregiver time required to assist in preparation, storage, and disposal of each device. For vial/syringe, 60% of patients required assistance in drawing up the appropriate dosage in the syringe, and 36% of patients required assistance when injecting insulin. A major portion of the patients (53%) could independently conduct injections (without nursing/caregiver assistance) during use of InnoLet, versus 20% for vial/syringe. As a result, mean daily nursing costs associated with the injection regimen were US$ 114 for the InnoLet device, and US$ 196 for vial/syringe (P<0.001). A majority of patients (82%) indicated a preference for the InnoLet device (P<0.001).

Aged↗
PubMed2003

The burden of COPD in the U.S.A.: results from the Confronting COPD survey.

Chronic obstructive pulmonary disease (COPD) is a progressive disorder of airflow limitation that is not fully reversible, with disabling symptoms including chronic cough and dyspnoea. Although a number of studies in the U.S.A. have assessed the impact of COPD on the healthcare system and society, data on healthcare resource utilization (particularly outpatient services and medication use) in patients with mild to moderate COPD, or patients who meet symptom criteria for COPD but have not received this diagnosis, are limited or unavailable. To fill gaps in current knowledge about the impact of this disease, an economic analysis was conducted on the data collected from patients enrolled in the U.S.A. sample of Confronting COPD in North America and Europe, the first large-scale international survey of the burden of the disease. The annual cost of healthcare resource utilization was estimated at US dollar 4119 per patient with COPD, with indirect (non-medical care) costs amounting to US dollar 1527 per patient. The annual estimated societal cost was therefore US dollar 5646 per patient. The majority of disease costs in the survey were associated with inpatient hospitalizations (US dollar 2891). The results of the survey suggest that interventions that improve COPD outcomes by decreasing symptoms and preventing acute exacerbations could substantially decrease the costs associated with this disease.

Absenteeism↗
PubMed2006

Impact of gastroesophageal reflux symptoms on health resource usage and work absenteeism in Spain.

OBJECTIVES: To estimate the impact of gastroesophageal reflux (GER) symptoms on the utilization of healthcare services and work absenteeism in Spain. METHODS: A cross-sectional study on 2,500 subjects representative of the Spanish population from 40 to 79 years of age. Data were collected via a telephone interview in January 2002 using Locke s questionnaire after its cross-cultural adaptation and validation for telephone use in Spain. RESULTS: GER is responsible for 296.8 doctor consultations (95% CI: 245.3-348.7) per 1,000 inhabitants per year, for 24 esophagogastrointestinal radiographic studies per 1,000 inhabitants per year (95% CI: 18-30), for 32.4 (95% CI: 25.5-39.3) high digestive endoscopies per 1,000 inhabitants per year, and for the loss of 201 (95% CI: 0-411.1) working days per 1,000 employed inhabitants with GER per year. In relation to medication intake, GER resulted in 4,092 (95% CI: 3,300-5,133) treatment days with H2 antagonists per 1,000 inhabitants per year, 9,030 (95% CI: 7,846-10,332) treatment days with proton pump inhibitors per 1,000 inhabitants per year, and 1,082 (95% CI: 519-1,549) treatment days with prokinetics per 1,000 inhabitants per year. CONCLUSIONS: GER has a large impact on the utilization of healthcare resources and work absenteeism in Spain, in contrast to the widespread belief that it is an illness of little importance.

Absenteeism↗
PubMed2006

The impact of intensive patient education on clinical outcome in a clinic-based migraine population.

OBJECTIVE: To determine whether the addition of patient education to routine medical management improves the clinical status of migraine patients and reduces their utilization of healthcare resources. BACKGROUND: Optimal migraine management typically requires effective patient education. Such education often is difficult to accomplish in the busy clinic setting. METHODS: One hundred consecutive patients with migraine presenting to an university-based headache clinic were randomized to receive or not receive a standardized course of didactic instruction regarding migraine biogenesis and management. The course consisted of 3 classes taught by lay migraineurs who themselves previously had undergone intensive training. All patients were evaluated initially and at 1, 3, and 6 months by a neurologist blinded as to the results of randomization. Clinical variables examined included headache frequency/severity, migraine disability assessment (MIDAS) scores, patient compliance, presence versus absence of analgesic use/overuse, and headache-related unscheduled visits or phone calls. Comparisons were made between baseline findings and findings at the 6-month follow-up visit, with the change in mean MIDAS score serving as the primary outcome variable. RESULTS: At 6 months the group randomized to receive intensive education exhibited a significantly greater reduction in mean MIDAS score than the group randomized to routine medical management only (24 vs. 14 points; P < .05). Those patients also experienced a reduction in mean headache days per month and a greater reduction in functionally incapacitating headache days per month, exhibited less analgesic overuse and need for abortive therapy, were more compliant with prophylactic therapy prescribed, and made fewer headache-related calls to the clinic or unscheduled visits. CONCLUSION: Intensive education of migraine patients by trained lay instructors may convey significant benefit to those patients and reduce their utilization of healthcare resources.

Adolescent↗
PubMed2004

Expenditures associated with preventive healthcare.

BACKGROUND: The Office of Disease Prevention and Health Promotion emphasizes the use of preventive healthcare interventions to "increase quality and years of healthy life". The objective of this study is to evaluate over a 1-year period the total individual healthcare expenditures based upon the likelihood of the person utilizing preventive healthcare measures. METHODS: We analyzed data from the 1998 Medical Expenditure Panel Survey (MEPS) to compare healthcare expenditures of respondents who have and have not followed generally accepted preventive healthcare measures including influenza vaccination, blood pressure checkup, prostate examination, cholesterol determination, and mammography. RESULTS: In general, respondents who lacked evidence of pursuing accepted preventive healthcare practices had lower overall healthcare expenditures in 1998 compared to those who pursued such practices. Specifically, they had lower expenditures for office-based visits and for prescriptions. CONCLUSIONS: People who pursue accepted preventive healthcare measures spent more for their total healthcare over a given year.

Aged↗
PubMed1993

Case-mix measurements for understanding and managing healthcare institutions.

This article will characterize the clinical classification systems which may be utilized in healthcare institutions by illustrating their use in data analysis and management, demonstrating current examples of reimbursement, and detailing recent research trends in clinical classification systems. The systems discussed are diagnosis related groups (DRGs), DRG systems adjusted for patient severity, and ambulatory patient groups (APGs).

Abstracting and Indexing↗
PubMed1992

High utilization rate offsets efficiencies in pilot military mental healthcare program.

Higher than expected utilization has resulted in millions of dollars in unexpected costs in a pilot project designed to fill gaps in mental health services for children of Army families. While the plan has succeeded in paring costs per patient, the overall price tag has called into question the ability of the military to design and operate a managed-care delivery system economically.

Adolescent↗
PubMed1997

Transforming resource utilization data into information.

In view of increasing financial pressures, resource utilization management and review have become a primary focus for many healthcare organizations. Utilization strategies have been supported and enhanced by information technologies in many organizations. This paper describes the development and implementation of an on-line application for resource utilization review. Developed for use by clinicians and case managers, access to on-line utilization data has markedly influenced strategic clinical and financial decisions. Recommendations for future use and revisions are provided.

Data Display↗
PubMed2004

Organizational and environmental factors affecting the utilization of telemedicine in rural home healthcare.

In the last five years, home health agencies have become increasingly interested in telemedicine as a potential means to meet the future healthcare needs of their aged and chronically ill clientele. This case study examines the organizational and environmental conditions that affected the implementation of a telemedicine program in one rural home healthcare organization. Several factors restricted the utilization of telemedicine, including Medicare's Prospective Payment System and corresponding documentation (Outcome Assessment and Information Set), the organization controlling grant funding for the program, and several environmental factors. Findings suggest that in rural communities, older homecare patients may have less opportunity to benefit from telemedicine. The study demonstrates the importance of environmental and organizational factors when implementing a telemedicine program. Recommendations are offered for home healthcare organizations considering development of telemedicine programs.

Aged↗
PubMed2003

Life and health concerns of Indonesian women in transnational marriages in Taiwan.

The number of transnational marriages between Taiwanese men and Southeast Asian women is increasing rapidly in Taiwan. Approximately one out of nine marriages in Taiwan is transnational. The rapid increase the number of foreign brides has greatly transformed Taiwan's social and demographic structures. This study focuses on Indonesian brides, the second largest immigrant group in Taiwan, to explore their life and health concerns. In-depth interview assisted by participant observation for a qualitative study was used in this study. Fifteen women participated in the study. Content analysis was used for data analysis. Findings revealed life and health concerns of immigrant Indonesian women in Taiwan could be categorized into four themes: immigrant adaptation, communication difficulty, family continuity, and barriers to healthcare system utilization. Based on the findings of this study, suggestions are made for healthcare and health policies. Moreover, healthcare professionals should understand that designing and providing culturally sensitive and appropriate healthcare to these women is very important for promoting their and their children's health.

Adaptation, Psychological↗
PubMed2005

Extracranial-intracranial bypass in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the United States between 1992 and 2001: a population-based study.

OBJECT: The authors assessed the results of extracranial-intracranial (EC-IC) bypass surgery in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the US between 1992 and 2001 by using population-based methods. METHODS: This is a retrospective cohort study based on data from the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, MD). Five hundred fifty-eight operations were performed at 158 hospitals by 115 identified surgeons. The indications for surgery were cerebral ischemia in 74% of the operations (2.4% mortality rate), unruptured aneurysms in 19% of the operations (7.7% mortality rate), and ruptured aneurysms in 7% of the operations (21% mortality rate). Overall, 4.6% of the patients died and 4.7% of the patients were discharged to long-term facilities, 16.4% to short-term facilities, and 74.2% to their homes. The annual number of admissions in the US increased from 190 per year (1992-1996) to 360 per year (1997-2001), whereas the mortality rates increased from 2.8% (1992-1996) to 5.7% (1997-2001). The median annual number of procedures was three per hospital (range one-27 operations) or two per surgeon (range one-21 operations). For 29% of patients, their bypass procedure was the only one recorded at their particular hospital during that year; for these institutions the mean annual caseload was 0.4 admissions per year. For 42% of patients, their particular surgeon performed no other bypass procedure during that year. Older patient age (p < 0.001) and African-American race (p = 0.005) were risk factors for adverse outcome. In a multivariate analysis in which adjustments were made for age, sex, race, diagnosis, admission type, geographic region, medical comorbidity, and year of surgery, high-volume hospitals less frequently had an adverse discharge disposition (odds ratio 0.54, p = 0.03). CONCLUSIONS: Most EC-IC bypasses performed in the US during the last decade were performed for occlusive cerebrovascular disease. Community mortality rates for aneurysm treatment including bypass procedures currently exceed published values from specialized centers and, during the period under study, the mortality rates increased with time for all diagnostic subgroups. This technically demanding procedure has become a very low-volume operation at most US centers.

Adolescent↗
PubMed2006

Is there a "July phenomenon" in pediatric neurosurgery at teaching hospitals?

OBJECT: Concern for patient safety, among other reasons, recently prompted sweeping changes in resident work policies in the US. Some have speculated that the arrival of new interns and residents at teaching hospitals each July might cause an annual transient increase in poor patient outcomes and inefficient care. METHODS: Data were analyzed for 4323 craniotomies for tumor resection and 22,072 shunt operations performed in pediatric patients between 1988 and 2000 in US nonfederal hospitals (Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, MD). In-hospital mortality rates, discharge outcome, complications, and efficiency measures (length of stay [LOS] and hospital charges) for patients treated in July and August were compared with similar data for patients in other months. There were no significant increases in any adverse end point for either tumor or shunt operations in July and August. Odds ratios (95% confidence interval [CI]) for outcome of tumor craniotomies performed in July and August compared with outcome for tumor craniotomies performed in other months were as follows: for mortality rate, 0.43 (0.14-1.32); for adverse discharge disposition, 1.03 (0.71-1.51); for neurological complications, 1.00 (0.63-1.59); for transfusion, 0.70 (0.41-1.19). Hospital charges were 0.5% lower (range -6 to 5%) in July and August, and LOS was 3% shorter (range -8 to 3%). Odds ratios (95% CI) for July or August shunt surgery compared with shunt surgery performed in other months were as follows: for mortality rate, 0.96 (0.58-1.60); for adverse discharge disposition, 0.85 (0.66-1.11); for neurological complications, 1.27 (0.75-2.16); for transfusion, 0.81 (0.48-1.37). Hospital charges were 0.2% higher in July and August (range -3 to 3%), and LOS was 3% shorter (range -5 to 0.5%). CONCLUSIONS: Although moderate increases in some adverse end points could not be excluded, there was no evidence that brain tumor or shunt surgery performed in pediatric patients at US teaching hospitals during July and August is associated with more frequent adverse patient outcome or inefficient care than similar surgery performed during other months.

Brain Neoplasms↗
PubMedDate not supplied

The role of the Internet in improving healthcare quality.

The Internet is a tool that has the potential to greatly affect and improve the quality of healthcare. This article discusses the ways in which the Internet is being utilized by healthcare administrators, physicians, and healthcare consumers to enhance the quality of care. Despite the Internet's growing popularity and use, several barriers remain that prevent its full implementation in the healthcare field. This article offers guidelines for administrators in using the Internet within their organizations.

Computer Communication Networks↗