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At least 487 records · Page 27Linked to original sources
PubMed2006

A cost-utility analysis of hysterectomy, endometrial resection and ablation and medical therapy for menorrhagia.

BACKGROUND: Four types of treatment [hysterectomy, endometrial resection/ablation, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral medical therapy] are available for management of menorrhagia. The objective of this study was to compare the cost and quality-adjusted life-years (QALYs) gained by these four treatment alternatives. METHODS: A Markov model was designed to simulate the healthcare resource utilization and QALYs of the four treatment alternatives for patients presenting with menorrhagia over 5 years. Clinical inputs were estimated from literature, and the cost analysis was conducted from the perspective of healthcare provider in Hong Kong. RESULTS: The base-case analysis showed that the hysterectomy group was the most effective (4.725 QALYs) alternative with the highest cost (USD6878, 1USD=7.8HKD). The incremental cost per additional QALY (ICER) gained by hysterectomy was USD23 500. The probability of extra surgery in the endometrial resection/ablation was an influential factor. Probabalistic sensitivity analysis of 10,000 simulations of the Monte Carlo model showed that the hysterectomy group gained higher number of QALYs than the LNG-IUS, oral medical treatment and endometrial resection/ablation groups, 99, 99 and 98% of the time, and it was more costly than the other three groups over 85% of the time. CONCLUSIONS: Hysterectomy appears to be cost effective, with ICER less than USD50,000, for management of menorrhagia.

Adult↗
PubMed2000

The interdependence of mental health service systems: the effects of VA mental health funding on veterans' use of state mental health inpatient facilities.

BACKGROUND: There are relatively few published data on how the financial structures of different health systems affect each other. With increasing financial restrictions in both public and private healthcare systems, it is important to understand how changes in one system (e.g. VA mental healthcare) affect utilization of other systems (e.g. state hospitals). AIMS OF THE STUDY: This study utilizes data from state hospitals in eight states to examine the relationship of VA per capita mental health funding and state per capita mental health expenditures to veterans' use of state hospitals, adjusting for other determinants of utilization. METHODS: This study utilized a large database that included records from all male inpatient admissions to state hospitals between 1984 and 1989 in eight states (n = 152541). Funding levels for state hospitals and VA mental health systems were examined as alternative enabling factors for veterans' use of state hospital care. Logistic regression models were adjusted for other determinants of utilization such as socio-economic status, diagnosis, travel distances to VA and non-VA facilities and the proportion of veterans in the population. RESULTS: The single strongest predictor of whether a state hospital patient would be a veteran was the level of VA mental healthcare funding (OR = 0.81 per $10 of funding per veteran in the population, p = 0.0001), with higher VA funding associated with less use of state hospitals by veterans. Higher per capita state funding, reciprocally, increased veterans' use of state hospitals. We also calculated elasticities for state hospital use with respect to VA mental healthcare funding and with respect to state hospital per capita funding. A 50% increase in VA per capita mental health spending was associated with a 30% decrease in veterans' use of state hospitals (elasticity of -0.6). Conversely, a 50% increase in state hospital per capita funding was associated with only an 11% increase in veterans' use of state hospitals (elasticity of 0.06). IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: These data indicate that per capita funding for state hospitals and VA mental health systems exerts a significant influence on service use, apparently mediated by the effect on supply of mental health services. Veterans are likely to substitute state hospital care for VA care when funding restrictions limit the availability of VA mental health services. However, due to the relative sizes of the two systems, VA funding has a larger effect than state hospital funding upon state hospital use by veterans. IMPLICATIONS FOR HEALTH POLICIES: These data indicate that changes in the organizational and/or financial structure of any given healthcare system have the potential to affect surrounding systems, possibly quite substantially. Policy makers should take this into account when making decisions, instead of approaching systems as independent, as has been traditional. IMPLICATIONS FOR FURTHER RESEARCH: Further research is needed in two areas. First, these results should be replicated in other systems of care using more recent data. Second, these results are difficult to generalize to individual behavior. Future research should examine the extent and individual determinants of cross-system use.

Journal Article↗
PubMed2006

Predictors of healthcare outcomes and costs related to medication use in patients with acne in the United States.

This study investigated the relationship among health status, costs linked with the treatment of acne in the United States, and other aspects related to medication use. The US Medical Expenditure Panel Survey (MEPS) database was analyzed for a cohort of people with acne. This cross-sectional study obtained costs, demographics, healthcare service utilization, and clinical patient variables from the MEPS database. The EuroQol Group's EQ-5D scores available in MEPS were used for health status information. Multivariate weighted analysis was performed for data for approximately 5 million patients (weighted sample size). Nearly 70% of the patients used some type of medication for acne. Acne-related medication accounted for approximately 36% of the total acne-related annual healthcare costs, with an average of 2 annual acne prescription refills per patient. Increased number of refills of acne-related medications was associated with an improvement in health status (P<.05). Increased physician office-based visits were the only predictors of higher acne-related annual healthcare costs (P<.01). Adherence to acne medications is an important component of better health status. Pharmacologic treatment of acne does not significantly add to acne-related annual healthcare costs.

Acne Vulgaris↗
PubMedDate not supplied

A cost/benefit analysis of patient education.

This article's purpose was to report the effects of a formalized patient education program in reducing implications and healthcare expenditures. In our current healthcare environment, caregivers must evaluate each service or treatment rendered in light of its impact or outcome. Impact or outcome must refer to a positive influence on the person receiving the service or treatment. In addition, in our era of extreme pressures to contain healthcare expenditures, the resultant benefit should be that of economic as well as therapeutic yield. The regulation of hospitals by a prospective payment system compels healthcare administrators to scrutinize available resources with a commitment to offer quality programs in patient care. How much healthcare can the consumer afford? Responsible cost benefit analysis will give healthcare providers a strong stance to justify programs. Using a study of pediatric patients with the same diagnosis and initial treatment, the authors evaluate the cost/benefit of a patient-education intervention. Two groups of patients, one with the patient education and the other without, are evaluated as to their utilization of healthcare services resulting from noncompliant behavior. There is less of an incidence of complications with the formalized patient-education program. In deriving a benefit to cost ratio of over seven to one, the effectiveness of the program was demonstrated. People assuming responsibility for their own health are a benefit to society at large.

Cost Control↗
PubMed2004

National health data warehouse: issues to consider.

A national data warehouse that links public and private data could be used to monitor trends in healthcare costs, utilization, quality of care, and adherence to quality guidelines and changes in treatment protocols. The development of the data warehouse, however, would require overcoming a number of political and technical challenges to gain access to private insurance data. This article outlines recommendations from a national conference sponsored by the Agency for Healthcare Research and Quality (AHRQ) on the private sector's role in quality monitoring and provides an operational outline for the development of a national private sector health data warehouse.

Confidentiality↗
PubMed2005

Using Healthcare Failure Mode and Effect Analysis tool to review the process of ordering and administrating potassium chloride and potassium phosphate.

During the spring of 2004, in the Calgary Health Region (CHR) two critical incidents occurred involving patients receiving continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). The outcome of these events resulted in the sudden death of both patients. The Department of Critical Care Medicine's Patient Safety and Adverse Events Team (PSAT), utilized the Healthcare Failure Mode and Effect Analysis (HFMEA) tool to review the process and conditions surrounding the ordering and administration of potassium chloride (KCI) and potassium phosphate (KPO4) in our ICUs. The HFMEA tool and the multidisciplinary team structure provided a solid framework for systematic analysis and prioritization of areas for improvement regarding the use of intravenous, high-concentration KCL and KPO4 in the ICU.

Aged, 80 and over↗
PubMedDate not supplied

Employment and utilization of dental hygienists in Minnesota healthcare facilities.

This study surveyed a representative sample from the entire listing of accredited hospitals and licensed nursing homes in Minnesota with bed accommodations of 100 or more. The purpose of the study was to determine (1) the current providers of oral healthcare to patients/residents in the selected facilities; (2) the employment and utilization of dental hygienists in these facilities; and (3) reasons for not employing a dental hygienist. A questionnaire was designed and sent to 147 facilities in November 1986 with a follow-up in January 1987. A total of 118 questionnaires were returned, resulting in a response rate of 80.3%. The results revealed that less than half of the facilities utilized a dental hygienist. In the majority of facilities surveyed, consulting dentists, registered nurses, licensed practical nurses, and nurse's aides were identified as those responsible for providing oral healthcare services. Insufficient funds was the primary reason identified by these facilities for not employing a dental hygienist. Dental hygienists employed in healthcare facilities provided therapeutic treatment and oral hygiene education services to staff and patients. In comparison, visiting dental hygienists tended to perform more staff training than patient education or therapeutic services. Most respondents indicated that a dental hygienist employed by their facility would improve the oral health status of their patients or residents. A large number of respondents appeared to be uncertain of the role of a dental hygienist in their healthcare facilities. Educational efforts are needed to increase the understanding of healthcare administrators and the public of the benefits of employing dental hygienists.

Dental Hygienists↗
PubMed2005

Impacts of a government-sponsored outpatient-based disease management program for patients with asthma: a preliminary analysis of national data from Taiwan.

In response to the high prevalence rates, mortality rates, and rising medical cost of asthma, the Bureau of National Health Insurance (BNHI) initiated a Healthcare Quality Improvement Program (HQIP) for people with asthma. The aim of this study was to investigate a preliminary analysis of the impact of a government-sponsored, outpatient-based disease management programs for people with asthma on the economic outcomes, the physician's and the patient's satisfaction. Using a retrospective design, a 1:4 (intervention vs. control group) matched cohort study design was used. Comparison of 1-year pre/post tests of utilizations of healthcare resources were conducted for 854 already diagnosed cases of patients with asthma. Comparison of independent tests between the intervention group and control group were performed for already diagnosed cases (n = 854) and newly-diagnosed cases (n = 231). Valid surveys were received from 212 physicians who participated the program, for a response rate of 46.0%, and 642 patients who enrolled in the program, for a response rate of 27.70%. Results indicated that the intervention group of already diagnosed cases had 39.94% fewer ED visits, 46.31% fewer inpatient visits, and 51.74% shorter length of stay, at a significant level. Though the HQIP program for people with asthma appeared to reduce medical care resource utilization for the intervention group, the control groups showed similar reductions but in different magnitude. For the newly diagnosed group, the intervention group had 197.43% more outpatient visits and 61.19% fewer ED visits of than those of the control group at a significant level. A majority of physicians (70%-85%) had positive opinions toward the HQIP program, but they admitted that the HQIP program prolonged the consultation time in outpatient visits (79.1%), and only 29.7% physicians did not feel interfered with while carrying out the HQIP. More than 80% of the patients showed positive feedback to the HQIP. The majority of the patients substantially adhered to physicians' suggestions, and had more accurate knowledge of and better self-care skills concerning asthma. These results have significance for the design of future programs aimed at improving the care of people with asthma and other chronic diseases in BNHI, Taiwan.

Adolescent↗
PubMed1994

Toward a definition of Information Therapy.

In these days of healthcare reform, there is an increasing need to control the costs of medical care. Preventive medical care can help by providing information to the patient, not only for illnesses, but for prevention and wellness. "Information Therapy" is a new term for supplying patients with health information, enabling them to make informed decisions about their health and care, participate in their own well-being, and thus decrease the utilization of healthcare resources. The formal definition for Information Therapy is presented and the basis for defining it lies in bibliotherapy, patient education, consumer health trends, patient's rights, and the Freedom of Information Act. The parameters and coverage of Information Therapy are discussed, the roles that Information Therapy can play in healthcare are explored, and the dual nature of its goals is presented. Barriers to its implementation are listed, however, the electronic age with its information superhighways is expected to provide a unique delivery system for Information Therapy.

Humans↗
PubMed2005

Utilization and costs of the introduction of system-wide palliative care in Alberta, 1993-2000.

BACKGROUND: De-institutionalization of health care services provided to terminally ill cancer patients is a cost-effective strategy that underpins health care reforms in Canada. The objective of this study therefore is to evaluate the economic implications associated with Canadian innovations in the delivery of palliative care services. METHODS: We identified 16,282 adults who died of cancer between 1993 and 2000 in two Canadian cities with newly introduced palliative care programs. Linkage of administrative databases was used to measure healthcare resource utilization. We sought to describe the utilization of palliative care services and its consequences for overall health care system costs. RESULTS: Use of palliative services increased from 45 to 81% of cancer patients during the study period. Identifiable public health care services cost dollars 28093Cdn/patient (19033US dollars, 11,508GBł, 17,778 euro) for terminally ill cancer patients in their last year of life. Acute care accounted for two-thirds (67%) of these costs; physician (10%), residential hospice care (8%), nursing homes (6%), home care (6%) and prescription medications (3%) comprise the remainder. Increased costs associated with the introduction of palliative care programs were offset by cost savings realized when terminally ill cancer patients spent less time in hospital. Palliative home care and residential hospice care accounted for the bulk of this substitution effect. Cost neutrality was observed from the public perspective. DISCUSSION: These results demonstrate that the introduction of comprehensive and community-based palliative care services resulted in increased palliative care service delivery and cost neutrality, primarily achieved through a decreased use of acute care beds.

Aged↗
PubMed2004

Relationships between healthcare and research records.

The ultimate end-point of healthcare and health-related life sciences, more or less as regulatory idea, is the prevention and cure of diseases, considering the fate of individual patients as well as the challenge of providing sufficient care for all. However, all undertakings stand under the "proviso of rightness of action". The movement of evidence-based medicine has triggered a renaissance of systematic self-assurance of best practise. The systematic utilization of healthcare records and research study recordings in an inter-linked manner provides a better enabling environment to improve evidence. Good e-health must contribute to accumulate inter-generation clinical experience. Qualified research should ensure methodological strictness via gold standards like controlled, randomised and masked trials. Building information systems for e-health as well as for e-science bears as a special focus the mutual cross-fertilization of these application domains. Analysing a variety of building blocks shows that both areas can benefit from generic solution pattern, keeping in mind that each domain has distinguished knowledge realms. Generic patterns as well as distinguished special features are illustrated by analysing state of the art solutions plus some experimental approaches, as there are: the generic part of the HL7 V3 RIM, the RCRIM work, laboratory information handling, vital sign standardization efforts, like ECG information models.Finally, the precision of the usage of the ubiquitous term "metadata" is taken as example of an open issue.

Data Collection↗
PubMed2001

Effect of prescription benefit changes on medical care utilization in a Medicare HMO population.

OBJECTIVE: To examine the impact of 2 cost-containment efforts in prescription benefits in successive years that included changes in copayment and coverage levels, expanded generic coverage, and brand name prescription drug limit-of-coverage in a Medicare health maintenance organization (HMO). The benefit changes included moving to a drug benefit with increased total coverage and higher copayments in the first year (1998) and to one with brand name limit-of-coverage and unlimited generic availability in the second year (1999). STUDY DESIGN: A repeated-measures analytical design with enrollee follow-up before and after introduction of the 2 policies. PATIENTS AND METHODS: A cohort of 2411 older adults continuously enrolled in a Medicare HMO since 1998 was followed up for 1 year pre-post for healthcare service utilization and costs; 259 patients enrolled since 1997 were available to test the effects of the first policy change. RESULTS: Bivariate and multivariate analyses found a significant decrease of 27% in prescription costs, a 4% decrease in physician visits, and a 6% decrease in total costs associated with the change in prescription benefit in the second year (1999). The policy change in the first year (1998) resulted in a 29% increase in prescription costs and 38% increased total costs for the HMO. CONCLUSIONS: Introduction of a prescription benefit that included substantial brand name limit-of-coverage and generic drug coverage expansion was associated with significantly reduced prescription costs. In addition, this change did not seem to increase nonprescription-related healthcare service use in the population.

Aged↗
PubMed2003

Prostate cancer--prevalence-based healthcare costs.

OBJECTIVE: To calculate the total costs of in- and outpatient healthcare for patients with prostate cancer based on an episode-of-care approach. The cost analysis includes costs incurred during the first year of diagnosis, a longitudinal 3-year analysis and the incremental cost of prostate cancer during the first year of diagnosis. MATERIAL AND METHODS: Patients registered with prostate cancer between 1998 and 2000, according to the data files of the Southern Swedish Regional Tumour Registry, were given encrypted identifiers that could also be used in the Patient Administrative System of the Region Skåne County Council, making it possible to identify consumption of healthcare on an episode-of-care basis. Itemized costs for resources used by each individual patient were calculated from the complete accounting system of the County Council. RESULTS: Healthcare costs for prostate cancer during the first year varied between 45 000 and 51 000 SEK per patient. The second- and third-year costs were progressively lower, with an estimated total cost of 114 000 SEK over a period of 3 years. The age-standardized incremental cost of prostate cancer corresponded to 33 000 SEK during the first year, compared to the average cost per inhabitant. CONCLUSIONS: The episode-of-care approach, based on encrypted identifiers for the identification of the diagnoses of individual patients and their utilization of healthcare, gives a unique opportunity to estimate the healthcare costs of specific diseases. The incremental healthcare cost per patient with prostate cancer corresponded to 33 000 SEK during the first year.

Aged↗
PubMed2001

Newness of drugs and use of HMO services by asthma patients.

OBJECTIVE: To define newness of drug technology and show associations between two measures of newness and health service utilization. METHODS: Healthcare use and changes in severity at each office visit were assessed for 1309 asthma patients from six health maintenance organizations (HMOs) during 1992. The age of each drug product, derived by subtracting its Food and Drug Administration (FDA) approval date from January 1, 1992, was used to construct two newness measures: the average age of all asthma drugs and, separately, all non-asthma drugs a patient used during the year and the percentages of a patient's asthma drugs from each of four time intervals of asthma drug breakthroughs. Service utilization variables included all primary care provider (PCP) visits, total prescription costs, emergency department (ED) visits, and hospitalizations. RESULTS: Using either measure of drug newness, multivariate analyses showed an association between greater use of newer asthma drugs and lower overall drug costs and fewer PCP visits. A trend was found between greater use of newer asthma drugs and fewer hospitalizations and ED visits. Newer non-asthma medications were associated with fewer ED visits. CONCLUSIONS: After controlling for patient and site variables, greater use of newer asthma drugs was associated with significantly lower drug costs and fewer PCP visits; associations with hospitalization rates and ED visits, although lower, were not significant.

Adult↗
PubMed2005

Predicting dire outcomes of patients with community acquired pneumonia.

Community-acquired pneumonia (CAP) is an important clinical condition with regard to patient mortality, patient morbidity, and healthcare resource utilization. The assessment of the likely clinical course of a CAP patient can significantly influence decision making about whether to treat the patient as an inpatient or as an outpatient. That decision can in turn influence resource utilization, as well as patient well being. Predicting dire outcomes, such as mortality or severe clinical complications, is a particularly important component in assessing the clinical course of patients. We used a training set of 1601 CAP patient cases to construct 11 statistical and machine-learning models that predict dire outcomes. We evaluated the resulting models on 686 additional CAP-patient cases. The primary goal was not to compare these learning algorithms as a study end point; rather, it was to develop the best model possible to predict dire outcomes. A special version of an artificial neural network (NN) model predicted dire outcomes the best. Using the 686 test cases, we estimated the expected healthcare quality and cost impact of applying the NN model in practice. The particular, quantitative results of this analysis are based on a number of assumptions that we make explicit; they will require further study and validation. Nonetheless, the general implication of the analysis seems robust, namely, that even small improvements in predictive performance for prevalent and costly diseases, such as CAP, are likely to result in significant improvements in the quality and efficiency of healthcare delivery. Therefore, seeking models with the highest possible level of predictive performance is important. Consequently, seeking ever better machine-learning and statistical modeling methods is of great practical significance.

Community-Acquired Infections↗
PubMed2004

Depression and fibromyalgia: treatment and cost when diagnosed separately or concurrently.

OBJECTIVE: Depression and fibromyalgia (FM) are often coincident. Both syndromes share common symptoms and impose significant economic burdens. This study compared claims for treatment and costs of FM plus depression with those for FM or depression alone. METHODS: Administrative claims data from a national Fortune 100 manufacturer were used to identify 3 mutually exclusive patient cohorts based on claims with a diagnosis for: FM only, depression only, and FM plus depression. A fourth cohort comprised a random sample of 10% of the employer's overall beneficiary population. Cohorts were compared for demographics, comorbid conditions, and healthcare resources utilization. Mean direct (treatment) costs were calculated and indirect (work loss) costs imputed, and these were assessed using Student's t test and Bonferroni adjustments. RESULTS: Mean annual employer payments (direct plus indirect costs) per patient were 5,163 dollars for FM only, 8,073 dollars for depression only, 11,899 dollars for FM plus depression, and 2,486 dollars for the overall sample. Mean incremental employer payments (i.e., above those for the random sample) per patient with FM plus depression were 9,413 dollars, an amount more than the sum of incremental costs for those with FM or depression alone (8,264 dollars). These costs are consistent with costs of other chronic diseases. CONCLUSION: Patients with FM plus depression are high users of healthcare services. As in studies that established relationships between depression and other medical conditions, incremental costs for patients with FM plus depression were more than additive of costs for each condition alone.

Adult↗
PubMedDate not supplied

CT imaging, then and now: a 30-year review of the economics of computed tomography.

The first computed tomography (CT) scanner in the US was installed in June 1973 at the Mayo Clinic in Rochester, MN. By the end of 1974, 44 similar systems had been installed at medical facilities around the country. Less than 4 years after the introduction of CT imaging in the US, at least 400 CT systems had been installed. The practice of pneumoencephalography was eliminated. The use of nuclear medicine brain scans significantly diminished. At the time, CT imaging was limited to head studies, but with the introduction of contrast agents and full body CT systems the changes in the practice of medicine became even more significant. CT imaging was hailed by the US medical community as the greatest advance in radiology since the discovery of x-rays. But the rapid spread of CT systems, their frequency of use, and the associated increase in healthcare costs combined to draw the attention of decision-makers within the federal and state governments, specifically to establish policies regarding the acquisition and use of diagnostic technologies. Initially, CT imaging was limited to neurological applications, but in the 30 years since its inception, capabilities and applications have been expanded as a result of the advancements in technology and software development. While neurological disorders are still a common reason for CT imaging, many other medical disciplines (oncology, emergency medicine, orthopedics, etc.) have found CT imaging to be the definitive tool for diagnostic information. As such, the clinical demand for CT imaging has steadily increased. Economically, the development of CT imaging has been one of success, even in the face of governmental action to restrict its acquisition and utilization by healthcare facilities. CTimaging has increased the cost of healthcare, but in turn has added unquantifiable value to the practice of medicine in the US.

Diffusion of Innovation↗
PubMed2006

Clinical trials in schizophrenia with results for the real world.

Most clinical data for antipsychotics come from studies designed to test the efficacy and safety of the drugs under ideal conditions, in limited subgroups of patients. In contrast, practical clinical trials (PCTs) are designed to test the effectiveness of different treatment options under conditions that more accurately reflect actual clinical practice. Consequently, PCTs are able to provide information that can be utilized by healthcare providers and other decision makers. Characteristics of PCTs include a clinically relevant question, a representative sample of patients and practice settings, sufficient power to identify modest relevant effects, randomization to protect against bias, uncertainty regarding the outcome of treatment, assessment and treatment protocols that enact best clinical practices, simple and relevant outcomes, and limited subject and investigator burden. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) research program is an example of a PCT. The CATIE study illustrates how PCTs, when properly designed, might be helpful in informing clinical decision making. Because the CATIE study was designed to reflect the effectiveness of antipsychotics under naturalistic clinical conditions, its results should have particular applicability to the arena of clinical practice. This article provides a discussion of the differences between efficacy and effectiveness studies. In assessing the practical utility of results from the CATIE study, much can be learned on how to shape future studies of effectiveness so as to better generate data that are applicable to the "real world."

Antipsychotic Agents↗