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PubMed2006

The potential impact of poison control centers on rural hospitalization rates for poisoning.

OBJECTIVE: This study tested the hypothesis that underutilization of poison control centers is associated with increased rates of hospitalizations attributable to poisonings in rural areas. METHODS: To measure the potential impact of poison control centers on hospitalization rates in rural areas among people who visit emergency departments because of poisoning, we estimated the reduction in hospitalization rates associated with increased rates of calls to centers. We used the 2003 State Inpatient Database and State Emergency Department Database from the Healthcare Cost and Utilization Project to calculate the numbers of emergency department visits and hospitalizations for each county in the 12 states analyzed. We used Toxic Exposure Surveillance System data from the American Association of Poison Control Centers to calculate the number of human exposure calls per capita according to county. RESULTS: In rural counties, a 1% higher poison control center human poison exposure call rate was associated with a 0.19% lower hospitalization rate among people who visited emergency departments because of poisoning. If the observed association is causative, then 43.3 calls would prevent 1 hospital admission, yielding 7321 dollars in net cost savings and a return on investment of 5.9:1 (from the health care system perspective). CONCLUSIONS: Our results establish the existence of the hypothesized association between rural poison control center utilization rates and hospitalization rates among emergency department-treated poisoning patients.

Child↗
PubMed2001

Economic impact of neutropenia and febrile neutropenia in breast cancer: estimates from two national databases.

STUDY OBJECTIVE: To estimate the economic burden of neutropenia and febrile neutropenia in female breast cancer hospital admissions in the United States. DESIGN: Retrospective database analysis. PATIENTS: Female admissions with a breast cancer diagnosis. MEASUREMENTS AND MAIN RESULTS: By reviewing two national databases (Healthcare Costs and Utilization Project, MarketScan), length of stay and charge or payment/admission were estimated from 1994-1996. Neutropenic and febrile neutropenic admissions were longer and incurred higher charges and payments than nonneutropenic and afebrile neutropenic admissions, respectively (p<0.05). The difference in mean charges between neutropenic and nonneutropenic admissions decreased from $13,143 in 1994 to $6913 in 1996, whereas the difference in payment was $4957 (adjusted to 1996 dollars). The difference in mean charges between febrile and afebrile neutropenic admissions decreased from $11,570 in 1994 to $2873 in 1996, whereas the difference in payment was $2390 (adjusted to 1996 dollars). CONCLUSION: There was a trend toward decreased charges for inpatient admissions with neutropenia in patients with breast cancer (1994-1996). Interventions that reduce the frequency of neutropenia and febrile neutropenia could reduce hospitalization costs of breast cancer admissions.

Age Factors↗
PubMed2005

Effect of clinical characteristics on neutropenia-related inpatient costs among newly diagnosed non-Hodgkin's lymphoma cases during first-course chemotherapy.

STUDY OBJECTIVE: To estimate the costs of hospitalization for neutropenia among chemotherapy-treated patients with newly diagnosed non-Hodgkin's lymphoma and to assess baseline patient factors associated with these costs. DESIGN: Retrospective cohort study. DATA SOURCE: Linked Surveillance, Epidemiology, and End Results Program-Healthcare Cost and Utilization Project databases for Iowa from 1993-1998. PATIENTS: Patients with newly diagnosed non-Hodgkin's lymphoma who received all inpatient care at Iowa hospitals during their first course of chemotherapy. MEASUREMENTS AND MAIN RESULTS: Neutropenia-related hospitalization costs were estimated from discharge abstracts found within the earliest of the following: 6 months after the diagnosis month, the date of bone marrow transplantation, or date of death. We performed univariate tests of differences in neutropenia-related hospitalization costs in all patients in the sample, as well as tests for neutropenia-related hospitalization costs, length-of-stay, and cost/inpatient day for patients with at least one hospitalization for neutropenia. We modeled total inpatient charges over the period for patients with at least one neutropenia-related hospitalization (multiple regression). A total of 1636 patients with non-Hodgkin's lymphoma had chemotherapy in Iowa and met inclusion criteria; of these, 316 had at least one hospitalization for neutropenia. The 316 patients had 418 stays. Patients with advanced stage (vs limited stage), previous anemia (vs no anemia), positive Charlson comorbidity score (vs score of 0), and diffuse large cell histology (vs follicular) had higher mean neutropenia-related hospitalization cost/patient with non-Hodgkin's lymphoma (p<0.05). Among those with neutropenia-related hospitalizations, a longer length of stay was associated with nonfollicular histologies, previous anemia, and positive Charlson score (p<0.05). CONCLUSION: When estimating expected payments for neutropenia-related hospitalization in patients with non-Hodgkin's lymphoma, payers need to be aware of the distribution of clinical characteristics in these patients.

Adult↗
PubMed2005

Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes.

OBJECTIVES: Considerable differences in prevalence of diabetes and management of the disease exist among racial/ethnic groups. We examined the relationship between race/ethnicity and hospital readmissions for diabetes-related conditions. METHODS: Nonmaternal adult patients with Medicare, Medicaid, or private insurance coverage hospitalized for diabetes-related conditions in 5 states were identified from the 1999 State Inpatient Databases of the Healthcare Cost and Utilization Project. Racial/ethnic differences in the likelihood of readmission were estimated by logistic regression with adjustment for patient demographic, clinical, and socioeconomic characteristics and hospital attributes. RESULTS: The risk-adjusted likelihood of 180-day readmission was significantly lower for non-Hispanic Whites than for Hispanics across all 3 payers or for non-Hispanic Blacks among Medicare enrollees. Within each payer, Hispanics from low-income communities had the highest risk of readmission. Among Medicare beneficiaries, Blacks and Hispanics had higher percentages of readmission for acute complications and microvascular disease, while Whites had higher percentages of readmission for macrovascular conditions. CONCLUSIONS: Racial/ethnic disparities are more evident in 180-day than in 30-day readmission rates, and greatest among the Medicare population. Readmission diagnoses vary by race/ethnicity, with Blacks and Hispanics at higher risk for those complications more likely preventable with effective postdischarge care.

Adolescent↗
PubMed2004

The economic burden of hospitalizations associated with child abuse and neglect.

OBJECTIVES: This study assessed the economic burden of child abuse-related hospitalizations. METHODS: We compared inpatient stays coded with a diagnosis of child abuse or neglect with stays of other hospitalized children using the 1999 National Inpatient Sample of the Healthcare Costs and Utilization Project. RESULTS: Children whose hospital stays were coded with a diagnosis of abuse or neglect were significantly more likely to have died during hospitalization (4.0% vs 0.5%), have longer stays (8.2 vs 4.0 days), twice the number of diagnoses (6.3 vs 2.8), and double the total charges (19,266 vs 9513 US dollars) than were other hospitalized children. Furthermore, the primary payer was typically Medicaid (66.5% vs 37.0%). CONCLUSION: Earlier identification of children at risk for child abuse and neglect might reduce the individual, medical, and societal costs.

Age Distribution↗
PubMed2003

Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample.

BACKGROUND: The relationship between volume and outcome of total knee arthroplasties has never been evaluated in a nationally representative sample, to our knowledge. We hypothesized that surgeons and hospitals with higher patient volumes would have better outcomes, as defined by lower mortality rates, shorter hospital stays, and lower postoperative complication rates. METHODS: The 1997 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample, Release 6, provided discharge abstracts of patients undergoing total knee arthroplasty from a national stratified probability sample. Logistic and multiple regression models were used to estimate the adjusted association of surgeon or hospital volume with rates of in-hospital mortality, pulmonary thromboembolism, deep venous thrombosis in the lower extremity, and postoperative wound infection as well as length of hospital stay. Estimates were calculated for a target population of 277,550 patients. Models were adjusted for comorbidity, age, gender, race, household income, and procedure (primary or revision arthroplasty). RESULTS: The patients were mostly white (70.2%) and female (62.7%), with a mean age of 68.9 years. The overall in-hospital mortality rate for the target population was 0.2%, and the average length of stay was 4.6 days for the primary total knee arthroplasties and 4.9 days for the revision procedures. Surgeon volumes of at least fifteen procedures per year and hospital volumes of at least eighty-five per year were significantly and linearly associated with lower mortality rates (odds ratio = 0.56 [0.24 to 1.31] for surgeon volume of > or = 60). No other association demonstrated a significant and directionally consistent linear trend for improved outcomes. CONCLUSION: Patients treated by providers with lower caseload volumes had higher rates of mortality following total knee arthroplasty in 1997. Proposing volume standards could decrease patient mortality following this procedure.

Aged↗
PubMed2002

The development and use of quality-of-life measures to evaluate health outcomes in Japan.

Health outcomes measurement forms a key aspect of data collection for economic evaluations. Quality-of-life instruments provide a measure of patient-focused health outcomes. Such instruments, including the EuroQoL questionnaire (EQ-5D) and the Short-form 36 (SF-36) are already being used in Japan. Utility instruments provide an alternative way of measuring quality of life for use in economic analyses. At present, utility measurement in Japan is limited to scores derived from the EQ-5D. Although the SF-36 was designed as a health profile measure, it has since been tested for use as a utility measure, with valuation of items now being undertaken in Japan. Utility measurement in Japan is likely to be advanced further by the validation and introduction of the Health Utilities Index. The experiences of other countries provide the opportunity for Japan to learn how utility scores may be used in cost-utility analyses of healthcare technologies.

Delivery of Health Care↗
PubMed2003

Multiple hospitalizations for patients with diabetes.

OBJECTIVE: To describe the extent to which hospitalizations for patients with diabetes reflect multiple stays by the same individuals and to examine how multiple hospitalizations vary by patient demographic and socioeconomic characteristics. RESEARCH DESIGN AND METHODS: Using the Healthcare Cost and Utilization Project complete discharge data for five states (California, Missouri, New York, Tennessee, and Virginia) in 1999, we identified 648,748 nonneonatal, nonmaternal patients who had one or more hospitalizations listing diabetes. Multiple hospitalizations were measured as percent of patients with multiple stays, percent of total stays represented by multiple stays, and average number of stays per patient. Total hospital costs were also examined. Stratified analysis and regression were performed to assess differences by age, sex, race/ethnicity, payer, location, and income. RESULTS: Among patients with diabetes who had been hospitalized, 30% had two or more stays accounting for >50% of total hospitalizations and hospital costs. Controlled for patient age, sex, and clinical characteristics, the likelihood of having multiple hospitalizations was higher for Hispanics and non-Hispanic blacks compared with non-Hispanic whites, as well as for patients covered by Medicare or Medicaid and those living in low-income areas. The prevalence of diabetes complications and multiple conditions differed by age, race/ethnicity, and payer among patients with multiple stays. CONCLUSIONS: Multiple hospitalizations are common among patients with diabetes but vary by age, race/ethnicity, payer, and income, with those populations traditionally considered to be more vulnerable experiencing higher likelihoods of multiple stays. Significant opportunities exist to reduce the proportion of multiple hospitalizations for patients with diabetes. Clinical and policy interventions to improve the quality of care and outcomes for these patients should be designed accordingly and have the potential to pay major dividends.

Adolescent↗
PubMed2005

Hospital finances and patient safety outcomes.

Hospitals recently have experienced greater financial pressures. Whether these financial pressures have led to more patient safety problems is unknown. Using the Healthcare Cost and Utilization Project (HCUP) State Inpatient Data for Florida from 1996 to 2000, this study examines whether financial pressure at hospitals is associated with increases in the rate of patient safety events (e.g., medical errors) for major surgeries. Findings show that patients have significantly higher odds of having adverse patient safety events (nursing-related patient safety events, surgery-related patient safety events, and all likely preventable patient safety events) when hospital profit margins decline over time. The finding that a within-hospital erosion of hospital operating profits increases the rate of adverse patient safety events suggests that any cost-cutting efforts be carefully designed and managed.

Adult↗
PubMedDate not supplied

Social and economic impact of infectious diseases--United States.

Despite major strides in the prevention and control of infectious diseases, they continue to take a significant economic and social toll in the United States. While progress toward meeting the Healthy People (HP) 2000 goals related to infections is generally on target, major disparities among certain groups (e.g., low-income, racial and ethnic minorities) still exist with regard to indicators such as immunization rates and rates of preventable infections. Preventable services for infectious diseases are among the most cost-effective. Progress toward meeting and sustaining the HP 2000 goals would be improved by universal entitlement for certain prevention services; reducing inconvenience as well as economic costs; appropriate utilization of all healthcare professionals and lay experts, as well as physicians; reducing inappropriate and costly use of resources such as antibiotics and specialist time; and engagement of the public and providers in national dialogue about risk benefit decision making, prioritization of use resources, and a focus on prevention rather than cure.

Communicable Disease Control↗
PubMed1997

Implications of managed care denials for pediatric inpatient care.

With the growing penetration of managed care into the healthcare market, providers continue to experience increasing cost constraints. In this environment, it is important to track reimbursement denials and understand the managed care organization's rationale for refusal of payment. This is especially critical for providers of pediatric care, as children justifiably have unique healthcare needs and utilization patterns. We developed a system for tracking and documenting denials in our institution and found that health maintenance organizations denied claims primarily for one of three reasons: medically unnecessary care, care provided as a response to social (rather than medical) need, and provider inefficiencies. Health maintenance organization denials are also growing annually at our institutions. This knowledge can not only help providers of pediatric care more effectively negotiate future contracts, but provides an opportunity to differentiate the health needs of the pediatric patient from those of the adult. This information can be used as a basis for education, pediatric outcome studies, and guideline development--all tools that can help providers receive reasonable reimbursement for pediatric services and enable them to meet the complex health needs of children. Recommendations for action are discussed.

Child↗
PubMed1998

Understanding the experience: patients' perceptions of postmyocardial infarction teaching.

It is a widely accepted belief among healthcare professionals that patient education for survivors of myocardial infarction (MI) is valuable. Patients benefit by learning about their disease, reducing their risk factors and modifying their lifestyle. Although these assumptions have been studied, the viewpoint of the consumer has not been elucidated. This study sought to determine patients' experience with an in-hospital, post-MI teaching program, the meaning attached to the teaching experience and the overall perceptions of the program. A qualitative focus group method was used to answer the study's questions. The findings suggest that patients valued the teaching experience and found it helped them establish new meaning in their lives. Not only was the teaching content valuable, but so were other factors crucial to their recovery from MI. Healthcare professionals can utilize these findings to develop teaching programs that truly meet the need of consumers.

Aged↗
PubMed2000

The marginal benefits of invasive treatments for acute myocardial infarction: does insurance coverage matter?

This paper applies instrumental variable (IV) techniques and estimates the average benefits of invasive surgical treatments for marginal acute myocardial infarction (AMI) patients by insurance coverage. The study uses data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases for the state of Washington, for years 1988-1993. We observed differences in average benefits for marginal patients across insurance subpopulations that cannot be explained by differences in measured clinical circumstances. Our empirical results show that the insurance subpopulations with the greatest estimated marginal benefits are those with the lowest expected payment generosity to providers. Because of the relatively weak explanatory power of our instruments for three insurance subpopulations, and because many of the parameter estimates across the insurance subpopulations are not statistically different from each other, policy recommendations should be approached cautiously. However, our application of IV techniques to AMI patients demonstrates the usefulness of this approach to estimate treatment effects across patient populations (e.g., across types of insurance coverage) for medical conditions of interest to policymakers. These estimates may help determine whether treatments are overutilized or underutilized.

Adult↗
PubMed2000

Use of major therapeutic procedures: are Hispanics treated differently than non-Hispanic Whites.

OBJECTIVES: This study examines whether Hispanics and non-Hispanic White patients, hospitalized with one of a wide range of conditions, receive major therapeutic procedures at the same rates. METHODS: The study examined hospital stays of Hispanic and non-Hispanic White adults using 1993 discharge abstract data from the Healthcare Cost and Utilization Project State Inpatient Database for California, Florida and New York, states containing half the Hispanic population in the country. Logistic regression modeling was used to identify the effect of ethnicity on the likelihood of receiving a major therapeutic procedure separately for 63 conditions, controlling for age, gender, disease severity, health insurance, income level of patient's community, and hospital characteristics. RESULTS: Hispanics are less likely than non-Hispanic Whites to receive major therapeutic procedures for 38% of the 63 conditions examined and more likely for 6% of the conditions. CONCLUSIONS: This study identified many conditions with apparent variations in treatment based on patient ethnicity. Future studies should examine reasons for disparities between ethnic groups, why these disparities occur for some conditions and not others, and appropriateness of procedures received.

Adolescent↗
PubMed2000

Evaluation of coding data quality of the HCUP National Inpatient Sample.

Quality ICD-9-CM coding depends on the selection of the appropriate diagnosis codes and the proper sequencing of the codes. A simple, diagnosis code-sequencing error was selected to evaluate the quality of diagnosis coding within the National Inpatient Sample of the Healthcare Costs and Utilization Project. The source of coding variation originates at the hospital level. Coding error rates were found to vary widely among states, hospitals within states, geographic location, and hospital characteristics. Coding errors were significantly different among patient demographic groups and whether the state used billing versus abstract data.

Abstracting and Indexing↗
PubMed2001

Hospital admissions, length of stay, charges, and in-hospital death among patients with systemic sclerosis.

OBJECTIVE: To investigate population hospitalization rates to community hospitals for systemic sclerosis (SSc, scleroderma) and examine whether age, sex, race, and insurance status independently predict length of stay (LOS), hospital charges, and in-hospital death. METHODS: The 1995 Healthcare Cost and Utilization Project national inpatient sample was used to identify 3,621 SSc hospitalizations. Weighted age, sex, and race-specific frequencies were divided by population estimates to calculate hospitalizations per million people. Regression models were used to model LOS, charges, and in-hospital death with age, sex, race, and insurance serving as the primary independent variables. Covariates included numbers of diagnoses and procedures, whether or not the admission was a transfer from another hospital, and the presence of comorbid conditions. RESULTS: Population hospitalization rates were higher for non-whites compared to whites among those < 65, while rates were higher for whites compared to non-whites for those > or =65 years old. On average, non-whites were at least 10 years younger than whites. The mean LOS was 7.5 days, with whites' average LOS being 10% shorter than non-whites', and patients with public health insurance having approximately 9% longer LOS than those with private insurance. Charges averaged almost US$15,000 per hospitalization (median = $8,441), amounting to $280 million in community hospital charges in the U.S. in 1995. The overall in-hospital death rate was 7.1%. CONCLUSION: These patterns are consistent with a greater burden and increased severity of disease among non-whites under age 65 with Ssc.

Adolescent↗
PubMed2001

Outpatient mastectomy: clinical, payer, and geographic influences.

OBJECTIVE: To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation. DATA SOURCES: Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96). STUDY DESIGN: Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban). PRINCIPAL FINDINGS: In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer. CONCLUSIONS: LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly outpatient in some states. Although clinical characteristics remain important, the state in which a woman receives care and whether she has an HMO payer are strong determinants of whether she receives an outpatient CMAS.

Adult↗
PubMed2002

A trend analysis of organ transplantation among ethnic groups.

PURPOSE: This research provides public policy implications regarding organ resource allocation and increases public awareness of the current status of transplant use in various ethnic populations. PROCEDURES: Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS) data were used to obtain a yearly estimate of the number of organ transplants by organ and by ethnic origin for 1988-1997. ICD-9-CM codes identified lung, heart, liver, and kidney organ-transplantation procedures. Each record in the sample was weighted by its respective discharge weight in order to extrapolate a national estimate. To assess whether there are significant differences among ethnic groups in organ transplantation rates over time, regression models were estimated for heart, liver, and kidney transplants. Transplantation rates were modeled as a function of time, ethnic origin, and interaction variables. FINDINGS: Examination of time trend graphs and regression analyses indicates that transplantation rates have not varied substantially across ethnic groups between 1988 and 1997. Rates for all groups, with the exception of Asians, exhibited similar time trends with little systematic variation. CONCLUSIONS: Further research is needed to determine whether variations exist due to organ availability versus prevalence of the disease.

Ethnicity↗