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PubMed2007

[Applicability, duration, and sociomedical course of rehabilitation of alcohol dependency. Current results and perspectives from the insurers' point of view].

Reducing the paucity of German studies on the rehabilitation of alcohol-dependent patients, this article presents current data of Germany's national Pension Insurance Federal Institution. Numbers of applications, grants and use of rehabilitation, length and duration of treatment, percentage of nonattendance, comorbidity, and sociomedical course after 2 years are discussed. There has been a constant increase in numbers of rehabilitative treatment, especially in the outpatient setting with decreased treatment length, a high rate of comorbidity, and improvements in the sociomedical course and vocational integration. Two years after rehabilitation, 87% of inpatients and 92% of outpatients were recontributing to the pension system continuously or sporadically. Despite the still marked deficits in the provision of rehabilitative treatment for addicted patients, rehabilitation plays an important and established role in this field and shows promising clinical results.

Adult↗
PubMed2004

Healthcare utilization among women who undergo surgery for stress urinary incontinence.

This study examined patterns of care for women undergoing surgery for stress urinary incontinence (SUI). A retrospective analysis of administrative claims data was performed and we identified 12520 women with a diagnosis of SUI and a subset of 3735 women with a surgical procedure code for SUI. For the main types of surgeries, we examined length of stay, pharmaceutical use, complications, and healthcare utilization related to incontinence greater than 6 months after surgery. Approximately 30% of women with a coded SUI diagnosis underwent surgery. Of the initial procedures, 40% were retropubic suspensions and 25% were sling procedures. Almost 4% of women underwent an additional surgery, and 14.1% had claims related to incontinence 6 or more months after the initial procedure. We examined medical care and pharmaceutical use for women undergoing continence surgery. This information may be important to patients and physicians discussing treatment options.

Adolescent↗
PubMed1998

Tossed on the horn of humerus: a legal case report.

Radiological cases constituted 2% of the total number of legal cases in Sweden during 1996. The young man in this report accused a radiologist of having missed a fracture 7 years earlier based on a new radiology examination and report. In reality the latter report was incorrect and the patient had a rare exostosis that explained the clinical signs and symptoms. The alleged fracture was an epiphyseal line to a non-unified ossification centre at the tip of the unique exostosis.

Adolescent↗
PubMed2005

Reimbursement and clinical guidance for pharmaceuticals in Sweden: do health-economic evaluations support decision making?

Introduction of the new Pharmaceutical Benefits Board (LFN; 1 October 2002) has markedly changed the principles of pricing and reimbursement of drugs in Sweden. The Board is required to make decisions based on information on cost-effectiveness, and pharmaceutical companies must submit economic evaluations when relevant as part of their applications for reimbursement. This study examined experience to date regarding the use of health-economic evaluations and cost-effectiveness information by the LFN. We also describe activities and the use of cost-effectiveness analysis by Swedish local formulary committees organized by the 21 county councils. It is concluded that economic evaluations have supported decision making by LFN, although cost-effectiveness seems to be of varying importance in different situations. While the use of health-economic evaluations and the outcome of decision making by LFN are similar to comparable committees in other countries, there is presently a gap in this sense between the LFN and Swedish local formulary committees. Coordinated decision making is much needed but may be difficult to implement as the perspective, expertise, and objectives of the two public authorities differ.

Cost Control↗
PubMed2006

Direct health care costs for children with pervasive developmental disorders: 1996-2002.

We compared direct costs of treatment of Pervasive Developmental Disorder (PDD), asthma, and diabetes in children aged 3-17 years. A retrospective, claims-based study was conducted using the California Medicaid (Medi-Cal) database (1996-2002). Seven hundred and thirty-one children with PDD were identified and matched for sex with an equal number of randomly selected children with asthma and diabetes. Mean total health care costs for PDD were two- to threefold higher than for asthma and diabetes post-diagnosis ($4,815 vs. $1,469 vs. $2,404, respectively, P < 0.0001). Children with PDD incur significantly greater health care costs when compared with children with other chronic pediatric diseases.

Adolescent↗
PubMed2007

The relationship of antipsychotic medication class and adherence with treatment outcomes and costs for Florida Medicaid beneficiaries with schizophrenia.

While some studies show a significant advantage in adherence rates with use of atypical versus typical antipsychotic medication, others show no advantage or mixed results (Jones et al. (2006). Archives of General Psychiatry, 63, 1079-1087; Rosenheck, (2006). Archives of General Psychiatry, 63, 1074-1076). This study examined treatment outcomes and costs associated with adherence rates by antipsychotic medication class for adult Medicaid beneficiaries in Florida diagnosed with schizophrenia. Outcomes examined include arrests, involuntary commitments, and physical and behavioral healthcare costs. Study findings demonstrate that medication adherence for persons with schizophrenia may be as important to treatment costs and benefits as the class of medication used.

Adolescent↗
PubMed2006

French claims data as a source of information to describe cancer incidence: predictive values of two identification methods of incident prostate cancers.

Claims data from the "Programme de Médicalisation du Système d'Information" (PMSI) have been commonly used for several years to complement cancer registries and describe cancer incidence in France. It is less clear whether or not it is possible to use these data as an independent source of information to assess cancer incidence, in the absence of a regional cancer registry. Following a similar study on breast cancer, we present a study which aimed to evaluate two methods of identifying incident prostate cancer using claims data. These methods were developed using claims data from the Hospices Civils de Lyon (HCL) and their validity was tested against medical records. The first method (M1) identified incident patients as those who had at least one stay with a principal diagnosis of prostate cancer. The second method (M2) had a prostate cancer treatment code in addition to the criteria for the first method. Both methods of identification had similar results, indicating a low rate of false negatives (negative predictive values: M1 = 100 [CI95: 93.8-100], M2 = 98.6 [CI95: 90.1-99.6]) and a high rate of false positives (positive predictive values: M1 = 33.3 [CI95: 23.2-42.1], M2 = 33.7 [CI95: 24.2-43.2]). The sample size did not allow us to produce consistent estimates of sensitivity and specificity. Our results showed that an estimation of the number of incident cases of prostate cancer using both methods of identification would be biased because of the high rate of false positives. Statistical methods that correct identification errors should be used.

France↗
PubMed2006

Child sociodemographic characteristics and common psychiatric diagnoses in medicaid encounter data: are they valid?

This study describes the rate that Medicaid encounter data on gender, race/ethnicity, and diagnosis matched information in the medical record, among a statewide sample of Medicaid children who received ongoing care for attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and major depression (MD) in outpatient specialty mental health clinics in 1998-1999. The match rate for gender was 99%; and for race/ethnicity it was 71.8%, 90.5%, and 89.7% for Caucasian, African American, and Hispanic children, respectively. Misidentified Caucasian children were more likely to be recorded as African American or Hispanic than misidentified minority children to be recorded as Caucasian. Diagnosis match rates were high (ADHD: 98%, CD: 89%, MD: 89%). If the California Department of Mental Health relied solely on Medicaid encounter data, misclassification of African American or Hispanic children as Caucasian could produce an underestimate of their service use.

Adolescent↗
PubMed1993

Two-year results of a randomized controlled trial of a health promotion program in a retiree population: the Bank of America Study.

OBJECTIVE: To evaluate the effectiveness of a health promotion program in a retiree population in terms of health risk reduction and reduction in medical costs. DESIGN: Randomized controlled trial. SUBJECTS: Bank of America retirees (n = 4,712), divided into 33 retiree club regions, were randomized into 3 groups and followed for 24 months by patient report and claims experience. Group 1, the intervention group, received a low-cost ($30/year), individualized, serially reinforcing health promotion program including risk appraisal, recommendation letters, and self-management materials, delivered entirely through the mail. Group 2 received risk appraisals only, without feedback, for the first 12 months and subsequently the full intervention for the second 12 months. Group 3 was followed with claims data only. Participation rates of 57% at 1 year and 47% at 2 years were achieved. MAIN RESULTS: Overall health risk scores improved by 12% at 12 months compared with control (p < 0.001) and by 23% (from baseline) at 24 months (p < 0.001). Individual health habit changes were favorable for all parameters studied, and were highly statistically significant for most variables. Similar health risk reductions were seen in age groups of 55 to 65 years, 65 to 75 years, and over 75. Cost reduction differences were more than 20% by self-report (p < 0.01) and 10% by claims experience (p = 0.02) at 12 months. For the randomized controlled period of the first 12 months, reductions averaged $164 in the intervention group contrasted with an average increase of $15 in the combined control groups. CONCLUSION: Risk reduction programs directed at retiree populations can improve health risk status and can reduce costs.

Age Factors↗
PubMed1988

Injury prevalence and associated costs among participants of an employee fitness program.

The prevalence, cost, and type of injury among participants of an employee fitness program and nonexercising co-workers were studied over a 2-year period from 1984 to 1985. The purpose of the study was to determine whether participants of an employee fitness program (n = 2,871) experienced a greater risk of injury and resultant higher costs than nonparticipants (n = 3,233). Overall, there were no significant differences in the rate or cost of injuries among the various participation levels (from 0 to 3 or more times per week). However, the data indicated that individuals who occasionally participated in the fitness program experienced a greater, but nonsignificant, risk of injury (6.3 per 100 persons who exercised less than 1 session per week, and 7.7 per 100 persons who exercised 1-2 sessions per week) than nonparticipants (5.7 per 100 persons). Injury prevalence was lower among individuals who exercised 3 or more sessions per week (5.4 per 100 persons) as was the resultant per capita cost of injuries ($32 vs $42 for nonparticipants). We conclude the impact of exercise at an onsite health and fitness facility on overall injury rates and costs among employees is negligible.

Adult↗
PubMedDate not supplied

The costs and effects of switching calcium channel blockers: evidence from Medicaid claims data.

This study used Medicaid claims data from Pennsylvania to examine the costs and effects of changing calcium channel blocker therapies. Specifically, we compared Procardia XL with Adalat CC. They are the only once-daily-dosed, extended-release forms of nifedipine available. These drugs were interesting to compare for several reasons. First, because the frequency of treatment regimens has been shown to be the most important determinant of long-term compliance with calcium channel blocker medications, it was desirable to compare drugs having identical dosing regimens. Second, switching from one to the other should be quite feasible in most patients. Third, Adalat CC is priced (ie, average wholesale price) less than Procardia XL. The results indicate that prescription prices were lower when patients were switched from Procardia XL to Adalat CC, with no apparent effects on blood pressure control, the incidence of adverse drug reactions, or nonprescription health care costs. The potential savings to Medicaid from switching patients from Procardia XL to Adalat CC appears to be large, more than $2.5 million annually for Procardia XL-treated Medicaid patients in the state of Pennsylvania. Our study also demonstrates that large retrospective databases can be used to evaluate economic and clinical outcomes for specific therapy alternatives. Such evaluations are increasingly relevant to third-party payers, health maintenance organizations, and other parties involved in managed care.

Cohort Studies↗
PubMed1990

An analysis of invalidity benefit claim durations for new male claimants in 1977/1978 and 1982/1983.

This study analyses the duration of Invalidity Benefit (IVB) claims commencing in 1977/1978 and 1982/1983 using a hazard rate model. The analysis was carried out against a background of a substantial increase in the numbers claiming IVB. The main data base comprises a 1% random sample of all National Insurance records for the period 1975-1984, provided by the DHSS. Estimates are made of factors that influence claim durations. The results suggest that while age and health conditions are important, claim durations are also influenced by more narrowly defined economic considerations.

Actuarial Analysis↗
PubMed1995

Development and validation of a claims based index for adjusting for risk of mortality: the case of acute myocardial infarction.

We developed a comorbidity index on a cohort of 162,699 Medicare beneficiaries who had an acute myocardial infarction (AMI) in 1987 and validate it on two national cohorts: (1) a cohort of 164,427 Medicare beneficiaries who had an AMI in 1988 and (2) a cohort of 10,466 patients admitted to Veterans Administration Hospitals (VAH) for AMI in 1988-1991. The impact of each sensitivity was expressed as; (1) the risk of mortality for those with the comorbidity, (2) the adjustment to the log odds for 2 year mortality and (3) the age-based likelihood of 2 year mortality. Models were validated by calculated the area under an ROC curve obtained by fitting a logistic regression model to each validation population. The two year mortality rate for 30-day survivors was approximately 30% in each of the 3 cohorts. The 5 most prevlent comorbidities coded in the developmental cohort were heart failure (34%), chronic angina (27%), minor arrythmias (25%) and uncomplicated hypertension (18%). Cancer was the most powerful predictor of 2 year mortality, impacting mortality the same as a 18.3 year age increase. Saturation (having all secondary diagnoses in the discharge summary filled) resulted in a 9.2 year age increase. Validation in the 1988 Medicare and in the Veterans Administration Hospitals cohorts resulted in areas of 73% and 72% under the respective ROC curves. Our methods can serve as a prototype for others wishing to assess comorbidity in other targeted subgroups.

Aged↗
PubMed1994

Risk management in cardiac anesthesia: the ASA Closed Claims Project perspective.

The ASA Closed Claims Project has generated a standardized collection of case summaries of adverse anesthetic outcomes, with the objectives of identifying major areas of anesthesiologist liability and the contribution of substandard care to anesthetic injury. Seventy-six (3%) of the files in the project's current database of over 2,400 case summaries are for anesthesia-related injuries sustained during cardiac surgery. The most common adverse outcomes in the cardiac surgical group were death (36%), brain damage (16%), stroke (13%), and nerve damage (11%). Equipment malfunction or misuse was responsible for 37% of the adverse outcomes in the cardiac group, compared with only 9% in the noncardiac group (P = < 0.01). Conversely, respiratory-related damaging events were responsible for only 9% of adverse outcomes in the cardiac group, compared with 32% of adverse outcomes in the noncardiac claims (P = < 0.01); incidences of damaging events related to the cardiovascular system and those events related to inadequate or inappropriate fluid therapy were similar in both groups. Although there are several important limitations intrinsic to closed-claims analysis, data from the Closed Claims Project suggest that careful attention to IV catheter management and cardiopulmonary bypass equipment will reduce the risk of injury to patients.

Anesthesia↗
PubMed2005

Do statins increase the risk of idiopathic polyneuropathy?

A recent European case-control study suggested that statins increase the risk for polyneuropathy, a rare but serious neurologic condition. This risk was assessed in 272 patients with idiopathic polyneuropathy and 1,360 matched controls in the Intermountain Health Care electronic database. It was found that statin use before diagnosis was not significantly greater in patients than controls (odds ratio 1.30, 95% confidence interval 0.3 to 2.1, p = 0.27), nor were doses different between patients and controls.

Case-Control Studies↗
PubMed2006

Predictors of the selection of coxibs over nonselective NSAIDs in an older Medicaid cohort.

BACKGROUND: Cyclooxygenase-2-selective inhibitors (coxibs) have been widely adopted, despite study findings suggesting that they are cost-effective only in certain populations. OBJECTIVE: This study was conducted to identify factors that were associated with the selection of coxibs rather than nonselective NSAIDs in the period before the emergence of safety concerns in 2004. METHODS: This was a retrospective cohort analysis of a 15% random sample of Kansas Medicaid beneficiaries aged >60 years that used inpatient, outpatient, and prescription claims data. Subjects were included if they received a prescription for a coxib or nonselective NSAID after a 6-month period without an anti-inflammatory prescription claim and if they underwent at least 90 days of follow-up after the initial prescription. Using 2 previously published models (Dominick et al and Shaya and Blume), we analyzed the impact of factors potentially associated with the preferential selection of a coxib, including age, sex, race, history of upper gastrointestinal disease, chronic or acute use, and recent anticoagulant or corticosteroid therapy. RESULTS: Study subjects (N = 853) were predominantly female (78.8%) and white (80.4%), and had a mean age of 78 years; 65.1% were prescribed a coxib and 34.9% were prescribed a nonselective NSAID. In bivariate analyses, coxib users were more likely than nonselective NSAID users to be white (83.2% vs 75.3%, respectively; P < 0.05), to be prescribed chronic rather than acute therapy (81.8% vs 58.7%; P < 0.001), and to have a concomitant prescription for warfarin (11.2% vs 5.7%; P < 0.05). Multivariate analyses indicated significance for the same predictors of coxib use: chronic versus acute therapy (Dominick model: adjusted odds ratio [AOR] = 3.39; 95% CI, 2.43-4.74; Shaya model: AOR = 3.39; 95% CI, 2.43-4.74); concomitant anticoagulant therapy (Dominick model: AOR = 2.16; 95% CI, 1.18-3.97; Shaya model: AOR = 2.31; 95% CI, 0.28-0.83); and black race (Dominick model: AOR = 0.48; 95% CI, 0.28-0.83; Shaya model: AOR = 0.49; 95% CI, 0.28-0.84). The most commonly prescribed nonselective NSAIDs were ibuprofen (14.3% of all subjects) and naproxen (6.6% of all subjects); the most commonly prescribed coxibs were rofecoxib (36.5%) and celecoxib (28.5%). CONCLUSIONS: In this study in an older population, coxibs constituted almost two thirds of all initial anti-inflammatory prescriptions. The prescription of a coxib was influenced by concomitant anticoagulant use and chronic use. Blacks were significantly more likely than whites to receive a nonselective NSAID. Although coxib use has been affected by the association with cardiovascular risk that emerged after the period of this study, rational drug selection and reduction of racial/ethnic disparities remain important targets for improved quality of care.

Age Factors↗
PubMed2006

Propoxyphene use and risk for hip fractures in older adults.

BACKGROUND: Published guidelines have identified propoxyphene as an inappropriate medication for use in aged patients. It is no more effective than acetaminophen, yet has been associated with the same adverse effects (AEs) associated with other opioid drugs. In particular, its central nervous system-related AEs, dizziness and sedation, may increase the risk for fracture resulting from falls in older adults. Nonetheless, US studies have reported widespread use of propoxyphene in the elderly US population. OBJECTIVE: The aim of this study was to examine the risk for fracture associated with propoxyphene use in older adults. METHODS: This prospective cohort study used a large administrative claims data set from adults aged > or =65 years. A time-varying (lagged) covariate defined each person as a propoxyphene user or nonuser based on propoxyphene exposure in the 14 days before each fracture event in the cohort. Another time-varying measure stratified propoxyphene users based on their mean daily dose of propoxyphene (high dose = >260 mg; low dose = < or =260 mg of propoxyphene hydrochloride or equivalent napsylate salt). Time-dependent Cox regression models were used to estimate the association between propoxyphene exposure and occurrence of hip fracture (using International Classification of Diseases, Ninth Revision, Clinical Modification code 820.xx). RESULTS: A total of 362,503 patients were included in the analysis. During a mean follow-up of 464 days, approximately 10% (37,569) of the sample had > or =1 propoxyphene prescription filled and approximately l% (5065) sustained a hip fracture. Propoxyphene users had a 2-fold higher risk for hip fracture (hazard ratio [HR] [95% CI], 2.05 [1.87-2.25]) compared with nonusers of analgesics. Multivariate analysis found a dose-response relationship between propoxyphene and hip fracture risk (low dose, HR [95% CI], 1.45 [1.26-1.67]; high dose, HR [95% CI], 2.05 [1.85-2.29]). Other opioid analgesics were associated with an increased risk for hip fractures. CONCLUSIONS: The results of this cohort database study suggest that propoxyphene use among adults aged > or =65 years is associated with increased risk for hip fracture and suggest a need for interventions to reduce propoxyphene use in older adults. Clinicians should be aware of the risk for hip fracture with other opioids as well and weigh them against potential benefits when prescribing for older adults.

Aged↗