Health Resource Utilization and Medical Care Cost of Acute Care Elderly Unit Patients

OBJECTIVE: In this study we compared the readmissions, medical care cost, and health resource utilization (HRU) of acute care elderly (ACE) unit patients and usual medical care patients. METHODS: Retrospective case-control design was used. Patients admitted to ACE unit (n = 680) between 1999 and 2002 with primary admitting diagnosis of pneumonia, congestive heart failure, or urinary tract infection were randomly selected from the health-care system's administrative database. Equal number controls (n = 680) were selected from usual medical care services and were matched by DRG, age, ethnicity, and Charlson comorbidity score. Data on HRU, annual number of admissions before and after index admission, length of stay (LOS), and medical care cost were obtained. Bootstrap, t-test, and Wilcoxon test were used to compare cost, LOS, and number of readmissions between ACE and non-ACE unit. Multivariate log-linear and Poisson regressions were used to assess the impact of ACE unit on incremental cost and number of readmissions, respectively. RESULTS: Mean LOS was 1 day shorter for ACE unit (4.9 vs. 5.9 P = 0.01). Mean cost of ACE unit was 9.7% lower than that of non-ACE unit (Dollars 13,586 vs. Dollars 15,040, P = 0.012). Both groups had similar costs of pharmacy, diagnostic and therapeutic procedures. Multiple log-linear and Poisson regression models indicated that ACE unit patients had 21% lower cost and 11% lower annual readmissions. CONCLUSIONS: Our results confirm the hypotheses that ACE unit patients have lower medical care cost, shorter LOS, and fewer readmissions. Thus, ACE unit may be a beneficial model for improved inpatient care of elderly.     

Impact of Diabetes Mellitus (DM) on the Health-Care Utilization and Clinical Outcomes of Patients with Stroke in Singapore

Objective:  This study aims to assess the impact of diabetes mellitus (DM) on the health-care utilization and clinical outcomes of patients with acute stroke.
Methods:  This is a retrospective cohort study. All patients who were admitted for the first time to one of the three public hospitals in the National Healthcare Group in Singapore from January 2005 to June 2007 with a primary diagnosis of acute stroke were included and were followed up for 1 year after the index hospitalization. The study population was divided into two groups: with DM and without DM. Both univariate and multivariate analyses were applied to compare the hospital length of stay (LOS), hospitalization costs, mortality, as well as the 1-year hospital readmissions between the DM and non-DM groups.
Results:  There were 9766 study patients, and 38.5% of them had DM. DM patients with ischemic stroke (IS) and transient ischemic attack (TIA) stayed 1-day and 0.6-day longer, and incurred 10% and 26% higher hospital cost during index admission, respectively, compared with their counterparts in the non-DM group. They also had more hospital readmission within 1 year. The mortality rate in IS patients with diabetes was 24% higher. After risk adjustment, subarachnoid hemorrhage patients with diabetes had more hospitalizations. Intracerebral hemorrhage (ICH) and IS patients in the DM group had all worse outcomes but the 1-year stroke recurrence; TIA patients with DM incurred longer LOS and hospital costs.
Conclusion:  DM predicts worse clinical outcomes and higher health-care expenditures in the 1-year poststroke especially for the IS, ICH, and TIA stroke subtypes.     

三级单位卒中单元模式对脑卒中疾病经济负担的影响

目的:探讨三级单位卒中单元在降低医疗费用、实现医疗资源合理配置方面的作用效果。方法:建立三级单位卒中单元,包括急性卒中病房、康复中心和家庭护理单位。通过完备的专人随诊体系,对卒中病人提供卒中管理,随诊1年。于急性期、康复期、3个月末、6个月末和12个月末共进行5次评价,统计各阶段的医疗费用。结果:三级单位卒中单元内患者,脑出血及脑梗塞急性期例均住院费用分别为7547元和6078元,仅为全国同类省级医院平均住院费用的57.30%及59.30%;平均住院日分别为14日和11日,均较全国同类省级医院为短。脑卒中患者发病1年内例均疾病负担为15074元,其中,入院急性期费用占45.57%,康复期占21.86%,出院康复期及间接费用占32.57%。结论:三级单位卒中单元是治疗脑卒中的一种有效方法,能明显减少住院时间和医疗费用,将有限的医疗资源合理分配到疾病全程,有助于调整医疗费用的结构,实现医疗资源的合理配置。     

Service Utilization and Health-Care Costs in the Advanced Elderly

Objectives:  Despite their increasing importance, the advanced elderly are often neglected in service utilization and costing studies. The purpose of this study was to analyze from societal perspective service utilization and direct health-care costs and its predictors in the advanced elderly population.
Methods:  A bottom-up costing study was conducted using a cross-sectional primary care sample aged 75+ (n = 452) in Germany. The main instruments were a questionnaire of service utilization and costs administered by an interviewer and the chronic disease score (CDS). Predictors were derived by means of multivariate regression models.
Results:  Respondents caused mean direct costs of €3730 (95% CI 3203–4257) in prices of 2004/2005. This included inpatient care 34%, pharmaceuticals 29%, outpatient physician services 15%, nursing care 10%, medical supply and dentures 6%, outpatient nonphysician providers 5%, assisted living 1%, and transportation 2%. A shift from lower to middle education and a one-point increase in CDS were associated with an increase of €1678 (95% CI 250–3369) and €482 (95% CI 316–654), respectively. Total mean direct costs did not differ significantly between sexes. Ischemic heart disease and diabetes mellitus were associated with excess costs of €711 and €290, both being not significant. Altogether 55% of the respondents accounted for 90% of total direct costs.
Conclusions:  Advanced elderly used a wide range of health services. Our study still underestimates the true costs to society. Further research should focus on economic evaluation of new health-care programs for this increasingly important age group.     

二级甲等医院的卒中单元医疗模式对脑卒中患者临床疗效研究

目的探讨二级甲等医院采用卒中单元医疗模式并在康复中加入针刺治疗脑卒中的效果。方法将246例脑卒中病人随机分为观察组（纳入卒中单元组）和对照组（传统治疗组）。分析两组治疗前后神经功能缺损程度（NIHSS）、疗效及常见并发症发生情况。结果治疗前观察组患者NIHSS评分（27．6±6．2）分，对照组（28．5±5．4）分，差别无统计学意义（P〉0．05），治疗后两组NIHSS评分分别为（18．3±6．7）分和（23．2±6．3）分，差别有统计学意义（P〈0．001）。在近期临床疗效上．观察组总有效率（78．57％）高于对照组（66．67％），两组差别有统计学意义（P〈0．05）。常见并发症的总发生率观察组（37．30％）低于对照组（69．17％），差别有统计学意义（P〈0．05）。结论二级甲等医院以卒中单元医疗模式管理治疗脑卒中病人。并在康复治疗中加入中医针刺治疗，效果优于传统治疗。     

应用卒中单元综合治疗脑出血临床疗效观察

目的观察卒中单元（strokeunit,SU）模式综合管理治疗脑出血的临床疗效。方法将128例脑出血患者随机分为SU组（62例）和SU组（66例）,两组患者分别接受SU模式综合管理治疗及常规治疗1个月．对比分析两组患者的感染率、多脏器功能衰竭（MOF）发生率、病死率及生活能力（Barthel）、神经功能（NIHSS）、社会功能（OHS）评价。结果治疗后,与非SU组比较,SU组的感染发生率、MODS发生率、病死率显著降低,NIHSS、Barthel、OHS评定显著改善。结论卒中单元模式综合管理治疗脑出血患者的疗效显著优于普通住院治疗模式。     

卒中单元医院感染控制的研究

目的 探讨卒中单元控制医院感染的方法、措施及临床护理干预对策.方法 采用前瞻性、目标性及回顾性调查研究方法,分试验组与对照组,对卒中单元出现医院感染的各项成因和影响因素进行危险度分析,提出预防控制方法和改进措施.结果 试验组医院感染发生率为9.13%、例次感染率为9.85%,明显低于对照组的14.60%、15.86%,二者比较χ2分别为17.44、19.59,差异有统计学意义(均P＜0.01);感染部位分布依次为呼吸道、泌尿道、胃肠道、皮肤感染.结论 进一步降低了卒中单元医院感染发生率,提高了脑卒中患者的抢救成功率和康复水平.     

应用卒中单元综合治疗脑出血临床疗效观察

目的观察卒中单元(stroke unit,SU)模式综合管理治疗脑出血的临床疗效。方法将128例脑出血患者随机分为SU组(62例)和SU组(66例),两组患者分别接受SU模式综合管理治疗及常规治疗1个月,对比分析两组患者的感染率、多脏器功能衰竭(MOF)发生率、病死率及生活能力(Barthel)、神经功能(NIHSS)、社会功能(OHS)评价。结果治疗后,与非SU组比较,SU组的感染发生率、MODS发生率、病死率显著降低,NIHSS、Barthel、OHS评定显著改善。结论卒中单元模式综合管理治疗脑出血患者的疗效显著优于普通住院治疗模式。     

The Direct Medical Costs of Undiagnosed Chronic Obstructive Pulmonary Disease

Objective:  To estimate the costs of undiagnosed chronic obstructive pulmonary disease (COPD) by describing inpatient, outpatient, and pharmacy utilization in the years before and after the diagnosis.
Methods:  A total of 6864 patients who were enrolled in the Lovelace Health Plan for at least 12 months during the study period (January 1, 1999 through December 31, 2004) were identified. The first date that utilization was attributed to COPD was considered the first date of diagnosis. Each COPD case was matched to up to three age- and sex-matched controls. All utilization and direct medical costs during the study period were compiled monthly and compared based on the time before and after the initial diagnosis.
Results:  Total costs were higher by an average of $1182 per patient in the 2 years before the initial COPD diagnosis, and $2489 in the 12 months just before the initial diagnosis, compared to matched controls. Most of the higher cost for undiagnosed COPD was attributable to hospitalizations. Inpatient costs did not increase after the diagnosis was made, but approximately one-third of admissions after the diagnosis were attributed to respiratory disease. Outpatient and pharmacy costs did not differ substantially between cases and matched controls until just a few months before the initial diagnosis, but remained 50% to 100% higher than for controls in the 2 years after diagnosis.
Conclusions:  Undiagnosed COPD has a substantial impact on health-care costs and utilization in this integrated managed care system, particularly for hospitalizations.     

Mortality,Health Care Use,and Costs of Clostridioides difficile Infections in Older Adults

ObjectivesEstimate mortality, cost, and health care resource utilization for Medicare beneficiaries aged ≥65 years who suffered a primary Clostridioides difficile infection (CDI) episode only or any recurrent CDI, and understand how outcomes covary with death.DesignRetrospective observational claims analysis.Setting and ParticipantsPatients aged ≥65 years who had an inpatient or outpatient CDI diagnosis claim to Medicare and continuous enrollment in Medicare parts A, B, and D during the 12-month pre- and post-index periods.MethodsUsing 100% Medicare Fee-for-Service claims data for 2009–2017, primary (pCDI, n = 345,893) and recurrent (rCDI: n = 151,596) CDI episodes were identified. Demographic and clinical characteristics, mortality, health care resource utilization, and costs (per patient per month) were summarized for 12 months before and up to 12 months after episode start. Regression models were estimated for hospitalization risk, hospital length of stay (LOS), and cost to adjust for comorbidities.ResultsCDI-associated deaths were almost 10 times higher after recurrent CDI (25.4%) than primary CDI (2.7%). Compared with survivors, decedents were older, had higher Charlson Comorbidity Index scores, and were more likely Black. Adjusting for comorbidities, during follow-up, decedents had higher hospitalization rates [pCDI: odds ratio (OR) = 1.83, P < .001; rCDI: OR = 2.58, P < .001], and recurrent CDI decedents had more intensive care unit use (OR = 2.34, P < .001) compared with survivors. Decedents also had a longer length of stay (pCDI: +3.2 days, P < .001; rCDI: +2.6 days, P < .001), and higher total cost (pCDI: +303%, P < .001; rCDI: +297%, P < .001).Conclusions and ImplicationsCDI is an important contributing diagnosis to all-cause mortality, particularly for recurrences. Prior to death, older Medicare beneficiaries who experienced CDI received longer, more intensive, and more costly care compared with survivors. Clinicians should be particularly attentive to prevention, identification, and appropriate treatment of CDI in older adults. Better treatments to reduce primary C difficile infection and recurrences in this vulnerable population can lower both mortality and economic burden.     

Health-Care Costs of Pediatric Clients Developing Adverse Events during Treatment with Antipsychotics

Objective:  To examine the differences over time in health-care costs associated with incident adverse events in children and adolescents treated with antipsychotic agents compared to an untreated control sample.
Method:  A retrospective cohort design evaluating South Carolina's Medicaid medical and pharmacy claims between January 1996 and December 2005 was employed for 4140 children and adolescents prescribed antipsychotic medications, and a random sample of 4500 children not treated with psychotropic medications. The main outcome measures were total health-care costs and emergency, inpatient, and outpatient services use.
Results:  Patients with the focal adverse medical conditions incurred significantly higher total care costs (34% higher, on average, over 8–9 years) compared with those without these conditions ( F  = 710.08; P  < 0.0001) or to children not treated with psychotropic medications ( F  = 2855.54; P  < 0.0001). Patients with incident adverse events associated with antipsychotic treatment had significantly higher rates/time under Medicaid coverage of outpatient, emergency, and inpatient services utilization than the control sample patients, controlling for preexisting conditions, receipt of multiple psychotropic medications, and individual risk factor differences for males, adolescents, and non-African Americans.
Conclusions:  The development of adverse medical conditions related to antipsychotic medication use in children and adolescents is significantly associated with higher total costs of health care and to utilization of outpatient, emergency, and inpatient services over time.     

Health Care Utilization and Costs Associated with Physical and Nonphysical-Only Intimate Partner Violence

Objective. To estimate health care utilization and costs associated with the type of intimate partner violence (IPV) women experience by the timing of their abuse.
Methods. A total of 3,333 women (ages 18–64) were randomly sampled from the membership files of a large health plan located in a metropolitan area and participated in a telephone survey to assess IPV history, including the type of IPV (physical IPV or nonphysical abuse only) and the timing of the abuse (ongoing; recent, not ongoing but occurring in the past 5 years; remote, ending at least 5 years prior). Automated annual health care utilization and costs were assembled over 7.4 years for women with physical IPV and nonphysical abuse only by the time period during which their abuse occurred (ongoing, recent, remote), and compared with those of never-abused women (reference group).
Results. Mental health utilization was significantly higher for women with physical or nonphysical abuse only compared with never-abused women—with the highest use among women with ongoing abuse (relative risk for those with ongoing abuse: physical, 2.61; nonphysical, 2.18). Physically abused women also used more emergency department, hospital outpatient, primary care, pharmacy, and specialty services; for emergency department, pharmacy, and specialty care, utilization was the highest for women with ongoing abuse. Total annual health care costs were higher for physically abused women, with the highest costs for ongoing abuse (42 percent higher compared with nonabused women), followed by recent (24 percent higher) and remote abuse (19 percent higher). Women with recent nonphysical abuse only had annual costs that were 33 percent higher than nonabused women.
Conclusion. Physical and nonphysical abuse contributed to higher health care utilization, particularly mental health services utilization.     

基层部队卫生装备使用管理浅析

从近几年对体系部队进行卫生装备检修所掌握的情况出发,阐述了目前基层部队卫生装备使用管理中存在的问题及原因。在强化教育、完善制度、坚持维护保养、加强人才培养及检修机构建设5个方面提出了改进意见,旨在更好地发挥卫生装备效益,提升保障能力。     

A Systematic Review Evaluating Health-Related Quality of Life, Work Impairment, and Health-Care Costs and Utilization in Abnormal Uterine Bleeding

OBJECTIVES: Abnormal uterine bleeding (AUB) impacts women's health-related quality of life (HRQoL) and puts a heavy economic burden on society. To date, this burden has not been systematically studied. We conducted a systematic review of the medical literature to evaluate the impact of AUB on HRQoL and to quantify the economic burden of AUB from a societal perspective. METHODS: We searched the PubMed and Cochrane databases, and article bibliographies for the period up to July 2005. Teams of two reviewers independently abstracted data from studies that reported outcomes of interest: prevalence, HRQoL, work impairment, and health-care utilization and costs associated with AUB. RESULTS: The search yielded 1009 English-language articles. Ninety-eight studies (including randomized controlled trials, observational studies, and reviews) that met the inclusion and exclusion criteria underwent a full-text review. The prevalence of AUB among women of reproductive age ranged from 10% to 30%. The HRQoL scores from the 36-item Short-Form Health Survey Questionnaire (SF-36) suggested that women with AUB have HRQoL below the 25th percentile of that for the general female population within a similar age range. The conservatively estimated annual direct and indirect economic costs of AUB were approximately $1 billion and $12 billion, respectively. These figures do not account for intangible costs and productivity loss due to presenteeism. CONCLUSIONS: The burden of AUB needs further and more thorough investigation. Additional research should prospectively evaluate the impact of AUB and the value of treatment provided to help guide future health resource allocation and clinical decision-making.     

Cardiovascular-Related Healthcare Resource Utilization and Costs in Patients with Hypertension Switching from Metoprolol to Nebivolol

Background

The prevalence of hypertension is increasing in the United States and the associated costs are soaring. Despite the many treatment options, only approximately 50% of Americans with hypertension achieve optimal control. Patients receiving nebivolol, a third-generation beta-blocker, have fewer adverse events and better treatment persistence compared with patients receiving other antihypertensive agents. Little is known about the impact of switching from a second-generation beta-blocker, such as metoprolol, to nebivolol on healthcare resource utilization and costs.

Objective

To assess the impact of switching patients with hypertension from metoprolol to nebivolol on the associated healthcare resource utilization and cost.

Method

This retrospective claims-based analysis included 765 adults aged ≥18 years who were diagnosed with hypertension between January 1, 2008, and December 31, 2012. Data were extracted from the HealthCore Integrated Research Database; the study was conducted between July 1, 2007, and June 30, 2013. To be included in the study, patients had to receive metoprolol for ≥6 months before switching from metoprolol to nebivolol (the preperiod), and continue to use nebivolol for an additional 6 months after switching (the postperiod). Patients with compelling indications for metoprolol but not for nebivolol were excluded from the study. The primary outcome measures were healthcare resource utilization and costs for cardiovascular (CV)-related events. The CV-related resource utilization was calculated based on 100 patients per month; the CV-related costs were calculated per patient per month (PPPM) in 2013 US dollars.

Results

A total of 765 patients were included in the analysis. Compared with the preperiod, patients switching to nebivolol had significantly fewer CV-related emergency department visits (0.2 [standard deviation (SD), 1.9] vs 0.04 [SD, 0.8], respectively; P = .012) and fewer CV-related outpatient visits (9.2 [SD, 19.9] vs 6.7 [SD, 17.5], respectively; P <.001). The numbers of inpatient visits in the preperiod and postperiod were similar (0.3 [SD, 2.4] vs 0.1 [SD, 1.5], respectively; P = .164). Patients switching to nebivolol also had significantly lower CV-related emergency department costs ($6 [SD, $78] vs $1 [SD, $27] PPPM, respectively; P = .028) and lower CV-related total medical costs ($94 [SD, $526] vs $54 [SD, $266] PPPM, respectively; P = .020).

Conclusion

This analysis of real-world data suggests that patients with hypertension who switch from the second-generation antihypertensive metoprolol to the third-generation hypertensive nebivolol have significantly lower CV-related healthcare resource utilization (eg, emergency department and outpatient visits) and lower CV-related medical costs.     

Patient-Reported Outcomes and Health-Care Resource Utilization in Patients with Psoriasis Treated with Etanercept: Continuous versus Interrupted Treatment

Objective:  The 24-week Etanercept Assessment of Safety and Effectiveness (EASE) study evaluated the effectiveness and tolerability of continuous versus interrupted etanercept treatment in patients with moderate to severe plaque psoriasis. The objective of this analysis was to assess patient-reported outcomes (PROs) and health-care resource utilization (HRU) data from the EASE study.
Methods:  Patients received open-label etanercept 50 mg twice weekly for 12 weeks and then received either continued or interrupted (single round of discontinuation and re-treatment with etanercept) etanercept 50 mg once weekly for the second 12 weeks. PROs included the following: 1) the patient global assessments of psoriasis, joint pain, and itching scores; 2) the Dermatology Life Quality Index; 3) the Medical Outcomes Study Short Form 36 vitality domain; 4) the Beck Depression Inventory; 5) the European Quality-of-Life Group Feeling Thermometer; and 6) a patient satisfactionsurvey. HRU was evaluated using the Economic Implications of Psoriasis patient questionnaire.
Results:  Continuous treatment with etanercept 50 mg twice weekly for 12 weeks followed by 50 mg once weekly for 12 weeks produced sustained and clinically important improvements in PROs and reductions in HRU. Reductions in some outcome measures after treatment discontinuation at week 12 were observed in the interrupted group; however, most changes did not revert to baseline levels, consistent with some residual clinical effect, and re-treatment produced improvements similar to week 12 levels.
Conclusions:  Continuous etanercept treatment provided greater sustained improvements in PROs than interrupted therapy; however, interrupting etanercept therapy, if needed, has predictable and manageable effects.     

Resource Utilization and Costs of Schizophrenia Patients Treated with Olanzapine versus Quetiapine in a Medicaid Population

ObjectiveCompare annual health-care costs and resource utilization associated with olanzapine versus quetiapine for treating schizophrenia in a Medicaid population.MethodsAdult schizophrenia patients were selected from deidentified Pennsylvania Medicaid claims database (1999–2003). Included patients were continuously enrolled and initiated with olanzapine or quetiapine monotherapy after a 90-day washout period. Treatment costs were calculated for 1-year post-therapy initiation and inflation adjusted to year 2003. To control for selection bias, olanzapine and quetiapine patients were 1:1 matched using an optimal matching algorithm on propensity score, which was generated using logistic regression controlling for demographics, prior drug therapy, utilization, and costs. Treatment costs for the matched cohorts were compared directly, as well as using a difference-in-difference analysis.ResultsA total of 6929 patients treated with olanzapine and 2321 with quetiapine met inclusion criteria. Quetiapine patients appeared more severe at baseline. After propensity score matching, 2321 patient pairs had similar baseline characteristics, including total costs. Compared with matched quetiapine patients, for the 1-year postindex period, olanzapine patients had similar drug costs ($6131 vs. $6014, P = 0.326), lower medical costs ($9897 vs. $11,218, P = 0.0128), and lower total health-care costs ($16,028 vs. $17,232, P = 0.0279). Lower psychiatric hospitalization costs account for most of the total cost difference. Difference-in-difference regression analysis confirmed olanzapine's economic advantage. Further adjusting for baseline variations, the total cost advantage of olanzapine patients was $962 (P = 0.032), and was mostly because of reduced psychiatric hospitalization costs of $992 (P = 0.004).ConclusionSchizophrenia patients treated with olanzapine had lower total costs than quetiapine patients, mostly attributable to reductions in psychiatric hospitalization costs.