Cost of Dementia and Its Correlation With Dependence

2016 ◽  
Vol 28 (8) ◽  
pp. 1448-1464 ◽  
Author(s):  
Örjan Åkerborg ◽  
Andrea Lang ◽  
Anders Wimo ◽  
Anders Sköldunger ◽  
Laura Fratiglioni ◽  
...  
Keyword(s):  
Cognitive Ability ◽  
Resource Utilization ◽  
Annual Cost ◽  
Neuropsychiatric Symptoms ◽  
Dementia Care ◽  
Cost Of Care ◽  
Path Model ◽  
National Study ◽  
Strong Impact ◽  
The Impact

Objective: To estimate the cost of dementia care and its relation to dependence. Method: Disease severity and health care resource utilization was retrieved from the Swedish National Study on Aging and Care. Informal care was assessed with the Resource Utilization in Dementia instrument. A path model investigates the relationship between annual cost of care and dependence, cognitive ability, functioning, neuropsychiatric symptoms, and comorbidities. Results: Average annual cost among patients diagnosed with dementia was €43,259, primarily incurred by accommodation. Resource use, that is, institutional care, community care, and accommodation, and corresponding costs increased significantly by increasing dependency. Path analysis showed that cognitive ability, functioning, and neuropsychiatric symptoms were significantly correlated with dependence, which in turn had a strong impact on annual cost. Discussion: This study confirms that cost of dementia care increases with dependence and that the impact of other disease indicators is mainly mediated by dependence.

Evaluation of Patient Outcome Benefits and Resource Utilization Associated with a Hematopathologist-Directed Workflow for Diagnosis of Hematological Malignancies

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3127-3127
Author(s):  
John F Leite ◽  
Sudipto Sur ◽  
Bashar Dabbas ◽  
James Gilmore ◽  
Sally Haislip ◽  
...  
Keyword(s):  
Overall Survival ◽  
Patient Outcomes ◽  
Resource Utilization ◽  
Analytical Framework ◽  
National Study ◽  
Regional Study ◽  
Cancer Specialists ◽  
One Year ◽  
The Impact ◽  
Selection Of

Abstract Abstract 3127 Background: Traditionally, the appropriate selection of diagnostic tests is determined solely by the ordering clinician. This can be quite challenging in the case of hematological malignancies, where guidelines require detailed correlation between molecular, morphologic and immunologic results for accurate classification. We have undertaken a study to determine the impact of including a hematopathologist in the initial test selection and case management. Our working hypothesis is that this should improve the timeliness and accuracy of diagnoses. Therefore, an analytical framework based on measuring patient outcomes and resource utilization is feasible to compare diagnostic workflows. We compared outcomes and resource utilization between cohorts of patients in which diagnosis was obtained using the traditional or hematopathologist supplemented workflows. Two studies were performed: the first utilized a smaller regional electronic health record (EHR) database from a Southeast US practice, affording a higher degree of practice and demographics uniformity, the second utilized a more heterogeneous national US claims database. Patients were matched by ultimate diagnosis and demographics and all studies were retrospective. Methods: In the first regional cohort, we studied 791 patients collected between 2007 and 2009 and required a minimum of one year of data post bone marrow biopsy to be available. The patients had a diagnostic evaluation by a hematopathologist-managed workflow (Test, n=640) or by laboratories that follow a traditional diagnostic workflow (Control, n=151). Patients were matched by gender, age, ethnicity, ECOG status and diagnosis. Outcomes were assessed as overall survival and transfusion dependence. Resource utilization (lab tests and supportive therapeutics) was also evaluated. As a sensitivity analysis, outcomes of 19, 416 patients from the national cohort were evaluated using patients collected between 2006 and 2008. These patients had a diagnostic evaluation by a hematopathologist-managed workflow (Test, n=3, 236) or by laboratories that follow a traditional diagnostic workflow (Control, n=16, 180). Patients were matched by gender, age, ethnicity, geography, payer type, Charlson co-morbidities and diagnosis. Results: Overall survival benefit for the regional EHR-based study was not observed beyond statistical significance (p=0.564, HR=0.530; 95%CI=0.233–1.205) although a strong trend favoring the Test cohort could be observed. In the national study, where claims data over one year was available for a greater proportion of patients, improved overall survival (p=0.050, HR=0.634; 95%CI=0.402–1.001) for Test cohort patients could be discerned. Test cohort patients exhibited improved transfusion dependence (p=0.009; HR=0.455, 95% CI=0.252–0.824) in the regional study, but this effect was not observed in the national study set (p=0.644; HR=0.959, 95% CI=0.803–1.145). Resource utilization was assessed in the regional study and Test cohort patients appear associated with significantly reduced resource utilization: lab tests (p<0.0001), ancillary procedures (p<0.0001), therapeutics (p<0.0001) and erythropoietin stimulating agents (p<0.0001). Conclusions: We present an analytical framework by which the impact on patient outcomes can be evaluated as a function of adding a hematopathologist in the selection of diagnostic tests and case management. Our initial results using EHR records from a multi-site single practice, and claims data from a national database, suggest that differences in outcomes and resource utilization can be discerned as a function of diagnostic workflow. Though we have done our best to reduce the possibility of distortion by confounding variables and unidentified bias, we hope that this study will provide the impetus for further replication across multiple cohorts, labs and prospective trials in the future. Disclosures: Leite: Genoptix-Novartis: Employment. Sur:Genoptix-Novartis: Consultancy. Dabbas:Genoptix-Novartis: Employment. Gilmore:Georgia Cancer Specialists: Employment. Haislip:Georgia Cancer Specialists: Employment. Nerenberg:Genoptix-Novartis: Employment.

Determinants Of Cost Of Care For Persons With Severe Hemophilia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2969-2969
Author(s):  
Michael W. Evans ◽  
M. Elaine Eyster ◽  
Christopher S. Hollenbeak
Keyword(s):  
Length Of Stay ◽  
Resource Utilization ◽  
Conflicts Of Interest ◽  
Statistical Significance ◽  
Treatment Recommendations ◽  
Demographic Variables ◽  
Cost Of Care ◽  
Inpatient Cost ◽  
Severe Hemophilia ◽  
The Impact

Abstract Background The ability of a person with hemophilia to adhere to treatment recommendations aimed at preventing and controlling bleeding likely impacts clinical outcomes and resource utilization. Annual cost of replacement factor for persons with severe hemophilia on prophylaxis is estimated to be as high as $300,000 per year (Johnson KA and Zhou ZY. ASH Annual Meeting Educational Program. 2011; 413-418). Hemophilia care is optimized when delivered by a highly specialized hemophilia treatment center (HTC) (Soucie et al. Blood. 2000; 96: 437-442). Consolidation of care for persons with hemophilia from a large geographic region within an HTC results in demographic heterogeneity that may impact an individual's ability to adhere to treatment recommendations. Little is known regarding the impact of socio-demographic factors on treatment outcomes for persons with hemophilia. The purpose of this study was to identify disease-related, treatment-related and demographic variables that have a significant impact on morbidity and resource utilization. Methods We identified 69 persons with severe hemophilia treated at our HTC between June 2009 and June 2012. We collected data for the variables listed below in table 1. To assess morbidity and resource utilization, we collected data for total factor use, total outpatient cost, total inpatient cost, frequency of inpatient and outpatient encounters and length of stay when hospitalized. Risk factors were identified using linear regression. A subset analysis was performed to evaluate the impact of prophylaxis on patients without inhibitors. All statistical analyses were performed using STATA (version 12.0 College Station, TX). Statistical significance was defined as P < 0.05. Results Age and inhibitor status were the only variables to significantly impact cost in both inpatient and outpatient settings (Table 1). The statistically significant beneficial impact of prophylaxis was confirmed by subgroup analysis of patients without inhibitors with respect to number of hospitalizations and length of stay, but not total cost. Conclusions Identifying and addressing potential barriers to care will likely reduce morbidity and cost for persons with hemophilia. Caregiver status and age are demographic variables that may contribute to poor medical adherence resulting in increased morbidity and cost of care for persons with severe hemophilia. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The BODECOST Index (BCI): a composite index for assessing the impact of COPD in real life

2016 ◽  
Vol 11 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Bartolome R. Celli
Keyword(s):  
Survival Time ◽  
Mortality Risk ◽  
Annual Cost ◽  
Composite Index ◽  
Real Life ◽  
Cost Of Care ◽  
Bode Index ◽  
Copd Patients ◽  
The Cost ◽  
The Impact

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition which is characterized by a dramatic socio-economic impact. Several indices were extensively investigated in order to asses the mortality risk in COPD, but the utilization of health care resources was never included in calculations. The aim of this study was to assess the predictive value of annual cost of care on COPD mortality at three years, and to develop a comprehensive index for easy calculation of mortality risk in real life. Methods: COPD patients were anonymously and automatically selected from the local institutional Data Base. Selection criteria were: COPD diagnosis; both genders; age ≥ 40 years; availability of at least one complete clinical record/year, including history; clinical signs; complete lung function, therapeutic strategy, health BODE index; Charlson Comorbidity Index, and outcomes, collected at the first visit, and over the following 3-years. At the first visit, the health annual cost of care was calculated in each patient for the previous 12 months, and the survival rate was also measured over the following 3 years. The hospitalization and the exacerbation rate were implemented to the BODE index and the novel index thus obtained was called BODECOST index (BCI), ranging from 0 to 10 points. The mean cost for each BCI step was calculated and then compared to the corresponding patients’ survival duration. Parametrical, non parametrical tests, and linear regression were used; p < 0.05 was accepted as the lower limit of significance. Results: At the first visit, the selected 275 patients were well matched for all variables by gender. The overall mortality over the 3 year survey was 40.4 % (n = 111/275). When compared to that of BODE index (r = 0.22), the total annual cost of care and the number of exacerbations showed the highest regression value vs the survival time (r = 0.58 and r = 0.44, respectively). BCI score proved strictly proportional to both the cost of care and the survival time in our sample of COPD patients. Discussion: BCI takes origin from the implementation of the BODE index with the two main components of the annual cost of care, such as the number of hospitalizations and of exacerbations occurring yearly in COPD patients, and their corresponding economic impact. In other words, higher the BCI score, shorter the survival and higher the cost, these trends being strictly linked. Conclusions: BCI is a novel composite index which helps in predicting the impact of COPD at 3 years in real life, both in terms of patients’ survival and of COPD economic burden.

Modeling Medicare’s Oncology Care Model bundles at more clinically granular levels: Evaluating the impact on provider performance.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18854-e18854
Author(s):  
Andrew Yue ◽  
Nora Connor ◽  
Lucio N. Gordan ◽  
Lisa Tran ◽  
Basit Iqbal Chaudhry
Keyword(s):  
Resource Utilization ◽  
Cost Of Care ◽  
Lymphocytic Leukemia ◽  
Myelogenous Leukemia ◽  
Fee For Service ◽  
Payment Reform ◽  
Provider Performance ◽  
Chronic Leukemia ◽  
Cancer Subtypes ◽  
The Impact

e18854 Background: Aggregating different subtypes of cancers into bundles is an important methodology in oncology payment reform as an alternative to fee for service. However, expected resource utilization can vary significantly across cancer subtypes. We evaluated the impact that modeling Chronic Leukemia into a more clinically granular two part framework of chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia would have on OCM results and the risk that the distribution of clinical subtypes at a practice would influence overall performance in the bundle. Methods: OCM episodes of chronic leukemia initiating between July 2016 and June 2019 were subdivided on the basis of individual ICD-10 coded diagnoses on cancer-related E&M visits. From a total of 4,658 episodes, we randomly sampled with replacement 3,500 episodes from 16 practices using empirical data distributions. Data models and mappings were developed based on clinical knowledge and exploratory data analyses to subdivide the OCM bundle of Chronic Leukemias into CLL and CML. Total cost of care and episode target prices were calculated through implementation of the OCM methodology. The distributional consistencies of episode target, cost, cost above target, and percent above target for the two diseases were evaluated by two-sample Kolmogorov-Smirnov (KS) tests. Results: The CML and CLL subtypes modeled from the aggregate OCM bundle demonstrated significantly different cost distributions relative to each other. As anticipated, treatments used in each subtype varied significantly marking different patterns of expected resource utilization. In our model, CLL episodes were on average 13.7% over target. Average CLL episode costs were $52.2K vs. an average target of $47.6K with 54% of episodes running over target. In contrast, CML episodes were 6.1% under target. Average CML episode costs were $45.2K vs. an average target of $50.3K with 43% of episodes running over target. Conclusions: Value based payment models in oncology such as OCM can be improved by modeling cancer bundles in more clinically granular ways that better reflect expected resource utilization for appropriate, standard of care. Insufficient clinical granularity in bundle construction can lead to provider performance being influenced by the distribution of patient subtypes at the practice. This can lead to inappropriate shifts of risk from payers to providers in value based models. Aggregate vs. subtype episode costs (mean, 5th, and 95th percentiles).[Table: see text]

scholarly journals Cohort differences in dementia recognition and treatment indicators among assisted living residents in Maryland: did a change in the resident assessment tool make a difference?

2013 ◽  
Vol 25 (12) ◽  
pp. 2047-2056 ◽  
Author(s):  
Quincy M. Samus ◽  
Amrita Vavilikolanu ◽  
Lawrence Mayer ◽  
Matthew McNabney ◽  
Jason Brandt ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Assisted Living ◽  
Behavioral Problems ◽  
Assessment Tool ◽  
Neuropsychiatric Symptoms ◽  
Care Quality ◽  
Dementia Care ◽  
Cross Sectional ◽  
Cohort Differences ◽  
The Impact

ABSTRACTBackground:There is a lack of empirical evidence about the impact of regulations on dementia care quality in assisted living (AL). We examined cohort differences in dementia recognition and treatment indicators between two cohorts of AL residents with dementia, evaluated prior to and following a dementia-related policy modification to more adequately assess memory and behavioral problems.Methods:Cross-sectional comparison of two AL resident cohorts was done (Cohort 1 [evaluated 2001–2003] and Cohort 2 [evaluated 2004–2006]) from the Maryland Assisted Living studies. Initial in-person evaluations of residents with dementia (n = 248) were performed from a random sample of 28 AL facilities in Maryland (physician examination, clinical characteristics, and staff and family recognition of dementia included). Adequacy of dementia workup and treatment was rated by an expert consensus panel.Results:Staff recognition of dementia was better in Cohort 1 than in Cohort 2 (77% vs. 63%, p = 0.011), with no significant differences in family recognition (86% vs. 85%, p = 0.680), or complete treatment ratings (52% vs. 64%, p = 0.060). In adjusted logistic regression, cognitive impairment and neuropsychiatric symptoms correlated with staff recognition; and cognitive impairment correlated with family recognition. Increased age and cognitive impairment reduced odds of having a complete dementia workup. Odds of having complete dementia treatment was reduced by age and having more depressive symptoms. Cohort was not predictive of dementia recognition or treatment indicators in adjusted models.Conclusions:We noted few cohort differences in dementia care indicators after accounting for covariates, and concluded that rates of dementia recognition and treatment did not appear to change much organically following the policy modifications.

scholarly journals Sensory Health and Dementia Care: Understanding and Addressing Unmet Needs in ADRD

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 85-85
Author(s):  
Carrie Nieman ◽  
Heather Whitson ◽  
Laura Gitlin
Keyword(s):  
Healthy Aging ◽  
Neuropsychiatric Symptoms ◽  
Cost Effective ◽  
Dementia Care ◽  
Sensory Function ◽  
Home Based ◽  
Care Partners ◽  
Public Health Challenges ◽  
Nonpharmacological Intervention ◽  
The Impact

Abstract Sensory health in dementia stands at the intersection of two major public health challenges. Hearing and vision impairments are among the most common and disabling comorbidities in dementia and may worsen the trajectory of decline yet frequently go unrecognized and unaddressed. Improving sensory function may be an accessible and cost-effective nonpharmacological intervention to aid in the management of neuropsychiatric symptoms, improve quality of life for persons with dementia, and reduce burden for care partners. This symposium presents the latest evidence on the impact of sensory impairment in dementia and efforts to integrate sensory health into the care of persons with dementia. This symposium will cover emerging evidence of the impact of hearing loss and vision impairment on persons living with dementia, specifically around neuropsychiatric symptoms, disability, and cost. In moving toward solutions, we will discuss new approaches to provide vision and hearing care for persons with dementia in diverse settings, from audiology to specialized memory clinics to home-based care. This discussion will include findings from a systematic review of telehealth in dementia care, which highlights the limitations of existing literature on accounting for the sensory needs of persons with dementia and their care partners. Finally, we will share new international practice recommendations on vision and hearing impairment among persons living with dementia. The symposium highlights the large, yet often unrecognized, sensory health needs of persons with dementia and the multi-prong approach required to identify and support sensory health and, ultimately, healthy aging among persons with dementia.

When Do Psychopathic Traits Affect Cooperative Behavior?: An Iterated Prisoner's Dilemma Experimental Study

2020 ◽  
Author(s):  
M Testori ◽  
M Kempf ◽  
RB Hoyle ◽  
Hedwig Eisenbarth
Keyword(s):  
Prisoner's Dilemma ◽  
Cooperative Behavior ◽  
Prisoner’S Dilemma ◽  
Selection Procedure ◽  
Psychopathic Traits ◽  
Strong Impact ◽  
Iterated Prisoner's Dilemma ◽  
Human Decision ◽  
The Impact ◽  
Iterated Prisoner’S Dilemma

© 2019 Hogrefe Publishing. Personality traits have been long recognized to have a strong impact on human decision-making. In this study, a sample of 314 participants took part in an online game to investigate the impact of psychopathic traits on cooperative behavior in an iterated Prisoner's dilemma game. We found that disinhibition decreased the maintenance of cooperation in successive plays, but had no effect on moving toward cooperation after a previous defection or on the overall level of cooperation over rounds. Furthermore, our results underline the crucial importance of a good model selection procedure, showing how a poor choice of statistical model can provide misleading results.

The Impact of Cognitive Ability on Roth IRA Ownership

2011 ◽  
Author(s):  
Benjamin F. Cummings ◽  
Michael S. Finke ◽  
Russell N. James
Keyword(s):  
Cognitive Ability ◽  
Roth Ira ◽  
The Impact

The Impact of Economic Crisis on Tourism Industry: A Bangladesh Perspective

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Md. Ziaul Haque
Keyword(s):  
Economic Crisis ◽  
Tourism Industry ◽  
Political Crisis ◽  
Strong Impact ◽  
Negative Consequences ◽  
Policy Makers ◽  
Tourism Product ◽  
International Tourist ◽  
Sustained Recovery ◽  
The Impact

The tourism sector is experiencing numerous challenges as a result of the global economic crisis. After a significant contraction in 2009, tourism rebounded strongly  in  2010  and  in  2011  the  international  tourist  arrivals  and  receipts  are projected to increase substantially. The Tourism industry is expected to show a sustained recovery in 2012. The crisis has particularly strong impact and slightly negative consequences in Bangladesh. The country is undergoing a political crisis, as well, and it seems that the forthcoming elections may be the only solution for the restoration of stability and social peace.  In addition, tourism can be the driving force behind Bangladesh economic recovery. However, for its achievement the country’s policy makers should take several measures towards restructuring and improving the sector. These measures include: enhancement of alternative forms of tourism; environmental protection; creation of quality infrastructure; and boost of competitiveness through a tourism product that offers value for money

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