Health Services Use and Health Care Expenditures for Children With Disabilities

PEDIATRICS ◽  
2004 ◽  
Vol 114 (1) ◽  
pp. 79-85 ◽  
Author(s):  
P. W. Newacheck
Keyword(s):  
Health Care ◽  
Health Services ◽  
Children With Disabilities ◽  
Health Care Expenditures ◽  
Health Services Use ◽  
Services Use

scholarly journals Health Services Use and Health Care Costs of Obese and Nonobese Individuals

2004 ◽  
Vol 164 (19) ◽  
pp. 2135 ◽  
Author(s):  
Marsha A. Raebel ◽  
Daniel C. Malone ◽  
Douglas A. Conner ◽  
Stanley Xu ◽  
Julie A. Porter ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Costs ◽  
Health Services Use ◽  
Care Costs ◽  
Services Use

Filters on the pathway to mental health care, II. Sociodemographic factors

1995 ◽  
Vol 25 (6) ◽  
pp. 1149-1160 ◽  
Author(s):  
J. J. Gallo ◽  
S. Marino ◽  
D. Ford ◽  
J. C. Anthony
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Disorder ◽  
The United States ◽  
Sociodemographic Characteristics ◽  
Health Services Use ◽  
Relative Odds ◽  
Services Use

SynopsisThis study uses the prospectively gathered data of the Epidemiologic Catchment Area Program, a multi-site interview survey of mental disturbances among adult household residents in the United States, to compare health services use by individuals with different sociodemographic characteristics, accounting for the first-time occurrence of psychiatric disorder, over the course of a 1-year follow-up interval. Case ascertainment was by means of a standardized interview method, the Diagnostic Interview Schedule. In the present investigation, 13400 continuing participants in the household sample who reported no contact with mental health services in the 6 months prior to the initial interview were studied with regard to health services use and sociodemographic characteristics. Separately, and before the mental health assessments were made, respondents were asked about their use of health and mental health services. African-Americans were significantly less likely than whites to have consulted with a specialist in mental health (estimated relative odds, 0·22, 95% confidence interval 0·10 to 0·52), even accounting for coincident psychiatric disorder, gender, and other covariates known to be associated with differential use of health care services. Hispanics and other minorities were also less likely to have consulted a specialist in mental health (estimated relative odds, 0·37 and 0·26, respectively). This large community study extends previous work on mental health services and ethnicity.

A marginalized two-part model for longitudinal semicontinuous data

2015 ◽  
Vol 26 (4) ◽  
pp. 1949-1968 ◽  
Author(s):  
Valerie A Smith ◽  
Brian Neelon ◽  
John S Preisser ◽  
Matthew L Maciejewski
Keyword(s):  
Health Care ◽  
Health Services ◽  
Random Effect ◽  
Continuous Distribution ◽  
Health Care Expenditures ◽  
Health Services Use ◽  
Services Research ◽  
Population Mean ◽  
Semicontinuous Data ◽  
Part Model

In health services research, it is common to encounter semicontinuous data, characterized by a point mass at zero followed by a right-skewed continuous distribution with positive support. Examples include health expenditures, in which the zeros represent a subpopulation of patients who do not use health services, while the continuous distribution describes the level of expenditures among health services users. Longitudinal semicontinuous data are typically analyzed using two-part random-effect mixtures with one component that models the probability of health services use, and a second component that models the distribution of log-scale positive expenditures among users. However, because the second part conditions on a non-zero response, obtaining interpretable effects of covariates on the combined population of health services users and non-users is not straightforward, even though this is often of greatest interest to investigators. Here, we propose a marginalized two-part model for longitudinal data that allows investigators to obtain the effect of covariates on the overall population mean. The model additionally provides estimates of the overall population mean on the original, untransformed scale, and many covariates take a dual population average and subject-specific interpretation. Using a Bayesian estimation approach, this model maintains the flexibility to include complex random-effect structures and easily estimate functions of the overall mean. We illustrate this approach by evaluating the effect of a copayment increase on health care expenditures in the Veterans Affairs health care system over a four-year period.

scholarly journals 0843 Prospective Associations of Insomnia Symptoms With Health Services Use in Community-Dwelling Older Adults

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A321-A321
Author(s):  
M Tzuang ◽  
J T Owusu ◽  
J Huang ◽  
O C Sheehan ◽  
G W Rebok ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Services ◽  
Home Health Care ◽  
Home Health ◽  
Community Dwelling ◽  
Health Services Use ◽  
Ed Visits ◽  
Insomnia Symptoms ◽  
Services Use

Abstract Introduction Limited research has examined links of insomnia with health services use, particularly using claims-based data. We investigated the association of insomnia symptoms with costly health services use, measured by Medicare claims, in a nationally representative sample of U.S. older adults. Methods Participants were 4,302 community-dwelling Medicare beneficiaries aged ≥65 years from Round 1 (2011) of the National Health and Aging Trends Study who had continuous fee-for-service Medicare coverage 1 year before and after the Round 1 interview. Participants reported past-month insomnia symptoms (i.e., sleep onset latency >30 minutes, difficulty returning to sleep after early awakening) which we categorized as 0, 1, or 2 symptoms. Outcomes were linked Medicare claims occurring after Round 1 interviews: emergency department (ED) visits, all-cause hospitalizations, preventable hospitalizations, all-cause 30-day readmissions, home health care (all measured as yes/no); and number of hospitalizations and ED visits. Results Overall, 18.9% of participants were hospitalized, 29.3% visited the ED, 3.1% had a preventable hospitalization, 2.6% had a readmission, and 11.7% used home health care. After adjustment for demographics, compared to participants with no insomnia symptoms, those with 2 symptoms had a higher odds of ED visits (odds ratio (OR)=1.42, p<0.001), all-cause hospitalizations (OR=1.30, p<0.01), preventable hospitalizations (OR=1.83, p<0.05), 30-day readmissions (OR=1.73, p<0.05), and home health care use (OR=1.27, p<0.05). These associations did not hold, however, upon further adjustment for health characteristics (i.e., depressive/anxiety symptoms, medical comorbidities and BMI). After full adjustment, reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits (Incidence Rate Ratio=1.16, p<0.05). Conclusion Among older adults, a greater number of insomnia symptoms is associated with greater health services use. Insomnia symptoms may be a marker of, or exacerbate, health conditions. Targeting insomnia may lower health services use. Support National Institute on Aging: R01AG050507 & R01AG050507-02S (PI: Spira); F31-AG058389; U01AG032947 (PI: Kasper) for the National Health and Aging Trends Study. Johns Hopkins Center on Aging and Health Data Use Agreement (PI: Roth, Co-I: Sheehan) with Centers for Medicare & Medicaid Services titled, “Potentially modifiable factors influencing outcomes in NHATS.”

scholarly journals O uso seletivo do território na distribuição dos serviços de saúde: um estudo de Sobral – Ceará

2017 ◽  
Vol 11 (2) ◽  
pp. 95
Author(s):  
Maria Cássia de Sá ◽  
Virgínia Célia Cavalcante de Holanda
Keyword(s):  
Health Care ◽  
Health Services ◽  
Healthcare Services ◽  
The State ◽  
Private Health Care ◽  
Health Services Use ◽  
Public And Private ◽  
Urban Network ◽  
Palabras Clave ◽  
Services Use

ResumoNa perspectiva de captar as expressões que Sobral congrega na rede urbana cearense, nos debruçamos durante essa pesquisa no estudo do uso do território de Sobral pelos serviços de saúde. Enquanto cidade média, a referida cidade responde por uma das quatro macrorregiões de saúde no estado, reunindo estabelecimentos públicos e privados que oferecem assistência à saúde nos três níveis de complexidade que compõe a rede de ações e serviços de saúde no Brasil. Os serviços de saúde seguem a lógica de uso corporativo do território, e Sobral historicamente vem garantindo seu lugar nessa topologia.Palavras-chave: Cidade Média. Sobral. Serviços de Saúde. Uso do Território.  AbstractIn  the perspective of capturing the expressions that Sobral aggregates  in the Ceará's urban network, we worked  during this research in the study of the use of territory of Sobral by health services While average city, this city accounts for one of the four macro health regions in the state, bringing together public and private health care offers three levels of complexity that makes up the network of actions and healthcare services in Brazil. Health services, follow the logic of corporate use of the territory, and Sobral historically has guaranteed its place in this topology.Keywords: Medium City. Sobral. Health Services. Use of the territory.  ResumenEn la perspectiva de captar las expresiones que Sobral aduna en la rede urbana cearense, direccionamos esa investigación en el estudio del uso del territorio de Sobral por los servicios de salud. Mientras ciudad media, la referida ciudad revelase como una de las cuatro macro-regiones de salud en estado, reuniendo establecimientos públicos y privados que ofrecen asistencia a la salud en los tres niveles de complexidad que compone la rede de acciones y servicios de salud en Brasil. Los servicios de salud siguen a lógica de uso corporativo del territorio, y Sobral históricamente viene garantizando su sitio en esa topología. Palabras Clave:  Ciudad Media. Sobral. Servicios de salud. Uso del territorio. 

Patterns of Health Services Use Before Age 1 in Children Later Diagnosed With ADHD

2021 ◽  
Vol 25 (12) ◽  
pp. 1639-1639
Author(s):  
Matthew Engelhard ◽  
Samuel Berchuck ◽  
Jyotsna Garg ◽  
Shelley Rusincovitch ◽  
Geraldine Dawson ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Services ◽  
Health Care Utilization ◽  
Outpatient Clinic ◽  
Hospital Admissions ◽  
Care Utilization ◽  
Health Services Use ◽  
Utilization Patterns ◽  
Services Use

Background: Children with ADHD have 2 to 3 times increased health care utilization and annual costs once diagnosed, but little is known about utilization patterns early in life, prior to diagnosis. Quantifying early health services use among children later diagnosed with ADHD could help us understand the early life impact of the disorder and uncover health care utilization patterns associated with higher ADHD risk. Methods: Electronic health record (EHR) data from the Duke University Health System (DUHS) was analyzed for patients born October 1, 2006–October 1, 2016. Those with at least two well-child visits before age 1 were grouped as ADHD or not ADHD based on retrospective billing codes. Adjusted odds ratios (AORs) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression controlling for sex, race, and ethnicity. Results: ADHD diagnoses were identified in 1,315 (4.4%) of 29,929 patients meeting criteria. Before age 1, individuals with ADHD had 60% increased odds of hospital admission, 58% increased odds of visiting the emergency department, and 41% increased odds of procedures ( p < .0001), including 4.7-fold increased odds of blood transfusion ( p < .0001). They also had more outpatient clinic visits (μ = 14.7 vs. μ = 12.5, p < .0001), including 52% increased odds of visiting a medical specialist, 38% increased odds of visiting a surgical specialist, 70% increased odds of visiting a neonatologist, and 71% increased odds of visiting an ophthalmologist ( p < .0001 for all AORs). In addition, individuals with ADHD had 6-fold increased odds of visits related to child abuse and neglect ( p = .0010). Conclusions: Children later diagnosed with ADHD were more likely to be admitted to the hospital, visit the ED, and visit specific medical and surgical services before age 1. Future work will identify patterns of health interactions unique to ADHD to stratify ADHD risk.

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