scholarly journals The Determinants of Caregiver use and its Costs for Elderly Inpatients in Korea: A study applying Andersen’s behavioral model of health care utilization and replacement cost method

2021 ◽  
Author(s):  
Jennifer Ivy Kim ◽  
Sukil Kim
Keyword(s):  
Chronic Diseases ◽  
Panel Study ◽  
Positive Association ◽  
Behavioral Model ◽  
Healthcare Management ◽  
Major Type ◽  
Care Utilization ◽  
Lower Probability ◽  
P Value ◽  
Elderly Inpatients

Abstract Objectives: The average annual healthcare expenditure among elderly patients in Korea is increasing rapidly in indirect healthcare sectors, requiring an understanding of factors related to the use of both formal and informal caregivers. This study aims to analyze the factors related to caregiver use and caregiving costs among hospitalized patients due to acute illness or exacerbation of chronic diseases and whether they differ by age group.Methods: A total of 1,550 study participants from the Korea Health Panel Study Data 2017, consisting of 819 elderly inpatients and 731 nonelderly inpatients, were used for the analysis. Costing methods were applied according to the major type of caregiver during hospitalization. Predisposing, enabling, and need factors were considered to determine the possible factors associated with caregiver use. A two-part model was applied to analyze the factors related to care receiving and estimate incremental costs from care after stratifying subjects by age.Results: Elderly inpatients who used tertiary hospitals (OR: 2.44, p-value <0.00), received financial support (OR: 2.70, p-value <0.00), and had disability status (OR: 1.76, p-value <0.05) were more likely to rely on a caregiver, while elderly inpatients living by themselves had a lower probability of using caregivers (OR: 0.48, p-value <0.00). Also, there was a positive association between caregiving costs and the number of chronic diseases among elderly inpatients (β: 0.66, p-value <0.05) with incremental costs of $567.Conclusion: This study presented significant health-related and socio-environmental characteristics to the use of formal and informal caregiving and its related expenditures. Therefore, healthcare management plans that encompass clinical and social levels should be implemented to ease the caregiver burden.Trial registration: Retrospectively registered

scholarly journals The determinants of caregiver use and its costs for elderly inpatients in Korea: a study applying Andersen’s behavioral model of health care utilization and replacement cost method

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Ivy Kim ◽  
Sukil Kim
Keyword(s):  
Elderly Patients ◽  
Financial Support ◽  
Informal Caregiver ◽  
Panel Study ◽  
Positive Association ◽  
Behavioral Model ◽  
Healthcare Management ◽  
Care Utilization ◽  
P Value ◽  
Elderly Inpatients

Abstract Objectives The average annual healthcare expenditure among elderly patients in Korea is increasing rapidly in indirect healthcare sectors, requiring an understanding of factors related to the use of both formal and informal caregivers. This study analyzed the characteristics of caregiver use and caregiving costs among elderly patients hospitalized due to acute illness or exacerbation of chronic diseases. Methods A total of 819 study participants were selected from the 2017 Korea Health Panel Study Data. Replacement costing methods were applied to estimate the hours of informal caregiver assistance received by elderly inpatients. Elderly inpatients’ predisposing, enabling, and need factors were studied to identify the relationship between caregiver uses, based on Andersen’s behavior model. A two-part model was applied to analyze the factors related to care receipt and to estimate the incremental costs of care. Results Elderly inpatients who used tertiary hospitals (OR: 2.77, p-value < 0.00) and received financial support (OR: 2.68, p-value < 0.00) were more likely to receive support from a caregiver. However, elderly inpatients living alone were lesser to do so (OR: 0.49, p-value < 0.00). Elderly inpatients with Medicaid insurance (β:0.54, p-value = 0.02) or financial aid (β: 0.64, p-value < 0.00) had a statistically positive association with spending more on caregiving costs. Additionally, financial support receivers had incremental costs of $627 in caregiving costs than nonreceivers. Conclusions This study presented significant socioenvironmental characteristics of formal and informal caregiver use and the related expenditures. Healthcare management plans that encompass multiple social levels should be implemented to ease the caregiver burden. Trial registration Retrospectively registered.

scholarly journals The Potential Risk of Using Historic Claims to Set Bundled Payment Prices: The Case of Physical Therapy After Lower Extremity Joint Replacement

2021 ◽  
Author(s):  
Sander Steenhuis ◽  
Geeske Hofstra ◽  
France Portrait ◽  
Fatima Amankour ◽  
Eric van der Hijden
Keyword(s):  
Physical Therapy ◽  
Claims Data ◽  
Behavioral Model ◽  
Care Utilization ◽  
P Value ◽  
Post Discharge ◽  
Enabling Factors ◽  
Bundled Payment ◽  
Dutch Health ◽  
Pt Utilization

Abstract Background One of the most significant challenges of implementing a multi-provider bundled payment contract is to determine an appropriate, casemix adjusted total bundle price. The most frequently used approach is to leverage historic care utilization based on claims data. However, those claims data may not accurately reflect appropriate care (e.g. due to supplier induced demand and moral hazard effects). This study aims to examine variation in claims-based costs of post-discharge physical therapy (PT) utilization after total knee and hip arthroplasties (TKA/THA) for osteoarthritis patients.Methods This retrospective cohort study used multilevel linear regression analyses to predict the factors that explain the variation in the utilization of post-discharge PT after TKA or THA for osteoarthritis patients, based on the historic (2015-2018) claims data of a large Dutch health insurer. The factors were structured as predisposing, enabling or need factors according to the behavioral model of Andersen.Results The 15,309 TKA and 14,325 THA patients included in this study received an average of 20.7 (SD 11.3) and 16.7 (SD 10.1) post-discharge PT sessions, respectively. Results showed that the enabling factor ‘presence of supplementary insurance’ was the strongest predictor for post-discharge PT utilization in both groups (TKA: β=7.46, SE=0.498, p-value<0.001; THA: β=5.72, SE=0.515, p-value<0.001). There were also some statistically significant predisposing and need factors, but their effects were smaller.Conclusions This study shows that enabling factors such as the presence of supplementary insurance can cause historic claims-based pricing methods to potentially overestimate clinically appropriate post-discharge PT use, which would result in a bundle price that is too high. Clinical guidelines and best practice standards should be leveraged more often in bundled payment pricing methods to target this potentially avoidable utilization of care, and to stimulate the implementation of multi-provider bundled payment contracts.

scholarly journals Financial Resources and Later-Year Relocation From the Annuitized Assessment of Income and Assets

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 50-50
Author(s):  
Jun-Hong Chen ◽  
Sojung Park
Keyword(s):  
Older Adults ◽  
Living Arrangement ◽  
Panel Study ◽  
Behavioral Model ◽  
Well Being ◽  
Economic Factor ◽  
Health Condition ◽  
Financial Resources ◽  
Individual Level ◽  
Mortality Table

Abstract Solid evidence has shown financial resources play important roles in housing decisions among older adults. Despite the growing research on the joint assessment of income and assets as valid economic well-being, little attention is paid to its role in relocation in old age. Drawing from the Behavioral Model of Elderly Migration, this study examined to what extent financial resources are associated with the likelihood of moving in later years. The data came from the 2017 Panel Study of Income Dynamic (PSID). A sample of 1354 people, 65 years and older, was used in the analyses. We used the annuitized approach, which is different from conventional approaches that assume people draw down all available assets to satisfy daily needs and leave no assets for use in later years. We (1) assessed annuitized assets based on the 2019 IRS Mortality Table, (2) assessed yearly income using supplementary income (i.e. income plus non-discretionary expense). A final indicator of the summed score was used in a logistic regression to predict the likelihood of moving. A set of covariates known to affect later- year relocation at an individual level (e.g. health condition, living arrangement change), environmental level (e.g. rural, non-metro area) are controlled for. In clear conflict with previous studies, we found annual financial resources did not significantly influence relocation among older adults. The notable absence of the well-known role of the economic factor provides critical initial evidence about the importance of simultaneous assessment of financial resources for the literature on later year relocation.

Plasma glycerophospholipid profile, erythrocyte n–3 PUFAs, and metabolic syndrome incidence: a prospective study in Chinese men and women

2021 ◽  
Author(s):  
Shuangshuang Chen ◽  
Qingqing Wu ◽  
Li Zhu ◽  
Geng Zong ◽  
Huaixing Li ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Fatty Acids ◽  
Polyunsaturated Fatty Acids ◽  
Animal Studies ◽  
Plasma Concentrations ◽  
Positive Association ◽  
Community Dwelling ◽  
P Value ◽  
Total N ◽  
Long Chain

ABSTRACT Background Animal studies have highlighted critical roles of glycerophospholipid (GP) metabolism in various metabolic syndrome (MetS)-related features such as dyslipidemia, obesity, and insulin resistance. However, human prospective studies of associations between circulating GPs and risks of MetS are scarce. Objectives We aimed to investigate whether GPs are associated with incidence of MetS in a well-established cohort. Methods A total of 1243 community-dwelling Chinese aged 50–70 y without MetS at baseline and followed up for 6 y were included in current analyses. A total of 145 plasma GPs were quantified by high-throughput targeted lipidomics. MetS was defined using the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. Results After 6 y, 429 participants developed MetS. Eleven GPs, especially those with long-chain polyunsaturated fatty acids (LCPUFAs) or very-long-chain polyunsaturated fatty acids (VLCPUFAs) at the sn-2 position, including 1 phosphatidylcholine (PC) [PC(18:0/22:6)], 9 phosphatidylethanolamines (PEs) [PE(16:0/22:6), PE(18:0/14:0), PE(18:0/18:1), PE(18:0/18:2), PE(18:0/20:3), PE(18:0/22:5), PE(18:0/22:6), PE(18:1/22:6), and PE(18:2/22:6)], and 1 phosphatidylserine (PS) [PS(18:0/18:0)], were positively associated with incident MetS (RRs: 1.16–1.30 per SD change; Bonferroni-corrected P &lt; 0.05). In network analysis, the strongest positive association for MetS incidence was evidenced in a module mainly composed of PEs containing C22:6 and PSs [RR: 1.21; 95% CI: 1.12, 1.31 per SD change; Bonferroni-corrected P &lt; 0.05]. This association was more pronounced in participants with lower erythrocyte total n–3 PUFA concentrations [Bonferroni-corrected Pinter(P value for the interaction)&lt; 0.05]. Conclusions Elevated plasma concentrations of GPs, especially PEs with LCPUFAs or VLCPUFAs at the sn-2 position, are associated with higher risk of incident MetS. Future studies are merited to confirm our findings.

scholarly journals Case Study of Pediatric Cerebral Sinus Venous Thrombosis Center of a Low Middle-Income Country

2021 ◽  
Vol 27 ◽  
pp. 107602962110228
Author(s):  
Bushra Moiz ◽  
Ronika Devi Ukrani ◽  
Aiman Arif ◽  
Inaara Akbar ◽  
Muhammed Wahhaab Sadiq ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Care Center ◽  
Tertiary Care ◽  
Age Groups ◽  
Activated Protein C ◽  
Positive Association ◽  
Cerebral Venous Sinus Thrombosis ◽  
P Value ◽  
Middle Income ◽  
Duration Of Symptoms

Pediatric cerebral venous sinus thrombosis (CVST) is rare but a potentially fatal disease requiring its understanding in local setting. In this study, we observed the clinical course, management, and outcome of pediatric patients with sinus thrombosis in a tertiary care center at Pakistan. Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were included. Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Of 143492 pediatric admissions, 32 (21 males and 11 females) patients with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 18.5 CVST events per million pediatric admissions. Adolescents were mostly affected, and the overall mortality was 7%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Activated protein C resistance (44%) was the most common inherited thrombophilia. Twenty-one (66%) patients were anemic with a mean (±SD) hemoglobin of 9.0 g/dL (±2.3). Regression analysis showed a positive association of anemia with multiple sinus involvement ( P-value 0.009) but not with duration of symptoms ( P-value 0.344), hospital stay ( P-value 0.466), age ( P-value 0.863) or gender ( P-value 0.542) of the patients. SARS-COV2 was negative in patients during 2020. Adolescents were primarily affected by sinus thrombosis and infections was the predominant risk factor for all age groups, with a low all-cause mortality. A high index of clinical suspicion is required for prompt diagnosis and intervention.

Computerization and Occupational Change: Assessing the Impact of Automation on Racial and Gender Employment Densities

2021 ◽  
pp. 003464462110552
Author(s):  
Patrick L. Mason
Keyword(s):  
Positive Association ◽  
Racial Group ◽  
High Density ◽  
Economic Effects ◽  
Ethnic Composition ◽  
White Female ◽  
Lower Probability ◽  
Minority Men ◽  
And Gender ◽  
The Impact

The current wave of technological change is driven by automation, the process of using computers to improve the labor process, viz., increasing the quantity and quality of work “by means of computer-controlled equipment.” Automation has had and will continue to have heterogeneous economic effects across alternative social groups—altering racial and gender inequality. This study empirically examines the relationship between the racial and gender density of occupations and the probability of automation of both minor and broad occupations. Regression analysis is used to uncover correlations between future employment change and the current racial and ethnic composition of occupations, alerting us to whether future employment growth will have a negative or positive association with occupations where each racial group of workers is currently concentrated. Increases in automation are correlated with increases in labor income inequality and increases in racial and gender employment differences. Male jobs may suffer more technological unemployment than female jobs. Specifically, within each racial group high density male jobs have a greater probability of automation (and lower probability of future demand) than high density female jobs. High density White female jobs appear to be most complementary to automation, while the high density occupations of racial minority men appear to be least complementary to automation.

Abstract P685: Primary Care Utilization for Primary Prevention Continues to Be Lacking in Patients With Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexander J Senetar ◽  
Daniel A Bonnin ◽  
Hannah E Branstetter ◽  
Alexis N Simpkins ◽  
Keyword(s):  
Primary Care ◽  
Regression Analysis ◽  
Primary Prevention ◽  
Hemoglobin A1c ◽  
Care Utilization ◽  
P Value ◽  
Stroke Severity ◽  
Institutional Review ◽  
And Gender ◽  
Ischemic Attack

Introduction: Primary care plays an essential role in stroke prevention. Yet still, for many stroke patients, a relationship with a primary care provider (PCP) is not established until after stroke. Our goal was to determine if lack of PCP and the consequential differences in management affects stroke severity. Methods: Data was obtained from our Institutional Review Board approved stroke admission database from 2017 to November 2019 of all stroke subtypes (ischemic stroke, transient ischemic attack, subarachnoid and intracerebral hemorrhages). Non-parametric Mann Whitney t-test and regression analysis was used to identify significant differences in medications, stroke risk factors and stroke severity. Results: A total of 559 patients were included, median age 67 (interquartile range (IQR) 58-76), 49% woman, 32% established care with a PCP, 36% on medications for diabetes mellitus (DM), 42% hyperlipidemia, 66% anti-hypertensives, 39% anti-platelet agents, and 10% anticoagulation. More patients with PCP were taking anti-hypertensive medications (80% versus (vs) 60%, p value < 0.0001), DM medications (56% vs 30%, p value < 0.0001), anti-platelet agents (46% vs 35%, p value = 0.0149), and medications for hyperlipidemia (49% vs 39%, p value = 0.0426). Admission NIHSS was lower in patients with a PCP median 6 (IQR 3-11) vs median 9 (IQR 4 -15), p value= 0.0016, and median hemoglobin A1c was higher in patients with a PCP 8 (IQR 5.7- 9.3) vs patients without a PCP prior to their stroke 6 (IQR 5.4 - 8.5), p value= 0.0002. Admitting systolic blood pressure was similar 155 (137-177) vs 152 (134-171). After correcting for age and gender, regression analysis demonstrated a significant association between whether a patient had PCP and antihypertensive medication use (odds ratio (OR) 2.413, 95% confidence interval 1.511 - 3.914) and hemoglobin A1c (OR 1.122, 95% CI 1.037 - 1.215). Also, patients with a PCP were more likely to have a lower NIHSS on admission (OR 0.9679, 95% CI 0.9423 - 0.9930). Conclusions: These result show that patients not followed by a PCP prior to stroke are less likely to be on medications for primary prevention of stroke, contributing to an increased stroke severity on admission. More research is needed to identify barriers to patients establishing care with PCP.

scholarly journals Anthropometric indices are associated with LDL cholesterol in postmenopausal Javanese women

2014 ◽  
Vol 13 (2) ◽  
pp. 124-127
Author(s):  
Syaefudin Ali Akhmad
Keyword(s):  
Postmenopausal Women ◽  
Ldl Cholesterol ◽  
Total Cholesterol Level ◽  
Lipid Level ◽  
Medical Science ◽  
Positive Association ◽  
Abdominal Circumference ◽  
P Value ◽  
Anthropometric Indices ◽  
Significant Positive Association

Introduction: Lipid abnormalities are seen to be linked lack of physical activity, obesity, metabolic syndrome and diabetes mellitus. Postmenopausal women experience the changes of body composition by increasing the visceral fat. The study was aimed to explore relationship between anthropometric indices and lipid level in postmenopausal Javanese women. Methods: This cross sectional study included 34 healthy postmenopausal Javanese women, age range between 46-59 years, from Dusun Trukan, Karanggede dan Marangan Prambanan subdistrict, Sleman district. Anthropometric measurements were carried following standard procedure. Appropriate statistical tools were used to analyze data using SPSS Version 17. A p value <0.05 was taken as level of significance. Results: Abdominal circumference showed significant positive association with LDL level (r=0.289, p=0.049) but not with triglyceride, HDL level and total cholesterol level. BMI also showed significant positive association with LDL level (r=0.336, p=0.026) but not with other variables. Conclusion: The data concluded that abdominal circumference and BMI are positively association with LDL cholesterol but not with other components of the lipid profile in Javanese postmenopausal women. Further studies, however, needed to warranted to understand the causal relationship involving large number of subjects multiple centres. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18293 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.124-127

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