scholarly journals Reducing Health Care Costs and Improving Clinical Outcomes Using an Improved Asheville Project Model

2015 ◽  
Vol 6 (4) ◽  
Author(s):  
Barry A. Bunting ◽  
Deepika Nayyar ◽  
Christine Lee
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Electronic Record ◽  
The Body ◽  
Control Group ◽  
Original Research ◽  
Group Model ◽  
Care Providers ◽  
Project Model ◽  
Care Costs

This study was designed to add to the body of knowledge gained through the original Asheville Project studies, and to address some of the limitations of the earlier studies. Scalability. Since the original Asheville Project publications there have been some successful replications, however, there is a need to broaden the geographic scope and increase the size of the study population. Study Design. Previous studies were limited to pre-post, self-as-control design. We added a control group. Model improvement. We were able to incorporate an electronic record of care. This allows incorporation of medical and prescription claims, ease of documentation, improved data capture, reporting, standardization of care, identification of deficiencies in care, and communication with other health care providers. This enhancement may be worthy of more comment than we devoted to it , however, we didn’t want to detract from the main goal of the study, and we wanted to avoid any hint of commercialization on the part of the organization that provided the electronic record. Relevance to profession. We sincerely hope the relevance goes beyond the profession of pharmacy and that it reinforces the message that the profession of pharmacy offers real solutions to rising health care costs in the U.S.   Type: Original Research

Life Themes: A Method to Understand Terminal Illness

1995 ◽  
Vol 31 (3) ◽  
pp. 189-206 ◽  
Author(s):  
Debbie Messer Zlatin
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Terminal Illness ◽  
Terminally Ill ◽  
Care Providers ◽  
Incurable Cancer ◽  
Doctor Patient Communication ◽  
The Patient’S View ◽  
Care Costs

As health care costs in general soar, the high cost of terminal care is questioned. Yet little is known about what kinds of medical care terminally ill persons, themselves, want. To explore the patient's view, I conducted a qualitative study of eight patients with incurable cancer to answer the question, “How do terminally ill persons understand their illnesses and treatments?” Analysis of interview transcripts indicated that study participants created illness-understandings within the context of their daily life experiences via life themes. Since life themes integrate and give meaning to illness events in both emic and etic ways and help to explain patients' coping strategies, it is recommended that health care providers elicit patients' life themes and use them in their approaches to diagnosis and treatment. The possible benefits of the life theme method are more balanced doctor/patient communication, improved patient satisfaction and quality of life, and the containment of health care costs.

User Fees for Health Care: Why a Bad Idea Keeps Coming Back (Or, What's Health Got to Do With It?)

1995 ◽  
Vol 14 (2) ◽  
pp. 360-390 ◽  
Author(s):  
Robert G. Evans ◽  
Morris L. Barer ◽  
Greg L. Stoddart
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Final Analysis ◽  
User Fees ◽  
Care Providers ◽  
Positive Effects ◽  
The Face ◽  
Care Costs

ABSTRACTCalls for user fees in Canadian health care go back as far as the debate leading up to the establishment of Canada's national hospital insurance program in the late 1950s. Although the rationales have shifted around somewhat, some of the more consistent claims have been that user fees are necessary as a source of additional revenue for a badly underfunded system, that they are necessary to control runaway health care costs, and that they will deter unnecessary use (read abuse) of the system. But the real reasons that user fees have been such hardy survivors of the health policy wars, bear little relation to the claims commonly made for them. Their introduction in the financing of hospital or medical care in Canada would be to the benefit of a number of groups, and not just those one usually thinks of. We show that those who are healthy, and wealthy, would join health care providers (and possibly insurers) as net beneficiaries of a reintroduction of user fees for hospital and medical care in Canada. The flip side of this is that those who are indigent and ill will bear the brunt of the redistribution (for that is really what user fees are all about), and seniors feature prominently in those latter groups. Claims of other positive effects of user fees, such as reducing total health care costs, or improving appropriateness or accessibility, simply do not stand up in the face of the available evidence. In the final analysis, therefore, whether one is for or against user fees reduces to whether one is for or against the resulting income redistribution.

scholarly journals Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs

2017 ◽  
Vol 76 (1) ◽  
pp. 89-114 ◽  
Author(s):  
Courtney Harold Van Houtven ◽  
Valerie A. Smith ◽  
Karen M. Stechuchak ◽  
Megan Shepherd-Banigan ◽  
Susan Nicole Hastings ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Family Caregivers ◽  
Health Care Costs ◽  
Care Utilization ◽  
Control Group ◽  
Veteran Health ◽  
Primary Specialty ◽  
Veteran Health Care ◽  
Care Costs

This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how Veterans’ use of Veteran Affairs health care and total health care costs changed in 6-month intervals up to 3 years after PCAFC enrollment. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC. Veterans in PCAFC had similar acute care utilization postenrollment when compared with those in the control group, but significantly greater primary, specialty, and mental health outpatient care use at least 30, and up to 36, months postenrollment. Estimated total health care costs for PCAFC Veterans were $1,500 to $3,400 higher per 6-month interval than for control group Veterans. PCAFC may have increased Veterans’ access to care.

scholarly journals Falls in the Medicare Population: Incidence, Associated Factors, and Impact on Health Care

2009 ◽  
Vol 89 (4) ◽  
pp. 324-332 ◽  
Author(s):  
Anne Shumway-Cook ◽  
Marcia A Ciol ◽  
Jeanne Hoffman ◽  
Brian J Dudgeon ◽  
Kathryn Yorkston ◽  
...  
Keyword(s):  
Health Care ◽  
Activities Of Daily Living ◽  
Health Care Costs ◽  
Fall Prevention ◽  
Daily Living ◽  
Associated Factors ◽  
Care Providers ◽  
Medicare Population ◽  
Recurrent Falls ◽  
Care Costs

Background and Purpose Falls are a major health problem in the elderly community; however, questions regarding incidence, risk factors, and provider response to falls exist. The purpose of this study was to examine the incidence of falls, associated factors, health care costs, and provider response to falls among Medicare beneficiaries. Participants The participants were 12,669 respondents to the Medicare Current Beneficiaries Survey (MCBS). Methods Categories of number of falls (none, one, recurrent) and injury type (medically injurious versus not medically injurious) were created from the falls supplement to the MCBS. Means and proportions for the entire Medicare population were estimated using sampling weights. The association between sociodemographic variables and fall status was modeled using ordinal or binary logistic regression. Aggregate health costs by fall category were estimated from claims data. Results Population estimates of falls reported in 2002 ranged from 3.7 million (single fall) to 3.1 million (recurrent falls), with an estimated 2.2 million people having a medically injurious fall. Recurrent falls were more likely with increased age, being female, being nonwhite, reporting fair or poor health, and increased number of limitations in personal activities of daily living and instrumental activities of daily living and comorbidities. Although estimates of the actual costs of falls could not be determined, “fallers” consistently had larger utilization costs than “nonfallers” for the year 2002. Fewer than half (48%) of the beneficiaries reported talking to a health care provider following a fall, and 60% of those beneficiaries reported receiving fall prevention information. Discussion and Conclusions Falls are common and may be associated with significant health care costs. Most importantly, health care providers may be missing many opportunities to provide fall prevention information to older people.

scholarly journals Total health insurance costs in children with a migraine diagnosis compared to a control group

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Viola Obermeier ◽  
Monika Murawski ◽  
Florian Heinen ◽  
Mirjam N. Landgraf ◽  
Andreas Straube ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Costs ◽  
Control Group ◽  
Health Insurance Data ◽  
German Health ◽  
Excess Costs ◽  
Headache Diagnosis ◽  
Migraine Group ◽  
Care Costs

Abstract Background Health care costs of migraine constitute a major issue in health economics. Several publications analyzed health care costs for adult migraine patients, based on questionnaires or secondary (health insurance) data. Although migraine often starts already in primary school age, data on migraine related costs in children is scarce. In this paper we aimed to assess the migraine-related health care costs in 6 to 11 year old children in Germany. Methods Using claims data of a large German health insurer (BARMER), overall annual health care costs of 6 to 11 year old children with a diagnosis of migraine in 2017 (n = 2597) were compared to a control group of 6 to 11 year old children without a headache diagnosis between 2013 and 2017 (n = 306,926). The association of migraine and costs was modeled by generalized linear regression (Gamma regression) with adjustment for sex, age and comorbidities. Results Children with migraine caused considerably higher annual per capita health care costs than children without a headache diagnosis (migraine group: € 1018, control group: € 618). Excess costs directly related to migraine amounted to € 115. The remaining excess costs were related to comorbidities, which were more frequent in the migraine group. Mental and behavioural disorders constituted the most expensive comorbidity, accounting for € 105 of the € 400 annual excess costs in the migraine group. Conclusion 6 to 11 year old children with a migraine diagnosis cause significant direct and comorbidity related excess costs in the German health care system.

scholarly journals P041: Point-of-care ultrasound utilization and monetary outcomes (POCUMON) study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S79-S79
Author(s):  
D. Rusiecki ◽  
S. Douglas ◽  
C. Bell
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Point Of Care ◽  
Cost Savings ◽  
Flank Pain ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Imaging Studies ◽  
Patient Assessments ◽  
Care Costs

Introduction: Point-of-care ultrasound (POCUS) is an integral tool in the modern emergency physician's toolkit. Evidence suggests many imaging and lab investigations are ordered without true medical indications; it is unknown how POCUS utilization impacts health care costs at a patient level. The purpose of this study was to assess whether POCUS use in the emergency department (ED) was associated with cost savings via decreased laboratory and radiographic testing. Methods: POCUMON is a single-center, prospective pilot study. The participants were a convenience sample of ED staff physicians and PGY-5 Emergency Medicine (EM) residents working in the ED from July-October 2019. Physicians who used POCUS as part of their assessment had the cost of their patient investigation plans compared with those proposed by a control group of ED physicians simultaneously on-shift. The control group was blinded to the POCUS findings but had access to the patient and medical record. The lab investigations and imaging studies ordered by both groups were recorded with respective costs. Data were analyzed using a paired T-test, with sub-group analyses. Ethics approval was obtained from the Queen's University HSREB (No.6026732). Results: 50 patient assessments using POCUS were captured in the study period. 76% of patient assessments were performed by EM staff physicians; 94% of control assessments were provided by EM staff physicians. Patient chief complaints included abdominal pain (7), chest pain/dyspnea (10), flank pain (3), pregnancy concerns (4), trauma (7), extremity complaints (4), back pain (3), and other (12). The POCUS group had a trend for lower number of laboratory tests (4.7 ± 0.44 vs 5.22 ± 0.39; p = 0.28) and imaging studies (0.94 ± 0.14 vs 1.1 ± 0.11; p = 0.33). Overall health care costs were similar in both groups, with a trend to cost savings in the POCUS group ($142.00 ± 15.44 vs $174.60 ± 17.00; p = 0.12). Subgrouping identified significant cost savings in the POCUS group for patients with a chief complaint of flank pain ($43.64 vs $248.82, p = 0.01). Conclusion: POCUS use was not associated with significant health care cost savings. ED POCUS usage did see a trend towards decreased laboratory and imaging investigations. Patients presenting with flank pain had significantly lower expenditures associated with their visit when POCUS was incorporated into their assessment. Large scale prospective studies are needed to investigate if POCUS is associated with cost-savings in ED patients.

P3812The economic burden of heart failure in Denmark from 1998 to 2016

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J S Bundgaard ◽  
U M Mogensen ◽  
S Christensen ◽  
U M Ploug ◽  
R Roerth ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care Costs ◽  
Economic Burden ◽  
Indirect Costs ◽  
Economic Consequences ◽  
Control Group ◽  
Background Population ◽  
The Individual ◽  
Care Costs

Abstract Background Heart failure (HF) imposes a large burden on the individual as well as society and the aim of this study was to investigate the economic burden attributed to direct and indirect costs of patients with HF before, at, and after time of diagnosis. Methods Using Danish nationwide registries we identified all patients >18 years with a first-time diagnosis of HF from 1998–2016 and matched them 1:1 with a control group from the background population on age, gender, marital status, and educational level. The economic analysis of the total costs after diagnosis was based on direct costs including hospitalization, procedures, medication, and indirect costs including social welfare and lost productivity to estimate the annual cost of HF. Results We included a total of 176,067 HF patients with a median age of 76 years, and 55% were male. Patients with HF incurred an average of €17,039 in sum of total annual direct (€11,926) and indirect (€5,113) health-care costs peaking at year of diagnosis compared to €5,936 in the control group with the majorityattributable to inpatient admissions. The total annual net costs including social transfer after index HF were €11,957 higher in patients with HF compared to controls and the economic consequences increased markedly 2 years prior to the diagnosis of HF (Figure 1). Conclusion Patients with HF impose significantly higher total annual health-care costs compared to a matched control group with findings evident more than 2 years prior to HF diagnosis Acknowledgement/Funding Novartis

Avalanche or Glacier?: Health Care and the Demographic Rhetoric

1995 ◽  
Vol 14 (2) ◽  
pp. 193-224 ◽  
Author(s):  
Morris L. Barer ◽  
Robert G. Evans ◽  
Clyde Hertzman
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Costs ◽  
Common Finding ◽  
Care Providers ◽  
Term Care ◽  
The Past ◽  
Effects Of Aging ◽  
Care Costs ◽  
Care System

ABSTRACTClaims that the health care system is about to be engulfed in a “wave of grey” have become commonplace. Recent cost escalation is commonly attributed to the aging of the population, and there is no shortage of dire warnings about the cost implications of the even more dramatic aging, and costs, still to come. These claims have been largely unsubstantiated. Yet they persist for a number of reasons. First, over long periods of time, the effects of demographic trends can be (and probably will be) quite substantial. But these effects move like glaciers, not avalanches. Second, the effects of aging populations on some types of services which cater differentially to seniors will be much more dramatic; observers of those sub-sectors (such as long-term care) tend to extrapolate that sector-specific experience to health care generally. Third, at the “coal-face,” health care providers are seeing their practices become ever more dominated by seniors. They mistake this increased “presence” of patients aged 65 and over in their practices as evidence of the effects of demographic changes. In this paper we discuss each of these sources of error about the effects of aging population on health care costs. We focus primarily on the confusion between changes in patterns of care for particular age groups, and changes in overall levels of care. Quite extensive empirical evidence has been collected over the past decade from analyses of British Columbia data bases, and these findings are not unique, in Canada, or beyond. The common finding of this body of research is that population aging has accounted for very little of the increase in health care costs over the past three decades, in Canada or elsewhere. Health care utilization has increased dramatically among seniors. But this has had less to do with the fact that there are more of them, than with the fact that the health care system is doing much more to (and for) them than was the case even a decade ago. This suggests that the appropriate care of elderly people should be a central issue for health care policy and management, but that demographic issues are, in the short run at least, largely a red herring.

Freestanding Emergency Centers: Regulation and Reimbursement

1985 ◽  
Vol 11 (1) ◽  
pp. 105-129
Author(s):  
Mitchell Katzman
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Health Care Providers ◽  
Health Care Market ◽  
Care Providers ◽  
Emergency Rooms ◽  
Hospital Emergency ◽  
Efficient Manner ◽  
Additional Layer ◽  
Care Costs

AbstractThe freestanding emergency center, which combines the functions of a doctor's office and a hospital emergency room, has emerged as a new provider of health care. These centers have generated considerable controversy over their role in the health care market. Proponents argue that freestanding emergency centers reduce costs by providing care in a more efficient manner and cause other health care providers such as hospital emergency rooms to reduce costs and improve service. Opponents argue that the centers create an additional layer of health care which duplicates existing services and increases total health care costs. This Note examines the controversial issues of licensure, regulation and reimbursement. The Note concludes that freestanding emergency centers can help to reduce health care costs and discusses the steps that should be taken to aid centers in achieving this goal.

scholarly journals A Retrospective Analysis of Precision Medicine Outcomes in Patients With Advanced Cancer Reveals Improved Progression-Free Survival Without Increased Health Care Costs

2017 ◽  
Vol 13 (2) ◽  
pp. e108-e119 ◽  
Author(s):  
Derrick S. Haslem ◽  
S. Burke Van Norman ◽  
Gail Fulde ◽  
Andrew J. Knighton ◽  
Tom Belnap ◽  
...  
Keyword(s):  
Health Care ◽  
Precision Medicine ◽  
Advanced Cancer ◽  
Health Care Costs ◽  
Metastatic Cancer ◽  
Progression Free Survival ◽  
Control Group ◽  
Free Survival ◽  
Cancer Medicine ◽  
Care Costs

Purpose: The advent of genomic diagnostic technologies such as next-generation sequencing has recently enabled the use of genomic information to guide targeted treatment in patients with cancer, an approach known as precision medicine. However, clinical outcomes, including survival and the cost of health care associated with precision cancer medicine, have been challenging to measure and remain largely unreported. Patients and Methods: We conducted a matched cohort study of 72 patients with metastatic cancer of diverse subtypes in the setting of a large, integrated health care delivery system. We analyzed the outcomes of 36 patients who received genomic testing and targeted therapy (precision cancer medicine) between July 1, 2013, and January 31, 2015, compared with 36 historical control patients who received standard chemotherapy (n = 29) or best supportive care (n = 7). Results: The average progression-free survival was 22.9 weeks for the precision medicine group and 12.0 weeks for the control group ( P = .002) with a hazard ratio of 0.47 (95% CI, 0.29 to 0.75) when matching on age, sex, histologic diagnosis, and previous lines of treatment. In a subset analysis of patients who received all care within the Intermountain Healthcare system (n = 44), per patient charges per week were $4,665 in the precision treatment group and $5,000 in the control group ( P = .126). Conclusion: These findings suggest that precision cancer medicine may improve survival for patients with refractory cancer without increasing health care costs. Although the results of this study warrant further validation, this precision medicine approach may be a viable option for patients with advanced cancer.

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