A Simulation Framework for Evaluating the Effectiveness of Chronic Disease Management Interventions

2014 ◽  
Vol 6 (4) ◽  
pp. 40-59 ◽  
Author(s):  
Rafael Diaz ◽  
Joshua G. Behr
Keyword(s):  
Health Outcomes ◽  
Chronic Conditions ◽  
The United States ◽  
Dynamics Simulation ◽  
Contributory Factor ◽  
Simulation Framework ◽  
Management Intervention ◽  
Management Interventions ◽  
Intervention Cost ◽  
Financial Consequences

The treatment and management of chronic diseases currently comprise a major fraction of the United States' healthcare expenditures. These expenses are projected to increase as the US population ages. Utilization of the ambulatory healthcare system stemming from chronic conditions has been seen as contributory factor in the rising expenditures. Efforts to better manage chronic conditions ought to result in better health outcomes and, by extension, savings through lower utilization of ambulatory services. The longer-term financial consequences of such interventions, however, are more uncertain. This study offers a System Dynamics simulation framework that identifies and models the critical relationships associated with health outcomes and longer-term financial consequences. This framework is demonstrated through a comparison between groups with a similar generic chronic condition, but one group is subjected to a management intervention and the other group is not. The framework provides constructive insights into how the initial intervention cost estimates, the resulting savings, and the health status may change depending on uncertainties, feedback effects, and cost structures.

A Simulation Framework for Evaluating the Effectiveness of Chronic Disease Management Interventions

2018 ◽  
pp. 455-474
Author(s):  
Rafael Diaz ◽  
Joshua G. Behr
Keyword(s):  
Health Outcomes ◽  
Chronic Conditions ◽  
Dynamics Simulation ◽  
Contributory Factor ◽  
Simulation Framework ◽  
Management Intervention ◽  
Cost Structures ◽  
Initial Intervention ◽  
Financial Consequences ◽  
Ambulatory Services

The treatment and management of chronic diseases currently comprise a major fraction of the United States' healthcare expenditures. These expenses are projected to increase as the US population ages. Utilization of the ambulatory healthcare system stemming from chronic conditions has been seen as contributory factor in the rising expenditures. Efforts to better manage chronic conditions ought to result in better health outcomes and, by extension, savings through lower utilization of ambulatory services. The longer-term financial consequences of such interventions, however, are more uncertain. This study offers a System Dynamics simulation framework that identifies and models the critical relationships associated with health outcomes and longer-term financial consequences. This framework is demonstrated through a comparison between groups with a similar generic chronic condition, but one group is subjected to a management intervention and the other group is not. The framework provides constructive insights into how the initial intervention cost estimates, the resulting savings, and the health status may change depending on uncertainties, feedback effects, and cost structures.

scholarly journals SELF-MANAGEMENT INTERVENTIONS IN DIALYSIS FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S69-S69
Author(s):  
Tiffany R Washington ◽  
Chivon Mingo ◽  
Matthew L Smith
Keyword(s):  
Chronic Conditions ◽  
Management Program ◽  
Self Management ◽  
Dialysis Patients ◽  
Management Intervention ◽  
Management Interventions ◽  
Implementation Studies ◽  
Dialysis Facilities ◽  
The Relationship ◽  
Management Behaviors

Abstract There have been few attempts to implement self-management interventions in dialysis facilities. This paper presentation describes four studies that constitute the formative work necessary to inform implementation. Studies one and two examined the relationship between psychosocial factors and kidney disease self-management, finding depression and cognitive decline to undermine self-management behaviors. Study three examined how dialysis patients define and think about self-management and their interest in participating in a self-management program. Among them, 78% affirmed they would participate in a self-management program if it were offered in their facility. Finally, when examining organizational readiness to implement a self-management intervention in dialysis facilities, staff perceived it to be consistent with facility values, and agreed they were well-positioned to implement the program. Taken together, these findings suggest a self-management intervention would be beneficial and supported, but would require thoughtful implementation considerations. These studies have implications for developmental self-management research with other chronic conditions.

scholarly journals Does Sexual Orientation Influence Trajectories of Change in Health? A 20-Year Follow-Up Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 517-517
Author(s):  
Christi Nelson ◽  
Ross Andel
Keyword(s):  
Social Support ◽  
Sexual Orientation ◽  
Health Outcomes ◽  
Chronic Conditions ◽  
Negative Binomial ◽  
Functional Limitations ◽  
Functional Limitation ◽  
The United States ◽  
And Bisexual ◽  
Over Time

Abstract We examined the differences in physical health outcomes over a 20-year period between lesbian, gay, and bisexual (LGB) and heterosexual middle-aged and older adults. We also examined whether the associations were moderated by social support and affect. The analytical sample included 168 LGB adults and 336 propensity-matched heterosexual adults from the Midlife in the United States (MIDUS) study, ranging in age from 25 to 74 years (mean age=42.83) at baseline. Using negative binomial generalized estimating equations and mixed-effects analyses, data from three waves of MIDUS, spanning approximately 20 years from 1995 to 2014, were used to examine the associations between sexual orientation and the health outcomes (number of chronic conditions and functional limitations). Social support and affect were added to the models to test for moderation. The results found that LGB participants reported one more chronic condition at baseline and scored significantly higher for functional limitations. However, LGB participants increased less over time for number of chronic conditions than heterosexual participants, and there were no significant differences in terms of changes in functional limitation over time. Positive affect reduced the strength of the relationship between sexual orientation and functional limitations for LGB participants. No other moderating effects were significant. The results of this study suggest that LGB individuals may become resilient to the negative health effects of minority stressors over time. Interventions should focus on improving the health of LGB individuals when they are younger and more at risk of negative health outcomes.

Health Outcomes and Health Care Utilization Among Obstetric Deliveries With Concurrent CKD in the United States

2020 ◽  
Vol 75 (1) ◽  
pp. 148-150 ◽  
Author(s):  
Andrea L. Oliverio ◽  
Lindsay K. Admon ◽  
Laura H. Mariani ◽  
Tyler N.A. Winkelman ◽  
Vanessa K. Dalton
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
Health Outcomes ◽  
The United States ◽  
Care Utilization

scholarly journals Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

2021 ◽  
Author(s):  
Gayathri S. Kumar ◽  
Jenna A. Beeler ◽  
Emma E. Seagle ◽  
Emily S. Jentes
Keyword(s):  
Health Outcomes ◽  
Physical Health ◽  
Public Health Practice ◽  
The United States ◽  
Inclusion Criteria ◽  
Physical Health Outcomes ◽  
Increased Risk ◽  
The Us ◽  
Bhutanese Refugee

AbstractSeveral studies describe the health of recently resettled refugee populations in the US beyond the first 8 months after arrival. This review summarizes the results of these studies. Scientific articles from five databases published from January 2008 to March 2019 were reviewed. Articles were included if study subjects included any of the top five US resettlement populations during 2008–2018 and if data described long-term physical health outcomes beyond the first 8 months after arrival in the US. Thirty-three studies met the inclusion criteria (1.5%). Refugee adults had higher odds of having a chronic disease compared with non-refugee immigrant adults, and an increased risk for diabetes compared with US-born controls. The most commonly reported chronic diseases among Iraqi, Somali, and Bhutanese refugee adults included diabetes and hypertension. Clinicians should consider screening and evaluating for chronic conditions in the early resettlement period. Further evaluations can build a more comprehensive, long-term health profile of resettled refugees to inform public health practice.

scholarly journals More Than Shelter: Housing for Urban Maternal and Infant Health

2021 ◽  
Vol 18 (7) ◽  
pp. 3331
Author(s):  
Jason Reece
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Health Outcomes ◽  
City Planning ◽  
Infant Health ◽  
The United States ◽  
Housing Quality ◽  
Housing Discrimination ◽  
Maternal Health Outcomes ◽  
The Impact

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

scholarly journals Hispanic/Latino Ethnic Identity and Diabetes: An Examination of Underlying Acculturation Processes and the Hispanic/Latino Health Advantage

2021 ◽  
Vol 48 (3) ◽  
pp. 285-294
Author(s):  
Jeannie B. Concha ◽  
Kristen Kelly ◽  
Briana Mezuk
Keyword(s):  
Ethnic Identity ◽  
Confidence Interval ◽  
Health Outcomes ◽  
Physical Health ◽  
Odds Ratio ◽  
Well Being ◽  
The United States ◽  
Diabetes Prevalence ◽  
Physical Health Outcomes ◽  
The Relationship

Background. Hispanics/Latinos in the United States experience both a health advantage and disadvantage in developing diabetes. Ethnic identity, a predictor of psychological well-being, has not been widely applied to physical health outcomes. The objective of this study is to apply what is known regarding ethnic identity and psychological health to physical health outcomes (diabetes) and to explore the moderating effect of education as a possible underlying mechanism of the Hispanic Health Advantage/Disadvantage. Specifically, this study examines (a) the association between ethnic identity and diabetes prevalence among adult Hispanics/Latinos and (b) determines whether education modifies this relationship. Method. Data come from the nationally representative adult U.S. household study, National Latino and Asian American Study (NLAAS), collected in 2001 to 2003 ( N = 1,746). Multiple logistic regression was conducted to examine the relationship between ethnic identity, education, and their interaction with likelihood of diabetes. Results. Hispanics/Latinos with high ethnic identity have a higher odds of reporting diabetes among those with 13 to 15 years of education (odds ratio: 1.84; 95% confidence interval: 1.16–2.92) and a lower odds among those with 16+ years of education (odds ratio: 0.53; 95% confidence interval: 0.34–0.84). Ethnic identity is associated with diabetes prevalence and the relationship is moderated by educational attainment. Conclusion. Given the growth, diversity, and diabetes disparities among Hispanics/Latinos, our buffering and exacerbating findings exemplify the complexity and fluidity of theory in understanding psychological/behavioral processes. The findings highlight the importance of designing targeted health interventions that take into account the diverse psychosocial and educational experiences of Hispanics/Latinos.

scholarly journals The Impacts of Discrimination and Filial Caregivers’ Age on Aspects of Physical Health

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 360-360
Author(s):  
Barbara Hodgdon ◽  
Jen Wong
Keyword(s):  
Physical Health ◽  
Family Caregivers ◽  
Family Caregiving ◽  
Chronic Conditions ◽  
The United States ◽  
Life Course Perspective ◽  
Late Adulthood ◽  
Study Results ◽  
The Face ◽  
The Impact

Abstract Filial caregivers (e.g., individuals caring for a parent or parent-in-law) are a part of the growing number of family caregivers in midlife and late adulthood. The responsibilities that filial caregivers navigate in midlife and late adulthood may expose them to multiple types of discrimination that may decrease their physical health, though this relationship has been understudied. As numbers of family caregivers grow, it is important to examine the potential vulnerability of younger and older filial caregivers’ physical health in the context of discrimination. Informed by the life course perspective, this study compares the physical health of younger (aged 34-64) and older (aged 64-74) filial caregivers who experience discrimination. Filial caregivers (N=270; Mage=53; SD=9.37) from the Midlife in the United States (MIDUS-II) Survey reported on demographics, family caregiving, daily discrimination, self-rated physical health, and chronic conditions via questionnaires and phone interviews. Regression analyses showed no differences between younger and older adults’ self-rated physical health or average chronic conditions. However, moderation analyses revealed that younger filial caregivers who experienced greater discrimination reported poorer self-rated physical health than their older counter parts as well as younger and older filial caregivers who experienced less discrimination. Additionally, younger caregivers with greater discrimination exposure exhibited more number of chronic conditions as compared to other caregivers. The study results highlight the impact of the intersection between filial caregivers’ age and discrimination on physical health. Findings have the potential to inform programs that could promote the health of filial caregivers in the face of discrimination.

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