scholarly journals Institutionalization-Free Survival and Health Care Costs among Quebec Community-Dwelling Elderly Patients with Dementia

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Sarah-Gabrielle Beland ◽  
Antoine Pariente ◽  
Yola Moride
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Costs ◽  
Reference Population ◽  
Community Dwelling ◽  
Third Party ◽  
Published Data ◽  
Administrative Claims ◽  
Free Survival ◽  
Care Costs

Background. Published data on burden of dementia mainly include patients of third-care facilities. Economic consequences in an outpatient setting remain poorly examined. Objectives. To evaluate institutionalization-free survival and direct health care costs of dementia in the Quebec community-dwelling elderly population. Methods. A retrospective cohort study was conducted using the Quebec administrative claims databases. The cohort included a random sample of patients with treated dementia between January 1, 2000, and December 31, 2009 (n=37,138). The reference population included elderly patients without dementia matched in age group, gender, and index date. Using a third-party payer perspective, direct costs over 5 years were assessed. Results. Institutionalization-free survival at 5 years was lower in patients with dementia than in elderly without dementia (38.9% and 72.2%, resp.). Over 5 years, difference in mean total direct health care costs per patient was CAD$19,159, distributed into institutionalizations (CAD$13,598), hospitalizations (CAD$3,312), and prescribed medications (CAD$2,320). Costs of medical services were similar (−CAD$96). In the first year of followup, cost differentials were mainly attributable to hospitalizations, while in the last year (year 5) they were due to institutionalizations. Conclusion. This study confirms that dementia is an important socioeconomic burden in the community, the nature of which depends on disease progression.

Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery

2019 ◽  
Vol 24 (3) ◽  
pp. 219-226 ◽  
Author(s):  
Keith B. Allen ◽  
Ethan Y. Brovman ◽  
Adnan K. Chhatriwalla ◽  
Katherine J. Greco ◽  
Nikhilesh Rao ◽  
...  
Keyword(s):  
Health Care ◽  
Cardiac Surgery ◽  
Pain Management ◽  
Length Of Stay ◽  
Health Care Costs ◽  
Adverse Drug Events ◽  
Management Strategies ◽  
Coronary Bypass ◽  
Administrative Claims ◽  
Care Costs

Purpose. Opioid-related adverse drug events (ORADEs) increase patient length of stay (LOS) and health care costs. However, ORADE rates may be underreported. This study attempts to understand the degree to which ORADEs are underreported in Medicare patients undergoing cardiac surgery. Materials and Methods. The Center for Medicare and Medicaid Services administrative claims database was used to identify ORADEs in 110 158 Medicare beneficiaries who underwent cardiac valve (n = 50 525) or coronary bypass (n = 59 633) surgery between April 2016 and March 2017. The International Classification of Disease (ICD)-10 codes specifically linked to ORADEs were used to identify an actual ORADE rate, while additional ICD codes, clinically associated with butas not specific to adverse drug events were analyzed as potential ORADEs. Length of stay (LOS) and hospital daily revenue were analyzed among patients with or without a potential ORADE. Results. Among patients undergoing valve or bypass surgery, the documented ORADE rate was 0.7% (743/110 158). However, potential ORADEs may have occurred in up to 32.4% (35 658/110 158) of patients. In patients with a potential ORADE, mean LOS was longer (11.4 vs 8.2 days; P < .0001) and mean Medicare revenue/day was lower ($4016 vs $4412; P < .0001). The mean net difference in revenue/day between patients with and without an ORADE varied between $231 and $1145, depending on the Diagnosis-Related Group analyzed. Conclusions. ORADEs are likely underreported following cardiac surgery. ORADEs can be associated with increased LOS and decreased hospital revenue. Understanding the incidence and economic impact of ORADEs may expedite changes to postoperative pain management. Adopting multimodal pain management strategies that reduce exposure to opioids may improve outcomes by reducing complications, side effects, and health care costs.

scholarly journals Multidimensional sleep health and subsequent health-care costs and utilization in older women

SLEEP ◽  
2019 ◽  
Vol 43 (2) ◽  
Author(s):  
Kristine E Ensrud ◽  
Allyson M Kats ◽  
John T Schousboe ◽  
Lisa Langsetmo ◽  
Tien N Vo ◽  
...  
Keyword(s):  
Health Care ◽  
Depressive Symptoms ◽  
Older Women ◽  
Health Care Costs ◽  
Functional Limitations ◽  
Community Dwelling ◽  
Medical Conditions ◽  
Sleep Health ◽  
Five Dimensions ◽  
Care Costs

Abstract Study Objectives Determine the association of poor multidimensional sleep health with health-care costs and utilization. Methods We linked 1,459 community-dwelling women (mean age 83.6 years) participating in the Study of Osteoporotic Fractures Year 16 visit (2002–2004) with their Medicare claims. Five dimensions of sleep health (satisfaction, daytime sleepiness, timing, latency, and duration) were assessed by self-report. The number of impaired dimensions was expressed as a score (range 0–5). Total direct health-care costs and utilization were ascertained during the subsequent 36 months. Results Mean (SD) total health-care costs/year (2017 dollars) increased in a graded manner across the sleep health score ranging from $10,745 ($15,795) among women with no impairment to up to $15,332 ($22,810) in women with impairment in three to five dimensions (p = 0.01). After adjustment for age, race, and enrollment site, women with impairment in three to five dimensions vs. no impairment had greater mean total costs (cost ratio [CR] 1.34 [95% CI = 1.13 to 1.60]) and appeared to be at higher risk of hospitalization (odds ratio (OR) 1.31 [95% CI = 0.96 to 1.81]). After further accounting for number of medical conditions, functional limitations, and depressive symptoms, impairment in three to five sleep health dimensions was not associated with total costs (CR 1.02 [95% CI = 0.86 to 1.22]) or hospitalization (OR 0.91 [95% CI = 0.65 to 1.28]). Poor multidimensional sleep health was not related to outpatient costs or risk of skilled nursing facility stay. Conclusions Older women with poor sleep health have higher subsequent total health-care costs largely attributable to their greater burden of medical conditions, functional limitations, and depressive symptoms.

scholarly journals Direct Access Compared With Referred Physical Therapy Episodes of Care: A Systematic Review

2014 ◽  
Vol 94 (1) ◽  
pp. 14-30 ◽  
Author(s):  
Heidi A. Ojha ◽  
Rachel S. Snyder ◽  
Todd E. Davenport
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Physical Therapy ◽  
Patient Outcomes ◽  
Health Care Costs ◽  
Third Party ◽  
Direct Access ◽  
Physician Referral ◽  
Episodes Of Care ◽  
Care Costs

Background Evidence suggests that physical therapy through direct access may help decrease costs and improve patient outcomes compared with physical therapy by physician referral. Purpose The purpose of this study was to conduct a systematic review of the literature on patients with musculoskeletal injuries and compare health care costs and patient outcomes in episodes of physical therapy by direct access compared with referred physical therapy. Data Sources Ovid MEDLINE, CINAHL (EBSCO), Web of Science, and PEDro were searched using terms related to physical therapy and direct access. Included articles were hand searched for additional references. Study Selection Included studies compared data from physical therapy by direct access with physical therapy by physician referral, studying cost, outcomes, or harm. The studies were appraised using the Centre for Evidence-Based Medicine (CEBM) levels of evidence criteria and assigned a methodological score. Data Extraction Of the 1,501 articles that were screened, 8 articles at levels 3 to 4 on the CEBM scale were included. There were statistically significant and clinically meaningful findings across studies that satisfaction and outcomes were superior, and numbers of physical therapy visits, imaging ordered, medications prescribed, and additional non–physical therapy appointments were less in cohorts receiving physical therapy by direct access compared with referred episodes of care. There was no evidence for harm. Data Synthesis There is evidence across level 3 and 4 studies (grade B to C CEBM level of recommendation) that physical therapy by direct access compared with referred episodes of care is associated with improved patient outcomes and decreased costs. Limitations Primary limitations were lack of group randomization, potential for selection bias, and limited generalizability. Conclusions Physical therapy by way of direct access may contain health care costs and promote high-quality health care. Third-party payers should consider paying for physical therapy by direct access to decrease health care costs and incentivize optimal patient outcomes.

Disease-Related and All-Cause Health Care Costs of Elderly Patients With Gout

2008 ◽  
Vol 14 (2) ◽  
pp. 164-175 ◽  
Author(s):  
Eric Q. Wu ◽  
Pankaj A. Patel ◽  
Andrew P. Yu ◽  
Reema R. Mody ◽  
Kevin E. Cahill ◽  
...  
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Costs ◽  
Care Costs

P4-163: HEALTH CARE COSTS AMONG NEWLY DIAGNOSED ALZHEIMER'S DISEASE PATIENTS IN A REAL-WORLD ADMINISTRATIVE CLAIMS DATABASE

2006 ◽  
Vol 14 (7S_Part_28) ◽  
pp. P1501-P1502
Author(s):  
Rezaul Karim Khandker ◽  
Richard B. Lipton ◽  
Ellen Thiel ◽  
Matthew Brouillette ◽  
Christopher M. Black
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health Care ◽  
Health Care Costs ◽  
Real World ◽  
Administrative Claims ◽  
Newly Diagnosed ◽  
Claims Database ◽  
Care Costs

scholarly journals PDB37 FACTORS ASSOCIATED WITH HEALTH CARE COSTS AMONG ELDERLY PATIENTS WITH DIABETIC NEUROPATHY

2008 ◽  
Vol 11 (3) ◽  
pp. A229
Author(s):  
L Boulanger ◽  
Y Zhao ◽  
Y Bao ◽  
C Cai ◽  
W Ye ◽  
...  
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Diabetic Neuropathy ◽  
Health Care Costs ◽  
Factors Associated ◽  
Care Costs
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