Browsing by Author "Ling, You-Li"
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Item Adherence to antidepressants and healthcare resource utilization and costs among medicare advantage beneficiaries with Parkinson’s disease and depression(2016-08) Ling, You-Li; Rascati, Karen L.; Barner, Jamie C; Wilson, James P; Lawson, Kenneth A; Suehs, Brandon TDepression is the most common comorbid psychiatric disorder in patients with Parkinson’s disease (PD) and imposes a significant negative impact on PD. Studies have shown that antidepressants (ADs) may both treat depression and ameliorate its negative effects on PD. However, little has been reported regarding how improved adherence to antidepressants affects the outcomes among PD patients with depression. The purpose of this study was to examine antidepressant use patterns (adherence, persistence, switching, and combination therapy) and evaluate the associated healthcare utilization and costs in PD patients with comorbid depression. A retrospective cohort analysis using claims data from the Humana healthcare insurance plan (2007-2010) was conducted. Medicare Advantage with Prescription Drug (MAPD) Plan insured patients with ADs and a diagnosis of both depression and PD were identified and followed for one year. Healthcare resource utilization and costs were compared between adherent and non-adherent AD users while adjusting for demographic and clinical covariates. Adherence was defined as having at least 80 percent of AD coverage for the year, using proportion of days covered (PDC) calculations. A total of 856 PD patients initiating AD treatment were included. Less than half (N= 355 (41.5%) were considered adherent. The mean PDC (±SD) for antidepressants was 0.63 (± 0.31). The mean persistence (using a 30-day gap period) for antidepressants was 194 days. Having a regimen modification, (11% of patients had switching or combination therapy) was associated with a greater likelihood of being adherent (odds ratio = 2.97, 95% CI = [1.88, 4.68], p < 0.001) and a lower likelihood of discontinuation (hazard ratio = 0.63, 95% CI = [0.47, 0.84], p = 0.0016). After adjusting for covariates, adherent AD users had fewer all-cause and PD-related inpatient visits (all p < 0.05). Adherent AD users also had lower all-cause nursing facility, inpatient, emergency room (ER), and total costs (all p < 0.05) than non-adherent AD users. However, the results were no longer significant when assessing PD-related costs. In conclusion, regimen modification (switching, or combination therapy) to antidepressants was associated with better adherence and persistence in depressed PD patients. Adherent AD users had some lower healthcare utilization and costs than non-adherent AD users among depressed PD patients.Item Outcomes and expenditures of clostridium difficile infection in pediatric solid organ transplant recipients(2014-05) Ling, You-Li; Rascati, Karen L.The main purpose of this study was to assess outcomes (i.e., inpatient mortality, transplant failure or rejection, colectomy, and hospital length of stay) of clostridium difficile infection (CDI) and the association of expenditures (i.e., charges and costs) and CDI in pediatric solid organ transplant (SOT) recipients. Data from the 2000, 2003, 2006, and 2009 Kids’ Inpatient Database (KID) files were used to identify events with SOT- related ICD-9-CM diagnosis codes. Logistic regression was used to assess the association of CDI and dichotomous outcome variables, while log-linked gamma regression models were used to assess the association of CDI and continuous outcome variables. Methods accounting for the complex survey sample design of the KID were used when performing all statistical analyses. The total number of pediatric SOT hospital events was 48,286. The overall prevalence of CDI for pediatric SOT hospitalizations was 1.76%. For SOT hospitalizations with CDI, inpatient mortality was 1.63%; the prevalence of transplant failure or rejection events was 27.71%; the prevalence of a colectomy was 4.86%. The median hospital length of stay was seven days; the median charge and cost for each hospitalization was $48,409 and $17,412, respectively. The results showed that CDI was not significantly associated with inpatient mortality or transplant failure/ rejection in pediatric SOT hospitalizations. SOT patients with CDI were 2.6 times more likely to have a colectomy than SOT patient without CDI. The mean hospital length of stay (LOS) for a SOT admission with CDI was approximately 2 times the mean LOS for a SOT admission without CDI. The mean charges and the mean costs for a SOT admission with CDI was approximately 2 times that for a SOT admission without CDI. In conclusion, CDI diagnoses were not significantly associated with higher inpatient mortality or transplant failure/ rejection for pediatric SOT hospitalizations. But CDI was significantly associated with a higher prevalence of a colectomy, longer hospital LOS, higher charges, and higher costs (all p<0.05). To avoid substantially higher expenditures and health care utilization, CDI in pediatric SOT recipients should be prevented when possible and promptly diagnosed and treated when it occurs.