Browsing by Subject "Medical care, Cost of"

Now showing 1 - 4 of 4

Clinical and economic impacts of a pharmacist-managed anticoagulation clinic
(2006) Doan, QuynhChau Diem; Shepherd, Marvin D.
Dynamics of health and employment : theory, evidence and policy implications
(2007-05) Han, Xiaoshu, 1977-; Cooper, Russell W., 1955-
Essays on the Economic and Clinical Impact of Health Information Technology
(2019-05) Bao, Chenzhang
The U.S. healthcare system is characterized as inefficient, with excessive expenditure but low care quality. Recent healthcare reform aims to address these concerns and advocates health information technology (IT) as a key component to assist in this goal. In this dissertation, we study the role of health IT innovations under the value-based care structure in reducing cost, boosting quality of care, and improving healthcare efficiency. In the first essay, we focus on the Medicare Accountable Care Organization (ACO) program, which is a major healthcare payment reform initiative. We find that electronic health record (EHR) as an enabler of health information exchange enhances the association between ACO efficiency and quality of care. Our results indicate that meaningful use of EHR contributes to the capability to pursue both performance dimensions with respect to delivery of high-quality care in an efficient manner. In the second essay, we further verify that health information sharing is beneficial in terms of shorter emergency department wait time, reduced inpatient expense, and lower length of stay. However, it is not easy to exchange patient health records across providers. We empirically show that hospitals that adopt electronic medical records (EMR) from commercial vendors are more likely to exchange clinical data when compared to hospitals that use self-developed EMR systems. We also find that both participating in a health information exchange (HIE) and using the same EMR as other regional peer hospitals contribute to the capability of communicating patient data. In the third essay, we focus on patient-centric health IT, termed “patient portals”. We examine the impact of effective usage of patient portal technologies on health outcomes of congestive heart failure patients. We observe that frequent usage of clinical-oriented features, including viewing lab results, requesting medication refills and advice, and interactive messaging with providers, is associated with improvements in several health outcome measures with respect to the frequency of inpatient and emergency visits, readmission risk, and length of hospital stay. Collectively, this dissertation reveals the impact and the mechanism through which health IT systems are improving healthcare delivery, thereby providing a foundation to better understand the role of health IT in the era of healthcare reform. We posit that our findings provide implications associated with the adoption and usage of health IT for healthcare practitioners and policy makers, in an endeavor to revive the U.S. healthcare system.
Total and segmented direct cost-of-care for stage IV non-small cell lung cancer in a privately insured population
(2011-05) Bell, Allison Miriam; Koeller, Jim; Frei, Christopher; Ryan, Laurajo; Penrod, John
Introduction: New treatments for stage IV (adv) NSCLC have emerged this past decade. Recent pharmacoeconomic research has focused on cost of treatment, comparative costs of therapies, and cost/cost effectiveness of adding a biologic to traditional therapy. Drug cost is thought to be a primary driver of cost change in NSCLC, yet to our knowledge, characterization of the direct cost of NSCLC has not been published since the new treatments have emerged in the guidelines. Our primary objective was to characterize the direct and segmented cost of adv NSCLC from 2000-9. We also want to determine cost impact of new therapies, and cost trend from 2000-9. Methods: This PharMetrics claims database study includes diagnosed NSCLC patients [greater than or equal to] 20 yo. Small cell lung cancer was excluded. Claims were divided into disease segments and time periods representative of changes in therapy ("pre" (2000-2), "transition" (2003-5), and "current" (2006-9) periods). Descriptive statistics (median, interquartile range (IQR)), chi-square test (nominal data), and Wilcoxan rank sum tests were performed on the data. To adjust for baseline confounders, multivariate least squares regression models were created. Results: Costs are reported as medians in terms of per patient per month (pppm). Overall monthly cost (n=969) was $10,281 pppm. Diagnosis cost $6,601 pppm, active treatment cost $9,287 pppm, and end-of life cost $12,215 pppm. There was no difference in cost between the “transition” (n=439) and “current” (n=503) periods overall or for any segment of disease. Comorbidities had no effect on cost. For patients receiving at least 5 months of active treatment medication (n=316) total median cost was $144,147 per patient ($9,371 pppm). Discussion: There was no difference in cost between the transition and current periods, in regards to either overall cost or segmented cost. The most expensive segment was end-of-life, with a median cost exceeding $12,000 pppm. Surprisingly, comorbidities had no effect on cost. Newer agents (biologics, TKIs, and pemetrexed) represent only a modest portion of cost, with a majority of cost for stage IV NSCLC comprised of non-drug costs.