Biomedical subjects

A Elixhauser

Publications and source records attributed to A Elixhauser.

8 recordsLinked to original sources

PubMed1992

Financial implications of implementing standards of care for diabetes and pregnancy.

This article examines the financial implications of implementing standards of care for pregnancy among women with diabetes, including both the costs of enhanced treatment and the savings of avoided adverse outcomes. Numerous studies have demonstrated the harmful effects of poor blood glucose control for both mother and fetus. Standards set forth by the American Diabetes Association aim to reduce maternal complications and fetal adverse outcomes, such as congenital malformations. Because the precise configuration of resources required to meet these standards was not outlined in the American Diabetes Association statement, a panel of physicians (all specialists in pregnancy care for women with diabetes) was convened to develop a model program. Implementing such a program during the preconception and prenatal periods will represent an intensification of resource use in the outpatient setting. However, through these preventive measures, medical care costs for maternal and fetal complications can be avoided.

Female↗

PubMed1991

Costs of breast cancer and the cost-effectiveness of breast cancer screening.

Breast cancer is the second leading cause of death by cancer among women in the United States. The total cost of illness for breast cancer has been estimated to be $3.8 billion, of which $1.8 billion represents medical care costs. It has been estimated that breast cancer detected early is considerably less expensive than when the tumor is discovered at a later stage. Mass screening using mammography can improve early detection by as much as 15-35%. Cost-effectiveness studies have estimated that the costs of breast cancer screening range between $13,200 and $28,000 per year of life saved. The cost-effectiveness of breast cancer screening in the 40-49-year-old age group is controversial. Mass screening for breast cancer will probably increase total health care costs, but when all economic costs are included, screening appears to be more cost-effective than not screening.

Adult↗

PubMed1991

A study of gastroenterologists in the United States.

A two-part study of gastroenterologists (GEs) was conducted. One component was the analysis of 1987 Part B Medicare Annual Data to assess volume of services and patterns of reimbursement to gastroenterologists. This study demonstrated that two-thirds of services billed by GEs are medical visits, whereas two-thirds of GEs' income is derived from endoscopies. Five endoscopies account for 50% of GEs' allowed charges. Correcting for case-mix and geographic location, GEs' charges for endoscopies are still 10% higher than other physicians performing the same procedures. The second component of the study was a survey of 379 members of three major gastroenterological associations. Demographic and practice characteristics are reported and compared, when possible, with other physician specialties. Respondents estimated they spent 52 h/wk in inpatient and outpatient activities, of which 17.5 h were spent performing endoscopies. Fewer than 50% of respondents billed for 31.4 h of professional activity each week. Medicare patients comprise 38.2% of their patients. Most physicians did not balance-bill, or balance-billed Medicare patients only when they were able to pay. Malpractice premiums have risen from $6,511 to $9,540 during the past 3 yr. Over 95% of respondents were able to correctly identify those conditions requiring upper gastrointestinal (UGI) endoscopy and colonoscopy.

Endoscopy, Digestive System↗

PubMed1990

Estimating costs in the economic evaluation of medical technologies.

The complexities and nuances of evaluating the costs associated with providing medical technologies are often underestimated by analysts engaged in economic evaluations. This article describes the theoretical underpinnings of cost estimation, emphasizing the importance of accounting for opportunity costs and marginal costs. The various types of costs that should be considered in an analysis are described; a listing of specific cost elements may provide a helpful guide to analysis. The process of identifying and estimating costs is detailed, and practical recommendations for handling the challenges of cost estimation are provided. The roles of sensitivity analysis and discounting are characterized, as are determinants of the types of costs to include in an analysis. Finally, common problems facing the analyst are enumerated with suggestions for managing these problems.

Cost-Benefit Analysis↗

PubMed1990

The effects of monitoring and feedback on compliance.

A two-group randomized experimental design was employed to assess the effects of monitoring and feedback on the compliance of 93 psychiatric outpatients treated with lithium. Compliance in both groups was measured using self-report, lithium level, appointment-keeping, and medication refill frequency. The experimental group was also monitored using a unique electronic device that records the time and day pills are removed. At the midpoint of the study, the experimental group received feedback about serum lithium levels and patterns of removing medications from the monitoring device while the control group received feedback about serum lithium levels only. The study demonstrated no sustained effect of the monitoring and feedback interventions on compliance.

Adult↗

PubMed1990

A comparison of in-house and regionalized computerized tomography scanning: clinical impact and cost.

Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were obtained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing services. Finally, a high-efficiency in-house machine was used. Clinical outcomes and costs of diagnosing 181 bronchogenic cancer patients were compared across the three time periods to identify any differences associated with regionalization of CT services. Patient groups were homogeneous with respect to sociodemographic characteristics, clinical presentation, and severity of disease. The first part of the analysis investigated whether the site of CT scanning affected clinical outcomes. Diagnostic procedures, surgical results, mortality, and length of stay were compared using one-way analysis of variance. Significant differences were found only for conventional tomography and CT utilization rates. While conventional tomography declined across the periods, CT utilization increased, exceeding national trends. The second part of the analysis examined the costs of CT scanning. During the regionalized period, the hospital paid a fixed fee of $519 per scan. Estimated costs of in-house scans were $285 in the low-efficiency and $141 in the high-efficiency periods. Charge-based payments made to the external facility and differences in the volumes of patients scanned internally account for the cost differences. The analysis showed that while regionalized CT scanning did not compromise the quality of care for these VA patients, it was more costly. Results suggest that VA hospital administrators should carefully consider ownership and payment arrangements when comparing regionalized and in-house provision of services.

Aged↗

PubMed1990

The costs of smoking and the cost effectiveness of smoking-cessation programs.

The impact of cigarette smoking on morbidity and mortality in this country is enormous. It is the cause of one out of every six deaths in the U.S., and is linked to conditions ranging from cardiovascular disease to cancer to low-birth weight. Economic analyses indicate that cessation of cigarette smoking will probably not lead to reduced health care expenditures in the general population because of increased health care utilization during those years of life saved as a result of cessation. However, when indirect costs (economic productivity) are taken into account, cessation of cigarette smoking appears to be cost saving. In addition, for particular subgroups (such as pregnant women and post-myocardial infarction patients), there may be health-care cost savings. Cost-effectiveness analyses of smoking cessation methods are reviewed. A relatively narrow range of smoking cessation methods has been evaluated for cost effectiveness. There is some evidence that cost-effective smoking cessation programs are tailored to the target population and consist of multiple interventions with reinforcement of the cessation techniques or messages. Equity considerations demand that smoking cessation programs not be chosen simply on the basis of their cost effectiveness because it is likely that certain groups (such as minorities or heavy smokers) will not be targeted. Some potentially efficacious smoking cessation methods such as bans on smoking in public places and excise taxes are not easily assessable using cost-effectiveness methodology.

Cost-Benefit Analysis↗

PubMed1989

Practice pattern variation between two medical schools.

This study examined physician test-ordering behavior at a large urban Veterans Administration Medical Center staffed by two medical schools. Patients are assigned randomly to the two schools' wards, which operate independently of each other. The medical records of 119 patients, admitted during a 5-month period, were abstracted for data on the process and outcomes of medical care. Only one statistically significant difference in diagnostic testing practices was revealed by the observation that 12% of patients on one service received another abdominal film, while no patients on the other service did. The implications of studies such as this for small-area analysis are discussed. If variation in the utilization of health services is observed in a geographic region, then a study of physician behavior at a single facility may help to identify the reason for the variation.

Diagnosis-Related Groups↗