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Biomedical subjects

Donald Fetterolf

Publications and source records attributed to Donald Fetterolf.

8 recordsLinked to original sources
PubMed2006

National evaluation of adherence to beta-blocker therapy for 1 year after acute myocardial infarction in patients with commercial health insurance.

BACKGROUND: Quality measures of evidence-based medications post-myocardial infarction have focused on prescription at hospital discharge. Yet survival benefits of these medications are best realized with sustained therapy. We sought to examine long-term beta-blocker adherence over the first year after myocardial infarction in patients with commercial health insurance and prescription drug benefits. METHODS: This multicenter analysis examined health plan records from members of 11 health plans who had myocardial infarction in 2001, survived at least 1 year, and maintained insurance coverage (N = 17,035). The primary outcome measure was adherence to beta-blockers (defined as prescription claims covering > or = 75% of days) for 360 days post-discharge. We also examined associations with adherence--time from discharge, health plan product (commercial or Medicare + Choice [M + C]), age (35-64 or > or = 65), sex, and region. RESULTS: For 360 days after discharge, only 45% of patients were adherent to beta-blockers, with the biggest drop in adherence between 30 and 90 days. In a multivariable model, statistically significant predictors of lower adherence were participation in M + C product, residence in the Southeast, and age (driven by young participants in M + C and young females in commercial products). CONCLUSIONS: In a population of patients with health insurance and prescription drug coverage, adherence to beta-blocker therapy in the first year after myocardial infarction is poor, indicating that factors other than medication cost are important determinants of long-term adherence. Quality improvement initiatives focused on long-term adherence are needed to realize maximal benefit from medical therapy in post-myocardial infarction patients.

Adrenergic beta-Antagonists↗
PubMed2006

Notes from the field: the economic value chain in disease management organizations.

The disease management (DM) "value chain" is composed of a linear series of steps that include operational milestones in the development of knowledge, each stage evolving from the preceding one. As an adaptation of Michael Porter's "value chain" model, the process flow in DM moves along the following path: (1) data/information technology, (2) information generation, (3) analysis, (4) assessment/recommendations, (5) actionable customer plan, and (6) program assessment/reassessment. Each of these stages is managed as a major line of product operations within a DM company or health plan. Metrics around each of the key production variables create benchmark milestones, ongoing management insight into program effectiveness, and potential drivers for activity-based cost accounting pricing models. The value chain process must remain robust from early entry of data and information into the system, through the final presentation and recommendations for our clients if the program is to be effective. For individuals involved in the evaluation or review of DM programs, this framework is an excellent method to visualize the key components and sequence in the process. The value chain model is an excellent way to establish the value of a formal DM program and to create a consultancy relationship with a client involved in purchasing these complex services.

Delivery of Health Care↗
PubMed2005

Specialty pharmacy: an emerging area of interest for medical management.

Specialty pharmaceuticals are expensive injectable and infusion therapies used to treat patients with chronic or life-threatening diseases. The high cost of these agents and their frequent usage in chronic diseases represent not only challenges, but also opportunities for medical management programs to improve the quality of care and moderate the rapid cost escalation seen in the industry. The number and variety of these agents have been increasing significantly, with hundreds of drug candidates in the development pipeline. The specialty pharmacy industry also is going through a consolidation stage, both horizontally and vertically. Industry approaches to medical management include the acquisition of specialty pharmacy companies, restrictive contracting to achieve concentrated buying power, and the development of utilization management strategies.

Chronic Disease↗
PubMed2004

Assessing return on investment of defined-population disease management interventions.

BACKGROUND: Strategies to reduce health expenditures through the improvement of health and quality of care are in high demand. A group of experts formed a nonpartisan, independent work group, under the sponsorship of the National Managed Health Care Congress. Its goal was to establish a list of easy-to-understand, actionable, and usable recommendations to enable disease management program advocates to conduct basic-level evaluations. RECOMMENDATIONS: The work group made recommendations concerning identification of reference and intervention population, population definitions, quantitative methods and data quality, confounding and bias, and stakeholder agreements/contracting. CASE STUDY: A case study was created to quantitatively illustrate some of the major issues raised by the work group. Five typical errors were simulated by applying different rules to the intervention population than to the reference population: differential inclusion (high versus low risk), differential exclusion (high versus low risk) and differential claims run-out. Compared with the true impact, four of the five errors resulted in a bias toward "intervention effect," while one (differential inclusion of high-risk patients) was biased against the "intervention effect." The direction and magnitude of the bias in natural settings will not necessarily follow this pattern.

Advisory Committees↗
PubMed2004

Estimating the return on investment in disease management programs using a pre-post analysis.

Disease management programs have become increasingly popular over the past 5-10 years. Recent increases in overall medical costs have precipitated new concerns about the cost-effectiveness of medical management programs that have extended to the program directors for these programs. Initial success of the disease management movement is being challenged on the grounds that reported results have been the result of the application of faulty, if intuitive, methodologies. This paper discusses the use of "pre-post" methodology approaches in the analysis of disease management programs, and areas where application of this approach can result in spurious results and incorrect financial outcome assessments. The paper includes a checklist of these items for use by operational staff working with the programs, and a comprehensive bibliography that addresses many of the issues discussed.

Cost-Benefit Analysis↗
PubMedDate not supplied

Analysis of a large cohort of health maintenance organization patients with congestive heart failure.

The aim of this article was to measure guideline compliance in the care of health plan members diagnosed with congestive heart failure (CHF). Chart review was conducted on members with a discharge diagnosis of CHF (n = 2,697). Information was entered onto a scannable form designed by the health plan, which was coupled to an optical character recognition reader and entered into a database. Eighty-four percent of the patients had an ejection fraction (EF) measured. An angiotensin-converting enzyme inhibitor was prescribed to 72% of patients with an EF less than 40%. Comorbidities and other measures were evaluated and based on guideline recommendations. Most of the CHF patients in this health plan are being treated appropriately during posthospitalization for CHF. The use of a novel, cost-effective method for data collection resulted in the rapid acquisition of clinical data for analysis.

Adult↗
PubMedDate not supplied

The business case for quality: combining medical literature research with health plan data to establish value for nonclinical managers.

Clinical managers face a growing need to communicate the value of what they do in terms that can be interpreted by nonclinical financial managers. We have sought to link the evidence basis of current guidelines to variables that will demonstrate in more financial terms the very real benefit of treating diseases aggressively. We have developed an approach using the medical literature that is designed to describe clinical initiatives in more concrete terms as desired by senior management. This becomes specifically critical during budget time and when justification for various clinical programs is needed. The approach uses medical research from the peer-reviewed literature to estimate the economic impact of various initiatives and then combines the analysis with an organization's actual data to impute potential benefit. A sample grid for developing the analysis is attached. A comprehensive bibliography that will assist others with similar endeavors has been included. Although not as rigorous as formal methods, actuarial analyses, or health services research activities, it presents a beginning framework around which an organization can create operational estimates of initiative effectiveness.

Financial Management↗