Biomedical subjects

G Edward Miller

Publications and source records attributed to G Edward Miller.

8 recordsLinked to original sources

PubMed2006

Trends in prescription drug expenditures by Medicaid enrollees.

OBJECTIVE: As prescription drug expenditures consume an increasingly larger portion of Medicaid budgets, states are anxious to control drug costs without endangering enrollees' health. In this report, we analyzed recent trends in Medicaid prescription drug expenditures by therapeutic classes and subclasses. Identifying the fastest growing categories of drugs, where drugs are grouped into clinically relevant classes and subclasses, can help policymakers decide where to focus their cost containment efforts. METHODS: We used data from the Medical Expenditure Panel Survey linked to a prescription drug therapeutic classification system, to examine trends between 1996/1997 and 2001/2002 in utilization and expenditures for the noninstitutionalized Medicaid population. We separated aggregate trends into changes in population with use and changes in expenditures per user, and percent generic. We also highlighted differences within the Medicaid population, including children, adults, disabled, and elderly. RESULTS: We found rapid growth in expenditures for antidepressants, antipsychotics, antihyperlipidemics, antidiabetic agents, antihistamines, COX-2 inhibitors, and proton pump inhibitors and found evidence supporting the rapid take-up of new drugs. In some cases these increases are the result of increased expenditures per user and in other cases the overall growth also comes from an increase in the population with use. CONCLUSIONS: Medicaid programs may want to reassess their cost-containment policies in light of the rapid take-up of new drugs. Our analysis also identifies areas in which more information is needed on the comparative effectiveness of new versus existing treatments.

Adolescent↗

PubMed2006

Children and antibiotics: analysis of reduced use, 1996-2001.

OBJECTIVES: We investigated trends in antibiotic use by U.S. children, from 1996 to 2001, a period that followed the launch of national campaigns to promote the appropriate use of antibiotics. DATA AND METHODS: We used nationally representative data from the Medical Expenditure Panel Survey for the years 1996-2001 to examine trends in antibiotic use and the contributions of changes in ambulatory visits and prescribing to these trends. We investigated trends in the use of antibiotics overall and for respiratory tract infections and examined these trends within subgroups of children defined by race/ethnicity and income. RESULTS: From 1996 to 2001, the proportion of children with antibiotic use overall and for respiratory tract infections decreased by 8.5 percentage points and 5.1 percentage points, respectively. Overall, the probability of a child having an ambulatory visit did not change. The decrease in overall antibiotic use resulted entirely from an increase in the probability that a child had an ambulatory visit(s) with no antibiotic use. By contrast, a decline in the probability that a child had a visit for a respiratory tract infection accounted for two-thirds of the reduction in antibiotic use for these conditions. The decline in overall use for white-other non-Hispanic children (-10.2 percentage points) was more than double the decline for black non-Hispanic or Hispanic children. CONCLUSION: Children's use of antibiotics, overall and for respiratory tract infections, showed significant declines from 1996 to 2001. The apparent response to campaigns to reduce inappropriate antibiotic use was widespread as reductions in use were found in all subgroups of children examined.

Adolescent↗

PubMed2005

Expected linking error resulting from item parameter drift among the common Items on Rasch calibrated tests.

In state assessment programs that employ Rasch-based common item linking procedures, the linking constant is usually estimated with only those common items not identified as exhibiting item difficulty parameter drift. Since state assessments typically contain a fixed number of items, an item classified as exhibiting parameter drift during the linking process remains on the exam as a scorable item even if it is removed from the common item set. Under the assumption that item parameter drift has occurred for one or more of the common items, the expected effect of including or excluding the "affected" item(s) in the estimation of the linking constant is derived in this article. If the item parameter drift is due solely to factors not associated with a change in examinee achievement, no linking error will (be expected to) occur given that the linking constant is estimated only with the items not identified as "affected"; linking error will (be expected to) occur if the linking constant is estimated with all common items. However, if the item parameter drift is due solely to change in examinee achievement, the opposite is true: no linking error will (be expected to) occur if the linking constant is estimated with all common items; linking error will (be expected to) occur if the linking constant is estimated only with the items not identified as "affected".

Calibration↗

PubMed2004

Evaluation of the 0.3 logits screening criterion in common item equating.

A number of state assessment programs that employ Rasch-based common item equating procedures estimate the equating constant with only those common items for which the two tests' Rasch item difficulty parameter estimates differ by less than 0.3 logits. The results of this study presents evidence that this practice results in an inflated probability of incorrectly dropping an item from the common item set if the number of examinees is small (e.g., 500 or less) and the reverse if the number of examinees is large (e.g., 5000 or more). An asymptotic experiment-wise error rate criterion was algebraically derived. This same criterion can also be applied to the Mantel-Haenszel statistic. Bonferroni test statistics were found to provide excellent approximations to the (asymptotically) exact test statistics.

Educational Measurement↗

PubMed2002

Moving the cut score on Rasch scored tests.

Empirically based item selection guidelines are presented for moving the cut score on equated tests consisting of n dichotomous items calibrated assuming the Rasch model. The cut score on a test form B, c(B), may be made higher than test form A's cut score, c(A), in the following ways: (1) select items for test form B such that the variance of test form B's item difficulties, sigma(2)(B), will be equal to test form A's sigma(2)(A), but test form B's mean item difficulty, mu(B), will be less that of test form A, mu(A); (2) given c(A) > n/2, select items for test form B such that mu(B) s(2)(A). To make c(B) lower than c(A), the direction of the changes listed above for the two tests item difficulties sigma(2) and mu should be reversed. Derivations of lemmas that underlie the guidelines are provided as well as a simulated example.

Educational Measurement↗

PubMedDate not supplied

Gender differences in drug use and expenditures in a privately insured population of older adults.

We examine gender differences in use and expenditures for prescription drugs among Medicare and privately insured older adults aged 65 and over, using data on a nationally representative sample of prescription drug purchases collected for the Medical Expenditure Panel Survey Household Component. Overall, women spent about $1,178 for drugs, about 17% more than the $1,009 in average expenditures by men. Older women constituted 50.7% of the population and had average annual aggregate expenditures for prescribed medicines of $6.93 billion compared to $5.77 billion for men. Women were more likely than men to use drugs from a number of therapeutic classes-analgesics, hormones and psychotherapeutic agents-and therapeutic subclasses-thyroid drugs, COX-2 inhibitors and anti-depressants. Women also had higher average prescriptions per user for a number of therapeutic classes-hormones, psychotherapeutic agents and analgesics-and therapeutic subclasses-anti-diabetic drugs and beta blockers. Prescribed medications are, arguably, the most important healthcare technology in preventing illness, disability, and death in older adults. It is critical that older women and men have proper access to prescribed medicines. Given the financial vulnerability of this priority population, particularly women, the expanded drug coverage available under the Medicare Modernization Act is of particular relevance in meeting this goal.

Aged↗

PubMedDate not supplied

Looking inside the nation's medicine cabinet: trends in outpatient drug spending by Medicare beneficiaries, 1997 and 2001.

We examine trends in outpatient prescription drug spending by the Medicare civilian, noninstitutionalized population in 1997 and 2001 using nationally representative data from the Medical Expenditure Panel Survey. We find that the 72 percent increase in drug spending over this period, in excess of price inflation for all goods and services, is primarily attributable to increases in the number of prescriptions per drug user and in the price per prescription. We also find, however, that an increase in the number of users is the primary reason for growth in a number of the fastest-growing subclasses of drugs.

Ambulatory Care↗

PubMedDate not supplied

New cardiovascular drugs: patterns of use and association with non-drug health expenditures.

The potential role of new drugs in reducing expenditures for non-drug health services has received considerable attention in recent policy debates. We estimate expenditure models to determine whether the use of newer drugs to treat cardiovascular conditions is associated with lower (or higher) non-drug expenditures for these conditions. We fail to substantiate the findings of previous research that newer drugs are associated with reductions in non-drug expenditures. We find, however, that increases in the number of drugs used, or the mix of drugs of different ages, are associated with increased non-drug expenditures and find that the number or mix of drugs used are important confounders in the estimated association between drug age and non-drug expenditures.

Adult↗