Biomedical subjects

M Cifaldi

Publications and source records attributed to M Cifaldi.

5 recordsLinked to original sources

PubMed2006

Development of a COPD severity score.

OBJECTIVE: Treatment of chronic obstructive pulmonary disease (COPD) is based on symptom control. This suggests that COPD severity can be determined by analyzing treatment intensity. The objective of this analysis was to develop and validate a severity score for adult COPD based on treatments. RESEARCH DESIGN: Using principal components analysis, a COPD severity score was developed using data based on treatments extracted from an employer claims database (development group). Variables included were identified from literature review and clinical expert opinion. External validity was tested in a separate group of adult chronic bronchitis patients in whom principal components analysis was re-conducted and factor loadings were compared to the development group. Construct validity was tested by comparing the incidence of acute exacerbations of chronic bronchitis (AECB) in patients with high and lower severity scores. To illustrate the use of the COPD severity score, effectiveness of alternative AECB antibiotic treatments was compared in a separate patient sample categorized by severe versus mild/moderate COPD. RESULTS: In the development group (n = 2068), principal components analysis produced a single main factor for severity scoring. Of the 12 variables contributing to this factor, the 6 with the highest factor loadings were treatment related. The factor performed similarly in the external validity group (n = 9127) as it did in the development group. In construct validity testing, severe COPD patients were 4 times more likely to have AECB episodes than mild/moderate patients. Patients with severe COPD and an AECB were more likely to fail treatment with antibiotics than those with mild/moderate COPD. Based on the COPD severity score developed, we found that treatment of patients with severe COPD and an AECB with fluoroquinolones was more likely to result in treatment failure than treatment with macrolides (OR = 2.01; p = 0.03). CONCLUSIONS: The analysis was successful in developing and validating a method to score COPD severity based on treatments. This method may prove useful in providing insights about the benefits of COPD treatments.

Anti-Bacterial Agents↗

PubMed1999

Targeted intervention programs: creating a customized practice model to improve the treatment of allergic rhinitis in a managed care population.

OBJECTIVE: To develop an intervention program to improve health outcomes among patients with allergic rhinitis in a managed care environment. STUDY DESIGN: The Episodes of Care (EOC) team at Lovelace Health Systems selected allergic rhinitis for an intervention program because it was identified as one of the top 10 reasons for visits to primary care clinics. The intervention program was based on a multidisciplinary team process designed to create a customized provider and patient education program to alter inconsistence or deficiencies in the treatment of allergic rhinitis. PATIENTS AND METHODS: The EOC team researched literature and current practices and then identified inconsistencies in diagnostic and treatment patterns. Based on this research, the team developed guidelines and a provider education program. Intervention strategies were structured around decision points in a treatment protocol. More than 500 patients were monitored throughout the allergy season by using written and telephone surveys, symptom diaries, and encounter data. Measurable outcomes were established for provider and patient behavior. Patient outcomes were derived from a preventive behavior index and administrative data reporting usage of 5 classes of medication. RESULTS: Approximately 50% of providers altered their practice patterns as a result of the intervention program. Patient outcomes showed a decrease in the use of rescue medications, particularly antibiotics, and an increase in preventive measures in the treatment group compared with the control group. CONCLUSION: The EOC model resulted in positive changes in provider and patient behavior. The multidisciplinary approach resulted in broad provider participation.

Algorithms↗

PubMed1999

Economic outcomes of a targeted intervention program: the costs of treating allergic rhinitis patients.

OBJECTIVES: To determine the annual costs of treating allergic rhinitis patients in a managed care environment and to assess the effect of a treatment intervention program on direct and indirect costs. DESIGN: Two arms of an economics study were designed to calculate annual costs of treating allergic rhinitis in Lovelace Health Systems. Direct and indirect costs were also reviewed for patients participating in an intervention program designed to improve patient outcomes during the 1996 fall allergy season. PATIENTS AND METHODS: Annual medical costs of treating allergic rhinitis within the Lovelace system were reviewed using a patient database. A total of 7936 patients with allergic rhinitis symptoms were identified in the database using a case-finding algorithm. An equal number of patients without allergy conditions were selected for the comparison group. In addition to calculating annual costs of treating allergic rhinitis, direct and indirect costs were reviewed for patients participating in a rhinitis intervention program to determine differences in cost between the treatment and control groups. An intervention group of 247 patients was selected to receive care at clinics randomized to use practice guidelines to improve treatment, while 255 patients were treated in the control group clinics, which did not alter treatment practices. RESULTS: Annual expenditures were nearly $2 million more for the allergic rhinitis group than for the control group. In the intervention study, treatment and control groups expended the same in direct costs, but the intervention group showed a trend toward decreased indirect costs. CONCLUSION: Costs of allergic rhinitis are not trivial to a managed care organization; a specifically designed intervention program shows potential for minimizing the costs associated with the ailment.

Anti-Allergic Agents↗

PubMed1977

[Methods for the sampling and tracing of caprolactam monomer dispersed in the air].

The problem of hygiene in the production of epsilon-caprolactam is very important; pollution of work room air is possible when the substance is stored, transported or packed in bags. In this work toxic and irritant properties of epsilon-caprolactam are described. Infrared spectroscopic, gas chromatrographic and spectrophotometric methods used by us, for the determination of epsilon-caprolactam traces, are also described.

Air Pollutants↗

PubMedDate not supplied

Economic burden of pneumonia in an employed population.

OBJECTIVE: To estimate the overall economic burden of pneumonia from an employer perspective. METHODS: The annual, per capita cost of pneumonia was determined for beneficiaries of a major employer by analyzing medical, pharmaceutical, and disability claims data. The incremental costs of 4036 patients with a diagnosis of pneumonia identified in a health claims database of a national Fortune 100 company were compared with a 10% random sample of beneficiaries in the employer overall population. RESULTS: Total annual, per capita, employer costs were approximately 5 times higher for patients with pneumonia ($11 544) than among typical beneficiaries in the employer overall population ($2368). The increases in costs were for all components (eg, medical care, prescription drug, disability, and particularly for inpatient services). A small proportion (10%) of pneumonia patients (almost all of whom were hospitalized) accounted for most (59%) of the costs. CONCLUSIONS: Patients with pneumonia present an important financial burden to employers. These patients use more medical care services, particularly inpatient services, than the average beneficiary in the employer overall population. In addition to direct health care costs related to medical utilization and the use of prescription drugs, indirect costs due to disability and absenteeism also contribute to the high cost of pneumonia to an employer.

Adult↗