Browsing by Subject "cost"
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Item An Evaluation of the Impact of Continuity of Care on Cost of Services in New and Renewing CHIP Enrollees(2001-01-01) Montague, Brian; Kristine Lykens; Muriel Marshall; Karan SinghObjective. To assess the impact of continuity of care as measured by enrollment history on the cost of services in Colorado’s state insurance program for children in low-income families, the Child Health Plan Plus. Design. A retrospective cohort study using data extracted from the eligibility/enrollment system and the claims payment system for inpatient and specialty services. All children enrolled in the program for at least 90 days and managed under the state managed-care network from its inception to April 1st of 2000 were included in the analysis (n-11841). Enrollees were separated into three enrollment groups: new members, renewing members, and members transition from a prior outpatient services group. The odds by enrollment groups: new members, renewing members, and members transition from a prior outpatient services program. The odds by enrollment group an average monthly claims greater than the 75th percentile amongst those with claims (n-2661) and the odds of presence of any claim in the full data set were compared means of a logistic regression model. In order to permit inferences regarding the total cost of care, all models included age group as a cofactor. Presence of chronic or congenital disease, ethnicity, primary language, urban residence, and the presence of multiple parents or caretakers were tested using univariate chi-square analysis and significant factors (p [less than] 0.1) were included as effects in the models. Results. All cofactors with the exception of ethnicity were significant in both models. Chronic disease status was associated with an increased risk of all claims. (OR=4.961, p [less than] 0.0001) and high claims (OR=9.639, p [less than] 0.0001). Renewal status was associated with a decreased risk of any claim (OR=0.921, p [less than] 0.0936) while rollover status was associated with both an increased risk of any claim (OR=1.157, p=0.0034) and a decreased risk of high claims (OR=0.731, p=0.0033). Residence in rural counties increased the risk of any claim (OR=0.0428, p [less than] 0.0001) and an increased risk of high claims (OR=1.472, p=0.0376). Conclusions. Enrollment history had a modest, though significant, effect on the presence of any claim and the specific presence of high claims. Rollover status was protective increasing utilization of the system overall but reducing the risk of high claims whereas renewal status only reduced the risk of utilization overall. The absence of multiple adults in the household showed a pattern consistent with episodic use of the system. Relative to urban residents, residents of rural counties were more likely to have used any service and less likely to have incurred high claims. This effect may be attributable to the transition of patients to HMO networks in urban counties. Linguistic or cultural barriers as reflected in primary language strongly decreased utilization, suggesting that these may be important barriers to address in outreach and member education.Item Analysis of the Clinical Research Methodologies Employed During a Phrase Three Efficacy Study for Ultracet as a Post-Herniorrhaphy Analgesic(2001-08-01) Aguilar-Zanatta, Jorge; Rustin Reeves; Don Peska; Della WeisThe history of pain management stems back many thousands of years. However, not until recent times have significant advancements in biochemistry and pharmacology allowed analgesics to be incorporated in clinical interventions and everyday life. Due to these advancement, attempts to refine pharmacological action on receptors in terms of specificity would render medications with fewer side effects. The technology is present, but the application and development of modern analgesics in post-surgical settings is substandard. According to C.L. Ireson and R.W. Schwartz, (2001), the outcomes of ailment interventions in the United States are “…no better and in numerous situations worse that those achieved in other countries,” even though the United States has the most expensive healthcare in the world. Furthermore, a study performed by Carr et al. (1998), has identified the United States as demonstrating consistent inadequacies in postoperative pain management. Several factors have been identified as being contributors of poor post-surgical pain control in America. Lack of awareness of the available strategies in acute pain control and its implementation in post surgical care are labeled as being problematic observations (Puid et al., 2001). In response to these conditions as well as the managed health care time and cost limitations, new and efficacious pharmaceuticals must be made available to a broad spectrum of socio-economic strata. Currently, there is a great debate over the use of laparoscopic herniorrhaphy versus open tension free approaches. In terms of cost, the laparoscopic herniorrhaphy versus open tension free approaches. In terms of cost, the laparoscopic herniorrhaphy versus open tension free approaches. In terms of cost, the laparoscopic procedure is more expensive and yields less postoperative pain, however the open tension free approaches are less expensive and yield more postoperative pain (Sarli et al., 2001, Medical Research Council Laparoscopic Groin Hernia Trial Group, 2001, Parviz et al., 1995). There are advantages and disadvantages to both procedures. Assuming that efficacious postoperative analgesics were available, the open tension free repair would be more feasible in terms of cost and hernia recurrence rates (Sarli et al., 2001). In terms of pharmaceutical development, the laws and guidelines by the regulatory agencies such as the Food and Drug Administration, institutional review boards, and pharmaceutical sponsor protocols must be followed. Along with good clinical practice standards, interdisciplinary collaboration in pain studies produce results that are statistically and clinically salient. The patient’s well-being and comfort is the ultimate goal in clinical pain studies and in medicine in general, therefore postoperative pain should be aggressively managed.Item Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community - A Six Month Follow-Up(1999-12-01) Coustasse, Alberto; Antonio Rene; Doug A. Mains; Gilbert RamirezCoustasse, Alberto, Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community – A Six Month Follow-up. Master of Public Health Track, Public Health Administration, December 1999, 22 pp., 9 tables, 9 illustrations, bibliography, 7 titles. The health fair approach was used as a method to establish individual and population health status baselines and to provide a mechanism to follow-up with an elderly population in a rural Texas community. A controlled trial sample of forty-four seniors was initially screened in a primary care clinic in August 1998. Patients were reevaluated at six months and results demonstrated a 46% increase in BMI [Body Mass Index]; 62% remained obese; 62% maintained elevated cholesterol or increased cholesterol values to abnormal values; 61% maintained or increased their BP [blood pressure] to abnormal values. A significant finding was that a change of one unit in the BMI correlated with a change of 19.88 mmHg [millimeter mercury] of SBP [systolic blood pressure] and 18.59 mmHg of DBP [diastolic blood pressure]. The societal economic impact of mortality and morbidity (without the benefit of target interventions) for the initial forty-four seniors was projected at & 74,949. Keywords: Health fairs; obesity; cardiovascular; cost; case management.Item Construction of a Cost Effective Nested-PCR Reaction for Use with the Applied Biosystems AmpFLSTR Identifiler Kit(2005-12-01) Mikeska, Margo M.; John Planz; Joseph Warren; Arthur EisenbergHuman STR analysis has greatly increased the ability to perform identity testing for many different situations. These situations include, but are not limited to, the identification of individuals involved in violent crimes, establishing paternity, and identification of unknown human remains. The most common type of DNA information currently used for identity testing is the short tandem repeat, or STR. STR testing utilizes the number of repeating units in the DNA to assign an allele. Alleles from several different loci are used to establish a genetic profile. Currently, the United States used a standard of 13 different DNA loci to establish identity. These 13 loci can be typed by using a number of different multiplex kits such as the Applied Biosystems Profiler Plus, Cofiler, and Identifiler Kits [1,2]. The 13 loci were selected based on a number of parameters. Each locus was required to be polymorphyic, and a tetranucleotide repeat. The loci also could not display any linkage between each other and extensive population studies had to be conducted to both verify the absence of linkage and to establish allelic frequencies [1]. The goal of this research was the construction of a more cost effective method of utilizing the Applied Biosystems Identifiler Kit. Across the country there is a large backlog of samples that need to be processed in order to obtain a genetic profile. If these samples could be tested using a more cost effective method, more funding could be directed to other endeavors. Paternity testing, as well as some research endeavors could be conducted at a fraction of the cost, leaving resources for other projects or additional staff. Although it would be inadvisable to use this technique on forensic samples, the implications on paternity and research samples would be positive. This research attempted to design a nested PCR reaction and subsequently dilute the Applied Biosystems Primers in order to reduce the cost. The first step was to design new primers for the first round of PCR, followed by testing of those primers. The new primers then required optimization so that they all worked effectively together. After optimization was accomplished, the Identifiler primers were diluted until loci began dropping out of the genetic profile.Item Evaluation of Health Care Cost and Utilization Project Data (HCUP) in Healthcare Research(2013-05-01) Abilez, Cristianna A.; John SchetzThis practicum project studies the development and historical contribution of the Healthcare Cost and Utilization Project (HCUP) to healthcare research. A PubMed search for publications that utilized HCUP databases was conducted. The literature review led to the development of Healthcare Improvement Categories to examine the contribution of HCUP to healthcare research. Hospital Quality Improvement was the most represented category, followed by Administrative Improvement. The practicum project developed clinical research management techniques during the coordination of a study “Assessing the association between hospital characteristics and in hospital mortality in acute myocardial infarction patients.” The study protocol was developed for the Epidemiology Department within the Institute of Health Care Research Improvement (IHCRI) for Baylor Health Care System.Item The White-Coat Dilemma: Are Collaborative Practices the Answer to the Primary Care Shortage?(2012-05-01) Murthy, Kenton K.; Kristine Lykens; Jose Pagán; Lakshmi BalasubramanianThis study was a comprehensive literature review of the characteristics of collaborative practices that could best utilize the strengths and knowledge of the physician with the skills and experience of the nurse practitioner. The literature review was conducted using multiple databases for peer-reviewed articles, reports and nonscholarly reports between the years 1980-2011. Out of 91 articles reviewed, 30 were relevant. The study found that there were three main elements of collaborative practices - communication, teamwork, and professionalism. Implementing collaborative practices is difficult but can improve patient care and increase access. Implementation of collaborative practices, along with interprofessional education, creates synergy between nurse practitioners and physicians and provides a model for increasing patient quality and access.