Search

Objective: To develop a sound method to identify patient and physician characteristics that influence specialty referrals.Design: A retrospective cohort analysis of medical claims data from 1996 supplemented with surveys of primary care physicians.Setting: A 600-member independent practice association in southeastern Michigan that provided care for 90,000 members of an HMO.Patients: Five cohorts, each of 2,000 to 6,000 patients with diagnoses that could be referred to cardiologists, ophthalmologists, pulmonologists, orthopedists, or general surgeons.Main Results: The referral rates for the different cohorts ranged from 1% to 7%. The discriminatory ability of the multivariate logistic models (c-statistic) ranged from 0.66 to 0.79. The likelihood of referral was associated with the patient's diagnoses and medications and with the referring physician's age, years out of medical school, satisfaction with the specialty being referred to, and the importance of making or confirming a diagnosis.Conclusions: Because these methods were not difficult to implement and the results were credible, we believe that other organizations should be able to use them. [ABSTRACT FROM AUTHOR]

Abstract Severity and frequency of gastroesophageal reflux disease (GERD) related symptoms are associated with impaired health-related quality of life (HRQL). This study evaluated the association between baseline heartburn severity and endpoint HRQL of patients treated for heartburn and the relationship between complete resolution of heartburn symptoms and HRQL outcomes after controlling for baseline severity. We completed a secondary analysis of clinical symptom and HRQL data from three clinical trials in adult patients receiving either omeprazole or ranitidine treatment for GERD. HRQL was assessed using the Psychological General Well-Being Index (PGWB) in each of the three clinical trials, and two of the trials also included the Medical Outcomes Study Sleep disturbance scale. Gastrointestinal symptoms were evaluated using either the Gastrointestinal Symptom Rating Scale or a modified version of the scale. Baseline heartburn severity (none/minor, mild, moderate or severe) was defined based on patient-reported symptoms. Analysis of covariance (ANCOVA) models were used to compare mean HRQL scores by baseline level of heartburn symptom severity and whether or not patients experienced complete heartburn resolution. At baseline, PGWB scores were significantly worse (p < 0.05) for patients with more severe heartburn symptoms. There were no statistically significant baseline severity by symptom resolution interactions in any of the ANCOVA models. For all three trials and across all follow-up assessments, mean PGWB scores were statistically significantly higher for patients with completely resolved heartburn symptoms versus those whose symptoms were unresolved (all p-values < 0.05). Few significant effects were observed for sleep disturbance scores. While the severity of heartburn symptoms at the start of medical treatment for GERD is not associated with improvements in HRQL in subsequent weeks of treatment, complete resolution of symptoms is associated with improvements in psychological well-being.

The cost-effectiveness of treatment with oral gemifloxacin versus oral clarithromycin for acute exacerbations of chronic bronchitis (AECB) was evaluated. Economic outcomes were assessed for the Gemifloxacin Long-term Outcomes in Bronchitis Exacerbations study. This prospective double-blind, controlled, health outcomes study compared health, economic, and clinical outcomes after randomized treatment with either oral gemifloxacin or oral clarithromycin for AECB. Base case analysis was performed from the third-party payer's perspective and considered the costs of respiratory tract infection-related medical care. Analysis from the societal perspective also included costs of lost productivity. Treatment effectiveness was measured as the proportion of patients without recurrence requiring antimicrobial treatment following resolution of the initial AECB. Data sources included the outcomes study itself and standard U.S. cost sources. Compared with clarithromycin, gemifloxacin treatment resulted in significantly more patients without AECB recurrence requiring antimicrobial treatment after 26 weeks (73.8% versus 63.8%, p = 0.024). Fewer patients receiving gemifloxacin were hospitalized (5 of 214 patients versus 14 of 224 patients, p = 0.059), and they had less time off from usual activities (8.3 days versus 10.1 days). The mean direct cost per patient receiving gemifloxacin was $127 less than with clarithromycin ($247 versus $374, respectively); mean total costs (direct plus indirect) per patient were $329 less for patients receiving gemifloxacin ($1413 versus $1742). Gemifloxacin dominated clarithromycin in cost-effectiveness analysis. Bootstrap analysis indicated that the probability of gemifloxacin being both cost saving and more effective than clarithromycin is 88% from a payer's perspective and 84% from the societal perspective. Gemifloxacin was more cost-effective, improving AECB outcomes and producing substantial cost offsets compared with clarithromycin.

The purpose of this study was to determine patient-level annual expenditures and resource use for heart failure (HF) and change in annual expenditure after a hospital admission for HF. The study population comprised members of an IPA-model MCO (N = 899) who were 40 to 74 years old and continuously enrolled for at least six months before and after an index hospital admission with a primary diagnosis of HF. A retrospective analysis was conducted of administrative claims data between 1996 and 1998. Analysis was stratified by five-year age groups and by quintiles created by rank-ordering individuals according to their pre-index annualized expenditure and then dividing the cohort into five equal groups. During the year before the index HF event, median annualized charges were $6,026 (mean +/- SD, $17,490 +/- $32,234), and median postevent charges were $14,292 (mean, $35,780 +/- $60,881), a 98% increase in median (105% increase in mean). Age was unrelated to average annual expenditure or to increase in expenditure after the index event. One-year readmission rates ranged from 30% (95% confidence interval [CI], 35%-51%), for patients in the least costly quintile, to 63% for the most costly quintile (95% CI, 55%-71%). Although HF prevalence increases with age, patient-level treatment expenditures are comparable across age groups. Hospital admission for HF is associated with a substantial increase in treatment intensity and annual expenditure.

Objective: To compare clinical, health-related quality of life (HRQL), and medical cost outcomes in patients with symptomatic gastroesophageal reflux disease (GERD) receiving omeprazole sodium or ranitidine hydrochloride treatment., Methods: A multicenter, randomized, open-label, medical effectiveness trial conducted in 5 university-based family medicine clinics. Two hundred sixty-eight patients with GERD were recruited and randomly assigned to omeprazole sodium, 20 mg once daily, or ranitidine hydrochloride, 150 mg twice daily, for up to 6 months. Main outcome assessments included the Gastrointestinal Symptom Rating Scale (GSRS) Reflux score, Psychological General Well-Being Index, and Short-Form-36 Health Survey administered at baseline and 2, 4, 12, and 24 weeks. Medical resource use and cost data were collected., Results: More omeprazole-treated patients reported improved heartburn resolution at 2 weeks (49.0% vs 33.3%; P=.007) and 4 weeks (58.6% vs 35.0%; P<.001) compared with ranitidine-treated patients. The GSRS Reflux scores across 3 months showed overall differences between omeprazole (mean, 2.67) and ranitidine (mean, 2.95) groups (P=.04). Mean total 6-month medical costs were $915 lower ($8371 vs $9286; P=.64), and no difference in mean outpatient medical costs ($1198 vs $1158; P=.76) were observed in the omeprazole group compared with the ranitidine group. A post hoc secondary analysis showed that, at 12 and 24 weeks, patients treated with omeprazole for 8 weeks or more reported greater heartburn resolution (ie, 24 [43%] of 56 patients at both intervals) than patients treated with ranitidine for 8 weeks or more (12 [24%] and 13 [26%] of 50 patients, respectively; P=.001)., Conclusions: Ranitidine and omeprazole were both effective at improving heartburn symptoms; however, omeprazole provided greater resolution of heartburn symptoms at 2 and 4 weeks. Despite omeprazole's higher acquisition cost, there were no significant differences in total or outpatient costs between groups.

Objective: To develop a sound method to identify patient and physician characteristics that influence specialty referrals., Design: A retrospective cohort analysis of medical claims data from 1996 supplemented with surveys of primary care physicians., Setting: A 600-member independent practice association in southeastern Michigan that provided care for 90,000 members of an HMO., Patients: Five cohorts, each of 2,000 to 6,000 patients with diagnoses that could be referred to cardiologists, ophthalmologists, pulmonologists, orthopedists, or general surgeons., Main Results: The referral rates for the different cohorts ranged from 1% to 7%. The discriminatory ability of the multivariate logistic models (c-statistic) ranged from 0.66 to 0.79. The likelihood of referral was associated with the patient's diagnoses and medications and with the referring physician's age, years out of medical school, satisfaction with the specialty being referred to, and the importance of making or confirming a diagnosis., Conclusions: Because these methods were not difficult to implement and the results were credible, we believe that other organizations should be able to use them.

Hospital characteristics vary greatly across a geographic area such as a state. Hospital peer groups internally exhibit similar characteristics and can be used as a basis for the analysis of data, the dissemination of information, and the adoption of continuous quality improvement project results. This paper reflects the efforts made toward the identification of hospital peer groups within the state of Michigan. Hospital characteristics data for fiscal year 1992 were obtained from the American Hospital Association's Annual Survey of Hospitals and the Health Care Financing Administration's MEDPRO database. Thirteen peer group clusters have been identified, reviewed, and commented on by the state's hospital association and have met general approval by hospital administrators across the state. The established peer groups are being used to identify the differences in patterns of care among hospitals in the state. The peer groups also are being used for the feedback of comparable data and the identification of hospitals for participation in continuous quality improvement projects. The next research objective is to experiment with other clustering techniques and other inpatient populations. The consistency of the peer groupings across all clustering techniques and across both Medicare and total inpatient populations will be studied.