1
|
Wang Y, Nonzee NJ, Zhang H, Ashing KT, Song G, Crespi CM. Interpretation of coefficients in segmented regression for interrupted time series analyses. RESEARCH SQUARE 2024:rs.3.rs-3972428. [PMID: 38464266 PMCID: PMC10925407 DOI: 10.21203/rs.3.rs-3972428/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Segmented regression, a common model for interrupted time series (ITS) analysis, primarily utilizes two equation parametrizations. Interpretations of coefficients vary between the two segmented regression parametrizations, leading to occasional user misinterpretations. Methods To illustrate differences in coefficient interpretation between two common parametrizations of segmented regression in ITS analysis, we derived analytical results and present an illustration evaluating the impact of a smoking regulation policy in Italy using a publicly accessible dataset. Estimated coefficients and their standard errors were obtained using two commonly used parametrizations for segmented regression with continuous outcomes. We clarified coefficient interpretations and intervention effect calculations. Results Our investigation revealed that both parametrizations represent the same model. However, due to differences in parametrization, the immediate effect of the intervention is estimated differently under the two approaches. The key difference lies in the interpretation of the coefficient related to the binary indicator for intervention implementation, impacting the calculation of the immediate effect. Conclusions Two common parametrizations of segmented regression represent the same model but have different interpretations of a key coefficient. Researchers employing either parametrization should exercise caution when interpreting coefficients and calculating intervention effects.
Collapse
|
2
|
DiPietro Mager N, Bright D, Shipman AJ. Beyond Contraception: Pharmacist Roles to Support Maternal Health. PHARMACY 2022; 10:pharmacy10060163. [PMID: 36548319 PMCID: PMC9780787 DOI: 10.3390/pharmacy10060163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
While contraception prescribing by pharmacists has seen rapid growth in recent years, pharmacist-provided services that can impact maternal health encompass more than just contraception. Each phase of maternal health-preconception, pregnancy, and post-pregnancy-has unique needs, and pharmacists are well equipped to provide services to meet those needs and are more accessible than other healthcare providers. While pharmacist-provided maternal health services may lead to significant savings to the healthcare system, additional research to more fully capture the value of pharmacist-provided maternal health services is needed. Robust implementation of a pharmacist-provided maternal health services program will require partnerships between providers, payers, and pharmacists. Infant and maternal mortality, preterm birth, and unintended pregnancies are significant public health issues, and pharmacists should be seen as a capable workforce who can provide needed maternal health care and serve as a gateway into the healthcare system for those capable of pregnancy.
Collapse
Affiliation(s)
- Natalie DiPietro Mager
- Department of Pharmacy Practice, Raabe College of Pharmacy, Ohio Northern University, Ada, OH 45810, USA
| | - David Bright
- Department of Pharmaceutical Sciences, Ferris State University College of Pharmacy, Big Rapids, MI 49307, USA
| | - Allie Jo Shipman
- National Alliance of State Pharmacy Associations, Richmond, VA 23235, USA
- Correspondence:
| |
Collapse
|
3
|
Ewusie J, Beyene J, Thabane L, Straus SE, Hamid JS. An improved method for analysis of interrupted time series (ITS) data: accounting for patient heterogeneity using weighted analysis. Int J Biostat 2022; 18:521-535. [PMID: 34473922 DOI: 10.1515/ijb-2020-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/05/2021] [Indexed: 01/10/2023]
Abstract
Interrupted time series (ITS) design is commonly used to evaluate the impact of interventions in healthcare settings. Segmented regression (SR) is the most commonly used statistical method and has been shown to be useful in practical applications involving ITS designs. Nevertheless, SR is prone to aggregation bias, which leads to imprecision and loss of power to detect clinically meaningful differences. The objective of this article is to present a weighted SR method, where variability across patients within the healthcare facility and across time points is incorporated through weights. We present the methodological framework, provide optimal weights associated with data at each time point and discuss relevant statistical inference. We conduct extensive simulations to evaluate performance of our method and provide comparative analysis with the traditional SR using established performance criteria such as bias, mean square error and statistical power. Illustrations using real data is also provided. In most simulation scenarios considered, the weighted SR method produced estimators that are uniformly more precise and relatively less biased compared to the traditional SR. The weighted approach also associated with higher statistical power in the scenarios considered. The performance difference is much larger for data with high variability across patients within healthcare facilities. The weighted method proposed here allows us to account for the heterogeneity in the patient population, leading to increased accuracy and power across all scenarios. We recommend researchers to carefully design their studies and determine their sample size by incorporating heterogeneity in the patient population.
Collapse
Affiliation(s)
- Joycelyne Ewusie
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jemila S Hamid
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| |
Collapse
|
4
|
Becker NV, Keating NL, Pace LE. ACA Mandate Led To Substantial Increase In Contraceptive Use Among Women Enrolled In High-Deductible Health Plans. Health Aff (Millwood) 2021; 40:579-586. [PMID: 33819082 DOI: 10.1377/hlthaff.2020.01710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act (ACA) mandated that private health plans cover contraceptives without out-of-pocket expenses for patients. Previously, long-acting reversible contraceptives (LARCs) were subject to deductibles, making them a higher-cost service for women with high-deductible health plans (HDHPs); however, the ACA mandate applied to HDHPs as well as traditional health plans. Using a national commercial claims database, we examined LARC use among continuously enrolled reproductive-age women between 2010 and 2017, comparing 9,014 women enrolled in HDHPs with 443,363 women enrolled in non-HDHPs. Using a quasi-experimental difference-in-differences analysis, we found that pre-ACA HDHP enrollees had lower LARC initiation rates than women in non-HDHPs and that rates of LARC initiation increased by 35 percent more postmandate for women in HDHPs than for women in traditional plans. These findings suggest that the ACA had a particularly important impact for women in HDHPs, who faced higher pre-ACA out-of-pocket expenses for these contraceptive methods.
Collapse
Affiliation(s)
- Nora V Becker
- Nora V. Becker is an assistant professor in the Division of General Medicine at the University of Michigan, in Ann Arbor, Michigan
| | - Nancy L Keating
- Nancy L. Keating is a professor of health care policy and medicine in the Department of Health Care Policy, Harvard Medical School, and the Division of General Internal Medicine, Brigham and Women's Hospital, both in Boston, Massachusetts
| | - Lydia E Pace
- Lydia E. Pace is an assistant professor in the Division of Women's Health, Brigham and Women's Hospital, and an assistant professor of medicine at Harvard Medical School
| |
Collapse
|
5
|
Acharya Y, Hillemeier MM, Sznajder KK, Kjerulff KH. Out-of-Pocket Medical Bills from First Childbirth and Subsequent Childbearing. Womens Health Issues 2021; 31:17-23. [PMID: 32896469 PMCID: PMC7770019 DOI: 10.1016/j.whi.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Many families in the United States struggle to pay medical debt. This study aims to investigate the association between having out-of-pocket medical bills from first childbirth sent to debt collection agencies and subsequent childbearing. METHODS As part of a large-scale birth cohort study (N = 2,169), women in Pennsylvania who delivered their first child in 2009 through 2011 were asked if any of the out-of-pocket medical expenditures resulting from the delivery were sent to debt collection agencies. Logistic regression models were used to assess the association between childbirth medical bills going to debt collections in the first year after delivery and subsequent childbearing over the following 2 years, controlling for relevant confounders, including maternal age, education, race/ethnicity, marital status, poverty level, insurance coverage, pregnancy intendedness, difficulty paying for basic needs, plans to have another child, pregnancy complications, and childbirth maternal and neonatal complications. RESULTS Women received out-of-pocket medical bills for as much as $32,000. Overall, 8.3% reported having medical bills from the childbirth sent to debt collections. These women were substantially less likely to have a subsequent child during the follow-up period (22.4%) compared with their counterparts, whose medical bills did not go to collections (44.4%; adjusted odds ratio, 0.60; 95% confidence interval, 0.39-0.93). CONCLUSIONS When out-of-pocket medical bills from first childbirth are more than American families can afford to pay, they may postpone having a second child. This finding may be particularly true when childbirth medical bills are sent to debt collection agencies.
Collapse
Affiliation(s)
- Yubraj Acharya
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania.
| | - Marianne M Hillemeier
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania
| | - Kristin K Sznajder
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, Pennsylvania
| | - Kristen H Kjerulff
- Departments of Public Health Sciences and Obstetrics and Gynecology, The Pennsylvania State University, Hershey, Pennsylvania
| |
Collapse
|
6
|
Abstract
High-deductible health plans (HDHPs) are becoming more popular owing to their potential to curb rising health care costs. Relative to traditional health insurance plans, HDHPs involve higher out-of-pocket costs for consumers, which have been associated with lower utilization of health services. We focus specifically on the impact that HDHPs have on the use of preventive services. We critique the current evidence by discussing the benefits and drawbacks of the research designs used to examine this relationship. We also summarize the findings from the most methodologically sophisticated studies. We conclude that the balance of the evidence shows that HDHPs are reducing the use of some preventive service, especially screenings. However, it is not clear if HDHPs affect all preventive services. Additional research is needed to determine why variability in conclusions exists among studies. We describe an agenda for future research that can further inform public health decision makers on the impact of HDHPs on prevention.
Collapse
Affiliation(s)
- Olena Mazurenko
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University-IUPUI, Indianapolis, Indiana 46202-2872, USA;,
| | - Melinda J.B. Buntin
- Department of Health Policy, School of Medicine, Vanderbilt University, Nashville, Tennessee 37203, USA
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University-IUPUI, Indianapolis, Indiana 46202-2872, USA;,
| |
Collapse
|
7
|
Chen W, Page TF. Impact of Health Plan Deductibles and Health Insurance Marketplace Enrollment on Health Care Experiences. Med Care Res Rev 2018; 77:483-497. [DOI: 10.1177/1077558718810129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High-deductible health plans (HDHPs) have become increasingly prevalent among employer-sponsored health plans and plans offered through the Health Insurance Marketplace in the United States. This study examined the impact of deductible levels on health care experiences in terms of care access, affordability, routine checkup, out-of-pocket cost, and satisfaction using data from the Health Reform Monitoring Survey. The study also tested whether the experiences of Marketplace enrollees differed from off-Marketplace individuals, controlling for deductible levels. Results from multivariable and propensity score weighted regression models showed that many of the outcomes were adversely affected by deductible levels and Marketplace enrollment. These results highlight the importance of efforts to help individuals choose the plan that fits both their medical needs and their budgets. The study also calls for more attention to improving provider acceptance of HDHPs and Marketplace plans as these plans become increasingly common over time.
Collapse
Affiliation(s)
- Weiwei Chen
- Florida International University, Miami, FL, USA
| | | |
Collapse
|
8
|
Agarwal R, Mazurenko O, Menachemi N. High-Deductible Health Plans Reduce Health Care Cost And Utilization, Including Use Of Needed Preventive Services. Health Aff (Millwood) 2017; 36:1762-1768. [DOI: 10.1377/hlthaff.2017.0610] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rajender Agarwal
- Rajender Agarwal is director of the Center for Health Reform, in Dallas, Texas, and a student in the Business of Medicine MBA program at Indiana University’s Kelley School of Business, in Indianapolis
| | - Olena Mazurenko
- Olena Mazurenko is an assistant professor of health policy and management at Indiana University, in Indianapolis
| | - Nir Menachemi
- Nir Menachemi is a professor of health policy and management and chair of the Department of Health Policy and Management at Indiana University, in Indianapolis
| |
Collapse
|