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Tripathi R, Knusel KD, Ezaldein HH, Bordeaux JS, Scott JF. National Burden of Hospitalization Due to Cutaneous Melanoma in Adolescents and Young Adults. Am J Clin Oncol 2019; 42:830-836. [PMID: 31569167 DOI: 10.1097/coc.0000000000000605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although adolescents and young adults (AYA) suffer disproportionately from cutaneous melanoma (CM), little is known regarding the burden of CM leading to hospitalization in AYA. The objective of this study was to elucidate sociodemographic/hospitalization characteristics of AYA CM inpatients, determine which factors lead to the greater length of stay (LOS) and cost of care for AYA CM inpatients, and evaluate trends in the prevalence, LOS, and cost of care for AYA CM hospitalizations. MATERIALS AND METHODS A retrospective cohort study of nationally representative data from the 2009 to 2015 National Inpatient Sample. Multivariable survey-weighted logistic regression models were used to determine sociodemographic factors associated with AYA CM hospitalization. Multivariable survey-weighted linear regression models were used to determine characteristics associated with the greater cost of care and LOS in AYA CM inpatients. RESULTS A total of 8986 AYA CM inpatients were included in this study. The prevalence of AYA CM hospitalizations is decreasing over time while the cost of care is increasing. On average, AYA CM hospitalizations were 3.3 days long and cost $38,018.40. Controlling for all covariates, male sex, older age, non-Hispanic white race, higher income, private insurance, and elective admissions were associated with AYA hospitalization due to CM (P<0.0001). Male sex was associated with longer LOS (P=0.007) and cost of care (P=0.01) among AYA hospitalized for CM. CONCLUSIONS Despite a decreasing prevalence of CM hospitalizations in AYA inpatients, the economic burden of these hospitalizations is increasing. Substantial sex-based differences exist in the inpatient burden of AYA CM. Further research is required to elucidate the causes of these differences and prevent AYA hospitalization due to CM.
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Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Konrad D Knusel
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Harib H Ezaldein
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Cleveland, OH
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Chong HY, Teoh SL, Wu DBC, Kotirum S, Chiou CF, Chaiyakunapruk N. Global economic burden of schizophrenia: a systematic review. Neuropsychiatr Dis Treat 2016; 12:357-73. [PMID: 26937191 PMCID: PMC4762470 DOI: 10.2147/ndt.s96649] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Schizophrenia is one of the top 25 leading causes of disability worldwide in 2013. Despite its low prevalence, its health, social, and economic burden has been tremendous, not only for patients but also for families, caregivers, and the wider society. The magnitude of disease burden investigated in an economic burden study is an important source to policymakers in decision making. This study aims to systematically identify studies focusing on the economic burden of schizophrenia, describe the methods and data sources used, and summarize the findings of economic burden of schizophrenia. METHODS A systematic review was performed for economic burden studies in schizophrenia using four electronic databases (Medline, EMBASE, PsycINFO, and EconLit) from inception to August 31, 2014. RESULTS A total of 56 articles were included in this review. More than 80% of the studies were conducted in high-income countries. Most studies had undertaken a retrospective- and prevalence-based study design. The bottom-up approach was commonly employed to determine cost, while human capital method was used for indirect cost estimation. Database and literature were the most commonly used data sources in cost estimation in high-income countries, while chart review and interview were the main data sources in low and middle-income countries. Annual costs for the schizophrenia population in the country ranged from US$94 million to US$102 billion. Indirect costs contributed to 50%-85% of the total costs associated with schizophrenia. The economic burden of schizophrenia was estimated to range from 0.02% to 1.65% of the gross domestic product. CONCLUSION The enormous economic burden in schizophrenia is suggestive of the inadequate provision of health care services to these patients. An informed decision is achievable with the increasing recognition among public and policymakers that schizophrenia is burdensome. This results in better resource allocation and the development of policy-oriented research for this highly disabling yet under-recognized mental health disease.
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Affiliation(s)
- Huey Yi Chong
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | | | - Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | | | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, WI, USA; School of Population Health, University of Queensland, Brisbane, Australia
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Alosaimi FD, Alhabbad A, Abalhassan MF, Fallata EO, Alzain NM, Alassiry MZ, Haddad BA. Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia. Neuropsychiatr Dis Treat 2016; 12:897-907. [PMID: 27143891 PMCID: PMC4844432 DOI: 10.2147/ndt.s100405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia. METHOD This cross-sectional observational study was conducted between July 2012 and June 2014 on patients seeking psychiatric advice at major hospitals in five main regions of Saudi Arabia. Male (n=651) and female (n=594) patients who signed the informed consent form and were currently or had been previously using psychotropic medications, irrespective of the patient's type of psychiatric diagnosis and duration of the disease, were included. A total of 1,246 patients were found to be suitable in the inclusion criteria of whom 464 were inpatients while 782 were outpatients. RESULTS Several studied demographic factors have shown that compared with outpatients, inpatients were more likely to be male (P=0.004), unmarried (P<0.001), have less number of children (1-3; P=0.002), unemployed (P=0.001), have a lower family income (<3,000 SR; P<0.001), live in rural communities (P<0.001), have a lower body mass index (P=0.001), and are smokers (P<0.001); however, there were no differences with regard to age or educational levels. The current frequency of use of psychotropic medications in overall patients was antipsychotics (76.6%), antidepressants (41.4%), mood stabilizers (27.9%), and antianxiety (6.2%). However, compared to outpatients, the current use of medications for inpatients was more frequent (93.8% vs 89.9%, P=0.019) with inpatients more likely to be treated with multiple medications (2.1 vs 1.8 medications). A similar trend was observed in the case of antipsychotics, high potency first-generation antipsychotics, second-generation antipsychotics, mood stabilizers, and antianxiety medicines where inpatients were more frequently treated with these medications for all psychiatric diagnoses when compared with outpatients. On the contrary, in the case of antidepressant treatment, an opposite trend was observed with more number of treated outpatients in comparison to inpatients. Among elderly patients, 75.9% received antipsychotics, mainly second-generation formulations (67.2%), whereas only 41% received antidepressants and 13.8% received mood stabilizers. CONCLUSION Based upon the present study data, it is concluded that among all the psychotropic medications, antipsychotics were heavily used and the frequency was found to be significantly high in the case of inpatients compared with outpatients. Such a practice may lead to multiple negative consequences among the Saudi psychiatric patient population. Further, extensive use of sodium valproate in the case of bipolar disorder, and also among females either in childbearing age or during pregnancy is also the cause of concern and warrants logical use. Overall, this study may help in assessing the burden of psychiatric illness within specific patient demographics and might be effectively used to strategically plan health resources allocation, generate new treatment hypothesis, or be used as a source of evidence that could further integrate other observational studies.
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Affiliation(s)
- Fahad D Alosaimi
- Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhadi Alhabbad
- Department of Psychiatry, Prince Mohammed Medical City, Aljouf, Saudi Arabia
| | - Mohammed F Abalhassan
- Department of Medicine, Prince Sattam Bin Abdulaz University, Al-Kharj, Saudi Arabia
| | - Ebtihaj O Fallata
- Department of Psychiatry, Mental Health Hospital, Jeddah, Saudi Arabia
| | - Nasser M Alzain
- Department of Psychiatry, Al-Amal complex for Mental health, Dammam, Saudi Arabia
| | | | - Bander Abdullah Haddad
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard, Riyadh, Saudi Arabia
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Ma X, Sayama H. Mental disorder recovery correlated with centralities and interactions on an online social network. PeerJ 2015; 3:e1163. [PMID: 26312174 PMCID: PMC4548489 DOI: 10.7717/peerj.1163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/17/2015] [Indexed: 12/02/2022] Open
Abstract
Recent research has established both a theoretical basis and strong empirical evidence that effective social behavior plays a beneficial role in the maintenance of physical and psychological well-being of people. To test whether social behavior and well-being are also associated in online communities, we studied the correlations between the recovery of patients with mental disorders and their behaviors in online social media. As the source of the data related to the social behavior and progress of mental recovery, we used PatientsLikeMe (PLM), the world’s first open-participation research platform for the development of patient-centered health outcome measures. We first constructed an online social network structure based on patient-to-patient ties among 200 patients obtained from PLM. We then characterized patients’ online social activities by measuring the numbers of “posts and views” and “helpful marks” each patient obtained. The patients’ recovery data were obtained from their self-reported status information that was also available on PLM. We found that some node properties (in-degree, eigenvector centrality and PageRank) and the two online social activity measures were significantly correlated with patients’ recovery. Furthermore, we re-collected the patients’ recovery data two months after the first data collection. We found significant correlations between the patients’ social behaviors and the second recovery data, which were collected two months apart. Our results indicated that social interactions in online communities such as PLM were significantly associated with the current and future recoveries of patients with mental disorders.
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Affiliation(s)
- Xinpei Ma
- Center for Collective Dynamics of Complex Systems , USA
| | - Hiroki Sayama
- Center for Collective Dynamics of Complex Systems , USA
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Zentner N, Baumgartner I, Becker T, Puschner B. Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records. Int J Health Policy Manag 2015; 4:153-60. [PMID: 25774372 DOI: 10.15171/ijhpm.2015.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/22/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time. METHODS Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self-reported treatment costs derived from the "Client Socio-demographic and Service Use Inventory" (CSSRI-EU) for two 6-month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication. RESULTS Sixty-one participants completed both assessments. Over one year, the average patient-reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = -2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status. CONCLUSION Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of post-hospital care, and what factors may help or inhibit post-discharge treatment engagement. Future research is also needed to examine long-term effects of inpatient psychiatric treatment on outcome and costs.
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Affiliation(s)
- Nadja Zentner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | | | - Thomas Becker
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
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Latimer EA, Garièpy G, Greenfield B. Cost-effectiveness of a rapid response team intervention for suicidal youth presenting at an emergency department. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:310-8. [PMID: 25007405 PMCID: PMC4079151 DOI: 10.1177/070674371405900604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 12/01/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the cost-effectiveness of a rapid response team (RRT), compared with usual care (UC), for treating suicidal adolescents. METHODS Suicidal adolescents (n = 286) presenting at an emergency department were enrolled in a trial to compare UC with enhanced outpatient care provided by an RRT of health professionals. Functioning (Child Global Assessment Scale) and suicidality (Spectrum of Suicidal Behavior Scale) scores were measured at baseline and 6 months later. Resource use and cost data were collected from several sources during the same period. RESULTS As previously reported, there was no statistically or clinically significant difference in either functioning or suicidality between the groups. Costs of the RRT were lower by $1886, thus -$1886 (95% CI -$4238 to $466), from the perspective of the treating hospital, and by $991, thus -$991 (95% CI -$5580 to $3598), from the perspective of society. If decision makers are not willing to pay for any improvement in functioning or suicidality, the RRT has a 95% probability of being cost-effective from the perspective of the treating hospital. From the point of view of society, the probability of the intervention being cost-effective is about 70% for functioning and 63% for suicidality. The difference between the 2 perspectives is mainly attributable to the cost of hospitalizations outside the treating hospital. CONCLUSIONS An RRT intervention appears to be cost-effective, compared with UC, from the point of view of the treating hospital, but there is no difference from the point of view of society.
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Affiliation(s)
- Eric A Latimer
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Research Scientist, Douglas Mental Health University Institute, Montreal, Quebec
| | - Geneviéve Garièpy
- Student, Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec
| | - Brian Greenfield
- Associate Professor of Clinical Psychiatry and Pediatrics, Division of Child Psychiatry, McGill University, Montreal, Quebec; Director, Emergency Psychiatric Service, Children's Hospital, McGill University Health Centre, Montreal, Quebec
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Harpaz-Rotem I, Libby D, Rosenheck RA. Psychotherapy use in a privately insured population of patients diagnosed with a mental disorder. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1837-44. [PMID: 22349151 DOI: 10.1007/s00127-012-0486-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 02/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Although there is growing evidence demonstrating the effectiveness of psychotherapy in the treatment of mental disorders, the use of psychotherapy in privately insured populations has not been examined. This study examines utilization rates and correlates of the receipt of psychotherapy. METHODS A large claims database of US private sector claims was used to examine utilization rates and correlates of receipt of psychotherapy. Altogether, 860,090 adults who received mental health services in 2005 were identified from the database. Multivariate binary regression and general linear models were used to assess the association of patient characteristics with use of psychotherapy, use of group or family therapy and the number of psychotherapy visits based on current procedural terminology (CPT) codes. RESULTS Only 32.4% of patients diagnosed with a mental illness received CPT codes indicating receipt of psychotherapy, and of these 96.5% received individual psychotherapy. Almost 75% of individuals diagnosed with posttraumatic stress disorder, 62% with major depressive disorder, and 54% with bipolar disorder received psychotherapy. Larger numbers of psychotherapy visits were associated with posttraumatic stress disorder (PTSD), alcohol use and mild depression. Larger numbers of psychotherapy visits were associated with PTSD, alcohol use and mild depression. Drug use, schizophrenia, bipolar disorder and major depressive disorder (MDD) were associated with fewer psychotherapy visits. CONCLUSIONS Substantial differences in use of psychotherapy were observed across diagnoses, perhaps reflecting the availability of alternative drug therapies. Greater use of psychotherapy in patients with PTSD may reflect weaker evidence of the effectiveness of pharmacological treatment, while less use in MDD may reflect greater evidence of drug benefits.
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Meyer B, Berger T, Caspar F, Beevers CG, Andersson G, Weiss M. Effectiveness of a novel integrative online treatment for depression (Deprexis): randomized controlled trial. J Med Internet Res 2009; 11:e15. [PMID: 19632969 PMCID: PMC2762808 DOI: 10.2196/jmir.1151] [Citation(s) in RCA: 235] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 03/02/2009] [Accepted: 03/27/2009] [Indexed: 02/05/2023] Open
Abstract
Background Depression is associated with immense suffering and costs, and many patients receive inadequate care, often because of the limited availability of treatment. Web-based treatments may play an increasingly important role in closing this gap between demand and supply. We developed the integrative, Web-based program Deprexis, which covers therapeutic approaches such as behavioral activation, cognitive restructuring, mindfulness/acceptance exercises, and social skills training. Objective To evaluate the effectiveness of the Web-based intervention in a randomized controlled trial. Methods There were 396 adults recruited via Internet depression forums in Germany, and they were randomly assigned in an 80:20 weighted randomization sequence to either 9 weeks of immediate-program-access as an add-on to treatment-as-usual (N = 320), or to a 9-week delayed-access plus treatment-as-usual condition (N = 76). At pre- and post-treatment and 6-month follow-up, we measured depression (Beck Depression Inventory) as the primary outcome measure and social functioning (Work and Social Adjustment Scale) as the secondary outcome measure. Completer analyses and intention-to-treat analyses were performed. Results Of 396 participants, 216 (55%) completed the post-measurement 9 weeks later. Available case analyses revealed a significant reduction in depression severity (BDI), Cohen’s d = .64 (CI 95% = 0.33 - 0.94), and significant improvement in social functioning (WSA), Cohen’s d = .64, 95% (CI 95% = 0.33 - 0.95). These improvements were maintained at 6-month follow-up. Intention-to-treat analyses confirmed significant effects on depression and social functioning improvements (BDI: Cohen’s d = .30, CI 95% = 0.05 - 0.55; WSA: Cohen’s d = .36, CI 95% = 0.10 - 0.61). Moreover, a much higher percentage of patients in the intervention group experienced a significant reduction of depression symptoms (BDI: odds ratio [OR] = 6.8, CI 95% = 2.90 - 18.19) and recovered more often (OR = 17.3, 95% CI 2.3 - 130). More than 80% of the users felt subjectively that the program had been helpful. Conclusions This integrative, Web-based intervention was effective in reducing symptoms of depression and in improving social functioning. Findings suggest that the program could serve as an adjunctive or stand-alone treatment tool for patients suffering from symptoms of depression. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 64953693; http://www.controlled-trials.com/ISRCTN64953693/64953693 (Archived by WebCite at http://www.webcitation.org/5ggzvTJPD)
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Affiliation(s)
- Björn Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building O59, 20246 Hamburg, Germany.
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Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. ACTA ACUST UNITED AC 2008; 168:27-32. [PMID: 18195192 DOI: 10.1001/archinternmed.2007.4] [Citation(s) in RCA: 650] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND While delirium has been increasingly recognized as a serious and potentially preventable condition, its long-term implications are not well understood. This study determined the total 1-year health care costs associated with delirium. METHODS Hospitalized patients aged 70 years and older who participated in a previous controlled clinical trial of a delirium prevention intervention at an academic medical center between 1995 and 1998 were followed up for 1 year after discharge. Total inflation-adjusted health care costs, calculated as either reimbursed amounts or hospital charges converted to costs, were computed by means of data from Medicare administrative files, hospital billing records, and the Connecticut Long-term Care Registry. Regression models were used to determine costs associated with delirium after adjusting for patient sociodemographic and clinical characteristics. RESULTS During the index hospitalization, 109 patients (13.0%) developed delirium while 732 did not. Patients with delirium had significantly higher unadjusted health care costs and survived fewer days. After adjusting for pertinent demographic and clinical characteristics, average costs per day survived among patients with delirium were more than 2(1/2) times the costs among patients without delirium. Total cost estimates attributable to delirium ranged from $16 303 to $64 421 per patient, implying that the national burden of delirium on the health care system ranges from $38 billion to $152 billion each year. CONCLUSIONS The economic impact of delirium is substantial, rivaling the health care costs of falls and diabetes mellitus. These results highlight the need for increased efforts to mitigate this clinically significant and costly disorder.
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Affiliation(s)
- Douglas L Leslie
- Department of Health Administration and Policy, Medical University of South Carolina, 151 Rutledge Ave, Bldg B, PO Box 250961, Charleston, SC 29425, USA.
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Woodward A, Das A, Raskin IE, Morgan-Lopez AA. An exploratory analysis of treatment completion and client and organizational factors using hierarchical linear modeling. EVALUATION AND PROGRAM PLANNING 2006; 29:335-351. [PMID: 17950862 DOI: 10.1016/j.evalprogplan.2006.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Data from the Alcohol and Drug Services Study (ADSS) are used to analyze the structure and operation of the substance abuse treatment industry in the United States. Published literature contains little systematic empirical analysis of the interaction between organizational characteristics and treatment outcomes. This paper addresses that deficit. It develops and tests a hierarchical linear model (HLM) to address questions about the empirical relationship between treatment inputs (industry costs, types and use of counseling and medical personnel, diagnosis mix, patient demographics, and the nature and level of services used in substance abuse treatment), and patient outcomes (retention and treatment completion rates). The paper adds to the literature by demonstrating a direct and statistically significant link between treatment completion and the organizational and staffing structure of the treatment setting. Related reimbursement issues, questions for future analysis, and limitations of the ADSS for this analysis are discussed.
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Affiliation(s)
- Albert Woodward
- Department of Research & Development, American College of Cardiology, 2400 N St. NW, Washington, DC, 20037, USA
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Kinchen KS, Long S, Orsini L, Crown W, Bump RC. Healthcare utilization among women who undergo surgery for stress urinary incontinence. Int Urogynecol J 2004; 15:154-9. [PMID: 15167992 DOI: 10.1007/s00192-004-1133-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2003] [Accepted: 11/19/2003] [Indexed: 10/26/2022]
Abstract
This study examined patterns of care for women undergoing surgery for stress urinary incontinence (SUI). A retrospective analysis of administrative claims data was performed and we identified 12520 women with a diagnosis of SUI and a subset of 3735 women with a surgical procedure code for SUI. For the main types of surgeries, we examined length of stay, pharmaceutical use, complications, and healthcare utilization related to incontinence greater than 6 months after surgery. Approximately 30% of women with a coded SUI diagnosis underwent surgery. Of the initial procedures, 40% were retropubic suspensions and 25% were sling procedures. Almost 4% of women underwent an additional surgery, and 14.1% had claims related to incontinence 6 or more months after the initial procedure. We examined medical care and pharmaceutical use for women undergoing continence surgery. This information may be important to patients and physicians discussing treatment options.
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Affiliation(s)
- Kraig S Kinchen
- Lilly Research Labs, Eli Lilly and Company, Indianapolis, IN 46278, USA.
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