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Utilization Rates (utilization + rate)
Selected AbstractsUtilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsiesLIVER INTERNATIONAL, Issue 5 2008Robert P. Myers Abstract Background: Liver biopsy is an important tool in the management of patients with liver disease. Because biopsy practices may be changing, we studied patterns of use in a large Canadian Health Region. We aimed to describe trends in biopsy utilization and the incidence and costs of complications from a population-based perspective. Methods: Administrative databases were used to identify percutaneous liver biopsies performed between 1994 and 2002. Significant complications were identified by reviewing medical records of patients hospitalized within 7 days of a biopsy and those with a diagnostic code indicative of a procedural complication. Analyses of biopsy rates employed Poisson regression. Results: Between 1994 and 2002, 3627 patients had 4275 liver biopsies (median 1 per patient; range 1,12). Radiologists performed the majority (90%), particularly during the latter years (1994 vs. 2002: 73 vs. 98%; P<0.0001). The overall annual biopsy rate was 54.8 per 100 000 population with a 41% (95% CI 23,61%) increase between 1994 and 2002. Annual increases were greatest in males and patients 30,59 years. Thirty-two patients (0.75%) had significant biopsy-related complications (1994,1997 vs. 1998,2002: 1.28 vs. 0.44%; P=0.003). Pain requiring admission (0.51%) and bleeding (0.35%) were most common. Six patients (0.14%) died; all had malignancies. The median direct cost of a hospitalization for complications was $4579 (range $1164,29 641). Conclusions: Liver biopsy rates are increasing likely owing to the changing epidemiology and management of common liver diseases. The similarity of the complication rate in our population-based study with estimates from specialized centres supports the safety of this important procedure. [source] Centers for Disease Control ,High-Risk' Donors and Kidney UtilizationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010K. I. Duan The aims of this study were to determine whether Centers for Disease Control high risk (CDCHR) status of organ donors affects kidney utilization and recipient survival. Data from the Scientific Registry of Transplant Recipients were used to examine utilization rates of 45 112 standard criteria donor (SCD) deceased donor kidneys from January 1, 2005, and February 2, 2009. Utilization rates for transplantation were compared between CDCHR and non-CDCHR kidneys, using logistic regression to control for possible confounders. Cox regression was used to determine whether CDCHR status independently affected posttransplant survival among 25 158 recipients of SCD deceased donor kidneys between January 1, 2005, and February 1, 2008. CDCHR kidneys were 8.2% (95% CI 6.9,9.5) less likely to be used for transplantation than non-CDCHR kidneys; after adjusting for other factors, CDCHR was associated with an odds ratio of utilization of 0.67 (95% CI 0.61,0.74). After a median 2 years follow-up, recipients of CDCHR kidneys had similar posttransplant survival compared to recipients of non-CDCHR kidneys (hazard ratio 1.06, 95% CI 0.89,1.26). These findings suggest that labeling donor organs as ,high risk' may result in wastage of approximately 41 otherwise standard kidneys per year. [source] Improved methods for carbon adsorption studies for water and wastewater treatmentENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 2 2006Wei-chi Ying Abstract An improved method was developed to rank activated carbon in removing organic water pollutants. The simple and standardized evaluation method uses a set of four adsorptive capacity indicators: phenol, iodine, methylene blue, and tannic acid numbers; those four indicator compounds were selected because they cover the molecular size range of most organic water pollutants. An improved microcolumn rapid breakthrough (MCRB) test method was developed from the existing HPMC (high-pressure minicolumn) and RSSCT (rapid small-scale column test) methods by simplifying the experimental procedure and using readily available low-cost pump, sampler, piping, and fittings. This method can be practiced in an ordinary environmental laboratory to select the best carbon, to verify the treatment effectiveness, and to estimate the adsorption treatment cost based on the observed capacity utilization rate for carbon in the adsorber without the problems often encountered with using small and mini traditional columns. The benefits of the four-parameter carbon selection method and the MCRB method were demonstrated by adsorption isotherm and breakthrough data for several indicator compounds and organic water pollutants. These improved methods will enable efficient carbon adsorption studies necessary for more applications of carbon adsorption technology in water and wastewater treatment. © 2006 American Institute of Chemical Engineers Environ Prog, 2006 [source] Effects of fungicides on thyroid function, metabolism, and thermoregulation in cotton rats,ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 8 2001Thomas E. Tomasi Abstract Among the myriad of recent studies on endocrine-disrupting chemicals, relatively few involve thyroid disruption, and most of these address exposure/disruption during embryonic life. Of those involving adult vertebrates, the endpoints examined are thyroid measurements. Even though thyroid disruption could potentially interfere with energy metabolism and thermoregulation such that over-winter survival might be compromised, the possible energetic consequences of these thyroid perturbations have not been investigated. We assessed thyroid function and measured resting metabolic rates of cotton rats chronically exposed to the fungicides vinclozolin or mancozeb. In addition, we measured norepinephrine-induced nonshivering thermogenesis and cold-induced thermogenesis and then cold-acclimated the mancozeb animals. Although thyroid hormone concentrations generally decreased, this was compensated for by an increase in thyroxine turnover (vinclozolin study only) such that thyroxine utilization rate was not different. In addition, there was no difference between the treated and control animals in any of the metabolic parameters measured. It is concluded that wild rodents exposed to these compounds are not energetically compromised. [source] Intercenter variation in initial management of children with Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 7 2007Michael D. Kappelman MD Abstract Background: Variation in care is a ubiquitous feature of medical practice and may lead to significant differences in health care costs, quality, and outcomes. We undertook this study to determine the extent of intercenter variation in the initial management of children newly diagnosed with Crohn's disease. Methods: We analyzed the utilization of 5 classes of medication (immunomodulators, prednisone, antibiotics, 5-aminosalicylates, and infliximab) among 311 children with newly diagnosed Crohn's disease followed at 10 North American pediatric gastroenterology centers. Multivariate logistic regression was used to compare the utilization rate of each class of medication at each of the 10 centers, adjusting for potential confounders including patient age, sex, race, disease severity, and anatomic location of disease. Results: Median utilization of each class of medication was: immunomodulators, 56% (range 29%,97%); prednisone, 78% (range 32%,88%); antibiotics, 29% (range 11%,68%); 5-aminosalicylates, 63.5% (range 18%,92%); and infliximab, 7.5% (range 3%,21%). Each of these treatments showed statistically significant intercenter variation in utilization (P < 0.001 for immunomodulators, prednisone, antibiotics, and 5-ASA; P = 0.02 for infliximab). After adjusting for the demographic and clinical factors listed above, intercenter variation remained significant; however, the low utilization of infliximab precluded multivariate analysis. Conclusions: Widespread intercenter variation in the medical management of newly diagnosed children with Crohn's disease was observed, even after adjusting for possible differences in case mix between institutions. This variation may lead to unintended differences in health care costs and outcomes. (Inflamm Bowel Dis 2007) [source] Prescription Duration After Drug Copay Changes in Older People: Methodological AspectsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2002Sebastian Schneeweiss MD OBJECTIVES: Impact assessment of drug benefits policies is a growing field of research that is increasingly relevant to healthcare planning for older people. Some cost-containment policies are thought to increase noncompliance. This paper examines mechanisms that can produce spurious reductions in drug utilization measures after drug policy changes when relying on pharmacy dispensing data. Reference pricing, a copayment for expensive medications above a fixed limit, for angiotensin-converting enzyme (ACE) inhibitors in older British Columbia residents, is used as a case example. DESIGN: Time series of 36 months of individual claims data. Longitudinal data analysis, adjusting for autoregressive data. SETTING: Pharmacare, the drug benefits program covering all patients aged 65 and older in the province of British Columbia, Canada. PARTICIPANTS: All noninstitutionalized Pharmacare beneficiaries aged 65 and older who used ACE inhibitors between 1995 and 1997 (N = 119,074). INTERVENTION: The introduction of reference drug pricing for ACE inhibitors for patients aged 65 and older. MEASUREMENTS: Timing and quantity of drug use from a claims database. RESULTS: We observed a transitional sharp decline of 11%± a standard error of 3% (P = .02) in the overall utilization rate of all ACE inhibitors after the policy implementation; five months later, utilization rates had increased, but remained under the predicted prepolicy trend. Coinciding with the sharp decrease, we observed a reduction in prescription duration by 31% in patients switching to no-cost drugs. This reduction may be attributed to increased monitoring for intolerance or treatment failure in switchers, which in turn led to a spurious reduction in total drug utilization. We ruled out the extension of medication use over the prescribed duration through reduced daily doses (prescription stretching) by a quantity-adjusted analysis of prescription duration. CONCLUSION: The analysis of prescription duration after drug policy interventions may provide alternative explanations to apparent short-term reductions in drug utilization and adds important insights to time trend analyses of drug utilization data in the evaluation of drug benefit policy changes. J Am Geriatr Soc 50:521,525, 2002. [source] Temperature dependency of granule characteristics and kinetic behavior in UASB reactorsJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 8 2004Hsin-Hsien Chou Abstract When an inhibitory substrate, phenol, was treated under mesophilic conditions (25, 30, 35, and 40 °C), the upflow anaerobic sludge bed (UASB) reactors at 30 °C resulted in the greatest amount of biomass and the largest granule size, while the UASB reactors at 25 °C resulted in the smallest granule size and the greatest amount of wash-out of sludge. The granule size tended to be negatively correlated with the amount of wash-out of sludge. With an increase in temperature, the kinetic constant k for anaerobic phenol degradation increased and the half saturation constant (Ks) decreased. The mass fraction of methanogens (f) increased with increasing operational temperature in the UASB reactors and the activation energy (Ea) for acetate methanogenesis was larger than that for phenol acidogenesis in the batch reactors, indicating that the operational temperature imposes a more influential effect on methanogens than on acidogens. From the results of the activity of acidogens and methanogens (expressed in specific COD utilization rate), the rate-limiting step is phenol acidogenesis. Copyright © 2004 Society of Chemical Industry [source] Municipal sludge degradation kinetic in thermophilic CSTRAICHE JOURNAL, Issue 12 2006Ángeles de la Rubia Abstract The performance of a pilot-scale continuous-flow stirred-tank reactor (CSTR) treating municipal sludge under thermophilic conditions has been studied. Two pilot-scale reactors (CSTR1 (175 L) and CSTR2 (850 L)) were operated at different hydraulic residence times (,: 40 to 15 days). The anaerobic sludge processes are generally affected by variations in the concentration of substrate (determined as influent volatile solids, VS) and volumetric flow, both of which lead to a modification in biomass concentration and VS removal efficiency. This unsteady-state situation is mathematically explained in terms of an autocatalytic kinetic model. The general kinetic equation in this model has been applied to experimental data obtained in CSTR1. The fit of the experimental data to the model was used to estimate kinetic parameters and the yield coefficients (,max, ,, YP/S). The estimated parameters were ,max: 0.175d,1, ,: 0.358, YP/S: 0.309 m3CH4/kgVS). These parameters were subsequently used to model the substrate utilization rate and the methane generation rate in CSTR2. The model with the estimated parameters was found to provide excellent results, and is satisfactory in describing the concentration of VS and the methane generation rate in an actual digestion plant. © 2006 American Institute of Chemical Engineers AIChE J, 2006 [source] Oral health and related quality of life status in patients from UK and Turkey: a comparative study in Behcet's diseaseJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 5 2009G. Mumcu Background:, The aim of this study was to evaluate and compare oral health-related quality of life (oral QoL) in patients from UK and Turkey with Behcet's disease (BD). Methods:, Thirty-one BD patients from UK (F/M: 18/13, mean age: 41.8 ± 11.5 years) and Turkey (F/M: 18/13, mean age: 41.5 ± 10.3) who were matched according to age and gender were included in the study. All patients had active oral ulcers. Oral QoL was assessed by Oral Health Impact Profile-14 (OHIP-14). Oral health was evaluated by dental and periodontal indices. Results:, No significant difference was found in OHIP-14 scores between patients from UK (22.7 ± 14.4) and Turkey (20.4 ± 14.3) (P = 0.709). The OHIP-14 score correlated with the healing time of oral ulcers in UK (r = 0.4, P = 0.04) and the number of oral ulcers in Turkey (r = 0.4, P = 0.012). The number of oral ulcers per month was significantly higher in UK (3.3 ± 2.8) compared with that in Turkey (1.5 ± 2.5) (P = 0.014). However, the number of filled teeth and frequency of tooth brushing were significantly lower in patients from Turkey compared with those in UK (P = 0.000). Similarly, the duration since the last dental visit (5.1 ± 7.2 months) was significantly lower in UK compared with that in Turkey (28.6 ± 23.7 months) (P = 0.000). Conclusions:, Oral QoL was similar in patients from UK and Turkey with active oral ulcers. However, the number of oral ulcers was observed to be higher in UK. As expected, a lower utilization rate of dental services might have led to a poorer oral health in patients from Turkey. [source] Life-cycle kinetic model for endospore-forming bacteria, including germination and sporulationBIOTECHNOLOGY & BIOENGINEERING, Issue 5 2009Seongjun Park Abstract We develop a mechanistic life-cycle model for endospore-forming bacteria (EFB) and test the model with experiments with a Bacillus mixed culture. The model integrates and quantifies how sporulation and germination are triggered by depletion or presence of a limiting substrate, while both substrates affect the rate of vegetative growth by a multiplicative model. Kinetic experiments show the accumulation of small spherical spores after the triggering substrate is depleted, substantially more rapid decay during sporulation than for normal decay of vegetative cells, and a higher specific substrate utilization rate for the germinating cells than that for growth of vegetative cells. Model simulations capture all of these experimental trends. According to model predictions, when a batch reactor is started, seeding with EFB spores instead of active EFB delays the onset of rapid chemical oxygen demand (COD) utilization and biomass growth, but the end points are the same. Simulated results with low aeration intensity show that germination can consume some substrate without dissolved oxygen (DO) depletion. Biotechnol. Bioeng. 2009; 104: 1012,1024. © 2009 Wiley Periodicals, Inc. [source] Classification of Static Behavior of a Class of Unstructured Models of Continuous BioprocessesBIOTECHNOLOGY PROGRESS, Issue 4 2001A. Ajbar The stability characteristics of a class of unstructured models of continuous bioreactors are analyzed using elementary concepts of singularity theory and continuation techniques. The class consists of models for which the non-biomass product formation rate is linearly proportional to the utilization rate of limiting substrate. The kinetics expressions of cell growth and product synthesis are allowed to assume general forms of substrate and product. Global analytical conditions are derived that allow the construction of a practical picture in the multidimensional parameter space delineating the different static behavior these models can predict, including unique steady states, coexistence of non-trivial steady states with wash-out conditions, and multistability resulting from hysteresis. These general results are applied to specific examples of bioprocesses and allow the study of the effect of kinetic and operating parameters on the stability characteristics of these models. [source] Resource Utilization and Economies of Size in Secondary SchoolsBULLETIN OF ECONOMIC RESEARCH, Issue 2 2000Jim Taylor This paper identifies the determinants of costs per pupil in English secondary schools. A distinction is made between the short run and the long run in order to estimate the separate effects on costs per pupil of short-run variations in school output and school size. A school's capacity utilization rate is used to indicate short-run deviations in output from pupil capacity, and pupil capacity is used as an indicator of school size to capture scale effects on costs per pupil. The statistical analysis uses both published and unpublished data for secondary schools in England. Two separate analyses are undertaken, one for grant-maintained schools alone and the other for all schools. A separate analysis is undertaken for grant-maintained schools since cost data are available only for schools in this sector. Staff hours per pupil is used as a proxy for costs per pupil for schools as a whole. The main finding is that costs per pupil and staff hours per pupil are both highly significantly negatively related to both school size and the capacity utilization rate of schools. A range of other variables are also estimated to have a significant effect on costs per pupil in secondary schools. The main finding is that there is scope for reducing the costs of schooling in the secondary schools sector in England. [source] Estimating the optimal external-beam radiotherapy utilization rate for genitourinary malignanciesCANCER, Issue 3 2005Geoff Delaney M.B.B.S. Abstract BACKGROUND Benchmark radiotherapy utilization rates for genitourinary malignancies are largely unknown, despite the finding that genitourinary cancers comprise approximately 19% of all registered malignancies in Australia. METHODS To develop an evidence-based benchmark of the optimal proportion of patients with genitourinary malignancies who should receive at least one course of radiotherapy at some time during their illness, the authors studied treatment guidelines and treatment reviews regarding genitourinary malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes that indicated possible benefit from radiotherapy based on evidence. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with genitourinary cancer for whom radiotherapy was considered appropriate. RESULTS The proportion of patients with genitourinary malignancies for whom radiotherapy was indicated at some point in their illness, according to the best available evidence, was estimated to be 27% of patients with renal cancer, 58% of patients with bladder cancer, 60% of patients with prostate cancer, and 49% of patients with testicular cancer. The occurrence of ureteric and penile cancers among patients was too rare, and, therefore, these patients were not included in the current study. CONCLUSIONS There was a large discrepancy between actual radiotherapy utilization and the evidence-based optimal rate. The authors recommended strategies to implement the evidence-based guidelines. Evidence-based benchmarks for radiotherapy utilization rates such as the ones described in the current study were important in the evaluation of the appropriate use of radiotherapy. Cancer 2005. © 2004 American Cancer Society. [source] Racial and Gender Trends in the Use of Implantable Cardioverter-Defibrillators Among Medicare Beneficiaries Between 1997 and 2003CONGESTIVE HEART FAILURE, Issue 2 2009Paul S. Chan MD Differences in the use of implantable cardioverter-defibrillators (ICDs) have been reported, but the extent to which they have widened after the publication of major clinical trials supporting their use is unclear. Using data on Medicare beneficiaries, the authors determined annual age-standardized population-based utilization rates of ICDs for white men, black men, white women, and black women from 1997 to 2003. During the study period, overall use of ICDs increased most for white men (81.7,254.7 procedures per 100,000 from 1997 to 2003) and black men (38.0,151.7 procedures per 100,000), with white women (28.9,98.4 procedures per 100,000) and black women (18.2,77.3 procedures per 100,000) showing smaller increases in comparison. After adjustment with multivariable regression models, differences in utilization rates between whites and men widened compared with blacks and women between 1997 and 2003, a period when indications for ICD therapy have expanded. [source] Factors associated with the use of aids to cessation in English smokersADDICTION, Issue 8 2009Daniel Kotz ABSTRACT Aims To assess factors associated with the use of smoking cessation aids among smokers trying to quit in a country where these aids are widely available and free or cheap to access. Design Cross-sectional household survey, the ,Smoking Toolkit Study'. Setting England. Participants A total of 3767 respondents who smoked and made at least one serious quit attempt in the past 12 months were interviewed from November 2006 to April 2008. Measurements We analysed differences across socio-demographic and smoking characteristics in the use of nicotine replacement therapy (NRT) over the counter or on prescription, bupropion, varenicline, telephone support and the National Health Service Stop Smoking Service (NHS-SSS) which combines behavioural support with medication. Findings More than half of smokers trying to quit (51.2%) had used any kind of treatment; 48.4% had used some form of medication but only 6.2% had used the NHS-SSS. The use of some form of smoking cessation treatment was higher in female than in male smokers [odds ratio (OR): 1.24, 95% confidence interval (CI): 1.08, 1.43] and increased with age (OR: 1.19, 95% CI: 1.14,1.25) and cigarettes smoked per day (OR = 1.05, 95% CI = 1.04,1.06). There was no association with social grade. Smokers who planned their quit attempt were more likely to have used all types of smoking cessation treatments, except for telephone support. Conclusions In England, half of all attempts to quit smoking are aided by some form of pharmacological or behavioural treatment. However, the use of the most effective treatment option (the NHS-SSS) is low, despite it being free of charge. Factors associated with an increased use of aids to cessation were female sex, older age, more cigarettes smoked per day and planning a quit attempt. Research is needed into how to increase utilization rates, particularly among males and younger smokers. [source] An In Situ Device to Measure Oxygen in the Vadose Zone and in Ground Water: Laboratory Testing and Field EvaluationGROUND WATER MONITORING & REMEDIATION, Issue 2 2008Bradley M Patterson Oxygen probes developed to measure in situ oxygen concentrations in gaseous and aqueous environments were evaluated in laboratory tests and during long-term field evaluation trials at contaminated sites. The oxygen probes were shown to have a linear calibration and to be accurate compared to conventional dissolved oxygen electrodes and gas chromatography, both of which require labor-intensive sample collection and processing. The probes, once calibrated, required no maintenance or recalibration for up to a period of 7 years in low-oxygen environments, demonstrating long-term stability. Times to achieve 90% of the stabilized concentration (t90) after a step change in aqueous oxygen concentration were 100,120 min in laboratory experiments and up to 180 min in field experiments, which is adequate for monitoring subsurface changes. Field application data demonstrated that the oxygen probes could monitor oxygen concentrations in hydrocarbon-contaminated ground water to a depth of 20 m below the water table or in pyritic vadose zones over extended periods. During bioremediation field trials, oxygen monitoring enabled estimation of oxygen utilization rates by microorganisms and hydrocarbon biodegradation rates. Also, probes were able to monitor the development of ground water desaturation during air sparging trials, enabling the automated assessment of the distribution of injected air. [source] Suboptimal provision of preventive healthcare due to expected enrollee turnover among private insurersHEALTH ECONOMICS, Issue 4 2010Bradley Herring Abstract Many preventive healthcare procedures are widely recognized as cost-effective but have relatively low utilization rates in the US. Because preventive care is a present-period investment with a future-period expected financial return, enrollee turnover among private insurers lowers the expected return of this investment. In this paper, I present a simple theoretical model to illustrate the suboptimal provision of preventive healthcare that results from insurers ,free riding' off of the provision from others. I also provide an empirical test of this hypothesis using data from the Community Tracking Study's Household Survey. I use lagged market-level measures of employment-induced insurer turnover to identify variation in insurers' expectations and test for the effect of turnover on several different measures of medical utilization. As expected, I find that turnover has a significantly negative effect on the utilization of preventive services and has no effect on the utilization of acute services used as a control. Copyright © 2009 John Wiley & Sons, Ltd. [source] The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacksHEALTH ECONOMICS, Issue 10 2009Mickael Bech Abstract The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time. Copyright © 2008 John Wiley & Sons, Ltd. [source] Progressive segmented health insurance: Colombian health reform and access to health servicesHEALTH ECONOMICS, Issue 1 2007Fernando Ruiz Abstract Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal. Copyright © 2006 John Wiley & Sons, Ltd. [source] The Relationship of Post-acute Home Care Use to Medicaid Utilization and ExpendituresHEALTH SERVICES RESEARCH, Issue 3 2002Susan M. C. Payne Research Objectives: To describe the use of post-acute home care (PAHC) and total Medicaid expenditures among hospitalized nonelderly adult Medicaid eligibles and to test whether health services utilization rates or total Medicaid expenditures were lower among Medicaid eligibles who used PAHC compared to those who did not. Study Population: 5,299 Medicaid patients aged 18,64 discharged in 1992,1996 from 29 hospitals in the Cleveland Health Quality Choice (CHQC) project. Data Sources: Linked Ohio Medicaid claims and CHQC medical record abstract data. Data Extraction: One stay per patient was randomly selected. Design: Observational study. To control for treatment selection bias, we developed a model predicting the probability (propensity) a patient would be referred to PAHC, as a proxy for the patient's need for PAHC. We matched 430 patients who used Medicaid-covered PAHC ("USE") to patients who did not ("NO USE") by their propensity scores. Study outcomes were inpatient re-admission rates and days of stay (DOS), nursing home admission rates and DOS, and mean total Medicaid expenditures 90 and 180 days after discharge. Principal Findings: Of 3,788 medical patients, 12.1 percent were referred to PAHC; 64 percent of those referred used PAHC. Of 1,511 surgical patients, 10.9 percent were referred; 99 percent of those referred used PAHC. In 430 pairs of patients matched by propensity score, mean total Medicaid expenditures within 90 days after discharge were $7,649 in the USE group and $5,761 in the NO USE group. Total Medicaid expenditures were significantly higher in the USE group compared to the NO USE group for medical patients after 180 days (p<.05) and surgical patients after 90 and 180 days (p<.001). There were no significant differences for any other outcome. Sensitivity analysis indicates the results may be influenced by unmeasured variables, most likely functional status and/or care-giver support. Conclusions: Thirty-six percent of the medical patients referred to PAHC did not receive Medicaid-covered services. This suggests potential underuse among medical patients. The high post-discharge expenditures suggest opportunities for reducing costs through coordinating utilization or diverting it to lower-cost settings. Controlling for patients' need for services, PAHC utilization was not associated with lower utilization rates or lower total Medicaid expenditures. Medicaid programs are advised to proceed cautiously before expanding PAHC utilization and to monitor its use carefully. Further study, incorporating non-economic outcomes and additional factors influencing PAHC use, is warranted. [source] Considering context, place and culture: the National Latino and Asian American StudyINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2004Margarita Alegria Abstract This paper provides a rationale for, and overview of, procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization by Latinos and Asian Americans in the US. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication) (NCS-R) and African Americans (from the National Survey of American Life) (NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research. Copyright © 2004 Whurr Publishers Ltd. [source] Religious Attendance, Health Maintenance Beliefs, and Mammography Utilization: Findings from a Nationwide Survey of Presbyterian WomenJOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION, Issue 4 2006MAUREEN R. BENJAMINS Preventive health services, such as mammography, play an increasingly important role in maintaining women's health. Social factors, such as religion, may influence utilization rates by expanding access, offering information, and increasing motivation. The current study examines the relationship between religious involvement, religious beliefs, and mammography usage in a nationally representative sample of Presbyterian women (N= 1,070). We use multivariate logistic regression models to estimate the influence of religious service attendance and two health-related religious beliefs on self-reported mammography use. The findings show that religious attendance is significantly associated with mammogram use. Women who attend services nearly every week are almost twice as likely to use mammograms compared to women who attend services less frequently or never. Furthermore, the belief that spiritual health is related to physical health is also associated with the use of mammograms. [source] Prescription Duration After Drug Copay Changes in Older People: Methodological AspectsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2002Sebastian Schneeweiss MD OBJECTIVES: Impact assessment of drug benefits policies is a growing field of research that is increasingly relevant to healthcare planning for older people. Some cost-containment policies are thought to increase noncompliance. This paper examines mechanisms that can produce spurious reductions in drug utilization measures after drug policy changes when relying on pharmacy dispensing data. Reference pricing, a copayment for expensive medications above a fixed limit, for angiotensin-converting enzyme (ACE) inhibitors in older British Columbia residents, is used as a case example. DESIGN: Time series of 36 months of individual claims data. Longitudinal data analysis, adjusting for autoregressive data. SETTING: Pharmacare, the drug benefits program covering all patients aged 65 and older in the province of British Columbia, Canada. PARTICIPANTS: All noninstitutionalized Pharmacare beneficiaries aged 65 and older who used ACE inhibitors between 1995 and 1997 (N = 119,074). INTERVENTION: The introduction of reference drug pricing for ACE inhibitors for patients aged 65 and older. MEASUREMENTS: Timing and quantity of drug use from a claims database. RESULTS: We observed a transitional sharp decline of 11%± a standard error of 3% (P = .02) in the overall utilization rate of all ACE inhibitors after the policy implementation; five months later, utilization rates had increased, but remained under the predicted prepolicy trend. Coinciding with the sharp decrease, we observed a reduction in prescription duration by 31% in patients switching to no-cost drugs. This reduction may be attributed to increased monitoring for intolerance or treatment failure in switchers, which in turn led to a spurious reduction in total drug utilization. We ruled out the extension of medication use over the prescribed duration through reduced daily doses (prescription stretching) by a quantity-adjusted analysis of prescription duration. CONCLUSION: The analysis of prescription duration after drug policy interventions may provide alternative explanations to apparent short-term reductions in drug utilization and adds important insights to time trend analyses of drug utilization data in the evaluation of drug benefit policy changes. J Am Geriatr Soc 50:521,525, 2002. [source] Assessing impacts of large herbivores on shrubs: tests of scaling factors for utilization rates from shoot-level measurementsJOURNAL OF APPLIED ECOLOGY, Issue 1 2007DANIELLE M. BILYEU Summary 1Accurate methods for estimating the intensity of browsing by herbivores are fundamental to understanding the ecology of shrub communities. Quantifying browse utilization on shrubs at large scales is difficult because shrubs have complex, spatially variable growth forms. Most existing methods estimate browsing rate at the scale of linear current-year shoots or twigs. How such fine-scale estimates relate to the proportion of current-year growth consumed from whole plants or plots is often unknown. The relationship is likely to be complex because herbivores selectively browse more productive plants and plant parts. 2Using a clipping experiment designed to mimic elk Cervus elaphus browsing, we quantified how utilization estimates at the scale of individual current-year shoots of two willow species, Salix bebbiana and Salix geyeriana, relate to actual mass removed at the scale of rooted stems. Three approaches to scaling were examined: (i) taking an average, (ii) multiplying by the proportion of shoots clipped and (iii) multiplying by a novel scaling factor that weights utilization by productivity. To address how to scale-up from stems to plots, we applied the most accurate stem-level method to elk-browsed willow and compared plot-level estimates by two scaling approaches. 3In scaling from shoots to stems, the novel scaling factor was most successful and resulted in accurate estimates for up to c. 45% of current annual growth clipped. In scaling from the stem to the plot, elk preference for more productive stems caused a simple average of stem-level utilization to differ from a productivity-weighted average by 15%. 4Synthesis and applications. In order to reflect accurately the proportion of biomass consumed at a whole-plant level, fine-scale estimates of utilization should be weighted by an estimate of pre-browse productivity, as this is mathematically equivalent to summing pre-browse and post-browse mass before calculating the proportion consumed. In developing methods to estimate utilization at plot scales, an important consideration is the choice of sampling unit, which should be both amenable to unbiased sampling and tractable in terms of measuring productivity. [source] A population-based cohort study of ambulatory care service utilization among older adultsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2010Jason X. Nie BSc (Hons) Abstract Rationale, aims and objectives, Age-related effects on ambulatory care service utilization are not well understood. We aim to measure the utilization patterns of ambulatory health care services (i.e. family physician visits, specialist physician visits and emergency room visits) in the late life course (65 years and older). Methods, A population-based retrospective cohort study was conducted for the period 1 April 2005 to 31 March 2006. All Ontario, Canada, residents aged 65+ and eligible for government health insurance were included in the analysis. Results, This population-based cohort study demonstrates considerable increase in utilization rates and variability of ambulatory services as age increases. Variations in utilization were observed by gender as overall women were more likely to consult a family physician, and men more likely to visit specialists and the emergency room. A small group of high users, constituting 5.5% of the total population, accounted for 18.7% of total ambulatory visits. Finally, we report socio-economic status (SES) based disparity for specialist services in which high users were more likely to have higher SES. Conclusions, There is increasing utilization and variability in ambulatory service utilization with increase in age. Further research is required to explain the gender and SES differences reported in this study. [source] Materials and Energy Flow Analysis of Paper Consumption in the United Kingdom, 1987-2010JOURNAL OF INDUSTRIAL ECOLOGY, Issue 3 2001Erik Sundin Summary This article presents the results of a life-cycle materials and energy flow analysis for the pulp and paper cycle in the United Kingdom. Material flows are reconstructed for the period be-tween 1987 and 1996 for all major processes associated with the paper cycle, and system energy requirements are calculated over this period using the best available data. Attention is drawn to the import dependence of U.K. paper demand, and the significant energy requirements associated with upstream forestry processes. The historical trend analysis is then used to model possible future developments in materials and energy consumption until 2010 under a variety of assumptions about process technology improvements, wastepaper utilization rates, and changing demand trends. The results indicate that policy options to increase recycling yield some energy benefits, but these are small by comparison with the benefits to be gained by reducing consumption of paper and improving process technology. The structure of the electricity supply industry in the United Kingdom means that global energy benefits could also be achieved by increasing the contribution from imported pulp. [source] Centers for Disease Control ,High-Risk' Donors and Kidney UtilizationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010K. I. Duan The aims of this study were to determine whether Centers for Disease Control high risk (CDCHR) status of organ donors affects kidney utilization and recipient survival. Data from the Scientific Registry of Transplant Recipients were used to examine utilization rates of 45 112 standard criteria donor (SCD) deceased donor kidneys from January 1, 2005, and February 2, 2009. Utilization rates for transplantation were compared between CDCHR and non-CDCHR kidneys, using logistic regression to control for possible confounders. Cox regression was used to determine whether CDCHR status independently affected posttransplant survival among 25 158 recipients of SCD deceased donor kidneys between January 1, 2005, and February 1, 2008. CDCHR kidneys were 8.2% (95% CI 6.9,9.5) less likely to be used for transplantation than non-CDCHR kidneys; after adjusting for other factors, CDCHR was associated with an odds ratio of utilization of 0.67 (95% CI 0.61,0.74). After a median 2 years follow-up, recipients of CDCHR kidneys had similar posttransplant survival compared to recipients of non-CDCHR kidneys (hazard ratio 1.06, 95% CI 0.89,1.26). These findings suggest that labeling donor organs as ,high risk' may result in wastage of approximately 41 otherwise standard kidneys per year. [source] Acute stroke therapy with tissue plasminogen activator (tPA) since it was approved by the U.S. Food and Drug Administration (FDA),ANNALS OF NEUROLOGY, Issue 1 2009Justin A. Zivin MD Tissue plasminogen activator (tPA) for acute ischemic stroke was approved by the U.S. Food and Drug Administration (FDA) in 1996. Since then it has been severely underutilized. At the time when most practitioners were first being exposed to the literature concerning tPA, there were many concerns about safety and the restrictions on use were quite onerous. Since then a good deal of further work has been done to loosen the restrictions and allay concerns about the risks. The true risk to benefit ratio is far better than is generally realized. Now it is mostly economic problems related to the costs of constantly supplying emergency care that is limiting access. Furthermore, in the current litigious environment, failure to treat is likely to be a more hazardous course of action than legal exposure due to poor outcomes. It must be emphasized that the drug is quite safe and highly effective, and current utilization rates are unacceptably low. Ann Neurol 2009;66:6,10 [source] Dizziness Presentations in U.S. Emergency Departments, 1995,2004ACADEMIC EMERGENCY MEDICINE, Issue 8 2008Kevin A. Kerber MD Abstract Objectives:, The objectives were to describe presentation characteristics and health care utilization information pertaining to dizziness presentations in U.S. emergency departments (EDs) from 1995 through 2004. Methods:, From the National Hospital Ambulatory Medical Care Survey (NHAMCS), patient visits to EDs for "vertigo-dizziness" were identified. Sample data were weighted to produce nationally representative estimates. Patient characteristics, diagnoses, and health care utilization information were obtained. Trends over time were assessed using weighted least squares regression analysis. Multivariable logistic regression analysis was used to control for the influence of age on the probability of a vertigo-dizziness visit during the study time period. Results:, Vertigo-dizziness presentations accounted for 2.5% (95% confidence interval [CI] = 2.4% to 2.6%) of all ED presentations during this 10-year period. From 1995 to 2004, the rate of visits for vertigo-dizziness increased by 37% and demonstrated a significant linear trend (p < 0.001). Even after adjusting for age (and other covariates), every increase in year was associated with increased odds of a vertigo-dizziness visit. At each visit, a median of 3.6 diagnostic or screening tests (95% CI = 3.2 to 4.1) were performed. Utilization of many tests increased over time (p < 0.01). The utilization of computerized tomography and magnetic resonance imaging (CT/MRI) increased 169% from 1995 to 2004, which was more than any other test. The rate of central nervous system diagnoses (e.g., cerebrovascular disease or brain tumor) did not increase over time. Conclusions:, In terms of number of visits and important utilization measures, the impact of dizziness presentations on EDs is substantial and increasing. CT/MRI utilization rates have increased more than any other test. [source] Estimating the optimal external-beam radiotherapy utilization rate for genitourinary malignanciesCANCER, Issue 3 2005Geoff Delaney M.B.B.S. Abstract BACKGROUND Benchmark radiotherapy utilization rates for genitourinary malignancies are largely unknown, despite the finding that genitourinary cancers comprise approximately 19% of all registered malignancies in Australia. METHODS To develop an evidence-based benchmark of the optimal proportion of patients with genitourinary malignancies who should receive at least one course of radiotherapy at some time during their illness, the authors studied treatment guidelines and treatment reviews regarding genitourinary malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes that indicated possible benefit from radiotherapy based on evidence. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with genitourinary cancer for whom radiotherapy was considered appropriate. RESULTS The proportion of patients with genitourinary malignancies for whom radiotherapy was indicated at some point in their illness, according to the best available evidence, was estimated to be 27% of patients with renal cancer, 58% of patients with bladder cancer, 60% of patients with prostate cancer, and 49% of patients with testicular cancer. The occurrence of ureteric and penile cancers among patients was too rare, and, therefore, these patients were not included in the current study. CONCLUSIONS There was a large discrepancy between actual radiotherapy utilization and the evidence-based optimal rate. The authors recommended strategies to implement the evidence-based guidelines. Evidence-based benchmarks for radiotherapy utilization rates such as the ones described in the current study were important in the evaluation of the appropriate use of radiotherapy. Cancer 2005. © 2004 American Cancer Society. [source] | ||||||||||||||||||||||