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Contemporary Analysis Of Reexcision And Conversion To Mastectomy Rates And Associated Healthcare Costs For Women Undergoing Breast-Conserving Surgery, Youngran Kim, Cecilia Ganduglia-Cazaban, Nina Tamirisa, Anthony Lucci, Trudy Millard Krause

Journal Articles

PURPOSE: This study was designed to provide a comprehensive and up-to-date understanding of population-level reoperation rates and incremental healthcare costs associated with reoperation for patients who underwent breast-conserving surgery (BCS).

METHODS: This is a retrospective cohort study using Merative™ MarketScan

RESULTS: The commercial cohort included 17,129 women with a median age of 55 (interquartile range [IQR] 49-59) years, and the Medicare cohort included 6977 women with a median age of 73 (IQR 69-78) years. Overall reoperation rates were 21.1% (95% confidence interval [CI] 20.5-21.8%) for the commercial cohort and 14.9% (95% CI 14.1-15.7%) for the Medicare cohort. In both cohorts, …

Barriers To Doula Use In New Jersey After 2021 Medicaid Coverage Expansion, June Solow, Aashna Reddy, Natali Sharma, Jonathan Lewis

Rowan-Virtua Research Day

Background: Doulas are trained non-clinical professionals that provide continuous support to a pregnant mother from the prenatal to postpartum period. Presence of a doula has been shown to benefit both mother and newborn health.

Purpose: To determine what prevents doula utilization in New Jersey.

Methods: A review of the current literature about doulas, mothers, clinicians, and legislation in other states was conducted. This included qualitative and quantitative data gathered in the United States.

Results: The most significant barrier from both the mother’s and doula’s perspectives is cost. Besides cost, diversity and number of doulas is low. A major barrier to …

Factors Associated With Delaying Medical Care: Cross-Sectional Study Of Nebraska Adults, Kendra Ratnapradipa, Snehal Jadhav, Josiane Kabayundo, Hongmei Wang, Lisa C. Smith

Journal Articles: Epidemiology

BACKGROUND: Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state.

METHODS: Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals.

RESULTS: The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the …

Healthcare Utilization Costs Of Emerging Adults With Mood And Anxiety Disorders In An Early Intervention Treatment Program Compared To A Matched Cohort, Ava A. John-Baptiste, Lihua Li, Wanrudee Isaranuwatchai, Elizabeth Osuch, Kelly K. Anderson

Epidemiology and Biostatistics Publications

AIM: The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care.

METHODS: We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and …

Continuing To Confront Copd International Patient Survey: Economic Impact Of Copd In 12 Countries, Jason Foo, Sarah H. Landis, Joe Maskell, Yeon-Mok Oh, Thys Van Der Molen, Meilan K. Han, David M. Mannino, Masakazu Ichinose, Yogesh Punekar

Preventive Medicine and Environmental Health Faculty Publications

Background The Continuing to Confront COPD International Patient Survey estimated the prevalence and burden of COPD across 12 countries. Using data from this survey we evaluated the economic impact of COPD.

Methods This cross-sectional, population-based survey questioned 4,343 subjects aged 40 years and older, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. Direct cost measures were based on exacerbations of COPD (treated and those requiring emergency department visits and/or hospitalisation), contacts with healthcare professionals, and COPD medications. Indirect costs were calculated from work loss values using the Work Productivity and Activity Impairment scale. Combined direct …

Urgent Care And Emergency Department Visits In The Pediatric Medicaid Population., Amanda Montalbano, Jonathan Rodean, Juhi Kangas, Brian R. Lee, Matt Hall

Manuscripts, Articles, Book Chapters and Other Papers

Background: Urgent care (UC) is one of the fastest growing venues of health care delivery. We compared clinical and cost attributes of pediatric UC and emergency department (ED) visits that did not result in admission.

Methods: Our study examined 5 925 568 ED and UC visits of children under 19 years old in the 2010 through 2012 Marketscan Medicaid Multi-State Database. Basic demographics, diagnoses, severity, and payments were compared. Between ED and UC visits, χ(2) tests were used for proportions and Wilcoxon rank-sum tests were used for continuous variables.

Results: The UC and ED had the same most common diagnoses. …

Costs And Consequences: Hepatitis C Seroprevalence In The Military And Its Impact On Potential Screening Strategies, David Brett-Major, Kevin D. Frick, Jennifer A. Malia, Shilpa Hakre, Jason F. Okulicz, Charmagne G. Beckett, Linda L. Jagodinski, Michael A. Forgione, Philip L. Gould, Stephen A. Harrison, Clinton K. Murray, Francisco J. Rentas, Adam W. Armstrong, Aatif M. Hayat, Laura A. Pacha, Peter Dawson, Angelia A. Eick-Cost, Hala H Maktabi, Nelson L. Michael, Steven B. Cersovsky, Sheila A. Peel, Paul T. Scott

Journal Articles: Epidemiology

UNLABELLED: Knowledge of the contemporary epidemiology of hepatitis C viral (HCV) infection among military personnel can inform potential Department of Defense screening policy. HCV infection status at the time of accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period 2007-2010. A cost model was developed from the perspective of the Department of Defense for a military applicant screening program. Return on investment was based on comparison between screening program costs and potential treatment costs avoided. The prevalence of HCV antibody-positive and chronic HCV …

The Patient Burden Of Screening Mammography Recall., Matthew Alcusky, Liane Philpotts, Machaon Bonafede, Janice L. Clarke, Alexandria Skoufalos

College of Population Health Faculty Papers

OBJECTIVE: The aim of this article is to evaluate the burden of direct and indirect costs borne by recalled patients after a false positive screening mammogram.

METHODS: Women aged 40-75 years undergoing screening mammography were identified from a U.S. commercial claims database. Women were required to have 12 months pre- and 6 months post-index enrollment to identify utilization and exclude patients with subsequent cancer diagnoses. Recall was defined as the use of diagnostic mammography or breast ultrasound during 6 months post-index. Descriptive statistics were presented for recalled and non-recalled patients; differences were compared using the chi square test. Out-of-pocket costs …

Assessing The Impact Of An Incentivized Employee Wellness Program On Participation And Weight, Jennifer T. Fink

Theses and Dissertations

ABSTRACT

ASSESSING THE IMPACT OF AN INCENTIVIZED EMPLOYEE WELLNESS PROGRAM ON PARTICIPATION AND WEIGHT

by

Jennifer Fink

The University of Wisconsin-Milwaukee, 2014

Under the Supervision of Dr. Doug Ihrke

Introduction: Employers are increasingly adopting workplace wellness programs designed to improve employee health and decrease employer costs associated with health insurance and job absenteeism. This dissertation examines the outcomes of 6,375 obese health care workers who were offered financial incentives for participating in an employee wellness program (EWP) as they relate to participation and potential change in body mass index (BMI). This study aims to contribute to three distinct literatures, including …

Analyzing The Health Care Cost Curve: A Case Study., Robert D. Lieberthal

College of Population Health Faculty Papers

This case study uses data from a self-insured employer plan to perform an analysis into the properties of the health care cost curve. The analysis shows that one statistical property of the health care cost curve is that costs rise continuously, not on an annual or monthly basis. Graphical analysis indicates that managed care techniques used to restrain costs can also smooth utilization, producing the continuously growing cost curve observed. The analysis further illustrates that there is no one "cost curve"-analysis must be segmented by population. Finally, the power of predictive models to fit the cost curve varies by population. …

Bending The Health Care Cost Curve In North Carolina: The Experience Of Community Health Centers, Patrick Richard, Peter Shin, Kristina Vasilkovska, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

North Carolina is known for innovative practices in primary care delivery and education, and accordingly one might expect to see greater efficiencies overall in care delivery, and less direct, measurable impact by community health centers on cost and outcome. Of interest is whether community health centers (CHCs) are cost effective providers in states with a sophisticated primary care infrastructure and focus on the needs of medically underserved communities. Building on the large body of health services research literature that has documented the quality and cost-effectiveness of federally-funded primary health centers nationwide, as well as estimates of national savings that are …

Who Are The Health Center Patients Who Risk Losing Care Under The House Of Representatives' Proposed Fy 2011 Spending Reductions?, Sara J. Rosenbaum, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

On February 20, 2011, the United States House of Representatives approved more than $61 billion in discretionary spending reductions for the remainder of FY 2011. The legislation includes $1.3 billion in direct spending cuts for community health centers. Using the NACHC patient estimates, we present evidence on the characteristics of patients whose continuing access to health center services is at risk. We arrived at these estimates using data from the Uniform Data System (UDS), the federal reporting system in which all health centers must participate, as well as national estimates from the Medical Expenditure Panel Survey (MEPS), and published reports …

Strengthening Primary Care To Bend The Cost Curve: The Expansion Of Community Health Centers Through Health Reform, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The recent enactment of health reform sets into motion important changes that will expand health insurance coverage, increase funding for community health centers and alter the way that health centers are paid. These reforms will have a major impact on two major challenges of health reform: bolstering the capacity of the nation's primary care system and reducing the long term growth in health care costs.

Our analyses examine the impact of the new health reform law on the number of patients who will receive primary care services at community health centers and the effect of the service expansions on overall …

Indirect Costs Associated With Surgery For Low Back Pain-A Secondary Analysis Of Clinical Trial Data., Reginald Fayssoux, Neil I Goldfarb, Alexander R Vaccaro, James Harrop

College of Population Health Faculty Papers

This study examines the indirect costs associated with surgery for axial low back pain using data obtained from a prospective multicenter clinical trial that compared Charité artificial disc replacement with anterior lumbar interbody fusion using iliac crest bone graft. While 75% of study subjects reported full- or part-time employment prior to surgery, this percentage dropped to 45% at 6 weeks postoperatively. Return to preoperative employment levels occurred at approximately 6 months postoperatively. Two years after surgery, employment levels were 16% higher than preoperative levels. Lost productivity related to absenteeism resulted in lost wages averaging $2884 per patient during the first …

Using Primary Care To Bend The Cost Curve: The Potential Impact Of Health Center Expansion In Senate Reforms, Leighton C. Ku, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This analysis of reforms being considered in the United States Senate reaches conclusions similar to those of our prior analyses of reforms being considered in the House of Representatives. The combination of expanded health insurance coverage and investments in the expansion of community health centers can produce substantial long-term savings both for the overall health care system and for the federal government. Our analysis of the Senate provisions from the HELP and Finance Committees estimates $369 billion in total medical savings, including $105 billion in federal Medicaid savings. The Senate provisions produce larger savings because they authorize larger funding increases …

Chronic Care At The Crossroads: Exploring Solutions For Chronic Care Management. Report On The Us Summit., Janice L Clarke

College of Population Health Faculty Papers

Report on the US Summit

Blue Ribbon Commission On The Regulation Of Health Care Expenditures, State Of Maine, 113th Legislature

Maine Collection

Blue Ribbon Commission on the Regulation of Health Care Expenditures

State of Maine, 113th Legislature (January, 1989)

Office of Policy and Legal Analysis, Room 101, State House--Sta. 13, Augusta, Maine 04333.

Contents: Preface / Executive Summary of Recommendations / Introduction and Background / Detailed Recommendations

Trends In Health Care Expenditures, Maine 1974-1978, Bruce Armstrong

Maine Collection

Trends in Health Care Expenditures, Maine 1974-1978

by Bruce Armstrong, Research Consultant

Maine Department of Human Services, Bureau of Health Planning and Development, Division of Data and Research, Augusta, Maine (August 1981).

Contents: Preface / Highlights / List of Tables and Figures / Yearly Tables / Trend Illustrations and Tabular Descriptions

Health Care Expenditures In Maine 1978 : A Funds Flow Analysis, Bruce Armstrong

Maine Collection

Health Care Expenditures in Maine 1978 : A Funds Flow Analysis

by Bruce Armstrong, Research Consultant

Maine Department of Human Services, Bureau of Health Planning and Development, Division of Data and Research, Augusta, Maine (August 1981).

Contents: Preface / Highlights / List of Tables and Figures / Introduction / Definitions / Health Expenditures / Sources of Funds / Type of Expenditure / Comparison of Maine and U.S. Per Capita Expenditures

Barriers To Attainment Of Health Care In West Central Maine : A Critique By The Poor, Health Facilities Planning Council

Maine Collection

Barriers to Attainment of Health Care in West Central Maine : A Critique by the Poor

"Conducted by the Health Facilities Planning Council, 11 Parkwood Drive, Augusta, Maine under contract to Maine Department of Health and Welfare, June, 1969."

Contents: Foreword / Table of Contents / Introduction / Map / Franklin County / Housing / Dental Rot / Franklin County Memorial Hospital / Family Planning / RN's / State Public Health Nurses / Unmet Health Needs / The Last Outpost / Home Visit in Farmington Falls / Home Visit in Industry / Home Visit in Rangeley Area / Conversations on …