Health Economics Commons^™

Orthostatic Hypotension In Older Adults And Its Economic Impact On The Healthcare System: A Systematic Literature Review, Olushola E. Ilogho, Jennifer Broyles, Viet Le, Denise Rizzolo

Lynchburg Journal of Medical Science

ABSTRACT

Orthostatic Hypotension (OH) has been shown to lead to poor quality of life, falls, and death. Literature suggests that falls from OH may be preventable, therefore opportunities to reduce its associated cost to the healthcare system exist. This literature review aims to evaluate the importance of diagnosing and treating OH in older adult patients. OH is the drop in blood pressure upon changing to an upright position. This acute hemodynamic drop in blood pressure causes hypoperfusion in the brain, leading to dizziness, syncope, and falls. An extensive literature search for publications in PubMed and Cumulative Index in Nursing and …

Validation Of The Jefferson Health-Related Social Needs Screener, Sara Beachy, Kristin L. Rising, Richard W. Hass, Terry Hyslop, Isabella Muti, Mackenzie Kemp, Rhea E. Powell, Cara Martino, Baligh R. Yehia, Joseph G. Cacchione, Patricia C. Henwood

Jefferson Hospital Staff Papers and Presentations

INTRODUCTION: Screening for health-related social needs (HRSN) is a growing national health priority. While multiple HRSN screening tools currently exist, none to our knowledge have been evaluated using robust statistical analyses. The goal of this work is to provide results from a validation study of the Jefferson HRSN screener conducted across inpatient and outpatient settings.

METHODS: This retrospective cross-sectional psychometric study included HRSN assessments conducted across inpatient and outpatient settings with adult patients from March 2023 to May 2024. The study was conducted across a 17-hospital academic health system serving a diverse community in a 9-county area crossing two states …

The Cost Of Malnutrition In Older Adults In The Mountain West, 2020, Taylor Volk, Anirudh Polagani, Olivia K. Cheche, Kristian Thymianos, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents 2020 data on the annual costs of disease-associated malnutrition for adults aged 65 years and older across the five Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah. The data are sourced from “Advancing Policies for Quality Malnutrition Care in Older Adults: A Toolkit for State Legislators,” a report published by Defeat Malnutrition Today and Women in Government.

Cooling Protocols Impact On Nickel-Titanium Rotary Instruments Cyclic Fatigue Resistance Under Extreme Curvatures And Sodium Hypochlorite, Palak Ravjibhai Ranparia, Chintan Joshi, Mona Somani, Aashray Patel, Urooj Desai, Janki Prajapati

Journal of Dentistry Indonesia

Objective: In this work, Hyflex CM, TruNatomy, and Plex V heat-treated nickel titanium rotary instruments were evaluated at body temperature (36 °C ± 1 °C) with and without a cooling protocol to assess the cyclic fatigue resistance. Methods: A 90° curved stainless-steel block was used for cyclic fatigue tests on 60 randomly selected rotary instruments, divided into two groups of 30: body temperature (n = 10) and body temperature with cooling (n = 10). Instruments were further subdivided into 6 groups of 3 different instruments. Cooling protocol group instruments received 5-second spray cooling every 30 seconds, along with continuous 5% …

Neutral Zone Vs. Conventional Denture Fabrication: A Randomized Crossover Study On Denture Performance, Karthik Kannaiyan, Arunima Chauhan, Vijayendranath Nayak, Riyshmaa Devendaran, Dashmita Peterson, Pavittra Kanesan, Vityaa Lakshmi

Journal of Dentistry Indonesia

Objectives: It is challenging to achieve satisfactory outcomes in a complete denture for patients with resorbed residual ridges. Utilization of neutral zone techniques to guide posterior denture tooth arrangement and denture base contouring has been considered for many decades. However, the evidence is still not enough to revise protocols. This study aimed to compare patient satisfaction and stability of neutral zone denture with conventional denture. Methods: A crossover clinical trial was conducted among patients with resorbed mandibular ridges. Each participant received two sets of dentures: one fabricated using the neutral zone technique and one using the conventional method, in a …

Experience Matters: An Application Of The Operative Value Index For Lumbar Fusions, Danyal Quraishi, Advith Sarikonda, D. Mitchell Self, Steven R. Glener, Arbaz A. Momin, Emily L. Isch, Ashmal K. Sami, Matthews Lan, Nicholas Clark, Ashwini Sharan, Srinivas Prasad, Jack Jallo, Joshua Pelta-Heller, Alex R. Vaccaro, James Harrop, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: As healthcare systems transition to value-based care models, it is critical to understand factors influencing costs and outcomes in neurosurgery. This study utilizes Time-Driven Activity-Based Costing (TDABC) to assess the impact of surgeon experience and case volume on costs, clinical outcomes, and operative value in lumbar fusions. While TDABC has been applied in various surgical specialties, its use in neurosurgery, particularly in analyzing surgeon-specific factors, remains limited.

METHODS: A retrospective cohort study was conducted at a single center, analyzing lumbar instrumented arthrodesis procedures from 2017 to 2019. Primary variables included surgeon experience (years) and case volume (annual procedures). Confounding …

Pengaruh Vaksinasi Covid-19 Terhadap Kesehatan Dan Kondisi Ekonomi Masyarakat Di Indonesia, Ayu Lestari, Fauziah Zen

Jurnal Ekonomi dan Pembangunan Indonesia

The COVID-19 vaccination is considered crucial for controlling the pandemic and accelerating economic recovery. However, empirical evidence on the impact of vaccination on health and the economy at the district/city level in Indonesia remains limited. This study aims to analyze the impact of vaccination on health outcomes and economic conditions. The methodology used is a fixed effect model with monthly panel data on vaccination and health outcomes (positivity rate and recovery), as well as annual data on per capita expenditure in 514 districts/cities from January 2021 to December 2022. The results show that the first dose of vaccination significantly reduces …

Cost Of Illness Pada Pasien Hipertensi Rawat Jalan Di Puskesmas Gamping 2, Yuni Andriani, Sephia Wulandari, Niken Larasati

Jurnal Ekonomi Kesehatan Indonesia

Hypertension is characterized by increased blood pressure due to various risks that do not function normally in stabilizing blood pressure. According to WHO, the number of hypertension patients worldwide in 2020 reached 972 million (26.4%) and increased in 2021 to 1.2 billion (29.2%). Hypertension treatment must be carried out long, requiring a substantial aggregate treatment cost. Based on BPJS data, in 2014, hypertension accounted for approximately Rp2.8 trillion in healthcare costs, which increased annually until 2016, reaching around Rp4.2 trillion. The purpose of this study is to describe the overall estimated cost of hypertension treatment for outpatients at Puskesmas Gamping …

Do Anterior-Posterior Lumbar Fusions Provide More Short-Term Value Than Posterior-Only? An Application Of The Operative Value Index, Steven R. Glener, Advith Sarikonda, D. Mitchell Self, Ashmal Sami, Danyal Quraishi, Emily Isch, Arbaz A. Momin, Cheritesh R. Amaravadi, Jack Jallo, Joshua Heller, Ashwini Sharan, Alex R. Vaccaro, Srinivas K. Prasad, James Harrop, Nicholas J. Clark, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

BACKGROUND: Lumbar fusion is a common treatment for degenerative spine changes. Although both anterior-posterior (AP) and posterior-only approaches are used, their cost-effectiveness remains uncertain. This study aims to compare the costs and short-term "value" (outcomes per dollar spent) of AP and posterior-only lumbar fusions using time-driven activity-based costing and patient-reported outcomes.

METHODS: A retrospective review of AP and posterior lumbar fusions from 2017 to 2022 was conducted. Time-driven activity-based costing was used to assign intraoperative costs based on resource utilization, and the Oswestry Disability Index (ODI) was collected preoperatively and 3 months postoperatively. The Operative Value Index (OVI) was defined …

Optimizing Costs In Plastic Surgery: A Systematic Review Of Time-Driven Activity-Based Costing Applications, Emily L. Isch, Gabrielle Kozlowski, D. Mitchell Self, Theodore E. Habarth-Morales, Sydney Somers, Ahilan Sivaganesan, David Kim, Heather A. Mcmahon, Andrew Newsman, Matthew Jenkins

Department of Surgery Faculty Papers

BACKGROUND: The rising complexity and cost of healthcare in plastic surgery, particularly in resource-intensive procedures like free flap and breast reconstruction, pose significant financial challenges. Time-driven activity-based costing (TDABC) offers a method to accurately assess these costs by mapping each step of the care cycle based on time and resources consumed. Although TDABC has been utilized in high-cost fields such as neurosurgery and spine surgery, its application in plastic surgery remains underexplored. This systematic review evaluates the literature on TDABC use in plastic surgery to identify key cost drivers and propose strategies for cost-efficiency.

METHODS: A systematic review was conducted …

Urban-Rural Divide In Inequality’S Impact On Substance Abuse, Jonathan E. Flores

Undergraduate Theses, Capstones, and Recitals

This thesis focuses on investigating the relationship between income inequality, measured through the Gini coefficient, and drug addiction, proxied through substance-related mortality. Specifically, this thesis focuses on how these dynamics vary across rural and urban counties in the United States, using population size as a proxy. County-level data from 2016 to 2020 were collected through both the CDC and the Census Bureau and subsequently analyzed using Stata, with crude death rates from drug and alcohol causes serving as a function of the Gini coefficient, labor force participation, racial composition, and other socioeconomic indicators. Through a quadratic version of the model, …

Time-Driven Activity-Based Costing For Cervical Myelopathy Surgery: A Step Towards Total Episode Costs, Kavantissa M. Keppetipola, Adam Leibold, Jay Trivedi, Ashmal Sami, Advith Sarikonda, D. Mitchell Self, Emily L. Isch, Steven R. Glener, Srinivas Prasad, Jack Jallo, Joshua E. Pelta-Heller, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

INTRODUCTION: Time-driven activity-based costing (TDABC) is a highly accurate method for determining the true cost of delivering a healthcare service. However, TDABC is most often applied to a singular phase of care such as an outpatient visit or a surgical event. Here we broaden the scope by using TDABC to estimate the costs of surgically treating cervical myelopathy - from the moment of surgical scheduling until post-operative hospital discharge.

METHODS: In a single-center retrospective study at a large tertiary academic institution, TDABC was employed to measure pre-operative, intra-operative, and post-operative (inpatient) costs for 63 patients undergoing elective surgery for cervical …

Protecting The Future Of Medical Innovation: Balancing Fiscal Responsibility With The Need For National Institutes Of Health And Federal Health Funding, Irina Petrache, Raed A. Dweik, Michelle Ng Gong, Jesse Roman, M. Patricia Rivera, Karen J. Collishaw

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

No abstract provided.

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

Is Anterior Cervical Discectomy And Fusion More Expensive At Quaternary Care Centers? An Application Of Time-Driven Activity-Based Costing, Jay Trivedi, Advith Sarikonda, Adam Leibold, D. Mitchell Self, Nikolaos Mouchtouris, Steven R. Glener, Ashmal Sami, Kavantissa M. Keppetipola, Emily Isch, Joshua Pelta-Heller, Srinivas Prasad, Ashwini Sharan, James Harrop, Alex R. Vaccaro, Ahilan Sivaganesan

Department of Neurosurgery Faculty Papers

OBJECTIVE: Hospital setting is postulated to be a key driver of cost variation for neurosurgical procedures. Limitations in contemporary costing methodologies have led to the development of time-driven activity-based costing (TDABC). This study applies TDABC to anterior cervical discectomy and fusion (ACDF) to compare intraoperative costs at quaternary care centers versus satellite hospitals affiliated with the same health network.

METHODS: Nine hundred and fifty-eight ACDF cases performed at two quaternary care hospitals (n = 806) and six satellite hospitals (n = 152) were reviewed. Process maps were created to map the intraoperative episode, and TDABC methodology was used to calculate …

Behavioral Responses To The Medicare Part D Coverage Gap And Its Closure, Selene Urbatsch

Theses and Dissertations

The author examines how exposure to the Medicare Part D coverage gap affects future prescription drug use and whether the closure of the gap under the Affordable Care Act (ACA) altered beneficiary behavior. Using 2007–2019 MEPS data, the analysis compares Part D enrollees to similarly aged, privately insured individuals, producing first-differences and difference-in-differences estimates. Before the ACA, exposure to the gap was associated with 4.9 fewer prescription fills relative to comparable non-Part D individuals. After the ACA, the effect fell to a reduction of 2.2 generic fills, with no significant decline in branded use. Sudden out-of-pocket cost increases prompted sharp …

Exploring Anticoagulant Prescription Disparities: A Focus On Hispanic Patient Care, Michael Acevedo, Vanessa Veltre

Rowan-Virtua Research Day

Anticoagulants play a critical role in preventing thromboembolic events, yet disparities persist in their prescription among minority populations. This presentation explores inequities in anticoagulant prescribing patterns, with a specific focus on Hispanic patient care. Using retrospective electronic health record data, we analyzed the prescription rates of warfarin versus direct oral anticoagulants (DOACs) among adults with clinical indications for anticoagulation. Our findings reveal that Hispanic patients are significantly less likely to receive DOACs compared to non-Hispanic White patients, even after adjusting for demographics, comorbidities, and insurance status. Contributing factors include language barriers, lack of insurance, and potential implicit bias in provider …

The Association Between Economic Outcomes And Abortion: A Scoping Review, Larisa Nicole Stephenson

Capstone Experience: Master of Public Health

Background: Abortion access is not just an issue of autonomy, but an economic issue as well. Evidence of the intersectionality of abortion health care and economics has endured due to the financial cascading effects a denial of an abortion, or the inability to access an abortion, has on one’s personal, professional, and economic upward mobility. A change in recent policies impacting access to abortion warrants an updated synthesis examining the relationships between economic outcomes and abortion access for people of reproductive age in the United States (U.S.).

Aim: This scoping review summarizes evidence pertaining to the association …

Strategizing Towards The Future Hospital: A Systems Thinking Approach, Ashish Kumar, Sean Shao Wei Lam, Sze Ling Chan, Yingqi Xu, Yao Ge, Geoffrey Kah Tack Gui, Hiang Khoon Tan

Research Collection School Of Economics

Background: The complex systemic nature of Future Hospital design in the rapidly ageing city-state of Singapore calls for systems thinking. We apply this approach to answer two research questions: (i) What are the variables that drive the present and future dynamics of the Future Hospital system? (ii) How are these driving variables related? Methods: Causal loop diagrams (CLDs) were developed collaboratively by a cross-functional system modelling team through group modelling discussions and reviews, totalling 20 sessions. Network analysis of the resulting CLDs was used to identify dominant variables. Results: Seven interlocking CLDs (national view, cluster view, and study hospital top …

Evaluation Of Dentistry Students' Perceptions And Attitudes Towards Artificial Intelligence In Kazakhstan, Yasin Yasa, Kubeisin Altynbekov, Nazgul Onaibekova

Journal of Dentistry Indonesia

Objective: Artificial intelligence’s (AI) potential to analyze medical data and improve patient outcomes is driving its rapid integration into healthcare systems. This study addresses the knowledge gap regarding Kazakhstani dental students’ attitudes toward AI in dentistry. Methods: A survey with 213 participants assessed dental students’ views on AI in dentistry at two Kazakhstani universities. A self-administered questionnaire (22 items) via Google Forms was used to gather data on demographics, baseline knowledge (information sources, understanding of AI principles, and familiarity with dental AI applications), and attitudes/perceptions. Frequency analyses and chi-square tests (p < 0.05) explored the responses. Results: The survey included 213 dental students (mean …

Synthesis And Partial Characterization Of Chitosan Phosphorylation From Marine Cuttlefish Sepia Aculeata (Orbingy, 1848) And Its Antimicrobial Potentials Against Oral Pathogens, Yathin Reddy Putta, Annathai Pitchai, Pasiyappazham Ramasamy

Journal of Dentistry Indonesia

Objectives: This study investigated the synthesis and partial characterization of phosphorylated chitosan extracted from the cuttlebone of Sepia aculeata (Orbingy, 1848) and evaluated its antimicrobial potential against oral pathogens. Methods: The synthesis of phosphorylated chitosan from Sepia aculeata cuttlebone involved several steps: cleaning, deproteinization, demineralization to extract chitin, deacetylation to produce chitosan, and phosphorylation to introduce phosphate groups. Phosphorylation enhances the properties of chitosan, making it a promising candidate for oral health applications. Phosphorylated chitosan was purified and characterized using Fourier Transform Infrared Spectroscopy (FTIR), X-ray diffraction (XRD), and Scanning Electron Microscopy (SEM) to confirm structural changes. This process enhances …

Evaluation Of Mandibular Condyle And Coronoid Process Anomalies Using Cone-Beam Computed Tomography, Rümeysa Şendişçi Gök, Bilay Stevanovic Sancar, Sevcihan Günen Yılmaz

Journal of Dentistry Indonesia

Objective: The aim of this study was to evaluate the prevalence of condylar and coronoid process anomalies, their types, and their relationship to sex. Method: Cone-beam computed tomography (CBCT) images were retrospectively analyzed for the presence and types of abnormalities in the condylar and coronoid processes. Statistical analysis of measurement data was performed using SPSS version 22. Medical histories of the individuals were obtained from their digital dental records. Results: CBCT images of 400 individuals were included in the study. Condylar anomalies were observed in 9.5% of cases, while coronoid anomalies were found in 7.5%. All condylar anomalies were more …

Microstructural And Elemental Characterization Of Hydrated Carbonated Hydroxyapatite As Pulp Capping Agent: An In Vitro Study, S.Swathi Priyadharshini, Chinnasamy Ragavendran, J. Ramana Ramya, Anand Sherwood

Journal of Dentistry Indonesia

Understanding the microstructural and elemental composition of pulp capping materials is crucial for predicting their biocompatibility and effectiveness in promoting pulp healing. Objectives: This study aimed to characterize the microstructural and elemental properties of carbonated hydroxyapatite as a dental pulp-capping material. Methods: Carbonated hydroxyapatite was synthesized using the precipitation method. MTA and Apacal ART were obtained from commercial sources. The materials were prepared into disk-shaped specimens, hydrated in deionized water at 37°C for 14 days, and analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Results: SEM images revealed that MTA exhibited smooth, plate-like crystalline structures surrounded by …

Does Periodontal Treatment During Pregnancy Reduce The Incidence Of Preterm Birth Rates?: A Meta-Analysis Of Randomized Controlled Trials, Ashraf Elzer, Raga A. Elzahaf, Hameda Asrafel, Khalid Sassi, Mohamed Jedeh

Journal of Dentistry Indonesia

Objective: To find out if scaling and root planing for periodontal disease during pregnancy lowers the incidence of preterm births. Methods: This is a meta-analysis study design; searches were conducted in the PubMed database and on Google Scholar between January 2000 and December 2023. Only randomized controlled trials (RCTs) were considered. The studies will be examined to determine the relationship between non-surgical periodontal treatment and preterm birth rates among pregnant women. Results: Only 14 trials were included out of 194 articles identified. The overall result indicated a statistically significant reduction in preterm birth rate when we use the random …

The Self-Sustainability Of Federally Qualified Health Centers, Javier Vallejo

MUSC Theses and Dissertations

This exploratory data analysis examines the self-sustainability of Federally Qualified Health Centers (FQHCs) using the 2023 Uniform Data Systems (UDS) dataset, focusing on health centers' reliance on government grants as a revenue source. FQHCs provide high-quality healthcare services to medically underserved populations; today, nearly 1 out of every 11 Americans receives some form of care at an FQHC. There is widespread variability in the delivery of care amongst FQHCs. Additionally, funding and reimbursement methodologies vary across states and geographic regions. FQHCs face challenges maintaining operational efficiency amid federal funding shortfalls, shifting reimbursement methodologies, and the lingering impact of the COVID-19 …

Evaluating The Current State Of Quality Measure Reporting In The Merit-Based Incentive Payment System, Kinan Sawar, Geoffrey Potts Md

Medical Student Research Symposium

The Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with other metrics that are used to determine an annual percentage adjustment to physician Medicare Part B payments. Unfortunately, physicians have been forced to choose from an ineffective, limited set of quality measures. This has led to an overreliance on process measures, which fail to stratify physician performance effectively; it has also led to differences in the number of reporting options across specialties, resulting in unequal opportunity for physicians to succeed in MIPS. Using Centers for Medicare and Medicaid Services (CMS) public use file data from 2021-2024, …

Risk And Outcomes Of Pregnancy-Related Acute Kidney Injury: A Cohort In Bronx, Ny, Erica Marnet, Mayssaa Hoteit, Isbell Crevantes, Sonail Gupta, Ladan Golestaneh

Posters

Pregnancy-related acute kidney injury (PR-AKI) has been increasing in incidence and is associated with worse maternofetal outcomes. The goal of this study is to examine risk and hospitalization outcomes of PR-AKI compared to pregnancy without AKI in a low-income, minoritized population in Bronx, New York

Implementation Of Performance-Based Budgeting For Public Health Care Service Delivery In An Emerging Economy, Isaac O. Randa, Christine A. Adere

Southern African Journal of Policy and Development

This study investigates the determinants and implications of the implementation of performance-based budgeting (PBB) on public health care service delivery at the Ministry of Health and Social Services (MoHSS) in Windhoek, Namibia. Using a cross-sectional survey research design targeting 100 respondents, this study employed a quantitative research approach involving MoHSS's budgeting and health care services departments. Data were analysed using partial least squares structural equation modelling. Communication, bureaucratic structures, and implementers’ disposition significantly influenced PBB implementation alignment, thereby enhancing service delivery. However, resource utilisation showed no significant effect. Additionally, implementation alignment effectively mediated the relationship between latent exogenous variables and …

Strengthening Local Health Systems And Governance For Universal Health Coverage: Experiences And Lessons From The Covid-19 Pandemic Response In Quezon City, Philippines, Esperanza Anita Escano-Arias, Ramona Asuncion D.G. Abarquez, Rolando V. Cruz, Rosalie Espeleta, Madeline Mae Ong, Arianna Maever L. Amit, Veincent Christian Pepito, Vida Gomez, Manuel M. Dayrit

Ateneo School of Medicine and Public Health Publications

The COVID-19 pandemic has disrupted the Philippines's transition toward universal health coverage. However, some local government units in the country made use of the pandemic as a catalyst to strengthen their local health system, scale-up the provision of preventive and primary care services, and improve health governance to make it more prepared to face future pandemics and realize the aims of the country's new Universal Healthcare Act. This paper describes the response of the local government of Quezon City, Philippines, to COVID-19 and how it strengthened local health systems. We also discuss enablers such as partnerships, collaborations, and foresight to …

The Nih Is A Sound Investment For The Us Taxpayer, Nicholas W. Gilpin

School of Medicine Faculty Publications

Research funded by the National Institutes of Health is essential for improving the health of Americans and developing new drugs and treatments for a wide range of diseases.