Dissertations / Theses on the topic 'Healthcare utilization outcomes'

In order to better understand variations of health behaviors between US-born and foreign-born elderly Asian Americans (65+) in the United States, the research aims to explore relationships among health outcomes, healthcare utilization, and sociodemographic characteristics. Data from the National Health Interview Survey 1998-2012 is used to construct structural equation models for the US born group and for the foreign born group. The results found that there is a reciprocal relationship between health outcomes and healthcare utilization in both groups. Use of healthcare services can positively affect health outcomes, while better health outcomes reduce the need for healthcare utilization. In addition, some sociodemographic characteristics, such as age, sex, and marital status have a direct effect on health outcomes, but some others, such as education, family size and combined family income, have an indirect effect on health outcomes via healthcare utilization. The region of residency has both direct and indirect effects on health outcomes. Regarding the effects of predictors on health outcomes, US-born elderly Asians usually receive more health advantages from using institutional health services than foreign-born elderly Asians. Practitioners, social gerontologists, and policy makers should be cautious about assuming that there is a positive impact of increased healthcare utilization on health outcomes in elderly Asian Americans.

A current body of research is finding significant connection between biological, psychological, social, and spiritual factors in health and wellbeing. Some studies have found significant improvements in treatment outcomes for patients who received medical treatment in collaboration with psychosocial therapeutic treatment. In this study, I sought to observe the impact collaborative treatment had on patients with diabetes who were treated at a community health center. I compared the treatment outcomes of a group of patients who received a collaborative treatment, looking to see if their overall health (measured by A1c, a diabetes severity marker) and medical utilization (or their number of doctors’ visits). I found no significant difference in the improvements in health outcomes (A1c) made by my treatment group who received collaborative treatment in addition to standard medical treatment for diabetes management when compared to my control group who received only medical treatment. I did find that collaborative treatment was associated with increases in medical utilization as were increases in age and initial A1c levels. Clinical implications include the need for therapists to be aware of how biological factors, such as age and severity of symptoms, may affect psychosocial-spiritual factors commonly addressed in therapy when working with patients who have chronic illnesses like diabetes. I hope that these findings will lead future research into the association of collaboration and medical utilization in order to find if there are any clinical benefits to recommending increased utilization for patients who are older or begin treatment with higher A1c levels.

Posttraumatic stress disorder (PTSD) has a persistent nature: PTSD troubles patients even decades after the occurrence of traumatic events. The “health behavioral model” is adopted to examine the effects of external environmental, predisposing, enabling, and need for care factors on the use of VA post-discharge ambulatory care and readmissions. Data were obtained from the Patient Treatment File (PTF) and the Outpatient Care File (OPT), the Area Resource File (ARF), American Hospital Association data sets (AHA), and the Uniform Crime Report (UCR). The use of VA post-discharge ambulatory care is analyzed by using structural equation modeling (SEM). The readmission to VAMCs is evaluated by Cox regression with forward selection. A cross-sectional study is performed on 1,420 PTSD veterans admitted to Veterans Affairs Medical Centers (VAMCs) in 1994 and 1,517 veterans in 1998 in the Veterans Integrated Services Networks 6 (VISN 6). In both years, the most important determinants of the use of VA post-discharge ambulatory care is “prior use of outpatient care services.” For the 1994 sample, prior use of inpatient services impeded the utilization of post-discharge ambulatory care. For the 1998 sample, barriers to access to care and the length of stay for other mental health encounters in the last year reduced the utilization of post-discharge ambulatory care. For readmission in both years, higher numbers of medical or mental VA post-discharge visits reduce the likelihood of readmission to VAMCs. The service lines program was found to increase the use of VA post-discharge ambulatory care and decrease readmission rates for PTSD veterans. The application of the “health behavioral model” can be extended to outcome research to investigate the contributing factors. A risk adjustment system can also be developed based upon the findings. Communities, VAMCs, and PTSD patients and their families should work to raise awareness of the factors that contributing to both use of care and outcomes, and should form a comprehensive network to improve the wellbeing of PTSD veterans.

Class of 2012 Abstract
Specific Aims: This study was aimed to evaluate inpatient clinical treatment characteristics associated with the use of intracranial implantation of chemotherapeutic wafers for malignant brain neoplasms within United States, and assess inpatient mortality and total charges regarding treatment with wafer versus without. Methods: A retrospective cohort investigation was conducted utilizing inpatient discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample from 2005 to 2009. From this nationally-representative sample, 9,455 adults aged 18 years or older were identified with malignant neoplasms of the brain treated with implantable chemotherapeutic wafers. Outcomes of inpatient mortality and charges were assessed via multivariate regression analysis, controlling for patient characteristics, hospital structure, comorbidities, and clinical complications. Main Results: The average age of patients with brain neoplasms was 56.6 (±16.5) years, and of those patients, 42.9% were female. The odds ratio for inpatient mortality of patients treated with implantable chemotherapeutic wafers was OR=0.380 (P<0.001), and patients that received wafer treatment had increased charges exp(b)=2.147 (P<0.001). Conclusions: Multiple factors were associated with inpatient mortality and charges among the 247,829 patients that were diagnosed with malignant brain neoplasms from 2005-2009. With regards to these patients, implantable chemotherapeutic wafers were associated with increased inpatient survival and increased charges.

Abstract Purpose This study is designed to determine whether managed care has had an influence on the number and distribution of procedures with demonstrated volume and outcome endogeneity in Florida healthcare markets; in addition, methods are developed to determine which measures of managed care activity best predict the impact of managed care on surgical procedure utiliation. Rationale A shift in surgical procedure volume on the basis of preferred provider arrangements has the potential to redistribute surgical procedures within hospital markets. The surgical procedures for which such a distribution could have the greatest impact on population health are those for which the volume of cases performed has a strong inverse influence on the outcomes observed. A shift in high risk surgical procedures to low volume hospitals could potentially reduce the number of cases performed at high volume centers and increase cases at low volume centers, adversely impacting quality in both. Methods A retrospective population based cohort design is used to capitalize on the variability among Florida metropolitan statistical areas between 1995 and 1999, a period which captured the full business life cycle of managed care plans in Florida. Multiple regression models are used to measure the impact of changes in managed care activity as measured by penetration, index of competition and consolidation on the change in the number and distribution of seven procedures for which volume is associated with patient outcome, controlling for socio-demographic and market factors known to influence surgical procedure utilization. Difference scores derived for each of the model variables were used to measure change from the baseline in 1995 to 1999. Post hoc analysis of the count data models was performed using the cases from all study years in a log linear generalized estimating equation to provide validation of the difference score approach. Key Findings Study procedure volume increased over the period, and remained a consistent proportion of the total inpatient surgical procedure volume. Procedure rate remained stable over the study period with substantial small area variation. Change in managed care concentration was consistently and negatively associated with procedure volume at both the MSA (&betaâ&beta = -19.67; p = 0.0489) and hospital level (&betaâ&beta = -4.088; p = 0.0027).Change in the total population and the number of specialty surgeons had a substantial, consistent and positive relationship to change in procedure volume at both the market and hospital level. The change in the index of competition was positively associated with change in hospital market share (&betaâ&beta = 0.1005; p = 0.05); whereas, neither change in managed care penetration nor change in managed care index of competition was predictive of change in procedure volume at the market level. The managed care variables were not correlated when difference scores were tested providing evidence that the managed care variables measure different constructs and behave differently. Implications As markets for managed care became more concentrated, the number of surgical procedures with volume and outcome endogeneity declined; the specific reasons for the observed decline require additional study. Competitive managed care markets have a favorable impact on hospital market share for these high risk, high margin procedures. Studies of managed care require consideration of the stage of managed care development in order to understand its influence and the use of difference scores as a method to measure change over time has substantial potential for the study of health care markets.

BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.

This thesis examines several issues concerning health outcomes and healthcare utilization. In the first chapter, I examine the relationship between health and human capital development in childhood and key adult outcomes---educational attainment and adult health status---using longitudinal data from the 1970 British Birth Cohort. I use robust measures of human capital in childhood including cognitive skill and so-called psychological capital and establish their effects on both educational attainment and adult health. Certain measures of health in childhood are also shown to affect these adult outcomes. I establish a relationship between parental socioeconomic status and the development of childhood health and human capital and discuss the implications for the inter-generational transmission of socioeconomic status and its effect on adult health. The second chapter uses the 1997 Medical Expenditure Panel Survey to examine the relationship between family income, insurance status, and chronic conditions in children and how these are associated with healthcare utilization. I find that while income is positively associated with some forms of utilization, there is no evidence of a differential effect for chronically-ill children. Insurance status---defined as private, public, or no insurance---does exhibit stronger associations with healthcare utilization for children with chronic conditions. I also present mixed evidence on the association between healthcare utilization and health outcomes. Finally, the third chapter focuses on the relationship between work characteristics and the utilization for a number of preventive and screening health services. I find that some work characteristics---including wage levels, paid sick leave, and retirement benefits---are positively related to utilization. Other characteristics---such as hours worked, irregular shifts, and working more than one job---are not significantly associated with use. I relate these findings to a conceptual framework in which time costs are important to the decision to use preventive services.

碩士
國立臺灣大學
健康政策與管理研究所
107
Background: Home care is an essential part of the long-term care system, and it also plays an important role in the medical system in an aging society. An aging society may cause changes in population and family structure, and increase the demand for care in the hospital and community. Patients may choose to receive care at home, nursing home or residential care home. This study aims to explore the expenditure and outcome of care delivered at different sites. Method: This study is a secondary data analysis of retrospective cohort studies. We used data for the year of 2010 from the National Health Insurance Research Database and collected data from patients receiving home care service in 2012. In this study, data from1,556 patients was collected and the patients were categorized into 3 groups: patients receiving care at home (HC), at nursing home (NH) and at residential care homes (RCH). Two-part model was used in this study. The first-stage multiple logistic regression analysis and second-stage generalized linear model analysis were conducted to verify the patients’ usages of outpatient department, emergency department, hospitalization, home care, and physician visits within one year after receiving home care, and make comparison between medical utilization and avoidable hospitalization. Results: Concerning medical utilization, in terms of (1) out-patient departments: patients utilizing nursing homes and residential care homes led to more outpatient visits than those utilizing home care by 44% and 13% (p<.001); and the outpatient expenses were higher among patients at nursing homes (14%, p<.01), and lower among patients at residential care homes (14%, p<.001) than among patients at home. (2) emergency room: patients utilizing nursing homes and residential care homes led to less emergency utilization than patients utilizing home care by 0.72 times (p<.05) and 0.63 times (p<.001); emergency visit: patients utilizing nursing homes and residential care homes led to less emergency visits than patients utilizing home care by 0.35 times and 0.43 times (p<.001) ; and the difference in emergency department expenses among different sites was not significant. (3) hospitalization: the difference in admission at different sites was not significant; patients utilizing nursing homes and residential care homes made fewer days of stay than those utilizing home care by 14% and 24% (p<.001); patients utilizing nursing homes and residential care homes made fewer expense than those utilizing home care by 17% (p<.05). (4) home care: patients utilizing nursing homes and residential care homes utilized more home care services than those utilizing home care by 5% (p<.05); patents utilizing residential care homes got more expense of home care services than those utilizing home care by 12% (p<.01). (5) utilization of physician visit: patients utilizing nursing homes and residential care homes made more utilization of physician visits than those utilizing home care by 1.95 times and 1.99 times (p<.01); physician visit: patients utilizing nursing homes and residential care homes made more physician visits than those utilizing home care by 28% and 21% (p<.01); and the expense for patients utilizing nursing home was higher than those utilizing home care by 17% (p<.001). Concerning care outcomes, no significant difference was found in visits of avoidable hospitalization; patients utilizing nursing homes and residential care homes made fewer days of avoidable hospitalization than those utilizing home care by 29% and 32% (p<.001); patients utilizing nursing homes and residential care homes made fewer expense of avoidable hospitalization than those utilizing home care by 35% and 33% (p<.001). While the total expense of home care services is lower for patients receiving home care at home, the total expense of medical use for them is much higher than those who received their home care service in residential care homes. Conclusions: Overall, among home care recipients, those who received home care at home made more emergency visits; but those who received home care at nursing home made most outpatient visits, outpatient expenses, home care utilization and physician visits, followed by those who received home care at residential care homes. Parameters of residential care homes are usually between nursing homes and homes, except patients utilizing residential care homes made least emergency visits. There was no difference among hospitalization visits among the three groups, but those who received home care at home made most days of stay and emergency department expenses. Concerning the care outcome, those who received home care at home made most days of stay and expenses of avoidable hospitalization, which is mainly caused by infection in urinary tract, bacterial pneumonia, and chronic obstructive pulmonary disease. It is obvious that nursing needs of the patients receiving home care at home cannot be satisfied owing to the lack of regular nursing staff, which demands more emergency use. The outcome demonstrated that patients utilizing nursing home made more outpatient and home care utilization but less emergency use. Despite the outcome may indicate decent collaborations among institutes and hospitals, further examination may still be needed to verify if there are adequate home care applied in institutes.

碩士
國立臺灣大學
健康政策與管理研究所
102
Background The Family Physician Integrated Care Program has been implemented for many years. The National Health Insurance Administration wants to establish the foundation plans to reach a Family Physician System by this program. However, in recent years, there have been few studies on the long-term effect of the program on healthcare utilization and outcomes. Purpose The purpose of this study was to evaluate the effect of the Family Physician Integrated Care Program on healthcare utilization and outcomes. Methods This study used the Nation Health Insurance data from 2004 to 2011. Patients were classified into two groups. Beneficiaries who did not join the program from 2004 to 2006 but joined the program from 2007 to 2011 were classified as an intervention group. Others who did not join the program from 2004 to 2011 were classified as a comparison group. We used the Difference in Difference method, Propensity Score method and multivariate regression models to examine the effect of the program on healthcare utilization and outcomes. Results There was an increase in adult preventive services utilization. Discussion This study shows that Family Physician Integrated Care Program can increase the prevention services utilization, meaning that family physicians may provide more preventive services to prevent their members from morbidity. However, the effect of the program other healthcare services utilization and outcomes is limited.

碩士
國立臺灣大學
健康政策與管理研究所
107
Background: Hemoglobin A1c(HbA1c) is associated with severe periodontal ailment among patients with type 2 diabetes, and can be lowered by non-surgical periodontal treatment. However, data from empirical studies on diabetes and periodontal treatment interventions are not robust, as Taiwan lacks population-based data. Objective: To evaluate the effect of dental scaling and subgingival curettage on outcomes and healthcare utilization among patients with diabetes. Methods: The retrospective cohort study was designed using the database of National Health Insurance for secondary analysis. Patients diagnosed with type 2 diabetes and periodontal disease in 2017 were selected, and we have used propensity score matching to reduce bias between treatment and control groups on a large number of covariates. If the difference between the results of 2017 and 2018 diabetes outcomes and utilization is due to periodontal treatment intervention is to be ascertained. Results: After dental scaling or subgingival curettage, compared with those who did not receive the treatment, the ratio of odds of subsequent HbA1c below 7% was 1.065, and the risk of renal ailment was lower by 13%, and of hospitalization by 27%. The data analysis shows that there was an increase in the number of medical outpatient visits, of dental visits, and total dental expenses, but there was decrease in the average length of hospital stays, total hospitalization expenses, and overall medical expenses. Conclusions: Patients with type 2 diabetes and periodontal disease who have received periodontal treatment have better subsequent diabetes outcomes, and lower hospitalization need and overall medical care. Hence, we recommend that health policymakers consider the inclusion of dentists in Diabetes Shared Care team and institute relevant referral systems.

碩士
高雄醫學大學
公共衛生學研究所碩士在職專班
92
The Healthcare Resource Utilization and Outcome of Very Low Birth Weight Infants in the First 2 Years after Initial Neonatal Hospitalization —A Comparison with Non-Followup Group Objective : This study was undertaken to evaluate the difference of cost and outcome between VLBW-follow up and VLBW-non follow up infants during the first two years after NICU-discharge. Study design: This was a retrospective review of prospectively collected data on neurodevelopmental outcome and medical cost in the first two years after initial neonatal hospitalization for all infants born in 2000 with birth weight < 1500g in the area of Tainan-Chiayi-Yuling ( N=156). A comparison VLBW-infants and full term newborn, and comparison of two groups of VLBW infants divided into follow-up (N=120) and non follow-up infants (N=36). Standard statistical methods for continuous and non-continuous data and regression procedures were performed. Results : 1. The medical care cost of VLBW infants in the first two years after neonatal initial hospitalization was higher than full term newborn (30：1) 2. The medical care cost of VLBM-follow up infants was higher than non-follow up group (3:1) 3. The medical care cost between follow-up and non-follow up of VLBW infants become no difference after 2 years. 4. The outcome and mortality of follow-up group was much better compared with the non follow-up infants. Conclusion : Neonatal intensive care and its sequelae are certainly very expensive, especially the very-low-birth-weight infants. How to avoid premature labor and prematurity is essential. Early educational intervention relying on a intensive schedule of home-visiting and center-based approaches resulted in substantial gains in cognitive and behavioral development even among those very-low-birth-weight infants.

Wong, King Moses.
"August 2010."
Thesis (M.Phil.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (leaves 158-172).
Abstracts in English and Chinese.
Chapter Chapter One: --- Introduction --- p.1
Chapter 1.1 --- Background --- p.1
Chapter 1.2 --- Research objectives --- p.5
Chapter 1.3 --- Research hypothesis --- p.7
Chapter 1.4 --- Research questions --- p.7
Chapter 1.5 --- Research structure --- p.9
Chapter Chapter Two: --- Literature Review --- p.10
Chapter 2.1 --- "Health geography: knowledge of population, people, places and health" --- p.10
Chapter 2.2 --- Understanding geographies of diseases: mapping and modeling diseases and health --- p.17
Chapter 2.3 --- Healthcare services provision and utilization --- p.22
Chapter 2.4 --- Hong Kong: facts and context --- p.31
Chapter 2.4.1 --- Demographics --- p.32
Chapter 2.4.2 --- Key challenges arising from population ageing --- p.37
Chapter 2.4.2.1 --- Implications to medico-social agenda --- p.38
Chapter 2.4.2.2 --- Implications to health status --- p.38
Chapter 2.4.2.3 --- Implications to disease pattern --- p.39
Chapter 2.4.3 --- Healthcare service delivery system in Hong Kong --- p.41
Chapter 2.4.3.1 --- Financing and expenditure --- p.42
Chapter 2.4.3.2 --- Organizational framework and healthcare policy --- p.44
Chapter 2.4.3.3 --- Healthcare resources --- p.49
Chapter 2.4.3.4 --- Utilization and provision of public healthcare services --- p.50
Chapter Chapter Three: --- Material & Methods --- p.55
Chapter 3.1 --- Background of main source of data --- p.55
Chapter 3.2 --- Sources of data --- p.57
Chapter 3.2.1 --- Hospital services utilization data --- p.57
Chapter 3.2.2 --- Healthcare resources data --- p.61
Chapter 3.2.3 --- Population data --- p.62
Chapter 3.3 --- Spatial scale of analysis --- p.62
Chapter 3.4 --- Statistical analyses --- p.63
Chapter 3.4.1 --- Service utilization ratios --- p.63
Chapter 3.4.2 --- Provision of healthcare resources to population --- p.65
Chapter 3.4.3 --- Adequacy of healthcare services provision --- p.65
Chapter 3.4.4 --- Mortality analysis --- p.67
Chapter 3.4.5 --- Multi-level analysis --- p.69
Chapter 3.4.6 --- Mapping of health services utilization ratio and mortality ratio --- p.70
Chapter 3.5 --- Statistical packages used --- p.73
Chapter 3.6 --- Cautions on interpretation --- p.74
Chapter 3.6.1 --- Confounding and ecological fallacy --- p.74
Chapter 3.6.2 --- Problem with the use of Standardized Mortality Ratio --- p.75
Chapter 3.6.3 --- Problem with mapping and visualization --- p.76
Chapter Chapter Four: --- Results --- p.78
Chapter 4.1 --- Socio-spatial variation in mortality --- p.78
Chapter 4.2 --- Statistical analysis and mapping of health services utilization ratio --- p.80
Chapter 4.3 --- Statistical and cartographic analysis in Standardized Mortality Ratio --- p.88
Chapter 4.4 --- Provision of healthcare resources to population --- p.91
Chapter 4.5 --- "Multi-level analysis of hospital services utilization, provision and mortality" --- p.92
Chapter 4.6 --- Further analysis --- p.95
Chapter Chapter Five: --- Discussion --- p.100
Chapter 5.1 --- Geographic variations in health services utilization ratios --- p.101
Chapter 5.2 --- Geographic variation in Standardized Mortality Ratio --- p.107
Chapter 5.3 --- "Multi-level models on health services utilization, provision and mortality" --- p.121
Chapter 5.3.1 --- Socio-demographic characteristics of health services utilization --- p.121
Chapter 5.3.1.1 --- Age --- p.121
Chapter 5.3.1.2 --- Gender --- p.124
Chapter 5.3.2 --- Health services utilization in relation to services provision --- p.129
Chapter 5.3.3 --- Health services utilization in relation to mortality --- p.132
Chapter 5.3.4 --- Adequacy of healthcare services provision --- p.134
Chapter 5.3.4.1 --- Adequacy of hospital care provision --- p.134
Chapter 5.3.4.2 --- Adequacy of primary care provision --- p.139
Chapter 5.4 --- Implications --- p.143
Chapter 5.5 --- Strengths of study --- p.146
Chapter 5.6 --- Limitations of study --- p.148
Chapter 5.7 --- Recommendations for future research --- p.151
Chapter Chapter Six: --- Conclusion --- p.154
References --- p.158