Browsing by Subject "Health care costs"

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    Asthma Health Outcomes Achieved through a Clinic-based Quality Improvement Program
    (2018-02) Rojanasarot, Sirikan
    Asthma is a chronic condition that is prevalent in both children and adults. However, despite numerous and costly national quality improvement efforts, persons with asthma continue to receive suboptimal care. This is due in part to providers’ non-adherence to asthma guidelines, which impedes achievement of asthma treatment goals, resulting in unnecessary use of health care resources. Thus, evidence-based quality improvement programs that enhance the quality of care would be beneficial to both providers and patients. The primary aim of my dissertation was to address research and practice gaps that exist in quality improvement research by establishing evidence for a community-based asthma care improvement program implemented in 65 clinic sites across four states. The aim of this program was to improve asthma care among providers in real-world practice. This dissertation focused on three outcomes: 1) six clinic-based, guideline-recommended performance measures of asthma care; 2) preventable health events due to asthma; and 3) total asthma-related health care costs. The results of this dissertation are presented as three publishable manuscripts. The first manuscript addresses the effect of the program on clinic-based performance measures. It was found that, compared with performance prior to program implementation, the rates of documenting the six guideline-based performance measures increased significantly and remained improved following program completion. The second manuscript examines the program’s effect on asthma-related emergency room visits and hospitalizations. The results showed that the rates of these two events decreased by 42.1% and 50.0%, respectively, during the 12-month implementation and 5-month post-program completion periods. Using patient-level administrative claims data in multilevel generalized linear modeling, the results from the third manuscript found that implementation was associated with a 56.4% reduction in total asthma-related health care costs, while post-program completion was associated with a 57.3% reduction. This dissertation contributes significantly to both clinical and policy perspectives on quality improvement research. First, this work provides evidence for the enhancement of both provider- and patient-focused asthma-related outcomes through standardized quality improvement efforts at the clinic level in diverse geographic areas and across multiple clinic sites. Further, this dissertation provides an analytical framework for the evaluation of real-world health care interventions that have been missing in quality improvement research. Policy researchers could apply the analytic framework documented in this dissertation in the evaluation of health outcomes of complex quality improvement programs, not only for patients with asthma, but also those with other chronic conditions.
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    Chronic medication adherence: its association with health care costs.
    (2011-07) Zhou, Siting
    Effective treatment for high-prevalence chronic diseases requires medication adherence. Improved medication adherence increases medication utilization, which leads to higher pharmacy costs. However, higher adherence may reduce medical services use that result in decrease in overall health care costs despite the increase in pharmacy costs. The objective of this study was to examine the impact of medical adherence on health care costs. The secondary objective of this study was to assess the independent effect of consumer directed health plans (CDHPs) on health care costs. The study samples were three independent cohorts of individuals with the separate conditions of diabetes, hypertension and hypercholesterolemia, identified from a pharmacy benefits management company between January 1, 2007 and December 31, 2009. Medication adherence was measured using Proportion of Days Covered (PDC) endorsed by Pharmacy Quality Assurance (PQA). Health care costs were measured at two levels: all-cause and condition-specific. At each level, pharmacy, medical and total health care costs were calculated. The generalized linear model with a gamma log link was used to fit six statistical models for each disease cohort. Control variables included patients’ demographics, socioeconomic information, health status, health services utilization. There were 22,012 individuals in the diabetes cohort, 64,600 in the hypertension cohort and 59,003 in the hypercholesterolemia cohort. At all-cause level, increased PDC was significant associated with decreased medical costs across the three cohorts (p<0.05). At condition-specific level, increased PDC was significant associated with decreased medical costs in the hypertension and hypercholesterolemia cohorts (p<0.001), but with increased medical cost in the diabetes cohort (p<0.001). Due to the significant increase in pharmacy costs associated with higher PDC (p<0.001), total health care costs were increased (p<0.001) both at all-cause and condition-specific levels in each cohorts. Enrollment in CDHPs was generally associated with decreased medical, pharmacy, and total health care costs at all-cause and condition-specific levels across the three cohorts. As adherence increases, the savings in medical costs are not able to offset the increase in pharmacy costs. Therefore, measures that aim to reduce pharmacy cost while preserving or improving adherence are needed.