Effects of an asthma management program on the asthmatic member: patient-centered results of a 2-year study in a managed care organization.
OBJECTIVE: To report the results of a 2-year pilot program of asthma education based on National Heart, Lung, and Blood Institute treatment guidelines. PATIENTS AND METHODS: Asthmatic members (n = 6698) of a managed care organization received education about their condition directly or through their primary care physician. Medical and pharmacy administrative claims data were reviewed to measure acute asthma events and prescribed therapies in the first (the baseline) and second years of the study. The claims data were augmented by member surveys from a stratified random sample of 2734 asthmatic patients who were members (6 years of age or older) in the baseline year. RESULTS: Compared with the first year, asthmatic members received fewer inpatient services and the proportion of asthmatic members prescribed oral inhaled corticosteroids increased 30% in the second year. Health-related quality of life, measured with validated general and disease-specific instruments; satisfaction with the quality of care; exposure to patient education; knowledge of the disease; and member's confidence in their ability to manage their disease showed statistically significant improvements during the follow-up year of the program for both adult and child asthmatic members. CONCLUSION: For asthmatic members of this health plan, a comprehensive asthma health management program improved processes of care and outcomes. (+info)
Method of linking Medicaid records to birth certificates may affect infant outcome statistics.
OBJECTIVES: This study assessed how different methods of matching Medicaid records to birth certificates affect Medicaid infant outcome statistics. METHODS: Claims paid by Medicaid for hospitalization of the newborn and for the mother's delivery were matched separately to 1995 North Carolina live birth certificates. RESULTS: Infant mortality and low-birthweight rates were consistently lower when Medicaid was defined by a matching newborn hospitalization record than when results were based on a matching Medicaid delivery record. CONCLUSIONS: Studies of birth outcomes in the Medicaid population may have variable results depending on the method of matching that is used to identify Medicaid births. (+info)
A claims data approach to defining an episode of care.
OBJECTIVE: To utilize health services research techniques in developing an episode of care using an administrative data set. This method is demonstrated for an episodic clinical condition, migraine. DATA SOURCES: Medicaid administrative data set of 3,372 patients with a diagnosis of migraine (ICD-9-CM 346.0, 346.1) in the state of Pennsylvania between May 1990 and March 1992. STUDY DESIGN: The duration of a migraine episode was measured by assessing the magnitude of resource utilization and the proportion of patients with charges in the period after the index migraine as compared to the period before the index migraine. A confidence interval (CI) was developed around each measure using bootstrap techniques. DATA COLLECTION METHODS: All charge data were extracted daily for a 113-day observation period surrounding each index migraine in order to observe the duration of impact of a migraine diagnosis on resource utilization. PRINCIPAL FINDINGS: The lower limits of both the 95% and 99% CIs for the difference in charges are greater than 0 for three weeks. The lower limits of both CIs for the difference in the proportion of patients with charges are above 0 for six weeks. CONCLUSIONS: Our analysis demonstrates that a health services research framework can be used to define an episode of care for a chronic disease category such as migraine. This method can be used to evaluate episodes of care for clinical studies of limited or episodic conditions and to complement clinical expertise in developing time horizons for clinical trials. (+info)
The impact of Medicaid managed care on community clinics in Sacramento County, California.
OBJECTIVES: The purpose of this study was to determine the impact of countywide Medicaid managed care on service use at community clinics. METHODS: Clinic use before and after introduction of Medicaid plans in one county was compared with that in a group of comparable counties without such plans. RESULTS: There were significant declines of 40% to 45% in the volumes of Medicaid clients, encounters, and revenues at clinics with the introduction of Medicaid plans. Declines of 23% in uninsured clients and encounters did not differ significantly. CONCLUSIONS: The introduction of Medicaid managed care with multiple commercial plans can have significant negative effects on nonprofit community clinics. (+info)
Costs and outcomes of hip fracture and stroke, 1984 to 1994.
OBJECTIVES: This study quantified changes in Medicare payments and outcomes for hip fracture and stroke from 1984 to 1994. METHODS: We studied National Long Term Care Survey respondents who were hospitalized for hip fracture (n = 887) or stroke (n = 878) occurring between 1984 and 1994. Changes in Medicare payment and survival were primary outcomes. We also assessed changes in functional and cognitive status. RESULTS: Medicare payments within 6 months increased following hip fracture (103%) or stroke (51%). Survival improved for stroke (P < .001) and to a lesser extent for hip fracture (P = .16). Condition-specific improvements were found in functional and cognitive status. CONCLUSIONS: During the period 1984 to 1994, Medicare payments for hip fracture and stroke rose and there were some improvements in survival and other outcomes. (+info)
Determining an episode of care using claims data. Diabetic foot ulcer.
OBJECTIVE: Amid changes in the organization and financing of health care, health care decision makers are increasingly interested in episodes of care. We sought to determine an episode of care for diabetic foot ulcer using an administrative claims database. RESEARCH DESIGN AND METHODS: We used 1993-1995 claims data to assess resource utilization for privately insured patients with diabetic foot ulcers. Over a 26-week period, we determined the episode length by comparing differences in average daily charges and proportion of patients with charges before and after foot ulcer diagnosis. All 13 weeks before diagnosis were used to calculate baseline values. Significance was determined by CIs, which were calculated by a nonparametric bootstrap technique. Costs associated with the episode were also calculated. A sensitivity analysis using weeks with highest and lowest values as baseline was also conducted. RESULTS: Based on average daily charges, the episode of care for diabetic foot ulcer was 5 weeks. Using proportion of patients with charges, the episode was longer than 13 weeks. The cost for an episode of care ranged from $900 to $2,600. In the sensitivity analyses, episodes of care ranged from 1 to 13 weeks. CONCLUSIONS: Episodes of care can be defined by the period beginning with increased resource consumption and ending when resource consumption returns to baseline levels. With the growth of managed care and disease management programs, episode-of-care analysis may have an increasingly important role in health care provision and delivery. (+info)
The intensity of physicians' work in patient visits--implications for the coding of patient evaluation and management services.
BACKGROUND: Clinicians use visit codes to bill for services involving the evaluation of patients and the management of their care. The existing guidelines for coding and documenting these services, as well as proposed revisions, have been criticized as complex, clinically irrelevant, and costly. We investigated whether easily measured characteristics of physician-patient visits accurately reflect differences in the amount of work performed. Such characteristics might provide the basis for a simple and equitable physician-payment scheme. METHODS: We collected information about the amount of physicians' work, the time spent in encounters with patients, and characteristics of patients and visits for 19,143 physician-patient visits in the practices of 339 urologists, rheumatologists, and general internists. Physicians recorded the actual time involved in evaluating the patient and managing his or her care during each visit and estimated the work involved in relation to a standardized, hypothetical visit. We used multivariate linear regression to identify factors related to differences in the total amount of work and to calculate work and work intensity (work per minute) for different types of visits. RESULTS: The duration of the face-to-face encounter with the patient or family (encounter time) was strongly predictive of the total amount of work. Total work, however, did not increase in direct proportion to encounter time. Visits with shorter encounter times were more intense than longer ones, in part because the work involved in providing fixed services, such as review of records and entry of information, did not vary in direct proportion to the length of the face-to-face encounter. Work intensity was greater for new patients than for established patients, for patients referred by other physicians than for those who were not, and for patients with new rather than previously existing problems. CONCLUSIONS: A simple coding scheme based on time spent by the physician in the face-to-face encounter and a limited set of characteristics of the visit would accurately reflect total work in actual practice. A fee structure based on these factors and the inverse relation between work per minute and the encounter time would provide equitable payment while encouraging efficiency and discouraging "upcoding" of services. (+info)
Using Medicaid claims to construct dental service market areas.
OBJECTIVE: To use Medicaid claims data to construct patient origin-based market areas for dental services and compare constructed market areas with those based on the practice county. DATA SOURCES: North Carolina Medicaid claims, eligibility, and provider files, the Cooperative Health Information Systems' dentist licensure files, and the Log Into North Carolina data. STUDY DESIGN: A visit-level file was created from the Medicaid claims data and aggregated by provider practice county and patient county of residence. Using the aggregated file and an algorithm based on the Elzinga-Hogarty approach, patient travel patterns were used to construct mutually exclusive patient origin market areas. DATA ANALYSIS: Market area characteristics were compared across definitions using Pearson correlation coefficients. In addition, estimations of provider participation were performed using market area characteristics as control variables. The beta coefficients associated with market area characteristics were compared across market area definitions. PRINCIPAL FINDINGS: Medicaid claims data, when combined with provider licensure files, can be used to construct market areas based on patient origin data. However, measures of market area characteristics are correlated highly between the two types of market areas studied. Furthermore, beta coefficients on market area variables in models of provider participation are similar in sign, significance, and magnitude across market definitions. CONCLUSIONS: Compared with market areas constructed using patient origin data, county-based market areas adequately proxy for dental markets. Using the county as the market area also avoids the time and computational costs associated with using a patient origin-based approach and facilitates the use of widely available data. (+info)