David Schaaf

The Potential Effects Of HEDIS Performance Measures On The Quality Of Care

We analyzed the potential effects of different levels of performance on eight Health Care Employer Data and Information Set (HEDIS) measures for cardiovascular disease and diabetes during 1995-2005. The measures targeted 3.3 million (25 percent) heart attacks. Improvements in performance to those achieved by the median plan in 2005 imply prevention of 1.9 million myocardial infarctions (MIs, 15 percent), 0.8 million strokes (8 percent), and 0.1 million cases of end-stage renal disease (17 percent). If performance had been 100 percent, 1.4 million more MIs would have been prevented. Control of blood pressure has the largest potential effect on quality at the national level.

Prevalence of Diagnosed Opioid Abuse and its Economic Burden in the Veterans Health Administration

Evaluate prevalence and risk‐adjusted healthcare costs of diagnosed opioid abuse in the national Veterans Health Administration (VHA). Costs were compared between patients with and without diagnosed opioid abuse.

The prevalence of diagnosed opioid abuse in commercial and Medicare managed care populations.

To measure the prevalence of diagnosed opioid abuse and prescription opioid use in a multistate managed care organization.

Systematic Literature Review and Meta-Analysis of the Efficacy and Safety of Prescription Opioids, Including Abuse-Deterrent Formulations, in Non-Cancer Pain Management

OBJECTIVE This study was conducted to compare safety and efficacy outcomes between opioids formulated with technologies designed to deter or resist tampering (i.e., abuse-deterrent formulations [ADFs]) and non-ADFs for commonly prescribed opioids for treatment of non-cancer pain in adults. METHODS PubMed and Cochrane Library databases were searched for opioid publications between September 1, 2001 and August 31, 2011, and pivotal clinical trials from all years; abstracts from key pain conferences (2010-2011) were also reviewed. One hundred and ninety-one publications were initially identified, 68 of which met eligibility criteria and were systematically reviewed; a subset of 16 involved a placebo group (13 non-ADFs vs placebo, 3 ADFs vs placebo) and reported both efficacy and safety outcomes, and were included for a meta-analysis. Summary estimates of standardized difference in mean change of pain intensity (DMCPI), standardized difference in sum of pain intensity difference (DSPID), and odds ratios (ORs) of each adverse event (AE) were computed through random-effects estimates for ADFs (and non-ADFs) vs placebo. Indirect treatment comparisons were conducted to compare ADFs and non-ADFs. RESULTS Summary estimates for standardized DMCPI and for standardized DSPID indicated that ADFs and non-ADFs showed significantly greater efficacy than placebo in reducing pain intensity. Indirect analyses assessing the efficacy outcomes between ADFs and non-ADFs indicated that they were not significantly different (standardized DMCPI [0.39 {95% confidence interval (CI) 0.00-0.76}]; standardized DSPID [-0.22 {95% CI -0.74 to 0.30}]). ADFs and non-ADFs both were associated with higher odds of AEs than placebo. Odds ratios from indirect analyses comparing AEs for ADFs vs non-ADFs were not significant (nausea, 0.87 [0.24-3.12]; vomiting, 1.54 [0.40-5.97]; dizziness/vertigo, 0.61 [0.21-1.76]; headache, 1.42 [0.57-3.53]; somnolence/drowsiness, 0.47 [0.09-2.58]; constipation, 0.64 [0.28-1.49]; pruritus 0.41 [0.05-3.51]). CONCLUSION ADFs and non-ADFs had comparable efficacy and safety profiles, while both were more efficacious than placebo in reducing pain intensity.

Effect of Smoking Cessation Advice on Cardiovascular Disease

Performance measures and guidelines encourage physicians to advise smokers to quit. The effect of these efforts on the morbidity, mortality, and cost of cardiovascular disease is not known. This article analyzes the effects of offering smoking cessation advice in the US population. The Archimedes model is used to simulate several clinical trials in which basic advice and medication advice are offered and to calculate the rates of myocardial infarctions, congestive heart disease deaths, strokes, life years, quality-adjusted life years (QALYs), costs, and cost/ QALY. The simulated population is a representative sample of the US population drawn from the Third National Health and Nutrition Survey conducted just before the performance measures and guidelines were introduced. The results show that offering basic advice and medication advice can prevent about 13% and 19% of myocardial infarctions and strokes, respectively. The 30-year cost/QALY is approximately

Pain Conditions Ranked by Healthcare Costs for Members of a National Health Plan

3000 less than the base-case assumptions and less than

Cost Drivers of Prescription Opioid Abuse in Commercial and Medicare Populations

10 000 under pessimistic assumptions.

Differences in Healthcare Utilization and Associated Costs Between Patients Prescribed vs. Nonprescribed Opioids During an Inpatient or Emergency Department Visit

Healthcare resource utilization (HCRU) and associated costs specific to pain are a growing concern, as increasing dollar amounts are spent on pain‐related conditions. Understanding which pain conditions drive the highest utilization and cost burden to the healthcare system would enable providers and payers to better target conditions to manage pain adequately and efficiently. The current study focused on 36 noncancer chronic and 14 noncancer acute pain conditions and measured the HCRU and costs per member over 365 days. These conditions were ranked by per‐member costs and total adjusted healthcare costs to determine the most expensive conditions to a national health plan. The top 5 conditions for the commercial line of business were back pain, osteoarthritis (OA), childbirth, injuries, and non‐hip, non‐spine fractures (adjusted annual total costs for the commercial members were

Systematic review on quality control for drug management programs: Is quality reported in the literature?

119 million,

Systematic Analysis of Outcomes Evaluations Applied to Drug Management Programs

98 million,