Hangsheng Liu

Economic burden associated with Parkinson's disease on elderly Medicare beneficiaries.

We evaluated medical utilization and economic burden of self‐reported Parkinsons disease (PD) on patients and society. Using the 1992–2000 Medicare Current Beneficiary Survey, we compared health care utilization and expenditures (in 2002 U.S. dollars) of Medicare subscribers with and without PD, adjusting for sociodemographic characteristics and comorbidities. PD patients used significantly more health care services of all categories and paid significantly more out of pocket for their medical services than other elderly (mean ± SE,

Accuracy of Medicare claims data in identifying Parkinsonism cases: comparison with the Medicare current beneficiary survey.

5,532 ±

Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia

329 vs.

Medicare Beneficiaries With Depression: Comparing Diagnoses in Claims Data With the Results of Screening

2,187 ±

What is the risk of developing parkinsonism following neuroleptic use

38; P < 0.001). After adjusting for other factors, PD patients had higher annual health care expenses than beneficiaries without PD (

Central line–associated blood stream infections in pediatric intensive care units: Longitudinal trends and compliance with bundle strategies

18,528 vs.

Compliance with prevention practices and their association with central line–associated bloodstream infections in neonatal intensive care units

10,818; P < 0.001). PD patients were more likely to use medical care (OR = 3.77; 95% CI = 1.44–9.88), in particular for long‐term care (OR = 3.80; 95% CI = 3.02–4.79) and home health care (OR = 2.08; 95% CI = 1.76–2.46). PD is associated with a significant economic burden to patients and society. Although more research is needed to understand the relationship between PD and medical expenditures and utilization, these findings have important implications for health care providers and payers that serve PD populations.

The association of state legal mandates for data submission of central line-associated bloodstream infections in neonatal intensive care units with process and outcome measures.

Administrative databases are commonly used to examine use of healthcare service, with researchers relying on diagnostic codes to identify medical conditions. This study evaluates the accuracy of administrative claims in identifying Parkinsonism cases compared to the self‐reported Parkinsons disease (PD).

Managed Care Quality of Care and Plan Choice in New York SCHIP

BackgroundHospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU) and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia (VAP); the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period.MethodsClinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR) and healthcare utilization incidence ratios (IR) were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status) and Medicaid status (i.e., dual eligibility) were controlled for in these models.ResultsIn 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HRu2009=u20091.39, Pu2009<u20090.01; and pneumonia HRu2009=u20091.58, Pu2009<u20090.01) and the risk persisted throughout the follow-up period. Persons with sepsis and pneumonia experienced higher utilization than controls (e.g., IR for long-term care utilization for those with sepsis ranged from 2.67 to 1.93 in years 1 through 5); and, utilization was partially related to impending death.ConclusionsThe infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings.

Nonprice competition and quality of care in managed care: the New York SCHIP market.

OBJECTIVEnThe study evaluated the accuracy of Medicare claims in identifying elderly patients with depression compared with diagnoses of depression made with validated self-report depression scales.nnnMETHODSnThe study included 1,551 participants in the Medicare Primary and Consumer-Directed Care Demonstration. They resided in 19 counties in three states. Depression diagnoses made by two validated self-rated scales- the Mini-International Neuropsychiatric Interview-Major Depressive Episode Module (MINI-MDE) and the 15-item Geriatric Depression Scale (GDS) were compared with depression identified diagnoses listed in Medicare claims. The main outcome measures were the sensitivity, specificity, and positive and negative predictive values for ICD-9-CM depression codes included in Medicare claims. For validation, two-year periods and additional diagnostic codes were also considered.nnnRESULTSnCompared with the MINI-MDE or GDS, the sensitivity and positive predictive values for Medicare claims were below 50%, and specificity and negative predictive values were over 70%.nnnCONCLUSIONSnThe study demonstrated the predictive power and limitations of using administrative claims data for identifying patients with depression in the Medicare population. Using Medicare claims to identify patients with depression may lead to underestimation of depression prevalence and may compromise researchers ability to examine issues related to quality, costs, and utilization.