Jill Boylston Herndon

Effect of prophylaxis on fungal infection and costs for high‐risk liver transplant recipients

We sought to determine whether the prophylactic use of amphotericin B products (conventional amphotericin B and liposomal amphotericin B) reduces the incidence of fungal infections in high‐risk liver transplant recipients, and if so, whether this lowers the cost of care. The study sample comprised 232 adult orthotopic liver transplants performed from 1994 to 2005 at a single center for patients classified as being at high risk for fungal infections. High‐risk patients who received transplants with a prophylaxis regimen of amphotericin B (n = 58 transplants) were compared with high‐risk patients who received no prophylaxis (n = 174 transplants). Fungal infections occurred in 3 transplants (5.17%) of those who received amphotericin B and 28 transplants (16.09%) in those without prophylaxis (P = 0.0432). Regression models were used to analyze fungal infection and costs for the 232 high‐risk transplants. Failure to offer prophylaxis conferred a 4‐fold greater risk of fungal infection (P = 0.046) compared with those who received amphotericin B. A fungal infection in a high‐risk recipient increased mean costs by 46.48%. The indirect effect of prophylaxis (operating through infection reduction) is estimated to reduce overall costs in high‐risk patients by 8.73%. Liver Transpl 13: 1743–1750, 2007.

Anti-inflammatory Medication Adherence, Healthcare Utilization and Expenditures Among Medicaid and Children's Health Insurance Program Enrollees with Asthma

AbstractBackground: Underuse of controller therapy among Medicaid-enrolled children is common and leads to more emergency department (ED) visits and hospitalizations. However, there is little evidence about the relationship between medication adherence, outcomes and costs once controller therapy is initiated. Objective: This study examined the relationship between adherence to two commonly prescribed anti-inflammatory medications, inhaled corticosteroids (ICS) and leukotriene inhibitors (LI), and healthcare utilization and expenditures among children enrolled in Medicaid and the Children’s Health Insurance Program in Florida and Texas in the US. Methods: The sample for this retrospective observational study consisted of 18456 children aged 2–18 years diagnosed with asthma, who had been continuously enrolled for 24 months during 2004–7 and were on monotherapy with ICS or LI. State administrative enrolment files were linked to medical claims data. Children were grouped into three adherence categories based on the percentage of days per year they had prescriptions filled (medication possession ratio). Bivariate and multivariable regression analyses that adjusted for the children’s demographic and health characteristics were used to examine the relationship between adherence and ED visits, hospitalizations, and expenditures. Results: Average adherence was 20% for ICS-treated children and 28% for LI-treated children. Children in the highest adherence category had lower odds of an ED visit than those in the lowest adherence category (p < 0.001). We did not detect a statistically significant relationship between adherence and hospitalizations; however, only 3.7% of children had an asthma-related hospitalization. Overall asthma care expenditures increased with greater medication adherence. Conclusions: Although greater adherence was associated with lower rates of ED visits, higher medication expenditures outweighed the savings. The overall low adherence rates suggest that quality improvement initiatives should continue to target adherence regardless of the class of medication used. However, low baseline hospitalization rates may leave little opportunity to significantly decrease costs through better disease management, without also decreasing medication costs.

The effect of premium changes on SCHIP enrollment duration.

RESEARCH OBJECTIVE To examine the impact of premium changes in Floridas State Childrens Health Insurance Program (SCHIP) on enrollment duration. DATA SOURCES Administrative records, containing enrollment and demographic data, were used to identify 173,330 enrollment spells for 153,768 children in Floridas SCHIP from July 2002 through June 2004. Health care claims data were used to classify the childrens health status. STUDY DESIGN Accelerated failure time models were used to examine the immediate and longer term effects on enrollment length of a temporary premium increase of

The Effect of Renewal Policy Changes on SCHIP Disenrollment

15 to

A Survivor Test of the American Agency System of Distributing Property Liability Insurance

20 per family per month (PFPM) for children in families with income between 101-150 percent of the federal poverty level (FPL) and a permanent premium increase of

Trends in dental-related use of hospital emergency departments in Florida

15 to

Participation of Older Patients With Prostate Cancer in Medicare Eligible Trials

20 PFPM for children in families with 151-200 percent FPL. Health status and sociodemographic variables were included as covariates. Transfers to other public health insurance programs were taken into account. PRINCIPAL FINDINGS Enrollment lengths decreased significantly immediately following the premium increases, with a greater percentage decrease among lower income children (61 percent) than higher income children (55 percent). Enrollment lengths partially recovered in the longer term for both the temporary and permanent changes. Those with significant acute or chronic health conditions had longer enrollment lengths and were less sensitive to premium changes than healthy children. CONCLUSIONS An increase in the PFPM premium amount had differential effects across income categories and health status levels. Enrollment lengths remained shortened after the premium increase was rescinded for lower income families, suggesting that it may be difficult to reverse the impacts of even a short-term premium increase.

Advanced topics in evidence-based urologic oncology: Economic analysis

OBJECTIVE To examine the impact of changing from a passive renewal process to an active renewal process in Floridas State Childrens Health Insurance Program (SCHIP) on disenrollment. DATA SOURCES Administrative records, containing enrollment and demographic data, were used to identify 414,396 enrollment spells from January 2004 through February 2006. Health care claims data were used to classify the childrens health status. STUDY DESIGN A Cox proportional hazards model was used to analyze the impact of changing to an active renewal process on the childrens risk of disenrolling, controlling for the childrens sociodemographic characteristics. Differential effects of the policy change by the childrens health status were examined, and transfers to other public health insurance programs were taken into account. PRINCIPAL FINDINGS Children faced almost a 10-fold greater risk of disenrolling in their renewal month under active renewal than under passive renewal. We did not detect differential impacts of the policy change across children with different health status levels. CONCLUSIONS The switch to an active renewal process in Floridas SCHIP significantly increased disenrollment rates, and the effect of this policy change does not appear to vary by health status.

United Shoe Machineryand the Antitrust Significance of “Free” Service

In earlier work byjoskow and by Cummins and VanDerhei, the American Agency system of distribution has been deemed inefficient, i.e. excessively costly. We test this in a natural way by examining whether the system survives in competition with more efficient systems. We find that it survives, but is in steady decline.

Measuring quality: caries-related emergency department visits and follow-up among children: Caries-related emergency department visits and follow-up

OBJECTIVES The inability to access regular dental care may lead to care seeking at hospital emergency departments (EDs). However, EDs generally are not equipped or staffed to provide definitive dental services. This study examined trends and patterns of hospital ED use for dental-related reasons in Florida, a large, diverse state with serious barriers to accessing dental care. METHODS Data for this study were drawn from ambulatory ED discharge records compiled by Floridas Agency for Health Care Administration for 2005-2014. Visits for dental-related reasons in Florida were defined by the patients reported reason for seeking care or the ED physicians primary diagnosis using ICD-9-CM codes. We calculated frequencies, age-specific and age-adjusted rates per 100,000 population, and secular trends in dental-related ED visits and their associated charges. RESULTS The number of dental-related visits to Florida EDs increased each year, from 104,642 in 2005 to 163,900 in 2014; the age-adjusted rate increased by 43.6 percent. Total charges for dental-related ED visits in Florida increased more than threefold during this time period, from