Sharada Weir

The Value of Trauma Center Care

BACKGROUND The cost of trauma center care is high, raising questions about the value of a regionalized approach to trauma care. To address these concerns, we estimate 1-year and lifetime treatment costs and measure the cost-effectiveness of treatment at a Level I trauma center (TC) compared with a nontrauma center hospital (NTC). METHODS Estimates of cost-effectiveness were derived using data on 5,043 major trauma patients enrolled in the National Study on Costs and Outcomes of Trauma, a prospective cohort study of severely injured adult patients cared for in 69 hospitals in 14 states. Data on costs were derived from multiple sources including claims data from the Centers for Medicare and Medicaid Services, UB92 hospital bills, and patient interviews. Cost-effectiveness was estimated as the ratio of the difference in costs (for treatment at a TC vs. NTC) divided by the difference in life years gained (and lives saved). We also measured cost-effectiveness per quality-adjusted life year gained where quality of life was measured using the SF-6D. We used inverse probability of treatment weighting to adjust for observable differences between patients treated at TCs and NTCs. RESULTS The added cost for treatment at a TC versus NTC was

Implications of comorbidity on costs for patients with Alzheimer disease.

36,319 per life-year gained (

Externality Effects of Education: Dynamics of the Adoption and Diffusion of an Innovation in Rural Ethiopia

790,931 per life saved) and

One-year treatment costs of trauma care in the USA.

36,961 per quality-adjusted life years gained. Cost-effectiveness was more favorable for patients with injuries of higher versus lower severity and for younger versus older patients. CONCLUSIONS Our findings provide evidence that regionalization of trauma care is not only effective but also it is cost-effective.

Predictors of prenatal and postpartum care adequacy in a medicaid managed care population.

Background:No prior studies have used a comprehensive clinical classification system to examine the effect of differences in overall illness burden and the presence of other diseases on costs for patients with Alzheimer disease (AD) when compared with demographically matched nondemented controls. Study Design:Of a total of 627,775 enrollees who were eligible for medical and pharmacy benefits for 2003 and 2004 in the MarketScan Medicare Supplemental and Coordination of Benefits Database, we found 25,109 AD patients. For each case, 3 demographically matched nondemented controls were selected using propensity scores. Applying the diagnostic cost groups (DCGs) model to all enrollees, 2003 diagnoses were used to estimate prospective relative risk scores (RRSs) that predict 2004 costs from all illness other than AD. RRSs were then used to control for illness burden to estimate ADs independent effect on costs. Results:Compared with the control group, the AD cohort has more comorbid conditions (8.1 vs. 6.5) and higher illness burden (1.23 vs. 1.04). Individuals with AD are more likely to have mental health conditions, neurologic conditions, cognitive disorders, cerebrovascular disease, diabetes with acute complications, and injuries. Annual costs for AD patients are

Beyond health plans: behavioral health disorders and quality of diabetes and asthma care for Medicaid beneficiaries

3567 (34%) higher than for controls. Excess costs attributable to AD, after controlling for non-AD illness burden, are estimated at

Utilization and Costs of Health Care after Geriatric Traumatic Brain Injury

2307 per year with outpatient pharmacy being the key driver (

Effects of paediatric limb loss on healthcare utilisation, schooling and parental labour supply

1711 in excess costs). Conclusions:AD patients are sicker and more expensive than demographically matched controls. Even after adjusting for differences in illness burden, costs remain higher for AD patients.

Disparities in Routine Breast Cancer Screening for Medicaid Managed Care Members with a Work- Limiting Disability

This article investigates the role of schooling at the household and community levels in the adoption and diffusion of agricultural innovations in rural Ethiopia. We find that household‐level education is important to the timing of adoption but less crucial to the question of whether a household has ever adopted fertilizer (since those without schooling may eventually copy the educated). Community‐level education substitutes for low levels of household education, encouraging uneducated farmers to adopt sooner than would be predicted in the absence of educated neighbors. Moreover, community‐level education is complementary to household education in determining which farmers will eventually adopt. Thus, evidence is presented to suggest that there are two externality effects: educated farmers are early innovators, providing an example that may be copied by less‐educated farmers; and educated farmers are better able to copy those who innovate first, enhancing diffusion of the new technology more widely within the site.

The role of education in facilitating risk-taking and innovation in agriculture

Although injuries are a leading cause of morbidity and mortality in the USA, few prior studies exist on the costs of trauma care. This article estimates treatment costs of care for 12 months following injury. Primary and secondary data were collected on over 5000 moderate-to-severely injured patients 18–84 years of age discharged from 69 US hospitals. Acute and post-acute costs of care were estimated from a combination of data sources: UB92 hospital bills, patient surveys, medical record abstracts, and where available, Medicare claims. Key analysis variables were demographic characteristics, insurance status and nature and severity of injury. Mean 1-year cost per patient of trauma care in our population was