Sr Erickson

Assessing Performance Reports to Individual Providers in the Care of Acute Coronary Syndromes

BACKGROUND As part of a quality improvement initiative in the management of acute coronary syndromes, performance reports on care of patients with acute myocardial infarction (MI) or unstable angina (UA) who were admitted to two cardiology services at the University of Michigan Medical Center in 1999 were disseminated to a range of providers. METHODS In 1999, data were routinely collected by chart review on presentation, comorbidities, treatments, outcomes, and key process of care indicators for nearly 300 patients with AMI and a similar number of patients with acute UA. Key process of care indicators and outcomes were the focus of the report cards for AMI and UA. RESULTS OF SURVEY ON REPORT CARDS: The return rate for the provider survey--a simple one-page, nine-item question/answer sheet--was highest among faculty who received physician-specific reports (14 out of 17; 82%). Overall, 18 (60%) of 30 providers indicated that the report was useful, 18 responded favorably to the format, and only 3 (10%) indicated that the information was repetitive. Importantly, 24 (80%) indicated a desire to see future performance reports. DISCUSSION Although hospitalwide or even statewide reports have become familiar, their overall impact on care within hospitals or health systems is unknown. Because so many different caregivers affect the care of a single patient, it is difficult to identify all of these and to consider which part of the care oversight should be ascribed to each provider. The care process itself must be reengineered to build in the systems and time required to accomplish continuous evaluation and improvement.

PCV35 VALIDATION OF THE EQ-5D QUESTIONNAIRE IN PATIENTS WITH A HISTORY OF ACUTE CORONARY SYNDROME

PCV33 COST ANALYSIS OF A PRIOR AUTHORIZATION PROGRAM FOR ANTI-OBESITY THERAPY IN A MEDICAID POPULATION Grauer DW, Karpinski TA The University of Kansas, Kansas City, KS, USA OBJECTIVE: Clinical trials have demonstrated moderate therapeutic efficacy for orlistat and sibutramine, with patients losing between 5–10% of initial body weight. Due to the cost of orlistat and sibutramine and moderate efficacy, Kansas Medicaid chose to use prior authorization to control expenditures on antiobesity agents. The objective of this study was to determine if differences exist in cost and effect between patients who received PA approval for anti-obesity therapy and those who did not. METHODS: A retrospective, cohort study was designed in which patients were divided into those that received PA approval for sibutramine or orlistat and those that did not. The payer perspective was used in this study. Cost data included the total direct costs incurred by the Medicaid program including medications, physician office visits, hospital admissions, and administrative costs of the PA program. Effectiveness therapy was measured by the probability of patients achieving greater than 5% loss of initial weight. Independent sample t-tests were used to determine if differences exist between mean costs and effectiveness between the alternatives. RESULTS: Patients who received PA approval for orlistat/sibutramine incurred

PCV51: PREDICTIVE MODELS OF HEALTH-RELATED QUALITY OF LIFE UTILIZING PATIENT REPORTED OUTCOMES DATA FROM A POPULATION WITH A HISTORY OF ACUTE CORONARY SYNDROME

16,730 ±

Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study

20,185 in average total costs over the study time period compared to

PMH49 ANTIDEPRESSANT UTILIZATION, ADHERENCE AND HEALTH CARE SPENDING IN THE UNITED STATES:THE CASE OF MDD PATIENTS 2000–2007

12,527 ±

PDB6 PERFORMANCES OF COMORBIDITY MEASURES IN HEALTH CARERELATED BEHAVIORS AND OUTCOMES IN TYPE 2 DIABETES

18,702 for patients who did not (p = 0.02). Average initial weights and BMIs for patients who received drug therapy were 286 pounds and 43.4kg/m2 respectively, while patients who didn’t had average initial weights of 255 pounds and BMI of 38.9kg/m2. Patients who received anti-obesity therapy met the effectiveness goal 33% of the time, compared to 5% of the time for a patient who didn’t (p < 0.001). CONCLUSION: The average cost per Medicaid beneficiary was

PCV17: RELATIONSHIP BETWEEN PATIENT BELIEFS ABOUT MEDICATION AND SELF-REPORTED MEDICATION ADHERENCE SIX MONTHS AFTER DISCHARGE FOR ACUTE CORONARY SYNDROMES

4203 higher for those patients who received prior authorization approval for anti-obesity therapy compared to those who did not. However, patients also had a significantly higher probability of losing weight.

CV8: WORK-RELATED OUTCOMES OF PATIENTS SIX MONTHS AFTER MYOCARDIAL INFARCTION

tions 7.2(±4.1); compliance score 4.8(±0.6); symptoms 6.2(±4.4); PCS-8 59.2(±7.9); MCS-8 51.2(±8.1); and VAS 82.4(±16.0). The mean WPS was 4.6(±0.5); mean employment duration of 14.6(±12.3) years and 2.5% reporting job dissatisfaction. Of the 3 models tested, that with the highest explanatory ability (r-square = 0.36) included number of symptoms, age, perceived cardiac severity, and PCS-8, with more symptoms, higher perceived severity, higher age, and lower PCS-8 scores associated with lower perceived work performance. CONCLUSIONS: Currently employed ACS patients report a high level of work performance. Symptomology, perceived disease severity, age, and physical function appear to be associated with work performance.