Teresa B. Gibson

Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

Persons with multiple chronic conditions are a large and growing segment of the US population. However, little is known about how chronic conditions cluster, and the ramifications of having specific combinations of chronic conditions. Clinical guidelines and disease management programs focus on single conditions, and clinical research often excludes persons with multiple chronic conditions. Understanding how conditions in combination impact the burden of disease and the costs and quality of care received is critical to improving care for the 1 in 5 Americans with multiple chronic conditions. This Medline review of publications examining somatic chronic conditions co-occurring with 1 or more additional specific chronic illness between January 2000 and March 2007 summarizes the state of our understanding of the prevalence and health challenges of multiple chronic conditions and the implications for quality, care management, and costs.

How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data.

Objective: To determine the accuracy of self-reported health care utilization and absence reported on health risk assessments against administrative claims and human resource records. Methods: Self-reported values of health care utilization and absenteeism were analyzed for concordance to administrative claims values. Percent agreement, Pearson’s correlations, and multivariate logistic regression models examined the level of agreement and characteristics of participants with concordance. Results: Self-report and administrative data showed greater concordance for monthly compared with yearly health care utilization metrics. Percent agreement ranged from 30% to 99% with annual doctor visits having the lowest percent agreement. Younger people, males, those with higher education, and healthier individuals more accurately reported their health care utilization and absenteeism. Conclusions: Self-reported health care utilization and absenteeism may be used as a proxy when medical claims and administrative data are unavailable, particularly for shorter recall periods.

The direct and indirect cost burden of Crohn's disease and ulcerative colitis.

Objective: To estimate the direct medical and indirect (absenteeism and short-term disability) cost burden of Crohns Disease (CD) and Ulcerative Colitis (UC). Methods: Data were obtained from 1999 to 2005 MarketScan databases. Twelve-month expenditures for patients with CD and UC were compared to expenditures among an equal number of propensity score matched comparison group patients. Regression analysis controlled for demographics and case-mix. Results: Annual medical expenditures were significantly higher for commercially insured CD and UC patients compared to matched comparison group patients (

Emergency Department Care in the United States: A Profile of National Data Sources

18,963 vs

Long-term medical costs and resource utilization in systemic lupus erythematosus and lupus nephritis: A five-year analysis of a large medicaid population

5300 for CD patients,

Direct and indirect costs to employers of patients with systemic lupus erythematosus with and without nephritis.

15,020 vs

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, medicare, and medicaid

4982 for UC patients, respectively, all P < 0.001). Indirect costs were also high for employed patients with these conditions. Conclusions: CD and UC are costly diseases with a significant cost burden related to health care utilization and productivity loss.

A Value-Based Insurance Design Program At A Large Company Boosted Medication Adherence For Employees With Chronic Illnesses

STUDY OBJECTIVE Emergency departments (EDs) are an integral part of the US health care system, and yet national data sources on the care received in the ED are poorly understood, thereby limiting their usefulness for analyses. We provide a comparison of data sources that can be used to examine utilization and quality of care in the ED nationally. DATA SOURCES AND COMPARISONS: This article compares 7 data sources available in 2005 for conducting analyses of ED encounters: the American Hospital Association Annual Survey Database(), Hospital Market Profiling Solution(c), National Emergency Department Inventory, Nationwide Emergency Department Sample, National Hospital Ambulatory Medical Care Survey, National Electronic Injury Surveillance System-All-Injury Program, and the National Health Interview Survey. In addition to describing the type and scope of data collection, available characteristics, and sponsor of the ED data sources, we compare (where possible) estimates of the total number of EDs, national and regional volume of ED visits, national and regional admission rates (percentage of ED visits resulting in hospital admission), patient characteristics, hospital characteristics, and reasons for visit generated by the various data sources. MAJOR FINDINGS The different data sources yielded estimates of the number of EDs that ranged from 4,609 to 4,884 and the number of ED encounters from more than 109 million to more than 116 million. Admission rates across data sources varied from 12.0% to 15.3%. Although comparisons of the 7 data sources were somewhat limited by differences in available information and operational definitions, variation in estimates of utilization and patterns of care existed by region, expected payer, and patient and hospital characteristics. The rankings and estimates of the top 5 first-listed conditions seen in the ED are relatively consistent between the 2 data sources with diagnoses, although the Nationwide Emergency Department Sample estimates 1.3 to 5.8 times more ED visits for each chronic and acute all-listed condition examined relative to the National Hospital Ambulatory Medical Care Survey. CONCLUSION Each of the data sources described in this article has unique advantages and disadvantages when used to examine patterns of ED care, making the different data sources appropriate for different applications. Analysts should select a data source according to its construction and should bear in mind its strengths and weaknesses in drawing conclusions based on the estimates it yields.

The direct and indirect cost burden of clinically significant and symptomatic uterine fibroids

OBJECTIVE To estimate the long-term direct medical costs and health care utilization for patients with systemic lupus erythematosus (SLE) and a subset of SLE patients with nephritis. METHODS Patients with newly active SLE were found in the MarketScan Medicaid Database (1999-2005), which includes all inpatient, outpatient, emergency department, and pharmaceutical claims for more than 10 million Medicaid beneficiaries. The date a patient became newly active was defined as the earliest observed SLE diagnosis code, with a 6-month clean period prior to the diagnosis. This method identified 2,298 patients with a consecutive followup of 5 years. A reference group of patients without SLE was constructed using propensity score matching. Nephritis was assessed based on diagnosis and procedure codes involving the kidney. RESULTS Mean annual medical costs for SLE patients totaled

Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices

16,089 at year 1, which is significantly greater (by