Tzahit Simon-Tuval

The Effect of Obstructive Sleep Apnea on Morbidity and Health Care Utilization of Middle‐Aged and Older Adults

OBJECTIVES: To determine whether elderly subjects with obstructive sleep apnea (OSA) had different morbidity and health care utilization than elderly subjects without OSA and middle‐aged patients with OSA 2 years before diagnosis.

Sleep quality predicts quality of life in chronic obstructive pulmonary disease

Purpose Chronic obstructive pulmonary disease (COPD) patients may suffer from poor sleep and health-related quality of life. We hypothesized that disturbed sleep in COPD is correlated with quality of life. Methods In 180 patients with COPD (forced expired volume in 1 second [FEV1] 47.6 ± 15.2% predicted, 77.8% male, aged 65.9 ± 11.7 years), we administered general (Health Utilities Index 3) and disease-specific (St George’s Respiratory) questionnaires and an index of disturbed sleep (Pittsburgh Sleep Quality Index). Results Overall scores indicated poor general (Health Utilities Index 3: 0.52 ± 0.38), disease- specific (St George’s: 57.0 ± 21.3) quality of life and poor sleep quality (Pittsburgh 11.0 ± 5.4). Sleep time correlated with the number of respiratory and anxiety symptoms reported at night. Seventy-seven percent of the patients had Pittsburg scores >5, and the median Pittsburgh score was 12. On multivariate regression, the Pittsburgh Sleep Quality Index was an independent predictor of both the Health Utilities Index 3 and the St George’s scores, accounting for 3% and 5%, respectively, of the scores. Only approximately 25% of the patients demonstrated excessive sleepiness (Epworth Sleepiness Scale >9). Conclusions Most patients with COPD suffer disturbed sleep. Sleep quality was correlated with general and disease-specific quality of life. Only a minority of COPD patients complain of being sleepy.

Determinants of healthcare system’s efficiency in OECD countries

ObjectiveFirstly, to compare healthcare systems’ efficiency (HSE) using two models: one incorporating mostly inputs that are considered to be within the discretionary control of the healthcare system (i.e., physicians’ density, inpatient bed density, and health expenditure), and another, including mostly inputs beyond healthcare systems’ control (i.e., GDP, fruit and vegetables consumption, and health expenditure). Secondly, analyze whether institutional arrangements, population behavior, and socioeconomic or environmental determinants are associated with HSE.DesignData envelopment analysis (DEA) was utilized to calculate OECD countries’ HSE. Life expectancy and infant survival rate were considered as outputs in both models. Healthcare systems’ rankings according to the super-efficiency and the cross-efficiency ranking methods were used to analyze determinants associated with efficiency.Results(1) Healthcare systems in nine countries with large and stable economies were defined as efficient in model I, but were found to be inefficient in model II; (2) Gatekeeping and the presence of multiple insurers were associated with a lower efficiency; and (3) The association between socioeconomic and environmental indicators was found to be ambiguous.ConclusionsCountries striving to improve their HSE should aim to impact population behavior and welfare rather than only ensure adequate medical care. In addition, they may consider avoiding specific institutional arrangements, namely gatekeeping and the presence of multiple insurers. Finally, the ambiguous association found between socioeconomic and environmental indicators, and a country’s HSE necessitates caution when interpreting different ranking techniques in a cross-country efficiency evaluation and needs further exploration.

Elevated healthcare utilisation in young adult males with obstructive sleep apnoea

The aim of the present study was to explore morbidity and healthcare utilisation among young adult males with obstructive sleep apnoea (OSA) compared with middle-aged OSA patients over the 5-yr period preceding diagnosis. A prospective case–control study was performed; 117 young (22–39-yr-old) males with OSA were matched with 117 middle-aged (40–64-yr-old) OSA males for body mass index, apnoea/hypopnoea index, arterial oxygen saturation, arousal and awakening index, and Epworth Sleepiness Scale score. Each OSA patient was matched with controls by age, geographic area and physician. Young adult males with OSA showed no increase in specific comorbidity compared with controls. Middle-aged OSA patients exhibited increased risk of cardiovascular disease. Healthcare utilisation for the 5-yr period was ≥1.9 times higher among young and middle-aged male OSA patients than among controls. Multiple logistic regression analysis revealed that hyperlipidaemia in young adults and a body mass index of >37 kg·m−2 and cardiovascular disease in middle-aged adults are the only independent determinants of the upper third, most costly, OSA patients. Compared with middle-aged males with obstructive sleep apnoea, in whom increased expenditure was related to cardiovascular disease and body mass index, utilisation was not related to any specific disease in younger cases.

The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis

Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU). Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS) enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010–2012 period (n = 470). Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410). HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391). Before diagnosis (baseline), the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group (

Tiotropium as part of inhaled polytherapy: Adherence and associated health‐care utilization

439 vs.

The influence of healthcare workers’ occupation on Health Promoting Lifestyle Profile

382, P<0.05), however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls (

Cost-effectiveness of adherence-enhancing interventions: a systematic review

1,327 vs.

Adherence to Self-Care Behaviors among Patients with Type 2 Diabetes-The Role of Risk Preferences.

380, respectively, P<0.001). Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001). Additional elevated costs were 3.6 times higher laboratory tests (P<0.001), 2.8 times higher emergency room visits (P<0.001), 1.8 times higher medication (P<0.001) and 1.3 times higher diagnostic procedures (P<0.001). We conclude that human brucellosis is associated with elevated HCU costs. Considering these results in cost-effective analyses may be crucial for both reducing health inequities and optimal allocation of health systems’ scarce resources.

Medical loss ratio as a potential regulatory tool in the Israeli healthcare system.

Previous studies had demonstrated association between Tiotropium therapy (once‐daily inhaled anticholinergic) and reductions of exacerbations, improvements in dyspnoea and quality of life in chronic obstructive pulmonary disease (COPD) patients. Little is known about the influence of adherence to Tiotropium on health‐care utilization. Our objective was to examine whether adherence to Tiotropium is associated with decreased health‐care utilization.