Browsing by Subject "health care costs"

Now showing 1 - 4 of 4
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    The 2014 Moreton Lecture: A Rebuttal
    (Elsevier, 2015-07) Borthakur, Gitasree; Kerridge, William D.; Ballenger, Zachary; Gunderman, Richard B.; Department of Radiology and Imaging, IU School of Medicine
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    The benefits of health information exchange: an updated systematic review
    (Oxford Academic, 2018-09) Menachemi, Nir; Rahurkar, Saurabh; Harle, Christopher A.; Vest, Joshua R.; Health Policy and Management, School of Public Health
    Objective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.
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    Initial collection of an inadequate 24-hour urine sample in children does not predict subsequent inadequate collections
    (Elsevier, 2018) Chan, Katherine H.; Moser, Elizabeth A.; Whittam, Benjamin M.; Misseri, Rosalia; Cain, Mark P.; Krambeck, Amy; Schwaderer, Andrew; Urology, School of Medicine
    Introduction Approximately half of adult stone formers submit specimens that are either under or over collections as determined by 24-h creatinine/kg. Previously identified predictors of inadequate collection in adults include female sex, older age, higher body mass index (BMI), vitamin D supplementation, and weekday collection. Objective The objective of this study is to determine risk factors for inadequate 24-h urinary specimen collection in the pediatric population. Study design A retrospective analysis of all children (<18 years of age) with renal and/or ureteral calculi evaluated at the study tertiary care pediatric center from 2005 to 2015 was performed. Those who had at least one 24-h urinary metabolic profile after a clinical visit for kidney and/or ureteral stones were included; children with bladder stones were excluded. Adequate collections had a urine creatinine of 10–15 mg/kg/24 h. A bivariate analysis of potential factors associated with inadequate collection of the initial urinary metabolic profile, including child demographics, parental socio-economic factors, history of stone surgery, and weekday vs. weekend urine collection, was performed. A mixed-effects logistic regression, controlling for correlation of specimens from the same patient, was also performed to determine whether an initial inadequate collection predicted a subsequent inadequate collection. Results Of 367 patients, 80 had an adequate collection (21.9%): median age, 13 years (interquartile range, 8–16); 61.1% female; 93.5% white; 19.5% obese; and 13.0% overweight. No parental or child factors were associated with inadequate collection (Summary Table). Of inadequate collections, more than 80% were over collections. In the 175 patients with more than one 24-h urinary specimen collection, the effect of an initial inadequate collection on subsequent inadequate collections was not significant after controlling for the correlation of samples from the same patient (p = 0.8). Discussion Any parental or child factors associated with the collection of inadequate 24-h urine specimens in children were not found. An initial inadequate collection does not predict subsequent inadequate collections. It was surprising that >80% of the inadequate collections were over collections rather than under collections. Possible explanations are that children collected urine samples for longer than the 24-h period or that stone-forming children produce more creatinine per 24-h period than healthy children due to hyperfiltration. Conclusion Inadequate collections are very common, and the risk factors for them are unclear. A repeat collection would be suggested if the first is inadequate. Further studies must be planned to explore barriers to accurate specimen collection using qualitative research methodology.
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    Investing Public and Philanthropic Values in the Social Good of Health Care
    (Office of the Vice Chancellor for Research, 2014-04-11) Craig, David M.
    As the national debate over health care reform continues, Americans are being asked what values they want the health care system to serve. With health care costs rising steadily, conservative proponents of consumer-directed health care and other market reforms champion the economic values of efficiency, innovation, transparency, and choice. Liberal advocates of the Affordable Care Act emphasize shared responsibilities for greater equity in insurance coverage and benefits and more affordability through public subsidies for low- to moderate-income Americans. In fact, health care in the United States has been organized around a range of values that are frequently in tension with one another. Using qualitative interviews conducted at religiously-affiliated health care organizations, this study identifies and assesses the values of excellence, innovation, compassion, solidarity, efficiency, and stewardship as foundational values of U.S. health care. Missing from today’s debate is a historical and practical understanding how these values have been invested in the training, delivery, and financing structures built up through decades of public policy and philanthropic initiatives by nonprofit providers. As a result, health care today is not a private good or a public good, but a social good. As escalating health costs absorb more of family income and government budgets, Americans need to take stock of the full range of health care values to create a different and more affordable community-based health care system.