Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

The Impact of Electronic Health Records on Healthcare Service Delivery, Patient Safety, and Quality

The HITECH Act has provided over $30 billion of support through the Meaningful Use program to implement Electronic Health Records (EHRs) with aims to improve healthcare service delivery, efficiency, quality, and patient safety. New healthcare models, such as pay-for-performance and value-based purchasing, were envisioned to aligning quality with reimbursement mediated with the use of EHRs. It is unclear of how EHRs and Meaningful Use have impacted health service delivery, patient safety, and quality of care. Thus, making it difficult to determine if the specific set of objectives for Meaningful Use have had a positive impact on outcomes, which ultimately is the goal of the program. The objective of this dissertation is to study the impact of EHRs on healthcare service delivery outcomes related to e-health services and productivity. Furthermore, the objectives are to study the impact of EHRs and Meaningful Use attestation on patient safety and inpatient quality of care. The results demonstrate gains in efficiency may be achieved during patient-physician interaction time with the use of fully EHRs, where physicians saved 1.53 minutes per visit in time spent with the patient, or a 6.1% gain in efficiency. EHR use significantly improved the odds of providing e-billing, e-consults, and e-prescribing. We found that fully-implemented EHRs that did not attest to Meaningful Use had a significant positive impact on 3 patient safety outcomes, and hospitals that attested to Meaningful Use had a significant positive impact on 2 patient safety outcomes. However, there were no significant differences in patient safety composite scores. Last, there were significant differences in inpatient quality composite scores. Hospitals attesting to Meaningful Use had 18% improvements in mortality for selected conditions, and 8% improvements in mortality for selected procedures. In conclusion, EHRs and the Meaningful Use program have had positive impacts on healthcare service delivery and inpatient quality of care. More efforts may be needed to improve patient safety with the use of EHRs, which may need to focus on EHR certification or Meaningful Use objectives. Future studies should determine specific EHR functionalities and Meaningful Use objectives that are associated with positive outcomes to further direct policy development

Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2011

Assesses the U.S. healthcare system's average performance in 2007-09 as measured by forty-two indicators of health outcomes, quality, access, efficiency, and equity compared with the 2006 and 2008 scorecards and with domestic and international benchmarks

STRIVING FOR APPROPRIATE ANTIBIOTIC USE: A BIOMARKER INITIATIVE, AND OUTCOMES ASSOCIATED WITH AZITHROMYCIN EXPOSURE

The introduction of antibiotics into clinical practice is considered the greatest medical breakthrough of the 20thcentury. However, the use of antibiotics can contribute to the development of resistance. In the United States (U.S.), approximately 2.8 million people are infected with antibiotic-resistant bacteria each year, and more than 35,000 people die as a result. Moreover, some antibiotics are known to cause cardiac side effects including QT prolongation, hypotension, and ventricular arrythmias. The U.S. Centers for Disease Control and Prevention (CDC) defines appropriate antibiotic use as the effort to use “the right antibiotic, at the right dose, for the right duration, at the right time, and reduce unnecessary antibiotic use”. The aspects of CDC’s appropriate antibiotic use definition covered in this dissertation are antibiotic duration and reducing unnecessary antibiotic use in Chapter 2, and the right antibiotic at the right time in Chapters 3 and 4. Chapter 2 and Chapter 3 contain summaries of literature regarding relevant scientific background, clinical background, historical context, and gaps in the literature. Chapter 2 additionally covers the biomarker intervention studied at UKHC, a pre-intervention cohort study, and a pre-post cohort study. Chapter 3 additionally includes a cohort study examining AZM exposure around a myocardial infarction and long-term cardiac outcomes. Chapter 4 includes a cohort study examining AZM exposure around a myocardial infarction and short-term cardiac outcomes. Finally, Chapter 5 discusses implications, future directions, and recommendations from the findings provided in this work

Effect of Beers Criteria on Healthcare Utilization and Cost in Community-Dwelling Elderly Patients

This retrospective cohort study uses 2013 Marketscan® claims data to quantify healthcare resource utilization and national healthcare costs attributable to using potentially inappropriate medications represented in 2012 Beers Criteria. We compare hospital admissions, days spent in the hospital, and total healthcare costs generated from inpatient and outpatient visits and prescription medication use for community-dwelling Medicare patients that received medications in Beers Criteria compared to a well-matched group of patients that received medications not included in Beers Criteria. Using Beers Criteria medications is associated with greater odds of hospital admission. Of those that are hospitalized, patients using Beers Criteria medications experience a greater number of hospital admissions and spend more days in the hospital compared to patients treated with medications not in Beers Criteria. We found total inpatient, outpatient, and prescription drug costs to be higher on average for patients that received Beers Criteria medications, and these patients were responsible for significantly higher annual healthcare costs in 2013. This study suggests the importance reducing the risk of unnecessary hospitalizations attributed to using inappropriate medications to minimize the burden the elderly population will have on our national healthcare system in the future