Ozone Alerts and Asthma Exacerbations: A Case Study of Dallas-Fort Worth 2000-2008.

The objective of this study was to evaluate the role of public information about air quality (ozone alerts) in modifying the effects of air pollution on asthma exacerbations, using a range of measures that encompass varying degrees morbidity. A time series dataset was constructed that related the daily number of medical care services utilized for asthma with ozone, fine particulates, ozone alert, and other control variables. The study included subjects enrolled in health plans offered by employers in Dallas-Fort Worth during the ozone seasons May 2000 – September 2008. Count models of asthma hospitalizations underestimated the harmful association with ozone by 40% when ozone alerts were not included as a control variable. A 20 ppb increase in 8-hr maximum ozone levels on the previous day was associated with a 11.6% increase in asthma hospitalizations (95% CI: 2.5%, 20.6%). The lowest ozone alert level (orange) on the previous day was associated with 14.1% fewer asthma hospitalizations (95% CI: -27.9%, -0.3%) and a red or higher ozone alert was associated with 19.9% fewer asthma hospitalizations (95% CI: -42.5%, 2.6%). Weaker relationships were found for asthma ER visits, possibly due to that fact that ER visits for asthma may be due to an inability to see a doctor in an outpatient setting (i.e. evenings and weekends) and thus these visits may less strongly related to environmental triggers. Most studies of the effects of air pollution do not account for behavioral responses to public health information about air quality, such as ozone alerts, and may underestimate the harmful effects of poor air quality.Ph.D.Health Services Organization and Policy and EconomicsUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/75941/1/smithga_1.pd

What Are the Total Costs of Surgical Treatment for Uterine Fibroids?

Abstract Objective: To investigate the direct and indirect costs of uterine fibroid (UF) surgery. Methods: Data were obtained from the MarketScan Commercial Claims and Encounters databases for 1999–2004. Our sample included 22,860 women with insurance coverage who were treated surgically for UF and 14,214 women who were treated nonsurgically for UF. Medical care costs and missed workdays were divided into baseline (1 year prior to surgery) and postoperative (1 year after surgery) periods. For a subsample of women, we calculated average annual costs 3 years before and after their surgery. Results: Of patients electing surgery, 85.9% underwent hysterectomy, 7.6% myomectomy, 4.9% endometrial ablation, and 1.6% uterine artery embolization (UAE). Women undergoing UAE incurred the highest medical care costs in the operative year ($16,430 unadjusted,$20,634 adjusted for confounders), followed by hysterectomy ($15,180 unadjusted,$17,390 adjusted), myomectomy ($14,726 unadjusted,$18,674 adjusted), and endometrial ablation ($12,096 unadjusted,$13,019 adjusted). Women treated nonsurgically incurred costs of $7,460 unadjusted and$8,257 adjusted during the year after they were diagnosed with UF. Three years after surgery, patients treated with hysterectomy had the lowest annual costs. Missed workdays in the year after surgery were high, resulting in significant losses to employers in the magnitude of $6,670–$25,229, depending on treatment, values assigned to missed workdays, and whether the analyses adjusted for confounders. Conclusions: UF surgical treatment costs were high. Absenteeism and disability were important components of the cost burden of UF treatment for women, their employers, and the healthcare system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63391/1/jwh.2008.0456.pd

A four-system comparison of patients with chronic illness: the Military Health System, Veterans Health Administration, Medicaid, and commercial plans

We compared chronic care utilization in four major health systems in the U.S.: the military health system (TRICARE), the Department of Veterans Affairs (VA), Medicaid, and employer-sponsored commercial plans. Prevalence rates and key performance indicators were constructed from administrative data in federal fiscal year 2003 for eight chronic conditions: hypertension, major depression, diabetes, tobacco dependence, ischemic heart disease, severe mental illness, persistent asthma, and stroke. Continuously enrolled beneficiaries under 65 years old were studied: TRICARE (N = 2,963,987), VA (N = 2,114,739), Medicaid enrollees in five states (N = 5,554,974), and commercial insurance (N = 5,212,833). Condition-specific adjusted prevalence rates and measures were compared using the standardized rate ratio. For the majority of the conditions, the estimated prevalence rates were highest in the VA and Medicaid populations. Prevalence rates were generally lower in TRICARE and commercial plans. Medicaid beneficiaries had the highest hospitalization rates in four of the six conditions where hospitalization rates were measured. These results provide empirical evidence of differences in chronically ill patient populations in several of the major U.S. health insurance systems