End-stage Renal Disease and Economic Incentives: The International Study of Health Care Organization and Financing

End-stage renal disease (ESRD), or kidney failure, is a debilitating, costly, and increasingly common medical condition. Little is known about how different financing approaches affect ESRD outcomes and delivery of care. This paper presents results from a comparative review of 12 countries with alternative models of incentives and benefits, collected under the International Study of Health Care Organization and Financing, a substudy within the Dialysis Outcomes and Practice Patterns Study. Variation in spending per ESRD patient is relatively small and is correlated with overall per capita health care spending. Between-country variations in spending are reduced using an input price parity index constructed for this study. Remaining differences in costs and outcomes do not seem strongly linked to differences in incentives embedded in national programs.

End-Stage Renal Disease and Economic Incentives: The International Study of Health Care Organization and Financing

End-stage renal disease (ESRD), or kidney failure, is a debilitating, costly, and increasingly common medical condition. Little is known about how different financing approaches affect ESRD outcomes and delivery of care. This paper presents results from a comparative review of 12 countries with alternative models of incentives and benefits, collected under the International Study of Health Care Organization and Financing, a substudy within the Dialysis Outcomes and Practice Patterns Study. Variation in spending per ESRD patient is relatively small and is correlated with overall per capita health care spending. Between-country variations in spending are reduced using an input price parity index constructed for this study. Remaining differences in costs and outcomes do not seem strongly linked to differences in incentives embedded in national programs

Comparison of mortality with home hemodialysis and center hemodialysis: A national study

Comparison of mortality with home hemodialysis and center hemodialysis: A national study. We sought to determine whether lower mortality rates reported with hemodialysis (HD) at home compared to hemodialysis in dialysis centers (center HD) could be explained by patient selection. Data are from the United States Renal Data System (USRDS) Special Study Of Case Mix Severity, a random national sample of 4,892 patients who started renal replacement therapy in 1986 to 1987. Intent-to-treat analyses compared mortality between home HD (N =70) and center HD patients (N = 3,102) using the Cox proportional hazards model. Home HD patients were younger and had a lower frequency of comorbid conditions. The unadjusted relative risk (RR) of death for home HD patients compared to center HD was 0.37 (P < 0.001). The RR adjusted for age, sex, race and diabetes, was 44% lower in home HD patients (RR = 0.56, P = 0.02). When additionally adjusted for comorbid conditions, this RR increased marginally (RR = 0.58, P = 0.03). A different analysis using national USRDS data from 1986/7 and without comorbid adjustment showed patients with training for self care hemodialysis at home or in a center (N = 418) had a lower mortality risk (RR = 0.78, P = 0.001) than center HD patients (N = 43,122). Statistical adjustment for comorbid conditions in addition to age, sex, race, and diabetes explains only a small amount of the lower mortality with home HD

The cost of procuring deceased donor kidneys: Evidence from OPO cost reports 2013-2017

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154616/1/ajt15669_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154616/2/ajt15669.pd

A Case Report of Cognitive Processing Therapy Delivered over a Single Week.

Although evidence-based treatments for posttraumatic stress disorder (PTSD), such as Cognitive Processing Therapy (CPT), have been developed and widely disseminated, the rate of veterans engaging in and completing these therapies is low. Alternative methods of delivery may be needed to help overcome key barriers to treatment. Delivering evidence-based therapies intensively may address practical barriers to treatment attendance as well as problems with avoidance. This report details the case of a combat veteran who received 10 sessions of Cognitive Processing Therapy delivered twice per day over a single, five-day work week (CPT-5). Post-treatment, the veteran reported large and clinically meaningful decreases in PTSD and depression symptom severity as well as in guilt cognitions, which is a purported mechanism of successful treatment. These effects persisted six weeks after treatment ended. Despite the intensive nature of the treatment, the veteran found CPT-5 tolerable and could cite many benefits to completing therapy in one work week. In conclusion, CPT-5 holds promise as a way to efficiently deliver an evidence-based therapy that is both clinically effective and acceptable to patients, although more rigorous clinical trials are needed to test this treatment delivery format

A tall order: Small area mapping and modelling of adult height among Swiss male conscripts

Adult height reflects an individual's socio-economic background and offers insights into the well-being of populations. Height is linked to various health outcomes such as morbidity and mortality and has consequences on the societal level. The aim of this study was to describe small-area variation of height and associated factors among young men in Switzerland. Data from 175,916 conscripts (aged between 18.50 and 20.50 years) was collected between 2005 and 2011, which represented approximately 90% of the corresponding birth cohorts. These were analysed using Gaussian hierarchical models in a Bayesian framework to investigate the spatial pattern of mean height across postcodes. The models varied both in random effects and degree of adjustment (professional status, area-based socioeconomic position, and language region). We found a strong spatial structure for mean height across postcodes. The range of height differences between mean postcode level estimates was 3.40cm according to the best fitting model, with the shorter conscripts coming from the Italian and French speaking parts of Switzerland. There were positive socioeconomic gradients in height at both individual and area-based levels. Spatial patterns for height persisted after adjustment for individual factors, but not when language region was included. Socio-economic position and cultural/natural boundaries such as language borders and mountain passes are shaping patterns of height for Swiss conscripts. Small area mapping of height contributes to the understanding of its cofactors

The dose of hemodialysis and patient mortality

The dose of hemodialysis and patient mortality. The relationship between the delivered dose of hemodialysis and patient mortality remains somewhat controversial. Several observational studies have shown improved patient survival with higher levels of delivered dialysis dose. However, several other unmeasured variables, changes in patient mix or medical management may have impacted on this reported difference in mortality. The current study of a U.S. national sample of 2,311 patients from 347 dialysis units estimates the relationship of delivered hemodialysis dose to mortality, with a statistical adjustment for an extensive list of comorbidity/risk factors. Additionally this study investigated the existence of a dose beyond which more dialysis does not appear to lower mortality. We estimated patient survival using proportional hazards regression techniques, adjusting for 21 patient comorbidity/risk factors with stratification for nine Census regions. The patient sample was 2,311 Medicare hemodialysis patients treated with bicarbonate dialysate as of 12/31/90 who had end-stage renal disease for at least one year. Patient follow-up ranged between 1.5 and 2.4 years. The measurement of delivered therapy was based on two alternative measures of intradialytic urea reduction, the urea reduction ratio (URR) and Kt/V (with adjustment for urea generation and ultrafiltration). Hemodialysis patient mortality showed a strong and robust inverse correlation with delivered hemodialysis dose whether measured by Kt/V or by URR. Mortality risk was lower by 7% (P = 0.001) with each 0.1 higher level of delivered Kt/V. (Expressed in terms of URR, mortality was lower by 11% with each 5 percentage point higher URR; P = 0.001). Above a URR of 70% or a Kt/V of 1.3 these data did not provide statistical evidence of further reductions in mortality. In conclusion, the delivered dose of hemodialysis therapy is an important predictor of patient mortality. In a population of dialysis patients with a very high mortality rate, it appears that increasing the level of delivered therapy offers a practical and efficient means of lowering the mortality rate. The level of hemodialysis dose measured by URR or Kt/V beyond which the mortality rate does not continue to decrease, though not well defined with this study, appears to be above current levels of typical treatment of hemodialysis patients in the U.S

Chronic Illness, Treatment Choice and Workforce Participation

Choices with respect to labor force participation and medical treatment are increasingly intertwined. Technological advances present patients with new choices and may facilitate continued employment for the growing number of chronically ill individuals. We examine joint work/treatment decisions of end stage renal disease patients, a group for whom these tradeoffs are particularly salient. Using a simultaneous equations probit model, we find that treatment choice is a significant predictor of employment status. However, the effect size is considerably smaller than in models that do not consider the joint nature of these choices.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45858/1/10754_2004_Article_5145693.pd

The ACS Nearby Galaxy Survey Treasury IX. Constraining asymptotic giant branch evolution with old metal-poor galaxies

In an attempt to constrain evolutionary models of the asymptotic giant branch (AGB) phase at the limit of low masses and low metallicities, we have examined the luminosity functions and number ratio between AGB and red giant branch (RGB) stars from a sample of resolved galaxies from the ACS Nearby Galaxy Survey Treasury (ANGST). This database provides HST optical photometry together with maps of completeness, photometric errors, and star formation histories for dozens of galaxies within 4 Mpc. We select 12 galaxies characterized by predominantly metal-poor populations as indicated by a very steep and blue RGB, and which do not present any indication of recent star formation in their color--magnitude diagrams. Thousands of AGB stars brighter than the tip of the RGB (TRGB) are present in the sample (between 60 and 400 per galaxy), hence the Poisson noise has little impact in our measurements of the AGB/RGB ratio. We model the photometric data with a few sets of thermally pulsing AGB (TP-AGB) evolutionary models with different prescriptions for the mass loss. This technique allows us to set stringent constraints to the TP-AGB models of low-mass metal-poor stars (with M<1.5 Msun, [Fe/H]<~-1.0). Indeed, those which satisfactorily reproduce the observed AGB/RGB ratios have TP-AGB lifetimes between 1.2 and 1.8 Myr, and finish their nuclear burning lives with masses between 0.51 and 0.55 Msun. This is also in good agreement with recent observations of white dwarf masses in the M4 old globular cluster. These constraints can be added to those already derived from Magellanic Cloud star clusters as important mileposts in the arduous process of calibrating AGB evolutionary models.Comment: To appear in ApJ, a version with better resolution is in http://stev.oapd.inaf.it/~lgirardi/rgbagb.pd