Preferences and Willingness to Pay for Osteoarthritis Treatments among the Medicare Population

The design of this study is a non-random cross sectional survey to determine Medicare beneficiaries’ preferences and willingness to pay for osteoarthritis (OA) treatments. The population of interest in this study is the Medicare eligible (over age 65) population in Memphis, TN, and surrounding cities. Data were collected at Senior Centers and one internal medicine practice. The sample size was 181. Choice-based conjoint analysis technique was utilized. The preferences and willingness to pay were determined using choice-based conjoint analysis, advanced design module with a dual-response none option. Choice-based conjoint analysis uses computer guided surveys to elicit patient preference for a series of comparisons of osteoarthritis treatments that are characterized differently. This conjoint analysis study provides a greater understanding of how patients might incorporate complementary and alternative therapies into their osteoarthritis (OA) treatment regimen. This data enables clinicians and health care professionals to determine how patients may trade-off different levels of treatment attributes (e.g., cost, allopathic treatments, combination therapies, and Complementary and Alternative Medicine (CAM) therapies) for OA treatments. Overall, for the total sample, prayer/spiritual healing had the highest utility value (.71). Therefore, all groups did not place higher utility on allopathic treatments over CAM treatments as hypothesized. When looking at product shares of preference, prayer/spiritual healing also had the highest share of preference (16.32%). When the sample was segmented by gender, women did not place higher utility on CAM treatments as hypothesized. They were slightly different, however. Males preferred herbal mineral supplements more than women (.39 vs. .01) and women preferred massage over men (.39 vs. -.06). Men and women had virtually the same negative utility values for chiropractic care and acupuncture, and the same positive utility values for prayer. When the sample was segmented by race, blacks did not place higher utility on CAM than whites, and whites did not place higher utility on allopathic treatments then blacks. However, whites did place higher utility on herbal/mineral supplements (.26 vs. .07) than blacks. As hypothesized blacks did place a higher utility on prayer/spiritual healing than did whites (1.56 vs.-0.03). These data indicate that doctors and other healthcare providers should be encouraged to develop methods to involve patients in making treatment decisions and take the time to understand the patients’ treatment preferences. Patients in this sample desire treatments beyond the standard treatment protocol for osteoarthritis

The comparative burden of mild, moderate and severe Fibromyalgia: results from a cross-sectional survey in the United States

<p>Abstract</p> <p>Background</p> <p>Fibromyalgia (FM) is characterized by chronic, widespread pain, fatigue, and other symptoms; yet few studies have comprehensively assessed its humanistic burden. This observational study evaluates the impact of FM severity on patients' symptoms, health-related quality of life (HRQoL), and productivity in the United States.</p> <p>Methods</p> <p>203 FM subjects were recruited from 20 physician offices. Subjects completed a questionnaire including the EuroQol 5D (EQ-5D), Fibromyalgia Impact Questionnaire (FIQ), Multidimensional Assessment of Fatigue (MAF), Medical Outcomes Study Sleep Scale (MOS-SS), and Hospital Anxiety and Depression Scale (HADS) and questions about demographics, pain and other symptoms, HRQoL and productivity. FIQ total scores were used to define FM severity, with 0- < 39, 39- < 59, and 59-100, representing mild, moderate, and severe FM, respectively. Sites recorded subjects' clinical characteristics and FM treatment on case report forms using medical records. Summary statistics were calculated for continuous variables and frequency distributions for categorical variables. Differences across FM severity groups were evaluated using the Kruskal-Wallis or Chi-square tests. Statistical significance was evaluated at the 0.05 level.</p> <p>Results</p> <p>Mean (SD) age was 47.9 (10.9); 95% were female. Most (92%) were prescribed medication for FM; 24% and 66% reported moderate and severe FM, respectively. Mean (SD) scores were: 6.3 (2.1) for pain intensity; 0.35 (0.35) for EQ-5D; 30.7 (14.2) for MAF; 57.5 (18.4) for MOS-SS Sleep Problems Index; 10.2 (4.8) for HADS anxiety and 9.4 (4.4) for HADS depression. Subjects with worse FM severity reported significantly increased pain severity, HRQoL, fatigue, sleep disturbance, anxiety and depression (p < 0.001). Overall, 50% of subjects reported some disruption in their employment due to FM; this differed across severity levels (p < 0.001). Employed subjects missed a mean (SD) of 1.8 (3.9) workdays during the past 4 weeks; this also differed across severity levels (p = 0.03).</p> <p>Conclusions</p> <p>FM imposes a substantial humanistic burden on patients in the United States, and leads to substantial productivity loss, despite treatment. This burden is higher among subjects with worse FM severity.</p

Adverse Events Among Patients With Diabetes And Ambulatory Practice Characteristics: Evidence From A Nationally Representative Survey

Medications are the most common treatment modality for diabetes; however, medications may lead to inadvertent injury. Reducing adverse events in patients with diabetes is an important health care goal. Using pooled data from the 2011-2013 National Ambulatory Medical Care Survey, this cross-sectional, observational study explored univariate associations between patient safety for patients with diabetes as measured by adverse events and practice characteristics, including health information technology capabilities. This study found that the overall rate of adverse events among adults with diabetes is 7%, inclusive of injury, poisoning, or adverse effect of medical/surgical care or medicinal drug. We find evidence that e-prescribing, seeing a primary care provider, and being an established patient are associated with less adverse events

Examining The Relationship Between Hospital Ownership And Population Health Efforts

Purpose: The purpose of this paper is to investigate the relationship between ownership type and population health initiatives adopted by hospitals using the 2015 American Hospital Association data. Design/methodology/approach: Hospitals of various sizes, ownership structures and geographic locations are represented in the survey. The outcome variables of interest include measures of hospital population health activities. Findings: Findings indicate that nonprofit hospitals are most likely to express commitment to population health and participate in population health activities, with for-profit hospitals being least likely. Implications for policy and practice are discussed. Research limitations/implications: This study demonstrates that discrepancies in population health approaches exist across ownership status – particularly, nonprofit hospitals appear to be the most likely to be involved in population health efforts. Practical implications: As we continue to push for population health management in the hospital setting, grappling with the definition and purpose of population health management will be essential. Social implications: Overall, these results suggest that nonprofit hospitals are more likely to be implementing population health efforts than for-profit or government-owned hospitals. Originality/value: Although there are several studies on population health in hospitals, this study is the first to investigate the relationship between ownership type and population health initiatives adopted by hospitals

E-Prescribing And Adverse Drug Events

Background: Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes. Objective: To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia. Design: This is a prospective, observational cohort study with patient fixed effects. Setting: 2011-2013 fee for service Medicare. Patients: In total, 3.1 million Medicare fee for service, Part D enrolled beneficiaries over age 66 with diabetes mellitus and at least 90 days of antidiabetic medications. Measurements: E-prescribing was measured as the percentage of all prescriptions a person received transmitted to the pharmacy electronically. The outcome measure was the occurrence of an emergency department (ED) visit or hospitalization for hypoglycemia or diabetes-related ADE. Results: Unadjusted results show that there were 21 ADEs per 1000 beneficiaries that had ≥75% of their medications e-prescribed. Beneficiaries with lower e-prescribing levels had significantly higher numbers of ADEs. We found a robust association between the greater use of electronic prescriptions in the outpatient setting and the lower risk of an inpatient or ED visit for an ADE event among Medicare beneficiaries with diabetes in our adjusted analysis. At the e-prescribing threshold of 75% and above, significant reductions in ADE risk can be seen. Limitations: As an observational study, the results show an association but do not prove causation. Conclusions: Use of e-prescribing is associated with lower risk of an ED visit or hospitalization for diabetes-related ADE

Inflammatory Bowel Disease: Cost-Driving Factors And Impact Of Cost Sharing On Outpatient Resource Utilization

Objectives: (1) To identify the cost-driving factors of health expenditure in inflammatory bowel disease (IBD), (2) to determine the effect of different cost-sharing levels on outpatient visits and (3) to determine the effect of different cost-sharing levels on medication adherence among patients with IBD. Method: This was a retrospective, longitudinal study in which data were collected from 1999 to 2013 using the Medical Expenditure Panel Survey. The study sample included all patients who had IBD, were at least 18 years old, and had insurance. A comprehensive list of demographic factors was assessed to identify cost-driving factors associated with high level of expenditure in IBD. Two logistic regression models were built to examine the association between outpatient cost sharing and number of outpatient visits, and between prescription cost sharing and medication adherence. Statistical significance was evaluated at P \u3c 0.05. Key findings: Significant cost-driving factors included age, body mass index, education, income, quality of life, Charlson Comorbidity Index and region. The study found that low outpatient cost sharing was associated significantly with high level of outpatient visits. However, different levels of prescription cost sharing had no significant relationship with medication adherence. Conclusions: The finding confirms the existence of financial barriers to care in IBD, which may lead to suboptimal outpatient and, thus, the rapid worsening of the diseases. The finding of cost-driving factors allows the identification of high-risk group for high expenditure, which can be used for future cost-saving strategy

Data Breach Locations, Types, And Associated Characteristics Among Us Hospitals

OBJECTIVES: The objectives of this study were to describe the locations in hospitals where data are breached, the types of breaches that occur most often at hospitals, and hospital characteristics, including health information technology (IT) sophistication and biometric security capabilities, that may be predicting factors of large data breaches that affect 500 or more patients. STUDY DESIGN: The Office of Civil Rights breach data from healthcare providers regarding breaches that affected 500 or more individuals from 2009 to 2016 were linked with hospital characteristics from the Health Information Management Systems Society and the American Hospital Association Health IT Supplement databases. METHODS: Descriptive statistics were used to characterize hospitals with and without breaches, data breach type, and location/mode of data breaches in hospitals. Multivariate logistic regression analysis explored hospital characteristics that were predicting factors of a data breach affecting at least 500 patients, including area characteristics, region, health system membership, size, type, biometric security use, health IT sophistication, and ownership. RESULTS: Of all types of healthcare providers, hospitals accounted for approximately one-third of all data breaches and hospital breaches affected the largest number of individuals. Paper and films were the most frequent location of breached data, occurring in 65 hospitals during the study period, whereas network servers were the least common location but their breaches affected the most patients overall. Adjusted multivariate results showed significant associations among data breach occurrences and some hospital characteristics, including type and size, but not others, including health IT sophistication or biometric use for security. CONCLUSIONS: Hospitals should conduct routine audits to allow them to see their vulnerabilities before a breach occurs. Additionally, information security systems should be implemented concurrently with health information technologies. Improving access control and prioritizing patient privacy will be important steps in minimizing future breaches

Dispatch From The Non-Hitech-Incented Health It World: Electronic Medication History Adoption And Utilization

Objective To document national trends of electronic medication history use in the ambulatory setting and describe the characteristics and predicting factors of providers who regularly use medication history transaction capabilities through their e-prescribing systems. Materials and Methods The study used provider-initiated medication history data requests, electronically sent over an e-prescribing network from all 50 states and the District of Columbia. Data from 138,000 prescribers were evaluated using multivariate analyses from 2007 to 2013. Results Medication history use showed significant growth, increasing from 8 to 850 million history requests during the study period. Prescribers on the network for \u3c5 years had a lower likelihood of requests than those on the network for 5 or more years. Although descriptive analyses showed that prescribers in rural areas were alongside e-prescribing, and requesting medication histories more often than those in large and small cities, these findings were not significant in multivariate analyses. Providers in orthopedic surgery and internal medicine had a higher likelihood of more requests than family practice prescribers, with 12% and 7% higher likelihood, respectively. Discussion Early adopters of e-prescribing have remained medication history users and have continually increased their volume of requests for medication histories. Conclusion Despite the fact that the use of medication histories through e-prescribing networks in the ambulatory care setting has not been encouraged through federal incentive programs, there has been substantial growth in the use of medication histories offered through e-prescribing networks

Societal and individual burden of illness among fibromyalgia patients in France: Association between disease severity and OMERACT core domains

Abstract Background Patients with fibromyalgia (FM) report widespread pain, fatigue, and other functional limitations. This study aimed to provide an assessment of the burden of illness associated with FM in France and its association with disease severity and core domains as defined by Outcome Measures in Rheumatology Clinical Trials (OMERACT) for FM. Methods This cross-sectional, observational study recruited patients with a prior diagnosis of FM from 18 community-based physician offices in France. Patients completed questions about FM impact (Fibromyalgia-Impact Questionnaire [FIQ]), core symptoms (defined by OMERACT), health-related quality of life (EQ-5D), current overall health status (rated on a scale from 0 to 100), productivity, treatment satisfaction, and out-of-pocket expenses related to FM. Site staff recorded patients' treatment and health resource use based on medical record review. Costs were extrapolated from 4-week patient-reported data and 3-month clinical case report form data and calculated in 2008 Euros using a societal perspective. Tests of significance used the Kruskal-Wallis test or Fisher's Exact test where P Results Eighty-eight patients (mean 55.2 y; female:male 74:14) were recruited. The majority of patients (84.1%) were prescribed medications for FM. Patients mainly described medications as a little/not at all effective (40.0%) or somewhat effective (52.9%). Current Overall Health rating was 52.9 (± 17.8) and FIQ total score was 54.8 (± 17.3). FIQ total score was used to define FM severity, and 17 patients scored 0- Conclusions In a sample of 88 patients with FM from France, we found that FM poses a substantial economic and human burden on patients and society. FM severity level was significantly associated with patients' health status and core symptom domains.</p