Persistent Variation in Medicare Payment Authorization for Home Hemodialysis Treatments

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142984/1/hesr12650-sup-0001-AppendixSA1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142984/2/hesr12650.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142984/3/hesr12650_am.pd

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 adoption of generic immunosuppressant medications in kidney, liver, and heart transplantation among recipients in Colorado or nationally with Medicare part D

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144701/1/ajt14722.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144701/2/ajt14722_am.pd

Mycobacterium chimaera pulmonary infection complicating cystic fibrosis: a case report

<p>Abstract</p> <p>Background</p> <p><it>Mycobacterium chimaera </it>is a recently described species within the <it>Mycobacterium avium </it>complex. Its pathogenicity in respiratory tract infection remains disputed. It has never been isolated during cystic fibrosis respiratory tract infection.</p> <p>Case presentation</p> <p>An 11-year-old boy of Asian ethnicity who was born on Réunion Island presented to our hospital with cystic fibrosis after a decline in his respiratory function over the course of seven years. We found that the decline in his respiratory function was correlated with the persistent presence of a <it>Mycobacterium avium </it>complex organism further identified as <it>M. chimaera</it>.</p> <p>Conclusion</p> <p>Using sequencing-based methods of identification, we observed that <it>M. chimaera </it>organisms contributed equally to respiratory tract infections in patients with cystic fibrosis when compared with <it>M. avium </it>subsp. <it>hominissuis </it>isolates. We believe that <it>M. chimaera </it>should be regarded as an emerging opportunistic respiratory pathogen in patients with cystic fibrosis, including young children, and that its detection warrants long-lasting appropriate anti-mycobacterial treatment to eradicate it.</p

The labor market effects of employment -based health insurance: Health-related job-lock and job sorting.

Three studies of the labor market effects of employment-based health insurance (EBHI) were conducted for workers ages 20--55 years. These studies evaluated job-lock, or reduced worker mobility due to EBHI, and job sorting based on preferences for health benefits. All studies focused on how EBHI affects the job choices of workers with health problems. The first study considered the trend in job-lock for married workers based on the 1987 National Medical Expenditure Survey (MMES) and the 1996--2000 Medical Expenditure Panel Survey (MEPS). Interactions of health insurance with family health measures (difference-in-difference) yielded job-lock estimates ranging from 20--50 percent during 1987. Previous negative findings may be explained by methods used to identify job-lock and estimate models of job turnover. No strong evidence of job-lock was found during 1996--2000. Despite rising health care costs, job-lock did not become more pervasive, and may have been alleviated by a stronger economy and health insurance legislation. This is the first study of the recent trend in job-lock using relatively standardized methods. The second study considered whether key omitted variables might explain job-lock findings by studying Canadian workers, for whom health insurance will not affect job turnover. Data were obtained for single workers in the NMES, the MEPS and the 1996--99 Canadian National Population Health Survey. Based on a relative reduction in mobility due to higher-cost chronic illnesses for U.S. workers with EBHI, there was evidence of job-lock in 1987, but not in 1996--98. A similar reduction in mobility was not observed for Canadian workers, either overall or in relative terms for those predicted to hold EBHI. The third study examined job sorting by predicting job changes involving a gain or loss in health benefits for single workers in the MEPS. Chronic illnesses, especially higher-cost conditions and conditions afflicting uninsured family members (worker or child), were strong predictors of gaining health benefits through a new job. Health-related job sorting may have both positive and negative implications for efficient labor allocation. Relatively few transitions to jobs with health benefits among workers with costly health problems suggests important efficiency and equity issues related to health insurance coverage.Ph.D.Health and Environmental SciencesLabor economicsPublic healthSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/123970/2/3106178.pd

Does Quality Influence Consumer Choice of Nursing Homes? Evidence from Nursing Home to Nursing Home Transfers

We estimated Cox proportional hazards models using assessment data from the Minimum Data Set to test whether nursing home residents and their proxies respond to quality of care by changing providers. Various indicators of poor quality increased the likelihood of transfer. Residents of for-profit homes or homes with excess capacity also were more likely to transfer. Inability to participate in care decisions and factors indicating frailty limited residents' ability to transfer. The apparent responsiveness to quality is encouraging. Nonetheless, because the absolute transfer rate is low, significant barriers to movement among nursing homes still may exist

Why Do Bigger Firms Receive Faster Drug Approvals?

We test several explanations for the commonly observed pattern that larger firms receive shorter FDA approval times for the drugs they submit. Candidate explanations include capture and rent-seeking and “external-signals” accounts. Analyses of 766 new molecular entities submitted to the FDA from 1979 to 2000 suggest that large-firm advantage in pharmaceutical regulation is primarily due to two factors: (1) enhanced regulator familiarity with large firms by virtue of their submission histories (an effect augmented when firms merge), and (2) regulatory favor for “early entrants” to a disease market, which is induced from disease-specific consumer pressure for approvals. Our analyses show that as much as 70% of observed large-firm advantage in expected FDA approval times can be attributed to these factors, 30-55% to familiarity alone. We find no consistent support for rent-seeking or “political clout” explanations.Governmen

Risk of peritonitis and technique failure by CAPD connection technique: A national study

Risk of peritonitis and technique failure by CAPD connection technique: A national study. Peritonitis has been a leading complication of long-term therapy with continuous ambulatory peritoneal dialysis (CAPD). This study was designed to evaluate the risk of peritonitis and technique failure according to the initial CAPD connection technique. Patients from all U.S. facilities starting CAPD therapy at home between January 1 and June 30, 1989 were followed for up to 21 months on the initial CAPD connection technique to change in technique or dialytic modality, to transplantation, death or loss to follow-up. Patients were grouped into standard connection techniques (SCT) (N = 1,133), Y-set (N = 1,067), standard UV set (N = 916) and O-set (N = 167). The time to first peritonitis episode was analyzed actuarially and by using the Cox proportional hazards model which adjusted for age, sex, race, cause of ESRD, CAPD program size and ESRD therapy prior to CAPD. Peritonitis occurred on average at 9.0 month intervals with SCT, 15.0 months with Y-set, 13.4 with standard UV and 9.4 with O-set. The relative risk (RR by Cox analysis) of first peritonitis compared to SCT was 0.60 (40% lower) for the Y-set (P < 0.01), 0.75 for standard UV (P < 0.01), and similar to SCT (RR = 0.96) for the O-set (NS), all else being equal. Analysis time to second (N = 1,271) peritonitis episode gave similar results as did analysis of time to CAPD technique failure. Significantly higher RR of peritonitis and technique failure was observed for younger and black patients. These findings suggest the utilization of connection techniques with superior results

Vers une approche semi-automatique pour la définition de motifs d'argumentation utilisés dans les résumés de projets scientifiques du domaine de la biodiversité

National audienceNous positionnons notre travail dans le domaine de l’analyse et de la visualisation de données textuelles produites par les scientifiques et réunies en corpus calibré. Ce domaine est reconnu pour sa contribution à la réflexion sur la composition et l’évaluation des politiques scientifiques. Le corpus que nous utilisons est une collection de tous les résumés de projets acceptés dans des guichets d’appels à projet dans le domaine de la biodiversité référencés par le réseau européen BiodivERsA. L’objectif de ce travail ancré dans la sociologie des sciences consiste à mieux comprendre les principales caractéristiques utilisées par les scientifiques pour présenter leur projet et convaincre de ses qualités. Pour cela nous avons utilisé une pluralité d’outils face à la difficulté de dépouiller l’information pour associer le niveau sémantique (structure de l’information) au niveau pragmatique (relations entre les rédacteurs de projet).Notre contribution repose sur un nouveau type d’extraction d’information, hors entités nommées, basé sur l'extraction de motifs d’argumentation. D’une part on remarque que l’usage de ces motifs marque la présence d'arguments dans des résumés de projets, et d’autre part croît avec le temps