Health-related quality of life improves with treatment-related GERD symptom resolution after adjusting for baseline severity

Severity and frequency of gastroesophageal reflux disease (GERD) related symptoms are associated with impaired health-related quality of life (HRQL). This study evaluated the association between baseline heartburn severity and endpoint HRQL of patients treated for heartburn and the relationship between complete resolution of heartburn symptoms and HRQL outcomes after controlling for baseline severity. We completed a secondary analysis of clinical symptom and HRQL data from three clinical trials in adult patients receiving either omeprazole or ranitidine treatment for GERD. HRQL was assessed using the Psychological General Well-Being Index (PGWB) in each of the three clinical trials, and two of the trials also included the Medical Outcomes Study Sleep disturbance scale. Gastrointestinal symptoms were evaluated using either the Gastrointestinal Symptom Rating Scale or a modified version of the scale. Baseline heartburn severity (none/minor, mild, moderate or severe) was defined based on patient-reported symptoms. Analysis of covariance (ANCOVA) models were used to compare mean HRQL scores by baseline level of heartburn symptom severity and whether or not patients experienced complete heartburn resolution. At baseline, PGWB scores were significantly worse (p < 0.05) for patients with more severe heartburn symptoms. There were no statistically significant baseline severity by symptom resolution interactions in any of the ANCOVA models. For all three trials and across all follow-up assessments, mean PGWB scores were statistically significantly higher for patients with completely resolved heartburn symptoms versus those whose symptoms were unresolved (all p-values < 0.05). Few significant effects were observed for sleep disturbance scores. While the severity of heartburn symptoms at the start of medical treatment for GERD is not associated with improvements in HRQL in subsequent weeks of treatment, complete resolution of symptoms is associated with improvements in psychological well-being

Implications of the Accuracy of MEPS Prescription Drug Data for Health Services Research

This paper assesses the quality of the Medical Expenditure Panel Survey (MEPS) drug data and the impact that misreporting prescription drug data has on descriptive and behavioral analyses. It does this by matching MEPS participants with Medicare Part D coverage during the period 2006–2007 to their Part D claims data. In the validation sample, the number of drug fills and total expenditures are reasonably accurate compared with claims. Household respondents tended to underreport the number of different drugs taken, but tended to overreport the number of fills of each drug. Behavioral analyses of the determinants of medication use and expenditures were largely unaffected because underreporting cut across most sociodemographic groups

Methods for Analyzing Referral Patterns

OBJECTIVE: To develop a sound method to identify patient and physician characteristics that influence specialty referrals. DESIGN: A retrospective cohort analysis of medical claims data from 1996 supplemented with surveys of primary care physicians. SETTING: A 600-member independent practice association in southeastern Michigan that provided care for 90,000 members of an HMO. PATIENTS: Five cohorts, each of 2,000 to 6,000 patients with diagnoses that could be referred to cardiologists, ophthalmologists, pulmonologists, orthopedists, or general surgeons. MAIN RESULTS: The referral rates for the different cohorts ranged from 1% to 7%. The discriminatory ability of the multivariate logistic models (c-statistic) ranged from 0.66 to 0.79. The likelihood of referral was associated with the patient's diagnoses and medications and with the referring physician's age, years out of medical school, satisfaction with the specialty being referred to, and the importance of making or confirming a diagnosis. CONCLUSIONS: Because these methods were not difficult to implement and the results were credible, we believe that other organizations should be able to use them