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  • 1
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    Online Resource
    Dementia Diagnosis Disparities by Race and Ethnicity
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Medical Care Vol. 59, No. 8 ( 2021-08), p. 679-686
    Details
    In: Medical Care, Ovid Technologies (Wolters Kluwer Health), Vol. 59, No. 8 ( 2021-08), p. 679-686
    Abstract: Dementia is often underdiagnosed and this problem is more common among some ethnoracial groups. Objective: The objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia. Research Design: This was a prospective cohort study. Subjects: A total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims. Measures: We performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity. Results: A higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P 〈 0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91–1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20–2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites. Conclusions: Non-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.
    Type of Medium: Online Resource
    ISSN: 0025-7079
    URL: Article
    DOI: 10.1097/MLR.0000000000001577
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2045939-7
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  • 2
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    Racial and Ethnic Differences in Hospice Use and End‐of‐life Hospitalizations among Medicare Beneficiaries with Dementia
    Wiley ; 2022
    In:  Alzheimer's & Dementia Vol. 18, No. S11 ( 2022-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 18, No. S11 ( 2022-12)
    Abstract: The pool of studies examining ethnoracial differences in hospice use and end‐of‐life hospitalizations among patients with dementia is limited and results are conflicting. This study examined how dementia end‐of‐life care utilization and patient treatment preferences differ by race and ethnicity. Methods Using U.S. national survey data from the Health and Retirement Study linked with Medicare and Medicaid claims, our sample included 5,058 beneficiaries aged ≥65 years diagnosed with dementia who died in 2000‐2016. We examined the frequency and costs of hospice care, emergency department (ED) visits, and hospitalizations during the last 180 days of life among Medicare decedents with dementia. We analyzed the proportion of dementia decedents with advance care planning and their end‐of‐life care preferences. Results Less than half of beneficiaries with dementia in our sample (48%) used hospice in the last 180 days of life; of these, one in three hospice users received the service for seven days or less. In adjusted analysis, non‐Hispanic (NH) Blacks, nursing home residents, and survey respondents represented by a proxy were less likely to use hospice, whereas older age, females, higher education, more severe cognitive impairment, and more IADL limitations were associated with higher hospice enrollment. Among dementia decedents, NH Blacks and Hispanics used more ED and inpatient services and incurred 〉 50% higher inpatient expenditures at the end of life, compared with NH whites. More NH Black and Hispanic beneficiaries with dementia enrolled in hospice were subsequently admitted to the ED or hospital before death. The proportion of dementia beneficiaries completing advance care planning was significantly lower among NH Blacks and Hispanics compared with NH whites (21% and 21% vs. 57%, p 〈 0.01). More NH Black and Hispanic decedents with dementia had written instructions choosing all care possible to prolong life, whereas more NH whites preferred to limit care in certain situations, withhold treatments, and forgo extensive life‐prolonging measures. Conclusion Our results highlighted substantial unmet end‐of‐life care needs among older adults with dementia, especially among NH Blacks and Hispanics. Medicare should consider alternative payment models to promote culturally competent end‐of‐life care and reduce low‐value interventions and costs among the population with dementia.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v18.S11
    DOI: 10.1002/alz.062289
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2201940-6
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  • 3
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    Dementia diagnosis disparities by race and ethnicity : Health services research: Cost of care and implications for intervention
    Wiley ; 2020
    In:  Alzheimer's & Dementia Vol. 16, No. S10 ( 2020-12)
    Details
    In: Alzheimer's & Dementia, Wiley, Vol. 16, No. S10 ( 2020-12)
    Abstract: Dementia is often underdiagnosed, and self‐reported data suggest that this problem may be more common among racial and ethnic minority groups. This study examined racial and ethnic disparities in the timeliness in which individuals receive a formal dementia diagnosis. Method This analysis used eight waves of US national surveys from 2000‐2014 Health and Retirement Study, linked with Medicare and Medicaid claims. We identified study participants age ≥70 with dementia using a well‐validated statistical model based on individual’s age, gender, education, cognition, and functional limitations. We assessed the proportion of patients not receiving a coded diagnosis of dementia in their claims by the time the prediction model classified them as having dementia. We used logistic regression models to compare the likelihood of missed or delayed dementia diagnoses in claims by race and ethnicity, adjusting for patient characteristics. We analyzed dementia severity, measured by cognition (TICS scores for self‐respondents; IQCODE scores for proxy‐respondents) and functional limitations, at the time of a dementia diagnosis documented in claims, by race/ethnicity. All analyses adjusted for sampling weights. Result Our sample included 3,966 older adults with dementia. Forty‐two percent had a missed or delayed dementia diagnosis in their claims. This proportion was higher among non‐Hispanic blacks and Hispanics than among non‐Hispanic whites (46% and 54% vs. 41%, p 〈 0.001). Logistic regression model indicated more frequent missed/delayed dementia diagnoses among non‐Hispanic blacks (OR=1.27; 95% CI: 1.05‐1.53) and Hispanics (OR=1.83; 95% CI: 1.43‐2.35), compared to non‐Hispanic whites. Over the study period, 76% had a dementia diagnosis documented in their claims. At the time of diagnosis, non‐Hispanic blacks and Hispanics had poorer cognitive function and more functional impairments, compared to non‐Hispanic whites. Conclusion Non‐Hispanic blacks and Hispanics may experience missed or delayed diagnoses of dementia more often than non‐Hispanic whites. When they are diagnosed, non‐Hispanic blacks and Hispanics may have more advanced dementia compared to non‐Hispanic whites. Public health efforts such as the Brain Health Initiative should tailor campaigns to different ethnoracial groups when promoting early diagnosis of dementia. The medical community should implement provider training on culturally competent dementia care and improve documentation of dementia diagnostic findings in health insurance claims.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    URL: Article
    DOI: 10.1002/alz.v16.S10
    DOI: 10.1002/alz.043183
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2201940-6
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  • 4
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    The peculiar economics of life-extending therapies: a review of costing methods in health economic evaluations in oncology
    Informa UK Limited ; 2015
    In:  Expert Review of Pharmacoeconomics & Outcomes Research Vol. 15, No. 6 ( 2015-11-02), p. 931-940
    Details
    In: Expert Review of Pharmacoeconomics & Outcomes Research, Informa UK Limited, Vol. 15, No. 6 ( 2015-11-02), p. 931-940
    Type of Medium: Online Resource
    ISSN: 1473-7167 , 1744-8379
    URL: Article
    DOI: 10.1586/14737167.2015.1102633
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2015
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  • 5
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    Assessment of the Influence of Test Characteristics on the Clinical and Cost Impacts of Methicillin-Resistant Staphylococcus aureus Screening Programs in US Hospitals
    Cambridge University Press (CUP) ; 2011
    In:  Infection Control & Hospital Epidemiology Vol. 32, No. 3 ( 2011-03), p. 250-257
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 32, No. 3 ( 2011-03), p. 250-257
    Abstract: To compare the impacts of different methicillin-resistant Staphylococcus aureus (MRSA) screening test options (eg, polymerase chain reaction [PCR], rapid culture) and program characteristics on the clinical outcomes and budget of a typical US hospital. Methods. We developed an Excel-based decision-analytic model, using published literature to calculate and compare hospital costs and MRSA infection rates for PCR- or culture-based MRSA screening and then used multivariate sensitivity analysis to evaluate key variables. Same-day PCR testing for a representative 370-bed teaching hospital in the United States was assessed in different populations (high-risk patients, intensive care unit [ICU] patients, or all patients) and compared with other test options. Results. Different screening program populations (all patients, high-risk patients, ICU patients, or patients with previous MRSA colonization or infection only) represented a potential savings of $12,158-$76,624 per month over no program ($188,618). Analysis of multiple test options in high-risk population screening indicated that same-day PCR testing of high-risk patients resulted in fewer infections over 1,720 patient-days (2.9, compared with 3.5 for culture on selective media and 3.8 for culture on nonselective media) and the lowest total cost ($112,012). The costs of other testing approaches ranged from $113,742 to $123,065. Sensitivity analysis revealed that variations in transmission rate, conversion to infection, prevalence increases, and hospital size are important to determine program impact. Among test characteristics, turnaround time is highly influential. Conclusion. All screening options showed reductions in infection rates and cost impact improvement over no screening program. Among the options, same-day PCR testing for high-risk patients slightly edges out the others in terms of fewest infections and greatest potential cost savings.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/658332
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2011
    detail.hit.zdb_id: 2106319-9
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  • 6
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    Online Resource
    3385 TARGETING DIABETES PREVENTION PROGRAMS: INDIVIDUAL RISK-BASED HEALTH ECONOMIC ANALYSIS
    Cambridge University Press (CUP) ; 2019
    In:  Journal of Clinical and Translational Science Vol. 3, No. s1 ( 2019-03), p. 155-156
    Details
    In: Journal of Clinical and Translational Science, Cambridge University Press (CUP), Vol. 3, No. s1 ( 2019-03), p. 155-156
    Abstract: OBJECTIVES/SPECIFIC AIMS: Objective: Approximately 86 million people in the US have prediabetes, but only a fraction of them receive proven effective therapies to prevent diabetes. Further, the effectiveness of these therapies varies with individual risk of progression to diabetes. We estimated the value of targeting those individuals at highest diabetes risk for treatment, compared to treating all individuals meeting inclusion criteria for the Diabetes Prevention Program (DPP). METHODS/STUDY POPULATION: METHODS: Using a micro-simulation model, we estimated total lifetime costs and quality-adjusted life expectancy (QALE) for individuals receiving: (1) lifestyle intervention involving an intensive program focused on healthy diet and exercise, (2) metformin administration, or (3) no intervention. The model combines several components. First a Cox proportional hazards model predicted onset of diabetes from baseline characteristics for each pre-diabetic individual and yielded a probability distribution for each alternative. We derived this risk model from the Diabetes Prevention Program (DPP) clinical trial data and the follow-up study DPP-OS. The Michigan Diabetes Research Center Model for Diabetes then estimated costs and outcomes for individuals after diabetes diagnosis using standard of care diabetes treatment. Based on individual costs and QALE, we evaluated NMB of the two interventions at population and individual levels, stratified by risk quintiles for diabetes onset at 3 years. RESULTS/ANTICIPATED RESULTS: Results: Compared to usual care, lifestyle modification conferred positive benefits for all eligible individuals. Metformin’s NMB was negative for the lowest population risk quintile. By avoiding use among individuals who would not benefit, targeted administration of metformin conferred a benefit of $500-$800 per person, depending on duration of treatment effect. When treating only 20% of the population (e.g., due to capacity constraints), targeting conferred a NMB of $14,000-$18,000 per person for lifestyle modification and $16,000-$20,000 for metformin. DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusions: Metformin confers value only among higher risk individuals, so targeting its use is worthwhile. While lifestyle modification confers value for all eligible individuals, prioritizing the intervention to high risk patients when capacity is constrained substantially increases societal benefits.
    Type of Medium: Online Resource
    ISSN: 2059-8661
    URL: Article
    DOI: 10.1017/cts.2019.356
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2898186-8
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  • 7
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    The Impact of Clinical Factors Observed during the Index Heart Failure Hospitalization on Costs Over 2 Years
    Elsevier BV ; 2017
    In:  Journal of Cardiac Failure Vol. 23, No. 8 ( 2017-08), p. S117-
    Details
    In: Journal of Cardiac Failure, Elsevier BV, Vol. 23, No. 8 ( 2017-08), p. S117-
    Type of Medium: Online Resource
    ISSN: 1071-9164
    URL: Article
    DOI: 10.1016/j.cardfail.2017.07.343
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
    detail.hit.zdb_id: 2048826-9
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  • 8
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    A Role for Research
    Elsevier BV ; 2013
    In:  American Journal of Preventive Medicine Vol. 44, No. 1 ( 2013-01), p. S12-S15
    Details
    In: American Journal of Preventive Medicine, Elsevier BV, Vol. 44, No. 1 ( 2013-01), p. S12-S15
    Type of Medium: Online Resource
    ISSN: 0749-3797
    URL: Article
    DOI: 10.1016/j.amepre.2012.09.016
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2013
    detail.hit.zdb_id: 2020236-2
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  • 9
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    The Economic Burden of Treatment-Resistant Depression
    Elsevier BV ; 2013
    In:  Clinical Therapeutics Vol. 35, No. 4 ( 2013-04), p. 512-522
    Details
    In: Clinical Therapeutics, Elsevier BV, Vol. 35, No. 4 ( 2013-04), p. 512-522
    Type of Medium: Online Resource
    ISSN: 0149-2918
    URL: Article
    DOI: 10.1016/j.clinthera.2012.09.001
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2013
    detail.hit.zdb_id: 2025417-9
    SSG: 15,3
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  • 10
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    The Impact of Broader Value Elements on Cost-Effectiveness Analysis: Two Case Studies
    Elsevier BV ; 2022
    In:  Value in Health Vol. 25, No. 8 ( 2022-08), p. 1336-1343
    Details
    In: Value in Health, Elsevier BV, Vol. 25, No. 8 ( 2022-08), p. 1336-1343
    Type of Medium: Online Resource
    ISSN: 1098-3015
    URL: Article
    DOI: 10.1016/j.jval.2022.01.025
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2011039-X
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