Thesis (M.H.P.A.)--Washington State University, May 2009. / Title from PDF title page (viewed on Apr. 26, 2010). "Department of Health Policy and Administration." Includes bibliographical references (p. 46-48).

Class of 2007 Abstract / Objectives: To investigate the relationship of price and prevalence of statins when new mediations enter the market and when old medications are withdrawn from the market. Methods: Patients that received a statin were enrolled in the Medicare Current Beneficiary Survey (MCBS) from 1992 to 2002. The overall prevalence of each statin as well as the prevalence of each statin for a patient’s drug coverage (no coverage, Medicaid, Medigap, employer coverage, or other public coverage) were analyzed. Results: The overall prevalence of statin was statistically significant for 1992 versus 2002 (p<0.001). When atorvastatin came to the market towards the end of 1996, there was no difference between simvastatin (p=0.24) and pravastatin (p=0.12) in 1997 versus 1998. Conclusions: There was a difference in the prevalence of statins when atorvastatin entered the market. When cerivastatin left the market, there was a difference in the prevalence of statin use. Atorvastatin became the most prevalent statin by the end of 2002. The price of statins appeared to decrease over time from $39.01 in 1992 to $31.95 in 2002. Also, the year atorvastatin was released the average price of statins increased to $36.57 in 1997.

This study evaluated the effect of community-based case management (CM) intervention on patient outcomes in Medicare beneficiaries with chronic illness in a rural Midwest region from 2002 to 2004. The relationships between 252 patients' access and clinical outcomes (the number of hospitalizations, length of stay (LOS), and emergency department (ED) visits) and CM were investigated. CM services were provided as four types: high home, high clinic, high telephone, and mixed-care services by nurse case managers. A descriptive, repeated-measurement design was used, and a secondary analysis of a data set containing longitudinal community-based CM data was conducted. The transitional care model and transition theory served as the theoretical background for the study. Descriptive statistics and frequency analysis, t-test, and a repeated-measure ANOVA analysis were used to analyze the data. Characteristic profiles of the patients were analyzed with their self-care Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores. The patients in this study were relatively healthy on their self-care functional status at the beginning of the study. The four types of CM services were compared with patient-reported clinical outcomes (the self-care ADL, IADL, symptom control, quality-of-life, and personal well-being scores) in each year. Analyses showed that patients' clinical outcomes were similar regardless of the type of CM services in each year. Two years of longitudinal CM intervention greatly affected patient's clinical outcomes and access outcomes. The study found that CM significantly reduced the number of hospital days and influenced patients' quality of life and symptom control. The impact of CM on LOS and ED visits was indeterminate. Further research is needed-including the effect of type and dosage of CM services and outcomes and the development of a comprehensive CM model-to guarantee CM as a core intervention in health care reconfiguration.

Thesis (Master of health policy and administration)--Washington State University, May 2010. / Title from PDF title page (viewed on July 6, 2010). "Department of Health Policy and Administration." Includes bibliographical references (p. 26-30).

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from PDF title page (viewed Sept. 21, 2009). Additional advisors: Richard M. Allman, Karlene K. Ball, Monika M. Safford, David E. Vance. Includes bibliographical references (p. 62-72).

The objectives of this study were to assess patient activation levels, to assess association between sociodemographic characteristics and patient activation, to assess association between health status characteristics and patient activation, and to assess association between patient activation and medication adherence among Medicare beneficiaries with type 2 diabetes. A retrospective cohort study was conducted using data from the 2009 through 2013 Medicare Current Beneficiary Survey (MCBS). Patient activation was measured with the Patient Activation Supplement in the MCBS and was categorized as low, moderate, and high levels based on activation scores. Medication adherence was assessed with proportion of days covered (PDC) using Medicare Part D administrative records from the MCBS within a period of six months after measurement of patient activation. The sample included Medicare beneficiaries who completed the MCBS Patient Activation questionnaire, who were diagnosed with type 2 diabetes, and who were 18 or older. Beneficiaries were excluded if they responded “Not ascertained,” “Not Applicable,” “Don’t know” or “Refused” to more than 50 percent of the Patient Activation questions, did not have continuous Medicare Part A and Part D coverage throughout the assessment period, had less than two Medicare Part D claims for an antidiabetic medication throughout the assessment period, used insulin during the assessment period, resided in long-term care facilities, or had Alzheimer’s disease, dementia, mental retardation or mental disorder. All analyses were conducted in SAS 9.4 for Unix environment. An <i>a priori</i> alpha level of 0.05 was used to determine significance. Bivariate and multivariable weighted ordinal logistic regression were applied for assessing associations. A total of 571 individuals met sample selection criteria. The mean age was 72.4 years. Of the 571 persons in the sample, 27.5 percent were at low activation level, 38.7 percent were at moderate activation level, and 33.7 percent were at high activation level. Approximately three-fourths of the sample persons were adherent to antidiabetic medications. Low activation was more likely to be found in males, less educated patients, and patients without arrhythmia. Ex-smokers as compared to non-smokers and overweight patients as compared to those with healthy weight were less likely to report low activation. In multivariable logistic analysis adjusting for race, gender, osteoporosis, Charlson Comorbidity Index score, and number of prescribed medications, patient activation level was not significantly associated with medication adherence. Non-Whites and patients with a Charlson Comorbidity Index score of 1 as compared to those with a score of 0 were more likely to be non-adherent. A lower number of prescribed medications was associated with higher odds of non-adherence.

Approximately 49 million Americans are 65 years and older, 80% of whom have ≥1 chronic condition, while nearly 70% of Medicare beneficiaries have ≥2 such conditions. Moreover, avoidance of medical care is frequently seen among older adults; a national survey reported that over 33% of participants avoided seeking care even when they suspected that they should go to the doctor. Healthcare avoidance, especially by older adults, can result in adverse health and economic outcomes including higher use of emergency department (ED), longer inpatient stays, and poorer health status, alongside emotional burden. Studies have shown that perceived satisfaction of care and the need to seek care as a result of presence of illness are associated with care seeking behaviors. Thus, this study aimed to examine the extent to which these enabling and need factors translate to care seeking behaviors among Medicare beneficiaries. This is a cross-sectional study that includes 13,441 Medicare beneficiaries who responded to the 2018 Medicare Current Beneficiary Survey (MCBS). MCBS provides information on the beneficiaries’ medical conditions including healthcare utilization, healthcare access, and satisfaction with care. Multivariate logistic regression analyses were conducted to test the association between satisfaction of available care by specialists; satisfaction with the quality of medical care received the year before; presence of chronic illness like cardiovascular diseases (CVD), diabetes, arthritis, lung disease (chronic obstructive pulmonary disease (COPD), asthma, etc.) and depression, with care seeking behavior among Medicare beneficiaries. Care seeking behavior, which is the outcome of interest, was defined using three measures: not doing anything to avoid going to the doctor, not keeping sickness to self, and going to the doctor as soon as one feels sick. Of the total respondents, only about 29% showed care seeking behavior. Being male, being Hispanic, and having more than high school education were significantly associated with higher care seeking behavior. Lower likelihood of care seeking behavior was seen among beneficiaries who were dissatisfied with ease getting to doctor from home [adjusted odd’s ratio (aOR)=0.635; p

No description available.

Musculoskeletal complaints are one of the most common reasons for visits to medical and chiropractic professionals in the United States, and spine-related symptoms in particular comprise the largest share of these complaints. Spine-related conditions increase as people age, having implications for rising disability and consequent spending by Medicare and Medicaid on increased health services use and long-term services and support. Chiropractic is one type of treatment used by older adults with these types of health problems. Covered by Medicare since 1972, chiropractic spinal manipulation is allowed for the express purpose to arrest the progression of functional decline or restore and possibly improve patient function. No studies, however, have examined whether chiropractic use by Medicare beneficiaries has indeed arrested functional decline, delayed disability, or restored health. The purpose of this dissertation research is to examine the comparative effectiveness of chiropractic use relative to no treatment and alternative medical care on the health and functional trajectories of community-dwelling older adults. I also examine the comparative effect of chiropractic on satisfaction with care. This is accomplished through the use of two longitudinal surveys with representative Medicare populations linked to Medicare provider claims. The first analysis examines the long-term comparative effect of chiropractic relative to no use and alternative care on functional decline, self-rated health decline, and the onset of additional depressive symptoms in a cohort of older Medicare beneficiaries, both with and without back conditions. The second study examines the effect of chiropractic compared to medical only episodes of care on health and functional decline in an older adult population with uncomplicated back conditions over a two-year period. The third and final study examines the comparative effect of chiropractic relative to medical care only on one-year changes in function, self-rated health, and satisfaction with care in a nationally representative age-eligible Medicare population with spine-related musculoskeletal conditions. Study results suggest that chiropractic has a consistently protective effect when compared to routine alternative medical care against decline in function among older adults with spine-related conditions, both over the long-term and the short-term. Chiropractic also has a comparative protective effect against decline in self-rated health in the short-term, but has no differential effect on the onset of depressive symptoms either in the short-term or long-term . Medicare beneficiaries using chiropractic for spine-related health conditions are relatively more satisfied than those using medical care only with the information provided to them about their condition, and with follow-up care provided after the initial visit. This research is the first of its kind to examine the comparative effectiveness of chiropractic relative to other usual sources of care for Medicare beneficiaries, in general and specifically among those with spine-related conditions, finding that chiropractic use has a comparatively beneficial effect on function, health, and satisfaction with care. The results have important policy implications for clinicians, patients, and Medicare because of the potential to shift clinical practice away from technologically intense and expensive treatments toward therapies like chiropractic spinal manipulation that demonstrate a comparative advantage in preserving health and function among older adults.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2006. / Title from first page of PDF document. Includes bibliographical references (p. 37-38).