Background: Hospital care utilization has been described as a key measurable indicator of care quality in patients with terminal respiratory diseases. Knowledge about patterns in service utilization for patients with advanced Chronic Obstructive Pulmonary Disease (COPD), however, is fairly limited. The goal of this study was to investigate health care utilization patterns in the last six months of life among patients who died with COPD compared with those who died of lung cancer, and also to examine variations in health care among individuals living with COPD between sex, age, comorbidity, and temporal trends. Methods: We conducted a retrospective study using administrative health data in the province of Saskatchewan to identify indicators associated with greater hospital care utilization between 1997 and 2006. Those with either COPD or lung cancer as the underlying cause of death (UCOD) were included in this study. Characteristics examined in this study included socio-demographics, comorbidity, location of death, and use of institutional services. Multiple logistic regression was the primary method of analysis. Results: Between 1997 and 2006, 7,114 persons covered by Saskatchewan Health were identified as having COPD (N=2,332) or lung cancer as the UCOD (N=4,782). Approximately 60% were males with an average age of 74.2 years (S.D. =10.1 years). Half of the decedents were rural dwellers (47.0%), and were married or common law (51.6%). The majority had multiple comorbid conditions (60.3%), died in hospitals (73.5%), and had never received services from long-term supportive care institutions (74.3%). Compared with those who died from lung cancer, people dying from COPD were less likely to be admitted to hospitals (OR=0.71, 95%CI: 0.64-0.80 in the last six months of life; OR=0.81, 95%CI: 0.70- 0.93 in the last month of life) and had shorter LOS for each admission (OR=0.78, 95%CI: 0.70-0.87 in the six months of life; OR=0.67, 95%CI: 0.60-0.75 in the last month of life). However, persons with COPD were more likely to be managed in an intensive care settings (5.3% of COPD subjects vs. 1.7% of lung cancer subjects in the last six months of life; 4.3% of COPD subjects vs. 0.06% of lung cancer subjects in the last month of life) and had higher numbers of transfers between long-term care facilities (7.7% of COPD subjects vs. 3.2% of lung cancer subjects). Between 1997 and 2006, there was no significant change in the hospital utilization among patients who died of COPD or those who died of lung cancer. Conclusions: Marked differences in terms of hospital service utilization in the last six months of life were observed between subjects dying with COPD and lung cancer. Our study results support previous work indicating that the nature of care management at the end of life for people who died of advanced COPD is different from those who died from lung cancer, which was reflected by reduced likelihood of hospital service usage, more ICU admissions, and frequent transfers between supportive care facilities. There is no significant change observed regarding the patterns of hospitalization over 10-year study period. We would suggest collecting more information on services managed in other care settings, such as emergency departments, out-patient settings, and clinics, etc. This would allow an in-depth examination regarding what types of institutional services influenced the usage of in-patient care. In addition, education of all health care professionals on the complex needs of patients living with respiratory illnesses is required.

Thesis (M.H.S.A.)--University of Michigan, 1980.

Thesis (M.H.S.A.)--University of Michigan, 1980.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Previous studies have shown that Parkinson’s disease (PD) patients are at an increased risk for a variety of complications impacting health related quality of life (HRQoL). Additionally, these various complications often lead to increased healthcare utilization. Wellness intervention in PD has shown to be effective in improving HRQoL and objective measures of disease burden such as motor functioning. What has not been demonstrated to date is whether patients who are given the opportunity to participate in regularly administered classes in these modalities will continue to attend and whether benefits will continue to be realized outside the strict confines of a controlled trial. This study examined whether intervening early in PD with a comprehensive Wellness Program is feasible and promotes lasting habits that will continue to provide sustained benefit. It was hypothesized that intervening early in PD with an intensive program involving structured exercise, socialization and PD specific education would serve to maintain or improve subject’s quality of life while decreasing healthcare utilization. Twenty‐one consenting ambulatory adult subjects diagnosed with PD within the last five years completed various screenings at baseline and following a required 6‐month Wellness Program intervention. Subjects were assessed at 12 and 18 months if they continued to participate. Patient demographics, disease specific quality of life, objective mobility, healthcare utilization and falls were assessed. Data were collected at Banner Sun Health Research Institute, located in Sun City, Arizona. All p‐values were 2‐tailed and P<0.05 was considered statistically significant. All data analyses were conducted using STATA‐14. Twenty of twenty‐one subjects completed the required 6‐month intervention. Continued participation was 70% at 12 months and 60% at 18 months. Overall HRQoL was stable at 18 months. Significant improvement was seen in patient reported mobility and emotion sub‐areas at 12 months. Communication specific HRQoL was significantly worsened at 12 months. Subjects demonstrated a stable level of physical activity while fatigue was significantly decreased. All objective measures were significantly improved from baseline. Healthcare utilization was decreased by 18 months. A total of 5 falls were reported by 3 subjects during the 6‐month interventional period. This pilot study demonstrates that comprehensive wellness intervention in early PD is feasible, effective, safe and valuable in establishing long‐term beneficial habits while potentially reducing healthcare utilization. The significant long‐term subject participation observed in this study establishes that wellness intervention may be practical for large scale implementation. The results also highlight the importance of addressing communication specific symptoms early in the course of the disease. Ultimately, this study will aid the design and implementation of future PD wellness interventions.

Background: Diabetes is a common and serious chronic condition. If not well-managed, significant multi-system complications often arise, resulting in increased health care utilization and poor health outcomes. There is considerable evidence that people with diagnosed diabetes are not receiving recommended care. A comprehensive program aimed at improving adherence to recommended care can improve patient outcomes and result in cost-savings. The key aim of this study was to determine whether the long-term receipt of appropriate clinical procedures by patients with type 2 diabetes was associated with higher medical care costs. Methodology: A cohort of 20,288 diagnosed type 2 diabetes patients was identified using physician and hospital records. An analytic file was created by linking information on patient characteristics with utilization of physician and acute care services during a five-year period (1996 to 2001). Adherence to recommended clinical procedures for the assessment of blood glucose, blood pressure and cholesterol levels, as well as retinopathy and nephropathy, were measured during this same five-year period. Subjects were assigned to both a categorical (low, medium and high) and a binary (low and high) adherence group. Physician and acute care resource use was converted to constant 2000 Canadian dollars. Multivariate logistic regression was used to assess the relationship between patient characteristics, including adherence as a categorical variable, and utilization of physician and acute care services. Results: Long-term adherence was suboptimal, with patients receiving just 53% of recommended procedures. Adherence to recommended procedures, however, improved during the five year period. Patient characteristics associated with poor adherence include being male, younger, low socio-economic status, having no diabetes-specific complicating conditions and living in certain geographic areas. Patients with high long-term adherence (receiving 73% of recommended clinical procedures) were 59% more likely to use a high level of physician resources but 22% less likely to use a high level of acute care resources. On the other hand, patients with low adherence (receiving 31% of procedures) were 28% less likely to use a high level of physician resources but 17% more likely to use a high level of acute care resources. The utilization difference related to adherence was particularly noticeable in older adults with higher levels of morbidity. Elderly patients in this low adherence group were more likely to be hospitalized (64.3% vs. 55.8% over the five-year period) and, when they were hospitalized, tended to stay in hospital for longer periods of time (11.9 vs. 6.7 days) than patients in the high adherence group. Conclusion: Improving long-term adherence may result in the avoidance of $4 in acute care costs for every additional $1 in physician costs. If all patients moved into the high adherence category, as much as $3.1 million in annual costs might be avoided across the study sample. If this analysis is applied to all adults with diagnosed diabetes in the province of British Columbia, the annual costs avoided could reach the level of $34.4 million. Systemic changes are required in the provision of primary care to promote long-term adherence to recommended diabetes care.

Background: Diabetes is a common and serious chronic condition. If not well-managed, significant multi-system complications often arise, resulting in increased health care utilization and poor health outcomes. There is considerable evidence that people with diagnosed diabetes are not receiving recommended care. A comprehensive program aimed at improving adherence to recommended care can improve patient outcomes and result in cost-savings. The key aim of this study was to determine whether the long-term receipt of appropriate clinical procedures by patients with type 2 diabetes was associated with higher medical care costs. Methodology: A cohort of 20,288 diagnosed type 2 diabetes patients was identified using physician and hospital records. An analytic file was created by linking information on patient characteristics with utilization of physician and acute care services during a five-year period (1996 to 2001). Adherence to recommended clinical procedures for the assessment of blood glucose, blood pressure and cholesterol levels, as well as retinopathy and nephropathy, were measured during this same five-year period. Subjects were assigned to both a categorical (low, medium and high) and a binary (low and high) adherence group. Physician and acute care resource use was converted to constant 2000 Canadian dollars. Multivariate logistic regression was used to assess the relationship between patient characteristics, including adherence as a categorical variable, and utilization of physician and acute care services. Results: Long-term adherence was suboptimal, with patients receiving just 53% of recommended procedures. Adherence to recommended procedures, however, improved during the five year period. Patient characteristics associated with poor adherence include being male, younger, low socio-economic status, having no diabetes-specific complicating conditions and living in certain geographic areas. Patients with high long-term adherence (receiving 73% of recommended clinical procedures) were 59% more likely to use a high level of physician resources but 22% less likely to use a high level of acute care resources. On the other hand, patients with low adherence (receiving 31% of procedures) were 28% less likely to use a high level of physician resources but 17% more likely to use a high level of acute care resources. The utilization difference related to adherence was particularly noticeable in older adults with higher levels of morbidity. Elderly patients in this low adherence group were more likely to be hospitalized (64.3% vs. 55.8% over the five-year period) and, when they were hospitalized, tended to stay in hospital for longer periods of time (11.9 vs. 6.7 days) than patients in the high adherence group. Conclusion: Improving long-term adherence may result in the avoidance of $4 in acute care costs for every additional $1 in physician costs. If all patients moved into the high adherence category, as much as $3.1 million in annual costs might be avoided across the study sample. If this analysis is applied to all adults with diagnosed diabetes in the province of British Columbia, the annual costs avoided could reach the level of $34.4 million. Systemic changes are required in the provision of primary care to promote long-term adherence to recommended diabetes care.

A nursing concern for patients with chronic obstructive airway disease (COAD) is to assist the patient/family in improving adaptation strategies and self-care abilities. Identification of emotional and behavioral characteristics impacting on symptoms and life quality may predict individuals at risk for greater utilization of health care resources. The purpose of this descriptive study was to apply Traver's Prediction Formula for Emergent Use to a more general COAD population to determine if the formula would accurately predict those subjects who have high versus low emergent use of institutional health care resources. Fifty subjects with a range of COAD severity were studied. Subjects completed instruments which measured symptoms and life quality: the Bronchitis-Emphysema Symptom Checklist and the Sickness-Impact Profile. Findings demonstrated Traver's Formula predicted low emergent subjects with 76 percent accuracy, high emergent subjects with 53 percent accuracy and predicted the overall emergent status of subjects with 67 percent accuracy.

No description available.

No description available.

This thesis involves development, execution and analyzing of the first of a two-part longitudinal study for use in researching and evaluating the 1980 advertising campaign sponsored by the Indiana Dental Association.The data for this analysis was derived from responses to a 501-person random telephone survey in eight Indiana cities. The results were used to determine the accuracy of the advertising campaign target audience as well as provide a basis for advertisement recognition in the post-test.