Abstract:
BACKGROUND:To examine key factors influencing chronic kidney disease (CKD) patients' total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality. METHODS:Using the 2002-2011 Medical Expenditure Panel Survey (MEPS) data, our cross-sectional study analyzed 197 patient records-79 patients with one record and 59 with two entries per patient (138 unique patients). We used three patient groups, based on international statistical classification of diseases version 9 code for condition (ICD9CODX) classification, to focus inference from the analysis: (a) non-dialysis dependent CKD, (b) dialysis and (c) transplant. Covariate information included region, demographic, co-morbid conditions and types of services. We used descriptive methods and multivariate generalized linear models to understand the impact of cost drivers. We compared actual and predicted CKD cost of care data using a hold-out sample of nine, randomly selected patients to validate the models. RESULTS:Total costs were significantly affected by treatment type, with dialysis being significantly higher than non-dialysis and transplant groups. Costs were highest in the West region of the U.S. Average costs for patients with public insurance were significantly higher than patients with private insurance (p < .0743), and likewise, for patients with co-morbid conditions over those without co-morbid conditions (p < .001). CONCLUSIONS:Managing CKD patients both before and after the onset of dialysis treatment and managing co-morbid conditions in individuals with CKD are potential sources of substantial cost savings in the care of CKD patients. Comparing total costs pre and post the United States Affordable Care Act could provide invaluable insights into managing the cost-quality tradeoff in CKD care.
journal_name
BMC Health Serv Resjournal_title
BMC health services researchauthors
Damien P,Lanham HJ,Parthasarathy M,Shah NLdoi
10.1186/s12913-016-1922-4subject
Has Abstractpub_date
2016-12-28 00:00:00pages
690issue
1issn
1472-6963pii
10.1186/s12913-016-1922-4journal_volume
16pub_type
杂志文章abstract:BACKGROUND:Whether activity-based financing of hospitals creates incentives to treat more patients and to reduce the length of each hospital stay is an empirical question that needs investigation. This paper examines how the level of the activity-based component in the financing system of Norwegian hospitals influences...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-172
更新日期:2013-05-07 00:00:00
abstract:BACKGROUND:Tuberculosis (TB) remains a major global health problem. The emerging epidemic of multi- and extensively drug-resistant (M/XDR) TB further imperils health workers, patients and public health. Health facilities with inadequate infection control are risky environments for the emergence and transmission of TB. ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1608-y
更新日期:2016-08-08 00:00:00
abstract:BACKGROUND:Limited health literacy (HL) and numeracy have been shown to be associated with a wide array of poor health-related outcomes, knowledge, and behaviors. The purpose of this study was to evaluate the clinical utility of brief HL and numeracy screening items in identifying Spanish-speaking adults' HL and numera...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-015-1046-2
更新日期:2015-09-14 00:00:00
abstract:BACKGROUND:Human resources for rehabilitation are often a neglected component of health services strengthening and health workforce development. This may be partly related to weaknesses in the available research and evidence to inform advocacy and programmatic strategies. The objective of this study was to quantitative...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-11-276
更新日期:2011-10-17 00:00:00
abstract:BACKGROUND:The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitli...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究
doi:10.1186/s12913-018-3151-5
更新日期:2018-05-16 00:00:00
abstract:BACKGROUND:To evaluate the extent of the difference in elective (ELCS) and emergency (EMCS) caesarean section (CS) rates between nulliparous women in public maternity hospitals in Ireland by model of care, and to quantify the contribution of maternal, clinical, and hospital characteristics in explaining the difference ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1494-3
更新日期:2016-07-08 00:00:00
abstract:BACKGROUND:Health, fair financing and responsiveness to the user's needs and expectations are seen as the essential objectives of health systems. Efforts have been made to conceptualise and measure responsiveness as a basis for evaluating the non-health aspects of health systems performance. This study assesses the app...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-9-243
更新日期:2009-12-22 00:00:00
abstract:BACKGROUND:Across low-income settings, community volunteers and health committee members support the formal health system - both routinely and amid emergencies - by engaging in health services such as referrals and health education. During the 2014-2015 Ebola epidemic, emerging reports suggest that community engagement...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2414-x
更新日期:2017-07-18 00:00:00
abstract:BACKGROUND:The national 10-year Development Programme for the Prevention and Care of Diabetes (DEHKO) was launched in Finland in 2000. The program focused on improving early diagnosis of type 2 diabetes and preventing diabetes-related complications. The FinDM database was established for epidemiological monitoring of d...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-267
更新日期:2013-07-09 00:00:00
abstract::Following publication of the original article [1], the author reported that their first names and last names were swapped. The original article has been corrected. ...
journal_title:BMC health services research
pub_type: 杂志文章,已发布勘误
doi:10.1186/s12913-018-3597-5
更新日期:2018-10-11 00:00:00
abstract:BACKGROUND:Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systemat...
journal_title:BMC health services research
pub_type: 杂志文章,评审
doi:10.1186/1472-6963-9-115
更新日期:2009-07-10 00:00:00
abstract:BACKGROUND:The performance of activities of daily living (ADL) at home is important for the recovery of older individuals after hip fracture. However, 20-90% of these individuals lose ADL function and never fully recover. It is currently unknown to what extent occupational therapy (OT) with coaching based on cognitive ...
journal_title:BMC health services research
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12913-016-1934-0
更新日期:2017-01-03 00:00:00
abstract:OBJECTIVE:This online cross-sectional survey assesses the signs/symptoms, the protective measures taken and the awareness and risk perception regarding COVID-19 among Italian dental hygienists. All Italian dental hygienists were invited to participate. The ad hoc online questionnaire was divided into four domains: pers...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05842-x
更新日期:2020-10-31 00:00:00
abstract:BACKGROUND:"Willingness to recommend" questions are being increasingly used to measure and manage patient loyalty. Yet, there is little data in the literature correlating the "willingness to recommend" question with commonly used perceived service quality items in surveys to identify the key drivers of the optimal pati...
journal_title:BMC health services research
pub_type: 杂志文章,多中心研究
doi:10.1186/1472-6963-11-46
更新日期:2011-02-25 00:00:00
abstract:BACKGROUND:Clinicians informally assess changes in patients' status over time to prognosticate their outcomes. The incorporation of trends in patient status into regression models could improve their ability to predict outcomes. In this study, we used a unique approach to measure trends in patient hospital death risk a...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-11-171
更新日期:2011-07-21 00:00:00
abstract:BACKGROUND:Although the expenses of liver cirrhosis are covered by a critical illness fund under the current health insurance program in China, the economic burden associated with hepatitis B virus (HBV) related diseases is not well addressed. In order to provide evidence to address the economic disease burden of HBV, ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-13-37
更新日期:2013-01-31 00:00:00
abstract:BACKGROUND:Growing understanding of the influence of social determinants of health (SDH) on healthcare costs and outcomes for low income populations is leading State Medicaid agencies to consider incorporating SDH into their program design. This paper explores states' current approaches to SDH. METHODS:A mixed-methods...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-3977-5
更新日期:2019-03-14 00:00:00
abstract:BACKGROUND:While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. This study presents the variety of breast disease managed at a government, ope...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1959-4
更新日期:2017-01-21 00:00:00
abstract:BACKGROUND:While local context costing evidence is relevant for healthcare planning, budgeting and cost-effectiveness analysis, it continues to be scarce in Ethiopia. This study assesses the cost of providing a prevention of mother-to-child transmission of HIV/AIDS (PMTCT) service across heterogeneous prevalence (high,...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-019-3978-4
更新日期:2019-03-06 00:00:00
abstract:BACKGROUND:Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-14-229
更新日期:2014-05-21 00:00:00
abstract:BACKGROUND:The presence of certain underlying medical conditions is known to increase the risk of pneumococcal disease in persons of all ages and across a wide spectrum of conditions, as demonstrated in two recent evaluations. Corresponding estimates of attributable economic costs have not been well characterized. We t...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-016-1432-4
更新日期:2016-05-13 00:00:00
abstract:BACKGROUND:The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PRE...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05099-4
更新日期:2020-04-16 00:00:00
abstract:BACKGROUND:Against a background of rising numbers of frail older people, there is a need to improve quality and safety of services whilst containing costs. Improving patient outcomes requires change across hospital and community systems. Our objective was to change practice in order to deliver a Hospital at Home progra...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-017-2334-9
更新日期:2017-06-05 00:00:00
abstract:BACKGROUND:Return to work after gynaecological surgery takes much longer than expected, irrespective of the level of invasiveness. In order to empower patients in recovery and return to work, a multidisciplinary care program consisting of an e-health intervention and integrated care management including participatory w...
journal_title:BMC health services research
pub_type: 杂志文章,随机对照试验
doi:10.1186/1472-6963-12-29
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:Delay in cancer diagnosis may be important for cancer prognosis. Large individual variations in the duration of delay have been observed. This study examines whether patients' socioeconomic characteristics are predictors of long patient-, doctor- and system-related delay in cancer diagnosis. METHODS:Danish ...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-8-49
更新日期:2008-02-28 00:00:00
abstract:BACKGROUND:Job satisfaction is an important focal attitude towards work. Understanding factors that relate to job satisfaction allows interventions to be developed to enhance work performance. Most research on job satisfaction among nurses has been conducted in acute care settings in industrialized countries. Factors t...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-12-156
更新日期:2012-06-12 00:00:00
abstract:BACKGROUND:A Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients' race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. This study assessed implementation of the regulation and its impact on the use of ra...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-10-352
更新日期:2010-12-31 00:00:00
abstract:BACKGROUND:Public drug insurance plans provide limited reimbursement for Alzheimer's disease (AD) medications in many jurisdictions, including Canada and the United Kingdom. This study was conducted to assess Canadians' level of support for an increase in annual personal income taxes to fund a public program of unrestr...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/1472-6963-9-246
更新日期:2009-12-29 00:00:00
abstract:BACKGROUND:Bladder cancer (BC) has the highest lifetime treatment costs per patient of all cancers. The objective of this study was to characterize the use of health-care services and costs associated with BC among patients who underwent radical cystectomy (RC) in the province of Quebec. METHODS:We conducted a descrip...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-015-0972-3
更新日期:2015-08-05 00:00:00
abstract:BACKGROUND:In the past two decades, the number of maternity hospitals in Finland has been reduced from 42 to 22. Notwithstanding the benefits of centralization for larger units in terms of increased safety, the closures will inevitably impair geographical accessibility of services. METHODS:This study aimed to employ a...
journal_title:BMC health services research
pub_type: 杂志文章
doi:10.1186/s12913-020-05222-5
更新日期:2020-04-21 00:00:00