Economic Impact of Digital Musculoskeletal Care Versus In-person Physical Therapy: A US Claims Analysis of Health Care Utilization and Outcomes.

To determine the incremental increases in health care utilization and expenditures associated with sleep disorders. Adults with a diagnosis of a sleep disorder (International Classification of Diseases, 10th Revision, code G47.x) within the medical conditions file of the 2018 Medical Expenditure Panel Survey medical conditions file were identified. This dataset was then linked to the consolidated expenditures file and comparisons in health care utilization and expenditures were made between those with and without sleep disorders. Multivariate analyses, adjusted for demographics and comorbidities, were conducted for these comparisons. Overall, 5.6% ± 0.2% of the study population had been diagnosed with a sleep disorder, representing approximately 13.6 ± 0.6 million adults in the United States. Those with sleep disorders were more likely to be non-Hispanic, White, and female, with a higher proportion with public insurance and higher Charlson Comorbidity Scores. Adults with sleep disorders were found to have increased utilization of office visits (16.3 ± 0.8 vs 8.7 ± 0.3, P < .001), emergency room visits (0.52 ± 0.03 vs 0.37 ± 0.02, P < .001), and prescriptions (39.7 ± 1.2 vs 21.9 ± 0.4, P < .001) vs those without sleep disorders. The additional incremental health care expenses for those with sleep disorders were increased in all examined measures: total health care expense ($6,975 ± $800, P < .001), total office-based expenditures ($1,694 ± $277, P < .001), total prescription expenditures ($2,574 ± $364, P < .001), and total self-expenditures for prescriptions ($195 ± $32, P < .001). Sleep disorders are associated with significantly higher rates of health care utilization and expenditures. By using the conservative prevalence estimate found in this study, the overall incremental health care costs of sleep disorders in the United States represents approximately $94.9 billion. Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-1986.

This is a six-year longitudinal study to determine if the treatment of alcoholism as a primary diagnosis results in a reduction of total health care cost and/or utilization for the alcoholic as well as other nonalcoholic family members. All health care costs and utilization were tracked for a group of 90 families, representing 245 individuals, enrolled with Blue Cross/Blue Shield through the Health Benefits Division, California Public Employees Retirement System. At least one member in each family received treatment under a specific diagnosis of alcoholism from July 1, 1974 to December 1, 1975. All health care utilization and costs were obtained for a 12-month period before initial treatment for alcoholism and up to July 1, 1979. In addition, a matched group of 83 comparison families with no alcoholic members and covering 291 persons was selected to reflect family composition, age, and sex. Total health care data were obtained over the same time period for these families. The results indicated that utilization and costs of all forms of inpatient care for both nonalcoholic family members as well as alcoholic family members dropped after alcoholism treatment began and ultimately reached a level similar to the matched comparison group. On the average, outpatient care also decreased in terms of frequency and costs for all members of the alcoholic's family; and in similar fashion converged in the fourth follow-up period to the matched comparison families. Total health care costs per family member decreased substantially over time following initiation of treatment of the alcoholic family member. The findings support the contention that the direct treatment of alcoholism can yield significant reductions in total health care costs and utilization not only for the alcoholic but his/her family members as well.

The association of weight loss with health care costs among older women is uncertain. Our study aim was to examine the association of objectively measured weight change with subsequent total health care (THC) costs and other health care utilization among older women. Our study population included 2,083 women (mean age 80.2 years) enrolled in the Study of Osteoporotic Fractures and U.S. Medicare Fee for Service. Weight loss and gain were defined, respectively, as ≥5% decrease and ≥5% increase in body weight, and weight maintenance as <5% change in body weight over a period of 4.5 years. THC costs, outpatient costs, hospitalizations, and skilled nursing facility [SNF] utilization were estimated from Medicare claims for 1 year after the period during which weight change was measured. The associations of weight change with THC and outpatient costs were estimated using generalized linear models with gamma variance and log link functions, and with hospitalizations and SNF utilization using logistic models. Adjusted for age and current body mass index (BMI), weight loss compared with weight maintenance was associated with a 35% increase in THC costs ($2148 [95% CI, 745 to 3552], 2014 U.S. dollars), a 15% increase in outpatient costs ($329 [95% C.I. −1 to 660]), and odds ratios of 1.42 (95% CI, 1.14 to 1.76) for ≥1 hospital stay and 1.45 (95% CI, 1.03 to 2.03) for ≥1 SNF stay. These associations did not vary by BMI category. After additional adjustment for multi-morbidity and functional status, associations of weight loss with all four outcomes were no longer significant. In conclusion, ≥5% weight loss among older women is not associated with increased THC and outpatient costs, hospitalization, and SNF utilization, irrespective of BMI category after accounting for multi-morbidity and impaired functional status that accompany weight loss.

Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population. To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD. Matched case-control secondary analysis of the 2000-2017 Medical Expenditure Panel Survey. Pediatric (age 0-21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively. Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy. There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63, P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831, P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558, P=0.00) and outpatient visits (coefficient=$1180, P=0.00). Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.

On the Critical List: The US Institution of Medicine

Background: No recent national estimates have examined overall trends in health care utilization in adults with diabetic kidney disease (DKD) or the association between DKD health care utilization and race/ethnicity. This study sought to fill this current gap in knowledge. Methods: Medical Expenditure Panel Survey data (2000-2020) for adults with DKD was used for this analysis. The dependent variable was total health care utilization for the calendar year for each individual including office-based medical provider, hospital outpatient, emergency room, inpatient hospital, pharmacy, dental, and home health care visits. The primary independent variable was race/ethnicity. Mean health care utilization by DKD status was estimated and negative binominal regression was used to estimate Incident Rate Ratios (IRR) for health care utilization while adjusting for demographics, comorbidities, and time. Stata version 17 was used with a significant p-value set at &amp;lt;0.05. Results: After full adjustments, African American (IRR 1.20 95% CI 1.09 - 1.31) and Hispanic (IRR 1.15 95% CI 1.04 - 1.28) adults with DKD had significantly higher rates of total health care utilization compared with Whites. In addition, African American adults with DKD had significantly higher rates of office visits (IRR 1.10 95% CI 1.01 - 1.20) and outpatient visits (IRR 1.41 95% CI 1.14 - 1.75) compared with Whites and lower rates of dental care visits (IRR 0.74 95% CI 0.61 - 0.89) and prescription utilization (IRR 0.83 95% CI 0.78 - 0.88) compared with Whites with DKD. Further, over time adults with DKD had higher mean total health care visits (17.0 - 23.6) compared with 8.8-10.4 visits in adults without DKD. Conclusions: Our findings show that compared with individuals without DKD, individuals with DKD had significantly higher health care utilization from 2000 to 2020 and racial differences in health care utilization exists and persists over this period. Disclosure M.N.Ozieh: None. A.Z.Dawson: None. J.S.Williams: None. L.E.Egede: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R21DK131356 to M.N.O.), (R01DK118038, R01DK120861 to L.E.E.); National Institute on Minority Health and Health Disparities (K23MD016448 to M.N.O), (R01MD013826 to L.E.E.)

Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare. To determine whether HA use is associated with health care costs and utilization in older adults. This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated. Encounter with the US health care system. (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits. Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, -$81 to -$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, -2% to -2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, -3% to -1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, -0.47 to -0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0). This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.

Digital health interventions such as smartphone applications (mHealth) or Internet resources (eHealth) are increasingly used to improve the management of chronic conditions, such as type 2 diabetes mellitus. These digital health interventions can augment or replace traditional health services and may be paid for using healthcare budgets. While the impact of digital health interventions for the management of type 2 diabetes on health outcomes has been reviewed extensively, less attention has been paid to their economic impact. This study aims to critically review existing literature on the impact of digital health interventions for the management of type 2 diabetes on health and social care utilisation and costs. Studies that assessed the impact on health and social care utilisation of digital health interventions for type 2 diabetes were included in the study. We restricted the digital health interventions to information provision, self-management and behaviour management. Four databases were searched (MEDLINE, EMBASE, PsycINFO and EconLit) for articles published between January 2010 and March 2021. The studies were analysed using a narrative synthesis approach. The risk of bias and reporting quality were appraised using the ROBINS-I checklist. The review included 22 studies. Overall, studies reported mixed evidence on the impact of digital health interventions on health and social care utilisation and costs, and suggested this impact differs according to the healthcare utilisation component. For example, digital health intervention use was associated with lower medication use and fewer outpatient appointments, whereas evidence on general practitioner visits and inpatient admissions was mixed. Most reviewed studies focus on a single component of healthcare utilisation. The review shows no clear evidence of an impact of digital health interventions on health and social care utilisation or costs. Further work is needed to assess the impact of digital health interventions across a broader range of care utilisation components and settings, including social and mental healthcare services. The study protocol was registered on PROSPERO before searches began in April 2021 (registration number: CRD42020172621).

Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018-2022). We used difference-in-differences methodology adjusting for patients' characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1000 persons), and number of inpatient admissions (by -32.4 per 1000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days' drug supply (by 0.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.

Association Between Acute and Routine Health Care Utilization and Disease-Related School Absences for Children with Sickle Cell Disease

BACKGROUND AND METHODS: The treatment of substance abuse is an important health service available in all industrialized countries throughout the world. Cost of treatment and its benefit or economic value is an important policy issue. Reduction in health care cost is one alternative way to measure benefits. This paper reviews a series of studies (all from the US) which address the cost-benefit question. Most studies have compared the monthly costs prior to initiation of substance abuse treatment with the costs following initiation. RESULTS FROM STUDIES OF ALCOHOLISM TREATMENT: Many studies have found that, over the time prior to alcoholism treatment initiation, total monthly health care costs increased and costs substantially increased during the 6-12 months prior to treatment. Following treatment initiation, monthly total medical care costs declined and the overall trend was downward, i.e., the slope was negative. In contrast to the use of general health care where women typically utilize more medical care than men, overall medical care costs were found to be similar. Alcoholics of different ages, however, showed distinct medical care costs, i.e., younger patients experienced greater declines in medical care costs following alcoholism treatment initiation. Inpatient treatment is most affected by alcoholism treatment. In some cases, outpatient treatment is actually increased in response to aftercare health care utilization, but at a substantially lower cost than inpatient treatment. If the alcoholism condition can be treated on an outpatient basis, then the total cost of such treatment is obviously lower and the potential for a cost-offset net effect is substantially increased. COST BENEFITS OF DRUG ABUSE TREATMENT: There have been few drug abuse treatment cost-benefit research studies. Early studies found that there was a decline in sickness and medical care utilization associated with initiation of treatment. A recent study found a substantial reduction in total health care costs following initiation of drug abuse treatment. Utilization of inpatient care and its associated costs are most affected by the absence and/or presence of treatment. SUMMARY AND CONCLUSION: This review describes the research findings from a number of cost-offset or cost-benefit studies of alcoholism and drug abuse treatment. In broad terms the findings of this research can be summarized as follows. (i) Untreated alcoholics or drug dependent persons use health care and incur costs at a rate about twice that of their age and gender cohorts. (ii) Once treatment begins, total health care utilization and costs begin to drop, reaching a level that is lower than pre-treatment initiation costs after a two- to four-year period. The conclusion is based on similar findings across different patient populations using a variety of research designs. (iii) There are no apparent gender differences in the utilization and associated costs before and after treatment initiation. (iv) There are age differences that support the value of early intervention. Younger treated substance abuse patients have pre-treatment total cost levels that are lower than pre-treatment levels for older patients. IMPLICATIONS OF HEALTH POLICY: The results of research provide consistent support for the cost benefits of substance abuse treatment. From a health policy perspective, such results are promising if the objective is to demonstrate that treatment investment can pay for all or part of its associated costs through reductions in other health care costs. One can hold a contrary position, i.e., lower future medical care costs for substance abusers could reflect denial of essential care. IMPLICATIONS FOR FURTHER RESEARCH: The studies that have addressed the potential cost offset of substance abuse treatment have been largely based upon overall or aggregate effects across all forms of substance abuse treatment. There have been no studies of the cost offset of specific treatment modalities, though this is what the next generation of studies should do

BACKGROUND: Gout is a common cause of inflammatory arthritis in the United States, and its prevalence has increased in recent decades, especially among older adults. Older adults with gout are of particular interest because they tend to experience higher rates of tophi, an advanced stage of gout, than do younger patients. OBJECTIVE: For older adults with gout to (1) assess health care utilization and costs from a third-party payer perspective; (2) evaluate health care costs related to tophi; and (3) explore the relationship between elevated serum uric acid (UA) level, an indicator of disease control, and health care utilization.

Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population

People are the Army's greatest strength and most valuable asset. The Holistic Health and Fitness (H2F) performance team was designed to optimize Soldiers' individual performance potential and well-being by becoming stronger, faster, and more ready in the physical and nonphysical domains of health and wellness. The H2F team is a human performance readiness platform composed of a team of professionals to include: strength and conditioning specialists, dietitian, nutrition care technician, occupational therapist, certified occupational therapist assistant, cognitive performance specialist, certified athletic trainers (ATs), physical therapists, and physical therapy technician. In the military health care system, where resources are limited, it is important to consider the H2F musculoskeletal (MSK) team as an integral part of the military health care system. For the 12-months analyzed, we tracked AT, physical therapy, and occupational therapy initial encounters, follow-ups, and rehabilitative treatment encounters. A retrospective analysis of ankle injuries, postoperative patients, and concussions was completed. During the 12-month period, a total of 946 initial AT, physical therapy, and occupational therapy evaluations were completed. Including follow-ups and rehabilitative treatments, a total of 4862 MSK medical encounters were completed during this time. The subanalysis comparing primary care manager-based care to H2F physical therapy and AT group for ankle injuries demonstrated a reduction in imaging, days on profile, and reduction in referral to specialty care. The subanalysis of postoperative MSK care within the H2F footprint demonstrates not only a 93% return to duty rate but minimizing lost duty time due to appointment location. For all 6 acute concussions identified, they were successful in Progressive Return to Activity, with an average of 4 occupational therapy visits and return to duty within 3 weeks of injury. Utilization of the H2F MSK care platform is essential to providing timely and efficient MSK care to return Soldiers to duty. To optimize Soldiers lethality and maintain a high level of readiness during the challenges of multi-domain operations, the Army developed the H2F team. This description of MSK care within an H2F team describes the importance of utilizing the H2F MSK care team within the military health care system to reduce cost, health care utilization, and minimize duty time lost to MSK injuries.

BackgroundGiven the complexity of the Systemic Sclerosis (SSc), patients usually require multidisciplinary treatment involving, apart from the rheumatologist, other medical specialists and non-medical health professionals such as physical therapists, occupational...