Lower Health Care Expenditures Research Articles

GAN-Augmented Naïve Bayes for identifying high-risk coronary artery disease patients using CT angiography data

Coronary artery disease (CAD) is one of the most common cardiovascular disorders affecting millions of individuals globally. It is the leading cause of mortality in both the wealthy and impoverished nations. CAD patients exhibit a wide range of symptoms, some of which are not evident until a major incident occurs. The development of techniques for early detection and precise diagnosis is heavily dependent on research. The proposed system introduces a novel approach, Generative Adversarial Networks Augmented Naïve Bayes (GAN-ANB), to classify high-risk CAD patients using Coronary Computed Tomography Angiography (CCTA) imaging data. The database included images from Coronary Computed Tomography Angiography (CCTA) records of 5,000 individuals. The developed GAN framework consists of a generator to generate synthetic patient profiles, and a discriminator to distinguish between genuine and synthetic profiles to improve the identification of high-risk CAD patients. Adding synthetic data to the training process allowed the discriminator to be utilized further to improve predictive modeling. The performance of the GAN-enhanced prediction model was assessed using accuracy, sensitivity, specificity, and area under the Receiver Operating Characteristic curve (ROC). The model exhibited an outstanding Dice Similarity Coefficient (0.91), Mean Intersection Over Union (0.90), recall (0.96), and precision (0.98) in differentiating between high-risk and low-risk individuals. The identification of high-risk patients with CAD is greatly enhanced by the integration of GANs with clinical and imaging data. ROC of 0.99 was achieved by the GAN-ANB model, which outperformed conventional machine learning models, was achieved using the GAN-ANB model. High cholesterol level, diabetes, and some CCTA-derived imaging characteristics, including plaque load and luminal stenosis, were among the major predictors. This method offers a powerful tool for early diagnosis and intervention, potentially leading to improved patient outcomes and lower healthcare expenditure.

Healthcare expenditures among older immigrants in the US with Alzheimer's disease and related dementias: Population-based study between 2007 and 2020.

Using nationally representative datasets, this study examined differences in healthcare expenditures between US-born and foreign-born individuals aged 65 and above by the presence of Alzheimer's disease and related dementias (ADRD) and cognitive limitations (CL). This study further examined whether healthcare expenditures among foreign-born individuals vary by their duration of residence in the US. The study used the 2007-2020 Medical Expenditure Panel Survey (MEPS) and employed generalized linear regression models to estimate differences in healthcare expenditures between US-born and foreign-born older adults with ADRD, CL, and without ADRD or CL. Survey weights were applied to all estimates. Our study identified significant differences in healthcare expenditures among older adults by the presence of ADRD/CL and immigrant status. Having ADRD/CL had a more pronounced impact on high healthcare expenditures among foreign-born older adults than US-born adults with ADRD/CL, thereby diminishing the difference in healthcare expenditures by US nativity status for the older adults with ADRD or CL. In the analysis further distinguishing immigrants by their duration of residence, lower healthcare expenditures were primarily observed among foreign-born individuals with ADRD or CL who had lived in the US for less than ten years. Our results suggest potential shifts in costs resulting from delayed access to, and diagnosis or treatment of ADRD at a younger age, leading to increased healthcare needs and expenses among US foreign-born older adults.

The Role of Vaccination in Preventing Infectious Diseases

Vaccination has played a critical role in preventing infectious diseases, resulting in the global eradication of terrible diseases such as smallpox and the near abolition of polio. This study investigates the historical evolution of vaccination, the processes by which vaccines stimulate the immune system, and the various vaccine types now in use. Furthermore, the advantages of vaccination, such as herd immunity and lower healthcare expenditures, are explored. Despite these advantages, vaccination programs confront several problems, including disinformation, vaccine reluctance, and new diseases. The study continues by underlining the importance of ongoing worldwide efforts in vaccine development and administration to prevent the comeback of vaccine-preventable diseases and address emerging infectious risks. Keywords: Vaccination, Immunization, Infectious diseases, Herd immunity, Vaccine-preventable diseases.

Effects of Clinical Pharmacist Intervention in a Saudi ICU: A Prospective, Cross-Sectional Study

Given their contributions to better patient outcomes, medication safety, and lower drug cost, critical care pharmacists are especially prepared to play a major role within the critical care interdisciplinary team in managing the therapeutic element. Consequently, this research set out to evaluate the ICU clinical pharmacist interventions' frequency, kind, and effect, as well as the acceptability of these interventions by the doctors who provide them. The research was prospective and cross-sectional in nature. Over the course of six months, from April 1, 2023, to October 1, 2023, data was collected daily from a minimum of 380 interventions. This research covered all patients hospitalized to the intensive care unit at Saudi Arabia throughout the specified time frame. Over the duration of the 6-month trial, 120 patients had a total of 500 interventions. Of these, 490 (98%) had physician approval for clinical pharmacist treatments. The majority of the recommendations (34.8%, or 174 out of 500) were related to safety concerns; among these, 48.27%, or 48 out of 174, were for medication cessation owing to extended duration, while 30.46%, or 53 out of 174, were for renal dosage modification. Coming up as a close second, another therapeutic intervention involving indication made up 22.8% (114/500). A total of 124 interventions, or 24.8 percent of the total, had some kind of cost-related component, according to the study's findings on cost-saving treatments. The results of this research showed that clinical pharmacists have the potential to improve quality treatment for critically ill patients and lower healthcare expenditures. Furthermore, it provides helpful information on the incorporation of clinical pharmacists in intensive care units, particularly in areas with limited resources.

Relationship between continuity of primary care and hospitalisation for patients with COPD: population-based cohort study from South Korea

ObjectivesThe existing evidence for the impacts of continuity of care (COC) in patients with chronic obstructive pulmonary disease (COPD) is low to moderate. This study aimed to investigate the associations...

Racial and Ethnic Disparity in Healthcare Expenditure and Resource Utilization Among Patients with Cardiovascular Diseases.

Despite extensive research, significant gaps remain in understanding racial disparity among individuals with cardiovascular diseases (CVD). These disparities, influenced by factors such as access to care and comorbid conditions, necessitate further investigation to develop targeted interventions. To evaluate the factors contributing to racial and ethnic disparities in healthcare resource utilization and total healthcare expenditure among individuals with CVD. Using data from the Medical Expenditure Panel Survey spanning 2014-2021, total healthcare expenditure and having a CVD visit were compared among Hispanic, Black, and White adults with CVD. Descriptive analysis, linear regression, and logistic regression models were used to compare the results. Multivariable models were used to evaluate the effect of demographic and socioeconomic factors on total healthcare expenditure and the likelihood of having a CVD visit among different races. With a weighted sample of 17,722,706, the study found that Hispanic and Black cohorts had 23% and 11% lower healthcare expenditures (both p < 0.001). Hispanic and Black cohorts also had lower odds of having a CVD visit (odds ratio [OR] = 0.61, 95% confidence interval [CI]:0.55-0.68; OR = 0.58, 95% CI: 0.52-0.65, respectively) compared to the White cohort. Key predictors included physical and cognitive limitations, insurance status, income, region, and the year of data collection. This study highlights the need for targeted interventions to address healthcare disparities and promote health equity among minority populations with CVD.

Pharmacist intervention to improve adherence to medication among heart failure patients at North East Ethiopia hospital.

Heart failure (HF) is a major and growing medical problem and its management is still challenging due to the coexistence of complications, co-morbidity, and medication non-adherence. HF patients who are adherent to their medication have fewer HF exacerbations, improved survival, and lower healthcare expenditure. Adherence to HF medication plays a pivotal role in attaining maximal therapeutic outcomes. The aim was to assess the medication adherence of heart failure patients at Debre Berhan Comprehensive Specialized Hospital (DBCSH). A pre-post interventional study was undertaken from July 1, 2022, to December 31, 2022, at the medical referral clinic of DBCSH. The educational interventions were provided for 6 months. Medication adherence was determined using the Morisky Green Levin Medication Adherence Scale (MGLS). The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics and binary logistic regression analysis were performed. The strength of the association between predictor variables and outcome variables was determined using a 95% confidence interval and adjusted odd ratio. In the pre-intervention phase, 54.6% of patients had medium medication adherence, while in the post-intervention phase, 36.4% of patients had high medication adherence and 61.9% of patients had medium medication adherence. Following the intervention, medication cost (120, 50%), inadequate availability of drugs (75, 31%), and forgetfulness (30, 13%) were the main reasons for medication non-adherence. The presence of co-morbidity and the number of co-morbidity (p < .05) were significantly associated with the occurrence of decreased medication adherence in the pre-intervention phase. Interventions by pharmacists to educate HF patients about the nature of their disease and providing brochures to increase awareness of their medications have been shown to improve medication adherence.

Persistence to Basal Insulin: Association With Health Outcomes in a Population With Type 2 Diabetes.

This study examined the association between persistence to basal insulin and clinical and economic health outcomes. The question of whether a persistence measure for basal insulin could be leveraged in quality measurement was also explored. Using the IBM-Truven MarketScan Commercial and Medicare Supplemental Databases from 1 January 2011 to 31 December 2015, a total of 14,126 subjects were included in the analyses, wherein 9,898 (70.1%) were categorized as persistent with basal insulin therapy. Basal insulin persistence was associated with lower A1C, fewer hospitalizations and emergency department visits, and lower health care expenditures. Quality measures based on prescription drug claims for basal insulin are feasible and should be considered for guiding quality improvement efforts.

Artificial Intelligence in Anesthetic Care: A Survey of Physician Anesthesiologists.

This study explored physician anesthesiologists' knowledge, exposure, and perceptions of artificial intelligence (AI) and their associations with attitudes and expectations regarding its use in clinical practice. The findings highlight the importance of understanding anesthesiologists' perspectives for the successful integration of AI into anesthesiology, as AI has the potential to revolutionize the field. A cross-sectional survey of 27,056 US physician anesthesiologists was conducted to assess their knowledge, perceptions, and expectations regarding the use of AI in clinical practice. The primary outcome measured was attitude toward the use of AI in clinical practice, with scores of 4 or 5 on a 5-point Likert scale indicating positive attitudes. The anticipated impact of AI on various aspects of professional work was measured using a 3-point Likert scale. Logistic regression was used to explore the relationship between participant responses and attitudes toward the use of AI in clinical practice. A 2021 survey of 27,056 US physician anesthesiologists received 1086 responses (4% response rate). Most respondents were male (71%), active clinicians (93%) under 45 (34%). A majority of anesthesiologists (61%) had some knowledge of AI and 48% had a positive attitude toward using AI in clinical practice. While most respondents believed that AI can improve health care efficiency (79%), timeliness (75%), and effectiveness (69%), they are concerned that its integration in anesthesiology could lead to a decreased demand for anesthesiologists (45%) and decreased earnings (45%). Within a decade, respondents expected AI would outperform them in predicting adverse perioperative events (83%), formulating pain management plans (67%), and conducting airway exams (45%). The absence of algorithmic transparency (60%), an ambiguous environment regarding malpractice (47%), and the possibility of medical errors (47%) were cited as significant barriers to the use of AI in clinical practice. Respondents indicated that their motivation to use AI in clinical practice stemmed from its potential to enhance patient outcomes (81%), lower health care expenditures (54%), reduce bias (55%), and boost productivity (53%). Variables associated with positive attitudes toward AI use in clinical practice included male gender (odds ratio [OR], 1.7; P < .001), 20+ years of experience (OR, 1.8; P < .01), higher AI knowledge (OR, 2.3; P = .01), and greater AI openness (OR, 10.6; P < .01). Anxiety about future earnings was associated with negative attitudes toward AI use in clinical practice (OR, 0.54; P < .01). Understanding anesthesiologists' perspectives on AI is essential for the effective integration of AI into anesthesiology, as AI has the potential to revolutionize the field.

The Role of Primary Care in Improving Population Health.

Policy Points Systems based on primary care have better population health, health equity, and health care quality, and lower health care expenditure. Primary care can be a boundary-spanning force to integrate and personalize the many factors from which population health emerges. Equitably advancing population health requires understanding and supporting the complexly interacting mechanisms by which primary care influences health, equity, and health costs.

The Importance of Drug Safety and the Strategies for Promoting it

With medications becoming the standard of treatment for many illnesses these days, drug safety has turned into a high priority in contemporary healthcare. Medicines might offer therapeutic benefits but carry side effects and risks. Drug safety is crucial for positive patient outcome, injury prevention, and lower healthcare expenditures. This particular paper offers a sweeping review of the significance of drug safety and also covers drug development, regulation, surveillance and control of unwanted side effects. The literature review points to the difficulty of drug safety because of patient variables including age, health condition and concurrent medicine. Specific care is required for vulnerable groups - people that are older, kids or even pregnant - who present considerable safety risks. Preclinical testing is informative but clinical trials with human subjects are still crucial for evaluating efficacy and drug safety before marketing. The paper discusses the crucial role of drug safety in public health and also offers views on its intricacy and advancement methods.

Habitual sleep duration and its relationship with cardiovascular health, healthcare costs, and resource utilization in a working population

Little is known about the relationship between habitual sleep duration, cardiovascular health (CVH) and their impact on healthcare costs and resource utilization. We describe the relationship between sleep duration and ideal CVH, and the associated burden of healthcare expenditure and utilization in a large South Florida employee population free from known cardiovascular disease. The study used data obtained from a 2014 voluntary Health Risk Assessment among 8629 adult employees of Baptist Health South Florida. Health expenditures and resource utilization information were obtained through medical claims data. Frequencies of the individual and cumulative CVH metrics across sleep duration were computed. Mean and marginal per-capita healthcare expenditures were estimated. The mean age was 43 years, 57% were of Hispanic ethnicity. Persons with 6-8.9hours and ≥9 hours of sleep were significantly more likely to report optimal goals for diet, physical activity, body mass index, and blood pressure when compared to those who slept less than 6 hours. Compared to those who slept less than 6 hours, those sleeping 6-8.9hours and ≥9hours had approximately 2- (odds ratio 2.1, 95% confidence interval: 1.9-3.0) and 3-times (odds ratio 3.0, 95% confidence interval: 1.6-5.6) higher odds of optimal CVH. Both groups with 6 or more hours of sleep had lower total per-capita expenditure (approximately $2000 and $2700 respectively), lower odds of visiting an emergency room, or being hospitalized compared to those who slept < 6 hours. Sleeping 6 or more hours was associated with better CVH, lower healthcare expenditures, and reduced healthcare resource utilization.

Evaluation of the Effect of a Multifunctional Telemedicine Device on Health Care Use and Costs: A Nonrandomized Pragmatic Trial.

Background: Telemedicine health insurance models are highly prevalent in the Swiss health care system. Nevertheless, the potential of telemedicine is only partly being achieved, since current telemedicine health insurance models are limited to an initial contact by telephone and a gatekeeper role that organizes access to health care providers such as general practitioners, specialists, or hospitals. Against this background, a telemedicine device with diverse visual and auscultatory examination functions was made available to 2,000 telemedicine-insured clients. This device allowed diagnostic information to be sent to a medical care provider and used for telemedical consultation. Objective: To determine whether the additional implementation of a multifunctional telemedicine examination device resulted in fewer physical consultations, reduced service utilization, and lower health care expenditures among telemedicine-insured clients. Methods: Our analysis is based on claims data from 135,636 clients insured in a telemedicine call center model covering the years 2019 and 2020. We compare the use of health care and health care costs of clients who received a telemedicine device with those without such a device, using multivariable regression to adjust for group differences due to self-selection. Results: We found lower total health care expenditures of -229 (Swiss Francs) and lower inpatient costs of -160 (Swiss Francs) on the part of clients with the telemedicine device. However, the implementation of the telemedicine device did not lead to a statistically significant reduction in service utilization. Conclusions: The treatment of telemedicine-insured clients was on average more cost-effective when they received the multifunctional telemedicine device. Accordingly, complementing the existing telemedicine model with telemedicine devices that allow for improved telemedical consultations has the potential to increase the cost-saving potential of the existing telemedicine call center models.

Benefits of Kangaroo Mother Care on the Physiological Stress Parameters of Preterm Infants and Mothers in Neonatal Intensive Care.

It is well documented that the stress of separation of mother and baby can lead to short-term physiological instability as well as neurological, sociological or psychological consequences that may last a lifetime. Objective: The goal was to estimate the effect of kangaroo mother care (KMC) on physiological and biochemical parameters of preterm infant stress and maternal stress in neonatal intensive care. Methods: The investigation involved 112 preterm infants. Two groups were compared according to the mean duration of KMC during 12 days of study: the KMC group (mean duration more than 90 min daily) and the control group (less than 90 min). Results: Kangaroo mother care for more than 90 min on average per day in preterm infants is associated 12 days after the intervention with lower mean cortisol levels (p = 0.02), greater weight gain and less need for parenteral nutrition in preterm infants, as well as less postpartum depression (p = 0.02) and lower cortisol levels (p = 0.002) in the mothers of preterm infants. Conclusions: This study suggests that KMC can be used to improve the stress of preterm infants and their mothers, and that the greater weight gain observed in these preterm infants could contribute to a shorter average hospital stay and lower healthcare expenditure.

Building a CAT clinic - real-world systems approaches to prevention and treatment

Cancer patients have an increased risk of developing venous thrombosis. The implementation of a cancer associated thrombosis clinic can be instrumental for the prevention, early recognition, and management of venous thromboembolism in this vulnerable population. Cancer thrombosis clinics rely on a multidisciplinary approach to care and require standardization along with a dedicated team of healthcare professionals. Cancer thrombosis clinics have the potential to improve patient outcomes and lower healthcare expenditure. Herein, we describe a successful model of a cancer thrombosis clinic and highlight the potential impact on clinical outcomes.

Building a CAT Clinic - real-world systems approaches to prevention and treatment

Cancer patients have an increased risk of developing venous thrombosis. The implementation of a cancer associated thrombosis clinic can be instrumental for the prevention, early recognition, and management of venous thromboembolism in this vulnerable population. Cancer thrombosis clinics rely on a multidisciplinary approach to care and require standardization along with a dedicated team of healthcare professionals. Cancer thrombosis clinics have the potential to improve patient outcomes and lower healthcare expenditure. Herein, we describe a successful model of a cancer thrombosis clinic and highlight the potential impact on clinical outcomes.

Publisher note

Cancer patients have an increased risk of developing venous thrombosis. The implementation of a cancer associated thrombosis clinic can be instrumental for the prevention, early recognition, and management of venous thromboembolism in this vulnerable population. Cancer thrombosis clinics rely on a multidisciplinary approach to care and require standardization along with a dedicated team of healthcare professionals. Cancer thrombosis clinics have the potential to improve patient outcomes and lower healthcare expenditure. Herein, we describe a successful model of a cancer thrombosis clinic and highlight the potential impact on clinical outcomes.

Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China

BackgroundThe zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures).MethodsA pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively.ResultsFour key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts.ConclusionsAlthough the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.

Simple Rules That Guide Generalist and Specialist Care.

The sometimes-paradoxical emergent behavior of complex systems may be explained by the interaction of simple rules. The paradox of primary care-that systems based on primary care have healthier populations, fewer health inequities, lower health care expenditures, and better system-level evidence-based disease care, despite less evidence-based care for individual diseases-may be explained by the iterative interaction among three simple rules that describe the generalist approach: (1) Recognize a broad range of problems/opportunities; (2) Prioritize attention and action with the intent of promoting health, healing, and connection; and (3) Personalize care based on the particulars of the individual or family in their local context. These are complemented by three simple rules for specialist care that represent current approaches to quality and health care system improvement: (1) Identify and classify disease for management; (2) Interpret through specialized knowledge; (3) Generate and carry out a management plan. Health care systems that support the enactment of the simple rules of the generalist approach are likely to have more effective primary and specialty care, and greater population health, equity, quality, and sustainable cost.

Sociodemographic determinants of health care expenditure: micro level evidence of a fast-growing developing country

PurposeThe objective of this study is to examine the sociodemographic factors that are associated with health care expenditure among households in Malaysia.Design/methodology/approachThis study examines health care participation decision and amount of expenditure using the exponential Type 2 Tobit model. A dataset of a large sample (n = 14,838) that is nationally representative is used.FindingsThe results suggest that household size, location of residence as well as age, education and marital status of the household heads are significantly associated with household expenditure on health care. Health care expenditure increases with the age and educational attainment of household heads, whereas those who are being employed and residing in rural areas have lower health care expenditure. Although larger households are more likely to consume health care than smaller households, they spend less on health care. Furthermore, marital status does not affect the participation decision of health care expenditure, but the variable is associated with the decision on the amount of the expenditure.Practical implicationsThe results provide insights into groups of population that can be targeted for healthcare intervention programmes and policy design.Originality/valueThis study is the first to our knowledge to use a microeconometric approach to analyse the health care participation as well as its level of expenditure among households in Malaysia.