Medical Cost Data Research Articles

Clinical outcomes and costs of robotic surgery in prostate cancer: a multiinstitutional study in Korea.

BackgroundThis study compared the surgical, functional, and oncologic outcomes of robot-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and retropubic radical prostatectomy (RRP) in Korean men.MethodsThe study population included 864 patients who underwent radical prostatectomy for prostate cancer in the departments of urology of five tertiary hospitals between 2010 and 2011. RALP, LRP, and RRP perioperative, oncological, and functional outcomes as well as complications were assessed. Medical cost data were analyzed for 682 of 864 patients.ResultsNo significant differences were found among the three groups regarding the length of stay, biochemical recurrence, complications, and metastasis. The RALP group had a significantly higher rate of pelvic lymph node dissection (64.6% vs. 35.3% or 53.3%, P value <0.0001) and bilateral nerve-sparing procedures (15.7% vs. 10.0% or 8.9%, P value <0.0001) and less blood loss (median 250 mL vs. 300 mL or 700 mL, P value <0.0001) than the LRP and RRP groups. The 12-month continence recovery rate was higher in the RALP group (92.1%) than in the LRP (86.5%) and RRP (84.4%) groups (P value <0.0001). Medical costs for RALP were approximately twofold to threefold higher than those for LRP or RRP.ConclusionsOur findings suggest that surgical and functional outcomes are better with robot-assisted surgery than with laparoscopic or open surgery in terms of estimated blood loss and urinary continence; however, no differences were found among groups in terms of biochemical recurrence and the rate of complications.

Modeling right-censored medical cost data in regression and the effects of covariates

This paper focuses on the problem of modeling medical costs with covariates when the cost data are subject to right-censoring. The prevailing methods are divided into three categories, (a) the inverse probability weighted (IPW) regressions; (b) the generalized survival-adjusted estimators; and (c) the joint-modeling methods. Comparisons are made both in and between categories to demonstrate their different mechanisms to handle the informative censoring, to take into account the covariates and the way they interpret the covariates effects. Based on the above discussion, we believe that the linear or generalized linear regressions using the IPW scheme are very popular due to its convenience to fit and interpret, which could be a good choice in practice with additional conditional means to address the role of survival to some extent. The recently proposed generalized survival-adjusted estimator is very intuitive as the derivative of the estimation function naturally decomposes the effects of covariates into the intensity part and the survival part, therefore especially useful when the covariates have substantial effect on survival. The joint-modelling methods have the advantage in providing the access to the correlation between medical cost and survival, although they suffer from theoretical and computational complexity. The effect of covariates on cost through survival in this kind of joint-modelling methods could be a desirable topic for further research.

Semiparametric Estimation of Longitudinal Medical Cost Trajectory

ABSTRACTEstimating the average monthly medical costs from disease diagnosis to a terminal event such as death for an incident cohort of patients is a topic of immense interest to researchers in health policy and health economics because patterns of average monthly costs over time reveal how medical costs vary across phases of care. The statistical challenges to estimating monthly medical costs longitudinally are multifold; the longitudinal cost trajectory (formed by plotting the average monthly costs from diagnosis to the terminal event) is likely to be nonlinear, with its shape depending on the time of the terminal event, which can be subject to right censoring. The goal of this article is to tackle this statistically challenging topic by estimating the conditional mean cost at any month t given the time of the terminal event s. The longitudinal cost trajectories with different terminal event times form a bivariate surface of t and s, under the constraint t ⩽ s. We propose to estimate this surface using bivariate penalized splines in an expectation-maximization algorithm that treats the censored terminal event times as missing data. We evaluate the proposed model and estimation method in simulations and apply the method to the medical cost data of an incident cohort of stage IV breast cancer patients from the Surveillance, Epidemiology, and End Results–Medicare Linked Database. Supplementary materials for this article are available online.

Pharmacoeconomic evaluation of hemodialysis patients: A study of cost of illness

Objective: The objective of the study is to analyze the health-care costs of the hemodialysis (HD) patients in a charitable hospital. Subjects and Methods: A prospective observational study was carried out in an outpatient HD unit of nephrology department in a charitable hospital for a period of 8 months from August 2016 to March 2017. The collected direct medical and nonmedical cost data were analyzed for the median interquartile (Q3–Q1) cost incurred in treating the HD patients. Results: A total of 39 outpatients were included in the study. Of 39 patients, majority of the HD patients were males (66.2%) followed by females (33.8%). Most of the patients underwent HD for twice a week (89.7%) followed by thrice a week (10.3%). The median direct medical costs (85,999.2 Indian rupee [INR]) were found to be higher than direct nonmedical costs (14,437.1 INR). Conclusions: The study revealed that the total median direct cost was found to be uppermost for the age group of 41–60 years (1,12,438.8 INR) when compared to all other age groups, and it was also observed that the total median direct cost for males (1,07,522.4 INR) was higher than females (1,03,170.7 INR). The factors such as type of comorbidities, age, and number of HD per week may affect the cost of illness.

Conditional Modeling of Longitudinal Data With Terminal Event

ABSTRACTWe consider a random effects model for longitudinal data with the occurrence of an informative terminal event that is subject to right censoring. Existing methods for analyzing such data include the joint modeling approach using latent frailty and the marginal estimating equation approach using inverse probability weighting; in both cases the effect of the terminal event on the response variable is not explicit and thus not easily interpreted. In contrast, we treat the terminal event time as a covariate in a conditional model for the longitudinal data, which provides a straightforward interpretation while keeping the usual relationship of interest between the longitudinally measured response variable and covariates for times that are far from the terminal event. A two-stage semiparametric likelihood-based approach is proposed for estimating the regression parameters; first, the conditional distribution of the right-censored terminal event time given other covariates is estimated and then the likelihood function for the longitudinal event given the terminal event and other regression parameters is maximized. The method is illustrated by numerical simulations and by analyzing medical cost data for patients with end-stage renal disease. Desirable asymptotic properties are provided. Supplementary materials for this article are available online.

Cost-Effectiveness of A Direct Aspiration First Pass Technique (ADAPT) For Thrombectomy Revascularization of Large Vessel Occlusion In Acute Ischemic Stroke (French Health Ministry Prme 16-0020)

To estimate the cost-effectiveness of Direct Aspiration First Pass Technique (ADAPT) versus mechanical thrombectomy with a Stent Retriever (SR) procedure in acute ischemic stroke from a French healthcare providers perspective. The cost-effectiveness study was carried out from a prospective, randomized and multicenter clinical trial including 8 French hospitals. Medical and costs data were collected prospectively relating to the initial procedure from the onset symptom to the best recanalization. The direct medical costs data were collected by micro-costing and analytical accounting. The primary outcome is the modified score Rankin scale (mRS) of independent at three-months (score 0-2). Economic acceptability for community of this new technique is analyzed by measuring the Incremental Cost-Effectiveness Ratio (ICER). Sensitivity analyses were performed. We include 381 eligible patients (192 allocated to ADAPT and 189 allocated to SR) from October 2015 to October 2016. The mean hospital costs were €8372 in ADAPT group, and €8069 in SR group (p-value = 0.49). The percentage of independent patients at 3 months was 55.17 % in ADAPT group, and 62.06 % in SR group (p-value = 0.23). The resulting ICER reveals the need to invest €4389 in order to achieve an additional percentage of independence with the innovative strategy compared to the standard strategy. Based on randomized trial, we demonstrate that ADAPT is not more efficient compared to SR. We will then consider the cost per QALY (mapping mRS into EQ-5D) at 12-months.

Relationship between health promotion volunteer experience and medical costs: Hoken-hodouin activities in Suzaka, Nagano.

Objectives This study demonstrated the relationship between experience as a health promotion volunteer (Hoken-hodouin) and medical costs in Japan. The study area was Suzaka City (March 2016 population: 51,637) in Nagano Prefecture, Japan, where a total of about 300 women have been engaged and trained as health promotion volunteers since 1958.Methods A cross-sectional survey was conducted in 2014 using a self-administered questionnaire, which included items on experiences as a health promotion volunteer, age at engagement, leadership status, and satisfaction with the experience. Eligible study participants were all residents of Suzaka aged 65 years or over. Medical cost data from April 2013 to March 2014 were collected for women aged 65-74 years who were beneficiaries of the Japanese National Health Insurance (n=2,304). Medical consultation rates and costs for treatment at outpatient and inpatient clinics were analyzed as outcomes. Adjustments were made for age, marital status, educational level, cohabitation status, equivalent income, alcohol use, smoking status, awareness about a healthy diet, and walking time per day.Results Of the 2,304 study participants, 1,274 (55.3%) had experience as health promotion volunteers. Poisson regression analysis revealed that volunteers' experience was positively associated with outpatient care rates (adjusted relative risk [RR]=1.04; 95% confidence interval [CI]=1.02-1.07), and negatively associated with inpatient care rates (RR=0.74; 95% CI=0.56-0.98). Multivariate regression analysis revealed that the adjusted geometric means of outpatient and inpatient care costs were 7% and 23% lower, respectively, among participants with volunteer experience than that among those with no volunteer experience (140,588-151,465 JPY for outpatient costs; 418,457-539,971 JPY for inpatient costs). These associations were stronger among participants who began health promotion volunteer at age 60 years or more, those who had leadership roles, and participants who had high levels of satisfaction regarding their volunteer experience.Conclusion These results suggest that experience as a health promotion volunteer is associated with lower medical costs, particularly for inpatient care.

Nonparametric estimation of medical cost quantiles in the presence of competing terminal events

ABSTRACTMedical care costs are commonly used by health policy-makers and decision-maker for evaluating health care service and decision on treatment plans. This type of data is commonly recorded in surveillance systems when inpatient or outpatient care service is provided. In this paper, we formulate medical cost data as a recurrent marker process, which is composed of recurrent events (inpatient or outpatient cares) and repeatedly measured marker measurements (medical charges). We consider nonparametric estimation of the quantiles of cost distribution among survivors in the absence or presence of competing terminal events. Statistical methods are developed for quantile estimation of the cost distribution for the purposes of evaluating cost performance in relation to recurrent events, marker measurements and time to the terminal event for different competing risk groups. The proposed approaches are illustrated by an analysis of data from the Surveillance, Epidemiology, and End Results (SEER) and Medicare linked database.

Assessment of Public Health and Economic Impact of Intranasal Live-Attenuated Influenza Vaccination of Children in France Using a Dynamic Transmission Model.

We estimated the epidemiological and economic impact of extending the French influenza vaccination programme from at-risk/elderly (≥65years) only to healthy children (2-17years). A deterministic, age-structured, dynamic transmission model was used to simulate the transmission of influenza in the French population, using the current vaccination coverage with trivalent inactivated vaccine (TIV) in at-risk/elderly individuals (current strategy) or gradually extending the vaccination to healthy children (aged 2-17years) with intranasal, quadrivalent live-attenuated influenza vaccine (QLAIV) from current uptake up to 50% (evaluated strategy). Epidemiological, medical resource use and cost data were taken from international literature and country-specific information. The model was calibrated to the observed numbers of influenza-like illness visits/year. The 10-year number of symptomatic cases of confirmed influenza and direct medical costs ('all-payer') were calculated for the 0-17- (direct and indirect effects) and ≥18-year-old (indirect effect). The incremental cost-effectiveness ratio (ICER) was calculated for the total population, using a 4% discount rate/year. Assuming 2.3 million visits/year and 1960 deaths/year, the model calibration yielded an all-year average basic reproduction number (R 0) of 1.27. In the population aged 0-17years, QLAIV prevented 865,000 influenza cases/year (58.4%), preventing 10-year direct medical expenses of €374 million. In those aged ≥18years with unchanged TIV coverage, 1.2 million cases/year were averted (27.6%) via indirect effects (additionally prevented expenses, €457 million). On average, 613 influenza-related deaths were averted annually overall. The ICER was €18,001/life-year gained. The evaluated strategy had a 98% probability of being cost-effective at a €31,000/life-year gained threshold. The model demonstrated strong direct and indirect benefits of protecting healthy children against influenza with QLAIV on public health and economic outcomes in France.

Economic burden of deep infiltrating endometriosis of the bowel and the bladder in Germany: The statutory health insurance perspective

BackgroundUntil now, there has been little discussion of the costs of the deep infiltrating endometriosis (DIE) of the bowel or the bladder. The aim of the present secondary data analysis was to describe the population affected by this disease and to determine the economic burden in Germany from a payer's perspective. MethodsHealth claims data of women diagnosed with DIE of the bladder or bowel, who were surgically treated as inpatients between Jan 1, 2008 and Dec 31, 2012, were evaluated retrospectively. All data were extrapolated on a national statutory health insurance (SHI) level and normalized based on the year of surgery (index year). Case-individual information on age, comorbidities and prescribed drugs were presented for the index year. Direct medical cost data were analysed before and after the index year, differentiated by cost sector and age group. ResultsThe data of 825 women with DIE were analysed. Sample size for different time points varied depending on insurance eligibility and continuous case information. The average age at surgery was 39 years. Besides DIE, 41 % of the women had at least one additional disease of the peritoneum. The mean annual total healthcare costs per DIE case were 12,868 Euros in the index year. Before surgery, mean annual costs varied between 548 and 2,475 Euros per case and after surgery between 1,739 and 2,818 Euros per case. In total, mean costs were higher in younger women as compared to older women, with a cost difference of 616 Euros over all time points. ConclusionDirect costs are highest during the year of surgical treatment, but DIE of the bowel and bladder places a substantial burden on the SHI also before and after surgery. Further studies on indirect costs would be desirable to complete the knowledge on the economic burden of DIE.

The weighted general linear model for longitudinal medical cost data – an application in colorectal cancer

ABSTRACTIdentifying cost-effective decisions that can take into account of medical cost and health outcome is an important issue under very limited resources. Analyzing medical costs has been challenged owing to skewness of cost distributions, heterogeneity across samples and censoring. When censoring is due to administrative reasons, the total cost might be related to the survival time since longer survivals are likely to be censored and the corresponding total cost will be censored as well. This paper uses the general linear model for the longitudinal data to model the repeated medical cost data and the weighted estimating equation is used to find more accurate estimates for the parameter. Furthermore, the asymptotic properties for the proposed model are discussed. Simulations are used to evaluate the performance of estimators under various scenarios. Finally, the proposed model is implemented on the data extracted from National Health Insurance database for patients with the colorectal cancer.

Double robust estimator of average causal treatment effect for censored medical cost data.

In observational studies, estimation of average causal treatment effect on a patient's response should adjust for confounders that are associated with both treatment exposure and response. In addition, the response, such as medical cost, may have incomplete follow-up. In this article, a double robust estimator is proposed for average causal treatment effect for right censored medical cost data. The estimator is double robust in the sense that it remains consistent when either the model for the treatment assignment or the regression model for the response is correctly specified. Double robust estimators increase the likelihood the results will represent a valid inference. Asymptotic normality is obtained for the proposed estimator, and an estimator for the asymptotic variance is also derived. Simulation studies show good finite sample performance of the proposed estimator and a real data analysis using the proposed method is provided as illustration. Copyright © 2016 John Wiley & Sons, Ltd.

The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women

Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.

A flexible model for correlated medical costs, with application to medical expenditure panel survey data.

We propose a flexible model for correlated medical cost data with several appealing features. First, the mean function is partially linear. Second, the distributional form for the response is not specified. Third, the covariance structure of correlated medical costs has a semiparametric form. We use extended generalized estimating equations to simultaneously estimate all parameters of interest. B-splines are used to estimate unknown functions, and a modification to Akaike information criterion is proposed for selecting knots in spline bases. We apply the model to correlated medical costs in the Medical Expenditure Panel Survey dataset. Simulation studies are conducted to assess the performance of our method.

Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care

ObjectiveTo report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. MethodsAn economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children’s Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. ResultsOn average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. ConclusionsThis economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care.

Measuring the cost-effectiveness of midwife-led versus physician-led intrapartum teams in developing countries.

International agencies have advocated scaling-up of midwifery resources as an important method for improving maternal health and reducing maternal mortality rates (MMR). The cost-effectiveness of midwife-led versus physician-led intrapartum care is an important consideration in the human resource planning required to reduce MMR. Studies suggest that midwife-led teams can achieve comparable effectiveness and outcomes using less medically intensive care compared with physician-led teams. In the absence of adequate medical cost data, decision makers should consider the substantially lower average costs for three main drivers: salaries, benefits and incentives (≥two-times lower); preservice training (three-times lower) and attrition (two-times lower) necessary to deliver intrapartum care at the level of midwife competencies. This suggests that scale-up of midwifery resources is a less expensive and more cost-effective way to reduce MMRs and could potentially increase access to skilled intrapartum care.

PHS138 - Colorectal Cancer (CRC) costs in the us: findings from the Medical Expenditure Panel Survey 2008-2012

To estimate colorectal cancer (CRC) -attributable cost in the United States by quantifying the direct medical cost of cancer care for CRC patients and to study the effects of CRC on direct healthcare costs. We used direct medical cost data from the household component of the Medical Expenditure Panel Surveys (MEPS) of 2008 to 2012that gather healthcare utilization and expenditures for the US civilian non-institutionalized population. To estimate CRC-attributable cost, patients reporting a past CRC diagnosis were matched with non-cancer controls on age, region, poverty level, race, insurance status, and marital status. Generalized linear model (GLM) was chosen to model costs. An average of 110 persons in each year reported a prior CRC diagnosis.The mean annual direct medical cost attributable to CRC was $18,240 in 2008, $18,211 in 2009, $11,192 in 2010, $11,113 in 2011 and $13,301 in 2012. Applying the findings to SEER estimates of population-wide CRC prevalence, CRC attributable costs were $27.59 billion in 2008, $25.45 billion in 2009, $14.11 billion in 2010, $13.03 billion in 2011 and $15.08 billion in 2012, a trend consistent with the documented overall healthcare cost decline following the 2008-09 recession. Our study revealed a significant decline in annual CRC attributable cost in 2010. Our findings may be confounded by 5-plus year survivors who may no longer qualify as “cancer” patients, and by stage at diagnosis among the study sample. Localized disease is associated with a 90% 5-year survival rate. Study limitations include: a) a lack of consistent data on time since cancer diagnosis which is relevant to cancer care cost computations, and, b) lack of data on stage at diagnosis. With about 130,000 new cases each year, additional research is warranted to develop accurate cost estimates.

On Huberized calibration regression for censored medical cost data.

Authors have observed that the distribution of medical expenditures has features that do not lend it to parametric modeling and can present significant challenges for least-squares-type estimators, even on a logarithmic scale. In this note, we discuss caveats and extensions of coefficient estimation in the bivariate accelerated lifetime model of medical cost and survival time on covariates. We consider the setting where medical cost is observed only when the event occurs and potential right-censoring of the event time induces a dependent censoring mechanism on cost. We adopt Huang's (2002) estimation framework using the weighted log-rank estimating equations and investigate his proposal for robust mark-scale coefficient estimation. Due to modeling restrictions on the joint distribution of survival time and cost, we conclude that his robust mark-scale coefficient estimator would benefit from a time-scale adjustment. We use basic principles from robust estimation to define a new weighted marked process that subsequently leads to a new time-corrected robust regression calibration estimator. Our simulation studies illustrate how the proposed estimator has desirable operating characteristics, including reduced sensitivity to extreme values in the cost distribution, smaller finite sample bias and variance than earlier proposals. We illustrate the method in an analysis of lifetime medical cost data from a lung cancer study conducted by the Southwest Oncology Group.

Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda

BackgroundVaccination has been increasingly promoted to help control epidemic and endemic typhoid fever in high-incidence areas. Despite growing recognition that typhoid incidence in some areas of sub-Saharan Africa is similar to high-incidence areas of Asia, no large-scale typhoid vaccination campaigns have been conducted there. We performed an economic evaluation of a hypothetical one-time, fixed-post typhoid vaccination campaign in Kasese, a rural district in Uganda where a large, multi-year outbreak of typhoid fever has been reported. MethodsWe used medical cost and epidemiological data retrieved on-site and campaign costs from previous fixed-post vaccination campaigns in Kasese to account for costs from a public sector health care delivery perspective. We calculated program costs and averted disability-adjusted life years (DALYs) and medical costs as a result of vaccination, to calculate the cost of the intervention per DALY and case averted. ResultsOver the 3 years of projected vaccine efficacy, a one-time vaccination campaign was estimated to avert 1768 (90%CI: 684–4431) typhoid fever cases per year and a total of 3868 (90%CI: 1353–9807) DALYs over the duration of the immunity conferred by the vaccine. The cost of the intervention per DALY averted was US$ 484 (90%CI: 18–1292) and per case averted US$ 341 (90%CI: 13–883). ConclusionWe estimated the vaccination campaign in this setting to be highly cost-effective, according to WHO's cost-effective guidelines. Results may be applicable to other African settings with similar high disease incidence estimates.

46. Effects of a Randomized Health Care Transition Care Coordination Intervention on Perception of Chronic Illness Care and Transition Readiness

Purpose: Care coordination has been reported to be effective in facilitating health care transition (HCT) from pediatric to adult care. No studies have examined the effects of HCT care coordination compared to a robust control group in real time. In this study we report longitudinal perception of chronic illness care and transition readiness data from a randomized HCTcare coordination intervention trial for youth with special health care needs. Methods: 210 participants ages 16-22 years old (mean age 18.9 +/-1.7 years) were enrolled in a randomized controlled HCT care coordination intervention and were recruited from a large urban academic adolescent health clinic located in a pediatric tertiary referral health system. Following enrollment and baseline data collection, 105 participants were randomized to the HCT care coordination intervention group, and the other 105 were randomized to the control group. All participants were interviewed at 0, 6 and 12 months completing the Patient Assessment of Care for Chronic Conditions (PACIC) which assesses five domains (patient activation, delivery system design, decision support, goal setting, problem solving, and follow-up/coordination), the Client Perceptions of Coordination Questionnaire (CPCQ) assessing perception of patient-centered care and care coordination, and a self-rating on a scale of 1-10 how ready they feel to transfer to adult care. We compared responses in intervention and control participants using contingency table analyses and relied on chi square tests to identify differences that were unlikely to have occurred by chance. Results: At baseline there were no statistical differences in PACIC, CPCQ or readiness scores when comparing the intervention to control group. At 6 months, no differences were observed in the PACIC scores, while intervention participants rated quality of chronic illness care higher (p1⁄40.065) and reported less conflicting advice from providers (p1⁄40.018) than the control group. At 12 month follow-up there were significant differences seen in the PACIC as patient activation (p1⁄40.015), goal setting (p1⁄40.034), problemsolving (p1⁄40.009) and coordination/follow-up (p1⁄40.016) all rated statistically significantly higher in the intervention than control group. At 12 months, intervention participants reported more often receiving the services they thought they needed (p1⁄40.03), were less confused about the role of providers (p1⁄40.012) and reported more frequent discussions with providers about future care (p1⁄40.05) than control participants. There were no differences in self-rating of transition readiness between the two groups throughout the study period. Conclusions: This HCT care coordination intervention improved many aspects of quality of chronic illness care for participants. Selfassessment of readiness was not impacted by this intervention. Future studies need to assess medical outcome and cost data to see if these perceptions of improved quality of care translate to better HCT outcomes. Sources of Support: This study is supported by grant R40MC23627 awarded to Lisa Tuchman from the Maternal and Child Health Research Program, Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.