Health Outcomes Research and Policy Center Joseph Thomas III, M.S., Ph.D., FAPhA.

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Presentation transcript:

Health Outcomes Research and Policy Center Joseph Thomas III, M.S., Ph.D., FAPhA

Need Health care spending relative to national income Concerns about sustainability of national programs Questions about value of treatments and choices among treatments

Outcomes Research Multidisciplinary and collaborative science that studies Variation in practice patterns Which treatment works best Develops criteria for determining circumstances in which procedures should or should not be performed Identifies patient preferences Develops tools to measure changes in health status and patient satisfaction

Value According to the Donabedian paradigm, the real value of studying health outcomes lies in understanding the relation of outcomes to the structure and processes of care that produced them Perrin

Example Outcomes Longevity, mortality Complications Physical functional status Psychosocial functioning Quality of life Use of specified services Satisfaction with care Academy Health

Center Mission Conduct innovative health outcomes research that provides objective evidence for health care practices that lead to optimal health outcomes and efficient health care delivery

Recent and Ongoing Research Criteria for identifying patients with dementia and prevalence estimates for dementia Effect of dual use of dementia drugs and bladder control drugs Potentially inappropriate medication use and associations with hospitalizations and mortality Medication use and functioning among Medicaid patients in nursing homes

Recent and Ongoing Research Evaluating Community-based long-term care for Medicaid patients Home and community based services as alternatives to nursing-home care Wellness checks and health care utilization among preschool children Incremental Costs of treatment of Dementia Criteria for identifying patients with dementia and prevalence estimates for dementia

Dementia Related Incremental Expenditures Dementia is characterized by a wide range of symptoms due to brain dysfunction such as loss of cognitive and emotional abilities that interfere with daily functioning and quality of life (Brodaty and Lie 1998) Individuals with dementia have higher risk of institutionalization Medicaid is primary payer for nursing home care Objective: Estimate incremental expenditures associate with dementia among Indiana Medicaid Beneficaries

Dementia Related Incremental Expenditures Sample: 40 > Y/O, Medicaid in 2004 Cost Models (Zero-inflated negative binomial) Response Variable: Cost Predictor and Covariates Dementia Comorbidity index Age Gender Race Marital status Medicaid region Months of Medicaid eligibility Months spend-down in effect Medicare Coverage Mortality during study period

Marginal effects of dementia and other risk factors on annualized total expenditures using average demographics of entire population at baseline. Variable Total Expenditures Standard Error Dementia$9829 **211 Age1.54**3 Male3,160**100 White4,75090 Married-3,394**93 Region North1,147**112 Central243**104 Mortality7,677**272 Charlson comorbidity index1,974**25 Months of Medicaid eligibility422**19 Months spend-down in effect-4,015**26 Months on Medicare285**9

Percent of All Medicaid Expenditures Accounted for by Incremental Expenditures Associated with Dementia

Dementia Related Incremental Expenditures Dementia associated expenditures are nearly one-fourth of total Medicaid expenditures for persons > 65 y/o After nursing home, incremental drug expenditures were the second largest category of expenditures Understanding the cost of treatment of dementia is importance in resource allocation, planning, and evaluating care options

Center Activities Research EducationDissemination

Goals Increase involvement in health outcomes research Increase numbers of individuals trained in outcomes research Link research to practice and policy needs

Acknowledgements Expert panel members Research Collaborators Murtuza Bharmal, Ph.D. -- Quintiles Strategic Research and Safety Seema Dedhiya, Ph.D. – Independent Consultant Laura Sands, Ph.D. – Purdue University, School of Nursing Michael Weiner, M.D. – Indiana University, School of Medicine Bruce Craig, Ph.D. – Purdue University, Department of Statistics Marc Rosenman, M.D. – Indiana Univesity, School of Medicine Kaycee Sink, M.D. - Wake Forrest University, Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning

Thank You