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Stroke utilization cost

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https://www.readbyqxmd.com/read/28716014/the-comprehensive-post-acute-stroke-services-compass-study-design-and-methods-for-a-cluster-randomized-pragmatic-trial
#1
Pamela W Duncan, Cheryl D Bushnell, Wayne D Rosamond, Sara B Jones Berkeley, Sabina B Gesell, Ralph B D'Agostino, Walter T Ambrosius, Blair Barton-Percival, Janet Prvu Bettger, Sylvia W Coleman, Doyle M Cummings, Janet K Freburger, Jacqueline Halladay, Anna M Johnson, Anna M Kucharska-Newton, Gladys Lundy-Lamm, Barbara J Lutz, Laurie H Mettam, Amy M Pastva, Mysha E Sissine, Betsy Vetter
BACKGROUND: Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes...
July 17, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28693742/impact-of-cirrhosis-in-patients-who-underwent-surgical-aortic-valve-replacement
#2
Robert J Steffen, Faisal G Bakaeen, Patrick R Vargo, Bogdan A Kindzelski, Douglas R Johnston, Eric E Roselli, A Marc Gillinov, Lars G Svensson, Edward G Soltesz
Cirrhosis is known to adversely affect cardiac surgery outcomes. Our objective was to quantify the morbidity, mortality, and cost that cirrhosis adds to surgical aortic valve replacement. From 1998 to 2011, 423,789 patients in the Nationwide Inpatient Sample Healthcare Cost Utilization Project underwent isolated aortic valve replacement; 2,769 (0.7%) had cirrhosis. Multivariable linear regression and 1:1 propensity matching were used to determine the effect of cirrhosis on postsurgical outcomes. The number of patients with cirrhosis who underwent surgical aortic valve replacement per year more than tripled during the 13-year study period...
May 30, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28689940/carotid-body-tumor-resection-just-as-safe-without-preoperative-embolization
#3
Adrienne N Cobb, Adel Barkat, Witawat Daungjaiboon, Pegge Halandras, Paul Crisostomo, Paul C Kuo, Bernadette Aulivola
BACKGROUND: Carotid body tumors (CBT) are rare entities for which surgical resection remains the gold standard. Given their hypervascularity, preoperative embolization is often used, however, controversy exists over whether a benefit is associated. Proponents of embolization argue it minimizes blood loss and complications. Critics argue cost and stroke outweigh benefits. This study aimed to investigate the impact of embolization on outcomes following CBT resection. METHODS: Patients undergoing CBT resection were identified using the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) for 5 states 2006-2013...
July 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28683732/chinese-acute-ischemic-stroke-treatment-outcome-registry-castor-protocol-for-a-prospective-registry-study-on-patterns-of-real-world-treatment-of-acute-ischemic-stroke-in-china
#4
Weiping Sun, Qianhua Ou, Zhijun Zhang, Jiazhi Qu, Yining Huang
RATIONALE: Stroke presents a serious health problem in China. Despite progresses made in recent years, there is still a lack of effective treatments for acute ischemic stroke (AIS) in clinical practices. AIMS: The Chinese Acute Ischemic Stroke Treatment Outcome Registry (CASTOR) is designed to evaluate the patterns and cost-effectiveness of current treatments for AIS in real-world settings in China. DESIGN: CASTOR is a prospective, multi-center study registered with ClinicalTrials...
July 6, 2017: BMC Complementary and Alternative Medicine
https://www.readbyqxmd.com/read/28657348/comparing-the-economic-burden-of-ischemic-stroke-patients-with-and-without-atrial-fibrillation-a-retrospective-study-in-beijing-china
#5
Liankui Wen, Jingjing Wu, Lin Feng, Li Yang, Feng Qian
BACKGROUND: Little is known about the Economic burden for ischemic stroke (IS) patients with atrial fibrillation (AF) in China. AIM: We aimed to compare the economic burden of treatment-related costs in IS patients with AF vs. without AF in China. METHODS: This retrospective analysis used economic burden data from the Beijing urban health insurance database. Using a random sampling method, 10% of the patients diagnosed with IS from January 1 through December 31, 2012 were enrolled...
June 28, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28650086/systemic-thrombolysis-catheter-directed-thrombolysis-and-anticoagulation-for-intermediate-risk-pulmonary-embolism-a-simulation-modeling-analysis
#6
Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur
OBJECTIVES: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT, and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28643129/magnetohydrodynamic-voltage-recorder-for-comparing-peripheral-blood-flow
#7
Kevin J Wu, T Stan Gregory, Michael C Lastinger, Jonathan R Murrow, Zion Tsz Ho Tse
Blood flow is a clinical metric for monitoring of cardiovascular diseases but current measurements methods are costly or uncomfortable for patients. It was shown that the interaction of the magnetic field (B 0) during MRI and blood flow in the body, through the magnetohydrodynamic (MHD) effect, produce voltages (V MHD) observable through intra-MRI electrocardiography (ECG), which are correlated with regional blood flow. This study shows the reproducibility of V MHD outside the MRI and its application in a portable flow monitoring device...
June 22, 2017: Annals of Biomedical Engineering
https://www.readbyqxmd.com/read/28641023/cardiovascular-event-incidence-and-cost-in-type-2-diabetes-mellitus-a-medicare-claims-based-actuarial-analysis
#8
Kathryn Fitch, Tyler Engel, Stephen Sander, Effie Kuti, Helen Blumen
OBJECTIVE: Assess the economic burden of cardiovascular events in Medicare beneficiaries with type 2 diabetes mellitus (T2DM). METHODS: This claims-based actuarial analysis queried 2013 and 2014 Medicare 5% Samples, defining a denominator of fee-for-service beneficiaries. Average per patient per month allowed cost ($PPPM) was calculated for T2DM, demographically adjusted non-T2DM, and denominator. Per member per month allowed cost ($PMPM) was calculated by dividing total population cost by member months in the denominator...
June 22, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28637460/healthcare-utilization-and-costs-for-patients-initiating-dabigatran-or-warfarin
#9
Shannon L Reynolds, Sameer R Ghate, Richard Sheer, Pranav K Gandhi, Chad Moretz, Cheng Wang, Stephen Sander, Mary E Costantino, Srinivas Annavarapu, George Andrews
BACKGROUND: Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population...
June 21, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28635339/methods-for-estimating-costs-in-patients-with-hyperlipidemia-experiencing-their-first-cardiovascular-event-in-the-united-kingdom
#10
Mark D Danese, Michelle Gleeson, Robert I Griffiths, David Catterick, Lucie Kutikova
AIMS: Methods for integrating external costs into clinical databases are not well-characterized. The purpose of this research was to describe and implement methods for estimating the cost of hospitalizations, prescriptions, and general practitioner and specialist visits used to manage hyperlipidemia patients experiencing cardiovascular (CV) events in the United Kingdom (UK). METHODS: This study was a retrospective cohort study using the Clinical Practice Research Datalink and Hospital Episode Statistics data...
June 21, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28627034/brief-mindfulness-meditation-group-training-in-aphasia-exploring-attention-language-and-psychophysiological-outcomes
#11
Rebecca Shisler Marshall, Jacqueline Laures-Gore, Kim Love
BACKGROUND: Stroke is currently the leading cause of long-term disability in adults in the United States. There is a need for accessible, low-cost treatments of stroke-related disabilities such as aphasia. AIMS: To explore an intervention for aphasia utilizing mindfulness meditation (MM). This preliminary study examines the feasibility of teaching MM to individuals with aphasia. Since physiological measures have not been collected for those with aphasia, the study was also an exploration of the potential attention, language and physiological changes after MM in adults with aphasia during a brief, daily group training...
June 19, 2017: International Journal of Language & Communication Disorders
https://www.readbyqxmd.com/read/28625371/cardiovascular-events-and-hospital-resource-utilization-pre-and-post-transcatheter-mitral-valve-repair-in-high-surgical-risk-patients
#12
Sreekanth Vemulapalli, Steven J Lippmann, Mitchell Krucoff, Adrian F Hernandez, Lesley H Curtis, Elyse Foster, Atif Qasim, Andrew Wang, Donald D Glower, Ted Feldman, Bradley G Hammill
MitraClip is an approved therapy for mitral regurgitation (MR); however, health care resource utilization pre- and post-MitraClip remains understudied. METHODS: Patients with functional and degenerative MR at high surgical risk in the EVEREST II High-Risk Registry and REALISM Continued-Access Study were linked to Medicare data. Pre- and post-MitraClip all-cause death, stroke, myocardial infarction, heart failure (HF), and bleeding hospitalizations were identified. Inpatient costs, adjusted to 2010 US dollars, were calculated, and event rate ratios and cost ratios were estimated with multivariable modeling...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28612680/benefits-of-stroke-treatment-delivered-using-a-mobile-stroke-unit-trial
#13
Jose-Miguel Yamal, Suja S Rajan, Stephanie A Parker, Asha P Jacob, Michael O Gonzalez, Nicole R Gonzales, Ritvij Bowry, Andrew D Barreto, Tzu-Ching Wu, David R Lairson, David Persse, Barbara C Tilley, David Chiu, Jose I Suarez, William J Jones, Andrei Alexandrov, James C Grotta
Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28574318/pediatric-abusive-head-trauma-and-stroke
#14
Nickalus R Khan, Brittany D Fraser, Vincent Nguyen, Kenneth Moore, Scott Boop, Brandy N Vaughn, Paul Klimo
OBJECTIVE Despite established risk factors, abusive head trauma (AHT) continues to plague our communities. Cerebrovascular accident (CVA), depicted as areas of hypodensity on CT scans or diffusion restriction on MR images, is a well-known consequence of AHT, but its etiology remains elusive. The authors hypothesize that a CVA, in isolation or in conjunction with other intracranial injuries, compounds the severity of a child's injury, which in turn leads to greater health care utilization, including surgical services, and an increased risk of death...
June 2, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28536168/psychiatric-hospitalization-increases-short-term-risk-of-stroke
#15
Jonah P Zuflacht, Yuefan Shao, Ian M Kronish, Donald Edmondson, Mitchell S V Elkind, Hooman Kamel, Amelia K Boehme, Joshua Z Willey
BACKGROUND AND PURPOSE: Recent evidence suggests that psychological distress, including the symptoms of psychiatric illness, may acutely increase the risk of stroke. However, existing studies are limited by small sample sizes, inherent recall bias, and poorly defined criteria for what constitutes psychological distress. METHODS: We analyzed administrative data from the Healthcare Cost and Utilization Project for the state of California from 2007 to 2009 using a case-crossover design...
May 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28527586/gastrointestinal-bowel-obstruction-in-acute-ischemic-stroke-incidence-risk-factors-and-outcomes-in-a-u-s-nationwide-analysis-of-3-998-667-hospitalizations
#16
Kavelin Rumalla, Ashwath S Kumar, Manoj K Mittal
OBJECTIVE: The prognosis from acute ischemic stroke (AIS) is worsened by poststroke medical complications. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS are not known. METHODS: We queried the Nationwide Inpatient Sample (2002-2011) to identify all patients with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariable analysis was utilized to identify risk factors for GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes...
May 17, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28516331/burden-of-herpes-simplex-virus-encephalitis-in-the-united-states
#17
S Modi, Abhimanyu Mahajan, D Dharaiya, P Varelas, P Mitsias
Herpes simplex virus encephalitis (HSVE) is a disease of public health concern, but its burden on the healthcare of United States has not been adequately assessed recently. We aimed to define the incidence, complications and outcomes of HSVE in the recent decade by analyzing data from a nationally representative database. Healthcare Cost and Utilization Project databases were utilized to identify patients with primary discharge diagnosis of HSVE. Annual hospitalization rate was estimated and several preselected inpatient complications were identified...
June 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28501349/potential-health-impact-and-cost-effectiveness-of-drug-therapy-for-prehypertension
#18
Tao Chen, Dahai Yu, Victoria Cornelius, Rui Qin, Yamei Cai, Zhixin Jiang, Zhanzheng Zhao
BACKGROUND: Studies have reported that pharmacologic interventions with candesartan or ramipril could reduce the risk of hypertension among prehypertensive subjects free of clinical cardiovascular disease (CVD), however, the cost-effectiveness and long-term cardiovascular risk of drug treatment among these population is unclear. METHOD: A Markov state-transition model was developed to simulate a hypothetical cohort of Chinese adults with high-range prehypertension (130-139/85-89mmHg) but without CVD...
May 5, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28497642/estimating-lifetime-medical-costs-from-censored-claims-data
#19
Jing-Shiang Hwang, Tsuey-Hwa Hu, Lukas Jyuhn-Hsiarn Lee, Jung-Der Wang
Claims databases consisting of routinely collected longitudinal records of medical expenditures are increasingly utilized for estimating expected medical costs of patients with a specific condition. Survival data of the patients of interest are usually highly censored, and observed expenditures are incomplete. In this study, we propose a survival-adjusted estimator for estimating mean lifetime costs, which integrates the product of the survival function and the mean cost function over the lifetime horizon. The survival function is estimated by a new algorithm of rolling extrapolation, aided by external information of age- and sex-matched referents simulated from national vital statistics...
May 12, 2017: Health Economics
https://www.readbyqxmd.com/read/28483774/observed-cost-and-variations-in-short-term-cost-effectiveness-of-therapy-for-ischemic-stroke-in-interventional-management-of-stroke-ims-iii
#20
Kit N Simpson, Annie N Simpson, Patrick D Mauldin, Yuko Y Palesch, Sharon D Yeatts, Dawn Kleindorfer, Thomas A Tomsick, Lydia D Foster, Andrew M Demchuk, Pooja Khatri, Michael D Hill, Edward C Jauch, Tudor G Jovin, Bernard Yan, RĂ¼diger von Kummer, Carlos A Molina, Mayank Goyal, Wouter J Schonewille, Mikael Mazighi, Stefan T Engelter, Craig Anderson, Judith Spilker, Janice Carrozzella, Karla J Ryckborst, L Scott Janis, Joseph P Broderick
BACKGROUND: Examination of linked data on patient outcomes and cost of care may help identify areas where stroke care can be improved. We report on the association between variations in stroke severity, patient outcomes, cost, and treatment patterns observed over the acute hospital stay and through the 12-month follow-up for subjects receiving endovascular therapy compared to intravenous tissue plasminogen activator alone in the IMS (Interventional Management of Stroke) III Trial. METHODS AND RESULTS: Prospective data collected for a prespecified economic analysis of the trial were used...
May 8, 2017: Journal of the American Heart Association
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