The Resource A Medicare benefit expansion : inpatient clinical and economic outcomes in deep brain stimulation for Parkinson's Disease, Jane Castelli Haley, (electronic resource)

A Medicare benefit expansion : inpatient clinical and economic outcomes in deep brain stimulation for Parkinson's Disease, Jane Castelli Haley, (electronic resource)

Label
A Medicare benefit expansion : inpatient clinical and economic outcomes in deep brain stimulation for Parkinson's Disease
Title
A Medicare benefit expansion
Title remainder
inpatient clinical and economic outcomes in deep brain stimulation for Parkinson's Disease
Statement of responsibility
Jane Castelli Haley
Creator
Contributor
Thesis advisor
Subject
Genre
Language
eng
Summary
Background: The Centers for Medicare and Medicaid Services, (CMS) implements National Coverage Decisions (NCD) to expand access or eliminate regional reimbursement differences. Policymakers may estimate clinical and economic consequences through short term pilots or demonstration projects. Objective: Examined whether short term outcomes mirror longer term outcomes for a CMS NCD for Deep Brain Stimulation (DBS) in Parkinson's Disease (PD). Methods: This observational study examined the inpatient clinical and economic outcomes associated with a CMS NCD for DBS in PD using Health Care Utilization Project (HCUP) retrospective data from 1999 through 2007. The Healthcare Utilization Project (HCUP) data, is supported by CMS. HCUP is the largest collection of all-payer, uniform, state-based inpatient surgery administrative data and covers the years of interest. Short-term cross-sectional analysis examined 12 months pre NCD (January 1, 1999 to March 31, 2003); and 12 months post NCD (April 1, 2003 to March 30, 2004). Long-term, cross-sectional analysis examined the three years, three months prior to the short term pre period (January 1, 1999 to March 31, 2002); and the three years, nine months after the short term post period (April 1 2004 to December 31, 2007). Results: A patient who had DBS surgery in the 12 months post NCD is more likely to be discharged to long or short term care rather than home (OR 3.671, p=0.0249); is associated with longer lengths of stay (0.2888, p=0.0001); and is positively associated with the log of total charges (0.19985, p=0.0240). A patient who has DBS surgery more than 12 months post NCD compared surgery more than 12 months pre NCD, was less likely to have complications (OR 0.376, 0.0004) , was associated with a shorter length of stay (-0.2857, p=0.0093), and is positively associated with the log of total charges (0.33875, p<0.001). Conclusions: These results suggest that after the benefit expansion, outcomes worsened in the short term, and improved in the long term. Policymakers may benefit from a longer term view when forecasting before--or interpreting outcomes after--a benefit design change. Differences in populations served may cause temporary or long term shifts in health outcomes and resource utilization
Cataloging source
UMK
http://library.link/vocab/creatorDate
1962-
http://library.link/vocab/creatorName
Haley, Jane Castelli
Degree
Ph. D.
Dissertation year
2011.
Granting institution
Dept. of Public Affairs and Administration and Dept. of Economics. University of Missouri-Kansas City
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
  • theses
http://library.link/vocab/relatedWorkOrContributorName
Rasu,Rafia
http://library.link/vocab/subjectName
  • Parkinson's disease
  • Brain stimulation
  • Outcome assessment (Medical care)
  • Medicare
  • Deep Brain Stimulation
  • Medicare
  • Outcome Assessment (Health Care)
  • Parkinson Disease
Label
A Medicare benefit expansion : inpatient clinical and economic outcomes in deep brain stimulation for Parkinson's Disease, Jane Castelli Haley, (electronic resource)
Instantiates
Publication
Note
  • "A dissertation in Public affairs and administration and Economics."
  • Advisor: Rafia Rasu
  • Vita
Antecedent source
not applicable
Bibliography note
Includes bibliographical references (pages 128-134)
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
black and white
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Contents
Introduction and problem statement -- Literature review -- Methods and hypotheses -- Results -- Hierarchical specification -- Discussion and implication -- Conclusions -- Appendix A. Data dictionary -- Appendix B. Complications - long run without physician variable -- Appendix C. Complications - long run with physician influence -- Appendix D. Non death disposition - long run full sample -- Appendix E. Non death disposition - long run with physician influence -- Appendix F. Length of stay - long run without physician influence -- Appendix G. Length of stay - long run with physician influence -- Appendix H. Log total charges - long run full sample -- Appendix L. Log total charges - long run subsample -- Appendix J. Complications -- short run full sample hierarchical logistic multivariate model -- Appendix K. Complications - short run subsample hierarchical logistic multivariate model -- Appendix L. Non death disposition - short run full sample hierarchical logistic multivariate model -- Appendix M. Non death disposition - short run subsample hierarchical logistic multivariate model -- Appendix N. Length of stay - short run full sample hierarchical negative binomial multivariate model -- Appendix O. Length of stay - short run subsample hierarchical negative binomial multivariate -- Appendix P. Log total charges - short run full sample hierarchical ordinary least squares multivariate model -- Appendix Q. Log total charges - short run subsample hierarchical ordinary least squares multivariate model
Control code
801094453
Dimensions
unknown
Extent
1 online resource (149 pages)
File format
one file format
Form of item
online
Level of compression
mixed
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
color illustrations
Quality assurance targets
not applicable
Specific material designation
remote
System control number
(OCoLC)801094453
System details
  • The full text of the dissertation is available as an Adobe Acrobat .pdf file; Adobe Acrobat Reader required to view the file
  • Mode of access: World Wide Web
Label
A Medicare benefit expansion : inpatient clinical and economic outcomes in deep brain stimulation for Parkinson's Disease, Jane Castelli Haley, (electronic resource)
Publication
Note
  • "A dissertation in Public affairs and administration and Economics."
  • Advisor: Rafia Rasu
  • Vita
Antecedent source
not applicable
Bibliography note
Includes bibliographical references (pages 128-134)
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
black and white
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Contents
Introduction and problem statement -- Literature review -- Methods and hypotheses -- Results -- Hierarchical specification -- Discussion and implication -- Conclusions -- Appendix A. Data dictionary -- Appendix B. Complications - long run without physician variable -- Appendix C. Complications - long run with physician influence -- Appendix D. Non death disposition - long run full sample -- Appendix E. Non death disposition - long run with physician influence -- Appendix F. Length of stay - long run without physician influence -- Appendix G. Length of stay - long run with physician influence -- Appendix H. Log total charges - long run full sample -- Appendix L. Log total charges - long run subsample -- Appendix J. Complications -- short run full sample hierarchical logistic multivariate model -- Appendix K. Complications - short run subsample hierarchical logistic multivariate model -- Appendix L. Non death disposition - short run full sample hierarchical logistic multivariate model -- Appendix M. Non death disposition - short run subsample hierarchical logistic multivariate model -- Appendix N. Length of stay - short run full sample hierarchical negative binomial multivariate model -- Appendix O. Length of stay - short run subsample hierarchical negative binomial multivariate -- Appendix P. Log total charges - short run full sample hierarchical ordinary least squares multivariate model -- Appendix Q. Log total charges - short run subsample hierarchical ordinary least squares multivariate model
Control code
801094453
Dimensions
unknown
Extent
1 online resource (149 pages)
File format
one file format
Form of item
online
Level of compression
mixed
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
color illustrations
Quality assurance targets
not applicable
Specific material designation
remote
System control number
(OCoLC)801094453
System details
  • The full text of the dissertation is available as an Adobe Acrobat .pdf file; Adobe Acrobat Reader required to view the file
  • Mode of access: World Wide Web

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