Research Informs Opportunities for Targeting Efforts to Improve Quality and Control Avoidable Health Care Spending for Medicaid’s Highest-Cost Subsets

Medicaid beneficiaries with disabilities frequently have multiple chronic conditions, and very high rates of psychiatric illness and cardiovascular disease, according to a study released today by the Center for Health Care Strategies. As national policymakers debate health reform, The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions provides insights for targeting efforts to improve care and control spending for Medicaid’s highest-need, highest-cost beneficiaries. These insights are relevant and applicable to other populations and patients with multiple complex comorbidities. The study was funded through a grant from Kaiser Permanente.

Building on an earlier analysis that examined one year of national Medicaid diagnostic data, this new study adds two data sets — pharmacy claims and five years of diagnostic data — to further refine what is known about Medicaid beneficiaries with chronic needs. The study, conducted by Rick Kronick, Ph.D., and Todd Gilmer, Ph.D., both from the University of California, San Diego, sought to expand the knowledge base regarding the prevalence and patterns of chronic conditions among Medicaid beneficiaries.

“Analyzing prescription drug use in addition to diagnostic claims identifies considerably more beneficiaries with comorbidities, and notably, a significant increase in patients with behavioral health issues,” said Dr. Kronick. “By expanding these insights into the population’s complex needs, this work can help Medicaid stakeholders in designing tailored care management interventions for patients with multiple chronic conditions.”

Compared to solely looking at diagnostic data, the addition of pharmacy data reveals higher rates of comorbidity among Medicaid beneficiaries with disabilities, including significantly higher prevalence of psychiatric illness and cardiovascular disease. Following are highlighted findings resulting from the addition of pharmacy data:

– The proportion of Medicaid beneficiaries with disabilities who are diagnosed with three or more chronic conditions increases from 35 percent to 45 percent.
– The frequency of psychiatric illness among Medicaid beneficiaries with disabilities increases from 29 percent to 49 percent. Similarly, the prevalence of cardiovascular disease increases from 32 percent to 44 percent.
– Costs for Medicaid-only beneficiaries with three or more chronic conditions increases from 66 percent to 75 percent of total spending for beneficiaries with disabilities.

Pharmacy data was particularly valuable in illustrating the prevalence of psychiatric illness in high-cost Medicaid beneficiaries. Examining diagnostic and pharmacy data together, psychiatric illness is represented in three of the top five most common pairs of diseases among the highest-cost 5 percent of Medicaid-only beneficiaries with disabilities. This was not apparent using diagnostic data alone.

“These patients account for much of the cost and use of services in Medicaid, and require special attention, considerable resources and an intensive approach to care management,” said Raymond J. Baxter, PhD, senior vice president, Community Benefit, Research and Health Policy, Kaiser Permanente. “This report contributes significantly to the body of information about how to understand and improve the care of patients with complex, chronic conditions.”

The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions is the third edition in CHCS’ Faces of Medicaid series. It is available for download at www.chcs.org.

Source: Kaiser Permanente


FDA approves new treatment for advanced form of kidney cancer

  • Author: Health Informer
  • Filed under: Health News
  • Date: Oct 20,2009

The U.S. Food and Drug Administration today approved Votrient (pazopanib), the sixth drug to be approved for kidney cancer since 2005.

Votrient is an oral medication that interferes with angiogenesis, the growth of new blood vessels needed for solid tumors to grow and survive.

Votrient is intended for people with advanced renal cell carcinoma, a type of kidney cancer in which the cancerous cells are found in the lining of very small tubes (tubules) in the kidney. In 2009, approximately 49,000 people were diagnosed with renal cell carcinoma and 11,000 people died from the disease.

“The last five years have seen dramatic improvements in treatment options for patients with kidney cancer. Before 2005, the options available offered only limited effectiveness,” said Richard Pazdur, M.D., director, Office of Oncology Drug Products in the FDA’s Center for Drug Evaluation and Research.

The five other drugs approved for kidney cancer and their approval dates are: Sorafenib (December 2005), Sunitinib (January 2006), Temsirolimus (May 2007), Everolimus (March 2009), and Bevacizumab (July 2009).

The safety and effectiveness of Votrient was evaluated in a 435-patient study that examined a patient’s progression-free survival – the length of time, following enrollment in the study, before the tumor began growing again or before the patient died. Progression-free survival averaged 9.2 months for patients receiving Votrient compared to 4.2 months for patients who did not receive the drug.

Adverse reactions included diarrhea, high blood pressure, hair color changes, nausea, loss of appetite, vomiting, fatigue, weakness, abdominal pain and headache. Votrient can also cause severe and fatal liver toxicity. Health care professionals should order blood tests to monitor liver function before and during treatment with the drug. Since Votrient can harm a fetus, it should not be used during pregnancy.

The drug has also been associated with heart rhythm irregularities. Patients receiving Votrient should be monitored with periodic electrocardiograms, which measure heart rhythm, and blood tests to monitor electrolytes since an electrolyte imbalance can lead to an irregular heart rhythm.

Votrient is manufactured by London-based GlaxoSmithKline.

Source: U.S. Food and Drug Administration


In addition, these avoidable infections result in more than $35 billion in societal costs and more than 8 million additional days spent in the hospital

The Alliance for the Prudent Use of Antibiotics (APUA) and Cook County Hospital (currently John H. Stroger, Jr. Hospital of Cook County), announced the release of an eye-opening study on the economic impact of antibiotic overuse and antibiotic-resistant infections (ARIs) sponsored by an unrestricted educational grant from bioMerieux and the Centers for Disease Control and Prevention (CDC).

The authors conducted an exhaustive chart-by-chart review of 1,391 patients hospitalized in the year 2000, 188 of which had ARIs (13.5%). The medical costs attributed to these ARIs ranged from $18,588 to $29,069 per patient, while the duration of hospital stay was extended 6.4 – 12.7 days for affected patients. Additionally, the excess mortality attributed to ARIs alone was 6.5% — a death rate two-fold higher than in patients without ARIs. The authors also estimated the societal costs incurred at this hospital as a result of the ARIs to be between $10.7 and $15 million, which is the cost that hits the families of those infected.

The study, titled “Hospital and Societal Costs of Antimicrobial Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship,” analyzed the medical and human cost associated with ARIs. It was conducted at the Cook County (Stroger) Hospital of Chicago, IL. Several studies have looked at the medical costs of these infections, but this is the first to look at the cost to families as well.

Antibiotic resistance is fueled by misuse and overuse of antibiotics. Bacteria become resistant to the very medicines developed to treat and cure the infection they cause. ARIs include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and a growing number of additional pathogens that are developing resistance to many common antibiotics.

The study will be published in the Oct. 15 issue of Clinical Infectious Diseases, published by the Infectious Disease Society of America.

“The findings indicate that significant health and economic benefits could be realized through effective interventions to reduce antimicrobial-resistant and healthcare-associated infections,” according to Dr. Rebecca Roberts, Department of Emergency Medicine, Cook County (Stroger) Hospital and the lead study author.

“At a time when our country is debating how to deliver better, more affordable care, this study demonstrates the enormous cost savings that could be realized, for both the healthcare system and to individuals and their families. These costs will only continue to increase if we don’t amend our behavior and practice a more prudent usage of antibiotics,” said Dr. Stuart Levy, professor of medicine at Tufts University School of Medicine, a senior author of the paper and co-founder and president of the APUA, which initiated the study in accord with its mission to “preserve the power of antibiotics”.

Extrapolating the costs nationwide

“The results offer some good insight regarding just how much ARIs are costing the nation: not just in terms of dollars, but human life and suffering,” said Dr. Levy. “As the enormous costs identified here are viewed on a national scale, it is clear that effectively addressing the issue of antimicrobial-resistant infection is an essential element for stemming the rising tide of healthcare costs in the United States.”

“Further study is required, specifically to see how much we could save on a national level if we took some basic steps to halt the development of resistant infections and their spread within hospitals,” Dr. Levy said.

Dr. Roberts explained, “If we apply the conservative costs seen in the Cook County (Stroger) Hospital study to all U.S. hospital admissions in the year 2000 and apply the same selection criteria used in that study nationwide, there would have been nearly 900,000 cases of ARIs in the year 2000.” By applying the range of additional costs seen in the Cook County (Stroger) Hospital study of $18,588 to $29,069 to this enormous number of ARIs, we could conceivably avoid $16.6 billion on the low end and up to $26 billion in additional healthcare costs stemming from the treatment of these preventable infections: “Even a 20% reduction in these infections would save between $3.2 and $5.2 billion a year and between 5.7 and 11.3 million additional days in the hospital. Clearly, any discussion of healthcare reform must look at the cost of current clinical practice and the savings we could realize if we used antibiotics more prudently,” noted Dr. Roberts. “Imagine if these hospital beds and healthcare resources were used instead for preventive care or for under-served patients,” she added.

“Assuming 900,000 ARI cases in the year 2000, based on the conservative selection criteria used in our study, the total societal costs of ARIs to U.S. households in the year 2000 was approximately $35 billion,” Dr. Roberts added. “This includes lost wages from extended hospital stays and from premature deaths.”(1)

“Keep in mind these data were collected in 2000, and the rate of notifications of antibiotic resistant cases has more than doubled since then, so these figures should be viewed as very conservative; further work is ongoing to estimate the current burden at state and national levels,” said Prof. Susan Foster, a co-author and health economist at APUA.

“Another mitigating factor that may also cause us to underestimate the true burden is the excellent clinical practice where the study actually occurred,” said Dr. Levy. “To its credit, Cook County (Stroger) Hospital happens to have an enviably low rate of healthcare associated infections, including ARIs.”

A study suggested by the late Senator Edward M. Kennedy

In discussions with the late Senator Edward M. Kennedy on the topic of drug resistance and healthcare, “I spoke frequently with Senator Kennedy about the avoidable costs from the misuse of antibiotics,” Levy said. “Without fail, the senator always concluded our discussions on the topic by telling me that we need to quantify the cost of treating antibiotic-resistant infections in order to make any real progress toward an appropriate policy for antibiotic stewardship. In a very real sense, this study grew from those talks with the late senator.”

“This study is the first to quantify the alarming impact of antibiotic resistant infections on treatment costs and patient outcomes,” said Herb Steward, general manager and executive vice president bioMerieux North America, which funded this study. “It also highlights the vital role of simple, rapid and cost effective diagnostics in order to get the right information to clinicians as fast as possible so they can treat patients appropriately and use antibiotics prudently, while improving care and patient outcomes and reining in unnecessary costs.”

Societal impact more than just financial

“The societal financial impact of $15 million based on just over 188 cases of ARI is an alarming finding,” said Dr. Robert A. Weinstein, interim chairman, Department of Medicine, Cook County (Stroger) Hospital, professor of Medicine at Rush University Medical College, and a senior author and initiator of the project at Cook County (Stroger) Hospital. “Sustaining these kinds of costs is simply not tenable for individual families and for the economy at large. With healthcare reform and the focus on the direct cost of care, this study should remind us that every dollar spent to treat avoidable illness ripples throughout society and has an impact on individual, family, community, and corporate budgets across the nation.”

The additional cost of patient care resulting from ARIs is not the only aspect of this study that has relevance to the ongoing debate over healthcare reform. “One topic that all parties seem to find agreement on is the need to bring healthcare information technology into the 21st century,” said Dr. Weinstein. “We at Cook County (Stroger) Hospital have adopted an electronic medical records system, which made the review of literally thousands of pages of patient records and lab results infinitely easier. However, most hospitals in the U.S. still do not have EMR systems so this kind of review would be nearly impossible.”

“Thanks to the leadership of the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), hospitals like ours have the tools and protocol to track ARIs,” Dr. Weinstein added. “However, this is a voluntary program. Several states mandate that their hospitals comply with NHSN protocols, but most do not. Until we have a uniform standard for reporting and disclosure, we may never know the true cost of these avoidable infections.”

References:

1. Prevention effectiveness: A guide to decision analysis and economic evaluation. 2nd edition. Editors: Haddix AC, Teutsch SM, Corso PS., New York: Oxford University Press 2003:345-57.

Source: bioMerieux


Study shows that diets of infants are improving

  • Author: Health Informer
  • Filed under: Health News
  • Date: Oct 19,2009

Concerns Remain for Toddlers and Preschoolers

Caregivers are feeding infants better diets, but may need more guidance to improve the diets of toddlers and preschoolers

Parents and caregivers are hearing and following the feeding guidance for infants, yet continued work needs to be done to help them also build good eating habits for their growing children, suggests data from the Nestle Feeding Infants and Toddlers Study (FITS) released at a symposium at the American Dietetic Association’s Food & Nutrition Conference & Expo.

The study reveals both progress and areas of concern in the diets of young children in the United States. The data show some positive trends versus 2002 when Gerber Products Company, now part of the Nestle family, first commissioned the FITS study. Infants are being breastfed longer; and fewer infants and toddlers are consuming sweets and sweetened beverages on a given day. However, other findings are less positive — on a given day, many toddlers and preschoolers aren’t eating a single serving of vegetables or fruit; and many toddlers and preschoolers are consuming diets with less than the recommended 30-to-40 percent of calories from fat. Most preschoolers are eating too much saturated fat and sodium.

The FITS findings suggest that more guidance and support is needed to help caregivers better transition from feeding their babies to meeting the unique nutrition and feeding needs of a toddler or preschooler. As a result, too many young children are mirroring the often unhealthy eating patterns of American adults.

Leveraging science to nourish a healthier generation

“Good nutrition from birth through preschool sets the foundation for healthy habits later in life,” said Dr. Kathleen Reidy, Head, Nutrition Science, Meals & Drinks, Nestle Nutrition. “The Nestle FITS data provide a rich source of information and we’ll continue to analyze the data for new insights, sharing and applying our findings to advance the quality of children’s diets.”

Nestle FITS is a dietary intake survey of a large, cross-sectional sample of parents and caregivers that provides a snapshot of the eating patterns and nutrient intakes on a given day of infants, toddlers, and preschoolers living in the United States. Data were collected for a sample of 3,378 children age zero-to-four years and provided important information on what foods are eaten at various different stages of development as children transition from an all milk diet onto the foods of the family. Nestle FITS 2008 is an updated and expanded survey from FITS 2002 that provided dietary data on a sample of 3,000 infants and toddlers age four-to-24 months.

The 2008 study offers a comparison to 2002 for those children age four-to-24 months, and provides new data and insight into the eating patterns and nutrient intakes of children age zero-to-three months and preschoolers. Mathematica Policy Research, a nonpartisan research firm, conducted the study on behalf of Nestle. Mathematica also conducted the FITS 2002 study.

“Parents and caregivers need support and education around the unique nutrition needs of young children,” said Dr. Nancy Butte, PhD. Professor, USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine. “The 2008 FITS data shows us that more feeding guidance is needed during the transition to table foods. We are seeing eating patterns in toddlers and preschoolers that mirror those of adults–24 percent of children ages two-to-five are overweight or obese in the United States. We need to put more focus on establishing healthy eating patterns during the first four years.”

2008 Nestle FITS Study Highlights

– Fewer infants are consuming sweets or sweetened beverages. Seventeen percent of infants age six-to-eight months, consumed a dessert, sweet or sweetened beverage on a given day versus 36 percent in 2002. A similar change was seen for children age nine-to-11 months old, with 43 percent in 2008 versus 59 percent in 2002 consuming any dessert, sweet or sweetened beverage.

– Fruit and vegetable consumption remains a problem for all age groups studied. About 25 percent of older infants, toddlers and preschoolers don’t eat a single serving of fruit on a given day, and 30 percent don’t eat a single serving of vegetables. These findings are similar to those in FITS 2002 for infants and toddlers.

– Fewer toddlers were consuming sweetened beverages in 2008 than in 2002. This was especially true among children age 12-to-14 months (14 percent drank a sweetened beverage on a given day in 2008 versus 29 percent in 2002) and children 18-to-20 months (29 percent in 2008 versus 47 percent in 2002).

– On a given day 23 percent of toddlers 12-to-24 months and one third of preschoolers are consuming diets of less than the recommended 30-to-40 percent of calories from fat. Yet, 75 percent of preschoolers are consuming too much saturated fat.

– Mothers are breastfeeding their children longer. In 2008, 33 percent of nine-to-11 month olds are still receiving breast milk compared to just 21 percent in 2002.

Other survey findings
– French fries are still the most popular vegetable among toddlers and preschoolers. However, among older babies there were improvements, and French fries are no longer ranked in the top five vegetables among infants age nine-to-11 months, compared to FITS 2002, when French fries ranked among the top vegetables in the diets of older infants on a given day.

– There is a significant reduction in the number of infants, age four-to-11 months, consuming juice on a given day, versus 2002.

– A small but important number of older infants are not getting enough iron. Twelve percent of children from six-to-11 months of age are not getting enough iron on a given day.

– Seventy-one percent of toddlers and eighty-four percent of preschoolers consume more sodium than recommended on a given day.

A dietary snapshot by developmental stage

The Nestle FITS 2008 findings provide insight into the diets of children at key developmental stages–infants, toddlers and preschoolers. The good news is that caregivers are hearing and following the feeding guidance for infants, yet FITS 2008 shows that more progress is needed in the diets of toddlers and preschoolers. Compared to FITS 2002, the number of months children breastfeed is longer, which builds the child’s immunity, aids a growing baby’s brain and eye development, and may help to lower the child’s risk of developing allergies and infections. What’s more, the introduction of juice is being delayed for infants, and fewer are consuming French fries, sweetened beverages and sweets on a given day. While FITS 2008 shows positive trends in the diets of infants, the data reveal that some older infants have low intakes of iron and consumption of iron-fortified infant cereal is being stopped earlier.

As infants grow into toddlers, it is clear from the FITS 2008 findings that more nutrition guidance for parents is needed for this important developmental stage. Overall, on a given day, toddlers are meeting most of their nutrient requirements for healthy growth and development, however, FITS data show gaps in the intake of vegetables, fruit, fiber, vitamin E, potassium and total fat. The data reflect promising downward trends among toddlers in the consumption of French fries, sweets and sweetened beverages, but more improvement is needed.

FITS 2008 provides a first-of-its-kind nutrition snapshot of preschoolers (children ages 24-to-48 months). The findings show that on a given day, many preschoolers have unhealthy eating patterns reflective of the diets of older children and adults in the United States. In particular, preschoolers are not consuming enough fruits and vegetables, fiber, potassium and vitamin E and are taking in too much saturated fat and sodium.

Help for parents: Start Healthy, Stay Healthy(TM)

FITS 2002 was the foundation of the Start Healthy, Stay Healthy(TM) nutrition system, Nestle’s patent-pending stage-based nutrition system that combines products, education and services to foster healthy growth and development and the early establishment of healthy eating habits from birth to preschool. Start Healthy, Stay Healthy Milestones Symbols(TM) direct parents to the information and products tailored to their child’s developmental stage. The insights from FITS, along with dietary recommendations from the United States Department of Agriculture (USDA), the National Academy of Sciences/Institute of Medicine (NAS/ IOM) and the American Academy of Pediatrics (AAP) are the foundation of the Start Healthy, Stay Healthy feeding guidelines and resources(1).

1. Not sponsored or endorsed by the USDA, NAS/IOM or AAP

Source: Nestle



Categories

Archives

Blogroll

Meta