Modeling Semicontinuous Longitudinal Expenditures: A Practical Guide

Smith, Valerie A.; Maciejewski, Matthew L.; Olsen, Maren K.

doi:10.1111/1475-6773.12815

Cited by 20 publications

(18 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Statistical Analysis To adjust for differences in the case-mix of patients assigned to different provider types, the association between provider type and utilization and cost outcomes was examined via multivariable logistic, negative binomial, truncated negative binomial, or marginalized zero-inflated negative binomial regression models; 31 log-skew-normal marginalized two-part models; or generalized linear models using a gamma distribution, as appropriate for each outcome. 32,33 Regression models with covariate adjustment, as opposed to inverse probability of treatment weighted models, were used for consistency because weighted versions have not yet been developed for use with marginalized zero-inflated models and marginalized two-part models. These regression models were used for key outcomes related to endocrinology use and inpatient hospitalization expenditures.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients

et al. 2019

Self Cite

View full text Add to dashboard Cite

Because of workforce needs and demographic and chronic disease trends, nurse practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care of medically complex patients with chronic conditions. Research shows good quality outcomes, but concerns persist that NPs' and PAs' care of vulnerable populations could increase care costs compared to the traditional physician-dominated system. We used 2012-13 Veterans Affairs data on a cohort of medically complex patients with diabetes to compare health services use and costs depending on whether the primary care provider was a physician, NP, or PA. Case-mix-adjusted total care costs were 6-7 percent lower for NP and PA patients than for physician patients, driven by more use of emergency and inpatient services by the latter. We found that use of NPs and PAs as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs.

show abstract

Section: Study Data and Methodsmentioning

confidence: 99%

Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…In adjusted analyses, we estimated mean total health care costs and ambulatory costs by comorbidity group, using generalized linear models (GLMs) with a gamma distribution and a log link. GLM fitted values were generated by using the recycled predictions method [ 20 , 21 ]. Because only a subset of patients used inpatient, ED, and prescription drugs, we performed two-part models to estimate each cost component.…”

Section: Methodsmentioning

confidence: 99%

Comorbidity Type and Health Care Costs in Type 2 Diabetes: A Retrospective Claims Database Analysis

2018

View full text Add to dashboard Cite

IntroductionPrevious studies suggest that the type and combination of comorbidities may impact diabetes care, but their cost implications are less clear. This study characterized how diabetes patients’ health care utilization and costs may vary according to comorbidity type classified on the basis of the Piette and Kerr framework.MethodsWe conducted a retrospective observational study of privately insured US adults newly diagnosed with type 2 diabetes (n = 138,466) using the 2014–2016 Optum Clinformatics® Data Mart. Diabetes patients were classified into five mutually exclusive comorbidity groups: concordant only, discordant only, both concordant and discordant, any dominant, and none. We estimated average health care costs of each comorbidity group by using generalized linear models, adjusting for patient demographics, region, insurance type, and prior-year costs.ResultsMost type 2 diabetes patients had discordant conditions only (27%), dominant conditions (25%), or both concordant and discordant conditions (24%); 7% had concordant conditions only. In adjusted analyses, comorbidities were significantly associated with higher health care costs (p < 0.0001) and the magnitude of the association varied with comorbidity type. Diabetes patients with dominant comorbidities incurred substantially higher costs ($38,168) compared with individuals with both concordant and discordant conditions ($20,401), discordant conditions only ($9173), concordant conditions only ($9000), and no comorbidities ($3365). More than half of the total costs in our sample (53%) were attributable to 25% of diabetes patients who had dominant comorbidities.ConclusionsDiabetes patients with both concordant and discordant conditions and with clinically dominant conditions incurred substantially higher health costs than other diabetes patients. Our findings suggest that diabetes management programs must explicitly address concordant, discordant, and dominant conditions because patients may have distinctly different health care needs and utilization patterns depending on their comorbidity profiles. The Piette and Kerr framework may serve as a screening tool to identify high-need, high-cost diabetes patients and suggest targets for tailored interventions.FundingSanofi.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0477-2) contains supplementary material, which is available to authorized users.

show abstract

“…I estimate an uncorrelated (hybrid) 6 TPM for longitudinal data (Smith, Maciejewski, and Olsen 2018):…”

Section: Methodsmentioning

confidence: 99%

The decentralisation of death? Local budgets and organised crime violence

Arends

2020

J. Pub. Pol.

View full text Add to dashboard Cite

Fiscal decentralisation theory calls for enhanced local revenue and spending responsibilities to promote the efficiency of public service delivery. However, some have pointed to the danger of local capture cancelling out these effects. I examine the argument that organised crime violence (OCV) intensifies as mafias fight for access to local government resources, which they consider an attractive income source. I regress violence on local spending (LS) in Mexican municipalities over the period 1995–2015. I find a significant relationship between LS and the intensity of violence: higher levels of LS per capita are strongly related to higher homicide rates, conditional on them being positive. However, LS does not determine the probability of OCV taking place in the first place. The results suggest that caution should be exercised when initiating decentralisation reforms in the context of local capture and OCV.

show abstract

Modeling Semicontinuous Longitudinal Expenditures: A Practical Guide

Abstract: Researchers should consider which modeling strategy for longitudinal expenditure outcomes is both consistent with research aims and appropriate for the data at hand.

Cited by 20 publications

References 35 publications

Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients

Impact Of Physicians, Nurse Practitioners, And Physician Assistants On Utilization And Costs For Complex Patients

Comorbidity Type and Health Care Costs in Type 2 Diabetes: A Retrospective Claims Database Analysis

The decentralisation of death? Local budgets and organised crime violence

Contact Info

Product

Resources

About