Quality Process Measures for Rheumatoid Arthritis: Performance from Members Enrolled in a National Health Plan

Tkacz, Joseph; Ellis, Lorie; Meyer, Richard W.; Bolge, S.; Brady, Brenna L.; Ruetsch, Charles

doi:10.18553/jmcp.2015.21.2.135

Cited by 3 publications

(5 citation statements)

References 35 publications

(31 reference statements)

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“…Members were predominately female, living mainly in the mid-American and the Southeastern regions of the United States, with a mean age of 52.8. 19 Demographic analyses by measure qualification groups revealed that members in the non-qualifying groups were generally older and had reduced overall health, indicated by a higher Charlson comorbidity index score. Additionally, for all measures with the exception of 0601, which only included new RA members, individuals in the qualifying groups were significantly more likely to be treated with biologic therapy than those in the non-qualifying groups ( P s < 0.05).…”

Section: Resultsmentioning

confidence: 99%

“…Measure numerators and denominators in this data set were calculated and reported previously. 19 As inclusion requirements for each numerator and denominator are independent for each measure, there is no common group of patients who meet the measures. Therefore, analyses were conducted for each measure individually ( Tables 2 and 3 ), and total costs and service utilization rates for all measure groups were summed across all measures to obtain the proportion of total costs contributed by each group ( Table 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…The study team has previously defined 8 process measures endorsed by the NQF from December 4, 2009, to July 21, 2014, for use with administrative claims data. 19 Currently, the association between health care costs and quality of care remains unclear, with studies reporting both positive and negative correlations between cost and quality. 20 The purpose of the present study is to examine the relationship between RA quality process measures and health care expenditures among a commercially insured sample of RA patients using administrative claims data.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs

Brady

Tkacz

Meyer

et al. 2017

Population Health Management

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The objective was to examine the relationship between health care costs and quality in rheumatoid arthritis (RA). Administrative claims were used to calculate 8 process measures for the treatment of RA. Associated health care costs were calculated for members who achieved or did not achieve each of the measures. Medical, pharmacy, and laboratory claims for RA patients (International Classification of Diseases, Ninth Revision, Clinical Modification 714.x) were extracted from the Optum Clinformatics Datamart database for 2011. Individuals were predominately female and in their mid-fifties. Measure achievement ranged from 55.9% to 80.8%. The mean cost of care for members meeting the measure was $18,644; members who did not meet the measures had a mean cost of $14,973. Primary cost drivers were pharmacy and office expenses, accounting for 42.4% and 26.3% of total costs, respectively. Regression analyses revealed statistically significant associations between biologic usage, which was more prevalent in groups attaining measures, and total expenditure across all measures (Ps < 0.001). Pharmacy costs were similar between both groups. Individuals meeting the measures had a higher proportion of costs accounted for by office visits; those not meeting the measures had a higher proportion of costs from inpatient and outpatient visits. These findings suggest that increased quality may lead to lower inpatient and outpatient hospital costs. Yet, the overall cost of RA care is likely to remain high because of intensive pharmacotherapy regimens.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs

Brady

Tkacz

Meyer

et al. 2017

Population Health Management

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“…Database analyses come with inherent limitations, and use of secondary data, without direct involvement of the patient or physician, may decrease confidence in the conclusions drawn [ 26 , 27 ]. Insurance claims data depend on professional ICD coding, and, given the complexity of the disease process, it must be recognized that accurate diagnosis of IPF can be challenging [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic burden of idiopathic pulmonary fibrosis: a retrospective cohort study

Raimundo¹,

Chang

Broder

et al. 2016

BMC Pulm Med

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BackgroundIdiopathic pulmonary fibrosis (IPF) is a devastating condition with a variable course. Not uncommonly, IPF patients are hospitalized for respiratory-related causes, including disease worsening. This study aimed to characterize the prevalence, and economic and health care burden of IPF.MethodsRetrospective insurance claims data collected yearly between January 1, 2009 and December 31, 2011, were used to determine prevalence and calculate all-cause and respiratory-related resource utilization and costs. Patients had at least one inpatient claim or two outpatient claims for IPF (ICD-9-CM code 516.3). Results for health care burden are reported for the 2011 cohort (similar findings in 2009–2010). Costs are reported in 2011 US dollars ($).ResultsPatients with IPF had a mean age of 69.8–71.3 years. Overall prevalence for IPF was 28.8, 28.1 and 19.8 per 100,000 insured persons in 2009, 2010 and 2011. In each year, prevalence increased with age. In 2011, 37.7 % of patients were hospitalized at least once for any cause; 19.5 % for respiratory-related reasons. Also in 2011, the mean number of all-cause outpatient visits and respiratory-related office visits was 18.5 and 5.7 per patient, respectively. All-cause health care costs in 2011 were $59,379 per patient; 36.6 % of costs ($21,732) were respiratory related.ConclusionsThe prevalence of IPF in this claims database increased with age, with a notable increase in those over 65 years. IPF is associated with a large economic and health care burden. Additional research is needed to determine how such burden might be reduced.

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“…We conducted a retrospective cohort descriptive analysis using administrative health data from the Clinformatics Data Mart (OptumInsight, Eden Prairie, MN) database. This database is from one of the nation's largest commercial health insurers and has been used to examine treatments in numerous epidemiologic and health service studies [21][22][23]. Persons covered by this insurer are enrolled in a fee-for-service or managed care plan (health maintenance organizations, preferred provider organizations, and exclusive provider organizations).…”

Section: Methodsmentioning

confidence: 99%

What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance

Baker

Stevans

Terhorst

et al. 2018

PM&R

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Background Treatment of carpal tunnel syndrome (CTS) in commercially insured patients across the spectrum of provider types has rarely been described. Objective The purpose of this study was to describe patterns of types of treatment for patients with CTS using a large commercial insurance database. Design Retrospective cohort descriptive study Setting Administrative health data from the Clinformatics® Datamart (OptumInsight, Eden Prairie, MN). Patients Adults with a primary diagnosis of CTS seen from between January, 2010 to December, 2012 who had a total of 48 months of continuous data (12 months prior to diagnosis and 36 months after diagnosis) (n = 24,931). Outcomes Frequency of types of treatment (heat, manual therapy, positioning, steroid, stretching, surgery) by number of treatments, number of visits, provider type, and characteristics. Results Fifty-three percent of patients received no reported treatment and 50.4% had no additional visits. Surgery (42.5%) and positioning (39.8%) were the most frequent single treatments. Patients who were seen by orthopedist for their first visit more frequently received some treatment (75.1%) and at least one additional visit (74.1%) compared to those seen by general practitioners (59.5%, 57.5% respectively) or other providers (65.4%, 68.4 respectively). Orthopedists more frequently prescribed positioning devices (26.8%) and surgery (36.8%) than general practitioners (18.8%, 14.1%, respectively) or other providers (15.7%, 19.7%, respectively). Older adults more frequently had CTS surgery as did people who lived in the Midwest. Overall, only 24% of CTS patients had surgery. Conclusions For more than half of patients with CTS no treatment was provided after an initial visit. Surgery rates were much lower than what has previously been reported in the literature. Generally, patients with CTS receive treatments that are supported by current treatment guidelines.

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Quality Process Measures for Rheumatoid Arthritis: Performance from Members Enrolled in a National Health Plan

Cited by 3 publications

References 35 publications

Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs

Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs

Clinical and economic burden of idiopathic pulmonary fibrosis: a retrospective cohort study

What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance

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