RESUMEN
PURPOSE: To investigate the population-based prevalence of keratoconus in US individuals aged 65 years and older. DESIGN: Multiyear retrospective cross-sectional claims analysis. METHODS: Fee-for-service claims from a 5% national sample of Medicare beneficiaries aged 65 years and older were reviewed. Claims records were queried on an annual basis for the years 1999 through 2003 for ICD-9 codes specific to keratoconus. The number of beneficiaries with keratoconus-related claims was counted for each calendar year. RESULTS: The number of beneficiaries receiving care for keratoconus rose steadily from 15.7/100,000 beneficiaries in 1999 to 18.5/100,000 in 2003, averaging 17.5/100,000 across the 5 years of the study. Keratoconus rates declined with increasing age but did not differ by gender. Keratoconus care was more prevalent in whites than in other races. CONCLUSIONS: Keratoconus is an uncommon disease in the Medicare population. Longitudinal analysis of Medicare claims data may provide a useful tool for monitoring uncommon diseases, such as keratoconus, in the elderly.
Asunto(s)
Queratocono/epidemiología , Medicare/estadística & datos numéricos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Población Negra/estadística & datos numéricos , Estudios Transversales , Humanos , Queratocono/etnología , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: In Georgia an estimated 32% of blacks and 28% of whites have high blood pressure. In 2004 the rate of death from stroke in Georgia was 12% higher than the national average, and blacks in the state have a 1.4 times greater rate of death from stroke than that of whites. CONTEXT: The Georgia legislature funds the Stroke and Heart Attack Prevention Program (SHAPP) to provide treatment and medications for indigent Georgians. The median rate of blood pressure (BP) control among SHAPP enrollees is approximately 60%, compared with the national average of 35%. METHODS: SHAPP was evaluated through interviews with key health care and administrative staff and through focus groups of patients in two clinics. CONSEQUENCES: Outcomes for patients were increased knowledge of their BP and improved compliance with taking medication and keeping clinic appointments. INTERPRETATION: Successful components of SHAPP include an easy enrollment process; affordable medication; use of evidence-based, documented protocols and patient tracking systems; routine follow-up of patients; and effective communication between staff and patients. Challenges and recommendations for improvement are identified.
Asunto(s)
Hipertensión/prevención & control , Hipertensión/fisiopatología , Pobreza , Servicios Preventivos de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , Antihipertensivos/economía , Antihipertensivos/uso terapéutico , Presión Sanguínea/fisiología , Centros Comunitarios de Salud/organización & administración , Georgia , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Hipertensión/tratamiento farmacológico , Cooperación del Paciente , Resultado del TratamientoRESUMEN
Better measurement of the case-mix complexity of patients receiving rehabilitation services is critical to understanding variations in the outcomes achieved by patients treated in different postacute care (PAC) settings. The Medicare program recognized this issue and is undertaking a major initiative to develop a new patient-assessment instrument that would standardize case-mix measurement in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies. The new instrument, called the Continuity Assessment Record and Evaluation Tool, builds on the scientific advances in measurement to develop standard measures of medical acuity, functional status, cognitive impairment, and social support related to resource need, outcomes, and continuity of care for use in all PAC settings.
Asunto(s)
Continuidad de la Atención al Paciente/tendencias , Reforma de la Atención de Salud , Política de Salud , Medicare/tendencias , Rehabilitación/tendencias , Continuidad de la Atención al Paciente/economía , Humanos , Medicare/economía , Sistema de Pago Prospectivo , Rehabilitación/normas , Estados UnidosRESUMEN
INTRODUCTION: Hypertension is a leading cause of stroke, coronary artery disease, heart attack, and heart and kidney failure in the United States, all of which contribute to the rising costs of health care. The Georgia Stroke and Heart Attack Prevention Program is an education and direct service program for low-income patients with hypertension. This project evaluated the cost-effectiveness of the program compared with the following two alternative scenarios: no treatment for high blood pressure and the typical hypertension treatment received in the private sector nationwide (usual care). METHODS: We estimated the preventive treatment costs and number of adverse health events averted (hemorrhagic and ischemic stroke, heart disease, and kidney failure) associated with the Georgia Stroke and Heart Attack Prevention Program in two Georgia health districts. We used program cost and service usage data obtained from the Georgia Department of Human Resources and probabilities and costs of expected adverse events published in peer-reviewed sources. We compared program costs and number of expected adverse health events averted with those expected from 1) no preventive care and 2) usual care for high blood pressure. RESULTS: The Georgia Stroke and Heart Attack Prevention Program was less costly and resulted in better health outcomes than either no preventive care or usual care. Compared with no preventive care in the two districts, the program was estimated to result in 54% fewer expected adverse events; compared with usual care, the program was estimated to result in 46% fewer expected adverse events. Combining the costs of preventive treatment with the costs of expected adverse events, the Georgia Stroke and Heart Attack Prevention Program cost an average of 486 dollars per patient annually, compared with average annual costs of 534 dollars for no care and 624 dollars for usual care. CONCLUSION: Maintaining a publicly financed stroke and heart attack prevention program is more cost-effective and results in greater health benefits than other plausible scenarios. Because the benefits of this program accrue to both the state and federal governments through reduced Medicaid and indigent care expenditures, both the state and federal governments have a financial incentive to support the program.