Assessment and prediction of costs and adverse health outcomes in COPD

评估和预测慢性阻塞性肺病的费用和不良健康结果

• 批准号: 7539710
• 负责人: Theodore A Omachi
• 金额: $ 5.67万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-01 至 2009-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7539710
• 关键词: Assessment; prediction; costs; adverse; health

DESCRIPTION (provided by the applicant): Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the United States and adds substantial economic burden to a health care system that is already under significant strain. To efficiently allocate our limited resources to maximize the overall health of our population, we must have a strong understanding of the total cost burden of this disease, including not only direct costs but also indirect costs such as lost work productivity. Moreover, having well-tested models which predict costs and adverse health outcomes is important in targeting disease management programs and, within a research context, when investigators are trying to understand the impact of a new exposure or intervention. Furthermore, risk adjustment for likely costs is critical in capitated payment mechanisms to discourage providers and insurers from avoiding high-cost patients and in risk-adjusting cost-efficiency evaluations of physicians. Poor risk adjustment methods may leave sicker patients with a dearth of physician and insurance-coverage options. The proposed study would add additional analyses and data collection to a parent study which has collected baseline survey and diagnostic testing information on a cohort of 1202 COPD subjects and 302 controls within Kaiser Permanente, a large integrated health system. The proposed study will first provide an assessment of both the direct and indirect costs for these subjects subsequent to their baseline assessment. We will utilize Kaiser's Cost Management Information System to determine direct costs. Indirect costs will be assessed with follow-up telephone surveys, using techniques similar to those employed by the applicant's research mentors in their examination of the indirect costs of asthma. Our second aim will then be to develop prediction-models for both costs and, as a secondary outcome, adverse health outcomes. These models will utilize both traditional measures used within risk-adjustment, such as sociodemographics and comorbidity data, and then test the additional predictive value of a multifaceted approach to measuring COPD severity. RELEVANCE: COPD is a leading cause of death and disability in the United States and adds substantial economic burden to a health care system which is already under considerable strain. Understanding the factors that drive costs in COPD, both costs borne by the institutions and by individuals, is critical to our ability to utilize our resources where they are needed most. Moreover, developing a transparent process to allow health care payers, such as the government, to predict which patients are likely to be the most costly will allow us to adjust payments to health insurers to discourage them from avoiding the sickest patients.

描述(由申请人提供)：慢性阻塞性肺疾病(COPD)是美国主要的死亡和残疾原因，给已经处于巨大压力下的医疗保健系统增加了巨大的经济负担。为了有效地分配我们有限的资源，以最大限度地提高我们人口的整体健康，我们必须对这种疾病的总成本负担有深刻的了解，不仅包括直接成本，而且还包括间接成本，如丧失工作生产率。此外，拥有经过良好测试的预测成本和不良健康结果的模型，对于针对疾病管理计划以及在研究背景下，当调查人员试图了解新的暴露或干预的影响时，是重要的。此外，对可能成本的风险调整在大写支付机制中至关重要，以阻止提供者和保险公司避免高成本患者，并在对医生进行风险调整成本效益评估时。糟糕的风险调整方法可能会让病情较重的患者缺乏医生和保险覆盖选择。这项拟议的研究将在一项母研究的基础上增加额外的分析和数据收集，该研究收集了大型综合卫生系统Kaiser Permanente内的1202名COPD患者和302名对照的基线调查和诊断测试信息。拟议的研究将首先在基线评估之后对这些对象的直接和间接费用进行评估。我们将利用凯撒的成本管理信息系统来确定直接成本。间接成本将通过后续电话调查进行评估，使用的技术类似于申请者的研究导师在检查哮喘间接成本时所使用的技术。然后，我们的第二个目标将是开发成本预测模型，并作为次要结果，开发不利的健康后果。这些模型将利用风险调整中使用的两种传统方法，如社会人口学和共病数据，然后测试多方面方法测量COPD严重性的额外预测价值。 相关性：慢性阻塞性肺病是美国死亡和残疾的主要原因，并给已经处于相当大压力下的医疗保健系统增加了巨大的经济负担。了解推动慢性阻塞性肺病成本的因素，包括机构和个人承担的成本，对于我们在最需要的地方利用我们的资源的能力至关重要。此外，开发一个透明的流程，允许政府等医疗保健支付者预测哪些患者可能是最昂贵的，这将使我们能够调整对医疗保险公司的支付，以阻止他们避开病情最严重的患者。