Development and validation of 15-month mortality prediction models: a retrospective observational comparison of machine-learning techniques in a national sample of Medicare recipients.

Objective: The objective is to develop and validate a predictive model for 15-month mortality using a random sample of community-dwelling Medicare beneficiaries.

Data Source: The Centres for Medicare & Medicaid Services' Limited Data Set files containing the five per cent samples for 2014 and 2015.

Participants: The data analysed contains de-identified administrative claims information at the beneficiary level, including diagnoses, procedures and demographics for 2.

Clinical metric and medication persistency effects: evidence from a Medicaid care management program.

The objective was to estimate clinical metric and medication persistency impacts of a care management program. The data sources were Medicaid administrative claims for a sample population of 32,334 noninstitutionalized Medicaid-only aged, blind, or disabled patients with diagnosed conditions of asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, or heart failure between 2005 and 2009. Multivariate regression analysis was used to test the hypothesis that exposure to a care management intervention increased the likelihood of having the appropriate medication or procedures performed, as well as increased medication persistency.

Dose-response effects for depression and Schizophrenia management on hospital utilization in Illinois Medicaid: a multivariate regression analysis.

Background: The prevalence of schizophrenia and depression in the United States is far higher among Medicaid recipients than in the general population. Individuals suffering from mental illness, including schizophrenia and depression, also have higher rates of emergency department utilization, which is costly and may not generate the positive health outcomes desired. Disease management programs strive to help individuals suffering from chronic illnesses better manage their condition(s) and seek health care in the appropriate settings.

Dose-response effects for disease management programs on hospital utilization in Illinois Medicaid.

The objective of this study is to estimate a dose-response impact of disease management contacts on inpatient admissions. Multivariate regression analysis of panel data was used to test the hypothesis that increased disease management contacts lower the odds of an inpatient admission. Subjects were 40,452 members of Illinois' noninstitutionalized Medicaid-only aged, blind, or disabled population diagnosed with asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, and/or heart failure.

An intervention for VA patients with congestive heart failure.

Objective: To assess the effect of a telephone intervention to improve quality of life among patients with congestive heart failure (CHF).

Study Design: Prospective randomized study.

Methods: Single-site recruitment of 458 patients using Veterans Health Administration care into a randomized controlled trial with a 1-year preintervention data collection period and a 1-year intervention and follow-up period.

Diabetes disease management results in Hispanic Medicaid patients.

Objectives: To investigate outcomes of a telephonic nursing disease management program for Medicaid patients with diabetes residing in Puerto Rico.

Study Design: A 12-month, matched-cohort study.

Study Population: Four hundred and ninety (490) intervention group members matched to 490 controls.

Cost and utilization avoidance with mail prompts: a randomized controlled trial.

Objective: To study the medical service utilization changes and return on investment from a health plan's direct mailings that either encouraged members to receive influenza vaccinations or encouraged members to call a nurse advice service.

Study Design: Randomized controlled trial with 2 intervention groups and 1 control group consisting of all members over age 65 years who were enrolled in 5 states in the Blue Cross and Blue Shield Government-wide Service Benefit Plan. Sample size was 134,791 individuals.

Understanding patient risk and its impact on chronic and non-chronic member trends.

A common method of performing commercial and government (ie, Medicare, Medicaid) disease management (DM) program savings evaluations--and the basis of DMAA's Guidelines--is the adjusted historical control method. This method uses a trend adjustment to adjust for the effects of utilization and unit cost changes over time. An appropriate trend adjuster is one that is based on a population with a constant-risk profile, so that utilization and price effects may be measured without being confounded by population changes.

Opening the door to coordination of care through teachable moments.

The challenge for care coordination is to identify members at a moment in time when they are receptive to intervention and provide the appropriate care management services. This manuscript describes a pilot program using inbound nurse advice calls from members to engage them in a care management program including disease management (DM). Annual medical claims diagnoses were used to identify members and their associated disease conditions.

Evaluation of a medicaid asthma disease management program.

This study evaluates 1-year outcomes of an asthma disease management program implemented in an Oregon Medicaid population. A non-randomized pre-post study, a matched case-control study, and a "programmatic effects" analysis were conducted. Compared to matched controls, the treatment cohort had significantly fewer emergency room visits per thousand (7 vs.

Health services outcomes for a diabetes disease management program for the elderly.

Our objective was to investigate the utilization, drug, and clinical outcomes of a telephonic nursing disease management (DM) program for elderly patients with diabetes. We employed a 24-month, matched-cohort study employing propensity score matching. The setting involved Medicare + Choice recipients residing in Ohio, Kentucky, and Indiana.

A matched-cohort study of utilization outcomes for an adult medicaid population enrolled in an asthma disease management program.

Few studies have examined the clinical and utilization impact of asthma disease management programs for Medicaid beneficiaries. This study examines utilization and clinical outcomes for an adult group of low- to moderate-risk patients with asthma. Propensity scores are used to construct matched samples of treated-control pairs in order to establish equivalent comparison groups and evaluate the effects of program participation.

What can a pilot congestive heart failure disease management program tell us about likely return on investment?: A case study from a program offered to federal employees.

In 1999, the Blue Cross and Blue Shield Federal Employee Program (FEP) implemented a pilot disease management program to manage congestive heart failure (CHF) among members. The purpose of this project was to estimate the financial return on investment in the pilot CHF program, prior to a full program rollout. A cohort of 457 participants from the state of Maryland was matched to a cohort of 803 nonparticipants from a neighboring state where the CHF program was not offered.

The National Program of Cancer Registries: explaining state variations in average cost per case reported.

Introduction: The Centers for Disease Control and Prevention's National Program of Cancer Registries is a federally funded surveillance program that provides support and assistance to state and territorial health departments for the operation of cancer registries. The objective of this study was to identify factors associated with the Centers for Disease Control and Prevention's costs to report cancer cases during the first 5 years of the National Program of Cancer Registries.

Methods: Information on expenditures and number of cases reported through the National Program of Cancer Registries was used to estimate the average cost per case reported for each state program.

A matched-cohort study of health services utilization outcomes for a heart failure disease management program.

Chronic disease is the leading cause of illness, disability, and death in the United States, affecting nearly 100 million Americans. Heart failure alone affects nearly 4.9 million Americans, with another 550,000 newly diagnosed cases each year.

Reducing medical service utilization by encouraging vaccines: randomized controlled trial.

Background: Vaccination against influenza is associated with reductions in hospitalizations for heart disease, cerebrovascular disease, pneumonia, or influenza, and the risk of death from all causes during the influenza season.

Design: Randomized controlled trial.

Participants: All members enrolled in the Blue Cross Blue Shield Association's Government Wide Service Benefit Program in the states of Oklahoma, Rhode Island, Kentucky, California, Arizona, Utah, and Colorado in October 2002.

A matched-cohort study of health services utilization and financial outcomes for a heart failure disease-management program in elderly patients.

Objectives: To investigate the utilization and financial outcomes of a telephonic nursing disease-management program for elderly patients with heart failure.

Design: A 1-year concurrent matched-cohort study employing propensity score matching.

Setting: Medicare+Choice recipients residing in Ohio, Kentucky, and Indiana.

Endogeneity bias in the absence of unobserved heterogeneity.

Purpose: To demonstrate that endogeneity bias can still arise even when no unobserved heterogeneity exists.

Methods: A formal mathematical proof and a Monte Carlo simulation are used to demonstrate that ordinary estimation techniques will generate biased parameter estimates.

Results: The Monte Carlo results support the formal proof.

Determinants of hospital length of stay for cervical dysplasia and cervical cancer: does managed care matter?

Objective: To examine whether type of health insurance plan, among other variables, affects the length of stay for cervical cancer-related hospitalizations.

Study Design, Patients, And Methods: Inpatient admission claims records for cervical dysplasia and cervical cancer were selected for 1994-1997 from the MarketScan private health insurance claims database. After identifying records by stage of disease and deleting records for pregnant women, 1145 unique patient records were used in a truncated count regression model to analyze the predictors of hospital length of stay.

Diabetes disease management in a community-based setting.

Purpose: The medical cost of diabetes in the United States in 1997 was at least $98 billion. This study illustrates the behavioral change and medical-care utilization impact that occurs in a community-based setting of a diabetes disease-management program that is applied to program participants in a health insurance plan's health maintenance organization and preferred provider organization.

Design: A historical control comparison of diabetes-management participants.