| Resource Use Trajectories for Aged Medicare Beneficiaries with Complex Coronary Conditions. | |
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MedLine Citation:
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PMID: 23347002 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use. DATA SOURCES: Medicare inpatient and outpatient claims from 2002 to 2008 for patients receiving multivessel revascularization for symptomatic coronary disease in 2003-2004. STUDY DESIGN: This retrospective cohort study of 102,877 beneficiaries assessed survival, days in institutional settings, and Medicare payments for up to 6 years following receipt of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). METHODS: A three-part estimator designed to provide robust estimates of a treatment's effect in the setting of mortality and censored follow-up was used. The estimator decomposes the treatment effect into effects attributable to survival differences versus treatment-related intensity of resource use. PRINCIPAL FINDINGS: After adjustment, on average CABG recipients survived 23 days longer, spent an 11 additional days in institutional settings, and had cumulative Medicare payments that were $12,834 higher than PCI recipients. The majority of the differences in institutional days and payments were due to intensity rather than survival effects. CONCLUSIONS: In this example, the survival benefit from CABG was modest and the resource implications were substantial, although further adjustments for treatment selection are needed. |
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Authors:
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Jerome J Federspiel; Sally C Stearns; Laura P D'Arcy; Kimberley H Geissler; Christopher A Beadles; Daniel J Crespin; Timothy S Carey; Joseph S Rossi; Brett C Sheridan |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2013-1-24 |
Journal Detail:
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Title: Health services research Volume: - ISSN: 1475-6773 ISO Abbreviation: Health Serv Res Publication Date: 2013 Jan |
Date Detail:
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Created Date: 2013-1-25 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0053006 Medline TA: Health Serv Res Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© Health Research and Educational Trust. |
Affiliation:
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Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC; School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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