Clinical Decision Support for High-Cost Imaging: A Randomized Clinical Trial
PLOS ONE 14(3), March 2019, p. e0213373.
Due to widespread concern over the health risks and healthcare costs from potentially inappropriate high-cost imaging, the Centers for Medicare and Medicaid Services (CMS) will soon require high-cost imaging orders to be accompanied by Clinical Decision Support (CDS): software that provides appropriateness information at the time orders are placed. To evaluate the impact of the CDS in context, the authors studied its effect on the ordering behavior of providers in a randomized trial of 3,511 healthcare providers at Aurora Health Care. They found that CDS reduced targeted imaging orders by a statistically significant 6 percent. However, there was no statistically significant change in the total number of high-cost or low-cost scans. One likely reason is that the software often makes a recommendation for an alternative high-cost imaging order. Thus, the CMS mandate requiring healthcare systems to adopt CDS may only modestly increase the appropriateness of high-cost imaging.
Medical Expenditures Attributable to Dementia
Health Services Research, March 2019.
As the population ages, it will be important for public and private decision makers to understand the magnitude of the direct medical care costs attributable to dementia. This longitudinal analysis simultaneously considers the impact of dementia on costs through its influence on length of survival and its influence on intensity of health service utilization. The researchers used Medicare data linked to the 1991-2012 Health and Retirement Study to compare the Medicare expenditures following a dementia diagnosis to those for a randomly selected, matched comparison group. They find that dementia's five-year incremental cost to the traditional Medicare program was approximately $15,700 per patient, nearly half of which was incurred in the first year after diagnosis. Shorter survival with dementia mitigated the incremental cost by about $2,650. Increased costs for individuals with dementia were driven by more intensive use of Medicare Part A covered services including inpatient, skilled nursing, and hospice care. At the end of life, however, individuals with dementia had consistently lower costs. There were significantly higher unadjusted costs among participants with dementia in the 12 months prior to diagnosis. These higher costs could reflect a greater comorbidity burden among individuals with dementia, the challenges of managing comorbid conditions with cognitive impairment, and the increased contact with the health care system leading to an eventual diagnosis. Overall, the findings underline the significance of dementia's cost to the traditional Medicare program, and indicate an opportunity to reduce incremental costs through earlier identification of dementia and improved care management.
Haemophilus Influenzae Type B Vaccination and Anthropometric, Cognitive, and Schooling Outcomes Among Indian Children
Annals of the New York Academy of Sciences, June 2019.
Haemophilus influenzae Type B (Hib) is a childhood disease for which India has the highest number of deaths in the world. It is a bacterial pathogen that causes pneumonia and bacterial meningitis and, to a lesser extent, epiglottitis and other infections among children under age 5. The Hib vaccine was introduced in 2011 by the Indian government as part of a pentavalent pediatric vaccine on a trial basis in two states. The researchers used longitudinal data and a propensity score matching technique to investigate the effects of receiving the vaccine on subsequent health and education outcomes. Children who received the vaccine before age 6 were found to be 11 to 16 percent taller than similar Hib‐unvaccinated children at ages 11–12 and 14–15 years. Hib‐vaccinated children also scored 7–12 percent higher on English and mathematics tests at age 11–12 years and 7–10 percent higher on reading and mathematics tests at age 14–15 years. They attained 11-12 percent more schooling at both ages as compared with their unvaccinated counterparts. The findings indicate potential long‐term health, cognitive, and schooling benefits of the Hib vaccine, subject to the effect of unobserved confounding factors such as parental investments in child health. The positive health and educational outcomes of the vaccine are correlated with positive economic outcomes, suggesting that the benefits of Hib vaccination for low- and middle-income countries could reverberate throughout society.