Development of the Diabetes Resource Consumption Index and profiling quality of diabetes care in the Veterans Health Administration
Issue Date
2003Keywords
Health Sciences, Pharmacy.Health Sciences, Public Health.
Health Sciences, Health Care Management.
Advisor
Malone, Daniel C.Metadata
Show full item recordPublisher
The University of Arizona.Rights
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.Abstract
The purpose of this study was to develop and validate a risk-adjustment index for one year healthcare resource use specific to diabetic patients, based on severity of illness measures; and to profile quality of diabetes care between outpatient clinics. The data for this study was collected from four outpatient clinics within the Southern Arizona Veterans Affairs Healthcare System, Tucson, AZ. The DRCI was developed using a sample size of 367 diabetic subjects that had complete information on diabetes-specific variables. Individual DRCI weights, based on the magnitude of one year healthcare resource use and socio-demographic characteristics, ranged from -471.5 to 3,081.2 for total healthcare costs, from -304.3 to 1,582.1 for outpatient costs, and -0.19 to 0.93 for risk of hospitalization. The DRCI was better than or equivalent to the Chronic Disease Score in predicting health care costs. Diabetics in the second cohort were predominantly elderly (mean = 66yrs ± 11.1), married (61%), white (73%), males (96%), had a high BMI (31 ± 6.3 kg/m²), and mean comorbidity score of 4.2 ± 1.8 conditions. Screening for HbA1c and microalbuminuria was frequently performed in all clinics. Overall, 61% and 36% of study patients did not have evidence of foot or eye examinations during the entire study period, respectively. Approximately, 27% (n = 408), 41% (n = 643), and 26% (n = 515) of the study patients had poor glycemic, renal function, and lipid control, respectively. Significant differences (p < .05) in HbA1c and creatinine clearance rates between the clinics were observed after adjusting for patient case-mix. However, differences between the clinics in cardiovascular outcome were not observed after adjusting for patient case-mix. This study demonstrated an association between diabetes severity with healthcare resource and costs. The DRCI, using laboratory data, is a diabetes-specific severity measure for prediction of one year healthcare resource use. Future studies are needed to validate this index in other settings. Finally, the results from this study emphasize the need to adjust for case-mix variable when comparing quality of diabetic care outcomes between outpatient clinics.Type
textDissertation-Reproduction (electronic)
Degree Name
Ph.D.Degree Level
doctoralDegree Program
Graduate CollegePharmacy Practice and Science
Degree Grantor
University of ArizonaCollections
Related items
Showing items related by title, author, creator and subject.
-
Modeling the cost-effectiveness of a regional poison control center using decision analysisUsing decision analysis techniques, the cost-effectiveness of two alternatives for treating human poison exposures were modeled. The alternatives were the treatment of poisonings with the services of a regional poison control center versus without access to any poison control center. The relative cost-effectiveness was modeled based on two outcomes (morbidity and mortality) for each of four typical poison exposures: acetaminophen overdose, tricyclic antidepressant overdose, cleaning substance exposure in children, and cough/cold preparation overdose in children. Additionally, analyses were conducted to test the sensitivity of the cost-effectiveness ratio to outcome probability, average inpatient and emergency room charges, and proportion of poison exposures managed on site by the regional poison control center. This research was conducted from society's point of view.
-
Immunological modulation of antioxidants in side-stream cigarette smoke (SSCS) exposed miceEnvironmental tobacco smoke (ETS) is a complex mixture of chemicals generated during the burning of tobacco products. The principle contributor to ETS is side-stream cigarette smoke (SSCS), the material emitted from the smoldering tobacco product between puffs Our hypothesis is that reactive oxygen species from SSCS are playing an essential role in disease promotion and antioxidant supplementation (a single form of alpha-tocopherol or a mixture of multiple antioxidants) will potentially prevent SSCS associated tissue damage, pulmonary dysfunction. The specific aims of the present study are to determine if: (1) SSCS would induce tissue lipid peroxidation and proinflammatory responses; (2) SSCS would provoke pulmonary and cardiac function changes; (3) SSCS would cause oxidative stress, reduce nutrient concentrations and suppress immune function in murine retrovirus infections; (4) dietary alpha-tocopherol, specifically, can enhance resistance to oxidative damage by SSCS and improve lung function; (5) multiple antioxidant supplementation can modulate proinflammatory cytokine secretion and tissue lipid peroxidation induced by SSCS exposure in old healthy mice. SSCS exposure methodology in a murine model was developed to facilitate these goals. For the first time we established a SSCS model in murine retrovirus infection. Also we conduced a SSCS dose-response model for a cardiac function study. We found that SSCS exposure in mice consistently increased oxidation, depleted tissue vitamin E levels, and promoted inflammatory cytokines production. SSCS exposure at 120-min/day, 5 days/week for 12 weeks decreased heart contractile function and increased vascular resistance. SSCS induced increased oxidative stress, reduced nutrient concentrations and suppressed immune function, which could make mice with murine retrovirus more susceptible to opportunistic infections. Dietary alpha-tocopherol enhanced resistance against SSCS-induced oxidation and improved lung function, primarily through the antioxidant property of alpha-tocopherol and its modulation of local cytokine production. The multiple antioxidant with beta-carotene, bioflavanoids, Coenzyme Q10, d-alpha-tocopherol, L-ascorbic acid, L-carnitine, magnesium, N-acetylcysteine, retinol, selenium and zinc given as a dietary supplementation prevented oxidation and IL-6 production in healthy old mice during SSCS exposure. (Abstract shortened by UMI.)
-
Continuity of care for migrant farm workers utilizing computer disksNot much has changed for the migrant farmworker in the last thirty years. In one of the wealthiest countries on earth, migrant farmworker health status remains comparable to that found in Third World countries because of poor sanitation, poor nutrition and exposure. Current estimates show that migrant clinics are serving less than 20% of this population, leaving about 2,000,000 farmworkers without medical care. The barriers to health care for this population are numerous. This study will focus on the barrier to care resulting from lack of continuity in care due to poor inter-clinic communication. In this study it has been shown that computer disks and a standard word-processing program can be used to create a portable medical health history for the migrant to improve inter-clinic communication. In the process of carrying out this study, it was also shown how other barriers to care for this vulnerable population might be removed as well.
