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Resource use trajectories for aged medicare beneficiaries with complex coronary conditions.

Publication ,  Journal Article
Federspiel, JJ; Stearns, SC; D'Arcy, LP; Geissler, KH; Beadles, CA; Crespin, DJ; Carey, TS; Rossi, JS; Sheridan, BC
Published in: Health Serv Res
April 2013

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.

Duke Scholars

Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

April 2013

Volume

48

Issue

2 Pt 2

Start / End Page

753 / 772

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Outpatients
  • Medicare
  • Male
  • Length of Stay
  • Humans
  • Health Resources
  • Health Policy & Services
 

Citation

APA
Chicago
ICMJE
MLA
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Federspiel, J. J., Stearns, S. C., D’Arcy, L. P., Geissler, K. H., Beadles, C. A., Crespin, D. J., … Sheridan, B. C. (2013). Resource use trajectories for aged medicare beneficiaries with complex coronary conditions. Health Serv Res, 48(2 Pt 2), 753–772. https://doi.org/10.1111/1475-6773.12028
Federspiel, Jerome J., Sally C. Stearns, Laura P. D’Arcy, Kimberley H. Geissler, Christopher A. Beadles, Daniel J. Crespin, Timothy S. Carey, Joseph S. Rossi, and Brett C. Sheridan. “Resource use trajectories for aged medicare beneficiaries with complex coronary conditions.Health Serv Res 48, no. 2 Pt 2 (April 2013): 753–72. https://doi.org/10.1111/1475-6773.12028.
Federspiel JJ, Stearns SC, D’Arcy LP, Geissler KH, Beadles CA, Crespin DJ, et al. Resource use trajectories for aged medicare beneficiaries with complex coronary conditions. Health Serv Res. 2013 Apr;48(2 Pt 2):753–72.
Federspiel, Jerome J., et al. “Resource use trajectories for aged medicare beneficiaries with complex coronary conditions.Health Serv Res, vol. 48, no. 2 Pt 2, Apr. 2013, pp. 753–72. Pubmed, doi:10.1111/1475-6773.12028.
Federspiel JJ, Stearns SC, D’Arcy LP, Geissler KH, Beadles CA, Crespin DJ, Carey TS, Rossi JS, Sheridan BC. Resource use trajectories for aged medicare beneficiaries with complex coronary conditions. Health Serv Res. 2013 Apr;48(2 Pt 2):753–772.
Journal cover image

Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

April 2013

Volume

48

Issue

2 Pt 2

Start / End Page

753 / 772

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Outpatients
  • Medicare
  • Male
  • Length of Stay
  • Humans
  • Health Resources
  • Health Policy & Services