Association between provider specialty and healthcare costs and glycemic control for patients with diabetes

Aims: To analyze the association between provider, healthcare costs, and glycemic control for patients with diabetes mellitus (DM).

Materials and methods: This cross-sectional study identified adults with type 1 or 2?DM (T1D, T2D) in the Optum database. The main independent variable was provider (endocrinologist or primary care). Regression analysis compared total medical and pharmacy costs, adjusting for health status and other patient differences, by provider.

Results: For all patients, HbA1C improvement was greater, and medical costs significantly lower with an endocrinologist rather than a primary care provider. The largest HbA1C improvement (4%) occurred for insulin-dependent patients seen by endocrinologists. Significant medical savings with endocrinologist management occurred within the Medicare Advantage population in every sub-group of patients, with 14% lower costs ($4,767) for patients with T1D, 11% lower costs ($3,160) for patients with macro- and microvascular complications, and 10% lower costs ($2,237) for insulin-dependent patients. Within the commercial insurance population, medical costs were reduced by ≥9% in every sub-group of patients, with a 20% reduction ($8,450) for patients with micro- and macrovascular complications. Overall total costs (medical and pharmacy) were 8% ($1,541) higher for patients receiving endocrinologist rather than primary care, although endocrinologist care resulted in a 9% reduction (–$3,710) in costs for Medicare Advantage patients with T1D. Total medical costs (excluding pharmacy costs) may be a more accurate indicator of costs associated with patients in various stages of DM.

Limitations: There was insufficient data to develop risk-adjustment payments for pharmacy costs based on disease severity. The cross-sectional design identifies associations and not cause–effect relationships.

Conclusion: DM management by an endocrinologist was associated with greater HbA1C improvement and significantly lower medical costs. Total costs were higher with an endocrinologist, but for patients with T1D lower costs were seen, ranging from 2–9% regardless of insurance type.     

ESTIMATING THE EFFECTS OF BROWNFIELDS AND BROWNFIELD REMEDIATION ON PROPERTY VALUES IN A NEW SOUTH CITY

Using data from Charlotte, NC, a New South city without a legacy of heavily contaminated properties, we find the distance from unremediated brownfields—typically former industrial properties believed to have modest contamination—to have no effect on residential sales values, but proposed cleanup and actual remediation have positive, substantial, and significant effects especially within 0.5 miles of the brownfield. Our results are consistent whether we examine all property values within a given distance, such as 0.5 miles, or examine discrete distances, such as 0.3–0.5 miles. An estimate of the benefits is on the order of $4 million. (JEL Q51, Q24, Q28, R52)     

Families at leisure outdoors: well-being through adventure

ABSTRACT

This study investigates families who choose to co-participate in outdoor adventure holidays, and explores how they benefit from these shared experiences. In so doing, it seeks to determine the role of adventure tourism in developing and enhancing family well-being (FWB). Hyper-modern family life for many is powered by technological hardware, each room in the house replete with on-line pleasures, distractions and identities. In response to this dystopia, some families opt to take adventure holidays together. However, scholarship concerning collective experiences of adventurous leisure, in this case as families, is limited. Using a qualitative whole family approach, 15 (adventure tourist) families were interviewed, totalling 62 interviewees (29 adults and 33 children under 18 years old), in their home environments. Four key themes related to FWB emerged. First, families extended their active lifestyles to adventure holidays and repeatedly mentioned the health and fitness benefits gained from these experiences. Second, adventure holidays facilitated unmediated time together for families. Third, parents harboured ideals of positive personal development for their children in these adventure settings. Fourth, making memories during adventure holidays, and recollecting these post-trip, were integral to family bonding. Further research should consider non-traditional families, and various socio-economic and cultural groups in this context.     

The long memory model of political support: some further results

This article extends the results of Byers et al. (1997 Byers, JD, Davidson, JEHD and Peel, DA. 1997. Modelling political popularity: an analysis of long range dependence in opinion poll series. Journal of the Royal Statistical Society, 160: 471–90. Series A [Google Scholar]) on long memory in support for the Conservative and Labour Parties in the UK using longer samples and additional poll series. It finds continuing support for the ARFIMA(0,?d,?0) model, though with somewhat smaller values of the long memory parameter. We find that the move to telephone polling in the mid-1990s had no apparent effect on the estimated value of d for either party. Finally, we find that we cannot reject the hypotheses that the parties share a common long memory parameter which we estimate at around 0.65.     

Analysis of the complexity of writing used in accounting textbooks over the past 100 years

The Accounting Education Change Commission (AECC) and the large international accounting firms have all emphasized that accountants must be able to work with unstructured problems to be successful in today's business environment. Measures of this ability are essential if accounting educators are to assist students in improving their abilities to work with unstructured problems. However, there appears to be no measure that has been widely accepted as being the ‘best’ measure. This study considers whether two linguistic performance measures might be usable by accounting educators for this purpose. We use data obtained from a student assessment centre to consider two measures of linguistic performance, idea density and grammatical complexity. We incorporate five criteria in deciding whether these measures could be usable: (1) whether the measures are related to students' performance when solving unstructured problems; (2) whether the measures distinguish between the ability to work with unstructured compared to structured problems; (3) ease of obtaining necessary information from students; (4) ease of scoring, and (5) robustness of the findings after considering other variables that may have an effect. Our results indicate that subjects' linguistic performance as measured by idea density meets these five criteria. However, grammatical complexity is not related to performance for either type of problem. These results were found even after controlling for the effects of other variables such as grade point average (GPA), experience, and personality variables. Because the measures can be obtained from virtually any written work produced by students, the information to be scored is relatively easy to obtain. Scoring is also relatively straightforward.     

Sequential decisions with tests

We consider a principal-agent problem where the principal wishes to be endorsed by a sequence of agents, but cannot truthfully reveal type. In the standard “herding” model, the agents learn from each other's decisions, which can lead to cascades on a given decision when later agents' private information is swamped. We augment the standard model to allow the principal to subject herself to a test designed to provide public information about her type. She must decide how tough a test to attempt from a continuum of test types, which involves trading off the higher probability of passing an easier test against the greater impact from passing a tougher test. We find that the principal will always choose to be tested, and will prefer a tough test to a neutral or easy one.     

Paul Mason Fotsch. Watching the Traffic Go By: Transportation and Isolation in Urban America

In this well-meaning but deeply flawed book, Paul Mason Fotschexamines what he calls "narratives that promote a reliance onthe automobile."(2) Fotsch's Watching the Traffic Go By examinesa series of different events, times, and ideas that he claimshave had a hegemonic power in American popular culture. Thisbook draws on the disciplines of cultural studies and history,and closely reads various books, movies, and events. It movesbetween exploring transport systems (particularly the     

Latino families report lower child injury rates than white families

Latino children have lower visit rates to emergency departments and primary care physicians than white children in the USA. Using a nationally representative household survey, this study asked whether parental report of injury was also lower for Latino children, after adjusting for demographic, socioeconomic, health status and health care access factors. Data were obtained on injuries for which medical advice or treatment was received from the National Health Interview Survey (NHIS) from 1997 to 2003. Using the multistage probability design of NHIS, annual rates and adjusted odds of childhood injury report by race and ethnicity were calculated. Respondents reported lower rates of injury for Latino children (6.0 (95% CI 5.3-6.8)/100 person-years) than white children (13.4 (12.7-14.2)/100 person-years). Lower injury rates were mainly due to lower rates of sports injuries and accidental falls. Latino children had lower odds of reported injury than white children, even after adjusting for multiple factors (odds ratio 0.7; 95% CI 0.6-0.8). Lower odds of injury report among Latino children are independent of direct measures of demographic, socioeconomic, health status and health care access factors and indirect measures of acculturation including respondent language and country of origin. Potential explanations include lower exposure to risk, greater child supervision, reporting bias, differences in cultural attitudes toward seeking of health care and reduced health care access that cannot be explored in NHIS due to the form of the current questions. Further research is needed to investigate cultural differences in risk exposure, child supervision and seeking of injury care.