Jeffrey S Harman

University of Florida, Gainesville, Florida, United States

Are you Jeffrey S Harman?

Claim your profile

Publications (53)138.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the impact of Florida's Medicaid Demonstration 4 years post-implementation on per member per month (PMPM) Medicaid expenditures and whether receiving care through HMOs versus provider service networks (PSNs) in the Demonstration was associated with PMPM expenditures. Florida Medicaid claims from two fiscal years prior to implementation of the Demonstration (FY0405, FY0506) and the first four fiscal years after implementation (FY0607-FY0910) from two urban Demonstration counties and two urban non-Demonstration counties. A difference-in-difference approach was used to compare changes in enrollee expenditures before and after implementation of the Demonstration overall and specifically for HMOs and PSNs. Claims data were extracted for enrollees in the Demonstration and non-Demonstration counties and collapsed into monthly amounts (N = 26,819,987 person-months). Among SSI enrollees, the Demonstration resulted in lower increases in PMPM expenditures over time ($40) compared with the non-Demonstration counties ($186), with Demonstration PSNs lowering PMPM expenditures by $7 more than HMOs. Savings were also seen among TANF enrollees but to a lesser extent. The Medicaid Demonstration in Florida appears to result in lower PMPM expenditures. Demonstration PSNs generated slightly greater reductions in expenditures compared to Demonstration HMOs. PSNs appear to be a promising model for delivering care to Medicaid enrollees.
    Health Services Research 11/2013; · 2.29 Impact Factor
  • Source
    Christopher A Harle, Jeffrey S Harman, Shuo Yang
    [Show abstract] [Hide abstract]
    ABSTRACT: Clinical inertia, the failure to adjust antihypertensive medications during patient visits with uncontrolled hypertension, is thought to be a common problem. This retrospective study used 5 years of electronic medical records from a multispecialty group practice to examine the association between physician and patient characteristics and clinical inertia. Hierarchical linear models (HLMs) were used to examine (1) differences in physician and patient characteristics among patients with and without clinical inertia, and (2) the association between clinical inertia and future uncontrolled hypertension. Overall, 66% of patients experienced clinical inertia. Clinical inertia was associated with one physician characteristic, patient volume (odds ratio [OR]=0.998). However, clinical inertia was associated with multiple patient characteristics, including patient age (OR=1.021), commercial insurance (OR=0.804), and obesity (OR=1.805). Finally, patients with clinical inertia had 2.9 times the odds of uncontrolled hypertension at their final visit in the study period. These findings may aid the design of interventions to reduce clinical inertia.
    Journal of Clinical Hypertension 11/2013; 15(11):820-824. · 2.36 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents-the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments.
    Journal of Aging & Social Policy 01/2013; 25(1):65-82. · 0.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:: Private equity has acquired multiple large nursing home chains within the last few years; by 2009, it owned nearly 1,900 nursing homes. Private equity is said to improve the financial performance of acquired facilities. However, no study has yet examined the financial performance of private equity nursing homes, ergo this study. PURPOSE:: The primary purpose of this study is to understand the financial performance of private equity nursing homes and how it compares with other investor-owned facilities. It also seeks to understand the approach favored by private equity to improve financial performance-for instance, whether they prefer to cut costs or maximize revenues or follow a mixed approach. METHODOLOGY/APPROACH:: Secondary data from Medicare cost reports, the Online Survey, Certification and Reporting, Area Resource File, and Brown University's Long-term Care Focus data set are combined to construct a longitudinal data set for the study period 2000-2007. The final sample is 2,822 observations after eliminating all not-for-profit, independent, and hospital-based facilities. Dependent financial variables consist of operating revenues and costs, operating and total margins, payer mix (census Medicare, census Medicaid, census other), and acuity index. Independent variables primarily reflect private equity ownership. The study was analyzed using ordinary least squares, gamma distribution with log link, logit with binomial family link, and logistic regression. FINDINGS:: Private equity nursing homes have higher operating margin as well as total margin; they also report higher operating revenues and costs. No significant differences in payer mix are noted. PRACTICE IMPLICATIONS:: Results suggest that private equity delivers superior financial performance compared with other investor-owned nursing homes. However, causes for concern remain particularly with the long-term financial sustainability of these facilities.
    Health care management review 05/2012; · 1.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Electronic medical records (EMR) are commonly believed to improve quality of care. Primary care patients with multiple chronic conditions have potentially greater opportunity to benefit from receiving care at practices with EMRs if these systems help coordinate complex care. To examine how chronic conditions impact the odds that depressed patients receive depression treatment in primary care practices with EMRs compared to practices without EMRs. The study uses logistic regression to analyze cross-sectional data of primary care physician office visits in freestanding, office-based practices from the 2006-2008 National Ambulatory Medical Care Surveys. All visits to primary care providers made by patients ages 18 and older with physician-identified depression (N = 3,467). Outcomes include depression treatment which is defined as receipt or ordering of antidepressant medication and/or mental health counseling. EMRs were associated with significantly lowered odds that depressed patients received depression treatment (OR = 0.75, p = 0.009, 95% CI: 0.61-0.93); however when stratified by the number of chronic conditions, this association was observed only in patients with three or more chronic conditions (OR = 0.50, p > 0.001, 95% CI: 0.36-0.70). EMRs did not have a significant association with depression treatment for patients with two or fewer chronic conditions. EMRs appear to have an unintended negative association with depression care provided during visits made by primary care patients with multiple chronic conditions.
    Journal of General Internal Medicine 02/2012; 27(8):962-7. · 3.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period. Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing levels and deficiency citations for 663 Florida nursing homes between 2002 and 2005. Using a generalized estimating equation approach in SAS Proc Genmod, we estimate the relationship between CNA and licensed nursing staff, and facilities' total deficiency score and quality of care deficiency scores-calculated using the Centers for Medicare and Medicaid Services' Nursing Home Compare Five-Star Quality Rating System, which accounts for the complexity of the scope and severity of the cittions. Our results confirmed that higher CNA staffing levels were predictors of lower total deficiency scores and quality of care deficiency scores after controlling for facility characteristics. With a large sample size, repeated measure design, and advanced methods, we have found a relationship between CNA staffing and nursing home quality.
    The Gerontologist 05/2011; 51(5):610-6. · 2.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Many factors have been shown to be associated with ESRD patient placement on the waiting list and receipt of kidney transplantation. Our study aim was to evaluate factors and assess the interplay of patient characteristics associated with progression to transplantation in a large cohort of referred patients from a single institution. We examined 3029 consecutive adult patients referred for transplantation from 2003 to 2008. Uni- and multivariable logistic models were used to assess factors associated with progress to transplantation including receipt of evaluations, waiting list placement, and receipt of a transplant. A total of 56%, 27%, and 17% of referred patients were evaluated, were placed on the waiting list, and received a transplant over the study period, respectively. Older age, lower median income, and noncommercial insurance were associated with decreased likelihood to ascend steps to receive a transplant. There was no difference in the proportion of evaluations between African Americans (57%) and Caucasians (56%). Age-adjusted differences in waiting list placement by race were attenuated with further adjustment for income and insurance. There was no difference in the likelihood of waiting list placement between African Americans and Caucasians with commercial insurance. Race/ethnicity, age, insurance status, and income are predominant factors associated with patient progress to transplantation. Disparities by race/ethnicity may be largely explained by insurance status and income, potentially suggesting that variable insurance coverage exacerbates disparities in access to transplantation in the ESRD population, despite Medicare entitlement.
    Clinical Journal of the American Society of Nephrology 05/2011; 6(7):1760-7. · 5.07 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To identify (1) the association between pre-pregnancy BMI (PP-BMI) and PPD symptoms, and (2) the association between PP-BMI and PPD symptoms after considering PNC utilization as a moderating variable. Data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed from 15 states. The study design utilized two risk-adjustment approaches. One approach included all women in the dataset and used statistical analyses to risk-adjust for pregnancy risk status, and the other approach, through a sensitivity analysis, modified the design of the study by truncating the sample to include only women with healthy pregnancies. An initial association was seen between obesity and PPD symptoms, and PNC and PPD symptoms in the multivariate analyses. However, the inclusion of case-mix variables into the multivariate models removed these associations. Overall, for both approaches, there was no indication of a moderating effect of PNC utilization. Results also revealed that many of the women were significantly affected by a variety of high-risk maternal morbidity (case-mix) variables. Although PNC is important for the health of mothers and babies, it does not appear to moderate the association of PP-BMI and PPD symptoms. However, since this study revealed associations between several high-risk maternal morbidities (included as case-mix variables), and PPD symptoms, it is recommended that future research further investigate the possible association of these morbidities with PPD symptoms. For practice, it is suggested that PNC providers focus on their patients, and establish suitable interventions accordingly.
    Maternal and Child Health Journal 05/2011; 16(3):656-67. · 2.24 Impact Factor
  • Kathryn Rost, Yi-Ping Hsieh, Stan Xu, Jeffrey Harman
    [Show abstract] [Hide abstract]
    ABSTRACT: Depressed women have greater than three times the odds of hospitalization as clinically comparable men. The objective of this study is to understand if these gender differences emerge in admissions decisions after depressed individuals' arrival at the emergency room (ER). We used multivariate logistic regression to examine gender differences in hospitalization after 6266 ER visits for depressive symptoms in the nationally representative 1998-2007 National Hospital Ambulatory Care Medical Survey. ER visits by depressed women have only 0.82 the odds of hospitalization (95% confidence interval [CI] 0.70-0.96, p=0.02) in models adjusted for sociodemographic, clinical, and system covariates. Sensitivity analyses demonstrate gender differences in visits by patients with no injury but not in visits by patients with self-inflicted injury. These findings suggest that admission decisions after ER visits are not responsible for the increased risk of hospitalization previously reported in depressed women, as ER visits by women with depressive symptoms actually have lower odds of hospitalization than visits by men. We encourage further research to explore the causes and consequences of this practice pattern to move toward rational delivery systems committed to providing comparable treatment to clinically comparable individuals regardless of gender.
    Journal of Women s Health 03/2011; 20(5):719-24. · 1.42 Impact Factor
  • Jingbo Yu, Jeffrey S Harman, Allyson G Hall, R Paul Duncan
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examines the impact of disenrolling from Medicaid/State Children's Health Insurance Programs (SCHIP) on health care utilization and expenditures among children using the 1996-2005 Medical Expenditure Panel Survey data. Changes in expenditures and utilization upon Medicaid/SCHIP disenrollment were examined for two disenrollment groups, children who became uninsured and those who transitioned to private insurance; relative to a control group, those continuously enrolled in Medicaid/SCHIP during the study period. In multivariate analysis, a modified two-part model and difference-in-difference analytic approach were used. The dependent variables were changes in total expenditures and changes in utilization (i.e., well-child visits, physician visits, emergency room visits, hospitalizations, and prescription drug use) from pre- to post-disenrollment round. This study found that losing Medicaid/SCHIP coverage is associated with decreased preventive care utilization among children, regardless of the insurance status post-disenrollment. In addition, children who become uninsured following Medicaid/SCHIP disenrollment may also experience reductions in physician visits and prescription drug use.
    Medical Care Research and Review 02/2011; 68(1):56-74. · 3.01 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the impact of Florida's Medicaid Reform Demonstration on per member per month (PMPM) Medicaid expenditures. Florida Medicaid claims data from the two fiscal years before implementation of the Demonstration (FY0405, FY0506) and the first two fiscal years after implementation (FY0607, FY0708) from two reform counties and two nonreform counties. A difference-in-difference approach was used to compare changes in expenditures before and after implementation of reforms between the reform counties and the nonreform counties. Medicaid claims and eligibility files were extracted for enrollees in the reform and nonreform counties and collapsed into monthly amounts (N=16,875,467). When examining the entire population, the reforms had little impact on PMPM expenditures, particularly among SSI enrollees. PMPM expenditures for SSI enrollees increased by an additional U.S.$0.35 in the reform counties compared with the nonreform counties and increased by an additional U.S.$2.38 for Temporary Assistance for Needy Families (TANF) enrollees. An analysis that limited the sample to individuals with at least 3 or 6 months of observations pre- and postimplementation, however, showed reduced PMPM expenditures of U.S.$11.15-U.S.$19.44 PMPM for both the SSI and TANF populations. Although Medicaid reforms in Florida did not result in significant reductions in PMPM expenditures when examining the full population, it does appear that expenditure reductions may be achieved among Medicaid enrollees with more stable enrollment, who have more exposure to managed care activities and may have more health care needs than the overall Medicaid population.
    Health Services Research 01/2011; 46(3):787-804. · 2.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Few quality of care evaluations examine the relationship between clinical processes and patient outcomes. To determine the association between health plan performance on Healthcare Effectiveness Data and Information Set (HEDIS) clinical processes and intermediate outcome measures and Health Outcomes Survey (HOS) self-reported physical and mental health scores among Medicare plan enrollees with diabetes. Secondary data analysis of 2002 HEDIS and 2001-2003 HOS data. This study focused on Medicare plan enrollees with self-reported diabetes (N = 8184). Plan-level HEDIS diabetes care measures for 2002 and longitudinal, patient-level 2001-2003 HOS physical and mental health outcomes scores. Hierarchical linear models estimated the relationship between plan HEDIS performance on diabetes process of care and intermediate outcome measures and 2-year changes in enrollee HOS physical and mental health scores. Each 10% point improvement in plan performance on HEDIS intermediate outcomes (ie, the proportion of well-controlled diabetes) was related to significant positive increase in the probability of being healthy as measured by both enrollee physical health scores (7 percentage point increase, P < 0.05) and mental health scores (11 percentage point increase, P < 0.01). Similar increases in plan process of care measures were associated with increases in the probability of being healthy as measured by enrollee mental health scores (11 percentage point increase, P < 0.001). This study represents one of the first attempts to link plan HEDIS performance to changes in enrollee health. The results suggest that improved quality of care, as measured by process and intermediate outcomes measures for diabetes, can result in better health among patients with diabetes. Further research should address whether this relationship exists in other quality measures, clinical conditions, and populations.
    Medical care 03/2010; 48(3):217-23. · 3.24 Impact Factor
  • Source
    John C Fortney, Jeffrey S Harman, Stanley Xu, Fran Dong
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the association between rurality and depression care. Data were extracted for 10,319 individuals with self-reported depression in the Medical Expenditure Panel Survey. Pharmacotherapy was defined as an antidepressant prescription fill, and minimally adequate pharmacotherapy was defined as receipt of at least 4 antidepressant fills. Psychotherapy was defined as an outpatient counseling visit, and minimally adequate psychotherapy was defined as > or = 8 visits. Rurality was defined using Metropolitan Statistical Areas (MSAs) and Rural Urban Continuum Codes (RUCCs). Over the year, 65.1% received depression treatment, including 58.8% with at least 1 antidepressant prescription fill and 24.5% with at least 1 psychotherapy visit. Among those in treatment, 56.2% had minimally adequate pharmacotherapy treatment and 36.3% had minimally adequate psychotherapy treatment. Overall, there were no significant rural-urban differences in receipt of any type of formal depression treatment. However, rural residence was associated with significantly higher odds of receiving pharmacotherapy (MSA: OR 1.16 [95% CI, 1.01-1.34; P= .04] and RUCC: OR 1.04 [95% CI, 1.00-1.08; P= .05]), and significantly lower odds of receiving psychotherapy (MSA: OR 0.62 [95% CI, 0.53-0.74; P < .01] and RUCC: OR 0.91 [95% CI, 0.88-0.94; P < .001]). Rural residence was not significantly associated with the adequacy of pharmacotherapy, but it was significantly associated with the adequacy of psychotherapy (MSA: OR 0.53 [95% CI, 0.41-0.69; P < .01] and RUCC: OR 0.92 [95% CI, 0.86-0.99; P= .02]). Psychiatrists per capita were a mediator in the psychotherapy analyses. Conclusions: Rural individuals are more reliant on pharmacotherapy than psychotherapy. This may be a concern if individuals in rural areas turn to pharmacotherapy because psychotherapists are unavailable rather than because they have a preference for pharmacotherapy.
    The Journal of Rural Health 01/2010; 26(3):205-13. · 1.44 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study examines the cost implications of outsourcing Medicaid functions to the private sector. We examine the expenditures for enrollees in three Medicaid primary care case management (PCCM) demonstration projects compared to Florida's PCCM program from February 2002-February 2003. The RAND two-part model was used to analyze the medica expenditures for enrollees in each program. After adjusting for sociodemographic factors and the probability of service use, we found that all three demonstration projects reduced expenditures compared to the PCCM program. The implications from the study are that Medicaid programs may want to consider outsourcing PCCM functions after further studies examine the utilization experience for enrollees in these programs.
    Journal of health care finance 01/2010; 37(1):1-12.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine the association between weight status and health service use, while considering the influence of psychosocial functioning and demographic variables. Two hundred child-parent dyads were recruited from pediatric primary care clinics and completed measures of height, weight, and questionnaires assessing psychosocial functioning. Claims and expenditure data over a 12-month retrospective period were extracted from the Medicaid claims database. Children who were obese incurred greater health service use and expenditures than children who were of a healthy weight, even after controlling for psychosocial functioning and other demographic variables. Children who were overweight (but not obese) did not have differing levels of claims or expenditures than their healthy weight peers. Understanding the impact of pediatric obesity on long-term expenditures is critical. These results provide some indication of the financial savings that might be achieved if obese children were supported to achieve a healthier weight status.
    Journal of Pediatric Psychology 12/2009; 35(8):883-91. · 2.91 Impact Factor
  • Jeffrey S Harman, Mark J Edlund, John C Fortney
    [Show abstract] [Hide abstract]
    ABSTRACT: This study investigated whether the trend of increasing rates of antidepressant use in the 1990s continued into 2000-2004. Antidepressant treatment rates were examined by age group and by the class of antidepressant in order to identify whether any observed trends were being driven by a particular age group of patients or class of medication. Secondary analysis was performed on data from the 2000-2004 Medical Panel Expenditure Surveys, a nationally representative survey of U.S. households, to examine trends in antidepressant use by age group and medication class in the total sample (N=166,435). Trends in the rates of antidepressant use among individuals with self-reported depression (N=10,959) and self-reported anxiety disorders without comorbid depression (N=6,899) were also examined. Antidepressant use increased among all Americans, from 6.6% in 2000 to 8.1% in 2004 (p<.001). Rates of antidepressant use by individuals with anxiety disorders without comorbid depression increased from 30.8% in 2000 to 39.0% in 2002, before declining to 33.2% in 2004. However, antidepressant use decreased among individuals with self-reported depression, from 63.1% in 2000 to 56.7% in 2004 (p<.001). This downward trend in antidepressant use was largely driven by a decrease in use of selective serotonin reuptake inhibitors, especially among children and middle-aged adults with depression. Rates of adequate antidepressant treatment (defined as receiving at least four antidepressant prescriptions at the minimum adequate daily dosage) peaked in 2002 (36.9%), and there was a significant decline by 2004 (31.7%) (p=.003). After years of increased use of antidepressant therapy to treat depression, a trend reversal in the beginning of the 21st century was observed, including decreasing rates of adequate antidepressant treatment. This downward trend preceded the black-box warnings included on antidepressant labels beginning in 2004.
    Psychiatric services (Washington, D.C.) 06/2009; 60(5):611-6. · 2.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There are currently over half a million end-stage renal disease patients and >70,000 patients listed to receive a deceased donor kidney transplant in the United States. To receive a deceased donor transplant, patients are placed on a waiting list at one of approximately 240 centers. Although candidate decisions to list at a particular center may often be made passively (based on proximity or physician referral), the important question remains as to whether the center of listing has a significant impact on patient outcomes. The study evaluated adult kidney transplant candidates in the United States listed from 1995 to 2000 (n = 108,928) with follow-up through 2006. The primary outcome of patient survival was investigated with survival models evaluated with respect to 4 center characteristics (volume, donor quality, waiting time, past performance). Center characteristics derived from years preceding listing, simulating information that could be attainable for prospective candidates. Center waiting time had a marked association with survival (Adjusted hazard ratio = 1.32, 95% confidence interval: 1.27-1.38 for the longest waiting times). Past performance and donor quality also had significant association with survival; center volume was not a significant factor. The cumulative impact of center factors resulted in an average 4-year difference in life expectancy. Center characteristics at listing were strongly correlated with levels at the time of transplantation and centers with the "best" characteristics were located in every region of the country. Center characteristics have significant impact on kidney transplant candidate survival. Information regarding the variability and importance of center factors should be clearly disseminated to transplant candidates.
    Medical care 02/2009; 47(2):146-53. · 3.24 Impact Factor
  • Allyson G Hall, Jeffrey S Harman, Jianyi Zhang
    [Show abstract] [Hide abstract]
    ABSTRACT: Gaps in Medicaid coverage can result in inadequate access to care. This can be particularly detrimental to those with a chronic disease such as diabetes. To assess whether a lapse in Medicaid coverage is associated with an increase in expenditures, and acute care utilization upon reenrollment among beneficiaries with diabetes. Using multivariate regression analyses, we compared pre- versus post-expenditures and utilization among 2102 individuals with diabetes who had experienced at least one 1-month lapse in their Medicaid coverage. Dependent variables were the number of inpatient episodes, total length of stay, total number of emergency room visits, total expenditure, and pharmaceutical expenditures. These were aggregated over 3-month spans that either immediately preceded or immediately followed a lapse in coverage. Key predictor variables included a variable that identified the span as occurring pre-lapse or post-lapse in coverage, and a continuous variable identifying the length of the lapse. Predicted expenditure and utilization were calculated. Overall total program expenditures were higher for post-lapse periods compared with pre-lapse periods. Total expenditures were estimated to increase by $239 per member per month for the 3-month period. The likelihood of having any expenditure was actually lower in the post-lapse period. However inpatient and emergency room use was higher. The results from this study suggest that interruptions in Medicaid coverage are associated with overall greater program expenditures in the post-lapse periods. However, this increase in expenditures seems to be driven by a subset of individuals whose greater use of inpatient and emergency room services increased overall program costs.
    Medical care 01/2009; 46(12):1219-25. · 3.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the total health care utilization and costs for children with constipation in the United States. We analyzed data from 2 consecutive years (2003 and 2004) of the Medical Expenditure Panel Survey (MEPS), a nationally representative household survey. We identified children who either had been reported as constipated by their parents or had received a prescription for laxatives in a given year. Outcome measures were service utilization and expenditures. The MEPS database included a total of 21 778 children age 0 to 18 years, representing 158 million children nationally. An estimated 1.7 million US children (1.1%) reported constipation in the 2-year period. No differences with respect to age, sex, race, and socioeconomic status were found between the children with constipation and those without constipation. The children with constipation used more health services than children without constipation, resulting in significantly higher costs: $3430/year vs $1099/year. This amounts to an additional cost for children with constipation of $3.9 billion/year. This study demonstrates that childhood constipation has a significant impact on the use and cost of medical care services. The estimated cost per year is 3 times than that in children without constipation, which likely is an underestimate of the actual burden of childhood constipation.
    The Journal of pediatrics 10/2008; 154(2):258-62. · 4.02 Impact Factor
  • Zhou Yang, David Bishai, Jeffrey Harman
    [Show abstract] [Hide abstract]
    ABSTRACT: There has been ongoing debate about the health risks associated with increased body weight among the elderly population. One issue has not been investigated thoroughly is that body weight changes over time, as both the reasons and results of, the development of chronic diseases and functional disabilities. Structural models have the ability to unravel the complicated simultaneous relationship between body weight, disability, and mortality along the aging process. Using longitudinal data from the Medicare Current Beneficiary Survey from 1992 to 2001, we constructed a structural model to estimate the longitudinal dynamic relationship between weight, chronic diseases, functional status, and mortality among the aging population. A simulation of an age cohort from 65 to 100 was conducted to show the changes in weight and health outcomes among the cohorts with different baseline weight based on the parameters estimated by the model. The elderly with normal weight at age 65 experience higher life expectancy and lower disability rates than the same age cohorts in other weight categories. The interesting prediction of our model is that the average body size of an elderly cohort will converge to the normal weight range through a process of survival, senescence, and behavioral adjustment.
    Economics & Human Biology 08/2008; 6(3):469-81. · 1.80 Impact Factor

Publication Stats

755 Citations
138.31 Total Impact Points

Institutions

  • 2003–2013
    • University of Florida
      • • College of Public Health and Health Professions
      • • Department of Clinical and Health Psychology
      • • Department of Health Services Research, Management and Policy
      Gainesville, Florida, United States
  • 2011
    • Florida State University
      • Department of Medical Humanities & Social Sciences
      Tallahassee, FL, United States
  • 2010
    • Texas A&M University System Health Science Center
      • School of Rural Public Health
      Bryan, TX, United States
  • 2008
    • Emory University
      • Department of Health Policy and Management
      Atlanta, GA, United States
  • 2007
    • Case Western Reserve University
      • Department of Pediatrics (University Hospitals Case Medical Center)
      Cleveland, OH, United States
  • 2001–2006
    • University of Pittsburgh
      • • School of Medicine
      • • Department of Psychiatry
      Pittsburgh, PA, United States
  • 2005
    • North Florida and South Georgia Veterans Health System
      Gainesville, Florida, United States
  • 2004–2005
    • The Ohio State University
      • Department of Psychology
      Columbus, OH, United States
    • Overton Brooks VA Medical Center
      Shreveport, Louisiana, United States
  • 2002
    • Childrens Hospital of Pittsburgh
      • Department of Pediatrics
      Pittsburgh, PA, United States
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States