William Marder | Truven Health Analytics (original) (raw)
Papers by William Marder
Clinical Therapeutics, 2004
The aims of this study were to estimate the effects of demographics, location, severity of multip... more The aims of this study were to estimate the effects of demographics, location, severity of multiple sclerosis (MS), comorbidities, plan type, coinsurance levels, and time of entry into the sample on the use of disease-modifying agents.
The Annals of Pharmacotherapy, 2010
Military Medicine, Sep 1, 2009
We compared chronic care utilization in four major health systems in the U.S.: the military healt... more We compared chronic care utilization in four major health systems in the U.S.: the military health system (TRICARE), the Department of Veterans Affairs (VA), Medicaid, and employer-sponsored commercial plans. Prevalence rates and key performance indicators were constructed from administrative data in federal fiscal year 2003 for eight chronic conditions: hypertension, major depression, diabetes, tobacco dependence, ischemic heart disease, severe mental illness, persistent asthma, and stroke. Continuously enrolled beneficiaries under 65 years old were studied: TRICARE (N = 2,963,987), VA (N = 2,114,739), Medicaid enrollees in five states (N = 5,554,974), and commercial insurance (N = 5,212,833). Condition-specific adjusted prevalence rates and measures were compared using the standardized rate ratio. For the majority of the conditions, the estimated prevalence rates were highest in the VA and Medicaid populations. Prevalence rates were generally lower in TRICARE and commercial plans. Medicaid beneficiaries had the highest hospitalization rates in four of the six conditions where hospitalization rates were measured. These results provide empirical evidence of differences in chronically ill patient populations in several of the major U.S. health insurance systems.
American Journal of Public Health, Dec 1, 1984
The hours worked by physicians are affected by changes in a number of factors, including attitude... more The hours worked by physicians are affected by changes in a number of factors, including attitudes towards labor-leisure tradeoffs, the characteristics of the physician workforce, and the level of demand for medical services. This paper analyzes changes in the hours worked per week by office-based physicians over the decade 1970-80. Overall, there has been a statistically significant decline in hours of approximately 3 per cent, or 1.5 hours per week. This decline was fairly uniform across most physician characteristics, although the decline was greater for those in primary care specialties. Female physicians increased their average hours worked, although this increase was not statistically significant. In terms of the delivery of skilled medical services, the decline in total hours was largely offset by an increase in the percentage of total hours devoted to patient care. The question of whether these trends will continue has important implications for the validity of projections of a physician surplus in the near future.
Military Medicine, 2009
We compared chronic care utilization in four major health systems in the U.S.: the military healt... more We compared chronic care utilization in four major health systems in the U.S.: the military health system (TRICARE), the Department of Veterans Affairs (VA), Medicaid, and employer-sponsored commercial plans. Prevalence rates and key performance indicators were constructed from administrative data in federal fiscal year 2003 for eight chronic conditions: hypertension, major depression, diabetes, tobacco dependence, ischemic heart disease, severe mental illness, persistent asthma, and stroke. Continuously enrolled beneficiaries under 65 years old were studied: TRICARE (N = 2,963,987), VA (N = 2,114,739), Medicaid enrollees in five states (N = 5,554,974), and commercial insurance (N = 5,212,833). Condition-specific adjusted prevalence rates and measures were compared using the standardized rate ratio. For the majority of the conditions, the estimated prevalence rates were highest in the VA and Medicaid populations. Prevalence rates were generally lower in TRICARE and commercial plans. Medicaid beneficiaries had the highest hospitalization rates in four of the six conditions where hospitalization rates were measured. These results provide empirical evidence of differences in chronically ill patient populations in several of the major U.S. health insurance systems.
Medical Care, 1990
The growing population of HIV-seropositives raises serious concerns about who will provide medica... more The growing population of HIV-seropositives raises serious concerns about who will provide medical care to this group. This article presents the first national estimates of physician involvement in, and attitudes toward, the treatment of HIV-seropositive patients. Nearly 50% of the nonfederal patient care physicians in our nationally representative sample have treated at least one HIV patient, with an average of 6.7 such patients being treated per physician. Perceived responsibility to treat HIV-seropositive patients is uniformly strong across such physician and practice characteristics as specialty, years of experience, and practice type. However, there are pronounced differences in actual physician involvement along these dimensions.
Journal of General Internal Medicine, 2007
Persons with multiple chronic conditions are a large and growing segment of the US population. Ho... more Persons with multiple chronic conditions are a large and growing segment of the US population. However, little is known about how chronic conditions cluster, and the ramifications of having specific combinations of chronic conditions. Clinical guidelines and disease management programs focus on single conditions, and clinical research often excludes persons with multiple chronic conditions. Understanding how conditions in combination impact the burden of disease and the costs and quality of care received is critical to improving care for the 1 in 5 Americans with multiple chronic conditions. This Medline review of publications examining somatic chronic conditions co-occurring with 1 or more additional specific chronic illness between January 2000 and March 2007 summarizes the state of our understanding of the prevalence and health challenges of multiple chronic conditions and the implications for quality, care management, and costs.
Annals of Pharmacotherapy, 2009
American Journal of Public Health, 1984
The hours worked by physicians are affected by changes in a number of factors, including attitude... more The hours worked by physicians are affected by changes in a number of factors, including attitudes towards labor-leisure tradeoffs, the characteristics of the physician workforce, and the level of demand for medical services. This paper analyzes changes in the hours worked per week by office-based physicians over the decade 1970-80. Overall, there has been a statistically significant decline in hours of approximately 3 per cent, or 1.5 hours per week. This decline was fairly uniform across most physician characteristics, although the decline was greater for those in primary care specialties. Female physicians increased their average hours worked, although this increase was not statistically significant. In terms of the delivery of skilled medical services, the decline in total hours was largely offset by an increase in the percentage of total hours devoted to patient care. The question of whether these trends will continue has important implications for the validity of projections of a physician surplus in the near future.
American Journal of Public Health, 1990
This study analyzes how the growing proportion of women in the United States physician population... more This study analyzes how the growing proportion of women in the United States physician population will affect the amount and type of physician services available to the US population. Female physicians work fewer hours per week, are slightly less likely to be in patient care, and tend to enter different specialties than male physicians. Female physicians also have higher retirement rates than male physicians, but due to their lower mortality rates, have work lives nearly as long as male physicians. We examined how the changing composition of the physician population will affect the availability of physician services by comparing historical and pro-Address reprint requests to
Medical care research and review : MCRR, Jan 4, 2016
This study examines the association between the quality of hospital discharge planning and all-ca... more This study examines the association between the quality of hospital discharge planning and all-cause 30-day readmissions and same-hospital readmissions. The sample included adults aged 18 years and older hospitalized in 16 states in 2010 or 2011 for acute myocardial infarction, heart failure, pneumonia, or total hip or joint arthroplasty. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems measured discharge-planning quality at the hospital level. A generalized linear mixed model was used to estimate the contribution of patient and hospital characteristics to 30-day all-cause and same-hospital readmissions. Discharge-planning quality was associated with (a) lower rates of 30-day hospital readmissions and (b) higher rates of same-hospital readmissions for heart failure, pneumonia, and total hip or joint replacement. These results suggest that by improving inpatient discharge planning, hospitals may be able to influence their 30-day readmissions and increase...
To examine whether market competition may influence the difference in the inpatient price per dis... more To examine whether market competition may influence the difference in the inpatient price per discharge between public (Medicare) and private payers across small geographic areas. Retrospective multivariate analysis. Data came from the 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs) in 162 counties from 6 states where an HCUP price-to-charge ratio (PCR) was available. The SIDs were linked with the Area Resource File, American Hospital Association Annual Survey Database, and US Census Bureau data files. Hospital inpatient prices were estimated by applying the HCUP PCR to total hospital charges. Payer-specific price comparisons were made for all discharges, an acute condition (acute myocardial infarction), and an elective condition (knee arthroplasty). Ordinary least squares models were used to examine the effect of market competition on the inpatient price per discharge by payer. Greater geographic variation was found in the inpatient price per discharge among private than public payers for most hospital services. Hospitals in more concentrated markets were associated with a higher price per discharge among knee arthroplasty discharges for both payers. Hospitals charged significantly higher prices to private than public payers. Because the payment policies from Medicare ultimately affect private payers, public policy efforts that take into consideration market-based approaches or payment reform may help to reduce price variations.
Clinical Therapeutics, 2004
The aims of this study were to estimate the effects of demographics, location, severity of multip... more The aims of this study were to estimate the effects of demographics, location, severity of multiple sclerosis (MS), comorbidities, plan type, coinsurance levels, and time of entry into the sample on the use of disease-modifying agents.
The Annals of Pharmacotherapy, 2010
Military Medicine, Sep 1, 2009
We compared chronic care utilization in four major health systems in the U.S.: the military healt... more We compared chronic care utilization in four major health systems in the U.S.: the military health system (TRICARE), the Department of Veterans Affairs (VA), Medicaid, and employer-sponsored commercial plans. Prevalence rates and key performance indicators were constructed from administrative data in federal fiscal year 2003 for eight chronic conditions: hypertension, major depression, diabetes, tobacco dependence, ischemic heart disease, severe mental illness, persistent asthma, and stroke. Continuously enrolled beneficiaries under 65 years old were studied: TRICARE (N = 2,963,987), VA (N = 2,114,739), Medicaid enrollees in five states (N = 5,554,974), and commercial insurance (N = 5,212,833). Condition-specific adjusted prevalence rates and measures were compared using the standardized rate ratio. For the majority of the conditions, the estimated prevalence rates were highest in the VA and Medicaid populations. Prevalence rates were generally lower in TRICARE and commercial plans. Medicaid beneficiaries had the highest hospitalization rates in four of the six conditions where hospitalization rates were measured. These results provide empirical evidence of differences in chronically ill patient populations in several of the major U.S. health insurance systems.
American Journal of Public Health, Dec 1, 1984
The hours worked by physicians are affected by changes in a number of factors, including attitude... more The hours worked by physicians are affected by changes in a number of factors, including attitudes towards labor-leisure tradeoffs, the characteristics of the physician workforce, and the level of demand for medical services. This paper analyzes changes in the hours worked per week by office-based physicians over the decade 1970-80. Overall, there has been a statistically significant decline in hours of approximately 3 per cent, or 1.5 hours per week. This decline was fairly uniform across most physician characteristics, although the decline was greater for those in primary care specialties. Female physicians increased their average hours worked, although this increase was not statistically significant. In terms of the delivery of skilled medical services, the decline in total hours was largely offset by an increase in the percentage of total hours devoted to patient care. The question of whether these trends will continue has important implications for the validity of projections of a physician surplus in the near future.
Military Medicine, 2009
We compared chronic care utilization in four major health systems in the U.S.: the military healt... more We compared chronic care utilization in four major health systems in the U.S.: the military health system (TRICARE), the Department of Veterans Affairs (VA), Medicaid, and employer-sponsored commercial plans. Prevalence rates and key performance indicators were constructed from administrative data in federal fiscal year 2003 for eight chronic conditions: hypertension, major depression, diabetes, tobacco dependence, ischemic heart disease, severe mental illness, persistent asthma, and stroke. Continuously enrolled beneficiaries under 65 years old were studied: TRICARE (N = 2,963,987), VA (N = 2,114,739), Medicaid enrollees in five states (N = 5,554,974), and commercial insurance (N = 5,212,833). Condition-specific adjusted prevalence rates and measures were compared using the standardized rate ratio. For the majority of the conditions, the estimated prevalence rates were highest in the VA and Medicaid populations. Prevalence rates were generally lower in TRICARE and commercial plans. Medicaid beneficiaries had the highest hospitalization rates in four of the six conditions where hospitalization rates were measured. These results provide empirical evidence of differences in chronically ill patient populations in several of the major U.S. health insurance systems.
Medical Care, 1990
The growing population of HIV-seropositives raises serious concerns about who will provide medica... more The growing population of HIV-seropositives raises serious concerns about who will provide medical care to this group. This article presents the first national estimates of physician involvement in, and attitudes toward, the treatment of HIV-seropositive patients. Nearly 50% of the nonfederal patient care physicians in our nationally representative sample have treated at least one HIV patient, with an average of 6.7 such patients being treated per physician. Perceived responsibility to treat HIV-seropositive patients is uniformly strong across such physician and practice characteristics as specialty, years of experience, and practice type. However, there are pronounced differences in actual physician involvement along these dimensions.
Journal of General Internal Medicine, 2007
Persons with multiple chronic conditions are a large and growing segment of the US population. Ho... more Persons with multiple chronic conditions are a large and growing segment of the US population. However, little is known about how chronic conditions cluster, and the ramifications of having specific combinations of chronic conditions. Clinical guidelines and disease management programs focus on single conditions, and clinical research often excludes persons with multiple chronic conditions. Understanding how conditions in combination impact the burden of disease and the costs and quality of care received is critical to improving care for the 1 in 5 Americans with multiple chronic conditions. This Medline review of publications examining somatic chronic conditions co-occurring with 1 or more additional specific chronic illness between January 2000 and March 2007 summarizes the state of our understanding of the prevalence and health challenges of multiple chronic conditions and the implications for quality, care management, and costs.
Annals of Pharmacotherapy, 2009
American Journal of Public Health, 1984
The hours worked by physicians are affected by changes in a number of factors, including attitude... more The hours worked by physicians are affected by changes in a number of factors, including attitudes towards labor-leisure tradeoffs, the characteristics of the physician workforce, and the level of demand for medical services. This paper analyzes changes in the hours worked per week by office-based physicians over the decade 1970-80. Overall, there has been a statistically significant decline in hours of approximately 3 per cent, or 1.5 hours per week. This decline was fairly uniform across most physician characteristics, although the decline was greater for those in primary care specialties. Female physicians increased their average hours worked, although this increase was not statistically significant. In terms of the delivery of skilled medical services, the decline in total hours was largely offset by an increase in the percentage of total hours devoted to patient care. The question of whether these trends will continue has important implications for the validity of projections of a physician surplus in the near future.
American Journal of Public Health, 1990
This study analyzes how the growing proportion of women in the United States physician population... more This study analyzes how the growing proportion of women in the United States physician population will affect the amount and type of physician services available to the US population. Female physicians work fewer hours per week, are slightly less likely to be in patient care, and tend to enter different specialties than male physicians. Female physicians also have higher retirement rates than male physicians, but due to their lower mortality rates, have work lives nearly as long as male physicians. We examined how the changing composition of the physician population will affect the availability of physician services by comparing historical and pro-Address reprint requests to
Medical care research and review : MCRR, Jan 4, 2016
This study examines the association between the quality of hospital discharge planning and all-ca... more This study examines the association between the quality of hospital discharge planning and all-cause 30-day readmissions and same-hospital readmissions. The sample included adults aged 18 years and older hospitalized in 16 states in 2010 or 2011 for acute myocardial infarction, heart failure, pneumonia, or total hip or joint arthroplasty. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems measured discharge-planning quality at the hospital level. A generalized linear mixed model was used to estimate the contribution of patient and hospital characteristics to 30-day all-cause and same-hospital readmissions. Discharge-planning quality was associated with (a) lower rates of 30-day hospital readmissions and (b) higher rates of same-hospital readmissions for heart failure, pneumonia, and total hip or joint replacement. These results suggest that by improving inpatient discharge planning, hospitals may be able to influence their 30-day readmissions and increase...
To examine whether market competition may influence the difference in the inpatient price per dis... more To examine whether market competition may influence the difference in the inpatient price per discharge between public (Medicare) and private payers across small geographic areas. Retrospective multivariate analysis. Data came from the 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SIDs) in 162 counties from 6 states where an HCUP price-to-charge ratio (PCR) was available. The SIDs were linked with the Area Resource File, American Hospital Association Annual Survey Database, and US Census Bureau data files. Hospital inpatient prices were estimated by applying the HCUP PCR to total hospital charges. Payer-specific price comparisons were made for all discharges, an acute condition (acute myocardial infarction), and an elective condition (knee arthroplasty). Ordinary least squares models were used to examine the effect of market competition on the inpatient price per discharge by payer. Greater geographic variation was found in the inpatient price per discharge among private than public payers for most hospital services. Hospitals in more concentrated markets were associated with a higher price per discharge among knee arthroplasty discharges for both payers. Hospitals charged significantly higher prices to private than public payers. Because the payment policies from Medicare ultimately affect private payers, public policy efforts that take into consideration market-based approaches or payment reform may help to reduce price variations.