National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Asthma (2)
- Behavioral Health (3)
- Blood Pressure (1)
- Cancer (5)
- Cancer: Colorectal Cancer (1)
- Cancer: Skin Cancer (1)
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- Care Management (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (8)
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- Comparative Effectiveness (2)
- Critical Care (2)
- Decision Making (1)
- Diabetes (1)
- Disparities (3)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Medical Services (EMS) (1)
- Eye Disease and Health (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (6)
- (-) Healthcare Costs (50)
- Healthcare Delivery (1)
- Healthcare Utilization (4)
- Health Information Technology (HIT) (2)
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- Health Services Research (HSR) (2)
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- Medical Expenditure Panel Survey (MEPS) (4)
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- Newborns/Infants (1)
- Nursing (1)
- Obesity (1)
- Orthopedics (1)
- Palliative Care (1)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Patient Safety (4)
- Payment (1)
- Policy (2)
- Prevention (1)
- Primary Care (1)
- Provider Performance (1)
- Public Health (1)
- Quality of Care (7)
- Quality of Life (1)
- Racial and Ethnic Minorities (2)
- Social Determinants of Health (1)
- Surgery (5)
- Treatments (1)
- Uninsured (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 50 Research Studies DisplayedBerry JG, Hall M, Neff J
Children with medical complexity and Medicaid: spending and cost savings.
The authors described the expenditures for children with medical complexity insured by Medicaid across the care continuum, reported the increasingly large amount of spending on hospital care for these children, and presented a business case that estimates how cost savings might be achieved from potential reductions in hospital and emergency department use and shows how the savings could underwrite investments in outpatient and community care. They concluded by discussing the importance of these findings in the context of Medicaid's quality of care and health care reform.
AHRQ-funded; HS023092.
Citation: Berry JG, Hall M, Neff J .
Children with medical complexity and Medicaid: spending and cost savings.
Health Aff 2014 Dec;33(12):2199-206. doi: 10.1377/hlthaff.2014.0828.
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Keywords: Children/Adolescents, Medicaid, Healthcare Costs, Inpatient Care, Quality of Care
Reiter KL, Jiang HJ, Wang J
AHRQ Author: Jiang HJ
Facing the recession: how did safety-net hospitals fare financially compared with their peers?
The authors examined the effect of the recession on the financial performance of safety-net versus non-safety-net hospitals. They concluded that safety-net hospitals may not be disproportionately vulnerable to macro-economic fluctuations, but their significantly lower margins leave less financial cushion to weather sustained financial pressure.
AHRQ-authored.
Citation: Reiter KL, Jiang HJ, Wang J .
Facing the recession: how did safety-net hospitals fare financially compared with their peers?
Health Serv Res 2014 Dec;49(6):1747-66. doi: 10.1111/1475-6773.12230.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitals
Raghavan R, Brown DS, Allaire BT
Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States.
The authors aimed to quantify the magnitude of Medicaid expenditures incurred in the purchase of psychotropic drugs for children with histories of abuse or neglect. They concluded that Medicaid agencies should focus their cost containment strategies on antidepressants and antimanic drugs, consider expanding primary care case management arrangements, and expand use of instruments such as the Child Behavior Checklist to identify and treat high-need children.
AHRQ-funded; HS020269.
Citation: Raghavan R, Brown DS, Allaire BT .
Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States.
Psychiatr Serv 2014 Dec;65(12):1445-51. doi: 10.1176/appi.ps.201400028.
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Keywords: Children/Adolescents, Healthcare Costs, Medicaid, Medication, Behavioral Health
Simeone RM, Oster ME, Cassell CH
AHRQ Author: Gray DT
Pediatric inpatient hospital resource use for congenital heart defects.
The authors sought to estimate healthcare costs for infants, children, and adolescents with congenital heart defects (CHDs). Using the 2009 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID), they found that hospitalizations for children with CHDs have disproportionately high hospital costs compared with other pediatric hospitalizations, and the 17% of hospitalizations with critical CHD diagnoses accounted for 27% of CHD hospital costs.
AHRQ-authored.
Citation: Simeone RM, Oster ME, Cassell CH .
Pediatric inpatient hospital resource use for congenital heart defects.
Birth Defects Res A Clin Mol Teratol 2014 Dec;100(12):934-43. doi: 10.1002/bdra.23262.
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Keywords: Cardiovascular Conditions, Children/Adolescents, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitalization
Vargas Bustamante A, Chen J
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
This study of the association between the timing of the Great Recession (GR) and health spending among uninsured U.S. immigrants found that the probability of any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported 27 percent higher spending during the GR.
AHRQ-funded; HS022634
Citation: Vargas Bustamante A, Chen J .
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
Health Serv Res. 2014 Dec;49(6):1900-24. doi: 10.1111/1475-6773.12193..
Keywords: Healthcare Costs, Uninsured, Disparities
Trudnak Fowler T, Fairbrother G, Owens P
AHRQ Author: Owens P
Trends in complicated newborn hospital stays & costs, 2002-2009: implications for the future.
The researchers used HCUP data to examine trends from 2002 through 2009 in complicated newborn hospital stays, and to explore the relationship between expected sources of payment and reasons for hospitalizations. They concluded that state Medicaid programs are paying for an increasing proportion of births and costly complicated births, and they suggested that policies to prevent common birth complications have the potential to reduce costs for public programs and improve birth outcomes.
AHRQ-authored.
Citation: Trudnak Fowler T, Fairbrother G, Owens P .
Trends in complicated newborn hospital stays & costs, 2002-2009: implications for the future.
Medicare Medicaid Res Rev 2014;4(4). doi: 10.5600/mmrr.004.04.a03.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Newborns/Infants
Angier H, Gregg J, Gold R
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
The researchers explored low-income parents’ perspectives on accessing health care. Interviews with 29 Oregon parents revealed that affordability and limited availability were seen as barriers to care; while a continuous relationship with a health care provider helped them overcome these barriers. Parents also described the difficult decisions they made between affordability and acceptability in order to get the best care they could for their children.
AHRQ-funded; HS018569.
Citation: Angier H, Gregg J, Gold R .
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
BMC Health Serv Res 2014 Nov 19;14:585. doi: 10.1186/s12913-014-0585-2..
Keywords: Access to Care, Children/Adolescents, Low-Income, Social Determinants of Health, Healthcare Costs
Berner ES, Burkhardt JH, Panjamapirom A
Cost implications of human and automated follow-up in ambulatory care.
This study tracked costs associated with using nurse-initiated telephone calls or interactive voice response (IVR) over the first two years of followup for a practice assumed to have 4800 acute care patient visits per year. For the first two years, costs were approximately the same but, in subsequent years, IVR followup is approximately $9000 per year less expensive than nurse followup.
AHRQ-funded; HS017060
Citation: Berner ES, Burkhardt JH, Panjamapirom A .
Cost implications of human and automated follow-up in ambulatory care.
Am J Manag Care. 2014 Nov;20(11 Spec No. 17):SP531-40..
Keywords: Healthcare Costs, Primary Care, Quality of Care, Critical Care
Geynisman DM, Chien CR, Smieliauskas F
Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review.
The researchers performed a comprehensive literature review of cost and cost-effectiveness research on therapeutic cancer vaccines and monoclonal antibodies, to better understand the economic impacts of these treatments. They discussed the implications surrounding the economic factors involved in cancer immunotherapies and suggested that further research on cost and cost-effectiveness of newer cancer vaccines and immunotherapies were warranted as this is a rapidly growing field with many new drugs on the horizon.
AHRQ-funded; HS018535.
Citation: Geynisman DM, Chien CR, Smieliauskas F .
Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review.
Hum Vaccin Immunother 2014;10(11):3415-24. doi: 10.4161/hv.29407.
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Keywords: Cancer, Healthcare Costs, Vaccination
Martsolf GR, Auerbach D, Benevent R
AHRQ Author: Stocks C, Jiang HJ
Examining the value of inpatient nurse staffing: an assessment of quality and patient care costs.
The authors assessed the effect of nurse staffing on quality of care and inpatient care costs. They found that increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, while changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Martsolf GR, Auerbach D, Benevent R .
Examining the value of inpatient nurse staffing: an assessment of quality and patient care costs.
Med Care 2014 Nov;52(11):982-8. doi: 10.1097/mlr.0000000000000248.
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Keywords: Healthcare Costs, Quality of Care, Healthcare Cost and Utilization Project (HCUP), Inpatient Care, Nursing
Trish E, Joyce G, Goldman DP
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
The authors analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007-11 pharmacy claims data. They found that annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, but specialty drugs accounted for less than ten percent of total drug spending per beneficiary. Additionally, in 2011, cost-sharing reductions under the Affordable Care Act significantly reduced specialty drug users' out-of-pocket burden, which decreased 26 percent from 2010.
AHRQ-funded; HS000046.
Citation: Trish E, Joyce G, Goldman DP .
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
Health Aff 2014 Nov;33(11):2018-24. doi: 10.1377/hlthaff.2014.0538.
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Keywords: Healthcare Costs, Health Insurance, Medicare, Medication
Mutter R, Stocks C
AHRQ Author: Stocks C
Using Healthcare Cost and Utilization Project (HCUP) data for emergency medicine research.
This article mentions Kocher et al., elsewhere in this issue, who use the HCUP Nationwide Inpatient Sample to examine the association between the volume of ED encounters that result in admission and inpatient mortality. It further discusses HCUP strengths, weaknesses, and future.
AHRQ-authored.
Citation: Mutter R, Stocks C .
Using Healthcare Cost and Utilization Project (HCUP) data for emergency medicine research.
Ann Emerg Med 2014 Nov;64(5):458-60. doi: 10.1016/j.annemergmed.2014.09.014.
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Keywords: Emergency Medical Services (EMS), Healthcare Costs, Healthcare Delivery, Health Services Research (HSR), Healthcare Cost and Utilization Project (HCUP)
Maeda JL, Mosher Henke R, Marder WD
AHRQ Author: Karaca Z, Friedman BS, Wong HS
Variation in hospital inpatient prices across small geographic areas.
The authors examined whether market competition may influence the difference in the inpatient price per discharge between public and private payers across small geographic areas. They found greater geographic variation in the inpatient price per discharge among private than public payers for most hospital services, while hospitals in more concentrated markets were associated with a higher price per discharge among knee arthroplasty discharges for both payers. They concluded that hospitals charged significantly higher prices to private than public payers.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Maeda JL, Mosher Henke R, Marder WD .
Variation in hospital inpatient prices across small geographic areas.
Am J Manag Care 2014 Nov;20(11):907-16.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Orthopedics, Surgery
Huang SS, Septimus E, TR TR
Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial.
The researchers estimated the incremental effect on healthcare costs associated with targeted decolonization and universal decolonization compared with screening and isolation, which is considered the current standard of care. They found that a strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and like reduce healthcare costs when compared to other strategies.
AHRQ-funded; 290201000008I; 29032007T.
Citation: Huang SS, Septimus E, TR TR .
Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S23-31. doi: 10.1086/677819..
Keywords: Healthcare Costs, Quality of Care, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Patient Safety
Lairson DR, Parikh RC, Cormier JN
Cost-utility analysis of chemotherapy regimens in elderly patients with stage III colon cancer.
The authors investigated community-level evidence on the effectiveness and cost effectiveness of treatment for stage III colon cancer for elderly patients among those receiving no chemotherapy, 5-fluorouracil (5-FU), and FOLFOX (5-FU + oxaliplatin). They concluded that FOLFOX appears more effective and cost effective than other strategies for colon cancer treatment of older patients, with results being sensitive to age.
AHRQ-funded; HS018956.
Citation: Lairson DR, Parikh RC, Cormier JN .
Cost-utility analysis of chemotherapy regimens in elderly patients with stage III colon cancer.
Pharmacoeconomics 2014 Oct;32(10):1005-13. doi: 10.1007/s40273-014-0180-8.
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Keywords: Cancer: Colorectal Cancer, Comparative Effectiveness, Healthcare Costs, Elderly, Patient-Centered Outcomes Research
Starner CI, Alexander GC, Bowen K
Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.
The investigators examined insurers' role in maintaining the affordability and accessibility of specialty drugs while maximizing their value. They found that drug coupons accounted for $21.2 million of patients' $35.3 million annual out-of-pocket costs. In the vast majority of cases, coupons reduced monthly cost sharing to less than $250, a point at which patients were far less likely to abandon therapy with biologic anti-inflammatory drugs or with drugs for multiple sclerosis. They highlighted that, by reducing cost sharing, coupons may also circumvent efforts to encourage patients to use the most cost-effective drugs.
AHRQ-funded; HS018960.
Citation: Starner CI, Alexander GC, Bowen K .
Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.
Health Aff 2014 Oct;33(10):1761-9. doi: 10.1377/hlthaff.2014.0497.
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Keywords: Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance
Parmar AD, Coutin MD, Vargas GM
Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.
The objective was to determine the threshold for probability of recurrent symptoms at which elective cholecystectomy became the most effective and cost-effective options for older patients with mild biliary disease. This procedure was more effective than observation when the probability of continued symptoms exceeded 45.3 percent; when the probability exceeded 82.7 percent, the procedure became more cost-effective as well.
AHRQ-funded; HS022134
Citation: Parmar AD, Coutin MD, Vargas GM .
Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.
J Gastrointest Surg. 2014 Sep;18(9):1616-22. doi: 10.1007/s11605-014-2570-9..
Keywords: Comparative Effectiveness, Healthcare Costs, Elderly, Surgery
David G, Lindrooth RC, Helmchen LA
Do hospitals cross-subsidize?
The authors used repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. They studied how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. They estimated that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose.
AHRQ-funded; HS010730.
Citation: David G, Lindrooth RC, Helmchen LA .
Do hospitals cross-subsidize?
J Health Econ 2014 Sep;37:198-218. doi: 10.1016/j.jhealeco.2014.06.007.
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Keywords: Healthcare Costs, Quality of Care, Hospitals
Joseph S, Sow M, Furukawa MF
AHRQ Author: Furukawa MF
HITECH spurs EHR vendor competition and innovation, resulting in increased adoption.
This study examined the impact of the Health Information Technology for Economic and Clinical Health Act (HITECH). It found increased provider adoption and also provides the first evidence of increased competitiveness and innovation in the electronic health records industry spurred by HITECH.
AHRQ-authored
Citation: Joseph S, Sow M, Furukawa MF .
HITECH spurs EHR vendor competition and innovation, resulting in increased adoption.
Am J Manag Care. 2014 Sep;20(9):734-40..
Keywords: Health Information Technology (HIT), Healthcare Costs, Electronic Prescribing (E-Prescribing), Electronic Health Records (EHRs)
Burke JF, Vijan S, Chekan LA
Targeting high-risk employees may reduce cardiovascular racial disparities.
A possible remedy for health disparities is for employers to promote cardiovascular health among minority employees. However, this study finds that there was no significant per person differential attributable to racial disparities for heart attack and stroke. A primary implication is that targeting cardiovascular disease strategies for African Americans is unlikely to be cost saving for employers.
AHRQ-funded; HS017690
Citation: Burke JF, Vijan S, Chekan LA .
Targeting high-risk employees may reduce cardiovascular racial disparities.
Am J Manag Care. 2014 Sep;20(9):725-33..
Keywords: Cardiovascular Conditions, Disparities, Healthcare Costs, Health Promotion, Health Status, Racial and Ethnic Minorities
Hockenberry JM, Helmchen LA
The nature of surgeon human capital depreciation.
The authors estimated how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). They found that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points but reduced total hospitalization costs by up to 0.59 percentage points, and among emergent patients treated by high-volume providers, an additional day away raised mortality risk by 0.398 percentage points but reduced cost by up to 1.4 percentage points. They concluded that their results are consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications.
AHRQ-funded; HS019743.
Citation: Hockenberry JM, Helmchen LA .
The nature of surgeon human capital depreciation.
J Health Econ 2014 Sep;37:70-80. doi: 10.1016/j.jhealeco.2014.06.001.
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Keywords: Healthcare Costs, Mortality, Provider Performance, Surgery
Crisp GD, Roberts AW, Esserman DA
The University of North Carolina's Health Care Pharmacy Assistance Program.
This study examined a program providing financial assistance to uninsured residents of North Carolina who need prescription medications. It found that from 2009 to 2011, the program served 7,180 patients in 81 counties. These patients received a mean of 23 prescriptions at an average cost of $754 per recipient per year.
AHRQ-funded; HS000032
Citation: Crisp GD, Roberts AW, Esserman DA .
The University of North Carolina's Health Care Pharmacy Assistance Program.
N C Med J. 2014 Sep-Oct;75(5):303-9..
Keywords: Healthcare Costs, Uninsured, Medication, Healthcare Utilization
Abdus S, Hudson J, Hill SC
AHRQ Author: Abdus S, Hudson J, Hill SC, Selden TM
Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.
Using MEPS data, the authors showed that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. They found that the increase in uninsurance is largest among children whose parents lack offers of employer coverage.
AHRQ-authored.
Citation: Abdus S, Hudson J, Hill SC .
Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.
Health Aff 2014 Aug;33(8):1353-60. doi: 10.1377/hlthaff.2014.0182.
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Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Low-Income
de Souza JA, Santana IA, de Castro Jr G
Economic analyses in squamous cell carcinoma of the head and neck: a review of the literature from a clinical perspective.
This review aims to evaluate the current literature related to economic analyses of treatment modalities for squamous cell cancer of the head and neck. The variation in findings among the studies reviewed demonstrates the challenges of performing economic analyses in a disease that requires an evolving and complex multidisciplinary approach.
AHRQ-funded; HS018535
Citation: de Souza JA, Santana IA, de Castro Jr G .
Economic analyses in squamous cell carcinoma of the head and neck: a review of the literature from a clinical perspective.
Int J Radiat Oncol Biol Phys. 2014 Aug 1;89(5):989-96. doi: 10.1016/j.ijrobp.2014.03.040..
Keywords: Cancer, Healthcare Costs
Gawron AJ, French DD, Pandolfino JE
Economic evaluations of gastroesophageal reflux disease medical management.
This article systematically evaluated the existing literature to identify economic evaluations of GERD medical management strategies and assess the scientific quality of these reports using the CHEERS guidelines. It concluded that initial empiric PPI therapy is likely the most cost-effective initial strategy for patients with typical GERD symptoms. Surgery may be cost effective in patients with chronic GERD symptoms at time horizons of 3–10 years.
AHRQ-funded; HS000078.
Citation: Gawron AJ, French DD, Pandolfino JE .
Economic evaluations of gastroesophageal reflux disease medical management.
Pharmacoeconomics 2014 Aug;32(8):745-58. doi: 10.1007/s40273-014-0164-8..
Keywords: Care Management, Chronic Conditions, Healthcare Costs