Jiang, Jianfei
(2015)
Group-based trajectory modeling for longitudinal data of healthcare financial charges in patients with inflammatory bowel disease.
Master's Thesis, University of Pittsburgh.
(Unpublished)
Abstract
Inflammatory bowel disease (IBD) is a heterogeneous group of lifelong chronic inflammatory diseases with variable and unpredictable disease courses which often require significant healthcare expenditures. There exists no uniform severity measure to capture the activity and the healthcare utilization of the disease. This study seeks to identify disease trajectories for the IBD patients based on their annual financial healthcare charges over time. We performed a longitudinal study of annual financial charges using a consented, prospective, natural history registry of 2,400 IBD patients at the University of Pittsburgh Medical Center from 2009 to 2013. The annual charges were calculated as the sum of inpatient admission charges and professional service charges, with (ChargeF) or without (ChargeR) biological medicine charges. Patients who completed a five-year follow-up were included in the study. The continuous financial charges were first categorized into sections of different price range, and then the data was fitted with a latent group-based zero-inflated Poisson model to identify different homogeneous trajectory patterns of financial charges. We identified six distinct trajectory groups of total annual charges obtained from each of the two calculation methods (ChargeF and ChargeR). We further compared between these trajectories for patient characteristics, disease activity indices (Harvey-Bradshaw Index and ulcerative colitis activity index), disease activity markers (high-sensitivity C-reactive protein and erythrocyte sedimentation rate), health-related quality of life index (short inflammatory bowel disease questionnaire, SIBDQ), healthcare utilization (emergency department, hospitalization, and surgery), and corticosteroid prescriptions.
We concluded that the healthcare financial charge could be a novel and uniform metric to evaluate the disease severity and the response of IBD patients to treatments. The present study is the first of its kind using latent group-based trajectory modeling of financial charges to identify distinct subsets of IBD patients with their response to treatments. The model could be used to determine the genetic, environmental, and other factors that influence disease severity and the patient’s response to medical therapies. It will provide important information for the development of personalized or precision medical interventions for IBD patients and the reduction of their health care cost.
Public Health Relevance:
This study proposed a new metric which could be an accurate reflection of classic disease activity parameters, biochemical markers of inflammation, disease activity indices, and health-related quality of life in a cohort of patients with inflammatory bowel disease. The model developed would be of great significance to exploring the risk factors that influence the response to medical interventions. It will provide important information for the development of personalized or precision medical interventions for patients with inflammatory bowel disease and the reduction of their health care cost.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
28 September 2015 |
| Date Type: |
Publication |
| Defense Date: |
5 June 2015 |
| Approval Date: |
28 September 2015 |
| Submission Date: |
2 June 2015 |
| Access Restriction: |
1 year -- Restrict access to University of Pittsburgh for a period of 1 year. |
| Number of Pages: |
56 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Biostatistics |
| Degree: |
MS - Master of Science |
| Thesis Type: |
Master's Thesis |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
group-based trajectory modeling; zero-
inflated-poisson (ZIP); inflammatory bowel diseases; healthcare financial charges
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| Date Deposited: |
28 Sep 2015 16:56 |
| Last Modified: |
15 Nov 2016 14:28 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/25293 |
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