Forecasting cost based on a stochastic utilization plan and a fixed cost function

The application of Markov processes is very useful to health-care problems. The objective of this study is to provide a structured methodology of forecasting cost based upon combining a stochastic model of utilization (Markov Chain) and deterministic cost function. The perspective of the cost in this study is the reimbursement for the services rendered. The data to be used is the OneCare database of claim records of their enrollees over a two-year period of January 1, 1996–December 31, 1997. The model combines a Markov Chain that describes the utilization pattern and its variability where the use of resources by risk groups (age, gender, and diagnosis) will be considered in the process and a cost function determined from a fixed schedule based on real costs or charges for those in the OneCare claims database. The cost function is a secondary application to the model. Goodness-of-fit will be used checked for the model against the traditional method of cost forecasting. ^

Commissioning an Anthropomorphic Spine and Lung Phantom for Remote Dose Verification of Institutions Participating in RTOG 0631

The RPC developed a new phantom to ensure comparable and consistent radiation administration in spinal radiosurgery clinical trials. This study assessed the phantom’s dosimetric and anatomic utility. The ‘spine phantom’ is a water filled thorax with anatomy encountered in spinal radiosurgery: target volume, vertebral column, spinal canal, esophagus, heart, and lungs. The dose to the target volume was measured with axial and sagittal planes of radiochromic film and thermoluminescent dosimeters (TLD). The dose distributions were measured with the radiochromic film calibrated to the absolute dose measured by the TLD. Four irradiations were administered: a four angle box plan, a seven angle conformal plan, a seven angle IMRT plan, and a nine angle IMRT plan (denoted as IMRT plan #1 and plan #2, respectively). In each plan, at least 95% of the defined tumor volume received 8 Gy. For each irradiation the planned and administered dose distributions were registered via pinpricks, and compared using point dose measurements, dose profiles, isodose distributions, and gamma analyses. Based on previous experience at the RPC, a gamma analysis was considering passing if greater than 95% of pixels passed the criteria of 5% dose difference and 3 mm distance-to-agreement. Each irradiation showed acceptable agreement in the qualitative assessments and exceeded the 95% passing rate at the 5% / 3 mm criteria, except IMRT plan #1, which was determined to have been poorly localized during treatment administration. The measured and planned dose distributions demonstrated acceptable agreement at the 5% / 3 mm criteria, and the spine phantom was determined to be a useful tool for the remote assessment of an institution’s treatment planning and dose delivery regimen.

BENCHMARKING AND IMPLEMENTATION OF A NEW INDEPENDENT MONTE CARLO DOSE CALCULATION QUALITY ASSURANCE AUDIT TOOL FOR CLINICAL TRIALS

Introduction Commercial treatment planning systems employ a variety of dose calculation algorithms to plan and predict the dose distributions a patient receives during external beam radiation therapy. Traditionally, the Radiological Physics Center has relied on measurements to assure that institutions participating in the National Cancer Institute sponsored clinical trials administer radiation in doses that are clinically comparable to those of other participating institutions. To complement the effort of the RPC, an independent dose calculation tool needs to be developed that will enable a generic method to determine patient dose distributions in three dimensions and to perform retrospective analysis of radiation delivered to patients who enrolled in past clinical trials. Methods A multi-source model representing output for Varian 6 MV and 10 MV photon beams was developed and evaluated. The Monte Carlo algorithm, know as the Dose Planning Method (DPM), was used to perform the dose calculations. The dose calculations were compared to measurements made in a water phantom and in anthropomorphic phantoms. Intensity modulated radiation therapy and stereotactic body radiation therapy techniques were used with the anthropomorphic phantoms. Finally, past patient treatment plans were selected and recalculated using DPM and contrasted against a commercial dose calculation algorithm. Results The multi-source model was validated for the Varian 6 MV and 10 MV photon beams. The benchmark evaluations demonstrated the ability of the model to accurately calculate dose for the Varian 6 MV and the Varian 10 MV source models. The patient calculations proved that the model was reproducible in determining dose under similar conditions described by the benchmark tests. Conclusions The dose calculation tool that relied on a multi-source model approach and used the DPM code to calculate dose was developed, validated, and benchmarked for the Varian 6 MV and 10 MV photon beams. Several patient dose distributions were contrasted against a commercial algorithm to provide a proof of principal to use as an application in monitoring clinical trial activity.

Development and validation of the Neuro Symptom Inventory in the primary brain tumor patient population

Symptoms has been shown to predict quality of life, treatment course and survival in solid tumor patients. Currently, no instrument exists that measures both cancer-related symptoms and the neurologic symptoms that are unique to persons with primary brain tumors (PBT). The aim of this study was to develop and validate an instrument to measure symptoms in patients who have PBT. A conceptual analysis of symptoms and symptom theories led to defining the symptoms experience as the perception of the frequency, intensity, distress, and meaning that occurs as symptoms are produced, perceived, and expressed. The M.D. Anderson Symptom Inventory (MDASI) measures both symptoms and how they interfere with daily functioning in patients with cancer, which is similar to the situational meaning defined in the analysis. A list of symptoms pertinent to the PBT population was added to the core MDASI and reviewed by a group of experts for validity. As a result, 18 items were added to the core MDASI (the MDASI-BT) for the next phase of instrument development, establishing validity and reliability through a descriptive, cross-sectional approach with PBT patients. Data were collected with a patient completed demographic data sheet, an investigator completed clinician checklist, and the MDASI-BT. Analysis evaluated the reliability and validity of the MDASI-BT in PBT patients. Data were obtained from 201 patients. The number of items was reduced to 22 by evaluation of symptom severity as well as cluster analysis. Regression analysis showed more than half (56%) of the variability in symptom severity was explained by the brain tumor module items. Factor analysis confirmed that the 22 item MDASI-BT measured six underlying constructs: (a) affective; (b) cognitive; (c) focal neurologic deficits; (d) constitutional symptoms; (e) treatment-related symptoms; and (f) gastrointestinal symptoms. The MDASI-BT was sensitive to disease severity and if the patient was hospitalized. The MDASI-BT is the first instrument to measure symptoms in PBT patients that has demonstrated reliability and validity. It is the first step in a program of research to evaluate the occurrence of symptoms and plan and evaluate interventions for PBT patients. ^

Evaluating the Harris County TexHealth 3-Share Plan: An exploratory study

An important health issue in the United States today is the large number of people who have problems accessing needed health care because they lack health insurance coverage. Providing health insurance coverage for the working uninsured is a particularly significant challenge in Texas, which has the highest percentage of uninsured in the nation. In response to the low rate of employer-sponsored coverage in the Houston area and the growing numbers of uninsured, the Harris County Health Care Alliance (HCHA) developed and implemented the Harris County 3-Share Plan. A 3-Share Plan is not insurance, but provides health coverage in the form of a benefits package to employers who subscribe to the program and offer it to their employees. ^ A cross sectional study design was conducted to describe 3-Share employer and employee participants and evaluate their outcomes after its first year of operation. Between September and December 2011, 85% of employers enrolled in the 3-Share Plan completed a survey about the affordability of the 3-Share Plan, their satisfaction with the Plan, and the Plan's impact on employee recruitment, retention, productivity, and absenteeism. Forty-five percent of employees enrolled in the 3-Share Plan responded to a survey asking about the affordability of the 3-Share plan, accessibility of health care, availability of providers on the plan, health plan availability, utilization of primary care providers and the ER, and satisfaction with the plan. ^ A summary of the findings shows employers and employees say that they joined the plan because of the low-cost, and once they had participated in the Plan, the majority of employers and employees found that it is affordable for them. The majority of employees say they are getting access easily and without delay, but for those who aren't able to get access, or are delayed, the main cause is related to non-financial barriers to care. Ultimately, employees are satisfied with the 3-Share, and they plan to continue with health coverage under the 3-Share Plan. The 3-Share Plan will keep people in a system of care, and promote health, which will benefit the individuals, the businesses and the community of Harris County.^

Evaluating the Harris County TexHealth 3-Share plan: An exploratory study

An important health issue in the United States today is the large number of people who have problems accessing needed health care because they lack health insurance coverage. Providing health insurance coverage for the working uninsured is a particularly significant challenge in Texas, which has the highest percentage of uninsured in the nation. In response to the low rate of employer-sponsored coverage in the Houston area and the growing numbers of uninsured, the Harris County Health Care Alliance (HCHA) developed and implemented the Harris County 3-Share Plan. A 3-Share Plan is not insurance, but provides health coverage in the form of a benefits package to employers who subscribe to the program and offer it to their employees. ^ A cross sectional study design was conducted to describe 3-Share employer and employee participants and evaluate their outcomes after its first year of operation. Between September and December 2011, 85% of employers enrolled in the 3-Share Plan completed a survey about the affordability of the 3-Share Plan, their satisfaction with the Plan, and the Plan's impact on employee recruitment, retention, and productivity. Forty-five percent of employees enrolled in the 3-Share Plan responded to a survey asking about the affordability of the 3-Share plan, accessibility of providers on the plan, satisfaction, and utilization of primary care providers and the ER. ^ A summary of the findings shows employers and employees say that they joined the plan because of the low-cost, and once they had participated in the Plan, the majority of employers and employees found that it is affordable for them. The majority of employees say they are getting access easily and without delay, but for those who aren't able to get access, or are delayed, the main cause is related to non-financial barriers to care. Ultimately, employees are satisfied with the 3-Share, and they plan to continue with health coverage under the 3-Share Plan. The 3-Share Plan will keep people in a system of care, and promote health, which will benefit the individuals, the businesses and the community of Harris County.^