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Center Explores Economic and Quality Issues
in Health Care
How do the uninsured cope? How cost-effective are prevention and disease management programs? Does socioeconomic status affect a patient’s care and management of disease?
A new research center in The University of Texas School of Public Health seeks answers to difficult questions surrounding health care: access, quality and cost-benefit analysis. The Center for Health Services Research is designed to study these issues and provide high-quality information to policy makers and health care providers grappling with the economic and social complexities spawned by the nation’s patchwork health care system.
Center co-directors Charles Begley, Ph.D., and David Lairson, Ph.D., both School of Public Health (SPH) professors of management, policy and community health, have longstanding research interests in the field and formed the center to cultivate teamwork in these areas with their colleagues.
As the center helps Houston-area officials better understand the challenges of the uninsured locally (see “Houston Endowment Funds Research on the Uninsured”), it also is conducting a national project studying the role of socioeconomic status in determining whether people with epilepsy receive appropriate treatment and get better.
Understanding and helping the uninsured is not new to the SPH or the center. Begley; Lairson; Associate Dean for Community Health Hardy Loe, M.D.; Lu Ann Aday, Ph.D., the Lorne D. Bain Distinguished Professor of Public Health and Medicine; and others have been engaged in the topic for years.
Breast and Colon Cancer Screening
Lairson has worked with the SPH Center for Health Promotion and Prevention Research examining the cost effectiveness of programs to increase breast and colon cancer screening.
“We know screening works,” Lairson explained. “The issue is the cost of expanding screening, reaching that added group. You need to determine the cost of a program, put it together with the program’s outcomes, and then compare that cost-effectiveness relative to other alternatives. Decision-makers need to know where to allocate their limited resources to have the greatest impact on health.”
$1 Million Grant for Epilepsy Research
Under a three-year, $1,050,000 grant from the U.S. Centers for Disease Control and Prevention, researchers will follow insured and low-income uninsured epilepsy patients in Houston and New York City.
“Basically, what we are asking is what the differences in care and outcomes are for people with this chronic disease based upon their social circumstance?” Begley said.
The team led by Begley, Lairson and Aday expects to enroll 1,000 people for the study, patients from Kelsey Seybold and Ben Taub Hospital in Houston and at Columbia Presbyterian Hospital and Harlem Hospital in New York.
The team will interview participants four times over 12 months, collect their health care information and monitor seizure activity. A quality of life questionnaire will be administered at the start and end of the period.
People with epilepsy are getting care; the question is whether the quality of care is different, Begley noted, and are patients’ capabilities to cope with the disease and comply with therapy different? Finally, how do all of those factors affect the quality of their lives?
“Our epilepsy work illustrates what we are trying to do at the center – basic health services research,” Begley said. “Our other niche is applied policy research with a state and local focus.”
Migrant Workers, Diabetes Management
Lairson has a pair of projects pending with national and local implications.
Austin-based Migrant Clinicians Network screens migrant workers for health problems. The network provides workers with a hotline to call when they move on to work in other states. They can dial the number to find out where they can go for care in Ohio or Washington state. Lairson has a proposal in to evaluate the cost-effectiveness of that program.
His team also is conducting a pilot study of a diabetes management system that Kelsey-Seybold is offering patients. “Kelsey Seybold wants to enhance the quality of care and control cost. We are going to evaluate the impact of this system on those two factors.”
Data from this study then will be used to apply for external funding from the U.S. Centers for Disease Control and Prevention or the U.S. Agency for Health Care Research and Quality.
Teaming Up To Address Crucial Issues
Begley believes the center’s focus will help advance their research and attract more funding to address these crucial issues. “We’ve been operating as individual entrepreneurs for many years and we’ve had good success individually. Dave and I decided that maybe we could do more by creating a center and working together more in teams.”
By Scott Merville, Public Affairs