Current Research Abstracts

David Weismantel is collaborating with Joseph Gardiner (PI), Carol Slomski, and Denise Holmes on a grant funded by Medicaid Match with MDCH – 10/1/05 – 9/30/06 - $74,139.

Bariatric Surgery

Specific Aims

We propose a retrospective review of all MAHP health plan members (Medicaid and Commercial) undergoing bariatric surgery during 1/1/2002 – 12/31/2003, inclusive to compare changes in health status before and after the surgical intervention. Approximately two thirds of the participating HMOs are Medicaid Health Plans. Bariatric surgery is a covered Medicaid benefit although pre-survey counseling is not. Bariatric surgery as a means of treating morbid obesity is increasing for all insured populations. Long-term treatment outcomes are not well researched. This study will provide important information to health plans and health insurance carriers regarding future coverage policies. Additionally, the results of this retrospective review will provide baseline estimates of clinical outcomes of managed care enrollees (Medicaid and Commercial) undergoing bariatric surgery and to suggest predictors of enhanced patient outcomes. The results will be used to frame prospective studies and clinical trials that will be better able to establish associations between policy directed care protocols, patient education and support services, and patient outcomes.

We will conduct a pre-post comparison of number and types (office vs. urgent/emergent vs. inpatient) of visits using the date of surgery as time zero. Our goal is to evaluate at least 18 months surrounding the date of surgery depending on patients’ affiliation with their health plan. We plan to conduct short-term and long-term comparisons if sufficient numbers remain with their health plan for longer periods (> 2-4 yrs). Based on claims data, we will describe referral services for specialty care received pre- and post-surgery. In addition to visit types, we will analyze pharmacy data to ascertain patterns of use for specific drug categories including: cardiatric-related medications (anti-hypertensives, anti-lipemics, etc); diabetes-related medications; and psychiatric medications. We will evaluate dosing regimens pre-post surgery and may include costs as available. We will compare additional specific clinical indicators including lipid and hemoglobin A1c levels as well as blood pressure readings, body mass index measurements before and after surgery, and short and long-term weight loss. Finally, we will describe total mortality, 30 day mortality (of surgical procedure), post-operative complications including return to OR, renal failure, dehydration and iron deficiencies occurring in the cohort. Sub-analyses will be performed to compare outcomes based on product line (i.e. Medicaid vs. Commercial), gender, race, etc., adjusting for multiple covariates.

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