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Comparative Effectiveness Research

Costs Vs. Benefits

This direction of research is a component of Dr. Bonilha’s KL2 grant. The main impetus of improving the rater reliability of features from laryngeal endoscopy is to be able to use laryngeal endoscopy as a treatment outcome tool. A related necessity in this time of medical expenditure cutbacks is to provide evidence of the importance of the role of laryngeal endoscopy in the diagnosis and treatment of persons with voice disorders. Dr. Kit Simpson, a guru in CER, is Dr. Bonilha’s mentor in this area.

Cost and Service Utilization

In the current medical spending climate, it is imperative to provide evidence for the cost and use of services provided by SLPs and proof of the importance of diagnostic and treatment procedures.

  1. Factors that Influence the Use of Diagnostic Procedures in Voice and Swallowing Disorders
    In this project, Dr. Bonilha and her collaborators are using hospital-level data to evaluate the frequency of diagnostic procedures common in voice and swallowing disorders and assessing differences in the utilization of these procedures with persons of varying age, race, rurality and comorbidities.
  2. One Year Cost of Dysphagia Post-Stroke
    In this study, Dr. Bonilha and her collaborators are assessing the additional medical cost of dysphagia in the first year post-stroke. They found that the one-year cost for persons with dysphagia post-ischemic stroke was $10,676 higher than that for persons without dysphagia post-ischemic stroke when controlling for age, co-morbidities, race, and proportion of time alive.
    They are continuing this line of research by investigating longer-term medical costs in dysphagia and the factors that influence this additional cost.
  3. Re-Evaluating the Incidence of Aspiration Pneumonia Post-Stroke
    Aspiration pneumonia post-stroke is commonly reported to be the #1 cause of rehospitalization after a stroke. However, several stroke specialists in the field of neurology do not report the same incidence of post-stroke aspiration pneumonia. It is possible, with growing knowledge in the evaluation and early detection and management of swallowing disorders, that the incidence of aspiration pneumonia post-stroke is decreasing. It is also possible that there is a disconnect in the care of stroke patients between their hospital discharge and subsequent follow-ups from neurology and future hospitalizations for aspiration pneumonia. Dr. Bonilha is using hospital-level data from states across the US to re-assess the incidence of aspiration pneumonia post-stroke. She hopes that a study across states will help to clarify whether the incidence of aspiration pneumonia post-stroke is actually decreasing or whether there is a disconnect in patient care that obscures its frequency.
 
 
 

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