ABSTRACT
Adult Basic Education (ABE) in the United States is an important tool for underrepresented and underserved communities to achieve the goal of high school graduation following noncompletion of K-12 education. Largely in urban settings, ABE centers serve millions of students annually, especially historically and contemporarily marginalized groups. ABE provides critical resources and skills to meet the educational needs of diverse peoples seeking to advance their station in life. ABE centers may serve students with potentially traumatic events (PTE), diagnosable trauma, and related poorer outcomes. Alarmingly, a paucity of research exists that examines the presence of PTEs for ABE students, particularly people and women of color. In the present research, the Patient Health Questionnaire 9-item and Generalized Anxiety Disorder 7-item measures were used to weigh depression and anxiety scores across the Life Events Checklist for the DSM-5 (LEC-5) trauma types in a sample (N=170) of predominantly women of color. We examined three respondent groups based on proximity and frequency of PTEs: (1) denied; (2) witnessed/learned about; and (3) experienced. Results indicate that those experiencing higher levels of PTEs (namely, sexual assault, unwanted/uncomfortable sexual experience, and sudden accidental death) also experienced higher ratings of depression and anxiety. More research is indicated, as women of color within ABE settings could benefit from tailored resources for prevention, intervention, and treatment.
ABSTRACT
BACKGROUND: Medical cost analysis is increasingly important, but the methodology is complex and varied. OBJECTIVE: To illustrate how different cost analysis methodologies influence conclusions generated from data from a prospective nonrandomized trial for treatment of cervical spondylotic myelopathy. METHODS: Patients 40 to 85 years of age with degenerative cervical spondylotic myelopathy were enrolled from 7 sites over 2 years (2007-2009). Patients were treated with ventral or dorsal fusion surgery, and outcomes were measured to 1 year postoperatively. A hospital-based cost analysis was performed using Medicare cost-to-charge ratios (CCRs) multiplied by hospital charges from the index hospitalization (CCR method). A society-based cost analysis was performed by estimating costs from the index hospitalization using Medicare coding reimbursement (the Medicare reimbursement method). A separate outpatient cost analysis was performed on a subset of 20 patients. RESULTS: Of the 85 patients analyzed, 72 had 1-year follow-up. The CCR method showed a difference in upfront direct costs between the dorsal and ventral approaches ($27,942 ± 14,220 vs $21,563 ± 8721; P = .02). Overall upfront direct costs with the Medicare reimbursement method were not different. With the CCR method, the ventral approach dominates an incremental cost-effectiveness ratio analysis. With the Medicare reimbursement method, the incremental cost-effectiveness ratio for ventral surgery is $34,533, the cost of 1 additional quality-adjusted life-year gained by using ventral instead of dorsal surgery. In the subanalysis, outpatient costs were less after ventral surgery than dorsal surgery ($1997 ± 1211 vs $4734 ± $2874; P = .006). CONCLUSION: The choice of cost methodology may substantially influence the final results of an economic study.
