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American Journal of Managed Care

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https://www.readbyqxmd.com/read/29372994/evidence-based-management-of-irritable-bowel-syndrome-with-diarrhea
#1
Mark Pimentel
Irritable bowel syndrome (IBS), a complex disorder of the gastrointestinal tract, is characterized by abdominal pain associated with defecation or changes in stool form or frequency. IBS is associated with substantial burden, including direct medical costs and indirect costs. Direct costs associated with IBS in the United States have been estimated to exceed $1 billion. However, indirect costs, such as negative effect on quality of life (QOL) and work productivity, are difficult to quantify. There are 3 main subtypes: IBS with prominent diarrhea (IBS-D), IBS with constipation, and IBS with mixed symptoms of both constipation and diarrhea...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29372991/evidence-based-management-of-irritable-bowel-syndrome-with-diarrhea
#2
Mark Pimentel
Irritable bowel syndrome (IBS), a complex disorder of the gastrointestinal tract, is characterized by abdominal pain associated with defecation or changes in stool form or frequency. IBS is associated with substantial burden, including direct medical costs and indirect costs. Direct costs associated with IBS in the United States have been estimated to exceed $1 billion. However, indirect costs, such as negative effect on quality of life (QOL) and work productivity, are difficult to quantify. There are 3 main subtypes: IBS with prominent diarrhea (IBS-D), IBS with constipation, and IBS with mixed symptoms of both constipation and diarrhea...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350514/hospitalized-patients-and-family-members-preferences-for-real-time-transparent-access-to-their-hospital-records
#3
Michael J Waxman, Kurt Lozier, Lana Vasiljevic, Kira Novakofski, James Desemone, John O'Kane, Elizabeth M Dufort, David Wood, Ashar Ata, Louis Filhour, Richard J Blinkhorn
OBJECTIVES: To better understand patient satisfaction and perceived engagement with traditional hospital-based communication and to elicit patient preferences for health information technologies that would lead to improved satisfaction and engagement. STUDY DESIGN: We performed a mixed-methods study involving qualitative interviews followed by a survey of hospitalized patients and their family members at a single large academic medical center. METHODS: We conducted semi-structured interviews with 41 patients and surveyed 267 patients or family members to elicit their perspectives on satisfaction with traditional hospital communication methods, information needed to more fully engage in the patients' medical care, and potential solutions for improved hospital-based communication...
January 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350513/racial-ethnic-variation-in-devices-used-to-access-patient-portals
#4
Eva Chang, Katherine Blondon, Courtney R Lyles, Luesa Jordan, James D Ralston
OBJECTIVES: We examined racial/ethnic variation in the devices used by patients to access medical records through an online patient portal. STUDY DESIGN: Retrospective, cross-sectional analysis. METHODS: Using data from 318,700 adults enrolled in an integrated delivery system between December 2012 and November 2013, we examined: 1) online patient portal use that directly engages the electronic health record and 2) portal use over desktops/laptops only, mobile devices only, or both device types...
January 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350512/electronic-health-record-problem-lists-accurate-enough-for-risk-adjustment
#5
Timothy J Daskivich, Garen Abedi, Sherrie H Kaplan, Douglas Skarecky, Thomas Ahlering, Brennan Spiegel, Mark S Litwin, Sheldon Greenfield
OBJECTIVES: To determine whether comorbidity information derived from electronic health record (EHR) problem lists is accurate. STUDY DESIGN: Retrospective cohort study of 1596 men diagnosed with prostate cancer between 1998 and 2004 at 2 Southern California Veterans Affairs Medical Centers with long-term follow-up. METHODS: We compared EHR problem list-based comorbidity assessment with manual review of EHR free-text notes in terms of sensitivity and specificity for identification of major comorbidities and Charlson Comorbidity Index (CCI) scores...
January 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350511/a-cost-effectiveness-analysis-of-cardiology-econsults-for-medicaid-patients
#6
Daren Anderson, Victor Villagra, Emil N Coman, Ianita Zlateva, Alex Hutchinson, Jose Villagra, J Nwando Olayiwola
OBJECTIVES: To evaluate the cost-effectiveness of electronic consultations (eConsults) for cardiology compared with traditional face-to-face consults. STUDY DESIGN: Cost-effectiveness analysis for a subset of Medicaid-insured patients in a cluster-randomized trial of eConsults versus the traditional face-to-face consultation process in a statewide federally qualified health center. METHODS: A total of 369 Medicaid patients were referred for cardiology consultations by primary care providers who were randomly assigned to use either eConsults or their usual face-to-face referral process...
January 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350510/electronic-sharing-of-diagnostic-information-and-patient-outcomes
#7
Darwyyn Deyo, Amir Khaliq, David Mitchell, Danny R Hughes
OBJECTIVES: Hospital sharing of electronic health record (EHR) diagnostic data has the potential to improve communication across providers and improve patient outcomes. However, implementing EHR systems can be difficult for hospitals. This study uses Hospital Compare (HC) and American Hospital Association (AHA) Annual Information Technology Survey data to estimate the association between sharing EHR data and patient outcomes. STUDY DESIGN: Descriptive and multivariate linear regression analyses...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350509/measuring-overuse-with-electronic-health-records-data
#8
Thomas Isaac, Meredith B Rosenthal, Carrie H Colla, Nancy E Morden, Alexander J Mainor, Zhonghe Li, Kevin H Nguyen, Elizabeth A Kinsella, Thomas D Sequist
OBJECTIVES: To measure overuse of low-value care using electronic health record (EHR) data and manual chart review and to evaluate whether certain low-value services are better captured using EHR data. STUDY DESIGN: We implemented algorithms to extract performance on 13 Choosing Wisely-identified healthcare services using EHR data at a large physician practice group between 2011 and 2013. METHODS: We calculated rates of overuse using automated EHR extracts...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350508/the-health-information-technology-special-issue-has-it-become-a-mandatory-part-of-health-and-healthcare
#9
Jacob Reider
The 7th annual Health Information Technology (IT) issue provides a window into how health IT tools are working well, how they may not be working as intended, and what we can do to continue making progress toward optimal use of technology to accomplish our shared goals: better health, better care experience, and lower per capita cost.
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350507/hospital-participation-in-meaningful-use-and-racial-disparities-in-readmissions
#10
Mark Aaron Unruh, Hye Young Jung, Rainu Kaushal, Joshua R Vest
OBJECTIVES: To measure the impact of hospital participation in Meaningful Use (MU) on disparities in 30-day readmissions associated with race. STUDY DESIGN: A retrospective cohort study that compared the likelihood of 30-day readmission for Medicare beneficiaries discharged from hospitals participating in Stage 1 of MU with the likelihood of readmission for beneficiaries concurrently discharged from hospitals that were not participating in the initiative. METHODS: Inpatient claims for 2,414,205 Medicare beneficiaries from Florida, New York, and Washington State were used as the primary data source...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350506/electronic-health-record-super-users-and-under-users-in-ambulatory-care-practices
#11
Juliet Rumball-Smith, Paul Shekelle, Cheryl L Damberg
OBJECTIVES: This study explored variation in the extent of use of electronic health record (EHR)-based health information technology (IT) functionalities across US ambulatory care practices. Use of health IT functionalities in ambulatory care is important for delivering high-quality care, including that provided in coordination with multiple practitioners. STUDY DESIGN: We used data from the 2014 Healthcare Information and Management Systems Society Analytics survey...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29350505/bridging-the-digital-divide-mobile-access-to-personal-health-records-among-patients-with-diabetes
#12
Ilana Graetz, Jie Huang, Richard J Brand, John Hsu, Cyrus K Yamin, Mary E Reed
OBJECTIVES: Some patients lack regular computer access and experience a digital divide that causes them to miss internet-based health innovations. The diffusion of smartphones has increased internet access across the socioeconomic spectrum, and increasing the channels through which patients can access their personal health records (PHRs) could help bridge the divide in PHR use. We examined PHR use through a computer-based Web browser or mobile device. STUDY DESIGN: Cross-sectional historical cohort analysis...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29337486/improving-risk-stratification-among-veterans-diagnosed-with-prostate-cancer-impact-of-the-17-gene-prostate-score-assay
#13
Julie A Lynch, Megan P Rothney, Raoul R Salup, Cesar E Ercole, Sharad C Mathur, David A Duchene, Joseph W Basler, Javier Hernandez, Michael A Liss, Michael P Porter, Jonathan L Wright, Michael C Risk, Mark Garzotto, Olga Efimova, Laurie Barrett, Brygida Berse, Michael J Kemeter, Phillip G Febbo, Atreya Dash
BACKGROUND: Active surveillance (AS) has been widely implemented within Veterans Affairs' medical centers (VAMCs) as a standard of care for low-risk prostate cancer (PCa). Patient characteristics such as age, race, and Agent Orange (AO) exposure may influence advisability of AS in veterans. The 17-gene assay may improve risk stratification and management selection. OBJECTIVES: To compare management strategies for PCa at 6 VAMCs before and after introduction of the Oncotype DX Genomic Prostate Score (GPS) assay...
January 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29297664/contemporary-management-of-moderate-to-severe-plaque-psoriasis
#14
Jashin J Wu
Psoriasis is a multisystem inflammatory disease that is often underdiagnosed, leaving many patients untreated. Plaque psoriasis, the most common form of the disease, affects approximately 80% to 90% of patients with psoriasis. Formulating a treatment plan can be complicated when various factors are considered. For example, type of therapy is dependent on the severity of the disease. Topical agents are preferred for mild disease, while phototherapy alone or in combination with systemic agents is recommended for the treatment of moderate to severe plaque psoriasis...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29297662/venous-thromboembolism-role-of-pharmacists-and-managed-care-considerations
#15
Tuesdy Horner, Charles E Mahan
Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism. Anticoagulation is used in patients with VTE to reduce the risk of recurrent VTE and VTE-related death. The overall incidence of VTE is 1 to 2 per 1000 person-years. Long-term mortality for patients with VTE is poor, with 25% of patients not surviving 7 days and nearly 40% not surviving the first year. Coagulation disorders demand effective anticoagulant therapy to avoid complications, especially recurrent VTE and VTE-related death...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29297661/the-role-of-direct-oral-anticoagulants-in-the-management-of-venous-thromboembolism
#16
Taylor Steuber
Appropriate treatment of venous thromboembolism (VTE) is critical to minimizing long-term morbidity and mortality. The emergence of direct oral anticoagulants (DOACs) has provided clinicians with expanded therapeutic options for patients with VTE, and as a result, updated practice guidelines released by the American College of Chest Physicians favor DOACs over traditional anticoagulants, such as warfarin. The newest DOAC, betrixaban, received FDA approval in 2017, with an indication for VTE prophylaxis in hospitalized adults...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29297660/overview-of-venous-thromboembolism
#17
Haley M Phillippe
Venous thromboembolism (VTE) describes the diagnoses of deep vein thrombosis (DVT) or pulmonary embolism (PE). DVT is the formation of thrombi in the deep veins, most commonly the large veins of the legs or pelvis. PE develops when thrombi dislodge from clots in vein walls and travel through the heart to pulmonary arteries. In many patients, the presenting manifestation of PE is sudden death. VTE may be categorized as provoked or unprovoked. This categorization influences the risk of recurrent VTE and duration of anticoagulation therapy...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29297659/fetal-fibronectin-testing-and-pregnancy-outcomes-among-texas-medicaid-patients-at-risk-for-preterm-birth
#18
Jamie C Barner, Allison A Petrilla, Hyeun Ah Kang, Xian Shen, Ahmed M Alshehri, Erin M Sullivan, Kathleen A Troeger, Kristin M Richards, Sean C Blackwell
OBJECTIVES: Fetal fibronectin (fFN) testing between the 24th and 34th weeks of pregnancy in patients with symptomatic preterm labor (PTL) helps assess the risk of spontaneous preterm birth (sPTB), yet the extent of its use is unknown. We assessed use of fFN testing among Texas Medicaid enrollees with symptomatic PTL and evaluated time to infant delivery and healthcare utilization/costs. STUDY DESIGN: Retrospective cohort study using medical and pharmacy claims for Texas Medicaid enrollees...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29297658/current-perspectives-on-the-use-of-fetal-fibronectin-testing-in-preterm-labor-diagnosis-and-management
#19
Michael S Ruma, Katie C Bittner, Clara B Soh
One in 10 infants in the United States is delivered preterm (ie, before the 37th week of pregnancy), contributing to the significant burden on the national healthcare system. Nevertheless, a lack of agreement continues among obstetric professional societies on guidelines for standardization of the approach to the diagnosis and management of patients with symptoms of preterm labor (PTL). This disparity in consensus has likely resulted in poor identification of women at an increased risk for preterm birth (PTB)...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29297657/pharmacotherapeutic-management-of-pseudobulbar-affect
#20
Jack J Chen
This activity will update pharmacists and other healthcare professionals on current treatments for pseudobulbar affect (PBA). Points of discussion will focus on the off-label therapies traditionally used to treat PBA, the FDA-approved combination drug product with PBA as an indication, and managed care aspects of treating PBA.
December 2017: American Journal of Managed Care
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