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Health Services Insights

Stephen H Linder, Kimberly Aguillard, Kelsey French, Arthur Garson
According to some estimates, the United States wastes as much as 30% of health care dollars. Some of that waste can be mitigated by reducing certain costs associated with Medicaid. We chose 5 areas of savings applicable to Medicaid: (1) modification of physician payment models to reduce unnecessary care, (2) development of a medication adherence program for patients dually eligible for Medicaid and Medicare support ("dual eligibles"), (3) improvement in unnecessary admissions and readmissions for dual eligibles, (4) reduction in emergency department visits among children in Medicaid and dual-eligible beneficiaries, and (5) improvement in adoption of end-of-life advance directives...
2018: Health Services Insights
Romayne Gallagher
The narrative of the opioid crisis is that ill-informed and careless prescribing by physicians has led to increases in opioid-related harms including overdose deaths. Focusing on reducing the access to prescribed opioids without treating substance use disorder has led to increases in use of heroin and illicitly produced fentanyl. Overall prescribing of opioids has declined causing collateral damage to those who use opioids appropriately to reduce pain and improve function. The complexity of this issue requires a change in focus and broad changes in society's approach to substance abuse and mental health...
2018: Health Services Insights
Chinonso N Igwesi-Chidobe, Isaac O Sorinola, Sheila Kitchen, Emma L Godfrey
Chronic low back pain (CLBP) is highly prevalent and CLBP disability reinforces poverty and Nigerian rural-urban inequality. Most rural Nigerian dwellers with CLBP consult unconventional practitioners due to difficulty in accessing conventional health care. This interaction may influence back pain beliefs and behaviours, and health outcomes including disability. In line with the recent Lancet Low Back Pain series call to address widespread misconceptions in the population and among health practitioners about low back pain, this study explored the beliefs and management strategies of unconventional practitioners consulted by people living with CLBP in rural Nigeria...
2018: Health Services Insights
Samantha R Lattof, Ernestina Coast, Tiziana Leone
Women's ability to access health care requires access to and control of resources as well as the ability to make personal health decisions. Female migrants may experience additional challenges in accessing health care due to marginalization and vulnerability resulting from both their gender and their migrant status. Rural-to-urban migrant women working in the informal sector, such as Ghana's head porters ( kayayei ), experience exclusion from the health system, risk of being uninsured, and poor health outcomes...
2018: Health Services Insights
George Theocharis, Konstantinos S Kechagias, Michael Oikonomou, Stamatia Chorepsima, Dionisis Rodis, Ioannis Salpigktis, Matthew E Falagas
Home care has been traditionally considered as an important type of medical service. "SOS Doctors" is a Greek organization providing out-of-hospital multispecialty emergency medicine services the past 25 years. Its services mainly meet the demands of the elderly and the nonambulatory patients. The decreased number of hospitalizations, hospital-related infections, and need for patient transportation are the main advantages of a model for out-of-hospital multispecialty emergency medicine. However, the time consumed by the doctor related to transportation is a drawback of medical house calls...
2018: Health Services Insights
Krisda H Chaiyachati, Kevin Moore, Michael Adelberg
Some state governments are considering cuts to the non-emergency medical transportation (NEMT) benefit for Medicaid enrollees, and some Federal officials have proposed making this easier. Yet, there is clear demand. In 2015 alone, low-income patients used 59 million rides for medical appointments. NEMT's future is under threat because evidence that NEMT improves health care access and downstream outcomes is incomplete. Second, it remains largely unknown whether scarce public resources for transportation are being driven to those who benefit from its availability...
2018: Health Services Insights
Tim K Mackey
The United States is in the midst of an opioid public health emergency, one that is also influenced by a convergence of Internet-based technology, health policy, and the need for stakeholder collaboration and action around the need to combat the illicit online sales of opioids by illegal online pharmacies and digital drug dealers. This risk is not new, however, with calls to actively reduce online opioid availability as online pharmacies use a growing array of digital channels, including search engines, social media platforms, and the dark Web...
2018: Health Services Insights
Maren Hopfe, Gerold Stucki, Jerome E Bickenbach, Birgit Prodinger
Functioning information constitutes a relevant component for determining patients' service needs and respective resource use. Diagnosis-Related Group (DRG) systems can be optimized by integrating functioning information. First steps toward accounting for functioning information in the German DRG (G-DRG) system have been made; yet, there is no systematic integration of functioning information. The G-DRG system is part of the health system; it is embedded in and as such dependent on various stakeholders and vested interests...
2018: Health Services Insights
Charles D Phillips
Background: State Medicaid programs in the United States provide services to children with special health care challenges through the Early Prevention, Screening, Diagnostic, and Treatment program. One element of the services provided is Medicaid Personal Care Services (PCS), which are intended to correct or ameliorate any functional impairments faced by a child or youth (C/Y) in the community. Previous research indicates that considerable variation in the allocation of PCS depends on the assessor...
2018: Health Services Insights
Bita A Kash, Ohbet Cheon, Nicholas M Halzack, Thomas R Miller
Background: Guidance for measuring team effectiveness in dynamic clinical settings is necessary; however, there are no consensus strategies to help health care organizations achieve optimal teamwork. This systematic review aims to identify validated survey instruments of team effectiveness by clinical settings. Methods: PubMed, MEDLINE, and ISI Web of Knowledge were searched for team effectiveness surveys deployed from 1990 to 2016. Validity and reliability were evaluated using 4 psychometric properties: interrater agreement, internal consistency, content validity, and structural integrity...
2018: Health Services Insights
Antoinette B Coe, Leticia R Moczygemba, Kelechi C Ogbonna, Pamela L Parsons, Patricia W Slattum, Paul E Mazmanian
Background: The number of yearly emergency department (ED) visits by older adults in the United States has been increasing. Purpose: The objectives were to (1) describe the demographics, health-related variables, and ED visit characteristics for community-dwelling older adults using an urban, safety-net ED; (2) examine the association between demographics, health-related variables, and ED visit characteristics with emergent vs nonemergent ED visits; and (3) examine the association between demographics, health-related variables, ED visit characteristics, and ED visit costs...
2018: Health Services Insights
Hazar Kanj, Ali Khalil, Mikhael Kossaify, Antoine Kossaify
Objective: This study aimed to determine the prevalence and predictors of undiagnosed and uncontrolled hypertension (HTN) in a local community in Lebanon. Design and methods: In this cross-sectional study, we interviewed 911 adults in the local community of Byblos, Lebanon, and 691 were enrolled in the study. Blood pressure (BP), height, and weight were measured. The diagnosis of HTN was based on the 2013 European Society of Hypertension (ESH)/ European Society of Cardiology (ESC) guidelines (systolic BP ⩾140 mm Hg and/or diastolic BP ⩾90 mm Hg)...
2018: Health Services Insights
Evan V Goldstein, Jie Cai, Anqi Liu
This article examines the initial effect of Affordable Care Act (ACA) Health Insurance Marketplace (Exchange) insurance on access to care among employed beneficiaries in a highly populated US state. Does Exchange insurance lead to better/worse health care access for employed beneficiaries, compared with similar individuals covered through standard employer-sponsored insurance (ESI) coverage? This retrospective study uses data from the 2015 Ohio Medicaid Assessment Survey, a dual-frame and computer-assisted telephone survey administered by the Ohio Colleges of Medicine Graduate Resource Center, the Ohio Department of Medicaid, the Ohio Department of Health, and Ohio State University, in conjunction with RTI International...
2018: Health Services Insights
Timo B Brakenhoff, Karel Gm Moons, Jolanda Kluin, Rolf Hh Groenwold
Background: When profiling health care providers, adjustment for case-mix is essential. However, conventional risk adjustment methods may perform poorly, especially when provider volumes are small or events rare. Propensity score (PS) methods, commonly used in observational studies of binary treatments, have been shown to perform well when the amount of observations and/or events are low and can be extended to a multiple provider setting. The objective of this study was to evaluate the performance of different risk adjustment methods when profiling multiple health care providers that perform highly protocolized procedures, such as coronary artery bypass grafting...
2018: Health Services Insights
Stefania Rodella, Sabine Mall, Massimiliano Marino, Graziella Turci, Giorgio Gambale, Maria Teresa Montella, Stefano Bonilauri, Roberta Gelmini, Piera Zuin
The adoption of a surgical checklist is strongly recommended worldwide as an effective practice to improve patient safety; however, several studies have reported mixed results and a number of issues are still unresolved. The main objective of this study was to explore the impact of the first 5-year period of a surgical checklist-based intervention in a large regional health care system in Italy (4 500 000 inhabitants). We conducted a retrospective longitudinal study on 1 166 424 patients who underwent surgery in 48 public hospitals between 2006 and 2014...
2018: Health Services Insights
Chidubem L Ogbudebe, Victor Adepoju, Christy Ekerete-Udofia, Ebere Abu, Ginika Egesemba, Nkem Chukwueme, Mustapha Gidado
Objectives: Understanding the factors that influence tuberculosis (TB) treatment outcomes in children is key to designing interventions to address them. This study aimed to determine the case category distribution of childhood TB in Nigeria and assess which clinical and demographic factors are associated with different treatment outcomes in childhood TB. Materials and methods: This was a retrospective cohort study involving a review of medical records of children (0-14 years) with TB in 3 states in Nigeria in 2015...
2018: Health Services Insights
Vinaya Gaduputi, Sridhar Chilimuri, Kinesh Changela
AIMS AND SCOPE This article serves in introducing the readers to the developing field of perioperative medicine. We have made an effort to come up with the latest management guidelines covering multiple subspecialties in form of a special supplement. This compendium in perioperative medicine serves as a comprehensive guide to a practicing clinician, in managing patients with various medical comorbidities undergoing surgical procedures and avoiding common pitfalls.
2018: Health Services Insights
Vivien Leung, Kristal Ragbir-Toolsie
Hyperglycemia has long been recognized to have detrimental effects on postoperative outcomes in patients undergoing surgery. The manifestations of uncontrolled diabetes are manifold and can include risk of hyperglycemic crises, postoperative infection, poor wound healing, and increased mortality. There is substantial literature supporting the role of diligent glucose control in the prevention of adverse surgical outcomes, but considerable debate remains as to the optimal glucose targets. Hence, most organizations advocate the avoidance of hypoglycemia while striving for adequate glucose control in the perioperative period...
2017: Health Services Insights
Manjeet Singh Dhallu, Ahmed Baiomi, Madhavi Biyyam, Sridhar Chilimuri
Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease...
2017: Health Services Insights
Charlene Harrington, Frode F Jacobsen, Justin Panos, Allyson Pollock, Shailen Sutaria, Marta Szebehely
This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures...
2017: Health Services Insights
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