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Shearwood McClelland, Joseph F Baker, Justin S Smith, Breton G Line, Thomas J Errico, Christopher P Ames, R Shay Bess
Parkinson's disease (PD) is a neurodegenerative disorder manifesting over time to result in reduced mobility. The impact of PD on spinal fusion has yet to be addressed on a nationwide level. The Nationwide Inpatient Sample (NIS) from 2001 to 2012 was used for analysis. Admissions with spinal fusion of two or more vertebrae (ICD-9 codes=81.62, 81.63 and 81.64) were included and then stratified based on the presence or absence of PD (ICD-9 code=332.0); patients with cancer (ICD-9 codes=140-239) or trauma (ICD-9 codes=805...
October 17, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Lee N Newcomer, Richard Weininger, Robert W Carlson
PURPOSE: To evaluate a computer-based prior authorization system that was designed to include and test two new concepts for physician review: (1) the tool would minimize denials by providing real-time decision support with alternative options if the original request was noncompliant, and (2) the tool would collect sufficient information to create a patient registry. METHODS: A new prior authorization tool incorporating real-time decision support was tested with a large national payer...
October 18, 2016: Journal of Oncology Practice
Philip Rocco, Andrew S Kelly, Daniel Béland, Michael Kinane
Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs' efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices...
October 11, 2016: Journal of Health Politics, Policy and Law
David Peiris, Madeleine C Phipps-Taylor, Courtney A Stachowski, Lee-Sien Kao, Stephen M Shortell, Valerie A Lewis, Meredith B Rosenthal, Carrie H Colla
Accountable care organizations (ACOs) have diverse contracting arrangements and have displayed wide variation in their performance. Using data from national surveys of 399 ACOs, we examined differences between the 228 commercial ACOs (those with commercial payer contracts) and the 171 noncommercial ACOs (those with only public contracts, such as with Medicare or Medicaid). Commercial ACOs were significantly larger and more integrated with hospitals, and had lower benchmark expenditures and higher quality scores, compared to noncommercial ACOs...
October 1, 2016: Health Affairs
Jennifer Y Lo, L LuAnn Minich, Lloyd Y Tani, Jacob Wilkes, Qian Ding, Shaji C Menon
Management guidelines for refractory Kawasaki disease (KD) are vague. We sought to assess practice variation and identify factors associated with large/complex coronary artery aneurysms (LCAA) and resource utilization in refractory KD. This retrospective cohort study identified patients aged ≤18 years with KD (2004 to 2014) using the Pediatric Health Information System. Refractory KD was defined as receiving >1 dose of intravenous immunoglobulin. Demographics, medications, concomitant infections, length of stay (LOS), and charges were collected...
August 31, 2016: American Journal of Cardiology
Hibbut-Ur-Rauf Naseem, Robert Michael Dorman, Kathryn D Bass, David H Rothstein
BACKGROUND: Hospital readmission in adult trauma is associated with significant morbidity, mortality, and resource utilization. In this study, we examine pediatric intensive care unit (PICU) admission as a risk factor for hospital readmission in pediatric trauma. MATERIALS AND METHODS: This was a retrospective cohort study of patients aged 1 through 19 y in the Pediatric Health Information System database discharged with a trauma diagnosis. Patient and clinical variables included demographics, payer status, length of stay, chronic comorbid conditions, presence of mechanical ventilation, all-patient refined diagnosis-related group and calculated severity of illness, and discharge disposition...
October 2016: Journal of Surgical Research
Melissa Martinson, Rupinder Bharmi, Nirav Dalal, William T Abraham, Philip B Adamson
AIMS: Haemodynamic-guided heart failure (HF) management effectively reduces decompensation events and need for hospitalizations. The economic benefit of clinical improvement requires further study. METHODS AND RESULTS: An estimate of the cost-effectiveness of haemodynamic-guided HF management was made based on observations published in the randomized, prospective single-blinded CHAMPION trial. A comprehensive analysis was performed including healthcare utilization event rates, survival, and quality of life demonstrated in the randomized portion of the trial (18 months)...
September 19, 2016: European Journal of Heart Failure
Mark Trusheim, Allison Ackerman Shrier, Zoran Antonijevic, Robert A Beckman, Robert K Campbell, Cong Chen, Keith Flaherty, John Loewy, Denis Lacombe, Subha Madhavan, Harry Selker, Laura Esserman
Adaptive, seamless, multi-sponsor, multi-therapy platform clinical trials, designs executed on a large scale could create superior evidence more efficiently than single- sponsor, single- drug trials. Extending these adaptive platform trials also could diminish barriers to trial participation, increase the representation of real-world populations, and create systematic evidence development for learning throughout a therapeutic life cycle, to continually refine its use. Comparable evidence could arise from multi-arm design, shared comparator arms, and standardized endpoints- aiding sponsors in demonstrating the distinct value of their innovative medicines; facilitating providers and patients in selecting the most appropriate treatments; assisting regulators in efficacy and safety determinations; helping payers make coverage and reimbursement decisions; and spurring scientists with translational insights...
September 19, 2016: Clinical Pharmacology and Therapeutics
Jiannong Liu, Mahesh Krishnan, Jincheng Zhou, Kimberly M Nieman, Yi Peng, David T Gilbertson
: ;Aims: Standardized mortality and hospitalization ratios (SMRs, SHRs) are used to measure dialysis facility performance in the US, with adjustment for demographics and comorbid conditions derived from the end-stage renal disease (ESRD) Medical Evidence (ME) Report. Sensitivities are low for ME-based comorbidity, and levels of under-reporting may differ among facilities. We aimed to assess the effect of data inaccuracy on performance comparison. METHODS: Using the United States Renal Data System ESRD database, we included patients who initiated hemodialysis July 1 - December 31 in each of the years 2006 - 2010, had Medicare as primary payer, were aged ≥ 66 years, and had no prior transplant...
November 2016: Clinical Nephrology
Sebastian Schneeweiss, Hans-Georg Eichler, Anna Garcia-Altes, Chris Chinn, Anne-Virginie Eggimann, Sarah Garner, Wim Goettsch, Robyn Lim, Wiebke Löbker, David Martin, Thomas Müller, B J Park, Richard Platt, Sarah Priddy, Michael Ruhl, Almath Spooner, Bart Vannieuwenhuyse, Richard J Willke
Analyses of healthcare database (claims, EHR) are useful supplements to clinical trials for generating evidence on the effectiveness, harm, use and value of medical products in routine care. A constant stream of data from the routine operation of modern healthcare systems, which can be analyzed in rapid cycles enables incremental evidence development to support accelerated and appropriate access to innovative medicines. Evidentiary needs by regulators, HTA, payers, clinicians and patients after marketing authorization comprise 1) monitoring of medication performance in routine care, including the materialized effectiveness, harm and value; 2) identifying new patient strata with added value or unacceptable harms; and 3) monitoring targeted utilization...
September 14, 2016: Clinical Pharmacology and Therapeutics
Linda C Lee, Armando J Lorenzo, Rakan Odeh, Michelle Falkiner, Dawn-Ann Lebarron, Jeffrey Traubici, Erika Mann, Paul R Bowlin, Martin A Koyle
PURPOSE: VCUG involves radiation exposure and is invasive. Several guidelines, including the AAP guidelines in 2011, no longer recommend routine VCUG after the initial UTI in children. The recent trend in VCUG use remains largely unknown. In this study, we examined practice patterns of VCUG use and explore the impact of these guidelines within a single-payer system over the past 8 years. MATERIALS AND METHODS: All VCUGs performed at a large pediatric referral center between January 2008 and December 2015 were identified...
September 1, 2016: Journal of Urology
Georgi Iskrov, Svetlan Dermendzhiev, Tsonka Miteva-Katrandzhieva, Rumen Stefanov
BACKGROUND: Assessment and appraisal of new medical technologies require a balance between the interests of different stakeholders. Final decision should take into account the societal value of new therapies. OBJECTIVE: This perspective paper discusses the socio-economic burden of disease as a specific reimbursement decision-making criterion and calls for the inclusion of it as a counterbalance to the cost-effectiveness and budget impact criteria. RESULTS/CONCLUSIONS: Socio-economic burden is a decision-making criterion, accounting for diseases, for which the assessed medical technology is indicated...
2016: Frontiers in Pharmacology
John C Fortney, Jürgen Unützer, Glenda Wrenn, Jeffrey M Pyne, G Richard Smith, Michael Schoenbaum, Henry T Harbin
OBJECTIVE: Measurement-based care involves the systematic administration of symptom rating scales and use of the results to drive clinical decision making at the level of the individual patient. This literature review examined the theoretical and empirical support for measurement-based care. METHODS: Articles were identified through search strategies in PubMed and Google Scholar. Additional citations in the references of retrieved articles were identified, and experts assembled for a focus group conducted by the Kennedy Forum were consulted...
September 1, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
(no author information available yet)
PURPOSE: Physicians, health care systems, and payers use quality measures to judge performance and monitor the outcomes of interventions. Practicing upper-limb surgeons desire quality measures that are important to patients and feasible to use, and for which it is fair to hold them accountable. METHODS: Nine academic upper-limb surgeons completed a RAND/University of California-Los Angeles Delphi Appropriateness process to evaluate the importance, feasibility, and accountability of 134 quality measures identified from systematic review...
August 28, 2016: Journal of Hand Surgery
Liliana E Pezzin, Purushottam Laud, Joan Neuner, Tina W F Yen, Ann B Nattinger
BACKGROUND: Challenged by public opinion, peers and the Congressional Budget Office, medical specialty societies have begun to develop "Top Five" lists of expensive procedures that do not provide meaningful benefit to at least some categories of patients for whom they are commonly ordered. The extent to which these lists have influenced the behavior of physicians or patients, however, remains unknown. METHODS: We partner with a statewide consortium of health systems to examine the effectiveness of two interventions: (i) "basic" public reporting and (ii) an "enhanced" intervention, augmenting public reporting with a smart phone-based application that gives providers just-in-time information, decision-making tools, and personalized patient education materials to support reductions in the use of eight breast cancer interventions targeted by Choosing Wisely® or oncology society guidelines...
September 2016: Contemporary Clinical Trials
Jean Y Ko, Stephen W Patrick, Van T Tong, Roshni Patel, Jennifer N Lind, Wanda D Barfield
Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that occurs primarily among opioid-exposed infants shortly after birth, often manifested by central nervous system irritability, autonomic overreactivity, and gastrointestinal tract dysfunction (1). During 2000-2012, the incidence of NAS in the United States significantly increased (2,3). Several recent publications have provided national estimates of NAS (2,3); however, data describing incidence at the state level are limited. CDC examined state trends in NAS incidence using all-payer, hospital inpatient delivery discharges compiled in the State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) during 1999-2013...
2016: MMWR. Morbidity and Mortality Weekly Report
Robin M A Clarke, Jessica Jeffrey, Mark Grossman, Thomas Strouse, Michael Gitlin, Samuel A Skootsky
Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiting providers, and integrating new services...
August 1, 2016: Health Affairs
Lynne T Braun, Kathleen L Grady, Jean S Kutner, Eric Adler, Nancy Berlinger, Renee Boss, Javed Butler, Susan Enguidanos, Sarah Friebert, Timothy J Gardner, Phil Higgins, Robert Holloway, Madeleine Konig, Diane Meier, Mary Beth Morrissey, Tammie E Quest, Debra L Wiegand, Barbara Coombs-Lee, George Fitchett, Charu Gupta, William H Roach
The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions...
September 13, 2016: Circulation
Joseph E Tanenbaum, Jacob A Miller, Vincent J Alentado, Daniel Lubelski, Benjamin P Rosenbaum, Edward C Benzel, Thomas E Mroz
BACKGROUND CONTEXT: The incidence of adverse care quality events among patients undergoing cervical fusion surgery is unknown using the definition of care quality employed by the Centers for Medicare and Medicaid Services (CMS). The effect of insurance status on the incidence of these adverse quality events is also unknown. PURPOSE: This study determined the incidence of hospital acquired conditions (HAC) and patient safety indicators (PSI) in cervical spine fusion patients and analyzed the association between primary payer status and these adverse events...
August 4, 2016: Spine Journal: Official Journal of the North American Spine Society
Jan B Pietzsch, Abigail M Garner, William J Marks
OBJECTIVES: Deep brain stimulation (DBS), which uses an implantable device to modulate brain activity, is clinically superior to medical therapy for treating advanced Parkinson's disease (PD). We studied the cost-effectiveness of DBS in conjunction with medical therapy compared to best medical therapy (BMT) alone, using the latest clinical and cost data for the U.S. healthcare system. MATERIALS AND METHODS: We used a decision-analytic state-transition (Markov) model to project PD progression and associated costs for the two treatment strategies...
October 2016: Neuromodulation: Journal of the International Neuromodulation Society
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