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https://www.readbyqxmd.com/read/28887349/population-health-management-an-independent-physician-organization-approach
#1
Jeanette L Altavela, Kathryn M Dorward, Thomas A Sorrento, Katherine M Diehl, Cori A Wyman
PURPOSE: The role of clinical pharmacists and their impact on population health and value-based contracts within a multidisciplinary care management team are described. SUMMARY: The Greater Rochester Independent Practice Association (GRIPA) has promoted high-quality, value-based care since its foundation 20 years ago. One of several ways that GRIPA enables its physicians to succeed in shared-savings agreements is by providing a community-based multidisciplinary care management team...
September 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28887240/temporal-trends-determinants-and-outcomes-of-inpatient-versus-outpatient-arteriovenous-fistula-operations
#2
Caitlin W Hicks, Michael Bronsert, Karl E Hammermeister, William G Henderson, Douglas R Gibula, James H Black, Natalia O Glebova
ObjectivesAs high health care costs are increasing scrutinized, a movement toward reducing patient hospital admissions and lengths of stay has emerged, particularly for operations that may be performed safely in the outpatient setting. Our aim is to describe recent temporal trends in the proportion of dialysis access procedures performed on an inpatient vs. outpatient basis, and to determine the effects of these changes on perioperative morbidity and mortality. MethodsThe 2005-2008 ACS NSQIP database was queried for all primary arteriovenous fistula (AVF) procedures using CPT codes...
September 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28882905/cost-comparison-of-orthopaedic-fracture-pathways-using-discrete-event-simulation-in-a-glasgow-hospital
#3
Gillian H Anderson, Paul J Jenkins, David A McDonald, Robert Van Der Meer, Alec Morton, Margaret Nugent, Lech A Rymaszewski
OBJECTIVE: Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. DESIGN: Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC)...
September 7, 2017: BMJ Open
https://www.readbyqxmd.com/read/28877800/disparities-in-mangement-of-patients-with-benign-colorectal-disease-impact-of-urbanization-and-specialized-care
#4
Viraj Pandit, Mazhar Khalil, Bellal Joseph, Jana Jandova, Tahereh Orouji Jokar, Ansab Abbas Haider, Bardiya Zangbar, Asad Azim, Ahmed Hassan, Valentine Nfonsam
Disparities in the management of patients with various medical conditions are well established. Colorectal diseases continue to remain one of the most common causes for surgical intervention. The aim of this study was to assess disparities (rural versus urban) in the surgical management of patients with noncancerous benign colorectal diseases. We hypothesized that there is no difference among rural versus urban centers (UC) in the surgical management for noncancerous benign colorectal diseases. The national estimates of surgical procedures for benign colorectal diseases from the National Inpatient Sample database 2011 representing 20 per cent of all in-patient admissions were abstracted...
November 1, 2016: American Surgeon
https://www.readbyqxmd.com/read/28874939/rapid-primary-care-follow-up-from-the-ed-to-reduce-avoidable-hospital-admissions
#5
Amanda S Carmel, Peter Steel, Robert Tanouye, Aleksey Novikov, Sunday Clark, Sanjai Sinha, Judy Tung
INTRODUCTION: Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28870446/hepacontrol-a-program-that-reduces-early-readmissions-mortality-at-60-days-and-healthcare-costs-in-decompensated-cirrhosis
#6
Betty P Morales, Ramon Planas, Ramon Bartoli, Rosa M Morillas, Margarita Sala, Irma Casas, Carolina Armengol, Helena Masnou
BACKGROUND & AIMS: Decompensated cirrhosis patients have an elevated incidence of early readmission, mortality and economic burden. The aims of HEPACONTROL were to reduce early readmission and to evaluate its impact on mortality and emergency department visits. PATIENTS AND METHODS: Quasi-experimental study with control group which compared two cohorts of patients discharged after being admitted for cirrhosis-related complications. A prospective cohort (n=80), who followed the HEPACONTROL program, which began with a follow-up examination seven days after discharge at the Hepatology Unit Day Hospital and a retrospective cohort of patients (n=112), who had been given a standard follow-up...
August 13, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28870101/effects-of-non-medical-switching-on-outcomes-among-patients-prescribed-tumor-necrosis-factor-inhibitors
#7
Allan Gibofsky, Martha Skup, Manish Mittal, Scott J Johnson, Matthew Davis, Jingdong Chao, David T Rubin
OBJECTIVE: To evaluate health care use and outcomes among patients who experienced a non-medical switch of their prescribed anti-tumor necrosis factor biological agent (anti-TNF) for cost containment reasons. METHODS: Retrospective evaluation of Humedica electronic health records of patients ≥18 years old with anti-TNF treatment for immune conditions. Using natural language processing, stable patients who experienced a non-medical switch (for cost or insurance reasons) of their anti-TNF between 2007 and 2013 were identified (NMS cohort, n = 158) and matched to patients who did not (control cohort, n = 4804)...
September 5, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28868591/early-ct-scanning-in-the-emergency-department-in-patients-with-penetrating-injuries-does-it-affect-outcome
#8
W J van den Hout, G M van der Wilden, F Boot, F J Idenburg, S J Rhemrev, R Hoencamp
BACKGROUND: To be a level I trauma center in the Netherlands a computed tomography (CT) scanner in the emergency department (ED) is considered desirable, as it is presumed that this optimizes the diagnostic process and that therapy can be directed based on these findings. Aim of this study was to assess the effects of implementing a CT scanner in the ED on outcomes in patients with penetrating injuries. METHODS: In this retrospective descriptive study, patients with penetrating injuries (shot and/or stab wounds), presented between 2000 and 2014 were analysed using the hospital's electronic database, and data from the West Netherlands trauma registry and the financial department...
September 4, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28865979/comparison-of-30-day-readmission-rates-and-risk-factors-between-carotid-artery-stenting-and-endarterectomy
#9
Hanaa Dakour Aridi, Satinderjit Locham, Besma Nejim, Mahmoud B Malas
OBJECTIVE: The aim of this study was to analyze the rates, reasons, and risk factors of 30-day readmission, both planned and unplanned, after carotid revascularization as well as to evaluate major outcomes associated with those readmissions. METHODS: Using the Premier Healthcare database, we retrospectively identified patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS) between 2009 and 2015. The primary outcome was 30-day all-cause readmission...
August 30, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28859952/predictors-of-post-colonoscopy-emergency-department-use
#10
Laurie B Grossberg, Alina Vodonos, Konstantinos Papamichael, Victor Novack, Mandeep Sawhney, Daniel A Leffler
BACKGROUND AND AIMS: Unplanned hospital visits within 7 days of colonoscopy was recently proposed as a quality measure. It is unknown if patient, procedure, or endoscopist characteristics predict post-colonoscopy emergency department (ED) visits. Our aim was to determine the incidence and relatedness of ED visits within 7 days of colonoscopy, and to identify predictors of post-colonoscopy ED use. METHODS: In this retrospective, single-center, cohort study, we evaluated outpatient colonoscopies performed at a tertiary academic medical center or affiliated facility between January 2008 and September 2013...
August 28, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28852817/risk-factors-for-heart-failure-and-its-costs-among-children-with-complex-congenital-heart-disease-in-a-medicaid-cohort
#11
Deipanjan Nandi, Joseph W Rossano, Yinding Wang, Jeanette M Jerrell
Little research attention has been paid to the occurrence of heart failure (HF) in children with complex congenital heart diseases (CHDs). Herein, we describe the prevalence, risk factors, and costs associated with HF in complex CHD. Patients aged ≤17 years and diagnosed with a complex CHD on multiple service visits over a 15-year period in the SC Medicaid dataset (1996-2010) were tracked and analyzed. The cohort included 2999 unduplicated patients; 51.0% were male; 34.4% were African American. HF was diagnosed in 7...
August 29, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28838870/effect-of-surgeon-and-hospital-volume-on-emergency-general-surgery-outcomes
#12
Ambar Mehta, David T Efron, Joseph K Canner, Linda Dultz, Tim Xu, Christian Jones, Elliott R Haut, Robert Sd Higgins, Joseph V Sakran
BACKGROUND: Emergency general surgeries (EGS) contribute to half of all surgical mortality nationwide, are associated with a 50% complication rate, and have a 15% readmission rate within 30-days. We assessed associations between surgeon and hospital EGS-volume with these outcomes. STUDY DESIGN: Using Maryland's Health Services Cost Review Commission database, we identified non-trauma EGS procedures performed by general surgeons among patients 20-years or older, who were admitted urgently or emergently, from 7/2012-9/2014...
August 21, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28835268/perioperative-antibiotic-prophylaxis-in-the-treatment-of-acute-cholecystitis-peanuts-ii-trial-study-protocol-for-a-randomized-controlled-trial
#13
Charlotte S Loozen, Hjalmar C van Santvoort, Antoinette A W van Geloven, Grard A P Nieuwenhuijzen, Philip R de Reuver, Mark H G Besselink, Bart Vlaminckx, Johannes C Kelder, Catherijne A J Knibbe, Djamila Boerma
BACKGROUND: The additional value of perioperative antibiotic prophylaxis in preventing infectious complications after emergency cholecystectomy for acute cholecystitis is a much-debated subject in the surgical community. Evidence-based guidelines are lacking, and consequently the use of antibiotic prophylaxis varies greatly among surgeons and hospitals. Recently, high-level evidence became available demonstrating that postoperative antibiotic prophylaxis in patients with acute cholecystitis does not reduce the risk of infectious complications...
August 23, 2017: Trials
https://www.readbyqxmd.com/read/28834070/patient-navigation-for-patients-frequently-visiting-the-emergency-department-a-randomized-controlled-trial
#14
David Seaberg, Stanton Elseroad, Michael Dumas, Sudave Mendiratta, Jessica Whittle, Cheryl Hyatte, Jan Keys
BACKGROUND: ED super-utilizers (patients with 5 or more visits/year) comprise only 5% of the patients seen yet comprise 25% of total ED visits. Though the reasons for this are multifactorial, the cost to the patient and the community is exceedingly high. The cost is not just monetary; care of these patients is inappropriately fragmented and their presence in the ED may contribute to overcrowding affecting the community's emergency readiness. Previous studies using staff trained to help patients navigate their care options have had conflicting results...
August 21, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28832927/innovation-in-a-learning-health-care-system-veteran-directed-home-and-community-based-services
#15
Melissa M Garrido, Richard M Allman, Steven D Pizer, James L Rudolph, Kali S Thomas, Nina R Sperber, Courtney H Van Houtven, Austin B Frakt
A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's (VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD-HCBS to veterans at risk of nursing home placement...
August 21, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28829626/transitioning-from-methadone-to-buprenorphine-maintenance-in-management-of-opioid-use-disorder-during-pregnancy
#16
Shakevia Johnson, Peter R Martin
BACKGROUND: Opioid use disorder during pregnancy is a growing health concern. Methadone maintenance is the treatment of choice but emerging data indicate buprenorphine is a viable alternative. Due to costs and limited accessibility of methadone, pregnant women may require transition from methadone to buprenorphine for maintenance treatment. OBJECTIVES: To assess safety and effectiveness of transitioning from methadone to buprenorphine when necessary during pregnancy...
August 22, 2017: American Journal of Drug and Alcohol Abuse
https://www.readbyqxmd.com/read/28827260/extending-the-liaison-psychiatry-service-in-a-large-hospital-in-the-uk-a-before-and-after-evaluation-of-the-economic-impact-and-patient-care-following-ed-attendances-for-self-harm
#17
Brent C Opmeer, William Hollingworth, Elsa M R Marques, Ruta Margelyte, David Gunnell
OBJECTIVES: To evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm. DESIGN: Retrospective before and after cohort study using routinely collected Self-Harm Surveillance Register data. SETTING: A large hospital in South West England. SUBJECTS: Patients attending the ED for self-harm. INTERVENTIONS: Extension of the LPS' working hours from 9:00 to 17:00, Monday to Friday to 8:00 to 22:00, 7 days a week, following a £250 000 annual investment MAIN OUTCOME MEASURES: Number and characteristics of ED attendances for self-harm...
August 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28817376/association-between-hospice-spending-on-patient-care-and-rates-of-hospitalization-and-medicare-expenditures-of-hospice-enrollees
#18
Melissa D Aldridge, Andrew J Epstein, Abraham A Brody, Eric J Lee, R Sean Morrison, Elizabeth H Bradley
BACKGROUND: Care at the end of life is increasingly fragmented and is characterized by multiple hospitalizations, even among patients enrolled with hospice. OBJECTIVE: To determine whether hospice spending on direct patient care (including the cost of home visits, drugs, equipment, and counseling) is associated with hospital utilization and Medicare expenditures of hospice enrollees. DESIGN: Longitudinal, observational cohort study (2008-2010)...
August 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28812193/cost-analysis-of-robot-assisted-choledochotomy-and-common-bile-duct-exploration-as-an-option-for-complex-choledocholithiasis
#19
Ahmed Almamar, Nawar A Alkhamesi, Ward T Davies, Christopher M Schlachta
AIM: The aim of this study is to evaluate the clinical outcomes and cost-effectiveness of elective, robot-assisted choledochotomy and common bile duct exploration (RCD/CBDE) compared to open surgery for ERCP refractory choledocholithiasis. METHOD: A prospective database of all RCD/CBDE has been maintained since our first procedure in April 2007 though April 2016. With ethics approval, this database was compared with all contemporaneous elective open procedures (OCD/CBDE) performed since March 2005...
August 15, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28801791/effectiveness-of-healthcare-coordination-in-patients-with-chronic-respiratory-diseases
#20
Donata Kurpas, Katarzyna Szwamel, Dorota Lenarcik, Marika Guzek, Artur Prusaczyk, Paweł Żuk, Jolanta Michalowska, Agnieszka Grzeda, Bożena Mroczek
Coordination of healthcare effectively prevents exacerbations and reduces the number of hospitalizations, emergency visits, and the mortality rate in patients with chronic respiratory diseases. The purpose of this study was to determine clinical effectiveness of ambulatory healthcare coordination in chronic respiratory patients and its effect on the level of healthcare services as an indicator of direct medical costs. We conducted a retrospective health record survey, using an online database of 550 patients with chronic respiratory diseases...
August 12, 2017: Advances in Experimental Medicine and Biology
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