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https://www.readbyqxmd.com/read/29779548/utilization-and-economic-contribution-of-psychiatric-mental-health-nurse-practitioners-in-public-behavioral-health-services
#1
Susan A Chapman, Bethany J Phoenix, Talia E Hahn, Deborah C Strod
INTRODUCTION: Expanded insurance coverage through the Affordable Care Act and parity in behavioral health coverage have increased demand for services. Yet there is a persistent shortage in the behavioral health workforce. Psychiatric Mental Health Nurse Practitioners (PMHNPs) may be part of the solution to shortages but are not yet fully utilized. The purpose of this study was to describe how PMHNPs are utilized, identify barriers to full utilization, and assess PMHNPs' economic contribution in public behavioral health systems...
June 2018: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/29778584/evaluating-the-capacity-of-california-s-publicly-funded-universities-to-provide-medication-abortion
#2
Sarah Raifman, Patricia Anderson, Shelly Kaller, Diane Tober, Daniel Grossman
OBJECTIVE: To explore the capacity of the University of California (UC) and California State University (CSU) student health centers to provide medication abortion (MA), to identify gaps in resources required to implement proposed Senate Bill 320, which would mandate the provision of MA on UC and CSU campuses, and to explore California student health center staff perspectives on the benefits and challenges of providing MA. STUDY DESIGN: UC and CSU student health center (SHC) staff participated in a self-administered online survey; we conducted in-depth data collection including site visits and conference calls at a subset of campuses...
May 17, 2018: Contraception
https://www.readbyqxmd.com/read/29777125/development-of-an-algorithm-to-identify-patients-with-physician-documented-insomnia
#3
Uri Kartoun, Rahul Aggarwal, Andrew L Beam, Jennifer K Pai, Arnaub K Chatterjee, Timothy P Fitzgerald, Isaac S Kohane, Stanley Y Shaw
We developed an insomnia classification algorithm by interrogating an electronic medical records (EMR) database of 314,292 patients. The patients received care at Massachusetts General Hospital (MGH), Brigham and Women's Hospital (BWH), or both, between 1992 and 2010. Our algorithm combined structured variables (such as International Classification of Diseases 9th Revision [ICD-9] codes, prescriptions, laboratory observations) and unstructured variables (such as text mentions of sleep and psychiatric disorders in clinical narrative notes)...
May 18, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29774623/medical-service-provider-networks
#4
Michel Mougeot, Florence Naegelen
In many countries, health insurers or health plans choose to contract either with any willing providers or with preferred providers. We compare these mechanisms when two medical services are imperfect substitutes in demand and are supplied by two different firms. In both cases, the reimbursement is higher when patients select the in-network provider(s). We show that these mechanisms yield lower prices, lower providers' and insurer's profits, and lower expense than in the uniform-reimbursement case. Whatever the degree of product differentiation, a not-for-profit insurer should prefer selective contracting and select a reimbursement such that the out-of-pocket expense is null...
May 17, 2018: Health Economics
https://www.readbyqxmd.com/read/29770887/the-importance-of-early-recognition-in-management-of-ercp-related-perforations
#5
Jason G Bill, Zachary Smith, Joseph Brancheck, Jeffrey Elsner, Paul Hobbs, Gabriel D Lang, Dayna S Early, Koushik Das, Thomas Hollander, Maria B Majella Doyle, Ryan C Fields, William G Hawkins, Steven M Strasberg, Chet Hammill, William C Chapman, Steven Edmundowicz, Daniel K Mullady, Vladimir M Kushnir
BACKGROUND: Iatrogenic perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare events, carrying with it a mortality of up to 8%. Given the rarity of this adverse event, there remains limited data and continued uncertainties when choosing therapeutic strategies. Our aims were to evaluate the management of ERCP-related perforations and compare outcomes based on timing of recognition. METHODS: The endoscopic databases of two tertiary care centers were interrogated to identify consecutive adult patients who sustained ERCP-related perforation over a 10-year period from 2006 to 2016...
May 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29767472/the-impact-of-real-world-cardiovascular-related-pharmacogenetic-testing-in-an-insured-population
#6
Jennifer Billings, Patrick N Racsa, Kristine Bordenave, Charron L Long, Jeffrey J Ellis
BACKGROUND: Pharmacogenomics is intended to help clinicians provide the right drug to the right patient at an appropriate dose. However, limited evidence of clinical utility has slowed uptake of pharmacogenomic testing (PGT). OBJECTIVE: To evaluate the impact of real-world cardiovascular (CV)-related PGT on clinical outcomes, healthcare resource utilisation (HCRU) and cost in a large, heterogeneous population. METHODS: Individuals with Medicare Advantage Prescription Drug, Medicaid, or commercial coverage between 1/1/2011 and 9/30/2015 and ≥1 atherosclerotic CV-related diagnosis were identified...
May 16, 2018: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/29766728/-euthanasia-legal-comparison-in-selected-european-countries
#7
Adam Doležal
This article deals with the subject of euthanasia (all its forms) and other end-of-life decisions, such as assisted suicide, withdrawing and whithholding life-sustaining treatments. Among other things, the article will also deal with the issue of the offense of Homicide by the Victims Request. Based on an empirical historical method, the article compares the various selected legal orders. From this analysis, it draws some conclusions that have an impact on ethical discourse. First of all, the terminology is defined in the article, which is very important in this area...
2018: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/29766499/optimal-timing-of-physician-visits-after-hospital-discharge-to-reduce-readmission
#8
Bruno D Riverin, Erin C Strumpf, Ashley I Naimi, Patricia Li
OBJECTIVE: To identify the optimal timing of in-person physician visit after hospital discharge to yield the largest reduction in readmission among elderly or chronically ill patients. DATA SOURCES/STUDY SETTING/EXTRACTION METHODS: We extracted insurance billing data on 620,656 admissions for any cause from 2002 to 2009 in Quebec, Canada. STUDY DESIGN: We used flexible survival models to estimate inverse probability weights for the precise timing (days) of in-person physician visit after discharge and weighted competing risk outcome models...
May 15, 2018: Health Services Research
https://www.readbyqxmd.com/read/29764166/chimeric-antigen-receptor-t-cells-a-savior-with-a-high-price
#9
Gilberto de Lima Lopes, George R Nahas
Chimeric antigen receptor (CAR) T cells represent a medical and scientific breakthrough that may represent a paradigm for the future of personalized medicine in the age of cancer immunotherapy. As with many new cancer agents, such novel and incredible results come with a high price. At the time of the writing of this article, there are two CAR T cells available, Kymriah, produced by Novrtis with a price tag of US$475,000 and Yescarta produced by Gilead Pharmaceuticals with a price tag of US$373,000, neither price including the required hospital admission in order to administer the agent in addition to potential treatment of side effects...
April 2018: Chinese Clinical Oncology
https://www.readbyqxmd.com/read/29762291/profiles-of-practicing-female-orthopaedists-caring-for-medicare-patients-in-the-united-states
#10
Talia R Chapman, Benjamin Zmistowski, James J Purtill, Antonia F Chen
BACKGROUND: The increase in the percentage of women in orthopaedics in the United States over the last half century has been substantially slower than in every other surgical specialty. While this percentage has improved recently, the current demographic and practice characteristics of female orthopaedic surgeons are not well known. This study defines the landscape of practicing female orthopaedic surgeons caring for Medicare patients. METHODS: Publicly available Medicare billing data sets from 2012 to 2014 were utilized to identify practicing orthopaedic surgeons...
May 16, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29762153/increased-mortality-and-reoperation-rates-after-treatment-for-septic-arthritis-of-the-knee-in-people-who-inject-drugs-nationwide-inpatient-sample-2000-2013
#11
David Hyung Won Oh, Alysse Gail Wurcel, David Joseph Tybor, Deirdre Burke, Mariano E Menendez, Matthew Joseph Salzler
BACKGROUND: The United States has a growing opioid epidemic impacting all aspects of health care including orthopaedic surgery. Septic arthritis of the knee is a condition commonly encountered by orthopaedic surgeons related to opioid and injection drug use (IDU). Changes in the frequency of hospitalizations for IDU-related septic arthritis and differences in septic arthritis patient outcomes according to IDU status in the setting of the burgeoning opioid epidemic are unknown. QUESTIONS/PURPOSES: (1) What proportion of patients with septic arthritis of the knee use injection drugs? (2) Are there any differences in complications, reoperations, length of stay, and leaving against medical advice among patients with septic arthritis of the knee with and without IDU? (3) What are the age and racial trends in IDU-related septic arthritis of the knee from 2000 to 2013? METHODS: The Healthcare Cost and Utilization Project, Nationwide Inpatient Sample database of years 2000 to 2013 was utilized for patients between ages 15 and 64 years with a principal discharge diagnosis of native septic arthritis of the lower leg, the vast majority of which represents the knee...
May 14, 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29757918/regulation-of-pediatric-intensive-care-unit-nurse-practitioner-practice-a-national-survey
#12
Kristin Hittle Gigli, Mary S Dietrich, Peter I Buerhaus, Ann F Minnick
PURPOSE: To describe the extent to which organizational regulation of pediatric intensive care unit (PICU) nurse practitioner (NP) practice and prescriptive authority aligns with state scope-of-practice (SSOP) regulations, to examine differences between PICU medical directors' and NPs' report of regulation, and to describe organizational-level restriction of PICU NP practice. METHODS: A 34-item national, quantitative cross-sectional descriptive survey of US PICU medical directors and NPs included demographic, institutional characteristics, and PICU NP regulation and role-related questions...
January 2018: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/29756475/national-survey-of-pediatric-care-providers-assessing-time-and-impact-of-coding-and-documentation-in-physician-practice
#13
Anshul Arora, Ashish Garg, Vrinda Arora, Munaza Rizvi, Ninad Desai
BACKGROUND: Documentation and billing/coding are essential to medical practice. Physicians spend significant time documenting to meet coding and medicolegal requirements, potentially reducing time for patient care and learning. We sought to assess time spent charting in pediatric practice and provider understanding and comfort level regarding billing/coding. METHODS: An anonymous web-based survey was emailed to members of American Academy of Pediatrics Section of Pediatric Trainees practicing in the United States...
May 1, 2018: Clinical Pediatrics
https://www.readbyqxmd.com/read/29752205/evaluation-of-the-frequency-of-dispensing-electronically-discontinued-medications-and-associated-outcomes
#14
Erin J Copi, Lindsey R Kelley, Kaleigh K Fisher
OBJECTIVES: To determine if outpatient pharmacies of an academic medical center inadvertently dispense discontinued medications and, if so, if these inadvertently dispensed prescriptions contribute to subsequent hospital admissions and patient harm. METHODS: This was a single-center retrospective chart review. Prescription billing data were analyzed for electronic prescriptions for hypotensives, hypoglycemics, anticoagulants, antiplatelets, and statins picked up from 3 outpatient pharmacies within the health system over a period of 1 year...
May 8, 2018: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/29741267/health-care-providers-perspectives-on-health-insurance-access-waiving-procedures-and-hospital-detention-practices-in-kenya
#15
Saskia Mostert, Festus Njuguna, Renske H M van der Burgt, Joyce Musimbi, Sandra Langat, Jodi Skiles, Anneloes Seijffert, Mei N Sitaresmi, Terry A Vik, Peter M van de Ven, Gertjan J L Kaspers
BACKGROUND: Patients at Kenyan public hospitals are detained if their families cannot pay their medical bills. Access to health insurance and waiving procedures to prevent detention may be limited. This study explores the perspectives of health-care providers (HCP) on health-insurance access, waiving procedures, and hospital detention practices. PROCEDURE: A self-administered structured questionnaire was completed by 104 HCP (response rate 78%) involved in childhood cancer care...
May 9, 2018: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/29735302/a-physician-led-initiative-to-improve-clinical-documentation-results-in-improved-health-care-documentation-case-mix-index-and-increased-contribution-margin
#16
Francesco A Aiello, Dejah R Judelson, Jonathan M Durgin, Danielle R Doucet, Jessica P Simons, Dawn M Durocher, Julie M Flahive, Andres Schanzer
INTRODUCTION: Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin...
May 4, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29724482/physician-visits-and-the-timing-of-skeletal-related-events-among-men-newly-diagnosed-with-metastatic-prostate-cancer-a-cohort-analysis
#17
Eberechukwu Onukwugha, Husam Albarmawi, Kai Sun, C Daniel Mullins, Abdalla Aly, Arif Hussain
INTRODUCTION: Men diagnosed with metastatic prostate cancer (PCa) are at increased risk for skeletal complications which are associated with significant morbidity and mortality. Although both the urologist and the medical oncologist play important roles in the management of patients with advanced PCa, there is limited information regarding their role in the context of skeletal complications. The current study investigated these relationships among newly diagnosed metastatic patients with PCa...
April 30, 2018: Urologic Oncology
https://www.readbyqxmd.com/read/29724423/acr-appropriateness-criteria-%C3%A2-abdominal-aortic-aneurysm-interventional-planning-and-follow-up
#18
Christopher J Francois, Erik P Skulborstad, Bill S Majdalany, Ankur Chandra, Jeremy D Collins, Khashayar Farsad, Marie D Gerhard-Herman, Heather L Gornik, A Tuba Kendi, Minhajuddin S Khaja, Margaret H Lee, Patrick D Sutphin, Baljendra S Kapoor, Sanjeeva P Kalva
Abdominal aortic aneurysms (AAAs) are a relatively common vascular problem that can be treated with either open, surgical repair or endovascular aortic aneurysm repair (EVAR). Both approaches to AAA repair require dedicated preoperative imaging to minimize adverse outcomes. After EVAR, cross-sectional imaging has an integral role in confirming the successful treatment of the AAA and early detection of complications related to EVAR. CT angiography is the primary imaging modality for both preoperative planning and follow-up after repair...
May 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29724414/acr-appropriateness-criteria-%C3%A2-lower-extremity-arterial-revascularization-post-therapy-imaging
#19
Kyle Cooper, Bill S Majdalany, Sanjeeva P Kalva, Ankur Chandra, Jeremy D Collins, Christopher J Francois, Suvranu Ganguli, Heather L Gornik, A Tuba Kendi, Minhajuddin S Khaja, Jeet Minocha, Patrick T Norton, Piotr Obara, Stephen P Reis, Patrick D Sutphin, Frank J Rybicki
Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or occlusion of previously treated vessels remains a pervasive issue in the postoperative setting. A variety of different imaging options are available to evaluate patients and are reviewed within the context of asymptomatic and symptomatic patients with PAD who have previously undergone endovascular or surgical revascularization...
May 2018: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29716613/task-shifting-in-health-service-delivery-from-a-decision-and-policy-makers-perspective-a-case-of-uganda
#20
Sebastian Olikira Baine, Arabat Kasangaki, Euzobia Margaret Mugisha Baine
BACKGROUND: Documented evidence shows that task shifting has been practiced in Uganda to bridge the gaps in the health workers' numbers since 1918. The objectives of this study were to provide a synthesis of the available evidence on task shifting in Uganda; to establish levels of understanding, perceptions on task shifting and acceptability from the decision and policy makers' perspective; and to provide recommendations on the implications of task shifting for the health of the population in Ugandan and human resource management policy...
May 2, 2018: Human Resources for Health
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