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Cheryl R Laratta, Willis H Tsai, James Wick, Sachin R Pendharkar, Kerri A Johannson, Paul E Ronksley
Obstructive sleep apnea (OSA) is a common condition associated with significant morbidity and health-care utilization. We determined the validity of an algorithm derived from administrative data for identifying OSA using the respiratory disturbance index (RDI) as the reference standard. We conducted a retrospective cohort study of adults in Alberta, Canada referred for facility and community-based sleep diagnostic testing between July 2005 and August 2007. Validity indices were estimated for several case definitions of OSA derived from outpatient physician billing claims and hospital discharge codes...
October 20, 2016: Journal of Sleep Research
Alvin Rajkomar, Joanne Wing Lan Yim, Kevin Grumbach, Ami Parekh
BACKGROUND: Characterizing patient complexity using granular electronic health record (EHR) data regularly available to health systems is necessary to optimize primary care processes at scale. OBJECTIVE: To characterize the utilization patterns of primary care patients and create weighted panel sizes for providers based on work required to care for patients with different patterns. METHODS: We used EHR data over a 2-year period from patients empaneled to primary care clinicians in a single academic health system, including their in-person encounter history and virtual encounters such as telephonic visits, electronic messaging, and care coordination with specialists...
October 14, 2016: JMIR Medical Informatics
Gwyn Bevan
Marchildon highlights the lack of evidence on policies of regionalization in Canada: with regionalization being in favour in the 2000s followed by disillusion and the abolition of regions by some provincial governments. This paper looks at evidence from the UK's single-payer system of the impacts of regions on the performance of the delivery of healthcare. In England, regions were an important part of the hierarchical structure of the National Health Service (NHS) from its beginning, in 1948, to the introduction of provider competition, in the 1990s...
2016: HealthcarePapers
Andrew W Roberts, Joel F Farley, G Mark Holmes, Christine U Oramasionwu, Chris Ringwalt, Betsy Sleath, Asheley C Skinner
Controlled substance lock-in programs are garnering increased attention from payers and policy makers seeking to combat the epidemic of opioid misuse. These programs require high-risk patients to visit a single prescriber and pharmacy for coverage of controlled substance medication services. Despite high prevalence of the programs in Medicaid, we know little about their effects on patients' behavior and outcomes aside from reducing controlled substance-related claims. Our study was the first rigorous investigation of lock-in programs' effects on out-of-pocket controlled substance prescription fills, which circumvent the programs' restrictions and mitigate their potential public health benefits...
October 1, 2016: Health Affairs
Anna R Gagliardi, Ariel Ducey, Pascale Lehoux, Sue Ross, Patricia Trbovich, Anthony Easty, Chaim Bell, Julie Takata, Christof Pabinger, David R Urbach
INTRODUCTION: Some cardiovascular devices are licensed based on limited evidence, potentially exposing patients to devices that are not safe or effective. Research is needed to ascertain if the same is true of other types of medical devices. Knee arthroplasty is a widely-used surgical procedure yet implant failures are not uncommon. The purpose of this study was to characterize available evidence on the safety and effectiveness of knee implants. METHODS: A review of primary studies included in health technology assessments (HTA) on total (TKA) and unicompartmental knee arthroplasty (UKA) was conducted...
2016: PloS One
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
Sarah M Bartsch, James A McKinnell, Leslie E Mueller, Loren G Miller, Shruti K Gohil, Susan S Huang, Bruce Y Lee
OBJECTIVES: The Centers for Disease Control and Prevention considers carbapenem-resistant Enterobacteriaceae (CRE) an urgent public health threat, however, its economic burden is unknown. METHODS: We developed a CRE clinical and economics outcomes model to determine the cost of CRE infection from the hospital, third party payer, and societal perspectives and to evaluate the health and economic burden of CRE to the US. RESULTS: Depending on the infection type, the median cost of a single CRE infection can range from $22,484-$66,031 for hospitals, $10,440-$31,621 for third party payers, and $37,778-$83,512 for society...
September 15, 2016: Clinical Microbiology and Infection
Quynh Pham, David Wiljer, Joseph A Cafazzo
BACKGROUND: Randomized controlled trials (RCTs) have long been considered the primary research study design capable of eliciting causal relationships between health interventions and consequent outcomes. However, with a prolonged duration from recruitment to publication, high-cost trial implementation, and a rigid trial protocol, RCTs are perceived as an impractical evaluation methodology for most mHealth apps. OBJECTIVE: Given the recent development of alternative evaluation methodologies and tools to automate mHealth research, we sought to determine the breadth of these methods and the extent that they were being used in clinical trials...
September 9, 2016: JMIR MHealth and UHealth
Nathan Cermak, Selim Olcum, Francisco Feijó Delgado, Steven C Wasserman, Kristofor R Payer, Mark A Murakami, Scott M Knudsen, Robert J Kimmerling, Mark M Stevens, Yuki Kikuchi, Arzu Sandikci, Masaaki Ogawa, Vincent Agache, François Baléras, David M Weinstock, Scott R Manalis
Methods to rapidly assess cell growth would be useful for many applications, including drug susceptibility testing, but current technologies have limited sensitivity or throughput. Here we present an approach to precisely and rapidly measure growth rates of many individual cells simultaneously. We flow cells in suspension through a microfluidic channel with 10-12 resonant mass sensors distributed along its length, weighing each cell repeatedly over the 4-20 min it spends in the channel. Because multiple cells traverse the channel at the same time, we obtain growth rates for >60 cells/h with a resolution of 0...
October 2016: Nature Biotechnology
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
Sinem Perk, Ronald C Wielage, Noll L Campbell, Timothy M Klein, Anthony Perkins, Linda M Posta, Thomas Yuran, Robert W Klein, Daniel B Ng
BACKGROUND: Oral pharmacological treatment for overactive bladder (OAB) consists of antimuscarinics and the beta-3 adrenergic agonist mirabegron. Antimuscarinic adverse events (AEs) such as dry mouth, constipation, and blurry vision can result in frequent treatment discontinuation rates, leaving part of the OAB population untreated. Antimuscarinics also contribute to a patient's anticholinergic cognitive burden (ACB), so the Beers Criteria recommends cautious use of antimuscarinics in elderly patients who take multiple anticholinergic medications or have cognitive impairment...
September 2016: Journal of Managed Care & Specialty Pharmacy
Sinem Perk, Ronald C Wielage, Noll L Campbell, Timothy M Klein, Anthony Perkins, Linda M Posta, Thomas Yuran, Robert W Klein, Daniel B Ng
BACKGROUND: Oral pharmacological treatment for overactive bladder (OAB) consists of antimuscarinics and the beta-3 adrenergic agonist mirabegron. Antimuscarinic adverse events (AEs) such as dry mouth, constipation, and blurry vision can result in frequent treatment discontinuation rates, leaving part of the OAB population untreated. Antimuscarinics also contribute to a patient's anticholinergic cognitive burden (ACB), so the Beers Criteria recommends cautious use of antimuscarinics in elderly patients who take multiple anticholinergic medications or have cognitive impairment...
September 2016: Journal of Managed Care & Specialty Pharmacy
Naveen M Krishnan, John P Fischer, Marten N Basta, Maurice Y Nahabedian
BACKGROUND: Prosthetic breast reconstruction is most commonly performed using the two-stage (expander-implant) technique. However, with the advent of skin-sparing mastectomy and the use of acellular dermal matrices, one-stage prosthetic reconstruction has become more feasible. Prior studies have suggested that one-stage reconstruction has economic advantages relative to two-stage reconstruction despite a higher revision rate. This is the first cost-utility analysis to compare the cost and quality of life of both procedures to guide patient care...
September 2016: Plastic and Reconstructive Surgery
Gary W Jean, Katherine Kelly, Jennie Mathew, Eneko Larumbe, Randall Hughes
PURPOSE: The purpose of this study is to compare the rates of recurrent VTE among cancer patients treated with parenteral agents to the oral anticoagulants. METHODS: This single-center study was a retrospective chart review of cancer patients with recurrent VTE between January 1, 2009 and December 31, 2014. The primary outcome of the study is the rate of recurrent VTE in patients who received a parenteral anticoagulant (enoxaparin, dalteparin, fondaparinux) versus those who received oral anticoagulants (warfarin and rivaroxaban)...
August 20, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Falk Schwendicke, Gerd Göstemeyer
INTRODUCTION: Single-visit root canal treatment requires fewer visits and reduces treatment time and material use compared with multiple-visit treatment. However, it might result in a higher risk of complications. We aimed to assess the long-term cost-effectiveness of single- versus multivisit root canal treatment using a model-based approach. METHODS: A mixed public-private-payer perspective in German health care was adopted. Permanent teeth were simulated over the lifetime of 40-year-old patients...
October 2016: Journal of Endodontics
Christopher Parker, Beth Woods, James Eaton, Esprit Ma, Ross Selby, Eugene Benson, Andreas Engstrom, Peter Sajosi, Andrew Briggs, Vijayveer Bonthapally
OBJECTIVE: Evaluate cost-effectiveness of brentuximab vedotin in patients with relapsed/refractory Hodgkin lymphoma who have received autologous stem cell transplantation, from a Scottish healthcare payer perspective. METHODS: A Microsoft Excel-based partitioned survival model comprising three health states (progression-free survival [PFS], post-progression survival, and death) was developed. Relevant comparators were chemotherapy with or without radiotherapy (C/R) and C/R with intent to allogeneic hematopoietic stem cell transplantation (alloSCT)...
July 29, 2016: Journal of Medical Economics
Thomas P Weil
Numerous papers have been written comparing the Canadian and US healthcare systems, and a number of health policy experts have recommended that the Americans implement their single-payer system to save 12-20% of its healthcare expenditures. This paper is different in that it assumes that neither country will undertake a significant philosophic or structural change in their healthcare system, but there are lessons to be learned that are inherent in one that could be a major breakthrough for the other. Following the model in Canada and in Western Europe, the USA could implement universal health insurance so that the 32...
July 2016: International Journal of Health Planning and Management
Ignacio Conget, Dídac Mauricio, Rafael Ortega, Bruno Detournay
OBJECTIVE: Several glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1Ra) have been made recently available in Spain for type 2 diabetes mellitus (DM2) treatment. There are no published data on the clinical and sociodemographic profile of patients initiating treatment with GLP-1Ra in Spain. Our objective was to understand these patients' characteristics in a real-world clinical practice setting. DESIGN: Cross-sectional observational study. SETTING: Spanish specialist outpatient clinics...
2016: BMJ Open
Alexander Marius van den Heever
In 2011, the South African government published a Green Paper outlining proposals for a single-payer National Health Insurance arrangement as a means to achieve universal health coverage (UHC), followed by a White Paper in 2015. This follows over two decades of health reform proposals and reforms aimed at deepening UHC. The most recent reform departure aims to address pooling and purchasing weaknesses in the health system by internalising both functions within a single scheme. This contrasts with the post-apartheid period from 1994 to 2008 where pooling weaknesses were to be addressed using pooling schemes, in the form of government subsidies and risk-equalisation arrangements, external to the public and private purchasers...
June 6, 2016: Health Policy
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