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"High value care"

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https://www.readbyqxmd.com/read/27987293/diagnostic-testing-in-the-context-of-high-value-care-incorporating-prior-probability
#1
Lucien Cardinal
This is the fifth article of a series on fundamental concepts in biostatistics and research. In this article, the author reviews the fundamental concepts in diagnostic testing, prior probability and predictive value, and how they relate to the concept of high-value care. The topics are discussed in common language with a minimum of jargon and mathematics. Emphasis is given to conceptual understanding. A companion article preceding this one focused on sensitivity and specificity.
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27943579/pilot-of-integrated-colocated-neurology-in-a-primary-care-medical-home
#2
Nathan P Young, Muhamad Y Elrashidi, Sarah J Crane, Jon O Ebbert
RATIONALE, AIMS, AND OBJECTIVES: Novel health care delivery models are needed to reduce health care use while delivering effective and safe care. We developed a model of a neurologist integrated and colocated in primary care leveraging "curbside," electronic, and traditional consultations. Our objective was to examine the impact on health care resource use of diagnostic testing and referrals for face-to-face neurological consultation and adverse outcomes associated with electronic and curbside consultations...
December 12, 2016: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/27939171/improving-the-electronic-nexus-between-generalists-and-specialists-a-public-health-imperative
#3
Michael J Young, Julien Pham
Recent changes in healthcare delivery and payment policy have precipitated interest among healthcare providers across the U.S. seeking innovative strategies to achieve higher quality, lower cost care through improved resource-utilization. One dimension of healthcare delivery with distinctive potential for improvement is care coordination between primary care and specialist providers. Optimizing the nexus between PCPs and specialists through innovations including eConsultation platforms portends reductions in unnecessary referrals and testing, and may help align incentives to promote high-value care...
December 2016: Healthcare
https://www.readbyqxmd.com/read/27923098/navigating-ethical-tensions-in-high-value-care-education
#4
Matthew DeCamp, Kevin R Riggs
No abstract text is available yet for this article.
December 6, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27919095/appropriate-use-of-therapeutic-interventions-to-foster-high-value-care
#5
Amir Qaseem
No abstract text is available yet for this article.
December 6, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27917076/the-cost-effectiveness-of-vedolizumab-for-inflammatory-bowel-disease-a-review-of-the-current-literature
#6
Yecheskel Schneider, Monica Saumoy, Shirley Cohen-Mekelburg, Adam F Steinlauf, Ellen J Scherl
The United States spends a greater share per gross domestic product on health care than any other developed country in the world. Cost-conscious, high-value care has an important role in the practice of medicine. Inflammatory bowel disease (IBD) affects 1.6 million people in the United States and is responsible for significant health care costs, with estimates as high as $31.6 billion annually, a large portion of which is attributable to the use of biologic therapies. As the number of therapeutic targets for IBD expands, gastroenterologists can anticipate the arrival of novel therapeutic agents on the market, and these may carry significant costs...
October 2016: Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27868308/-partnerships-are-crucial-an-evaluation-of-the-aboriginal-family-birthing-program-in-south-australia
#7
Philippa Middleton, Tanya Bubner, Karen Glover, Alice Rumbold, Donna Weetra, Wendy Scheil, Stephanie Brown
OBJECTIVES: To evaluate implementation and outcomes of the Aboriginal Family Birthing Program (AFBP), which provides culturally competent antenatal, intrapartum and early postnatal care for Aboriginal families across South Australia (SA). METHODS: Analysis of births to Aboriginal women in SA 2010-2012; interviews with health professionals and AFBP clients. RESULTS: Around a third of all Aboriginal women giving birth in SA 2010-2012 (n=486) attended AFBP services...
November 20, 2016: Australian and New Zealand Journal of Public Health
https://www.readbyqxmd.com/read/27862710/frequent-emergency-department-visitors-are-frequent-primary-care-visitors-and-report-unmet-primary-care-needs
#8
Amy Cunningham, Dawn Mautner, Bon Ku, Kevin Scott, Marianna LaNoue
A small percentage of emergency department (ED) visitors account for a disproportionate portion of ED visits. Little is known about their relationships with their primary care providers (PCPs). This study compares frequent and infrequent ED visitors' primary care utilization and perceptions of primary care access, continuity, and connectedness and examines primary care utilization and perceptions as predictors of ED use. Data were obtained from 2 cross-sectional studies of psychosocial predictors of high levels of utilization at 2 urban hospitals...
November 8, 2016: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/27824769/palliative-care-in-obstetrics-and-gynecology
#9
Carolyn Lefkowits, Caroline Solomon
Palliative care is specialized care for people with life-limiting illness; it focuses on symptom management and quality of life and ensures that a patient's care is concordant with her goals and values. Unlike end-of-life care, palliative care can be offered concurrently with disease-directed therapies, including when the goal is cure. Obstetrics and gynecology patients for whom palliative care is most appropriate include women with gynecologic cancer and women with a fetus or neonate with a potentially life-limiting illness...
December 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27798226/development-of-a-high-value-care-culture-survey-a-modified-delphi-process-and-psychometric-evaluation
#10
Reshma Gupta, Christopher Moriates, James D Harrison, Victoria Valencia, Michael Ong, Robin Clarke, Neil Steers, Ron D Hays, Clarence H Braddock, Robert Wachter
BACKGROUND: Organisational culture affects physician behaviours. Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists. We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by healthcare leaders and training programmes to target future improvements in value-based care. METHODS: We conducted a two-phase national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds...
October 26, 2016: BMJ Quality & Safety
https://www.readbyqxmd.com/read/27789539/anchoring-bias-as-a-limiting-factor-in-high-value-care-a-case-of-fever-of-unknown-origin-in-a-hospitalized-child
#11
Natalia Festa, K T Park, Hayden Schwenk
No abstract text is available yet for this article.
November 2016: Hospital Pediatrics
https://www.readbyqxmd.com/read/27701750/assessment-of-respiratory-distress-by-the-roth-score
#12
Ehud Chorin, Allison Padegimas, Ofer Havakuk, Edo Y Birati, Yacov Shacham, Anat Milman, Guy Topaz, Nir Flint, Gad Keren, Ori Rogowski
INTRODUCTION: Health care demand is increasing due to greater longevity of patients with chronic comorbidities. This increasing demand is occurring in a setting of resource scarcity. To address these changes, high-value care initiatives, such as telemedicine, are valuable resource-preservation strategies. This study introduces the Roth score as a telemedicine tool that uses patient counting times to accurately risk-stratify dyspnea severity in terms of hypoxia. HYPOTHESIS: The Roth score has correlation with dyspnea severity...
November 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/27687915/scalable-principles-of-community-based-high-value-care-for-seriously-ill-individuals-diamonds-in-the-rough
#13
Ravi B Parikh, Brynn Bowman, Constance Dahlin, Jeanne S Twohig, Diane E Meier
Early, integrated palliative care has been shown to improve quality of life and reduce utilization in both inpatient and outpatient settings. As health systems shift to risk-based payment structures, palliative care will play an increasing role in improving value of care outside of the hospital. Based on successful models of community-based palliative care, we identify six principles - interdisciplinary team-based care; 24/7 access and responsiveness; concurrent palliative care with disease-directed treatment; targeting services to high-risk patients; integrated medical and social supports; and caregiver support - that are widely implemented because of their impact on improving value for seriously ill individuals...
September 27, 2016: Healthcare
https://www.readbyqxmd.com/read/27683668/leadership-perspectives-on-operationalizing-the-learning-health-care-system-in-an-integrated-delivery-system
#14
Wayne Psek, F Daniel Davis, Gloria Gerrity, Rebecca Stametz, Lisa Bailey-Davis, Debra Henninger, Dorothy Sellers, Jonathan Darer
INTRODUCTION: Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders' perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders' perspectives on the LHS and learning activities in an integrated delivery system...
2016: EGEMS
https://www.readbyqxmd.com/read/27609736/utilization-of-4t-score-to-determine-the-pretest-probability-of-heparin-induced-thrombocytopenia-in-a-community-hospital-in-upstate-new-york
#15
Yazan Samhouri, Mohammad Telfah, Ruth Kouides, Timothy Woodlock
BACKGROUND: Thrombocytopenia is common in hospitalized patients. Heparin-induced thrombocytopenia (HIT) is a life-threatening condition which can lead to extensive thrombosis. Diagnosis of HIT relies on clinical suspicion determined by 4T score and immunoassays through testing for anti-PF4/heparin antibodies. Clinical practice guidelines published by the American Society of Hematology in 2013 recommended use of the 4T score before ordering the immunoassays as a measure of pretest probability...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27542429/cancer-screening-in-older-adults
#16
REVIEW
Ashley H Snyder, Allison Magnuson, Amy M Westcott
When screening for cancer in older adults, it is important to consider the risks of screening, how long it takes to benefit from screening, and the patient's comorbidities and life expectancy. Delivering high-value care requires the consideration of evidence-based screening guidelines and careful selection of patients. This article considers the impact of cancer. It explores perspectives on the costs of common cancer screening tests, illustrates how using life expectancy can help clinicians determine who will benefit most from screening, and provides tools to help clinicians discuss with their older patients when it may be appropriate to stop screening for cancer...
September 2016: Medical Clinics of North America
https://www.readbyqxmd.com/read/27520384/residents-self-report-on-why-they-order-perceived-unnecessary-inpatient-laboratory-tests
#17
REVIEW
Mina S Sedrak, Mitesh S Patel, Justin B Ziemba, Dana Murray, Esther J Kim, C Jessica Dine, Jennifer S Myers
Resident physicians routinely order unnecessary inpatient laboratory tests. As hospitalists face growing pressures to reduce low-value services, understanding the factors that drive residents' laboratory ordering can help steer resident training in high-value care. We conducted a qualitative analysis of internal medicine (IM) and general surgery (GS) residents at a large academic medical center to describe the frequency of perceived unnecessary ordering of inpatient laboratory tests, factors contributing to that behavior, and potential interventions to change it...
December 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27474012/fully-capitated-payment-breakeven-rate-for-a-mid-size-pediatric-practice
#18
Steven A Farmer, Joel Shalowitz, Meaghan George, Frank McStay, Kavita Patel, James Perrin, Ali Moghtaderi, Mark McClellan
BACKGROUND AND OBJECTIVES: Payers are implementing alternative payment models that attempt to align payment with high-value care. This study calculates the breakeven capitated payment rate for a midsize pediatric practice and explores how several different staffing scenarios affect the rate. METHODS: We supplemented a literature review and data from >200 practices with interviews of practice administrators, physicians, and payers to construct an income statement for a hypothetical, independent, midsize pediatric practice in fee-for-service...
August 2016: Pediatrics
https://www.readbyqxmd.com/read/27451862/hospital-resources-are-associated-with-value-based-surgical-performance
#19
Richard S Hoehn, Dennis J Hanseman, Derek Go, Koffi Wima, Alex Chang, Audrey E Ertel, Shimul A Shah, Daniel E Abbott
BACKGROUND: We have previously shown that inferior outcomes at safety-net hospitals are largely dependent on hospital factors. We hypothesized that hospitals providing "high value" care (low cost and better outcomes) would have advantages in human and financial resources. METHODS: The University HealthSystems Consortium Clinical Database and the American Hospital Association Annual Survey were used to examine hospitals performing eight complex surgical procedures from 2009 to 2013...
July 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27444638/the-transition-to-value-based-care
#20
REVIEW
Jordan C Ray, Fred Kusumoto
Delivery of medical care is evolving rapidly worldwide. Over the past several years in the USA, there has been a rapid shift in reimbursement from a simple fee-for-service model to more complex models that attempt to link payment to quality and value. Change in any large system can be difficult, but with medicine, the transition to a value-based system has been particularly hard to implement because both quality and cost are difficult to quantify. Professional societies and other medical groups are developing different programs in an attempt to define high value care...
October 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
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