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"High value care"

Peter M Waters, Brian W Yang, Doreen White, Ellen Barth, Vincent Chiang, Arielle Mizrahi-Arnaud, William Sparks
BACKGROUND: Providing high-value care for urgent orthopaedic trauma patients requires effective and timely treatment. Herein, we describe the implementation of an innovative program utilizing the operating room (OR) capacity of a satellite campus to decrease stress on a pediatric tertiary care center without jeopardizing patient safety. METHODS: In addition to the daily emergency surgical room on the main campus, a dedicated orthopaedic trauma surgery OR was established in a satellite hospital location for 3 days per week in the summer and for 2 days per week for the rest of the year...
May 16, 2018: Journal of Bone and Joint Surgery. American Volume
Elizabeth Snyder, Lilja Solnes, Karen M Horton, Pamela T Johnson
RATIONALE AND OBJECTIVES: The role of a radiologist has expanded beyond the tripartite mission of patient care, education, and research to include cross-specialty consultation for patient management, innovative solutions to improve health-care quality and safety, device design, and policy advocacy. As such, radiology residency programs should incorporate formalized training to prepare residents for these various professional roles. MATERIALS AND METHODS: Since the 2015-2016 academic year, five training tracks focused on noninterpretative skills have been integrated into our residency training program: Clinician Educator, Quality Improvement, Entrepreneurship/Innovation, Health Policy Advocacy, and High-Value Care...
June 2018: Academic Radiology
Justin Lockwood, Justin Robison, Todd Carpenter, Jennifer Reese
No abstract text is available yet for this article.
May 10, 2018: Hospital Pediatrics
Christopher P Filson
The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer...
April 2018: Translational Andrology and Urology
Melanie D Whittington, Jonathan D Campbell, R Brett McQueen
Section 340B of the Public Health Service Act requires drug manufacturers to enter into price agreements with the Department of Health and Human Services. These agreements result in variation in the price paid to acquire a drug by sector, which complicates the price used in cost-effectiveness analyses. We describe the transactions and sectors in a 340B agreement using a multiple sclerosis drug. Cost-effectiveness estimates were calculated for the drug using drug prices from the manufacturer and payer perspective...
April 2018: Neurology. Clinical Practice
Parth K Modi, David Portney, Brent K Hollenbeck, Chad Ellimoottil
PURPOSE OF REVIEW: Telehealth, or the remote delivery of healthcare services using telecommunications technology, has the potential to revolutionize the delivery of healthcare and contribute to ongoing efforts to provide high-value care. RECENT FINDINGS: We discuss several categories of telehealth that have been applied to healthcare. Several of these approaches, in particular video visits and teleconsultations, have promising early data demonstrating the significant benefits of telehealth technology with respect to the quality of care, access, cost savings, and patient experience...
April 24, 2018: Current Opinion in Urology
Kira L Ryskina, Cynthia D Smith, Vineet M Arora, Aimee K Zaas, Andrew J Halvorsen, Arlene Weissman, Sandhya Wahi-Gururaj
PURPOSE: To measure the association between institutional investment in high value care (HVC) performance improvement and resident HVC experiences. METHOD: The authors analyzed data from two 2014 surveys assessing institutions' investments in HVC performance improvement as reported by program directors (PDs) and residents' perceptions of the frequency of HVC teaching, participation in HVC-focused quality improvement (QI), and views on HVC topics. The authors measured the association between institutional investment and resident-reported experiences using logistic regression, controlling for program and resident characteristics...
April 24, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Meghan M Galligan, Tara W Bamat, Annique K Hogan, Joseph Piccione
Children with special healthcare needs have been identified nationally as a population whose health care is associated with unmet needs; increased morbidity; fragmentation of care and medical errors; caregiver dissatisfaction; and disproportionately high costs. A subset of these children are medically fragile, with medical complexity that requires a reliance on tertiary care-based services-including subspecialty appointments, surgical procedures, and care coordination resources. For medically complex patients affected by upper and lower respiratory tract and gastrointestinal disorders, multidisciplinary aerodigestive centers have emerged at tertiary care centers across the United States to facilitate coordinated, high-quality, and high value care...
April 12, 2018: Current Problems in Pediatric and Adolescent Health Care
Kristen A Calabro, Mehul V Raval, David H Rothstein
As healthcare systems increasingly shift focus toward providing high-quality and high-value care to patients, there has been a simultaneous growth in assessing the patient's experience through patient-reported outcomes. Along with well-known patient reported outcomes such as health-related quality of life and current health state, patient satisfaction can be a valuable assessment of quality. Patient and family satisfaction measures not only affect a patient's clinical course and influence overall patient compliance, but are increasingly used to gauge physician performance and guide reimbursement...
April 2018: Seminars in Pediatric Surgery
Lisa B VanWagner, Fasiha Kanwal
With the passage of the Affordable Care Act (ACA) followed by the physician payment reform, there is an urgent need to better understand the complex relationships between structure (including incentives), processes, and outcomes of health care and, based on this understanding, identify interventions that can ensure delivery of high value care to patients with liver disease. As hepatologists, how do we systematically address these issues and ensure that we provide high-value care to our patients? These factors combine in the burgeoning field of health services research...
March 14, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Prem N Ramkumar, Heather S Haeberle, Sergio M Navarro, Assem A Sultan, Michael A Mont, Eric T Ricchetti, Mark S Schickendantz, Joseph P Iannotti
BACKGROUND: Mobile technology offers the prospect of delivering high-value care with increased patient access and reduced costs. Advances in mobile health (mHealth) and telemedicine have been inhibited by the lack of interconnectivity between devices and software and inability to process consumer sensor data. The objective of this study was to preliminarily validate a motion-based machine learning software development kit (SDK) for the shoulder compared with a goniometer for 4 arcs of motion: (1) abduction, (2) forward flexion, (3) internal rotation, and (4) external rotation...
March 7, 2018: Journal of Shoulder and Elbow Surgery
Danelle Cayea, Kim Tartaglia, Amit Pahwa, Heather Harrell, Amy Shaheen, Valerie J Lang
PURPOSE: The clinical skills needed to practice high-value care (HVC) are core to all medical disciplines. Medical students form practice habits early and HVC instruction is essential to this formation. The purpose of this study was to describe the state of HVC instruction and assessment in internal medicine clerkships and identify needs for additional curricula. METHOD: In 2014, the Clerkship Directors in Internal Medicine conducted its annual survey of 121 U.S...
March 6, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
William G Mantyh, Bruce H Cohen, Luana Ciccarelli, Lindsey M Philpot, Lyell K Jones
Historically, payment for cognitive, nonprocedural care has required provision of face-to-face evaluation and management as part of general ambulatory or inpatient care. Although non-face-to-face patient care (e.g., care via electronic means or telephone) is commonly performed and is integral to patient-centered care, appropriate reimbursement for this type of care is lacking. Beginning in 2017, Centers for Medicare and Medicaid (CMS) has taken a large step forward in reimbursing an increased number of cognitive care and non-face-to-face codes...
February 2018: Neurology. Clinical Practice
Donevan Westerveld, Vikas Khullar, Lazarus Mramba, Fares Ayoub, Tony Brar, Mitali Agarwal, Justin Forde, Joydeep Chakraborty, Michael Riverso, Yaseen B Perbtani, Anand Gupte, Chris E Forsmark, Peter Draganov, Dennis Yang
Background:  Adherence to quality indicators and surveillance guidelines in the management of Barrett's esophagus (BE) promotes high-quality, cost-effective care. The aims of this study were (1) to evaluate adherence to standardized classification (Prague Criteria) and systematic (four-quadrant) biopsy protocol, (2) to identify predictors of practice patterns, and (3) to assess adherence to surveillance guidelines for non-dysplastic BE (NDBE). Methods:  This was a single-center retrospective study of esophagogastroduodenoscopy (EGD) performed for BE (June 2008 to December 2015)...
March 2018: Endoscopy International Open
Elisabeth Pordes, John Gordon, Lee M Sanders, Eyal Cohen
Children with medical complexity (CMC) are a subset of children and youth with special health care needs with high resource use and health care costs. Novel care delivery models in which care coordination and other services to CMC are provided are a focus of national and local health care and policy initiatives. Current models of care for CMC can be grouped into 3 main categories: (1) primary care-centered models, (2) consultative- or comanagement-centered models, and (3) episode-based models. Each model has unique advantages and disadvantages...
March 2018: Pediatrics
Nicholas L Berlin, Vickram J Tandon, Ji Qi, Hyungjin M Kim, Jennifer B Hamill, Adeyiza O Momoh, Andrea L Pusic, Edwin G Wilkins
OBJECTIVE: Our objectives were to investigate case-mix adjusted hospital variations in 2-year clinical and patient-reported outcomes following immediate breast reconstruction. BACKGROUND: Over the past few decades, variations in medical practice have been viewed as opportunities to promote best practices and high-value care. METHODS: The Mastectomy Reconstruction Outcomes Consortium Study is an National Cancer Institute-funded longitudinal, prospective cohort study assessing clinical and patient-reported outcomes of immediate breast reconstruction after mastectomy at 11 leading medical centers...
February 27, 2018: Annals of Surgery
Joshua Tseng, Ronald J Halbert, Nareg Minissian, Hector Rodriguez, Shrinath Barathan, Patricia Hain, Rodrigo F Alban
No abstract text is available yet for this article.
April 1, 2018: JAMA Internal Medicine
Nghia H Nguyen, Rohan Khera, Lucila Ohno-Machado, William J Sandborn, Siddharth Singh
BACKGROUND & AIMS: We estimated the annual burden and costs of hospitalization in patients with chronic gastrointestinal and liver diseases, and identified characteristics of high-need, high-cost patients, in a nationally representative sample. METHODS: Using Nationwide Readmissions Database 2013, we identified patients with at least 1 hospitalization between January and June 2013, and a diagnosis of inflammatory bowel diseases (IBDs), chronic liver diseases (CLDs), functional gastrointestinal disorders (FGIDs), gastrointestinal hemorrhage, or pancreatic diseases, with 6 months or more of follow up...
February 21, 2018: Clinical Gastroenterology and Hepatology
Tom Chau, Laura Loertscher
Background : Teaching the practice of high-value care (HVC) is an increasingly important function of graduate medical education but best practices and long-term outcomes remain unknown. Objective : Whether a multimodal curriculum designed to address specific drivers of low-value care would affect resident attitudes, skills, and performance of HVC as tested by the Internal Medicine In-Training Exam (ITE). Methods : In 2012, we performed a baseline needs assessment among internal medicine residents at a community program regarding drivers of healthcare utilization...
2018: Journal of Community Hospital Internal Medicine Perspectives
Michael J Tchou, Maya Dewan, Lisa E Herrmann
No abstract text is available yet for this article.
March 2018: Hospital Pediatrics
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