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"High value care"

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...
October 4, 2016: Clinical Cardiology
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
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
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
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
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...
August 13, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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
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
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
Deborah Korenstein, Arlene Weissman, Cynthia D Smith
BACKGROUND: The value of care, defined as the relationship of cost, harm, and benefit, has garnered increased focus in recent years. Program directors (PDs) can provide information about resident skill and institutional priorities related to high-value care. OBJECTIVE: The objective of the study was to evaluate changes between 2012 and 2014 in PD-reported resident skills and institutional priorities related to high-value care. METHODS: We performed annual surveys of US internal medicine PDs from 2012-2014 and evaluated responses to identical questions related to high care value...
July 2016: Journal of Graduate Medical Education
Elizabeth A Nardi, Julie A Wolfson, Steven T Rosen, Robert B Diasio, Stanton L Gerson, Barbara A Parker, Joseph C Alvarnas, Harlan A Levine, Yuman Fong, Dennis D Weisenburger, C Lyn Fitzgerald, Maggie Egan, Sharon Stranford, Robert W Carlson, Edward J Benz
Key challenges facing the oncology community today include access to appropriate, high quality, patient-centered cancer care; defining and delivering high-value care; and rising costs. The National Comprehensive Cancer Network convened a Work Group composed of NCCN Member Institution cancer center directors and their delegates to examine the challenges of access, high costs, and defining and demonstrating value at the academic cancer centers. The group identified key challenges and possible solutions to addressing these issues...
July 2016: Journal of the National Comprehensive Cancer Network: JNCCN
Lucien J Cardinal
This is the fourth article of a series on fundamental concepts in biostatistics and research. In this article, the author reviews the fundamental concepts in diagnostic testing, sensitivity, and specificity 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, and with clinical examples. Emphasis is given to conceptual understanding. A companion article will follow focusing on predictive value and prior probability.
2016: Journal of Community Hospital Internal Medicine Perspectives
L James Nixon, Hilary F Ryder, Irene Alexandraki, Maureen D Lyons, Kelsey Angell McEwen, Deborah J DeWaay, Sarita Warrier, Valerie J Lang, Jeffrey LaRochelle
Since its inception in 1989, Clerkship Directors in Internal Medicine (CDIM) has promoted excellence in medical student education. CDIM members move medical education forward by sharing innovations in curriculum and assessment and discoveries related to educating our students and administering our programs. The Alliance for Academic Internal Medicine, of which CDIM is a founding member, broadens the umbrella beyond student education to include five academically focused specialty organizations representing departments of medicine, teaching hospitals, and medical schools working together to advance learning, discovery, and caring...
July 2016: Teaching and Learning in Medicine
Christine D Hudak, Charles von Gunten
Referral of advanced cancer patients for hospice care is of growing importance for oncologists. Hospice care is high quality and high value care that can benefit the patient and family's experience of living and dying with terminal cancer. We are challenged to become a part of the shift from hospice meaning "giving up" to hospice meaning "giving more, but differently." The purpose of this report is to frame a communication approach that any oncologist can incorporate into his or her practice that will facilitate the timely referral of appropriate patients for hospice care...
July 2016: Current Oncology Reports
Diana Tisnado, Jennifer Malin, Katherine Kahn, Mary Beth Landrum, Robert Fletcher, Carrie Klabunde, Steven Clauser, Selwyn O Rogers, Nancy L Keating
PURPOSE: Chemotherapy prolongs survival in patients with advanced non-small-cell lung cancer. However, few studies have included patients with poor performance status. This study examined rates of oncologists' recommendations for chemotherapy by patient performance status and symptoms and how physician characteristics influence chemotherapy recommendations. METHODS: We surveyed medical oncologists involved in the care of a population-based cohort of patients with lung cancer from the CanCORS (Cancer Care Outcomes Research and Surveillance) study...
July 2016: Journal of Oncology Practice
Joseph D Shirk, Hung-Jui Tan, Jim C Hu, Christopher S Saigal, Mark S Litwin
BACKGROUND: Care interactions as perceived by patients and families are increasingly viewed as both an indicator and lever for high-value care. To promote patient-centeredness and motivate quality improvement, payers have begun tying reimbursement with related measures of patient experience. Accordingly, the authors sought to determine whether such data correlate with outcomes among patients undergoing surgery for genitourinary cancer. METHODS: The authors used the Nationwide Inpatient Sample and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data from 2009 through 2011...
August 15, 2016: Cancer
Eugene C Rich, James D Reschovsky
The Medicare Access and CHIP Reauthorization Act (MACRA) introduces incentives for clinicians serving Medicare patients to move away from traditional "fee-for-service" and into alternative payment models (APMs) such as accountable care organizations and bundled payment arrangements. Thus, MACRA creates strong reasons for various teaching clinical services to participate in APMs, not only for Medicare patients but for other public and private payers as well. Unfortunately, different APMs may be more or less applicable to the diverse teaching physician roles, academic clinical programs, and patient populations served by medical schools and teaching hospitals...
July 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Michael Camilleri, David A Katzka
BACKGROUNG & AIMS: The objective of this review is to identify common areas in gastroenterology practice where studies performed provide an opportunity for enhancing value or lowering costs. METHODS: We provide examples of topics in gastroenterology where clinicians could enhance value by either using less invasive testing, choosing a single best test, or by using patient symptoms to guide additional testing. RESULTS: The topics selected for review are selected in esophageal, pancreatic, and colorectal cancer; functional gastrointestinal diseases (irritable bowel syndrome, bacterial overgrowth, constipation); immune-mediated gastrointestinal diseases; and pancreaticobiliary pathology...
October 2016: Clinical Gastroenterology and Hepatology
Carl D Stevens
In this issue, Coleman and colleagues propose an ambitious strategic action framework for academic health center (AHC) department chairs seeking to expand faculty expertise in quality improvement and patient safety (QI/PS). Noting the advent of value-based payment models and that AHCs lag behind some community hospitals in QI/PS, Coleman and colleagues call for deliberate, proactive faculty development and recognition measures to build QI/PS capacity at AHCs. In this Commentary, the author addresses the five challenges to strengthening QI/PS capacity identified by Coleman and colleagues: (1) the mentorship gap: the paucity of expert senior faculty who can mentor junior colleagues in QI/PS; (2) data and analytic bottlenecks: information systems and analytic requests to support QI/PS projects often get pushed to the back of long queues of prioritized queries from other departments, effectively halting QI/PS projects; (3) misalignment between existing reimbursement mechanisms and QI/PS: current fee-for-service and prospective payment mechanisms drive high utilization of costly interventions and can financially penalize organizations that keep patients well and avoid interventions; (4) limited recognition for QI/PS achievement in academic advancement decisions; and (5) pressure to invent and deploy alternative business models that reward value and results rather than the volume and pricing of services, to better align payer, provider, and patient incentives around high-value care...
May 17, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
David L Coleman, Richard M Wardrop, Wendy S Levinson, Mark L Zeidel, Polly E Parsons
Academic clinical departments have the opportunity and responsibility to improve the quality and value of care and patient safety by supporting effective quality improvement activities. The pressure to provide high-value care while further developing academic programs has increased the complexity of decision making and change management in academic health systems. Overcoming these challenges will require faculty engagement and leadership; however, most academic departments do not have a sufficient number of individuals with expertise and experience in quality improvement and patient safety (QI/PS)...
May 17, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
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