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"High value 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.
February 26, 2018: JAMA Internal Medicine
Nghia H Nguyen, Rohan Khera, Lucila Ohno-Machado, William J Sandborn, Siddharth Singh
BACKGROUND: We estimated 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-June 2013, and a diagnosis of inflammatory bowel diseases (IBD), chronic liver diseases (CLDs), functional gastrointestinal disorders (FGIDs), gastrointestinal hemorrhage, or pancreatic diseases, with 6 months or more of follow up...
February 20, 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
Jimmy B Beck, Corrie E McDaniel, Miranda C Bradford, Doug Brock, Carolyn D Sy, Tiffany Chen, Jeffrey Foti, Andrew A White
OBJECTIVES: Establishing a high-value care (HVC) culture within an institution requires a multidisciplinary commitment and participation. Bedside rounds provide an ideal environment for role modeling and learning behaviors that promote an HVC culture. However, little is understood regarding the types of HVC discussions that take place at the bedside and who participates in those discussions. METHODS: A prospective observational study at a tertiary-care, university-affiliated, free-standing children's hospital...
March 2018: Hospital Pediatrics
Veronica X Vela, Elizabeth W Patton, Darshak Sanghavi, Susan F Wood, Peter Shin, Sara Rosenbaum
CONTEXT: Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. METHODS: Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies...
January 9, 2018: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
Paul G Barnett, Juliette S Hong, Evan Carey, Gary K Grunwald, Karen Joynt Maddox, Thomas M Maddox
Importance: The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. Objectives: To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Design, Setting, and Participants: Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment...
January 3, 2018: JAMA Cardiology
Yogesh Jain, Gajanan Phutke
Even though 1% of people require palliative and end-of-life care in low-resource situations, it remains an uncharted arena. Yet it is as important as curative care to alleviate suffering. Palliative care is not only a need in cancer and HIV disease; but is needed in a diverse group of illnesses ranging from tuberculosis, renal failures, paraplegia to chronic lung diseases. In a lower resource setting, the gaps in palliation may be the need for more technology and interventions or more healthcare professionals...
October 25, 2017: Indian Journal of Medical Ethics
Micah T Prochaska, Samuel F Hohmann, Matthew Modes, Vineet M Arora
BACKGROUND: Identifying hospitals that are both early and consistent adopters of high-value care can help shed light on the culture and practices at those institutions that are necessary to promote high-value care nationwide. The use of troponin to diagnose acute myocardial infarction (AMI), and not to test for myoglobin or creatine kinase-MB (CK-MB), is a high-value recommendation of the Choosing Wisely® campaign. OBJECTIVE: To examine the variation in cardiac biomarker testing and the effect of the Choosing Wisely® troponin-only recommendation for the diagnosis of AMI...
December 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Karina W Davidson, Siqin Ye, George A Mensah
Implementation science has traditionally focused on increasing the delivery of evidence-based care. The science of systematically stopping low-value and wasteful care is substantially under-recognized, and if successful, may decrease the workload of clinicians. De-implementation science identifies problem areas of low-value and wasteful practice, carries out rigorous scientific examination of the factors that initiate and maintain such behaviors, and then employs evidence-based interventions to cease these practices...
2017: Ethnicity & Disease
Deirdre A Hill, Jennifer S Haas, Robert Wellman, Rebecca A Hubbard, Christoph I Lee, Jennifer Alford-Teaster, Karen J Wernli, Louise M Henderson, Natasha K Stout, Anna N A Tosteson, Karla Kerlikowske, Tracy Onega
BACKGROUND: Breast cancer screening with magnetic resonance imaging (MRI) may be a useful adjunct to screening mammography in high-risk women, but MRI uptake may be increasing rapidly among low- and average-risk women for whom benefits are unestablished. Comparatively little is known about use of screening MRI in community practice. OBJECTIVE: To assess relative utilization of MRI among women who do and do not meet professional society guidelines for supplemental screening, and describe utilization according to breast cancer risk indications...
March 2018: Journal of General Internal Medicine
Clifford C Sheckter, Evan Matros, Arash Momeni
INTRODUCTION: Breast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high-value care models. METHODS: A systematic review of PubMed, Web of Science, and the Cost-Effectiveness Analysis Registry was conducted...
March 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
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