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https://www.readbyqxmd.com/read/28340128/crossing-the-health-it-chasm-considerations-and-policy-recommendations-to-overcome-current-challenges-and-enable-value-based-care
#1
Julia Adler-Milstein, Peter J Embi, Blackford Middleton, Indra Neil Sarkar, Jeff Smith
While great progress has been made in digitizing the US health care system, today's health information technology (IT) infrastructure remains largely a collection of systems that are not designed to support a transition to value-based care. In addition, the pursuit of value-based care, in which we deliver better care with better outcomes at lower cost, places new demands on the health care system that our IT infrastructure needs to be able to support. Provider organizations pursuing new models of health care delivery and payment are finding that their electronic systems lack the capabilities needed to succeed...
March 15, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28322509/teaching-medical-students-about-cost-effectiveness
#2
Mark Iscoe, Robert Lord, John Schulz, David Lee, Danelle Cayea, Amit Pahwa
BACKGROUND: Rising and burdensome health care costs have driven interest in the practice of high-value care (HVC) and have inspired calls for increased HVC training across all levels of medical education, including among undergraduate medical students. CONTEXT: Classroom-based HVC curricula targeted to medical students have not been previously described in the medical literature. INNOVATION: We developed and evaluated a workshop comprising a lecture, a small-group exercise and a group discussion to instruct medical students on interpreting cost-effectiveness analyses (CEA), applying CEA to patient care and discussing the cost of care with patients...
March 21, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28291382/cost-implications-of-an-evidence-based-approach-to-radiation-treatment-after-lumpectomy-for-early-stage-breast-cancer
#3
Rachel A Greenup, Rachel C Blitzblau, Kevin L Houck, Julie Ann Sosa, Janet Horton, Jeffrey M Peppercorn, Alphonse G Taghian, Barbara L Smith, E Shelley Hwang
INTRODUCTION: Breast cancer treatment costs are rising, and identification of high-value oncology treatment strategies is increasingly needed. We sought to determine the potential cost savings associated with an evidence-based radiation treatment (RT) approach among women with early-stage breast cancer treated in the United States. PATIENTS AND METHODS: Using the National Cancer Database, we identified women with T1-T2 N0 invasive breast cancers treated with lumpectomy during 2011...
March 14, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28264949/outcomes-for-high-needs-patients-practices-with-a-higher-proportion-of-these-patients-have-an-edge
#4
Dori A Cross, Genna R Cohen, Christy Harris Lemak, Julia Adler-Milstein
High-value primary care for high-needs patients-those with multiple physical, mental, or behavioral health conditions-is critical to improving health system performance. However, little is known about what types of physician practices perform best for high-needs patients. We examined two scale-related characteristics that could predict how well physician practices delivered care to this population: the proportion of patients in the practice that were high-needs and practice size (number of physicians). Using four years of data on commercially insured, high-needs patients in Michigan primary care practices, we found lower spending and utilization among practices with a higher proportion of high-needs patients (more than 10 percent of the practice's panel) compared to practices with smaller proportions...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28248575/ten-principles-to-guide-health-reform
#5
Joe K Gerald
Americans face inevitable trade-offs between health care affordability, accessibility, and innovation. Although numerous reforms have been proposed, universal principles to guide decision-making are lacking. Solving the challenges that confront us will be difficult, owing to intense partisan divisions and a dysfunctional political process. Nevertheless, we must engage in reasoned debate that respects deeply held differences of opinion regarding our individual and collective obligations to promote healthy living and ensure affordable access to health care...
March 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28192792/management-of-low-back-pain-getting-from-evidence-based-recommendations-to-high-value-care
#6
Steven J Atlas
No abstract text is available yet for this article.
February 14, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28182806/student-perceptions-of-high-value-care-education-in-internal-medicine-clerkships
#7
Amit Pahwa, Danelle Cayea, Amanda Bertram, Ariella Apfel, Chad Miller, Nick Van Wagoner, James Willig, Reena Karani, Bimal Ashar
No abstract text is available yet for this article.
February 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28166559/should-we-prescribe-antibiotics-to-this-patient-with-persistent-upper-respiratory-symptoms-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#8
Howard Libman, Diane M Brockmeyer, Howard S Gold
The American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) recently published advice for high-value care on the appropriate use of antibiotics for acute respiratory tract infections. They conducted a narrative literature review of evidence for antibiotic use in this setting that included recent clinical guidelines from professional societies supplemented by randomized, controlled trials; meta-analyses; and systematic reviews. They concluded that clinicians should reserve antibiotic treatment for acute rhinosinusitis in patients with persistent symptoms for more than 10 days, high fever and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or worsening symptoms after a typical viral illness that lasted 5 days and had initially improved ("double-sickening")...
February 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28156503/health-care-utilization-and-costs-at-end-of-life-among-patients-with-leukemia-or-lymphoma-in-a-regional-cancer-registry-insurance-claims-linked-database
#9
Catherine R Fedorenko, Karma L Kreizenbeck, Ted Conklin, Bruce Smith, Gary H Lyman, Scott David Ramsey
184 Background: End-of-life (EOL) care for persons with hematologic malignancies is variable and often involves high-intensity services at death approaches, which may not reflect patient or family preferences. We characterized healthcare utilization and associated costs in the last 30 days of life among subjects with leukemia or lymphoma to better understand patterns of care in this population. METHODS: We linked enrollment and claims records from two regional commercial insurers to Surveillance, Epidemiology, and End Results (SEER) records for patients diagnosed with leukemia or lymphoma in Western Washington state between January 1, 2007 and December 31, 2015...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152888/the-benefits-of-clinical-pathways-cp-for-radiation-oncology-in-a-large-cancer-care-network
#10
Sushil Beriwal, Hans Benson, Zach Lorinc, Amanda Barry, Kathleen Lokay
148 Background: UPMC CancerCenter and the University of Pittsburgh Cancer Institute (UPMC) created a radiation oncology CP program (now incorporated separately as Via Pathways) in 2003 to standardize care at 19 radiation sites. The program exists to ensure consistency and rapid adoption of best evidence-based care in a large, integrated NCI-designated comprehensive cancer center. METHODS: The web-based CP portal integrates with electronic medical records to provide point-of-care patient-specific decision support...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28134553/using-organizational-and-clinical-performance-data-to-increase-the-value-of-mental-health-care
#11
Eric M Schmidt, Dean D Krahn, Marsden H McGuire, Sara Tavakoli, David M Wright, Hugo E Solares, Sonne Lemke, Jodie Trafton
U.S. health systems, policy makers, and patients increasingly demand high-value care that improves health outcomes at lower cost. This study describes the initial design and analysis of the Mental Health Management System (MHMS), a performance data and quality improvement tool used by the Veterans Health Administration (VHA) to increase the value of its mental health care. The MHMS evaluates access to and quality of mental health care, organizational structure and efficiency, implementation of innovative treatment options, and, in collaboration with management, resource needs for delivering care...
February 2017: Psychological Services
https://www.readbyqxmd.com/read/28130386/ethics-and-high-value-care
#12
Matthew DeCamp, Jon C Tilburt
High-value care (HVC) is en vogue, but the ethics of physicians' roles in the growing number of HVC recommendations demands further attention. In this brief report, we argue that, from the standpoint of individual physicians' primary commitments and duties to individual patients, not all HVC is ethically equal. Our analysis suggests that the ethical case for HVC may be both stronger and weaker than is ordinarily supposed. In some cases, HVC is not merely a 'good thing to do' but is actually ethically obligatory...
January 26, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28121645/finding-the-value-of-minimally-invasive-gynecologic-surgery
#13
James L Whiteside
Minimally invasive surgery is indistinctly defined and some cases possess clinical outcomes that are similarly indistinct or excessively costly. Seeking to clarify these issues will offer organized medicine an opportunity to deliver value-based health care. Context (patient, society, and clinician) is critical to finding that clarity, although the clinician context likely offers the best insights into how the ideal of high-value care may be incorporated into minimally invasive gynecologic surgery.
January 24, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27987293/diagnostic-testing-in-the-context-of-high-value-care-incorporating-prior-probability
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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