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https://www.readbyqxmd.com/read/29145584/critical-lessons-from-high-value-oncology-practices
#1
Douglas W Blayney, Melora K Simon, Beatrice Podtschaske, Scott Ramsey, Margaret Shyu, Craig Lindquist, Arnold Milstein
Importance: Cancer care is expensive. Cancer care provided by practice organizations varies in total spending incurred by patients and payers during treatment episodes and in quality of care, and this unnecessary variation contributes to the high cost. Objective: To use the variation in total spending and quality of care to assess oncology practice attributes distinguishing "high value" that may be tested and adopted by others to produce similar results. Design, Setting, and Participants: "Positive deviance" was used in this exploratory mixed-methods (quantitative and qualitative) analysis of interview results...
November 16, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/29145548/supported-discharge-teams-for-older-people-in-hospital-acute-care-hospital-a-randomised-controlled-trial
#2
Matthew Parsons, John Parsons, Paul Rouse, Avinesh Pillai, Sean Mathieson, Rochelle Parsons, Christine Smith, Tim Kenealy
Background: Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. Objective: To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs...
November 14, 2017: Age and Ageing
https://www.readbyqxmd.com/read/29145407/predicting-mortality-and-hospitalization-of-older-adults-by-the-multimorbidity-frailty-index
#3
Yao-Chun Wen, Liang-Kung Chen, Fei-Yuan Hsiao
BACKGROUND: Existing operational definitions of frailty are personnel-costly and time-consuming, resulting in estimates with a small sample size that cannot be generalized to the population level. The objectives were to develop a multimorbidity frailty index using Taiwan's claim database, and to understand its ability to predict adverse event. METHODS: This is a retrospective cohort study. Subjects aged 65 to 100 years who have full National Health Insurance coverage in 2005 were included...
2017: PloS One
https://www.readbyqxmd.com/read/29145359/racial-ethnic-health-disparities-among-rural-adults-united-states-2012-2015
#4
Cara V James, Ramal Moonesinghe, Shondelle M Wilson-Frederick, Jeffrey E Hall, Ana Penman-Aguilar, Karen Bouye
PROBLEM/CONDITION: Rural communities often have worse health outcomes, have less access to care, and are less diverse than urban communities. Much of the research on rural health disparities examines disparities between rural and urban communities, with fewer studies on disparities within rural communities. This report provides an overview of racial/ethnic health disparities for selected indicators in rural areas of the United States. REPORTING PERIOD: 2012-2015...
November 17, 2017: MMWR. Surveillance Summaries: Morbidity and Mortality Weekly Report. Surveillance Summaries
https://www.readbyqxmd.com/read/29145353/cdc-grand-rounds-improving-medication-adherence-for-chronic-disease-management-innovations-and-opportunities
#5
Andrea B Neiman, Todd Ruppar, Michael Ho, Larry Garber, Paul J Weidle, Yuling Hong, Mary G George, Phoebe G Thorpe
Adherence to prescribed medications is associated with improved clinical outcomes for chronic disease management and reduced mortality from chronic conditions (1). Conversely, nonadherence is associated with higher rates of hospital admissions, suboptimal health outcomes, increased morbidity and mortality, and increased health care costs (2). In the United States, 3.8 billion prescriptions are written annually (3). Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration (4)...
November 17, 2017: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/29145327/current-practice-and-usual-care-of-major-cervical-disorders-in-korea-a-cross-sectional-study-of-korean-health-insurance-review-and-assessment-service-national-patient-sample-data
#6
A Ryeon Choi, Joon-Shik Shin, Jinho Lee, Yoon Jae Lee, Me-Riong Kim, Min-Seok Oh, Eun-Jung Lee, Sungchul Kim, Mia Kim, In-Hyuk Ha
Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea.Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia)...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29144718/the-emerging-role-of-gammacore%C3%A2-in-the-management-of-cluster-headache-expert-panel-recommendations
#7
Stephen D Silberstein, Anne H Calhoun, Christina Treppendahl, David W Dodick, Alan M Rapoport, Avinash Mamidi, Peter Vargas, Thomas H Ebert, Stewart J Tepper
A panel of 9 experts, including neurologists, other headache specialists, and medical and pharmacy directors, from 4 health plans (1 integrated delivery network and 3 plans with commercial, Medicare, and Medicaid lines of business), convened to discuss cluster headache (CH). Topics covered included the current treatment landscape, treatment challenges, economic impact of disease, and gaps in care for patients with CH. One major challenge in the management of CH is that it is underrecognized and frequently misdiagnosed, leading to delays in and suboptimal treatment for patients who suffer from this painful and disabling condition...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29144599/assessing-social-values-for-california-s-efforts-to-reduce-the-overuse-of-unnecessary-medical-care
#8
Susan L Perez, Desiree Backman, Marge Ginsburg
BACKGROUND: A partnership of large health-care purchasers created a workgroup to reduce the overuse of harmful and wasteful medical care in California. OBJECTIVE: Employ a civic engagement process to identify the social values important to the public in considering different strategies to reduce overuse. INTERVENTION: Use of deliberation techniques for 3 case examples that explore possible strategies: physician oversight, physician compensation, increased patient cost-sharing or taking no definitive action...
November 16, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/29144586/relationship-between-hospital-level-percentage-of-midwife-attended-births-and-obstetric-procedure-utilization
#9
Laura Attanasio, Katy B Kozhimannil
INTRODUCTION: Research has shown good outcomes among individual low-risk women who receive perinatal care from midwives, yet little is known about how hospital-level variation in midwifery care relates to procedure use and maternal health. This study aimed to document the association between the hospital-level proportion of midwife-attended births and obstetric procedure utilization. METHODS: This analysis used 2 data sources: Healthcare Cost and Utilization Project State Inpatient Database data for New York in 2014, and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014...
November 16, 2017: Journal of Midwifery & Women's Health
https://www.readbyqxmd.com/read/29143960/predicting-frequent-emergency-department-use-among-children-with-epilepsy-a-retrospective-cohort-study-using-electronic-health-data-from-2-centers
#10
Zachary M Grinspan, Anup D Patel, Baria Hafeez, Erika L Abramson, Lisa M Kern
OBJECTIVE: Among children with epilepsy, to develop and evaluate a model to predict emergency department (ED) use, an indicator of poor disease control and/or poor access to care. METHODS: We used electronic health record data from 2013 to predict ED use in 2014 at 2 centers, benchmarking predictive performance against machine learning algorithms. We evaluated algorithms by calculating the expected yearly ED visits among the 5% highest risk individuals. We estimated the breakeven cost per patient per year for an intervention that reduced ED visits by 10%...
November 16, 2017: Epilepsia
https://www.readbyqxmd.com/read/29143681/economic-evaluation-of-hcv-testing-approaches-in-low-and-middle-income-countries
#11
REVIEW
Jake R Morgan, Maria Servidone, Philippa Easterbrook, Benjamin P Linas
BACKGROUND: Hepatitis C virus (HCV) infection represents a major public health burden with diverse epidemics worldwide, but at present, only a minority of infected persons have been tested and are aware of their diagnosis. The advent of highly effective direct acting antiviral (DAA) therapy, which is becoming available at increasingly lower costs in low and middle income countries (LMICs), represents a major opportunity to expand access to testing and treatment. However, there is uncertainty as to the optimal testing approaches and who to prioritize for testing...
November 1, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29143626/methodological-challenges-in-appraising-evidence-on-diagnostic-testing-for-who-guidelines-on-hepatitis-b-and-hepatitis-c-virus-infection
#12
Roger Chou, Philippa Easterbrook, Margaret Hellard
Linking persons with hepatitis B (HBV) and hepatitis C (HCV) infection with appropriate prevention and treatment requires that they first be diagnosed. The World Health Organization (WHO) has developed its first guidelines on testing for chronic HBV and HCV infection, using a framework based on methods from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group for the formulation of recommendations, including determining the strength of recommendations and quality of evidence...
November 1, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29143622/lives-saved-tool-list-costing-a-module-to-examine-costs-and-prioritize-interventions
#13
Lori A Bollinger, Rachel Sanders, William Winfrey, Adebiyi Adesina
BACKGROUND: Achieving the Sustainable Development Goals will require careful allocation of resources in order to achieve the highest impact. The Lives Saved Tool (LiST) has been used widely to calculate the impact of maternal, neonatal and child health (MNCH) interventions for program planning and multi-country estimation in several Lancet Series commissions. As use of the LiST model increases, many have expressed a desire to cost interventions within the model, in order to support budgeting and prioritization of interventions by countries...
November 7, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29143620/optimising-diagnosis-of-viraemic-hepatitis-c-infection-the-development-of-a-target-product-profile
#14
Elena Ivanova Reipold, Philippa Easterbrook, Alessandra Trianni, Nivedha Panneer, Douglas Krakower, Stefano Ongarello, Teri Roberts, Veronica Miller, Claudia Denkinger
BACKGROUND: The current low access to virological testing to confirm chronic viraemic HCV infection in low- and middle-income countries (LMIC) is limiting the rollout of hepatitis C (HCV) care. Existing tests are complex, costly and require sophisticated laboratory infrastructure. Diagnostic manufacturers need guidance on the optimal characteristics a virological test needs to have to ensure the greatest impact on HCV diagnosis and treatment in LMIC. Our objective was to develop a target product profile (TPP) for diagnosis of HCV viraemia using a global stakeholder consensus-based approach...
November 1, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29143611/one-or-two-serological-assay-testing-strategy-for-diagnosis-of-hbv-and-hcv-infection-the-use-of-predictive-modelling
#15
John V Parry, Philippa Easterbrook, Anita R Sands
BACKGROUND: Initial serological testing for chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is conducted using either rapid diagnostic tests (RDT) or laboratory-based enzyme immunoassays (EIA)s for detection of hepatitis B surface antigen (HBsAg) or antibodies to HCV (anti-HCV), typically on serum or plasma specimens and, for certain RDTs, capillary whole blood. WHO recommends the use of standardized testing strategies - defined as a sequence of one or more assays to maximize testing accuracy while simplifying the testing process and ideally minimizing cost...
November 1, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29143609/survey-of-programmatic-experiences-and-challenges-in-delivery-of-hepatitis-b-and-c-testing-in-low-and-middle-income-countries
#16
Azumi Ishizaki, Julie Bouscaillou, Niklas Luhmann, Stephanie Liu, Raissa Chua, Nick Walsh, Sarah Hess, Elena Ivanova, Teri Roberts, Philippa Easterbrook
BACKGROUND: There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up...
November 1, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29142796/impact-of-depression-on-hospitalization-and-related-outcomes-for-parkinson-s-disease-patients-a-nationwide-inpatient-sample-based-retrospective-study
#17
Rikinkumar S Patel, Ramkrishna Makani, Zeeshan Mansuri, Upenkumar Patel, Rupak Desai, Amit Chopra
Background Major Depressive Disorder (MDD) is a common comorbidity that significantly affects the quality of life and disease outcomes in Parkinson's disease (PD) patients. No studies have been conducted to our knowledge to address the health care utilization and its outcomes in these patients. The aim of this study is to analyze and discern the differences in the hospitalization outcomes, comorbid conditions, and utilization of procedures in PD patients versus patients with comorbid MDD. Methods We used the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project from year's 2010-2014...
September 3, 2017: Curēus
https://www.readbyqxmd.com/read/29142513/sedation-for-routine-gastrointestinal-endoscopic-procedures-a-review-on-efficacy-safety-efficiency-cost-and-satisfaction
#18
REVIEW
Otto S Lin
Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continue to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals (monitored anesthesia care) or whether properly trained non-anesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation...
October 2017: Intestinal Research
https://www.readbyqxmd.com/read/29142077/syndromic-panel-based-testing-in-clinical-microbiology
#19
REVIEW
Poornima Ramanan, Alexandra L Bryson, Matthew J Binnicker, Bobbi S Pritt, Robin Patel
The recent development of commercial panel-based molecular diagnostics for the rapid detection of pathogens in positive blood culture bottles, respiratory specimens, stool, and cerebrospinal fluid has resulted in a paradigm shift in clinical microbiology and clinical practice. This review focuses on U.S. Food and Drug Administration (FDA)-approved/cleared multiplex molecular panels with more than five targets designed to assist in the diagnosis of bloodstream, respiratory tract, gastrointestinal, or central nervous system infections...
January 2018: Clinical Microbiology Reviews
https://www.readbyqxmd.com/read/29141839/patient-health-record-systems-scope-and-functionalities-literature-review-and-future-directions
#20
REVIEW
Lina Bouayad, Anna Ialynytchev, Balaji Padmanabhan
BACKGROUND: A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels. OBJECTIVE: The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice...
November 15, 2017: Journal of Medical Internet Research
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