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https://www.readbyqxmd.com/read/29153847/effect-of-incentive-payments-on-chronic-disease-management-and-health-services-use-in-british-columbia-canada-interrupted-time-series-analysis
#1
M Ruth Lavergne, Michael R Law, Sandra Peterson, Scott Garrison, Jeremiah Hurley, Lucy Cheng, Kimberlyn McGrail
We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods...
November 10, 2017: Health Policy
https://www.readbyqxmd.com/read/29153353/-something-humane-has-been-lost-re-evaluation-of-the-attitudes-of-senior-physicians-towards-the-g-drg-system-a-qualitative-normative-analysis
#2
Marco Knoll, Ina Otte, Sabine Salloch, Caroline Ruiner, Esta Kruppa, Jochen Vollmann
Only a few years after the implementation of the G-DRG (German Diagnosis Related Group) system physicians already began to complain of its negative effects on the quality of inpatient healthcare. The present study examines the recent experiences senior physicians have made with regard to the impact of the G-DRG system on the quality of healthcare and medical professionalism. Nine qualitative guided expert interviews were conducted focusing on the experiences of physicians in leading positions dealing with the G-DRG system in their everyday work...
November 15, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/29148344/moderating-effects-of-patient-characteristics-on-the-impact-of-financial-incentives
#3
Meredith B Rosenthal, Andrea B Troxel, Kevin G Volpp, Walter F Stewart, Thomas D Sequist, James B Jones, AnneMarie G Hirsch, Karen Hoffer, Jingsan Zhu, Wenli Wang, Amanda Hodlofski, Darra Finnerty, Jack J Huang, David A Asch
While financial incentives to providers or patients are increasingly common as a quality improvement strategy, their impact on patient subgroups and health care disparities is unclear. To examine these patterns, we analyzed data from a randomized clinical trial of financial incentives to lower low-density lipoprotein (LDL) cholesterol levels in patients at risk for cardiovascular disease. Patients with higher baseline LDL experienced greater cholesterol reductions in the shared incentive arm (0.23 mg/dL per unit change in baseline LDL, 95% CI [-0...
May 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148329/the-implementation-of-performance-management-systems-in-u-s-physician-organizations
#4
Alexander F Pimperl, Hector P Rodriguez, Julie A Schmittdiel, Stephen M Shortell
Performance management systems (PMSYS) aid in improving the quality and efficiency of care, but little is known about factors that influence more robust PMSYS among physician organizations. Using a nationally representative survey of U.S. medical practices, we examined the extent to which organizational capabilities and external factors were associated with more developed PMSYS. Linear regression estimated the relative impact of these factors on PMSYS. On average, practices implemented a minority (32 points out of 100) of the PMSYS processes assessed...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29138742/hysterectomy-pathway-as-the-global-engine-of-practice-change-implications-for-value-in-care
#5
Amin Sanei-Moghaddam, Sharon Goughnour, Robert Edwards, John Comerci, Joseph Kelley, Nicole Donnellan, Faina Linkov, Suketu Mansuria
Introduction: In 2012, University of Pittsburgh Medical Center (UPMC) introduced a hysterectomy clinical pathway to reduce the number of total abdominal hysterectomies performed for benign gynecological indications. This study focused on exploring physician and patient factors impacting the utilization of hysterectomy clinical pathways. Methods: An online survey with 24 questions was implemented to explore physicians' attitudes and perceived barriers toward implementing the pathway...
2017: Central Asian Journal of Global Health
https://www.readbyqxmd.com/read/29137515/choosing-wisely-campaign-valuable-for-providers-who-knew-about-it-but-awareness-remained-constant-2014-17
#6
Carrie H Colla, Alexander J Mainor
Together with physician specialty societies, the Choosing Wisely® campaign has codified recommendations of which health care services' use should be questioned and discussed with patients. The ABIM Foundation administered surveys in 2014 and 2017 to examine physicians' attitudes toward and awareness of the use of low-value care. The surveys included questions on the factors driving that use, physicians' comfort in having conversations with patients about that use, and physicians' exposure to the Choosing Wisely campaign...
November 2017: Health Affairs
https://www.readbyqxmd.com/read/29135661/reconsidering-the-affordable-care-act-s-restrictions-on-physician-owned-hospitals-analysis-of-cms-data-on-total-hip-and-knee-arthroplasty
#7
P Maxwell Courtney, Brian Darrith, Daniel D Bohl, Nicholas B Frisch, Craig J Della Valle
BACKGROUND: Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA)...
November 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29133491/exploring-attributes-of-high-value-primary-care
#8
Melora Simon, Niteesh K Choudhry, Jim Frankfort, David Margolius, Julia Murphy, Luis Paita, Thomas Wang, Arnold Milstein
PURPOSE: Medicare's merit-based incentive payment system and narrowing of physician networks by health insurers will stoke clinicians' and policy makers' interest in care delivery attributes associated with value as defined by payers. METHODS: To help define these attributes, we analyzed 2009 to 2011 commercial health insurance claims data for more than 40 million preferred provider organization patients attributed to over 53,000 primary care practice sites. We identified sites ranking favorably on both quality and low total annual per capita health care spending ("high-value") and sites ranking near the median ("average-value")...
November 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/29126109/do-prospective-payment-systems-ppss-lead-to-desirable-providers-incentives-and-patients-outcomes-a-systematic-review-of-evidence-from-developing-countries
#9
Si Ying Tan, G J Melendez-Torres
The reform of provider payment systems, from retrospective to prospective payment, has been heralded as the right move to contain costs in the light of rising health expenditures in many countries. However, there are concerns on quality trade-off. The heightened attention given to prospective payment system (PPS) reforms and the rise of empirical evidence regarding PPS interventions among developing countries suggest that a systematic review is necessary to understand the effects of PPS reforms in developing countries...
November 6, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/29116661/complying-with-the-emergency-medical-treatment-and-labor-act-emtala-challenges-and-solutions
#10
Charleen Hsuan, Jill R Horwitz, Ninez A Ponce, Renee Y Hsia, Jack Needleman
The Emergency Medical Treatment and Labor Act (EMTALA), which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. We conducted 11 semistructured key informant interviews with hospitals, hospital associations, and patient safety organizations in the Centers for Medicare and Medicaid Services region with the highest number of EMTALA complaints filed...
November 8, 2017: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
https://www.readbyqxmd.com/read/29098382/-indicators-of-an-increase-in-dementia-diagnosis-rate-in-primary-care
#11
Bernhard Michalowsky, Karel Kostev, Wolfgang Hoffmann, Jens Bohlken
BACKGROUND: In 2013 and 2014 dementia diagnoses in general practitioner (GP) practices dramatically increased, a phenomenon most likely caused by monetary incentives. OBJECTIVE: Which GP practice-dependent indicators are associated with the increase in dementia diagnoses and are thus decisive factors for the way in which physicians in GP practices respond to monetary incentives? MATERIAL AND METHODS: We performed a retrospective, longitudinal analysis of 856 GP practices...
November 2, 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/29088995/a-multicenter-survey-of-house-staff-knowledge-about-sepsis-and-the-surviving-sepsis-campaign-guidelines-for-management-of-severe-sepsis-and-septic-shock
#12
Richard R Watkins, Nairmeen Haller, Melinda Wayde, Keith B Armitage
BACKGROUND: We aimed to assess the knowledge, attitudes, and perceptions of resident physicians regarding sepsis in general and the Surviving Sepsis Campaign Guidelines in particular. METHODS: After institutional review board approval, we surveyed internal medicine (IM) and emergency medicine (EM) house staff from 3 separate institutions. House staff were notified of the survey via e-mail from their residency director or chief resident. The survey was Internet-based (using http://www...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29080890/noninvasive-sampling-of-the-intrauterine-environment-in-women-with-preterm-labor-and-intact-membranes
#13
Teresa Cobo, Marian Kacerovsky, Bo Jacobsson
Spontaneous preterm birth has enormous consequences for newborns, children, and families. Intra-amniotic inflammation (IAI) is the leading cause of spontaneous preterm delivery, mainly at earlier gestational ages. Amniocentesis is the only method used to identify IAI in clinical practice. Although it is an invasive procedure with a very low risk of complications, many women and physicians are hesitant about amniocentesis on this indication. This has been an incentive to explore IAI and the intra-amniotic environment through noninvasive techniques, such as sampling cervical mucus, vaginal fluid, or maternal blood...
October 28, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/29075552/patient-copayments-provider-incentives-and-income-effects-theory-and-evidence-from-the-essential-medications-list-under-china-s-2009-healthcare-reform
#14
Brian K Chen, Y Tony Yang, Karen Eggleston
Expanding access through insurance expansion can increase healthcare utilization through moral hazard. Reforming provider incentives to introduce more supply-side cost sharing is increasingly viewed as crucial for affordable, sustainable access. Using both difference-in-differences and segmented regression analyses on a panel of 1,466 hypertensive and diabetic patients, we empirically examine Shandong province's initial implementation of China's 2009 Essential Medications List policy. The policy reduced drug sale markups to providers but also increased drug coverage benefits for patients...
March 2017: World Medical & Health Policy
https://www.readbyqxmd.com/read/29073234/the-effects-of-patient-cost-sharing-on-inpatient-utilization-cost-and-outcome
#15
Yuan Xu, Ning Li, Mingshan Lu, Elijah Dixon, Robert P Myers, Rachel J Jelley, Hude Quan
BACKGROUND: Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. METHODS: Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases...
2017: PloS One
https://www.readbyqxmd.com/read/29063149/primary-care-physicians-report-high-trust-in-and-usefulness-of-the-stockholm-drug-and-therapeutic-committee-s-list-of-recommended-essential-medicines-the-wise-list
#16
Jaran Eriksen, Marie-Louise Ovesjö, Martina Vallin, Maria Juhasz-Haverinen, Eva Andersén-Karlsson, Kristina Ateva, Lars L Gustafsson, Malena Jirlow, Pia Bastholm-Rahmner
PURPOSE: Inappropriate use of medicines causes increased morbidity, mortality, adverse drug reactions, therapeutic failures and drug resistance as well as wastes valuable resources. Evidence-based cost-effective treatment recommendations of essential medicines are a way of avoiding these. We assessed primary care prescribers' knowledge about and perceptions of an essential medicines formulary, as well as the reasons for adhering to the recommendations. METHODS: We conducted a web based questionnaire survey targeting all physicians working in the primary healthcare of the Stockholm healthcare region (2...
October 23, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29056181/a-scalable-program-for-customized-patient-education-videos
#17
Ishani Ganguli, Chrisanne Sikora, Briana Nestor, Rachel Clark Sisodia, Adam Licurse, Timothy G Ferris, Sandhya Rao
PROBLEM DEFINITION: Patients must make sense of increasingly complex information to navigate their health and the health care system, with limited opportunity to do so in clinical settings. Patient education videos may help to communicate key information, but they are often impersonal and cumbersome to produce or update with new evidence. To address these limitations, a program was developed to facilitate local video creation to deliver targeted information to patients. APPROACH: The Patient Education Video Program was created at a large urban academic medical center...
November 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29045429/preclinical-antivenom-efficacy-testing-reveals-potentially-disturbing-deficiencies-of-snakebite-treatment-capability-in-east-africa
#18
Robert A Harrison, George O Oluoch, Stuart Ainsworth, Jaffer Alsolaiss, Fiona Bolton, Ana-Silvia Arias, José-María Gutiérrez, Paul Rowley, Stephen Kalya, Hastings Ozwara, Nicholas R Casewell
BACKGROUND: Antivenom is the treatment of choice for snakebite, which annually kills an estimated 32,000 people in sub-Saharan Africa and leaves approximately 100,000 survivors with permanent physical disabilities that exert a considerable socioeconomic burden. Over the past two decades, the high costs of the most polyspecifically-effective antivenoms have sequentially reduced demand, commercial manufacturing incentives and production volumes that have combined to create a continent-wide vacuum of effective snakebite therapy...
October 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/29029048/general-practitioners-perception-of-being-a-doctor-in-urban-vs-rural-regions-in-germany-a-focus-group-study
#19
Nadine J Pohontsch, Heike Hansen, Ingmar Schäfer, Martin Scherer
Background: Inadequate recruitment numbers for GPs in rural regions give cause for concern. Working in rural regions is less attractive among medical students because of strong associations concerning a higher workload, restriction of privacy and demands exceeding their competences. We aimed to explore perceptions of GPs working in urban versus rural regions to contrast these prejudices. Methods: We conducted nine focus groups with GPs [female = 21, male = 44] from urban and rural regions, using a semi-structured guideline...
September 23, 2017: Family Practice
https://www.readbyqxmd.com/read/28983431/evaluation-of-policy-options-for-increasing-the-availability-of-primary-care-services-in-rural-washington-state
#20
Mark W Friedberg, Grant R Martsolf, Chapin White, David I Auerbach, Ryan Kandrack, Rachel O Reid, Emily Butcher, Hao Yu, Simon Hollands, Xiaoyu Nie
The Washington State legislature has recently considered several policy options to address a perceived shortage of primary care physicians in rural Washington. These policy options include opening the new Elson S. Floyd College of Medicine at Washington State University in 2017; increasing the number of primary care residency positions in the state; expanding educational loan-repayment incentives to encourage primary care physicians to practice in rural Washington; increasing Medicaid payment rates for primary care physicians in rural Washington; and encouraging the adoption of alternative models of primary care, such as medical homes and nurse-managed health centers, that reallocate work from physicians to nurse practitioners (NPs) and physician assistants (PAs)...
January 2017: Rand Health Quarterly
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