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"Managed care"

M Martínez-García, J Vargas-Barrón, F Bañuelos-Téllez, H González-Pacheco, C Fresno, E Hernández-Lemus, M A Martínez-Ríos, M Vallejo
OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. STUDY DESIGN: Retrospective data analysis. METHODS: STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence)...
March 13, 2018: Public Health
Cheryl Lynn Wolverton, Sue Lasiter, Joanne R Duffy, Michael T Weaver, Anna M McDaniel
Objectives: The overall purpose of this study was to evaluate the validity and reliability of the Caring Assessment Tool-Administration survey. Three specific aims were to (1) evaluate construct validity of the Caring Assessment Tool-Administration survey by testing the hypothesized eight-factor structure of staff nurses' perceptions of nurse manager caring behaviors, (2) estimate the internal consistency, and (3) conduct item reduction analysis. Methods: A 94-item Caring Assessment Tool-Administration designed to assess nurse manager caring behaviors appeared in the literature but lacked robust psychometric testing...
2018: SAGE Open Medicine
Tatiana Catanzarite, Daniel D Klaristenfeld, Marco J Tomassi, Gisselle Zazueta-Damian, Marianna Alperin
BACKGROUND: Pelvic organ prolapse is prevalent among women with rectal prolapse. OBJECTIVE: This study aimed to determine whether clinically significant pelvic organ prolapse impacts rectal prolapse recurrence after surgical repair. DESIGN: A retrospective cohort. SETTING: This study was performed at a single managed-care institution. PATIENTS: Consecutive women undergoing rectal prolapse repair between 2008 and 2016 were included...
March 8, 2018: Diseases of the Colon and Rectum
Elias Atallah, Kimon Bekelis, Hassan Saad, Nohra Chalouhi, Sophia Dang, Jonathan Li, Ayan Kumar, Justin Turpin, Randa Barsoom, Stavropoula Tjoumakaris, David Hasan, Maureen Deprince, Giuliana Labella, Robert H Rosenwasser, Pascal Jabbour
OBJECTIVES: Neurologists have continually led the assessment and management of Acute Ischemic Stroke(AIS) by use of IV-rtPA, anti-platelet therapy, antihypertensives, and other pharmacologic agents. Since the advent of mechanical thrombectomy(MT) and its proven efficacy, neurovascular surgeons(NS) are playing an increasingly important role in the management and overall care of AIS. We assessed outcomes of AIS patients managed by NS, who have been traditionally managed by neurologists...
February 23, 2018: Clinical Neurology and Neurosurgery
Mary Patricia Nowalk
Influenza is an acute viral respiratory disease caused by the influenza A and B viruses. The epidemiologic characteristics of influenza are in constant flux as the viruses mutate frequently, and the subsequent spread of illness depends on the affected population's susceptibility to the new antigens. These viral mutations necessitate frequent updates to the annual seasonal influenza vaccine. Those most at risk for serious complications of influenza are young children and elderly persons. Although influenza vaccination rates are highest among adults 65 years or older, vaccine effectiveness in this age group is often less than among younger persons...
March 2018: American Journal of Managed Care
Miranda Wilhelm
Influenza affects millions of people in the United States each year. Older patients are particularly at risk for infection, hospitalization, and death due to influenza-related complications, such as pneumonia. One of the best ways to avoid becoming ill is to have the annual influenza vaccination. Unfortunately, immunization rates are poor in the older adult population, at about 65% each year. Vaccine effectiveness in this population is reduced because of lower seroconversion rates that arise from poorer immunologic response to vaccination...
March 2018: American Journal of Managed Care
Marsha Burks, Simone Stickel, Nazzareno Galiè
Combination therapy is now regarded as the standard of care in pulmonary arterial hypertension (PAH) and is becoming widely used in clinical practice. Given the inherent complexities of combining medications, there is a need for practical advice on implementing this treatment strategy in the clinic. Drawing on our experience and expertise, within this review, we discuss some of the challenges associated with administration of combination therapy in PAH and how these can be addressed in the clinic. Despite their differing modes of action, all of the currently available classes of PAH therapy induce systemic vasodilation...
March 6, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
Eric M Plakun
This column compares a clinical perspective on the continuum of care for mental health and substance use disorders with a different perspective derived from publicly available insurance company documents and experience dealing with managed care utilization reviewers. The latter perspective tends to determine the need for access to levels of care based on the need for crisis stabilization, whereas the generally accepted clinical standard is more nuanced than the need for crisis stabilization alone. The column proposes that this discrepancy in perspectives makes a substantial contribution to disagreements between treating clinicians, such as therapists, and insurance utilization reviewers concerning the medical necessity of various requested levels of care...
March 2018: Journal of Psychiatric Practice
Galen H Smith, Cicily Hampton, William P Brandon
BACKGROUND: No studies were found that consider the role of race and gender concordance in patient-physician extender relationships. METHODS: A telephone survey in summer 2012 allowed measures of the relationship between physicians and physician extenders with race and gender concordance. Randomized stratified sampled adults (n = 1,401) enrolled in North Carolina Medicaid's managed care networks met the study's criteria. FINDINGS: The analysis determined the association of provider type and race and gender concordance...
2018: Journal of Health Care for the Poor and Underserved
Carolyn Allshouse, Meg Comeau, Rylin Rodgers, Nora Wells
This article, written by a group of experienced parents of children with medical complexity (CMC), provides an overview of the demands of managing care from their unique perspective. The article articulates why attention to understanding the challenges that families of CMC face with a fragmented health care system, inadequate health insurance coverage, deficits in the delivery of medical care, and problems accessing other critical services (as well as lack of support for children and adolescents in developing and exercising self-management skills) are vital to efforts to improve the current system and positively impact the life course of vulnerable populations...
March 2018: Pediatrics
Clinton Protack, Brian Wengerter, Raymond A Jean, Shirley Liu, Hamid Mojibian, Bauer Sumpio, Alan Dardik, Adrian A Maung, Young Erben
Objective  In an era of managed care and cost savings, we are faced with the question of whether another test is necessary to confirm our clinical suspicion. We hypothesized that a few computed tomography angiographies (CTAs) are necessary to identify lower extremity vascular injuries (LEVIs). We reviewed our trauma center's experience in the management of LEVI. Methods  A retrospective review of all trauma patients between 2012 and 2016 was performed. Four-thousand nine-hundred fourteen trauma patients were evaluated with 46 suspected LEVIs (either with cross-sectional imaging and/or operative exploration)...
March 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Philip S Wells, Anthonie W A Lensing, Lloyd Haskell, Bennett Levitan, François Laliberté, Michael Durkin, Veronica Ashton, Yongling Xiao, Concetta Crivera, Dominique Lejeune, Jeff Schein, Patrick Lefebvre
AIMS: The EINSTEIN-Extension trial (EINSTEIN-EXT) found that continued treatment with rivaroxaban for an additional 6 or 12 months (versus placebo) after 6-12 months of initial anticoagulation significantly reduced the risk of recurrent venous thromboembolism (VTE) with a small non-significant increased risk of major bleeding (none fatal or in critical site). This study aimed to compare total healthcare cost between rivaroxaban and placebo based on the EINSTEIN-EXT event rates. METHODS: Total healthcare cost was calculated as sum of treatment and clinical event costs from a US managed care perspective...
February 22, 2018: Journal of Medical Economics
Clara Berridge
BACKGROUND: Recent years have seen an influx of location-tracking, activity-monitoring sensors, and Web-cameras to remotely monitor the safety of older adults in their homes and to reduce reliance on in-person assistance. The state of research on these monitoring technologies leaves open crucial financial, social, and ethical cost-benefit questions, which have prevented widespread use. Medicaid is now the first large third-party payer in the United States to pay for these technologies, and their use is likely to increase as states transition to managed long-term services and supports (MLTSS)...
February 21, 2018: Journal of Medical Internet Research
Ernest Law, Rachel Harrington, G Caleb Alexander, Soumi Saha, Elisabeth Oehrlein, Eleanor M Perfetto
The goal of comparative effectiveness research (CER) and patient-centered outcomes research (PCOR) is to improve health outcomes by providing stakeholders with evidence directly relevant to decision making. In January 2017, the Pharmaceutical Research and Manufacturers Association Foundation, alongside the Academy for Managed Care Pharmacy, organized a conference aimed at engaging experts and opinion leaders representing clinicians, patients and payers to identify and discuss barriers and strategies to enhancing uptake and use of CER/PCOR...
February 21, 2018: Journal of Comparative Effectiveness Research
Ivan Cherrez Ojeda, Emanuel Vanegas, Michell Torres, Juan Carlos Calderón, Erick Calero, Annia Cherrez, Miguel Felix, Valeria Mata, Sofia Cherrez, Daniel Simancas
BACKGROUND: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. OBJECTIVE: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients...
February 20, 2018: Journal of Medical Internet Research
W-H Hsu, J C-H Yang, T S Mok, H H Loong
Front-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) therapy is the standard of care for lung cancer patients with sensitising EGFR mutations (exon 19 deletion or L858R mutation). Several phase III studies have demonstrated the superiority of gefitinib, erlotinib (first generation of TKIs) or afatinib (second generation) to chemotherapy in progression-free survival and response rates. Drug-related toxicities, such as diarrhoea, acneiform skin rash, mucositis, and paronychia, are frequently encountered in patients who receive EGFR TKIs...
January 1, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
Rachel Mosher Henke, Zeynal Karaca, Teresa B Gibson, Eli Cutler, Chapin White, Herbert S Wong
BACKGROUND: Research has suggested that growth in the Medicare Advantage (MA) program indirectly benefits the entire 65+-year-old population by reducing overall expenditures and creating spillover effects of patient care practices. Medicare programs and innovations initiated by the Affordable Care Act (ACA) have encouraged practices to adopt models applying to all patient populations, which may influence the continued benefits of MA program growth. OBJECTIVE: This study investigated the relationship between MA program growth and inpatient hospital costs and utilization before and after the ACA...
February 16, 2018: Medical Care
Richard H Stanford, Arpita Nag, Douglas W Mapel, Todd A Lee, Richard Rosiello, Michael Schatz, Francis Vekeman, Marjolaine Gauthier-Loiselle, J F Philip Merrigan, Mei Sheng Duh
OBJECTIVES: To develop and validate a predictive model for first severe chronic obstructive pulmonary disease (COPD) exacerbation using health insurance claims data and to validate the risk measure of controller medication to total COPD treatment (controller and rescue) ratio (CTR). STUDY DESIGN: A predictive model was developed and validated in 2 managed care databases: Truven Health MarketScan database and Reliant Medical Group database. This secondary analysis assessed risk factors, including CTR, during the baseline period (Year 1) to predict risk of severe exacerbation in the at-risk period (Year 2)...
February 1, 2018: American Journal of Managed Care
(no author information available yet)
This document announces the extension of statewide temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey, as applicable, to prevent and combat fraud, waste, and abuse. This extension also applies to the enrollment of new non-emergency ground ambulance suppliers and home health agencies, subunits, and branch locations in Medicaid and the Children's Health Insurance Program in those states...
January 30, 2018: Federal Register
(no author information available yet)
Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions...
February 20, 2018: Journal of Managed Care & Specialty Pharmacy
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