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https://www.readbyqxmd.com/read/28817859/collaboration-in-primary-care-through-the-integration-of-behavioral-health-professionals
#1
Jeremy J Vogt, H Bruce Vogt
Rising costs, poorer outcomes, and dissatisfied patients have challenged medical systems to rethink their approach to health care delivery. Although up to 70 percent of primary care visits stem from psychosocial issues, behavioral health services have traditionally occurred in separate buildings and systems. In order to decrease barriers and meet patients' and providers' needs, primary care practices have begun integrating behavioral health professionals into their clinics. Various levels of integration exist, but the best models fully integrate behavioral health clinicians into primary care teams, allowing for seamless collaboration...
2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28817857/patient-centered-home-model-of-care-and-the-role-of-patient-care-teams-in-the-treatment-and-management-of-chronic-disease
#2
Maryam Rahim Sheikh, Muhammad Shahjahan Khan, Jean M Lageson
Patient-centered medical home (PCMH) is a concept of a team of providers caring for a panel of patients with the goals to improve the quality of care while simultaneously decreasing the cost of that care. The clinical evidence that the PCMH approach achieves either goal is mixed. More studies are in progress that will provide more data.
2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28817791/using-practice-facilitation-to-increase-rates-of-colorectal-cancer-screening-in-community-health-centers-north-carolina-2012-2013-feasibility-facilitators-and-barriers
#3
Bryan J Weiner, Catherine L Rohweder, Jennifer E Scott, Randall Teal, Alecia Slade, Allison M Deal, Naima Jihad, Marti Wolf
INTRODUCTION: Practice facilitation involves trained individuals working with practice staff to conduct quality improvement activities and support delivery of evidence-based clinical services. We examined the feasibility of using practice facilitation to assist federally qualified health centers (FQHCs) to increase colorectal cancer screening rates in North Carolina. METHODS: The intervention consisted of 12 months of facilitation in 3 FQHCs. We conducted chart audits to obtain data on changes in documented recommendation for colorectal cancer screening and completed screening...
August 17, 2017: Preventing Chronic Disease
https://www.readbyqxmd.com/read/28817779/the-price-may-not-be-right-the-value-of-comparison-shopping-for-prescription-drugs
#4
Sanjay Arora, Neeraj Sood, Sophie Terp, Geoffrey Joyce
OBJECTIVES: To measure variations in drug prices across and within zip codes that may reveal simple strategies to improve patients' access to prescribed medications. STUDY DESIGN: We compared drug prices at different types of pharmacies across and within local markets. In-store prices were compared with a Web-based service providing discount coupons for prescription medications. Prices were collected for 2 generic antibiotics because most patients have limited experience with them and are less likely to know the price ranges for them...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817372/financial-burden-in-survivors-of-childhood-cancer-a-report-from-the-childhood-cancer-survivor-study
#5
Ryan D Nipp, Anne C Kirchhoff, Douglas Fair, Julia Rabin, Kelly A Hyland, Karen Kuhlthau, Giselle K Perez, Leslie L Robison, Gregory T Armstrong, Paul C Nathan, Kevin C Oeffinger, Wendy M Leisenring, Elyse R Park
Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs (≥ 10% of annual income) and issues related to financial burden (jeopardizing care or changing lifestyle) among survivors of childhood cancer and a sibling comparison group. Methods Between May 2011 and April 2012, we surveyed an age-stratified, random sample of survivors of childhood cancer and a sibling comparison group who were enrolled in the Childhood Cancer Survivor Study...
August 17, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28817302/comparative-effectiveness-and-costs-of-insulin-pump-therapy-for-diabetes
#6
Ronald T Ackermann, Amisha Wallia, Raymond Kang, Andrew Cooper, Theodore A Prospect, Lewis G Sandy, Deneen Vojta
OBJECTIVES: Continuous subcutaneous insulin infusion (CSII), or "insulin pump" therapy, is an alternative to multiple daily insulin injections (MDII) for management of diabetes. This study evaluates patterns of healthcare utilization, costs, and blood glucose control for patients with diabetes who initiate CSII. STUDY DESIGN: Pre-post with propensity-matched comparison design involving commercially insured US adults (aged 18-64 years) with insulin-requiring diabetes who transitioned from MDII to CSII between July 1, 2009, and June 30, 2012 ("CSII initiators"; n = 2539), or who continued using MDI (n = 2539)...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817299/how-do-medicare-advantage-beneficiary-payments-vary-with-tenure
#7
Paul D Jacobs, Eamon Molloy
OBJECTIVES: To compare how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. STUDY DESIGN: Descriptive and fixed effects regression analyses. METHODS: Using linked administrative enrollment and plan data, we compared the costs of the MA plans that beneficiaries chose with the costs of other plans available to them. We show predicted values adjusted for age, gender, race/ethnicity, disability, individual health risk, presence of mental health diagnoses, health plan quality, relative size of the plan's provider network, and the number of years continuously enrolled in the same plan...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817296/patients-views-on-price-shopping-and-price-transparency
#8
Hannah L Semigran, Rebecca Gourevitch, Anna D Sinaiko, David Cowling, Ateev Mehrotra
OBJECTIVES: Driven by the growth of high deductibles and price transparency initiatives, patients are being encouraged to search for prices before seeking care, yet few do so. To understand why this is the case, we interviewed individuals who were offered access to a widely used price transparency website through their employer. STUDY DESIGN: Qualitative interviews. METHODS: We interviewed individuals enrolled in a preferred provider organization product through their health plan about their experience using the price transparency tool (if they had done so), their past medical experiences, and their opinions on shopping for care...
June 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817294/heterogeneity-of-nonadherent-buprenorphine-patients-subgroup-characteristics-and-outcomes
#9
Charles Ruetsch, Joseph Tkacz, Vijay R Nadipelli, Brenna L Brady, Naoko Ronquest, Hyong Un, Joseph Volpicelli
OBJECTIVES: To examine patient characteristics and outcomes associated with nonadherence to buprenorphine and to identify specific patterns of nonadherent behavior. STUDY DESIGN: Cross-sectional, retrospective analysis of health claims data. METHODS: Aetna's administrative claims data were used to categorize incident opioid use disorder (OUD) patients based on buprenorphine medication possession ratio (MPR) into adherent (n = 172) and nonadherent (n = 305) groups...
June 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28816896/factors-associated-with-adverse-events-in-inpatient-elective-spine-knee-and-hip-orthopaedic-surgery
#10
Dov B Millstone, Anthony V Perruccio, Elizabeth M Badley, Y Raja Rampersaud
BACKGROUND: Orthopaedic procedures for degenerative musculoskeletal conditions (predominantly osteoarthritis and spinal stenosis) represent an increasing burden on the health-care system. These procedures are also associated with adverse event rates and related cost. The objective of this study was to identify risk factors for adverse events associated with orthopaedic surgeries as captured within a common clinical point-of-care system for documenting adverse events (Orthopaedic Surgical AdVerse Events Severity [OrthoSAVES] system)...
August 16, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28816869/spine-trauma-what-are-the-current-controversies
#11
Cumhur Oner, Shanmuganathan Rajasekaran, Jens R Chapman, Michael G Fehlings, Alexander R Vaccaro, Gregory D Schroeder, Said Sadiqi, James Harrop
Although less common than other musculoskeletal injuries, spinal trauma may lead to significantly more disability and costs. During the last 2 decades there was substantial improvement in our understanding of the basic patterns of spinal fractures leading to more reliable classification and injury severity assessment systems but also rapid developments in surgical techniques. Despite these advancements, there remain unresolved issues concerning the management of these injuries. At this moment there is persistent controversy within the spinal trauma community, which can be grouped under 6 headings...
September 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28816736/distance-traveled-for-an-abortion-and-source-of-care-after-abortion
#12
Ushma D Upadhyay, Nicole E Johns, Karen R Meckstroth, Jennifer L Kerns
OBJECTIVE: To examine the association between distance traveled for an abortion and site of postabortion care among low-income women. METHODS: We conducted a retrospective cohort study using claims data from 39,747 abortions covered by California's Medicaid program in 2011-2012. Primary outcomes were the odds of abortion-related visits to an emergency department (ED) and the original abortion site, and the secondary outcome was total abortion care costs. We used mixed-effects logistic regression adjusting for patient and abortion characteristics to examine the associations between distance traveled and subsequent abortion-related care at each location...
August 14, 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28816547/drug-utilization-among-hypertensive-patients-in-the-outpatient-department-of-medicine-in-a-tertiary-care-hospital-a-cross-sectional-study
#13
Sarika G Paradkar, Shyamal R Sinha
BACKGROUND: Hypertension is one of the leading risk factors for cardiovascular, cerebrovascular, and renal disease. Its increasing prevalence and treatment costs influence the prescribing pattern among physicians. Drug utilization studies provide insights into the current prescribing practices and help us facilitate the rational use of drugs. We carried out the present study to assess the pattern of drug utilization in hypertensive patients. METHOD: Adults seeking treatment for hypertension were recruited...
August 17, 2017: Clinical and Experimental Hypertension: CHE
https://www.readbyqxmd.com/read/28816502/cost-of-malingering-mild-traumatic-brain-injury-related-cognitive-deficits-during-compensation-and-pension-evaluations-in-the-veterans-benefits-administration
#14
John H Denning, Robert D Shura
Given the high rates of exaggeration in those claiming long-term cognitive deficits as a result of mild traumatic brain injury (mTBI), the aim of this study was to evaluate the rates of malingering in those seeking disability through the Veterans Benefits Administration and estimate the financial burden of disability payments for those receiving compensation despite exaggerated mTBI-related cognitive deficits. Retrospective review included 74 veterans seen for Compensation and Pension evaluations for mTBI. Rates of malingering were based on failure of the Medical Symptom Validity Test (MSVT) and/or the Test of Memory Malingering (TOMM) trial 1 ≤ 40...
August 17, 2017: Applied Neuropsychology. Adult
https://www.readbyqxmd.com/read/28815837/cost-of-asthma-in-children-a-nationwide-population-based-cost-of-illness-study
#15
Manuel José Ferreira de Magalhães, Rita da Silva Amaral, Ana Margarida Pereira, Ana Isabel Alves de Sá E Sousa Santos, Maria Inês Águeda de Azevedo, Luís Filipe Ribeiro de Azevedo, João Almeida Lopes Fonseca
BACKGROUND: Childhood asthma is very prevalent and costs can be high, especially in severe disease. This study aimed to estimate the cost of asthma in Portuguese children and the variations by level of asthma control. METHODS: A nationwide, population- and prevalence-based cost-of-illness study with a societal perspective was conducted. We measured direct and indirect costs using a bottom-up approach and a human capital method, respectively, for 208 children (<18 years), from two national repositories...
August 17, 2017: Pediatric Allergy and Immunology
https://www.readbyqxmd.com/read/28815611/the-value-of-frontal-sinusotomy-for-chronic-rhinosinusitis-with-nasal-polyps-a-cost-utility-analysis
#16
George A Scangas, Ashton E Lehmann, Aaron K Remenschneider, Brooke M Su, Mark G Shrime, Ralph Metson
OBJECTIVES/HYPOTHESIS: The number of surgical procedures performed for frontal sinusitis and the associated costs have increased dramatically over the past decade. The purpose of this study was to evaluate the cost-effectiveness of endoscopic frontal sinusotomy (EFS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). STUDY DESIGN: Cohort-style Markov decision-tree economic model with a 36-year time horizon. METHODS: Matched cohorts of CRSwNP patients who underwent endoscopic sinus surgery (ESS) with (n = 139) and without (n = 49) EFS were compared to each other and to patients (n = 139) from the Medical Expenditures Survey Panel database who underwent medical management for chronic rhinosinusitis...
August 16, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28815151/eye-tracking-for-clinical-decision-support-a-method-to-capture-automatically-what-physicians-are-viewing-in-the-emr
#17
Andrew J King, Harry Hochheiser, Shyam Visweswaran, Gilles Clermont, Gregory F Cooper
Eye-tracking is a valuable research tool that is used in laboratory and limited field environments. We take steps toward developing methods that enable widespread adoption of eye-tracking and its real-time application in clinical decision support. Eye-tracking will enhance awareness and enable intelligent views, more precise alerts, and other forms of decision support in the Electronic Medical Record (EMR). We evaluated a low-cost eye-tracking device and found the device's accuracy to be non-inferior to a more expensive device...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28815132/precision-diagnosis-of-melanoma-and-other-skin-lesions-from-digital-images
#18
Abhishek Bhattacharya, Albert Young, Andrew Wong, Simone Stalling, Maria Wei, Dexter Hadley
Melanoma will affect an estimated 73,000 new cases this year and result in 9,000 deaths, yet precise diagnosis remains a serious problem. Without early detection and preventative care, melanoma can quickly spread to become fatal (Stage IV 5-year survival rate is 20-10%) from a once localized skin lesion (Stage IA 5- year survival rate is 97%). There is no biomarker for melanoma in clinical use, and the current diagnostic criteria for skin lesions remains subjective and imprecise. Accurate diagnosis of melanoma relies on a histopathologic gold standard; thus, aggressive excision of melanocytic skin lesions has been the mainstay of treatment...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28814934/direct-medical-costs-of-dengue-fever-in-vietnam-a-retrospective-study-in-a-tertiary-hospital
#19
Nhung Thi Tuyet Vo, Trang Ngo Diem Phan, Trung Quang Vo
BACKGROUND: In Vietnam, dengue fever is a major health concern, yet comprehensive information on its economic costs is lacking. The present study investigated treatment costs associated with dengue fever from the perspective of health care provision. METHODS: This retrospective study was conducted between January 2013 and December 2015 in Cu Chi General Hospital. The following dengue-related treatment costs were calculated: hospitalisation, diagnosis, specialised services, drug usage and medical supplies...
May 2017: Malaysian Journal of Medical Sciences: MJMS
https://www.readbyqxmd.com/read/28814890/clinical-and-economic-analysis-of-outcomes-of-dose-tapering-or-withdrawal-of-tumor-necrosis-factor-%C3%AE-inhibitors-upon-achieving-stable-disease-activity-in-rheumatoid-arthritis-patients
#20
Daniel Aletaha, Sonya J Snedecor, Varun Ektare, Mei Xue, Yanjun Bao, Vishvas Garg
OBJECTIVE: To compare the real-world, 5-year clinical and cost impact of maintaining treatment with the tumor necrosis factor-α inhibitors (anti-TNFs) adalimumab, etanercept, or infliximab vs dose tapering or withdrawal in rheumatoid arthritis (RA) patients who have achieved remission (defined as a 28-joint count Disease Activity Score [DAS28] < 2.6) or low disease activity (LDA; DAS28 < 3.2). METHODS: Using a 5-year Markov model with 1-month cycle length, we examined the clinical and cost impact of three treatment strategies: withdrawal, tapering, or maintenance of anti-TNFs among RA patients in remission or who have achieved LDA...
2017: ClinicoEconomics and Outcomes Research: CEOR
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