Relevant bibliographies by topics / Healthcare utilization outcomes

Academic literature on the topic 'Healthcare utilization outcomes'

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Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Healthcare utilization outcomes"

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Akinbami, Lara J., Sean D. Sullivan, Jonathan D. Campbell, Robert W. Grundmeier, Tina V. Hartert, Todd A. Lee, and Robert A. Smith. "Asthma outcomes: Healthcare utilization and costs." Journal of Allergy and Clinical Immunology 129, no. 3 (March 2012): S49—S64. http://dx.doi.org/10.1016/j.jaci.2011.12.984.

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Encinosa, William E., Didem M. Bernard, Chi-Chang Chen, and Claudia A. Steiner. "Healthcare Utilization and Outcomes After Bariatric Surgery." Medical Care 44, no. 8 (August 2006): 706–12. http://dx.doi.org/10.1097/01.mlr.0000220833.89050.ed.

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Kramer, David. "Intensive care unit outcomes: Healthcare utilization versus physiology." Critical Care Medicine 28, no. 8 (August 2000): 3117–18. http://dx.doi.org/10.1097/00003246-200008000-00092.

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EDOUMIEKUMO, SAMUEL GOWON, and TARI MOSES KARIMO. "INEQUITY IN HEALTHCARE UTILISATION AND HEALTH OUTCOMES AMONG HOUSEHOLDS IN BAYELSA STATE, NIGERIA." WILBERFORCE JOURNAL OF THE SOCIAL SCIENCES 7, no. 1 (June 30, 2022): 1–14. http://dx.doi.org/10.36108/wjss/2202.70.0110.

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This study examines inequity in the use of health care and health outcomes in Nigeria with specific focus on Bayelsa State. The study is based on 426 households who were administered with questionnaire. Health care utilization for general purposes and antenatal care are used as proxy for health care utilization, while maternal death, under-5 death and infant deaths are proxy for health outcomes. Results from concentration index estimates show more concentration of health care utilization for general purposes among the poor which is surprising, and more concentration of use of antenatal services among the rich. The study also found pro-rich inequity in all three health outcome indicators. The study concludes that health care utilization and health outcomes are inequitably distributed among households in Bayelsa: while the rich and poor have similar health needs, the rich enjoy better access to health services and health outcomes.
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Mezuk, Briana, Weidi Qin, Linh Dang, and Rodlescia Sneed. "CARE COORDINATION, HEALTH OUTCOMES, AND HEALTHCARE UTILIZATION AMONG ADULTS WITH MULTIMORBIDITY." Innovation in Aging 6, Supplement_1 (November 1, 2022): 22. http://dx.doi.org/10.1093/geroni/igac059.082.

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Abstract Care coordination is a vehicle for improving patient-provider and provider-provider communication to improve outcomes and reduce unnecessary healthcare utilization, particularly for adults with multimorbidity. However, the clinical effectiveness of coordination at the population level remains unknown. This study examined the association between experiences of care coordination with subsequent health and healthcare outcomes among US adults over age 50. The analytic sample (n=695) included respondents from the Health and Retirement Study who had at least two chronic conditions, completed an Experimental Module on Coordinated Care in 2016, and were re-interviewed in 2018. Three domains of care coordination were examined as predictors: perceptions of coordination; using tangible supports (e.g., seeing a care coordinator); and using technical supports (e.g., patient portal). A range of outcomes related to health (i.e., self-rated health, functioning, pain) and healthcare (i.e., medication adherence, visits, hospitalizations, care satisfaction) were assessed in 2018. Weighted linear and logistic regression models, adjusted for demographic and socioeconomic characteristics, were fit for each lagged outcome. Higher engagement with tangible supports was positively associated with subsequent hospitalization (OR: 1.08, 95%CI: 1.01-1.15), greater pain (OR: 1.11 , 95%CI: 1.03-1.20), and marginally worse self-rated health (B=-0.02, p< 0.063). Better perceptions of coordination were also positively associated with care satisfaction (B=0.03, p< 0.020). Care coordination was not associated with functioning, adherence, or number of medical visits. Findings indicate the salience of tangible support for coordination among older adults with multi-morbidity, and that positive perceptions of coordination contribute to healthcare satisfaction.
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Toolan, Shane, Mark Griffin, Mark Coyne, Kate O'Mahony, Joy Lewis, Chandan D'Souza, Daniel G. Connaghan, et al. "Predictors of Healthcare Utilization in Newly Diagnosed Myeloma." Blood 136, Supplement 1 (November 5, 2020): 37–38. http://dx.doi.org/10.1182/blood-2020-138857.

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Introduction The introduction of novel therapies has significantly improved outcomes in myeloma. However, the economic burden of enhanced healthcare utilization is significant and cannot be discounted. This study sought to identify baseline characteristics that may influence outcomes and subsequent healthcare utilization. Patients were also stratified by induction therapy to determine the impact newer combinations have on healthcare utilization. Methods This retrospective single-center study enrolled all newly diagnosed patients with myeloma between 2005 and 2020. Three outcome measures were used to determine healthcare utilization - total inpatient length of stay (LOS), number of admissions, and day ward attendances. Univariate and multivariable analyses were performed to identify significant covariates related to overall survival (OS) and healthcare utilization. Outcomes were subsequently adjusted for duration of follow-up and per patient year. Results There were 113 patients included; 60 (53.1%) female; median age at diagnosis was 67 years (IQR 62, 73 years) and 22.1% were high risk International Staging System (ISS). Further baseline demographics are presented in Table 1. Median duration of follow up was 3.2 years (IQR 1.50, 6.55). Sixty patients (53.1%) died, 91.7% attributable to myeloma or its treatment. Predictors of OS by multivariable analysis were advanced stage [ISS III (p<0.001)] and IgA idiotype [(IgA vs IgG) (p=0.0002)]. Stem cell transplant eligibility was associated with improved OS (p=0.003). The total number of admissions to hospital was 547 (median 4; IQR 2, 7), with 55.4% unplanned. In the multivariable analysis, younger age (p=0.020), higher paraprotein levels (p=0.045), dialysis (p=0.037), and SCT eligibility (p=0.0012) were predictive of greater number of admissions. During the study period, there were 7000 inpatient bed occupancy days (median 46; IQR 26, 80). Only younger age remained significant (p=0.0028) in the multivariable analysis. There were a total of 5987 day care attendances during the study period. Multivariable analysis identified younger age at diagnosis (p<0.0001), WBC (p=0.0072), and light chain (kLC vs lLC) (p=0.0027) as predictive of increased day ward attendance. Healthcare utilization correlated with increased survival, as depicted in figure 1. There was no significant relationship between treatment type and LOS (p=0.055); this remained unchanged when adjusted per patient year (p=0.24). There was significant relationship between treatment type and total number of admissions (p=0.015). Patients receiving anthracycline based therapy (p=0.003), Immunomodulatory (IMiD)/Proteasomal Inhibition (PI)/Steroid (p=0.020), or PI/Steroid (p=0.021) were more likely to have a greater number of admissions. However, when adjusted per patient year, this association was no longer evident (p=0.19). A highly significant relationship between treatment type and day ward attendances was identified (p<0.0001). Alkylator based (pp=0.005), alkylator/PI/Steroid (p=0.006), anthracycline based (p=0.0002), IMiD/PI/Steroid (p=0.0007), or PI/Steroid (0.0002) were more likely to have greater day ward attendance. When adjusted per patient year, this significant association between treatment type and day ward attendance remained (p=0.0002). Conclusion Studies assessing healthcare utilization in patients with myeloma are mostly limited to relapsed refractory setting. In this population, younger age at presentation was a significant predictor for all three measures of healthcare utility. Whilst treatment type did not demonstrate a significant impact of LOS, we did determine that novel triplet therapy combinations were associated with increased number of admissions and day care attendances. We also showed that healthcare utilization increased with survival time. While survival outcomes with novel agents have improved, given current financial and capacity limitations within which the majority of health systems function, resource demand implications must be considered when planning future service provision and novel treatment strategies. Disclosures No relevant conflicts of interest to declare.
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Shireman, Theresa I., Pamela C. Heaton, Wendy E. Gay, Robert J. Cluxton, and Charles J. Moomaw. "Relationship between Asthma Drug Therapy Patterns and Healthcare Utilization." Annals of Pharmacotherapy 36, no. 4 (April 2002): 557–64. http://dx.doi.org/10.1345/aph.1a067.

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BACKGROUND AND OBJECTIVE: Asthma drug therapy problems contribute significantly to preventable hospitalizations and increased healthcare use in asthmatics. Since asthma patients often require >1 medication for control of symptoms, concurrent asthma drug therapies may be important in predicting excessive healthcare utilization. The purpose of this study was to link inappropriate asthma drug therapy patterns and selected patient demographics to healthcare utilization. METHODS: This study was a retrospective, cross-sectional analysis of Ohio Medicaid medical, institutional, and prescription claims. We included ambulatory patients aged 15–65 years who had ≥2 claims for asthma (493.x) and who were continuously enrolled in the Medicaid fee-for-service program for the 12-month period from April 1998 through March 1999. We examined age, race, gender, metropolitan residence, presence of gastroesophageal reflux disease, and the usage patterns of inhaled corticosteroids, short-acting β2-agonists, long-acting β2-agonists, theophylline, and leukotriene receptor modifiers to identify asthma drug therapy problems based on national guidelines. The primary outcomes included the number of asthma-related hospitalizations, asthma-related emergency department visits, and oral steroid bursts. RESULTS: Among 10 959 asthma patients, only 46.8% of the study patients received >1 puff of inhaled corticosteroid per day. Forty-four percent of the patients received >3 puffs of short-acting β2-agonists per day. The most common outcome was an oral steroid burst (46.5%). Patients on high doses of short-acting β2-agonists had the greatest odds of receiving an oral steroid burst and were most likely to be hospitalized. African Americans were more likely to incur a hospitalization or emergency department visit. Women had greater odds of any undesirable asthma outcome. Higher use of short-acting β2-agonists led to higher odds of receiving a steroid burst or being hospitalized. Leukotriene receptor modifier use was related to higher levels of all outcomes. CONCLUSIONS: A large percentage of Ohio Medicaid patients were not receiving asthma medications in compliance with the National Heart, Lung, and Blood Institute guidelines. Despite nearly a decade of national efforts, asthma drug therapy patterns still have substantial room for improvement and continue to be associated with excess healthcare utilization.
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Killingmo, Rikke Munk, Kjersti Storheim, Danielle van der Windt, Zinajda Zolic-Karlsson, Ørjan Nesse Vigdal, Lise Kretz, Milada Cvancarova Småstuen, and Margreth Grotle. "Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study." BMJ Open 12, no. 6 (June 2022): e057778. http://dx.doi.org/10.1136/bmjopen-2021-057778.

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ObjectivesTo describe healthcare utilization and estimate associated costs during 1 year of follow-up among older people seeking primary care due to a new episode back pain and to describe healthcare utilization across patients with different risk profiles stratified using the StarT Back Screening Tool (SBST).DesignProspective cohort study.Participants and settingA total of 452 people aged ≥55 years seeking Norwegian primary care with a new episode of back pain were included.Outcome measuresThe primary outcome of this study was total cost of healthcare utilization aggregated for 1 year of follow-up. Secondary outcomes included components of healthcare utilization aggregated for 1 year of follow-up. Healthcare utilization was self-reported and included: primary care consultations, medications, examinations, hospitalisation, rehabilitation stay, and operations. Costs were estimated based on unit costs collected from national pricelists. Healthcare utilization across patients with different SBST risk profiles was compared using Kruskal-Wallis test, post hoc Mann-Whitney U tests and Bonferroni adjustment.ResultsIn total, 438 patients were included in the analysis. Mean (BCa 95% CI) total cost per patient over 1 year was €825 (682-976). Median (BCa 95% CI) total cost was €364 (307-440). The largest cost category was primary care consultations, accounting for 56% of total costs. Imaging rate was 34%. The most commonly used medication was paracetamol (27%–35% of patients). Medium- and high-risk patients had a significantly higher degree of healthcare utilization compared with low-risk patients (p<0.030).ConclusionThis study estimated a 1 year mean and median cost of healthcare utilization of €825 and €364, respectively. Patients within the top 25th percentile accounted for 77% of all costs. Patients classified as medium risk and high risk had a significantly higher degree of healthcare utilization compared with patients classified as low risk.Trial registration numberClinicalTrials.gov NCT04261309, results
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Ray, Emily Miller, Richard F. Riedel, Christel N. Rushing, and Anthony N. Galanos. "Healthcare utilization among cancer patients prior to hospice." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 135. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.135.

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135 Background: The integration of palliative medicine in oncologic care has become increasingly recognized and supported. We have previously reported improved health system and quality of care outcomes for solid tumor patients admitted to our novel, fully-integrated palliative care (PC) and medical oncology inpatient service at Duke University Medical Center (DUMC). In this study, we explored healthcare utilization in patients specifically discharged to hospice pre- and post-PC integration. Methods: We conducted a retrospective cohort study of hospitalized patients on the solid tumor unit at DUMC who were discharged to hospice care between September 1, 2009-June 30, 2010 (pre-PC integration) and September 1, 2011-June 30, 2012 (post-PC integration). Cohorts were compared on the following outcome variables occurring within 30 days prior to discharge to hospice: number of hospitalizations, ICU days, ED visits, invasive procedures, subspecialty consultations, radiologic studies, medical oncology clinic visits, and use of chemotherapy or radiation. Wilcoxon rank-sum and Chi square tests were used for statistical analyses. Results: A total of 296 patients were included (133 pre-PC integration; 163 post-PC integration) in the analyses. Patient characteristics were well matched between cohorts. The overall mean age was 63 years (range 25-96), 62% were Caucasian, 51% were male, and 98% of patients had recurrent or metastatic disease. Of particular note, there were no significant differences noted between cohorts with regards to the resource utilization outcome variables assessed. Conclusions: Understanding healthcare utilization in this patient population is of great interest to clinical providers and policymakers alike. While we have previously demonstrated the benefit of integrating palliative care and medical oncology for reducing hospital readmissions and length of stay, this study shows no significant impact of an integrated approach on the utilization of healthcare resources measured within the 30 days prior to discharge to hospice. This may reflect the aggressive approach to management of symptoms for end-of-life patients, which often involves invasive procedures, use of imaging, and other resources to meet their needs.
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Dewland, Thomas A., David V. Glidden, and Gregory M. Marcus. "Healthcare Utilization and Clinical Outcomes after Catheter Ablation of Atrial Flutter." PLoS ONE 9, no. 7 (July 1, 2014): e100509. http://dx.doi.org/10.1371/journal.pone.0100509.

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Dissertations / Theses on the topic "Healthcare utilization outcomes"

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Huang, Jacob Chao-Lun. "Healthcare Utilization and Health Outcomes: US-born and Foreign-born Elderly Asian Americans." Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc804863/.

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In order to better understand variations of health behaviors between US-born and foreign-born elderly Asian Americans (65+) in the United States, the research aims to explore relationships among health outcomes, healthcare utilization, and sociodemographic characteristics. Data from the National Health Interview Survey 1998-2012 is used to construct structural equation models for the US born group and for the foreign born group. The results found that there is a reciprocal relationship between health outcomes and healthcare utilization in both groups. Use of healthcare services can positively affect health outcomes, while better health outcomes reduce the need for healthcare utilization. In addition, some sociodemographic characteristics, such as age, sex, and marital status have a direct effect on health outcomes, but some others, such as education, family size and combined family income, have an indirect effect on health outcomes via healthcare utilization. The region of residency has both direct and indirect effects on health outcomes. Regarding the effects of predictors on health outcomes, US-born elderly Asians usually receive more health advantages from using institutional health services than foreign-born elderly Asians. Practitioners, social gerontologists, and policy makers should be cautious about assuming that there is a positive impact of increased healthcare utilization on health outcomes in elderly Asian Americans.
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Johnson, Adam M. "The Impact of Collaborative Behavioral Health on Treatment Outcomes of Diabetes." DigitalCommons@USU, 2019. https://digitalcommons.usu.edu/etd/7615.

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A current body of research is finding significant connection between biological, psychological, social, and spiritual factors in health and wellbeing. Some studies have found significant improvements in treatment outcomes for patients who received medical treatment in collaboration with psychosocial therapeutic treatment. In this study, I sought to observe the impact collaborative treatment had on patients with diabetes who were treated at a community health center. I compared the treatment outcomes of a group of patients who received a collaborative treatment, looking to see if their overall health (measured by A1c, a diabetes severity marker) and medical utilization (or their number of doctors’ visits). I found no significant difference in the improvements in health outcomes (A1c) made by my treatment group who received collaborative treatment in addition to standard medical treatment for diabetes management when compared to my control group who received only medical treatment. I did find that collaborative treatment was associated with increases in medical utilization as were increases in age and initial A1c levels. Clinical implications include the need for therapists to be aware of how biological factors, such as age and severity of symptoms, may affect psychosocial-spiritual factors commonly addressed in therapy when working with patients who have chronic illnesses like diabetes. I hope that these findings will lead future research into the association of collaboration and medical utilization in order to find if there are any clinical benefits to recommending increased utilization for patients who are older or begin treatment with higher A1c levels.
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Hammonds, Tracy Lynn. "The Influence of the Caregiver on Healthcare Outcomes in Patients with Chronic Obstructive Pulmonary Disease (COPD)." Kent State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=kent1426543939.

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Luu, Shyuemeng. "The Determinants of Post-discharge Healthcare Utilization and Outcomes for Veterans with Posttraumatic Stress Disorder: A Social Ecological Perspective." VCU Scholars Compass, 2000. https://scholarscompass.vcu.edu/etd/5231.

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Posttraumatic stress disorder (PTSD) has a persistent nature: PTSD troubles patients even decades after the occurrence of traumatic events. The “health behavioral model” is adopted to examine the effects of external environmental, predisposing, enabling, and need for care factors on the use of VA post-discharge ambulatory care and readmissions. Data were obtained from the Patient Treatment File (PTF) and the Outpatient Care File (OPT), the Area Resource File (ARF), American Hospital Association data sets (AHA), and the Uniform Crime Report (UCR). The use of VA post-discharge ambulatory care is analyzed by using structural equation modeling (SEM). The readmission to VAMCs is evaluated by Cox regression with forward selection. A cross-sectional study is performed on 1,420 PTSD veterans admitted to Veterans Affairs Medical Centers (VAMCs) in 1994 and 1,517 veterans in 1998 in the Veterans Integrated Services Networks 6 (VISN 6). In both years, the most important determinants of the use of VA post-discharge ambulatory care is “prior use of outpatient care services.” For the 1994 sample, prior use of inpatient services impeded the utilization of post-discharge ambulatory care. For the 1998 sample, barriers to access to care and the length of stay for other mental health encounters in the last year reduced the utilization of post-discharge ambulatory care. For readmission in both years, higher numbers of medical or mental VA post-discharge visits reduce the likelihood of readmission to VAMCs. The service lines program was found to increase the use of VA post-discharge ambulatory care and decrease readmission rates for PTSD veterans. The application of the “health behavioral model” can be extended to outcome research to investigate the contributing factors. A risk adjustment system can also be developed based upon the findings. Communities, VAMCs, and PTSD patients and their families should work to raise awareness of the factors that contributing to both use of care and outcomes, and should form a comprehensive network to improve the wellbeing of PTSD veterans.
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Jayawant, Sujata Satish. "Effect of dosing regimens on medication use, healthcare resource utilization, and costs in Medicaid enrolled Type 2 diabetes mellitus patients." The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1203710092.

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Wu, Jun. "Statin Medication Adherence and Associated Outcomes in Type 2 Diabetes Medicaid Enrollees with Comorbid Hyperlipidemia." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1276258784.

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Culver, Mark, Justin VandenBerg, and Grant Skrepnek. "Clinical Outcomes and Economic Characteristics Regarding Inpatient Treatment of Brain Tumors with Implantable Wafers in the United States." The University of Arizona, 2012. http://hdl.handle.net/10150/614463.

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Class of 2012 Abstract
Specific Aims: This study was aimed to evaluate inpatient clinical treatment characteristics associated with the use of intracranial implantation of chemotherapeutic wafers for malignant brain neoplasms within United States, and assess inpatient mortality and total charges regarding treatment with wafer versus without. Methods: A retrospective cohort investigation was conducted utilizing inpatient discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample from 2005 to 2009. From this nationally-representative sample, 9,455 adults aged 18 years or older were identified with malignant neoplasms of the brain treated with implantable chemotherapeutic wafers. Outcomes of inpatient mortality and charges were assessed via multivariate regression analysis, controlling for patient characteristics, hospital structure, comorbidities, and clinical complications. Main Results: The average age of patients with brain neoplasms was 56.6 (±16.5) years, and of those patients, 42.9% were female. The odds ratio for inpatient mortality of patients treated with implantable chemotherapeutic wafers was OR=0.380 (P<0.001), and patients that received wafer treatment had increased charges exp(b)=2.147 (P<0.001). Conclusions: Multiple factors were associated with inpatient mortality and charges among the 247,829 patients that were diagnosed with malignant brain neoplasms from 2005-2009. With regards to these patients, implantable chemotherapeutic wafers were associated with increased inpatient survival and increased charges.
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Rejzer, Courtney Brynne. "The influence of the acute care nurse practitioner on healthcare delivery outcomes : a systematic review /." Full-text of dissertation on the Internet (211 KB), 2009. http://www.lib.jmu.edu/general/etd/2009/Honors/Rejzer_CourtneyB/rejzercb_honors_11-11-2009.pdf.

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Gipson, Linda Stephens. "The Impact of Managed Care on the Utilization and Distribution of Inpatient Surgical Procedures with Demonstrated Volume and Outcome Endogeneity." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3118.

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Abstract Purpose This study is designed to determine whether managed care has had an influence on the number and distribution of procedures with demonstrated volume and outcome endogeneity in Florida healthcare markets; in addition, methods are developed to determine which measures of managed care activity best predict the impact of managed care on surgical procedure utiliation. Rationale A shift in surgical procedure volume on the basis of preferred provider arrangements has the potential to redistribute surgical procedures within hospital markets. The surgical procedures for which such a distribution could have the greatest impact on population health are those for which the volume of cases performed has a strong inverse influence on the outcomes observed. A shift in high risk surgical procedures to low volume hospitals could potentially reduce the number of cases performed at high volume centers and increase cases at low volume centers, adversely impacting quality in both. Methods A retrospective population based cohort design is used to capitalize on the variability among Florida metropolitan statistical areas between 1995 and 1999, a period which captured the full business life cycle of managed care plans in Florida. Multiple regression models are used to measure the impact of changes in managed care activity as measured by penetration, index of competition and consolidation on the change in the number and distribution of seven procedures for which volume is associated with patient outcome, controlling for socio-demographic and market factors known to influence surgical procedure utilization. Difference scores derived for each of the model variables were used to measure change from the baseline in 1995 to 1999. Post hoc analysis of the count data models was performed using the cases from all study years in a log linear generalized estimating equation to provide validation of the difference score approach. Key Findings Study procedure volume increased over the period, and remained a consistent proportion of the total inpatient surgical procedure volume. Procedure rate remained stable over the study period with substantial small area variation. Change in managed care concentration was consistently and negatively associated with procedure volume at both the MSA (&betaâ&beta = -19.67; p = 0.0489) and hospital level (&betaâ&beta = -4.088; p = 0.0027).Change in the total population and the number of specialty surgeons had a substantial, consistent and positive relationship to change in procedure volume at both the market and hospital level. The change in the index of competition was positively associated with change in hospital market share (&betaâ&beta = 0.1005; p = 0.05); whereas, neither change in managed care penetration nor change in managed care index of competition was predictive of change in procedure volume at the market level. The managed care variables were not correlated when difference scores were tested providing evidence that the managed care variables measure different constructs and behave differently. Implications As markets for managed care became more concentrated, the number of surgical procedures with volume and outcome endogeneity declined; the specific reasons for the observed decline require additional study. Competitive managed care markets have a favorable impact on hospital market share for these high risk, high margin procedures. Studies of managed care require consideration of the stage of managed care development in order to understand its influence and the use of difference scores as a method to measure change over time has substantial potential for the study of health care markets.
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Herman, Patricia, Sally Dodds, Melanie Logue, Ivo Abraham, Rick Rehfeld, Amy Grizzle, Terry Urbine, Randy Horwitz, Robert Crocker, and Victoria Maizes. "IMPACT - Integrative Medicine PrimAry Care Trial: protocol for a comparative effectiveness study of the clinical and cost outcomes of an integrative primary care clinic model." BioMed Central, 2014. http://hdl.handle.net/10150/610366.

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BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.
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Books on the topic "Healthcare utilization outcomes"

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Jordan, Joanne M., Kelli D. Allen, and Leigh F. Callahan. Age, gender, race/ethnicity, and socioeconomic status in osteoarthritis and its outcomes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0010.

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Osteoarthritis (OA) is the most common joint condition worldwide. It can impair mobility and result in significant disability, need for total joint replacement, and healthcare utilization. OA is unusual in those younger than 40 years, then commonly the result of an underlying metabolic disorder or a prior joint injury. Some geographic and racial/ethnic variation exists in the prevalence and incidence of OA for specific joints, likely due to variation in genetics, anatomy, and environmental exposures. Many OA outcomes vary by socioeconomic status and other social factors. This chapter describes demographic and social determinants of knee, hip, and hand OA, including how these factors impact radiographic and symptomatic OA, OA-related pain and function, and its treatment.
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Clyne, Mindy, Amy Kennedy, and Muin J. Khoury. Using Precision Medicine to Improve Health and Healthcare. Edited by David A. Chambers, Wynne E. Norton, and Cynthia A. Vinson. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190647421.003.0033.

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Implementation science can be incorporated within genomics precision medicine research across the cancer care continuum. Cancer is at the forefront of precision medicine. To move the field forward, the use of implementation science frameworks, theories, models, strategies, and outcome measures is essential so that we can consistently explore how precision medicine discoveries are optimally integrated into care delivery systems. Learning health care systems are model systems for adoption, uptake, and sustainability of precision medicine throughout the cancer care continuum, with both systematic processes in place for research to inform practice, and capacity for a multilevel research agenda, including the utilization of implementation strategies across and among multiple levels. This chapter explores precision medicine across the cancer care continuum and describes implementation science challenges and opportunities.
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Berger, Robert H., Robyn J. Wahl, and M. Paul Chaplin. Formulary management/pharmacy and therapeutics committees. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0028.

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While the cost of health care rises in all public healthcare organizations, budgets for that care have remained the same or have decreased. This is most certainly true in correctional settings. Because pharmaceutical expenditures are a substantial percentage of a health care organization’s budget, medication utilization is closely scrutinized. Clinicians must consider the appropriateness, effectiveness, and safety of medications prescribed to incarcerated patients. The abundance of available drugs and the complex issues with respect to their safe and effective use make a sound program for maximizing rational drug use critical. This is a challenging task in jails and prisons that requires a reexamination of the treatments provided. This is not a process of arbitrarily limiting prescriber choices or their decision-making authority solely based on cost-saving incentives. Evidence-based, best practices that inform the development of, and adherence to, disease management guidelines and a preferred, restricted medication formulary enhances the quality, safety, and effectiveness of the care provided. This chapter details the process and procedures to develop, implement, and monitor prescription practice change by establishing an effective Pharmacy & Therapeutics Committee (P & TC). The chapter further addresses: the roles and responsibilities of a P & TC; P & TC decision-making processes; formulary development and modification; formulary process decision-making; medication therapy management guidelines; prescriber education; and data analytics to assist in monitoring outcomes, medication use, and prescriber adherence to P & TC policies.
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Trestman, Robert L. Funding of correctional health care and its implications. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0010.

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Correctional healthcare is funded through a range of mechanisms, reflecting many of the community fee-for-service and managed care parallels. Like community healthcare, utilization of healthcare in correctional settings is increasing. It is however, often under more significant budgetary constraints and tighter management. The funding of correctional healthcare is a complex enterprise, driven by constitutionally mandated care obligations on the one hand, and resource constraints on the other. Along with the dramatic increase in the incarcerated population during the past two decades, correctional healthcare has evolved as well. The costs of care are quite substantial, and the diversity of models of care delivery offer an administrative challenge, a financial challenge to the relevant jurisdiction, and a significant opportunity for cost effectiveness. Unfortunately, as of yet, no comparative study of funding models has been done. As integrated electronic health and financial records are gradually introduced into correctional settings, opportunities for such studies, and the policy guidance provided by those results, may yield important information applicable to health care cost and outcome management in society more broadly. This chapter includes a discussion of global capitation, per inmate costs, at-risk contracting, liability concerns, performance indicators, and a variety of contractual relationships.
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Book chapters on the topic "Healthcare utilization outcomes"

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Shoemaker, Laura, and Susan McInnes. "Starting a Palliative Care Program at a Cancer Center." In The Comprehensive Cancer Center, 107–20. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-82052-7_12.

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AbstractPalliative care is now considered an integral component in the provision of comprehensive cancer care services, from diagnosis to treatment to ultimate recovery or death. High-quality evidence in the setting of both solid tumors and hematologic malignancies suggests that incorporation of palliative care is associated with higher quality care, greater patient and family satisfaction, improved clinician experience, more appropriate healthcare resource utilization, and better patient outcomes, including survival. Strategic investment, staffing, and support for a palliative care program also makes cancer care patient-centric and cost-effective. This chapter provides pragmatic guidance on setting up a palliative care program within a cancer center and discusses strategies and opportunities for early and late planning, launch of the program and its integration within other cancer services, making it sustainable, monitoring outcomes and quality, and using it as a platform for research.
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Diaz, Rafael, and Joshua G. Behr. "A Simulation Framework for Evaluating the Effectiveness of Chronic Disease Management Interventions." In Health Economics and Healthcare Reform, 455–74. IGI Global, 2018. http://dx.doi.org/10.4018/978-1-5225-3168-5.ch025.

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The treatment and management of chronic diseases currently comprise a major fraction of the United States' healthcare expenditures. These expenses are projected to increase as the US population ages. Utilization of the ambulatory healthcare system stemming from chronic conditions has been seen as contributory factor in the rising expenditures. Efforts to better manage chronic conditions ought to result in better health outcomes and, by extension, savings through lower utilization of ambulatory services. The longer-term financial consequences of such interventions, however, are more uncertain. This study offers a System Dynamics simulation framework that identifies and models the critical relationships associated with health outcomes and longer-term financial consequences. This framework is demonstrated through a comparison between groups with a similar generic chronic condition, but one group is subjected to a management intervention and the other group is not. The framework provides constructive insights into how the initial intervention cost estimates, the resulting savings, and the health status may change depending on uncertainties, feedback effects, and cost structures.
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Wainwright, Sheryl Joane Dobson. "The Benefits of Technology in Healthcare Management." In Health Informatics and Patient Safety in Times of Crisis, 1–22. IGI Global, 2022. http://dx.doi.org/10.4018/978-1-6684-5499-2.ch001.

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Technology adoption can improve healthcare delivery, outcomes, and cost-efficiency. Using the COVID-19 pandemic as a foundation, this chapter discusses technology's role during the crisis and explores the barriers to successful healthcare management strategies due to inadequate or inappropriate technology adoption. This chapter also explores the pros and cons of technology and provides tools to help determine when adoption will benefit healthcare providers, systems, and consumers. The author discusses operational effectiveness and efficiency, effective communication, team coordination, health outcomes, data collection and utilization, and risk management in this chapter.
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Kupper, Nina, and Johan Denollet. "Impact of psychological factors on outcomes." In ESC CardioMed, edited by Susanne Pedersen, 3044–49. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198784906.003.0790.

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The economic impact of both coronary artery disease and psychological distress (e.g. depression) in their own right is high. Globally, depression is associated with 4 million estimated ischaemic heart disease disability-adjusted life years, 3.5 million years of life lost, and 250,000 years of life lived with a disability. In case of emotional distress in the context of coronary artery disease, evidence suggests that costs accumulate. A recent systematic review shows that the evidence is fairly consistent with respect to an association between depression and increased healthcare utilization (e.g. ambulatory care, emergency care, and hospital costs). The WISE study in women with suspected ischaemia showed that the annual overall and cardiovascular healthcare costs were higher in patients with both clinical and subclinical depression.
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Kaben, Stefane M., Jatinder Takhar, Raymond Leduc, and Rick Burjaw. "Medical Education in the 21st Century." In Encyclopedia of Developing Regional Communities with Information and Communication Technology, 488–93. IGI Global, 2005. http://dx.doi.org/10.4018/978-1-59140-575-7.ch086.

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As with many disciplines, the fields of healthcare in general and medicine, in particular, have made vast strides in improving patient outcomes and healthcare delivery. But, have healthcare professionals and medical academia been able to maximize the utilization of new technologies to improve the delivery of the right knowledge, to the right people, at the right time across geographical boundaries? In order to provide the best quality of care, regardless of patient or provider location, specific issues must be addressed.
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Testik, Murat Caner, George C. Runger, Bradford Kirkman-Liff, and Edward A. Smith. "Data Mining and Knowledge Discovery in Healthcare Organizations." In Creating Knowledge-Based Healthcare Organizations, 78–90. IGI Global, 2005. http://dx.doi.org/10.4018/978-1-59140-459-0.ch007.

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Health care organizations are struggling to find new ways to cut healthcare utilization and costs while improving quality and outcomes. Predictive models that have been developed to predict global utilization for a healthcare organization cannot be used to predict the behavior of individuals. On the other hand, massive amounts of healthcare data are available in databases that can be used for exploring patterns and therefore knowledge discovery. Diversity and complexity of the healthcare data requires attention to the use of statistical methods. By nature, healthcare data are multivariate, making the analysis difficult as well as interesting. In this chapter, our intention is to classify individuals that are future high-utilizers of healthcare. In particular, we answer the question of whether a mathematical model can be generated utilizing a large claims database that will predict which individuals who are not using a service in a yet untested database will be high utilizers of that health service in the future. For this purpose, an integrated dataset from enrollment, medical claims, and pharmacy databases containing more than 150 million medical and pharmacy claim line items and for over four million patients is analyzed for knowledge discovery. A modern data-mining tool, namely decision trees, which may have a broad range of applications in healthcare organizations, was used in our analyses and a discussion of this valuable tool is provided. The results and managerial aspects are discussed. Several approaches are proposed for the use of this technique depending on the health plan.
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Testik, Murat Caner, George C. Runger, Bradford Kirkman-Liff, and Edward A. Smith. "Data Mining and Knowledge Discovery in Healthcare Organizations." In Data Warehousing and Mining, 2494–505. IGI Global, 2008. http://dx.doi.org/10.4018/978-1-59904-951-9.ch152.

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Health care organizations are struggling to find new ways to cut healthcare utilization and costs while improving quality and outcomes. Predictive models that have been developed to predict global utilization for a healthcare organization cannot be used to predict the behavior of individuals. On the other hand, massive amounts of healthcare data are available in databases that can be used for exploring patterns and therefore knowledge discovery. Diversity and complexity of the healthcare data requires attention to the use of statistical methods. By nature, healthcare data are multivariate, making the analysis difficult as well as interesting. In this chapter, our intention is to classify individuals that are future high-utilizers of healthcare. In particular, we answer the question of whether a mathematical model can be generated utilizing a large claims database that will predict which individuals who are not using a service in a yet untested database will be high utilizers of that health service in the future. For this purpose, an integrated dataset from enrollment, medical claims, and pharmacy databases containing more than 150 million medical and pharmacy claim line items and for over four million patients is analyzed for knowledge discovery. A modern data-mining tool, namely decision trees, which may have a broad range of applications in healthcare organizations, was used in our analyses and a discussion of this valuable tool is provided. The results and managerial aspects are discussed. Several approaches are proposed for the use of this technique depending on the health plan.
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Woodside, Joseph M., and Iftikhar U. Sikder. "GIS Application of Healthcare Data for Advancing Epidemiological Studies." In New Technologies for Advancing Healthcare and Clinical Practices, 362–77. IGI Global, 2011. http://dx.doi.org/10.4018/978-1-60960-780-7.ch021.

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Healthcare practices increasingly rely on advanced technologies to improve analysis capabilities for decision making. In particular, spatial epidemiological approach to healthcare studies provides significant insight in evaluating health intervention and decisions through Geographic Information Systems (GIS) applications. This chapter illustrates a space-time cluster analysis using Kulldorff’s Scan Statistics (1999), local indicators of spatial autocorrelation, and local G-statistics involving routine clinical service data as part of a limited data set collected by a Northeast Ohio healthcare organization over a period 1994 – 2006. The objective is to find excess space and space-time variations of lung cancer and to identify potential monitoring and healthcare management capabilities. The results were compared with earlier research (Tyczynski & Berkel, 2005); similarities were noted in patient demographics for the targeted study area. The findings also provide evidence that diagnosis data collected as a result of rendered health services can be used in detecting potential disease patterns and/or utilization patterns, with the overall objective of improving health outcomes.
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Woodside, Joseph M., and Iftikhar U. Sikder. "GIS Application of Healthcare Data for Advancing Epidemiological Studies." In Geographic Information Systems, 1183–99. IGI Global, 2013. http://dx.doi.org/10.4018/978-1-4666-2038-4.ch071.

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Healthcare practices increasingly rely on advanced technologies to improve analysis capabilities for decision making. In particular, spatial epidemiological approach to healthcare studies provides significant insight in evaluating health intervention and decisions through Geographic Information Systems (GIS) applications. This chapter illustrates a space-time cluster analysis using Kulldorff’s Scan Statistics (1999), local indicators of spatial autocorrelation, and local G-statistics involving routine clinical service data as part of a limited data set collected by a Northeast Ohio healthcare organization over a period 1994 – 2006. The objective is to find excess space and space-time variations of lung cancer and to identify potential monitoring and healthcare management capabilities. The results were compared with earlier research (Tyczynski & Berkel, 2005); similarities were noted in patient demographics for the targeted study area. The findings also provide evidence that diagnosis data collected as a result of rendered health services can be used in detecting potential disease patterns and/or utilization patterns, with the overall objective of improving health outcomes.
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Huang, Jacob Chao-Lun. "Influence of Healthcare Utilization and Social Characteristics on Health Outcomes Among Elderly Asian Americans: A Structural Equation Analysis." In Research in the Sociology of Health Care, 211–30. Emerald Publishing Limited, 2017. http://dx.doi.org/10.1108/s0275-495920170000035011.

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Conference papers on the topic "Healthcare utilization outcomes"

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Lindroth, H., S. Wang, C. Xu, P. H. Hanneman, S. Gao, S. H. Khan, Y. T. Jawed, M. Boustani, and B. A. Khan. "Impact of Critical Care Recovery Center on 2-Year Healthcare Utilization Outcomes." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a2698.

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Dekoven, M., K. Mandia, N. DeFabis, J. Chen, and A. Ruscio. "Patient Characteristics, Healthcare Resource Utilization and Outcomes Among Non-Cystic Fibrosis Bronchiectasis Patients with High Frequency Chest Wall Oscillation (HFCWO) Therapy." In American Thoracic Society 2022 International Conference, May 13-18, 2022 - San Francisco, CA. American Thoracic Society, 2022. http://dx.doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a3090.

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Opris-Belinski, D., S. Erdes, S. Grazio, L. Šenolt, M. Hojnik, O. Nagy, L. Iosub, and S. Szántό. "THU0363 Impact of adalimumab on clinical outcomes, healthcare resource utilization and sick leaves in ankylosing spondylitis patients in central and eastern europe." In Annual European Congress of Rheumatology, 14–17 June, 2017. BMJ Publishing Group Ltd and European League Against Rheumatism, 2017. http://dx.doi.org/10.1136/annrheumdis-2017-eular.5244.

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Shah, D., M. DeKoven, and M. Wanjala. "Impact of Positive Expiratory Pressure Therapy on Clinical Outcomes, Healthcare Cost and Utilization in Adult Patients with Non-Cystic Fibrosis Bronchiectasis in the U.S." In American Thoracic Society 2021 International Conference, May 14-19, 2021 - San Diego, CA. American Thoracic Society, 2021. http://dx.doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3961.

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Basavaraj, A., M. DeKoven, D. Shah, A. Murray, C. Urrea, B. Becker, and M. Wanjala. "Impact of High Frequency Chest Wall Oscillation on Clinical Outcomes and Healthcare Resource Utilization in Adult Patients with Non-Cystic Fibrosis Bronchiectasis in the United States: A Pre-Post Cohort Analysis." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a7758.

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Basavaraj, A., D. Shah, M. DeKoven, B. C. Becker, C. Urrea, A. Murray, and M. Wanjala. "A Pre-Post Analysis Assessing the 3-Year Long-Term Impact of High Frequency Chest Wall Oscillation Therapy on Clinical Outcomes, Healthcare Cost and Utilization in Adult Patients with Non-Cystic Fibrosis Bronchiectasis in the U.S." In American Thoracic Society 2021 International Conference, May 14-19, 2021 - San Diego, CA. American Thoracic Society, 2021. http://dx.doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3944.

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Martaningrum, Herlina Ika, Uki Retno Budihastuti, and Bhisma Murti. "Factors Affecting the Use of Visual Inspection Acetic Acid Test in Magelang, Central Java." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.03.90.

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ABSTRACT Background: Visual inspection acetic acid (VIA) can help detect cervical cancer at an early stage. However, under-utilization of the screening (e.g. rural residence, poor knowledge, low education, acceptability by the healthcare providers, etc.) persists as a major challenge. This study aimed to determine factors affecting the use of VIA test. Subjects and Method: A cross sectional study was carried out at 25 community health centers (puskesmas) in Magelang, Central Java, from September to October 2019. A sample of 200 women aged 30-50 years old was selected for this study randomly. The dependent variable was VIA test. The independent variables were knowledge, observational learning, reinforcement, cues to action, informational access, attitude, self-efficacy, outcome expectation, and family support. The data were collected by questionnaire and analyzed by a multiple logistic regression. Jenis penelitian ini adalah analitik observasional dengan pendekatan cross sectional. Results: VIA use increased with good knowledge (b= 3.97; 95% CI= 0.84 to 7.10; p= 0.013), high observational learning (b= 2.20; 95% CI= -0.09 to 4.49; p= 0.060), srong reinforcement behavior (b= 3.90; 95% CI= 1.02 to 6.77; p= 0.008), strong cues to action (b= 4.87; 95% CI= 1.07 to 8.67; p= 0.012), good information access (b= 3.32; 95% CI= 0.94 to 5.69; p= 0.006), strong family support (b= 3.81; 95% CI= 0.62 to 6.99; p= 0.019), positive attitude (b= 2.91; 95% CI= 0.20 to 5.62; p= 0.035), strong self efficacy (b= 2.71; 95% CI= 0.44 to 4.99; p= 0.019), and high outcome expectation (b= 3.22; 95% CI= 0.72 to 5.73; p= 0.012). Conclusion: VIA use increases with good knowledge, high observational learning, srong reinforcement behavior, strong cues to action, good information access, strong family support, positive attitude, strong self efficacy, and high outcome expectation. Keywords: cervical cancer, visual inspection acetic acid, social cognitive theory Correspondence: Herlina Ika Martaningrum. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: herlinaika21@gmail.com. Mobile: 085643528156 DOI: https://doi.org/10.26911/the7thicph.03.90
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Reports on the topic "Healthcare utilization outcomes"

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Mulaku, Mercy N. What are the effects of interventions to improve healthcare utilization and health outcomes in people with low health literacy? SUPPORT, 2016. http://dx.doi.org/10.30846/1610113.

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People with low health literacy are more likely to use health services incorrectly and to have poorer health outcomes than people with high health literacy. Single strategies to improve health literacy (e.g. alternative presentations of numerical data) might improve health service utilisation and health outcomes by improving health literacy. Other mixed strategies, such as self-management, disease management, and adherence interventions, might improve healthcare utilization and health outcomes in people with low health literacy by facilitating patient/provider communication, circumventing barriers to healthcare, or improving health-related skills.
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Young, Taryn. How do pharmaceutical policies that restrict reimbursement for selected medications effect health outcomes, drug use and expenditures, and healthcare utilization? SUPPORT, 2016. http://dx.doi.org/10.30846/1608106.

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Restrictions on reimbursement are defined as insurance policies that restrict reimbursement for selected drugs or drug classes, often using additional patient specific information related to health status or need.
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Cantor, Amy, Heidi D. Nelson, Miranda Pappas, Chandler Atchison, Brigit Hatch, Nathalie Huguet, Brittny Flynn, and Marian McDonagh. Effectiveness of Telehealth for Women’s Preventive Services. Agency for Healthcare Research and Quality (AHRQ), June 2022. http://dx.doi.org/10.23970/ahrqepccer256.

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Objectives. To evaluate the effectiveness, use, and implementation of telehealth for women’s preventive services for reproductive healthcare and interpersonal violence (IPV), and to evaluate patient preferences and engagement for telehealth, particularly in the context of the coronavirus (COVID-19) pandemic. Data sources. Ovid MEDLINE®, CINAHL®, Embase®, and Cochrane CENTRAL databases (July 1, 2016, to March 4, 2022); manual review of reference lists; suggestions from stakeholders; and responses to a Federal Register Notice. Review methods. Eligible abstracts and full-text articles of telehealth interventions were independently dual reviewed for inclusion using predefined criteria. Dual review was used for data abstraction, study-level risk of bias assessment, and strength of evidence (SOE) rating using established methods. Meta-analysis was not conducted due to heterogeneity of studies and limited available data. Results. Searches identified 5,704 unique records. Eight randomized controlled trials, one nonrandomized trial, and seven observational studies, involving 10,731 participants, met inclusion criteria. Of these, nine evaluated IPV services and seven evaluated contraceptive care, the only reproductive health service studied. Risk of bias was low in one study, moderate in nine trials and five observational studies, and high in one study. Telehealth interventions were intended to replace usual care in 14 studies and supplement care in 2 studies. Delivery modes included telephone (5 studies), online modules (5 studies), and mobile applications (1 study), and was unclear or undefined in five studies. There were no differences between telehealth interventions to supplement contraceptive care and comparators for rates of contraceptive use, sexually transmitted infection, and pregnancy (low SOE); evidence was insufficient for abortion rates. There were no differences between telehealth IPV services versus comparators for outcomes measuring repeat IPV, depression, post-traumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). The COVID-19 pandemic increased telehealth utilization. Barriers to telehealth interventions included limited internet access and digital literacy among English-speaking IPV survivors, and technical challenges and confidentiality concerns for contraceptive care. Telehealth use was facilitated by strategies to ensure safety of individuals who receive IPV services. Evidence was insufficient to evaluate access, health equity, or harms outcomes. Conclusions. Limited evidence suggests that telehealth interventions for contraceptive care and IPV services result in equivalent clinical and patient-reported outcomes as in-person care. Uncertainty remains regarding the most effective approaches for delivering these services, and how to best mobilize telehealth, particularly for women facing barriers to healthcare.
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Konnyu, Kristin J., Louise M. Thoma, Monika Reddy Bhuma, Wagnan Cao, Gaelen P. Adam, Shivani Mehta, Roy K. Aaron, et al. Prehabilitation and Rehabilitation for Major Joint Replacement. Agency for Healthcare Research and Quality (AHRQ), November 2021. http://dx.doi.org/10.23970/ahrqepccer248.

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Objectives. This systematic review evaluates the rehabilitation interventions for patients who have undergone (or will undergo) total knee arthroplasty (TKA) or total hip arthroplasty (THA) for the treatment of osteoarthritis. We addressed four Key Questions (KQs): comparisons of (1) rehabilitation prior (“prehabilitation”) to TKA versus no prehabilitation, (2) comparative effectiveness of different rehabilitation programs after TKA, (3) prehabilitation prior to THA versus no prehabilitation, (4) comparative effectiveness of different rehabilitation programs after THA. Data sources and review methods. We searched Medline®, PsycINFO®, Embase®, the Cochrane Register of Clinical Trials, CINAHL®, Scopus®, and ClinicalTrials.gov from Jan 1, 2005, to May 3, 2021, to identify randomized controlled trials (RCTs) and adequately adjusted nonrandomized comparative studies (NRCSs). We evaluated clinical outcomes selected with input from a range of stakeholders. We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. Meta-analysis was not feasible, and evidence was synthesized and reported descriptively. The PROSPERO protocol registration number is CRD42020199102. Results. We found 78 RCTs and 5 adjusted NRCSs. Risk of bias was moderate to high for most studies. • KQ 1: Compared with no prehabilitation, prehabilitation prior to TKA may increase strength and reduce length of hospital stay (low SoE) but may lead to comparable results in pain, range of motion (ROM), and activities of daily living (ADL) (low SoE). There was no evidence of an increased risk of harms due to prehabilitation (low SoE). • KQ 2: Various rehabilitation interventions after TKA may lead to comparable improvements in pain, ROM, and ADL (low SoE). Rehabilitation in the acute phase (initiated within 2 weeks of surgery) may lead to increased strength (low SoE) but result in similar strength when delivered in the post-acute phase (low SoE). No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period following TKA. Compared with various controls, post-acute rehabilitation may not increase the risk of harms (low SoE). • KQ 3: For all assessed outcomes, there is insufficient (or no) evidence addressing the comparison between prehabilitation and no prehabilitation prior to THA. • KQ 4: Various rehabilitation interventions after THA may lead to comparable improvements in pain, strength, ADL, and quality of life. There is some evidence of no increased risk of harms due to the intervention (low SoE). • There is insufficient evidence regarding which patients may benefit from (p)rehabilitation for all KQs and insufficient evidence regarding comparisons of different providers and different settings of (p)rehabilitation for all KQs. There is insufficient evidence on costs of (p)rehabilitation and no evidence on cost effectiveness for all KQs. Conclusion. Despite the large number of studies found, the evidence regarding various prehabilitation programs and comparisons of rehabilitation programs for TKA and THA is ultimately sparse. This is a result of the diversity of interventions studied and outcomes reported across studies. As a result, the evidence is largely insufficient or of low SoE. New high-quality research is needed, using standardized intervention terminology and core outcome sets, especially to allow network meta-analyses to explore the impact of intervention attributes on patient-reported, performance-based, and healthcare-utilization outcomes.
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