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Scott, Ian A., Clair Sullivan, and Andrew Staib. "Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation." Australian Health Review 43, no. 3 (2019): 302. http://dx.doi.org/10.1071/ah17153.
Анотація:
Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.
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Ryan, Benjamin, Richard Franklin, Frederick Burkle, Erin Smith, Peter Aitken, and Peter Leggat. "Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster." Prehospital and Disaster Medicine 34, s1 (May 2019): s47—s48. http://dx.doi.org/10.1017/s1049023x19001122.
Анотація:
Introduction:Natural disasters often damage the public health infrastructure required to maintain the wellbeing of people with noncommunicable diseases. This increases the risk of an acute exacerbation or complications, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of noncommunicable diseases will continue, if not increase, due to an increasing disease prevalence, sustained rise in the frequency and intensity of disasters, and rapid unsustainable urbanization in disaster-prone areas. However, the traditional focus of public health and disaster systems remains on communicable diseases, despite a low risk. There is now an urgent need to expand the public health response to include noncommunicable diseases.Aim:To explore the key influences on patient ability to successfully manage their noncommunicable disease after a natural disaster.Methods:A survey of people with noncommunicable diseases in Queensland, Australia, collected data on demographics, disease/condition, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with Bonferroni-adjustment were used to analyze data.Results:There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue and shortness of breath were common concerns for all noncommunicable diseases. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.Discussion:The key influences on successful self-management post disaster for people with noncommunicable diseases must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
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Ryan, Benjamin J., Richard C. Franklin, Frederick M. Burkle, Erin C. Smith, Peter Aitken, and Peter A. Leggat. "Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster." Prehospital and Disaster Medicine 34, no. 03 (May 13, 2019): 241–50. http://dx.doi.org/10.1017/s1049023x1900431x.
Анотація:
AbstractIntroduction:Natural disasters often damage or destroy the protective public health service infrastructure (PHI) required to maintain the health and well-being of people with noncommunicable diseases (NCDs). This interruption increases the risk of an acute exacerbation or complication, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of NCDs will continue, if not increase, due to an increasing prevalence and sustained rise in the frequency and intensity of disasters, along with rapid unsustainable urbanization in flood plains and storm-prone coastal zones. Despite this, the focus of disaster and health systems preparedness and response remains on communicable diseases, even when the actual risk of disease outbreaks post-disaster is low, particularly in developed countries. There is now an urgent need to expand preparedness and response beyond communicable diseases to include people with NCDs.Hypothesis/Problem:The developing evidence-base describing the risk of disaster-related exacerbation of NCDs does not incorporate the perspectives, concerns, and challenges of people actually living with the conditions. To help address this gap, this research explored the key influences on patient ability to successfully manage their NCD after a natural disaster.Methods:A survey of people with NCDs in Queensland, Australia collected data on demographics, disease, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with a Bonferroni-adjustment were used to analyze data.Results:There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue, and shortness of breath were common concerns for all patients with NCDs. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.Conclusion:The key influences on successful self-management post-disaster for people with NCDs must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
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Marsden, Dianne Lesley, Kerry Boyle, Louise-Anne Jordan, Judith Anne Dunne, Jodi Shipp, Fiona Minett, Amanda Styles, et al. "Improving Assessment, Diagnosis, and Management of Urinary Incontinence and Lower Urinary Tract Symptoms on Acute and Rehabilitation Wards That Admit Adult Patients: Protocol for a Before-and-After Implementation Study." JMIR Research Protocols 10, no. 2 (February 4, 2021): e22902. http://dx.doi.org/10.2196/22902.
Анотація:
Background Urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are commonly experienced by adult patients in hospitals (inpatients). Although peak bodies recommend that health services have systems for optimal UI and LUTS care, they are often not delivered. For example, results from the 2017 Australian National Stroke Audit Acute Services indicated that of the one-third of acute stroke inpatients with UI, only 18% received a management plan. In the 2018 Australian National Stroke Audit Rehabilitation Services, half of the 41% of patients with UI received a management plan. There is little reporting of effective inpatient interventions to systematically deliver optimal UI/LUTS care. Objective This study aims to determine whether our UI/LUTS practice-change package is feasible and effective for delivering optimal UI/LUTS care in an inpatient setting. The package includes our intervention that has been synthesized from the best-available evidence on UI/LUTS care and a theoretically informed implementation strategy targeting identified barriers and enablers. The package is targeted at clinicians working in the participating wards. Methods This is a pragmatic, real-world, before- and after-implementation study conducted at 12 hospitals (15 wards: 7/15, 47% metropolitan, 8/15, 53% regional) in Australia. Data will be collected at 3 time points: before implementation (T0), immediately after the 6-month implementation period (T1), and again after a 6-month maintenance period (T2). We will undertake medical record audits to determine any change in the proportion of inpatients receiving optimal UI/LUTS care, including assessment, diagnosis, and management plans. Potential economic implications (cost and consequences) for hospitals implementing our intervention will be determined. Results This study was approved by the Hunter New England Human Research Ethics Committee (HNEHREC Reference No. 18/10/17/4.02). Preimplementation data collection (T0) was completed in March 2020. As of November 2020, 87% (13/15) wards have completed implementation and are undertaking postimplementation data collection (T1). Conclusions Our practice-change package is designed to reduce the current inpatient UI/LUTS evidence-based practice gap, such as those identified through national stroke audits. This study has been designed to provide clinicians, managers, and policy makers with the evidence needed to assess the potential benefit of further wide-scale implementation of our practice-change package. International Registered Report Identifier (IRRID) DERR1-10.2196/22902
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KANE, SISTER. "Hospital Strategies for Contracting with Managed Care Plans." AORN Journal 48, no. 2 (August 1988): 369–70. http://dx.doi.org/10.1016/s0001-2092(07)68859-0.
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Mozaffari, Essy, and Sean D. Sullivan. "Home care reimbursement for intravenous ganciclovir therapy." American Journal of Health-System Pharmacy 53, no. 2 (January 15, 1996): 161–63. http://dx.doi.org/10.1093/ajhp/53.2.161.
Анотація:
Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing ageiicies, 22 served patients covered by managed care or state assistance that reimbursed on a per diem trasis, and 9 did not provide care to fee-for-service patients. The mean total daily-reimbursement rate (for ganciclovir, supplies, and nursing services) from managed care per diem plans was $137.69 per patient, compared with $I29.18 from fee-for-service plans and $72.68 from state assistance per diem plans. The dissimilarity may have been due to geographic variations in reimbursement and different mechanisms of reimbursement. Providers of home i.v. ganciclovir therapy for persons with CMV retinitis received the highest tnean total daily reimbursement from managed care per diem plans, followed by fee-for-service plans and state assistance per diem plans.
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Havighurst, Clark C. "Vicarious Liability: Relocating Responsibility For The Quality Of Medical Care." American Journal of Law & Medicine 26, no. 1 (2000): 7–29. http://dx.doi.org/10.1017/s0098858800010807.
Анотація:
AbstractManaged health care has recently generated a great deal of distrust, even anger, in the public mind. To be sure, much of this public reaction is based on anecdotal evidence and one-dimensional thinking. But many unbiased experts observing managed care today are themselves unhappy with the health care industry's performance. While these observers find little justification for the current political backlash against managed care, they are also disappointed that today's health plans have not made a more positive difference. Indeed, informed observers commonly regret that the new arrangements for the financing and delivery of care have done so little to get physicians to adopt truly efficient practices, achieving not only cost reductions but also substantial improvements in health status and patient outcomes— that is, in the quality of care. Although managed care has not demonstrably harmed the overall quality of health care in the United States, it has done little to improve it.
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Aledort, Louis M., and James Coates. "Can Health Care Plans Afford Hemophilia Costs? Yes." Blood 106, no. 11 (November 16, 2005): 5551. http://dx.doi.org/10.1182/blood.v106.11.5551.5551.
Анотація:
Abstract Hemophilia care has high annual recurring costs. 80–90% of these costs are to cover replacement therapy. Managed care programs have, in general, not recruited specialists to help determine the guidelines of care, the use of hemophilia treatment centers (HTC) by their patients or the multiple sources and charges for acquiring these expensive biologics. Aetna has 700–750 hemophilia patients in a typical year whose medical costs are upward of $60 million. These patients represent only.005% of the total membership, and 0.198% of the health care dollars spent. A hemophilia specialist was asked to evaluate these patients vis-á-vis site of care, optimal treatment plan, and potential savings for covered members, payers and employers. Methods: working with the Aetna nurse case managers, individual patients were evaluated for the above issues. Results: From June 2004 to June 2005, 190 patient files were reviewed. Of these, 18% had lifetime caps, and 30% were not treated in an HTC. 16% of these patients decided to transfer to an HTC for either their care or product procurement. The remainder decided not to pursue this path. Table I Patients Issue 1) 4.5 % Altered regimen, product or product procurement 2) 3 % Contemplating altered regimen, product or product procurement 3) 17 % Physician contacted regarding optimal therapy 4) 9.5 % Prices of product negotiated downward 5) 12 % Product procurement switch to PHS pricing 6) 3 % Adhering to previous regimen Table II $ Savings (using above categories) Real Potential 1) 2,978,028 2) --- 353,972 3) 0 4) 1,157,504 5) 4,334,523 6) --- 1,904,360 Total 8,470,055 2,258,332 The potential savings represent those who are either contemplating change but, in the main, are physicians and/or patients who chose not to accept the recommendations made. Realized annualized savings of more than $8 million affect all aspects of the care system. It is particularly revelant to those with lifetime caps. If this model were expanded for other high cost disorders, medical expenses could diminish and premium inflation could eventually decrease. Hemophilia biologics have continued to increase in costs from cryoprecipitate in the 1960s to current recombinant products. Fostering access to HTCs substantially improves quality of care and reduces medical expenditures. In conclusion, we believe that by using this approach, hemophilia care and its costs can be appropriately managed.
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Furst, Daniel E. "Measuring the impact of managed care plans on the use of biologics." Arthritis & Rheumatism 53, no. 3 (2005): 318–19. http://dx.doi.org/10.1002/art.21168.
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Latham, Stephen R. "Regulation of Managed Care Incentive Payments to Physicians." American Journal of Law & Medicine 22, no. 4 (1996): 399–432. http://dx.doi.org/10.1017/s0098858800011904.
Анотація:
A large and growing number of physicians in today’s managed care market are paid for their services according to incentive schemes that offer financial rewards for the provision of less, and less expensive, medical care. Such schemes typically reward physicians for reducing their own costs of care and reward primary care physicians for reducing the number and cost of referrals for inpatient and specialty care. Consumers, fearful that such schemes will prompt physicians to deny them medically necessary care, have protested the implementation of such incentive plans. Various states are considering bills to ban or to limit physician incentive payments.Federal policy with regard to incentive schemes has been confused and contradictory. On one hand, regulators concerned with controlling health care costs and limiting the provision of unnecessary care have encouraged such financial incentives. For example, federal Stark regulations, which ban referrals tied to physician compensation, include explicit exceptions for incentive schemes.
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Duckett, Stephen. "The new market in health care:Prospects for managed care in Australia." Australian Health Review 19, no. 2 (1996): 7. http://dx.doi.org/10.1071/ah960007.
Анотація:
Most developed countries are experimenting, or moving at full speed, to implementnew forms of health delivery based in part on capitation arrangements and strongeraccountability of health service providers. Proposals for introduction of capitation ormanaged care have been advanced in Australia but have attracted strong oppositionfrom the medical profession. This paper reviews the policy issues surrounding theintroduction of managed care, including how Australia?s current institutional formsmay evolve into managed care provision.
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Allen, Shari N., and Mebanga Ojong-Salako. "Pharmacist-Initiated Prior Authorization Process to Improve Patient Care in a Psychiatric Acute Care Hospital." Journal of Pharmacy Practice 28, no. 1 (December 10, 2014): 31–34. http://dx.doi.org/10.1177/0897190014562383.
Анотація:
A prior authorization (PA) is a requirement implemented by managed care organizations to help provide medications to consumers in a cost-effective manner. The PA process may be seen as a barrier by prescribers, pharmacists, pharmaceutical companies, and consumers. The lack of a standardized PA process, implemented prior to a patient’s discharge from a health care facility, may increase nonadherence to inpatient prescribed medications. Pharmacists and other health care professionals can implement a PA process specific to their institution. This article describes a pharmacist-initiated PA process implemented at an acute care psychiatric hospital. This process was initiated secondary to a need for a standardized process at the facility. To date, the process has been seen as a valuable aspect to patient care. Plans to expand this process include collecting data with regards to adherence and readmissions as well as applying for a grant to help develop a program to automate the PA program at this facility.
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Andrade, Susan E., and Cynthia Willey. "H2 Receptor Antagonist use Among Medicaid Patients Enrolled in Managed Care Health Plans." Clinical Research and Regulatory Affairs 15, no. 3-4 (January 1998): 131–44. http://dx.doi.org/10.3109/10601339809109191.
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Kinney, Eleanor D. "The Brave New World of Medical Standards of Care." Journal of Law, Medicine & Ethics 29, no. 3-4 (2001): 323–34. http://dx.doi.org/10.1111/j.1748-720x.2001.tb00351.x.
Анотація:
There have always been medical standards of care in the American health-care sector. However, never before have they been so deeply incorporated in the delivery of health care as they are today. With the increased delivery of care through integrated delivery systems, as well as the development of the computerized patient record, medical standards of care are now used in innovative ways by providers and health plans in delivering health care to individual patients. There is great potential for even more innovative uses of medical standards of care in the future.This article first presents a taxonomy of the medical standards of care that are involved in health-care delivery today Next, the article traces the historical evolution of medical standards of care since the early 1980s. Included in this discussion are the origins of the standard-setting movement as well as the developments that led to the way standards of care are currently used by large institutional providers and managed care plans to improve the quality of their health-care services. The article concludes with a brief analysis of the key legal issues that affect how standards of care can be used to improve the health care of patients.
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Thiel de Bocanegra, Heike, Alia McKean, Philip Darney, Erin Saleeby, and Denis Hulett. "Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care." Health Services Research and Managerial Epidemiology 5 (January 1, 2018): 233339281774887. http://dx.doi.org/10.1177/2333392817748870.
Анотація:
Context: Clinical guidelines recommend the documentation of pregnancy intention and family planning needs during primary care visits. Prior to the 2014 Medicaid expansion and release of these guidelines, the documentation practices of Medicaid managed care providers are unknown. Methods: We performed a chart review of 1054 Medicaid managed care visits of women aged 13 to 49 to explore client, provider, and visit characteristics associated with documentation of immediate or future plans for having children and contraceptive method use. Five managed care plans used Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes to identify providers with at least 15 women who had received family planning or well-woman care in 2013. We conducted multilevel logistic regression analyses with documentation of contraceptive method and pregnancy intention as outcome variables and clinic site as the level 2 random effect. Results: Only 12% of charts had documentation of pregnancy intention and 59% documented contraceptive use. Compared to women with a family planning visit reason, women with an annual, reproductive health, or primary care reason for their visit were significantly less likely to have contraception documented (odds ratio [OR] = 11.0; 95% confidence interval [CI] = 6.8-17.7). Age was also a significant predictor with women aged 30 to 49 (OR = 0.6; 95% CI = 0.4-0.9), and women aged 13 to 19 (OR = 0.2; 95% CI = 0.1-0.6) being less likely to have a note about pregnancy intention in their chart. Pregnancy intention was more likely to be documented in multispecialty clinics (OR = 15.5; 95% CI = 2.7-89.2). Conclusions: Interventions to improve routine medical record documentation of contraception and pregnancy intention regardless of patient age and visit characteristics are needed to facilitate the provision of family planning in managed care visits and, ultimately, achieving better maternal infant health outcomes and reduced costs.
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Blum, John D. "The Evolution of Physician Credentialing into Managed Care Selective Contracting." American Journal of Law & Medicine 22, no. 2-3 (1996): 173–203. http://dx.doi.org/10.1017/s0098858800007814.
Анотація:
In a field littered with analogies, health care in the mid-nineties is best characterized as an enterprise caught in the violent cross winds of a tropical storm known as managed care. Like a series of hurricanes, managed care has reshaped the landscape of health care delivery in drastic and unpredictable ways. While the forces of managed care have increasingly altered more health care markets, others are only beginning to feel the winds of change. As managed care overtakes fee-for-service (FFS) medicine, profound alterations in health delivery are occurring which affect every aspect of American health care.Particularly noteworthy is the use of capitation as a primary method of reimbursement. The ramifications of capitated health care are broad and warrant exploration from several vantage points. One basic concern in capitated health plans and managed care is the effect of new payment incentives on physician evaluation for purposes of credentialing. This Article focuses on managed care credentialing—the process of appointing, reappointing, and delineating clinical privileges—from a legal perspective. While the Article centers on the link between capitation and credentialing, it has broader applicability in that the same physician evaluation mechanisms in capitated settings are found in discounted FFS arrangements as well. The piece provides a brief overview of capitation and credentialing, and a discussion of trends that have altered hospital medical staff credentialing processes.
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Reilly, M. "(P2-78) Creating Alternate Care Sites and Community-Based Care Centers for the Delivery of Medical Care During Public Health Emergencies." Prehospital and Disaster Medicine 26, S1 (May 2011): s161. http://dx.doi.org/10.1017/s1049023x1100522x.
Анотація:
IntroductionDeveloping alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites or community-based care centers which can serve as areas for primary screening and triage or short-term medical treatment can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Additionally, if planned for correctly these facilities can also be used to decant less critical patients from inpatient wards thereby increasing the surge capacity of acute care hospitals.MethodsA model concept of operations plan for alternate care sites to be used during pandemics and large-scale public health emergencies was developed over a 3 year period, 2007–2010. Subject matter experts were convened and best-practice methods were used to design operational plans, clinical protocols, modified standards of care, and checklists for facilities appropriate to locate such a facility. This model plan was designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting and then ultimately return to their homes for convalescence, following a public health emergency where regional surge capacity had been exceeded.ResultsOver three years of interagency, comprehensive planning, training and review was conducted to create the model alternate care site/community-based care center concept of operations plan. Accomplishments and milestones included: Creating stakeholders, engaging community partners, site selection, staffing issues, detailed medical protocols and clinical pathways, functional role development, equipment and supplies, site security, media and communications plans, designing training programs and conducting drills and exercises.ConclusionThe key tenets of the concept, planning, operation and demobilization of an alternate care site or community-based care center will be discussed in this session. Participants will learn what has worked based on our planning experience. Lessons learned and best-practices developed in our program will be presented to assist attendees in beginning or continuing the process of creating surge capacity in the out-of-hospital setting, by planning to operate alternate care sites in their local areas.
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Offei-nkansah, Gerald, and Lindsey B. Amerine. "Conversion from paper to electronic acute care chemotherapy orders." American Journal of Health-System Pharmacy 77, no. 18 (July 23, 2020): 1516–21. http://dx.doi.org/10.1093/ajhp/zxaa201.
Анотація:
Abstract Purpose UNC Medical Center converted to an electronic health record (EHR) in 2014. This conversion allowed for the transition of paper chemotherapy orders to be managed electronically. This article describes the process for converting inpatient paper chemotherapy orders into the new EHR in a safe and effective manner. Summary A collaborative interdisciplinary approach to the EHR transition enabled our organization to move from using paper chemotherapy orders to fully electronic chemotherapy treatment plans in both ambulatory and acute care areas. Active chemotherapy orders for acute care inpatients were reviewed and transcribed by two oncology pharmacists in the cancer hospital prior to being signed by an attending physician. The newly input orders were independently verified by two pharmacists in the cancer hospital inpatient pharmacy. Nurse review of the signed and verified treatment plans, along with reconciliation of the medication administration record ensured a safe transition to the new EHR workflow. Providers benefit from the ability to review treatment plans remotely, track changes, and include supportive medications in one consolidated location. The coordinated team effort allowed for a smooth transition with minimal interruptions to patient care. Conclusion The pharmacist-led, multidisciplinary conversion to electronic chemotherapy orders was safe, accurate, and occurred ahead of schedule for the EHR go-live. Advance communication and planning around scheduled inpatient admissions helped to minimize the impact of the transition from paper to electronic treatment plans. Both pharmacist and physician engagement were necessary to ensure a smooth transition for active inpatient treatment plans.
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Collen, M. F. "Historical Evolution of Preventive Medical Informatics in the USA." Methods of Information in Medicine 39, no. 03 (2000): 204–7. http://dx.doi.org/10.1055/s-0038-1634344.
Анотація:
AbstractA major reorganization of healthcare services is occurring in the United States. It has evolved from the solo- and group-practice models of the 1940s with fee-for-service and insurer-indemnification financing that used paper-based information systems to support preventive medical services. In the 1990s there emerged nation-wide, managed-care plans employing enhanced computer-based information systems with online preventive medical practice guidelines and Internet-supported home-care telemedicine. It is helpful to review how this major reengineering of medicine has come about.
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Akinci, F., and T. Sinay. "Perceived access in a managed care environment: determinants of satisfaction." Health Services Management Research 16, no. 2 (May 1, 2003): 85–95. http://dx.doi.org/10.1258/095148403321591401.
Анотація:
With increasing competition in the local and regional healthcare markets, and growing interest in assessing the effectiveness of services and patient outcomes, satisfaction measures are becoming prominent in evaluating the performance of the healthcare system. This study examines the independent effect of predisposing, enabling and medical need factors on perceived access to care with particular focus on insurance plans. A survey questionnaire is developed to investigate access limitations at three levels: (1) the health plan, (2) the individual provider(s) and (3) the healthcare organization. In addition, shortage of providers, residents' perceptions of their health status, satisfaction with access to care and socio-demographic indicators are incorporated into the analysis. Multivariate logistic regression is used to assess the independent effects of the above factors on a dichotomous dependent variable - residents' overall satisfaction with access to healthcare services. The most salient determinants of overall satisfaction with access to care were the type of health insurance plan, cost of insurance premiums, co-payments, difficulty with obtaining referrals, self-rated general health, the opportunity cost of taking time to see a provider (measured by the loss of hourly wages), marital status and the age factor over 80 years.
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Ramsey, Scott D., Alan L. Hillman, and Mark V. Pauly. "The Effects of Health Insurance on Access to New Medical Technologies." International Journal of Technology Assessment in Health Care 13, no. 2 (1997): 357–67. http://dx.doi.org/10.1017/s0266462300010412.
Анотація:
AbstractWe examined the use of percutaneous transluminal coronary angioplasty, kidney stone lithotripsy, and bone marrow transplant among patients with different health insurance plans in California. HMO enrollees were less likely to receive these procedures compared with fee-for-service patients. Our results have implications for the inflationary effects of technology under managed care.
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Rosen, Amy K., and Allison Mayer-Oakes. "Developing a Tool for Analyzing Medical Care Utilization of Adult Asthma Patients in Indemnity and Managed Care Plans: Can an Episodes of Care Framework Be Used?" American Journal of Medical Quality 13, no. 4 (December 1998): 203–12. http://dx.doi.org/10.1177/106286069801300406.
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Furrow, Barry R. "The Problem of Medical Misadventures: A Review of E. Haavi Morreim's Holding Health Care Accountable." Journal of Law, Medicine & Ethics 29, no. 3-4 (2001): 381–93. http://dx.doi.org/10.1111/j.1748-720x.2001.tb00355.x.
Анотація:
Health-care provider liability has again taken center stage in American political debate, but with an ironic twist. In the seventies, physicians wanted tort reform, but they measured such reform solely by a reduction in both the risk of being sued and the size of any judgment a plaintiff could win. Malpractice reforms in many states in the seventies therefore capped damages, reduced contingency awards to lawyers, and restricted other tort rules to limit plaintiff success. Today physicians are conflicted. They want an increase in liability exposure — not for themselves, but for managed care plans. We have therefore ended up with a series of overlapping debates, with the same debaters taking contradictory positions. Should managed care organizations—until now protected by ERISA preemption from liability—be liable? Physicians say yes. But should physicians be protected from the threat of suit, which they argue acts as an in terrorem device that drives disclosure of medical errors into hiding?
24
Shephard, Mark, Anne Shephard, Susan Matthews, and Kelly Andrewartha. "The Benefits and Challenges of Point-of-Care Testing in Rural and Remote Primary Care Settings in Australia." Archives of Pathology & Laboratory Medicine 144, no. 11 (October 27, 2020): 1372–80. http://dx.doi.org/10.5858/arpa.2020-0105-ra.
Анотація:
Context.— Point-of-care (POC) testing has significant potential application in rural and remote Australian communities where access to laboratory-based pathology testing is often poor and the burden of chronic, acute, and infectious disease is high. Objective.— To explore the clinical, operational, cultural, and cost benefits of POC testing in the Australian rural and remote health sector and describe some of the current challenges and limitations of this technology. Data Sources.— Evidence-based research from established POC testing networks for chronic, acute, and infectious disease currently managed by the International Centre for Point-of-Care Testing at Flinders University are used to highlight the experience gained and the lessons learned from these networks and, where possible, describe innovative solutions to address the current barriers to the uptake of POC testing, which include governance, staff turnover, maintaining training and competency, connectivity, quality testing, sustainable funding mechanisms, and accreditation. Conclusions.— Point-of-care testing can provide practical and inventive opportunities to revolutionize the delivery of pathology services in rural and remote sectors where clinical need for this technology is greatest. However, many barriers to POC testing still exist in these settings, and the full potential of POC testing cannot be realized until these limitations are addressed and resolved.
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Nicholas, Lauren Hersch. "Better Quality of Care or Healthier Patients? Hospital Utilization by Medicare Advantage and Fee-for-Service Enrollees." Forum for Health Economics and Policy 16, no. 1 (January 1, 2013): 137–61. http://dx.doi.org/10.1515/fhep-2012-0037.
Анотація:
Abstract Do differences in rates of use among managed care and Fee-for-Service Medicare beneficiaries reflect selection bias or successful care management by insurers? I demonstrate a new method to estimate the treatment effect of insurance status on health care utilization. Using clinical information and risk-adjustment techniques on data on acute admission that are unrelated to recent medical care, I create a proxy measure of unobserved health status. I find that positive selection accounts for between one-quarter and one-third of the risk-adjusted differences in rates of hospitalization for ambulatory care sensitive conditions and elective procedures among Medicare managed care and Fee-for-Service enrollees in 7 years of Healthcare Cost and Utilization Project State Inpatient Databases from Arizona, Florida, New Jersey and New York matched to Medicare enrollment data. Beyond selection effects, I find that managed care plans reduce rates of potentially preventable hospitalizations by 12.5 per 1000 enrollees (compared to mean of 46 per 1000) and reduce annual rates of elective admissions by 4 per 1000 enrollees (mean 18.6 per 1000).
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Hotz, PhD, Gillian A., Zakiya B. Moyenda, MD, MBA, Jerry Bitar, MD, Marlon Bitar, MD, Henri R. Ford, MD, Barth A. Green, MD, David M. Andrews, MD, and Enrique Ginzburg, MD. "Developing a trauma critical care and rehab hospital in Haiti: A year after the earthquake." American Journal of Disaster Medicine 7, no. 4 (September 1, 2012): 273–79. http://dx.doi.org/10.5055/ajdm.2012.0100.
Анотація:
Objective: Prior to the devastating earthquake in Haiti, January 12, 2010, a group of Haitian physicians, leaders and members of Project Medishare for Haiti, a Nongovernmental Organization, had developed plans for a Trauma Critical Care Network for Haiti.Design: One year after the earthquake stands a 50-bed trauma critical care and rehab hospital that employs more than 165 Haitian doctors, nurses and allied healthcare professionals, and administrative and support staff in Port-Au-Prince. Hospital Bernard Mevs Project Medishare (HBMPM) has been operating with the following two primary goals: 1) to provide critical- care- and trauma-related medical and rehabilitation services and 2) to provide clinical education and training to Haitian healthcare professionals.1Results: These goals have been successfully accomplished, with more than 43,000 outpatients seen, 6,500 emergency room visits, and about 2,300 surgical procedures performed. Daily patient care has been managed by Haitian medical staff as well as more than 2,400 international volunteers including physicians, nurses, and allied healthcare professionals.With the continued assistance of weekly volunteers, many programs and services have been developed; however, many challenges remain.Conclusions: This article highlights the development and progress of HBMPM over the last year with emphasis on developing inpatient and outpatient services, which include surgical, clinical laboratory, wound care, radiology, rehabilitation, and prosthesis/orthotics programs. Some of the challenges faced and how they were managed will be discussed as well as future plans to conduct more training and education to increase the building of medical capacity for Haiti.
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Mayes, Rick, and Robert E. Hurley. "Pursuing cost containment in a pluralistic payer environment: from the aftermath of Clinton's failure at health care reform to the Balanced Budget Act of 1997." Health Economics, Policy and Law 1, no. 3 (June 2, 2006): 237–61. http://dx.doi.org/10.1017/s1744133106003033.
Анотація:
Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton's attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation's convoluted health care system that could be (and was) eliminated through competitive negotiations between medical providers and insurers, employers, or managed care organizations. One of our primary arguments in this article is that managed care operated partly as a systematic suppression of price discrimination or differential pricing (often referred to as ‘cost shifting’), as managed care organizations qua purchasing agents prevented hospitals and physicians from summarily raising prices to private payers to meet their financial requirements. Over time, however, managed care fell victim to inflated expectations, its own initial success, and larger fiscal forces. During this same period, Republicans and Democrats struggled to reach a consensus over the future direction of Medicare. Their disagreements contributed to the impasse over budget policy in 1995 and the infamous partial federal government shutdown. After President Clinton's reelection in 1996, partisan disagreements over Medicare dissipated. And, in 1997, Congress and the president passed the Balanced Budget Act of 1997, which emerged as a massive piece of patchwork legislation that sought to balance the federal budget, rein in Medicare spending, and increase the number of the programme's beneficiaries in private health plans.
28
de Loor, Sanne, and Tiny Jaarsma. "Nurse-Managed Heart Failure Programmes in the Netherlands." European Journal of Cardiovascular Nursing 1, no. 2 (June 2002): 123–29. http://dx.doi.org/10.1016/s1474-51510200007-5.
Анотація:
Heart failure (HF) care in Europe is going through a lot of changes. Nurses have increasingly important roles in providing optimal care for these chronically ill patients in the Netherlands. The first steps to organise HF nurses have been taken and an overview of HF management programmes in Netherlands has been recently made available. A descriptive study was performed consisting of: (1) a screening phase in which all hospitals ( n=109) and 105 home care organisations were approached by telephone to assess availability of HF management programmes and (2) a questionnaires in which content and organisation of the programmes were described. At the moment, the majority of all the hospitals (75%) have, or are currently developing a HF management programme. In 19 home care organisations (18%) a programme was available and 3 organisations had concrete plans to start on short notice. Components of HF programmes differ considerably, with follow-up after discharge from the hospital as the most often reported component. Other components of programmes include patient education, increased access to health care professionals and adjusting medication. Exercise programmes are not often available. Organisational aspects in regard to setting, financing and staffing also differ between various programmes. It was concluded that there is a considerable increase in the number of HF management programmes in the Netherlands, both hospital based and home based. A lot of questions in regard to the most optimal content and the organisation of HF management programmes remain unanswered.
29
Davison, Tanya E., John Snowdon, Nathan Castle, Marita P. McCabe, David Mellor, Gery Karantzas, and Janelle Allan. "An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities." International Psychogeriatrics 24, no. 4 (December 5, 2011): 631–41. http://dx.doi.org/10.1017/s1041610211002146.
Анотація:
ABSTRACTBackground: Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression.Methods: A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facility managers took part in an interview to determine barriers to the effective implementation of the instrument.Results: The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9–13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change.Conclusions: The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.
30
O'Hara, Rebecca, Heather Rowe, Louise Roufeil, and Jane Fisher. "Should endometriosis be managed within a chronic disease framework? An analysis of national policy documents." Australian Health Review 42, no. 6 (2018): 627. http://dx.doi.org/10.1071/ah17185.
Анотація:
Objective The aim of this study was to determine whether endometriosis meets the definition for chronic disease in Australian policy documents. Methods A qualitative case study approach was used to thematically analyse the definitions contained in Australian chronic disease policy documents and technical reports. The key themes were then compared with descriptions of endometriosis in peer-reviewed literature, clinical practice guidelines and expert consensus statements. Results The search yielded 18 chronic disease documents that provided a definition or characteristics of chronic disease. The thematic analysis identified key elements of chronic diseases pertaining to onset, causation, duration, treatment, disease course and impact (individual and societal). A comparison with endometriosis descriptions indicated that endometriosis meets five of the six chronic disease key elements. Conclusion In Australia, long-term and complex conditions are managed within a chronic disease framework and include mechanisms such as chronic disease management plans (CDMPs) to assist with coordination and management of these conditions. Because endometriosis has most of the characteristics of chronic disease, it could potentially be reframed as a chronic disease in endometriosis clinical practice guidelines and consensus statements. Further, the use of CDMPs may provide a mechanism to promote individualised care and multidisciplinary management of this chronic, enigmatic and debilitating disease. What is known about the topic? In Australia, long-term complex diseases can be managed within a chronic disease framework that include mechanisms for coordinated care such as CDMPs and team care arrangements. Endometriosis is described as an inflammatory, progressive, relapsing and, for some women, debilitating condition, but is rarely described as a chronic disease in the clinical practice guidelines and consensus statements available in Australia. What does this paper add? Endometriosis shares most of the characteristics of a chronic disease so may benefit from chronic disease management systems such as CDMPs. What are the implications for practitioners? CDMPs may be a useful mechanism to coordinate and improve the effectiveness of care for women with endometriosis who experience sustained symptoms of endometriosis.
31
Watson, Sidney D. "Medicaid Physician Participation: Patients, Poverty, and Physician Self-Interest." American Journal of Law & Medicine 21, no. 2-3 (1995): 191–220. http://dx.doi.org/10.1017/s0098858800006316.
Анотація:
“They might as well say this is Communist Russia.” — Dr. James Kennedy, Franklin, Tennessee.Medicaid has failed in its mission to care for the poor because doctors refuse to participate in the program. New ways are needed to entice physicians to treat Medicaid patients. TennCare, Tennessee’s Medicaid managed care demonstration project, shows that managed care plans can induce physicians to treat the poor by creating substantial collective purchasing power and by conditioning access to middle class patients on treatment of the poor, thus appealing to physicians’ financial self-interest. TennCare shows a new and promising approach, no matter how vociferously physicians complain about it.TennCare, Tennessee’s Medicaid experiment, seeks to double Medicaid coverage in Tennessee—from approximately 750,000 people to 1.5 million. TennCare removes limits on Medicaid services, expands the medical services offered, and emphasizes low cost, cost-effective primary care. Perhaps most importantly, TennCare promises to mainstream health care for the poor by providing preventive and primary care in private physicians’ offices, moving the site of care away from expensive emergency rooms and hospitals. TennCare sounds like an ideal solution.
32
Hall, Mark A., and Carl E. Schneider. "Can Consumers Control Health-Care Costs?" Forum for Health Economics and Policy 15, no. 3 (September 10, 2012): 23–52. http://dx.doi.org/10.1515/fhep-2012-0008.
Анотація:
Abstract The ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today’s health policy watchword. This article evaluates consumerism and the regulatory mechanism of which it is essentially an example – legally mandated disclosure of information. We do so by assessing the crucial assumptions about human nature on which consumerism and mandated disclosure depend. Consumerism operates in a variety of contexts in a variety of ways with a variety of aims. To assess so protean a thing, we ask what a patient’s life would really be like in a consumerist world. The literature abounds in theories about how medical consumers should behave. We look for empirical evidence about how real people actually buy health plans, choose providers, and select treatments. We conclude that consumerism is unlikely to accomplish its goals. Consumerism’s prerequisites are too many and too demanding. First, consumers must have choices that include the coverage, care-takers, and care they want. Second, reliable information about those choices must be available. Third, information must be put before consumers in helpful ways, especially by doctors. Fourth, the information must be complete and comprehensible enough for consumers to use it. Fifth, consumers must understand what they are told. Sixth, consumers must actually analyze the information and do so well enough to make good choices. Our review of the empirical evidence concludes that these prerequisites cannot be met reliably most of the time. At every stage people encounter daunting hurdles. Like so many other dreams of controlling costs and giving patients control, consumerism is doomed to disappoint. This does not mean that consumerist tools should never be used. If all that consumerism accomplished is to raise general cost-consciousness among patients, still, it could make a substantial contribution to the larger cost-control efforts by insurers and the government. Once patients bear responsibility for much day-to-day spending on their health needs, they should be increasingly sensitized to the difficult trade-offs that abound in medical care and might even begin to understand that public and private health insurers have a legitimate interest in controlling medical spending.
33
McKenzie, Scott R., Patrick Lefebvre, Brahim K. Bookhart, François Laliberté, and Mei S. Duh. "Medical Visit Patterns in Cancer Chemotherapy Patients Receiving Erythropoiesis-Stimulating Agents in a Managed Care Setting." Blood 110, no. 11 (November 16, 2007): 5156. http://dx.doi.org/10.1182/blood.v110.11.5156.5156.
Анотація:
Abstract Background: Avoiding unnecessary medical visits related to erythropoiesis-stimulating agent (ESA) treatment represents an important consideration for managed-care organizations. Observational data have reported varying visit patterns for cancer chemotherapy patients receiving epoetin alfa (EPO) and darbepoetin alfa (DARB). Few studies have characterized visit patterns in this population during ESA treatment. Objective and Purpose: The objective of this analysis was to describe visit patterns and identify the proportion of medical visits made exclusively for ESA treatment in cancer chemotherapy patients. Methods: Analysis of medical claims between 1/2004–12/2005 using the Integrated Health Care Information Systems national database, representing >35 health plans, was conducted. Patients were ≥18 years old, had a cancer diagnosis, received >1 ESA administration, and concurrent chemotherapy (during or within 14 days of ESA initiation). Medical visits during the ESA treatment duration (time from first to last ESA administration) were categorized into mutually exclusive groups based on procedure codes recorded on the visit day: ESA administration, chemotherapy/radiotherapy administration, physician visit, blood count, WBC growth factor administration and other (hydration, antiemetics/antibiotics, etc). Results: 3,462 EPO and 2,839 DARB patients were identified representing 107,149 unique visits (EPO 62,785, DARB 44,364). Mean ESA treatment duration was similar between groups (Days: EPO 59.3; DARB 57.6, p=0.212). The proportion of visits were categorized into mutually exclusive service groups, presented below. Conclusion: Cancer chemotherapy patients receiving ESAs incurred visits for many reasons, but primarily for receiving chemotherapy. Less than 5% of all visits were solely related to ESA administration, regardless of ESA received. Table Service Group EPO DARB Chemotherapy 10.3% 12.2% Chemotherapy + ESA 24.9% 27.3% Physician visit 11.9% 12.5% Physician visit + ESA 13.0% 9.9% Blood count 1.1% 2.1% Blood count + ESA 10.1% 8.4% WBC growth factor 0.3% 0.5% WBC growth factor + ESA 5.9% 6.8% Other 15.9% 14.8% Other and ESA 2.6% 2.6% ESA only 4.1% 2.9% Total 100% 100%
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Quinn, Charlene C., Anthony Roggio, Barr Erik, and Ann Gruber-Baldini. "NURSING HOME TELEED INTERVENTION: ADVANCING NEW CARE MODELS." Innovation in Aging 3, Supplement_1 (November 2019): S337—S338. http://dx.doi.org/10.1093/geroni/igz038.1225.
Анотація:
Abstract New reimbursement and managed care models demonstrate the need to reduce avoidable Emergency Department (ED) use and limit preventable inpatient admissions for older adults in Skilled Nursing Facilities (SNF). The objective was to develop an ED telemedicine consultation intervention for SNF residents with acute medical problems. Secondary objectives including evaluation of health care utilization, provider satisfaction. Demonstration evaluation in three urban SNFs, telemedicine linked to university medical center ED. Mobile telemedicine cart equipment assessed SNF residents for any change in condition. ED physicians used tablets with secure access to conduct the resident assessment. Provider satisfaction measures imbedded in EMRs were completed at consultation visit end. 460 patients had changes in condition, 327 resulted in 911 calls, 85 deemed eligible for telemedicine consult. Conducted 57 telehealth consults. Forty (70%) telemedicine consult residents remained in the SNF. Fourteen residents were transferred to the ED. Average satisfaction scores were 5.8/7 for SNF nurses (n=49) and 5.6 for ED physicians (n=45). Lower-rated items related to technical equipment problems. ED physicians reported residents transferred to ED after telehealth visit had better continuity of care. The intervention was effective in preventing or delaying transfer of acutely ill, medically complex SNF residents. Implementation of the intervention identified need for SNF admission policy and procedure changes; weekly telemedicine training; SNF clinical advocates; on-site tracking and linkage of EMRs across providers; HIPAA shared medical record concerns. Future research plans include analyses of detailed SNF resident characteristics and business case assessment for reduction of transfers, ED and hospital utilization.
35
Dutch, Martin J., and Kristy B. Austin. "Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams." Prehospital and Disaster Medicine 27, no. 5 (July 19, 2012): 463–67. http://dx.doi.org/10.1017/s1049023x12000994.
Анотація:
AbstractIntroductionRecreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure.ObjectiveTo describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams.MethodsRetrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from January 2010 through May 2011.Main outcome measuresClinical presentation, medical interventions and discharge destination.ResultsSixty-one patients with GHB intoxication attended medical teams during the study period. The median age was 22 years, and 64% were male. Altered conscious state was present in 89% of attendances, and a GCS <9 in 44%. Hypotension, bradycardia and hypothermia were commonly encountered. Endotracheal intubation was required in three percent of patrons. Median length of stay onsite was 90 minutes. Ambulance transport to hospital was avoided in 65% of presentations.ConclusionsThe deployment of medical teams at dance events and music festivals successfully managed the majority of GHB intoxications onsite and avoided acute care ambulance transfer and emergency department attendance.DutchMJ,AustinKB.Hospital in the field: prehospital management of GHB intoxication by medical assistance teams.Prehosp Disaster Med.2012;27(4):1-5.
36
Menzin, Joseph, Luke Boulanger, Ole Hauch, Mark Friedman, Cheryl Beadle Marple, Gail Wygant, Judith S. Hurley, Stephen Pezzella, and Scott Kaatz. "Quality of Anticoagulation Control and Costs of Monitoring Warfarin Therapy among Patients with Atrial Fibrillation in Clinic Settings: A Multi-Site Managed-Care Study." Annals of Pharmacotherapy 39, no. 3 (March 2005): 446–51. http://dx.doi.org/10.1345/aph.1e169.
Анотація:
BACKGROUND: Warfarin is recommended for prevention of stroke in patients with atrial fibrillation who are at moderate or high risk, but requires intensive management to achieve safe and optimal anticoagulation control. Anticoagulation clinics are often used to administer warfarin therapy more effectively. OBJECTIVE: To collect data from multiple sites and assess the quality and costs associated with anticoagulation clinic services. METHODS: A random sample of 600 adults with chronic nonvalvular atrial fibrillation (CNVAF) receiving warfarin was selected from anticoagulation clinics affiliated with 3 health plans. Patients were identified between 1996 and 1998 and followed for up to one year. We assessed the proportion of time that international normalized ratio (INR) values were within the recommended range (2.0–3.0) and the costs of anticoagulation clinic care. RESULTS: Patients had an average of 18 clinic contacts over a mean duration of follow-up of 10.5 months. On average, patients were within the recommended INR range 62% of this time, with 25% of days below range and 13% above range. The mean per-patient cost of warfarin monitoring over the follow-up period averaged $261 at site A, $305 at site B, and $205 at site C (in 2003 US$). Mean costs for patients treated for one full year were $288, $339, and $216, respectively. CONCLUSIONS: In 3 geographically diverse health plans, anticoagulation clinics provided a generally higher quality of control than previously reported in other observational studies. This study highlights the costs of obtaining this level of control.
37
Omelyanovskiy, V. V., E. S. Saybel, T. P. Bezdenezhnykh, and G. R. Khachatryan. "The health technology assessment system in Australia." FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology 12, no. 4 (February 18, 2020): 333–41. http://dx.doi.org/10.17749/2070-4909.2019.12.4.333-341.
Анотація:
In Australia, the federal government is in charge of providing the health care to patients. The government agencies determine the list of reimbursable pharmaceuticals and medical services and also define the preferential categories of the population. The states and territories may have their own health care programs in addition to the federal ones. The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for the health technology assessment (HTA) and decides which technology is eligible for reimbursement by the federal budget. The drug evaluation process includes five stages: a review of general information about the product, assessment of its clinical efficacy, cost-effectiveness analysis, assessment of financial implications of including the drug in the reimbursement list, and consideration of any other factors that may influence the committee decision. In addition to the full reimbursement of pharmaceuticals, the committee may decide to provide funding based on a managed entry agreement.
38
Tripaydonis, Anne, and Rachel Conyers. "Adolescent survivor of childhood Acute Myeloid Leukaemia undertakes pregnancy with a severe anthracycline induced cardiomyopathy and risk taking behaviours." Case Reports in Internal Medicine 3, no. 4 (September 29, 2016): 64. http://dx.doi.org/10.5430/crim.v3n4p64.
Анотація:
A 16-year-old female survivor of childhood Acute Myeloid Leukaemia (AML) presented 12 weeks pregnant to her haematology oncology late effects appointment. Having failed to attend recent healthcare appointments her severe cardiomyopathy secondary to chemotherapy during childhood was poorly managed and she had missed the opportunity to discuss her reproductive plans and have her periconceptional care delivered. This case emphasises the challenges in engaging Adolescent and Young Adult-aged (AYA-aged) cancer survivors with their healthcare and the importance of narrative medicine, adequate health literacy and early transition to adult services for improved medical care.
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Foody, JoAnne M., Amie T. Joyce, Amy E. Rudolph, Larry Z. Liu, and Joshua S. Benner. "Cardiovascular outcomes among patients newly initiating atorvastatin or simvastatin therapy: A large database analysis of managed care plans in the United States." Clinical Therapeutics 30, no. 1 (January 2008): 195–205. http://dx.doi.org/10.1016/j.clinthera.2008.01.003.
40
Chang, Angela T., Belinda Gavaghan, Shaun O'Leary, Liza-Jane McBride, and Maree Raymer. "Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?" Australian Health Review 42, no. 3 (2018): 334. http://dx.doi.org/10.1071/ah16222.
Анотація:
Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated. Results Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged. Conclusions Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services. What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re-present for further specialist medical care. What does this paper add? This paper identifies that the majority (95%) of patients managed by an advanced practice physiotherapy-led service did not re-present for further medical care for the same condition within 12 months of discharge. What are the implications for practitioners? This paper supports the use of advanced practice physiotherapy-led services in the management of overburdened neurosurgical and orthopaedic specialist out-patient waiting lists.
41
Schneider, Carl E., and Mark A. Hall. "The Patient Life: Can Consumers Direct Health Care?" American Journal of Law & Medicine 35, no. 1 (March 2009): 7–65. http://dx.doi.org/10.1177/009885880903500101.
Анотація:
AbstractThe ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today's health policy watchword.This article evaluates consumerism and the regulatory mechanism of which it is essentially an example — legally mandated disclosure of information. We do so by assessing the crucial assumptions about human nature on which consumerism and mandated disclosure depend. Consumerism operates in a variety of contexts in a variety of ways with a variety of aims. To assess so protean a thing, we ask what a patient's life would really be like in a consumerist world The literature abounds in theories about how medical consumers should behave. We look for empirical evidence about how real people actually buy health plans, choose providers, and select treatments.We conclude that consumerism, and thus mandated disclosure generally, are unlikely to accomplish the goals imagined for them. Consumerism's prerequisites are too many and too demanding. First, consumers must have choices that include the coverage, care-takers, and care they want. Second, reliable information about those choices must be available. Third, information must be put before consumers, especially by doctors. Fourth, consumers must receive the information. Fifth, the information must be complete and comprehensible enough for consumers to use it. Sixth, consumers must understand what they are told. Seventh, consumers must be willing to analyze the information. Eighth, consumers must actually analyze the information and do so well enough to make good choices.Our review of the empirical evidence concludes that these prerequisites cannot be met reliably most of the time. At every stage people encounter daunting hurdles. Like so many other dreams of controlling costs and giving patients control, consumerism is doomed to disappoint. This does not mean that consumerist tools should never be used. It means they should not be used unadvisedly or lightly, but discreetly, advisedly, soberly, and in the fear of error.
42
Schlesinger, Mark, Shannon Mitchell, and Bradford Gray. "Measuring Community Benefits Provided by Nonprofit and For-Profit HMOs." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 40, no. 2 (May 2003): 114–32. http://dx.doi.org/10.5034/inquiryjrnl_40.2.114.
Анотація:
Despite the dramatic shift from nonprofit to for-profit ownership in the managed care industry, little is known about the implications for health plans' relations with the communities in which they operate. This paper provides the first comprehensive comparison of the community benefit activities of nonprofit and for-profit health maintenance organizations (HMOs). We develop a conceptual framework for identifying these activities and provide evidence from a nationally representative survey of plans fielded in 1999. We find that nonprofit plans exceed their for-profit counterparts on some, but not all, aspects of community benefit activity. The most consistent ownership-related differences involve redistributive programs (subsidized services and general philanthropy), commitments to medical research, and services that benefit the entire local population, beyond the plan's enrollees. Other forms of community benefits show mixed or modest differences between nonprofit and for-profit plans. Unexpectedly, for-profit plans actually appear more active in helping consumers deal with information asymmetries. The paper concludes with a discussion of implications for policy and future research.
43
Tahhan, Nina, Belinda Kate Ford, Blake Angell, Gerald Liew, Joseph Nazarian, Glen Maberly, Paul Mitchell, Andrew J. R. White, and Lisa Keay. "Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia." BMJ Open 10, no. 10 (October 2020): e036842. http://dx.doi.org/10.1136/bmjopen-2020-036842.
Анотація:
ObjectivesTo determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use resources, compared with hospital-based care.DesignRetrospective audit of medical and financial records to compare two models of care.SettingA large, urban tertiary Australian publicly funded hospital.InterventionC-EYE-C is a collaborative care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. The C-EYE-C model of care was implemented from January to October 2017.ParticipantsNew low-risk patient referrals with diabetes received at a tertiary hospital ophthalmology unit.Primary and secondary outcomesHistorical standard hospital care was compared with C-EYE-C for attendance, wait-times, outcomes and costs. Clinical concordance between the optometrist and ophthalmologist diagnosis and management was assessed using weighted kappa statistic.ResultsThere were 133 new low-risk referrals, managed in standard hospital care (n=68) and C-EYE-C (n=65). Attendance rates were similar between the models of care (72.1% hospital vs 67.7% C-EYE-C, p=0.71). C-EYE-C had shorter appointment wait-time (53 vs 118 days, p<0.01). In the C-EYE-C model of care, 68.2% of patients did not require hospital appointments and costs were 43% less than hospital care. There was substantial agreement between optometrists and ophthalmologists for diagnosis (κ=0.64, CI 0.47–0.81) and management (κ=0.66, CI 0.45–0.87).ConclusionThis Australian study showed that collaborative eye care resulted in reduced patient waiting times and considerable cost-savings, while maintaining a high standard of patient care compared with traditional hospital-based care in the management of low-risk hospital referrals with diabetic eye disease. The improved access and reduced costs were largely the result of better task allocation through greater utilisation of primary eye care professionals to provide services for low-risk patients. Better resource use may free up further resources for other eye care services.
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Kunin, Marina, Dan Engelhard, Shane Thomas, Mark Ashworth, and Leon Piterman. "Influenza pandemic 2009/A/H1N1 management policies in primary care: a comparative analysis of three countries." Australian Health Review 37, no. 3 (2013): 291. http://dx.doi.org/10.1071/ah12022.
Анотація:
Background. During the influenza pandemic 2009/A/H1N1, the main burden of managing patients fell on primary care physicians (PCP). This provided an excellent opportunity to investigate the implications of pandemic policies for the PCP role. Aim. To examine policies affecting the role of PCP in the pandemic response in Australia (in the state of Victoria), Israel and England. Methods. Content analysis of the documents published by the health authorities in Australia, Israel and England during the pandemic 2009/A/H1N1. Results. The involvement of PCP in the pandemic response differed among the countries in timing and allocated responsibilities. The Israeli approach during the containment phase was to maximise the protection of PCP at the expense of putting pressure on hospitals where the suspected cases were tested and treated. In Australia and England, PCP managed the suspected patients from the beginning of the pandemic. The work of PCP in England was supported by the introduction of the National Pandemic Flu Service during the mitigation phase, whereas Australian PCP had no additional support structures and their role was constant and intensive throughout the pandemic period. Conclusion. Health authorities need to engage with representatives of PCP to evaluate policies for pandemic planning and management. Adequate support and protection for PCP during different stages of pandemic management should be provided. What is known about the topic? During the influenza pandemic 2009/A/H1N1, the main burden of diagnosing and managing the patients fell on PCP. The prominent role of PCP in the 2009/A/H1N1 pandemic presents an excellent opportunity to investigate implications of pandemic policies for primary care and to tackle the possible problems that these policies may impose on the ability of PCP to effectively participate in the public health response. What does this paper add? This paper examines policies that affected the roles of PCP in managing the influenza pandemic 2009/A/H1N1 in three countries: Australia, Israel and England. Although general evaluations of the pandemic response in different countries have previously been reported, this is the first study that focuses on policies for pandemic management at the primary care level. What are the implications for practitioners? Practitioners (PCP and primary care workers in general) would benefit if pandemic preparedness plans were constructed to provide an adequate system of support and protection to primary care workers during different stages of pandemic management. For policy makers, this analysis may help to overhaul the strategies for primary care engagement in the pandemic response.
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Lingaratnam, Senthil, Leon J. Worth, Monica A. Slavin, Craig A. Bennett, Suzanne W. Kirsa, John F. Seymour, Andrew Dalton, et al. "A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment." Australian Health Review 35, no. 4 (2011): 491. http://dx.doi.org/10.1071/ah10951.
Анотація:
Background. Adult febrile neutropenic oncology patients, at low risk of developing medical complications, may be effectively and safely managed in an ambulatory setting, provided they are appropriately selected and adequate supportive facilities and clinical services are available to monitor these patients and respond to any clinical deterioration. Methods. A cost analysis was modelled using decision tree analysis, published cost and effectiveness parameters for ambulatory care strategies and data from the State of Victoria’s hospital morbidity dataset. Two-way sensitivity analyses and Monte Carlo simulation were performed to evaluate the uncertainty of costs and outcomes associated with ambulatory care. Results. The modelled cost analysis showed that cost savings for two ambulatory care strategies were ~30% compared to standard hospital care. The weighted average cost saving per episode of ‘low-risk’ febrile neutropenia using Strategy 1 (outpatient follow-up only) was 35% (range: 7–55%) and that for Strategy 2 (early discharge and outpatient follow-up) was 30% (range: 7–39%). Strategy 2 was more cost-effective than Strategy 1 and was deemed the more clinically favoured approach. Conclusion. This study outlines a cost structure for a safe and comprehensive ambulatory care program comprised of an early discharge pathway with outpatient follow-up, and promotes this as a cost effective approach to managing ‘low-risk’ febrile neutropenic patients. What is known about the topic? Febrile neutropenia is a common complication of chemotherapy for patients with cancer. There is high level evidence supporting the use of ambulatory care strategies to manage patients with febrile neutropenia who are deemed to be at low risk of developing medical complications. What does this paper add? This paper highlights a cost structure for an adequately equipped and cost-effective ambulatory care strategy suitable for Australian hospitals to manage patients with low-risk febrile neutropenia. What are the implications for practitioners? The strategy advocated in this paper affords eligible patients the choice of early discharge from hospital. It advocates for improved resource utilisation and expansion of outpatient services in order to minimise opportunity costs faced by cancer treatment facilities.
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Tao, Zhuliang, Yong Li, Stephen Stemkowski, Kelly D. Johnson, Camilo J. Acosta, Dongmu Zhang, and A. Mark Fendrick. "Impact of Out-of-Pocket Cost on Herpes Zoster Vaccine Uptake: An Observational Study in a Medicare Managed Care Population." Vaccines 6, no. 4 (November 21, 2018): 78. http://dx.doi.org/10.3390/vaccines6040078.
Анотація:
Herpes zoster (HZ) vaccination is approved for adults aged 50+ for the prevention of HZ, but it is underutilized. The objective of this study was to evaluate the association between out-of-pocket cost and HZ vaccine utilization. Adults aged 65 or older enrolled for at least 12 months in Medicare Advantage/Part D (MAPD) and Medicare Part D only (PDP) plans from 1 January 2007 to 30 June 2014 were selected. Abandonment was defined as a reversed claim for HZ vaccine with no other paid claim within 90 days. Out-of-pocket costs used were actual amounts recorded in the claim. Overall, the HZ vaccine abandonment rate was 7.3%. Mean out-of-pocket costs were higher for individuals who abandoned versus those who did not ($88 (±$55) versus $80 (± $49)). Logistic regression indicated individuals with out-of-pocket costs of $80–$90 were 21% more likely (OR = 1.21, 1.16–1.27 95% CI), and those with out-of-pocket costs >$90 were 90% more likely (OR = 1.90, 1.85–1.96 95% CI) to abandon than those with out-of-pocket costs <$80. The models also suggested that socioeconomic, racial, and ethnic disparities in vaccine abandonment existed. Different vaccine targeting efforts and pharmacy benefit design strategies may be needed to increase use, improve adherence, and minimize disparities.
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Pelletier, Elise M., Paula J. Smith, and Carole J. Dembek. "Payer Costs of Autologous Stem Cell Transplant: Results from a U.S. Claims Data Analysis." Blood 112, no. 11 (November 16, 2008): 2373. http://dx.doi.org/10.1182/blood.v112.11.2373.2373.
Анотація:
Abstract Objectives: Autologous stem cell transplant (ASCT) includes costly pre-transplant care which must be considered in the overall cost of treatment. The objective of this study was to evaluate total costs of an ASTC, from mobilization/apheresis through 100 days following transplant, in U.S. managed care plans. Methods: Patients 18+ years of age with evidence of an ASCT between January 1, 2000 and December 31, 2006 were identified from a nationally-representative database of medical and pharmacy claims from over 90 U.S. managed care health plans. Patients were required to have a claim for apheresis within 60 days prior to the ASCT and have a history of multiple myeloma, non-Hodgkin’s lymphoma, or Hodgkin’s disease. Patients were included in the study only if they were continuously enrolled in one health plan for a minimum of 90 days before to 100 days following the ASCT; patients with evidence of a prior ASCT were excluded. Costs were calculated for 4 phases of ASCT: Mobilization/Apheresis: 5 days prior to the first G-CSF administration through the last apheresis claim, Conditioning: 1 day after the last apheresis claim to 1 day prior to ASCT, Transplant: ASCT through 30 days post-transplant, and Follow-up: 31 to 100 days following transplant. Paid claims (payer perspective) were used as a proxy for medical costs and were expressed in 2006 US$, adjusted as necessary using the medical care component of the U.S. Consumer Price Index. Results: A total of 249 ASCT patients were identified; the mean age was 50 years and 57% were male. Total costs from mobilization to 100 days post-transplant averaged $146,890 per patient (median $134,878). Mobilization and apheresis costs comprised 27% of the total costs (mean $38,803), while conditioning therapy represented 43% of the total costs (mean $63,369). Transplant costs (mean $22,032) and follow-up costs (mean $22,686) each accounted for approximately 15% of the total costs. Conclusion: ASCTs are costly procedures with mean payer costs of almost $150,000. This study reviewed recent U.S. managed care health plan claims data to determine the component costs of ASCT. Conditioning therapy and mobilization/apheresis were identified as the main cost drivers, comprising 43% and 27% of the total costs, respectively. Delineating these ASCT-related costs is important in evaluating the overall economic burden of ASCT on the healthcare system and in estimating the benefit of new therapies that could provide greater efficiency and reduce cost in these areas. Total Medical Costs from Mobilization through 100 Days Post-ASCT in ASCT Patients (N=249). Mean (SD) % of Total Costs Total Costs from Mobilization through 100 Days Post-ASCT $146,890 (87,628) -- Mobilization/Apheresis $38,803 (31,060) 26.5% Conditioning $63,369 (70,836) 43.1% Transplant $22,032 (30,960) 15.0% Follow-up $22,686 (38,129) 15.4%
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Veal, Felicity, Mackenzie Williams, Luke Bereznicki, Elizabeth Cummings, and Tania Winzenberg. "A retrospective review of pain management in Tasmanian residential aged care facilities." BJGP Open 3, no. 1 (March 5, 2019): bjgpopen18X101629. http://dx.doi.org/10.3399/bjgpopen18x101629.
Анотація:
BackgroundThe management of pain by GPs for residents of aged care facilities (ACFs) is very common.AimTo measure the prevalence and assess the management of pain in ACF residents, particularly those with dementia.Design & settingA retrospective review of ACF residents’ medical records was undertaken at five southern Tasmanian (Australia) ACFs.MethodData extracted included results of the most recent assessment of pain and its management, frequency and treatment of pain incidents in the previous 7 days, demographics, and medical and medication history. Univariate analysis was used to identify variables associated with increased frequency of pain episodes.ResultsThe final analysis included 477 residents. At least one episode of pain in the preceding 7 days was documented in 25.6% (n = 122) of residents' notes. Pain episodes were most commonly managed by analgesics (45.5%), massage (40.7%), and heatpacks (13.8%). Residents with dementia were not less likely to have pain identified during the past week (14% versus 20%; P = 0.09), but they were much less likely to have pain identified on their most recent pain assessment (P = 0.03).ConclusionGPs should carefully consider the suitability of using ‘as required’ analgesics. Furthermore, on admission to an ACF, GPs need to ensure a patient’s medical history includes all pain or potentially pain-causing conditions, to ensure that a resident’s pain assessment is complete. This is especially necessary for those with dementia, to ensure that staff remain vigilant about the possibility of the resident experiencing pain.
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Davies, O., and S. James. "52 A Community Cure for Frequent Reattenders: Developing An Interface Geriatrics Service." Age and Ageing 49, Supplement_1 (February 2020): i14—i17. http://dx.doi.org/10.1093/ageing/afz186.06.
Анотація:
Abstract Topic Setting up an interface geriatrics service in a seaside area with a large elderly population. Many elderly patients are readmitted due to the challenge of managing their chronic health conditions in the community. These patients are frail, with frequently exacerbated chronic conditions causing regular readmissions. We noted that treatment was rarely changed during these admissions and patients were not uniformly managed. Aims Aims for this project were to improve care for older people, reduce readmissions and produce clear patient care plans. Interventions Our first PDSA cycle involved implementing geriatrician presence at community MDTs (involving social services, GPs, intermediate care teams, and various others). This generated home visits to several patients, with a mix of acute and chronic issues. We offered Advance Care planning where appropriate to these patients. We noted several patients were repeatedly discussed at MDT. This brought into focus frequent attenders who were usually well-known to the community. In the next cycle we introduced ‘frequent attender’ plans for these patients, ensuring a unified approach to their management. Subsequent cycles involved geriatrician presence at the ‘frequent attenders’ steering group, and further links with community teams. Our primary intervention has been Advance care & frequent attender plans offering tailored management for complex patients. These are completed by a geriatrician discussing patients wishes for treatment and future care. Improvements Readmission rates show up to 90% reduction in admissions/ED attendances for patients following care plan implementation. Feedback from families and patients is positive – the service is ‘pragmatic and supportive’, delivering ‘empathetic care’. Discussion Implementing an interface geriatrics service highlights the importance of caring for frail patients in their preferred place of care, reducing unnecessary/inappropriate hospitalisations. Geriatrician presence at community MDTs has improved care by offering prompt access to medical advice and review of complex patients. It highlights patients presenting frequently to services, allowing us to work with patients and families to improve management. A frequent attender list generated by the hospital helps target patients for whom intervention will give significant benefit. We plan to extend this further by working with nursing homes that have high conveyancing rates. The service is being extended to more areas within our region, and we are working with GPs and care homes to further offer advance care planning to vulnerable and frail patients.
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Aledort, Louis M., Roger M. Lyons, Gary Okano, and Joseph Leveque. "The Clinical and Direct Medical Cost Burden of Splenectomy among Managed Care Patients with Chronic Immune Thrombocytopenic Purpura (ITP)." Blood 108, no. 11 (November 16, 2006): 5536. http://dx.doi.org/10.1182/blood.v108.11.5536.5536.
Анотація:
Abstract Background: ITP is a serious chronic disease involving increased platelet destruction and impaired platelet production. Corticosteroids (CS) are used most commonly to treat ITP and are associated with reduction in quality of life. Splenectomy is used less frequently but is a bigger cost driver. Improved therapies for ITP are needed in view of these compromises. Objective: A retrospective database analysis assessed clinical and economic burdens of ITP in a managed care population, focusing on CS use and splenectomy. Methods: Patients with a diagnosis of ITP (ICD9-CM code 287.3) between July 1, 2000, and December 31, 2003, were included if they had continuous health plan enrollment 6 months prior to and 12 months after index ITP diagnosis, were aged ≥18 years, and had any ITP-related treatment. This analysis used data from the PharMetrics Integrated Medical and Pharmaceutical Database, which includes data on diagnoses (ICD-9-CM format), procedures (CPT-4 and HCPCS formats), prescriptions (classified by NDC and AHFS), amounts paid and charged, and dates of service for all claims from >45 million patients participating in 82 different managed care plans (80% commercial, 3% Medicaid, 1.7% Medicare Risk, with the remainder “other”). Results: A total of 770 patients met the study criteria. The mean age was 43.2 years (±14.9) and females accounted for approximately 64% (n=489) of patients. A majority of patients (n=632, 82%) had at least one claim for CS therapy during the 12-month follow-up, and 93% (n=718) received CS for an average of 59.2 (±90.8) days during the 18 months surrounding the index diagnosis; 12% of patients (n=90) received splenectomy within 12 months of index diagnosis. The average time from ITP diagnosis to splenectomy was 119 days (±97). The average annual cost of care per patient was $23,420, with 43% attributable to inpatient hospitalizations. Splenectomized patients incurred an average annual cost of care of $48,424 (±$62,034), compared with $20,110 (±$45,466) for nonsplenectomized patients. Inpatient hospitalizations were the primary cost driver in patients who had undergone splenectomy (39.6%) as well as in those who had not (43.8%). Total health care costs were higher 14 days postsplenectomy ($12,839) versus 14 days presplenectomy ($7,176); this was consistent for inpatient costs ($6,988 vs $4,708), outpatient costs ($834 vs $631) and other combined costs ($4,623 vs $1,178). Almost 90% of splenectomized patients also received CS; this percentage was also greater at 14 days postsplenectomy (48.9%) compared with 14 days presplenectomy (30%). Anti-rhesus D (anti-D) immunoglobulin was also administered more frequently post- versus presplenectomy (8.9% vs 1.1%); this is potentially important, as average annual costs were higher ($32,268 ± 43,704) for patients with anti-D rescue therapy than for those without ($21,718 ± 48,494). Conclusions: Splenectomized patients (n=90) were nearly 2.5 times more costly than nonsplenectomized patients (n=680), incurring almost $28,000 greater costs, and also showed increased CS use after versus before splenectomy. Additional subanalyses are underway to assess impact of treatment-specific costs in this ITP patient population. Prospectively designed studies are needed to reevaluate standards of care for ITP and long-term patient outcomes as new treatments for ITP are developed.