The American journal of managed care最新文献

{"title":"Primary care practice structural capabilities in health professional shortage areas.","authors":"Ani Bilazarian, Grant R. Martsolf, Amelia E Schlak, Vaneh E Hovsepian, Jianfang Liu, Lusine Poghosyan","doi":"10.37765/ajmc.2022.89142","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89142","url":null,"abstract":"OBJECTIVES\u0000To evaluate structural capabilities in primary care practices employing nurse practitioners (NPs) and test whether they differ across health professional shortage areas (HPSAs) and non-HPSAs.\u0000\u0000\u0000STUDY DESIGN\u0000Secondary analysis of cross-sectional survey data and health care workforce data from 2018-2019.\u0000\u0000\u0000METHODS\u0000We computed bivariate analyses and multivariable adjusted regression models to evaluate differences in NP characteristics and practice characteristics and to determine the odds of having particular structural capabilities in HPSA practices compared with non-HPSA practice.\u0000\u0000\u0000RESULTS\u0000The majority of NPs worked in HPSA practices (61%). We found statistically significant differences in NP educational degrees, practice certifications, and structural capabilities between HPSAs and non-HPSAs. Care coordination was 77% more likely to be delivered in HPSA practices compared with non-HPSA practices (odds ratio, 1.77; P < .05).\u0000\u0000\u0000CONCLUSIONS\u0000Expanding care coordination may be beneficial for HPSA populations with high rates of morbidity and socioeconomic needs. Future research is needed to understand how the NP workforce may be optimized to meet the growing primary care demands in underserved areas.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126303488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Use of Surveillance Colonoscopy and Potential Impacts","authors":"","doi":"10.37765/ajmc.2022.89144","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89144","url":null,"abstract":"","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129804187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving care coordination and reducing ED utilization through patient navigation.","authors":"Salina Bakshi, L. Carlson, Joy Gulla, Priscilla Wang, Kristy Helscel, Brian J. Yun, C. Vogeli, Amy O Flaster","doi":"10.37765/ajmc.2022.89140","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89140","url":null,"abstract":"OBJECTIVES\u0000Our study examines the impact of an emergency department (ED) patient navigation program for patients in a Medicaid accountable care organization across 3 hospitals in a large health system. Our program engages community health workers to (1) promote primary care engagement, (2) facilitate care coordination, and (3) identify and address patients' health-related social needs.\u0000\u0000\u0000STUDY DESIGN\u0000Our study was a retrospective analysis of health care utilization and costs in the 30 days following the index ED visit, comparing individuals receiving ED navigation and matched controls. The primary outcome of interest was all-cause return ED visits, and our secondary outcomes were hospital admissions and completed primary care appointments.\u0000\u0000\u0000METHODS\u0000Patients with ED visits who received navigation were matched to comparable patients with ED visits without an ED navigator interaction. Outcomes were analyzed using fixed effects logistic regression models adjusted for patient demographics, ED visit characteristics, and preceding utilization. Our primary outcome was odds of a return ED visit within 30 days, and our secondary outcomes were odds of a hospitalization within 30 days and odds of having primary care visit within 30 days.\u0000\u0000\u0000RESULTS\u0000In our sample, there were 1117 ED visits by patients meeting our inclusion criteria with an ED navigator interaction, with 3351 matched controls. ED navigation was associated with 52% greater odds of a completed follow-up primary care appointment (odds ratio [OR], 1.52; 95% CI, 1.29-1.77). In patients with no ED visits in the preceding 6 months, ED navigation was associated with 32% decreased odds of repeat ED visits in the subsequent 30 days (OR, 0.68; 95% CI, 0.52-0.90). There was no statistically significant impact on return ED visits in those with higher baseline ED utilization.\u0000\u0000\u0000CONCLUSIONS\u0000Our program demonstrates that high-intensity, short-term patient navigation in the ED can help reduce ED visits in those with low baseline ED utilization and facilitate stronger connections with primary care.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"379 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116578822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician prices and low-value services: evidence from general internal medicine.","authors":"Amelia M. Bond, Yongkang Zhang, F. Toscano, Manyao Zhang, Phyllis Johnson, Yuting Qian, M. Unruh, L. Casalino","doi":"10.37765/ajmc.2022.89149","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89149","url":null,"abstract":"OBJECTIVES\u0000To assess the cross-sectional relationship between prices paid to physicians by commercial insurers and the provision of low-value services.\u0000\u0000\u0000STUDY DESIGN\u0000Observational study design using Health Care Cost Institute claims representing 3 large national commercial insurers.\u0000\u0000\u0000METHODS\u0000The main outcome was count of 19 potential low-value services in 2014. The secondary outcome was total spending on the low-value services. Independent variables of interest were price quintiles based on each physician's mean geographically adjusted price of a mid-level office visit, the most commonly billed service by general internal medicine (GIM) physicians. We estimated the association between physician price quintile and provision of low-value services via negative binomial or generalized linear models with adjustments for measure, region, and patient and physician characteristics.\u0000\u0000\u0000RESULTS\u0000This study included 750,452 commercially insured patients attributed to 28,951 GIM physicians. In 2014, the mean geographically adjusted price for physicians in the highest price quintile was $122.6 vs $54.7 for physicians in the lowest quintile ($67.9 difference; 95% CI, $67.5-$68.3). Relative to patients attributed to the lowest-priced physicians, those attributed to the highest-priced physicians received 3.6, or 22.9%, fewer low-value services per 100 patients (95% CI, 2.7-4.7 services per 100 patients). Spending on low-value services attributed to the highest-priced physicians was 10.9% higher ($520 difference per 100 patients; 95% CI, $167-$872).\u0000\u0000\u0000CONCLUSIONS\u0000Commercially insured patients of high-priced physicians received fewer low-value services, although spending on low-value services was higher. More research is needed to understand why high-priced providers deliver fewer low-value services and whether physician prices are correlated with other measures of quality.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114346701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising use of surveillance colonoscopy and potential impacts.","authors":"M. A. Adams, J. Rubenstein, Robert G Holleman, R. Lipson, M. Klamerus, Shannon Zoulek, S. Saini","doi":"10.37765/ajmc.2022.89143","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89143","url":null,"abstract":"OBJECTIVES\u0000To quantify temporal changes in colonoscopy indication and assess appropriateness of surveillance use in older adults.\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective longitudinal study of national Veterans Health Administration (VHA) data of all patients who underwent outpatient colonoscopy in 2005-2014.\u0000\u0000\u0000METHODS\u0000After validating an electronic algorithm for classifying colonoscopy indication in VHA, we examined trends in colonoscopy indication over time and across patient characteristics.\u0000\u0000\u0000RESULTS\u0000The proportion of colonoscopies performed for postpolypectomy surveillance increased significantly during the study period, particularly among older patients with limited life expectancy, raising concern for possible overuse.\u0000\u0000\u0000CONCLUSIONS\u0000Guidelines should make clear recommendations about when and how to discontinue postpolypectomy surveillance colonoscopy. Doing so would potentially reduce harms due to complications from low-value procedures and in turn moderate demand and thereby enhance overall procedural access for patients more likely to benefit.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124119396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of co-pay assistance on patient, clinical, and economic outcomes.","authors":"Krupa D Parekh, W. Wong, L. Zullig","doi":"10.37765/ajmc.2022.89151","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89151","url":null,"abstract":"OBJECTIVES\u0000Patient assistance programs (eg, co-pay assistance) may reduce patients' out-of-pocket costs for prescription medicines, providing financial assistance to access medicines for reduced or no cost. A literature review to identify peer-reviewed articles on studies evaluating the impact of co-pay assistance on clinical, patient, and economic outcomes was conducted.\u0000\u0000\u0000STUDY DESIGN\u0000A literature review was conducted by searching Embase and MEDLINE.\u0000\u0000\u0000METHODS\u0000The population of interest was patients who had received co-pay assistance; the intervention was co-pay assistance; comparator was no co-pay assistance; and outcomes were treatment adherence, compliance, discontinuation, interruption, barriers to adherence, and specific therapeutic outcomes. Articles from the United States published between January 2015 and June 2021 were included.\u0000\u0000\u0000RESULTS\u0000A total of 1249 initial articles were identified, of which 19 published articles representing 12 studies were included. Most studies were retrospective claims analyses (n = 10); there was also 1 randomized controlled trial and 1 prospective and observational study. One article assessed the association between co-pay assistance and patient-reported outcomes, 7 explored the relationship between co-pay assistance and clinical outcomes, and 6 assessed the impact of policy/program changes on co-pay assistance. Co-pay assistance was associated with improved treatment persistence/adherence across various diseases, with limited indirect evidence of this translating into clinical outcomes improvements. Lack of long-term outcomes and uncertainty around program sustainment from co-pay assistance programs are limitations.\u0000\u0000\u0000CONCLUSIONS\u0000Limited evidence suggests a potential link between co-pay assistance and clinical outcomes; future research addressing study design challenges in measuring the effects of co-pay assistance is needed.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122405786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of opioid use in commercially insured patients with cancer.","authors":"T. Le, Sean P. Fleming, L. Simoni-Wastila","doi":"10.37765/ajmc.2022.89141","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89141","url":null,"abstract":"OBJECTIVES\u0000In an era of heightened opioid prescribing scrutiny, ensuring safe and adequate pain management is challenging. Understanding opioid use in patients with cancer can facilitate effective pain management regimens while minimizing safety concerns. This study characterized patterns of and factors associated with opioid use following a new cancer diagnosis.\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective cohort study.\u0000\u0000\u0000METHODS\u0000Our study included patients with a new cancer diagnosis aged 18 to 64 years in IQVIA PharMetrics Plus 2007-2013 who were continuously enrolled 12 months before receiving their cancer diagnosis and 24 months after. Study outcomes included opioid prevalence and measures of potentially high-risk opioid use (total days supplied, number of prescriptions, and morphine equivalent daily dose [MEDD]). Descriptive analyses and logistic regression were implemented.\u0000\u0000\u0000RESULTS\u0000Of 191,616 eligible individuals, 93,739 (48.9%) received opioid prescriptions; of these, 56,025 (59.8%) were new opioid users. Opioid users received 4.6 prescriptions on average, covering 65 total days with a mean MEDD of 31.8 mg. Only 2387 (2.5%) patients received higher than recommended (≥ 90 mg) MEDD. Predictors of opioid use post cancer included prior opioid use, select comorbidities, use of nonopioid pain treatment adjuvants (muscle relaxants, sedative/hypnotics, anticonvulsants, antidepressants, and steroids), cancer site, and metastatic cancer.\u0000\u0000\u0000CONCLUSIONS\u0000Fewer than half of patients received opioids in the 2 years following cancer onset. Among users, we found a relatively small proportion of potentially problematic opioid use. Further research is warranted to assess the adequacy of cancer pain treatment and determinants of high-risk opioid use.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132442294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' needs following emergency care for ambulatory care-sensitive conditions.","authors":"K. Cordasco, Anita H. Yuan, K. Aoki, D. Ganz","doi":"10.37765/ajmc.2022.89145","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89145","url":null,"abstract":"OBJECTIVES\u0000Poor coordination across care transitions for patients with chronic ambulatory care-sensitive conditions (ACSCs) leads to adverse clinical outcomes. Veterans are at high risk for post-emergency department (ED) adverse outcomes, but the care needs of patients leaving the ED after \"treat-and-release\" visits are poorly characterized. To inform intervention development and implementation, we assessed for medication changes and follow-up care needs among patients with treat-and-release Veterans Affairs (VA) ED visits for chronic ACSCs.\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective, observational study.\u0000\u0000\u0000METHODS\u0000We identified treat-and-release ED visits at the Greater Los Angeles VA (10/1/2017-6/30/2018) with diagnostic codes (in any position) for the ACSCs of asthma, chronic obstructive pulmonary disease, heart failure, diabetes, and/or hypertension. For 249 randomly selected visits, a trained nurse abstractor reviewed the ED notes using a structured abstraction tool.\u0000\u0000\u0000RESULTS\u0000Most of the patients (91%) were male; the median (IQR) age was 67 (58-73) years. In 128 (51%) visits, a medication change was recommended; a new medication was prescribed in 109 (44%), changed in 24 (10%), and stopped in 7 (3%) visits. One or more follow-up care needs were specified in 165 (66%) visits; 55 (22%) specified 2 needs, and 13 (5%) specified 3 or more needs. The 2 most common follow-up care needs were symptom check (41%) and potential medication adjustments post ED (21%).\u0000\u0000\u0000CONCLUSIONS\u0000More than half of patients with treat-and-release ED visits for chronic ACSCs have recommended medication changes, and two-thirds have at least 1 follow-up care need. This information offers potential foci for testing interventions to improve care coordination for patients with ACSCs who are released from the ED.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129244831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing surveillance utilization and value in commercially insured patients with colorectal cancer.","authors":"K. Suh, V. Shankaran, A. Bansal","doi":"10.37765/ajmc.2022.89147","DOIUrl":"https://doi.org/10.37765/ajmc.2022.89147","url":null,"abstract":"OBJECTIVES\u0000Real-world patterns of surveillance testing in colorectal cancer (CRC) and the effects on health and cost outcomes are largely unknown. Our objectives were to (1) assess trends in carcinoembryonic antigen (CEA) testing, CT scans, and colonoscopy utilization and (2) examine the value of CEA testing intensity by characterizing receipt of curative treatment for recurrence and measuring direct medical costs.\u0000\u0000\u0000STUDY DESIGN\u0000Prospective cohort study.\u0000\u0000\u0000METHODS\u0000We used an IBM MarketScan database to identify patients with a diagnosis of and treatment for CRC between 2008 and 2015. We used a negative binomial model to assess utilization of CEA testing and logistic models to assess utilization of CT scans and colonoscopies. We used a Cox proportional hazards model to assess surveillance intensity and time to curative treatment. We estimated direct medical costs using the Kaplan-Meier sample average estimator to account for censored costs.\u0000\u0000\u0000RESULTS\u0000We identified 3197 eligible patients. The mean numbers of CEA tests, CT scans, and colonoscopies remained relatively constant in the study period, but adherence to guidelines varied by surveillance. When categorizing individuals by their CEA utilization adherence to guidelines (perfect utilizers and overutilizers), overutilizers had an HR for curative treatment of 2.11 (95% CI, 1.46-3.05) relative to perfect utilizers. Although overutilizers underwent potentially curative procedures for recurrence at higher rates compared with perfect utilizers, direct medical costs were much higher in the overutilizer group.\u0000\u0000\u0000CONCLUSIONS\u0000Higher intensity of surveillance, beyond what is recommended by guidelines, may lead to earlier recurrence detection and subsequent treatment, but this is associated with significantly higher direct medical costs.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132688358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perceptions of in-home urgent care via mobile integrated health.","authors":"S. Dorner, Amy J. Wint, P. Brenner, Bronwyn Keefe, J. Palmisano, L. Iezzoni","doi":"10.37765/ajmc.2022.88859","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88859","url":null,"abstract":"OBJECTIVES\u0000Emergency department (ED) crowding poses a severe public health threat, and identifying acceptable means of treating medical conditions in alternative sites of care is imperative. We compared patients' experiences with in-home urgent care via mobile integrated health (MIH) vs urgent care provided in EDs.\u0000\u0000\u0000STUDY DESIGN\u0000Survey, completed on paper, online, or by telephone. We surveyed all patients who received MIH care for an urgent health problem (n = 443) and consecutive patients who visited EDs for urgent care (n = 1436).\u0000\u0000\u0000METHODS\u0000Study participants were members of a managed care plan who were dually eligible for Medicare and Medicaid, 21 years or older, and treated either by MIH or in an ED for nonemergent conditions around Boston, Massachusetts, between February 2017 and June 2018. The survey assessed patients' perceptions of their urgent care experiences.\u0000\u0000\u0000RESULTS\u0000A total of 206 patients treated by community paramedics and 718 patients treated in EDs completed surveys (estimated 66% and 62% response rates, respectively). Patients treated by MIH perceived higher-quality care, more frequently reporting \"excellent\" (54.7%) or \"very good\" (32.4%) care compared with ED patients (40.7% and 24.3%, respectively; P < .0001), and were significantly more likely to report that decisions made about their care were \"definitely right\" compared with patients treated in the ED (66.1% vs 55.6%; P = .02).\u0000\u0000\u0000CONCLUSIONS\u0000Patients appear satisfied with receiving paramedic-delivered urgent care in their homes rather than EDs, perceiving higher-quality care. This suggests that in-home urgent care via MIH may be acceptable for patients with nonemergent conditions.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125592319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}