The American journal of managed care最新文献

{"title":"Pharmacist hypertension management using an electronic health record-based approach.","authors":"Kristin K. Soreide, Octavia Solomon, Nada M Farhat, Sarah Kolander, Terry Gottschall, D. George, E. Szandzik, J. Kalus, Emily Thomas","doi":"10.37765/ajmc.2022.88864","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88864","url":null,"abstract":"OBJECTIVES\u0000To evaluate the impact of the chronic medication optimization pharmacist (CMOP) program on blood pressure (BP) control and time to goal compared with usual care in the ambulatory care setting.\u0000\u0000\u0000STUDY DESIGN\u0000This was a retrospective cohort study that included patients from June 2018 to June 2020 who were seen in an ambulatory care clinic for hypertension management.\u0000\u0000\u0000METHODS\u0000Patients aged 18 to 80 years were divided into 2 cohorts based on hypertension management by usual care or the CMOP program. Patients were enrolled in the CMOP program either by referral or identification via a data analytics tool. The primary outcome assessed the proportion of patients within BP goal (< 140/90 mm Hg) at 3 months. Secondary outcomes assessed the proportion of patients within goal at 6 months, time and number of visits to goal, and adherence (CMOP cohort only).\u0000\u0000\u0000RESULTS\u0000The primary end point demonstrated a greater proportion of patients within goal in the CMOP cohort compared with usual care (69.4% vs 42.3%; P < .001). The CMOP cohort also displayed a greater proportion of patients achieving goal within 6 months (75.7% vs 60.4%; P = .014) and faster time to goal (42.99 vs 63.12 days; P = .002), but more visits (1.67 vs 1.18; P = .001). Lastly, adherence improved from 50.4% to 72.1% in the patients with a documented adherence assessment in the pharmacist group (P = .03).\u0000\u0000\u0000CONCLUSIONS\u0000The pharmacist intervention improved BP control in a primarily African American patient population compared with usual care. Future studies should assess the sustainability of this intervention.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"24 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":"131505891","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":"Shifting away from emergency department and office-based urgent care: no place like home?","authors":"N. Solomon, A. Fendrick","doi":"10.37765/ajmc.2022.88857","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88857","url":null,"abstract":"As promising advances in providing care at home evolve, further research-with special attention to underserved populations-is needed to assess the clinical, equity, and economic impacts and to accelerate implementation where appropriate.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"27 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":"125094773","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":"Incorrect data set used for analyses.","authors":"","doi":"10.37765/ajmc.2022.88863","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88863","url":null,"abstract":"Correction to the Original Research article \"Behavior-Based Diabetes Management: Impact on Care, Hospitalizations, and Costs\" published in the March 2021 issue of The American Journal of Managed Care.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"76 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":"132543374","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":"Racial trends in clinical preventive services use, chronic disease prevalence, and lack of insurance before and after the Affordable Care Act.","authors":"K. Thorpe","doi":"10.37765/ajmc.2022.88865","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88865","url":null,"abstract":"OBJECTIVES\u0000To compare the relative change in the use of clinical preventive services, prevalence of chronic disease, and share uninsured among White, Black, and Hispanic adults before and after the introduction of the Affordable Care Act (ACA).\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective analysis using the Medical Expenditure Panel Survey of adults aged 18 to 64 years. The regression relies on a fully interacted set of indicator variables of each racial group by 3 time periods: 2005-2009, 2010-2013, and 2014-2018.\u0000\u0000\u0000METHODS\u0000Outcomes included indicators of mammography, colonoscopy, and lipid panel use. Several chronic conditions were examined, including diabetes, hyperlipidemia, hypertension, coronary heart disease, and mental health status. The final outcome variables examined health insurance (uninsured or not) and out-of-pocket spending as a share of family income. Regression models were used controlling for patient characteristics (age, income, education) and for a set of fully interacted indicator variables of race and time period. We tested for relative changes in White adults vs minority adults for each outcome variable. We used the Wald test (test command in Stata) to test for relative changes over time.\u0000\u0000\u0000RESULTS\u0000We found reductions in baseline (pre-ACA) disparities over time in several of the measures between minority adults and White adults. This included greater growth in the use of mammograms and colonoscopies among minority populations. The results also saw relative reductions in hypertension, coronary heart disease, and fair or poor mental health. Finally, the share uninsured among Hispanic adults decreased at a faster rate than among White adults pre-ACA compared with the ACA period examined.\u0000\u0000\u0000CONCLUSIONS\u0000The ACA is associated with a reduction in baseline differences in the use of some clinical preventive services, chronic disease prevalence, health insurance coverage, and out-of-pocket spending. Continued efforts to promote prevention and further expansions of coverage would appear to pay dividends.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"104 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":"132955323","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":"Association of 340B contract pharmacy growth with county-level characteristics.","authors":"S. Nikpay, Gabriela Gracia, Hannah Geressu, R. Conti","doi":"10.37765/ajmc.2022.88840","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88840","url":null,"abstract":"OBJECTIVES\u0000To estimate the association of 340B contract pharmacy growth between 2009 and 2019 with county-level characteristics, including availability of health care providers, health care spending, population, and socioeconomic characteristics.\u0000\u0000\u0000STUDY DESIGN\u0000Observational study.\u0000\u0000\u0000METHODS\u0000We constructed county-level maps of 340B contract pharmacy penetration for the years 2009 and 2019 by 340B participant type (hospital or safety-net clinic). We then used a multivariable linear probability regression model to estimate the association of county-level characteristics in 2009 with the probability of gaining at least one 340B contract pharmacy within the county by 2019. We estimated separate regressions for safety-net clinics and hospitals.\u0000\u0000\u0000RESULTS\u0000We find that growth of contracts with 340B hospitals was uncorrelated with uninsured rates, poverty rates, or areas of medical underservice. By contrast, we find that growth of contracts with 340B safety-net clinics was positively correlated with poverty rates and metropolitan statistical status. These findings suggest different patterns of access for patients.\u0000\u0000\u0000CONCLUSIONS\u0000Our results add systematic evidence of a difference in how the 2 main types of 340B participants-hospitals and safety-net clinics-use the 340B program. Policy proposals to reform 340B should consider reforms for safety-net clinics and hospitals separately.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134025792","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":"Adverse drug effects across patients with heart failure: a systematic review.","authors":"M. Butzner, R. Riello, P. Sarocco, N. Desai","doi":"10.37765/ajmc.2022.88844","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88844","url":null,"abstract":"OBJECTIVES\u0000To summarize published literature on the incidence of adverse drug effects (ADEs) associated with guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF).\u0000\u0000\u0000STUDY DESIGN\u0000Systematic literature review.\u0000\u0000\u0000METHODS\u0000A systematic literature review was conducted in PubMed, Ovid MEDLINE, and Clinical Key covering January 1990 to December 2018. Key search terms were ADEs for β-blockers (BBs), ACE inhibitors (ACEis), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), and/or angiotensin receptor-neprilysin inhibitors (ARNis) in adult patients (≥ 18 years) with HFrEF.\u0000\u0000\u0000RESULTS\u0000A total of 279 eligible articles were identified, of which 29 reported drug-related adverse effects and were included in this review. Of the 29 studies, 11 examined BBs; 9, MRAs; 6, ARNis; 2, ACEis; and 1, ARBs. The most common reported ADEs across these therapeutic classes included bradycardia, dizziness, hypotension, hyperkalemia, cough, and renal impairment. The incidence of BB-induced bradycardia was 1% to 52% based on 9 studies, and 6 studies described dizziness as a result of BBs and ARNis (15%-43%). Fourteen studies reported induced hypotension (1.4%-63%); 13 studies, hyperkalemia (0.6%-30.2%); 3 studies, cough (37%-50%); and 4 studies, renal impairment (0.6%-7.6%).\u0000\u0000\u0000CONCLUSIONS\u0000Findings show that drug-related adverse effects are commonly reported in clinical trials and highlight the sizable burden of ADEs with medical therapy across patients with HFrEF. Additional real-world evidence and studies aiming to improve the tolerability of GDMT for patients with HFrEF are warranted.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127801272","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":"Exploring neovascular age-related macular degeneration and diabetic macular edema and advances in treatment.","authors":"Judy E. Kim","doi":"10.37765/ajmc.2022.88853","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88853","url":null,"abstract":"Retinal and choroidal vascular diseases are principal causes of blindness for adults in developed countries around the world. Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) are 2 significant contributors to this global vision loss and confer substantial social and economic burdens on patients and society. Anti-vascular endothelial growth factor intravitreal injection therapy has dominated as the standard of care treatment for over 15 years, but poor adherence and high treatment burden have led to suboptimal visual outcomes in the real world compared with the clinical trial results. New treatments are emerging that expand the therapeutic targets and use innovative delivery mechanisms with longer durability to ease the treatment burden. Understanding the benefits and drawbacks of these therapies is key to designing new treatment pathways that improve visual outcomes while decreasing the treatment burden on patients and healthcare institutions.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126290848","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":"The unintended consequences of Medicare's wage index adjustment on device-intensive hospital procedures.","authors":"G. David, C. Gunnarsson, Liisa T. Laine, Michael T. Ryan, S. Clancy, Gunnar Gunnarsson, Kimberly A Moore, W. Irish","doi":"10.37765/ajmc.2022.88842","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88842","url":null,"abstract":"OBJECTIVES\u0000To study the association between Medicare's wage index adjustment and the differential use of labor-intensive surgical procedures and medical device-intensive minimally invasive clinical procedures across the United States.\u0000\u0000\u0000STUDY DESIGN\u0000We combine a conceptual model and an empirical investigation of its predictions, applied to aortic valve replacement, to study the relationship between variation in Medicare wage index payment adjustment across hospital referral regions (HRRs) and the utilization of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in these areas.\u0000\u0000\u0000METHODS\u0000Using detailed individual Medicare claims data for 2013-2018 and a novel geographical crosswalk to nest information on Medicare's wage index and utilization of TAVR and SAVR, we estimate a mixed effects Poisson regression model across HRRs to test our hypotheses.\u0000\u0000\u0000RESULTS\u0000We find regional variation in Medicare wage index adjustment levels to be correlated with differential TAVR and SAVR utilization and growth over time. In particular, in HRRs where the wage index is half the national mean there is a 35% decline in the rate of TAVR use and in HRRs where the wage index is 50% higher than the national mean there is a 52% increase in the rate of TAVR use.\u0000\u0000\u0000CONCLUSIONS\u0000Consistent with our framework and hypothesis, our results highlight the importance of adjusting Medicare hospital inpatient payments for device-intensive procedures. Absent such adjustment, access to appropriate interventions may be reduced in areas with low wage index, and lower reimbursement, when driven by wage index adjustment, may influence the treatment approach selected.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133150730","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":"Primary care redesign and care fragmentation among Medicare beneficiaries.","authors":"Lori Timmins, C. Urato, L. Kern, Arkadipta Ghosh, E. Rich","doi":"10.37765/ajmc.2022.88843","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88843","url":null,"abstract":"OBJECTIVES\u0000To determine associations between a large-scale primary care redesign-the Comprehensive Primary Care Plus (CPC+) Initiative-and the extent of continuity or fragmentation of ambulatory care for Medicare fee-for-service beneficiaries during the first 3 years of CPC+.\u0000\u0000\u0000STUDY DESIGN\u0000We used a difference-in-differences framework with a comparison group of practices that were similar to CPC+ practices at baseline (eg, practice size, demographics, Medicare spending). Regressions controlled for clustering, baseline patient characteristics, and practice fixed effects. Our study covered January 2016 through December 2019 and included 1,085,707 beneficiaries attributed to 2883 CPC+ practices and 2,274,068 beneficiaries attributed to 6912 comparison practices.\u0000\u0000\u0000METHODS\u0000We focused on beneficiaries with highly fragmented care at baseline because they may have changed the most in response to CPC+. Key outcome measures were the numbers of ambulatory visits and unique practitioners, reported by specialty category; the percentage of visits with the usual provider of care (measuring continuity); and the reversed Bice-Boxerman Index (rBBI; measuring fragmentation).\u0000\u0000\u0000RESULTS\u0000Medicare beneficiaries with high fragmentation (rBBI ≥ 0.85) at baseline (40% of the sample) had a mean of 13 ambulatory visits across 7 practitioners; the most frequent provider of care accounted for only 28% of visits. By contrast, the remaining beneficiaries had a mean of 10 visits across 4 practitioners, with the most frequent provider accounting for 54% of visits. There were no differences in continuity or fragmentation of care for CPC+ vs comparison beneficiaries.\u0000\u0000\u0000CONCLUSIONS\u0000We find no evidence that CPC+ increased continuity or decreased fragmentation of care.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114944274","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":"Continuously updated forecasting of SARS-CoV-2 in a regional health system.","authors":"Tori J Finch, Alexander Crowell, M. Bhatia, Jose Martinez, Kadin Caines, Fei Teng, Eric Watson, M. Horberg","doi":"10.37765/ajmc.2022.88838","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88838","url":null,"abstract":"OBJECTIVES\u0000To build a model of local hospital utilization resulting from SARS-CoV-2 and to continuously update it with new data.\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective analysis of real performance resulting from a model deployed in a major regional health system.\u0000\u0000\u0000METHODS\u0000Using hospitalization data from the Kaiser Permanente Mid-Atlantic States integrated care system during the period from March 10, 2020, through December 31, 2020, and a custom-developed genetic particle filtering algorithm, we modeled the SARS-CoV-2 outbreak in the mid-Atlantic region. This model produced weekly forecasts of COVID-19-related hospital admissions, which we then compared with actual hospital admissions over the same period.\u0000\u0000\u0000RESULTS\u0000We found that the model was able to accurately capture the data-generating process (weekly mean absolute percentage error, 10.0%-48.8%; Anderson-Darling P value of .97 when comparing percentiles of observed admissions with the uniform distribution) once the effects of social distancing could be accurately measured in mid-April. We also found that our estimates of key parameters, including the reproductive rate, were consistent with consensus literature estimates.\u0000\u0000\u0000CONCLUSIONS\u0000The genetic particle filtering algorithm that we have proposed is effective at modeling hospitalizations due to SARS-CoV-2. The methods used by our model can be reproduced by any major health care system for the purposes of resource planning, staffing, and population care management to create an effective forecasting regimen at scale.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123301256","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}