American Journal of Managed Care最新文献_第6页

Identifying chronic kidney disease stage 3 with excess disease burden. 识别疾病负担过重的慢性肾脏病 3 期。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-06-01 DOI: 10.37765/ajmc.2024.89564

Austin Campbell, Lihao Chu, Stanley Crittenden, Abe Sutton, Adam Boehler

{"title":"Identifying chronic kidney disease stage 3 with excess disease burden.","authors":"Austin Campbell, Lihao Chu, Stanley Crittenden, Abe Sutton, Adam Boehler","doi":"10.37765/ajmc.2024.89564","DOIUrl":"10.37765/ajmc.2024.89564","url":null,"abstract":"Objectives: Chronic kidney disease (CKD) is a widely prevalent disease with heterogeneous disease progression. Prior study findings suggest that early referral to nephrologists can improve health outcomes for patients with CKD. Current practice guidelines recommend nephrology referral when patients are diagnosed with CKD stage 4. We tested whether a subset of patients with CKD stage 3 and common medical comorbidities demonstrates disease progression, cost, and utilization patterns that would merit earlier referral.Study design: Retrospective study of Medicare fee-for-service beneficiaries with CKD stages 3 through 5 and end-stage kidney disease.Methods: We identified 7 comorbidities with high prevalence in patients with progressive CKD and segmented beneficiaries with CKD stage 3 based on the presence of these comorbidities. Outcomes including costs, utilization, and disease progression were then compared across beneficiaries with different stages of CKD.Results: We identified that beneficiaries with CKD stage 3 and at least 1 of the selected comorbidities (CKD stage 3-plus) represented 35.4% of all beneficiaries with CKD stage 3. The CKD stage 3-plus cohort had cost and utilization patterns that were more similar to beneficiaries with CKD stages 4 and 5 than to beneficiaries with CKD stage 3 without the selected comorbidities.Conclusions: Our findings demonstrate the use of a claims-based algorithm to identify patients with CKD stage 3 who have high costs and are at risk of disease progression, highlighting a potential subset of patients who might benefit from earlier nephrology intervention.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Whither CAR T? will the FDA being under the hood and the availability of bispecifics make these therapies less attractive? FDA 的介入以及双特异性药物的出现是否会降低 CAR T 疗法的吸引力？

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-06-01 DOI: 10.37765/ajmc.2024.89576

Sang Chao, Justin Tse, Amy VanGalder, Garrick Wong, Terra Wonsettler, Andrew Hertler

引用次数: 0

Accountable care organization initiatives to improve the cost and outcomes of specialty care. 责任医疗组织改善专科医疗成本和效果的举措。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89536

Robert E Mechanic, Louise Secordel, Sam Sobul, Jennifer Perloff

{"title":"Accountable care organization initiatives to improve the cost and outcomes of specialty care.","authors":"Robert E Mechanic, Louise Secordel, Sam Sobul, Jennifer Perloff","doi":"10.37765/ajmc.2024.89536","DOIUrl":"10.37765/ajmc.2024.89536","url":null,"abstract":"Objectives: To assess initiatives to manage the cost and outcomes of specialty care in organizations that participate in Medicare accountable care organizations (ACOs).Study design: Cross-sectional analysis of 2023 ACO survey data.Methods: Analysis of responses to a 12-question web-based survey from 101 respondents representing 174 ACOs participating in the Medicare Shared Savings Program or the Realizing Equity, Access, and Community Health ACO model in 2023.Results: Improving specialist alignment was a high priority for 62% of the 101 respondents and a medium priority for 34%. Only 11% reported that employed specialists were highly aligned and 7% reported that contracted specialists were highly aligned. A subset of ACOs reported major efforts to engage specialists in quality improvement projects (38%) and to convene specialists to develop evidence-based care pathways (30%). They also reported supporting primary care physicians through providing specialist directories (44%), specialist e-consults (23%), and sharing specialist cost data (20%). The most common challenges reported were the influence of fee-for-service payment on specialist behavior (58%), lack of data to evaluate specialist performance (53%), and insufficient bandwidth or ACO resources to address specialist alignment (49%).Conclusions: Engaging specialists in accountable care is an emerging area for ACOs but one with numerous challenges. Making better data on specialist costs and outcomes available to Medicare ACOs is essential for accelerating progress.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Implementing team-based telemedicine workflows in safety-net primary care. 在安全网初级保健中实施基于团队的远程医疗工作流程。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89550

Marianna Kong, Rachel Willard-Grace, Elaine Khoong, Anjana Sharma, Monjori Mukerjee, George Su, Delphine Tuot

{"title":"Implementing team-based telemedicine workflows in safety-net primary care.","authors":"Marianna Kong, Rachel Willard-Grace, Elaine Khoong, Anjana Sharma, Monjori Mukerjee, George Su, Delphine Tuot","doi":"10.37765/ajmc.2024.89550","DOIUrl":"10.37765/ajmc.2024.89550","url":null,"abstract":"Objectives: Challenges in implementing telemedicine disproportionately affect patients served in safety-net settings. Few studies have elucidated pragmatic, team-based strategies for successful telemedicine implementation in primary care, especially with a safety-net population.Study design: We conducted in-depth, semistructured qualitative interviews with primary care clinicians and staff in a large urban safety-net health care system on the facilitators, challenges, and impact of implementing team workflows for synchronous telemedicine video and audio-only visits.Methods: Interviews were analyzed using modified grounded theory with multistage coding. Common themes were identified and reviewed to describe within-group and between-group variations. We used the Practical, Robust Implementation Sustainability Model framework to organize the final themes with an implementation science lens.Results: Four themes emerged from 11 interviews: (1) having a dedicated individual preparing patients for video visits is a prerequisite for the successful introduction of video visits to patients with limited digital literacy; (2) health care maintenance during video and audio-only visits benefits from standardized workflows and communication; (3) the increased flexibility and accessibility of telemedicine visits were perceived benefits to patient care, despite barriers for subsets of patients; and (4) telemedicine visits generally have a positive impact on work experience for clinicians and staff due to increased efficiency, despite audio-only visits feeling less engaging.Conclusions: Understanding how to strategically use team-based workflows to expand video visit access while ensuring care quality of all telemedicine visits will allow primary care practices to maximize telemedicine's benefits to patients in the safety-net setting.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141185010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Interventional analytics in skilled nursing facilities associated with reduced readmissions. 专业护理机构的干预分析与减少再入院率有关。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89557

Derek A Kaknes, Tanner B Barbour, Wenyan Ji, Steven M Stein, Mary D Naylor, Alexandra L Hanlon

{"title":"Interventional analytics in skilled nursing facilities associated with reduced readmissions.","authors":"Derek A Kaknes, Tanner B Barbour, Wenyan Ji, Steven M Stein, Mary D Naylor, Alexandra L Hanlon","doi":"10.37765/ajmc.2024.89557","DOIUrl":"10.37765/ajmc.2024.89557","url":null,"abstract":"Objective: To assess differences in longitudinal profiles for 30-day risk-adjusted readmission rates in skilled nursing facilities (SNFs) associated with Penn Medicine's Lancaster General Hospital (LGH) that implemented an interventional analytics (IA) platform vs other LGH facilities lacking IA vs other SNFs in Pennsylvania vs facilities in all other states.Study design: Retrospective longitudinal analysis of CMS readmissions data from 2017 through 2022, and cross-sectional analysis using CMS quality metrics data.Methods: CMS SNF quality performance data were aggregated and compared with risk-adjusted readmissions by facility and time period. Each SNF was assigned to a cohort based on location, referral relationship with LGH, and whether it had implemented IA. Multivariable mixed effects modeling was used to compare readmissions by cohort, whereas quality measures from the fourth quarter of 2022 were compared descriptively.Results: LGH profiles differed significantly from both state and national profiles, with LGH facilities leveraging IA demonstrating an even greater divergence. In the most recent 12 months ending in the fourth quarter of 2022, LGH SNFs with IA had estimated readmission rates that were 15.24, 12.30, and 13.06 percentage points lower than the LGH SNFs without IA, Pennsylvania, and national cohorts, respectively (all pairwise P < .0001). SNFs with IA also demonstrated superior CMS claims-based quality metric outcomes for the 12 months ending in the fourth quarter of 2022.Conclusions: SNFs implementing the studied IA platform demonstrated statistically and clinically significant superior risk-adjusted readmission rate profiles compared with peers nationally, statewide, and within the same SNF referral network (P < .0001). A more detailed study on the use of IA in this setting is warranted.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141185011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Modeling the economic value of cardiometabolic virtual-first care programs. 模拟心脏代谢虚拟第一护理计划的经济价值。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89549

Madison Noble, Fang Chen, Sarah Linke, Timothy M Dall, Jenna Napoleone

{"title":"Modeling the economic value of cardiometabolic virtual-first care programs.","authors":"Madison Noble, Fang Chen, Sarah Linke, Timothy M Dall, Jenna Napoleone","doi":"10.37765/ajmc.2024.89549","DOIUrl":"10.37765/ajmc.2024.89549","url":null,"abstract":"Objectives: This study simulated the potential multiyear health and economic benefits of participation in 4 cardiometabolic virtual-first care (V1C) programs: prevention, hypertension, diabetes, and diabetes plus hypertension.Study design: Using nationally available data and existing clinical and demographic information from members participating in cardiometabolic V1C programs, a microsimulation approach was used to estimate potential reduction in onset of disease sequelae and associated gross savings (ie, excluding the cost of V1C programs) in health care costs.Methods: Members of each program were propensity matched to similar records in the combined 2012-2020 National Health and Nutrition Examination Survey files based on age, sex, race/ethnicity, body mass index, and diagnosis status of diabetes and/or hypertension. V1C program-attributed changes in clinical outcomes combined with baseline biometric levels and other risk factors were used as inputs to model disease onset and related gross health care costs.Results: Across the V1C programs, sustained improvements in weight loss, hemoglobin A1c, and blood pressure levels were estimated to reduce incidence of modeled disease sequelae by 2% to 10% over the 5 years following enrollment. As a result of sustained improvement in biometrics and reduced disease onset, the estimated gross savings in medical expenditures across the programs would be $892 to $1342 after 1 year, and cumulative estimated gross medical savings would be $2963 to $4346 after 3 years and $5221 to $7756 after 5 years. In addition, high program engagement was associated with greater health and economic benefits.Conclusions: V1C programs for prevention and management of cardiometabolic chronic conditions have potential long-term health and financial implications.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141185022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A decade of progress: advances in the third-line treatment of patients with metastatic colorectal cancer. 十年进展：转移性结直肠癌患者的三线治疗进展。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89545

Tanios Bekaii-Saab

引用次数: 0

Management of procalcitonin test overuse in an emergency department through a computer algorithm. 通过计算机算法管理急诊科过度使用降钙素原检测。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89554

Maria Salinas, Maite López-Garrigós, Ruth Torreblanca, Emilio Flores, Elena Diaz, Carlos Leiva-Salinas

{"title":"Management of procalcitonin test overuse in an emergency department through a computer algorithm.","authors":"Maria Salinas, Maite López-Garrigós, Ruth Torreblanca, Emilio Flores, Elena Diaz, Carlos Leiva-Salinas","doi":"10.37765/ajmc.2024.89554","DOIUrl":"10.37765/ajmc.2024.89554","url":null,"abstract":"Objectives: To show the procalcitonin (PCT) test demand from an emergency department (ED) over several years, to decrease PCT measurement via a computerized algorithm based on C-reactive protein (CRP) value, and to evaluate the subsequent economic savings.Study design: A cross-sectional study was performed from January 1, 2018, to May 31, 2019, to evaluate an intervention to avoid PCT measurement in the ED of Hospital Universitario San Juan in Alicante in Spain, when CRP values are low.Methods: A PCT result of at least 1.5 ng/mL was agreed upon with ED providers in our study as the value for clinical decision-making, with values less than 1.5 ng/mL considered negative. We retrospectively reviewed all PCT and CRP values for ED patients and calculated the diagnostic indicators for PCT at 4 different CRP cutoffs using the PCT quantification as the gold standard. From July 1, 2019, to April 30, 2021, the agreed-upon strategy was implemented, and we counted the PCT tests avoided and calculated the savings.Results: PCT was not measured when CRP values were less than the selected CRP cutoff of 0.8 mg/dL, at which false-negative results were 1% and the 99th percentile of PCT was 1.5 ng/mL. In the postintervention period, 1091 PCT values were not measured and $11,553.69 was saved.Conclusions: An intervention to decrease PCT measurement in the ED designed by the clinical laboratory staff in consensus with requesting clinicians and based on CRP values decreased PCT testing and generated significant economic savings.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141185012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Shared decision-making for lung cancer screening: more straw for the camel's back. 肺癌筛查的共同决策：骆驼背上的更多稻草。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89548

Jonas B Green

引用次数: 0

Bleeds and resource use in hemophilia B: retrospective observational study. B 型血友病患者的出血和资源使用情况：回顾性观察研究。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-05-01 DOI: 10.37765/ajmc.2024.89543

Lisa Young, Lu Ban, Yong Chen, Patrick F Fogarty

{"title":"Bleeds and resource use in hemophilia B: retrospective observational study.","authors":"Lisa Young, Lu Ban, Yong Chen, Patrick F Fogarty","doi":"10.37765/ajmc.2024.89543","DOIUrl":"10.37765/ajmc.2024.89543","url":null,"abstract":"Objectives: To describe people with hemophilia B (PWHB) in the US who experience bleeds despite factor replacement therapy and to quantify the associated burden from the third-party payer perspective.Study design: Observational study of adult male PWHB treated with factor IX replacement therapy identified from the PharMetrics Plus claims data from 2010 to 2019.Methods: Patients with medically recorded bleeds (MRBs) were identified using diagnostic codes. Rates and rate ratios of inpatient admissions, emergency department (ED) visits, and outpatient visits among PWHB with and without MRBs were estimated. The presence of comorbidities was identified using diagnostic codes, and the analysis was stratified by age group.Results: There were 345 PWHB with MRBs and 252 without MRBs. More than half of PWHB with MRBs (56.8%) had 1 or more comorbidity vs 39.3% of PWHB without MRBs. The prevalence of anxiety and depression was high in PWHB, regardless of bleed status and age group, whereas the prevalence of other comorbidities increased with age group. The rate of all-cause inpatient admissions for PWHB with MRBs was 14.8 per 100 person-years (95% CI, 12.8-17.1), 2.5 times higher than for PWHB without MRBs. The rate of all-cause ED visits for PWHB with MRBs was 67.6 per 100 person-years (95% CI, 63.2-72.3), 2.7 times higher than for those without MRBs.Conclusions: This study reports significant resource use and clinical burden among PWHB who seek medical care. PWHB with MRBs had considerable all-cause resource use compared with PWHB without MRBs. The prevalence of mental illness was consistently high across all age groups.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0