65,637 results match your criteria Medicare Patient Management [Journal]


Recommended Cancer Screening in Accountable Care Organizations: Trends in Colonoscopy and Mammography in the Medicare Shared Savings Program.

J Oncol Pract 2019 Apr 18:JOP1800352. Epub 2019 Apr 18.

1 Brigham and Women's Hospital, Boston, MA.

Purpose: Accountable care organizations (ACOs) are a delivery and payment model designed to encourage integrated, high-value care. We designed a study to test the association between ACOs and two recommended cancer screening tests, colonoscopy for colorectal cancer and mammography for breast cancer.

Methods: Using the random 20% sample of Medicare claims, beneficiaries were attributed to ACO or non-ACO cohorts on the basis of providers' enrollment in the Medicare Shared Savings Program. Read More

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http://dx.doi.org/10.1200/JOP.18.00352DOI Listing

Budget Impact Model of Omadacycline on Replacing a Proportion of Existing Treatment Options Among Patients Who Present to the Emergency Department with Acute Bacterial Skin and Skin Structure Infections.

Am Health Drug Benefits 2019 Feb;12(1-Supplement 2):S13-S24

Professor, Albany College of Pharmacy and Health Sciences, NY.

Background: Omadacycline is an oral and intravenous (IV) once-daily aminomethylcycline antibiotic that is approved in the United States for the treatment of adults with acute bacterial skin and skin structure infections (ABSSSI). It has broad-spectrum activity against common causative pathogens of ABSSSI, including methicillin-resistant . Omadacycline has been shown to be noninferior to linezolid for the treatment of adults with ABSSSI across 2 phase 3 clinical trials. Read More

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February 2019

Canada finally opens up data on new drugs and devices.

BMJ 2019 04 17;365:l1825. Epub 2019 Apr 17.

University of Maryland School of Pharmacy, Baltimore MD, USA.

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http://dx.doi.org/10.1136/bmj.l1825DOI Listing

Comparing Rural and Urban Medicare Advantage Beneficiary Characteristics.

Rural Policy Brief 2019 Mar 1;2019(1):1-4. Epub 2019 Mar 1.

Purpose: The Medicare Advantage (MA) program allows Medicare beneficiaries to receive benefits from private plans rather than from traditional fee-for-service (FFS) Medicare. Little is known about the rural and urban differences in the populations that enroll in the MA program, and these differences may be important for setting policy. This brief uses data from the 2012-13 Medicare Current Beneficiary Survey (MCBS) to describe these differences, and combined with county-level data on MA issuer participation, this dataset also allows us to assess the degree to which issuers may engage in selective MA market entry on the basis of demographic characteristics. Read More

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Accuracy of Valuations of Surgical Procedures in the Medicare Fee Schedule.

N Engl J Med 2019 04;380(16):1546-1554

From the Center for Health Policy-Center for Primary Care and Outcomes Research, Stanford University School of Medicine (D.C.C., D.M.S.), and Stanford Law School (D.M.S.), Stanford, the Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto (D.C.C.), and the Department of Economics, University of California Los Angeles, Los Angeles (J.H.) - all in California.

Background: The Relative Value Scale Update Committee (RUC) of the American Medical Association plays a central role in determining physician reimbursement. The RUC's role and performance have been criticized but subjected to little empirical evaluation.

Methods: We analyzed the accuracy of valuations of 293 common surgical procedures from 2005 through 2015. Read More

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http://dx.doi.org/10.1056/NEJMsa1807379DOI Listing

Maryland's Global Hospital Budgets: Impacts on Medicare Cost and Utilization for the First 3 Years.

Med Care 2019 Apr 15. Epub 2019 Apr 15.

RTI International, Research Triangle Park, NC.

Background: Global budgets have been proposed as a way to control health care expenditures, but experience with them in the United States is limited. Global budgets for Maryland hospitals, the All-Payer Model, began in January 2014.

Objectives: To evaluate the effect of hospital global budgets on health care utilization and expenditures. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001118DOI Listing
April 2019
1 Read

Telehealth Intervention Programs for Seniors: An Observational Study of a Community-Embedded Health Monitoring Initiative.

Telemed J E Health 2019 Apr 17. Epub 2019 Apr 17.

1 Department of Telemedicine and Virtual Rehabilitation, Burke Medical Research Institute, White Plains, New York.

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http://dx.doi.org/10.1089/tmj.2018.0248DOI Listing

Genetic counseling referral for ovarian cancer patients: a call to action.

Fam Cancer 2019 Apr 16. Epub 2019 Apr 16.

Thorton Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA.

The hereditary contribution to ovarian cancer has been increasingly recognized over the past decade, with a 2014 Society of Gynecologic Oncology (SGO) recommendation for all women with epithelial ovarian cancer to be considered for genetic testing. The objective of the study was to determine if disparities exist in genetic referrals and characterize referral patterns over time. A retrospective cohort study included all women diagnosed with invasive epithelial ovarian cancer at the University of Virginia from 2004 to 2015. Read More

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http://dx.doi.org/10.1007/s10689-019-00129-5DOI Listing

Febrile neutropenia-related care and associated costs in elderly patients with breast cancer, lung cancer, or non-Hodgkin lymphoma.

Support Care Cancer 2019 Apr 15. Epub 2019 Apr 15.

Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.

Purpose: Limited information is available regarding elderly patients experiencing febrile neutropenia (FN). This study evaluated FN-related care among elderly cancer patients who received high/intermediate FN-risk chemotherapy and experienced ≥ 1 FN episodes.

Methods: We used Medicare data to identify patients aged ≥ 66 years who initiated high/intermediate FN-risk chemotherapy between 1 January 2008 and 31 August 2015 to treat breast cancer (BC), lung cancer (LC), or non-Hodgkin lymphoma (NHL) and had ≥ 1 FN episodes. Read More

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http://dx.doi.org/10.1007/s00520-019-04795-0DOI Listing

Long-term ozone exposures and cause-specific mortality in a US Medicare cohort.

J Expo Sci Environ Epidemiol 2019 Apr 16. Epub 2019 Apr 16.

Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.

We examined the association of long-term, daily 1-h maximum O (ozone) exposures on cause-specific mortality for 22.2 million US Medicare beneficiaries between 2000-2008. We modeled the association between O and mortality using age-gender-race stratified log-linear regression models, adjusted for state of residence. Read More

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http://www.nature.com/articles/s41370-019-0135-4
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http://dx.doi.org/10.1038/s41370-019-0135-4DOI Listing
April 2019
1 Read

Bundled Payments Are Effective in Reducing Costs Following Bilateral Total Joint Arthroplasty.

J Arthroplasty 2019 Mar 28. Epub 2019 Mar 28.

The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.

Background: Alternative payment models such the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative have been effective in reducing costs following unilateral total hip (THA) and knee arthroplasty (TKA), but few studies exist on bilateral arthroplasty. This study aimed to determine whether the BPCI program for bilateral THA and TKA reduced episode-of-care costs.

Methods: We retrospectively reviewed a consecutive series of patients who underwent simultaneous bilateral primary THA and TKA between 2015 and 2016. Read More

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http://dx.doi.org/10.1016/j.arth.2019.03.041DOI Listing

Medicare's new voluntary bundled payment program: Episode selection and participant characteristics.

Healthc (Amst) 2019 Apr 13. Epub 2019 Apr 13.

Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA; Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; CMC Philadelphia VA Medical Center, Philadelphia, PA 19104, USA.

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http://dx.doi.org/10.1016/j.hjdsi.2019.04.002DOI Listing

Quantifying institutional resource utilization of adjuvant brachytherapy and intensity-modulated radiation therapy for endometrial cancer via time-driven activity-based costing.

Brachytherapy 2019 Apr 13. Epub 2019 Apr 13.

Department of Radiation Oncology, Arizona Oncology, The US Oncology Network, Tucson, AZ. Electronic address:

Purpose: The purpose of this study was to quantify the cost of resources required to deliver adjuvant radiation therapy (RT) for high- to intermediate-risk endometrial cancer using time-driven activity-based costing (TDABC).

Methods And Materials: Comparisons were made for three and five fractions of vaginal cuff brachytherapy (VCB), 28 fractions of intensity-modulated radiation therapy (IMRT), and combined modality RT (25-fraction IMRT followed by 2-fraction VCB). Process maps were developed representing each phase of care. Read More

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http://dx.doi.org/10.1016/j.brachy.2019.03.003DOI Listing

The impact of Medicare part D on income-related inequality in pharmaceutical expenditure.

Int J Equity Health 2019 Apr 16;18(1):57. Epub 2019 Apr 16.

Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, VIC, 3010, Australia.

Background: Income-related inequality measures such as the concentration index are often used to describe the unequal distribution of health, health care access, or expenditure in a single measure. This study demonstrates the use of such measures to evaluate the distributional impact of changes in health insurance coverage. We use the example of Medicare Part D in the United States, which increased access to prescription medications for Medicare beneficiaries from 2006. Read More

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https://equityhealthj.biomedcentral.com/articles/10.1186/s12
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http://dx.doi.org/10.1186/s12939-019-0955-9DOI Listing
April 2019
1 Read

Psychoeducation for chronic cognitive impairment and reduced early readmissions amongst pulmonary inpatients.

Psychol Health Med 2019 Apr 16:1-6. Epub 2019 Apr 16.

c Henry Ford Hospital , Wayne State University , Detroit , MI , USA.

Patients with chronic pulmonary disease have been found to have among the highest rates of early (30 days) readmissions by the Center for Medicare and Medicaid Services. Proactive identification and psychoeducational intervention for the effect of chronic cognitive impairment on readmission have not been tested in this population. This is a pre-post quality improvement study for service-wide inpatient pulmonary readmission rates in chronic pulmonary disease. Read More

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http://dx.doi.org/10.1080/13548506.2019.1601749DOI Listing

Aggregating Claims Data Across Payers: Approaches, Challenges, and Lessons Learned From the Comprehensive Primary Care Initiative.

Am J Med Qual 2019 Apr 16:1062860619843350. Epub 2019 Apr 16.

1 Mathematica Policy Research, Washington, DC.

The Comprehensive Primary Care (CPC) initiative fueled the emergence of new organizational alliances and financial commitments among payers and primary care practices to use data for performance improvement. In most regions of the country, practices received separate confidential feedback reports of claims-based measures from multiple payers, which varied in content and provided an incomplete picture of a practice's patient panel. Over CPC's last few years, participating payers in several regions resisted the tendency to guard data as a proprietary asset, instead working collaboratively to produce aggregated performance feedback for practices. Read More

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http://dx.doi.org/10.1177/1062860619843350DOI Listing

Outcomes of Older Patients with Pulmonary Fibrosis and Non-Small Cell Lung Cancer.

Ann Am Thorac Soc 2019 Apr 16. Epub 2019 Apr 16.

Icahn School of Medicine at Mount Sinai, Medicine, New York, New York, United States.

Rationale: Characteristics and outcomes of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) in the United States (US) remain understudied.

Objectives: To determine the tumor characteristics and survival of IPF patients with non-small cell lung cancer (NSCLC) using US population-based data.

Methods: We selected Medicare beneficiaries from the Surveillance, Epidemiology and End Results registry with histologically confirmed NSCLC diagnosed between 2007-2011. Read More

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http://dx.doi.org/10.1513/AnnalsATS.201808-510OCDOI Listing

Broken smiles: The impact of untreated dental caries and missing anterior teeth on employment.

J Public Health Dent 2019 Apr 16. Epub 2019 Apr 16.

Brandeis University, The Heller School for Social Policy and Management, Waltham, MA, USA.

Objectives: We aimed to quantify the impact of dental caries and missing anterior teeth on employment, estimate the impact of a routine dental visit on the health of anterior teeth, and the benefits of expanding dental coverage for nonelderly adults.

Methods: We used the 2013-2014 Continuous National Health and Nutritional Examination Survey to develop a dental problem index (DPI) using tooth counts and tooth surface conditions. We estimated the impact of DPI on employment with logistic regression, controlling for seven demographic and socioeconomic covariates. Read More

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http://dx.doi.org/10.1111/jphd.12317DOI Listing

Exploring Disparities in Influenza Immunization for Older Women.

J Am Geriatr Soc 2019 Apr 16. Epub 2019 Apr 16.

RAND Corporation, Santa Monica, California.

Objectives: While women obtain most recommended preventive health interventions more often than men, evidence is mixed regarding influenza vaccination for older adults. Therefore, we evaluated sex differences in influenza vaccination among older adults.

Design: Nationally representative cross-sectional survey. Read More

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http://dx.doi.org/10.1111/jgs.15887DOI Listing
April 2019
1 Read

National trends in urinary diversion over the past 20 years: an Australian study.

ANZ J Surg 2019 Apr 15. Epub 2019 Apr 15.

Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.

Background: To investigate the trends in urinary diversion (UD) in Australia over the past 20 years, to correlate with patient demographics and to compare with international data.

Methods: A retrospective analysis of Medicare Australia data was performed using the relevant Medicare Benefit Schedule procedure codes over the past 20 years. Included diversion procedures were ureterocutaneous, ureterocolonic, intestinal conduit and continent reservoir. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/ans.15134
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http://dx.doi.org/10.1111/ans.15134DOI Listing
April 2019
1 Read

Income-based inequities in access to mental health services in Canada.

Authors:
Mary Bartram

Can J Public Health 2019 Apr 15. Epub 2019 Apr 15.

Carleton University's School of Public Policy and Administration, Ottawa, Canada.

Objectives: While mental health services provided by general practitioners and psychiatrists can be billed to public health insurance programs in Canada, services provided by psychologists, social workers and other non-physician providers cannot. This study assesses the extent to which access to mental health services varies by income after first taking into account the higher concentration of mental health needs at lower income levels.

Method: Data from the Canadian Community Health Survey 2013-2014 are used to calculate need-standardized concentration indices for access to mental health services. Read More

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http://link.springer.com/10.17269/s41997-019-00204-5
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http://dx.doi.org/10.17269/s41997-019-00204-5DOI Listing
April 2019
2 Reads

What the Protecting Access to Medicare Act Means for Clinical Laboratories.

Clin Chem 2019 Apr 15. Epub 2019 Apr 15.

Director, Corporate Reimbursement, Government Affairs, Abbott Laboratories, Abbott Park, IL.

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http://dx.doi.org/10.1373/clinchem.2019.303255DOI Listing

Safety of Dynamic Intravenous Iron Administration Strategies in Hemodialysis Patients.

Clin J Am Soc Nephrol 2019 Apr 15. Epub 2019 Apr 15.

Department of Epidemiology.

Background And Objectives: Intravenous iron therapy for chronic anemia management is largely driven by dosing protocols that differ in intensity with respect to dosing approach (, dose, frequency, and duration). Little is known about the safety of these protocols.

Design, Setting, Participants, & Measurements: Using clinical data from a large United States dialysis provider linked to health care utilization data from Medicare, we constructed a cohort of patients with ESKD aged ≥65 years who initiated and continued center-based hemodialysis for ≥90 days between 2009 and 2012, and initiated at least one of the five common intravenous iron administration strategies; ranked by intensity (the amount of iron given at moderate-to-high iron indices), the order of strategies was 3 (least intensive), 2 (less intensive), 1 (reference), 4 (more intensive), and 5 (most intensive). Read More

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http://cjasn.asnjournals.org/lookup/doi/10.2215/CJN.03970318
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http://dx.doi.org/10.2215/CJN.03970318DOI Listing
April 2019
1 Read

Osteoclast inhibitor treatment among men with metastatic castration-resistant prostate cancer.

Clin Oncol Res 2018 6;1(3):2-7. Epub 2018 Sep 6.

Northwestern University Feinberg School of Medicine, Chicago, IL.

Background: National Comprehensive Cancer Network guidelines recommend monthly osteoclast inhibitor treatment (OIT) in men with metastatic castration-resistant prostate cancer (mCRPC) to prevent skeletal related events (SREs). We assessed adherence to guidelines by quantifying treatment for SRE prevention in a population-based cohort of men with mCRPC.

Methods: Using Surveillance, Epidemiology, and End Results-Medicare data, we identified men aged >65 with prostate cancer as a primary cause of death during 2006-2010. Read More

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https://www.sciencerepository.org/osteoclast-inhibitor-treat
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http://dx.doi.org/10.31487/j.COR.2018.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457685PMC
September 2018
1 Read

Psychometric Properties of Functional, Ambulatory, and Quality of Life Instruments in Lower Limb Amputees: A Systematic Review.

Arch Phys Med Rehabil 2019 Apr 12. Epub 2019 Apr 12.

Providence VA Medical Center, Providence, RI 02908; Center for Gerontology, School of Public Health, Brown University, Providence, RI 02912.

Objective: Summarize the psychometric properties of functional, ambulatory, and quality of life instruments among adult lower limb amputees, highlighting evidence deemed generalizable to U.S. Medicare population. Read More

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http://dx.doi.org/10.1016/j.apmr.2019.02.015DOI Listing

Time to fecal immunochemical test completion for colorectal cancer screening.

Am J Manag Care 2019 Apr;25(4):174-180

Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101. Email:

Objectives: Fecal immunochemical tests (FITs) can efficiently screen for colorectal cancer (CRC), but little is known on the timing to their completion. We investigate the time to return of a FIT following an order and describe patient characteristics associated with FIT return.

Study Design: Retrospective cohort study. Read More

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April 2019
1 Read

Primary Care Spending in the Fee-for-Service Medicare Population.

JAMA Intern Med 2019 Apr 15. Epub 2019 Apr 15.

RAND Corporation, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamainternmed.2018.8747DOI Listing

Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program.

JAMA Intern Med 2019 Apr 15. Epub 2019 Apr 15.

Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, Michigan.

Importance: Beginning in fiscal year 2019, Medicare's Hospital Readmissions Reduction Program (HRRP) stratifies hospitals into 5 peer groups based on the proportion of each hospital's patient population that is dually enrolled in Medicare and Medicaid. The effect of this policy change is largely unknown.

Objective: To identify hospital and state characteristics associated with changes in HRRP-related performance and penalties after stratification. Read More

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http://dx.doi.org/10.1001/jamainternmed.2019.0117DOI Listing

Shoulder Arthroplasty for a Fracture Is Not the Same as Shoulder Arthroplasty for Osteoarthritis: Implications for a Bundled Payment Model.

J Am Acad Orthop Surg 2019 Apr 11. Epub 2019 Apr 11.

From the Department of Orthopaedics, Wexner Medical Center at The Ohio State University Columbus, OH.

Introduction: The Center for Medicare Services currently bundles all shoulder arthroplasties, total shoulder arthroplasty and reverse total shoulder arthroplasty, into one Diagnosis-Related Group on which bundled reimbursements are then further characterized. An arthroplasty performed for traumatic indications, such as fractures, may have a different postoperative course of care compared with the one being done for degenerative arthritis/osteoarthritis (OA), despite having the same Current Procedural Terminology (CPT) and Diagnosis-related Group code.

Methods: The 2012 to 2016 American College of Surgeons-National Surgical Quality Improvement Program databases were queried using CPT-23472 to retrieve records of patients undergoing total shoulder arthroplasty/reverse total shoulder arthroplasty for degenerative arthritis/OA or proximal humerus fracture. Read More

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http://dx.doi.org/10.5435/JAAOS-D-18-00268DOI Listing

Development and Psychometric Analysis of the Revised Patient Perceptions of Integrated Care Survey.

Med Care Res Rev 2019 Apr 15:1077558719842951. Epub 2019 Apr 15.

3 Harvard Medical School, Boston, MA, USA.

This article describes the development and psychometric testing of the Patient Perceptions of Integrated Care (PPIC 2.1) survey, which we administered to 12,364 Medicare beneficiaries who received treatment from 150 randomly selected physician organizations, receiving 3,067 responses (26%). Psychometric analyses, performed using two methods to adjust for respondent inherent optimism (as a measure of response tendency), supported a 6-factor, 22-item model with excellent fit. Read More

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http://dx.doi.org/10.1177/1077558719842951DOI Listing

A health care delivery model focusing on development of a cadre of primary care physicians-Recommendations of Organized Medicine Academic Guild.

J Family Med Prim Care 2019 Feb;8(2):330-335

Sarvoday Hospital, Bokaro, Jharkhand, India.

Organized medicine is the academic guild of professional medical organizations in India. It was founded at the annual conference of Indian Academy of Pediatrics (PEDICON) on January 7, 2018. Organized medicine is constituted by leading professional medical organizations and mandated to support the sustainability of health agenda of the Government of India. Read More

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http://dx.doi.org/10.4103/jfmpc.jfmpc_31_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436257PMC
February 2019

Cost-Effectiveness of Cervical Epidural Steroid Injections: A 3-Month Pilot Study.

Global Spine J 2019 Apr 31;9(2):143-149. Epub 2018 Jul 31.

Cleveland Clinic, Cleveland, Ohio, USA.

Study Design: Retrospective cohort.

Objectives: There are conflicting reports on the short- and long-term quality of life (QOL) outcomes and cost-effectiveness of cervical epidural steroid injections (ESIs). The present study analyzes the cost-effectiveness analysis of ESIs versus conservative management for patients with radiculopathy or neck pain in the short term. Read More

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http://dx.doi.org/10.1177/2192568218764913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448201PMC

Baseline history of patients using selexipag for pulmonary arterial hypertension.

Ther Adv Respir Dis 2019 Jan-Dec;13:1753466619843774

Actelion Pharmaceuticals US, Inc., South San Francisco, CA, USA.

Introduction: Since its introduction to the market in 2016, selexipag has been an alternative oral therapy among both treatment-naïve patients and those with mono or dual therapy failure; however, limited information is available regarding the presentation and management of patients with pulmonary arterial hypertension (PAH) prior to selexipag initiation. This study examined treatment patterns, healthcare utilization, and costs in the 12 months prior to and the 6 months following selexipag initiation.

Methods: This was a retrospective study of adult commercial and Medicare Advantage with Part D (MAPD) health plan members with a medical or pharmacy claim for selexipag from 1 January 2016 through 31 May 2017, a diagnosis of pulmonary hypertension, and continuous health plan enrollment for 12 months prior to selexipag initiation (baseline period). Read More

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http://dx.doi.org/10.1177/1753466619843774DOI Listing

What's Driving High Disenrollment in Medicare Advantage?

Inquiry 2019 Jan-Dec;56:46958019841506

1 University of Maryland School of Public Health, College Park, MD, USA.

Disenrollment rates are one way that policy makers assess the performance of Medicare Advantage (MA) health plans. We use 3 years of data published by the Centers for Medicare & Medicaid Services (CMS) to examine the characteristics of MA contracts with high disenrollment rates from 2015 to 2017 and the relationship between disenrollment rates in MA contracts and 6 patient experiences of care performance measures. We find that MA contracts with high disenrollment rates were significantly more likely to be for-profit, small, and enroll a greater proportion of low-income and disabled individuals. Read More

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http://dx.doi.org/10.1177/0046958019841506DOI Listing

Emergency Department Visit Within One Year Prior to Elective Total Joint Arthroplasty Is Predictive of Postoperative Return to Emergency Department Within 90 Days.

J Arthroplasty 2019 Mar 19. Epub 2019 Mar 19.

Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI.

Background: The Comprehensive Care for Joint Replacement Model, developed by Centers for Medicare and Medicaid Services, aims to improve the quality of joint replacement. Metrics including emergency room visit rates after primary total knee and total hip arthroplasty (TKA and THA) are of particular interest. The purpose of this study is to determine if preoperative emergency department (ED) visits are predictive of postoperative ED visits among patients undergoing elective THA or TKA. Read More

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http://dx.doi.org/10.1016/j.arth.2019.03.037DOI Listing

Disparities in Hospice Utilization for Older Cancer Patients Living in the Deep South.

J Pain Symptom Manage 2019 Apr 11. Epub 2019 Apr 11.

Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham AL, USA; Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham AL, USA; Comprehensive Cancer Center, UAB Medicine, Birmingham AL, USA.

Context: Hospice utilization is an end-of-life quality indicator. The Deep South has known disparities in palliative care that may affect hospice utilization.

Objectives: To evaluate the association among Deep South patient and hospital characteristics and hospice utilization. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S08853924193017
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http://dx.doi.org/10.1016/j.jpainsymman.2019.04.006DOI Listing
April 2019
2 Reads

Incidence of hepatocellular carcinoma among older Americans attributable to hepatitis C and hepatitis B: 2001 through 2013.

Cancer 2019 Apr 12. Epub 2019 Apr 12.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.

Background: In the United States, incidence and mortality rates of hepatocellular carcinoma (HCC) are increasing in older individuals. Chronic infection with hepatitis C virus (HCV) and hepatitis B virus (HBV) are important causes of HCC; however, the contribution of viral hepatitis to recent trends in HCC incidence among older Americans is unclear.

Methods: Data from the Surveillance, Epidemiology, and End Results-Medicare linkage (SEER-Medicare) for the years 2001 through 2013 were used to identify HCC cases among individuals aged ≥66 years and Medicare files were used to assess the HCV and HBV status of these HCC cases. Read More

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http://dx.doi.org/10.1002/cncr.32129DOI Listing

Prostate cancer in the medicare shared savings program: are Accountable Care Organizations associated with reduced expenditures for men with prostate cancer?

Prostate Cancer Prostatic Dis 2019 Apr 12. Epub 2019 Apr 12.

Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Objectives: To assess whether Medicare expenditures for men with incident prostate cancer, treated in Accountable Care Organizations (ACOs) differ from those of men treated in non-ACOs.

Methods: Using the 20% Medicare sample, total charges for 1 year following an initial diagnosis of prostate cancer were abstracted from Medicare claims. Prostate cancer expenditures were calculated by subtracting total charges from the year prior to diagnosis. Read More

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http://dx.doi.org/10.1038/s41391-019-0138-1DOI Listing

Illuminating an Invisible Epidemic: A Systemic Review of the Clinical and Economic Benefits of Early Diagnosis and Treatment in Inflammatory Disease and Related Syndromes.

J Clin Med 2019 Apr 11;8(4). Epub 2019 Apr 11.

Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.

Healthcare expenditures in the United States are growing at an alarming level with the Centers for Medicare and Medicaid Services (CMS) projecting that they will reach $5.7 trillion per year by 2026. Inflammatory diseases and related syndromes are growing in prevalence among Western societies. Read More

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http://dx.doi.org/10.3390/jcm8040493DOI Listing
April 2019
1 Read

Factors Associated With the Interhospital Transfer of Emergency General Surgery Patients.

J Surg Res 2019 Apr 9;240:191-200. Epub 2019 Apr 9.

Department of Surgery, University of Wisconsin, Madison, Wisconsin.

Background: Transferred emergency general surgery (EGS) patients constitute a highly vulnerable, acutely ill population. Guidelines to facilitate timely, appropriate EGS transfers are lacking. We determined patient- and hospital-level factors associated with interhospital EGS transfers, a critical first step to identifying which patients may require transfer. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00224804183084
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http://dx.doi.org/10.1016/j.jss.2018.11.053DOI Listing
April 2019
2 Reads

Association of post-discharge specialty outpatient visits with readmissions and mortality in high-risk heart failure patients.

Am Heart J 2019 Mar 21;212:101-112. Epub 2019 Mar 21.

Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC.

Heart failure (HF) outcomes are especially poor in high-risk patients with certain comorbidities including diabetes mellitus (DM), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD). Whether early specialty or primary care provider (PCP) follow-up after HF discharge affects outcomes in high-risk patients is unknown.

Methods: We analyzed patients discharged from a Get With The Guidelines HF-participating hospital from 2007-2012 with linked Medicare claims to investigate the association of medical specialist visit within 14 days of discharge stratified by comorbidity with the primary outcome of 90-day HF readmission. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00028703193006
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http://dx.doi.org/10.1016/j.ahj.2019.03.005DOI Listing
March 2019
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Cost-effectiveness of Short-Course Radiation Therapy vs Long-Course Chemoradiation for Locally Advanced Rectal Cancer.

JAMA Netw Open 2019 Apr 5;2(4):e192249. Epub 2019 Apr 5.

Department of Radiation Oncology, Massachusetts General Hospital, Boston.

Importance: Although both short-course radiotherapy and long-course chemoradiotherapy have been practiced in parallel for more than 15 years, no cost-effectiveness analysis comparing these 2 approaches in patients with locally advanced rectal cancer has been published.

Objective: To analyze the cost-effectiveness of short-course radiotherapy vs long-course chemoradiotherapy for the treatment of patients with locally advanced rectal cancer.

Design, Setting, And Participants: This economic evaluation used a cost-effectiveness model simulating 10-year outcomes for 1 million hypothetical patients aged 65 years with locally advanced rectal cancer treated with either short-course radiotherapy or long-course chemoradiotherapy, followed by surgery and chemotherapy. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2019.2249DOI Listing

Differential Safety Between Top-Ranked Cancer Hospitals and Their Affiliates for Complex Cancer Surgery.

JAMA Netw Open 2019 Apr 5;2(4):e191912. Epub 2019 Apr 5.

Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.

Importance: Leading cancer hospitals have increasingly shared their brands with other hospitals through growing networks of affiliations. However, the brand of top-ranked cancer hospitals may evoke distinct reputations for safety and quality that do not extend to all hospitals within these networks.

Objective: To assess perioperative mortality of Medicare beneficiaries after complex cancer surgery across hospitals participating in networks with top-ranked cancer hospitals. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2019.1912DOI Listing

Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort.

Eur Heart J 2019 Apr 11. Epub 2019 Apr 11.

Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA 02215, USA.

Aims: We sought to identify the prevalence and related outcomes of frail individuals undergoing transcatheter mitral valve repair and transcatheter aortic valve replacement (TAVR).

Methods And Results: Patients aged 65 and older were included in the study if they had at least one procedural code for transcatheter mitral valve repair or TAVR between 1 January 2016 and 31 December 2016 in the Centers for Medicare and Medicaid Services Medicare Provider and Review database. The Hospital Frailty Risk Score, an International Classification of Diseases, Tenth Revision (ICD-10) claims-based score, was used to identify frailty and the primary outcome was all-cause 1-year mortality. Read More

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http://dx.doi.org/10.1093/eurheartj/ehz187DOI Listing

Does an all-condition case management program for high-risk patients reduce health care utilization in medicaid and medicare beneficiaries with diabetes?

J Diabetes Complications 2019 Jan 22. Epub 2019 Jan 22.

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. Electronic address:

Objective: To assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes.

Research Design And Methods: 1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP) Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM) and community health worker (CHW) per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). Read More

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https://linkinghub.elsevier.com/retrieve/pii/S10568727183049
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http://dx.doi.org/10.1016/j.jdiacomp.2018.12.011DOI Listing
January 2019
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Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016.

BMC Geriatr 2019 Apr 11;19(1):103. Epub 2019 Apr 11.

Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, 06510, USA.

Background: Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. Read More

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http://dx.doi.org/10.1186/s12877-019-1117-zDOI Listing

Have Hospice Costs Increased Following Implementation of the Hospice Quality Reporting Program?

J Pain Symptom Manage 2019 Apr 8. Epub 2019 Apr 8.

Background: The Centers for Medicare & Medicaid Services (CMS) Hospice Quality Reporting Program (HQRP) introduced the requirement that hospices nationwide begin collecting and submitting standardized patient-level quality data on July 1, 2014.

Objectives: This study examined whether this requirement has increased hospice total costs, general costs and visiting services costs.

Research Design: We conducted a cross-sectional study using data from the 2012 and 2014 Medicare hospice cost reports linked to hospice claims. Read More

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http://dx.doi.org/10.1016/j.jpainsymman.2019.03.013DOI Listing

Medicare and patient spending among beneficiaries diagnosed with chronic myelogenous leukemia.

Cancer 2019 Apr 11. Epub 2019 Apr 11.

Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.

Background: The authors examined Medicare spending and patient spending in older patients with chronic myelogenous leukemia (CML) over the first 5 years from the time of CML diagnosis in the tyrosine kinase inhibitor (TKI) era.

Methods: Medicare beneficiaries with CML who were diagnosed between 2007 and 2012 at age >65 years were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (805 beneficiaries). A noncancer Medicare beneficiary sample was frequency-matched based on age, sex, and race/ethnicity (805 individuals). Read More

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http://dx.doi.org/10.1002/cncr.32137DOI Listing
April 2019
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Patient Factors Affecting Emergency Department Utilization and Hospital Readmission Rates after Primary Anterior Cervical Discectomy and Fusion: A review of 41,813 cases.

Spine (Phila Pa 1976) 2019 Apr 8. Epub 2019 Apr 8.

All authors are affiliated with the Hospital for Special Surgery.

Study Design: Retrospective database analysis.

Objective: To identify preoperative risk factors for ED visit and unplanned hospital readmission after primary ACDF at 30 and 90 days.

Summary Of Background Data: Limited data exist to identify factors associated with ED visit or readmission after primary anterior cervical discectomy and fusion (ACDF) within the first 3 months following surgery. Read More

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http://dx.doi.org/10.1097/BRS.0000000000003058DOI Listing
April 2019
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Temporal trends and regional variation in the utilization of low-value breast cancer care: has the Choosing Wisely campaign made a difference?

Breast Cancer Res Treat 2019 Apr 10. Epub 2019 Apr 10.

Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.

Purpose: Since 2012, about 80 specialty societies have released Choosing Wisely (CW) recommendations aimed at reducing the use of low-value, unproven, or ineffective medical services. The extent to which these recommendations have influenced the behavior of physicians and patients remains largely unknown.

Methods: Using MarketScan Commercial Claims and Medicare Supplemental and Coordination of Benefits databases, we identified annual cohorts of women with incident, early-stage breast cancer and estimated the prevalence of four initial treatment and six surveillance metrics deemed as low-value breast cancer care by CW. Read More

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http://dx.doi.org/10.1007/s10549-019-05213-zDOI Listing