COVID-19's Effect on Practice Quality Improvement and Transformation Activities: Practice Survey Results.

Background And Objectives: The Transforming Clinical Practices Initiative (TCPI) was a 4-year, large-scale, collaborative, peer-based learning initiative for physician practices of all specialties with broad goals to improve the quality of patient care, spend health care dollars more wisely, and assist practices in being ready to succeed under value-based payment (VBP). We investigated whether the COVID-19 pandemic had erased or diminished practice transformation progress made during the TCPI program period, through a follow-up survey of participating practices fielded in October 2021.

Methods: In October 2021 to April 2022, we surveyed a probability sample of 2207 primary care and specialty practices that participated in the TCPI, receiving 610 responses.

Practice Transformation in the Transforming Clinical Practice Initiative and Emergency Department Use.

To provide insight on how ambulatory care practices can reduce emergency department (ED) visits, we studied changes in Medicare ED visits for primary and specialty care practices in the Transforming Clinical Practice Initiative. We compared practices that transformed more vs less during the 6-year period ending in 2021 (3,773 practices). Using data from a practice transformation assessment tool completed at multiple intervals, we found improvement in the transformation score was associated with reduced ED visits by 6% and 4% for primary and specialty care practices, respectively, 3 to 4 years after first assessment.

Comparing the quality of care in physician networks to usual care for elderly patients in three German regions: a quasi-experimental cohort study.

Objectives: Patients in Germany have free choice of physicians in the ambulatory care sector and can consult them as often as they wish without a referral. This can lead to inefficiencies in treatment pathways. In response, some physicians have formed networks to improve the coordination and quality of care.

Organization and quality of care in patient-sharing networks.

Healthcare systems seek to provide continuous and coordinated care of high quality. However, patient pathways in the ambulatory sector may differ and result in various provider units. Our aim was to analyze whether health outcomes and the quality of care differ between different types of patient-sharing physician networks.

Do physician networks with standardized audit and feedback deliver better quality care for older patients compared to regular care?: a quasi-experimental study using claims data from Bavaria, Germany.

Background: Physician networks (PNs) are a recent development in Germany, designed to improve the coordination and quality of healthcare. We compared the performance of PNs that use a standardized system of audit and feedback to that of regular care.

Methods: We analysed a large sample of claims data from Bavaria, Germany, using nearest-neighbour propensity score matching.

Regional variations in multimorbidity burden among office-based physicians in Germany.

Background: Multimorbidity is associated with higher utilization of healthcare services. However, many countries do not consider multimorbidity when estimating physician supply. The main aim of this study was to assess how regional multimorbidity levels can be integrated when estimating the need for office-based physician supply.

Lumit: A Homogeneous Bioluminescent Immunoassay for Detecting Diverse Analytes and Intracellular Protein Targets.

Traditional immunoassays to detect secreted or intracellular proteins can be tedious, require multiple washing steps, and are not easily adaptable to a high-throughput screening (HTS) format. To overcome these limitations, we developed Lumit, a novel immunoassay approach that combines bioluminescent enzyme subunit complementation technology and immunodetection. This bioluminescent immunoassay does not require washes or liquid transfers and takes less than 2 h to complete in a homogeneous "Add and Read" format.

Diffusion of a new drug among ambulatory physicians-The impact of patient pathways.

When drugs enter the market, physicians' prescribing behavior plays a crucial role in the diffusion process. Although regulations to foster economically efficient prescribing exist, physicians have some degree of freedom in choosing medication and are subject to various influencing factors. The aim of the present analysis is to investigate how interaction among patients and physicians affects the diffusion.

Health economic evaluation of the 'Flying Intervention Team' as a novel stroke care concept for rural areas: study protocol of the TEMPiS-GÖA study.

Introduction: Providing comprehensive stroke care poses major organisational and financial challenges to the German healthcare system. The quasi-randomised TEMPiS-Flying Intervention Team (TEMPiS-FIT) study aims to close the gap in the treatment of patients who had ischaemic stroke in rural areas of Southeast Bavaria by flying a team of interventionalists via helicopter directly to patients in the regional TEMPiS hospitals instead of transporting the patients to the next comprehensive stroke centre. The objective of the present paper is to describe the methods for the economic evaluation (TEMPiS-Gesundheitsökonomische Analyse (TEMPiS-GÖA)) alongside the TEMPiS-FIT study to determine whether the new form of care is cost-effective compared with standard care.

Development of indicators to assess quality and patient pathways in interdisciplinary care for patients with 14 ambulatory-care-sensitive conditions in Germany.

Background: In settings like the ambulatory care sector in Germany, where data on the outcomes of interdisciplinary health services provided by multiple office-based physicians are not always readily available, our study aims to develop a set of indicators of health care quality and utilization for 14 groups of ambulatory-care-sensitive conditions based on routine data. These may improve the provision of health care by informing discussions in quality circles and other meetings of networks of physicians who share the same patients.

Methods: Our set of indicators was developed as part of the larger Accountable Care in Deutschland (ACD) project using a pragmatic consensus approach.

Routine data-based quality indicators for the treatment of gonarthrosis and coxarthrosis patients in the ambulatory care sector - A study protocol for a cluster-randomised pilot trial to evaluate the MobilE-ARTH study.

Background: In 2019, Germany had the highest rate of hip replacement surgery and the fourth highest rate of knee replacement surgery among more than 30 OECD countries. The age-standardised rates were estimated at 174 hip joint and 137 knee joint replacements per 100,000 population. Against this background, the contrast between financial incentives for surgery and missing incentives for non-surgical treatment options is repeatedly discussed.

Patterns of pregabalin prescribing in four German federal states: analysis of routine data to investigate potential misuse of pregabalin.

Objectives: The objectives of this study were to investigate the utilisation patterns of pregabalin, to identify users potentially misusing pregabalin and to compare this group of patients to patients prescribed recommended doses of pregabalin concerning their personal characteristics and the coordination among their prescribers. Unintended coprescription of drugs with addictive potential might occur when care is insufficiently coordinated.

Design: Secondary data analysis of linked data from three regional sickness funds in Germany (AOK) for the years 2014-2016.

A homogeneous bioluminescent immunoassay for parallel characterization of binding between a panel of antibodies and a family of Fcγ receptors.

Fc engineering efforts are increasingly being employed to modulate interaction of antibodies with variety of Fc receptors in an effort to improve the efficacy and safety of the therapeutic antibodies. Among the various Fc receptors, Fc gamma receptors (FcγRs) present on variety of immune cells are especially relevant since they can activate multiple effector functions including antibody dependent cellular cytotoxicity (ADCC) and antibody dependent cellular phagocytosis (ADCP). Depending on the desired mechanism of action (MOA) of the antibody, interactions between Fc domain of the antibody and FcγR (denoted as Fc/FcγR) may need to be enhanced or abolished.

Transforming Clinical Practice Initiative Boosted Participation in Medicare Alternative Payment Models.

The Centers for Medicare & Medicaid Services' (CMS's) Transforming Clinical Practice Initiative (TCPi) was the largest national-scale practice transformation model. We analyzed the effect of TCPi on new enrollment into Medicare Alternative Payment Models (APMs) through January 2020 (3 months after program end), using 6958 physician practices enrolled in TCPi and a closely matched comparison group of 6958 practices. More TCPi practices enrolled in Medicare APMs and Medicare Advanced APMs relative to comparison practices overall and in subgroups, including rural, small, and specialty practices.

Using social network analysis methods to identify networks of physicians responsible for the care of specific patient populations.

Background: Coordinating health care within and among sectors is crucial to improving quality of care and avoiding undesirable negative health outcomes, such as avoidable hospitalizations. Quality circles are one approach to strengthening collaboration among health care providers and improving the continuity of care. However, identifying and including the right health professionals in such meetings is challenging, especially in settings with no predefined patient pathways.

Fertility control in ancient Rome.

This paper surveys and evaluates the range of methods recommended mostly to promote but also to prevent pregnancy in ancient Rome, and then discusses the practices of adult adoption and infant exposure in more detail in order to interrogate the notion of 'fertility control' from an ancient historical perspective. Is this formulation sufficiently flexible to encompass Roman procreative projects and the resources they were able to bring to bear on them? Were the methods deployed sufficiently effective to qualify as 'control', and was it 'fertility' that was being acted on through adoption and exposure? This essay answers these questions positively and argues that the Roman case has plenty to offer wider debates about the history of reproduction as it includes the desires to have and not to have children, to limit and increase offspring, to shape families in different ways.

Improving the continuity and coordination of ambulatory care through feedback and facilitated dialogue-a study protocol for a cluster-randomised trial to evaluate the ACD study (Accountable Care in Germany).

Background: Patients in Germany are free to seek care from any office-based physician and can always ask for multiple opinions on a diagnosis or treatment. The high density of physicians and the freedom to choose among them without referrals have led to a need for better coordination between the multiple health professionals treating any given patient. The objectives of this study are to (1) identify informal networks of physicians who treat the same patient population, (2) provide these physicians with feedback on their network and patients, using routine data and (3) give the physicians the opportunity to meet one another in facilitated network meetings.

Bioluminescent Bridging Immunoassay for Anti-Drug Antibody (ADA) Detection.

Any immune reaction to therapeutic antibodies will impact the drug efficacy and can have serious consequences for patient safety. Therefore, detection and reporting of anti-drug antibodies (ADA) during clinical trials is required by regulatory agencies during drug approval process. We have developed a bioluminescent bridging immunoassay for ADA detection, which uses an extremely bright NanoLuc enzyme as a reporter.

Deciphering the Interaction between Neonatal Fc Receptor and Antibodies Using a Homogeneous Bioluminescent Immunoassay.

Long half-life of therapeutic Abs and Fc fusion proteins is crucial to their efficacy and is, in part, regulated by their interaction with neonatal Fc receptor (FcRn). However, the current methods (e.g.

Development of a novel homogeneous immunoassay using the engineered luminescent enzyme NanoLuc for the quantification of the mycotoxin fumonisin B1.

Compared to the traditional heterogeneous assays, a homogeneous immunoassay is a preferred format for its simplicity. By cloning and isolating luminescent proteins from bioluminescent organisms, bioluminescence has been widely used for various biological applications. In this study, we present the development of a homogeneous luminescence immunoassay (FNanoBiT assay) for detection of fumonisin B1 (FB1), based on the binding of two subunits of an engineered luminescent protein (NanoLuc).

Exploring the microbial biotransformation of extraterrestrial material on nanometer scale.

Exploration of microbial-meteorite redox interactions highlights the possibility of bioprocessing of extraterrestrial metal resources and reveals specific microbial fingerprints left on extraterrestrial material. In the present study, we provide our observations on a microbial-meteorite nanoscale interface of the metal respiring thermoacidophile Metallosphaera sedula. M.

The impact of antimicrobials on gonococcal evolution.

The sexually transmitted pathogen Neisseria gonorrhoeae is regarded as being on the way to becoming an untreatable superbug. Despite its clinical importance, little is known about its emergence and evolution, and how this corresponds with the introduction of antimicrobials. We present a genome-based phylogeographical analysis of 419 gonococcal isolates from across the globe.

Extending the dynamic range of biomedical micro-computed tomography for application to geomaterials.

Background: X-ray computed tomography (CT) can non-destructively examine objects by producing three-dimensional images of their internal structure. Although the availability of biomedical micro-CT offers the increased access to scanners, CT images of dense objects are susceptible to artifacts particularly due to beam hardening.

Objective: This study proposes and evaluates a simple semi-empirical correction method for beam hardening and scatter that can be applied to biomedical scanners.

Sensory uncertainty impacts avoidance during spatial decisions.

When making risky spatial decisions, humans incorporate estimates of sensorimotor variability and costs on outcomes to bias their spatial selections away from regions that incur feedback penalties. Since selection variability depends on the reliability of sensory signals, increasing the spatial variance of targets during visually guided actions should increase the degree of this avoidance. Healthy adult participants (N = 20) used a computer mouse to indicate their selection of the mean of a target, represented as a 2D Gaussian distribution of dots presented on a computer display.