Association of Postsurgical Opioid Refills for Patients With Risk of Opioid Misuse and Chronic Opioid Use Among Family Members.

Importance: The US health care system is experiencing a sharp increase in opioid-related adverse events and spending, and opioid overprescription may be a key factor in this crisis. Ambient opioid exposure within households is one of the known major dangers of overprescription.

Objective: To quantify the association between the postsurgical initiation of prescription opioid use in opioid-naive patients and the subsequent prescription opioid misuse and chronic opioid use among opioid-naive family members.

Aetna's Compassionate Care Program: Sustained Value for Our Members with Advanced Illness.

In 2004, Aetna, a national health insurer, launched the Aetna Compassionate Care Program (ACCP) targeting members diagnosed with an advanced illness with a view to increase access to palliative care and hospice services. The objective of this study is to evaluate the impact of ACCP on health care utilization and hospice enrollment among enrolled members. This was a retrospective cohort study comparing participants in ACCP to a matched control group using a propensity score method.

The Future of Virtual Care Services: A Payor's Perspective.

Whereas majority of telemedicine services today are focused on minor acute clinical ailments, the true potential of virtual care models lies in their ability to improve access to chronic condition care for medically complex individuals. Virtual models focused on chronic condition management will require continuity of care and the availability of in-person evaluations when necessary. Such services are more likely to be delivered by community-based primary care and specialty physicians, rather than vendor-administered, which is the most common model today.

Impact of Direct to Consumer Store-and-Forward Teledermatology on Access to Care, Satisfaction, Utilization, and Costs in a Commercial Health Plan Population.

Purpose: Store-and-forward teledermatology can improve access to dermatology by enabling asynchronous consults. This study assesses it on access, satisfaction, utilization, and costs in a commercial health plan setting.

Methodology: In this prospective observational study with matched control, 47,411 individuals were provided access to teledermatology services staffed by board-certified, licensed dermatologists for 6 months.

Chronic Obstructive Pulmonary Disease Readmissions and Other Measures of Hospital Quality.

Rationale: The Centers for Medicare and Medicaid Services recently implemented financial penalties to reduce hospital readmissions for select conditions, including chronic obstructive pulmonary disease (COPD). Despite growing pressure to reduce COPD readmissions, it is unclear how COPD readmission rates are related to other measures of quality, which could inform efforts on common organizational factors that affect high-quality care.

Objectives: To examine the association between COPD readmissions and other quality measures.

Remove barriers to sharing health data and create a continuously learning healthcare system.

In a May 2016 paper in the journal Academic Medicine, I described moving to the "third curve" of healthcare. The first curve is traditional fee-for-service medicine. The second is population health, as represented by traditional healthcare organizations shifting their focus to value-based relationships.

Academic Medicine's Critical Role in the "Third Curve" of Health Care.

Over the last several years, the health care landscape has changed at an unprecedented rate due to new economic and regulatory forces ushered in by the Affordable Care Act and the introduction of innovative technologies, such as personalized medicine, that are poised to open the door to consumer-driven health care. Tremendous pressure exists on academic health centers to rapidly evolve clinically while not abandoning their unique academic mission. The convergence of personalized medicine, new digital technologies, and changes in health professionals' scope of practice alongside new payment structures will accelerate the move to a patient-centered health system.

Reinventing Emergency Department Flow via Healthcare Delivery Science.

Healthcare system flow resulting in emergency departments (EDs) crowding is a quality and access problem. This case study examines an overcrowded academic health center ED with increasing patient volumes and limited physical space for expansion. ED capacity and efficiency improved via engineering principles application, addressing patient and staffing flows, and reinventing the delivery model.

Attitudes About and Practices of Health Promotion and Prevention Among Primary Care Providers.

The Patient Protection and Affordable Care Act's emphasis on health promotion and prevention activities required an examination of the current practices of primary care providers in these areas. A total of 196 primary care providers completed a survey to assess current health promotion and prevention attitudes, practices, and barriers. Results of this study showed that family physicians in Pennsylvania recognize the importance of and their role in providing health promotion and prevention and offer advice in key behavioral and disease prevention areas.

Employee health benefit redesign at the academic health center: a case study.

The rapidly escalating cost of health care, including the cost of providing health care benefits, is a significant concern for many employers. In this article, the authors examine a case study of an academic health center that undertook a complete redesign of its health benefit structure to control rising costs, encourage use of its own provider network, and support employee wellness. With the implementation in 2006 of a high-deductible health plan combined with health reimbursement arrangements and wellness incentives, the Penn State Hershey Medical Center (PSHMC) was able to realize significant cost savings and increase use of its own network while maintaining a high level of employee satisfaction.

Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003.

Objective: To determine recent trends in rates of hospitalization, mortality, and hospital case fatality for severe sepsis in the United States.

Design: Trend analysis for the period from 1993 to 2003.

Setting: U.

Occurrence and outcomes of sepsis: influence of race.

Objective: To evaluate premorbid conditions and sociodemographic characteristics associated with differences in hospitalization and mortality rates of sepsis in blacks and whites.

Design: Secondary data analysis of the publicly available New Jersey State Inpatient Database for 2002.

Setting: Acute care hospitals in New Jersey.

Safety and efficacy of affinity-purified, anti-tumor necrosis factor-alpha, ovine fab for injection (CytoFab) in severe sepsis.

Objective: Tumor necrosis factor (TNF) is a critical inflammatory mediator in sepsis. This trial was designed to evaluate the safety and effectiveness of polyclonal ovine anti-TNF fragment antigen binding (Fab) fragments (CytoFab) on plasma TNF-alpha, interleukin-6 (IL-6), and interleukin-8 (IL-8) concentrations and the number of shock-free and ventilator-free days in severely septic patients.

Design: Phase II, randomized, blinded, placebo-controlled trial conducted from September 1997 to July 1998.

Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations.

Objective: To determine recent trends in severe sepsis-related rates of hospitalization, mortality, and hospital case fatality in a large geographic area and to determine the impact of age, race, and gender on these outcomes.

Design: Trend analysis for the period of 1995 to 2002.

Setting: Acute care hospitals in New Jersey.