Clinical burden of asynchrony in patients with asthma when using metered-dose inhalers for control.

Asynchrony, or lack of coordination between inhalation and actuation when using a pressurized metered-dose inhaler (MDI), could theoretically impact the delivery of inhaled medications and treatment efficacy. To assess the real-world association between asynchrony and clinical outcomes among patients with asthma who receive controller therapy delivered by MDIs. A cohort of patients was assembled via electronic health records.

Quantifying Sex Differences in Cardiovascular Care Among Patients Evaluated for Suspected Ischemic Heart Disease.

Cardiovascular care sex differences are controversial. We examined sex differences in management and clinical outcomes among patients undergoing noninvasive testing for ischemic heart disease (IHD). In a rural integrated healthcare system, we identified adults age 40-79 without diagnosed IHD who underwent initial evaluation with a cardiac stress test with imaging or coronary computed tomographic angiography (CTA), 2013-2014.

Measuring Adherence and Outcomes in the Treatment of Patients With Multiple Sclerosis.

Context: Both adherence and outcomes are more difficult to measure in patients with multiple sclerosis (MS) than in patients with diseases such as hypertension, for which most medications are taken orally and surrogate outcomes (eg, blood pressure) are routinely collected.

Objectives: To characterize the adherence and outcomes of patients with MS within a large integrated health system and to assess the relationship between adherence and outcomes.

Study Design: Retrospective review of adherence and health care utilization outcomes via electronic health records and claims (2004-2013) combined with a prospective survey regarding adherence and functional outcomes (2012-2013).

Burden of Readmissions Among Patients With Critical Limb Ischemia.

Background: Readmissions constitute a major health care burden among critical limb ischemia (CLI) patients.

Objectives: This study aimed to determine the incidence of readmission and factors affecting readmission in CLI patients.

Methods: All adult hospitalizations with a diagnosis code for CLI were included from State Inpatient Databases from Florida (2009 to 2013), New York (2010 to 2013), and California (2009 to 2011).

Factors associated with opioid overdose: a 10-year retrospective study of patients in a large integrated health care system.

Objective: Opioid overdoses (ODs) have been increasing, and harm reduction efforts are a priority. The success of these efforts will be dependent on the identification of at-risk patients and improved access to the antidote naloxone. Therefore, to identify access to naloxone and factors associated with negative health outcomes, we conducted a retrospective study of patients with OD to identify those at highest risk of adverse outcomes and to assess the use of naloxone.

Mixed Incontinence Masked as Stress Induced Urgency Urinary Incontinence.

Purpose: We sought to understand variations in the expression and temporal relation of bladder control episodes among women with mixed urinary incontinence.

Materials And Methods: A random sample of women 40 years old or older with mixed urinary incontinence on GLOBE-UI (General Longitudinal Overactive Bladder Evaluation-Urinary Incontinence) was recruited in a digital daily diary study using a smartphone application. When a bladder control event occurred, women were instructed to answer episode specific questions.

The value of value-based insurance design: savings from eliminating drug co-payments.

Objectives: To estimate the cost impact of a $0 co-pay prescription drug program implemented by a large healthcare employer as a part of its employee wellness program.

Study Design: A $0 co-pay program that included approximately 200 antihypertensive, antidiabetic, and antilipid medications was offered to Geisinger Health System (GHS) employees covered by Geisinger Health Plan (GHP) in 2007. Claims data from GHP for the years 2005 to 2011 were obtained.

Mental Health Disorders and Treatment Seeking Among Veterans in Non-VA Facilities: Results and Implications from the Veterans' Health Study.

We surveyed 700 veterans who were outpatients in a non-Veterans Affairs (VA) multihospital system. Our objective was to assess the prevalence of mental disorders and service use among these veterans. The majority were Vietnam veterans (72.

The impact of free trial acceptance on demand for alternative nicotine products: evidence from experimental auctions.

Objectives: This study explored the relationship between product trials and consumer demand for alternative nicotine products (ANP).

Methods: An experimental auction was conducted with 258 adult smokers, wherein participants were randomly assigned to one of four experimental conditions. The participants received the opportunity to try, but did not have to accept, one of three relatively novel ST products (i.

Cost-effectiveness of IL28Β genotype-guided protease inhibitor triple therapy versus standard of care treatment in patients with hepatitis C genotypes 2 or 3 infection.

Background/aims: Triple therapy [adding protease inhibitors to standard of care (SOC)] dramatically increases treatment response in selected patients with hepatitis C virus (HCV). Interleukin 28B (IL28Β) genotyping helps predict responsiveness in these patients; however, the economic implications of IL28Β genotyping in HCV genotype 2 or 3 infected patients are unknown. Short- and long-term costs and outcomes of SOC therapy were calculated and used to determine the cost-effectiveness thresholds for using triple therapy in HCV genotype 2 or 3 infected patients.

Chronic care model strategies in the United States and Germany deliver patient-centered, high-quality diabetes care.

Improving the quality of care for chronic diseases is an important issue for most health care systems in industrialized nations. One widely adopted approach is the Chronic Care Model (CCM), which was first developed in the late 1990s. In this article we present the results from two large surveys in the United States and Germany that report patients' experiences in different models of patient-centered diabetes care, compared to the experiences of patients who received routine diabetes care in the same systems.

Primary care diabetes bundle management: 3-year outcomes for microvascular and macrovascular events.

Objectives: To determine whether a system of care with an all-or-none bundled measure for primary-care management of diabetes mellitus reduced the risk of microvascular and macrovascular complications compared with usual care.

Study Design: A parallel pre-post observational design was used. In 2006, a system of care for diabetes was implemented for some members of the Geisinger Health Plan.

The impact of product information and trials on demand for smokeless tobacco and cigarettes: evidence from experimental auctions.

Introduction: Epidemiological and toxicological evidence suggests lower risk of smokeless tobacco (ST) products compared to cigarettes. Less is known, however, about consumer perceptions and use of novel forms of ST, including snus and dissolvable tobacco.

Methods: In this study, we conducted in-person experimental auctions in Buffalo, NY, Columbia, SC, and Selinsgrove, PA with 571 smokers to test the impact of information and product trials on smokers' preferences.

Can health insurance improve employee health outcome and reduce cost? An evaluation of Geisinger's employee health and wellness program.

Objective: To evaluate the impact of a health plan-driven employee health and wellness program (known as MyHealth Rewards) on health outcomes (stroke and myocardial infarction) and cost of care.

Methods: A cohort of Geisinger Health Plan members who were Geisinger Health System (GHS) employees throughout the study period (2007 to 2011) was compared with a comparison group consisting of Geisinger Health Plan members who were non-GHS employees.

Result: The GHS employee cohort experienced a stroke or myocardial infarction later than the non-GHS comparison group (hazard ratios of 0.