Transforming Health Care from Volume to Value: Moving the Needle Through Population Health.

United States health systems face unique challenges in transitioning from volume-based to value-based care, particularly for academic institutions. Providing complex specialty and tertiary care dependent on servicing large geographic areas, and concomitantly meeting education and research academic missions may limit the time and resources available for focusing on the care coordination needs of complex local populations. Despite these challenges, academic medicine is well situated to capitalize on the promise of value-based care and to lead broad improvements in both teaching and nonteaching hospitals.

Impactability Modeling for Reducing Medicare Accountable Care Organization Payments and Hospital Events in High-Need High-Cost Patients: Longitudinal Cohort Study.

Background: Impactability modeling promises to help solve the nationwide crisis in caring for high-need high-cost patients by matching specific case management programs with patients using a "benefit" or "impactability" score, but there are limitations in tailoring each model to a specific program and population.

Objective: We evaluated the impact on Medicare accountable care organization savings from developing a benefit score for patients enrolled in a historic case management program, prospectively implementing the score, and evaluating the results in a new case management program.

Methods: We conducted a longitudinal cohort study of 76,140 patients in a Medicare accountable care organization with multiple before-and-after measures of the outcome, using linked electronic health records and Medicare claims data from 2012 to 2019.

Risk from delayed or missed care and non-COVID-19 outcomes for older patients with chronic conditions during the pandemic.

Background: During the COVID-19 pandemic, patients with chronic illnesses avoided regular medical care, raising concerns about long-term complications. Our objective was to identify a population of older patients with chronic conditions who may be at risk from delayed or missed care (DMC) and follow their non-COVID outcomes during the pandemic.

Methods: We used a retrospective matched cohort design using Medicare claims and electronic health records at a large health system with community and academic clinics.

A practical model for research with learning health systems: Building and implementing effective complex case management.

For researchers to contribute meaningfully to the creation of learning health systems, practical tools are required to operationalize existing conceptual frameworks. We describe a model currently in use by the University of Wisconsin Health Innovation Program (HIP). The HIP model consolidates and enhances existing learning health system frameworks by defining specific steps needed to create sustainable change based on research conducted within the health system.

The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet).

Objective: Case management programs for high-need high-cost patients are spreading rapidly among health systems. PCORNet has substantial potential to support learning health systems in rapidly evaluating these programs, but access to complete patient data on health care utilization is limited as PCORNet is based on electronic health records not health insurance claims data. Because matching cases to comparison patients on baseline utilization is often a critical component of high-quality observational comparative effectiveness research for high-need high-cost patients, limited access to claims may negatively affect the quality of the matching process.

WITHDRAWN: Endothelium in the allograft.

The paper entitled "Endothelium in the allograft" by Bryan N Becker et al, which was published online on 9 September 2009, has been withdrawn at the authors' request. Kidney International advance online publication, 9 September 2009; doi:10.1038/ki.

Calciphylaxis responsive to lanthanum carbonate (FOSRENOL) therapy.

Calciphylaxis is a rare and debilitating vasculopathy predominantly seen in patients with renal failure. The proposed mechanism of injury is active vascular calcification with associated elevated parathyroid hormone, hypercalcemia, or hyperphosphatemia. With improved pharmacologic agents including non-calcium containing phosphate binders, vitamin D analogues, calcimimetics, and bisphosphonates, targeted therapy on the mineralization process has been tried with varied success.

Knowledge of phosphorus compared with other nutrients in maintenance dialysis patients.

Objective: This study's objective was to assess knowledge of phosphorus compared with other nutrients in patients undergoing maintenance dialysis (MD).

Design: We compared knowledge of phosphorus vs. other nutrients important to the MD diet (potassium, sodium, and protein) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD).

Local television news reporting of kidney disease.

Background: Local television is the primary news source for the majority of Americans. This study aims to describe how local news reports on kidney disease.

Methods: Using our searchable database of health-related late local news segments from 2002, we identified stories with the key words kidney, hypertension, blood pressure, or diabetes.

Conflicting dietary advice for adhering to low-sodium and low-phosphorus diets.

Objective: To elucidate conflicts that patients face when advised to limit multiple nutrients in their diet.

Design: We analyzed the phosphorus content of low-sodium foods compared with their regular-sodium content counterparts, and the sodium content of low-phosphorus foods compared with foods containing higher levels of phosphorus. Low-sodium and low-phosphorus foods were identified with the use of recommendations from National Kidney Foundation patient information Web sites.

Karyomegalic tubulointerstitial nephritis--a case report.

Karyomegalic tubulointerstitial nephritis is a rare disease of uncertain etiology, which leads to progressive renal failure. Here, we report on a 39-year-old patient who presented with asymptomatic progressive decline of renal function. Two sequential renal biopsies demonstrated chronic tubulointerstitial nephritis with bizarre and dramatic enlargement of proximal tubule epithelial cell nuclei - the hallmark of karyomegalic nephritis.

Low serum magnesium is associated with decreased graft survival in patients with chronic cyclosporin nephrotoxicity.

Background: Hypomagnesaemia is a common side effect of cyclosporin A (CsA) therapy. Animal studies suggest that magnesium (Mg) supplementation inhibits chronic CsA nephropathy.

Methods: To determine if low Mg levels correlate with true CsA-induced nephrotoxicity in humans, we examined kidney transplant biopsy records at our centre for all transplant biopsies performed between 1990 and 2002.

Evaluation of eHealth web sites for patients with chronic kidney disease.

Background: Chronic kidney disease (CKD) affects up to 19.2 million Americans, and untreated kidney disease can progress to kidney failure. Patient education is an important part of slowing disease progression, but the ability of health professionals to provide this education is limited by time constraints.