Do Employees From Less-Healthy Communities Use More Care and Cost More? Seeking to Establish a Business Case for Investment in Community Health.

Introduction: Few studies have examined the impact of community health on employers. We explored whether employed adults and their adult dependents living in less-healthy communities in the greater Philadelphia region used more care and incurred higher costs to employers than employees from healthier communities.

Methods: We used a multi-employer database to identify adult employees and dependents with continuous employment and mapped them to 31 zip code regions.

A predictive model of hospitalization risk among disabled medicaid enrollees.

Objectives: To identify Medicaid patients, based on 1 year of administrative data, who were at high risk of admission to a hospital in the next year, and who were most likely to benefit from outreach and targeted interventions.

Study Design: Observational cohort study for predictive modeling.

Methods: Claims, enrollment, and eligibility data for 2007 from a state Medicaid program were used to provide the independent variables for a logistic regression model to predict inpatient stays in 2008 for fully covered, continuously enrolled, disabled members.

Implementing the physician quality reporting system in an academic multispecialty group practice: lessons learned and policy implications.

The Centers for Medicare and Medicaid Services (CMS) introduced the Physician Quality Reporting System (PQRS) in 2007. PQRS was developed as a value-based, pay-for-reporting initiative intended to increase quality and decrease costs. Jefferson University Physicians (JUP) was an early participant in this voluntary program.

An economic model to value companion diagnostics in non-small-cell lung cancer.

Aim: An economic model was used to evaluate the potential economic impact and cost-effectiveness of companion diagnostic testing for patients with non-small-cell lung cancer (NSCLC).

Materials & Methods: A decision analysis model examined alternative patient management strategies for patients with advanced NSCLC who were not amenable to surgical treatment. A review of the literature provided the variables used to develop a timely base case and sensitivity analysis.

Measuring migraine-related quality of care across 10 health plans.

Objectives: To refine a previously published standardized quality and utilization measurement set for migraine care and to establish performance benchmarks.

Study Design: Retrospective application of the migraine measurement set to health plan data in order to assess patterns of health service utilization.

Methods: Measurement specifications were applied to data from 10 health plans for measurement year 2009.

Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain.

Objective: Several prominent guidelines recommend that patients on long-term opioid therapy have periodic urine drug monitoring (UDM) for appropriate use; however, none address the specific questions of which patients to test, which substances to test for, how often to test, and how to act on the results.

Design: In the absence of adequate scientific evidence in the literature, a panel of experts in the field of pain and addiction medicine was convened to develop consensus UDM recommendations. The panel met three times between March 2010 and April 2011, and reviewed several drafts of the recommendations document between meetings.

Improved cardiac management with a disease management program incorporating comprehensive lipid profiling.

The objective of this study was to evaluate the improved effectiveness of a disease management treatment protocol incorporating comprehensive lipid profiling and targeted lipid care based on lipid profile findings in patients with ischemic heart disease (IHD) or congestive heart failure (CHF) enrolled in a managed care plan. This retrospective cohort study, conducted over a 2-year period, compared outcomes between patients with a standard lipid profile to those evaluated with a comprehensive lipid profile. All adult members of the WellMed Medical Management, Inc.

Costs to hospitals of acquiring and processing blood in the US: a survey of hospital-based blood banks and transfusion services.

Background: little is known about the economics of acquiring and processing the more than 14 million units of red blood cells used annually in the US.

Objective: to determine the average price paid by hospitals to suppliers for a unit of red blood cells and to identify cost variations by region and facility type and size. A secondary objective was to examine costs for additional blood components as well as costs for blood-related processes performed by hospitals.

Effectiveness of guideline-recommended cardiac drugs for reducing mortality in the elderly medicare heart failure population: a retrospective, survey-weighted, cohort analysis.

Background: Heart failure (HF) management guidelines recommend that most patients with HF receive an ACE inhibitor or an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker [ARB]) and a β-blocker (β-adrenoceptor antagonist), collectively referred to as 'cardiac drugs', based on results from randomized controlled trials showing that these drugs reduce mortality. However, the results of randomized controlled trials may not be generalizable to the population most likely (i.e.

Quality of care for 2 common pediatric conditions treated by convenient care providers.

Rates of adherence to 2 quality measures, modeled after Heathcare Effectiveness Data and Information Set (HEDIS) measures, were evaluated in a pediatric population in a convenient care (retail medicine) clinic setting. The measures were appropriate testing for children with pharyngitis and appropriate treatment for children with upper-respiratory infection (URI). The convenient care clinic (CCC) achieved a ranking above the HEDIS 90th percentile for the pharyngitis measure and approximately midway between the 50th and 90th percentiles for the URI measure for the 2007 reporting period.

Indirect costs associated with surgery for low back pain-a secondary analysis of clinical trial data.

This study examines the indirect costs associated with surgery for axial low back pain using data obtained from a prospective multicenter clinical trial that compared Charité artificial disc replacement with anterior lumbar interbody fusion using iliac crest bone graft. While 75% of study subjects reported full- or part-time employment prior to surgery, this percentage dropped to 45% at 6 weeks postoperatively. Return to preoperative employment levels occurred at approximately 6 months postoperatively.

Is disease management right for oncology?

The disease management (DM) model for the treatment of chronic conditions has been around for many years and has been found to be effective for diseases of high prevalence and high cost (eg, diabetes, asthma, heart disease). With an increasing number of people living with cancer and the continual escalation of treatment costs, DM vendors have begun to implement DM concepts into cancer care. However, the multitude of cancer types, treatment options, and adverse effects have all presented barriers to oncology DM, and data reflecting the effectiveness of oncology DM have remained scarce.

Quality measurement in diabetes care.

This study aimed to evaluate diabetes quality measurement efforts, assess their strengths and areas for improvement, and identify gaps not adequately addressed by these measures. We conducted an environmental scan of diabetes quality measures, focusing on metrics included in the National Quality Measures Clearinghouse or promulgated by leading measurement organizations. Key informant interviews were also completed with thought leaders who develop, promote, and use quality measures.

High rates of inappropriate drug use in the chronic pain population.

Chronic opioid treatment is a highly effective method to treat chronic pain; however, the prevalence of abuse of opioids can make treating patients with these agents difficult for clinicians. The objective of this study was to describe rates of inappropriate utilization, abuse, and diversion in a population of patients who were prescribed chronic opioids, as measured by urine drug testing in the clinical setting. A retrospective analysis was conducted of results from all urine drug tests conducted by Ameritox, Ltd.

Ambulatory quality improvement in academic medical centers: a changing landscape.

Efforts to improve the quality of ambulatory care have received tremendous attention as bold new initiatives aimed at influencing the environment of care through financial incentives, public transparency, and information technology rapidly spread. Academic medical centers, which represent a long tradition of excellence and innovation in medical care, might be expected to lead the charge in these new arenas, but motivation for change may be mitigated by the unique complexity and multiple goals of these institutions. A survey conducted in the fall of 2006 examined the early impact of these major new influences on faculty practice plans.

Assessing quality of care for migraineurs: a model health plan measurement set.

Quality of care measures are increasingly important to health plans, purchasers, physicians, and patients. Appropriate measures can be used to assess quality and evaluate improvement and are necessary components of pay-for-performance programs. Despite the broad scope of activity in the development of quality measures, migraine headache has received little attention.

In chronic disease, nationwide data show poor adherence by patients to medication and by physicians to guidelines.

Purpose: It is widely acknowledged in small studies that provider variation from evidence-based care guidelines and patient medication nonadherence lead to less than optimal health outcomes, increasing costs, and higher utilization. The research presented here aims to determine the prevalence of patient adherence to a medication regimen and provider adherence to guidelines for a variety of chronic conditions, using nationally representative data.

Design: A retrospective analysis of administrative claims data from a large national insurer was conducted.

Candidemia in the in-patient setting: treatment options and economics.

Candidemia is the most common nosocomial fungal infection in the US. More than one in four adults who acquire candidemia in the hospital setting die prior to discharge. In addition to high case-fatality rates and other adverse clinical outcomes in survivors, candidemia is associated with a substantial economic burden.

Association between frequency of telephonic contact and clinical testing for a large, geographically diverse diabetes disease management population.

Diabetes disease management (DM) programs strive to promote healthy behaviors, including obtaining hemoglobin A1c (A1c) and low-density lipoprotein (LDL) tests as part of standards of care. The purpose of this study was to examine the relationship between frequency of telephonic contact and A1c and LDL testing rates. A total of 245,668 members continuously enrolled in diabetes DM programs were evaluated for performance of an A1c or LDL test during their first 12 months in the programs.

A focused telephonic nursing intervention delivers improved adherence to A1c testing.

Compliance with hemoglobin A1c (A1c) testing is suboptimal despite the clear national recommendations and guidelines established for care of patients with diabetes. Recent studies have demonstrated a relationship between participation in a diabetes disease management (DM) program and improved adherence to A1c testing. A focused intervention study was initiated to investigate the ability of a DM program to drive improvement in A1c testing.

Impact of chronic conditions on quality of life in patients with inflammatory bowel disease.

Background: Although studies suggest that inflammatory bowel disease (IBD) has a significant impact on an individual's health-related quality of life, the added weight of other health conditions and comorbidities has not been investigated. The purpose of this study was to expand on prior research by taking into account the impact of other chronic health conditions on the health-related quality of life of individuals with IBD, and to develop a model to help clinicians understand the relative impact of various predictors of their patients' physical and mental health-related quality of life.

Methods: 615 patients from the gastroenterology outpatient practice of a large, urban university hospital received a self-administered survey including questions about their health conditions, the severity of their bowel symptoms, and their health-related quality of life (measured using the SF-36 instrument).

Remote physiological monitoring: clinical, financial, and behavioral outcomes in a heart failure population.

This article reports on the outcomes associated with remote physiological monitoring (RPM) conducted as part of a heart failure disease management program. Claims data, medical records, data transmission records, and survey results for 91 individuals ages 50-92 (mean 74 years) successfully completing a heart failure RPM program were analyzed for time periods before, during, and after the monitoring intervention. The program was associated with significant reductions in per member per month costs and emergency room and hospital utilization.

Asthma management programs in managed care organizations.

The aim of this work was to investigate how managed care organizations (MCOs) currently approach asthma treatment and management and to determine factors affecting asthma outcomes. A Web-based survey was administered to a national sample of 351 medical directors of MCOs to investigate the asthma management program components in their organizations as well as gaps and barriers in the management of patients with asthma. All 134 (38.