Association of Anxiety With High-Cost Health Care Use Among Individuals With Type 2 Diabetes.

Objective: People with type 2 diabetes vary greatly in their use of high-cost health care resources. We examined the association of anxiety with high-cost use after accounting for depression and medical comorbidity.

Research Design And Methods: Using electronic health record data, we assessed past anxiety diagnosis, health care use and costs, demographics, comorbidities, and diabetes control status and complications during 2008-2012 for 143,573 adult members of an integrated health care system with type 2 diabetes.

Strategies for Building Delivery Science in an Integrated Health Care System.

Health systems today have increasing opportunities and imperatives to conduct delivery science, which is applied research that evaluates clinical or organizational practices that systems can implement or encourage. Examples include research on eliminating racial/ethnic disparities in hypertension management and on identifying the types of patients who can successfully use video visits. Clinical leaders and researchers often face barriers to delivery science, including limited funding, insufficient leadership support, lack of engagement between operational and research leaders, limited pools of research expertise, and lack of pathways to identify and develop ideas.

Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs.

A high proportion of U.S. health care costs are attributable to a relatively small proportion of patients.

The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators.

Objective: To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California.

Design: Longitudinal analysis.

Setting: 35 medical facilities of Kaiser Permanente Northern California, 1997-2007.

Does population management of chronic disease lead to lower costs of care?

The paper by Bruce Fireman and colleagues is an important contribution to the dialogue about the role of chronic disease management in quality improvement and health care cost mitigation. There is much enthusiasm for the potential impact of disease management techniques on the costs associated with chronic and complex health conditions. This Perspective describes several considerations that are important to the interpretation of studies of the cost impact of disease management and to assessments of the future usefulness of these interventions.