Physician networks and potentially inappropriate opioid prescriptions.

Opioid overdose is a national health priority and curbing inappropriate prescribing is critical. In 2016, the Centers for Disease Control and Prevention (CDC) issued appropriate prescribing guidelines. Examine associations between care networks defined by shared patients and problematic opioid prescribing.

Behavioral Health's Integration Within a Care Network and Health Care Utilization.

Objective: Examine how behavioral health (BH) integration affects health care costs, emergency department (ED) visits, and inpatient admissions.

Data Sources/study Setting: Truven Health MarketScan Research Databases.

Study Design: Social network analysis identified "care communities" (providers sharing a high number of patients) and measured BH integration in terms of how connected, or central, BH providers were to other providers in their community.

Health Benefits and Cost-Effectiveness of Brief Clinician Tobacco Counseling for Youth and Adults.

Purpose: To help clinicians and care systems determine the priority for tobacco counseling in busy clinic schedules, we assessed the lifetime health and economic value of annually counseling youth to discourage smoking initiation and of annually counseling adults to encourage cessation.

Methods: We conducted a microsimulation analysis to estimate the health impact and cost effectiveness of both types of tobacco counseling in a US birth cohort of 4,000,000. The model used for the analysis was constructed from nationally representative data sets and structured literature reviews.

Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention.

Purpose: Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity.

Methods: We used a single, integrated, microsimulation model to generate comparable results for 3 services recommended by the US Preventive Services Task Force: aspirin counseling for the primary prevention of CVD and colorectal cancer, screening and treatment for lipid disorders (usually high cholesterol), and screening and treatment for hypertension. Analyses compare lifetime outcomes from the societal perspective for a US-representative birth cohort of 100,000 persons with and without access to each clinical preventive service.

Updated Priorities Among Effective Clinical Preventive Services.

Purpose: The Patient Protection and Affordable Care Act's provisions for first-dollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts.

Age-related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines.

Objective: In 2006, the American College of Surgeons' Committee on Trauma and the Centers for Disease Control and Prevention released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions.

System Transformation in Patient-Centered Medical Home (PCMH): Variable Impact on Chronically Ill Patients' Utilization.

Background: Research connecting patient-centered medical homes (PCMHs) with improved quality and reduced utilization is inconsistent, possibly because individual domains of change, and the stage of change, are not incorporated in the research design. The objective of this study was to examine the association between stage and domain of change and patterns of health care utilization.

Methods: This was a cross-sectional observational study that including 87 Minnesota clinics certified as medical homes.

Modeled Health and Economic Impact of Team-Based Care for Hypertension.

Introduction: Team-based interventions for hypertension care have been widely studied and shown effective in improving hypertension outcomes. Few studies have evaluated long-term effects of these interventions; none have assessed broad-scale implementation. This study estimates the prospective health, economic, and budgetary impact of universal adoption of a team-based care intervention model that targets people with treated but uncontrolled hypertension in the U.

Aspirin for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: A Decision Analysis for the U.S. Preventive Services Task Force.

Background: Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) but also increases the risk for gastrointestinal (GI) and cerebral hemorrhages.

Objective: To assess the net balance of benefits and harms from routine aspirin use across clinically relevant age, sex, and CVD risk groups.

Design: Decision analysis using a microsimulation model.

Practice change toward better adherence to evidence-based treatment of early dental decay in the National Dental PBRN.

Background: Significant national investments have aided the development of practice-based research networks (PBRNs) in both medicine and dentistry. Little evidence has examined the translational impact of these efforts and whether PBRN involvement corresponds to better adoption of best available evidence. This study addresses that gap in knowledge and examines changes in early dental decay among PBRN participants and non-participants with access to the same evidence-based guideline.

Reducing childhood obesity through U.S. federal policy: a microsimulation analysis.

Background: Childhood obesity prevalence remains high in the U.S., especially among racial/ethnic minorities and low-income populations.

The effect of price reduction on salad bar purchases at a corporate cafeteria.

The objective of this study was to determine the effect of a price reduction on salad bar purchases in a corporate cafeteria. We reduced the price of salad bar purchases by 50% during March 2012 and analyzed sales data by month for February through June 2012. We also conducted an anonymous survey.

Patient-centered medical home cost reductions limited to complex patients.

Objectives: To examine the long-term relationships between costs, utilization, and patient-centered medical home (PCMH) clinical practice systems.

Study Design: Clinical practice systems were evaluated at baseline by the Physician Practice Connections-Research Survey (PPC-RS). Annual costs and utilization of a retrospectively constructed cohort of 58,391 persons receiving primary care at 1 of 22 medical groups over a 5-year period (2005-2009) were compared.

Cost-effectiveness analysis of screening for KRAS and BRAF mutations in metastatic colorectal cancer.

Background: In 2009, the American Society of Clinical Oncology recommended that patients with metastatic colorectal cancer (mCRC) who are candidates for anti-epidermal growth factor receptor (EGFR) therapy have their tumors tested for KRAS mutations because tumors with such mutations do not respond to anti-EGFR therapy. Limiting anti-EGFR therapy to those without KRAS mutations will reserve treatment for those likely to benefit while avoiding unnecessary costs and harm to those who would not. Similarly, tumors with BRAF genetic mutations may not respond to anti-EGFR therapy, though this is less clear.

Patient medical group continuity and healthcare utilization.

Objectives: To measure continuity among medical groups of insured patients over a 5-year period and to test whether group continuity of care is associated with healthcare utilization and costs.

Study Design: Retrospective observational study.

Methods: We studied natural patient behavior by using insurance claims data in the absence of any medical group or health plan incentives for continuity.

Teaching and clinical efficiency: competing demands.

Introduction: Teaching ability and efficiency of clinical operations are important aspects of physician performance. In order to promote excellence in education and clinical efficiency, it would be important to determine physician qualities that contribute to both. We sought to evaluate the relationship between teaching performance and patient throughput times.

Are characteristics of the medical home associated with diabetes care costs?

Objective: To examine the relationship between primary care medical home clinical practice systems corresponding to the domains of the Chronic Care Model and annual diabetes-related health care costs incurred by members of a health plan with type-2 diabetes and receiving care at one of 27 Minnesota-based medical groups.

Study Design: Cross-sectional analysis of the relation between patient-level costs and Patient-Centered Medical Home (PCMH) practice systems as measured by the Physician Practice Connections Readiness Survey.

Methods: Multivariate regressions adjusting for patient demographics, health status, and comorbidities estimated the relationship between the use of PCMH clinical practice systems and 3 annual cost outcomes: total costs of diabetes-related care, outpatient medical costs of diabetes-related care, and inpatient costs of diabetes-related care (ie, inpatient and emergency care).

Application of the emergency department census model.

As health care systems across the United States continue to grapple with emergency department (ED) crowding and identify mechanisms to improve ED throughput, quantification of intradepartmental efficiency and workload is required to provide much-needed objective measures to assist in the continuing development, implementation, and evaluation of these strategic initiatives. In an attempt to establish a straightforward measure of ED efficiency in relation to daily census and ED crowding, T. J.

Trends in quality during medical home transformation.

PURPOSE We describe changes over time in performance on measures of technical quality and patient experience as a group of primary care clinics transformed themselves into level III patient-centered medical homes. METHODS A group of 21 Minnesota primary care clinics achieving level III recognition as medical homes by the National Committee for Quality Assurance has been tracking a variety of quality and patient satisfaction measures for years. We analyzed trends in these measures and compared them with those of other medical groups in the community to estimate what we might expect as other primary care sites gear up to achieve medical home status.

Relationship of clinic medical home scores to health care costs.

Multilevel, multivariate models examined the relationship between Primary Care Medical Home (PCMH) practice systems as measured by the Physician Practice Connections®-Readiness Survey™ (PPC®-RS™) and costs (total, outpatient, and inpatient) using 2008 patient data from 21 primary care clinics. Overall, PPC-RS scores were associated with insignificant changes in total (-$75/person, 1.1%) outpatient (-$67/person, 1.

Relationship of clinic medical home scores to quality and patient experience.

We tested the association between medical home characteristics and measures of technical quality and patient experience of care in the 21 clinics of a large medical group that had all achieved level III recognition from the National Committee for Quality Assurance. There was substantial variation among them in both scores on the recognition instrument and in clinic performance measures. However, the few statistically significant associations that were identified disappeared when correction for multiple analyses was applied.

Is consistent primary care within a patient-centered medical home related to utilization patterns and costs?

The patient-centered medical home (PCMH) is seen as an important vehicle for providing consistent primary care and achieving cost savings through care coordination. We used health plan administrative data to evaluate utilization and cost among enrollees who attended a PCMH compared with those who fragmented their care. Controlling for demographic differences, PCMH attendees made significantly fewer primary care and specialist visits than other groups, and associated professional fees were significantly lower than for enrollees receiving less consistent primary care.

Greater use of preventive services in U.S. health care could save lives at little or no cost.

There is broad debate over whether preventive health services save money or represent a good investment. This paper analyzes the estimated cost of adopting a package of twenty proven preventive services--including tobacco cessation screening, alcohol abuse screening, and daily aspirin use--against the estimated savings that could be generated. We find that greater use of proven clinical preventive services in the United States could avert the loss of more than two million life-years annually.

Cardiovascular and metabolic effects of high-dose insulin in a porcine septic shock model.

Objectives: High-dose insulin (HDI) has inotropic and vasodilatory properties in various clinical conditions associated with myocardial depression. The authors hypothesized that HDI will improve the myocardial depression produced by severe septic shock and have beneficial effects on metabolic parameters. In an animal model of severe septic shock, this study compared the effects of HDI treatment to normal saline (NS) resuscitation alone.