Population health management
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Concierge medicine (also called retainer practices or consumer-focused care) represents a new approach to the delivery of primary care. This model involves more personalized attention and greater resources for individual patients, thus limiting the number of patients who can be served at each practice. All enrolled members must pay an annual membership fee or retainer. Given the short history and novelty of concierge medicine, this article explores the clinical, economic, marketing, ethical, and policy implications of this innovative approach to primary care.
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The study objective was to facilitate investigations by assessing the external validity and generalizability of the Centricity Electronic Medical Record (EMR) database and analytical results to the US population using the National Ambulatory Medical Care Survey (NAMCS) data and results as an appropriate validation resource. Demographic and diagnostic data from the NAMCS were compared to similar data from the Centricity EMR database, and the impact of the different methods of data collection was analyzed. Compared to NAMCS survey data on visits, Centricity EMR data shows higher proportions of visits by younger patients and by females. ⋯ Likely explanations include differences in data collection using the EMR versus the survey, particularly more comprehensive medical documentation requirements for the Centricity EMR and its inclusion of laboratory results and medication data collected over time, compared to the survey, which focused on the primary reason for that visit. It is likely that Centricity data reflect medical problems more accurately and provide a more accurate estimate of the distribution of diagnoses in ambulatory visits in the United States. Further research should address potential methodological approaches to maximize the validity and utility of EMR databases.
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This article presents the results of an exploratory case study that assessed a multistakeholder alliance's initiative to motivate quality improvement in primary care physician (PCP) practices. The initiative utilized a "pay-for participation" strategy that provided incentives to PCPs to participate in the National Committee for Quality Assurance's Diabetes Physician Recognition Program (DPRP). The intervention took place over a 2-year period in 8 practices with large safety-net populations located in the Rochester, New York area. ⋯ The majority of practices cited the program's honorarium and other incentives as key motivators for participation. Our findings suggest that pay-for-participation may be a viable strategy to promote quality improvement in physician practices. However, absent continuing reinforcement, it is uncertain if such programs can lead to sustained quality improvement activities.
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The objective of this study was to evaluate the economic and humanistic burden of chronic sleep maintenance insomnia characterized by nighttime awakenings (CINA). A database analysis of National Health and Wellness Survey, an annual cross-sectional study of health status and outcomes of US adults, was performed. CINA was defined as experiencing nighttime awakenings at least twice per week for more than 1 month that have moderate to severe impact on daily life and not experiencing difficulty falling asleep. ⋯ Controlling for demographics and comorbidity, CINA sufferers had greater resource utilization (0.1 [P < 0.001] more emergency room visits, 0.2 [P = 0.001] more days hospitalized, and 2.5 [P < 0.001] more provider visits), 22.4% (P < 0.001) greater activity impairment, and SF-8 physical and mental summary scores that were 6.2 (P < 0.001) and 6.8 (P < 0.001) points lower than those with no insomnia, respectively. Among those employed full time, CINA sufferers had greater work productivity impairment (4.0% due to absenteeism, 17.6% due to presenteeism, and 15.6% greater overall productivity impairment) than those with no insomnia (P < 0.001 for all). CINA in relative isolation was associated with a significant negative impact on health care utilization and its associated costs, health-related quality 16 of life, and work productivity.