JAMA : the journal of the American Medical Association
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Observational Study
Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality.
Transformation of US health care from volume to value requires meaningful quantification of costs and outcomes at the level of individual patients. ⋯ Implementation of a multifaceted value-driven outcomes tool to identify high variability in costs and outcomes in a large single health care system was associated with reduced costs and improved quality for 3 selected clinical projects. There may be benefit for individual physicians to understand actual care costs (not charges) and outcomes achieved for individual patients with defined clinical conditions.
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International studies report a decline in mortality following non-ST-elevation myocardial infarction (NSTEMI). Whether this is due to lower baseline risk or increased utilization of guideline-indicated treatments is unknown. ⋯ Among patients hospitalized with NSTEMI in England and Wales, improvements in all-cause mortality were observed between 2003 and 2013. This was significantly associated with use of an invasive coronary strategy and not entirely related to a decline in baseline clinical risk or increased use of pharmacological therapies.
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Is continuous long-term treatment with colchicine associated with lower rates of all-cause mortality and myocardial infarction and higher rates of adverse events? ⋯ Continuous long-term treatment with colchicine may be associated with lower rates of myocardial infarction, but may be associated with higher rates of gastrointestinal adverse events.