Journal of general internal medicine
-
Many states have adopted laws that limit the amount or duration of opioid prescriptions. These limits often focus on prescriptions for acute pain, but there may be unintended consequences for those diagnosed with chronic pain, including reduced opioid prescribing without substitution of appropriate non-opioid treatments. ⋯ These findings do not support an association between state opioid prescribing cap laws and changes in the treatment of chronic non-cancer pain.
-
Observational Study
Patterns of Healthcare Utilization and Spending Among Homebound Older Adults in the USA: an Observational Study.
Homebound older adults have complex social, medical, and financial needs, but little is known about their healthcare utilization and spending. ⋯ Homebound older adults use more hospital-based care and less outpatient care than the non-homebound, contributing to higher levels of overall Medicare spending.
-
Given persistent racial/ethnic differences in type 2 diabetes outcomes and the lasting benefits conferred by early glycemic control, we examined racial/ethnic differences in diabetes medication initiation during the year following diagnosis. ⋯ Initiation of glucose-lowering treatment during the year following type 2 diabetes diagnosis differed markedly by race/ethnicity, particularly for those with lower HbA1c values. Future research should examine how patient preferences, provider implicit bias, and shared decision-making contribute to these early treatment differences.
-
This paper shares lessons learned from providing planning and technical assistance to the grantees of the Merck Foundation's 5-year, $16 million initiative, Bridging the Gap: Reducing Disparities in Diabetes Care, designed to improve access to high-quality diabetes care and reduce disparities in health outcomes among vulnerable and underserved U. S. populations with type 2 diabetes. Our objective was to co-create, with the sites, financial sustainability plans to sustain their work once the initiative had ended and to improve and/or expand it to serve more patients, better. ⋯ The sites were diverse in terms of their approaches to clinical transformation and integration of SDOH interventions, geography, organizational context, external environment, and populations served. These factors influenced the sites' capacity to build and implement viable financial sustainability strategies and the eventual plans themselves. Philanthropy has a critical role in investing in providers' capacity to develop and implement financial sustainability plans.
-
Observational Study
Improving Diabetes Care Through Population Health Innovations and Payments: Lessons from Western Maryland.
Global budgets might incentivize healthcare systems to develop population health programs to prevent costly hospitalizations. In response to Maryland's all-payer global budget financing system, University of Pittsburgh Medical Center (UPMC) Western Maryland developed an outpatient care management center called the Center for Clinical Resources (CCR) to support high-risk patients with chronic disease. ⋯ CCR participation was associated with improved patient-reported outcomes, glycemic control, and hospital utilization for high-risk patients with diabetes. Payment arrangements like global budgets can support the development and sustainability of innovative diabetes care models.