The American journal of managed care
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Venous thromboembolism is a frequent complication of total hip or total knee arthroplasty, with serious clinical and economic consequences. It is largely preventable with adherence to evidence-based guidelines for thromboprophylaxis. ⋯ Now, however, government and quality agencies are stepping in with new initiatives that affect reimbursement for preventable events and are designed to reduce the number of thromboembolic events that occur as the result of insufficient or no prophylactic therapy. The development of new oral anticoagulants will play an important role in increasing the effectiveness, safety, and convenience of thromboprophylactic therapy, which may improve adherence to guidelines for thromboprophylaxis.
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Venous thromboembolism (VTE) following joint replacement surgery represents an economic as well as a clinical burden; however, the risk of thromboembolic events is greatly reduced by appropriate anticoagulation. Rivaroxaban, a Factor Xa inhibitor currently in phase III development, was compared with the low molecular weight heparin enoxaparin in 4 clinical trials, collectively called the RECORD program (REgulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism). In a pooled analysis of data from the RECORD trials, rivaroxaban was superior to enoxaparin regimens in reducing the composite end point of symptomatic venous thromboembolism and all-cause mortality in patients following elective primary total hip or total knee arthroplasty (THA or TKA), with a comparable incidence of major bleeding events. In cost-effectiveness analyses, compared with enoxaparin, rivaroxaban showed the potential to reduce costs associated with the prophylaxis and treatment of thromboembolic events in a post-orthopedic surgery/arthroplasty population.
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To examine the relationship between glycated hemoglobin (A1C) levels and the number of days spent waiting for primary care appointments. ⋯ Decreasing wait times has the potential to reduce A1C levels by 0.18 percentage point for patients with baseline A1C levels exceeding 8%. This effect is roughly one-third of what is achieved with the most successful existing quality improvement strategies. Ensuring timely access to outpatient care could be an important addition to future diabetes care quality improvement programs.
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To determine the longitudinal effect on healthcare costs of multiple chronic conditions among adults aged 18 to 64 years. ⋯ While multiple chronic conditions are common in the population 65 years and older, they are also of great concern for the working-age population. Understanding how to effectively manage individuals with multiple chronic conditions is an important challenge. Effective care management focused on managing the patient as opposed to a condition has the potential to significantly affect healthcare costs.