The American journal of managed care
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Comparative Study
Outcomes among chronically ill adults in a medical home prototype.
To compare quality, utilization, and cost outcomes for patients with selected chronic illnesses at a patient-centered medical home (PCMH) prototype site with outcomes for patients with the same chronic illnesses at 19 nonintervention control sites. ⋯ A clinic-level population-based PCMH redesign can decrease downstream utilization and reduce total healthcare costs in a subpopulation of patients with common chronic illnesses.
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Improving quality of care for people with multiple chronic conditions (MCCs) requires performance measures reflecting the heterogeneity and scope of their care. Since most existing measures are disease specific, performance measures must be refined and new measures must be developed to address the complexity of care for those with MCCs. ⋯ This model organizes measures into a comprehensive framework and identifies areas where measures are lacking. In this context, performance measures can be prioritized and implemented at different levels, in the context of patients' overall healthcare needs.
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To identify inefficiencies in drug and medical service utilization related to pain management in patients with osteoarthritis and chronic low back pain. ⋯ Pain management inefficiencies are common and costly among Humana Medicare members with osteoarthritis and/or chronic low back pain. Further work by providers and payers is needed to determine benefits of member identification and early intervention for these inefficiencies.
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Although large differences by race/ethnicity in breast cancer survival are well established, it is unknown whether disparities in nodal surgery utilization explain the racial/ethnic disparities in survival among women with micrometastasis and macrometastasis in sentinel lymph nodes (SLNs). ⋯ The disparities in survival among African American and Hispanic women with breast cancer are not explained by nodal surgery utilization among women with micrometastasis and macrometastasis in SLNs.
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The concept of the physician assistant (PA) was developed by US physicians in the 1960s as a workforce strategy to improve the delivery of medical services. Then as now there is an anticipated shortage of physicians, particularly in primary care. Use of PAs is viewed as 1 possible strategy to mitigate this growing gap in provider services. ⋯ Optimal organizational efficiency and cost savings in health services delivery will depend on how well the PA can be utilized.