The American journal of managed care
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Multicenter Study Observational Study
Real-world outcomes among patients with early rapidly progressive rheumatoid arthritis.
To characterize treatment patterns, healthcare resource utilization (HRU), and disease activity among patients with early rapidly progressive rheumatoid arthritis (eRPRA) in the United States when treated with a first-line biologic disease-modifying antirheumatic drug (bDMARD) tumor necrosis factor-α (TNF) inhibitor or first-line abatacept. ⋯ Adjusting for disease severity, patients with eRPRA who were treated with first-line abatacept were less likely to have hospitalizations, ED visits, and MRI use during the first 6 months of bDMARD treatment and more likely to achieve low disease activity within 100 days of bDMARD start compared with those who received a first-line TNF inhibitor.
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Alcohol misuse is a leading cause of preventable death in the United States. This pilot study examined rates of screening and follow-up for unhealthy alcohol use among health plan beneficiaries. ⋯ Rates of screening and follow-up for unhealthy alcohol use are low in plan populations. There is room for improvement in documentation and quality of care for alcohol misuse.
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To examine the impact of coordinated care organizations (CCOs), Oregon's Medicaid accountable care organizations, on hospitalization by admission source among female Medicaid beneficiaries of reproductive age. ⋯ CCO led to reductions in hospital admissions, especially preventable admissions, among female Medicaid beneficiaries of reproductive age in Oregon. Findings, if replicated, may imply that the accountable care delivery model implemented in Oregon Medicaid promotes efficient resource utilization.
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The use of electronic health record (EHR) systems by US clinicians is nearly ubiquitous. One motivation for EHR implementation is the ability to increase provider efficiency and improve patient-centered outcomes. There are no data examining how EHR design aligns with the ordering of high- and low-value clinical services. ⋯ In EHR systems used nationwide, no association existed between the clinical value of a service and the ease of ordering. This disconnect suggests that EHR redesign can significantly improve clinician workflow to facilitate the use of more high-value care and fewer low-value services.
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Febrile neutropenia (FN) is a life-threatening complication of chemotherapy that can lead to hospitalizations, chemotherapy dose reductions or delays, and mortality. Granulocyte colony-stimulating factor (G-CSF) prophylaxis reduces the incidence of FN, enabling patients to undergo and remain on myelosuppressive chemotherapy. We estimate the benefits of continuing current G-CSF use patterns and an alternative that aligns prophylactic G-CSF use with guideline recommendations. ⋯ Current use of G-CSF prophylaxis would provide $96 billion in SV over the next 10 years. Targeting G-CSF prophylaxis to align with guidelines would more than double SV, highlighting the substantial value of appropriate FN risk assessment and targeted G-CSF prophylaxis.