The American journal of managed care
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Many healthcare systems use prediction models to estimate and manage patient-level probability of hospitalization. Patients identified as high-risk at one point in time may not, however, remain high-risk. We aimed to describe subgroups of patients with distinct longitudinal risk score patterns to inform interventions tailored to patients' needs. ⋯ Few patients who were high-risk for hospitalization at baseline remained so. Nonrandomized evaluations of interventions that identify patients based on a single high-risk score may spuriously appear to have positive effects. Clinical interventions may need to focus on individuals who are persistently high-risk.
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Comparative Study
Managed care for long-stay nursing home residents: an evaluation of Institutional Special Needs Plans.
To evaluate the patterns of clinical service use for long-term nursing home residents enrolled in UnitedHealthcare's Medicare Advantage Institutional Special Needs Plans (I-SNPs), which provide on-site direct coordinated care for beneficiaries through the use of advanced practice clinicians. ⋯ "At-risk" models, administered through specialized Medicare Advantage plans, that invest in clinical management in the nursing home setting have the potential to allow individuals to receive care on-site and avoid costly inpatient transfers.
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The Veterans Affairs (VA) Geriatric Scholars Program (GSP) is a workforce development program to enhance skills and competencies among VA clinicians who provide healthcare for older veterans in VA primary care clinics. An intensive geriatrics didactics (IGD) course is a core element of this professional development program. The objective of this study was to evaluate the impact of completing the IGD course on providers' rates of prescribing definite potentially inappropriate medications (DPIMs) based on Beers Criteria from 2008 to 2016. ⋯ Although the size of the effect was modest, we found that participation in the GSP IGD course reduced prescribing of DPIMs for older veterans.