The American journal of managed care
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To measure continuity among medical groups of insured patients over a 5-year period and to test whether group continuity of care is associated with healthcare utilization and costs. ⋯ Although a small proportion, health plan members who visited a primary care provider but had low or medium continuity among medical groups had higher inpatient and ED use than those with high continuity. Improved coordination and integration has potential to lower utilization and costs in this group.
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(1) To describe a unique initiative to implement a standardized system of electronic decision support for ambulatory orders for hightech diagnostic imaging (HTDI) statewide, and (2) to evaluate the impact of a pilot version of that system, plus prior notification on the volume of such orders. ⋯ Although it is not possible to disentangle the effects of these separate approaches, the much greater physician acceptance of the decision support system has led payers to financially support the creation of a unique statewide implementation of a version of this system to replace prior notification/authorization approaches.
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Considering cardiovascular (CV) risk could make clinical care more efficient and individualized, but most practice guidelines focus on single risk factors. We sought to determine if hypertension treatment intensification (TI) is more likely in patients with elevated CV risk. ⋯ While an individual's BP alters clinical decisions about TI, overall CV risk does not appear to play a role in clinical decision making. Adoption of TI decision algorithms that incorporate CV risk could substantially enhance the efficiency and clinical utility of CV preventive care.
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To assess the effects of patient cost sharing on initiation of disease-modifying therapies (DMTs) in multiple sclerosis (MS). ⋯ High cost-sharing is associated with delayed initiation of effective MS therapies.