The American journal of managed care
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Observational Study
Hospital outcomes of male breast cancer in the United States.
Hospital utilization and costs of female breast cancer have been well documented. However, evidence focusing on male breast cancer is scarce, despite the different clinical characteristics between female and male breast cancer. We aim to estimate hospital length of stay (LOS) and costs associated with male breast cancer in the United States. ⋯ LOS and hospital costs for male patients with breast cancer were associated with metastatic status and comorbidities. This information can be used to assess the health care resources needed to treat male breast cancer.
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Observational Study
Association between hospital-insurer contract structure and hospital performance.
To describe the association between the form of hospitals' contracts-either markup from a benchmark or a discount from a list price-and performance: price, charge, cost, and length of stay. ⋯ Limited research exists on the relationship between contract structure and hospital performance. Our results suggest that hospital performance is related to contract structure, possibly due to factors such as differences in bargaining strategies or ex post incentives.
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The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait times and improve the patient experience. ⋯ Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics' common wait areas could be reappropriated to increase the number of clinic exam rooms.
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The price of analogue insulin has increased dramatically, making it unaffordable for many patients and insurance carriers. By contrast, human synthetic insulins are available at a fraction of the cost. The objective of this study was to examine whether patients with financial constraints were more likely to use low-cost human insulins compared with higher-cost analogue insulins and to determine whether outcomes differ between users of each type of insulin. ⋯ Patients with financial risk factors may be more likely to use low-cost human synthetic insulins compared with insulin analogues. Outcomes were similar, even when stratified by financial risk.
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This study measured the likelihood of adult patients with diabetes being referred to diabetes self-management education (DSME) when "in need" according to clinical guidelines and identified which types of clinical need predict a greater likelihood of provider referral to DSME. ⋯ Although findings indicate that patient need for DSME does improve the likelihood of being referred, provider referral rates were significantly lower than anticipated. Future research should explore barriers to clinical guideline adherence and whether clinical decision support in EHR systems can facilitate provider referrals.