The American journal of managed care
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Randomized Controlled Trial
Patient satisfaction with letter-based communication of LCS pulmonary nodule results.
To analyze patient satisfaction with letter-based communication of lung cancer screening (LCS) pulmonary nodule results. ⋯ Patients were generally satisfied with receiving their LCS pulmonary nodule results via letters, reporting that the letters included adequate information about their diagnosis and follow-up steps. This may provide a basis for feasible result communication via letters for cancer screening programs in underdeveloped regions in China.
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Observational Study
Factors associated with primary care physician turnover in the VA.
To quantify the association between primary care team workload satisfaction and primary care physician (PCP) turnover and examine potential mediation of workplace climate factors using survey and administrative data. ⋯ Our study findings highlight the key role that achieving primary care workload satisfaction can play in reducing PCP turnover. Identification of direction by senior managers as an underlying mechanism is an important finding for strategic planning to mitigate PCP turnover.
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Utilization of low- and high-value health care by individuals with and without cognitive impairment.
Cognitive impairment and dementia have rising prevalence and impact the health care utilization and lives of older adults. Receipt of low-value (LV) care and underutilization of high-value (HV) care by individuals with these cognitive disorders may have negative consequences for patient health, health system efficiency, and societal welfare. Evidence on health care value among cognitively impaired individuals is limited; we thus ascertained receipt of LV and HV health care in older adults with normal cognition, cognitive impairment without dementia (CIND), and dementia. ⋯ LV service receipt is wasteful and may be harmful, but it was not consistently associated with cognitive status. Lack of HV care for those with cognitive impairment could be a missed opportunity to improve well-being or reduce preventable adverse events. Our results suggest opportunities for improving the quality of care received by all older adults, including those with cognitive impairment.
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Observational Study
Clinician characteristics associated with fluoride varnish applications during well-child visits.
To identify factors associated with clinicians' likelihood and intensity of applying fluoride varnish (FV) overall and for visits paid by Medicaid and private insurers. ⋯ Despite clinical recommendations and mandated insurance reimbursements, the likelihood and intensity of FV applications was low for most pediatric primary care clinicians. Clinician behavior was associated with patient-panel characteristics, suggesting the need for interventions that account for these differences.
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To quantify the magnitude of an ISPOR novel value element, insurance value, as applied to new treatments for a rare, severe disease with pediatric onset: Duchenne muscular dystrophy (DMD). ⋯ Individuals planning to have children in the future are willing to pay more for insurance coverage of novel DMD treatments than is assumed under risk-neutral, QALY-based frameworks.