The American journal of managed care
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The Massachusetts Medicaid and Children's Health Insurance Program, MassHealth, offers comprehensive Senior Care Options (SCO) plans to its Medicare-eligible members 65 years and older. Historically, MassHealth has paid a fixed per-person capitation rate for any "nursing home-certifiable" SCO member despite considerable heterogeneity of need. Our objective was to develop a model to predict long-term services and supports (LTSS) costs for community-dwelling SCO members. ⋯ Predictive models using administrative data and functional status information can appropriately allocate payments for subgroups of members with LTSS needs that differ substantially from average. Calibrating payment to need mitigates incentives for population skimming and promotes the sustainability of mission-oriented organizations.
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Autologous peripheral stem cell transplantation (ASCT) with high-dose chemotherapy is a preferred treatment for relapsed non- Hodgkin lymphoma (NHL) patients. Estimated failure rates with current stem cell mobilization (SCM) regimens are 5% to 30%. Granulocyte colony-stimulating factor (G-CSF) with plerixafor (G P) is superior to G-CSF alone for SCM in heavily pretreated NHL patients. ⋯ Using G P for SCM in ASCT of patients with DLBCL meets accepted standards of cost-effectiveness, primarily because of its effectiveness in SCM.
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Hypertension (HTN) control among diabetics is essential to preventing macrovascular complications. We investigated correlates of HTN control among a national sample of 1313 patients with diabetes receiving care in ambulatory care settings. ⋯ Patients with diabetes seen in diverse primary care settings had a low probability of having blood pressure (BP) controlled to the recommended levels. Care setting-specific policies may prove useful in improving BP control. Continued attention is still warranted for racial and ethnic disparities in HTN control.
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The study's objectives were to explore the impact of personal/organizational knowledge, prior breach status of organizations, and framed scenarios on the choices made by privacy officers regarding the decision to report a breach. ⋯ Study findings show there are gray areas where privacy officers make their own decisions, and there is a difference in the types of decisions they are making on a day-to-day basis. Future guidance and policies need to address these gaps and can use the insight provided by the results of this study.
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Violence against health care workers is an ever-present threat that has been increasing over the past several years. The majority of physicians and nurses report that they have been victims of workplace violence at least once throughout their careers. Such violent attacks negatively affect the delivery, quality, and accessibility of health care. ⋯ Encountering violent individuals has legal implications and can compromise the moral framework of physicians. With action from institution administrations, advocates, leaders, and government, this issue that detrimentally affects health care can be combatted and reduced. By implementing required staff training, increasing security, strengthening the doctor-patient relationship, using medical chaperones, and reforming policy, positive changes can be made to protect health care workers and the health care system.