The American journal of managed care
-
Multicenter Study Observational Study
Clinical outcomes and healthcare use associated with optimal ESRD starts.
To assess the association between optimal end-stage renal disease (ESRD) starts and clinical and utilization outcomes in an integrated healthcare delivery system. ⋯ Compared with patients with nonoptimal starts, patients with optimal ESRD starts have lower morbidity and mortality and less use of inpatient and outpatient care. Late-stage chronic kidney disease and ESRD care in an integrated system may be associated with greater benefits than those previously reported in the literature.
-
Observational Study
Nudging physicians and patients with autopend clinical decision support to improve diabetes management.
To determine the impact on routine glycated hemoglobin (A1C) laboratory test completion of incorporating an autopend laboratory order functionality into clinical decision support, which (1) routed provider alerts to a separate electronic folder, (2) automatically populated preauthorization forms, and (3) linked the timing and content of electronic patient health maintenance topic (HMT) reminders to the provider authorization. ⋯ Automated patient-centered decision support can improve guideline-concordant monitoring of A1C among patients with diabetes, particularly among patients who read reminders in a timely fashion.
-
Observational Study
Medicare savings from conservative management of low back pain.
Low back pain (LBP) is a common and expensive clinical problem, resulting in tens of billions of dollars of direct medical expenditures in the United States each year. Although expensive imaging tests are commonly used, they do not improve outcomes when used in the initial management of idiopathic LBP. We estimated 1-year medical costs associated with early imaging of Medicare beneficiaries with idiopathic LBP. ⋯ Medicare beneficiaries with low-risk LBP frequently receive early imaging studies. Early imaging was associated with greater long-term costs than a conservative diagnostic strategy; Medicare expenditures could be reduced by $362 million annually by managing newly diagnosed LBP in accordance with clinical guidelines.
-
Reducing utilization of high-cost healthcare services is a common population health goal. Food insecurity-limited access to nutritious food owing to cost-is associated with chronic disease, but its relationship with healthcare utilization is understudied. We tested whether food insecurity is associated with increased emergency department (ED) visits, hospitalizations, and related costs. ⋯ Food insecurity is associated with higher healthcare use and costs, even accounting for other socioeconomic factors. Whether food insecurity interventions improve healthcare utilization and cost should be tested.
-
Language barriers in healthcare are associated with worse glycemic control among Latino patients with limited English proficiency and diabetes. We examined the association of patient-physician language concordance with lipid (low-density lipoprotein cholesterol [LDL-C]) and systolic blood pressure (SBP) control. ⋯ We found no evidence that ethnicity or language barriers in healthcare were associated with poorer lipid or blood pressure control among Latino and white patients with diabetes receiving care in settings with professional interpreters.