The American journal of managed care
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Review
Care pathways in US healthcare settings: current successes and limitations, and future challenges.
Care pathways are used widely in US healthcare settings and are expected to have greater influence on quality of care and patient outcomes in the future. We conducted qualitative research to evaluate the state of care pathways and their impact in the United States. ⋯ Our research confirms that high-quality evidence of efficacy and safety are expected to be central to future pathway development, and that physicians play a major role in development and implementation. To achieve the goals of improving quality of care while managing costs, further efforts are required regarding systematic development and evaluation, consistent implementation and compliance metrics, and transparency in implementation outcomes and financial motivators.
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To examine whether continuity of ambulatory asthma care can lower asthma-specific emergency department (ED) utilization by children with asthma in Taiwan. ⋯ High continuity of ambulatory asthma care can decrease asthma-specific ED utilization risk in children with newly diagnosed asthma in Taiwan. We suggest that providers and the government reinforce the use of follow-up care and education for high-risk groups to improve the continuity of ambulatory asthma care.
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To identify factors associated with all-cause discontinuation (patient discontinued on their own or physician discontinuation) of oral anticoagulants (OACs) among nonvalvular atrial fibrillation (NVAF) patients. ⋯ The risk of independent discontinuation of OAC treatment among NVAF patients was high. Patients on DOACs compared with warfarin and those with several comorbid conditions had significantly lower risk of discontinuation, while those with prior bleeding were more likely to discontinue.
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To develop a model that identifies patients at high risk for missing scheduled appointments ("no-shows" and cancellations) and to project the impact of predictive overbooking in a gastrointestinal endoscopy clinic-an exemplar resource-intensive environment with a high no-show rate. ⋯ Information from EHRs can accurately predict whether patients will no-show. This method can be used to overbook appointments, thereby maximizing service utilization while staying within clinic capacity.
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Between 2013 and 2014, spending on specialty drugs, including biologics, increased 32.4%, while spending on small-molecule drugs increased just 6.8%. By 2016, 8 of the 10 top-selling drugs are expected to be biologics. ⋯ A strong factor and assumption surrounding biosimilar development and use is the potential for healthcare cost savings; the introduction of biosimilars is expected to reduce drug costs, although to a lesser degree than seen with small-molecule generic drugs. Managed care clinicians and providers must carefully consider the economic implications and potential cost-effectiveness of uptake of biosimilars for therapy in clinical practice.