The American journal of managed care
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Current shifts toward patient-centered healthcare and accountable payment options point to the more personalized production of better health, not just healthcare, as a next organizational paradigm. Transformation to a system geared toward promoting health requires us to think broadly about what it means to engage patients meaningfully, to give them a voice in their health and care, and to capture more of their varied experience and attitudes beyond the provider visit. The collection and use of patient-reported outcome data into electronic health records represents an important step forward for the transition to a more patient-centered health system. We set out an agenda for better understanding how and when patient-reported outcomes may improve patient health and care experience.
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Multicenter Study
A team approach to systematic behavioral screening and intervention.
Unhealthy behaviors are responsible for most chronic disease, ample healthcare costs, and around 40% of deaths. This study assessed patient satisfaction and behavioral outcomes for a program that enables healthcare settings to deliver evidence-based, cost-saving behavioral screening and intervention (BSI) services, as recommended by the US Preventive Services Task Force and others. ⋯ With intensive training and ongoing support, cost-efficient paraprofessionals can deliver effective alcohol, drug, and depression screening and intervention services in busy healthcare settings. The approach holds promise for systematically addressing on a population-wide basis a variety of important behavioral health determinants and reducing related healthcare costs.
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Comparative Study
Hepatitis B virus infection testing and prevalence among Asian and Pacific Islanders.
Asian and Pacific Islanders (APIs) constitute less than 6% of the US population, but account for more than half of Americans with chronic hepatitis B virus (HBV) infection. We sought to examine the effect of country of origin on HBV testing and chronic HBV infection prevalence among APIs. ⋯ Less than one-third of this managed care API population (29% of 53,573) was tested, yet the prevalence of chronic HBV infection (3.2%) was 12 times higher than that of the general US population. These findings underscore the importance of adherence to HBV testing guidelines to identify persons with infection so they may be linked to care.
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Comparative Study
Emergency department visit classification using the NYU algorithm.
Reliable measures of emergency department (ED) use are important for studying ED utilization and access to care. We assessed the association of emergent classification of an ED visit based on the New York University ED Algorithm (EDA) with hospital mortality and hospital admission. ⋯ This analysis assessed the NYU algorithm in measuring emergent and nonemergent ED use in the general population. Emergent classification based on the algorithm was strongly and significantly positively associated with hospitalization and death in a nationally representative population. The algorithm can be useful in studying ED utilization and evaluating policies that aim to change it.
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Comparative Study
How does drug coverage vary by insurance type? Analysis of drug formularies in the United States.
To quantify how access to on-patent drugs by tier placement varies by insurance type and therapeutic area. ⋯ The degree of coverage of on-patent drugs in the lowest copay tiers varies dramatically between insurance types, especially for expensive protein-tyrosine kinase inhibitors.