The American journal of managed care
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We sought to evaluate trends in door-to-balloon (D2B) times and false activation rates for the cardiac catheterization laboratory (CCL) in patients presenting to the emergency department (ED) with acute ST-elevation myocardial infarction (STEMI). In patients with STEMI, national efforts have focused on reducing D2B times for primary percutaneous coronary intervention (P-PCI). This emphasis on time-to-treatment may increase the rate of false CCL activations and unnecessary healthcare utilization. ⋯ Over a 5-year period with a strong emphasis on reducing D2B times, there has been an increased CCL false activation rate for P-PCI.
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We explored the process of physician selection, focusing on selection of surgeons for knee and hip replacement to increase the probability of a new relationship, making cost and quality scorecard information more relevant. ⋯ Additional research is needed to determine whether Internet access is causal in improved responsiveness to market information and incentives, or a proxy for other factors. In addition, we see evidence that efforts to improve healthcare quality and costs through market forces should be tailored to the patient's place of residence.
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After a new formulation of levothyroxine was distributed in Israel, side effects were reported to the Ministry of Health generating extensive media coverage. The purpose of this study was to determine whether the new formulation was associated with a change in thyroid-stimulating hormone (TSH) levels of treated patients and to evaluate the effect of the extensive media coverage on the incidence of laboratory test performance. ⋯ These results demonstrate the power of mass media to influence patient behavior and to foment a public health scare.
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To assess the level of hospital participation in the first 18 months of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, and to identify whether vulnerable hospitals lag behind. ⋯ There is broad participation in the federally led incentive program to promote nationwide EHR uptake. Lower rates of participation among smaller hospitals and Critical Access hospitals merit close monitoring to ensure that broad adoption is achieved.