The American journal of managed care
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Comparative Study
Knowledge, attitudes, and preferences regarding advance directives among patients of a managed care organization.
To examine attitudes, experiences, and preferences regarding advance directives (ADs) among adults of all ages. ⋯ Room for improvement exists for increasing the number of patients who complete an AD or engage in discussion of their wishes. Ways to involve healthcare providers in the process should be explored, as it seems that patients are receptive to physician-initiated discussions of ADs.
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To examine drug costs and entry and exit rates into the Part D coverage gap for beneficiaries with diabetes in Medicare Advantage managed care plans. ⋯ Fewer diabetes patients in this study entered the coverage gap than had been previously estimated, but the entry rate was much higher than that of the general Medicare Advantage Part D population. Patients entering the gap had lower subsequent monthly drug expenditures; this may be due to lower-than-expected drug prices and greater use of generics in managed care, or it may potentially signal poorer drug adherence. Future work should examine these hypotheses and explore risk factors for entering the Part D coverage gap.
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Comparative Study
Reporting hospitals' antibiotic timing in pneumonia: adverse consequences for patients?
To determine whether publicly reporting hospital scores on antibiotic timing in pneumonia (percentage of patients with pneumonia receiving antibiotics within 4 hours) has led to unintended adverse consequences for patients. ⋯ Despite concerns, public reporting of hospital antibiotic timing scores has not led to increased pneumonia diagnosis, antibiotic use, or a change in patient prioritization.
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To evaluate measurement of physician quality performance, which is increasingly used by health plans as the basis of quality improvement, network design, and financial incentives, despite concerns about data and methodological challenges. ⋯ Available administrative data for a single health plan may provide insufficient information for benchmarking performance for individual physicians. Efforts are needed to develop consensus on assigning measure accountability and to expand information available for each physician, including accessing electronic clinical data, exploring composite measures of performance, and aggregating data across public and private health plans.
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To examine the association between physicians' reimbursement perceptions and outpatient test performance among patients with diabetes mellitus. ⋯ Reimbursement perception was associated with electrocardiography but not with other commonly performed outpatient procedures. Future research should investigate how associations change with perceived amount of reimbursement and their interactions with other influences on test-ordering behavior such as perceived appropriateness.