The American journal of managed care
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To examine associations between Medicare health maintenance organization (HMO) penetration and stroke mortality outcomes among older persons. ⋯ Increased Medicare HMO penetration was associated with a shift in ischemic stroke deaths from hospitals to nonhospital settings. The effect of Medicare HMO penetration on quality of stroke care needs further research.
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This article describes how the National Asthma Education and Prevention Program Guidelines for the Diagnosis and Management of Asthma can be used in the clinical setting to improve a patient's everyday function and quality of life. Major recommendations are detailed and case studies provide a practical approach for patient management.
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The prevalence of hypertension in the United States is increasing despite increased awareness of the importance of controlling blood pressure (BP). The growing prevalence of obesity is a major factor in the increased prevalence of hypertension; the aging of the population is another factor. ⋯ Although Healthy People 2010 has established a target of 50% for hypertension control, the most recent National Health and Nutrition Examination Survey indicates that only about 30% of individuals with hypertension have their BP controlled. Several barriers to effective BP control have been identified, including patient access and adherence to therapy and provider failure to initiate or intensify therapy.
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Combination therapy with peginterferon alfa and ribavirin now eliminates detectable hepatitis C virus (HCV) from the blood of more than half of patients with long-term infections. However, many of those infected with HCV have low rates of response to therapy and/or are more susceptible to drug side effects that limit adherence to therapy. African Americans with HCV, for example, tend to be more difficult to cure with drug therapy. ⋯ In all patients remaining on therapy, efforts to boost adherence will also enhance the overall rate of sustained virologic response. Special attention should be paid to managing depression and cytopenias with patient education and either dose reduction or use of hematopoietic growth factors. These 2 basic treatment strategies--of stopping treatment early or, alternatively, of pressing for full patient compliance over the full course of therapy--are flip sides of the same management coin that health plans and clinicians can employ to optimize results and cost effectiveness with the current standard of therapy for chronic HCV infection.
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To use empirical data from previously published literature to address 2 research questions: (1) Do interventions that incorporate at least 1 element of the Chronic Care Model (CCM) result in improved outcomes for specific chronic illnesses? (2) Are any elements essential for improved outcomes? ⋯ Interventions that contain at least 1 CCM element improve clinical outcomes and processes of care--and to a lesser extent, quality of life--for patients with chronic illnesses.