The American journal of managed care
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Women with obstructive coronary disease appear to be more challenging diagnostically and suffer a more adverse prognosis than men. More than one half of women with symptoms of ischemic heart disease have no obstructive coronary artery disease at coronary angiography, yet these women frequently have persistent symptom-related disability and consume large amounts of healthcare resources. Prior evidence has been limited regarding effective diagnostic strategies for the assessment of symptomatic women. ⋯ In addition to recent published evidence (drawn from much larger cohorts of women) that stress echocardiography and nuclear imaging are similar in their ability to risk-stratify women, the WISE study is exploring new pathophysiological mechanisms of microvascular dysfunction in women. An unfolding body of evidence suggests that as tests become more diagnostically and prognostically accurate, the process will become more cost efficient. The results from a growing number of large observational series and National Institutes of Health-sponsored studies are expected to be the foundation for cost-effective diagnostic and prognostic strategies for the approximately 5 million women who undergo evaluation for coronary disease annually.
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Randomized Controlled Trial Clinical Trial
A randomized trial of nurse specialist home care for women with high-risk pregnancies: outcomes and costs.
To examine prenatal, maternal, and infant outcomes and costs through 1 year after delivery using a model of prenatal care for women at high risk of delivering low-birth-weight infants in which half of the prenatal care was provided in women's homes by nurse specialists with master's degrees. ⋯ This model of care provides a reasoned solution to improving pregnancy and infant outcomes while reducing healthcare costs.
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Comparative Study
Hospice use in Medicare managed care and fee-for-service systems.
To examine whether patterns of hospice use by older Medicare beneficiaries are consistent with the differing financial incentives in Medicare managed care (MC) and fee-for-service (FFS) settings. Specifically, are use patterns consistent with incentives that might encourage hospice use for MC enrollees and discourage hospice use for FFS enrollees? ⋯ System of care is an important determinant of hospice use in the elderly Medicare population.
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To assess patient satisfaction and a health plan's return on investment associated with a telephone-based triage service. ⋯ The telephone-based nurse triage service appears to be a cost-effective intervention that improves access to medical advice, thereby encouraging appropriate use of medical services. The service is associated with reductions in utilization of hospital ED and physician office services and with high levels of member satisfaction.
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Guidelines for the treatment of community-acquired pneumonia (CAP) have been issued by various institutions. These therapeutic recommendations, culled from available medical literature, can be conflicting and confusing. ⋯ Moreover, costs of care and clinical outcomes can vary significantly with therapeutic approaches. All of these factors point to a critical need for more consistent medical guidelines for treating CAP.