Utilization of High-Cost Interventions for Targeted Clinical Conditions During the Early Stages of ACO Development in a Commercially Insured Population.

This study compared utilization patterns of high-cost services and medications for patients receiving care from Accountable Care Organization (ACO)-participating physicians and those receiving care from non-ACO physicians during the initial phases of ACO development in a commercially insured environment. Patients ≥18 years (≥40 years for chronic obstructive pulmonary disease [COPD]) with prevalent rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, type 2 diabetes, COPD, or chronic low back pain between January 1, 2012, and August 31, 2014 were identified in the HealthCore Integrated Research DatabaseSM. Patients were assigned to the ACO cohort if their primary treating physician was contracted to the health plan through an ACO agreement. Each clinical condition was stratified for severity of illness. Cohort utilization patterns were compared for the 12-month period following the index encounter. The primary outcome measures show that there was no statistically significant utilization difference between the ACO and non-ACO cohorts for 90% of the 82 comparisons made. It is expected that some measures will achieve significant difference simply because of having this many comparisons, but no clear pattern was identified. This study did not observe statistically significant differences in utilization of high-cost services and medications between ACO and non-ACO cohorts with limited experience in the ACO model. Future analyses with longer study durations, a...
Source: Pain Physician - Category: Anesthesiology Authors: Tags: Popul Health Manag Source Type: research

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ConclusionsRemission of type 2 diabetes 5 years after bariatric surgery was associated with improvements in albuminuria and stabilized prognostic risk for CKD, but not with eGFR. Lower kidney function and greater prognostic risk at the time of bariatric surgery was linked to a lower likelihood of diabetes remission. These results highlight the need to identify the mechanisms through which bariatric surgery may delay the long-term progression of CKD in type 2 diabetes.
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
ConclusionThese results highlight areas that local units can focus on to reduce their litigation burden. Targeted initiatives aimed at improving patient-clinician communication, the consent process and improving local organisational efficiency will address a significant proportion of claims. Re-examination of this data on a regular basis can serve as a useful adjunct in assessing the impact of quality improvement initiatives and implementation of best practiseswithin the speciality.
Source: The Surgeon - Category: Surgery Source Type: research
ConclusionThis case is one of few cases reported in the literature highlighting the rarity of this injury pattern.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
ConclusionThe incidence of midline and lateral port site recurrence after laparoscopy for diagnosis or resection of ovarian cancer has not been determined. Limitation of trochar sites to the midline may reduce the extent of abdominal wall disease spread.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
ConclusionThere is some previous caution in using a laparoscopic approach for cystic masses due to potential seeding intra-operatively, in case of fluid spillage of a possible malignant neoplasm. We show through our case that it is possible to efficiently and safely use such an approach.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
ConclusionThe report aims at pointing out the possibility of undergoing this kind of surgery not only in case of pulmonary mass (on which the previous literature has focused) but also when mediastinum lesions occur, as in our case.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Publication date: Available online 19 July 2019Source: Journal of Science and Medicine in SportAuthor(s): Eduardo Martinez-Valdes, Fiona Wilson, Neil Fleming, Sarah-Jane McDonnell, Alex Horgan, Deborah FallaAbstractObjectivesDespite the high prevalence of low back pain (LBP) in rowers, there are few studies investigating changes in lumbar muscle activation in rowers with a recent history of LBP. Such knowledge is relevant to understand potential mechanisms contributing to the maintenance and recurrence of LBP in rowers. For the first time, we evaluate the spatial distribution of erector spinae (ES) activity in rowers with ...
Source: Journal of Science and Medicine in Sport - Category: Sports Medicine Source Type: research
Publication date: Available online 19 July 2019Source: The Arts in PsychotherapyAuthor(s): West Rebecca, J. Silverman MichaelAbstractThere is a gap in the literature concerning service users’ music therapy (MT) technique choices and ensuing effects on mood and pain for adults on a general neuroscience unit. Therefore, the purpose of this investigation was to study the frequency of service user MT technique choices and their resultant effects on mood and pain in adults receiving MT applied for the first time on a neuroscience unit. Participants (N = 29) self-selected into one of three pre-determined sing...
Source: Arts in Psychotherapy - Category: Psychiatry & Psychology Source Type: research
Authors: Hamouda L, Miliani M, Hadjidj Z, Messali R, Aribi M Abstract BACKGROUND: Monocytes are the main blood innate mononuclear phagocyte and one of the most important effector cells expressing Fcγ receptor, which is critical for the interaction with Fc domain of antibodies. OBJECTIVE: To evaluate the effect of Rituximab (RTX, a chimeric human anti-CD20 monoclonal antibody) on the functional activities of Monocytes (MOs) at the onset of human Type 1 Diabetes (T1D). METHODS: MOs were isolated from peripheral blood mononuclear cells (PBMCs) obtained from volunteer patients with recent-onset T1D and he...
Source: Endocrine, Metabolic and Immune Disorders Drug Targets - Category: Drugs & Pharmacology Tags: Endocr Metab Immune Disord Drug Targets Source Type: research
Authors: Wykretowicz M, Katulska K, Zwanzig M, Krauze T, Piskorski J, Guzik P, Wykretowicz A Abstract OBJECTIVES: Left atrial fibrosis represents a substrate for atrial fibrillation (AF) and cardioembolic events. White matter hyperintensities (WMH) are commonly found on magnetic resonance imaging (MRI) and are regarded, at least partly as ischemic brain lesions. Aortic excess pressure (excessPTI) represents an extra work performed by the left ventricle and is a new risk metric associated with cardiovascular complications. The aim of our study was to assessed whether there is a correlation between the degree of LA f...
Source: Scandinavian Cardiovascular Journal - Category: Cardiology Tags: Scand Cardiovasc J Source Type: research
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