Advanced Care Management Strategies Reduce Costs and Improve Patient Health in High-Risk Insurance Pools

2005 ◽  
Vol 10 (5) ◽  
pp. 261???263
Author(s):  
Cheri Lattimer
Keyword(s):  
High Risk ◽  
Care Management ◽  
Management Strategies ◽  
Patient Health ◽  
Risk Insurance ◽  
Improve Patient

HHS Moves to Set Up High-Risk Insurance Pools

2010 ◽  
Vol 40 (7) ◽  
pp. 4
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
High Risk ◽  
Set Up ◽  
Risk Insurance

scholarly journals Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dalal Al Hasan ◽  
Ameen Yaseen ◽  
Mohammad Al Roudan ◽  
Lee Wallis
Keyword(s):  
Severe Hypoglycaemia ◽  
Management Strategies ◽  
Severe Hypoglycemia ◽  
Inclusion Criteria ◽  
Initial Management ◽  
Scene Management ◽  
Prehospital Management ◽  
Improve Patient Management ◽  
Current Guidelines ◽  
Improve Patient

Abstract Background The objective of this study was to describe the epidemiology of severe hypoglycaemia in Kuwait, aiming to provide a preliminary background to update the current guidelines and improve patient management. Method This was a prospective analysis of severe hypoglycaemia cases retrieved from emergency medical services (EMS) archived data between 1 January and 30 June 2020. The severe hypoglycaemia cases were then sub-grouped based on EMS personal initial management and compared in terms of scene time, transportation rate, complications and outcomes. The primary outcomes were GCS within 10–30 min and normal random blood glucose (RBS) within 10–30 min. Results A total of 167 cases met the inclusion criteria. The incidence of severe hypoglycaemia in the national EMS was 11 per 100,000. Intramuscular glucagon was used on scene in 89% of the hypoglycaemic events. Most of the severe hypoglycaemia patients regained normal GCS on scene (76.5%). When we compared the two scene management strategies for severe hypoglycaemia cases, parenteral glucose administration prolonged the on-scene time (P = .002) but was associated with more favourable scene outcomes than intramuscular glucagon, with normal GCS within 10–30 min (P = .05) and normal RBS within 10–30 min (P = .006). Conclusion: Severe hypoglycaemia is not uncommon during EMS calls. Appropriate management by EMS personals is fruitful, resulting in favourable scene outcomes and reducing the hospital transportation rate. More research should be invested in improving and structuring the prehospital management of severe hypoglycaemia. One goal is to clarify the superiority of parenteral glucose over intramuscular glucagon in the prehospital setting.

scholarly journals Sharing With Patients the Uncertainties Regarding the Management of Dyspepsia

2021 ◽  
Vol 8 ◽  
Author(s):  
Jochanan Benbassat
Keyword(s):  
Gastric Cancer ◽  
Patient Satisfaction ◽  
High Risk ◽  
Life Expectancy ◽  
Early Diagnosis ◽  
Cancer Detection ◽  
Symptom Relief ◽  
Management Strategies ◽  
Detection Rates ◽  
Test And Treat

Background: The management of patients with dyspepsia is uncertain. Some authors advocate endoscopy for all; others restrict endoscopy only to patients at high risk of gastric cancer, namely to those above an age threshold, or with a family history, dysphagia, loss of weight, anemia, or a childhood in Asian countries. Still others recommend various combinations between test-and-treat for Helicobacter pylori, anti-secretory treatment, and/or endoscopy.Objective: To highlight the uncertainties in the choice between the various strategies and argue that these uncertainties should be shared with the patient.Method: An overview of reported life expectancy, patient satisfaction, gastric cancer detection rates, symptom relief, and cost effectiveness of the management strategies for dyspepsia.Main Findings: There are no randomized controlled trials of the effect of screening by endoscopy on mortality of patients with gastric cancer. Lower grades of evidence suggest that early diagnosis reduces this mortality. Analyses, which assume a survival benefit of early diagnosis, indicate that mass screening in countries of high incidence gastric cancer (> 10 cases per 100,000) and targeted screening of high-risk persons in countries of low-intermediate incidence (<10 cases per 100,000) is cost-effective at a willingness to pay of $20,000–50,000 per QALY. Prompt endoscopy appears to be best for patient satisfaction and gastric cancer detection, and test-and-treat for H pylori—for symptom relief and avoiding endoscopies.Conclusions: The gain in life expectancy is the main source of uncertainty in the choice between management strategies. This choice should be shared with the patients after explaining uncertainties and eliciting their preferences.

scholarly journals Online Mental Health Assessments of COVID-19 Patients in South Korea

2021 ◽  
Vol 12 ◽  
Author(s):  
Jung Hyun Lee ◽  
Dayoung Lee ◽  
Soyoen Hyun ◽  
Ji Sun Hong ◽  
Chang-Hoon Kim ◽  
...  
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Mental Health Problems ◽  
Health Problems ◽  
Self Report ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Post Traumatic Stress ◽  
Patient Health ◽  
Post Traumatic

Experiences of infectious diseases cause stressful and traumatic life events, hence, coronavirus disease 2019 (COVID-19) patients could suffer from various mental health problems requiring psychological support services. This study investigates the severity of mental health problems among confirmed COVID-19 patients. From March to November 2020, we collected the data from 118 COVID-19 patients who voluntarily participated in the National Center for Disaster Trauma's online mental health assessment consisting of self-report scales like Primary Care of Posttraumatic Stress Disorder screen (PC-PTSD), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Health Questionnaire-15 (PHQ-15), and P4 Suicidality Screener. For control, 116 other disaster-experienced and 386 non-COVID-19-experienced participants were recruited. The COVID-19 patients showed more severe symptoms including post-traumatic symptoms, depression, anxiety, and somatic symptoms than control groups across all four screening scales (p < 0.001). Regarding high-risk, COVID-19 patients had an increased association with high-risk compared to the comparison groups (PC-PTSD: OR = 24.16, 95% CI = 13.52–43.16 p < 0.001; PHQ-9: OR = 14.45, 95% CI = 8.29–25.19, p < 0.001; GAD-7: OR=20.71, 95% CI = 10.74–39.96, p < 0.001; PHQ-15: OR = 5.65, 95% CI = 3.44–9.25, p < 0.001; P4: OR = 14.67, 95% CI = 8.95–25.07, p < 0.001). This study's results imply that there is a high-risk of overall mental health problems, especially stronger associations of post-traumatic stress symptoms, in COVID-19 patients. These findings help inform practitioners about the psychological responses to COVID-19 experiences and to prepare appropriate interventions and services for the incremental number of confirmed cases.

scholarly journals Breast cancer risk assessment: How risk models can “overdiagnose” risk.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 184-184
Author(s):  
Elissa Ozanne ◽  
Brian Drohan ◽  
Kevin S. Hughes
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
High Risk ◽  
Resource Utilization ◽  
Management Strategies ◽  
Cancer Risk Assessment ◽  
Cancer Society ◽  
Total Study Population ◽  
Breast Cancer Risk Assessment ◽  
The Impact

184 Background: Overdiagnosis is commonly defined as a diagnosis of "disease" which will never cause symptoms or death during a patient's lifetime. Similarly, overdiagnosis can also happen when individuals are given the diagnosis of being at risk for a disease, such as being at high-risk for developing breast cancer. Women can be given such a diagnosis by meeting a set of risk assessment criteria, which are often accompanied by recommended management strategies. We sought to identify the extent and consequences of overdiagnosis for individuals being at high risk for breast cancer using the American Cancer Society (ACS) guidelines for the appropriate use of Magnetic Resonance Imaging (MRI). Methods: We identified women who fit the ACS criteria in a population based sample at a community hospital. The ACS criteria mentions three risk assessment models for determining a woman’s risk, and these criteria were reviewed to determine the extent of possible overdiagnosis in this population. The expected resource utilization resulting from this overdiagnosis, and the impact on patient quality of life are extrapolated. Results: 5,894 women who received mammography screening at the study site were included. 342 (5.8%) of the women were diagnosed as high risk by at least one model. However, only 0.2% of the total study population were diagnosed as high risk by all three models. One model identified 330 (5.6%) to be at high risk, while the other two models identified many fewer eligible women (25, 0.4% and 54, 0.9% respectively). Conclusions: Using different models to evaluation the ACS criteria identifies very different populations, implying a large potential for overdiagnosis. Further, this overdiagnosis is likely to result in the outcome of screening too many women, incurring false positives and unnecessary resource utilization.

scholarly journals Protecting the most vulnerable during COVID-19 and beyond: a case report on the remote management of heart failure patients with cardiac implantable electronic devices

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6
Author(s):  
Fozia Zahir Ahmed ◽  
Carol Crosbie ◽  
Matthew Kahn ◽  
Manish Motwani
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Electronic Devices ◽  
Management Strategies ◽  
Phone Call ◽  
Cardiac Resynchronization ◽  
Physiological Data ◽  
Related Data ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk

Abstract Background Heart failure (HF) patients with cardiac implantable electronic devices (CIEDs) represent an important cohort. They are at increased risk of hospitalization and mortality. We outline how remote-only management strategies, which leverage transmitted health-related data, can be used to optimize care for HF patients with a CIED during the COVID-19 pandemic. Case summary An 82-year-old man with HF, stable on medical therapy, underwent cardiac resynchronization therapy implantation in 2016. Modern CIEDs facilitate remote monitoring by providing real-time physiological data (thoracic impedance, heart rate and rhythm, etc.). The ‘Triage Heart Failure Risk Score’ (Triage-HFRS), available on Medtronic CIEDs, integrates several monitored physiological parameters into a risk prediction model classifying patients as low, medium, or high risk of HF events within 30 days. In November 2019, the patient was enrolled in an innovative clinical pathway (Triage-HF Plus) whereby any ‘high’ Triage-HF risk status transmission prompts a phone call-based virtual consultation. A high-risk alert was received via remote transmission on 11 March, triggering a phone call assessment. Upon reporting increasing breathlessness, diuretics were initiated. The prescription was remotely issued and delivered to the patient’s home. This approach circumvented the need for all face-to-face reviews, delivering care in an entirely remote manner. Discussion The challenges posed by COVID-19 have prompted us to think differently about how we deliver care for patients, both now and following the pandemic. Contemporary CIEDs facilitate the ability to remotely monitor HF patients by providing rich physiological data that can help identify individuals at elevated risk of decompensation using automated device-generated alerts.

scholarly journals A UTILIZAÇÃO DE MEDICAMENTOS HOMEOPÁTICOS NA REGIÃO METROPOLITANA DE CURITIBA

2004 ◽  
Vol 5 (2) ◽  
Author(s):  
Andrezza Beatriz OLIVEIRA ◽  
Sandra M. W. ZANIN ◽  
Marilis D. Miguel
Keyword(s):  
Therapeutic Option ◽  
Metropolitan Region ◽  
Pharmaceutical Service ◽  
Medicinal Treatment ◽  
Exchange Information ◽  
Patient Health ◽  
Improve Patient ◽  
Service Optimization

A Homeopatia é uma opção terapêutica que inclui o tratamento medicamentoso individualizado e unicista, com apresentação de efeitos indesejáveis nula devido ao grau de diluição infinitesimal. Estas características, junto à verificação de melhora e cura do estado patológico do paciente, têm promovido o aumento da utilização da Homeopatia. Com o objetivo de verificar a amplitude do uso desta terapêutica, realizou-se pesquisa em farmácias de manipulação homeopática de Curitiba e Região Metropolitana, buscando detectar quais os medicamentos mais solicitados pelos médicos, assim como formas farmacêuticas e escalas de diluição infinitesimal. A percepção da predominância do uso de policrestos remete à importância da presença do farmacêutico na farmácia homeopática. Este com função de esclarecimento e orientação ao paciente no que diz respeito ao tratamento e cuidados com os medicamentos, os promotores da cura. Além do acompanhamento do tratamento ao lado do médico, mantendo troca de informações com o mesmo, o que permite a otimização do atendimento farmacêutico dentro do conceito de promotor de saúde. HOMEOPATHIC MEDICINES UTILIZATION AT CURITIBA METROPOLITAN REGION Abstract Homeopathy is a therapeutic option that includes individual and unicist medicinal treatment. Since it can cure or improve patient health, its use has increased over the years. A research was realized in Homeopathic Manufacturing Pharmacies in the greater Curitiba area with the objective of verifying its utilization extent. In addition, the goal was to detect what homeopathic medicines are the most used by doctors, with its pharmaceutical presentations and dilution scale. Policrest was the most predominantly used treatment prescribed by homeopathic pharmacies. Treatment was accompanied by doctors, and the patient-doctor exchange information was crucial for treatment. That allowed a pharmaceutical service optimization under the health promoter concept.

scholarly journals High-risk medications identified from the Danish Patient Safety Database and the challenge of dissemination

2018 ◽  
Vol 24 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Pia Knudsen ◽  
Lena Graversen ◽  
Torsten Larsen
Keyword(s):  
Patient Safety ◽  
High Risk ◽  
Improve Patient Safety ◽  
Healthcare Staff ◽  
Safety Database ◽  
Danish Patient ◽  
National Patient ◽  
Medication Incidents ◽  
Patient Safety Incidents ◽  
Improve Patient

Since 2004, patient safety incidents in Denmark have been reported to a national patient safety reporting system – the Danish Patient Safety Database. The goal of the system is to improve patient safety. In 2011, a decision was made to develop a national list of high-risk medications based on the medication incidents reported to the Danish Patient Safety Database. The high-risk medications are defined as medications that have been involved in medication errors and have caused harm to patients. The purpose is to identify medications that posed a particular and preventable risk for patients. It became clear through updates that there was a group of medications that caused severe harm to the patients more frequently than others. Based on the list, the Danish Patient Safety Authority in 2015 identified seven groups of medications that require special attention from healthcare staff: antidiabetic medications, anticoagulants, low-dose methotrexate, concentrated potassium, opioids, gentamicin and digoxin. Better handling of these seven types of medication could improve patient safety significantly. For many years, Danish Patient Safety Authority has distributed tables and booklets about these high-risk medications. In addition, ‘patient safety warnings’ are issued when it is considered necessary. In spite of this, many patient safety incidents involving these medications still occur. This points to the fact that disseminating knowledge from a government level all the way to frontline healthcare staff poses a challenge. On that background, Danish Patient Safety Authority is exploring new ways to disseminate knowledge to frontline healthcare staff about patient safety incidents.

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