scholarly journals Improved Value of Individual Prenatal Care for the Interdisciplinary Team

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ella Damiano ◽  
Regan Theiler
Keyword(s):  
Prenatal Care ◽  
Retrospective Chart Review ◽  
Median Number ◽  
Interdisciplinary Teams ◽  
Cost Of Care ◽  
Coordination Of Care ◽  
Primary Endpoints ◽  
Number Of Visits ◽  
The Cost ◽  
Testing And Counseling

Objective. Innovative models of prenatal care are needed to improve pregnancy outcomes and lower the cost of care. We sought to increase the value of traditional prenatal care by using a new model (PodCare) featuring a standardized visit schedule and coordination of care within small interdisciplinary teams in an academic setting. Methods. Prenatal providers and clinic staff were divided into four “Pods”. Testing and counseling topics were assigned to visits based on gestational age. Interdisciplinary weekly Pod meetings provided coordination of care. A retrospective chart review was performed. The primary endpoints were the number of prenatal care visits and number of providers seen. Results. After PodCare implementation, more patients choose care with the low-risk physician team (42% compared to 26%). Study subjects included 85 women in 2013 and 165 women in 2014. The median number of visits decreased from 13 to 10 (p < 0.00004) and the median number of providers seen decreased from 7 to 5 (p < 0.0000008). Conclusion. PodCare increased the value of individual prenatal care by decreasing the number of visits, increasing continuity, and providing care coordination. The model provides a robust experience in interdisciplinary care. The PodCare model may be successful at other academic institutions.

Proteinuria monitoring in patients receiving bevacizumab at a community cancer center.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 13-13
Author(s):  
Amin Benyounes ◽  
Sherry Pomerantz ◽  
Ann Christian ◽  
Gentry Teng King ◽  
Nancy Leahy ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Albert Einstein ◽  
Cancer Center ◽  
Primary Endpoints ◽  
Routine Monitoring ◽  
Bevacizumab Treatment ◽  
Progression Of Disease ◽  
Grade 3 ◽  
The Cost ◽  
Nephrotic Range Proteinuria

13 Background: The use of bevacizumab has been associated with the development of proteinuria. The manufacturer suggests monitoring for proteinuria with serial urine dipsticks. We set to evaluate the relevance and cost of this practice in a Community Cancer Center in Philadelphia. Methods: We performed a retrospective chart review at Albert Einstein Cancer Center. Consecutive patients treated with bevacizumab from January 2011 to March 2014 were included in the study. Primary endpoints were the incidence and grade of proteinuria under bevacizumab therapy and the implication of proteinuria in treatment (holding or cessation of bevacizumab). Secondary objectives included the association between the number of bevacizumab infusions or patient’s comorbidities (diabetes, hypertension, chronic kidney disease) and the development or worsening of proteinuria. We also calculated the cost of monitoring for proteinuria in our cohort. Results: 71 patients were screened. A total of 66 patients (corresponding to 738 infusions) were included in the analysis. Typical monitoring interval was every 2 cycles. None developed nephrotic range proteinuria. One patient (1.5%) developed grade 2 proteinuria. Bevaciuzumab was discontinued due to proteinuria in 2 patients (3%): neither of them developed permanent kidney damage or required an intervention as a consequence of the proteinuria. The most common reason of bevacizumab discontinuation was progression of disease (75%). Neither the number of infusions nor concomitant comorbidities were significantly associated with the development or worsening of proteinuria (p=0.8, p>0.05 respectively). The cost of monitoring for proteinuria in our cohort was estimated at $3980. Conclusions: These results show that the development of grade 2 proteinuria, let alone grade 3, with bevacizumab is uncommon and rarely affects treatment decisions in our Community Cancer Center. We therefore question the necessity of routine monitoring for proteinuria during bevacizumab treatment.

Economic benefits of adaptive abiraterone therapy for advanced prostate cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18343-e18343
Author(s):  
Neil Thomas Mason ◽  
Jason M Burkett ◽  
Ryan Nelson ◽  
Julio M. Pow-Sang ◽  
Robert A Gatenby ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Annual Cost ◽  
Economic Value ◽  
Standard Of Care ◽  
Economic Benefits ◽  
Cost Of Care ◽  
Castration Resistant Prostate Cancer ◽  
Billing Data ◽  
Primary Endpoints ◽  
The Cost

e18343 Background: We recently completed a study showing that adaptive abiraterone therapy (AT) led to more than a doubling of the time to radiographic progression (TTP) compared to continuous therapy (CT) in patients with metastatic castration resistant prostate cancer (mCRPC), [Nat Commun. 2017; 1816]. This study compared the cost of care in the AT cohort versus the standard of care CT cohort. Methods: We conducted a retrospective economic analysis of mCRPC patients receiving intermittent AT compared to patients receiving CT abiraterone. The study followed the adaptive therapy trial protocol (NCT02415621). The primary endpoints were costs of care per patient per year and cost per treatment month. We used itemized billing data and standardized to Medicare reimbursement rates to determine the pharmacy, lab, and imaging costs. Results: Patients receiving adaptive abiraterone therapy (N = 15) had a mean annual cost of care of $80,668 compared to a mean annual cost of care of $132,631 for CT patients. The cost of treatment per month was $6,713 for the AT versus $11,088 for the CT. The economic benefits persisted even after taking into account the cost of abiraterone (Table). Conclusions: The reduction in cost of care in patients with mCRPC with nearly an additional year of TTP from adaptive abiraterone therapy demonstrates the potential value of novel precision medicine approaches. If confirmed by other, larger scale studies, AT may provide significant economic value from far more effective therapy. [Table: see text]

scholarly journals Retrospective Chart Review Study to Evaluate the Cost of Care of Patients with Symptomatic Multiple Myeloma in France

2016 ◽  
Vol 19 (3) ◽  
pp. A155 ◽  
Author(s):  
S Gonzalez-McQuire ◽  
K Yong ◽  
H Leleu ◽  
A Flinois ◽  
C Gazzola ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Cost Of Care ◽  
Review Study ◽  
The Cost

scholarly journals PSY17 Retrospective Chart Review Study of the Cost of Care of Systemtic Lupus Erythematousus (Sle) in Five European Countries

2011 ◽  
Vol 14 (7) ◽  
pp. A413
Author(s):  
A. Doria ◽  
Z. Amoura ◽  
J. Richter ◽  
R. Cervera ◽  
M. Khamashta ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Cost Of Care ◽  
European Countries ◽  
Review Study ◽  
The Cost

GSS 2011 Linked with TIFF: Exploring the Cost of Child Care in Canada and the Use of the Child Care Tax Benefit

2019 ◽  
Vol 12 (1) ◽  
pp. 81-103
Author(s):  
Leanne Findlay ◽  
Dafna Kohen
Keyword(s):  
Child Care ◽  
General Social Survey ◽  
Cost Of Care ◽  
Indigenous Identity ◽  
Social Survey ◽  
The Cost ◽  
Care Costs ◽  
Compare And Contrast ◽  
Employment Characteristics ◽  
Different Sources

Affordability of child care is fundamental to parents’, in particular, women’s decision to work. However, information on the cost of care in Canada is limited. The purpose of the current study was to examine the feasibility of using linked survey and administrative data to compare and contrast parent-reported child care costs based on two different sources of data. The linked file brings together data from the 2011 General Social Survey (GSS) and the annual tax files (TIFF) for the corresponding year (2010). Descriptive analyses were conducted to examine the socio-demographic and employment characteristics of respondents who reported using child care, and child care costs were compared. In 2011, parents who reported currently paying for child care (GSS) spent almost $6700 per year ($7,500 for children age 5 and under). According to the tax files, individuals claimed just over $3900 per year ($4,700). Approximately one in four individuals who reported child care costs on the GSS did not report any amount on their tax file; about four in ten who claimed child care on the tax file did not report any cost on the survey. Multivariate analyses suggested that individuals with a lower education, lower income, with Indigenous identity, and who were self-employed were less likely to make a tax claim despite reporting child care expenses on the GSS. Further examination of child care costs by province and by type of care are necessary, as is research to determine the most accurate way to measure and report child care costs.

scholarly journals Budget Impact Analysis of Anticoagulation Clinics in Patients with Atrial Fibrillation under Chronic Therapy with Oral Anticoagulants

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
William Uribe-Arango ◽  
Juan Manuel Reyes Sánchez ◽  
Natalia Castaño Gamboa
Keyword(s):  
Atrial Fibrillation ◽  
Impact Analysis ◽  
Budget Impact ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Group Versus ◽  
Cost Of Care ◽  
Chronic Therapy ◽  
Colombian Government ◽  
The Cost

Objectives To assess budget impact of the implementation of an anticoagulation clinic (AC) compared to usual care (UC), in patients with non-valvular atrial fibrillation (NVAF). Method A decision tree was designed to analyze the cost and events rates over a 1-year horizon. The patients were distributed according to treatment, 30% Direct Oral Anticoagulant (DOAC) regimens and the rest to warfarin. The thromboembolism and bleeding were derived from observational studies which demonstrated that ACs had important impact in reducing the frequency of these events compared with UC, due to higher adherence with DOACs and proportion of time in therapeutic range (TTR) with warfarin. Costs were derived from the transactional platform of Colombian government, healthcare authority reimbursement and published studies. The values were expressed in American dollars (USD). The exchanged rate used was COP $3.693 per dollar. Results During 1 year of follow-up, in a cohort of 228 patients there were estimated 48 bleedings, 6 thromboembolisms in AC group versus 84 bleedings, and 12 thromboembolisms events in patients receiving UC. Total costs related to AC were $126 522 compared with $141 514 in UC. The AC had an important reduction in the cost of clinical events versus UC ($52 085 vs $110 749) despite a higher cost of care facilities ($74 436 vs $30 765). A sensibility analysis suggested that in the 83% of estimations, the AC produced savings varied between $27 078 and $135 391. Conclusions This study demonstrated that AC compared with UC, produced an important savings in the oral anticoagulation therapy for patients with NVAF.

scholarly journals Use of past care markers in risk-adjustment: accounting for systematic differences across providers

2021 ◽  
Author(s):  
Laura Anselmi ◽  
Yiu-Shing Lau ◽  
Matt Sutton ◽  
Anna Everton ◽  
Rob Shaw ◽  
...  
Keyword(s):  
Risk Adjustment ◽  
Fixed Effects ◽  
Goodness Of Fit ◽  
Reporting Quality ◽  
Cost Of Care ◽  
Local Health ◽  
Administrative Records ◽  
Practice Level ◽  
Improve Model ◽  
The Cost

AbstractRisk-adjustment models are used to predict the cost of care for patients based on their observable characteristics, and to derive efficient and equitable budgets based on weighted capitation. Markers based on past care contacts can improve model fit, but their coefficients may be affected by provider variations in diagnostic, treatment and reporting quality. This is problematic when distinguishing need and supply influences on costs is required.We examine the extent of this bias in the national formula for mental health care using administrative records for 43.7 million adults registered with 7746 GP practices in England in 2015. We also illustrate a method to control for provider effects.A linear regression containing a rich set of individual, GP practice and area characteristics, and fixed effects for local health organisations, had goodness-of-fit equal to R2 = 0.007 at person level and R2 = 0.720 at GP practice level. The addition of past care markers changed substantially the coefficients on the other variables and increased the goodness-of-fit to R2 = 0.275 at person level and R2 = 0.815 at GP practice level. The further inclusion of provider effects affected the coefficients on GP practice and area variables and on local health organisation fixed effects, increasing goodness-of-fit at GP practice level to R2 = 0.848.With adequate supply controls, it is possible to estimate coefficients on past care markers that are stable and unbiased. Nonetheless, inconsistent reporting may affect need predictions and penalise populations served by underreporting providers.

scholarly journals 308. Re-purposing Beta-lactam Antibiotics as Fluoroquinolone Sparing Stepdown Therapy for the Treatment of Enterobacteriales Bloodstream Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Matthew Davis ◽  
Dayna McManus ◽  
Michael Ruggero ◽  
Jeffrey E Topal
Keyword(s):  
Positive Culture ◽  
Retrospective Chart Review ◽  
Bloodstream Infections ◽  
Central Line ◽  
Cost Of Care ◽  
Cns Infection ◽  
Oral Antibiotic ◽  
Beta Lactam ◽  
Clostridioides Difficile ◽  
Secondary Outcomes

Abstract Background Oral antimicrobial therapy for Enterobacteriales bloodstream infection (EB-BSI) is advantageous to reduce the risk of central line complications, cost of care, and length of stay. Fluoroquinolones (FQ) given their high bioavailability have been utilized as the standard for stepdown therapy (SDT) for EB-BSI. Given the recent increased warnings around FQ use including Clostridioides difficile infection (CDI) and the increasing FQ resistance alternative oral options for treatment are warranted. Recent literature has suggested beta-lactams (BLM) may be an option for EB-BSI. To enhance the antimicrobial stewardship goal of reducing FQ use, our team began recommending de-escalation to a BLM for EB-BSI and the objective of this study is to evaluate the outcomes of this approach. Methods This study was a retrospective chart review of patients with EB-BSI due to ceftriaxone sensitive monomicrobial E. coli, Klebsiella spp., or P. mirabilis who received a BLM or a FQ as SDT. Patients were excluded if &lt; 18 years of age; pregnant; ANC &lt; 1000 cells/µL; had endocarditis, a bone/joint, or a CNS infection; discharged to hospice or expired prior to discharge; anaphylactic BLM allergy; or prior kidney transplant. SDT was defined as a switch to a definitive oral antibiotic after empiric IV therapy. The primary outcome was clinical cure defined as completion of therapy without signs of infection (increase in WBC &gt; 2000 cells/mL if WBC was ≥ 12,000 cells/mL, fever (&gt;38°C), or change in antibiotic due to failure). Secondary outcomes included 30 day re-admission rates, reinfection rate defined as positive culture within 30 days of completion of therapy, antibiotic associated adverse events defined as side effects leading to discontinuation and/or CDI within 90 days from start of treatment. Results A total of 159 patients were included in the study (Figure 1). The BLM patients had a higher median age (78 vs 72, p=0.008), higher median PITT bacteremia score (2 vs 1, p=0.037), were less likely to be immunosuppressed (9% vs 25%, p=0.045), and had shorter median duration of therapy (13 vs 14, p=0.034). There was no difference in the primary or secondary outcomes (Table 2). Conclusion BLM may enhance stewardship efforts as a FQ sparing option for treatment of EB-BSI; however, prospective studies in this area are warranted. Disclosures All Authors: No reported disclosures

scholarly journals Testing strategies for couple engagement in prevention of mother-to-child transmission of HIV and family health in Kenya: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zachary Kwena ◽  
Liza Kimbo ◽  
Lynae A. Darbes ◽  
Abigail M. Hatcher ◽  
Anna Helova ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Standard Care ◽  
Family Health ◽  
Child Transmission ◽  
Home Based ◽  
Self Testing ◽  
The Cost ◽  
Mother To Child ◽  
Testing And Counseling

Abstract Background HIV-related maternal deaths and HIV infection among infants remain unacceptably high across sub-Saharan Africa despite increased antenatal care attendance and provision of antiretroviral therapy to pregnant women. In the Jamii Bora (“Better Family” in Swahili) Study, we seek to test the efficacy of an interdependence theory-based couple intervention. The intervention reaches pregnant women and male partners through home visits by male-female pairs of lay health workers. The aim is to increase access to home-based couples’ HIV testing and counseling services to improve family health. Methods This is a three-arm randomized control trial among 1080 pregnant women 15 years of age or older, living with their male partners, and who have not undergone couples’ HIV testing and counseling in Kisumu and Migori Counties in Kenya. Couples will be randomized into three groups: home-based couple visits, HIV self-testing kits for couple use, or standard care (male partner clinic invitation letters). Participants will be followed up to 18 months postpartum. The study has three aims: in aim 1, we will determine the effects of the intervention on our primary outcome of couple HIV testing, compared to HIV self-testing kits and standard care; in aim 2, we will examine the intervention impact on HIV prevention behaviors, facility delivery, and postnatal healthcare utilization, as well as secondary health outcomes of maternal viral suppression and HIV-free child survival up to 18 months for couples living with HIV; and in aim 3, we will compare the cost-effectiveness of the home-based couple intervention to the less resource-intensive strategies used in the other two study arms. Assessments with couples are conducted at baseline, late pregnancy, and at months 3, 6, 12, and 18 after birth. Discussion The results from this study will inform decision-makers about the cost-effective strategies to engage pregnant couples in the prevention of mother-to-child transmission and family health, with important downstream benefits for maternal, paternal, and infant health. Trial registration ClinicalTrials.gov NCT03547739. Registered on May 9, 2018

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