Abstract T MP100: Improving Encounter Frequency, Physician Prescribing, or Patient Adherence - What Works Best for Controlling Blood Pressure? Results From a Validated Micro-Simulation Model

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Valy Fontil ◽  
Kirsten Bibbins-Domingo ◽  
Dhruv Kazi ◽  
Pamela Coxson ◽  
Steve Sidney ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Patient Adherence ◽  
The United States ◽  
Control Model ◽  
Uncontrolled Hypertension ◽  
Base Case ◽  
Treatment Intensification ◽  
Case Scenario ◽  
Base Case Scenario

Background: Only half of hypertensive adults achieve blood pressure (BP) control in the United States. Methods: We developed the BP Control Model to simulate physician- and patient-level processes relevant in achieving BP control. We validated the model by simulating the intervention arm of a recent multicenter clinical trial and used the validated model to examine the effects of isolated improvements in three modifiable processes on BP control. Data from national surveys, cohort studies, and trials were used to parameterize the model. We simulated 5,000 hypothetical adult patients with uncontrolled hypertension (systolic BP≥ 140) using probability sampling of participants from the 2009-2010 National Health and Nutrition Examination Survey. We modeled 50% improvements and ideal scenarios for each process parameter. Outcome: We reported outcomes in terms of BP control (% with SBP < 140 mmHg), and average change in BP at 52 weeks. Results: In our validation analysis, the model-predicted BP control was similar to what was achieved in the VIPER-BP clinical trial (63.5% vs. 63.8%). In our base case scenario, 24% of the NHANES-derived cohort achieved BP control at 52 weeks. In scenarios with 50% improvements, the model predicted small increases in BP control, but substantially larger and more variable effects when processes were idealized (Table). Control was reached in 77% with ideal treatment intensification, 44% with ideal encounter frequency, only 32% with ideal adherence, and 97% when all three processes were idealized. Conclusion: While improving patient adherence to medications would improve BP control, healthcare systems can achieve similar or greater success by focusing on increasing the frequency of clinical encounters and improving physicians’ prescribing behavior. The BP Control Model can be used to predict how much improvement to expect from such interventions.

scholarly journals Evaluating the Impact of the Registered Provisional Immigrant Program: A Cost-Benefit Analysis

2016 ◽  
Vol 23 ◽  
pp. 20
Author(s):  
Odia Bintou Cissé
Keyword(s):  
Undocumented Immigrants ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
The United States ◽  
Base Case ◽  
Benefit Analysis ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Worst Case ◽  
The Impact

On June 27, 2013, the Senate passed the Border Security, Economic Opportunity, and Immigration Modernization Act of 2013 (referred to as S.744). The bill addresses key elements of the immigration process through five sections. This analysis serves as an ex-ante Cost-Benefit Analysis (CBA) of the proposed Registered Provisional Immigrant (RPI) program under Section II of S.744, which would allow undocumented immigrants in the US to obtain legal status. The CBA looks at a 10-year timeframe from 2015 through 2025 and estimates the costs and benefits to four groups: undocumented immigrants, US taxpayers, employers of undocumented immigrants, and the United States Citizenship and Immigration Services (USCIS) under a base case scenario, a distributional weight scenario, and a worst-case scenario. Given the positive net benefits observed under the three scenarios, significant evidence recommends the implementation of the RPI program.

Abstract 096: Comparing Strategies to Improve Systolic Blood Pressure Over 10 Years: A Simulation Study Using the Blood Pressure Control Model

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Brandon K Bellows ◽  
Andrew E Moran ◽  
Natalia Ruiz-Negrón ◽  
Kirsten Bibbins-Domingo ◽  
Mark Pletcher ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Usual Care ◽  
Pressure Control ◽  
Control Model ◽  
Uncontrolled Hypertension ◽  
Hypertension Control ◽  
Treatment Intensification ◽  
Visit Frequency ◽  
Global Strategies

Background: Uncontrolled hypertension increases patients’ risk for cardiovascular and kidney disease. This study compared strategies to improve systolic blood pressure (SBP) among 1000 simulated patients with uncontrolled hypertension (SBP >=140 mmHg) from the National Health and Nutrition Examination Survey (NHANES). Methods: The Blood Pressure Control Model (BPCM) is a microsimulation, health state transition model that predicts the weekly SBP of patients receiving usual care. In the BPCM, patient SBPs are estimated using office visit frequency, measured SBP accuracy and variability, probability of treatment intensification with uncontrolled SBP, effect of antihypertensive medications, and adherence. BPCM inputs are derived from national survey data, meta-analyses, and other published literature. The effects of usual care on SBP were compared to 10% and 50% increases in global strategies for SBP control (i.e., visit frequency, treatment intensification, and/or adherence) over 10 years. SBP outcomes were validated against published literature values of 44-46% prior to implementation (i.e., usual care) and 74-80% 8-10 years after implementation of aggressive hypertension management programs in large health systems. Results: In the simulated NHANES population, the mean (SD) age was 61.1 (14.6), 52% were male, and mean baseline SBP was 153.2 (13.6) mmHg. Under usual care, the BPCM estimated a mean SBP of 140.1 (16.4) mmHg and 49% of patients achieving SBP <140 mmHg after 10 years. Compared to usual care, 50% improvements in global strategies resulted in more rapid reductions in SBP and earlier achievement of SBP control. Simultaneously improving all global strategies by 50% resulted in an estimated mean SBP of 132.4 (15.5) mmHg with 71% achieving control after 10 years. Conclusions: Usual care and intervention BPCM predictions are consistent with hypertension control rates observed in contemporary national surveys and the observed results of recent systematic hypertension control improvement programs. These results show the BPCM may be used by health system planners to project the impact of implementing hypertension control strategies.

scholarly journals What Will It Take to Reduce HIV Incidence in the United States: A Mathematical Modeling Analysis

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Allison Perry ◽  
Parastu Kasaie ◽  
David W Dowdy ◽  
Maunank Shah
Keyword(s):  
United States ◽  
Retention In Care ◽  
The United States ◽  
Base Case ◽  
People Living With Hiv ◽  
Hiv Incidence ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Care Continuum ◽  
Living With Hiv

Abstract Background The National HIV/AIDS Strategy has set ambitious goals to improve the epidemic in the United States. However, there is a paucity of usable program-level benchmarks tied to population-level epidemiologic goals. Our objective was to define tangible benchmarks for annual rates along the care continuum that are likely to translate to meaningful reductions in incidence. Methods We used a validated mathematical model of HIV transmission and care engagement to characterize care continuum parameters that would translate into 50% reductions in incidence by 2025, compared with a base case scenario of the current US care continuum. We generated a large pool of simulations in which rates of screening, linkage, and retention in care were varied across wide ranges to evaluate permutations that halved incidence by 2025. Results Among all simulations, 7% achieved a halving of incidence. It was impossible for our simulations to achieve this target if the annual rate of disengagement from care exceeded 20% per year, even at high rates of care reengagement. When retention in care was 95% per year and people living with HIV (PLWH) out of care reengaged within 1.5 years (on average), the probability of halving incidence by 2025 was approximately 90%. Conclusions HIV programs should aim to retain at least 95% of PLWH in care annually and reengage people living with HIV into care within an average of 1.5 years to achieve the goal of halving HIV incidence by 2025.

scholarly journals Modelling and mitigating dose to firefighters from inhalation of radionuclides in wildland fire smoke

2015 ◽  
Vol 24 (5) ◽  
pp. 723 ◽  
Author(s):  
Brian J. Viner ◽  
Tim Jannik ◽  
Daniel Stone ◽  
Allan Hepworth ◽  
Luke Naeher ◽  
...  
Keyword(s):  
Environmental Conditions ◽  
Wildland Fire ◽  
Radioactive Material ◽  
Fuel Load ◽  
Base Case ◽  
Published Data ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Fuel Loads ◽  
Radiological Dose

Firefighters responding to wildland fires where surface litter and vegetation contain radiological contamination will receive a radiological dose by inhaling resuspended radioactive material in the smoke. This may increase their lifetime risk of contracting certain types of cancer. Using published data, we modelled hypothetical radionuclide emissions, dispersion and dose for 70th and 97th percentile environmental conditions and for average and high fuel loads at the Savannah River Site. We predicted downwind concentration and potential dose to firefighters for radionuclides of interest (137Cs, 238Pu, 90Sr and 210Po). Predicted concentrations exceeded dose guidelines in the base case scenario emissions of 1.0 × 107 Bq ha–1 for 238Pu at 70th percentile environmental conditions and average fuel load levels for both 4- and 14-h shifts. Under 97th percentile environmental conditions and high fuel loads, dose guidelines were exceeded for several reported cases for 90Sr, 238Pu and 210Po. The potential for exceeding dose guidelines was mitigated by including plume rise (>2 m s–1) or moving a small distance from the fire owing to large concentration gradients near the edge of the fire. This approach can quickly estimate potential dose from airborne radionuclides in wildland fire and assist decision-making to reduce firefighter exposure.

scholarly journals The Effect of the Mobile ‘Blood Pressure Management Application’ on Hypertension Self-Management Enhancement: A Randomised Controlled Trial

2019 ◽  
Author(s):  
Ali Bozorgi ◽  
Hamed Hosseini ◽  
Hassan Eftekhar ◽  
Reza Majdzadeh ◽  
Ali Yoonessi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Clinical Trial ◽  
Repeated Measures ◽  
Patient Adherence ◽  
Intervention Group ◽  
Public Hospitals ◽  
Self Management ◽  
Control Group ◽  
Management Application

Abstract Background : Self-management of blood pressure is of great significance given the increasing incidence of hypertension and associated disabilities. With the increased use of mobile health in medicine, the present study evaluated the effect of the self-management application on patient adherence to hypertension treatment. Methods : This clinical trial was performed on 120 hypertensive patients who were provided with a mobile intervention for 8 weeks and followed-up to 24 th weeks. Data on the primary outcome (adherence to treatment) and secondary outcomes (adherence to the DASH diet, regular monitoring of blood pressure, and physical activity) were collected using a questionnaire and a mobile application, respectively. The inter-group change difference over time was analyzed using repeated measures ANOVA (General Linear Model). Results : The treatment adherence score increased by an average of 5.9 (95%CI: 5.0-6.7) in the intervention group compared to the control group. Scores of adherence to the low-fat and low-salt diet plans were 1.7 (95%CI: 1.3-2.1) and 1.5 (95%CI: 1.2-1.9), respectively. Moreover, moderate physical activity increased to 100.0 minutes (95%CI: 61.7-138.3) per week in the intervention group. Conclusion: The treatment and control of blood pressure require a multifaceted approach given its complexity and multifactorial nature. Considering the widespread use of smartphones , mhealth interventions can be effective in self-management and better patient adherence to treatments. Our results showed that this application can be used as a successful tool for hypertension self-management in patients attending public hospitals in developing countries. Trial registration: This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on 1 January 2016.

scholarly journals Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial (Preprint)

2018 ◽  
Author(s):  
Stacie L Daugherty ◽  
Suma Vupputuri ◽  
Rebecca Hanratty ◽  
John F Steiner ◽  
Julie A Maertens ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Medication Adherence ◽  
Racial Disparities ◽  
Stereotype Threat ◽  
Primary Outcome ◽  
Racial Bias ◽  
The United States ◽  
Uncontrolled Hypertension ◽  
Values Affirmation

BACKGROUND Medication nonadherence is a significant, modifiable contributor to uncontrolled hypertension. Stereotype threat may contribute to racial disparities in adherence by hindering a patient’s ability to actively engage during a clinical encounter, resulting in reduced activation to adhere to prescribed therapies. OBJECTIVE The Hypertension and Values (HYVALUE) trial aims to examine whether a values-affirmation intervention improves medication adherence (primary outcome) by targeting racial stereotype threat. METHODS The HYVALUE trial is a patient-level, blinded randomized controlled trial comparing a brief values-affirmation writing exercise with a control writing exercise among black and white patients with uncontrolled hypertension. We are recruiting patients from 3 large health systems in the United States. The primary outcome is patients’ adherence to antihypertensive medications, with secondary outcomes of systolic and diastolic blood pressure over time, time for which blood pressure is under control, and treatment intensification. We are comparing the effects of the intervention among blacks and whites, exploring possible moderators (ie, patients’ prior experiences of discrimination and clinician racial bias) and mediators (ie, patient activation) of intervention effects on outcomes. RESULTS This study was funded by the National Heart, Lung, and Blood Institute. Enrollment and follow-up are ongoing and data analysis is expected to begin in late 2020. Planned enrollment is 1130 patients. On the basis of evidence supporting the effectiveness of values affirmation in educational settings and our pilot work demonstrating improved patient-clinician communication, we hypothesize that values affirmation disrupts the negative effects of stereotype threat on the clinical interaction and can reduce racial disparities in medication adherence and subsequent health outcomes. CONCLUSIONS The HYVALUE study moves beyond documentation of race-based health disparities toward testing an intervention. We focus on a medical condition—hypertension, which is arguably the greatest contributor to mortality disparities for black patients. If successful, this study will be the first to provide evidence for a low-resource intervention that has the potential to substantially reduce health care disparities across a wide range of health care conditions and populations. CLINICALTRIAL ClinicalTrials.gov NCT03028597; https://clinicaltrials.gov/ct2/show/NCT03028597 (Archived by WebCite at http://www.webcitation.org/72vcZMzAB). INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12498

scholarly journals Impact of changes in the methodology of external price referencing on medicine prices: discrete-event simulation

2020 ◽  
Author(s):  
Sabine Vogler ◽  
Peter Schneider ◽  
Lena Lepuschütz
Keyword(s):  
Cost Containment ◽  
Discrete Event ◽  
Real Life ◽  
Base Case ◽  
Case Scenario ◽  
Medicine Price ◽  
Base Case Scenario ◽  
The Real ◽  
Methodological Choices ◽  
Medicine Prices

Abstract Background: Several governments apply the policy of external price referencing (EPR), which considers the prices of a medicine in one or more other countries for the purpose of setting the price in the own country. Different methodological choices can be taken to design EPR. The study aimed to analyse whether, or not, and how changes in the methodology of EPR can impact medicine prices.Methods: The real-life EPR methodology as of Q1/2015 was surveyed in all European Union Member States (where applicable), Iceland, Norway and Switzerland through a questionnaire responded by national pricing authorities. Different scenarios were developed related to the parameters of the EPR methodology. Discrete-event simulations of fictitious prices in the 28 countries of the study that had EPR were run over 10 years. The continuation of the real-life EPR methodology in the countries as surveyed in 2015, without any change, served as base case.Results: In most scenarios, after ten years, medicine prices in all or most surveyed countries were – sometimes considerably – lower than in the base case scenario. But in a few scenarios medicine prices increased in some countries. Consideration of discounts (an assumed 20% discount in five large economies and the mandatory discount in Germany, Greece and Ireland) and determining the reference price based on the lowest price in the country basket would result in higher price reductions (on average -47.2% and -34.2% compared to the base case). An adjustment of medicine price data of the reference countries by purchasing power parities would lead to higher prices in some more affluent countries (e.g. Switzerland, Norway) and lower prices in lower-income economies (Bulgaria, Romania, Hungary, Poland). Regular price revisions and changes in the basket of reference countries would also impact medicine prices, however to a lesser extent.Conclusions: EPR has some potential for cost-containment. Medicine prices could be decreased if certain parameters of the EPR methodology were changed. If public payers aim to apply EPR to keep medicine prices at more affordable levels, they are encouraged to explore the cost-containment potential of this policy by taking appropriate methodological choices in the EPR design.

scholarly journals Skenario Pengembangan Untuk Meningkatkan Recovery Factor Pada Lapangan TR Lapisan X Dengan Menggunakan Simulasi Reservoir

PETRO ◽  
2018 ◽  
Vol 4 (4) ◽  
Author(s):  
Muhamad Taufan Azhari
Keyword(s):  
Reservoir Simulation ◽  
History Matching ◽  
Control Volume ◽  
Base Case ◽  
Case Scenario ◽  
Injection Wells ◽  
Base Case Scenario ◽  
Development Scenarios ◽  
Production Wells ◽  
Grid Construction

<p>Reservoir simulation is an area of reservoir engineering in which computer models are used to predict the flow of fluids through porous media. Reservoir simulation process starts with several steps; data preparation, model and grid construction, initialization, history matching and prediction. Initialization process is done for matching OOIP or total initial hydrocarbon which fill reservoir with hydrocarbon control volume with volumetric method.</p><p>To aim the best encouraging optimum data, these development scenarios of TR Field Layer X will be predicted for 30 years (from 2014 until January 2044). Development scenarios in this study consist of 4 scenarios : Scenario 1 (Base Case), Scenario 2 (Base Case + Reopening non-active wells), Scenario 3 (scenario 2 + infill production wells), Scenario 4 (Scenario 2 + 5 spot pattern of infill injection wells).</p>

Optimizing Strategies for Chlamydia trachomatis and Neisseria gonorrhoeae Screening in Men Who Have Sex With Men: A Modeling Study

2019 ◽  
Vol 70 (9) ◽  
pp. 1966-1972
Author(s):  
Nicolas Voirin ◽  
Camille Allam ◽  
Caroline Charre ◽  
Christine Fernandez ◽  
Matthieu Godinot ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Screening Strategy ◽  
Unprotected Sex ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Systematic Screening ◽  
Ct Screening ◽  
Sex With Men

Abstract Background International guidelines recommend the systematic screening for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections in all men who have sex with men (MSM) who have engaged in unprotected sex. However, the optimal screening strategy remains unclear. We developed a modeling approach to optimize NG/CT screening strategy in MSM. Methods A compartmental model of NG/CT screening and infection was implemented. NG/CT anal, pharyngeal, and urine (APU) samples from MSM attending the sexually transmitted infections clinic were used to estimate the screening rate, prevalence, and incidence in a base case scenario. Different screening strategies (scenarios; S) were then evaluated: APU samples every 12 months (S1); APU samples every 3 months (S2); APU samples every 6 months (S3); anal and pharyngeal (AP) samples every 6 months (S4); and AP samples every 3 months (S5). Results We analyzed 2973 triplet APU samples from 1255 patients. We observed 485 NG and 379 CT diagnoses. NG/CT prevalence and incidence estimates were 12.0/11.1% and 40/29 per 100 person-years, respectively, in the base case scenario. As compared to S2, the reference strategy, the proportions of missed NG/CT diagnoses were 42.0/41.2% with S1, 21.8/22.5% with S3, 25.6/28.3% with S4, and 6.3/10.5% with S5, respectively. As compared to S2, S1 reduced the cost of the analysis by 74%, S3 by 50%, S4 by 66%, and S5 by 33%. The numbers needed to screen for catching up the missed NG/CT diagnoses were 49/67 with S1, 62/82 with S3, 71/87 with S4, and 143/118 with S5. Conclusions S5 appears to be the best strategy, missing only 6.3/10.5% of NG/CT diagnoses, for a cost reduction of 33%.

scholarly journals Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention: Rentabilité D’une Intervention de Contact et d’un Programme de Psychothérapie Pour la Prévention du Suicide Après le Congé de L’hôpital

2020 ◽  
pp. 070674372098013
Author(s):  
Gonzalo Martínez-Alés ◽  
José B. Cruz Rodríguez ◽  
Pablo Lázaro ◽  
Arce Domingo-Relloso ◽  
María Luisa Barrigón ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Suicide Prevention ◽  
Cost Effective ◽  
Cost Data ◽  
Base Case ◽  
Case Scenario ◽  
Post Discharge ◽  
Base Case Scenario ◽  
Augmentation Strategies

Objective: To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. Methods: We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid’s official list of public health care prices. Indirect cost data were derived from Spain’s National Institute of Statistics. Results: Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €−196 per averted attempt). Conclusions: Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.

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