Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope

2021 ◽  
pp. 000992282110382
Author(s):  
Tracey M. Thompson ◽  
Ty E. Hasselman ◽  
Yanzhi Wang ◽  
David W. Jantzen
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Pediatric Cardiology ◽  
Cost Effective ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cost Effectiveness Ratio ◽  
Improve Cost Effectiveness ◽  
Cardiology Clinic ◽  
Improve Cost

The pediatric appropriate use criteria (AUC) were applied to transthoracic echocardiograms (TTE) ordered by primary care providers (PCPs) and pediatric cardiologists for the diagnosis of syncope to compare appropriateness ratings and cost-effectiveness. Included were patients ≤18 years of age from October 2016 to October 2018 with syncope who underwent initial outpatient pediatric TTE ordered by a PCP or were seen in Pediatric Cardiology clinic. Ordering rate of TTE by pediatric cardiologists, AUC classification, and TTE findings were obtained. PCPs ordered significantly more TTEs than pediatric cardiologists for “rarely appropriate” indications (61.5% vs 7.5%, P < .001). Cardiologists ordered TTEs at 17.2% of visits. Using appropriateness as a marker of effect, with the incremental cost-effectiveness ratio, it was more cost-effective ($543.33 per patient) to refer to a pediatric cardiologist than to order the TTE alone. This suggests that improved PCP education of the AUC and appropriate indications of TTEs for syncope may improve cost-effectiveness when using order appropriateness as a marker of effectiveness.

scholarly journals Validation of the Primary Care Pathway Model for Management of Orthopedic Injuries: Results of a Prospective, Queensland Study

2020 ◽  
Vol 11 ◽  
pp. 215013272096722
Author(s):  
Christian Fuschini ◽  
Timothy Bussoletti ◽  
Caitlin Shaw ◽  
Mohammad Shazhad ◽  
Lin Qi ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Pathway ◽  
Cost Effective ◽  
Primary Care Providers ◽  
Low Risk ◽  
Care Providers ◽  
Model Of Care ◽  
Fracture Clinic ◽  
Limb Injuries ◽  
Orthopedic Injuries

Objective: A “virtual fracture clinic” (VFC) is viewed as a safe, cost effective method of managing suitable low risk orthopedic injuries without direct orthopedic review. This method is used throughout the Glasgow Royal Infirmary (GRI) and National Health System (NHS) as a cornerstone for efficient patient care. This study assessed the outcomes of a newly implemented Queensland based Primary Care Pathway (PCP) for management of simple orthopedic injuries. Methods: A prospective cohort was formed of patients presenting over a 4-week period with an acute orthopedic injury to either the Emergency Department (ED) or Primary Care Providers within the Logan Hospital catchment in Queensland, Australia. Patients were triaged to either a PCP management protocol with General Practitioners (GP), Allied-Health Professionals (AHP) or to a traditional in-person Fracture Clinic (FC) orthopedic review. Patients were followed for 6-months. Data were collected about epidemiology, complications, appropriate allocation, and injury type. Results: A total of 1283 patients were referred over the study period, of which 267 were triaged to PCP management. ED referrals accounted for 62.5% of appropriate referrals to either clinic. Upper limb injuries were the most common conditions managed through the PCP. Patients managed by the PCP model of care experienced a 4.29% complication rate over the 6-month follow-up period. Conclusion: The PCP model of care is effective in managing criteria specific, low risk orthopedic injuries with a low rate of complications (4.29%) without direct orthopedic FC review. Use of a PCP reduces demand on hospital resources, and provides a safe, cost-effective alternative to a resource-restricted outpatient service.

scholarly journals Cost-Effectiveness of a Clinical Childhood Obesity Intervention

2018 ◽  
pp. 136-152
Author(s):  
Mona Sharifi ◽  
Calvin Franz ◽  
Christine M. Horan ◽  
Catherine M. Giles ◽  
Michael W. Long ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Cost Effectiveness ◽  
Childhood Obesity ◽  
Primary Care Providers ◽  
Obesity Prevalence ◽  
Care Providers ◽  
Obesity Intervention ◽  
National Implementation ◽  
Behavior Change Support

OBJECTIVES To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. METHODS In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. RESULTS The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention’s effect worsened the former. CONCLUSIONS A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence.

scholarly journals Dermoscopic Lotus of Learning: Implementation and Dissemination of a Multimodal Dermoscopy Curriculum for Primary Care

2021 ◽  
Vol 8 ◽  
pp. 238212052198998
Author(s):  
Elizabeth Seiverling ◽  
Hadjh Ahrns ◽  
Kathryn Stevens ◽  
Lindsay Ayers ◽  
Tyler Nussinow ◽  
...  
Keyword(s):  
Primary Care ◽  
Learning Strategies ◽  
Cost Effective ◽  
Primary Care Providers ◽  
Skin Lesions ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Cross Sectional ◽  
Primary Care Residency ◽  
Workshop Intervention

Dermoscopy is a cost-effective tool for detection of skin cancers yet there is limited training available for primary care. The goal of this project was to develop, implement, and disseminate a multimodal curriculum for primary care across a health system based on a previously validated algorithm (Triage Amalgamated Dermoscopic Algorithm; TADA). This cross-sectional study analyzes the dermoscopy workshop intervention of a dermoscopy multimodal curriculum. Volunteers attended one 120-minute dermoscopy workshop on benign and malignant growths using a validated algorithm. Participants took a 30-image pre- and posttest. Survey questions on dermoscopy use, preferences for learning, and skin biopsy performance were included to enhance curriculum development. About 96 participants completed both pre- and postintervention tests. The mean preintervention score (out of 30) was 18.6 and increased to 24.4 on the postintervention evaluation. There was a statistically significant improvement in scores for both benign and malignant skin growths after the intervention ( P < .05). Short dermoscopy workshops have a positive intervention effect when training primary care providers to identify images of benign and malignant dermoscopic skin lesions. A multimodal dermoscopy curriculum allows learners to build on initial training using spaced review and blended learning strategies. The “Dermoscopic Lotus of Learning” has the potential to be a model for other primary care residency programs. A healthy partnership between dermatologists and primary care is essential.

scholarly journals ANALISIS EFEKTIVITAS BIAYA PENGGUNAAN ERITROPOETIN (HEMAPO® , EPOTREX®, NEORECORMON®) PADA PASIEN HEMODIALISIS DI RSUP PERSAHABATAN

2018 ◽  
Vol 18 (3) ◽  
Author(s):  
Chandra Widianti ◽  
Yusi Anggriani ◽  
Tri Kusumaeni ◽  
Okpri Meila
Keyword(s):  
Cost Effectiveness ◽  
Health Care Providers ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Care Providers ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Level Increase ◽  
Therapy Cost ◽  
Case Base

Abstrak. Penerapan INA-CBGs (Indonesia Case Base Groups) di era JKN mendorong penyedia layanan kesehatan, untuk menghitung biaya yang dikeluarkan agar tidak merugi. Pada pasien Gagal Ginjal Kronis (GGK) yang menjalani hemodialisis, prevalensi anemia cukup tinggi, sehingga diberikan eritropoetin (EPO). Dibutuhkan penelitian untuk mengetahui dari beberapa jenis EPO, mana yang lebih cost-effective. Penelitian deskriptif non-eksperimental dilakukan di Unit Hemodialisa Rumah Sakit Persahabatan. Efektivitas terapi ditentukan oleh peningkatan kadar hemoglobin (Hb) setelah 3 (tiga) bulan berturut-turut mendapatkan terapi EPO yang sama. Analisis efektivitas-biaya diperoleh dengan menghitung nilai CER (Cost-Effectiveness Ratio). Hasil menunjukkan penggunaan Neorecormon® memiliki efektivitas yang lebih tinggi dengan persentase jumlah pasien yang mengalami peningkatan Hb sebesar 56,41% dibandingkan Hemapo® (54%) dan Epotrex® (52,63%). Total biaya pengobatan rata-rata dengan Hemapo® , Epotrex® dan Neorecormon® masing-masing Rp. 32.552.117, Rp. 34.787.487 dan Rp. 32.866.969. Hasil perhitungan nilai CER dalam penggunaan Neorecormon® untuk pasien yang mengalami peningkatan Hb adalah Rp 58.264.437, lebih kecil daripada Hemapo® (Rp. 60.281.698) and Epotrex® (Rp. 66.098.208). Berdasarkan nilai CER dan tabel efektivitas-biaya, menunjukkan bahwa Neorecormon® adalah pilihan terapi yang lebih cost-effective daripada Hemapo® dan Epotrex®.Kata-kata kunci: Analisis efektivitas-biaya, hemodialisis, eritropoetinAbstract. INA-CBGs (Indonesia Case Base Groups) in JKN era, encourages health care providers to calculate costs incurred so as not to lose money. In Chronic Renal Failure (CRF) patients who undergo hemodialysis, anemia prevalence is high enough to require administration of erythropoietin (EPO). It’s necessary to investigate the therapeutic treatment from several types of EPO, which is more cost-effective. Descriptive non-experimental research conducted in the Hemodialysis Unit in Persahabatan Hospital. The effectiveness determined by an increased in hemoglobin (Hb) levels after three (3) months earned the same EPO therapy. Cost-effectiveness analysis is obtained by calculated the CER (Cost-Effectiveness Ratio). The results shows that Neorecormon® have a higher effectiveness with the percentage of patients whose Hb level increase by 56.41% comparing to Hemapo® (54%) and Neorecormon® (52.63%). The average total cost with Hemapo®, Epotrex® and Neorecormon® each successive Rp. 32.552.117, Rp. 34.787.487 and Rp. 32.866.969. The CER value of Neorecormon® show cost-effectiveness of Rp 58.264.437 for a patient with an increase in Hb, smaller than Hemapo® (Rp. 60.281.698) and Epotrex® (Rp. 66.098.208). Based on CER value and cost effectiveness grid, shows that Neorecormon® is the choice that is more cost-effective than Hemapo® and Epotrex®. Keywords : Cost effectiveness analysis, hemodialysis, erythropoetin

Cost-Effective Primary Care Providers: An Important Component of Health Care Reform

1994 ◽  
Vol 10 (2) ◽  
pp. 249-257 ◽  
Author(s):  
Patricia A. Prescott
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Reform ◽  
Cost Effective ◽  
Primary Care Providers ◽  
Advanced Practice ◽  
Care Providers ◽  
Important Resource

AbstractPlanning for a cost-effective mix of providers is an important aspect of health care reform. Currently, there are too many specialists and insufficient numbers of primary care providers. Nurses in advanced practice roles are an important resource for expanding the nation's supply of primary care providers.

scholarly journals COST-EFFECTIVENESS ANALYSIS OF COUNSELING IN THERAPY FOR OUTPATIENTS WITH HYPERTENSION

2018 ◽  
Vol 11 (13) ◽  
pp. 18
Author(s):  
Diah Ramadhani ◽  
Urip Harahap ◽  
Azizah Nasution
Keyword(s):  
Cost Effectiveness ◽  
Health Care Providers ◽  
Cost Effective ◽  
Care Providers ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Quasi Experimental ◽  
Group A ◽  
The Cost ◽  
The Impact

 Objectives: To determine the effect of counseling on effectiveness and cost of the treatment for outpatient with primary hypertension (HTN) in Cut Meutia Hospital, Indonesia.Methods: This 6-month prospective quasi-experimental study was undertaken to analyze the impact of counseling toward cost and effectiveness in the treatment in patients with primary HTN and evaluation of each month at Cut Meutia Hospital, Indonesia. The study sample consisted of 22 patients for each group. A cost analysis was conducted from the perspective of the health-care providers. The cost in the treatment of both groups was analyzed by calculating the cost-effectiveness ratio (CER) and incremental CER (ICER).Results: Most of the patients with HTN (54.55%) were males with ages ranging from 35 to 64 years old (77.27%). Patients who achieved a blood pressure <140/90 mmHg on HTN treatment: With counseling, 77.27%; without counseling, 18.18%. CER for HTN treatment with and without counseling were Rp 1,756,117,86 and Rp 6,704,247,91, respectively. The ICER was Rp 233,745.13.Conclusion: Treatment of HTN with counseling was more cost-effective than without counseling.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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