scholarly journals Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253919
Author(s):  
Michaela Olm ◽  
Ewan Donnachie ◽  
Martin Tauscher ◽  
Roman Gerlach ◽  
Klaus Linde ◽  
...  
Keyword(s):  
Cost Estimation ◽  
Cohort Analysis ◽  
Substantial Reduction ◽  
Routine Data ◽  
Ambulatory Setting ◽  
Coordination Of Care ◽  
Coordinated Care ◽  
Multinomial Regression ◽  
Before And After ◽  
Longitudinal Regression

To strengthen the coordinating function of general practitioners (GPs) in the German healthcare system, a copayment of €10 was introduced in 2004. Due to a perceived lack of efficacy and a high administrative burden, it was abolished in 2012. The present cohort study investigates characteristics and differences of GP-coordinated and uncoordinated patients in Bavaria, Germany, concerning morbidity and ambulatory specialist costs and whether these differences have changed after the abolition of the copayment. We performed a retrospective routine data analysis, using claims data of the Bavarian Association of the Statutory Health Insurance Physicians during the period 2011–2012 (with copayment) and 2013–2016 (without copayment), covering 24 quarters. Coordinated care was defined as specialist contact only with referral. Multinomial regression modelling, including inverse probability of treatment weighting, was used for the cohort analysis of 500 000 randomly selected patients. Longitudinal regression models were calculated for cost estimation. Coordination of care decreased substantially after the abolition of the copayment, accompanied by increasing proportions of patients with chronic and mental diseases in the uncoordinated group, and a corresponding decrease in the coordinated group. In the presence of the copayment, uncoordinated patients had €21.78 higher specialist costs than coordinated patients, increasing to €24.94 after its abolition. The results indicate that patients incur higher healthcare costs for specialist ambulatory care when their care is uncoordinated. This effect slightly increased after abolition of the copayment. Beyond that, the abolition of the copayment led to a substantial reduction in primary care coordination, particularly affecting vulnerable patients. Therefore, coordination of care in the ambulatory setting should be strengthened.

scholarly journals Impact of the abolition of copayments on the GP-centred coordination of care in Bavaria, Germany: analysis of routinely collected claims data

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e035575
Author(s):  
Michaela Olm ◽  
Ewan Donnachie ◽  
Martin Tauscher ◽  
Roman Gerlach ◽  
Klaus Linde ◽  
...  
Keyword(s):  
Routine Data ◽  
Secondary Outcome ◽  
Coordination Of Care ◽  
Coordinated Care ◽  
Specialist Care ◽  
Doctor Shopping ◽  
Specialist Services ◽  
Number Of Patients ◽  
Time Series Analyses ◽  
Insured Patients

ObjectivesIn 2012, Germany abolished copayment for consultations in ambulatory care. This study investigated the effect of the abolition on general practitioner (GP)-centred coordination of care. We assessed how the proportion of patients with coordinated specialist care changed over time when copayment to all specialist services were removed. Furthermore, we studied how the number of ambulatory emergency cases and apparent ‘doctor shopping’ changed after the abolition.DesignA retrospective routine data analysis of the Bavarian Association of Statutory Health Insurance Physicians, comparing the years 2011 and 2012 (with copayment), with the period from 2013 to 2016 (without copayment). Therefore, time series analyses covering 24 quarters were performed.SettingPrimary care in Bavaria, Germany.ParticipantsAll statutorily insured patients in Bavaria, aged ≥18 years, with at least one ambulatory specialist contact between 2011 and 2016.Primary and secondary outcome measuresPrimary outcome was the percentage of patients with GP-coordinated care (every regular specialist consultation within a quarter was preceded by a GP referral). Secondary outcomes were the number of ambulatory emergency cases and apparent ‘doctor shopping’.ResultsAfter the abolition, the proportion of coordinated patients decreased from 49.6% (2011) to 15.5% (2016). Overall, younger patients and those living in areas with lower levels of deprivation showed the lowest proportions of coordination, which further decreased after abolition. Additionally, there were concomitant increases in the number of ambulatory emergency contacts and to a lesser extent in the number of patients with apparent ‘doctor shopping’.ConclusionsThe abolition of copayment in Germany was associated with a substantial decrease in GP coordination of specialist care. This suggests that the copayment was a partly effective tool to support coordinated care. Future studies are required to investigate how the gatekeeping function of GPs in Germany can best be strengthened while minimising the associated administrative overhead.

The effects of critical care outreach services before and after critical care: A matched-cohort analysis

2010 ◽  
Vol 25 (2) ◽  
pp. 196-204 ◽  
Author(s):  
David A. Harrison ◽  
Haiyan Gao ◽  
Catherine A. Welch ◽  
Kathryn M. Rowan
Keyword(s):  
Critical Care ◽  
Cohort Analysis ◽  
Matched Cohort ◽  
Outreach Services ◽  
Before And After ◽  
Critical Care Outreach

Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

2021 ◽  
pp. 1-9
Author(s):  
Aakriti R. Carrubba ◽  
Amy E. Glasgow ◽  
Elizabeth B. Habermann ◽  
Amanda P. Stanton ◽  
Megan N. Wasson ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Cohort Analysis ◽  
Oral Morphine ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Before And After ◽  
Legislative Changes

<b><i>Objectives:</i></b> This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. <b><i>Design:</i></b> This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. <b><i>Methods:</i></b> Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum <i>t</i> tests for OMEs and χ<sup>2</sup> <i>t</i> tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). <b><i>Results:</i></b> In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate remained unchanged at 7.4% (<i>p</i> = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; <i>p</i> = 0.739). <b><i>Limitations:</i></b> Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. <b><i>Conclusions:</i></b> Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert

2021 ◽  
pp. emermed-2020-210331
Author(s):  
James S Ford ◽  
Tasleem Chechi ◽  
Michella Otmar ◽  
Melissa Baker ◽  
Sarah Waldman ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Underserved Populations ◽  
Cohort Analysis ◽  
Treponema Pallidum ◽  
Interrupted Time Series ◽  
Health Record ◽  
Interrupted Time Series Analysis ◽  
Syphilis Testing ◽  
Before And After ◽  
Electronic Health

BackgroundThe prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation.MethodsWe implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January–November 2018) and the postimplementation period (January–November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time.ResultsFour-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001).ConclusionsOur study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing.

Abstract 15666: Effectiveness of Sharpsense™ Algorithms in Reducing Pause and Bradycardia Detection: Real-world Performance Before and After the Software Upgrade in Confirm Rx™ Insertable Cardiac Monitor

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rakesh Gopinathannair ◽  
Dhanunjaya Lakkireddy ◽  
Christopher Piorkowski ◽  
Muhammad Afzal ◽  
Ghulam Murtaza ◽  
...  
Keyword(s):  
Real World ◽  
False Positive ◽  
False Positive Rate ◽  
Substantial Reduction ◽  
Cryptogenic Stroke ◽  
Cardiac Monitor ◽  
Before And After ◽  
Positive Rate ◽  
Software Upgrade ◽  
Insertable Cardiac Monitor

Background: Recent enhancements have been introduced to the Abbott Confirm Rx™ insertable cardiac monitor (ICM) arrhythmia detection algorithms (SharpSense™). This study aims to characterize the real-world performance of SharpSense™ algorithms, in the upgraded ICM devices by comparing device detected pause and bradycardia (brady) episodes before and after the SharpSense™ upgrade. Methods: Confirm Rx™ devices with at least 90 days monitoring each before and after SharpSense™ upgrade were included in the study. Brady and pause episodes were extracted from Merlin.net™ patient care network for evaluation and adjudicated by expert adjudicators. Results: A total of 197 devices were included in the analysis. Devices were implanted for syncope (35%), AF management (33%), and other indications, including cryptogenic stroke and palpitations (32%). The SharpSense™ upgrade significantly reduced the total number of detected episodes by 92% (pause: 93%, brady: 87%) and the rate of transmitted episodes by 73.6% from 50.3 to 13.3 (pause: 34.9 to 6.0, brady: 7.8 to 1.5) episodes per patient-week (p < 0.001). SharpSense™ reduced false positive episodes by 82.8% and 91.5% for pause and brady, respectively. The percentage of devices with at least one false positive episode was reduced from 52% to 35% for pause and from 39% for 20% for brady. The number of devices with false positive rate greater than 1 episode per week was reduced from 39% to 20% for pause and from 23% to 8% for brady. Conclusion: SharpSense™ upgrade resulted in substantial reduction of pause and bradycardia episode detections, false positive detections, and frequency of transmitted episodes for clinic review.

The Affordable Care Act and emergency department use by low acuity patients in a US hospital

2020 ◽  
pp. 095148482094359
Author(s):  
Daniel Keyes ◽  
Hisham Valiuddin ◽  
Hassan Mouzaihem ◽  
Patrick Stone ◽  
Jaqueline Vidosh
Keyword(s):  
Emergency Department ◽  
Affordable Care Act ◽  
Cohort Analysis ◽  
Severity Index ◽  
Chi Square ◽  
Before And After ◽  
Primary Care Patients ◽  
Ed Visits ◽  
The Affordable Care Act ◽  
Status Data

Background The Affordable Care Act (ACA) is one of the biggest healthcare reforms in US history. A key issue is the ACAs effect on low acuity, potentially primary care patients. This study evaluates the effect of the ACA on low acuity patients seen in the emergency department (ED). Methods This is an age-period-cohort analysis for a community hospital ED in Michigan, from 2009 to 2015. Patients were stratified by age, year seen, emergency severity index (ESI) and insurance status. Data were compared between before and after ACA along with descriptive statistics, Chi-square and Student t-tests. The primary outcome was the change in ED usage by low acuity. Patients > 65 were used as a temporal control. Results 305,350 ED visits were analyzed. ED visits with ESI 4/5 increased from 11.9% to 14.8%. Patients < 19 years increased from 25.5% to 34.3% (p = .0026). Ages 19–25 increased from 16.3% to 19.7% (p = 0.0515). Ages 26–64 increased from 11% to 14.9% (p = 0.0129). Ages > 65 increased from 5.1% to 6.5%. Patients < 65 showed a decreased uninsured rate from 12.30% to 6.28% (p < 0.0001). Comparatively, for age > 65: uninsured rate remained the same 0.46% to 0.49%. Conclusion Low acuity ED visits increased with the ACA reform in conjunction with a more insured population.

scholarly journals Evaluation of a national lung cancer symptom awareness campaign in Wales

2019 ◽  
Vol 122 (4) ◽  
pp. 491-497 ◽  
Author(s):  
Grace McCutchan ◽  
Stephanie Smits ◽  
Lucy Ironmonger ◽  
Ciarán Slyne ◽  
Amanda Boughey ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Routine Data ◽  
X Rays ◽  
Before And After ◽  
Symptom Awareness ◽  
Gp Visits ◽  
Symptom Recall ◽  
The Impact

Abstract Background Lung cancer is the leading cause of cancer mortality in Wales. We conducted a before- and after- study to evaluate the impact of a four-week mass-media campaign on awareness, presentation behaviour and lung cancer outcomes. Methods Population-representative samples were surveyed for cough symptom recall/recognition and worry about wasting doctors’ time pre-campaign (June 2016; n = 1001) and post-campaign (September 2016; n = 1013). GP cough symptom visits, urgent suspected cancer (USC) referrals, GP-ordered radiology, new lung cancer diagnoses and stage at diagnosis were compared using routine data during the campaign (July–August 2016) and corresponding control (July–August 2015) periods. Results Increased cough symptom recall (p < 0.001), recognition (p < 0.001) and decreased worry (p < 0.001) were observed. GP visits for cough increased by 29% in the target 50+ age-group during the campaign (p < 0.001) and GP-ordered chest X-rays increased by 23% (p < 0.001). There was no statistically significant change in USC referrals (p = 0.82), new (p = 0.70) or early stage (p = 0.27) diagnoses, or in routes to diagnosis. Conclusions Symptom awareness, presentation and GP-ordered chest X-rays increased during the campaign but did not translate into increased USC referrals or clinical outcomes changes. Short campaign duration and follow-up, and the small number of new lung cancer cases observed may have hampered detection effects.

scholarly journals Preparation and Characterization of Composites Materials with Rubber Matrix and with Polyvinyl Chloride Addition (PVC)

Polymers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 1978
Author(s):  
Dan Dobrotă ◽  
Valentin Petrescu ◽  
Cristinel Sabin Dimulescu ◽  
Mihaela Oleksik
Keyword(s):  
Substantial Reduction ◽  
Accelerated Aging ◽  
Mechanical Tests ◽  
Point Of View ◽  
Rubber Matrix ◽  
The Finite Element Method ◽  
Composites Materials ◽  
Before And After ◽  
Conveyor Belts

An important problem that arises at present refers to the increase in performances in the exploitation of the conveyor belts. Additionally, it is pursued to use some materials, which can be obtained by recycling rubber and PVC waste, in their structure. Thus, the research aimed at creating conveyor belts using materials obtained from the recycling of rubber and PVC waste. Under these conditions, conveyor belts were made that had in their structure two types of rubber and PVC, which was obtained by adding in certain proportions of reclaimed rubber and powder obtained from grinding rubber waste. In order to study the effect of adding PVC on properties, four types of conveyor belts were made, with the structure of rubber, PVC and textile reinforcement. These have been subjected to certain mechanical tests, also being analyzed from the point of view of the behavior of the accelerated aging. The results obtained showed that the addition of PVC lead to a decrease in tensile stress for the strips made, but also an increase in the tensile strain. Additionally, the elasticity tests performed before and after the accelerated aging showed that the presence of PVC in the structure of the conveyor belts determined a substantial reduction of the aging process of the rubber in the conveyor belts. Under these conditions, it has been established that the use of PVC in the structure of rubber matrix conveyor belts is beneficial if conveyor belts are to be produced that are less subject to mechanical stress, but that work in conditions that can cause accelerated aging of materials. An analysis with the finite element method (FEM) of the test samples was also performed.

scholarly journals Reducing Medication Therapy Problems in the Transition from Hospital to Home: A Pre- & Post-Discharge Pharmacist Collaboration

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 86 ◽  
Author(s):  
Anne Schullo-Feulner ◽  
Lisa Krohn ◽  
Alison Knutson
Keyword(s):  
Medication Management ◽  
Transition Process ◽  
Ambulatory Setting ◽  
Inpatient Setting ◽  
Post Discharge ◽  
Readmission Rates ◽  
Severity Rating ◽  
Medication Therapy ◽  
Before And After ◽  
Hospital To Home

Background: With 30-day Medicare readmission rates reaching 20%, a heightened focus has been placed on improving the transition process from hospital to home. For many institutions, this charge has identified medication-use safety as an area where pharmacists are well-positioned to improve outcomes by reducing medication therapy problems (MTPs). Methods: This system-wide (425 bed community hospital plus 18 primary care clinics) prospective study recruited inpatient and ambulatory pharmacists to provide comprehensive medication management before and after hospital discharge. The results analyzed were the success rate and timing of the inpatient to ambulatory pharmacist handoff, as well as the number, type, and severity of MTPs resolved in both settings. Results: Of the 105 eligible patients who received a pharmacist evaluation before discharge, 61 (58%) received follow-up with an ambulatory pharmacist an average of 2.88 days after discharge (range 1–8 days). An average of 5 and 1.4 MTPs per patient were identified and resolved in the inpatient vs. ambulatory setting, respectively. Although average MTP severity ratings were higher in the inpatient setting, the highest severity rating was seen most frequently in the ambulatory setting. Conclusions: In the transition from hospital to home, pharmacist evaluation in both the inpatient and ambulatory settings are necessary to resolve medication therapy problems.

scholarly journals Evaluating the dissemination and scale-up of two evidence-based parenting interventions to reduce violence against children: study protocol

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Yulia Shenderovich ◽  
Catherine L. Ward ◽  
Jamie M. Lachman ◽  
Inge Wessels ◽  
Hlengiwe Sacolo-Gwebu ◽  
...  
Keyword(s):  
Parenting Practices ◽  
Contextual Information ◽  
Scale Up ◽  
Evaluation Research ◽  
Secondary Data ◽  
Routine Data ◽  
Parenting Programs ◽  
Primary Data ◽  
Violence Against Children ◽  
Before And After

Abstract Background Eliminating violence against children is a prominent policy goal, codified in the Sustainable Development Goals, and parenting programs are one approach to preventing and reducing violence. However, we know relatively little about dissemination and scale-up of parenting programs, particularly in low- and middle-income countries (LMICs). The scale-up of two parenting programs, Parenting for Lifelong Health (PLH) for Young Children and PLH for Parents and Teens, developed under Creative Commons licensing and tested in randomized trials, provides a unique opportunity to study their dissemination in 25 LMICs. Methods The Scale-Up of Parenting Evaluation Research (SUPER) study uses a range of methods to study the dissemination of these two programs. The study will examine (1) process and extent of dissemination and scale-up, (2) how the programs are implemented and factors associated with variation in implementation, (3) violence against children and family outcomes before and after program implementation, (4) barriers and facilitators to sustained program delivery, and (5) costs and resources needed for implementation. Primary data collection, focused on three case study projects, will include interviews and focus groups with program facilitators, coordinators, funders, and other stakeholders, and a summary of key organizational characteristics. Program reports and budgets will be reviewed as part of relevant contextual information. Secondary data analysis of routine data collected within ongoing implementation and existing research studies will explore family enrolment and attendance, as well as family reports of parenting practices, violence against children, child behavior, and child and caregiver wellbeing before and after program participation. We will also examine data on staff sociodemographic and professional background, and their competent adherence to the program, collected as part of staff training and certification. Discussion This project will be the first study of its kind to draw on multiple data sources and methods to examine the dissemination and scale-up of a parenting program across multiple LMIC contexts. While this study reports on the implementation of two specific parenting programs, we anticipate that our findings will be of relevance across the field of parenting, as well as other violence prevention and social programs.

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