scholarly journals Evaluating the Impact of a Web-Based Risk Assessment System (CareSage) and Tailored Interventions on Health Care Utilization: Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Ramya Sita Palacholla ◽  
Nils C Fischer ◽  
Stephen Agboola ◽  
Mariana Nikolova-Simons ◽  
Sharon Odametey ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
High Risk ◽  
Controlled Trial ◽  
Study Groups ◽  
Emergency Department Visits ◽  
Assessment System ◽  
Care Utilization ◽  
Value Based Care ◽  
The Impact

BACKGROUND Soaring health care costs and a rapidly aging population, with multiple comorbidities, necessitates the development of innovative strategies to deliver high-quality, value-based care. OBJECTIVE The goal of this study is to evaluate the impact of a risk assessment system (CareSage) and targeted interventions on health care utilization. METHODS This is a two-arm randomized controlled trial recruiting 370 participants from a pool of high-risk patients receiving care at a home health agency. CareSage is a risk assessment system that utilizes both real-time data collected via a Personal Emergency Response Service and historical patient data collected from the electronic medical records. All patients will first be observed for 3 months (observation period) to allow the CareSage algorithm to calibrate based on patient data. During the next 6 months (intervention period), CareSage will use a predictive algorithm to classify patients in the intervention group as “high” or “low” risk for emergency transport every 30 days. All patients flagged as “high risk” by CareSage will receive nurse triage calls to assess their needs and personalized interventions including patient education, home visits, and tele-monitoring. The primary outcome is the number of 180-day emergency department visits. Secondary outcomes include the number of 90-day emergency department visits, total medical expenses, 180-day mortality rates, time to first readmission, total number of readmissions and avoidable readmissions, 30-, 90-, and 180-day readmission rates, as well as cost of intervention per patient. The two study groups will be compared using the Student t test (two-tailed) for normally distributed and Mann Whitney U test for skewed continuous variables, respectively. The chi-square test will be used for categorical variables. Time to event (readmission) and 180-day mortality between the two study groups will be compared by using the Kaplan-Meier survival plots and the log-rank test. Cox proportional hazard regression will be used to compute hazard ratio and compare outcomes between the two groups. RESULTS We are actively enrolling participants and the study is expected to be completed by end of 2018; results are expected to be published in early 2019. CONCLUSIONS Innovative solutions for identifying high-risk patients and personalizing interventions based on individual risk and needs may help facilitate the delivery of value-based care, improve long-term patient health outcomes and decrease health care costs. CLINICALTRIAL ClinicalTrials.gov NCT03126565; https://clinicaltrials.gov/ct2/show/NCT03126565 (Archived by WebCite at http://www.webcitation.org/6ymDuAwQA).

scholarly journals Multiple Sclerosis Wellness Shared Medical Appointment Model: A Pilot Study

2021 ◽  
Author(s):  
Justin R. Abbatemarco ◽  
Jeffrey A. Cohen ◽  
Belinda L. Udeh ◽  
Sunakshi Bassi ◽  
Mary R. Rensel
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Body Mass Index ◽  
Health Care Utilization ◽  
Body Mass ◽  
Private Insurance ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Patient Reported ◽  
The Impact

Abstract Background: Shared medical appointments (SMAs) are group medical visits combining medical care and patient education. We examined the impact of a wellness-focused pilot SMA in a large multiple sclerosis (MS) clinic. Methods: We reviewed data on all patients who participated in the SMA from January 2016 through June 2019. Data were collected 12 months pre/post SMA; included demographics, body mass index, patient-reported outcomes, and health care utilization; and were compared using Wilcoxon rank sum test. Results: Fifty adult patients (mean ± SD age, 50.1 ± 12.3 years) attended at least one MS wellness SMA. Most patients had private insurance (50%), and 26% had Medicaid coverage. The most common comorbidity was depression/anxiety (44%). Pre/post SMA outcomes showed a small but significant reduction in body mass index (30.2 ± 7.3 vs 28.8 ± 7.1, P = .03), and Patient Health Questionnaire-9 scores decreased from 7.3 ± 5.5 to 5.1 ± 5.6 (P = .001). The number of emergency department visits decreased from 13 to two (P = .0005), whereas follow-up visits increased with an attendees’ primary care provider from 19 to 41 (P < .001), physical therapist from 15 to 27 (P = .004), and psychologist from six to 19 (P = .003). Conclusions: This pilot MS wellness SMA was associated with improved physical and psychological outcomes. There was increased, lower-cost health care utilization with reduced acute, high-cost health care utilization, suggesting that SMAs may be a cost-effective and beneficial method in caring for patients with MS.

scholarly journals Practitioner Due Diligence: Real-World Lumacaftor/Ivacaftor Use

2020 ◽  
Vol 25 (5) ◽  
pp. 431-436
Author(s):  
Emily M. Stephan ◽  
Christopher J. Nemastil ◽  
Ann Salvator ◽  
Susan Gemma ◽  
Clarissa J. Dilaveris ◽  
...  
Keyword(s):  
Health Care ◽  
Body Mass Index ◽  
Cystic Fibrosis ◽  
Health Care Utilization ◽  
Body Mass ◽  
Real World ◽  
Forced Expiratory Volume ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
The Impact

OBJECTIVE Previous trials evaluated the efficacy of lumacaftor/ivacaftor in Phe508del homozygotes. These trials are limited by manufacturer sponsorship and were conducted under strict protocol. Additionally, this therapy is costly and does not allow for reduction in daily cystic fibrosis therapies. This study assessed the efficacy of lumacaftor/ivacaftor therapy and its effect on health care utilization in a real-world setting. METHODS Retrospective chart review comparing the first 12 months of therapy to the 24 months prior was conducted to evaluate the impact of lumacaftor/ivacaftor on pulmonary function following a streamlined process for therapy introduction. The impact on body mass index and healthcare utilization were also evaluated. The following measurements were assessed: percent predicted forced expiratory volume in 1 second, body mass index and z-scores, number of admissions, length of stay, number of emergency department visits. RESULTS Mean ppFEV1 was improved for the first 12 months on lumacaftor/ivacaftor treatment when compared with the 24 months prior: 78.8 (95% CI: 72.6, 84.9) vs 76.2 (95% CI: 70.1, 82.3) (p = 0.03). Body mass index significantly improved (patients ≥20 years), but improvement in BMI z-score (patients <20 years) was not significant. Number of admissions and LOS were significantly decreased, but ED visits were not. CONCLUSIONS Lumacaftor/ivacaftor is effective for improving ppFEV1 and BMI and for reducing health care utilization. However, this small reduction does not overcome the financial cost of treatment. Long-term outcomes and use must be studied to determine the overall effect of this therapy on cystic fibrosis interventions and their costs.

scholarly journals Effectiveness of Yoga Lifestyle on Lipid Metabolism in a Vulnerable Population—A Community Based Multicenter Randomized Controlled Trial

Medicines ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 37
Author(s):  
Raghuram Nagarathna ◽  
Saurabh Kumar ◽  
Akshay Anand ◽  
Ishwara N. Acharya ◽  
Amit Kumar Singh ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
High Risk ◽  
Controlled Trial ◽  
Density Lipoprotein ◽  
Lipid Profiles ◽  
Community Based ◽  
Randomized Controlled ◽  
Rural And Urban ◽  
Yoga Group ◽  
The Impact

Background: Dyslipidemia poses a high risk for cardiovascular disease and stroke in Type 2 diabetes (T2DM). There are no studies on the impact of a validated integrated yoga lifestyle protocol on lipid profiles in a high-risk diabetes population. Methods: Here, we report the results of lipid profile values of 11,254 (yoga 5932 and control 5322) adults (20–70 years) of both genders with high risk (≥60 on Indian diabetes risk score) for diabetes from a nationwide rural and urban community-based two group (yoga and conventional management) cluster randomized controlled trial. The yoga group practiced a validated integrated yoga lifestyle protocol (DYP) in nine day camps followed by daily one-hour practice. Biochemical profiling included glycated hemoglobin and lipid profiles before and after three months. Results: There was a significant difference between groups (p < 0.001 ANCOVA) with improved serum total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein in the yoga group compared to the control group. Further, the regulatory effect of yoga was noted with a significant decrease or increase in those with high or low values of lipids, respectively, with marginal or no change in those within the normal range. Conclusion: Yoga lifestyle improves and regulates (lowered if high, increased if low) the blood lipid levels in both genders of prediabetic and diabetic individuals in both rural and urban Indian communities.

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