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[PMID]:28747463
[Au] Autor:Man S; Schold JD; Uchino K
[Ad] Endereço:From the Clinical Neuroscience Institute, Miami Valley Hospital, Wright State University Boonshoft School of Medicine Dayton, OH (S.M.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (J.D.S.); and Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (K.U.).
[Ti] Título:Impact of Stroke Center Certification on Mortality After Ischemic Stroke: The Medicare Cohort From 2009 to 2013.
[So] Source:Stroke;48(9):2527-2533, 2017 09.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: An increasing number of hospitals have been certified as primary stroke centers (PSCs). It remains unknown whether the action toward PSC certification has improved the outcome of stroke care. This study aimed to understand whether PSC certification reduced stroke mortality. METHODS: We examined Medicare fee-for-service beneficiaries aged ≥65 years who were hospitalized between 2009 and 2013 for ischemic stroke. Hospitals were classified into 3 groups: new PSCs, the hospitals that received initial PSC certification between 2009 and 2013 (n=634); existing PSCs, the PSCs certified before 2009 (n=785); and non-SCs, the hospitals that have never been certified as PSCs (n=2640). Multivariate logistic regression and Cox proportional hazards model was used to compare the mortality among the 3 groups. RESULTS: Existing PSCs were significantly larger than new PSCs as reflected by total number of beds and annual stroke admission ( <0.0001). Compared with existing PSCs, new PSCs had lower in-hospital (odds ratio, 0.862; 95% confidence interval [CI], 0.817-0.910) and 30-day mortality (hazard ratio [HR], 0.981; 95% CI, 0.968-0.993), after adjusting for patient demographics and comorbidities. Compared with non-SCs, new PSCs had lower adjusted in-hospital (odds ratio, 0.894; 95% CI, 0.848-0.943), 30-day (HR, 0.904; 95% CI, 0.892-0.917), and 1-year mortality (HR, 0.907; 95% CI, 0.898-0.915). Existing PSCs had lower adjusted 30-day (HR, 0.922; 95% CI, 0.911-0.933) and 1-year mortality (HR, 0.900; 95% CI, 0.892-0.907) than non-SCs. CONCLUSIONS: Obtaining stroke certification may reduce stroke mortality and overcome the disadvantage of being smaller hospitals. Further study of other outcome measures will be useful to improve stroke system of care.
[Mh] Termos MeSH primário: Isquemia Encefálica/mortalidade
Certificação/estatística & dados numéricos
Hospitais/estatística & dados numéricos
Acidente Vascular Cerebral/mortalidade
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Planos de Pagamento por Serviço Prestado
Feminino
Seres Humanos
Joint Commission on Accreditation of Healthcare Organizations
Modelos Logísticos
Masculino
Medicare
Análise Multivariada
Prognóstico
Modelos de Riscos Proporcionais
Qualidade da Assistência à Saúde
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016473


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[PMID]:28468784
[Au] Autor:Kalbaugh CA; Kucharska-Newton A; Wruck L; Lund JL; Selvin E; Matsushita K; Bengtson LGS; Heiss G; Loehr L
[Ad] Endereço:Department of Surgery, School of Medicine, The University of North Carolina at Chapel Hill, NC corey_kalbaugh@med.unc.edu.
[Ti] Título:Peripheral Artery Disease Prevalence and Incidence Estimated From Both Outpatient and Inpatient Settings Among Medicare Fee-for-Service Beneficiaries in the Atherosclerosis Risk in Communities (ARIC) Study.
[So] Source:J Am Heart Assoc;6(5), 2017 May 03.
[Is] ISSN:2047-9980
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Outpatient ascertainment of peripheral artery disease (PAD) is rarely considered in the measurement of PAD clinical burden; therefore, the clinical burden of PAD likely has been underestimated while contributing to a decreased awareness of PAD in comparison to other circulatory system disorders. METHODS AND RESULTS: The purpose of this study was to estimate the age-standardized annual period prevalence and incidence of PAD in the outpatient and inpatient settings using data from the Atherosclerosis Risk in Communities (ARIC) study linked with Centers for Medicare and Medicaid Services claims. The majority (>70%) of all PAD encounters occurred in the outpatient setting. The weighted mean age-standardized prevalence and incidence of outpatient PAD was 11.8% (95% CI 11.5-12.1) and 22.4 per 1000 person-years (95% CI 20.8-24.0), respectively. Black patients had higher weighted mean age-standardized prevalence (15.6%; 95% CI 14.6-16.4) compared with white patients (11.4%; 95% CI 11.1-11.7). Black women had the highest weighted mean age-standardized prevalence (16.9%; 95% CI 16.0-17.8). Black patients also had a higher incidence rate of PAD (31.3 per 1000 person-years; 95% CI 27.3-35.4) compared with white patients (25.4 per 1000 person-years; 95% CI 23.5-27.3). PAD prevalence and incidence did not differ by sex alone. CONCLUSIONS: This study provides comprehensive estimates of PAD in the inpatient and outpatient settings where the majority of PAD burden was found. PAD is an important circulatory system disorder similar in prevalence to stroke and coronary heart disease.
[Mh] Termos MeSH primário: Assistência Ambulatorial
Planos de Pagamento por Serviço Prestado
Medicare
Admissão do Paciente
Doença Arterial Periférica/epidemiologia
[Mh] Termos MeSH secundário: Demandas Administrativas em Assistência à Saúde
Afroamericanos
Distribuição por Idade
Idoso
Assistência Ambulatorial/economia
Comorbidade
Grupo com Ancestrais do Continente Europeu
Planos de Pagamento por Serviço Prestado/economia
Feminino
Custos Hospitalares
Seres Humanos
Incidência
Masculino
Medicare/economia
Admissão do Paciente/economia
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/economia
Doença Arterial Periférica/etnologia
Prevalência
Fatores de Risco
Distribuição por Sexo
Fatores de Tempo
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:29209722
[Au] Autor:Blumenthal DM; Olenski AR; Tsugawa Y; Jena AB
[Ad] Endereço:Cardiology Division, Massachusetts General Hospital, Boston.
[Ti] Título:Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries.
[So] Source:JAMA;318(21):2119-2129, 2017 12 05.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. Objective: To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. Design, Setting, and Participants: A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. Exposures: Treatment by locum tenens general internal medicine physicians. Main Outcomes and Measures: The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. Results: Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154), significantly longer mean length of stay (5.64 days vs 5.21 days; adjusted difference, 0.43 days; 95% CI, 0.34 to 0.52), and significantly lower 30-day readmissions (22.80% vs 23.83%; adjusted difference, -1.00%; 95% CI -1.57% to -0.54%). Conclusions and Relevance: Among hospitalized Medicare beneficiaries treated by a general internist, there were no significant differences in overall 30-day mortality rates among patients treated by locum tenens compared with non-locum tenens physicians. Additional research may help determine hospital-level factors associated with the quality and costs of care related to locum tenens physicians.
[Mh] Termos MeSH primário: Serviços Contratados
Custos Hospitalares
Mortalidade Hospitalar
Hospitalização/economia
Hospitais/recursos humanos
Medicina Interna
Medicare
Qualidade da Assistência à Saúde
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Planos de Pagamento por Serviço Prestado
Feminino
Seres Humanos
Tempo de Internação
Modelos Logísticos
Masculino
Medicare/economia
Readmissão do Paciente
Admissão e Escalonamento de Pessoal
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.17925


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[PMID]:29241894
[Au] Autor:Adams AS; Madden JM; Zhang F; Lu CY; Ross-Degnan D; Lee A; Soumerai SB; Gilden D; Chawla N; Griggs JJ
[Ad] Endereço:Kaiser Permanente Division of Research, Oakland, CA, USA. Electronic address: Alyce.S.Adams@kp.org.
[Ti] Título:Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer.
[So] Source:Value Health;20(10):1345-1354, 2017 12.
[Is] ISSN:1524-4733
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer. METHODS: We leveraged a representative 5% national sample of all fee-for-service dual enrollees in the United States (2004-2007) to evaluate the impact of the removal of caps on the number of reimbursable prescriptions per month (drug caps) under Part D on 1) prevalence and 2) average days' supply dispensed for antidepressants, antihypertensives, and lipid-lowering agents overall and by race (white and black). RESULTS: The removal of drug caps was associated with increased use of lipid-lowering medications (days' supply 3.63; 95% confidence interval [CI] 1.57-5.70). Among blacks in capped states, we observed increased use of lipid-lowering therapy (any use 0.08 percentage points; 95% CI 0.05-0.10; and days' supply 4.01; 95% CI 2.92-5.09) and antidepressants (days' supply 2.20; 95% CI 0.61-3.78) and increasing trends in antihypertensive use (any use 0.01 percentage points; 95% CI 0.004-0.01; and days' supply 1.83; 95% CI 1.25-2.41). The white-black gap in the use of lipid-lowering medications was immediately reduced (-0.09 percentage points; 95% CI -0.15 to -0.04). We also observed a reversal in trends toward widening white-black differences in antihypertensive use (level -0.08 percentage points; 95% CI -0.12 to -0.05; and trend -0.01 percentage points; 95% CI -0.02 to -0.01) and antidepressant use (-0.004 percentage points; 95% CI -0.01 to -0.0004). CONCLUSIONS: Our findings suggest that the removal of drug caps under Part D had a modest impact on the treatment of hypercholesterolemia overall and may have reduced white-black gaps in the use of lipid-lowering and antidepressant therapies.
[Mh] Termos MeSH primário: Antidepressivos/administração & dosagem
Anti-Hipertensivos/administração & dosagem
Hipolipemiantes/administração & dosagem
Medicare Part D/economia
Neoplasias/tratamento farmacológico
[Mh] Termos MeSH secundário: Afroamericanos/estatística & dados numéricos
Idoso
Antidepressivos/economia
Anti-Hipertensivos/economia
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos
Planos de Pagamento por Serviço Prestado
Feminino
Acesso aos Serviços de Saúde
Seres Humanos
Hipercolesterolemia/tratamento farmacológico
Hipercolesterolemia/economia
Hipolipemiantes/economia
Masculino
Medicaid/economia
Meia-Idade
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
[Nm] Nome de substância:
0 (Antidepressive Agents); 0 (Antihypertensive Agents); 0 (Hypolipidemic Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:29176369
[Au] Autor:Tsai Y
[Ad] Endereço:National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
[Ti] Título:Payments and Utilization of Immunization Services Among Children Enrolled in Fee-for-Service Medicaid.
[So] Source:Med Care;56(1):54-61, 2018 Jan.
[Is] ISSN:1537-1948
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To examine the association between state Medicaid vaccine administration fees and children's receipt of immunization services. METHODS: The study used the 2008-2012 Medicaid Analytic eXtract data and included children aged 0-17 years and continuously enrolled in a Medicaid fee-for-service plan in each study year. Analyses were restricted to 8 states with a Medicaid managed-care penetration rate <75%. Linear regressions were used to estimate the probability of children making ≥1 vaccination visit and the numbers of vaccination visits in the year as a function of state Medicaid vaccine administration fees, age group, sex, race/ethnicity, state unemployment rate, state managed-care penetration rate, and state and year-fixed effects. RESULTS: A total of 1,678,288 children were included. In 2008-2012, the average proportion of children making ≥1 vaccination visit per year was 31% and the mean number of vaccination visits was 0.9. State Medicaid reimbursements for vaccine administration was positively associated with immunization service utilization; for every $1 increase in the payment amount, the probability of children making ≥1 vaccination visit increased by 0.72 percentage point (95% confidence interval, 0.23-1.21; P=0.01), representing a 2% increase from the mean and the number of vaccination visits increased by 0.03 (95% confidence interval, -0.00 to 0.06; P<0.1). The estimated effect was greater among younger children. CONCLUSION: Higher Medicaid reimbursements for vaccine administration were associated with increased proportion of children receiving immunization services.
[Mh] Termos MeSH primário: Planos de Pagamento por Serviço Prestado/economia
Gastos em Saúde/estatística & dados numéricos
Imunização/economia
Imunização/utilização
Medicaid/economia
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Recém-Nascido
Modelos Lineares
Masculino
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1097/MLR.0000000000000844


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[PMID]:29274632
[Au] Autor:Centers for Medicare & Medicaid Services (CMS), HHS.
[Ti] Título:Medicare Program; Medicare Shared Savings Program: Extreme and Uncontrollable Circumstances Policies for Performance Year 2017. Interim final rule with comment period.
[So] Source:Fed Regist;82(246):60912-9, 2017 Dec 26.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This interim final rule with comment period establishes policies for assessing the financial and quality performance of Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs) affected by extreme and uncontrollable circumstances during performance year 2017, including the applicable quality reporting period for the performance year. Under the Shared Savings Program, providers of services and suppliers that participate in ACOs continue to receive traditional Medicare fee-for-service (FFS) payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. ACOs in performance-based risk agreements may also share in losses. This interim final rule with comment period establishes extreme and uncontrollable circumstances policies for the Shared Savings Program that will apply to ACOs subject to extreme and uncontrollable events, such as Hurricanes Harvey, Irma, and Maria, and the California wildfires, effective for performance year 2017, including the applicable quality data reporting period for the performance year.
[Mh] Termos MeSH primário: Redução de Custos/economia
Redução de Custos/legislação & jurisprudência
Medicare/economia
Medicare/legislação & jurisprudência
[Mh] Termos MeSH secundário: Organizações de Assistência Responsáveis/economia
Organizações de Assistência Responsáveis/legislação & jurisprudência
Planos de Pagamento por Serviço Prestado/economia
Planos de Pagamento por Serviço Prestado/legislação & jurisprudência
Seres Humanos
Qualidade da Assistência à Saúde/economia
Qualidade da Assistência à Saúde/legislação & jurisprudência
Reembolso de Incentivo/economia
Reembolso de Incentivo/legislação & jurisprudência
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171225
[St] Status:MEDLINE


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[PMID]:29235785
[Au] Autor:Patel YM; Guterman S
[Ti] Título:The Evolution of Private Plans in Medicare.
[So] Source:Issue Brief (Commonw Fund);2017:1-10, 2017 Dec 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: Since the 1980s, private plans have played an increasingly important role in the Medicare program. While initially created with the goals of reducing costs, improving choice, and enhancing quality, risk-based plans--now known as Medicare Advantage plans--have undergone significant policy changes since their inception; these changes have not always aligned with the original policy objectives. Goal: To examine major policy changes to Medicare risk plans and the effects of these policies on plan participation, enrollment, average premiums and cost-sharing, total costs to Medicare, and quality of care. Methods: Review of key policy documents, reports, position statements, and academic studies. Findings and Conclusions: Private plans have changed considerably since their introduction into Medicare. Enrollment has risen to 33 percent of all Medicare beneficiaries; 99 percent of beneficiaries have access to private plans in 2017. Recent policies have improved risk-adjustment methods, rewarded plans' performance on quality of care, and reduced average payments to private plans to 100 percent of traditional Medicare spending. As enrollment in private plans continues to grow and as health care costs rise, policymakers should enhance incentives for private plans to meet intended goals for higher-quality care at lower cost.
[Mh] Termos MeSH primário: Medicare Part C/estatística & dados numéricos
Medicare/estatística & dados numéricos
Setor Privado/estatística & dados numéricos
[Mh] Termos MeSH secundário: Custo Compartilhado de Seguro
Planos de Pagamento por Serviço Prestado/economia
Planos de Pagamento por Serviço Prestado/tendências
Previsões
Sistemas Pré-Pagos de Saúde
Seres Humanos
Medicare/tendências
Medicare Part C/tendências
Qualidade da Assistência à Saúde
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29224686
[Au] Autor:Windsor MA; Sun SJJ; Frick KD; Swanson EA; Rosenfeld PJ; Huang D
[Ad] Endereço:Association for Research in Vision and Ophthalmology, Rockville, Maryland.
[Ti] Título:Estimating Public and Patient Savings From Basic Research-A Study of Optical Coherence Tomography in Managing Antiangiogenic Therapy.
[So] Source:Am J Ophthalmol;185:115-122, 2018 Jan.
[Is] ISSN:1879-1891
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To compare patient and Medicare savings from the use of optical coherence tomography (OCT) in guiding therapy for neovascular age-related macular degeneration (nvAMD) to the research investments made in developing OCT by the National Institutes of Health (NIH) and the National Science Foundation (NSF). DESIGN: Observational cohort study. METHODS: Main outcome measures were spending by Medicare as tracked by Current Procedural Terminology codes on intravitreal injections (67028), retinal OCT imaging (92134), and anti-vascular endothelial growth factor (anti-VEGF) treatment-specific J-codes (J0178, J2778, J9035, J3490, and J3590). These claims were identified from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services among fee-for-service (FFS) Medicare beneficiaries from 2012 to 2015; 2008 claims were acquired from the 100% FFS Part B Medicare Claims File. OCT research costs were determined by searching for grants awarded by NIH and NSF from inception to 2015. All costs and savings were discounted by 3% annually and adjusted for inflation to 2015 dollars. RESULTS: From 2008 to 2015, the United States government and nvAMD patients have accrued an estimated savings of $9.0 billion and $2.2 billion, respectively, from the use of OCT to guide personalized anti-VEGF treatment. The $9.0 billion represents a 21-fold return on government investment into developing the technology through NIH and NSF grants. CONCLUSIONS: Although an overall cost-benefit ratio of government-sponsored research is difficult to estimate because the benefit may be diffuse and delayed, the investment in OCT over 2 decades has been recouped many times over in just a few years through better personalized therapy.
[Mh] Termos MeSH primário: Inibidores da Angiogênese/administração & dosagem
Saúde Pública
Tomografia de Coerência Óptica/métodos
Degeneração Macular Exsudativa/tratamento farmacológico
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Planos de Pagamento por Serviço Prestado
Feminino
Seres Humanos
Injeções Intravítreas
Masculino
Medicare Part B
Estados Unidos
Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
Degeneração Macular Exsudativa/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Angiogenesis Inhibitors); 0 (Vascular Endothelial Growth Factor A)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE


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[PMID]:27776908
[Au] Autor:Weeks WB; Schoellkopf WJ; Sorensen LS; Masica AL; Nesse RE; Weinstein JN
[Ad] Endereço:The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire.
[Ti] Título:The High Value Healthcare Collaborative: Observational Analyses of Care Episodes for Hip and Knee Arthroplasty Surgery.
[So] Source:J Arthroplasty;32(3):702-708, 2017 03.
[Is] ISSN:1532-8406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Broader use of value-based reimbursement models will require providers to transparently demonstrate health care value. We sought to determine and report cost and quality data for episodes of hip and knee arthroplasty surgery among 13 members of the High Value Healthcare Collaborative (HVHC), a consortium of health care systems interested in improving health care value. METHODS: We conducted a retrospective, cross-sectional observational cohort study of 30-day episodes of care for hip and knee arthroplasty in fee-for-service Medicare beneficiaries aged 65 or older who had hip or knee osteoarthritis and used 1 of 13 HVHC member systems for uncomplicated primary hip arthroplasty (N = 8853) or knee arthroplasty (N = 16,434), respectively, in 2012 or 2013. At the system level, we calculated: per-capita utilization rates; postoperative complication rates; standardized total, acute, and postacute care Medicare expenditures for 30-day episodes of care; and the modeled impact of reducing episode expenditures or per-capita utilization rates. RESULTS: Adjusted per-capita utilization rates varied across HVHC systems and postacute care reimbursements varied more than 3-fold for both types of arthroplasty in both years. Regression analysis confirmed that total episode and postacute care reimbursements significantly differed across HVHC members after considering patient demographic differences. Potential Medicare cost savings were greatest for knee arthroplasty surgery and when lower total reimbursement targets were achieved. CONCLUSION: The substantial variation that we found offers opportunities for learning and collaboration to collectively improve outcomes, reduce costs, and enhance value. Ceteris paribus, reducing per-episode reimbursements would achieve greater Medicare cost savings than reducing per-capita rates.
[Mh] Termos MeSH primário: Artroplastia de Quadril/economia
Artroplastia do Joelho/economia
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Artroplastia de Quadril/utilização
Artroplastia do Joelho/utilização
Redução de Custos
Estudos Transversais
Assistência à Saúde
Cuidado Periódico
Planos de Pagamento por Serviço Prestado
Feminino
Gastos em Saúde
Seres Humanos
Tempo de Internação
Masculino
Medicare/economia
Meia-Idade
Osteoartrite do Joelho
Análise de Regressão
Estudos Retrospectivos
Cuidados Semi-Intensivos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29176368
[Au] Autor:Koroukian SM; Basu J; Schiltz NK; Navale S; Bakaki PM; Warner DF; Dor A; Given CW; Stange KC
[Ad] Endereço:Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University.
[Ti] Título:Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992-2011.
[So] Source:Med Care;56(1):39-46, 2018 Jan.
[Is] ISSN:1537-1948
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results. OBJECTIVE: To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time. DESIGN: Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and health outcomes between MCEs and FFSBs across 3 time periods: 1992-1998, 1999-2004, and 2005-2011. We used multivariable analysis, stratified by, and pooled across the study periods. The unit of analysis was the person-wave (n=167,204). SUBJECTS: HRS participants who were also enrolled in Medicare. MEASURES: Outcome measures included self-reported fair/poor health, 2-year self-rated worse health, and 2-year mortality. Our main covariate was a composite measure of multimorbidity (MM), MM0-MM3, defined as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. RESULTS: The case-mix differential between MCEs and FFSBs persisted over time. Results from multivariable models on the pooled data and incorporating interaction terms between managed care status and study period indicated that MCEs and FFSBs were as likely to die within 2 years from the HRS interview (P=0.073). This likelihood remained unchanged across the study periods. However, MCEs were more likely than FFSBs to report fair/poor health in the third study period (change in probability for the interaction term: 0.024, P=0.008), but less likely to rate their health worse in the last 2 years, albeit at borderline significance (change in probability: -0.021, P=0.059). CONCLUSIONS: Despite the persistence of selection bias, the differential in self-reported fair/poor status between MCEs and FFSBs seems to be closing over time.
[Mh] Termos MeSH primário: Planos de Pagamento por Serviço Prestado/estatística & dados numéricos
Benefícios do Seguro/estatística & dados numéricos
Programas de Assistência Gerenciada/estatística & dados numéricos
Medicare/estatística & dados numéricos
Avaliação de Resultados da Assistência ao Paciente
[Mh] Termos MeSH secundário: Idoso
Autoavaliação Diagnóstica
Feminino
Seres Humanos
Masculino
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1097/MLR.0000000000000847



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