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The Duration of Office Visits in the United States, 1993 to 2010Nationally representative data show that outpatient office visits to both primary care physicians and specialists grew longer over the period from 1993 to 2010.
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Three Proposals to Reform the 340B Drug Discount ProgramThe 340B Drug Discount Program has rapidly expanded over the last few years and may be missing its original intent. Here are 3 possible steps that could enhance the program’s function and mirror Congress’ original intent to enhance access for the poor to essential medical services.
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Cost Sharing, Adherence, and Health Outcomes in Patients With DiabetesHigher cost-sharing levels reduced adherence to antidiabetic medications in patients with type 2 diabetes.
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Electronic Consults for Improving Specialty Care Access for VeteransThe combination of electronic consultations and active triage of specialty care consults effectively reduces wait times for outpatient clinics.
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Are Benefits From Diabetes Self-Management Education Sustained?Conventional individualized diabetes self-management education resulted in sustained improvement in self-efficacy and diabetes distress. Short-term improvements in A1C, nutrition, and physical activity were not sustained.
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Cost-Effectiveness of Laparoscopic Gastric Banding and Bypass for Morbid ObesityLaparoscopic adjustable gastric banding and gastric bypass are cost-effective treatments for morbid obesity compared with no treatment.
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Standardization Improves Postoperative Patient Handoff Experience for Junior CliniciansStandardization of operating room to intensive care handoff with a “time-out for sign-out” process for health care providers was beneficial for junior clinicians.
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Healthcare Utilization and Costs in Persons With Insomnia in a Managed Care PopulationPatients with an insomnia diagnosis have higher healthcare utilization and costs than a matched control group, both before and after the diagnosis.
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A Systematic Review of Measurement Properties of Instruments Assessing PresenteeismA systematic review of presenteeism instruments found that most have been validated to some extent, but evidence for criterion validity is virtually absent.
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Depression Care Following Psychiatric Hospitalization in the Veterans Health AdministrationDifferent patient characteristics predict adequate antidepressant treatment after hospitalization, received by 58.7% of patients, versus adequate psychotherapy, received by 12.9% of patients.
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Oral Antidiabetic Medication Adherence and Glycemic Control in Managed CareIn this retrospective study of patients with diabetes, adherent patients were more likely to achieve glycemic control than nonadherent patients.
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Impact of Weekly Feedback on Test Ordering PatternsProviding a weekly feedback report significantly influences the test ordering behavior of internal medicine residents and reduces laboratory overutilization.
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Costs and Spillover Effects of Private Insurers' Coverage of Hepatitis C TreatmentExpanding private-payer coverage of hepatitis C treatment may yield significant long-term cost savings for private payers, reduced costs to Medicare, and increased social value.
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Ambulatory Care–Sensitive Emergency Visits Among Patients With Medical Home AccessPatients often self-refer to the emergency department (ED) for management of an ambulatory care–sensitive condition, and the ED may be the most appropriate care location.
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Toyota Production System Quality Improvement Initiative Improves Perioperative Antibiotic TherapyUse of Toyota production system methods as part of a nosocomial MRSA prevention initiative on a surgical unit improved quality of care in other areas.
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Impact of Primary and Specialty Care Integration via Asynchronous CommunicationGeisinger’s Ask-a-Doc program, which enables direct asynchronous communication between primary and specialty care, was associated with lower healthcare utilization and cost, implying more efficient care.
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Economic Implications of Weight Change in Patients With Type 2 Diabetes MellitusModest weight loss (>3%) among metformin-treated patients with type 2 diabetes mellitus was associated with decreased costs, lower resource utilization, and lower rates of treatment discontinuation.
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Methodological Effects on the Measurement of Repeat HospitalizationsThe rates of potentially preventable readmissions vary across measurement methodologies which explains inconsistencies in previous studies. Results suggest measurement of readmissions incentivizes inefficient behavior.
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Relationship Between Quality Improvement Processes and Clinical PerformanceThis study examines the clinical effects of care management and quality improvement interventions implemented by physician groups on pay-for-performance success.
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Impact of Formulary Restrictions on Medication Use and CostsPlacing formulary restrictions on brand name drugs shifts use toward generics, lowers the cost per prescription fill, and has minimal impact on overall adherence for antidiabetes, antihyperlipidemia, and antihypertension medications among low-income subsidy recipients in Medicare Part D plans.
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Health Information Technology for Ambulatory Care in Health SystemsHealth systems are important in driving electronic health record adoption in ambulatory clinics, although the uptake of key functionalities varies across systems.
