Pediatrician and child

The medical home and hospital readmissions

The medical home and hospital readmissions

Despite the fact that primary care medical homes have received considerable attention, little is known about the degree to which they influence early post-discharge utilization. In this article, Dr. Ryan Coller et al. examined whether patients with medical homes were less likely to have early post-discharge hospital or emergency department encounters. In a prospective cohort study of patients who had an acute hospitalization at a children's hospital, the authors found that more than 65% of patients enrolled in the study did not have a medical home and that patients who had a "usual source of sick and well care" had fewer readmissions than those without. Readmissions were higher among patients who had parents with less confidence in avoiding a readmission, subspecialist primary care providers, longer length of index hospital stay, and more hospitalizations in the last year.

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IBD pills

Examining systemic steroid use in older inflammatory bowel disease patients using hurdle models

Examining systemic steroid use in older inflammatory bowel disease patients using hurdle models

This study by Sophia Johnson et al. sought to evaluate the relationship between patient characteristics and the frequency and duration of incident steroid use for inflammatory bowel disease. In a national Medicare sample, 21% of IBD patients without baseline steroid use used systemic steroids, despite general consensus that systemic steroid use should be limited. Odds of receiving systemic steroids were greater in patients that were younger, lived in rural areas, and receiving other agents. Available patient characteristics failed to predict longer steroid treatment duration. 

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Woman thinking

Association of anxiety and depression with hypertension control

Association of anxiety and depression with hypertension control

This study by Dr. Heather Johnson's team aimed to evaluate rates and predictors of incident hypertension control among patients with anxiety and/or depression compared to patients without either mental health diagnosis. The 4-year retrospective analysis included patients over the age of 18 with hypertension. Those with anxiety and/or depression demonstrated more primary care and specialty visits than those without either condition. Other association of hypertension control included female gender, absence of tobacco use, Medicaid use, and a higher Adjusted Clinical Group Risk Score.

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Doctor counseling patient

Visit patterns for severe mental illness with implementation of integrated care

Visit patterns for severe mental illness with implementation of integrated care

This retrospective cohort pilot study by Meghan Fondow et al. examined visit patterns for over 1,000 patients with severe mental illness using EHR data from two federally qualified health centers. During the intervention period of a model that integrated behavioral health services with primary care, there was a significant increase in the proportion of visits per month. After the intervention, this rate declined but remained above pre-intervention period.

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Chronic diseases

The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

The impact of a patient's concordant and discordant chronic conditions on diabetes care quality measures

Dr. Elizabeth Magnan et al. sought to determine the impact of the number of concordant and discordant chronic conditions on diabetes care quality. Using EHR data, authors found that a higher number of concordant conditions were associated with higher odds of achieving testing and control goals for all outcomes except blood pressure control. Having more concordant conditions makes diabetes care goal achievement more likely.

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Blood sugar monitor and pills

Establishing chronic condition concordance and discordance with diabetes

Establishing chronic condition concordance and discordance with diabetes

This study by Dr. Elizabeth Magnan et al. aimed to determine which chronic conditions are concordant and discordant with diabetes care. Using the Delphi technique, the study team surveyed PCPs in an academic practice. They found 12 conditions were concordant with diabetes care and 50 were discordant, and 31 of the discordant conditions did not overlap with any of the diabetes care goals. This study adds information that may prove useful in developing multimorbidity guidelines and interventions.

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Pills in a row

Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar 1 disorder among dually enrolled beneficiaries

Effects of Medicare Part D on guideline-concordant pharmacotherapy for bipolar 1 disorder among dually enrolled beneficiaries

Marguerite Burns et al. examined the effect of an insurance coverage transition that occured in 2006, which shifted coverage from Medicaid to Medicare Part D private drug plans for individuals who were enrolled in both programs. In this study, the authors investigated the receipt of guideline-concordant pharmacotherapy for biopolar I disorder after the transition and found that 16 months after the transition to Part D, the number of people with any recommended use of anti-manic drugs was higher than expected, and the number of ED visits per month temporarily increased by 19% immediately after the transition.

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Pills coming out of bottle

The effect of Medicare Part D on the quality of pharmacotherapy for bipolar 1 disorder among dually enrolled beneficiaries

The effect of Medicare Part D on the quality of pharmacotherapy for bipolar 1 disorder among dually enrolled beneficiaries

In this article, Dr. Marguerite Burns et al. sought to determine whether the shift in 2006 from Medicaid coverage for medications to Medicare Part D for dually enrolled beneficiares affected psychiatric medication management. They examined Medicaid and Medicare administrative data and the effect of the coverage transition on receipt of guideline-concordant antimanic medication, antidepressant monotheray, and emergency department visits, and found that 16 months after the transition to Part D, the proportion of the population with any recommended use of antimanic drugs was 3.1% higher than expected, and the proportion of beneficiaries with antidepressant monotherapy was 2.1% lower than expected. The number of ED visits temporarily increased by 19% immediately post-transition.

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Health team

PAs and NPs perform effective roles on teams caring for Medicare patients with diabetes

PAs and NPs perform effective roles on teams caring for Medicare patients with diabetes

Christine Everett et al. used Medicare claims and EHR data from a large physician group to compare outcomes for patients with diabetes with various levels of complexity. Outcomes were generally equivalent for care teams with PAs or NPs and those with physicians only. Findings suggest that patient characteristics as well as goals should be considered when determining how to deploy PAs and NPs on primary care teams.

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Doctors and nurses

Division of primary care services between physicians, PAs, and NPs for older patients with diabetes

Division of primary care services between physicians, PAs, and NPs for older patients with diabetes

Using Medicare claims and EHR data from a large physician group, Christine Everett et al. looked at how to incorporate physician assistants and nurse pracitioners (PA/NPs) into primary care teams. This article describes the division of patients and services between PCPs for older diabetes patients on panels with varying levels of PA/NP involvement. Panels with PA/NP providers had higher proportions of patients with Medicaid, disability, and depression. 

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