Reviewing a report

Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve performance

Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve performance

Investigators analyzed 14 publicly reported quality of care ambulatory measures for the Wisconsin Collaborative for Healthcare Quality to learn whether the reports impact quality of care for patients. Physician groups in the collaborative improved their performance during the study period and when surveyed, reported that the public measures motivated them to act on some, but not all, of the quality measures. 

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Lipid test checklist and vial of blood

Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities

Lipid testing in patients with rheumatoid arthritis and key cardiovascular-related comorbidities

Annual lipid testing is recommended to reduce morbidity and mortality for patients with rheumatoid arthritis and comorbid cardiovascular disease, diabetes, or hyperlipidemia. Dr. Christie Bartels et al. used Chronic Conditions Warehouse data to examine the extent to which lipid testing was performed among patients over 65 years old with rheumatoid arthritis and found that although 90% of the patients had cardiovascular disease, 64% had hyperlipidemia, and 46% had diabetes, annual lipid testing was only performed in 63% of the patients. Additionally, 30% of patients saw a primary care provider less than once per year, and those patients were 16% less likely to have lipid testing. Patients who were older, had higher complexity scores, more hospitalizations, and lived in a large town were also less likely to receive lipid testing.

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Man getting blood drawn

Monitoring diabetes in patients with and without rheumatoid arthritis

Monitoring diabetes in patients with and without rheumatoid arthritis

Diabetes mellitus is an important predictor of mortality in patients with rheumatoid arthritis (RA), and both diseases increase the risk of cardiovascular disease. In this study, Dr. Christie Bartels et al. identified patients 65 years or older who had diabetes and examined whether they had comorbid RA and whether they received guideline recommended A1c and lipid testing. They found that among the patients with diabetes, 2% had RA, and those with comorbid RA were more likely to have baseline cardiovascular disease, diabetes-related complications, lower extremity ulcers, and peripheral vascular disease. The patients with RA were less likely to receive recommended A1c testing, but were slightly more likely to receive lipid testing.

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Graphs and phone

Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups

Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups

This Health Affairs article by Dr. Maureen Smith et al. examined how physician groups respond to public reporting. The authors found that publicly reported metrics, along with participation in large or externally sponsored projects, increased a clinic's implementation of diabetes improvement interventions. Accountability metrics should be structured to capture incremental improvements in quality to reward early and ongoing improvement activities. 

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Diabetes sugar testing

Minority status and diabetes screening in an ambulatory population

Minority status and diabetes screening in an ambulatory population

Ethnicity has been identified as a risk factor for type 2 diabetes, as well as increased morbidity and mortality with the disease. This study looked at the effect of minority status on diabetes screening practices in an ambulatory, insured population. The authors found that minority status did not independently lead to recommended diabetes screening. Factors other than insurance or access to care may affect preventive care for minorities.

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Disabled elderly woman getting out of van

Low frequency of primary lipid screening among Medicare patients with rheumatoid arthritis

Low frequency of primary lipid screening among Medicare patients with rheumatoid arthritis

Dr. Christie Bartels et al. examined the performance of primary lipid screening in rheumatoid arthritis patients. The retrospective cohort study examined a 5% Medicare sample and found that primary lipid screening was performed in fewer than half of eligible RA patients highlighting a key target for cardiovascular disease risk reduction efforts. Half of RA patients saw their rheumatologist as often or more often than they saw a primary care provider, illustrating the need for optimal partnerships betweeen PCPs and rheumatologists for screening patients for CVD risks.

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Pills on dollar bill

Why some disabled adults in Medicaid face large out-of-pocket expenses

Why some disabled adults in Medicaid face large out-of-pocket expenses

Marguerite Burns et al. used Medical Expenditure Panel survey data to examine out-of-pocket health care spending for Medicaid enrollees aged 18-64 with disabilities. They found that the Medicaid program effectively limited out-of-pocket health costs for the majority of community-dwelling enrollees and that most of the spending is concentrated on prescription medications. However, for 10% of these enrollees, annual out-of-pocket spending was $1,200 or higher, which can be a significant cost burden for low-income individuals.

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Man showing doctor stomach pain

The diagnosis of diverticulitis in outpatients: On what evidence?

The diagnosis of diverticulitis in outpatients: On what evidence?

Investigators used electronic health record data to examine the clinical assessment generating the diagnostic label of diverticulitis in outpatients. They found that diverticulitis in the outpatient setting is often characterized by infrequent use of CT scans, lack of leukocytosis, and rare need for urgent surgery or early admission. Further study is needed as this diagnostic label seems to be commonly applied without objective evidence.

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Blood sugar test

Analysis of guidelines for screening diabetes mellitus in an ambulatory population

Analysis of guidelines for screening diabetes mellitus in an ambulatory population

This study compared the case-finding ability of current national guidelines for screening diabetes mellitus and characterized factors that affect testing practices in an ambulatory population. In this retrospective analysis, investigators found that compared with the American Diabetes Association (ADA) recommendations, the United States Preventive Services Task Force (USPSTF) guidelines result in a lower number of patients eligible for screening and decreased case-finding significantly. The number and type of risk factors predict diabetes, and lack of health insurance decreases testing.

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Nurse holding a tablet and smiling

Physician assistants and nurse practitioners as a usual source of care

Physician assistants and nurse practitioners as a usual source of care

This article published in The Journal of Rural Health used Wisconsin Longitudinal study data to identify characteristics and outcomes of patients who primarily see physician assistants (PAs) or nurse practitioners (NPs). Populations served most by PA/NPs tend to live in rural areas and have public insurance or no insurance coverage. They are also more likely to be women, younger, and have lower extroversion scores. There were few differences in utilization and no reported differences in difficulties/delays in care or outcomes compared to patients that primarily see doctors. 

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