The American journal of managed care
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Randomized Controlled Trial
Effectiveness and cost-effectiveness of diabetes prevention among adherent participants.
We report the 10-year effectiveness and within-trial cost-effectiveness of the Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) interventions among participants who were adherent to the interventions. ⋯ Over 10 years, lifestyle intervention and metformin were cost-effective or cost saving compared with placebo. These analyses confirm that lifestyle and metformin represent a good value for money.
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Accountable Care Organizations (ACOs) have potential to improve care for chronic conditions through incentives for better performance and bundled payments that promote care coordination. The Chronic Care Model (CCM) is a framework for providing health services for chronic conditions in primary care settings consistent with the organizational and financial goals of ACOs. ⋯ However, under the Medicare Shared Savings Program ACOs currently do not specify financial or organizational incentives for providing integrated mental health care through the CCM, leaving a missed opportunity to realize the full potential of ACOs to improve patient outcomes. We describe the rationale for incorporating mental health care into ACOs; how it can benefit consumers, providers, and ACOs; and what health care organizations can do to implement integrated mental health care.
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Uncertainty about human epidermal growth factor receptor-2 (HER2) testing practice in Canada continues to hinder efforts to improve personalized medicine. Pathologists routinely perform HER2 assessment for all tumors > 1 cm, and pathology is reported centrally to the provincial cancer registry. ⋯ Despite a universal testing policy, the rate of centralized HER2 test documentation was lower than expected and related to disease severity. Differences in regional reporting likely reflect ascertainment bias inherent to centralized pathology reporting rather than testing access. Improved HER2 reporting is encouraged for cancer registration, quality-of-care measurement, and program evaluation.
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Targeted messaging that encourages consumers who are frequent users of the emergency department (ED) to contact their primary care physician in advance of an ED visit could reduce healthcare expenditures in select populations. However, such messaging has not been thoroughly evaluated. We used the input from consumers in a capitated plan to develop and test messaging designed to encourage primary care physician (PCP) contact prior to an ED visit. ⋯ A simple message that challenges consumers to think about whether the ED is truly more convenient and that provides a simple mechanism for finding out whether a trip to the ED is necessary (primary care practice contact) holds promise as a mechanism to reduce ED use for those who have ready access to primary care.