The American journal of managed care
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Heart failure (HF) substantially impacts the health and financial security of an increasing proportion of the US population. It worsens debility and quality of life and may lead to hospitalization and death. HF is a clinical syndrome with diverse symptomatic presentations. ⋯ Clinicians should focus on diagnosing, treating, and preventing the etiologies that are known to cause HFpEF. Results from a small proportion of randomized controlled trials have shown therapeutic benefit for small molecules, although limited, if any, demonstrated mortality benefit has been noted. More research and investment are needed to decrease the burden of HFpEF and to discover lifesaving treatments for this growing population.
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Defining a path toward improved heart failure (HF) care is essential, as there is a clear need to improve HF treatment quality, outcomes, and value. This article reviews potential strategies to help improve the quality of HF clinical care and decrease costs. To start, HF phenotyping may be useful in guiding patient treatment, as some phenotypes are associated with higher hospitalization costs and longer length of stay. ⋯ FFS models can lead to low-quality care focused on treating illness instead of supporting wellness initiatives. By contrast, VBP models aim to decrease excessive health care costs, thereby increasing incentives to hospitals that deliver high-quality patient care. Further, novel care delivery approaches, such as hospital-at-home and other digital tools, can provide patients with lower-cost care and are associated with improved QOL, including reductions in hospital readmission.
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Adults with a new diagnosis of cancer frequently visit emergency departments (EDs) for disease- and treatment-related issues, although not exclusively. Many cancer care providers have 24/7 clinician phone triage available, but initial recorded phone messages tend to advise patients to go to the nearest ED if they are "experiencing a medical emergency." It is unclear how well patients triage themselves to the optimal site of care. ⋯ Adults with cancer infrequently use available clinician advice before visiting the ED and may use factors other than clinical severity to determine their need for emergency care. Future work should explore the challenges that patients face navigating unplanned acute care, including reasons for underusing existing resources.
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Observational Study
Factors associated with lung cancer risk factor documentation.
To identify factors associated with the minimum necessary information to determine an individual’s eligibility for lung cancer screening (ie, sufficient risk factor documentation) and to characterize clinic-level variability in documentation. ⋯ We found a low rate of sufficient lung cancer risk factor documentation and associations of risk factor documentation based on patient-level factors such as race, insurance status, language, and patient portal activation. Risk factor documentation rates varied across clinics, and only approximately half the variation was explained by factors in our analysis.
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Complex Medicare Advantage (MA) health plan choices may overwhelm immigrants, especially for those facing decision-making constraints due to limited English proficiency (LEP). We examined the trends and patterns of MA enrollment by immigration and English proficiency status. ⋯ Our findings suggest higher MA enrollment among immigrants, especially for LEP immigrants. Future research should study the care experience of immigrants in MA.