The American journal of managed care
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To determine (1) whether commercial health plans' coverage criteria for a costly technology-based medical intervention are consistent with recent clinical effectiveness evidence, (2) whether medical directors adhere to planwide coverage criteria when making coverage determinations for individual patients, and (3) if any organizational characteristics are associated with having more stringent coverage criteria or making more frequent coverage denials. ⋯ Health plans apply varied criteria in coverage policies for technology-based treatments such as EBGS, but do not always adhere to stated criteria when determining coverage for individual patients. For-profit status, accreditation status, geographic location, and size of plan are not associated with being more or less likely to authorize EBGS.
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Multicenter Study Comparative Study
The relationship of system-level quality improvement with quality of depression care.
To explore the relationship of systemwide continuous quality improvement (CQI) with depression care quality in the Veterans Health Administration (VHA). ⋯ Although CQI may help bridge the healthcare quality gap, it may not be associated with higher disease-specific quality of care.
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Randomized Controlled Trial Clinical Trial
Matching patients and practitioners based on beliefs about care: results of a randomized controlled trial.
To determine whether an intervention designed to inform and guide patients in choosing a primary care provider (PCP) could increase satisfaction and trust. ⋯ The discrepancy between patient and practitioner beliefs about care is an important determinant of trust and satisfaction, and involving patients in the selection of their PCP can have an independent positive effect. It should be possible to build on the experience of this project to develop programs that better match patients and practitioners within managed care plans.
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Characterized by chronic widespread joint and muscle pain, fibromyalgia is a syndrome of unknown etiology. The American College of Rheumatology's classification criteria for fibromyalgia include diffuse soft tissue pain of at least 3 months' duration and pain on palpation in at least 11 of 18 paired tender points. Symptoms are often exacerbated by exertion, stress, lack of sleep, and weather changes. ⋯ Once the diagnosis is made, providers should aim to increase patients' function and minimize pain. This can be accomplished through nonpharmacological ahd pharmacological interventions. With proper management, the rate of disability appears to be significantly reduced.
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Research conducted by James Caro, MDCM, focuses on the economic costs of stroke in patients with atrial fibrillation (AF), and how much can be saved by optimizing anticoagulation in these patients. His research will have practical implications not only for researchers but also the clinicians and decision makers within managed care settings who must allocate resources for competing prevention programs. ⋯ Caro recently reported preliminary results from his economic analyses at the 2004 World Stroke Congress in Vancouver, BC. He spoke with an editor from AJMC about those studies.