The American journal of managed care
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To determine the costs associated with conducting concurrent utilization review, a utilization management strategy widely used by the managed care industry. ⋯ These figures are conservative in that they do not include the payer component of the costs, which could be as high as the hospital provider cost. Given a denial rate of < 2% and the high cost of the process, it may be beneficial to investigate alternative processes for conducting utilization review.
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Comparative Study
Variation in racial and ethnic differences in consumer assessments of health care.
Prior studies have documented significant racial and ethnic disparities in health and healthcare, but data about disparities from consumer assessments of care are inconsistent. ⋯ Significant race/ethnic differences in experience with, access to, and use of care exist in health plans. Substantial variation in racial differences suggests compromised quality of healthcare and opportunities for quality improvement.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
High- versus low-dose angiotensin converting enzyme inhibitor therapy in the treatment of heart failure: an economic analysis of the Assessment of Treatment with Lisinopril and Survival (ATLAS) trial.
Angiotensin-converting enzyme (ACE) inhibitors reduce heart failure death and hospitalization. Prescribed doses often are lower than randomized clinical trial (RCT) targets and practice guideline recommendations. ⋯ Cost savings from fewer heart failure hospitalizations offset higher ACE inhibitor costs in the high-dose group. The improved clinical outcomes were achieved without increased treatment costs.
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Physician willingness to reduce medical costs is mixed. Some physicians might be unwilling to reduce medical costs because they are concerned about where the savings would go. ⋯ Although US primary care physicians vary in where they think money saved in healthcare goes, most believe that more of it goes to the salaries of insurance company executives and the profits of insurance company owners than to improved clinical services or reduced premiums. The more physicians believe that this is where the money goes, the less willing they are to reduce healthcare costs.
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Antiplatelet therapy, most notably aspirin, has been well documented to reduce risks of subsequent cardiovascular disease (CVD) in secondary prevention, acute myocardial infarction (MI), acute occlusive stroke, as well as in primary prevention. In secondary prevention, the most recent Antithrombotic Trialists' Collaboration reviewed 194 published randomized trials of antiplatelet therapy, mostly aspirin, involving more than 212 000 patients (ie, 135 000 using antiplatelet therapy or control and 77 000 using different antiplatelet regimens). In a very wide range of patients who have survived a prior occlusive vascular event-including MI, transient ischemic attacks, occlusive stroke, unstable and stable angina, percutaneous coronary interventions, and coronary artery bypass graft-aspirin prevents about 25% of serious vascular events. ⋯ Aspirin should be an adjunct, not an alternative, to managing other cardiovascular risk factors. Recently, the US Preventive Services Task Force and the American Heart Association recommended aspirin use for all men and women whose 10-year risks are > 6% and > or = 10%, respectively. In all these patient categories, including secondary prevention, acute MI and acute occlusive stroke, as well as primary prevention, increased and appropriate use of aspirin will prevent large numbers of premature deaths and MIs.