Clinical and Economic Burden of Depression/Anxiety in Chronic Obstructive Pulmonary Disease Patients within a Managed Care Population

Background: Anxiety and depression are common co-morbidities that can complicate the course of chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate their impact on healthcare utilization and costs in a managed care COPD population. Methods: Administrative claims data were used to conduct a retrospective cohort study of COPD patients ≥40 years of age, including those with co-morbid COPD-Depression (including anxiety). COPD-Depression patients were matched to COPD patients without depression (COPD-Only cohort) using propensity scores. Conditional logistic regression models assessed the 1-year risk of COPD exacerbations (i.e., emergency room [ER] visit/inpatient hospitalization) between cohorts. Differences in annual all-cause and COPD-related utilization/costs, along with 2-year costs, were also compared between the cohorts. Results: There were 3,761 patients per cohort. Patients in the COPD-Depression cohort were 77% more likely to have a COPD-related hospitalization (odds ratio [OR] = 1.77, P < 0.001), 48% more likely to have an ER visit (OR = 1.48, P < 0.001), and 60% more likely to have hospitalization/ER visit (OR = 1.60, P < 0.001) compared to the COPD-Only cohort. Average annual all-cause medical cost per patient was $23,759 for COPD-Depression vs $17,765 for COPD-Only (P < 0.001) and total (medical plus pharmacy) cost was $28,961 vs $22,512 (P < 0.001), respectively; corresponding average annual COPD-related medical cost was $2,040 vs $1,392 (P < 0.001) and total cost was $3,185 vs $2,680 (P < 0.001). Similar trends were observed over the 2-year period. Conclusions: In the COPD population, patients with depression/anxiety have significantly higher risk of COPD exacerbations and annual all-cause and COPD-related costs than patients without these co-morbidities. These findings may have therapeutic implications and seem worthy of further exploration.     

循证医学与电子信息资源

随着医学文献的与日俱增，如何在浩瀚的信息和文献海洋中筛选出最优的证据已成为实践循证医学所要解决的核心问题。随着计算机的日益普及，全球信息高速公路的发展，查找最佳证据不再仅停留在以手工操作咪主的印刷型资源中，电子信息资源成为查找医生证据的主要来源。本文介绍了电子信息资源在收集循证医学证据中的运用。     

A Novel Approach to Gathering and Acting on Relevant Clinical Information: SCAMPs

The current tools to adequately inform the process of improving health-care delivery consist primarily of retrospective studies, prospective trials, and clinical practice guidelines. We propose a novel and systematic approach that bridges the gap of our current tools to affect change, provides an infrastructure to improve health-care delivery, and identifies unnecessary resource utilization. The objective of this special article is to introduce the rationale and methods for this endeavor entitled “Standardized Clinical Assessment and Management Plans” (SCAMPs). SCAMPs take a relatively heterogeneous patient population and through a process of iterative analysis and modification of standardized assessment and management algorithms, SCAMPs allow the intrinsic biologic variability in a patient population to emerge and be understood. SCAMPs can be used to complement our currently available tools in order to result in incremental and sustained improvement in health-care delivery.     

Incidence,Frequency, and Clinical Characteristics of Type 3 Myocardial Infarction in Clinical Practice

Objectives

Cardiac death in a patient with symptoms and electrocardiographic changes indicative of myocardial ischemia but without available measurements of cardiac biomarkers is designated a type 3 myocardial infarction. We wanted to investigate the incidence, the frequency, and the characteristics of patients diagnosed as type 3 myocardial infarction.

The relationship between diabetes and oral health status,and dental visits among American Indian,Alaska Native,and Native Hawaiian elders

BackgroundAmerican Indian (AI), Alaska Native (AN), and Native Hawaiian (NH) populations report higher rates of diabetes, poorer oral health, and fewer dental visits than their peers. The authors aimed to identify relationships between oral health and dental visits and diabetes diagnosis among AI, AN, and NH elders.MethodsData were obtained from a national survey of AI, AN, and NH elders 55 years and older (April 2014-2017) and included 16,136 respondents. Frequencies and χ² tests were used to assess the relationship between oral health and dental visits, and diabetes.ResultsNearly one-half of the elders reported receiving a diagnosis of diabetes (49.2%). A significantly (P < .01) greater proportion of elders with diabetes reported a dental visit in the past year (57.8%) than those without. Differences (P < .01) were found between reported diabetes and need for extraction, denture work, and relief of dental pain. The authors found lower dental visit rates among elders with diabetes who were low income, older, unemployed, not enrolled in the tribe, lived on the reservation, and had only public insurance.ConclusionsThere is a need to increase oral health literacy and dental visits among elders with diabetes and, more urgently, a need to focus on providing care for subpopulations reporting lower visit rates.Practical ImplicationsDental providers must serve as a referral resource for at-risk elders and must work with and educate about the importance of oral health those who assist tribal elders with diabetes management, including primary care physicians, certified diabetes educators, nutritionists and dietitians, and public health care professionals.     

Hospital in-patient statistics underestimate the morbidity associated with diabetes mellitus.

Hospital in-patient statistics are an important outcome measurement in the assessment of the morbidity associated with diabetes mellitus. A prospective study of 157 consecutive admissions over a 28-day period compared diagnoses obtained from the clinical records with the ICD9 coding of the same admissions recorded at the Information and Statistics Division of the Scottish Health Service. Sixty-one percent of all discharge summaries omitted the diagnosis of diabetes. Even when admission was principally related to diabetes complications, 47% of medical and 88% of surgical discharge summaries omitted diabetes as a diagnostic category. ICD9 coding underestimated the percentage of admissions accounted for by diabetic patients by 100% (2.8 vs 5.6%) and as a result underestimated bed occupancy by over 200% (4.3 vs 13.7%), and is thus failing to fulfil its potential as a demographic and epidemiological record of resource use by disease classification.     

联合重组图强提升实力为本

介绍了该医院集团改革、重组所采取的措施及经验体会,在合理配置卫生资源、开拓专业服务、提高工作效率、质量、建设专业队伍等方面取得的成效,提出了当前面临的问题与对策。     

Organizational and Environmental Determinants of Hospital EMR Adoption: A National Study

The recent focus on health care quality improvement and cost containment has led some policymakers and practitioners to advocate the adoption of health information technology. One such technology is the Electronic Medical Record (EMR), which is predicted to change and improve health care in the USA. Little is known about factors that influence hospital adoption of this relatively new technology. The purpose of this paper is to determine the national prevalence of EMR adoption in acute care hospitals while examining the organizational and environmental correlates using a Resource Dependence Theoretical Perspective. Significant predictors of hospital EMR use may indicate barriers to use for some hospitals and can be used to guide policy. This study uses a non-experimental cross sectional design to examine hospital EMR use in 2004. A logistic regression approach is used to determine the correlations between hospital EMR use and organizational and environmental characteristics. Hospital EMR use was identified using the HIMSS Analytics data. Organizational and environmental variables were measured using data from the AHA, CMS (financial and case mix) and ARF. Hospital EMR adoption is significantly associated with environmental uncertainty, type of system affiliation, size, and urban-ness. The effects of competition, munificence, ownership, teaching status, public payer mix, and operating margin were not statistically significant. Significant predictors of hospital EMR adoption represent barriers that may prevent certain hospitals from obtaining and using EMRs. These hospitals include those that are smaller, more rural, non-system affiliated, and in areas of low environmental uncertainty. Since EMR adoption may be an organizational survival strategy for hospitals to improve quality and efficiency, hospitals that are at risk of missing the wave of implementation should be offered services and incentives to enable them to implement and maintain EMR systems.     

上海郊区社区卫生服务中心医疗资源利用效能调查分析

通过对上海市郊某社区卫生服务中心不同医疗保障病人就诊情况进行研究,分析医疗资源利用存在的问题,探讨进一步提高医疗保障资源利用效能的对策。