Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care6/12/2015
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The New York Times (5/5, Frakt, Subscription Publication) “The Upshot” reports that growth in healthcare spending is slowing, “and one reason might be that cost sharing is rising.” The share of insured workers with a deductible of at least $1,000 was 41 percent last year, quadruple that in 2006. One concern is that patients facing higher cost sharing for prescription drugs will cut back on their medications. Indeed, a recent study from the National Bureau of Economic Research found that patients with chronic illnesses cut their drug use even when the medications were exempt from the deductible, perhaps because they did not understand the drugs had no deductible.
Manisha Juthani-Mehta, MD1
Author Affiliations JAMA Intern Med. Published online May 26, 2015.;():. doi:10.1001/jamainternmed.2015.1888. Asymptomatic bacteriuria (ASB) is one of the most common reasons for inappropriate antimicrobial use.1 Despite the recommendation for decades that patients with indwelling urinary catheters should not be screened for ASB or treated with antimicrobial therapy, this practice is still commonplace.2 In an effort to have physicians and patients work collaboratively to reduce unnecessary antimicrobial prescriptions, the first evidence-based recommendation made by the Infectious Diseases Society of America in conjunction with the American Board of Internal Medicine in the Choosing Wisely campaign is “Don’t treat asymptomatic bacteriuria with antibiotics.” Overuse of Bridging Anticoagulation for Patients With Venous Thromboembolism: First, Do No Harm6/12/2015 Daniel J. Brotman, MD1,2; Michael B. Streiff3,4
Author Affiliations JAMA Intern Med. Published online May 26, 2015.;():. doi:10.1001/jamainternmed.2015.1858. Patients receiving anticoagulation for venous thromboembolism (VTE) have varying risks of recurrence on cessation of the therapy. Time from the most recent thrombotic event is perhaps the most important determinant of short-term VTE recurrence because patients who stop anticoagulation therapy before the stabilization of an active thrombus are particularly prone to propagation and embolization. If use of anticoagulation is stopped during the first 4 weeks of treatment, the risk of recurrent VTE is 0.3% to 1.3% per day, dropping to 0.03% to 0.2% per day over the next 4 to 12 weeks.1 After 3 months, many patients can safely discontinue anticoagulation therapy, particularly if the thrombotic event occurred in the setting of a reversible precipitant. Modern Healthcare (5/5, Subscription Publication) reports that of the $360 billion Medicare payments made to providers in 2013, “58% continued to flow through traditional fee-for-service models with no regard for quality or outcomes, according to a new analysis by the employer-backed Catalyst for Payment Reform.” The report comes as “a consensus is emerging that the industry is moving--and should move--rapidly away from fee-for-service payments as the dominant way of paying for healthcare services.”
Reuters (3/24, Seaman) reports that research published in JAMA Internal Medicine suggests that taking people off of statins as they near the end of their lives may improve their quality of life.
The NPR (3/24, Shute) “Shots” blog reports that investigators also found that individuals “approaching the end of life who” stopped taking “statins were not more likely to have a heart attack or stroke than those who kept taking the” medications. The Washington Post “To Your Health” blog reported that “more than half of” the food Americans “buy contains more than the recommended amount of salt for each serving” consumed. In the April issue of the journal Preventing Chronic Disease, researchers from the CDC found that “meat and pasta mixed dishes...were the top culprits, with better than 80 percent of each containing too much salt in the three regions of the country examined (Pacific, East North Central, and South Atlantic).” Other foods containing more than the recommended amount of salt include “pizza (better than 70 percent), soups (more than 60 percent) and cold cuts (50 to 60 percent, depending on the region).”
Review: Antipsychotics less effective than non-drug treatments for controlling dementia symptoms.6/2/2015 The NPR (3/6, Jaffe) “Morning Edition” program and “Shots” blog report that “antipsychotics are much less effective than non-drug treatments in controlling the symptoms of dementia, according to a” review (3/6) published March 4 in the British Medical Journal. Researchers arrived at that conclusion after examining “more than two decades of scientific studies.” The review’s authors “say the treatments that showed the best results were the ones that trained caregivers how to communicate calmly and clearly, and to introduce hobbies or other activities for the patient.” The piece also notes that the FDA has warned that “antipsychotics increase the risk of death for people with dementia.
Bloomberg News (4/16) reports that an “ambitious Obamacare experiment in cutting health-care costs led to a reduction of about 1.2 percent in spending on Medicare patients in its first year, researchers said, calling the savings a promising start.” However, the government may need to make changes to keep providers in the Pioneer program, Harvard University researchers said in the study published in the New England Journal of Medicine.
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