<h3>Context</h3>Treating hypertension decreases mortality and disability from cardiovascular disease, but most remains inadequately controlled.<h3>Objective</h3>To determine if a new model of care that uses patient Web services, home blood pressure (BP) monitoring, pharmacist-assisted improves BP control.<h3>Design, Setting, Participants</h3>A 3-group randomized controlled trial, the Electronic Communications Home Blood Pressure Monitoring study was based on Chronic Care Model. The trial...

As the patient-centered medical home model emerges as a key vehicle to improve quality of health care and control costs, experience Seattle-based Group Health Cooperative with its pilot takes on added importance. This paper examines effects prototype patients' experiences, quality, burnout clinicians, total costs at twenty-one twenty-four months after implementation. The results show improvements in clinician through two years. Compared other clinics, patients experienced 29 percent fewer...

Objectives. Develop and estimate the RxRisk model, a risk assessment instrument that uses automated ambulatory pharmacy data to identify chronic conditions predict future health care cost. The model's performance in predicting cost is compared with demographic-only Ambulatory Clinical Groups (ACG), Hierarchical Coexisting Conditions (HCC) ICD-9-CM diagnosis-based instruments. Each power forecast resource use assessed. Data Sources. Health services utilization for approximately 1.5 million...

Background. Assessment of disease burden is the key to many aspects health care management. Patient diagnoses are commonly used for case-mix assessment. However, issues pertaining diagnostic data availability and reliability make pharmacy-based strategies attractive. Our goal was provide a reliable valid classification system chronic diseases found in Veterans Health Administration (VHA) population. Objective. To detail development category definitions VA-adapted version RxRisk (formerly...

Background: This study compared prevalent health utilization and costs for persons with without metabolic syndrome investigated the independent associations of various factors that make up syndrome. Methods: Subjects were enrollees three plans who had all clinical measurements (blood pressure, fasting plasma glucose, body mass index, triglycerides, high-density lipoprotein cholesterol) necessary to determine risk over 2-year period (n = 170,648). We used values, International Classification...

This DataWatch presents estimates of the health care costs for all adults who were continuously enrolled in a large staff-model maintenance organization (HMO) during 1992. More than one-third these diagnosed with at least one chronic condition 1992, and this population are twice those without conditions. A diagnosis results an expected increase 80 percent-300 percent, depending on age, sex, profile. Previous studies illness have focused fee-for-service sector. As managed continues to grow,...

Objective. To measure the impact of asthma on use and cost health care by children in a managed organization. Design. Population-based historical cohort study. Setting. A medium-sized staff model maintenance organization western Washington state. Subjects. All 71 818 children, between age 1 to 17 years, who were enrolled used services during 1992. Outcome Measures. Children identified with one or more diagnoses 1992 using automated encounter data. Nonurgent outpatient visits, pharmacy fills,...

We describe the prevalence, types, duration, frequency, and severity of intimate partner violence ("partner violence") in older women.We randomly sampled a total 370 English-speaking women (65 years age older) from health care system to participate cross-sectional telephone interview. Using 5 questions Behavioral Risk Factor Surveillance System (BRFSS) 10 Women's Experience with Battering (WEB) Scale, we assessed woman's exposure violence. estimated lifetime prevalence using BRFSS (physical,...

The goal was to determine whether differences in health care costs and utilization exist for children whose mothers experienced intimate partner violence versus those who did not.A longitudinal cohort study performed an integrated delivery organization with 760 of no history 631 a since age 18. Health before, during, after exposure were compared nonabused mothers.Health higher most categories violence, significantly values mental services, primary visits, costs, laboratory costs. Children...

<h3>Importance</h3> Compared with traditional Medicare (TM) fee-for-service plans, Advantage (MA) plans may provide more-efficient care for beneficiaries Alzheimer disease and related dementias (ADRD) without compromising quality. <h3>Objective</h3> To determine differences in health utilization, satisfaction, status MA TM ADRD. <h3>Design, Setting, Participants</h3> A cohort study was conducted of ADRD from all publicly available years the Current Beneficiary Survey between 2010 2016....

Background. Risk adjustment models typically use diagnoses from claims or encounter records to assess illness severity. However, concerns about the availability and reliability of diagnostic data raise potential for alternative methods risk adjustment. Here, we explore pharmacy as an complement in Objectives. To develop test a pharmacy-based model SSI TANF Medicaid populations. Research Design. Pharmacological review combined with empirical evaluation. We developed Rx model, system that...

Background. The Chronic Disease Score is a risk-adjustment metric based on age, gender, and history of dispensed drugs. We compared four versions the score for their ability to predict hospitalization among members eight health maintenance organizations nationwide. Methods. study included 29,247 women age 45 years older. Logistic regression models were constructed using rank quintile decile indicators each scores as predictors during year after 1 October 1995. Discrimination model fit...

To compare longitudinal changes in healthcare costs between fallers admitted to the hospital at time of fall (admitted), those not (nonadmitted), and nonfaller controls; test hypotheses related differences mean within these groups over time; estimate attributable falling.Longitudinal cohort.Group Health Cooperative Puget Sound.Seven thousand nine hundred ninety-three nonadmitted fallers, 976 8,956 nonfallers aged 67 older enrolled an integrated delivery system. Fallers were identified...

Background: Patient-shared electronic health records provide opportunities for care outside of office visits. However, those who might benefit may be unable to or choose not use these resources, while others need them. Objective: Electronic Communications and Home Blood Pressure Monitoring (e-BP) was a randomized trial that demonstrated Web-based pharmacist led improved blood pressure (BP) control. During recruitment we attempted contact all patients with hypertension from 10 clinics...

Summary Objective: We evaluated the role of home monitoring, communication with pharmacists, medication intensification, adherence and lifestyle factors in contributing to effectiveness an intervention improve blood pressure control patients uncontrolled essential hypertension. Methods: performed a mediation analysis published randomized trial based on Chronic Care Model delivered over secure patient website from June 2005 December 2007. Study arms analyzed included usual care monitor...

Background: The high economic burden of cancer is projected to continue growing. Cost-of-care estimates are key inputs for comparative effectiveness and analyses that aim inform policies associated with care. Existing based largely on SEER-Medicare data in the elderly, leaving a knowledge gap regarding costs patients aged <65 years. Methods: We estimated total net medical care using individuals diagnosed breast, colorectal, lung, or prostate (n=45,522) noncancer controls (n=314,887) enrolled...

Objective To estimate dementia's incremental cost to the traditional Medicare program. Data Sources Health and Retirement Study ( HRS ) survey‐linked part A B claims from 1991 2012. Design We compared expenditures for 60 months following a claims‐based dementia diagnosis those randomly selected, matched comparison group. Collection/Extraction Methods used estimator that accounts differential survival between individuals with without decomposes costs into intensity components. Principal...

Background. Although most widely used risk adjustment systems use diagnosis data to classify patients, there is growing interest in based on computerized pharmacy data. The Veterans Health Administration (VHA) an ideal environment which test the efficacy of a pharmacy-based approach. Objective. To examine ability RxRisk-V predict concurrent and prospective costs care VHA compare performance simple age/gender model, original RxRisk, two leading diagnosis-based approaches: Adjusted Clinical...

OBJECTIVE Our goal was to measure the impact of chronic rhinosinusitis (CRS) on use and cost health care by adults in a maintenance organization (HMO). SETTING AND SUBJECTS In setting Group Health Cooperative, an HMO Washington State, we conducted study all 218,587 (≥18 years) who used services during 1994. Using automated data, 20,175 were identified with one or more CRS diagnoses OUTCOME MEASURES We nonurgent outpatient visits, pharmacy fills, urgent hospital days, their associated costs...