Maximizing Quality and Value in Medicaid: Using Return on Investment Forecasting to Support Effective Policymaking

Outlines how forecasting the return on investment of quality measures enhances the efficient allocation of resources, adoption of evidence-based policies, and payment reform. Presents examples from states in an ROI Forecasting Calculator pilot program

A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)

<i>Aims/hypothesis</i> The aim of this study was to develop a simulation model for Type 2 diabetes that can be used to estimate the likely occurrence of major diabetes-related complications over a lifetime, in order to calculate health economic outcomes such as quality-adjusted life expectancy. <i>Methods</i> Equations for forecasting the occurrence of seven diabetes-related complications and death were estimated using data on 3642 patients from the United Kingdom Prospective Diabetes Study (UKPDS). After examining the internal validity, the UKPDS Outcomes Model was used to simulate the mean difference in expected quality-adjusted life years between the UKPDS regimens of intensive and conventional blood glucose control. <i>Results</i> The models forecasts fell within the 95% confidence interval for the occurrence of observed events during the UKPDS follow-up period. When the model was used to simulate event history over patients lifetimes, those treated with a regimen of conventional glucose control could expect 16.35 undiscounted quality-adjusted life years, and those receiving treatment with intensive glucose control could expect 16.62 quality-adjusted life years, a difference of 0.27 (95% CI: –0.48 to 1.03). <i>Conclusions/interpretations</i> The UKPDS Outcomes Model is able to simulate event histories that closely match observed outcomes in the UKPDS and that can be extrapolated over patients lifetimes. Its validity in estimating outcomes in other groups of patients, however, remains to be evaluated. The model allows simulation of a range of long-term outcomes, which should assist in informing future economic evaluations of interventions in Type 2 diabetes

User's Guide to the ROI Forecasting Calculator: Estimating ROI for Medicaid Quality Improvement Programs

Explains the online tool for state Medicaid agencies, health plans, and stakeholders to assess the cost-savings potential of quality improvement measures. Outlines analytical issues and best practices for each component and how to interpret the results

Study protocol for the Anesthesiology Control Tower—Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: A pilot randomized controlled trial in intraoperative telemedicine [version 1; referees: 2 approved]

Background: Each year, over 300 million people undergo surgical procedures worldwide. Despite efforts to improve outcomes, postoperative morbidity and mortality are common. Many patients experience complications as a result of either medical error or failure to adhere to established clinical practice guidelines. This protocol describes a clinical trial comparing a telemedicine-based decision support system, the Anesthesiology Control Tower (ACT), with enhanced standard intraoperative care. Methods: This study is a pragmatic, comparative effectiveness trial that will randomize approximately 12,000 adult surgical patients on an operating room (OR) level to a control or to an intervention group. All OR clinicians will have access to decision support software within the OR as a part of enhanced standard intraoperative care. The ACT will monitor patients in both groups and will provide additional support to the clinicians assigned to intervention ORs. Primary outcomes include blood glucose management and temperature management. Secondary outcomes will include surrogate, clinical, and economic outcomes, such as incidence of intraoperative hypotension, postoperative respiratory compromise, acute kidney injury, delirium, and volatile anesthetic utilization. Ethics and dissemination: The ACTFAST-3 study has been approved by the Human Resource Protection Office (HRPO) at Washington University in St. Louis and is registered at clinicaltrials.gov (NCT02830126). Recruitment for this protocol began in April 2017 and will end in December 2018. Dissemination of the findings of this study will occur via presentations at academic conferences, journal publications, and educational materials

Effect of Poverty Level on the Relationship Between Hyperlipidemia and Cardiorenal Syndrome

Purpose. Elevated cholesterol is known to be associated with chronic kidney disease (CKD) and cardiovascular disease (CVD) independently. Cardiorenal syndrome (CRS), a recently defined syndrome, is characterized by renal failure that is closely interrelated to cardiac dysfunction. The effect of socioeconomic status on cardiorenal syndrome has not been explored in a multi-ethnic population. In this retrospective secondary analysis, the hypothesis was tested if socioeconomic status modifies the effect of hyperlipidemia on CRS. Methods. The National Health and Nutrition Examination Survey (NHANES) is a cross sectional survey done on the non-institutionalized population of the United States. All patients from the NHANES study, 20 years and older between the years 1999-2010 were included in the analysis. CRS was determined using a standard GFR equation and history of CVD. Analysis was performed using complex samples logistic regression to determine the relationship of hyperlipidemia on CRS. Results. Data on CRS status was available for 24,625 individuals (48.9% males & 51.1% females) and was representative of 173,805,863 individuals. The overall unadjusted odds ratio of CRS for hyperlipidemia to no hyperlipidemia was 3.01 (95% confidence interval [CI], 2.62-3.47, p \u3c 0.001). The adjusted OR was elevated, 2.20 (CI 1.20-4.05, p \u3c 0.01), among individuals living below poverty threshold but close to 1.0 (1.63 CI 1.31-2.03, p \u3c 0.001) among patients above poverty threshold, after the results were controlled for medical risk factors and demographic risk factors. Conclusions. Hyperlipidemia is strongly associated with CRS in a nationally representative multi-ethnic population and must be taken into special consideration when treating underprivileged patients. Longitudinal studies should further examine this association and demonstrate how socioeconomic status plays a role

Expanding congenital abnormalities of the kidney and urinary tract (CAKUT) genetics: basonuclin 2 (BNC2) and lower urinary tract obstruction

his work was supported by FIS PI16/02057, PI19/00588, PI19/00815, DTS18/00032, REDinREN RD016/0009 Fondos FEDER, ERA-PerMed-JTC2018 (KIDNEY ATTACK AC18/00064 and PERSTIGAN AC18/00071), Sociedad Española de Nefrología, FRIAT, and Comunidad de Madrid B2017/BMD-3686 CIFRA2 and Rio Hortega to MV Perez-Gome

“Being in Balance”: Self-Management Experiences Among Young Women with Type 1 Diabetes

Women possess characteristics and experiences unique and different from men. Biological processes such as puberty, menstruation, motherhood and menopause may present challenges to self-management for individuals living with type 1 (T1) diabetes mellitus. In this study, descriptive phenomenology was used to uncover the self-management experiences of nine women aged 22- 30 years living with T1 diabetes. Data collection and analysis occurred simultaneously and followed the methodical structure of van Manen (1997). Study findings revealed five themes: 1) elusiveness of control; 2) dualism of technology; 3) forecasting and maintaining routines; 4) dealing with the “ups and downs”; and, 5) interfacing with the health care team. The essence of the experience for participants revolved around trying to achieve a state of “being in balance.” For these young women, self-management encompassed a desire and need to be in balance with their life and blood sugar levels