The impact of a Medicare Public Health Emergency policy change for continuous glucose monitors on utilization and total cost of care for diabetes

Home glucose monitoring was revolutionized in 1999 when the U.S. Food and Drug Administration (FDA) approved the first professional continuous glucose monitor (CGM). With the advancements in technology, newer CGMs are available for personal use and have greatly impacted the way diabetes is managed. Although there are data regarding the benefits of CGMs in lowering hemoglobin A1c, data is currently lacking regarding whether the use of CGM affects the number of hospitalization/emergency department visits as well as the effect on cost of care. In addition, while CGMs have been traditionally used in patients with type 1 diabetes due to their insulin necessity, they have also shown benefit in patients with type 2 diabetes on basal-bolus insulin therapy. According to Ruedy et al, “Continuous Glucose Monitoring in Older Adults with Type 1 and Type 2 Diabetes using Multiple Daily Injections of Insulin”, use of CGMs was associated with improvements in hemoglobin A1c as well as reduction in glycemic variability. Criteria for coverage of CGMs for Medicare beneficiaries is outlined in the Local Coverage Determination (LCD) L33822 “Glucose Monitors;” use is restricted to patients with diabetes using multiple daily insulin injections that had been testing blood sugar at least four times per day with traditional finger stick tests. On March 30th, 2020, the Centers for Medicare and Medicaid Services (CMS), in response to the COVID-19 Public Health Emergency (PHE), issued a memo allowing Medicare plans to relax requirements on coverage of CGMs to provide better access. At this time, PHA lifted the prior authorization requirement on the preferred therapeutic CGM (Dexcom®) for Medicare beneficiaries. The purpose of this study is to explore the effects of the PHE removal of PA on utilization of CGMs, impact on management of diabetes, and total cost of care related to diabetes. This is a single institution, retrospective data and chart review of PHA Medicare members with a diagnosis of diabetes utilizing a CGM and continuous enrollment from April 2019 through March 2021. Patients were identified using eligibility information, primary ICD-10 codes for diabetes (type 1 diabetes, type 2 diabetes, or other diabetes), and if members had a claim for a CGM from April 2020 through March 2021. The primary outcome is the utilization of CGM and total cost of care related to diabetes to the health plan and members pre and post removal of PA. The secondary outcomes include member’s hemoglobin A1c and number of hospitalization/ED visits related to diabetes pre and post removal of PA. The outcomes will be compared against two different reporting periods: the baseline reporting period from April 2019 through March 2020 and the comparator reporting period from April 2020 through March 2021. Data regarding utilization, cost, hospitalization/ED visits, and adherence will be pulled from claims data. Chart review will be conducted for Medicare members with access to electronic medical records (EMR) to analyze hemoglobin A1c. Results and conclusions will be shared when the project is completed. (IRB Approved)https://digitalcommons.psjhealth.org/oaa_ppmcstvin_22/1016/thumbnail.jp

Multiple stakeholders' perspectives on patient and public involvement in community mental health services research: A qualitative analysis

Abstract Background Patient and public involvement (PPI) has become essential in health research. However, little is known about multiple stakeholders' perspectives on the implementation of PPI in community mental health research settings. The present study aimed to qualitatively analyse multiple stakeholders' views on PPI, including potential concerns, barriers and approaches. Methods This study involved conducting focus group interviews and collecting qualitative data from 37 participants in multiple stakeholder groups (patients = 6, caregivers = 5, service providers = 7, government staff = 5 and researchers = 14) in the community mental health field. The data were qualitatively analysed using a data‐driven approach that derived domains, themes and subthemes related to perspectives on PPI and to specific challenges and approaches for implementing PPI. Results The qualitative analysis identified four domains. The ‘Positive views and expectations regarding PPI’ domain consisted of themes related to supportive views of PPI in a mental health service research setting and improvements in the quality of research and service. The ‘General concerns about PPI’ domain included themes concerning the need for non‐PPI research and tokenism, excessive expectations concerning social changes and use of evidence from PPI research, and heavy burdens resulting from PPI. The ‘Specific issues regarding the implementation of PPI’ domain consisted of four themes, including academic systems, selection methods (e.g., representativeness and conflict of interest issues), relationship building, and ambiguous PPI criteria. In particular, all stakeholder groups expressed concerns about relational equality during PPI implementation in Japan. The ‘Approaches to PPI implementation’ domain included themes such as facilitating mutual understanding, creating a tolerant atmosphere, establishing PPI support systems (e.g., training, ethics and human resource matching) and empowering patient organizations. Conclusion The study replicated most of the barriers and approaches to PPI reported by qualitative research in Western counties. However, utilization of evidence produced by PPI research and partnership in the PPI process may be particularly serious issues in Japan. Future PPI studies should carefully address solutions that fit each culture. Patient or Public Contribution A patient‐researcher was involved in all stages of this project, from development of the research topic and the protocol to manuscript preparation

Polyurethanes containing platinum in the main chain : Synthesis, structure and mechanofluorochromism

Hydroxy-tethered platinum(II) complexes were synthesized and used as diol monomers for polyurethane synthesis. Polyurethanes with moderate molecular weights were obtained by the conventional polyaddition with a diisocyanate. The polyurethane containing platinum(II) complex substituted with t-Bu groups was well soluble in common organic solvents including CHCl₃ and tetrahydrofuran. Segmented polyurethanes containing platinum(II) complex moieties were also synthesized using polytetrahydrofuran and 1,4-butanediol. They showed good elastic properties. The non-segmented polyurethane exhibited distinguishable photoluminescence changes upon grinding in the solid state, while the segmented polyurethanes did not.This research was financially supported by JSPS KAKENHI Grant Number JP21K05203, the Kansai University Fund for Supporting Young Scholars, 2021