Strategies to increase appropriate prescribing.

<p>✓ = yes; X = no.</p><p>* may not be available for all conditions.</p

Additional file 1: of Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis

Appendix 1. PubMed search strategy. (DOCX 15 kb

Association between Drug Insurance Cost Sharing Strategies and Outcomes in Patients with Chronic Diseases: A Systematic Review

<div><p>Background</p><p>Prescription drugs are used in people with hypertension, diabetes, and cardiovascular disease to manage their illness. Patient cost sharing strategies such as copayments and deductibles are often employed to lower expenditures for prescription drug insurance plans, but the impact on health outcomes in these patients is unclear.</p><p>Objective</p><p>To determine the association between drug insurance and patient cost sharing strategies on medication adherence, clinical and economic outcomes in those with chronic diseases (defined herein as diabetes, hypertension, hypercholesterolemia, coronary artery disease, and cerebrovascular disease).</p><p>Methods</p><p>Studies were included if they examined various cost sharing strategies including copayments, coinsurance, fixed copayments, deductibles and maximum out-of-pocket expenditures. Value-based insurance design and reference based pricing studies were excluded. Two reviewers independently identified original intervention studies (randomized controlled trials, interrupted time series, and controlled before-after designs). MEDLINE, EMBASE, Cochrane Library, CINAHL, and relevant reference lists were searched until March 2013. Two reviewers independently assessed studies for inclusion, quality, and extracted data. Eleven studies, assessing the impact of seven policy changes, were included: 2 separate reports of one randomized controlled trial, 4 interrupted time series, and 5 controlled before-after studies.</p><p>Findings</p><p>Outcomes included medication adherence, clinical events (myocardial infarction, stroke, death), quality of life, healthcare utilization, or cost. The heterogeneity among the studies precluded meta-analysis. Few studies reported the impact of cost sharing strategies on mortality, clinical and economic outcomes. The association between patient copayments and medication adherence varied across studies, ranging from no difference to significantly lower adherence, depending on the amount of the copayment.</p><p>Conclusion</p><p>Lowering cost sharing in patients with chronic diseases may improve adherence, but the impact on clinical and economic outcomes is uncertain.</p></div

The association between cost sharing and drug and non-drug expenditures.

<p>The association between cost sharing and drug and non-drug expenditures.</p

Additional file 2: of Palliative care in the home: a scoping review of study quality, primary outcomes, and thematic component analysis

Table S1. Included study characteristics. (DOCX 48 kb

Flow diagram depicting included and excluded studies for the qualitative systematic review.

<p>Flow diagram depicting included and excluded studies for the qualitative systematic review.</p

The association between cost sharing and clinically relevant outcomes.

<p>The association between cost sharing and clinically relevant outcomes.</p

Incidence of Appendicitis over Time: A Comparative Analysis of an Administrative Healthcare Database and a Pathology-Proven Appendicitis Registry

<div><p>Importance</p><p>At the turn of the 21^st century, studies evaluating the change in incidence of appendicitis over time have reported inconsistent findings.</p><p>Objectives</p><p>We compared the differences in the incidence of appendicitis derived from a pathology registry versus an administrative database in order to validate coding in administrative databases and establish temporal trends in the incidence of appendicitis.</p><p>Design</p><p>We conducted a population-based comparative cohort study to identify all individuals with appendicitis from 2000 to2008.</p><p>Setting & Participants</p><p>Two population-based data sources were used to identify cases of appendicitis: 1) a pathology registry (n = 8,822); and 2) a hospital discharge abstract database (n = 10,453).</p><p>Intervention & Main Outcome</p><p>The administrative database was compared to the pathology registry for the following <i>a priori</i> analyses: 1) to calculate the positive predictive value (PPV) of administrative codes; 2) to compare the annual incidence of appendicitis; and 3) to assess differences in temporal trends. Temporal trends were assessed using a generalized linear model that assumed a Poisson distribution and reported as an annual percent change (APC) with 95% confidence intervals (CI). Analyses were stratified by perforated and non-perforated appendicitis.</p><p>Results</p><p>The administrative database (PPV = 83.0%) overestimated the incidence of appendicitis (100.3 per 100,000) when compared to the pathology registry (84.2 per 100,000). Codes for perforated appendicitis were not reliable (PPV = 52.4%) leading to overestimation in the incidence of perforated appendicitis in the administrative database (34.8 per 100,000) as compared to the pathology registry (19.4 per 100,000). The incidence of appendicitis significantly increased over time in both the administrative database (APC = 2.1%; 95% CI: 1.3, 2.8) and pathology registry (APC = 4.1; 95% CI: 3.1, 5.0).</p><p>Conclusion & Relevance</p><p>The administrative database overestimated the incidence of appendicitis, particularly among perforated appendicitis. Therefore, studies utilizing administrative data to analyze perforated appendicitis should be interpreted cautiously.</p></div

Incidence of Appendicitis over Time: A Comparative Analysis of an Administrative Healthcare Database and a Pathology-Proven Appendicitis Registry - Fig 2

<p>Annual incidence of appendicitis stratified by perforated and non-perforated from cohorts derived by A) a pathology proven registry; and B) an administrative healthcare database.</p

Clinical characteristics of patients with appendicitis derived from a pathology-proven registry and from an administrative healthcare database.

<p>Clinical characteristics of patients with appendicitis derived from a pathology-proven registry and from an administrative healthcare database.</p