Patients as Consumers: Making the Health Care System Our Own. 9th Annual Herbert Lourie Memorial Lecture on Health Policy.

I ask you to think about our health care system. Think beyond the issues that are in front of us today: the anxiety we have about managed care, obtaining our own health care and paying for it, the survival of Medicare, and the unpredictable impact of government regulations. Think about our *health*, what we want from our health care system, what we're spending all this money for, and what we care about for ourselves and for our families. The challenge we face in the next five, ten, or fifteen years is to place the American health care system under the control of the people who pay for it, who receive the care, and who care the most about the health of the people in our communities.

Patients as Consumers: Making the Health Care System Our Own.

I ask you to think about our health care system. Think beyond the issues that are in front of us today: the anxiety we have about managed care, obtaining our own health care and paying for it, the survival of Medicare, and the unpredictable impact of government regulations. Think about our *health*, what we want from our health care system, what we\u27re spending all this money for, and what we care about for ourselves and for our families. The challenge we face in the next five, ten, or fifteen years is to place the American health care system under the control of the people who pay for it, who receive the care, and who care the most about the health of the people in our communities

A Portrait of the Chronically Ill in America, 2001

Looks at how well Americans are living with chronic illness, how well they are able to care for themselves, and how well health professionals and healthcare organizations are delivering care to their patients

A Portrait of Adolescents in America, 2001

Examines the health and healthcare experiences of adolescents. Looks at the perceptions and behaviors that promote or threaten their health, focusing on teens that have risky health behaviors, symptoms of depression, or special healthcare needs

A Portrait of Informal Caregivers in America, 2001

Explores the experiences of caregivers of the chronically ill, including what caregivers are feeling about providing care and what they need from the healthcare and social services systems

Health Plan Quality Improvement Strategy Reporting Under the Affordable Care Act: Implementation Considerations

Outlines considerations for implementing the requirement for employer group health plans and those in the exchange to report quality improvement activities, proposes a framework for measures and reporting rules, and summarizes current assessment methods

The Clinical Utility of a Precision Medicine Blood Test Incorporating Age, Sex, and Gene Expression for Evaluating Women with Stable Symptoms Suggestive of Obstructive Coronary Artery Disease: Analysis from the PRESET Registry.

Background: Evaluating women with symptoms suggestive of coronary artery disease (CAD) remains challenging. A blood-based precision medicine test yielding an age/sex/gene expression score (ASGES) has shown clinical validity in the diagnosis of obstructive CAD. We assessed the effect of the ASGES on the management of women with suspected obstructive CAD in a community-based registry. Materials and Methods: The prospective PRESET (A Registry to Evaluate Patterns of Care Associated with the Use of Corus® CAD in Real World Clinical Care Settings) Registry (NCT01677156) enrolled 566 patients presenting with symptoms suggestive of stable obstructive CAD from 21 United States primary care practices from 2012 to 2014. Demographics, clinical characteristics, and referrals to cardiology or further functional and/or anatomical cardiac studies after ASGES testing were collected for this subgroup analysis of women from the PRESET Registry. Patients were followed for 1-year post-ASGES testing. Results: This study cohort included 288 women with a median age 57 years. The median body mass index was 29.2, with hyperlipidemia and hypertension present in 48% and 43% of patients, respectively. Median ASGES was 8.5 (range 1-40), with 218 (76%) patients having low (≤15) ASGES. Clinicians referred 9% (20/218) low ASGES versus 44% (31/70) elevated ASGES women for further cardiac evaluation (odds ratio 0.14, p < 0.0001, adjusted for patient demographics and clinical covariates). Across the score range, higher ASGES were associated with a higher likelihood of posttest cardiac referral. At 1-year follow-up, low ASGES women experienced fewer major adverse cardiac events than elevated ASGES women (1.3% vs. 4.2% respectively, p = 0.16). Conclusions: Incorporation of ASGES into the diagnostic workup demonstrated clinical utility by helping clinicians identify women less likely to benefit from further cardiac evaluation

Improving the EM Algorithm

5 pages, 1 article*Improving the EM Algorithm* (Lansky, David; Casella, George) 5 page

Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) – systematic review and meta-analysis

BACKGROUND: The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR). TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported. METHODS: This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals. RESULTS: Seven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P = 0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P <0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P = 0.460), also cardiac- and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P = 0.830). CONCLUSION: These data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR