Showing papers by "Regenstrief Institute published in 2005"
TL;DR: An evaluation of the feasibility and utility of a comprehensive screening and diagnosis program for dementia in primary care in England found it to be feasible and utility.
Abstract: BACKGROUND: Primary care physicians are positioned to provide early recognition and treatment of dementia. We evaluated the feasibility and utility of a comprehensive screening and diagnosis program for dementia in primary care. METHODS: We screened individuals aged 65 and older attending 7 urban and racially diverse primary care practices in Indianapolis. Dementia was diagnosed according to International Classification of Diseases (ICD)-10 criteria by an expert panel using the results of neuropsychologic testing and information collected from patients, caregivers, and medical records. RESULTS: Among 3,340 patients screened, 434 scored positive but only 227 would agree to a formal diagnostic assessment. Among those who completed the diagnostic assessment, 47% were diagnosed with dementia, 33% had cognitive impairment—no dementia (CIND), and 20% were considered to have no cognitive deficit. The overall estimated prevalence of dementia was 6.0% (95% confidence interval (CI) 5.5% to 6.6%) and the overall estimate of the program cost was $128 per patient screened for dementia and $3,983 per patient diagnosed with dementia. Only 19% of patients with confirmed dementia diagnosis had documentation of dementia in their medical record. CONCLUSIONS: Dementia is common and undiagnosed in primary care. Screening instruments alone have insufficient specificity to establish a valid diagnosis of dementia when used in a comprehensive screening program; these results may not be generalized to older adults presenting with cognitive complaints. Multiple health system and patient-level factors present barriers to this formal assessment and thus render the current standard of care for dementia diagnosis impractical in primary care settings.
271 citations
TL;DR: The aim of this study is to determine the effect of collaborative care management for depression on physical functioning in older adults and to establish a baseline for this study.
Abstract: 0.7; 45% of participants rated their health as fair or poor. Intervention patients experienced significantly better physical functioning at 1 year than usual-care patients as measured using between-group differences on the PCS of 1.71 (95% confidence interval (CI) 5 0.96–2.46) and IADLs of � 0.15 (95% CI 5 � 0.29 to � 0.01). Intervention patients were also less likely to rate their health as fair or poor (37.3% vs 52.4%,Po.001). Combining both study groups, patients whose depression improved were more likely to experience improvement in physical functioning. CONCLUSION: The IMPACT collaborative care model for late-life depression improves physical function more than usual care. J Am Geriatr Soc 53:367–373, 2005.
201 citations
TL;DR: The presence of multiple comorbid medical illnesses did not affect patient response to a multidisciplinary depression treatment program and the IMPACT collaborative care model was equally effective for depressed older adults with or without comorbrid medical illnesses.
176 citations
TL;DR: Endoscopic therapy is superior to medical therapy for preventing recurrent hemorrhage in patients with bleeding peptic ulcers and adherent clots.
147 citations
TL;DR: Care suggestions shown to physicians and pharmacists on computer workstations had no effect on the delivery or outcomes of care for patients with reactive airways disease.
Abstract: In 2001, the Institute of Medicine documented the gap between recommended and actual practice of medicine in the United States (Institute of Medicine 2001). Many proven interventions were not routinely being used. Reactive airways diseases, asthma and chronic obstructive pulmonary disease (COPD), are an example. They are common, morbid, and costly conditions (McFadden and Gilbert 1992). Despite widely accepted evidence-based treatment guidelines (Canadian Thoracic Society Workshop Group 1992; National Asthma Education Program Expert Panel Report. Executive Summary: Guidelines for the Diagnosis and Management of Asthma 1994), many physicians do not prescribe such treatments to patients who might benefit from them (Cabana et al. 2001).
The Institute of Medicine has also stated that electronic medical record systems are “an essential technology for health care” (Institute of Medicine, Committee on Improving the Medical Record 1991) that could improve medical practice (Johnston et al. 1994; Tierney 2001). However, clinical information systems are expensive (Dambro, Weiss, and McClure 1988), potentially intrusive (Krall and Sittig 2001), and have not always improved care (Johnston et al. 1994). We have previously shown that computer-based interventions can increase preventive care (McDonald et al. 1984; Tierney, Hui, and McDonald 1986; McDonald et al. 1999; Tierney 2001) and reduce costs (Tierney, Miller, and McDonald 1990; Tierney et al. 1993). We have had less success affecting chronic management of renal disease (Harris et al. 1998) or heart disease (Tierney et al. 2003; Subramanian et al. 2004). We assessed whether guideline-based care suggestions delivered via physicians' and pharmacists' computer workstations could improve the outpatient management and outcomes among patients with asthma or COPD.
138 citations
TL;DR: Significant hepatotoxicity from lovastatin was very infrequent in this study, and individuals with elevated baseline liver enzyme levels did not have higher frequency of Lovastatin hepatot toxicity than those with normal liver enzymes levels.
134 citations
TL;DR: The findings suggest that the patient-centered format may improve printed medication instructions available in many pharmacies, which should help older adults to better understand how to take their medications.
Abstract: Purpose We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure. Design and methods Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the same medications from a chain pharmacy (standard pharmacy instructions). Thirty-two adults (age, M = 63.8) read and answered questions about each instruction, recalled medication information (free recall), and then answered questions from memory (cued recall). Results Patient-centered instructions were better recalled and understood more quickly than the standard instructions. Instructions for the familiar medications also were better recalled. Patient-centered instructions were understood more accurately for the unfamiliar medications, but standard instructions were understood more accurately for the familiar medications. However, the recall measures showed that the advantage of the standard format for familiar medications was short lived. Implications The findings suggest that the patient-centered format may improve printed medication instructions available in many pharmacies, which should help older adults to better understand how to take their medications.
133 citations
TL;DR: The development and structure of this EMR, designed with input from clinicians who understand the local community and constraints of providing care in resource poor settings, is described and plans for future development that include wireless connections, tablet computers, and migration to a Web-based platform are described.
122 citations
TL;DR: Physical symptoms are highly prevalent in older primary care patients and predict hospitalization and mortality at one year and future work is needed to determine how to target symptoms as a potential mechanism to reduce health care use and mortality.
102 citations
TL;DR: Critical elements that promote the teaching of humanistic care include establishing a humanistic learning climate, creating clear individualized learning goals within a framework of humanism, developing an educational diagnosis of the learner, and integrating psychosocial issues into the teaching intervention.
Abstract: Humanistic medical care is an important element of quality health care, and teaching humanism is increasingly recognized as an integral component of medical education. The goal of this article is to illustrate a series of tools that are effective in fostering both the provision and teaching of humanistic medical care in the ambulatory setting. Through a series of discussions, workshops, literature review, and practice, the authors have identified critical elements that promote the teaching of humanistic care. These elements include establishing a humanistic learning climate, creating clear individualized learning goals within a framework of humanism, developing an educational diagnosis of the learner, integrating psychosocial issues into the teaching intervention, reflecting on the learning experience with the learner, providing feedback throughout the teaching encounter, and planning follow-up with the learner. Strategies for implementation of these critical elements are presented with an emphasis on efficient educational interactions as required by busy ambulatory settings. Through the effective use of these teaching strategies, one can promote the teaching of the human dimensions of care in the outpatient setting.
77 citations
TL;DR: Results of this study show that it is possible to increase SFDs in children and move organizations toward guideline recommendations on asthma control in settings where most children are receiving controller medications at baseline, however, the improvements were realized with an increase in the costs associated with asthma care.
Abstract: Background A decision to implement innovative disease management interventions in health plans often requires evidence of clinical benefit and financial impact. The Pediatric Asthma Care Patient Outcomes Research Team II trial evaluated 2 asthma care strategies: a peer leader–based physician behavior change intervention (PLE) and a practice-based redesign called the planned asthma care intervention (PACI). Objective To estimate the cost-effectiveness of the interventions. Methods This was a 3-arm, cluster randomized trial conducted in 42 primary care practices. A total of 638 children (age range, 3-17 years) with mild to moderate persistent asthma were followed up for 2 years. Practices were randomized to PLE (n = 226), PACI (n = 213), or usual care (n = 199). The primary outcome was symptom-free days (SFDs). Costs included asthma-related health care utilization and intervention costs. Results Annual costs per patient were as follows: PACI, $1292; PLE, $504; and usual care, $385. The difference in annual SFDs was 6.5 days (95% confidence interval [CI], −3.6 to 16.9 days) for PLE vs usual care and 13.3 days (95% CI, 2.1-24.7 days) for PACI vs usual care. Compared with usual care, the incremental cost-effectiveness ratio was $18 per SFD gained for PLE (95% CI, $5.21-dominated) and $68 per SFD gained for PACI (95% CI, $37.36-$361.16). Conclusions Results of this study show that it is possible to increase SFDs in children and move organizations toward guideline recommendations on asthma control in settings where most children are receiving controller medications at baseline. However, the improvements were realized with an increase in the costs associated with asthma care.
Proceedings Article•
01 Jan 2005TL;DR: It is concluded that electronic note templates can improve the timeliness and comprehensiveness of operative documentation, while decreasing transcription costs and requiring minimal additional effort on the part of surgeons.
Abstract: Surgeons typically document operative events using dictation services Dictated reports are frequently incomplete or delayed Electronic note templates could potentially improve this process Using a study design of alternating four week blocks, we compared the timeliness and comprehensiveness of operative notes created through the use of electronic templates (structured text documents for reuse) versus dictation services for five surgical procedures Templates resulted in dramatically faster times to the presence of a verified operative report in the medical record compared to dictation services (mean 28 v 22,440 minutes) Templates increased overall compliance with national standards for operative note documentation and avoided transcription costs Documentation with templates took slightly more time than dictation (mean 677 v 596 minutes; P=0036), not including the additional time necessary to subsequently verify dictated reports We conclude that electronic note templates can improve the timeliness and comprehensiveness of operative documentation, while decreasing transcription costs and requiring minimal additional effort on the part of surgeons
TL;DR: The critical policy action is the identification of a "common framework" of standards and policies, maintained by a new Standards and Policy Entity that reflects both public- and private-sector participation.
Abstract: The fragmentation of our health care system, our need to accommodate the diversity of existing health information exchanges, the lack of consistent implementation of clinical information standards,...
TL;DR: Care for behavioral symptoms related to dementia (BSRD) and their potential correlates among residents with dementia living in 45 assisted living facilities and nursing homes from four states are described and attention to staff training and depression management might improve BSRD.
Abstract: This article describes care for behavioral symptoms related to dementia (BSRD) and identifies their potential correlates among 347 residents with dementia living in 45 assisted living facilities and nursing homes from four states. The prevalence of BSRD was associated with staff training and resident cognition, mood, mobility, and psychotropic use. Attention to staff training and depression management might improve BSRD.
TL;DR: Baseline impairment may increase the risk for SSRI antidepressant switching and patients who discontinued were significantly less likely to be depressed 9 months after starting medication than those who either continued or switched medication, and were less symptomatic and impaired than patients who switched.
TL;DR: This analysis showed a slight increase in ambulatory asthma visits as a result of asthma care improvement interventions, using automated data, and the absence of detectable impact on medication use at the practice level differs from the positive intervention effect observed in patient self-reported data from trial enrollees.
Abstract: Asthma is responsible for substantial morbidity as measured by symptom burden, functional impairment (Fowler, Davenport, and Garg 1992; Maier et al. 1998; Newacheck and Halfon 2000; Annett 2001), and health care utilization (Lozano et al. 1997; Weiss, Sullivan, and Lyttle 2000) among 5.6 percent of U.S. children (Mannino et al. 2002). Treatment guidelines, developed by the National Asthma Education and Prevention Project (NAEPP), were designed to improve and standardize diagnosis and treatment. These were initially promulgated in 1991 (National Asthma Education Program 1991) and revised in 1997 (National Asthma Education and Prevention Program 1997). However, a number of studies have documented suboptimal care for children with asthma, well after their publication (Jatulis et al. 1998; Legoretta et al. 1998; Finkelstein et al. 2000, 2002; Diette et al. 2001). Some of the reasons for slow guideline adoption have been well-documented (Lomas et al. 1989; Cabana et al. 1999), and are not surprising given the limited ability of passive dissemination strategies to change physician behavior (Davis et al. 1995; Soumerai, Mujumdar, and Lipton 2000).
The Pediatric Asthma Care Patient Outcomes Research Team (PAC PORT) designed and fielded a randomized controlled trial to test two strategies for implementation of the NAEPP guidelines in primary care practices belonging to one of three geographically separated health systems. One strategy used practice-based physician peer leader education (PLE) to engage and activate a physician change agent within a practice group. The other involved a more comprehensive intervention that similarly trained peer leaders, but added an asthma nurse educator to implement organizational change (Planned Asthma Care) within the practice, based, in part, on a model for the optimal treatment of chronic disease (Wagner 1998; Bodenheimer, Wagner, and Grumbach 2002). Previously published parent-reported outcomes of the interventions included fewer symptom days, by parent report (using 14-day recall periods), among enrollees in the PLE and Planned Care practices of 6.5 (CI: −16.9, 3.6) and 13.3 (CI: −24.7, 2.1) days per year, respectively, as well as lower rates of steroid bursts in the two intervention arms (Lozano et al. 2004). As both interventions attempted to change physician behavior and asthma management strategies in a practice overall, they might have been expected to improve asthma care for all of the children served by the practice, not only the 638 trial enrollees from whom detailed self-reported longitudinal outcome data were collected.
Because the participating practices were affiliated with managed health care plans, automated data were available for measurement of medication dispensing and health care utilization outcomes on the entire population served by a practice. The specific aims of the current analysis were to determine the effect of each intervention on (1) the rates of appropriate controller medication use (primary outcome); (2) asthma exacerbations as measured by dispensings of oral steroid courses; and (3) medical care utilization including hospital-based and ambulatory visits.
TL;DR: Primary care providers agreed with less than half of computer-generated care suggestions from evidence-based CHF guidelines, most often because the suggestions were felt to be inapplicable to their patients or unlikely to be tolerated.
Abstract: Objectives: We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF). Methods: This study is an analysis of primary care providers’ responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding patients with CHF, with or without inclusion of patient symptom data obtained from previsit questionnaires. At one center, providers were asked to respond to the suggestions with hand-written comments and a numerical agreement scale. Results: Providers responded to 774 care suggestions (62% of the 1246 delivered). They agreed with 41%, had major disagreements with 12%, and had minor disagreements with 22%. For 7% of the care suggestions, providers asked to not see it again for that patient. The most common reasons for major or minor disagreements were a belief that the suggestion was wrong or unnecessary (45%) or would not be tolerated by the patient (32%). External barriers to implementation of guidelines, lack of guideline awareness, or disagreement with guidelines were uncommon reasons cited by providers in this study. Conclusions: Providers agreed with less than half of computer-generated care suggestions from evidence-based CHF guidelines, most often because the suggestions were felt to be inapplicable to their patients or unlikely to be tolerated.
TL;DR: Most surveyed hospitals had implemented some measures to address the NFID–CDC recommendations; however, hospitals need to do much more to improve antimicrobial use and to increase their efforts to detect, report, and control the spread of antimicrobial resistance.
Abstract: OBJECTIVE: To examine the extent to which the strategies recommended by the National Foundation for Infectious Diseases (NFID)-Centers for Disease Control and Prevention (CDC) co-sponsored workshop, Antimicrobial Resistance in Hospitals: Strategies to Improve Antimicrobial Use and Prevent Nosocomial Transmission of Antimicrobial-Resistant Microorganisms, have been implemented and the relationship between the degree of implementation and hospital culture, leadership, and organizational factors. DESIGN: Survey. SETTING: A representative sample of U.S. hospitals stratified by teaching status, bed size, and geographic region. PARTICIPANTS: Infection control professionals. RESULTS: Surveyed hospitals had implemented strategies to optimize the use of antimicrobials and to detect, report, and prevent transmission of antimicrobial-resistant microorganisms. Multivariate analyses found that hospitals with a greater degree of implementation of the NFID-CDC strategic goals were more likely to have management support, education of staff, and interdisciplinary groups specifically to address these issues; they were also more likely to engage in benchmarking on broader quality of care indicators. CONCLUSIONS: Most surveyed hospitals had implemented some measures to address the NFID-CDC recommendations; however, hospitals need to do much more to improve antimicrobial use and to increase their efforts to detect, report, and control the spread of antimicrobial resistance. A supportive hospital administration must foster a culture of ongoing support, education, and interdisciplinary work groups focused on this important issue to successfully accomplish these goals.
TL;DR: It is suggested that diabetics with elevated baseline liver enzymes do not have a higher risk of hepatotoxicity from rosiglitazone than those with normal enzymes.
TL;DR: There is only slight agreement between patient-derived and clinician-assigned NYHA functional class, and a different approach with patients may be needed if providers hope to use patients' reports to identify those at risk for hospitalization.
TL;DR: A two-stage, telephonic approach involving the PHQ-8 instrument for Medicaid members with either depressed mood or anhedonia could identify two clinically depressed persons for every nine members screened.
Proceedings Article•
01 Jan 2005TL;DR: This work describes the 4-year implementation plan for the Indiana Network for Patient Care, including the design rationale and how it plan to address the specific implementation challenges of data collection, connectivity in diverse environments and current hospital buy-in.
Abstract: Although many organizations are beginning to develop strategies to implement and study regional and national health information exchanges, there are few operational examples to date. The Indiana Network for Patient Care (INPC) is an example of a currently operational Regional Health Information Organization (RHIO) built upon a foundation of open, robust healthcare information standards. Having demonstrated the scalability of this design, the Indiana State Department of Health (ISDH) contracted with the Regenstrief Institute to implement a statewide disease surveillance system incorporating encounter data from all 114 Indiana hospitals with emergency departments. We describe the 4-year implementation plan, including our design rationale and how we plan to address the specific implementation challenges of data collection, connectivity in diverse environments and current hospital buy-in. To date, 42 hospitals are in various stages of engagement, with 33 hospitals actively providing real-time surveillance data. We will discuss how this project creates the foundation for a potential statewide health information exchange.
Journal Article•
TL;DR: The results suggest that the variable nature of asthma may affect how the HEDIS performance measure should be used for assessing quality of care and the period between identification of the target population and performance assessment should be closely related in time.
Abstract: BACKGROUND The most widely used performance measure for asthma, the Health Plan Employer Data and Information Set (HEDIS), has been criticized because the delay between classification (year 1) and assessment of medication dispensing (year 2) may produce a "misalignment" and weaken the validity of the measure. OBJECTIVE To examine whether a previously observed association between the HEDIS performance measure and asthma-related emergency department visits is robust when the period between the classification and outcome assessment is evaluated during a 2-year period as defined. METHODS Children (N = 2766) aged 3 to 15 years enrolled in 1 of 3 managed care organizations with at least 1 asthma diagnosis listed for a hospitalization, an emergency department visit, or an ambulatory encounter and at least 2 consecutive years of data for analysis from July 1996 through June 1999 were identified. RESULTS Children did not consistently meet the HEDIS criteria for persistent asthma, and 24% to 28% of children did not requalify in year 2 of observation. Multivariate regression models showed that a protective relationship between controller medication dispensing and asthma-related emergency department visits was no longer seen among children meeting the HEDIS criteria for persistent asthma when the total period of observation is extended to 2 years (odds ratio, 0.7; 95% confidence interval, 0.4-1.2). CONCLUSIONS Our results suggest that the variable nature of asthma may affect how the HEDIS performance measure should be used for assessing quality of care. The period between identification of the target population and performance assessment should be closely related in time.
TL;DR: An electronic medical records system can be used instead of chart review to measure use of β-blockers after myocardial infarction, and this should lead to integration of real time automated performance measurement into electronicmedical records.
Abstract: Objective: Electronic medical records seldom integrate performance indicators into daily operations. Assessing quality indicators traditionally requires resource intensive chart reviews of small samples. We sought to use an electronic medical record to assess use of s-adrenergic antagonist medications (s-blockers) following myocardial infarction, to compare a standardized manual assessment with assessment using electronic medical records, and to discuss potential for future integration of performance indicators into electronic records.
Design: Cross-sectional data analysis.
Setting: An urban academic medical center.
Participants: US Medicare beneficiaries 65 years of age or older, admitted to hospital with myocardial infarction between 1995 and 1999.
Measurements and main results: Manual chart review was compared with a computer driven assessment of electronic records. Administration of s-blockers and cases excluded from use of s-blockers were measured, based on Medicare criteria. Among 4490 older adults, 391 (4%) of 9018 hospital admissions contained codes for myocardial infarction. In 323 (83%) of the 391 hospital admissions, criteria for excluding s-blockers were met; 235 (60%) were excluded due to heart failure. Of 68 hospital admissions for myocardial infarction that did not meet exclusion criteria, physicians prescribed s-blockers in 49 (72%) on admission and 42 (62%) at discharge. Compared with manual chart review, electronic review had a sensitivity of 83–100% and led to fewer false negative findings.
Conclusions: An electronic medical records system can be used instead of chart review to measure use of s-blockers after myocardial infarction. This should lead to integration of real time automated performance measurement into electronic medical records.
TL;DR: Current adherence rates and the organizational factors related to provider adherence to the COPD guideline are described and organizations can play an important role in providing a supportive climate to facilitate their providers' adherence to guidelines.
Abstract: Rationale, aims and objectives A clinical practice guideline for chronic obstructive pulmonary disease (COPD) was implemented in all Veterans Health Administration (VHA) hospitals in the US. The aim of the current analyses is to describe current adherence rates and the organizational factors related to provider adherence to the COPD guideline. Methods We administered a survey to key informants that assessed adherence to the COPD guideline, approaches to disseminating and implementing the COPD guideline, providers’ views of the COPD guideline and guidelines in general, and attitudes about the organizational climate. Results Surveys were returned by 242 key informants (58%) at 130 of the 143 VHA hospitals (91%). Adherence to the COPD clinical practice guideline is perceived by quality managers within the VHA to be good. The final multivariable predictor model identified five measures that were related to provider adherence with the COPD guideline (R 2 = 0.43): responsibilities were changed to support adherence to the COPD guideline, physicians believe that guidelines implemented in the past year were applicable to their practice, patient care providers consistently participate in activities to improve the quality of care, the regional network office monitors the pace at which guidelines are implemented, and there is a system to provide feedback on routinely collected guideline adherence data collected in addition to External Peer Review Program data. Conclusions Organizations can play an important role in providing a supportive climate to facilitate their providers’ adherence to guidelines by implementing processes and culture changes that involve these five measures.
Proceedings Article•
01 Jan 2005TL;DR: The special query tool as developed for the Indianapolis/Regenstrief SPIN node, integrated into the ever-expanding Indiana Network for Patient care (INPC) allows for the retrieval of de-identified data sets using complex logic, auto-coded final diagnoses, and intrinsically supports multiple types of statistical analyses.
Abstract: The Shared Pathology Informatics Network (SPIN), a research initiative of the National Cancer Institute, will allow for the retrieval of more than 4 million pathology reports and specimens. In this paper, we describe the special query tool as developed for the Indianapolis/Regenstrief SPIN node, integrated into the ever-expanding Indiana Network for Patient care (INPC). This query tool allows for the retrieval of de-identified data sets using complex logic, auto-coded final diagnoses, and intrinsically supports multiple types of statistical analyses. The new SPIN/INPC database represents a new generation of the Regenstrief Medical Record system – a centralized, but federated system of repositories.
TL;DR: Patients with diabetes showed a trend toward declining 1-year post-MI mortality rate that was not significantly different from that seen in patients without diabetes, and further work needs to be done to narrow the gap between the two groups.
TL;DR: Women were more likely than men to respond correctly to name-of-this-place and mother's-maiden-name items and African Americans were morelikely than Whites to correctly give their correct telephone numbers.
Abstract: This secondary data analysis investigated differential item functioning (DIF) in the Short Portable Mental Status Questionnaire (SPMSQ) across demographic subgroups. The study was conducted at an academic primary care group practice on 3,954 patients aged 60 years and older who completed the SPMSQ during routine office visits. After adjusting for overall cognitive ability, women were more likely than men to respond correctly to name-of-this-place andmother's-maiden-name items. African Americans were more likely than Whites to correctly give their correct telephone numbers. Those with 0 to 8 years of education were less likely to name the current president and correctly answer the serial-threes item than those with 12 or more years of education. Those aged 80 or older were less likely to correctly identify the day of the week than those aged 60 to 69. Future studies seeking to develop newcognitive screening measures should perform DIF analyses in the instrument development phase to eliminate DIF items a pr...
TL;DR: This simple model based on readily available administrative data stratified Medicaid members according to predicted future utilization as well as more complicated models.
Abstract: Objective:The objective of this study was to compare the ability of risk stratification models derived from administrative data to classify groups of patients for enrollment in a tailored chronic disease management program.Subjects:This study included 19,548 Medicaid patients with chronic heart fail
TL;DR: This research aims to review the literature relating to the use of acetyl cholinesterase inhibitors in Parkinson's disease dementia and to establish a causative mechanism behind the disease.
Abstract: Objective: To review the literature relating to the use of acetyl cholinesterase inhibitors in Parkinson's disease dementia (PDD). Method: MEDLINE (1966 – December 2004), PsychINFO (1972 – December 2004), EMBASE (1980 – December 2004), CINHAL (1982 – December 2004), and the Cochrane Collaboration were searched in December 2004. Results: Three controlled trials and seven open studies were identified. Efficacy was assessed in three key domains: cognitive, neuropsychiatric and parkinsonian symptoms. Conclusion: Cholinesterase inhibitors have a moderate effect against cognitive symptoms. There is no clear evidence of a noticeable clinical effect against neuropsychiatric symptoms. Tolerability including exacerbation of motor symptoms – in particular tremor – may limit the utility of cholinesterase inhibitors.