The American Journal of Managed Care 

About: The American Journal of Managed Care is an academic journal published by Managed Care and Healthcare Communications. The journal publishes majorly in the area(s): Health care & Managed care. It has an ISSN identifier of 1088-0224. Over the lifetime, 4235 publications have been published receiving 91579 citations. The journal is also known as: AJMC.

Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days.

Abstract: Objectives To determine whether hospitals where patients report higher overall satisfaction with their interactions among the hospital and staff and specifically their experience with the discharge process are more likely to have lower 30-day readmission rates after adjustment for hospital clinical performance. Study design Among patients 18 years or older, an observational analysis was conducted using Hospital Compare data on clinical performance, patient satisfaction, and 30-day risk-standardized readmission rates for acute myocardial infarction, heart failure, and pneumonia for the period July 2005 through June 2008. Methods A hospital-level multivariable logistic regression analysis was performed for each of 3 clinical conditions to determine the relationship between patient-reported measures of their satisfaction with the hospital stay and staff and the discharge process and 30-day readmission rates, while controlling for clinical performance. Results In samples ranging from 1798 hospitals for acute myocardial infarction to 2562 hospitals for pneumonia, higher hospital-level patient satisfaction scores (overall and for discharge planning) were independently associated with lower 30-day readmission rates for acute myocardial infarction (odds ratio [OR] for readmission per interquartile improvement in hospital score, 0.97; 95% confidence interval [CI], 0.94-0.99), heart failure (OR, 0.96; 95% CI, 0.95-0.97), and pneumonia (OR, 0.97; 95% CI, 0.96-0.99). These improvements were between 1.6 and 4.9 times higher than those for the 3 clinical performance measures. Conclusions Higher overall patient satisfaction and satisfaction with discharge planning are associated with lower 30-day risk-standardized hospital readmission rates after adjusting for clinical quality. This finding suggests that patient-centered information can have an important role in the evaluation and management of hospital performance.

Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization.

Abstract: Among the 20 million Americans with diabetes, microvascular and macrovascular complications result in enormous morbidity, 1-4 disability,5 and mortality.6-8 Diabetes complications account for more than 35% of the estimated $91.8 billion in direct medical expenditures for this disease.9 Although much research has addressed individual complications, end-organ complications usually develop simultaneously or consecutively in a patient with diabetes rather than independently.10 Thus, an indicator that captures the severity or type of complications may be more powerful in predicting mortality and hospitalization than a simple count of complications. Few attempts have been made to quantify the overall severity of diabetes complications in a reproducible fashion for risk assessment, or for prediction of mortality or future treatment needs and costs.11 Risk equations have been developed to predict adverse cardiovascular outcomes12,13 and to identify high-risk patients to target for intervention.14 However, these risk models considered only cardiovascular disease risk factors and not the broader array of diabetes complications that can now be assessed in large populations enrolled in health plans with automated medical records. Because it is well established that diabetes contributes to increased morbidity and mortality in the general population,15-19 a logical next step is to use information relevant to the degree of progression of the disease to assess the level of risk for adverse outcomes, including hospitalization and mortality. Given that healthcare organizations have limited resources to invest in creating disease management interventions for high-risk patients with diabetes, it is important to develop models to predict which patients are at highest risk of adverse medical outcomes. In this study, we sought to develop a method of assessing the level of risk for diabetes adverse outcomes, including hospitalization and mortality, from automated medical record data on diabetes complications. To quantify the severity of complications and to potentially better predict the risk of adverse outcomes, we developed and employed the Diabetes Complications Severity Index (DCSI). The DCSI is a 13-point scale scored from automated diagnostic, pharmacy, and laboratory data. We compared the DCSI with a simple count of diabetes complications to assess whether a severity index of diabetes complications based on clinical diagnoses would improve the prediction of adverse diabetes outcomes.

New medication adherence scale versus pharmacy fill rates in seniors with hypertension.

Abstract: Objective The availability of self-report scales that accurately identify low adherers to antihypertensive medication in real time could improve outpatient management of this disease. We evaluated the association and concordance of the new 8-item self-report Morisky Medication Adherence Scale (MMAS) with pharmacy fill data in a sample of community dwelling seniors with hypertension.

A meta-analysis of interventions to improve care for chronic illnesses.

Abstract: OBJECTIVE The Chronic Care Model (CCM) is a framework aimed at improving chronic illness care. We used empirical data from previously published literature to address two research questions: 1) do interventions that incorporate one or more elements of the CCM result in improved outcomes of interest for specific chronic illnesses; and 2) are any elements essential for improved outcomes?

Overactive bladder significantly affects quality of life.

Abstract: Overactive bladder (OAB), with symptoms of frequency, urgency, and urge incontinence, substantially affects the lives of millions of people The symptoms associated with OAB can significantly affect the social, psychological, occupational, domestic, physical, and sexual aspects of those who suffer from it Unfortunately, many sufferers are reluctant to discuss their condition with their healthcare provider or family members As a result, OAB remains underreported, despite increased awareness and improved diagnosis and treatment Health-related quality of life can be measured objectively, and several instruments have been developed, validated, and used in research Currently, there are 2 major types of quality-of-life questionnaires: generic and disease specific Although these questionnaires have been helpful and are widely used, the goal is to establish a single questionnaire that is acceptable throughout the world for use by urologists, gynecologists, urogynecologists, geriatricians, and epidemiologists