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Danville, PA, United States

Maeng D.D.,Center for Health Research | Khan N.,PricewaterhouseCoopers | Tomcavage J.,Geisinger Health System | Graf T.R.,Geisinger Health System | And 2 more authors.
Health Affairs | Year: 2015

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care. © 2015 Project HOPE- The People-to-People Health Foundation, Inc.

Bucaloiu I.D.,Geisinger Medical Center | Kirchner H.L.,Biostatistics and Research Data core | Norfolk E.R.,Geisinger Medical Center | Hartle J.E.,Geisinger Medical Center | And 2 more authors.
Kidney International | Year: 2012

Acute kidney injury increases mortality risk among those with established chronic kidney disease. In this study we used a propensity score-matched cohort method to retrospectively evaluate the risks of death and de novo chronic kidney disease after reversible, hospital-associated acute kidney injury among patients with normal pre-hospitalization kidney function. Of 30,207 discharged patients alive at 90 days, 1610 with reversible acute kidney injury that resolved within the 90 days were successfully matched across multiple parameters with 3652 control patients who had not experienced acute kidney injury. Median follow-up was 3.3 and 3.4 years (injured and control groups, respectively). In Cox proportional hazard models, the risk of death associated with reversible acute kidney injury was significant (hazard ratio 1.50); however, adjustment for the development of chronic kidney injury during follow-up attenuated this risk (hazard ratio 1.18). Reversible acute kidney injury was associated with a significant risk of de novo chronic kidney disease (hazard ratio 1.91). Thus, a resolved episode of hospital-associated acute kidney injury has important implications for the longitudinal surveillance of patients without preexisting, clinically evident kidney disease. © 2012 International Society of Nephrology.

Shrank W.H.,Brigham and Womens Hospital | Choudhry N.K.,Harvard University | Liberman J.N.,Center for Health Research | Brennan T.A.,CVS Caremark
Health Affairs | Year: 2011

In this article we highlight the important role that medication therapy can play in preventing disease and controlling costs. Focusing on coronary artery disease, we demonstrate that prevention, with the appropriate use of generic medications, appears far more cost-effective than previously documented, and it may even save on costs. For example, an earlier study estimated that reducing blood pressure to widely established clinical guidelines in nondiabetic patients cost an estimated $52,983 per quality-adjusted life-year if a brand-name drug was used. However, we estimate that the cost is just $7,753 per quality-adjusted life-year at generic medication prices. As the nation attempts to find strategies to improve population health without adding to the unsustainably high cost of care, policy makers should focus on ensuring that patients have access to essential generic medications. © 2011 Project HOPE-The People-to-People Health Foundation, Inc.

Elder C.,Center for Health Research
The Permanente journal | Year: 2012

Participants in a randomized trial of traditional Chinese medicine (TCM) for temporomandibular joint dysfunction (TMD) had a linear decline in pain over 16 TCM visits. To investigate whether reductions in pain among participants receiving TCM can be explained by increased use of pain medications, or whether use of pain medications also declined in this group. One hundred sixty-eight participants with TMD were treated with TCM or enhanced self-care according to a stepped-care design. Those for whom self-care failed were sequentially randomized to further self-care or TCM. This report includes 111 participants during their first 16 TCM visits. The initial 8 visits occurred more than once a week; participants and practitioners determined the frequency of subsequent visits.Outcome measures: Average pain (visual analog scale, range 0-10) and morphine and aspirin dose equivalents. The sample was 87% women and the average age was 44 ± 13 years. Average pain of narcotics users (n = 21) improved by 2.73 units over 16 visits (p < 0.001). Overall narcotics use trended downward until visit 11 (-3.27 doses/week, p = 0.156), and then trended upward until week 16 (+4.29 doses/week, p = 0.264). Among those using narcotics, use of nonsteroidal anti-inflammatory drugs (NSAIDs) declined linearly over visits 1-16 (-1.94 doses/week, p = 0.002).Among the top quartile of NSAID-only users (n = 22), average pain decreased linearly over 16 visits (-1.52 units, p = 0.036). Overall NSAID doses/week declined between visits 1 and 7 (-9.95 doses/week, p < 0.001) and then remained stable through 16 visits. NSAID use also declined among the third quartile (n = 23) and remained low and stable among the lower half (sorted by total intake) of NSAID users. Among the heaviest NSAID users, we observed a short-term reduction in NSAID use that was sustained as TCM visits became less frequent. There was no indication that pain reduction during TCM treatment was influenced by drug use.

Nadkarni P.M.,Center for Health Research | Marenco L.A.,Yale University
Journal of the American Medical Informatics Association | Year: 2010

Maintaining a large controlled biomedical vocabulary requires ensuring the content's internal consistency. This is done through rules, specified by the vocabulary's curators, which denote how the vocabulary's concepts should be defined. When individual organizations deploy such vocabularies, local concepts are typically added and linked to concepts in the main vocabulary: the process of maintaining and linking local content should follow the same rules. The operation of content-maintenance software can be facilitated by maintaining such rules in computable form. In this paper, we demonstrate how to implement computable rules for attribute usage in SNOMED CT using a table-driven approach where a given rule is expressed as one or more rows in a table and is consulted by generic code. This approach, which is tailored to database implementations, is computationally efficient and allows new attribute-definition rules to be created as data while needing minimal or no code modification.

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