Strategies for Delivering Value-Based Care: Do Care Management Practices Improve Hospital Performance?

EXECUTIVE SUMMARY: Value-based payment has the potential to rein in the volume incentive inherent in fee-for-service payment by holding providers accountable for the quality of patient care they deliver. Success under the new payment structure will depend on how effectively key organizational reforms are embraced by providers in the implementation of quality improvement processes for care delivery. This study examined the relationship between implementation of care management processes (CMPs, the specific tactics that enable the practice of value-based care) and hospital performance under value-based payment. Using the American Hospital Association's Survey of Care Systems and Payment and the Centers for Medicare & Medicaid Services' Hospital Compare, we estimated the relationship between hospital implementation of CMPs and performance as it relates to spending, patient satisfaction, readmission reduction, value-based purchasing, and clinical care outcomes. We found that hospitals increased implementation of CMPs from 2013 to 2014, which has led to modest changes in performance. We concluded that care coordination is associated with greater improvements in hospital performance. However, the long-term effects of resulting changes in care delivery may differ from the short-term effects. Thus, study findings underscore the importance of continued evaluation of care management practice as a strategy for optimizing delivery of high-quality, efficient patient care.

Benefits of a physician-facing tablet presentation of patient symptom data: comparing paper and electronic formats.

BACKGROUND: Providing patient information to physicians in usable form is of high importance. Electronic presentation of patient data may have benefits in efficiency and error rate reduction for these physician facing interfaces. Using a cancer symptom measurement tool (the MD Anderson Symptom Inventory (MDASI)) we assessed the usability of patient data in its raw paper form and compared that to presentation on two electronic presentation formats of different sizes. METHODS: In two separate experiments, undergraduates completed two identical six-part questionnaires on two twenty-patient MDASI data sets. In Experiment 1, participants completed one questionnaire using a paper packet and the other questionnaire using an in-house designed iPad application. In Experiment 2, MDASI data was evaluated using an iPad and iPod Touch. Participants assessed the usability of the devices directly after use. In a third experiment, medical professionals evaluated the paper and iPad interfaces in order to validate the findings from Experiment 1. RESULTS: Participants were faster and more accurate answering questions about patients when using the iPad. The results from the medical professionals were similar. No appreciable accuracy, task time, or usability differences were observed between the iPad and iPod Touch. CONCLUSIONS: Overall, the use of our tablet interface increased the accuracy and speed that users could extract pertinent information from a multiple patient MDASI data set compared to paper. Reducing the size of the interface did not negatively affect accuracy, speed, or usability. Generalization of the results to other physician facing interfaces is discussed.

Synthesis and biological evaluation of naphthoquinone analogs as a novel class of proteasome inhibitors.

Screening of the NCI Diversity Set-1 identified PI-083 (NSC-45382) a proteasome inhibitor selective for cancer over normal cells. Focused libraries of novel compounds based on PI-083 chloronaphthoquinone and sulfonamide moieties were synthesized to gain a better understanding of the structure-activity relationship responsible for chymotrypsin-like proteasome inhibitory activity. This led to the demonstration that the chloronaphthoquinone and the sulfonamide moieties are critical for inhibitory activity. The pyridyl group in PI-083 can be replaced with other heterocyclic groups without significant loss of activity. Molecular modeling studies were also performed to explore the detailed interactions of PI-083 and its derivatives with the beta5 and beta6 subunits of the 20S proteasome. The refined model showed an H-bond interaction between the Asp-114 and the sulfonamide moiety of the PI-083 in the beta6 subunit.

Rates of Routine Cancer Screening and Diagnosis Before vs After the COVID-19 Pandemic.

This cross-sectional study analyzes patterns in the rates of routine screening and diagnosis for breast, cervical, and colorectal cancer before and after the COVID-19 pandemic.

Prevalence And Spending Associated With Patients Who Have A Behavioral Health Disorder And Other Conditions.

People with multiple medical conditions are a growing and increasingly costly segment of the U.S. POPULATION: Despite the co-occurrence of physical and behavioral health comorbidities, the US health care system tends to treat these conditions separately rather than holistically. To identify opportunities for population health improvement, we examined the treated prevalence of and health care spending on behavioral health disorders, by the number of coexisting physical disorders, among noninstitutionalized adults. The vast majority (85 percent) of spending was attributed to treatment of the physical comorbidities. Only 15 percent was attributed to treatments of the behavioral disorders; of these, a primary diagnosis of depression was most common, seen in 57 percent of the sample. These findings suggest the potential to improve outcomes and reduce spending by applying collaborative care models more broadly. Policies should promote payment and delivery reforms that advance the integration of behavioral health and primary care.

Discovery and synthesis of hydronaphthoquinones as novel proteasome inhibitors.

Screening efforts led to the identification of PI-8182 (1), an inhibitor of the chymotrypsin-like (CT-L) activity of the proteasome. Compound 1 contains a hydronaphthoquinone pharmacophore with a thioglycolic acid side chain at position 2 and thiophene sulfonamide at position 4. An efficient synthetic route to the hydronaphthoquinone sulfonamide scaffold was developed, and compound 1 was synthesized in-house to confirm the structure and activity (IC(50) = 3.0 ± 1.6 µM [n = 25]). Novel hydronaphthoquinone derivatives of 1 were designed, synthesized, and evaluated as proteasome inhibitors. The structure-activity relationship (SAR) guided synthesis of more than 170 derivatives revealed that the thioglycolic acid side chain is required and the carboxylic acid group of this side chain is critical to the CT-L inhibitory activity of compound 1. Furthermore, replacement of the carboxylic acid with carboxylic acid isosteres such as tetrazole or triazole greatly improves potency. Compounds with a thio-tetrazole or thio-triazole side chain in position 2, where the thiophene was replaced by hydrophobic aryl moieties, were the most active compounds with up to 20-fold greater CT-L inhibition than compound 1 (compounds 15e, 15f, 15h, 15j, IC(50) values around 200 nM, and compound 29, IC(50) = 150 nM). The synthetic iterations described here not only led to improving potency in vitro but also resulted in the identification of compounds that are more active such as 39 (IC(50) = 0.44 to 1.01 µM) than 1 (IC(50) = 3.54 to 7.22 µM) at inhibiting the proteasome CT-L activity in intact breast cancer cells. Treatment with 39 also resulted in the accumulation of ubiquitinated cellular proteins and inhibition of tumor cell proliferation of breast cancer cells. The hit 1 and its analogue 39 inhibited proteasome CT-L activity irreversibly.