Population Health Management for Diabetes: Health Care System-Level Approaches for Improving Quality and Addressing Disparities.

PURPOSE OF REVIEW: Population care approaches for diabetes have the potential to improve the quality of care and decrease diabetes-related mortality and morbidity. Population care strategies are particularly relevant as accountable care organizations (ACOs), patient-centered medical homes (PCMH), and integrated delivery systems are increasingly focused on managing chronic disease care at the health system level. This review outlines the key elements of population care approaches for diabetes in the current health care environment. RECENT FINDINGS: Population care approaches proactively identify diabetes patients through disease registries and electronic health record data and utilize multidisciplinary care teams, personalized provider feedback, and decision support tools to target and care for patients at risk for poor outcomes. Existing evidence suggests that these strategies can improve care outcomes and potentially ameliorate existing race/ethnic disparities in health care. However, such strategies may be less effective for patients who are disengaged from the health care system. As population care for diabetes continues to evolve, future initiatives should consider ways to tailor population care to meet individual patient needs, while leveraging improvements in clinical information systems and care integration to optimally manage and prevent diabetes in the future.

A systematic review of economic studies on biological agents used to treat Crohn's disease.

BACKGROUND: Identifying clinical scenarios that maximize the cost-effectiveness of biological treatments can lead to optimized health care cost-saving and clinical effectiveness from a society's perspective. METHODS: Published articles between January 1995 and June 2012 were searched in PubMed, EMBASE, ABI/INFORM, Tuft's Cost-Effectiveness Analysis Registry Database, Cochrane National Health Service Economic Evaluation Database, International Pharmaceutical Abstracts, Web of Science, and Google Scholar. Studies of interest included the following: (1) cost studies, (2) economic evaluations, or (3) narrative or systematic reviews related to economic evaluations of biological treatments for moderate-to-severe Crohn's disease (CD). The primary outcomes of interest included costs associated with biological treatments and cost-effectiveness measures, including incremental cost-effectiveness ratios. A threshold of $100,000/quality-adjusted life year (£60,000/quality-adjusted life year) gained was used for treatment cost-effectiveness. RESULTS: Thirty-eight studies were identified, including 15 economic evaluations and 23 cost studies or reviews of economic evaluations. Economic evaluations found that infliximab and adalimumab were more cost-effective than standard therapy for luminal CD when provided as an induction therapy followed by episodic therapy over 5 or more years. The cost-effectiveness of infliximab and adalimumab versus standard therapy for luminal CD was less certain when used as 1-year maintenance treatment with or without previous induction therapy. Cost studies revealed that infliximab therapy reduced health care resource utilization and cost. Older reviews were inconclusive about the cost-effectiveness of biological treatments used for CD. CONCLUSIONS: Current evidence suggests that biological treatments may be cost-effective for CD under certain clinical scenarios. Future studies evaluating all biological treatments are needed to compare their respective benefits and costs.

Assessment of polychlorinated dibenzo-p-dioxins and dibenzofurans contribution from different media to surrounding duck farms.

Since the "Toxic Egg Event" broke out in central Taiwan, the possible sources of the high content of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in eggs have been a serious concern. In this study, the PCDD/F contents in different media (feed, soil and ambient air) were measured. Evaluation of the impact from electric arc furnace dust treatment plant (abbreviated as EAFDT plant), which is site-specific to the "Toxic Egg Event", on the duck total-PCDD/F daily intake was conducted by both Industrial Source Complex Short Term model (ISCST) and dry and wet deposition models. After different scenario simulations, the worst case was at farm A and at 200 g feed and 5 g soil for duck intake, and the highest PCDD/F contributions from the feed, original soil and stack flue gas were 44.92, 47.81, and 6.58%, respectively. Considering different uncertainty factors, such as the flow rate variation of stack flue gas and errors from modelling and measurement, the PCDD/F contribution fraction from the stack flue gas of EAFDT plant may increase up to twice as that for the worst case (6.58%) and become 13.2%, which was still much lower than that from the total contribution fraction (86.8%) of both feed and original soil. Fly ashes contained purposely in duck feed by the farmers was a potential major source for the duck daily intake. While the impact from EAFDT plant has been proven very minor, the PCDD/F content in the feed and soil, which was contaminated by illegal fly ash landfills, requires more attention.