A Mixed-Methods Approach for Evaluating Implementation Processes and Program Costs for a Hypertension Management Program Implemented in a Federally Qualified Health Center.

Team-based care approaches are effective at improving hypertension control and have been used in clinical practice to improve hypertension outcomes. This study implemented and evaluated the Hypertension Management Program (HMP), which was originally developed in a high-resource health setting, in a health system with fewer resources and a patient population disproportionately affected by hypertension. Our objectives were to describe how a health system could adapt HMP to meet their needs and calculate total program costs. HMP uses a team-based, patient-centered approach involving clinical pharmacists who contribute to managing patients who have hypertension and ultimately preventing premature death due to uncontrolled hypertension. HMP has 10 components (e.g., EHR patient registries and outreach lists, no copayment walk-in blood pressure checks). Our project involved implementing the key components of HMP in a federally qualified health center (FQHC) in South Carolina. Adaptations from the key components of HMP were made to fit the participants' settings. A mixed-methods evaluation assessed implementation processes, program costs, and implementation facilitators and barriers. From September 2018 to December 2019, clinical pharmacists conducted 758 hypertension management visits (HMVs) with 316 patients with hypertension. Total program costs for HMP were $325,532 overall and $16,277 per month. Monthly cost per patient was $3.62. The high engagement among clinical pharmacists, along with provider engagements, followed up by the subsequent referral of patients to HMP, facilitated the implementation process. Staff members observed improvements in hypertension control, which increased participation buy-in. Barriers included staff turnover, the perception among some providers that HMP took too much time, as well as perception of HMP as a pharmacy-specific initiative. A team-based, patient-centered approach to hypertension management can be adapted for FQHCs or similar settings that serve patient populations disproportionately affected by hypertension.

Cost and Treatment Characteristics of Sport-Related Knee Injuries Managed by Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network.

CONTEXT: Knee injuries are common during sport participation. However, little is known about the overall management and estimated direct costs of care associated with these injuries when under the care of athletic trainers. OBJECTIVE: To describe the treatment characteristics and direct costs of care for athletic training services provided for patients with knee injuries. DESIGN: Descriptive study. SETTING: Ninety-five athletic training facilities across 24 states. PATIENTS OR OTHER PARTICIPANTS: A total of 117 athletic trainers (females = 56.4%, age = 29.4 ± 8.7 years, years certified = 4.7 ± 6.0, years employed at site = 1.6 ± 4.1). MAIN OUTCOME MEASURE(S): Complete patient cases were identified using International Classification of Disease-10 diagnostic codes between 2009 and 2020. Summary statistics were calculated for patient demographics, treatment characteristics, and direct costs of care. Treatment characteristics included the type of athletic training service, duration, amount (eg, number of visits), and direct costs of care. RESULTS: A total of 441 patient cases were included. The most common injuries reported were cruciate ligament sprain (18.1%, n = 80), medial collateral ligament sprain (15.4%, n = 68), and knee pain (14.1%, n = 62). Injuries occurred most frequently during football (35.4%, n = 156), basketball (14.7%, n = 65), and soccer (12.7%, n = 56). A total of 8484 athletic training services were recorded over 4254 visits, with therapeutic exercise (29.8%, n = 2530), hot or cold pack (25.8%, n = 2189), and therapeutic activities (11.2%, n = 954) being the most frequently reported services. The median duration of care was 23 days and number of visits was 8. The median total cost of care was $564 per injury and $73 per visit. CONCLUSIONS: Patients with knee injuries demonstrated greater time loss than those with other lower extremity injuries. Thus, it is unsurprising that knee injuries were associated with a longer duration and higher cost of care than other lower extremity injuries such as ankle sprains. Future researchers should examine the effectiveness of common treatment strategies and aim to identify treatments that can reduce costs and improve patient outcomes.

TWO-DIMENSIONAL VIDEO ANALYSIS IS COMPARABLE TO 3D MOTION CAPTURE IN LOWER EXTREMITY MOVEMENT ASSESSMENT.

BACKGROUND: Although 3D motion capture is considered the "gold standard" for recording and analyzing kinematics, 2D video analysis may be a more reasonable, inexpensive, and portable option for kinematic assessment during pre-participation screenings. Few studies have compared quantitative measurements of lower extremity functional tasks between 2D and 3D. PURPOSE: To compare kinematic measurements of the trunk and lower extremity in the frontal and sagittal planes between 2D video camera and 3D motion capture analyses obtained concurrently during a SLS. STUDY DESIGN: Descriptive laboratory study. METHODS: Twenty-six healthy, recreationally active adults volunteered to participate. Participants performed three trials of the single leg squat on each limb, which were recorded simultaneously by three 2D video cameras and a 3D motion capture system. Dependent variables analyzed were joint displacement at the trunk, hip, knee, and ankle in the frontal and sagittal planes during the task compared to single leg quiet standing. RESULTS: Dependent variables exhibited moderate to strong correlations between the two measures in the sagittal plane (r = 0.51-.093), and a poor correlation at the knee in the frontal plane (r = 0.308) at (p ≤ 0.05) All other dependent variables revealed non-significant results between the two measures. Bland-Altman plots revealed strong agreement in the average mean difference in the amount of joint displacement between 2D and 3D in the sagittal plane (trunk = 1.68 º, hip = 2.60 º, knee = 0.74 º, and ankle = 3.12 º). Agreement in the frontal plane was good (trunk = 7.92 °, hip = -8.72 º, knee = -6.62 º, and ankle = 3.03 °). CONCLUSION: Moderate to strong relationships were observed between 2D video camera and 3D motion capture analyses at all joints in the sagittal plane, and the average mean difference was comparable to the standard error of measure with goniometry. The results suggest that despite the lack of precision and ability to capture rotations, 2D measurements may provide a pragmatic method of evaluating sagittal plane joint displacement for assessing gross movement displacement and therein risk of lower extremity injury. LEVEL OF EVIDENCE: 3.