[Intended utilization of health care services in cases of mental illnesses with varying urgency]. / Intendierte Inanspruchnahme von Versorgungsangeboten bei psychischen Erkrankungen mit unterschiedlicher Dringlichkeit.

OBJECTIVE: To investigate variations in intended utilization in cases of an acute psychotic episode, an alcohol related or depressive disorder depending on different case characteristics. METHODS: A telephone survey with case vignettes was conducted (N=1,200). Vignettes varied in terms of urgency of symptoms, daytime, sex of the afflicted person and age/mental disorder. The respondents were asked to indicate whom they would contact first in the described case. RESULTS: Outpatient physicians were named most frequently as the first point of contact (61.1%) while only 6.5% of the respondents named emergency medicine including the medical on call service (8.1% in high urgency cases, i. e. emergencies that did not tolerate any delay). Intended utilization varied by urgency and age/mental illness. CONCLUSION: More Information about the need to seek medical help immediately in cases of mental illnesses with high urgency should be provided.

Mental health service utilization review patterns in a Medicaid managed care program.

OBJECTIVES: The current study investigated mental health utilization review (UR) clinical service authorization requests, denials, and reasons for denial in a statewide Medicaid managed care organization (MMCO) program. STUDY DESIGN: Retrospective analysis of utilization review data reported by MMCOs in New York State. METHODS: Data from the utilization review practices of 15 MMCOs were collected and analyzed for calendar years 2017 and 2018. The data reported are specific to mental health services and include the number of authorization requests, number of clinical denials, and the reasons specified for each denial. Analyses were undertaken to determine the UR denial rates and most common reasons for denials. RESULTS: A total of 264,901 requests for inpatient mental health service authorizations and 53,687 requests for outpatient mental health service authorizations were made in 2017 and 2018. Of these, 1.5% of inpatient authorization requests and 0.4% of outpatient authorization requests were denied for reasons related to medical necessity. The most common reason for inpatient mental health service denials was that the patient no longer met the standard for the requested level of care. CONCLUSIONS: Low UR denial rates warrant further examination of the relationship between UR and both quality of care and patient outcomes in mental health care. With the substantial resources spent on UR, findings could point to areas of potential reforms to the system that may minimize these costs and improve care for patients with mental illness.

Razão oferta/necessidade de consultas médicas, exames de diagnóstico e acompanhamento da doença renal crônica no Sistema Único de Saúde: estudo descritivo, estado de São Paulo, 2019 / Relación oferta/necesidad de consultas médicas, pruebas diagnósticas y seguimiento de la enfermedad renal crónica en el Sistema Único de Salud: estudio descriptivo, São Paulo, Brasil, 2019 / Supply/demand ratio for medical consultations, diagnostic tests and chronic kidney disease monitoring in the Brazilian National Health System: a descriptive study, state of São Paulo, Brazil, 2019

Objetivo: Determinar a razão oferta/necessidade de procedimentos relacionados com o diagnóstico e assistência à doença renal crônica no Sistema Único de Saúde (SUS), no estado de São Paulo, Brasil, 2019. Métodos: Estudo descritivo, utilizando dados dos sistemas de informações ambulatoriais e hospitalares do SUS. Os números de consultas médicas e exames diagnósticos e de acompanhamento da doença renal realizados no período foram comparados com as estimativas de necessidade obtidas por diretrizes ministeriais. Resultados: Usuários exclusivos do SUS eram 28.791.244, e indivíduos com hipertensão e/ou diabetes mellitus, 5.176.188. O número de procedimentos realizados e a razão entre esse número e a necessidade da população foram de 389.414 consultas com nefrologista (85%); 11.540.371 dosagens de creatinina sérica (223%); 705.709 dosagens de proteinúria (14%); 438.123 ultrassonografias renais (190%); e 1.045 biópsias renais (36%). Conclusão: Na assistência à doença renal crônica no SUS existem, simultaneamente, falta de oferta, desperdício e rastreamento deficiente de procedimentos importantes.

Objetivo: Determinar la relación oferta/necesidad de procedimientos relacionados con el diagnóstico y atención de la enfermedad renal crónica en Sistema Único de Salud (SUS) del Estado de São Paulo, Brasil, en 2019. Métodos: Estudio descriptivo utilizando datos de los sistemas de información ambulatoria y hospitalaria del SUS. Se comparó el número de consultas médicas, pruebas de diagnóstico y seguimiento de la enfermedad renal realizados con las estimaciones de necesidad recomendadas por directrices ministeriales. Resultados: Los usuarios exclusivos de SUS fueron 28.791.244 e hipertensos y/o diabéticos, 5.176.188. El número de procedimientos realizados y la relación entre este número y la necesidad de la población fueran de 389.414 consultas con nefrólogo (85%); 11.540.371 determinaciones de creatinina sérica (223%); 705.709 determinaciones de proteinuria (14%); 438.123 ecografías renales (190%); y 1.045 biopsias renales (36%). Conclusión: En la atención de enfermedad renal en SUS existe, simultáneamente, falta de oferta, desperdicio y seguimiento deficiente de procedimientos importantes.

Objective: To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019. Methods: This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines. Results: Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%). Conclusion: In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.

Mind the gap: Patterns of red blood cell product usage in South Africa, 2014 - 2019.

BACKGROUND: A key component of any successful healthcare system is the availability of sufficient, safe blood products delivered in an equitable manner. South Africa (SA) has a two-tiered healthcare system with public and privately funded sectors. Blood utilisation data for both sectors are lacking. Evaluation of blood utilisation patterns in each healthcare sector will enable implementation of systems to bring about more equality. OBJECTIVES: To conduct a critical evaluation of red blood cell (RBC) product utilisation patterns at the South African National Blood Service (SANBS). METHODS: Operationally collected data from RBC requests submitted to SANBS blood banks for the period 1 January 2014 - 31 March 2019 were used to determine temporal RBC product utilisation patterns by healthcare sector. Demographic patterns were determined, and per capita RBC utilisation trends calculated. RESULTS: Of the 2 356 441 transfusion events, 65.9% occurred in the public and 34.1% in the private sector. Public sector patients were younger (median (interquartile range (IQR)) 33 (22 - 49) years) than in the private sector (median (IQR) 54 (37 - 68) years), and mainly female in both sectors (66.2% in the public sector and 53.4% in the private sector). Between 2014 and 2018, per capita RBC utilisation decreased from 11.9 to 11.0/1 000 population in the public sector, but increased from 34.8 to 38.2/1 000 population in the private sector. CONCLUSIONS: We confirmed distinctly different RBC utilisation patterns between the healthcare sectors in SA. Possible drivers for these differences may be healthcare access, differing patient populations and prescriber habits. Better understanding of these drivers may help inform equitable public health policy.

Utilization, Determinants, and Prospects of Electronic Medical Records in Ethiopia.

BACKGROUND: A lot of effort is being done in the electronic medical record (EMR) system. However, it has not been implemented and used at the expected scale for maximal effectiveness. There is limited evidence on the factors affecting the utilization of EMR in this particular context, which are critical for targeted strategies. OBJECTIVE: To assess the magnitude and factors affecting the utilization of EMR among health professionals in eastern Ethiopia. METHODS: An institutional-based cross-sectional study was conducted among randomly selected 412 health professionals from Harari and Dire Dawa, eastern Ethiopia, using a pretested self-administered questionnaire. The tool was developed from previous literature, and a pilot survey was done before the actual study. Bivariable and multivariable binary logistic regression were done to assess the relationship between an independent variable with EMR use. Crude and an adjusted odds ratio with a 95% confidence interval were reported. A P value of less than 0.05 was used to declare a statistically significant association. RESULTS: A total of 412 health professionals with a mean age of 29 years (±6.4 years) were included. A total of 229 (55.6%) and 300 (72.8%) of them had good knowledge and attitude towards the EMR, while 279 (67.7%) used the service (54% used it on a daily basis). About 272 (66%) of the respondents reported that they prefer EMRs to paper-based systems. Health professionals with more than five years of experience had two times higher odds of using the service (AOR = 2.22; 95% CI; 1.12-4.42) than early-career workers. Health professionals trained in EMR would use the service more (AOR = 5.88; 95% CI; 2.93-11.88) compared to those who did not take the training. In addition, having good knowledge (AOR = 1.52; 95% CI; 0.92-1.5) and a good attitude towards the EMR system (AOR = 2.4; 95% CI; 1.35-4.31) showed to use EMR as compared to counterparts. CONCLUSIONS: The utilization of EMR was found to be optimal. Age, work experience, knowledge, attitude, and training of professionals were positively associated with the use of the service in their facility.

Anaphylaxis and digital medicine.

PURPOSE OF REVIEW: Digital medicine (mHealth) aims to help patients and healthcare providers (HCPs) improve and facilitate the provision of patient care. It encompasses equipment/connected medical devices, mHealth services and mHealth apps (apps). An updated review on digital health in anaphylaxis is proposed. RECENT FINDINGS: In anaphylaxis, mHealth is used in electronic health records and registries.It will greatly benefit from the new International Classification of Diseases-11 rules and artificial intelligence. Telehealth has been revolutionised by the coronavirus disease 2019 pandemic, and lessons learnt should be extended to shared decision making in anaphylaxis. Very few nonvalidated apps exist and there is an urgent need to develop and validate such tools. SUMMARY: Although digital health appears to be of great importance in anaphylaxis, it is still insufficiently used.

Diagnóstico de situación de la evaluación de tecnologías sanitarias en instituciones de ámbito de la salud en Argentina / Diagnosis of the situation of health technology assessment in health care institutions of Argentina

INTRODUCCIÓN: La Evaluación de Tecnologías Sanitarias (ETS) es el proceso sistemático de valorización de las propiedades, los efectos y el impacto de la tecnología utilizada. La institucionalización de la ETS es una herramienta fundamental para llevar adelante las políticas de salud y conseguir mejores resultados con mayor eficiencia y equidad. El objetivo del estudio fue describir el estado actual en la institucionalización de la ETS a nivel nacional y conocer las características de estas organizaciones. MÉTODOS: Se efectuó un estudio exploratorio transversal descriptivo a través de una encuesta autoadministrada para identificar organizaciones que realizan ETS y describir sus características, recursos, producción y procesos. RESULTADOS: Se recibieron encuestas de 70 instituciones, de las cuales 39 realizan informes de ETS. Entre las limitaciones referidas para su implementación se señaló la falta de recursos humanos capacitados y de financiamiento específico. Según el 80%, para mejorar el impacto de las recomendaciones es importante incrementar el apoyo organizacional, dinamizar las estructuras de toma de decisiones y estimular los canales de comunicación y redes establecidas. DISCUSIÓN: Existe una considerable capacidad institucional para desarrollar ETS en Argentina. Los datos obtenidos permiten guiar el esfuerzo para fomentar el uso de la ETS en la toma de decisiones, fortalecer los vínculos entre las organizaciones identificadas, incrementar el intercambio de información y articular esfuerzos

INTRODUCTION: Health Technology Assessment (HTA) is the systematic process of assessing the properties, effects and impact of the technology used. The institutionalization of the HTA is a fundamental tool to carry out health policies and achieve better results with more efficiency and equity. The objective of the study was to describe current state of the institutionalization of HTA in Argentina and to know the characteristics of these organizations. METHODS: A descriptive cross-sectional exploratory study was conducted through a selfadministered survey to identify organizations and to describe their characteristics, resources, production and processes for the development of HTA. RESULTS: A total of 70 surveys were received, 39 of those institutions carry out HTA reports. The lack of trained human resources and the lack of specific financing were among the limitations for the implementation of HTA. According to 80% of respondents, it is important to increase organizational support, streamline decision-making structures and foster the established communication channels and networks in order to improve the impact of the recommendations. DISCUSSION: There is a significant institutional capacity to develop HTA in Argentina. The data obtained can serve as a reference to promote the use of HTA in decision-making, strengthen the links between the organizations identified, increase information exchange and coordinate efforts

Ambulatory care, insurance, and avoidable emergency department utilization in North Carolina.

OBJECTIVE: To examine whether and how avoidable emergency department (ED) utilization is associated with ambulatory or primary care (APC) utilization, insurance, and interaction effects. DESIGN AND SAMPLE: A cross-sectional analysis of electronic health records from 70,870 adults residing in Mecklenburg County, North Carolina, who visited an ED within a large integrated healthcare system in 2017. METHODS: APC utilization was measured as total visits, categorized as: 0, 1, and > 1. Insurance was defined as the method of payment for the ED visit as: Medicaid, Medicare, private, or uninsured. Avoidable ED utilization was quantified as a score (aED), calculated as the sum of New York University Algorithm probabilities multiplied by 100. Quantile regression models were used to predict the 25th, 50th, 75th, 95th, and 99th percentiles of avoidable ED scores with APC visits and insurance as predictors (Model 1) and with an interaction term (Model 2). RESULTS: Having >1 APC visit was negatively associated with aED at the lower percentiles and positively associated at higher percentiles. A higher aED was associated with having Medicaid insurance and a lower aED was associated with having private insurance, compared to being uninsured. In stratified models, having >1 APC visit was negatively associated with aED at the 25th percentile for the uninsured and privately insured, but positively associated with aED at higher percentiles among the uninsured, Medicaid-insured, and privately insured. CONCLUSIONS: The association between APC utilization and avoidable ED utilization varied based on segments of the distribution of ED score and differed significantly by insurance type.

Utilization fraction of rhinoplasty instrument sets: Model for efficient use of surgical instruments.

OBJECTIVES: Recognize the avoidable costs incurred due to overpacking of rhinoplasty instrument trays. Reduce rhinoplasty instrument trays by including only instruments used frequently. Establish methods to reduce trays prepared for other otolaryngologic procedures. METHODS: This is a prospective study. The study evaluates the specific use of instruments opened for rhinoplasty procedures at the New York Eye & Ear Infirmary of Mount Sinai. Instruments were counted in 10 rhinoplasty cases. Usage rate was calculated for each instrument. Additionally, all instruments used in at least 20% of cases were noted. This "20%" threshold was used to create new rhinoplasty tray inventories more reflective of actual instrument usage. Some instruments above the 20% threshold were included in multiples (i.e. two Adson Brown forceps vs. one curved iris scissor). RESULTS: 189 instruments were opened, and 32 instruments were used on average in each rhinoplasty. 55 instruments were used in at least 20% of cases. The 55 "high usage" instruments were used to create new, reduced rhinoplasty tray inventory lists. Based on our analysis, a new rhinoplasty tray inventory was created comprised of 68 instruments, a 64% reduction from 189. CONCLUSION: Instruments are sterilized and packed in gross excess for rhinoplasty procedures. Previously published figures estimate re-sterilization costs of $0.51 to $0.77 per instrument. Reduction in instruments opened from 189 to 68 is expected to lead to cost savings ranging from $62 to $93 per case, yielding a savings between $6200 and $9300 per 100 cases performed. LEVEL OF EVIDENCE: II-3.

Unscheduled Care Access in the United States-A Tale of Two Emergency Departments.

BACKGROUND: Rural communities face challenges in accessing healthcare services due to physician shortages and limited unscheduled care capabilities in office settings. As a result, rural hospital-based Emergency Departments (ED) may disproportionately provide acute, unscheduled care needs. We sought to examine differences in ED utilization and the relative role of the ED in providing access to unscheduled care between rural and urban communities. METHODS: Using a 20% sample of the 2012 Medicare Chronic Condition Warehouse, we studied the overall ED visit rate and the unscheduled care rate by geography using the Dartmouth Atlas' hospital referral regions (HRR). We calculated HRR urbanicity as the proportion of beneficiaries residing in an urban zip code within each HRR. We report descriptive statistics and utilize K-means clustering based on the ED visit rates and unscheduled care rates. RESULTS: We found rural ED use is more common and disproportionately the site of unscheduled care delivery when compared to urban communities. The ED visit and. unscheduled care proportions were negatively correlated with increased urbanicity (r =. -0.48, p < 0.001; r = -0.58, p < 0.001). CONCLUSION: The use and role of EDs by Medicare beneficiaries appears to be substantially different between urban and rural areas. This suggests that the ED may play a distinct role within the healthcare delivery system of rural communities that face disproportionate barriers to care access.

Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers.

BACKGROUND: A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. METHODS: The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. RESULTS: Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. CONCLUSIONS: The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.

Utilization of emergency ophthalmology services in Taiwan: a nationwide population study.

The aim of this study was to conduct a nationwide survey of the use of emergency ophthalmology services using a sub-dataset of one million beneficiaries sampled from Taiwan's National Health Insurance Research Database (NHIRD) for the years 2008 through 2012. By analyzing this population dataset, the study illustrates the disease landscape of emergency eye care services. The five-year, one-million-person NHIRD sub-dataset for 2008 through 2012 was used to explore emergency visits and ophthalmology specialty visits and to analyze the associated demographics and diagnosis codes based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Diagnoses were categorized into three groups: urgent, non-urgent, and intermediate. A total of 2454 emergency eye care visits were identified. The mean age of the patients who made these visits was 34.6 years old, and their sex ratio was 1.36 men to women. The percentages of urgent, non-urgent, and intermediate eye care visits in this study were 48.2%, 30.9%, and 20.9%, respectively. The leading diagnoses in the urgent category were corneal abrasions, foreign bodies in the eyes, eye burns, and blunt eye injuries. The leading diagnoses for the non-urgent visits were conjunctivitis, subconjunctival hemorrhages, trichiasis, and dry eye disease. Those for the intermediate category were superficial punctate keratitis, corneal opacity and degeneration, and lid, orbital, and lacrimal drainage infections. The urgent visit category accounted for nearly half of all the visits identified in this study. Compared to outpatient department visitors, the emergency ophthalmology service patients were younger and more predominantly male. These results were consistent with those of previous reports. Low copays have made emergency ophthalmology services highly accessible in Taiwan. However, future policies can be designed to more effectively allocate resources to urgent cases.

Reference Laboratory Testing for Neurologic Disorders.

Laboratory testing plays a critical role in the diagnosis and monitoring of patients with neurologic disorders. Although common tests are often performed in a central hospital laboratory, an increasing number of essential but esoteric tests are performed at reference laboratories or other outside health care facilities. In this article, we analyze recent trends in neurologic disease testing within the overall context of reference laboratory testing and discuss strategies to facilitate the provision of high-quality, cost-effective laboratory services.

Utilization Review in Workers' Compensation: Review of Current Status and Recommendations for Future Improvement.

: Utilization review (UR) is a process that assesses aspects of a treating provider's care plans and then provides recommendations to payors/insurance carriers, third party administrators, etc, concerning the appropriateness of the proposed care. UR has become an integral part of medical practice and has influenced medical care within the workers' compensation (WC) system and is mandated in several states and jurisdictions. This guidance statement from the American College of Occupational and Environmental Medicine (ACOEM) reviews structural elements of UR programs and proposes a possible template for operational standards. UR has a unique role in protecting patients and educating providers on evidence-based guidelines, new research, and best practices.

Association of Health Care Use and Economic Outcomes After Injury in Cameroon.

Importance: Despite the highest injury rates worldwide, formal medical care is not often sought after injuries in Sub-Saharan Africa. Unaffordable costs associated with trauma care might inhibit injured patients from seeking care. Objectives: To (1) determine the injury epidemiology in Cameroon using population-representative data, (2) identify the barriers to use of formal health care after injury, and (3) determine the association between use of care and economic outcomes after injury. Design, Setting, and Participants: This mixed-methods, cross-sectional study included a population-representative, community-based survey and nested qualitative semistructured interviews in the urban-rural Southwest Region of Cameroon. Three-stage cluster sampling was used to select target households. Data were collected from January 3 to March 14, 2017, and analyzed from March 3, 2017, to March 3, 2019. Exposures: Injuries occurring in the preceding 12 months. Main Outcomes and Measures: Postinjury use of health care services, disability, and economic outcomes. All survey data were adjusted for cluster sampling. Results: Of 1551 total households approached, 1287 (83.0%) were surveyed for a total sample size of 8065 participants. The 8065 individuals surveyed included 4181 women (52.0%), with a mean age of 23.9 (standard error [SE], 0.2) years. A total of 503 injuries were identified among 471 unique participants, including 494 nonfatal injuries. Among these, 165 (34.6%) did not seek formal medical services. Disability occurred after 345 injuries (68.6%) and resulted in 11 941 lost days of work in the sample. Family economic hardship after injury was substantially increased among the injured cohort who used formal medical care. Injuries brought to formal medical care, compared with those that were note, incurred higher mean treatment costs ($101.08 [SE, $236.23] vs $12.13 [SE, $36.78]; P < .001), resulted in higher rates of lost employment (19.9% [SE, 3.6%] vs 5.6% [SE, 1.6%]; P = .004), and more frequently led affected families to use economic coping strategies, such as borrowing money (26.2% [SE, 2.7%] vs 7.1% [SE, 1.2%]; P < .001). After adjusting for age and severity, use of formal medical care in Cameroon was independently associated with severe economic hardship after injury, defined as a new inability to afford food or rent (adjusted odds ratio, 1.67; 95% CI, 1.05-2.65). Conclusions and Relevance: In this study, injury in Southwestern Cameroon was associated with significant disability and lost productivity. Formal medical treatment of injury was associated with significant financial consequences for households of injured patients. Primary prevention of road traffic injuries and financial restructuring of emergency care could improve trauma care access in Cameroon and reduce the societal effects of injury.

Evaluation of Practice Patterns Among Oncologists Participating in the Oncology Care Model.

Importance: Health insurers reimburse clinicians in many ways, including the ubiquitous fee-for-service model and the emergent shared-savings models. Evidence on the effects of these emergent models in oncological treatment remains limited. Objectives: To analyze the early use and cost associations of a recent Medicare payment program, the Oncology Care Model (OCM), which included a shared savings-like component. Design, Setting, and Participants: This nonrandomized controlled study used a difference-in-differences approach on 2 years of data, from July 1, 2015, to June 30, 2017-1 year before and 1 year after launch of the OCM-to compare the differences between participating and nonparticipating practices, controlling for patient, clinician, and practice factors. Participation in the OCM began on July 1, 2016. Associations of participation with care use and cost were estimated for care directly managed by clinicians from a large network within their Medicare populations for breast, lung, colon, and prostate cancers. Data were analyzed from September 2019 to March 2020. Exposures: Participating practices were paid a monthly management fee of $160 per beneficiary and a potential risk-adjusted performance-based payment for eligible patients who received chemotherapy treatment, in addition to standard fee-for-service payments. Main Outcomes and Measures: Office visits, drug administrations, patient hydrations, drug costs, and total costs. Results: Monthly means data at the physician-level were evaluated for 11 869 physician-months for breast cancers, 11 135 physician-months for lung cancers, 8592 physician-months for colon cancers, and 9045 physician-months for prostate cancers. Patients at OCM practices had a mean (SD) age of 63.4 (3.1) years, and a mean (SD) of 59% (7 percentage points) of their patients were women. Participation in the OCM was associated with less physician-administered prostate cancer drug use (difference, 0.29 [95% CI, -0.47 to -0.11] percentage points, or 24.0%) translating to a mean of $706 (95% CI, -$1383 to -$29) less in drug costs per month. Monthly drug costs were also lower, at $558 (95% CI, -$1173 to $58) less for treatment for lung cancer. Total costs were lower by 9.7% or $233 (95% CI, -$495 to $30) for breast cancer, 9.9% or $337 (95% CI, -$618 to -$55) for lung cancer, 14.2% or $385 (95% CI, -$780 to $10) for colon cancer, and 29.2% or $610 (95% CI, -$1095 to -$125) for prostate cancer; however, these differences were largely offset by program costs. Clinician visits were also lower by 11.2% or 0.11 (95% CI, -0.20 to -0.01) percentage points among patients with breast cancer and by 14.4% or 0.19 (95% CI, -0.37 to -0.02) among patients with colon cancer. Conclusions and Relevance: These findings suggest that payment models with shared-savings components can be associated with fewer visits and lower costs in certain cancer settings in the first year, but the savings can be modest given the costs of program administration.

Health Care Resource Utilization of Late Premature Versus Term Infants With Bronchiolitis.

It is controversial whether it is cost-beneficial for late preterm infants to receive respiratory syncytial virus prophylaxis. This study compares community and hospital health care resource utilization (HCRU) of late premature infants (33-36 weeks gestational age) with term infants (>36 weeks gestational age) hospitalized with bronchiolitis. This was a retrospective, population-based, observational study spanning a 9-year period (2004-2012). HCRU data were obtained from the Health Maintenance Organization "Clalit" and included duration of hospitalization, physician visits, laboratory tests, and treatments. Compared with term infants, late preterm infants had significantly longer duration of hospitalization and higher admission rates to pediatric intensive care unit. They also had higher rates of mean outpatients clinic visits, total outpatient clinic and specialist visits, blood chemistry, and virology testing. HCRU of term infants with bronchiolitis was also substantial, indicating that they also can greatly benefit from respiratory syncytial virus prophylaxis. These findings can guide stakeholders in decisions concerning the prevention of bronchiolitis and will be useful in performing further cost-benefit analysis.