Community-Based Health Education Programs Designed to Improve Clinical Measures Are Unlikely to Reduce Short-Term Costs or Utilization Without Additional Features Targeting These Outcomes.

Stakeholders often expect programs for persons with chronic conditions to "bend the cost curve." This study assessed whether a diabetes self-management education (DSME) program offered as part of a multicomponent initiative could affect emergency department (ED) visits, hospital stays, and the associated costs for an underserved population in addition to the clinical indicators that DSME programs attempt to improve. The program was implemented in Camden, New Jersey, by the Camden Coalition of Healthcare Providers to address disparities in diabetes care. Data used are from medical records and from patient-level information about hospital services from Camden's hospitals. Using multivariate regression models to control for individual characteristics, changes in utilization over time and changes relative to 2 comparison groups were assessed. No reductions in ED visits, inpatient stays, or costs for participants were found over time or relative to the comparison groups. High utilization rates and costs for diabetes are associated with longer term disease progression and its sequelae; thus, DSME or peer support may not affect these in the near term. Some clinical indicators improved among participants, and these might lead to fewer costly adverse health events in the future. DSME deployed at the community level, without explicit segmentation and targeting of high health care utilizers or without components designed to affect costs and utilization, should not be expected to reduce short-term medical needs for participating individuals or care-seeking behaviors such that utilization is reduced. Stakeholders must include financial outcomes in a program's design if those outcomes are to improve.

Biomechanical analysis and injury prevention in off-highway vehicular crashes - biomed 2010.

Traffic safety has significantly improved over the past several decades reducing injury and fatality rates. However, there is a paucity of research effort directed to address the safety issues in off-highway vehicular crashes, specifically the all terrain/utility vehicular crashes. Rollover crashes are severe accidents leading to the increase in fatalities and injuries. The appropriate safety measures to contain occupants in vehicular compartments are crucial in mitigating injuries in rollover crashes. The purpose of this study is to delineate the occupant kinematics in simulated rollover conditions and to evaluate the injury prevention aspects. Two utility/all terrain vehicles were used. Each vehicle was placed on the motorized test equipment in the laboratory. The motorized dynamic rollover test equipment simulated the rollover environment in a controlled manner. Human surrogate models representing 1th percentile female, 50th percentile male and 96th percentile male were utilized in the testing. The multi-phase dynamic testing was conducted to quantify the occupant kinematic responses in foreseeable real world conditions. A total of 39 tests were conducted. The vehicle with belted surrogates was rolled 90 degrees at a roll rate up to 45 degrees/second. The excursion of the head, upper extremity and lower extremities beyond the plane of the vehicular structure was measured and compared between the two vehicles using two onboard cameras and three off-board cameras. Results show that the advanced restraint system with the occupant containment feature significantly reduced the occupant excursion. Such a significant reduction of occupant movement will better protect occupants in rollover off-highway accidents.

Evaluation of Medicare Health Support chronic disease pilot program.

The Medicare Program is conducting a randomized trial of care management services among fee-for-service (FFS) beneficiaries called the Medicare Health Support (MHS) pilot program. Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries. In this article, we present 6-month intervention results on beneficiary selection and participation rates, mortality rates, trends in hospitalizations, and success in achieving Medicare cost savings. Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization.