Continuous Glucose Monitoring: An Opportunity for Population-Based Diabetes Management.

The increasing prevalence of prediabetes and diabetes in the United States poses a serious threat to the health of the population. Closely associated with obesity, hypertension, dyslipidemia, and cardiovascular disease, a diagnosis of diabetes or prediabetes carries with it life-altering demands. Critically important among these is the requirement for frequent glucose level checks-typically performed with blood obtained from a fingerstick. Innovative real-time continuous glucose monitoring (rtCGM) technology makes it possible for patients and their clinicians to receive continuous glucose level measurements around the clock without finger sticks. Accruing evidence shows that rtCGM is an effective tool for patients and their clinicians in managing diabetes (ie, maintaining glucose levels within the recommended target range) and in understanding how lifestyle behaviors directly influence glucose levels. In recent years, a number of large payer organizations (eg, private health insurers, employers) have incorporated rtCGM in their diabetes management programs as a means of addressing the dual challenge of achieving/maintaining control of glucose levels and preventing or delaying the onset of complications. Programmatic integrated approaches have been used successfully and cost-effectively for managing other chronic conditions. Incorporating rtCGM in similar integrated approaches in diabetes management may be of value in improving quality outcomes and reducing costs on a population level. The evidence supports broader adoption and continued study to evaluate models that incorporate the use of rtCGM.

Rural Aging in America: Proceedings of the 2017 Connectivity Summit.

Rural Aging in America: Proceedings of the 2017 Connectivity Summit Alexis Skoufalos, EdD, Janice L. Clarke, RN, BBA, Dana Rose Ellis, BA, Vicki L. Shepard, MSW, MPA, and Elizabeth Y. Rula, PhD Editorial: Creating a Movement to Transform Rural Aging David B. Nash, MD, MBA, with Donato J. Tramuto, and Joseph F. Coughlin, PhD S-3 Introduction S-4 Summit Proceedings S-5 Roundtable 1: The Power of Community - Enabling Social Connections and Access to Health Resources Through Community-Based Programs S-5 Roundtable 2: Technology and Rural Health: Innovative Solutions to Bridge the Distance, Improve Care, and Deliver Programs S-7 Roundtable 3: An Integrated Experience: The Exponential Potential of a Collaborative Approach to Rural Aging S-8 General Discussion and Recommendations S-8 Post-Summit Debriefing S-9 Strategy and objectives S-9 6-12 month action plan S-9 Conclusion S-9.

Sexually Transmitted Infections: Compelling Case for an Improved Screening Strategy.

Sexually Transmitted Infections: Compelling Case for an Improved Screening Strategy Stephen Hull, MHS, Seán Kelley, MD, MSc, and Janice L. Clarke, RN, BBA Editorial: Sexually Transmitted Infections-A Fixable Problem: David B. Nash, MD, MBA S-3 Introduction S-3 Rising Prevalence of Sexually Transmitted Diseases (STIs) S-4 Current Screening Rates for Chlamydia and Gonorrhea S-4 The Human Toll and Economic Burden of STI-Related Illness S-5 Current Screening Guidelines for Chlamydia and Gonorrhea S-5 Factors Contributing to Inadequate Screening, Diagnosis, and Treatment for STIs S-6 Methods Used to Improve Screening Rates S-7 Benefits of Opt-Out Screening Strategies for STIs S-8 Cost-Effectiveness of Screening for STIs S-8 Discussion S-9 Conclusion S-10.

An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions.

Although the health care reform movement has brought about positive changes, lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal-higher quality health care and improved population health outcomes at a lower cost. The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients and their caregivers, diminishing positive health outcomes and driving costs ever higher. Long-entrenched acute care-focused treatment and reimbursement paradigms hamper more effective deployment of existing resources to improve the ongoing care of these patients. New models for care coordination during transitions, longitudinal high-risk care management, and unplanned acute episodic care have been conceived and piloted with promising results. Utilizing existing resources, Mobile Integrated Healthcare is an emerging model focused on closing these care gaps by means of a round-the-clock, technologically sophisticated, physician-led interprofessional team to manage care transitions and chronic care services on-site in patients' homes or workplaces.

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting.

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting Janice L. Clarke, RN, Alexis Skoufalos, EdD, Alice Medalia, PhD, and A. Mark Fendrick, MD Editorial: A Call to Action : David B. Nash, MD, MBA S-2 OVERVIEW: Depression and the Population Health Imperative S-3 Promoting Awareness of the Issues and Opportunities for Improvement S-5 Cognitive Dysfunction in Affective Disorders S-5 Critical Role of Employers in Improving Health Outcomes for Employees with Depression S-6 Closing the Behavioral Health Professional and Process Gaps S-6 Achieving the Triple Aim for Patients with Depressive Disorders S-6 Improving the Experience of Care for Patients with Depression S-6 Improving Quality of Care and Health Outcomes for Patients with Depression S-7 Changing the Cost of Care Discussion from How Much to How Well S-8 Panel Insights and Recommendations S-9 Conclusion S-10.

The diagnosis of CAD in women: addressing the unmet need - a report from the national expert roundtable meeting.

A multistakeholder panel comprising experts in the fields of clinical cardiology, medical technology innovation, women's health research and policy analysis, personalized medicine, payers (including self-insured employers), patient advocacy, and health economics was convened at the Heart House in Washington, DC. The following points emerged as key concepts: (1) Diagnostic challenges in the evaluation of women with symptoms suggestive of obstructive coronary artery disease (CAD) result from: (a) presentation with atypical symptoms and lower pretest probability of disease compared to men, (b) fatty tissue and breast tissue attenuation on cardiac imaging leading to false positive findings, and (c) the presence of microvascular CAD. (2) Diagnostic challenges lead to both over-testing of low-risk women and under-testing of high-risk women. (3) Efforts should be directed toward increasing clinician, clinical professional society, and consumer awareness and understanding of sex-specific differences between men and women in the pathophysiology of CAD. (4) Multiple health care stakeholders should be made aware of new advances in genomic approaches to address the challenges of diagnosing obstructive CAD; specifically, the Corus CAD gene expression test, which was shown to have high sensitivity and negative predictive value in a recent clinical trial. As such, it has promise as a tool to help clinicians to rule out obstructive CAD as a cause of a patient's symptoms. (Population Health Management 2015;18:86-92).

Conservative spine care: opportunities to improve the quality and value of care.

Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways.

Improving awareness of best practices to reduce surgical site infection: a multistakeholder approach.

Surgical site infection (SSI) is recognized as a focus area by the Centers for Medicare and Medicaid Services, the Joint Commission, the Institute for Healthcare Improvement, and the Institute of Medicine. An estimated 47% to 84% of SSIs present after discharge from the hospital or ambulatory care facility and, as a result, go undetected by standard SSI surveillance programs. Evidence-based processes and practices that are known to reduce the incidence of SSIs tend to be underused in routine practice. This article describes a multistakeholder process used to develop an educational initiative to raise awareness of best practices to reduce SSIs. The goal was to create a patient-centric educational initiative that involved an active partnership among all stakeholders-medical professional organizations, hospitals/health systems, health insurers, employers and other purchasers, and consumers/patients-to provide the climate necessary to create and sustain a culture of safety.

Opportunity, resources, and affordability: multistakeholder perspectives.

On two occasions last year, the Jefferson School of Population Health convened a National Advisory Board of scientists and opinion leaders from key stakeholder groups at a high-level forum to explore different perspectives and to discuss improving access for patients who require treatment with biologic drugs. The following is the first of two articles documenting these discussions. The second article will appear in a subsequent issue of Biotechnology Healthcare.

Building a value-based approach to biologic drugs.

In the absence of comprehensive position papers from professional organizations on the complex issue of patient affordability of biologic therapies, the Jefferson School of Population Health reconvened a National Advisory Board to discuss the issue. The objectives of the board were to quantify the issues and to identify potential solutions - including a recommended approach for payers.