Practice efficiency and total cost of care with bispecifics and CAR-T in relapsed/refractory diffuse large B-cell lymphoma: an institutional perspective.

Aim: Novel treatment options for relapsed/refractory diffuse large B-cell lymphoma include T-cell targeting therapies. Practice efficiency and cost are important for informed treatment decisions.Materials/methods: An institutional decision-maker cost model was developed for 6-month, 1-year and median cycles of treatment time horizons comparing practice efficiency and costs of epcoritamab vs glofitamab and axicabtagene ciloleucel (axi-cel).Results: Overall, epcoritamab required the shortest personnel and chair time, except over 1 year (second shortest chair time). Across all time horizons, epcoritamab was cost-saving vs axi-cel and had similar costs to glofitamab on a per-month basis.Conclusion: Epcoritamab reduced personnel and chair time. Additionally, epcoritamab was cost-saving vs axi-cel and had similar costs to glofitamab on a per-month basis.

There are new ways to treat diffuse large B-cell lymphoma, which is a type of cancer called lymphoma. When new treatments are available it is important to see if they take more or less time to give to patients and how much they cost versus other treatments. This study looked at three drugs used to treat diffuse large B-cell lymphoma, including epcoritamab, axi-cel and glofitamab. It estimated the time and cost with those treatments in patients who get them for 6 months, 1 year or for the most common length of time in the clinical trials. In most of the scenarios, epcoritamab had the least time needed for nurses or doctors and the least time needed for a patient to be in a chair in a clinic. When thinking about the cost per month, epcoritamab saved money versus axi-cel and was similar to glofitamab.

Observational vs coaching feedback on non-dominant whole-body motor skill performance - application to technique training.

We studied the effect of peer- and self-observational feedback versus coaching feedback during technique training on performance in competitive adolescent cross-country skiers. Fifty-four skiers (14.3 ± 0.6 years) were divided into a control group and three intervention groups (dyad practice, video, or coaching feedback), which practiced in the asymmetrical uphill sub-technique G2 on one side (non-dominant side), but not the other (dominant side) for 6 × 30 min over a 5 weeks period, on roller skis outdoors. High-speed performance and skiing economy were assessed on a roller ski treadmill before and after the intervention, and a questionnaire was answered post-intervention. The video feedback (p = .025, d = .65) and coaching feedback (p = .007, d = .89) groups improved high-speed performance during the intervention and an ANCOVA showed a tendency for different change scores between interventions (F3,49  = 2.5, p = .068, η p 2  = .134), with a difference between the coaching feedback and dyad practice (p = .05). No change was seen in skiing economy in any group. Coaching feedback ranked higher on enjoyment compared with dyad practice (p < .001) and led to higher self-perception of improved technique compared with the control group (p = .038). Overall, feedback from a competent coach seems better than observation for improving performance in young athletes, although self-observation through video with attentional cues seems a promising tool for increasing individual feedback when coaching large groups.

Profit efficiency of physician practices: a stochastic frontier approach using panel data.

While determinants of efficiency have been the subject of a large number of studies in the inpatient sector, relatively little is known about factors influencing efficiency of physician practices in the outpatient sector. With our study, we provide the first paper to estimate physician practice profit efficiency and its' determinants. We base our analysis on a unique panel data set of 4964 physician practices for the years 2008 to 2010. The data contains information on practice costs and revenues, services provided, as well as physician and practice characteristics. We specify the profit function of the physician practice as a translog functional form. We estimated the stochastic frontier using the comprehensive one-step approach for panel data of Battese and Coelli (1995). For estimation of the profit function, we regressed yearly profit on several inputs, outputs and input/output price relationships, while we controlled for a range of control variables such as patients' case-mix or share of patients covered by statutory health insurance. We find that participation in disease management programs and the degree of physician practice specialization are associated with significantly higher profit efficiency. In addition, our analyses show that group practices perform significantly better than single practices.

Efficiency of physician specialist groups.

This is the first study to use stochastic frontier analysis to simultaneously estimate the technical, cost and profit efficiency of physician practices for different physician specialist groups. We base our analysis on a unique panel data set of 4964 physician practices in Germany for the years 2008 to 2010. The data contains information on practice costs and revenues, services provided, as well as physician characteristics and practice characteristics. Additionally we consider a wide range additional variables not previously analyzed in this context (e.g. sub-specialization of physician groups and environmental factors such as physician density in the area). We investigate differences in cost, technical and profit efficiency utilizing production-/cost- and profit-functions with a translog functional form. We estimated the stochastic frontier using the comprehensive one-step approach for panel data following Battese and Coelli (Empir Econ 20(2): 325-332, 10). Overall findings indicate that participation in disease management programs and the degree of specialization are associated with significantly higher technical- cost-, and profit-efficiency for most physician specialist groups, e.g. due to the standardization of processes. In addition, our analyses show that group practices perform significantly better than single practices. This may be due to indivisibilities in expensive technical equipment, which can lead to different health care services being provided by different practice types. A more thorough look at specialist groups suggests that it is important to investigate all efficiency types for different physician groups, as results may depend on the type of efficiency analyzed as well as the physician group in question.

Commentary on an Innovative Interprofessional Dental Practice for 2026.

UNLABELLED: An innovative interprofessional model is described for the delivery of dental care in the year 2026 to optimize efficiency and profitability while enhancing quality of care. BACKGROUND: The dental practice of tomorrow may look different than today. Although not broken, the current system can be improved in efficiency and effectiveness. Although traditional private practices will continue to exist and many will thrive over the next decades, they may not present the optimal model for dental practice. To manage complex patient needs, a more collaborative model of multidisciplinary, interprofessional clinical teams capable of treating patients comprehensively has been suggested by the authors. They explore an alternative model of practice that may be possible in the next 10 years to better serve patients and improve outcomes while honoring the role of practitioners. METHODS: Landmark publications and reviews are used to examine evidence showing the potential benefits of an innovative interprofessional approach to the delivery of care in the oral health care setting. CONCLUSIONS: By examining key studies, the authors provide commentary on the potential for enhanced efficiency, profitability, and quality of care in the oral health care setting through a collaborative model of multidisciplinary, interprofessional clinical teams capable of treating patients comprehensively.

Cognitive Ergonomics: A Review of Interventions for Outpatient Practice.

Doctoring is difficult mental work, involving many cognitively demanding processes such as diagnosing, decision-making, parallel processing, communicating, and managing the emotions of others. According to cognitive load theory (CLT), working memory is a limited cognitive resource that can support a finite amount of cognitive load. While the intrinsic cognitive load is the innate load associated with a task, the extraneous load is generated by inefficiency or suboptimal work conditions. Causes of extraneous cognitive load in healthcare include inefficiency, distractions, interruptions, multitasking, stress, poor communication, conflict, and incivility. High levels of cognitive load are associated with impaired function and an increased risk of burnout among physicians. Cognitive ergonomics is the branch of human factors and ergonomics (HFE) focused on supporting the cognitive processes of individuals within a system. In health care, where the cognitive burden on physicians is high, cognitive ergonomics can establish practices and systems that decrease extraneous cognitive load and support pertinent cognitive processes. In this review, we present cognitive ergonomics as a useful framework for conceptualizing an oft-overlooked dimension of labor and apply theory to practice by summarizing evidence-based cognitive ergonomics interventions for outpatient care settings. Our proposed interventions are structured within four general recommendations: 1. minimize distractions, interruptions, and multitasking; 2. optimize the use of the electronic health record (EHR); 3. optimize the use of health information systems (HIS); and 4. support good communication and teamwork. Best practices in cognitive ergonomics can benefit patients, minimize practice inefficiency, and support physician career longevity.

Medmont Meridia™: Much More Than a Corneal Topographer.

In recent years, advanced diagnostic instruments have become widely available in optometric practices, offering various functions that optimize clinical information gathering. This article focuses on the Medmont Meridia™, a state-of-the-art multipurpose diagnostic device with corneal topography and cutting-edge features. Corneal topography is pivotal in the early diagnosis of corneal disorders, determining baseline ocular surface assessment, helping in contact lens fitting, and monitoring ocular health over time. The Medmont Meridia boasts Placido-disc-based imaging with extensive corneal coverage. Furthermore, the Meridia accurately measures the horizontal visible iris diameter, pupil diameter, and palpebral fissure width, which assists in making contact lens parameter decisions. Additionally, it offers sagittal height data for scleral lens design and first lens selection, streamlining the fitting process. Beyond its topography capabilities, the Meridia excels as a comprehensive dry eye assessment tool. With features like tear meniscus height, tear film surface quality, and meibography capabilities, it aids in diagnosing dry eye and monitoring its progression. The device also provides customizable dry eye reports with integrated grading scales and questionnaires, making dry eye management, patient education, and compliance more accessible. In conclusion, the Medmont Meridia consolidates a multitude of examination tools in a single instrument, enhancing practice efficiency and elevating patient care and communication. Its versatility and accuracy make it an invaluable asset in optometric practices worldwide.

Implementation of point-of-care testing in a general internal medicine practice: A confirmation study.

BACKGROUND: In a previous study we reported on the impact of point-of-care testing (POCT) on practice efficiency in an academic primary care practice that was established to develop new models of care delivery. Here we report a follow-on confirmation study in a more typical primary care practice in the community. METHODS: In this observational study with a retrospective comparison analysis we measured metrics of practice efficiency on two patient cohorts: those that did not receive POCT and those that did. RESULTS: In the patient cohort that received POCT there was a 99% reduction in letters to patients (p<0.001), a 75% decrease in calls to patients (not significant due to small numbers), a 50% reduction in follow-up tests per visit (p=0.044) and a 38% reduction in follow-up visits due to abnormal test results (p=0.178). Financial analysis including testing costs, revenues and efficiency gains to the practice demonstrated a net financial benefit of $11.90-14.74 per patient visit. CONCLUSIONS: Our data confirm the earlier published findings that POCT can improve metrics of practice efficiency in a primary care practice.

Implementation of point-of-care testing in an ambulatory practice of an academic medical center.

OBJECTIVES: Point-of-care laboratory testing (POCT) offers reduced turnaround time and may promote improved operational efficiency. Few studies have been reported that document improvements from implementing POCT in primary care. METHODS: We measured metrics of practice efficiency in a primary care practice before and after implementation of POCT, including the total number of tests ordered, letters and phone calls to patients, and revisits due to abnormal test results. We performed a cost and revenue analysis. RESULTS: Following implementation of POCT, there was a 21% decrease in tests ordered per patient (P < .0001); a decrease in follow-up phone calls and letters by 89% and 85%, respectively (P < .0001 and P < .0001); and a 61% decrease in patient revisits (P = .0002). Estimated testing revenues exceeded expenses by $6.62 per patient, and potential cost savings from improved efficiency were $24.64 per patient. CONCLUSIONS: POCT can significantly improve clinical operations with cost reductions through improved practice efficiency.