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Journal articles on the topic 'Managed care plans (Medical care) Australia'

Author: Grafiati

Published: 4 June 2021

Last updated: 19 February 2022

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1

Scott, Ian A., Clair Sullivan, and Andrew Staib. "Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation." Australian Health Review 43, no. 3 (2019): 302. http://dx.doi.org/10.1071/ah17153.

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Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a mul

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Ryan, Benjamin, Richard Franklin, Frederick Burkle, Erin Smith, Peter Aitken, and Peter Leggat. "Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster." Prehospital and Disaster Medicine 34, s1 (May 2019): s47—s48. http://dx.doi.org/10.1017/s1049023x19001122.

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Introduction:Natural disasters often damage the public health infrastructure required to maintain the wellbeing of people with noncommunicable diseases. This increases the risk of an acute exacerbation or complications, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of noncommunicable diseases will continue, if not increase, due to an increasing disease prevalence, sustained rise in the frequency and intensity of disasters, and rapid unsustainable urbanization in disaster-prone areas. However, the traditional focus of public health and disaster

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Ryan, Benjamin J., Richard C. Franklin, Frederick M. Burkle, Erin C. Smith, Peter Aitken, and Peter A. Leggat. "Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster." Prehospital and Disaster Medicine 34, no. 03 (May 13, 2019): 241–50. http://dx.doi.org/10.1017/s1049023x1900431x.

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AbstractIntroduction:Natural disasters often damage or destroy the protective public health service infrastructure (PHI) required to maintain the health and well-being of people with noncommunicable diseases (NCDs). This interruption increases the risk of an acute exacerbation or complication, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of NCDs will continue, if not increase, due to an increasing prevalence and sustained rise in the frequency and intensity of disasters, along with rapid unsustainable urbanization in flood plains and storm-pr

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Marsden, Dianne Lesley, Kerry Boyle, Louise-Anne Jordan, Judith Anne Dunne, Jodi Shipp, Fiona Minett, Amanda Styles, et al. "Improving Assessment, Diagnosis, and Management of Urinary Incontinence and Lower Urinary Tract Symptoms on Acute and Rehabilitation Wards That Admit Adult Patients: Protocol for a Before-and-After Implementation Study." JMIR Research Protocols 10, no. 2 (February 4, 2021): e22902. http://dx.doi.org/10.2196/22902.

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Background Urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are commonly experienced by adult patients in hospitals (inpatients). Although peak bodies recommend that health services have systems for optimal UI and LUTS care, they are often not delivered. For example, results from the 2017 Australian National Stroke Audit Acute Services indicated that of the one-third of acute stroke inpatients with UI, only 18% received a management plan. In the 2018 Australian National Stroke Audit Rehabilitation Services, half of the 41% of patients with UI received a management plan. There

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KANE, SISTER. "Hospital Strategies for Contracting with Managed Care Plans." AORN Journal 48, no. 2 (August 1988): 369–70. http://dx.doi.org/10.1016/s0001-2092(07)68859-0.

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Mozaffari, Essy, and Sean D. Sullivan. "Home care reimbursement for intravenous ganciclovir therapy." American Journal of Health-System Pharmacy 53, no. 2 (January 15, 1996): 161–63. http://dx.doi.org/10.1093/ajhp/53.2.161.

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Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing ageiicies,

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Havighurst, Clark C. "Vicarious Liability: Relocating Responsibility For The Quality Of Medical Care." American Journal of Law & Medicine 26, no. 1 (2000): 7–29. http://dx.doi.org/10.1017/s0098858800010807.

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AbstractManaged health care has recently generated a great deal of distrust, even anger, in the public mind. To be sure, much of this public reaction is based on anecdotal evidence and one-dimensional thinking. But many unbiased experts observing managed care today are themselves unhappy with the health care industry's performance. While these observers find little justification for the current political backlash against managed care, they are also disappointed that today's health plans have not made a more positive difference. Indeed, informed observers commonly regret that the new arrangemen

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Aledort, Louis M., and James Coates. "Can Health Care Plans Afford Hemophilia Costs? Yes." Blood 106, no. 11 (November 16, 2005): 5551. http://dx.doi.org/10.1182/blood.v106.11.5551.5551.

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Abstract Hemophilia care has high annual recurring costs. 80–90% of these costs are to cover replacement therapy. Managed care programs have, in general, not recruited specialists to help determine the guidelines of care, the use of hemophilia treatment centers (HTC) by their patients or the multiple sources and charges for acquiring these expensive biologics. Aetna has 700–750 hemophilia patients in a typical year whose medical costs are upward of $60 million. These patients represent only.005% of the total membership, and 0.198% of the health care dollars spent. A hemophilia specialist was a

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Furst, Daniel E. "Measuring the impact of managed care plans on the use of biologics." Arthritis & Rheumatism 53, no. 3 (2005): 318–19. http://dx.doi.org/10.1002/art.21168.

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Latham, Stephen R. "Regulation of Managed Care Incentive Payments to Physicians." American Journal of Law & Medicine 22, no. 4 (1996): 399–432. http://dx.doi.org/10.1017/s0098858800011904.

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A large and growing number of physicians in today’s managed care market are paid for their services according to incentive schemes that offer financial rewards for the provision of less, and less expensive, medical care. Such schemes typically reward physicians for reducing their own costs of care and reward primary care physicians for reducing the number and cost of referrals for inpatient and specialty care. Consumers, fearful that such schemes will prompt physicians to deny them medically necessary care, have protested the implementation of such incentive plans. Various states are consideri

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Duckett, Stephen. "The new market in health care:Prospects for managed care in Australia." Australian Health Review 19, no. 2 (1996): 7. http://dx.doi.org/10.1071/ah960007.

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Most developed countries are experimenting, or moving at full speed, to implementnew forms of health delivery based in part on capitation arrangements and strongeraccountability of health service providers. Proposals for introduction of capitation ormanaged care have been advanced in Australia but have attracted strong oppositionfrom the medical profession. This paper reviews the policy issues surrounding theintroduction of managed care, including how Australia?s current institutional formsmay evolve into managed care provision.

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Allen, Shari N., and Mebanga Ojong-Salako. "Pharmacist-Initiated Prior Authorization Process to Improve Patient Care in a Psychiatric Acute Care Hospital." Journal of Pharmacy Practice 28, no. 1 (December 10, 2014): 31–34. http://dx.doi.org/10.1177/0897190014562383.

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A prior authorization (PA) is a requirement implemented by managed care organizations to help provide medications to consumers in a cost-effective manner. The PA process may be seen as a barrier by prescribers, pharmacists, pharmaceutical companies, and consumers. The lack of a standardized PA process, implemented prior to a patient’s discharge from a health care facility, may increase nonadherence to inpatient prescribed medications. Pharmacists and other health care professionals can implement a PA process specific to their institution. This article describes a pharmacist-initiated PA proces

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Andrade, Susan E., and Cynthia Willey. "H2 Receptor Antagonist use Among Medicaid Patients Enrolled in Managed Care Health Plans." Clinical Research and Regulatory Affairs 15, no. 3-4 (January 1998): 131–44. http://dx.doi.org/10.3109/10601339809109191.

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Kinney, Eleanor D. "The Brave New World of Medical Standards of Care." Journal of Law, Medicine & Ethics 29, no. 3-4 (2001): 323–34. http://dx.doi.org/10.1111/j.1748-720x.2001.tb00351.x.

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There have always been medical standards of care in the American health-care sector. However, never before have they been so deeply incorporated in the delivery of health care as they are today. With the increased delivery of care through integrated delivery systems, as well as the development of the computerized patient record, medical standards of care are now used in innovative ways by providers and health plans in delivering health care to individual patients. There is great potential for even more innovative uses of medical standards of care in the future.This article first presents a tax

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Thiel de Bocanegra, Heike, Alia McKean, Philip Darney, Erin Saleeby, and Denis Hulett. "Documentation of Contraception and Pregnancy Intention In Medicaid Managed Care." Health Services Research and Managerial Epidemiology 5 (January 1, 2018): 233339281774887. http://dx.doi.org/10.1177/2333392817748870.

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Context: Clinical guidelines recommend the documentation of pregnancy intention and family planning needs during primary care visits. Prior to the 2014 Medicaid expansion and release of these guidelines, the documentation practices of Medicaid managed care providers are unknown. Methods: We performed a chart review of 1054 Medicaid managed care visits of women aged 13 to 49 to explore client, provider, and visit characteristics associated with documentation of immediate or future plans for having children and contraceptive method use. Five managed care plans used Current Procedural Terminology

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Blum, John D. "The Evolution of Physician Credentialing into Managed Care Selective Contracting." American Journal of Law & Medicine 22, no. 2-3 (1996): 173–203. http://dx.doi.org/10.1017/s0098858800007814.

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In a field littered with analogies, health care in the mid-nineties is best characterized as an enterprise caught in the violent cross winds of a tropical storm known as managed care. Like a series of hurricanes, managed care has reshaped the landscape of health care delivery in drastic and unpredictable ways. While the forces of managed care have increasingly altered more health care markets, others are only beginning to feel the winds of change. As managed care overtakes fee-for-service (FFS) medicine, profound alterations in health delivery are occurring which affect every aspect of America

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Reilly, M. "(P2-78) Creating Alternate Care Sites and Community-Based Care Centers for the Delivery of Medical Care During Public Health Emergencies." Prehospital and Disaster Medicine 26, S1 (May 2011): s161. http://dx.doi.org/10.1017/s1049023x1100522x.

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IntroductionDeveloping alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites or community-based care centers which can serve as areas for primary screening and triage or short-term medical treatment can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Additionally, if planned for correctly these facilities can also

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Offei-nkansah, Gerald, and Lindsey B. Amerine. "Conversion from paper to electronic acute care chemotherapy orders." American Journal of Health-System Pharmacy 77, no. 18 (July 23, 2020): 1516–21. http://dx.doi.org/10.1093/ajhp/zxaa201.

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Abstract Purpose UNC Medical Center converted to an electronic health record (EHR) in 2014. This conversion allowed for the transition of paper chemotherapy orders to be managed electronically. This article describes the process for converting inpatient paper chemotherapy orders into the new EHR in a safe and effective manner. Summary A collaborative interdisciplinary approach to the EHR transition enabled our organization to move from using paper chemotherapy orders to fully electronic chemotherapy treatment plans in both ambulatory and acute care areas. Active chemotherapy orders for acute c

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Collen, M. F. "Historical Evolution of Preventive Medical Informatics in the USA." Methods of Information in Medicine 39, no. 03 (2000): 204–7. http://dx.doi.org/10.1055/s-0038-1634344.

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AbstractA major reorganization of healthcare services is occurring in the United States. It has evolved from the solo- and group-practice models of the 1940s with fee-for-service and insurer-indemnification financing that used paper-based information systems to support preventive medical services. In the 1990s there emerged nation-wide, managed-care plans employing enhanced computer-based information systems with online preventive medical practice guidelines and Internet-supported home-care telemedicine. It is helpful to review how this major reengineering of medicine has come about.

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Akinci, F., and T. Sinay. "Perceived access in a managed care environment: determinants of satisfaction." Health Services Management Research 16, no. 2 (May 1, 2003): 85–95. http://dx.doi.org/10.1258/095148403321591401.

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With increasing competition in the local and regional healthcare markets, and growing interest in assessing the effectiveness of services and patient outcomes, satisfaction measures are becoming prominent in evaluating the performance of the healthcare system. This study examines the independent effect of predisposing, enabling and medical need factors on perceived access to care with particular focus on insurance plans. A survey questionnaire is developed to investigate access limitations at three levels: (1) the health plan, (2) the individual provider(s) and (3) the healthcare organization.

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Ramsey, Scott D., Alan L. Hillman, and Mark V. Pauly. "The Effects of Health Insurance on Access to New Medical Technologies." International Journal of Technology Assessment in Health Care 13, no. 2 (1997): 357–67. http://dx.doi.org/10.1017/s0266462300010412.

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AbstractWe examined the use of percutaneous transluminal coronary angioplasty, kidney stone lithotripsy, and bone marrow transplant among patients with different health insurance plans in California. HMO enrollees were less likely to receive these procedures compared with fee-for-service patients. Our results have implications for the inflationary effects of technology under managed care.

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Rosen, Amy K., and Allison Mayer-Oakes. "Developing a Tool for Analyzing Medical Care Utilization of Adult Asthma Patients in Indemnity and Managed Care Plans: Can an Episodes of Care Framework Be Used?" American Journal of Medical Quality 13, no. 4 (December 1998): 203–12. http://dx.doi.org/10.1177/106286069801300406.

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Furrow, Barry R. "The Problem of Medical Misadventures: A Review of E. Haavi Morreim's Holding Health Care Accountable." Journal of Law, Medicine & Ethics 29, no. 3-4 (2001): 381–93. http://dx.doi.org/10.1111/j.1748-720x.2001.tb00355.x.

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Health-care provider liability has again taken center stage in American political debate, but with an ironic twist. In the seventies, physicians wanted tort reform, but they measured such reform solely by a reduction in both the risk of being sued and the size of any judgment a plaintiff could win. Malpractice reforms in many states in the seventies therefore capped damages, reduced contingency awards to lawyers, and restricted other tort rules to limit plaintiff success. Today physicians are conflicted. They want an increase in liability exposure — not for themselves, but for managed care pla

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Shephard, Mark, Anne Shephard, Susan Matthews, and Kelly Andrewartha. "The Benefits and Challenges of Point-of-Care Testing in Rural and Remote Primary Care Settings in Australia." Archives of Pathology & Laboratory Medicine 144, no. 11 (October 27, 2020): 1372–80. http://dx.doi.org/10.5858/arpa.2020-0105-ra.

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Context.— Point-of-care (POC) testing has significant potential application in rural and remote Australian communities where access to laboratory-based pathology testing is often poor and the burden of chronic, acute, and infectious disease is high. Objective.— To explore the clinical, operational, cultural, and cost benefits of POC testing in the Australian rural and remote health sector and describe some of the current challenges and limitations of this technology. Data Sources.— Evidence-based research from established POC testing networks for chronic, acute, and infectious disease currentl

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Nicholas, Lauren Hersch. "Better Quality of Care or Healthier Patients? Hospital Utilization by Medicare Advantage and Fee-for-Service Enrollees." Forum for Health Economics and Policy 16, no. 1 (January 1, 2013): 137–61. http://dx.doi.org/10.1515/fhep-2012-0037.

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Abstract Do differences in rates of use among managed care and Fee-for-Service Medicare beneficiaries reflect selection bias or successful care management by insurers? I demonstrate a new method to estimate the treatment effect of insurance status on health care utilization. Using clinical information and risk-adjustment techniques on data on acute admission that are unrelated to recent medical care, I create a proxy measure of unobserved health status. I find that positive selection accounts for between one-quarter and one-third of the risk-adjusted differences in rates of hospitalization for

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Hotz, PhD, Gillian A., Zakiya B. Moyenda, MD, MBA, Jerry Bitar, MD, Marlon Bitar, MD, Henri R. Ford, MD, Barth A. Green, MD, David M. Andrews, MD, and Enrique Ginzburg, MD. "Developing a trauma critical care and rehab hospital in Haiti: A year after the earthquake." American Journal of Disaster Medicine 7, no. 4 (September 1, 2012): 273–79. http://dx.doi.org/10.5055/ajdm.2012.0100.

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Objective: Prior to the devastating earthquake in Haiti, January 12, 2010, a group of Haitian physicians, leaders and members of Project Medishare for Haiti, a Nongovernmental Organization, had developed plans for a Trauma Critical Care Network for Haiti.Design: One year after the earthquake stands a 50-bed trauma critical care and rehab hospital that employs more than 165 Haitian doctors, nurses and allied healthcare professionals, and administrative and support staff in Port-Au-Prince. Hospital Bernard Mevs Project Medishare (HBMPM) has been operating with the following two primary goals: 1)

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Mayes, Rick, and Robert E. Hurley. "Pursuing cost containment in a pluralistic payer environment: from the aftermath of Clinton's failure at health care reform to the Balanced Budget Act of 1997." Health Economics, Policy and Law 1, no. 3 (June 2, 2006): 237–61. http://dx.doi.org/10.1017/s1744133106003033.

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Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton's attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation's convoluted health care system that could be (and was) eli

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de Loor, Sanne, and Tiny Jaarsma. "Nurse-Managed Heart Failure Programmes in the Netherlands." European Journal of Cardiovascular Nursing 1, no. 2 (June 2002): 123–29. http://dx.doi.org/10.1016/s1474-51510200007-5.

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Heart failure (HF) care in Europe is going through a lot of changes. Nurses have increasingly important roles in providing optimal care for these chronically ill patients in the Netherlands. The first steps to organise HF nurses have been taken and an overview of HF management programmes in Netherlands has been recently made available. A descriptive study was performed consisting of: (1) a screening phase in which all hospitals ( n=109) and 105 home care organisations were approached by telephone to assess availability of HF management programmes and (2) a questionnaires in which content and o

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Davison, Tanya E., John Snowdon, Nathan Castle, Marita P. McCabe, David Mellor, Gery Karantzas, and Janelle Allan. "An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities." International Psychogeriatrics 24, no. 4 (December 5, 2011): 631–41. http://dx.doi.org/10.1017/s1041610211002146.

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ABSTRACTBackground: Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression.Methods: A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facili

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O'Hara, Rebecca, Heather Rowe, Louise Roufeil, and Jane Fisher. "Should endometriosis be managed within a chronic disease framework? An analysis of national policy documents." Australian Health Review 42, no. 6 (2018): 627. http://dx.doi.org/10.1071/ah17185.

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Objective The aim of this study was to determine whether endometriosis meets the definition for chronic disease in Australian policy documents. Methods A qualitative case study approach was used to thematically analyse the definitions contained in Australian chronic disease policy documents and technical reports. The key themes were then compared with descriptions of endometriosis in peer-reviewed literature, clinical practice guidelines and expert consensus statements. Results The search yielded 18 chronic disease documents that provided a definition or characteristics of chronic disease. The

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Watson, Sidney D. "Medicaid Physician Participation: Patients, Poverty, and Physician Self-Interest." American Journal of Law & Medicine 21, no. 2-3 (1995): 191–220. http://dx.doi.org/10.1017/s0098858800006316.

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“They might as well say this is Communist Russia.” — Dr. James Kennedy, Franklin, Tennessee.Medicaid has failed in its mission to care for the poor because doctors refuse to participate in the program. New ways are needed to entice physicians to treat Medicaid patients. TennCare, Tennessee’s Medicaid managed care demonstration project, shows that managed care plans can induce physicians to treat the poor by creating substantial collective purchasing power and by conditioning access to middle class patients on treatment of the poor, thus appealing to physicians’ financial self-interest. TennCar

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Hall, Mark A., and Carl E. Schneider. "Can Consumers Control Health-Care Costs?" Forum for Health Economics and Policy 15, no. 3 (September 10, 2012): 23–52. http://dx.doi.org/10.1515/fhep-2012-0008.

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Abstract The ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today’s health pol

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McKenzie, Scott R., Patrick Lefebvre, Brahim K. Bookhart, François Laliberté, and Mei S. Duh. "Medical Visit Patterns in Cancer Chemotherapy Patients Receiving Erythropoiesis-Stimulating Agents in a Managed Care Setting." Blood 110, no. 11 (November 16, 2007): 5156. http://dx.doi.org/10.1182/blood.v110.11.5156.5156.

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Abstract Background: Avoiding unnecessary medical visits related to erythropoiesis-stimulating agent (ESA) treatment represents an important consideration for managed-care organizations. Observational data have reported varying visit patterns for cancer chemotherapy patients receiving epoetin alfa (EPO) and darbepoetin alfa (DARB). Few studies have characterized visit patterns in this population during ESA treatment. Objective and Purpose: The objective of this analysis was to describe visit patterns and identify the proportion of medical visits made exclusively for ESA treatment in cancer che

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Quinn, Charlene C., Anthony Roggio, Barr Erik, and Ann Gruber-Baldini. "NURSING HOME TELEED INTERVENTION: ADVANCING NEW CARE MODELS." Innovation in Aging 3, Supplement_1 (November 2019): S337—S338. http://dx.doi.org/10.1093/geroni/igz038.1225.

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Abstract New reimbursement and managed care models demonstrate the need to reduce avoidable Emergency Department (ED) use and limit preventable inpatient admissions for older adults in Skilled Nursing Facilities (SNF). The objective was to develop an ED telemedicine consultation intervention for SNF residents with acute medical problems. Secondary objectives including evaluation of health care utilization, provider satisfaction. Demonstration evaluation in three urban SNFs, telemedicine linked to university medical center ED. Mobile telemedicine cart equipment assessed SNF residents for any ch

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Dutch, Martin J., and Kristy B. Austin. "Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams." Prehospital and Disaster Medicine 27, no. 5 (July 19, 2012): 463–67. http://dx.doi.org/10.1017/s1049023x12000994.

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AbstractIntroductionRecreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure.ObjectiveTo describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams.MethodsRetrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from Janua

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Menzin, Joseph, Luke Boulanger, Ole Hauch, Mark Friedman, Cheryl Beadle Marple, Gail Wygant, Judith S. Hurley, Stephen Pezzella, and Scott Kaatz. "Quality of Anticoagulation Control and Costs of Monitoring Warfarin Therapy among Patients with Atrial Fibrillation in Clinic Settings: A Multi-Site Managed-Care Study." Annals of Pharmacotherapy 39, no. 3 (March 2005): 446–51. http://dx.doi.org/10.1345/aph.1e169.

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BACKGROUND: Warfarin is recommended for prevention of stroke in patients with atrial fibrillation who are at moderate or high risk, but requires intensive management to achieve safe and optimal anticoagulation control. Anticoagulation clinics are often used to administer warfarin therapy more effectively. OBJECTIVE: To collect data from multiple sites and assess the quality and costs associated with anticoagulation clinic services. METHODS: A random sample of 600 adults with chronic nonvalvular atrial fibrillation (CNVAF) receiving warfarin was selected from anticoagulation clinics affiliated

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Omelyanovskiy, V. V., E. S. Saybel, T. P. Bezdenezhnykh, and G. R. Khachatryan. "The health technology assessment system in Australia." FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology 12, no. 4 (February 18, 2020): 333–41. http://dx.doi.org/10.17749/2070-4909.2019.12.4.333-341.

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In Australia, the federal government is in charge of providing the health care to patients. The government agencies determine the list of reimbursable pharmaceuticals and medical services and also define the preferential categories of the population. The states and territories may have their own health care programs in addition to the federal ones. The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for the health technology assessment (HTA) and decides which technology is eligible for reimbursement by the federal budget. The drug evaluation process includes five stages: a rev

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Tripaydonis, Anne, and Rachel Conyers. "Adolescent survivor of childhood Acute Myeloid Leukaemia undertakes pregnancy with a severe anthracycline induced cardiomyopathy and risk taking behaviours." Case Reports in Internal Medicine 3, no. 4 (September 29, 2016): 64. http://dx.doi.org/10.5430/crim.v3n4p64.

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A 16-year-old female survivor of childhood Acute Myeloid Leukaemia (AML) presented 12 weeks pregnant to her haematology oncology late effects appointment. Having failed to attend recent healthcare appointments her severe cardiomyopathy secondary to chemotherapy during childhood was poorly managed and she had missed the opportunity to discuss her reproductive plans and have her periconceptional care delivered. This case emphasises the challenges in engaging Adolescent and Young Adult-aged (AYA-aged) cancer survivors with their healthcare and the importance of narrative medicine, adequate health

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Foody, JoAnne M., Amie T. Joyce, Amy E. Rudolph, Larry Z. Liu, and Joshua S. Benner. "Cardiovascular outcomes among patients newly initiating atorvastatin or simvastatin therapy: A large database analysis of managed care plans in the United States." Clinical Therapeutics 30, no. 1 (January 2008): 195–205. http://dx.doi.org/10.1016/j.clinthera.2008.01.003.

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Chang, Angela T., Belinda Gavaghan, Shaun O'Leary, Liza-Jane McBride, and Maree Raymer. "Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?" Australian Health Review 42, no. 3 (2018): 334. http://dx.doi.org/10.1071/ah16222.

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Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to special

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Schneider, Carl E., and Mark A. Hall. "The Patient Life: Can Consumers Direct Health Care?" American Journal of Law & Medicine 35, no. 1 (March 2009): 7–65. http://dx.doi.org/10.1177/009885880903500101.

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AbstractThe ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans, providers, and treatments. Expecting patients to choose what they need at the price they want, consumerists believe that market competition will constrain costs while optimizing quality. This classic form of consumerism is today's health poli

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Schlesinger, Mark, Shannon Mitchell, and Bradford Gray. "Measuring Community Benefits Provided by Nonprofit and For-Profit HMOs." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 40, no. 2 (May 2003): 114–32. http://dx.doi.org/10.5034/inquiryjrnl_40.2.114.

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Despite the dramatic shift from nonprofit to for-profit ownership in the managed care industry, little is known about the implications for health plans' relations with the communities in which they operate. This paper provides the first comprehensive comparison of the community benefit activities of nonprofit and for-profit health maintenance organizations (HMOs). We develop a conceptual framework for identifying these activities and provide evidence from a nationally representative survey of plans fielded in 1999. We find that nonprofit plans exceed their for-profit counterparts on some, but

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Tahhan, Nina, Belinda Kate Ford, Blake Angell, Gerald Liew, Joseph Nazarian, Glen Maberly, Paul Mitchell, Andrew J. R. White, and Lisa Keay. "Evaluating the cost and wait-times of a task-sharing model of care for diabetic eye care: a case study from Australia." BMJ Open 10, no. 10 (October 2020): e036842. http://dx.doi.org/10.1136/bmjopen-2020-036842.

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ObjectivesTo determine whether a collaborative model of care that uses task-sharing for the management of low-risk diabetic retinopathy, Community Eye Care (C-EYE-C), can improve access to care and better use resources, compared with hospital-based care.DesignRetrospective audit of medical and financial records to compare two models of care.SettingA large, urban tertiary Australian publicly funded hospital.InterventionC-EYE-C is a collaborative care model, involving community-based optometrist assessment and ‘virtual review’ by ophthalmologists to manage low-risk patients. The C-EYE-C model of

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Kunin, Marina, Dan Engelhard, Shane Thomas, Mark Ashworth, and Leon Piterman. "Influenza pandemic 2009/A/H1N1 management policies in primary care: a comparative analysis of three countries." Australian Health Review 37, no. 3 (2013): 291. http://dx.doi.org/10.1071/ah12022.

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Background. During the influenza pandemic 2009/A/H1N1, the main burden of managing patients fell on primary care physicians (PCP). This provided an excellent opportunity to investigate the implications of pandemic policies for the PCP role. Aim. To examine policies affecting the role of PCP in the pandemic response in Australia (in the state of Victoria), Israel and England. Methods. Content analysis of the documents published by the health authorities in Australia, Israel and England during the pandemic 2009/A/H1N1. Results. The involvement of PCP in the pandemic response differed among the c

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Lingaratnam, Senthil, Leon J. Worth, Monica A. Slavin, Craig A. Bennett, Suzanne W. Kirsa, John F. Seymour, Andrew Dalton, et al. "A cost analysis of febrile neutropenia management in Australia: ambulatory v. in-hospital treatment." Australian Health Review 35, no. 4 (2011): 491. http://dx.doi.org/10.1071/ah10951.

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Background. Adult febrile neutropenic oncology patients, at low risk of developing medical complications, may be effectively and safely managed in an ambulatory setting, provided they are appropriately selected and adequate supportive facilities and clinical services are available to monitor these patients and respond to any clinical deterioration. Methods. A cost analysis was modelled using decision tree analysis, published cost and effectiveness parameters for ambulatory care strategies and data from the State of Victoria’s hospital morbidity dataset. Two-way sensitivity analyses and Monte C

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Tao, Zhuliang, Yong Li, Stephen Stemkowski, Kelly D. Johnson, Camilo J. Acosta, Dongmu Zhang, and A. Mark Fendrick. "Impact of Out-of-Pocket Cost on Herpes Zoster Vaccine Uptake: An Observational Study in a Medicare Managed Care Population." Vaccines 6, no. 4 (November 21, 2018): 78. http://dx.doi.org/10.3390/vaccines6040078.

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Herpes zoster (HZ) vaccination is approved for adults aged 50+ for the prevention of HZ, but it is underutilized. The objective of this study was to evaluate the association between out-of-pocket cost and HZ vaccine utilization. Adults aged 65 or older enrolled for at least 12 months in Medicare Advantage/Part D (MAPD) and Medicare Part D only (PDP) plans from 1 January 2007 to 30 June 2014 were selected. Abandonment was defined as a reversed claim for HZ vaccine with no other paid claim within 90 days. Out-of-pocket costs used were actual amounts recorded in the claim. Overall, the HZ vaccine

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Pelletier, Elise M., Paula J. Smith, and Carole J. Dembek. "Payer Costs of Autologous Stem Cell Transplant: Results from a U.S. Claims Data Analysis." Blood 112, no. 11 (November 16, 2008): 2373. http://dx.doi.org/10.1182/blood.v112.11.2373.2373.

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Abstract Objectives: Autologous stem cell transplant (ASCT) includes costly pre-transplant care which must be considered in the overall cost of treatment. The objective of this study was to evaluate total costs of an ASTC, from mobilization/apheresis through 100 days following transplant, in U.S. managed care plans. Methods: Patients 18+ years of age with evidence of an ASCT between January 1, 2000 and December 31, 2006 were identified from a nationally-representative database of medical and pharmacy claims from over 90 U.S. managed care health plans. Patients were required to have a claim for

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Veal, Felicity, Mackenzie Williams, Luke Bereznicki, Elizabeth Cummings, and Tania Winzenberg. "A retrospective review of pain management in Tasmanian residential aged care facilities." BJGP Open 3, no. 1 (March 5, 2019): bjgpopen18X101629. http://dx.doi.org/10.3399/bjgpopen18x101629.

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BackgroundThe management of pain by GPs for residents of aged care facilities (ACFs) is very common.AimTo measure the prevalence and assess the management of pain in ACF residents, particularly those with dementia.Design & settingA retrospective review of ACF residents’ medical records was undertaken at five southern Tasmanian (Australia) ACFs.MethodData extracted included results of the most recent assessment of pain and its management, frequency and treatment of pain incidents in the previous 7 days, demographics, and medical and medication history. Univariate analysis was used to identi

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Davies, O., and S. James. "52 A Community Cure for Frequent Reattenders: Developing An Interface Geriatrics Service." Age and Ageing 49, Supplement_1 (February 2020): i14—i17. http://dx.doi.org/10.1093/ageing/afz186.06.

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Abstract Topic Setting up an interface geriatrics service in a seaside area with a large elderly population. Many elderly patients are readmitted due to the challenge of managing their chronic health conditions in the community. These patients are frail, with frequently exacerbated chronic conditions causing regular readmissions. We noted that treatment was rarely changed during these admissions and patients were not uniformly managed. Aims Aims for this project were to improve care for older people, reduce readmissions and produce clear patient care plans. Interventions Our first PDSA cycle i

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Aledort, Louis M., Roger M. Lyons, Gary Okano, and Joseph Leveque. "The Clinical and Direct Medical Cost Burden of Splenectomy among Managed Care Patients with Chronic Immune Thrombocytopenic Purpura (ITP)." Blood 108, no. 11 (November 16, 2006): 5536. http://dx.doi.org/10.1182/blood.v108.11.5536.5536.

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Abstract Background: ITP is a serious chronic disease involving increased platelet destruction and impaired platelet production. Corticosteroids (CS) are used most commonly to treat ITP and are associated with reduction in quality of life. Splenectomy is used less frequently but is a bigger cost driver. Improved therapies for ITP are needed in view of these compromises. Objective: A retrospective database analysis assessed clinical and economic burdens of ITP in a managed care population, focusing on CS use and splenectomy. Methods: Patients with a diagnosis of ITP (ICD9-CM code 287.3) between

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