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1. Clinical decision support to Optimize Care of patients with Atrial Fibrillation or flutter in the Emergency department: protocol of a stepped-wedge cluster randomized pragmatic trial (O’CAFÉ trial)

Author

Vinson, David R, Rauchwerger, Adina S, Karadi, Chandu A, Shan, Judy, Warton, E Margaret, Zhang, Jennifer Y, Ballard, Dustin W, Mark, Dustin G, Hofmann, Erik R, Cotton, Dale M, Durant, Edward J, Lin, James S, Sax, Dana R, Poth, Luke S, Gamboa, Stephen H, Ghiya, Meena S, Kene, Mamata V, Ganapathy, Anuradha, Whiteley, Patrick M, Bouvet, Sean C, Babakhanian, Leon, Kwok, Edward W, Solomon, Matthew D, Go, Alan S, and Reed, Mary E

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Clinical Trials and Supportive Activities, Comparative Effectiveness Research, Heart Disease, Health Services, Emergency Care, Prevention, Cardiovascular, 7.3 Management and decision making, Management of diseases and conditions, Stroke, Good Health and Well Being, Adult, Humans, Anticoagulants, Atrial Fibrillation, Atrial Flutter, Decision Support Systems, Clinical, Emergency Service, Hospital, Randomized Controlled Trials as Topic, Pragmatic Clinical Trials as Topic, Atrial fibrillation, Atrial flutter, Emergency medicine, Randomized trial, Cardioversion, Patient admission, Kaiser Permanente CREST Network, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Cardiovascular System & Hematology, General & Internal Medicine, Clinical sciences, Epidemiology, Health services and systems
Abstract

BackgroundManagement of adults with atrial fibrillation (AF) or atrial flutter in the emergency department (ED) includes rate reduction, cardioversion, and stroke prevention. Different approaches to these components of care may lead to variation in frequency of hospitalization and stroke prevention actions, with significant implications for patient experience, cost of care, and risk of complications. Standardization using evidence-based recommendations could reduce variation in management, preventable hospitalizations, and stroke risk.MethodsWe describe the rationale for our ED-based AF treatment recommendations. We also describe the development of an electronic clinical decision support system (CDSS) to deliver these recommendations to emergency physicians at the point of care. We implemented the CDSS at three pilot sites to assess feasibility and solicit user feedback. We will evaluate the impact of the CDSS on hospitalization and stroke prevention actions using a stepped-wedge cluster randomized pragmatic clinical trial across 13 community EDs in Northern California.DiscussionWe hypothesize that the CDSS intervention will reduce hospitalization of adults with isolated AF or atrial flutter presenting to the ED and increase anticoagulation prescription in eligible patients at the time of ED discharge and within 30 days. If our hypotheses are confirmed, the treatment protocol and CDSS could be recommended to other EDs to improve management of adults with AF or atrial flutter.Trial registrationClinicalTrials.gov NCT05009225 .  Registered on 17 August 2021.

Published
2023

5. Effect of Out‐of‐Pocket Cost on Medication Initiation, Adherence, and Persistence among Patients with Type 2 Diabetes: The Diabetes Study of Northern California (DISTANCE)

Author

Karter, Andrew J, Parker, Melissa M, Solomon, Matthew D, Lyles, Courtney R, Adams, Alyce S, Moffet, Howard H, and Reed, Mary E

Subjects
Health Services and Systems, Health Sciences, Aging, Behavioral and Social Science, Prevention, Health Services, Clinical Research, Diabetes, Metabolic and endocrine, Good Health and Well Being, Adult, Aged, California, Comorbidity, Cost Sharing, Diabetes Mellitus, Type 2, Female, Financing, Personal, Health Expenditures, Humans, Hypoglycemic Agents, Male, Medication Adherence, Middle Aged, Socioeconomic Factors, Adherence, medical expenditures, pharmacy benefits, out-of-pocket costs, Public Health and Health Services, Policy and Administration, Health Policy & Services, Health services and systems, Policy and administration
Abstract

ObjectiveTo estimate the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes.Data sources/settingElectronic health records from a large, health care delivery system for 223,730 patients with diabetes prescribed 842,899 new cardiometabolic medications during 2006-2012.Study designObservational, new prescription cohort study of the effect of OOP cost on medication initiation and adherence.Data collectionAdherence and OOP costs were based on pharmacy dispensing records and benefits.Principal findingsPrimary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index; 7 percent were never dispensed the new medication when OOP cost ≥$11, 5 percent with OOP cost of $1-$10, and 3 percent when the medication was free of charge (p

Published
2018

9. Practice characteristics and HMO enrollee satisfaction with specialty care: an analysis of patients with glaucoma and diabetic retinopathy.

Author

Escarce, José J, Kapur, Kanika, Solomon, Matthew D, Mangione, Carol M, Lee, Paul P, Adams, John L, Wickstrom, Steven L, and Quiter, Elaine S

Subjects
Humans, Glaucoma, Open-Angle, Diabetic Retinopathy, Health Care Surveys, Logistic Models, Physician-Patient Relations, Ophthalmology, Optometry, Middle Aged, Independent Practice Associations, Practice Management, Medical, Patient Satisfaction, Quality Indicators, Health Care, United States, Female, Male, Surveys and Questionnaires, satisfaction, quality of care, managed care, financial incentives, Glaucoma, Open-Angle, Practice Management, Medical, Quality Indicators, Health Care, Health Services, Clinical Research, Diabetes, Aging, Neurosciences, Eye Disease and Disorders of Vision, 8.1 Organisation and delivery of services, 7.3 Management and decision making, Eye, Metabolic and Endocrine, Health Policy & Services, Public Health and Health Services, Policy and Administration
Abstract

BACKGROUND:The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential. OBJECTIVE:To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR). SUBJECTS/STUDY SETTING: A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices. STUDY DESIGN:We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction. PRINCIPAL FINDINGS:Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction. CONCLUSIONS:Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction.

Published
2003

10. Characteristics of eye care practices with managed care contracts.

Author

Solomon, Matthew D, Lee, Paul P, Mangione, Carol M, Kapur, Kanika, Adams, John L, Wickstrom, Steven L, and Escarce, José J

Subjects
Humans, Health Care Surveys, Cross-Sectional Studies, Ophthalmology, Optometry, Capitation Fee, Financial Management, Contract Services, Managed Care Programs, Group Practice, Practice Management, Medical, Private Practice, Total Quality Management, Utilization Review, United States, Clinical Research, Eye Disease and Disorders of Vision, Health Services, Health and social care services research, 8.1 Organisation and delivery of services, Eye, Physician practice patterns, Managed care plans, Eye--Care and hygiene, X-PublishedAs-Type: articleX-PublishedAs-Journal: American Journal of Managed CareX-PublishedAs-Year: 2002X-PublishedAs-Volume: 8X-PublishedAs-Pages: 1057-1067, Public Health and Health Services, Health Policy & Services
Abstract

OBJECTIVES: To describe the variation in practice structure, financial arrangements, and utilization and quality management systems for eye care practices with managed care contracts. STUDY DESIGN: Cross-sectional survey of 88 group and 56 solo eye care practices that contract with 6 health plans affiliated with a national managed care organization. The survey contained modules on practice structure, financial arrangements, utilization management, and quality management. The survey response rate was 85%. RESULTS: Group practices with both ophthalmologists and optometrists were triple the size of ophthalmology-only groups, and 5 times the size of optometry-only groups. Fee-for-service payments were the primary source of group practice revenues, although 60% of groups derived some revenues from capitation payments. Group practices paid their physicians almost exclusively with fee-for-service payments or salary arrangements, with minimal capitation at the individual level. Almost no practices used both capitation and bonuses to compensate providers. Most practices received practice profiles and three fourths were subject to utilization review, which mainly consisted of preauthorization for procedures, tests, or referrals. Nearly all practices used clinical guidelines, protocols, or pathways in managing patients with diabetic retinopathy or glaucoma. Further, nearly all group practices used computerized information systems to assist in delivering care, and most had provider education programs. CONCLUSIONS: Managed care has affected the way eye care providers organize, finance, and deliver healthcare. In general, our findings paint an optimistic picture of eye care practices that contract with managed care organizations. Few practices bear substantial financial risk, and nearly all practices use quality management tools that could help to improve the quality of care.

Published
2002

11. TEMPORAL TRENDS IN THE PREVALENCE AND SEVERITY OF AORTIC STENOSIS WITHIN AN INTEGRATED HEALTH CARE DELIVERY SYSTEM

Author

Ambrosy, Andrew P., primary, Go, Alan S., additional, Leong, Thomas Kiichi, additional, Garcia, Elisha, additional, Le, Kathy, additional, Chang, Alex, additional, Slade, Justin J., additional, McNulty, Edward J., additional, Mishell, Jacob M., additional, Rassi, Andrew N., additional, Lange, David Christopher, additional, Philip, Femi, additional, Galper, Benjamin Zev, additional, Berry, Natalia, additional, and Solomon, Matthew D., additional

Published
2023
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13. PHYSICIAN ASSESSMENT OF AORTIC STENOSIS SEVERITY AND LONG-TERM OUTCOMES: RESULTS FROM THE KP-VALVE PROJECT

Author

Solomon, Matthew D., primary, Tabada, Grace H., additional, Sung, Sue Hee, additional, Allen, Amanda, additional, Mishell, Jacob M., additional, Rassi, Andrew N., additional, McNulty, Edward J., additional, Philip, Femi, additional, Lange, David Christopher, additional, Ambrosy, Andrew P., additional, Zaroff, Jonathan G., additional, Krishnaswami, Ashok, additional, Lee, Catherine, additional, DeMaria, Anthony N., additional, and Go, Alan S., additional

Published
2023
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28. Association Between Cardiovascular Health Status and Healthcare Utilization in a Large Integrated Healthcare System

Author

Lien, Irvin C., Moffet, Howard H., Liu, Jennifer Y., Karter, Andrew J., Solomon, Matthew D., Go, Alan S., Nasir, Khurram, Sidney, Stephen, and Rana, Jamal S.

Abstract

The American Heart Association Life's Simple 7 schema can be used to categorize patients’ cardiovascular health status as poor, intermediate, or ideal on the basis of smoking, BMI, physical activity, dietary patterns, blood pressure, cholesterol, and fasting blood sugar. This study examined the association between cardiovascular health status and subsequent healthcare utilization.

Published
2024
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38. Reply

Author

Hlatky, Mark A., primary, Andersson, Charlotte, additional, Chang, Tara I., additional, Kazi, Dhruv, additional, Solomon, Matthew D., additional, and Go, Alan S., additional

Published
2014
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47. Eligibility and Potential Benefit of Transcatheter Edge-to-Edge Repair in a Contemporary Cohort with Heart Failure: Evidence from a Large Integrated Health Care Delivery System

Author

Ambrosy, Andrew P., Yang, Jingrong, Tai, Andrew S., Dimbil, Sadia J., Garcia, Elisha A., Sung, Sue Hee, Bhatt, Ankeet S., Solomon, Matthew D., Ku, Ivy A., Mishell, Jacob M., McNulty, Edward J., Zaroff, Jonathan G., Rassi, Andrew N., Kong, Jeremy, and Go, Alan S.

Abstract

The eligibility and potential benefit of transcatheter edge-to-edge repair (TEER) in addition to guideline-directed medical therapy to treat moderate-severe or severe secondary mitral regurgitation (MR) has not been reported in a contemporary heart failure (HF) population. In this study 50,841 adults with HF identified between 2013-2018 were screened for TEER eligibility based on the Food and Drug Administration (FDA) labeling. After applying the FDA eligibility criteria, 2,461 of these patients (4.8%) qualified for TEER (FDA+). These patients had higher natriuretic peptide levels and were more likely to have had a prior 1-year HF hospitalization. The estimated number needed to treat to prevent or postpone all-cause hospitalization was 4.4, 8.8 for HF hospitalization, and 5.3 for all-cause death at 24 months. The low prevalence of FDA eligibility for TEER treatment was primarily due to absence of moderate-severe or severe MR. Additional research is necessary to validate the scope of eligibility and comparative effectiveness of TEER.

Published
2023
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