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The role of pharmacoeconomics in disease management - A pharmaceutical benefit management company perspective

PHARMACOECONOMICS 1996年第0期9卷 9-15页

作者： Thomas, N PCS HLTH SYST INC CLIN SERV DIVMINNEAPOLISMN

In the US, managed-care organisations (MCOs) have turned to pharmacy benefit management (PBM) companies to contain costs and provide total disease management packages. The demand for pharmacoeconomic research and information by purchasers of healthcare has contributed to the growth of PBM companies and to recent acquisitions by pharmaceutical manufacturers. PBMs influence prescribing via formulary management and drug utilisation review (DUR). Formularies are generally open, and pharmacoeconomic data contribute to formulary management decisions. Prospective and concurrent DURs used in hospitals can soon be integrated into community pharmacy, as PBMs obtain integrated online information about prescribing. PBM prescription databases are used as as educational tools for physicians, providing drug utilisation data, formulary compliance, generic prescribing rates, and guidelines for pharmacotherapy for particular conditions. They can also evaluate medication regimens for patients with particular problems such as drug-drug interactions. However, PBM databases typically lack patient diagnostic, outcome and medical claim data. PBMs will be better placed to move from medication management to disease management when they can obtain these data and link them appropriately to their own prescribing and physician databases.

关键词：药物利用评审经济学药学保险药剂师工作/经济学管理医疗规划/经济学医师诊疗模式/经济学人类

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Management of Barrett's esophagus: A national study of practice patterns and their cost implications

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AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第12期94卷 3440-3447页

作者： Gross, CP Canto, MI Hixson, J Powe, NR Johns Hopkins Univ Sch Med Baltimore MD USA Welch Ctr Prevent Epidemiol & Clin Res Div Gastroenterol Hepatol Robert Wood Johnson Clin Scholars Program Baltimore MD USA

OBJECTIVE: The optimal management of Barrett's esophagus (BE) is controversial. Little is known about current practice patterns or associated direct medical costs. METHODS: In a national cross-sectional survey, we asked, a random sample of gastroenterologists how they would manage patients with BE and various degrees of dysplasia. We used logistic regression to identify factors associated with so-called "frequent" (at least every 12 months) surveillance. We calculated direct. medical costs using Medicare payments and population-based estimates of the number of BE patients under surveillance. RESULTS: Approximately 50% of 555 gastroenterologists responded. More than 96% of respondents recommended endoscopic surveillance for BE. For BE without dysplasia, 30% would perform frequent surveillance;this was the case particularly gastroenterologists older than age 45 yr (odds ratio = 1.91, p = 0.038) or those receiving primarily fee-for-service reimbursement (odds ratio = 2.57, p = 0.004). For BE with low-grade dysplasia, the frequency of endoscopy was highly variable (range, 1-24 months). For BE with high-grade dysplasia, 73% of gastroenterologists recommended esophagectomy and the remainder recommended endoscopic surveillance. Approximately 95% of the gastroenterologists who recommended surveillance for high-grade dysplasia, however, were not in agreement with recommended protocols. We estimated the national annual expenditure for surveillance endoscopy every 24 months fur BE without dysplasia to be at least: $22 million. Increase in surveillance intensity from low frequency (every 36 months) to high frequency (every 12 months) strategies would escalate costs by $29 million annually. CONCLUSIONS: Physician age and reimbursement influence BE surveillance practice, suggesting the influence of non-clinical factors on clinical decisionmaking, The majority of clinicians who would recommend surveillance for high-grade dysplasia may not be using an appropriately aggressive strat

关键词：腺癌/经济学腺癌/治疗 Barrett食管/经济学 Barrett食管/治疗费用效益分析成本及成本分析横断面研究食管肿瘤/经济学食管肿瘤/治疗 Logistic模型 Medicare/经济学医师诊疗模式/经济学癌前状态/经济学癌前状态/治疗偿还途径/经济学美国成年人老年人女(雌)性人类男(雄)性中年人

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Should this study change my practice?

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ACADEMIC EMERGENCY MEDICINE 2003年第5期10卷 417-422页

作者： Cone, DC Lewis, RJ Yale Univ Sch Med Sect Emergency Med New Haven CT 06510 USA Harbor UCLA Med Ctr Dept Emergency Med Torrance CA 90509 USA

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Do cardiologists and general internists differ in testing and treating patients with aortic stenosis or mitral regurgitation? A preliminary study with editorial perspective

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AMERICAN HEART JOURNAL 1999年第4期137卷 596-600页

作者： Alloggiamento, T Cummings, SR Redberg, RF Univ Calif San Francisco Div Cardiol San Francisco CA 94143 USA Stanford Univ Div Cardiovasc Med Stanford CA 94305 USA Vet Adm Hlth Care Syst Div Hlth Serv Res Palo Alto CA USA Univ Calif San Francisco Div Gen Internal Med San Francisco CA 94143 USA

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Projected responses to changes in physician RBRVS reimbursement: induced-demand theory versus contingency theory.

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Medical care review 1992年第1期49卷 67-91页

作者： Fahey, D.F. West Covina Medical Clinic 91790. CA United States

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Implementing an integrated program of resource management.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1995年第3期17卷 17-22,30页

作者： Lawson, R.D. Methodist Hospitals of Memphis TN United States

The physicians at Methodist Hospitals of Memphis have designed a program of resource management that has resulted in significant patient care cost savings while maintaining an excellent quality of care. The program combines methods of increasing physician awareness of cost issues, sharing physician utilization and quality data with them, and coordinating patient care through the use of multidisciplinary clinical pathways and case management. Our physicians, patients, nursing staff, and quality management personnel are enthusiastic about the program's positive effect on costs and improved quality patient care.

关键词：医师诊疗模式/经济学田纳西利用情况审核

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Sharing financial information with doctors: making it work.

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Journal for healthcare quality : official publication of the National Association for Healthcare Quality 1993年第4期15卷 26-33页

作者： Lawson, R.D. Methodist Hospitals of Memphis. United States

Physicians are becoming increasingly aware of how their practice patterns affect the financial viability of their practices and of the hospitals in which they work. Programs of diagnosis-related group (DRG) analysis may be used not only to educate physicians but to provide data for physician-directed efforts to reduce variations in practice patterns and deal with physicians whose practice habits may be counter to cost-effective, high-quality care. A combination of early, extensive physician involvement and subsequent multidisciplinary interaction will ensure the development of and adherence to cost-effective, high-quality patient care.

关键词：数据收集诊断相关患者组/经济学财务管理医院医务人员医院/经济学医务人员医院/组织和管理医师诊疗模式/经济学医师诊疗模式/统计学和数值数据规划技术人员开发/方法田纳西

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Physician benchmarking: Measuring variation in practice behavior in treatment of otitis media

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Health Care Management Science 1998年第1期1卷 5-17页

作者： Ozcan, Yasar A. Department of Health Administration Virginia Commonwealth University Richmond VA 23298-0203 PO Box 980203 United States

The study uses Data Envelopment Analysis (DEA) to analyze physician practice behavior and develops measures of physician practice efficiency as a basis for improving productivity and reducing costs in otitis media treatment. Other objectives include determining geographic variations in practice patterns for otitis media, and the impact of inefficient practice patterns on the cost of treatment of otitis media. Only 46 (28.8%) of the 160 physicians were classified as efficient. Average total cost of an episode by efficient providers was $357.03 and $492.06 for inefficient providers. By restricting particular inputs and outputs, and directing all physicians to treat otitis media through a balanced primary care model, physicians would be able to provide the same quality care at an average savings of 23.7% per efficient and 4.4% per inefficient provider. © Baltzer Science Publishers BV.

关键词：规范/统计学和数值数据费用节省治疗过程片断卫生保健费用/统计学和数值数据中耳炎/经济学中耳炎/治疗医师诊疗模式/经济学医师诊疗模式/统计学和数值数据弗吉尼亚人类

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Women's choice? The impact of private health insurance on episiotomy rates in Australian hospitals

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MIDWIFERY 2000年第3期16卷 204-212页

作者： Shorten, A Shorten, B Univ Wollongong Dept Nursing Wollongong NSW 2522 Australia

Objective: to assess the extent to which variations in episiotomy rates in Australian hospitals are justified by clinical variables and to further explore the relationships between episiotomy, insurance status, perineal trauma and outcomes for babies. Design: a retrospective analysis of anonymous medical record data using logistic regression models, aimed at identifying factors influencing both episiotomy rates and outcomes for babies. Setting: a large regional public hospital, New South Wales, Australia. Participants: the study sample consisted of 2028 women who delivered vaginally during a 12 month period during 1996-1997, Results: after controlling for clinical and other factors privately insured women were estimated to be up to twice as likely to experience episiotomy as publicly insured women, This difference most plausibly reflects differences in labour management styles between obstetricians and midwives. Other significant contributors to episiotomy were instrumental delivery, indications of possible fetal distress and lower parity, Severe perineal trauma (third degree tear) was found to be positively associated with episiotomy. Furthermore, the incidence of additional tears requiring suture was also substantially higher among privately insured women, the net effect being that these women had a substantially lower chance of achieving an intact perineum, Neither episiotomy nor insurance status had any significant effect on the well-being of babies. Implications for practice: private health insurance appears to deny many women the opportunity of achieving normal vaginal delivery with intact perineum, Episiotomy rates amongst privately insured women in Australia may be higher than is clinically appropriate, and severe perineal trauma within this study was associated with this practice, (C) 2000 Harcourt Publishers Ltd.

关键词：决策产房/经济学会阴切开术/经济学会阴切开术/利用医院费用医院私立/经济学医院公立/经济学保险住院 Logistic模型病案新南威尔士产次围生期医护/标准会阴/损伤会阴/外科学医师诊疗模式/经济学妊娠结局回归分析回顾性研究危险因素女(雌)性人类婴儿新生妊娠

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Evidence-based medicine: is translating evidence into practice a solution to the cost-quality challenges facing medicine?

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The Joint Commission journal on quality improvement 1999年第9期25卷 480-485页

作者： Larson, E.B. University of Washington Medical Center Seattle 98195 USA.

BACKGROUND: Evidence-based medicine (EBM) and practice guidelines have been embraced by increasing numbers of scholars, administrators, and medical journalists as an intellectually attractive solution to the dilemma of improving health care quality while reducing costs. However, certain factors have thus far limited the role that EBM might play in resolving cost-quality trade-offs. FACTORS FOR SUCCESS OF EBM RECOMMENDATIONS AND GUIDELINES: Beyond the quality of the guideline and the evidence base itself, critical factors for success include local clinician involvement, a unified or closed medical staff, protocols that minimize use of clinical judgment and that call for involvement of so-called physician extenders (such as nurse practitioners and physician assistants), and financial incentive. TROUBLESOME ISSUES RELATED TO COST-QUALITY TRADE-OFFS: Rationing presents many dilemmas, but for physicians one critical problem is determining what is the physician's responsibility. Is the physician to be the patient's advocate, or should the physician be the advocate of all patients (the patients' advocate)? How do we get physicians out of potentially conflicted roles? EBM guidelines are needed to help minimize the number of instances physicians are asked to ration care at the bedside. If the public can decide to share and limit resources--presumably based on shared priorities--physicians would have a basis to act as advocates for all patients. CONCLUSIONS: Although EBM alone is not a simple solution to the problems of increasing costs and public expectations, it can be an important source of input and information in relating the value of service and medical technology to public priorities.

关键词：临床医学/经济学临床医学/标准费用效益分析决策组织循证医学/经济学循证医学/标准卫生保健公平提供/组织和管理卫生服务使用研究/组织和管理病人辩护医师诊疗模式/经济学医师诊疗模式/标准医师的作用诊疗准则(主题)/标准卫生保健质量美国人类

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