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We began analyses with panel OLS to examine how changes in the values of variables might affect the treatment costs. Hausman tests were used to determine whether patient-specific costs were random or fixed. We allowed the ICOC variables in the regressions to lag by 1 to 3 years to mimic the common practice of using COC at baseline to predict the cost effect in the following years. Finally, we used subsamples of patients who patron clinics as principal care provider to re-estimate the ICOC elasticities for treatment costs to investigate how ICOC elasticities change with provider characteristics.
The patient characteristics, as shown in Table 1 , reflect that patients self-selected themselves into different types of providers. Patients were grouped in accordance with the accreditation level of their principal providers in and , respectively.
As shown by the data, patients frequently changed their principal providers from year to year. Those patients who were cared by the clinics tended to be healthier and they were more likely to be women. The conventional thinking is that patients may need to visit larger hospitals as their conditions progress, and they need more specialist care.
The patients in this study, however, by , tended to use clinics more as their principal providers, perhaps because during this time Taiwan was experiencing an increasing number of small-scale for-profit hospitals closure while more clinics were entering the market.
As for the treatment costs, patients using clinics as their principal providers incurred the least costs while patients with the regional hospitals or medical centers at higher accreditation level incurred higher treatment costs. For all providers, the average outpatient costs, not surprisingly, were approximately half of the inpatient costs. Annual numbers of admissions were as low as 0. Table 2 reports the regression estimates for ICOC elasticities. For 2SLS, the first stage regression results not reported in the tables revealed that average local provider P4P participation rate by accreditation-level was positively and significantly associated with patient ICOC.
The second stage regressions produced a different ICOC elasticity for outpatient costs, i. The Andersen-Rubin Wald F statistics rejected the hypothesis that average local provider P4P participation rate was a weak instrument, and the Wald test for endogeneity supported that ICOC was endogenous for both outpatient and inpatient costs. The ICOC elasticities for inpatient and total costs were consistently negative, but the sign for the ICOC elasticity on outpatient costs changed with the number of years lagged.
This study established ICOC as a potentially new index to investigate the cost-saving effect using an 8-year database of newly diagnosed diabetes patients.
As many medical groups are adopting an integrated team care approach for chronic disease management, this ICOC index serves as a valid and reliable indicator to provide important policy reference in the evidence-based policy making process. In this case, the cost-saving effect of ICOC and unobserved individual effect e. The ICOC elasticity of 1. However, in nonexperimental settings, when treatment effects the impact of ICOC on health costs in this paper are likely to be heterogeneous, it may not be possible to draw inferences about the effect of treatment in the population represented by a particular sample of people [ 34 ].
That is, our results are applicable to our study sample, but may not be generalized to all DM population. Our findings also have shown that an increase in the ICOC score is associated with an increase in outpatient costs and a decrease in inpatient expenses. The net effect is that an increase in the ICOC score is associated with a significant saving effect on the total treatment cost.
The estimated ICOC elasticity of As the distribution of inpatient costs has a big spike of zeros and is skewed to the right, the ICOC elasticity estimated from the 2SLS might be biased.
The results show that the estimated ICOC elasticity is The estimated ICOC elasticity for total costs is To the best of our knowledge, no study has ever estimated ICOC elasticity. However, quite a few studies have used elasticity to assess the impact of cost-sharing on total spending, and the estimated arc price elasticities range between 0.
Except for Cutler et al. Given the above findings, clinic visits appear to produce cost-saving under the payment system even though the NHI provides clinics with a lower reimbursement rate than hospitals for the same services.
When we applied sub-group panel regression analyses to estimate ICOC elasticities for just the clinics data, we found a promising cost-saving effect of ICOC.
In contrast, the ICOC elasticity for hospital outpatient costs is positive probably because outpatient services in hospitals are likely to exploit expensive diagnostic testing and high-end medical technology.
Two research constraints bear noting. First, our findings are applicable only to new diabetes patients who could maintain at least 4 visits per year. This study expands the boundary of continuity of care COC to explicitly incorporate the COC effect at the institutional level and then evaluates the relative cost-saving effects of ICOC among outpatient, inpatient, and total treatment costs.
Institutional characteristics are likely to have impacts on treatment costs for diabetes patients. Institutional continuity of care ICOC is associated with higher outpatient costs but lower inpatient costs. As a result, the cost-saving effect of ICOC appear to be much greater in countries where inpatient care costs are substantially higher than the costs of outpatient care.
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Published online Oct Yu-Ping Wen , 1 Sandra S. Becker , 4 and Jui-fen Rachel Lu 1, 5, 6. Find articles by Yu-Ping Wen. Sandra S. Find articles by Ji-Tian Sheu. Find articles by Hong-Huei Wang. Edmund R. Find articles by Jui-fen Rachel Lu. Author information Article notes Copyright and License information Disclaimer.
Jui-fen Rachel Lu, Email: wt. Corresponding author. Received Aug 26; Accepted Sep The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Abstract Background The high costs of chronic conditions call for new treatment approaches that reduce costs while ensuring desirable health outcomes.
Results Our results show that ICOC significantly reduced inpatient costs but increased outpatient costs with the elasticity for treatment costs of Conclusions Institutional continuity of care has a substantial impact on the treatment costs of diabetes patients. Keywords: Continuity of care, Diabetes mellitus, Team care, Two-stage least squares regression, Costs.
Background In , approximately million adults 2079 years were living with diabetes. Results Sample Characteristics The patient characteristics, as shown in Table 1 , reflect that patients self-selected themselves into different types of providers.
Open in a separate window. All variables were significantly different at 0. Table 3 ICOC elasticity for treatment cost estimates with 13 years lagged. Discussion This study established ICOC as a potentially new index to investigate the cost-saving effect using an 8-year database of newly diagnosed diabetes patients. Table 4 ICOC elasticity for sub-samples.
References 1. International Diabetes Federation. Brussels; GBD Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for diseases and injuries for countries, a systematic analysis for the Global Burden of Disease Study GBD Diseases and Injuries Collaborators Global burden of diseases and injuries in countries and territories, a systematic analysis for the Global Burden of Disease Study Health Aff Millwood ; 36 5 Transforming the organization and delivery of primary care.
Health Serv Res. Health Aff Millwood ; 36 3 Effectiveness of chronic care models for the management of type 2 diabetes mellitus in Europe: a systematic review and meta-analysis. BMJ Open. Saving Primary Care. Bujold E. McWhinney I. A textbook of family medicine. Oxford: Oxford University Press; Continuity of outpatient care and avoidable hospitalization: a systematic review.
Am J Manag Care. Continuity in primary care: a critical but neglected component for achieving high-quality universal health coverage. BMJ Glob Health. Does patient-centered care improve provision of preventive services? J Gen Intern Med. Med Care. Continuity of care, medication adherence, and health care outcomes among patients with newly diagnosed type 2 diabetes: a longitudinal analysis. Medical care. Worrall G, Knight J. Continuity of care is good for elderly people with diabetes: retrospective cohort study of mortality and hospitalization.
Can Fam Physician. Patients with diabetes in pay-for-performance programs have better physician continuity of care and survival. American Journal of Managed Care.
Applied Health Economics Health Policy. Relational and management continuity survey in patients with multiple long-term conditions. J Health Serv Res Policy. A meta-synthesis of qualitative studies. Int J Qual Health Care. Pu C, Chou YJ. The impact of continuity of care on emergency room use in a health care system without referral management: an instrumental variable approach. Ann Epidemiol. Indices for continuity of care: a systematic review of the literature. Medical Care Research Review.
National Health Insurance Administration. Taipei: National Health Insurance Administration; Brussels: International Diabetes Federation; Health Econ. Developing a prediction rule from automated clinical databases to identify high-risk patients in a large population with diabetes.
Diabetes Care. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. Caffrey is one of 11 practicing licensed physicians on the Board and will serve for two years. Members are appointed by the governor under the advisement of the Secretary of the Department of Health. As a board member, Dr. Spearheaded by David Newman-Toker, professor of neurology, ophthalmology, and otolaryngology, Johns Hopkins University School of Medicine and director, Armstrong Institute Center for Diagnostic Excellence, the professorship will support a highly innovative, collaborative, and entrepreneurial diagnostic medical technology-focused research program.
The program establishes a unique approach to the diagnosis of stroke and other neurological disorders through advanced eye movement detection systems. Food and Drug Administration to treat ischemic stroke. In addition to following treatment guidelines, staff also provide education to patients to help them manage their health and rehabilitation once at home.
The center is one of only a few academic centers in the U. Led by Ng, pediatric surgeon Daniel Rhee and pediatric endocrinologist Kristin Arcara, a team of pediatric providers and staff members from gastroenterology, surgery, endocrinology, radiology, anesthesia and critical care medicine, radiology, nutrition, social work and child life are involved in the TPIAT program. The criteria include having the required expert physician specialties such as gastroenterologists, pancreas surgeons and interventional radiologists, along with more patient-focused programs such as a pain management service, psychosocial support and more.
Winners were selected for the honor based on their professional experience, community involvement and commitment to inspiring change. Congratulations to Sarah on this honor. Congratulations to Suzanne on this honor.
Deborah J. The honor celebrates Dr. Esther Oh, M. The American Delirium Society is an organization dedicated to advancing research and improving care in delirium, and collaborates closely with the European Delirium Association and the Australasian Delirium Association.
Nancy Schoenborn, M. The results showed that older adults with the same age and same comorbidity status faced frailty at different levels, which suggest that frailty and comorbidities are independent predictors of mortality. View the full list of winners and their respective categories. Sheila K. West, Ph. The award was delayed by one year because of the pandemic. Elizabeth Edsall Kromm, Ph. Kromm leads population health activities, strategic planning and community engagement efforts for the hospital, and serves as president of the Howard Hospital Foundation.
Each year, The Daily Record recognizes women with a commitment to excellence and outstanding professional achievements. The Daily Record received more than nominations. This is the 26th year for the awards. He also will provide oversight for compliance with local, state and federal environmental health and safety requirements, as well as initiatives to promote environmental stewardship. Each year, The Daily Record recognizes women with a commitment to their community.
The Daily Record received over nominations. Cohen received translational funding for his work developing a CortiTech, an atraumatic brain retractor for minimally invasive neurosurgery. Class of Fellows were welcomed into the National Academies of Practice as part of a virtual awards and induction ceremony on March 20, Fellowship in the National Academies of Practice is an honor extended to those who have excelled in their profession and are dedicated to furthering interprofessional practice, scholarship and policy in support of interprofessional care.
The central purpose of NAP is to advise public policy makers on health care issues using NAP's unique perspective -- that of expert practitioners and scholars joined in interprofessional dialogue and advocacy. The Watkins-Saunders Award is named for two cardiologists Dr. Levi Watkins and Dr. Elijah Saunders who were in the vanguard of physicians fighting health disparities in Maryland.
Weisfeldt will receive the award during the Heart of Maryland Digital Experience celebration on May 20, at 12 p. Fasika Woreta, M. The award presented by Women in Ophthalmology recognizes teachers who have consistently provided an exceptionally positive and rewarding experience to medical students, residents and fellows. Jeanne Hitchcock has been a practicing attorney, small business owner, and has served in executive management positions in the private, corporate and nonprofit sectors.
Jeanne also served for eight years as an assistant attorney general in the office of the Maryland Attorney General. For eight years she was national director of urban market development at The Southland Corporation, owner and operator of 7-Eleven stores. Her experience also includes a tenure as chief operating officer with the national office of the NAACP in Baltimore, Maryland, and as managing partner in her own law firm in Baltimore.
All recipients will be recognized at the 17th Annual Maryland Patient Safety Conference, to be held virtually on April 29, He has also helped us navigate the logistics of providing food for staff negatively impacted by the pandemic, to ensure that they can feed their families.
Angelo is also an important part of extensive efforts to provide free meals for families in the communities we serve. His teams are also focused on the development and implementation of new patient and retail programs to create a culture of quality food for all that they serve.
She joined the Department of Surgery as an established researcher and collaborator in While her research focuses on the intersection of aging and end-stage kidney disease ESKD , she has been highly effective as a multi-RO1 NIH funded researcher, coordinator and mentor for early career investigators.
Additionally, she has extensive experience conducting clinical trials to identify interventions to improve patient care outcomes. Her specific leadership goals in JSCOR are to improve and foster the research mentoring of faculty members in the Department of Surgery. Johnston is an Associate Professor in the Department of Surgery. Jacobs is an Associate Professor of Surgery and surgical oncologist who specializes in breast cancer and melanoma.
She was recruited to Johns Hopkins in , with an academic interest in clinical trials and she participated in the American College of Surgeons Oncology Group, becoming the site Principal Investigator for the Alliance for Clinical Trials at Johns Hopkins. Jacobs serves as the Chair of the Cancer Committee at The Johns Hopkins Hospital and at Howard County General Hospital, which establishes both programmatic and quality improvement goals for cancer care across the health system on a yearly basis.
Jaclyn has been on the transplant team since October and has been instrumental in navigating the complex regulatory environment that is part of the organ transplantation world. Nate Permpalung, M. David Gaston, M. Karen Carroll, M. Matthew Robinson, M. Challice Bonifant, M. Maged Mohamed Harraz, M. Netz Arroyo, Ph.
Maxim Rosario, D. The Solomon H. Alex Kolodkin, Ph. His research focuses on the connections between neurons and how neural connections are formed during development. Elizabeth Treide and A. Jeremy A. Greene, M. The Michael Burke, M. Sumeska Thavarajah, M. Thavarajah served as the medical advisory board chair for NKF of Maryland and Delaware from to , and has been a board member of the chapter since This recognition program acknowledges emerging leaders ago 40 or under, who have made significant contributions in the areas of innovation and financial, operational and clinical excellence early in their careers.
This award recognizes organizational excellence in patient safety and celebrates the efforts of risk management professionals in promoting patient safety across the health care enterprise. Njoku has been a member of the AUA since , when she began her journey toward a goal of contributing to her academic society.
She is a recognized international leader in academic anesthesiology, specifically, induced autoimmune hepatitis, where she formulated a rodent model utilizing knowledge obtained regarding anesthetic hepatitis in patients.
In this role she will work with the society's leadership to promote the mission of AUA. Lee Guo, O. His specialty and research revolve around dry eye disease and rehabilitation of the ocular surface.
Guo is particularly interested in dry eye procedural treatments including microblepharoexfoliation, intense pulsed light, and both thermal and mechanical expression therapies for Meibomian Gland Dysfunction. These scores are a testament to the daily diligence of employees across JHHC, and providers throughout Johns Hopkins Medicine, to ensure members get the care they need and make each health plan the best that it can be.
Maria Trent, M. Trent has been on the faculty of Johns Hopkins University School of Medicine since and serves as the principal or key investigator on multiple research projects.
A major focus of Trent's research and clinical interest has been on reducing adolescent and young adult sexual and reproductive health disparities. Dale M. Needham, M.
Honorary membership is the highest honor awarded to non-physical therapists by the APTA, acknowledging significant, measurable and profound contributions to the field. Michael X. Repka, M. The Armstrong Institute Center for Diagnostic Excellence played a key role in the grant submission and will be integral to project completion.
Jeremy Nathans, M. The medal is awarded to visionary scientists whose achievements have made a positive impact on the future. Laura Ensign, Ph. Ensign was elected for outstanding contributions to nanomedicine, drug delivery, and translation of nanotechnologies from the bench to the bedside. Yassine Daoud, M. A reception will be held in the fall of to honor newly appointed and promoted associate professors. Shameema Sikder, M. The ANCC Practice Transition Accreditation Program sets the global standard for residency programs that transition registered nurses into new practice settings.
The good news comes after over a year spent completing the rigorous application process, which included submitting a page self-study document, a survey of currently enrolled and recent graduates of the JHH NRP program, and a virtual site visit with ANCC evaluators. The JHH NRP program is an invaluable experience for new nurses who are just transitioning from the academic setting of nursing school to the clinical setting as a professional nurse.
All new graduate nurses with six months or less experience hired at The Johns Hopkins Hospital are automatically enrolled in the year-long nurse residency program, where they receive the practical experience and knowledge to deliver safe, high-quality patient care as well as the tools and support to build their resilience and self-care.
Kapil Mishra, M. Mishra received this honor from a pool of over Johns Hopkins residents. His nominator described that he, "did an outstanding job teaching" and "his dedication to the mentorship of other residents and his team players mentality are outstanding characteristics that have made him a great resident.
Congratulations to our surgeon-in-chief Robert S. We are so proud of your accomplishment in helping to lead chairs of surgery from across the U. This award recognizes and celebrates exceptional pioneers and renowned leaders of the evidence-based practice movement in the United States. Congratulations to all of the ED staff and everyone at our hospital for making Suburban the best in our community! Mark E. Anderson, M. This honor recognizes Dr. He is widely recognized as an international expert in defining the role of calmodulin kinase II CaMKII regulation in heart failure and arrhythmias.
Anderson has published more than peer-reviewed publications and is frequently an invited speaker nationally and internationally to present his research. Cynda Rushton, Ph. As a forerunner in helping nurses overcome the burden of burnout, Dr.
Rushton played a key role in bringing forth evidence-based recommendations for addressing this problem in the future. These practices were shared during a national webinar in September As a participating hospital in the adult program, The Johns Hopkins Hospital was among 88 of eligible hospitals to be recognized. The achievement is based on a composite quality score, each determined through a different weighted formula combining outcomes in eight clinical areas.
The program was recognized for its deliberate and thoughtful approach to improving the recruitment of students underrepresented in medicine, which has resulted in the most diverse class of interns in the programs history the past two years, and more than any residency program within the school. This award is given to a leader in innovating the delivery of home health services, standards of practice and the patient experience.
This program is the first-of-its kind to develop nurses who have expertise in the full continuum of care, from inpatient admission to transition to home. This award is given to a CNA that consistently exceeds expectations on a day-to-day basis. Philana is routinely recognized for going above and beyond for her patients and is a role model for her peers. She has a strong work ethic and holds herself and others to high standards.
Philana shines as a bright example of someone committed to quality, client satisfaction and the Johns Hopkins Home Care Group. Michelle has made a positive impact on her patients and has raised the profile of home care in the community. She has a passion for low vision patients and enrolls them in the "mailing library" so they can have access to books while homebound, including books to accommodate their visual impairments. Jenny was recognized for her outstanding contributions to patient care and customer service.
She has helped patients and families make difficult decisions regarding palliative care in the home and initiate home care services to achieve the best outcomes. She has incredible critical thinking skills and is able to identify situations that need urgent or emergent care. As part of the Performance Improvement Committee, she has actively participated in focus groups, bringing fresh ideas to develop disease management pathways.
Jenny is respected among her peers and management and is an asset to her team. Maria Trent, professor of pediatrics, recently completed a term of 10 years on the Executive Committee of the Section on Adolescent Health for the American Academy of Pediatrics, the last four as the chairperson.
Under her leadership, the section flourished.
|Carefirst headquarters phone||Besides his clinical interests in hepatitis C and liver cancer, Dr. These scores are a testament to the daily diligence of employees across JHHC, and providers throughout Johns Hopkins Medicine, to ensure members get the care they need and make each health plan the best that it can be. Am J Manag Care. She has been instrumental in the development of the World Health Organization SAFE strategy for trachoma prevention and control, a sustainable strategy that is now widely used throughout the world and is preventing blindness among both children and adults. The trustees of The John Healrh. In the context where inpatient care costs are significantly source than that of the outpatient famoly, ICOC would lead to a meaningful cost-saving effect.|
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|Cigna information||Maxim Rosario, D. Trent has been on the faculty of Johns Hopkins University School of Medicine since and serves read article the principal or key investigator on multiple research projects. The ICOC score ranges between 0 and 1, with 1 indicating the highest degree of continuity. His nominator described that he, "did an carefidst job teaching" and "his dedication to the mentorship of other residents and his team players mentality are outstanding characteristics that conqay made him a great resident. These coefficients reflect the ICOC elasticities for treatment costs. Sharon Solomon, M.|
|Careers at alcon||Restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Prior to joining the Creative Alternatives team, she served a psychiatric nurse therapist in the adult outpatient program in community psychiatry. Am J Manag Care. The proposed studies could further validate a novel glial cell mechanism underlying chronic inflammation and neurodegeneration in MS. Jenny is respected among her peers and management and is an asset to coonway team. Conclusions Institutional continuity of care has a substantial impact on the treatment costs learn more here diabetes patients. She has incredible critical thinking skills and is able to identify situations that need urgent or emergent care.|
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