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Article ; Online: Understanding Clinician Preferences for Treatment Attributes in Oncology: A Discrete Choice Experiment of Oncologists' and Urologists' Preferences for First-Line Treatment of Locally Advanced/Unresectable Metastatic Urothelial Carcinoma in Five European Countries.

Panattoni, Laura / Kearney, Mairead / Land, Natalie / Flottemesch, Thomas / Sullivan, Patrick / Kirker, Melissa / Bharmal, Murtuza / Hauber, Brett

PharmacoEconomics

2024

Abstract: Introduction: Prior discrete choice experiments (DCE) in oncology found that, on average, clinicians rank survival as the most important treatment attribute. We investigate heterogeneity in clinician preferences within the context of first-line ... ...

Abstract	Introduction: Prior discrete choice experiments (DCE) in oncology found that, on average, clinicians rank survival as the most important treatment attribute. We investigate heterogeneity in clinician preferences within the context of first-line treatment for advanced urothelial carcinoma in Spain, France, Italy, Germany, and the UK. Methods: The online DCE included 12 treatment choice tasks, each comparing two hypothetical therapy profiles defined by treatment attributes: grade 3/4 treatment-related adverse events (TRAEs), induction and maintenance administration schedules, progression-free survival, and overall survival (OS). We used a random parameters logit model to estimate attribute relative importance (RI) (0-100%) and generate preference shares for four treatment profiles. Results were stratified by country. Preference heterogeneity was evaluated by latent class analysis. Results: In August and September 2022, 498 clinicians (343 oncologists and 155 urologists) completed the DCE. OS had the strongest influence on clinicians' preferences [RI = 62%; range, 51.6% (Germany) to 63.7% (Spain)] followed by frequency of grade 3/4 TRAEs (RI = 27%). Among treatment profiles, the chemotherapy plus immune checkpoint inhibitor maintenance therapy profile had the largest preference share [51%; range, 38% (Italy) to 56% (UK)]. Four latent classes of clinicians were identified (N = 469), with different treatment profile preferences: survival class (30.1%), trade-off class (22.4%), no strong preference class (40.9%), and aggressive treatment class (6.6%). OS was not the most important attribute for 30.0% of clinicians. Conclusion: While average sample results were consistent with those of prior DCEs, this study found heterogeneity in clinician preferences within and across countries, highlighting the diversity in clinician decision making in oncology.
Language	English
Publishing date	2024-03-12
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	1100273-6
ISSN	1179-2027 ; 1170-7690
ISSN (online)	1179-2027
ISSN	1170-7690
DOI	10.1007/s40273-024-01359-x
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Zs.A 3579: Show issues

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Article: Completeness of cohort-linked U.S. Medicare data: An example from the Agricultural Health Study (1999-2016).

Parks, Christine G / Shrestha, Srishti / Long, Stuart / Flottemesch, Thomas / Woodruff, Sarah / Chen, Honglei / Andreotti, Gabriella / Hofmann, Jonathan N / Beane Freeman, Laura E / Sandler, Dale P

Preventive medicine reports

2022 Volume 27, Page(s) 101766

Abstract: Medicare Fee for Service (FFS) claims data, including inpatient (Part A) and outpatient (Part B) services, provide a valuable resource for research on older adults (≥65 year) in linked U.S. cohorts. Here we describe our experience linking the ... ...

Abstract	Medicare Fee for Service (FFS) claims data, including inpatient (Part A) and outpatient (Part B) services, provide a valuable resource for research on older adults (≥65 year) in linked U.S. cohorts. Here we describe our experience linking the Agricultural Health Study cohort, including 47,501 licensed pesticide applicators and spouses from North Carolina (NC) and Iowa (IA) to Medicare claims data from 1999 to 2016. Given increased Part C (i.e., managed care/Medicare Advantage) enrollment during this period, and a resulting lack of available Part C claims data prior to 2015, we also explored potential for informative missingness. We compared those with partial or limited/no FFS to those with complete FFS coverage (i.e., ≥11 months per year parts AB, but not C, throughout Medicare enrollment) in relation to baseline farm size, general pesticide use, and mortality, in logistic regression models adjusted for age, sex, race, education, and smoking, and stratified by state. While 46,689 participants (98%) were linked to Medicare IDs, only 33,487 (70%) had complete FFS, 9353 (20%) had partial FFS (≥1 year FFS but not complete), and 3849 (8%) had limited/no FFS (Part A or Part C-only). Incomplete FFS was more common in NC, mostly due to Part C, and was associated with farm characteristics, pesticide use, and mortality. These findings indicate that, in addition to reduced sample size in analyses limited to complete FFS, missingness may not be random. The potential impact of incomplete FFS data and changes in coverage type need to be considered when planning linked analyses and interpreting results.
Language	English
Publishing date	2022-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2785569-7
ISSN	2211-3355
ISSN	2211-3355
DOI	10.1016/j.pmedr.2022.101766
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Article ; Online: Physician networks and potentially inappropriate opioid prescriptions.

McClellan, Chandler / Flottemesch, Thomas J / Ali, Mir M / Jones, Jenna / Mutter, Ryan / Hohlbauch, Andriana / Whalen, Daniel

Journal of addictive diseases

2020 Volume 38, Issue 3, Page(s) 301–310

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Databases, Factual ; Drug Prescriptions/statistics & numerical data ; Drug Utilization/statistics & numerical data ; Humans ; Inappropriate Prescribing/statistics & numerical data ; Medicaid ; Practice Patterns, Physicians'/statistics & numerical data ; Practice Patterns, Physicians'/trends ; United States
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2020-05-07
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	1077616-3
ISSN	1545-0848 ; 1055-0887
ISSN (online)	1545-0848
ISSN	1055-0887
DOI	10.1080/10550887.2020.1760655
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Article ; Online: System Transformation in Patient-Centered Medical Home (PCMH): Variable Impact on Chronically Ill Patients' Utilization.

Carlin, Caroline S / Flottemesch, Thomas J / Solberg, Leif I / Werner, Ann M

Journal of the American Board of Family Medicine : JABFM

2016 Volume 29, Issue 4, Page(s) 482–495

Abstract: Background: Research connecting patient-centered medical homes (PCMHs) with improved quality and reduced utilization is inconsistent, possibly because individual domains of change, and the stage of change, are not incorporated in the research design. ... ...

Abstract	Background: Research connecting patient-centered medical homes (PCMHs) with improved quality and reduced utilization is inconsistent, possibly because individual domains of change, and the stage of change, are not incorporated in the research design. The objective of this study was to examine the association between stage and domain of change and patterns of health care utilization. Methods: This was a cross-sectional observational study that including 87 Minnesota clinics certified as medical homes. Patients included those receiving management for diabetes or cardiovascular disease with insurance coverage by payers participating in the study. PCMH transformation stage was defined by practice systems in place, with measurements summarized in 5 domains. Health care utilization was measured by total utilization, frequency of outpatient visits and prescriptions, and occurrence of inpatient and emergency department visits. Results: PCMH transformation was associated with few changes in utilization, but there were important differences by the underlying domains of change. We demonstrate meaningful differences in the impact of PCMH transformation by diagnosis cohort and comorbidity status of the patient. Conclusions: Because the association of health care utilization with PCMH transformation varied by transformation domain and patient diagnosis, practice leaders need to be supported by research incorporating detailed measures of PCMH transformation.
MeSH term(s)	Adult ; Aged ; Ambulatory Care/statistics & numerical data ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/therapy ; Chronic Disease ; Comorbidity ; Cross-Sectional Studies ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/therapy ; Drug Prescriptions/statistics & numerical data ; Emergency Service, Hospital/statistics & numerical data ; Female ; Health Care Costs ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Minnesota ; Patient Acceptance of Health Care/statistics & numerical data ; Patient-Centered Care/economics ; Patient-Centered Care/statistics & numerical data ; Quality Improvement ; Research Design
Language	English
Publishing date	2016-07
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2016.04.150360
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Article ; Online: Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention.

Dehmer, Steven P / Maciosek, Michael V / LaFrance, Amy B / Flottemesch, Thomas J

Annals of family medicine

2017 Volume 15, Issue 1, Page(s) 23–36

Abstract: Purpose: Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and ... ...

Abstract	Purpose: Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity. Methods: We used a single, integrated, microsimulation model to generate comparable results for 3 services recommended by the US Preventive Services Task Force: aspirin counseling for the primary prevention of CVD and colorectal cancer, screening and treatment for lipid disorders (usually high cholesterol), and screening and treatment for hypertension. Analyses compare lifetime outcomes from the societal perspective for a US-representative birth cohort of 100,000 persons with and without access to each clinical preventive service. Primary outcomes are health impact, measured by the net difference in lifetime quality-adjusted life years (QALYs), and cost-effectiveness, measured in incremental cost per QALY or cost savings per person in 2012 dollars. Results are also presented for population subgroups defined by sex and race/ethnicity. Results: Health impact is highest for hypertension screening and treatment (15,600 QALYs), but is closely followed by cholesterol screening and treatment (14,300 QALYs). Aspirin counseling has a lower health impact (2,200 QALYs) but is found to be cost saving ($31 saved per person). Cost-effectiveness for cholesterol and hypertension screening and treatment is $33,800 per QALY and $48,500 per QALY, respectively. Findings favor hypertension over cholesterol screening and treatment for women, and opportunities to reduce disease burden across all services are greatest for the non-Hispanic black population. Conclusions: All 3 CVD preventive services continue to rank highly among other recommended preventive services for US adults, but individual priorities can be tailored in practice by taking a patient's demographic characteristics and clinical objectives into account.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aspirin/therapeutic use ; Colorectal Neoplasms/diagnosis ; Cost-Benefit Analysis ; Counseling ; Ethnic Groups ; Female ; Humans ; Hypercholesterolemia/diagnosis ; Hypercholesterolemia/drug therapy ; Hypertension/diagnosis ; Hypertension/drug therapy ; Male ; Mass Screening/economics ; Middle Aged ; Primary Prevention/economics ; Quality-Adjusted Life Years ; Sex Distribution ; United States ; Young Adult
Chemical Substances	Aspirin (R16CO5Y76E)
Language	English
Publishing date	2017-01-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2171425-3
ISSN	1544-1717 ; 1544-1709
ISSN (online)	1544-1717
ISSN	1544-1709
DOI	10.1370/afm.2015
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Article ; Online: Application of the emergency department census model.

Bellow, Aaron A / Flottemesch, Thomas J / Gillespie, Gordon L

Advanced emergency nursing journal

2012 Volume 34, Issue 1, Page(s) 55–64

Abstract: As health care systems across the United States continue to grapple with emergency department (ED) crowding and identify mechanisms to improve ED throughput, quantification of intradepartmental efficiency and workload is required to provide much-needed ... ...

Abstract	As health care systems across the United States continue to grapple with emergency department (ED) crowding and identify mechanisms to improve ED throughput, quantification of intradepartmental efficiency and workload is required to provide much-needed objective measures to assist in the continuing development, implementation, and evaluation of these strategic initiatives. In an attempt to establish a straightforward measure of ED efficiency in relation to daily census and ED crowding, T. J. Flottemesch (2006) developed the ED Census Model. The purpose of this study was to apply the ED Census Model in a Southwestern U.S. community hospital setting. This application of the ED Census Model yielded 3 components: the ED Census Component, the ED Throughput Component, and the ED Efficiency Threshold Component. The components provide information necessary for understanding the impact of patient arrivals and departures on the underlying workflow processes that determine throughput.
MeSH term(s)	Censuses ; Crowding ; Efficiency, Organizational ; Emergency Nursing ; Emergency Service, Hospital/organization & administration ; Humans ; Models, Organizational ; Pilot Projects ; Time Factors ; United States ; Workflow
Language	English
Publishing date	2012-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2257871-7
ISSN	1931-4493 ; 1931-4485
ISSN (online)	1931-4493
ISSN	1931-4485
DOI	10.1097/TME.0b013e31823ced53
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Book ; Online: Aspirin use to prevent cardiovascular disease and colorectal cancer

Dehmer, Steven P / Maciosek, Michael V / Flottemesch, Thomas J

a decision analysis

(Evidence syntheses ; No. 131s ; AHRQ publication ; No. 15-05229-EF-1)

2015

Abstract: BACKGROUND: Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC), but regular use also increases risk for gastrointestinal (GI) and cerebral hemorrhages. OBJECTIVE: To assess ... ...

Title variant	Aspirin to prevent CVD/cancer: decision analysis
Institution	United States. / Agency for Healthcare Research and Quality, Oregon Evidence-based Practice Center (Center for Health Research (Kaiser-Permanente Medical Care Program. Northwest Region))
Author's details	Steven P. Dehmer, Michael V. Maciosek, Thomas J. Flottemesch
Series title	Evidence syntheses ; No. 131s AHRQ publication ; No. 15-05229-EF-1
Abstract	BACKGROUND: Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC), but regular use also increases risk for gastrointestinal (GI) and cerebral hemorrhages. OBJECTIVE: To assess the net balance of benefits and harms from routine use of aspirin for primary prevention across clinically relevant age, sex, and CVD risk groups. DESIGN: Decision analysis using a microsimulation model. DATA SOURCES: Relative risks of aspirin benefits and harms are sourced from three updated systematic evidence reviews. TARGET POPULATION: Men and women aged 40 to 79 years with 10-year CVD risk of 20 percent or less, no history of CVD, and non-elevated risk for GI or cerebral hemorrhage. TIME HORIZON: Lifetime, 20 years, and 10 years. PERSPECTIVE: Clinical. INTERVENTION: Daily use of low-dose aspirin (100mg or less). OUTCOME MEASURES: Primary outcomes are net benefits in terms of life years and quality-adjusted life years (QALYs). Benefits include reduction of non-fatal myocardial infarction, non-fatal ischemic stroke, fatal CVD, CRC incidence, and CRC mortality. Harms include increase in fatal and non-fatal GI bleeding and hemorrhagic stroke. RESULTS OF BASE-CASE ANALYSIS: Lifetime net benefits from routine aspirin use for primary prevention are found to be positive for men and women aged 40-69 in all 10-year CVD risk levels. For men and women aged 70-79, lifetime net outcomes are mixed: net life years are negative, but net QALYs are positive. The largest lifetime net benefits from aspirin are found among men and women aged 40-59 with moderate-to-high baseline CVD risk. Net benefits from aspirin over 10 and 20 years of use are generally much lower and may be negative. Net benefit calculations also favor early over delayed initiation of aspirin use for all men and women aged 40-69. RESULTS OF SENSITIVITY ANALYSIS: Net benefit results are most sensitive to uncertainty regarding the effect of low-dose aspirin on the increased risk of hemorrhagic stroke and in the primary prevention of CVD mortality. Imposing small disutilities on routine aspirin use can substantially diminish the net benefit of using aspirin to improve overall quality of life. LIMITATIONS: Sensitivity analyses demonstrate that our current imprecision in understanding aspirin's effects on benefits and harms, when used for primary prevention, carry through to model estimates. Persons aged 40-49 are not as well represented in the studies informing aspirin's effects, and therefore, the modeling results may not reliably apply to persons in this age group. Improved ability to estimate individual GI bleeding risk would enhance precision. Modeled results do not account for potential correlations between CVD risk factors and GI bleeding risk, except for age and sex. CONCLUSION: Benefits are predicted to exceed harms among persons aged 40-69 with non-elevated bleeding risk who take aspirin for primary prevention of CVD and CRC over their lifetimes. Net benefits from routine aspirin use over a 10- or 20-year horizon are expected to be substantially smaller, and in many cases, harms may exceed benefits. Findings do not differ markedly between men and women; however, deterministic and probabilistic sensitivity analyses reveal meaningful uncertainty about the magnitude of net benefit.
MeSH term(s)	Aspirin/therapeutic use ; Cardiovascular Diseases/drug therapy ; Colorectal Neoplasms/drug therapy ; Primary Prevention ; Treatment Outcome
Language	English
Size	1 online resource (1 PDF file (iv, 95 pages)) :, illustrations.
Document type	Book ; Online
Note	Title from PDF t.p. ; "September 2015." ; At head of title: "Technical report."
Database	Catalogue of the US National Library of Medicine (NLM)

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Article ; Online: Aspirin for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: A Decision Analysis for the U.S. Preventive Services Task Force.

Dehmer, Steven P / Maciosek, Michael V / Flottemesch, Thomas J / LaFrance, Amy B / Whitlock, Evelyn P

Annals of internal medicine

2016 Volume 164, Issue 12, Page(s) 777–786

Abstract: Background: Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) but also increases the risk for gastrointestinal (GI) and cerebral hemorrhages.: Objective: To assess the ... ...

Abstract	Background: Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) but also increases the risk for gastrointestinal (GI) and cerebral hemorrhages. Objective: To assess the net balance of benefits and harms from routine aspirin use across clinically relevant age, sex, and CVD risk groups. Design: Decision analysis using a microsimulation model. Data sources: 3 systematic evidence reviews. Target population: Men and women aged 40 to 79 years with a 10-year CVD risk of 20% or less, and no history of CVD and without elevated risk for GI or cerebral hemorrhages that would contraindicate aspirin use. Time horizon: Lifetime, 20 years, and 10 years. Perspective: Clinical. Intervention: Low-dose aspirin (≤100 mg/d). Outcome measures: Primary outcomes are length and quality of life measured in net life-years and quality-adjusted life-years. Benefits include reduced nonfatal myocardial infarction, nonfatal ischemic stroke, fatal CVD, CRC incidence, and CRC mortality. Harms include increased fatal and nonfatal GI bleeding and hemorrhagic stroke. Results of base-case analysis: Lifetime net quality-adjusted life-years are positive for most adults initiating aspirin at ages 40 to 69 years, and life expectancy gains are expected for most men and women initiating aspirin at ages 40 to 59 years and 60 to 69 years with higher CVD risk. Harms may exceed benefits for persons starting aspirin in their 70s and for many during the first 10 to 20 years of use. Results of sensitivity analysis: Results are most sensitive to the relative risk for hemorrhagic stroke and CVD mortality but are affected by all relative risk estimates, baseline GI bleeding incidence and case-fatality rates, and disutilities associated with aspirin use. Limitations: Aspirin effects by age are uncertain. Stroke benefits are conservatively estimated. Gastrointestinal bleeding incidence and case-fatality rates account only for age and sex. Conclusion: Lifetime aspirin use for primary prevention initiated at younger ages (40 to 69 years) and in persons with higher CVD risk shows the greatest potential for positive net benefit. Primary funding source: Agency for Healthcare Research and Quality.
MeSH term(s)	Adult ; Aged ; Anticarcinogenic Agents/administration & dosage ; Anticarcinogenic Agents/adverse effects ; Anticarcinogenic Agents/therapeutic use ; Aspirin/administration & dosage ; Aspirin/adverse effects ; Aspirin/therapeutic use ; Cardiovascular Diseases/prevention & control ; Colorectal Neoplasms/prevention & control ; Decision Support Techniques ; Female ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/adverse effects ; Fibrinolytic Agents/therapeutic use ; Gastrointestinal Hemorrhage/chemically induced ; Humans ; Male ; Middle Aged ; Primary Prevention ; Quality-Adjusted Life Years ; Risk Assessment ; Stroke/chemically induced
Chemical Substances	Anticarcinogenic Agents ; Fibrinolytic Agents ; Aspirin (R16CO5Y76E)
Language	English
Publishing date	2016--21
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M15-2129
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Article ; Online: Behavioral Health's Integration Within a Care Network and Health Care Utilization.

McClellan, Chandler / Flottemesch, Thomas J / Ali, Mir M / Jones, Jenna / Mutter, Ryan / Hohlbauch, Andriana / Whalen, Daniel / Nordstrom, Nils

Health services research

2018 Volume 53, Issue 6, Page(s) 4543–4564

Abstract: Objective: Examine how behavioral health (BH) integration affects health care costs, emergency department (ED) visits, and inpatient admissions.: Data sources/study setting: Truven Health MarketScan Research Databases.: Study design: Social ... ...

Abstract	Objective: Examine how behavioral health (BH) integration affects health care costs, emergency department (ED) visits, and inpatient admissions. Data sources/study setting: Truven Health MarketScan Research Databases. Study design: Social network analysis identified "care communities" (providers sharing a high number of patients) and measured BH integration in terms of how connected, or central, BH providers were to other providers in their community. Multivariable generalized linear models adjusting for age, sex, number of prescriptions, and Charlson comorbidity score were used to estimate the relationship between the centrality of BH providers and health care utilization of BH patients. Data collection/extraction methods: Used outpatient, inpatient, and pharmacy claims data from six Medicaid plans from 2011 to 2013 to identify study outcomes, comorbidities, providers, and health care encounters. Principal findings: Behavioral health centrality ranged from 0 (no BH providers) to 0.49. Relative to communities at the median BH centrality (0.06), in 2012, BH patients in communities at the 75th percentile of BH centrality (0.31) had 0.2 fewer admissions, 2.1 fewer all-cause ED visits, and accrued $1,947 fewer costs, on average. Conclusions: Increased behavioral centrality was significantly associated with a reduced number of ED visits, less frequent inpatient admissions, and lower overall health care costs.
MeSH term(s)	Adult ; Aged ; Comorbidity ; Databases, Factual ; Delivery of Health Care, Integrated/statistics & numerical data ; Emergency Service, Hospital/statistics & numerical data ; Female ; Health Care Costs/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Insurance Claim Review/statistics & numerical data ; Male ; Medicaid/statistics & numerical data ; Mental Disorders/diagnosis ; Mental Disorders/therapy ; Middle Aged ; Patient Acceptance of Health Care/statistics & numerical data ; Retrospective Studies ; United States
Language	English
Publishing date	2018-05-30
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	410435-3
ISSN	1475-6773 ; 0017-9124
ISSN (online)	1475-6773
ISSN	0017-9124
DOI	10.1111/1475-6773.12983
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Article ; Online: Updated Priorities Among Effective Clinical Preventive Services.

Maciosek, Michael V / LaFrance, Amy B / Dehmer, Steven P / McGree, Dana A / Flottemesch, Thomas J / Xu, Zack / Solberg, Leif I

Annals of family medicine

2017 Volume 15, Issue 1, Page(s) 14–22

Abstract: Purpose: The Patient Protection and Affordable Care Act's provisions for first-dollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a ... ...

Abstract	Purpose: The Patient Protection and Affordable Care Act's provisions for first-dollar coverage of evidence-based preventive services have reduced an important barrier to receipt of preventive care. Safety-net providers, however, still serve a substantial uninsured population, and clinician and patient time remain limited in all primary care settings. As a consequence, decision makers continue to set priorities to help focus their efforts. This report updates estimates of relative health impact and cost-effectiveness for evidence-based preventive services. Methods: We assessed the potential impact of 28 evidence-based clinical preventive services in terms of their cost-effectiveness and clinically preventable burden, as measured by quality-adjusted life years (QALYs) saved. Each service received 1 to 5 points on each of the 2 measures-cost-effectiveness and clinically preventable burden-for a total score ranging from 2 to 10. New microsimulation models were used to provide updated estimates of 12 of these services. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. Results: The 3 highest-ranking services, each with a total score of 10, are immunizing children, counseling to prevent tobacco initiation among youth, and tobacco-use screening and brief intervention to encourage cessation among adults. Greatest population health improvement could be obtained from increasing utilization of clinical preventive services that address tobacco use, obesity-related behaviors, and alcohol misuse, as well as colorectal cancer screening and influenza vaccinations. Conclusions: This study identifies high-priority preventive services and should help decision makers select which services to emphasize in quality-improvement initiatives.
MeSH term(s)	Adolescent ; Adult ; Child ; Colorectal Neoplasms/prevention & control ; Cost-Benefit Analysis ; Female ; Health Priorities/economics ; Humans ; Male ; Mass Screening/economics ; Obesity/prevention & control ; Patient Protection and Affordable Care Act ; Preventive Health Services/economics ; Quality-Adjusted Life Years ; Safety-net Providers ; Tobacco Use/prevention & control ; United States
Language	English
Publishing date	2017-01-06
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	2171425-3
ISSN	1544-1717 ; 1544-1709
ISSN (online)	1544-1717
ISSN	1544-1709
DOI	10.1370/afm.2017
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