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To describe the association between the form of hospitals' contracts-either markup from a benchmark or a discount from a list price-and performance price, charge, cost, and length of stay.

Retrospective observational study using administrative claims data matched with hospital characteristics from the American Hospital Association Annual Survey and the Healthcare Cost Reporting Information System. Data include a balanced panel of 1889 general acute care hospitals for the years 2011 to 2015.

Inpatient hospital commercial claims data from the Health Care Cost Institute were used to classify claims by contract type based on claim-line billed and allowed charges. Hospital-level performance measures-prices, charges, costs, and length of stay-were analyzed using linear regression models to identify the association of each measure with contract types. All measures were risk adjusted to control for differences in hospital case mix, and the regression specifications controlled for numerous hospital characteristics.

Our estimate of the distribution of contract types in the data is similar to estimates using other methods. We find that discounted charges contracts are associated with higher prices and higher costs but not higher charges. Fixed-rate contracts are associated with lower prices as well as lower costs.

Limited research exists on the relationship between contract structure and hospital performance. Our results suggest that hospital performance is related to contract structure, possibly due to factors such as differences in bargaining strategies or ex post incentives.

Limited research exists on the relationship between contract structure and hospital performance. Our results suggest that hospital performance is related to contract structure, possibly due to factors such as differences in bargaining strategies or ex post incentives.

To determine (1) factors linked to hospitalizations among managed care patients (MCPs), (2) outcome improvement with use of outpatient off-label treatment, and (3) outcome comparison between MCPs and a mirror group.

Retrospective cohort study comparing MCPs with an age- and gender-matched mirror group in Florida from April 1, 2020, to May 31, 2020.

A total of 38,193 MCPs in a Florida primary care group were monitored for COVID-19 incidence, hospitalization, and mortality. The highest-risk patients were managed by the medical group's COVID-19 Task Force. As part of a population health program, the COVID-19 Task Force contacted patients, conducted medical encounters, and tracked data including comorbidities and medical outcomes. The MCPs enrolled in the medical group were compared with a mirror group from the state of Florida.

The mean (SD) age among the MCPs was 67.9 (15.2) years, and 60% were female. Older age and hypertension were the most important factors in predicting COVID-19. Obesity, chronic kidney disease (CKD), and congestive heart failure (CHF) were linked to higher rates of hospitalizations. Patients prescribed off-label outpatient medications had 73% lower likelihood of hospitalization (P < .05). Compared with the mirror group, MCPs had 60% lower COVID-19 mortality (P < .05).

MCPs have risk factors similar to the general population for COVID-19 incidence and progression, including older age, hypertension, obesity, CHF, and CKD. Outpatient treatment with off-label medicines decreased hospitalizations. A comprehensive population health program decreased COVID-19 mortality.

MCPs have risk factors similar to the general population for COVID-19 incidence and progression, including older age, hypertension, obesity, CHF, and CKD. Outpatient treatment with off-label medicines decreased hospitalizations. A comprehensive population health program decreased COVID-19 mortality.

The price of analogue insulin has increased dramatically, making it unaffordable for many patients and insurance carriers. By contrast, human synthetic insulins are available at a fraction of the cost. The objective of this study was to examine whether patients with financial constraints were more likely to use low-cost human insulins compared with higher-cost analogue insulins and to determine whether outcomes differ between users of each type of insulin.

Retrospective cohort study.

Analysis of 4 cycles of the National Health and Nutrition Examination Survey was performed. Adults with diabetes who reported use of insulin were included. The primary outcome was use of human insulin or analogue insulin. The dependent variable was self-reported financial constraints, a composite variable. Secondary analysis examined the association between use of human vs analogue insulin and patient outcomes.

Of 22,263 eligible respondents, 698 (3.1%) reported use of insulin and the type of insulin used, representing 485,228 patients nationally. Patients with 1 or more financial risk factors were more likely to use human insulin compared with patients without any financial risk factors (88.5% vs 76.7%; P = .014). There was no association between use of human vs analogue insulin on diabetic or other patient outcomes among patients regardless of financial risk.

Patients with financial risk factors may be more likely to use low-cost human synthetic insulins compared with insulin analogues. Outcomes were similar, even when stratified by financial risk.

Patients with financial risk factors may be more likely to use low-cost human synthetic insulins compared with insulin analogues. Outcomes were similar, even when stratified by financial risk.

The COVID-19 pandemic has fundamentally changed the workflow of clinics. We applied Lean Six Sigma processes to optimize clinic workflow to reduce patient wait times and improve the patient experience.

Prospective cohort study.

We implemented (1) pushing most extended wait times to the end of the workflow by rooming the patient directly and (2) using distractions during the waiting process by using educational videos and a timer for physician arrival in the patient exam room. We compared the patient wait times and subcomponents of Press Ganey scores as a surrogate for changes in patient experience and satisfaction from the preimplementation period (n = 277) to the 3-month (September 1, 2020, to November 30, 2020) postimplementation period (n = 218).

There was a significant reduction in overall throughput time (38 vs 35 minutes) and wait before rooming (11 vs 8 minutes), and increased physician time with patients (15 vs 17 minutes) (P < .0001 for all). These results corresponded with a significant improvement in Press Ganey subcomponents of (1) waiting time in the exam room before being seen by the care provider, (2) degree to which you were informed about any delays, (3) wait time at clinic (from arriving to leaving), and (4) length of wait before going to an exam room (P < .001 for all).

Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics' common wait areas could be reappropriated to increase the number of clinic exam rooms.

Simple, inexpensive measures can improve patient engagement and provide a safe setting for patients for clinic visits in the wake of COVID-19. In the future, clinics' common wait areas could be reappropriated to increase the number of clinic exam rooms.This review is devoted to the modern method of monitoring of pupil diameter and reactivity in patients with acute brain injury. The authors present complete data on diagnostic and prognostic capabilities of automated infrared pupillometry, which should take its rightful place in comprehensive assessment of functional brain state in ICU patients. In authors' opinion, clinical introduction of pupillometry will improve prediction of outcomes following acute brain injury and quality of neurological monitoring in patients with cerebral edema and intracranial hypertension.Cavernous malformations (CMs) of central nervous system are vascular malformations usually localized in the brain and rarely in the spinal cord. To date, these malformations are well studied. However, some problems of the management of this pathology are still unresolved. This is due to rare localization of intramedullary CMs in the spinal cord and difficult treatment of spinal pathology per se. To date, about 1000 cases of spinal CM are described in the literature. This review is devoted to natural course of disease and postoperative outcomes. These data allow getting a complete picture of modern concepts of the treatment of spinal CMs and formulating the questions requiring further discussion.

Retropleural and/or retrodiaphragmatic approach is one of the options for anterolateral access to the thoracic spine and thoracolumbar region. This technique has no disadvantages associated with thoracotomy or extensive tissue dissection following posterolateral approaches.

Systematic analysis of foreign and national researches devoted to the possibility, safety and effectiveness of lateral retropleural approach to the thoracic spine and meta-analysis of the most common complications associated with this approach.

Initial searching revealed 133 abstracts for further study. Inclusion criteria 1) available full-text version of the manuscript in English or Russian; 2) age of patients over 18 years; 3) description of lateral retropleural or retrodiaphragmatic approach complicated or not complicated by access-associated complications. According to these criteria, we enrolled 10 manuscripts.

Meta-analysis showed high (10.6%) probability of pleural injury associated with surgical approach. Compared to endoscf this structure occurs in 10.6% of cases. Skin incision 7.1 cm and rib resection for at least 5 cm may be valuable to prevent plural damage.

Minimally invasive anterolateral retropleural and/or retrodiaphragmatic approach to the thoracic spine and thoracolumbar junction for corpectomy and discectomy ensures effective spinal canal decompression and less incidence of complications following open or thoracoscopic thoracic spine surgery. Dissection of parietal pleura should be of special attention because injury of this structure occurs in 10.6% of cases. Skin incision 7.1 cm and rib resection for at least 5 cm may be valuable to prevent plural damage.The authors report a patient with recurrent bifocal germinoma of the optical nerves and chiasm after previous combined treatment. The tumor resulted progressive visual acuity loss despite subsequent therapy (glucocorticoid therapy, chemo- and radiotherapy). Differential diagnosis between tumor progression and consequences of radiotherapy was complicated by MRI negative pattern. Subsequent development of the process, signs of anterior visual pathway damage and tumor spread throughout the ventricular system and subarachnoid spaces according to neuroimaging data indicated recurrence of disease.The authors report resection of anaplastic convexital meningioma in a middle-aged woman complicated by expected massive blood loss. The most intense bleeding occurred at the final stage of resection and it was impossible to stop it with traditional approaches. The surgeon pressed a standard tachocomb plate moistened with a diluted solution of recombinant activated factor VII (coagil, Russia) to the most bleeding area for 5 minutes. Subsequently, surgeon replaced finger pressure with a permanent napkin. Hemostatic effect of recombinant activated factor VII following its systemic administration is well known and convincingly proven in many surgical areas including neurosurgery. ABBV-744 solubility dmso However, we do not know any descriptions of its local application in neurosurgical patients.