Whitney Palmer

Healthcare. Politics. Family.

Beyond Watson: AI in Radiology

Published on the April 14, 2016, DiagnosticImaging.com website

By Whitney L.J. Howell

Imagine this: your hospital administrator asks you to help reduce the length of inpatient stays and they need a plan within a week. Could you do it?

Chances are, most of you couldn’t. But, the technology to mine and analyze your data does exist. Much like your daily Google searches, it’s possible to input your search criteria, click Enter, and have answers at your fingertips in seconds.

Doing so is part of radiology’s push toward using big data, said Woojin Kim, MD, director of innovation at Montage Healthcare Solutions, Inc.

“Radiology doesn’t yet have big data like other industries, but that’s changing rapidly. People want access to data to be able to turn insight into action,” he said. “Providers want quick easy access to radiology reports, and they want to mine through data intelligently for research and quality and performance improvements.”

That’s why Kim, along with William Boonn, MD, Curtis Langlotz, MD, and Rajan Agarwal, MD, co-founded Montage. Its products use proprietary natural language processing to search and pull information from your RIS and electronic medical record (EMR), pinpointing clinical findings to augment business performance and clinical-quality analytics.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/pacs-and-informatics/beyond-watson-ai-radiology

April 14, 2016 Posted by | Healthcare | , , | Leave a comment

Aggressive Cost-Sharing Forces Some Patients to go Without

Published on the April 13, 2016 Rheumatology Network website

By Whitney L.J. Howell

Specialty drugs have long been associated with higher prices and greater patient cost-sharing, but a new study delved into whether current cost-sharing requirements impact a patient’s likelihood to forego, delay or reduce specialty drug-adherence.

In an article from the Perelman School of Medicine published in the March 2016 American Journal of Managed Care, researchers evaluated existing literature to determine whether cost-sharing impacted the use of non-drug medical services, health outcomes and spending.

Currently, individuals using specialty drugs comprise between 1 percent and 5 percent of patients and account for $95 billion in drug spending – roughly 29 percent of all prescription drug expenditures nationwide. Drugs for cancer and autoimmune conditions, such as rheumatoid arthritis (RA) or multiple sclerosis (MS), are responsible for two-thirds of that price tag. In fact, patients frequently pay co-insurance equal to between 30 and 50 percent of the drug cost.

Researchers conducted a literature review, analyzing Medline-indexed studies in OVID from 1995 to 2014 to determine the cost-sharing impact. They identified 19 studies focused on specialty drugs for RA (8), MS (9), and cancer (8). The studies addressing RA touched on prescription abandonment (2), initiation (4), adherence (3), persistence/discontinuation (3), and drug spending (1).

According to these studies, if cost-sharing doubles, there’s a 5 to 9 percent drop in the number of RA patients taking a specialty drug for the first time (initiation). There’s also a 3.8 percent reduction in continuation if cost-sharing doubles after they start. Existing research also revealed non-initiation, non-compliance or abandonment are less likely among patients with life-threatening conditions, such as cancer, than among those with auto-immune disease.

To help determine how best to address cost-sharing in the future, researchers suggested establishing policies that could offer patients additional protections against aggressive cost-sharing policies. Such measures could result in higher medication compliance and improved health outcomes.

Traditional three-tiered cost-sharing designs are seldom used by insurers and pharmacy benefit managers because there often few options in specialty medicine. Instead, they use utilization management (UM) tools, such as prior authorization and quantity limits.

“Nevertheless, growing pressure to control spending has led insurers to increasingly place self-administered specialty drugs on new, separate “specialty tiers,” the authors wrote.

Specialty tiers are usually associated with a co-insurance that can be as high as 30-50 percent of the drug cost. But cost-sharing is typically associated with fixed co-payments of increasing amounts for generics, preferred brands and non-preferred brands.

“There is a critical need for methodologically rigorous research to further evaluate whether the aggressive cost-sharing arrangements found in the current marketplace may cause patients to forego, delay or decrease adherence to specialty drugs and whether that results in poor health outcomes and higher total spending,” the authors wrote.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/aggressive-cost-sharing-forces-some-patients-go-without

April 14, 2016 Posted by | Healthcare | , , | Leave a comment

Where Biologics Fail in RA, Baricitinib Could Succeed

Published on the April 13, 2016, Rheumatology Network website

By Whitney L.J. Howell

Patients with active rheumatoid arthritis (RA) resistant to standard-of-care treatments with synthetic or conventional DMARDs can benefit from selective Janus kinase (JAK) 1 and 2 inhibitors when paired with once-daily baricitinib, a study shows.

In a study, designed to test baricitinib safety and efficacy, from Stanford University Medical Center published in the March 31 New England Journal of Medicine issue, researchers found patients experience the largest reduction in rheumatoid arthritis symptoms with a 4mg daily baricitinib dose. Symptoms also decreased with a 2 mg daily dose.

“These results provide evidence that selective inhibition of JAK1 and JAK2 with once-daily baricitinib has clinical efficacy in patients with active rheumatoid arthritis that is refractory to aggressive standard-of-care treatment with both conventional synthetic DMARDs and biologic DMARDs,” the authors wrote.

In this phase III, 24-week trial with 527 patients, investigators divided participants into three groups:  a 4 mg baricitinib group, a 2 mg barcitinib group, and a placebo group. At 12 weeks, patients were tested for the American College of Rheumatology 20 percent (ACR20) response, the Health Assessment Questionnaire-Disability Index (HAQ-DI) Score, 28-Joint Disease Activity Score based on C-reactive protein level (DAS28-CRP), and Simplified Disease Activity Index (SDAI) Score of 3.3 or less.

At 12 weeks, more participants receiving 4 mg than the placebo had an ACR20 response — 55 percent and 27 percent, respectively. The same patient group also saw significant improvement in DAS28-CRP and HAQ-DI scores. There was no significant difference in SDAI scores for 2 mg and placebo groups.

Higher levels of adverse effects, such as withdrawal, cancer or cardiovascular events, appeared throughout the 24 weeks for both the 2 mg and 4 mg groups rather than the placebo. Among the 2 mg, 4 mg, and placebo groups, the rates were 71 percent, 77 percent, and 64 percent, respectively. Infections occurred in 44 percent, 40 percent, and 31 percent of cases. Serious events occurred in 4 percent, 10 percent, and 7 percent of patients, respectively.

According to study authors, results revealed rheumatoid arthritis patients with active disease and inadequate DMARD responses see the most clinical improvement from 4 mg baricitinib daily doses after 12 weeks. Additional studies are necessary, however, to determine long-term safety and response durability.

To read the article at its original location: http://www.rheumatologynetwork.com/rheumatoid-arthritis/where-biologics-fail-ra-baricitinib-could-succeed

 

April 14, 2016 Posted by | Healthcare | , , | Leave a comment

   

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