opportunities to improve quality & cost-effectiveness of health-care
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Management
- general
- identify financial incentives associated with clinical guidelines
- HIV1 infection
- 13% of the 1.2 million people with HIV1 infection in the U.S. have undiagnosed infection[1]
- 30-40% of patients with known HIV1 infection are not getting regular care[2]
- 13% of the 1.2 million people with HIV1 infection in the U.S. have undiagnosed infection[1]
- diabetes mellitus type 2
- 25% of patients with diabetes have not been diagnosed[3]
- disease often present for 5-10 years prior to diagnosis
- retinopathy, neuropathy & nephropathy are commonly seen at clinical presentation
- disease often present for 5-10 years prior to diagnosis
- diet is the most important management strategy, but for many patients, diet control is more optimism than science[4]
- Mediterranean diet
- improves glycemic control in new onset type-2 diabetes[5]
- reduces cardiovascular complications in patients with type-2 diabetes, including those with 'TT' variant of the TCF7L2 gene (high-risk polymorphism)[6]
- regular exercise
- 25% of patients with diabetes have not been diagnosed[3]
- cancer prevention
- cardiovascular risk reduction
- diet & lifestyle modifications are the cornerstone of management[11]
- 4 of 5 MIs in men are preventable through healthy diet & lifetyle; NNT of 20 for 10 years to prevent 1 MI[12]
- Alzheimer's disease
- there is no good evidence that anything prevents the pathology of Alzheimer's disease[13]
- participation in new stimulating activities contributes to cognitive fitness & might delay cognitive decline[14]
- Mediterranean diet in combination with exercise reduces the risk of dementia & Alzheimer's disease[15]
- evaluate financial incentives associated with implementation of clinical guidelines
Additional terms
References
- ↑ 1.0 1.1 Hall IH Prevalence of Diagnosed and Undiagnosed HIV Infection - United States, 2008-2012. MMWR. Weekly. June 26, 2015 / 64(24);657-662 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6424a2.htm
Seth P et al Identifying New Positives and Linkage to HIV Medical Care - 23 Testing Site Types, United States, 2013 MMWR. Weekly. June 26, 2015 / 64(24);663-667 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6424a3.htm - ↑ 2.0 2.1 Sax PE HIV and ID Observations (Blog). July 7, 2105 For HIV in the USA, Not in Care Exceeds the Undiagnosed - Solutions Welcome. http://blogs.jwatch.org/hiv-id-observations/index.php/for-hiv-in-the-usa-not-in-care-exceeds-the-undiagnosed-solutions-welcome/2015/07/07/
- ↑ 3.0 3.1 Ali MK et al A Cascade of Care for Diabetes in the United States: Visualizing the Gaps. Ann Intern Med. 2014;161(10):681-689. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25402511 <Internet> http://annals.org/article.aspx?articleid=1935052
- ↑ 4.0 4.1 Journal Watch 24(18):145, 2004
Hippisley-Cox J, Pringle M. Prevalence, care, and outcomes for patients with diet- controlled diabetes in general practice: cross sectional survey. Lancet. 2004 Jul 31;364(9432):423-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15288740 - ↑ 5.0 5.1 Esposito K et al Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: A randomized trial. Ann Intern Med 2009 Sep 1; 151:306. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19721018
- ↑ 6.0 6.1 Corella D et al Mediterranean Diet Reduces the Adverse Effect of the TCF7L2- rs7903146 Polymorphism on Cardiovascular Risk Factors and Stroke Incidence. A randomized controlled trial in a high- cardiovascular-risk population. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23942586 <Internet> http://care.diabetesjournals.org/content/early/2013/08/06/dc13-0955.abstract
- ↑ 7.0 7.1 Nylen ES, Kokkinos P, Myers J, Faselis C Prognostic effect of exercise capacity on mortality in older adults with diabetes mellitus. J Am Geriatr Soc. 2010 Oct;58(10):1850-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20929462
- ↑ 8.0 8.1 Andrews RC et al. Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: The Early ACTID randomised controlled trial. Lancet 2011 Jun 25 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60442-X/fulltext
Hu FB. Diet and exercise for new-onset type 2 diabetes? Lancet 2011 Jun 25; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60692-2/fulltext - ↑ 9.0 9.1 American Diabetes Association Standards of Medical Care in Diabetes-2015: Summary of Revisions Diabetes Care. Jan 2015. 38:S1-S2 http://care.diabetesjournals.org/content/38/Supplement_1
- ↑ 10.0 10.1 Moore LV, Thompson FE Adults Meeting Fruit and Vegetable Intake Recommendations - United States, 2013 MMWR Weekly. July 10, 2015 / 64(26);709-713 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a1.htm
USDA: How Many Vegetables Are Needed Daily or Weekly? http://www.choosemyplate.gov/printpages/MyPlateFoodGroups/Vegetables/food-groups.vegetables-amount.pdf
USDA: How Much Fruit Is Needed Daily? http://www.choosemyplate.gov/printpages/MyPlateFoodGroups/Fruits/food-groups.fruits-amount.pdf - ↑ 11.0 11.1 Djousse L et al Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA 2009 Jul 22/29; 302:394. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19622818
- ↑ 12.0 12.1 Akesson A, Larsson SC, Discacciati A, Wolk A. Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men. J Am Coll Cardiol 2014; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25257629 <Internet> http://content.onlinejacc.org/article.aspx?articleID=1909605
Mozaffarian D. The promise of lifestyle for cardiovascular health. J Am Coll Cardiol 2014 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25257630 - ↑ 13.0 13.1 NATIONAL INSTITUTES OF HEALTH STATE-OF-THE-SCIENCE CONFERENCE STATEMENT NIH State-of-the-Science Conference: Preventing Alzheimer's Disease and Cognitive Decline April 26-28, 2010 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20547888 <Internet> http://consensus.nih.gov/2010/docs/alz/alz_stmt.pdf
- ↑ 14.0 14.1 14.2 Klusmann V, Evers A, Schwarzer R Complex mental and physical activity in older women and cognitive performance: a 6-month randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2010 Jun;65(6):680-8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20418350
- ↑ 15.0 15.1 Scarmeas N et al, Mediterranean diet and Alzheimer's disease mortality. Neurology 2007, 69:1084 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17846408
Galvin JE Pass the grain; spare the brain. Neurology 2007, 69:1072 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17846407
Scarmeas N et al. Physical activity, diet, and risk of Alzheimer disease. JAMA 2009 Aug 12; 302:627. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671904
Feart C et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 2009 Aug 12; 302:638. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671905
Knopman DS. Mediterranean diet and late-life cognitive impairment: A taste of benefit. JAMA 2009 Aug 12; 302:686. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671912