The objective of this study was to evaluate the impact on health care utilization and expenditure trends over time of a personalized preventive medicine program delivering individualized care focused on lifestyle behavior modification, disease prevention, and compliance with quality-related metrics. MD-Value in Prevention (MDVIP) is a network of affiliated primary care physicians who utilize a model of health care delivery based on an augmented physician-patient relationship and focused on personalized preventive health care. Multivariate modeling was used to control for demographics, socioeconomics, supply of health care services, and health status among 10,186 MDVIP members and randomly selected, matched nonmembers. Health care utilization and expenditure trends were tracked from the pre period prior to member enrollment for a period of up to 3 years post enrollment. MDVIP members experienced reduced utilization of emergency room and urgent care services compared to nonmembers. Program savings ranges indicated that, over time, increasing percentages of members achieved cost savings compared to nonmembers. Older age groups were more likely to realize savings in the early years with preventive activities indicating condition management, and younger age groups were most likely to achieve savings by the third year after enrollment. These results indicate that a primary care model based on an enhanced physician-patient relationship and focused on quality and personalized preventive care within a time frame of 3 years can achieve positive health care expenditure outcomes and improved health management.

Risedronate significantly reduced the risk of new vertebral fractures compared with placebo, regardless of PPI concomitant use.

OBJECTIVES:To quantify the effect of age on the incidence of osteoporosis-related fractures and of risedronate treatment on fracture risk in different age groups in women with postmenopausal osteoporosis. DESIGN: Data from four randomized, double-blind, placebo-controlled, Phase III studies were pooled and analyzed. PARTICIPANTS: The analysis population (N 5 3,229) consisted of postmenopausal women with osteoporosis as determined on the basis of prevalent vertebral fractures, low bone mineral density (BMD), or both. INTERVENTION: Patients had received risedronate 5 mg daily or placebo for 1 to 3 years. MEASUREMENTS: The endpoints of interest were the incidence of osteoporosis-related fractures, clinical fractures, nonvertebral fractures, and morphometric vertebral fractures. The effect of age on fracture risk and treatment benefit was examined using Cox regression models with age and treatment as explanatory variables. The 3-year fracture risk was estimated for patients in each treatment group at a given age. RESULTS: Irrespective of treatment, fracture risks were greater in older patients (Po.001). On average, for every 1-year increase in age, a patient's risk for osteoporosisrelated fracture increased 3.6% (95% confidence interval 5 2.3-5.0%). Irrespective of age, risedronate treatment reduced fracture risk 42%. Risedronate-treated patients had fracture risks similar to those of placebo-treated patients 10 to 20 years younger. CONCLUSION: Patients treated with risedronate have a significantly lower fracture risk, similar to that of untreated patients 10 to 20 years younger. J Am Geriatr Soc 58:658-663, 2010.

Lifestyle-related diseases have common risk factors: physical inactivity, poor diet, inadequate sleep, high stress, substance use, and social isolation. Evidence is mounting for the benefits of incorporating effective methods that promote healthy lifestyle habits into routine health care treatments. Research has established that healthy habits foster psychological and physiological health and that emotional well-being is central to achieving total well-being. The Happiness Science and Positive Health Committee of the American College of Lifestyle Medicine aims to raise awareness about strategies for prioritizing emotional well-being. The Committee advocates for collaborative translational research to adapt the positive psychology and behavioral medicine evidence base into methodologies that address emotional well-being in nonmental health care settings. Another aim is to promote health system changes that integrate evidence-based positive-psychology interventions into health maintenance and treatment plans. Also, the Committee seeks to ameliorate health provider burnout through the application of positive psychology methods for providers' personal health. The American College of Lifestyle Medicine and Dell Medical School held an inaugural Summit on Happiness Science in Health Care in May 2018. The Summit participants recommended research, policy, and practice innovations to promote total well-being via lifestyle changes that bolster emotional well-being. These recommendations urge stakeholder collaboration to facilitate translational research for health care settings and to standardize terms, measures, and clinical approaches for implementing positive psychology interventions. Sample aims of joint collaboration include developing evidence-based, practical, low-cost behavioral and emotional assessment and monitoring tools; grants to encourage dissemination of pilot initiatives; medical record dashboards with emotional well-being and related aspects of mental health as vital signs; clinical best practices for health care teams; and automated behavioral programs to extend clinician time. However, a few simple steps for prioritizing emotional well-being can be implemented by stakeholders in the near-term.

Objective Diabetes is a risk equivalent for cardiovascular events. The increase in vascular inflammation with diabetes is believed to be responsible for increased risk of ischemic events in diabetic patients. Our goal was to assess whether knowledge of vascular inflammation alters cardiovascular risk over time, and how knowledge of vascular inflammation changes risk in non-diabetic, pre-diabetic and diabetic patients. Methods We retrospectively studied >100,000 primary-care patients per annum for 5 years (baseline in 2011 through 2015) with tests including lipoprotein profile, hemoglobin A1C and the vascular-specific inflammation risk marker myeloperoxidase. Results were obtained during the patient's MD Value In Prevention (MDVIP) annual wellness program physical. Results We show that rates of patients with elevated myeloperoxidase levels were reduced from 14.4%, 15.2% and 21.3% to 4.0%, 4.0% and 6.7% in non-diabetic, pre-diabetic and diabetic patients, respectively, over the 5-year period. Decreases in vascular inflammation were achieved without decreases in the prevalence of pre-diabetes (hemoglobin A1C 5.7%-6.4%) or diabetes (hemoglobin A1C >6.4%) and were observed in patients below or above guideline low-density lipoprotein targets. Conclusions These data demonstrate that physicians informed of elevated markers of vascular inflammation can lower vascular inflammation correlating with biomarker-based decreased risk of cardiovascular events.