BACKGROUND: Educational interventions have long been used as a means of influencing prescribing behavior. Various techniques including educational mailings, academic detailing, prescriber feedback with or without disclosing patient-identifying data, and supplemental patient information have been used to promote appropriate prescribing habits, reduce costs, and optimize patient care. While the effects of educational intervention programs are widely reported, little information is available regarding the effectiveness of various mailed intervention techniques.

The field of health outcomes research has increased the utilization of health-related quality-of-life (HRQoL) instruments to document economic, clinical, and humanistic outcomes (ECHO). The Medical Outcomes Study Short Form 36-item Questionnaire (MOSSF-36, SF-36) has been utilized extensively in many disease states for this purpose, although it is not validated for use in chronic pain patients. The Total Outcomes of Pain Survey (TOPS) incorporates all the domains of the SF-36, and includes additional domains relevant in the management of chronic pain patients. The TOPS is well validated in these patients. In addition to its utility as an outcomes research tool, the TOPS is sensitive enough to document clinical changes in individual patients, making it a useful assessment tool for clinicians.

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discharged for any of the 280 PACT policy defined DRGs with an LOS shorter than the geometric mean for the DRG. To investigate the potential benefits of this policy, we assessed differences in re-admissions and healthcare costs between PACT eligible patients discharged to HH and those discharged to home with no home healthcare. Methods: Patients enrolled in Medicare Advantage with a PACT eligible discharge in 2018 were evaluated for this retrospective, claims analysis of a large national health plan. Index was the date of discharge. Patients with a claim for HH services within 7 days post-index comprised the HH group. Patients discharged to home with no claim for HH in the 90-day post-index period were the comparison group. Cox proportional-hazards models with an instrumental variable (hospital-level probability of HH referral) and adjustment for case-mix were used to assess all-cause readmissions post-index. Post-index total healthcare costs were modeled using generalized estimating equations fit to a gamma distribution. Results: There were 3,753 HH patients and 13,342 home only patients in the study cohort. HH patients were older [mean age 71.7 (+/-7) vs 70.8 (+/-9)], more frequently female (58.5%), with mostly surgical DRGs (85.4%). For HH patients, the risk of 30-day readmission was reduced by 60%, 60-day by 45% and 90-day by 37%. Healthcare costs were 11% lower for the HH group. Conclusions: For PACT eligible patients, the provision of additional healthcare services in the home setting was associated with fewer hospital re-admissions and reduced total healthcare costs, including costs of home health.