Background: New population health community-based models of palliative care can result in more compassionate, affordable, and sustainable high-quality care.Objectives: We evaluated utilization and cost outcomes of a standardized, population health community-based palliative care program provided by nurses and social workers.Design: We conducted a retrospective propensity-adjusted study to quantify cost savings and resource utilization associated with a community-based palliative care program. We analyzed claims data from a Medicare Advantage (MA) plan and used a proprietary predictive model to identify 804 members at high risk for overmedicalized end-of-life care. We enrolled 204 members in the palliative care program and compared them with 600 who received standard, telephonic, health plan case management. We excluded members with fewer than two months of enrolled experience or those with insufficient data for analysis, leaving 176 members in the study group and 570 in the control group for evaluation. We compared differences in utilization and costs (medical and pharmacy), hospital admissions, bed days (acute and intensive care unit [ICU]), and emergency department visits.Setting/Subjects: A 30,000-member MA plan and a health system in Central Ohio between October 2015 and June 2016.Results: Members who received community-based palliative care showed a statistically significant 20% reduction in total medical costs ($619 per enrolled member per month), 38% reduction in ICU admissions, 33% reduction in hospital admissions, and 12% reduction in hospital days.Conclusion: A structured nurse and social work model of community-based palliative care using a predictive model to identify MA candidates for intervention can reduce utilization and medical costs.

Objective-To assess the stability and reproducibility of computerised QT dispersion (QTd) measurement in healthy subjects, as this is presently being incorporated into commercial electrocardiographic systems. Methods-70 healthy volunteers (mean (SD) age 38 (10) years, 35 men, 35 women) with a normal 12 lead electrocardiogram (ECG) were studied. From each subject, 70 ECG recordings were taken using the MAC VU ECG recorder (Marquette). In study A, 50 ECGs were recorded in each subject: 10 supine, 10 sitting, 10 standing, 10 holding breath in maximum inspiration, and 10 holding breath in maximum expiration. After a mean interval of 8 (3) days (range 7 to 23), 10 recordings in supine and 10 in the standing position were repeated in each subject (study B). On measurements made using a research version of the commercial software without manual modification, the reproducibility of QTd was assessed by coeYcient of variance (CV) and relative error, and comparisons made with other ECG indices. Results-(1) QTd measurements were stable and not influenced by changes in posture and respiratory cycle; (2) there was no diVerence in QTd measurements between men and women, or between age groups dichotomised at 35 years; (3) no correlation was found between QTd and heart rate or QT interval; (4) short term reproducibility of all QTd measurements (CV 15.6% to 43.8%) was worse than that of conventional ECG indices (CV 1.4% to 5.3%); (5) long term reproducibility of QTd measurements (relative error 27.4% to 31.0%) was also worse than that of conventional ECG indices (relative error 1.8% to 7.9%) (p < 0.0001); (6) the reproducibility of QTd measurements tended to increase when several serial recordings were averaged. Conclusions-Computerisedmeasurements of global QTd and global QT-SD from 12 lead ECG by the MAC VU/QT Guard system are not significantly altered by changes in posture and respiration. The reproducibility of all QTd measurements is inferior to that of conventional ECG indices in healthy subjects. (Heart 1998;80:459-466)

Our results indicate that elevated plasma Lp(a) is an independent risk factor for angiographic CAD in chronic stable angina and may have particular significance in women.