Preparing for accountable care organizations: a physician primer.

The concept of the accountable care organization (ACO) offers the opportunity to better integrate the health system into a value proposition aligned toward improved care, more efficient delivery, and higher patient satisfaction. As a significant component of health reform, the ACO has many implications for physicians. Physicians interested in joining ACOs have a variety of options, including forming their own, integrating (virtual or otherwise) with larger health systems, or joining multiple, existing ACOs. To succeed, fundamental changes away from the past fee-for-service model will be necessary. Clinical and financial data will become of paramount importance. The data will need to be more accessible, more accurate, and more appropriately used to align with the greater ACO value proposition. Physicians will also need to embrace the "era of persuasion" with its underlying assumption that engaging patients and other physicians are as necessary as a proper diagnosis and treatment plan. As there is a wide array of options in the marketplace, providers must have a clear understanding of patient attribution, financial incentives, and quality metrics within any ACO agreement. Finally, the health-care system must acknowledge the difficulties associated with the pace of change itself and invest in resources to aid in the adaptive reserve of all components of the health-care system.

Anthropometric and pulmonary function test profiles of outpatients with stable chronic obstructive pulmonary disease.

PURPOSE: To determine the prevalence of abnormalities in the nutritional status, and their correlation with pulmonary function test results, in a population of outpatients with stable chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: During 1 year of study, body weight, height, triceps skinfold, arm muscle circumference, and pulmonary function parameters were assessed in 126 patients. On the basis of body mass index (BMI = weight/height2) of less than 20, 20 to 27, and greater than 27, the patients were divided into underweight (n = 29, 23%), normal weight (n = 67, 53.2%), and overweight (n = 30, 23.8%), respectively. RESULTS: Diffusing capacity for carbon monoxide (DLCO), both as absolute and percent predicted, differed significantly among the three groups, being lowest in the underweight and highest in the overweight patients. A significant and positive correlation was present between BMI as the independent variable and DLCO, forced expiratory volume in 1 second, and its ratio to forced vital capacity. A significant and negative correlation existed between BMI and residual volume and its ratio to total lung capacity. CONCLUSION: A substantial number of stable COPD patients (46.8%) have nutritional abnormalities. BMI is a simple and accurate indicator of nutritional status in these patients. BMI correlates significantly with some tests of pulmonary function.