Evaluating the Addition of Clinical and Staging Data to Improve the Pricing Methodology of the Oncology Care Model.

PURPOSE: The Oncology Care Model (OCM) is the largest value-based care model focusing on oncology, but the current pricing methodology excludes relevant data on the cancer stage and current clinical status, limiting the precision of the risk adjustment. METHODS: This analysis evaluated 15,580 episodes of breast cancer, lung cancer, and multiple myeloma, starting between July 1, 2016, and January 1, 2020, with data from a cohort of OCM practices affiliated with academic medical centers. The authors merged clinical data with claims for OCM episodes defined by the Center for Medicare and Medicaid Innovation to identify potential quality improvement opportunities. The regression model evaluated the association of the cancer stage at initial diagnosis and current clinical status with variance to the OCM target price. RESULTS: Cancer stage at the time of initial diagnosis was significant for breast and lung cancers, with stage IV episodes having the highest losses of -$6,700 (USD) for breast cancer (P < .001) and -$18,470 (USD) for lung cancer (P < .001). Current clinical status had a significant impact for all three cancers in the analysis, with losses correlated with clinical complexity. Breast cancer and multiple myeloma episodes categorized as recurrent or progressive disease had significantly higher losses than stable episodes, at -$6,755 (USD) for breast (P < .001) and -$19,448 (USD) for multiple myeloma (P < .001). Lung cancer episodes categorized as initial diagnosis had significantly fewer losses than stable episodes, at -$3,751 (USD) (P = .001). CONCLUSION: As the Center for Medicare and Medicaid Innovation designs and launches new oncology-related models, the agency should adopt methodologies that more accurately set target prices, by incorporating relevant clinical data within cancer types to minimize penalizing practices that provide guideline-concordant cancer care.

Mild cognitive impairment: an update in Parkinson's disease and lessons learned from Alzheimer's disease.

Cognitive dysfunction is an important focus of research in Parkinson's disease (PD) and Alzheimer's disease (AD). While the concept of amnestic mild cognitive impairment (MCI) as a prodrome to AD has been recognized for many years, the construct of MCI in PD is a relative newcomer with recent development of diagnostic criteria, biomarker research programs and treatment trials. Controversies and challenges, however, regarding PD-MCI's definition, application, heterogeneity and different trajectories have arisen. This review will highlight current research advances and challenges in PD-MCI. Furthermore, lessons from the AD field, which has witnessed an evolution in MCI/AD definitions, relevant advances in biomarker research and development of disease-modifying and targeted therapeutic trials will be discussed.

Assessing pedometer accuracy while walking, skipping, galloping, sliding, and hopping.

The purpose of this study was to determine the accuracy of the pedometer when walking, skipping, galloping, sliding, and hopping. One hundred-two college students were fitted with a pedometer (Walk4Life LS-7010) at mid-thigh on the right and left of the hip. Participants then performed the randomly assigned movements for the length (26 m) of a hardwood court playing surface, during which time the investigator tallied the steps with a hand counter. Each step with the lead foot elicited a tally on the counter. Participants were instructed to perform the movement at a brisk pace, to jump-stop at the end of the court, and to remain still until after the pedometer reading was recorded. Repeated measure ANOVAs using the Bonferroni technique were used to compare differences between pedometer counts and hand counts. Significant differences were evident between the hand tally counts and readings from the right and left pedometers during all five locomotor movements (P < .01). Mean error was lowest between the hand tally and the average of the right and left pedometers while walking (-1.35 +/- 1.60) and hopping (-2.94 +/- 2.33), and increased while sliding (-6.42 +/- 4.78), galloping (-8.22 +/- 4.63), and skipping (-8.30 +/- 4.45). Results indicate the pedometer may not consistently register the vertical force produced by the trail foot contact, the lead foot contact, or a combination of the two while skipping, galloping, and sliding. Though the pedometer is a valid instrument when estimating physical activity levels, caution is urged when interpreting movements other than walking.

Elevated Anterior Compartment Pressure in the Leg After Creatine Supplementation: A Controlled Case Report.

OBJECTIVE: To report abnormal changes in lower leg anterior compartment pressure in 1 subject who consumed creatine as a dietary supplement. BACKGROUND: The subject received creatine at a dosage of 0.3 g.kg body mass(-1).d(-1) for 6 days, followed by 0.03 g.kg body mass(-1).d(-1) for 28 days. Thereafter, the subject consumed no supplement for 21 days. Compartment pressure was measured pre-exercise and for 15 minutes postexercise after a treadmill run for 20 minutes at 80% of VO(2) max before supplementation and after 6 and 34 days of supplementation. DIFFERENTIAL DIAGNOSIS: Normally, resting anterior compartment pressure is less than 15 mm Hg, whereas postexercise pressure is below 30 to 35 mm Hg. Creatine supplementation for 6 days dramatically increased pressure at rest (31 mm Hg) and at 1 minute (67 mm Hg), 5 minutes (35 mm Hg), 10 minutes (28 mm Hg), and 15 minutes (26 mm Hg) postexercise. Pressure remained high at rest (35 mm Hg) and at 1 minute (109 mm Hg), 5 minutes (90 mm Hg), 10 minutes (87 mm Hg), and 15 minutes (69 mm Hg) postexercise after 34 days of supplementation. TREATMENT: The subject stopped taking creatine for 21 days. Compartment pressure was measured at rest and after exercise after 7 and 21 days with no supplementation. Anterior compartment pressure decreased after cessation of creatine supplementation. However, pressures were elevated at 7 days postsupplementation at rest (26 mm Hg) and at 1 minute (112 mm Hg), 5 minutes (58 mm Hg), 10 minutes (40 mm Hg), and 15 minutes (30 mm Hg) postexercise. Pressures at 21 days postsupplementation remained high at rest (24 mm Hg) and at 1 minute (64 mm Hg), 5 minutes (42 mm Hg), 10 minutes (27 mm Hg), and 15 minutes (27 mm Hg) postexercise. CONCLUSION: These data indicate that creatine supplementation can substantially increase anterior compartment pressure in the leg.