The Accountable Care Organization results:Population health management and quality improvement programs associated with increased quality of care and decreased utilization and cost of care

Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN)is one of the original CMS Pioneer ACO programs and implemented a comprehensive disease management program based on the collaborative care model.Key performance indicators for CMS reflected quality and cost of care.Results:BHN has demonstrated both improved quality and cost savings in the first two years of the pilot program.The disease management program based on the collaborative care model appears to have improved patient health outcomes based on quality improvement measures.In addition the program has reduced emergency department and hospital utilization,resulting in cost savings.Conclusions:The BHN quality improvement program is the platform for analyzing and improving on the BHN ACO model.This model appears to have excellent application to the China health care system that is also focused on prevention and improvement of chronic disease and cost-effectiveness.

Prevalence and correlates of lifestyle behavior,anxiety and depression in Chinese college freshman:A cross-sectional survey

Objectives:First-year college students had exposure to unhealthy lifestyle behaviors that correlate with a high prevalence of anxiety and depression.Regarding to the modifiable lifestyle behaviors factors,this study investigated the prevalence and correlation of multiple lifestyle behaviors,anxiety and depression in a sample of Chinese first-year college students.Methods:Cross-sectional data were extracted from Residents eHealth app of health lifestyle behaviors survey from September to October 2019.Anxiety,depression,eating regular meals,consumption of snacks in-between meals,consumption of fruit,dessert and sugar-sweetened beverages,smoking and secondhand smoke exposure,consuming alcohol,physical activity,sedentary time were assessed by self-report.Socio-demographic including age,gender,education,family income,religion,and health condition were captured.Logistic regression was used to explore the association of multiple lifestyle behaviors,anxiety and depression.Results:Totally 1,017 participants were included in the study.The prevalence of anxiety and depression(from mild to severe) were 40.3% and 45.3%,respectively.In multivariable analyses,religion (believe in Buddhism,OR =2.438,95%CI:1.097-5.421;believe in Christian,OR =5.886,95%CI:1.604-21.597),gender (Female,OR =1.405,95%CI:1.001-1.971),secondhand smoke exposure (OR =1.089,95%CI:1.001-1.184),and eating regular meals (OR =0.513,95%C1:0.346-0.759) were associated with anxiety.Family income (OR =0.732,95%CI:0.596-0.898),eating regular meals (OR =0.641,95%CI:0.415-0.990),frequency of breakfast (OR =0.813,95%CI:0.690-0.959),with a chronic disease (OR =1.902,95%CI:1.335-2.712),and consumption of nocturnal snack (OR =1.337,95%CI:1.108-1.612) were associated with depression.Conclusions:These results highlighted the need for early lifestyle behavior intervention,especially modifying diet patterns considering the background of religion,health condition,and social-economic status in first-year college students to improve their mental health.

Life’s Essential 8 and risk of non-communicable chronic diseases:Outcome-wide analyses

Background:Life’s Simple 7,the former construct of cardiovascular health(CVH)has been used to evaluate adverse non-communicable chronic diseases(NCDs).However,some flaws have been recognized in recent years and Life’s Essential 8 has been established.In this study,we aimed to analyze the association between CVH defined by Life’s Essential 8 and risk of 44 common NCDs and further estimate the population attributable fractions(PAFs)of low-moderate CVH scores in the 44 NCDs.Methods:In the UK Biobank,170,726 participants free of 44 common NCDs at baseline were included.The Life’s Essential 8 composite measure consists of four health behaviours(diet,physical activity,nicotine exposure,and sleep)and four health factors(body mass index,non-high density lipoprotein cholesterol,blood glucose,and blood pressure),and the maximum CVH score was 100 points.CVH score was categorized into low,moderate,and high groups.Participants were followed up for 44 NCDs diagnosis across 10 human system disorders according to the International Classification of Diseases 10th edition(ICD-10)code using linkage to national health records until 2022.Cox proportional hazard models were used in this study.The hazard ratios(HRs)and PAFs of 44 NCDs associated with CVH score were examined.Results:During the median follow-up of 10.85 years,58,889 incident NCD cases were documented.Significant linear dose-response associations were found between higher CVH score and lower risk of 25(56.8%)of 44 NCDs.Low-moderate CVH(<80 points)score accounted for the largest proportion of incident cases in diabetes(PAF:80.3%),followed by gout(59.6%),sleep disorder(55.6%),chronic liver disease(45.9%),chronic kidney disease(40.9%),ischemic heart disease(40.8%),chronic obstructive pulmonary disease(40.0%),endometrium cancer(35.8%),lung cancer(34.0%),and heart failure(34.0%)as the top 10.Among the eight modifiable factors,overweight/obesity explained the largest number of cases of incident NCDs in endocrine,nutritional,and metabolic diseases(35.4%),digestive system disorders(21.4%),mental and behavioral disorders(12.6%),and cancer(10.3%);however,the PAF of ideal sleep duration ranked first in nervous system(27.5%)and neuropsychiatric disorders(9.9%).Conclusions:Improving CVH score based on Life’s Essential 8 may lower risk of 25 common NCDs.Among CVH metrics,avoiding overweight/obesity may be especially important to prevent new cases of metabolic diseases,NCDs in digestive system,mental and behavioral disorders,and cancer.

New models for chronic disease management in the United States and China

In the United States(US)the role of the general practitioner in primary care is changing rapidly as the team leader in the new“Patient-centered Medical Home”model of care that is designed to improve the management of chronic disease.The“Collaborative Care Model”is an integrated model of treating multiple medical and behavioral conditions.These new approaches include a nurse case manager who serves as the key point of contact to provide education,facilitate treatment adherence,and guide the patient to improvements in nutrition and physical activity that cause obesity and chronic disease.A gap analysis was conducted comparing the US and Chinese general practitioner models for providing care to patients with chronic diseases.The results of the analysis were used to make recommendations for adding components of these models that are feasible and effective for Chinese general practitioners in community health centers.