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Phillips, Russell

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Phillips

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Phillips, Russell
Author's Publications: search.filters.isAuthorOfPublication.8ddc981e-7f88-4bdc-b7c4-03a73ef84da8

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Now showing 1 - 9 of 9
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    The Coming Primary Care Revolution
    (Springer US, 2017) Ellner, Andrew; Phillips, Russell
    The United States has the most expensive, technologically advanced, and sub-specialized healthcare system in the world, yet it has worse population health status than any other high-income country. Rising healthcare costs, high rates of waste, the continued trend towards chronic non-communicable disease, and the growth of new market entrants that compete with primary care services have set the stage for fundamental change in all of healthcare, driven by a revolution in primary care. We believe that the coming primary care revolution ought to be guided by the following design principles: 1) Payment must adequately support primary care and reward value, including non-visit-based care. 2) Relationships will serve as the bedrock of value in primary care, and will increasingly be fostered by teams, improved clinical operations, and technology, with patients and non-physicians assuming an ever-increasing role in most aspects of healthcare. 3) Generalist physicians will increasingly focus on high-acuity and high-complexity presentations, and primary care teams will increasingly manage conditions that specialists managed in the past. 4) Primary care will refocus on whole-person care, and address health behaviors as well as vision, hearing, dental, and social services. Design based on these principles should lead to higher-value healthcare, but will require new approaches to workforce training.
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    Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices
    (American College of Physicians, 2015) Basu, Sanjay; Phillips, Russell; Bitton, Asaf; Song, Zirui; Landon, Bruce
    Background: Physicians have traditionally been reimbursed for face-to-face visits. A new non–visit-based payment for chronic care management (CCM) of Medicare patients took effect in January 2015. Objective: To estimate financial implications of CCM payment for primary care practices. Design: Microsimulation model incorporating national data on primary care use, staffing, expenditures, and reimbursements. Data Sources: National Ambulatory Medical Care Survey and other published sources. Target Population: Medicare patients. Time Horizon: 10 years. Perspective: Practice-level. Intervention: Comparison of CCM delivery approaches by staff and physicians. Outcome Measures: Net revenue per full-time equivalent (FTE) physician; time spent delivering CCM services. Results of Base-Case Analysis: If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year (95% CI, $234 to $429) if CCM services were delivered by registered nurses (RNs), approximately $372 (CI, $276 to $468) if services were delivered by licensed practical nurses, and approximately $385 (CI, $286 to $485) if services were delivered by medical assistants. For a typical practice, this equates to more than $75 000 of net annual revenue per FTE physician and 12 hours of nursing service time per week if 50% of eligible patients enroll. At a minimum, 131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services. Results of Sensitivity Analysis: If physicians were to deliver all CCM services, approximately 25% of practices nationwide could expect net revenue losses due to opportunity costs of face-to-face visit time. Limitation: The CCM program may alter long-term primary care use, which is difficult to predict. Conclusion: Practices that rely on nonphysician team members to deliver CCM services will probably experience substantial net revenue gains but must enroll a sufficient number of eligible patients to recoup costs. Primary Funding Source: None.
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    Reduced Emergency Department Utilization after Increased Access to Primary Care
    (Public Library of Science, 2016) Basu, Sanjay; Phillips, Russell
    Sanjay Basu and Russell Phillips discuss the findings from Whittaker and colleagues on the link between extending primary care hours and emergency department utilization.
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    Ambient Temperature and Biomarkers of Heart Failure: A Repeated Measures Analysis
    (National Institute of Environmental Health Sciences, 2012) Wilker, Elissa; Yeh, Gloria; Wellenius, Gregory Alexander; Davis, Roger; Phillips, Russell; Mittleman, Murray
    Background: Extreme temperatures have been associated with hospitalization and death among individuals with heart failure, but few studies have explored the underlying mechanisms. Objectives: We hypothesized that outdoor temperature in the Boston, Massachusetts, area (1- to 4-day moving averages) would be associated with higher levels of biomarkers of inflammation and myocyte injury in a repeated-measures study of individuals with stable heart failure. Methods: We analyzed data from a completed clinical trial that randomized 100 patients to 12 weeks of tai chi classes or to time-matched education control. B-type natriuretic peptide (BNP), C-reactive protein (CRP), and tumor necrosis factor (TNF) were measured at baseline, 6 weeks, and 12 weeks. Endothelin-1 was measured at baseline and 12 weeks. We used fixed effects models to evaluate associations with measures of temperature that were adjusted for time-varying covariates. Results: Higher apparent temperature was associated with higher levels of BNP beginning with 2-day moving averages and reached statistical significance for 3- and 4-day moving averages. CRP results followed a similar pattern but were delayed by 1 day. A 5°C change in 3- and 4-day moving averages of apparent temperature was associated with 11.3% [95% confidence interval (CI): 1.1, 22.5; :p = 0.03) and 11.4% (95% CI: 1.2, 22.5; p = 0.03) higher BNP. A 5°C change in the 4-day moving average of apparent temperature was associated with 21.6% (95% CI: 2.5, 44.2; p = 0.03) higher CRP. No clear associations with TNF or endothelin-1 were observed. Conclusions: Among patients undergoing treatment for heart failure, we observed positive associations between temperature and both BNP and CRP—predictors of heart failure prognosis and severity.
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    P04.42. Use of Complementary and Alternative Medicine among Adults with Neuro-Psychiatric Symptoms Common to Mild Traumatic Brain Injury
    (BioMed Central, 2012) Purohit, Maulik Prafull; Wells, R; Bertisch, Suzanne; Zafonte, Ross; Davis, Robert; Phillips, Russell
    Purpose: One in three adults uses complementary and alternative medicine (CAM) annually in the United States. However, the pattern of CAM use among adults with neuropsychiatric symptoms commonly reported by patients with mild traumatic brain injury (mTBI), a serious public health concern, is not well studied. Methods: We analyzed data from the 2007 National Health Interview Survey (n=23,393) to compare CAM use between adults with and without neuropsychiatric symptoms common to mTBI. Symptoms included self-reported anxiety, depression, insomnia, headaches, memory deficits, attentional deficits, and excessive sleepiness. CAM use was defined as use of mind-body (e.g., meditation), biological (e.g., herbs), manipulation (e.g., massage) therapies, and alternative medical systems (e.g., Ayurveda), within the past 12 months. We estimated prevalence and reasons for CAM use in patients with and without neuropsychiatric symptoms. We also explored variations in CAM use by the number of symptoms. Multivariable logistic regression was performed to examine the association between neuropsychiatric symptoms and CAM use after adjustment for sociodemographic characteristics, illness burden (e.g,. fibromyalgia, low back pain), access to care, and health habits. Results: Adults with neuropsychiatric symptoms had higher CAM use compared to adults without neuropsychiatric symptoms (44% vs. 30%, p<0.001); prevalence increased with increasing number of symptoms (p-value for trend <0.001, table below). Differences persisted after adjustment (table below). Twenty percent used CAM because standard treatments were either too expensive or ineffective; 25% used CAM because it was recommended by a provider. Conclusion: More than 40% of adults with neuropsychiatric symptoms observed in mTBI used CAM. An increasing number of symptoms was associated with increased use. Future research is needed to understand the use, efficacy, and safety of CAM in mTBI patients.
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    P02.109. Stress management counseling in primary care: results of a national study
    (BioMed Central, 2012) Nerurkar, A; Bitton, Asaf; Davis, R; Phillips, Russell; Yeh, Gloria
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    Effects of Ambient Air Pollution on Functional Status in Patients with Chronic Congestive Heart Failure: a Repeated-Measures Study
    (BioMed Central, 2007) Wellenius, Gregory A.; Yeh, Gloria; Coull, Brent; Suh MacIntosh, Helen H.; Phillips, Russell; Mittleman, Murray
    Background: Studies using administrative data report a positive association between ambient air pollution and the risk of hospitalization for congestive heart failure (HF). Circulating levels of B-type natriuretic peptide (BNP) are directly associated with cardiac hemodynamics and symptom severity in patients with HF and, therefore, serves as a marker of functional status. We tested the hypothesis that BNP levels would be positively associated with short-term changes in ambient pollution levels among 28 patients with chronic stable HF and impaired systolic function. Methods: BNP was measured in whole blood at 0, 6, and 12 weeks. We used linear mixed models to evaluate the association between fine particulate matter (PM2.5), carbon monoxide, sulfur dioxide, nitrogen dioxide, ozone, and black carbon and log(BNP). Lags of 0 to 3 days were considered in separate models. We calculated the intraclass correlation coefficient and within-subject coefficient of variation as measures of reproducibility. Results: We found no association between any pollutant and measures of BNP at any lag. For example, a 10 μg/m3 increase in PM2.5 was associated with a 0.8% (95% CI: -16.4, 21.5; p = 0.94) increase in BNP on the same day. The within-subject coefficient of variation was 45% on the natural scale and 9% on the log scale. Conclusion: These results suggest that serial BNP measurements are unlikely to be useful in a longitudinal study of air pollution-related acute health effects. The magnitude of expected ambient air pollution health effects appears small in relation to the considerable within-person variability in BNP levels in this population.
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    Providing High-Quality Care for Limited English Proficient Patients: The Importance of Language Concordance and Interpreter Use
    (Springer-Verlag, 2007) Ngo-Metzger, Quyen; Sorkin, Dara H.; Phillips, Russell; Greenfield, Sheldon; Massagli, Michael P.; Clarridge, Brian; Kaplan, Sherrie H.
    Background: Provider–patient language discordance is related to worse quality care for limited English proficient (LEP) patients who speak Spanish. However, little is known about language barriers among LEP Asian-American patients. Objective: We examined the effects of language discordance on the degree of health education and the quality of interpersonal care that patients received, and examined its effect on patient satisfaction. We also evaluated how the presence/absence of a clinic interpreter affected these outcomes. Design: Cross-sectional survey, response rate 74%. Participants: A total of 2,746 Chinese and Vietnamese patients receiving care at 11 health centers in 8 cities. Measurements: Provider–patient language concordance, health education received, quality of interpersonal care, patient ratings of providers, and the presence/absence of a clinic interpreter. Regression analyses were used to adjust for potential confounding. Results: Patients with language-discordant providers reported receiving less health education (β = 0.17, p < 0.05) compared to those with language-concordant providers. This effect was mitigated with the use of a clinic interpreter. Patients with language-discordant providers also reported worse interpersonal care (β = 0.28, p < 0.05), and were more likely to give low ratings to their providers (odds ratio [OR] = 1.61; CI = 0.97–2.67). Using a clinic interpreter did not mitigate these effects and in fact exacerbated disparities in patients’ perceptions of their providers. Conclusion: Language barriers are associated with less health education, worse interpersonal care, and lower patient satisfaction. Having access to a clinic interpreter can facilitate the transmission of health education. However, in terms of patients’ ratings of their providers and the quality of interpersonal care, having an interpreter present does not serve as a substitute for language concordance between patient and provider.
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    Factors Associated with Herb and Dietary Supplement Use by Young Adults in the United States
    (BioMed Central, 2007) Gardiner, Paula; Kemper, Kathi J; Legedza, Anna; Phillips, Russell
    Background: Little is known about the association between use of herbs and dietary supplements (HDS) and lifestyle/behavior factors in young adults in the US. Methods: Analyzing the 2002 National Health Interview Survey (NHIS), we examined the patterns of HDS (excluding vitamins/minerals) use among young adults in the United States using descriptive statistics and logistic regression. Results: In our sample of 18 to 30 year olds (n = 6666), 26% were current smokers, 24% were moderate/heavy drinkers, 43% had high physical activity, and 54% and 76% use prescription and over the counter (OTC) medications respectively. Non-vitamin, non-mineral HDS was used by 17% of the overall sample in the last 12 months. In the multivariable analysis, the lifestyle and behavioral factors associated with HDS use include: current smoking (odds ratio 1.41 95% CI [1.16–1.72]); being a former smoker (1.50 [1.15–1.95]); moderate/heavy alcohol use (2.02 [1.53–2.65]); high physical activity levels (2.45 [1.98–3.03]); and prescription medication use (1.51 [1.26–1.81]). Among HDS users, only 24% discussed their use with a health care professional. Conclusion: Nearly one in five young adults report using non-vitamin/non-mineral HDS.