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Buchanan JL, Rauckhorst AJ, Taylor EB. 3-hydroxykynurenine is a ROS-inducing cytotoxic tryptophan metabolite that disrupts the TCA cycle. bioRxiv 2023:2023.07.10.548411. [PMID: 37502990 PMCID: PMC10369892 DOI: 10.1101/2023.07.10.548411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Tryptophan is an essential amino acid that is extensively characterized as a regulator of cellular function through its metabolism by indoleamine 2,3-deoxygenase (IDO) into the kynurenine pathway. However, despite decades of research on tryptophan metabolism, the metabolic regulatory roles of it and its metabolites are not well understood. To address this, we performed an activity metabolomics screen of tryptophan and most of its known metabolites in cell culture. We discovered that treatment of human colon cancer cells (HCT116) with 3-hydroxykynurenine (3-HK), a metabolite of kynurenine, potently disrupted TCA cycle function. Citrate and aconitate levels were increased, while isocitrate and all downstream TCA metabolites were decreased, suggesting decreased aconitase function. We hypothesized that 3HK or one of its metabolites increased reactive oxygen species (ROS) and inhibited aconitase activity. Accordingly, we observed almost complete depletion of reduced glutathione and a decrease in total glutathione levels. We observed a dose-dependent decrease in cell viability after 48 hours of 3HK treatment. These data suggest that raising the intracellular levels of 3HK could be sufficient to induce ROS-mediated apoptosis. We modulated the intracellular levels of 3HK by combined induction of IDO and knockdown of kynureninase (KYNU) in HCT116 cells. Cell viability decreased significantly after 48 hours of KYNU knockdown compared to controls, which was accompanied by increased ROS production and Annexin V staining revealing apoptosis. Finally, we identify xanthommatin production from 3-HK as a candidate radical-producing, cytotoxic mechanism. Our work indicates that KYNU may be a target for disrupting tryptophan metabolism. Interestingly, many cancers exhibit overexpression of IDO, providing a cancer-specific metabolic vulnerability that could be exploited by KYNU inhibition.
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Affiliation(s)
- Jane L. Buchanan
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Adam J. Rauckhorst
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- FOEDRC Metabolomics Core Research Facility, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Eric B. Taylor
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- FOEDRC Metabolomics Core Research Facility, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
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Brashears CB, Prudner BC, Rathore R, Caldwell KE, Dehner CA, Buchanan JL, Lange SE, Poulin N, Sehn JK, Roszik J, Spitzer D, Jones KB, O'Keefe R, Nielsen TO, Taylor EB, Held JM, Hawkins W, Van Tine BA. Malic Enzyme 1 Absence in Synovial Sarcoma Shifts Antioxidant System Dependence and Increases Sensitivity to Ferroptosis Induction with ACXT-3102. Clin Cancer Res 2022; 28:3573-3589. [PMID: 35421237 PMCID: PMC9378556 DOI: 10.1158/1078-0432.ccr-22-0470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the metabolism of synovial sarcoma (SS) and elucidate the effect of malic enzyme 1 absence on SS redox homeostasis. EXPERIMENTAL DESIGN ME1 expression was measured in SS clinical samples, SS cell lines, and tumors from an SS mouse model. The effect of ME1 absence on glucose metabolism was evaluated utilizing Seahorse assays, metabolomics, and C13 tracings. The impact of ME1 absence on SS redox homeostasis was evaluated by metabolomics, cell death assays with inhibitors of antioxidant systems, and measurements of intracellular reactive oxygen species (ROS). The susceptibility of ME1-null SS to ferroptosis induction was interrogated in vitro and in vivo. RESULTS ME1 absence in SS was confirmed in clinical samples, SS cell lines, and an SS tumor model. Investigation of SS glucose metabolism revealed that ME1-null cells exhibit higher rates of glycolysis and higher flux of glucose into the pentose phosphate pathway (PPP), which is necessary to produce NADPH. Evaluation of cellular redox homeostasis demonstrated that ME1 absence shifts dependence from the glutathione system to the thioredoxin system. Concomitantly, ME1 absence drives the accumulation of ROS and labile iron. ROS and iron accumulation enhances the susceptibility of ME1-null cells to ferroptosis induction with inhibitors of xCT (erastin and ACXT-3102). In vivo xenograft models of ME1-null SS demonstrate significantly increased tumor response to ACXT-3102 compared with ME1-expressing controls. CONCLUSIONS These findings demonstrate the translational potential of targeting redox homeostasis in ME1-null cancers and establish the preclinical rationale for a phase I trial of ACXT-3102 in SS patients. See related commentary by Subbiah and Gan, p. 3408.
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Affiliation(s)
- Caitlyn B. Brashears
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Bethany C. Prudner
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Richa Rathore
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Katharine E. Caldwell
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Carina A. Dehner
- Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University in St. Louis, St. Louis, Missouri
| | - Jane L. Buchanan
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Sara E.S. Lange
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Neal Poulin
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer K. Sehn
- Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University in St. Louis, St. Louis, Missouri
| | - Jason Roszik
- Departments of Melanoma Medical Oncology and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dirk Spitzer
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Kevin B. Jones
- Department of Orthopedics, University of Utah, Salt Lake City, Utah.,Department of Oncological Sciences, University of Utah, Salt Lake City, Utah.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Regis O'Keefe
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Orthopedics, Washington University in St. Louis, St. Louis, Missouri
| | - Torsten O. Nielsen
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric B. Taylor
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.,Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa
| | - Jason M. Held
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri
| | - William Hawkins
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri
| | - Brian A. Van Tine
- Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri.,Siteman Cancer Center, Washington University in St. Louis, St. Louis, Missouri.,Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.,Corresponding Author: Brian A. Van Tine, Division of Medical Oncology, Washington University in St. Louis, 660 South Euclid, Campus Box 8007, St. Louis, MO 63110. Phone: 314-747-3096: E-mail:
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3
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Tompkins SC, Sheldon RD, Rauckhorst AJ, Noterman MF, Solst SR, Buchanan JL, Mapuskar KA, Pewa AD, Gray LR, Oonthonpan L, Sharma A, Scerbo DA, Dupuy AJ, Spitz DR, Taylor EB. Disrupting Mitochondrial Pyruvate Uptake Directs Glutamine into the TCA Cycle away from Glutathione Synthesis and Impairs Hepatocellular Tumorigenesis. Cell Rep 2020; 28:2608-2619.e6. [PMID: 31484072 PMCID: PMC6746334 DOI: 10.1016/j.celrep.2019.07.098] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/14/2019] [Accepted: 07/26/2019] [Indexed: 12/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a devastating cancer increasingly caused by non-alcoholic fatty liver disease (NAFLD). Disrupting the liver Mitochondrial Pyruvate Carrier (MPC) in mice attenuates NAFLD. Thus, we considered whether liver MPC disruption also prevents HCC. Here, we use the N-nitrosodiethylamine plus carbon tetrachloride model of HCC development to test how liver-specific MPC knock out affects hepatocellular tumorigenesis. Our data show that liver MPC ablation markedly decreases tumorigenesis and that MPC-deficient tumors transcriptomically downregulate glutathione metabolism. We observe that MPC disruption and glutathione depletion in cultured hepatomas are synthetically lethal. Stable isotope tracing shows that hepatocyte MPC disruption reroutes glutamine from glutathione synthesis into the tricarboxylic acid (TCA) cycle. These results support a model where inducing metabolic competition for glutamine by MPC disruption impairs hepatocellular tumorigenesis by limiting glutathione synthesis. These findings raise the possibility that combining MPC disruption and glutathione stress may be therapeutically useful in HCC and additional cancers. Tompkins et al. utilize stable glutamine isotope tracers in vivo and ex vivo to demonstrate hepatocyte MPC disruption increases TCA cycle glutamine utilization at the expense of glutathione synthesis and decreases hepatocellular tumorigenesis.
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Affiliation(s)
- Sean C Tompkins
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Ryan D Sheldon
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Adam J Rauckhorst
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Maria F Noterman
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Shane R Solst
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Jane L Buchanan
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Kranti A Mapuskar
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Alvin D Pewa
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA; FOEDRC Metabolomics Core Research Facility, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Lawrence R Gray
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Lalita Oonthonpan
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Arpit Sharma
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Diego A Scerbo
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Adam J Dupuy
- Department of Anatomy and Cell Biology, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA; Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Douglas R Spitz
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA; Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
| | - Eric B Taylor
- Department of Biochemistry, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA; Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA; Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA; Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA; Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA; FOEDRC Metabolomics Core Research Facility, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA.
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4
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Buchanan JL, Taylor EB. Mitochondrial Pyruvate Carrier Function in Health and Disease across the Lifespan. Biomolecules 2020; 10:biom10081162. [PMID: 32784379 PMCID: PMC7464753 DOI: 10.3390/biom10081162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/25/2022] Open
Abstract
As a nodal mediator of pyruvate metabolism, the mitochondrial pyruvate carrier (MPC) plays a pivotal role in many physiological and pathological processes across the human lifespan, from embryonic development to aging-associated neurodegeneration. Emerging research highlights the importance of the MPC in diverse conditions, such as immune cell activation, cancer cell stemness, and dopamine production in Parkinson’s disease models. Whether MPC function ameliorates or contributes to disease is highly specific to tissue and cell type. Cell- and tissue-specific differences in MPC content and activity suggest that MPC function is tightly regulated as a mechanism of metabolic, cellular, and organismal control. Accordingly, recent studies on cancer and diabetes have identified protein–protein interactions, post-translational processes, and transcriptional factors that modulate MPC function. This growing body of literature demonstrates that the MPC and other mitochondrial carriers comprise a versatile and dynamic network undergirding the metabolism of health and disease.
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Affiliation(s)
- Jane L. Buchanan
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA;
| | - Eric B. Taylor
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA;
- Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Fraternal Order of Eagles Diabetes Research Center (FOEDRC), University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, IA 52240, USA
- Correspondence:
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Abstract
Physician organizations in California broke new ground in the 1980s by accepting capitated contracts and taking on utilization management functions. In this paper we present new data that document the scale, structure, and vertical affiliations of physician organizations that accept capitation in California. We provide information on capitated enrollment, the share of revenue derived by physician organizations from capitation contracts, and the scope of risk sharing with health maintenance organizations (HMOs). Capitation contracts and risk sharing dominate payment arrangements with HMOs. Physician organizations appear to have responded to capitation by affiliating with hospitals and management companies, adopting hybrid organizational structures, and consolidating into larger entities.
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Affiliation(s)
- M B Rosenthal
- Department of Health Policy and Management, Harvard School of Public Health, USA
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6
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Goldman DP, Buchanan JL, Keeler EB. Simulating the impact of medical savings accounts on small business. Health Serv Res 2000; 35:53-75. [PMID: 10778824 PMCID: PMC1089115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To simulate whether allowing small businesses to offer employer-funded medical savings accounts (MSAs) would change the amount or type of insurance coverage. STUDY SETTING Economic policy evaluation using a national probability sample of nonelderly non-institutionalized Americans from the 1993 Current Population Survey (CPS). STUDY DESIGN We used a behavioral simulation model to predict the effect of MSAs on the insurance choices of employees of small businesses (and their families). The model predicts spending by each family in a FFS plan, an HMO plan, an MSA, and no insurance. These predictions allow us to compute community-rated premiums for each plan, but with firm-specific load fees. Within each firm, employees then evaluate each option, and the firm decides whether to offer insurance-and what type-based on these evaluations. If firms offer insurance, we consider two scenarios: (1) all workers elect coverage; and (2) workers can decline the coverage in return for a wage increase. PRINCIPAL FINDINGS In the long run, under simulated conditions, tax-advantaged MSAs could attract 56 percent of all employees offered a plan by small businesses. However, the fraction of small-business employees offered insurance increases only from 41 percent to 43 percent when MSAs become an option. Many employees now signing up for a FFS plan would switch to MSAs if they were universally available. CONCLUSIONS Our simulations suggest that MSAs will provide a limited impetus to businesses that do not currently cover insurance. However, MSAs could be desirable to workers in firms that already offer HMOs or standard FFS plans. As a result, expanding MSA availability could make it a major form of insurance for covered workers in small businesses. Overall welfare would increase slightly.
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Marquis MS, Buchanan JL. Simulating the effects of employer contributions on adverse selection and health plan choice. Health Serv Res 1999; 34:813-37. [PMID: 10536972 PMCID: PMC1089043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE To investigate the effect of employer contribution policy and adverse selection on employees' health plan choices. STUDY DESIGN Microsimulation methods to predict employees' choices between two health plan options and to track changes in those choices over time. The simulation predicts choice given premiums, healthcare spending by enrollees in each plan, and premiums for the next period. DATA SOURCES The simulation model is based on behavioral relationships originally estimated from the RAND Health Insurance Experiment (HIE). The model has been updated and recalibrated. The data processed in the simulation are from the 1993 Current Population Employee Benefits Supplement sample. PRINCIPAL FINDINGS A higher fraction of employees choose a high-cost, high-benefit plan if employers contribute a proportional share of the premium or adjust their contribution for risk selection than if employees pay the full cost difference out-of-pocket. When employees pay the full cost difference, the extent of adverse selection can be substantial, which leads to a collapse in the market for the high-cost plan. CONCLUSIONS Adverse selection can undermine the managed competition strategy, indicating the importance of good risk adjusters. A fixed employer contribution policy can encourage selection of more efficient plans. Ironically, however, it can also further adverse selection in the absence of risk adjusters.
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Buchanan JL, Bohacek RS, Luke GP, Hatada M, Lu X, Dalgarno DC, Narula SS, Yuan R, Holt DA. Structure-based design and synthesis of a novel class of Src SH2 inhibitors. Bioorg Med Chem Lett 1999; 9:2353-8. [PMID: 10476868 DOI: 10.1016/s0960-894x(99)00388-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The structure-based design and synthesis of a novel class of 2,4-disubstituted thiazoles as Src SH2 inhibitors is described. Initial results are presented, including the X-ray and NMR analysis of one thiazole inhibitor bound to Lck and Src SH2.
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Affiliation(s)
- J L Buchanan
- ARIAD Pharmaceuticals, Inc., Cambridge, Massachusetts 02139-4234, USA
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9
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Buchanan JL, Vu CB, Merry TJ, Corpuz EG, Pradeepan SG, Mani UN, Yang M, Plake HR, Varkhedkar VM, Lynch BA, MacNeil IA, Loiacono KA, Tiong CL, Holt DA. Structure-activity relationships of a novel class of Src SH2 inhibitors. Bioorg Med Chem Lett 1999; 9:2359-64. [PMID: 10476869 DOI: 10.1016/s0960-894x(99)00389-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The structure-activity relationships (SAR) of a novel class of Src SH2 inhibitors are described. Variation at the pY+1 and pY+3 side chain positions using 2,4- and 2,5-substituted thiazoles and 1,2,4-oxadiazoles as scaffolds resulted in inhibitors that bound as well as the standard tetrapeptide Ac-pYEEI-NH2.
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Affiliation(s)
- J L Buchanan
- ARIAD Pharmaceuticals, Inc., Cambridge, Massachusetts 02139-4234, USA.
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10
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Buchanan JL, Marquis MS. Who gains and who loses with community rating for small business? Inquiry 1999; 36:30-43. [PMID: 10335309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
This paper compares community rating with experience rating for small businesses using a microsimulation model to determine what firms offer and who within these firms purchases insurance. We generate four years of data and find that our results are remarkably stable through time. Both offer and purchase rates are about five percentage points higher under experience rating, but community rating leads to more stable offerings. Under community rating, high-risk firms and families purchase insurance, whereas under experience rating, it is the low-risk firms and families who are the purchasers. Young families and poor families have the lowest purchase rates, with these rates being disproportionately low under community rating.
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Affiliation(s)
- J L Buchanan
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
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Himmelstein J, Buchanan JL, Dembe AE, Stevens B. Health services research in workers' compensation medical care: policy issues and research opportunities. Health Serv Res 1999; 34:427-37. [PMID: 10199686 PMCID: PMC1089012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To describe some of the unique aspects of medical care offered under workers' compensation insurance systems and discuss the major policy considerations relevant to health services researchers undertaking investigations in this area. BACKGROUND AND FINDINGS State-based workers' compensation (WC) insurance systems requiring employers to pay for medical care and wage replacement for workplace injuries and illnesses were first developed between 1910 and 1920 in the United States. Employers are generally required to purchase state-regulated workers' compensation insurance that includes first-dollar payment for all medical and rehabilitative services and payment of lost wages to workers with work-related illness or injury. Injured workers have variable but usually limited latitude in choosing their health care provider. Employers and workers' compensation insurers have incentives for controlling both the cost of medical care and lost wages. CONCLUSION The major policy issues in WC medical care--the effect of patient choice of provider and delivery system structure, the ensuring of high-quality care, the effect of integrating benefits, and investigation of the interrelationships between work, health, and productivity--can be informed by current studies in health services research and by targeted future studies of workers' compensation populations. These studies must consider the extent of patient choice of physician, the regulatory environment, the unique role of the workplace as a risk and modifying factor, and the complex interaction between health and disability insurance benefits.
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Affiliation(s)
- J Himmelstein
- Center for Health Policy and Health Services Research, University of Massachusetts Medical School/Dept. of Family Medicine and Community Health, Worcester 01655, USA
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Reuben DB, Schnelle JF, Buchanan JL, Kington RS, Zellman GL, Farley DO, Hirsch SH, Ouslander JG. Primary care of long-stay nursing home residents: approaches of three health maintenance organizations. J Am Geriatr Soc 1999; 47:131-8. [PMID: 9988282 DOI: 10.1111/j.1532-5415.1999.tb04569.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the innovative programs of three health maintenance organizations (HMOs) for providing primary care for long-stay nursing home (NH) residents and to compare this care with that of fee-for-service (FFS) residents at the same NHs. DESIGN Cross-sectional interviews and case-studies, including retrospective chart reviews for 1 year. SETTING The programs were based in 20 community-based nursing homes in three regions (East, West, Far West). PARTICIPANTS Administrative and professional staff of HMOs in three regions and 20 NHs; 215 HMO and 187 FFS residents at these homes were studied. MAIN OUTCOME MEASURES Emergency department (ED) and hospital utilization. RESULTS All HMO programs utilized nurse practitioner/physician's assistants (NP/PA), but the structural configuration of physicians' (MD) practices differed substantially. At nursing homes within each region, all three HMO programs provided more total (MD plus NP/PA) visits per month than did FFS care (2.0 vs 1.1, 1.3 vs .6, and 1.4 vs .8 visits per month; all P < .05). The HMO that provided the most total visits had a significantly lower percentage of residents transferred to EDs (6% vs 16%, P = .048), fewer ED visits per resident (0.1 vs .4 per year, P = .027), and fewer hospitalizations per resident (0.1 vs .5 per year, P = .038) than FFS residents; these differences remained significant in multivariate analyses. However, the other two programs did not achieve the same benefits on healthcare utilization. CONCLUSIONS HMO programs for NH residents provide more primary care and have the potential to reduce ED and hospital use compared with FFS care. However, not all programs have been associated with decreased ED and hospital utilization, perhaps because of differences in structure or implementation problems.
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Affiliation(s)
- D B Reuben
- UCLA Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, California 90095-1687, USA
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Levin JR, Wenger NS, Ouslander JG, Zellman G, Schnelle JF, Buchanan JL, Hirsch SH, Reuben DB. Life-sustaining treatment decisions for nursing home residents: who discusses, who decides and what is decided? J Am Geriatr Soc 1999; 47:82-7. [PMID: 9920234 DOI: 10.1111/j.1532-5415.1999.tb01905.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether nursing home residents and their families reported discussions about life-sustaining treatment with their physicians, the relationship between such discussions and orders to limit therapy, and predictors of physician-patient communication about life-sustaining treatment. DESIGN Cross-sectional interviews and retrospective chart abstraction. SETTING Three regions: West Coast, New England, Western. SAMPLE A total of 413 nursing home residents, 363 family/surrogate interviews, and 192 resident interviews. MAIN OUTCOME MEASURES Measured were (1) physician-resident communication about life-sustaining treatment and (2) presence of an advance directive or do not resuscitate (DNR) order in resident's chart. RESULTS Seventy-four percent of residents had DNR orders, and 32% had advance directives; only 29% of residents reported discussions about life-sustaining treatment. Of residents with DNR orders who could have participated in discussions about life-sustaining treatment, nearly half reported they had not discussed CPR with their caregivers. Older age, longer duration of time living in nursing home, location in a New England nursing home, physician-family member discussion, and the presence of an advance directive in the medical chart were positively associated with having DNR orders. Physician-resident discussion was not associated with having a DNR order. For the subsample of interviewed residents, age and a diagnosis of cognitive impairment were negatively associated with a physician-resident discussion about life-sustaining treatment, whereas the likelihood of having a discussion increased with increasing numbers of medical diagnoses. CONCLUSIONS Chart orders to limit therapy are common, but physician-resident discussions about life-sustaining treatments are not. Far more family members than residents report such discussions with the resident's physicians.
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Affiliation(s)
- J R Levin
- Multicampus Program in Geriatric Medicine and Gerontology, UCLA School of Medicine, Los Angeles, California 90095-1687, USA
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Goldman DP, Leibowitz A, Buchanan JL, Keesey J. Redistributional consequences of community rating. Health Serv Res 1997; 32:71-86. [PMID: 9108805 PMCID: PMC1070170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To predict the geographical effects of community rating of health insurance premiums on the amount individuals pay for insurance. DATA SOURCES We estimate premiums and health expenditures for a 5 percent sample of Californians from the 1990 U.S. Census (the Public Use Microdata Sample) and use data from Blue Cross of California to adjust for regional price differences in services. STUDY DESIGN We use an episodic health simulation model to estimate health expenditures for 975,074 Californians. Because the simulations do not reflect expenditure differences due to price variation in cost of services, we adjust these data for relative price differences by county. This leaves us with a sample of Californians for whom we have estimated health expenditures. We then compute average expenditures within areas of different sizes (all California, two regions, within counties) to estimate community-rated premiums. We then compare these premiums with actual expenditures on a county-by-county basis. PRINCIPAL FINDINGS With a single California-wide premium, rural residents pay premiums that exceed their use of care, while urban residents pay premiums that are less than their use of care. These transfers are substantial. Dividing California into regional risk pools at the county level still results in poorer communities providing substantial subsidies to their more wealthy counterparts. CONCLUSIONS Mandated community rating of premiums in a heterogeneous state such as California results in large unintended transfers of wealth from poorer, rural communities to urban, wealthier communities. Allowing premiums to vary with the regional cost of medical care would eliminate some of the transfers without sacrificing the benefits of community rating. Subsidies to low-income families could also effectively mitigate this redistribution. UTILITY: This article points out some potentially regressive consequences of geographic community rating and suggests ways to mitigate them.
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Keeler EB, Malkin JD, Goldman DP, Buchanan JL. Can medical savings accounts for the nonelderly reduce health care costs? JAMA 1996; 275:1666-71. [PMID: 8637141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To understand how medical savings account (MSA) legislation for the nonelderly would affect health care costs. DESIGN Economic policy evaluation based on the RAND Health Expenditures Simulation Model. SETTING National probability sample of nonelderly noninstitutionalized households. PARTICIPANTS Persons in 23 157 sampled households from the 1993 Current Population Survey. INTERVENTIONS Medical savings account legislation would allow all Americans who are covered only by a catastrophic health care plan to set up a tax-exempt account that they can use to pay medical bills not covered by their health insurance. The interventions we evaluate differ in the deductibles of the catastrophic plan and in whether the employee or employer funds the MSA. MAIN OUTCOME MEASURES Changes in national health expenditures and net societal benefits of health care. RESULTS If all insured nonelderly Americans switched to MSAs, their health care expenditures would decline by between 0% and 13%, depending on how the MSAs are designed. However, not all nonelderly Americans would choose MSAs; taking into account selection patterns, health spending would change by + 1% to -2%. CONCLUSIONS Medical savings account legislation would have little impact on health care costs of Americans with employer-provided insurance. However, depending on the size of the catastrophic limit, waste from the excessive use of generously insured care could be reduced, and MSAs would be attractive to both sick and healthy people.
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Affiliation(s)
- E B Keeler
- Health Sciences Program, RAND, Santa Monica, CA 90407-2138, USA.
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Abstract
OBJECTIVE This study compares Medicare program charges through time for outpatient rehabilitation services across different types of institutional providers. DESIGN Observational study of Medicare Part B claims. The analytic methods include a decomposition analysis and analysis of variance via regression. SETTING Data come from six different institutional providers types: community hospital outpatient departments, rehabilitation hospital outpatient departments, skilled nursing facilities, independent rehabilitation agencies, comprehensive outpatient rehabilitation facilities, and home health agencies. PATIENTS Five percent random sample of Medicare beneficiaries who used any institutionally based Part B physical, occupational, or speech therapy during the calendar years 1987 to 1990. MAIN OUTCOME MEASURE Charges for Medicare Part B rehabilitation therapies (physical and occupational therapy, speech pathology). RESULTS Charges for rehabilitation services grew more than 86% during this period across all provider types. Both the likelihood of using rehabilitation services and the average annual charges per patient grew rapidly. We found large differences in average annual per person charges and in the growth in charges across the six institutional provider types. Analyses that controlled for patient demographic characteristics and diagnoses across five provider types did not explain observed differences. Hospital outpatient departments were consistently the least costly type of institutional provider and independent rehabilitation agencies the most expensive. Diagnostic data were not available for home health agency claims, so these were omitted from the multivariate analysis of annual charges. CONCLUSIONS The large increases in charges cannot be explained by increases in the Medicare eligible population, aging, or inflation. The level and differential in growth is highest among new provider types and those dominated by proprietary ownership. These observations suggest that therapy services are profitable and that provider incentives may be an important component in overall growth.
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Affiliation(s)
- J L Buchanan
- Health Sciences Program, RAND Corporation, Santa Monica, CA, USA
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Abstract
A randomized trial to evaluate the Florida site of the Program for Prepaid Managed Care showed that the plan, a staff model health maintenance organization, was successful in attracting Medicaid enrollees. The evaluation established that the health maintenance organization was able to limit members' utilization. The savings were in the form of lower likelihood of using care. The amount of services received, once care was initiated, was the same in both fee-for service Medicaid and health maintenance organizations. The authors detected no differences in inpatient use or costs. Additionally, they found evidence that the plan attracted sicker than average enrollees, so this reduced utilization translates into Medicaid program savings.
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Mauldon J, Leibowitz A, Buchanan JL, Damberg C, McGuigan KA. Rationing or rationalizing children's medical care: comparison of a Medicaid HMO with fee-for-service care. Am J Public Health 1994; 84:899-904. [PMID: 8203683 PMCID: PMC1614958 DOI: 10.2105/ajph.84.6.899] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This paper examines how medical care obtained by children enrolled in a Medicaid health maintenance organization (HMO) differs from that obtained by similar children who receive care from fee-for-service Medicaid providers. METHODS In a randomized trial, some Medicaid households were assigned to remain in a traditional fee-for-service arrangement and others were randomly selected to join a Medicaid prepaid plan (an HMO). Participating households recorded data on children's health status and use of medical care. RESULTS The prepaid plan members and the fee-for-service recipients received equivalent numbers of checkup visits, but the children in the prepaid plan made significantly fewer acute care visits. This plan appeared to target its services to children with the greatest health care needs. However, the content of health visits in the two systems did not differ, nor did prepaid and fee-for-service enrollees use the emergency room differently. CONCLUSIONS It is possible to design a Medicaid HMO that achieves financial savings without reducing services to the most vulnerable patients. However, these findings alone do not provide a basis for widespread policy change in the direction of Medicaid HMOs. Further research is needed to establish whether the children treated in the HMO differed in health outcomes from those treated by fee-for-service care.
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Affiliation(s)
- J Mauldon
- Graduate School of Public Policy, University of California at Berkeley
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Marquis MS, Buchanan JL. How will changes in health insurance tax policy and employer health plan contributions affect access to health care and health care costs? JAMA 1994; 271:939-44. [PMID: 8120964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To understand how changes in federal taxation of and employer contributions to health insurance benefits affect the decisions of firms to offer insurance, the willingness of households to purchase different health plans, and the resultant health expenditures. DESIGN Economic policy simulation. SETTING Secondary data analysis. PARTICIPANTS A total of 18,343 sampled families (representing 77 million total families throughout the United States) with a working household head from the 1988 Current Population Survey who were not covered by either Medicare, Medicaid, or CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) insurance. INTERVENTIONS One intervention limits the amounts of tax-free employer contributions to health insurance premiums to 80% of our estimate of the base plan in the market and assumes that employer contributions will also be limited to this maximum. A second intervention eliminates the favorable tax treatment of employer-paid premiums altogether and assumes that employees will pay the full price of insurance. MAIN OUTCOME MEASURES Change in the number of working families offered employment-based insurance, change in insurance plan choice, and change in medical spending. RESULTS Capping the favorable tax treatment and employer contributions decreases the number of families offered employment-based insurance by approximately 91,000, increases the number of families selecting the least generous insurance plan from 20% under the current situation to 33%, and reduces overall health spending by less than 2%. By eliminating the tax exemption altogether, the number of families offered employment-based insurance decreases by approximately half a million families, the number of families selecting the least generous plan goes from 20% to 40%, and overall spending falls by about $16 billion. CONCLUSIONS Eliminating the tax subsidy and limiting employer-paid contributions to the low-cost plan substantially increases the number of low-income uninsured under a voluntary insurance system, decreases overall spending only modestly, but would raise tax revenues by $36 billion. These tax revenues could be used to assist low-income families to obtain insurance coverage.
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Abstract
The use of a cross-sectional sample of nursing home residents rather than a sample of admissions to estimate admission characteristics carries a potential bias. The purpose of this study was to fill this void by comparing abstracted records data for an admissions cohort (n = 1,118) and a residents cohort (n = 830) residing in the same nursing homes. Compared to residents, admissions were significantly more dependent in their ability to get around and to dress themselves, received more clinical services, and had a higher rate of medication use. Over a 12-month period, admissions had a fivefold greater likelihood of being discharged to community, but about the same mortality rate as residents. Within both groups, those discharged to the community as well as those who died had expenditures that were almost twice as high as those of their counterparts who remained alive in the nursing home.
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Affiliation(s)
- J Garrard
- Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis
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Davis LM, Buchanan JL, Wells KB. PPS and TEFRA effects on charges for treatment of depression. Adv Health Econ Health Serv Res 1993; 14:87-104. [PMID: 10164718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
- L M Davis
- RAND Corporation, Santa Monica, CA, USA
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Abstract
The value of health-care services used by AFDC Medicaid patients receiving care in a voluntary enrollment HMO is contrasted with that of health care services used by Medicaid patients receiving fee-for-service (FFS) care. The randomized assignment of Medicaid recipients to the HMO or to FFS allows the authors to conclude that the apparent lower use of HMO enrollees results from the HMO's selection of patients with lower needs for care rather than from technical efficiency. Patients had lower use while in the HMO, but disenrollees and those who refused enrollment had significantly higher use than FFS participants. In contrast to the effect of HMOs on non-Medicaid populations, the Medicaid HMO studied provided significantly fewer outpatient services, but the same level of inpatient services as the FFS sector. Overall, voluntary enrollment of Medicaid eligibles into the HMO resulted in higher state expenditures for Medicaid because of favorable selection.
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Abstract
We conducted a quasi-experiment to evaluate the impact of a Medicare waiver which allowed the use of nurse practitioners (NPs) and physicians assistants (PAs) to deliver primary care to Massachusetts nursing home patients and removed the limits on the reimbursable numbers of visits per month. A carefully matched set of 1,327 Medicaid patients from 95 non-participating homes in the same areas of Massachusetts was compared to 1,324 Medicaid demonstration patients from 75 homes. Information came from specially designed record reviews and the Medicaid and Medicare information systems. Separate analyses were done for newly admitted cases and rollovers. Comparisons of quality of care suggested that the medical groups using NPs and PAs provided as good or better care than did the physicians in the control group. There were no differences in functional status changes or in the use of medications. The demonstration patients received more attention, as reflected in more orders written and an average of one additional visit a month. Demonstration patients showed higher scores on three of seven specially designed quality tracers, congestive heart failure and hypertension for both new administrations and rollovers, and new urinary incontinence for new admissions. Rollovers had significantly fewer emergency and total hospital days. A cost analysis suggests that the use of NPs and PAs saves at least as much as it costs and may save additional money with more sustained use.
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Affiliation(s)
- R L Kane
- University of Minnesota School of Public Health, Minneapolis 55455
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Garrard J, Kane RL, Radosevich DM, Skay CL, Arnold S, Kepferle L, McDermott S, Buchanan JL. Impact of geriatric nurse practitioners on nursing-home residents' functional status, satisfaction, and discharge outcomes. Med Care 1990; 28:271-83. [PMID: 2314136 DOI: 10.1097/00005650-199003000-00007] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study evaluated the impact of geriatric nurse practitioners (GNP) employed by nursing homes on quality of patient care and residents' outcomes during a 12-month study period. Quality of care was assessed in standardized interviews of 525 residents in five nursing homes with GNPs and 323 residents in five other nursing homes without GNPs. Each resident was interviewed up to four times during the study period (at baseline, and 3, 6, and 12 months later) to determine functional status, satisfaction with care, and physical condition at each of these points. The only significant difference between groups was that fewer newly admitted residents were hospitalized from GNP homes than from those without a GNP. The results of this interview study showed that the GNP as a nursing home employee had little impact on residents' functional status, physical condition, or satisfaction.
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Affiliation(s)
- J Garrard
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis 55455
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Leibowitz A, Buchanan JL. Setting capitations for Medicaid: a case study. Health Care Financ Rev 1990; 11:79-85. [PMID: 10113405 PMCID: PMC4193124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article examines the methodology New York State used to set capitation rates for a Medicaid health maintenance organization. By examining the methods used and the assumptions made in a particular case, some general lessons are drawn about the ratesetting process. Greater reliance on statewide data to assure fair and statistically stable estimates is needed. Although the article focuses on one State and its ratesetting for one particular plan (Health Care Plus), the issues raised have general interest for other plans and for other States concerned with the setting of capitation rates for Medicaid enrollees in prepaid plans.
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Buchanan JL, Bell RM, Arnold SB, Witsberger C, Kane RL, Garrard J. Assessing cost effects of nursing-home-based geriatric nurse practitioners. Health Care Financ Rev 1990; 11:67-78. [PMID: 10113273 PMCID: PMC4193088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Employment of geriatric nurse practitioners (GNPs) is one strategy to improve nursing home care. The effects of GNPs on costs and profitability of nursing homes and on costs of patient medical service use outside the nursing home are examined. Employment of GNPs does not adversely affect nursing home costs or significantly affect profits. There is some evidence of cost savings in medical service use for newly admitted patients but no evidence of savings for continuing residents. GNPs reduce the use of hospital services for both groups, and the reduction is statistically significant for newly admitted patients.
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Kane RL, Garrard J, Skay CL, Radosevich DM, Buchanan JL, McDermott SM, Arnold SB, Kepferle L. Effects of a geriatric nurse practitioner on process and outcome of nursing home care. Am J Public Health 1989; 79:1271-7. [PMID: 2504064 PMCID: PMC1349703 DOI: 10.2105/ajph.79.9.1271] [Citation(s) in RCA: 102] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.
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Affiliation(s)
- R L Kane
- School of Public Health, University of Minnesota, Minneapolis 55455
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Mershon DH, Ballenger WL, Little AD, McMurtry PL, Buchanan JL. Effects of room reflectance and background noise on perceived auditory distance. Perception 1989; 18:403-16. [PMID: 2798023 DOI: 10.1068/p180403] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Perceptions of egocentric auditory distance were investigated within an environment for which the reverberation time could be systematically varied without changes in the size or shape of the room. Two levels of wide-band background noise, differing by 20 dB, were used as a masking stimulus. Target sounds were presented from distances between 0.75 and 6.0 m and verbal reports of distance were collected from 288 listeners in two separate experiments. Changes in physical distance produced variation in reported distance in each configuration. Reported distance was generally proportional to real distance, but considerably underestimated when room reflectance was low. When room reflectance was high (T60 approximately 1.7 s for the range of frequencies used), initial reports of distance were often overestimates; upon repeated presentation, judgments in the high reflectance room became more nearly veridical. The effect of increasing the background noise level was to decrease the perceived distance. These findings are in accord with expectations based upon the importance of reverberation cue(s) to distance and upon previous analyses from this laboratory.
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Affiliation(s)
- D H Mershon
- Department of Psychology, North Carolina State University, Raleigh 27695
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Abstract
This study analyzes the health plan selection history of approximately 30,000 employees of a large aerospace corporation. The data show that families selecting HMOs were younger, had lower income, and had less time on the job. HMOs attracted families with lower annual claimed expenditures, and these families' claimed expenses were lower still in the year immediately prior to switching into the HMO. Lower costs among families switching into the HMOs are partly explained by the composition of these families compared with families who stayed in the FFS plan. However, the selection pattern persisted even after adjusting for the size of the family, the age and sex of family members, and other family characteristics, such as race and income. Families switching out of HMOs had higher total annual claims during their first year back in the FFS sector compared with families about to switch into HMOs. However, recent HMO exiters did not always differ from families who never left the FFS plan.
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Buchanan JL, Primack MP, Tapley DF. Effect of inhibition of mitochondrial protein synthesis in vitro upon thyroxine stimulation of oxygen consumption. Endocrinology 1971; 89:534-7. [PMID: 5558001 DOI: 10.1210/endo-89-2-534] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Buchanan JL, Wilde RC, Yates AJ, Longabaugh EE. Operating for varicose veins. Postgrad Med 1969; 46:136-40. [PMID: 5802712 DOI: 10.1080/00325481.1969.11696445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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