Alexis Skoufalos

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways.

The American Opioid Epidemic: Population Health Implications and Potential Solutions. Report from the National Stakeholder Panel

The American Opioid Epidemic: Population Health Implications and Potential Solutions. Report from the National Stakeholder Panel Janice L. Clarke, RN, Alexis Skoufalos, EdD, and Richard Scranton, MD, MPH Editorial: David B. Nash, MD, MBA   S-1 Introduction   S-1 The Evolution of Opioid Use in the United States   S-2 Unintended Consequences of Postsurgical Pain Management   S-2 Pivotal Role of Postsurgical Prescribing Practices   S-3 • Population health and societal implications   S-4 The Case for Multimodal Pain Management for Surgical Patients   S-4 Optimizing Health Outcomes   S-4 • Emerging profile of opioids: pros and cons   S-5 • Planning for perioperative pain   S-5 • Minimizing risk of postsurgical overuse and misuse of opioids   S-5 Optimizing Economic Outcomes by Managing Pain Differently   S-6 Expert Panel Insights   S-7 Conclusion   S-7

Treating pain in addicted patients: recommendations from an expert panel.

Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches.

A Targeted Approach to Reducing Overutilization: Use of Percutaneous Coronary Intervention in Stable Coronary Artery Disease

Overutilization, defined as use of unnecessary care when alternatives may produce similar outcomes, results in higher cost without increased value. Overutilization can be understood by focusing on settings where overuse is obvious. One example is percutaneous coronary intervention (PCI) in chronic stable angina. PCI is a potentially lifesaving procedure in an acute setting, but current practice guidelines indicate low-risk patients with chronic stable angina should be treated initially with optimal medical therapy (OMT) and lifestyle modification. A decision to move from this approach to PCI should be based on severity of symptoms and degree of risk. Over the last 30 years, advances in equipment, adjunctive medical treatments, and safety have made PCI more common. Recent evidence questions the benefit of PCI in stable coronary artery disease demonstrating no reduction in overall mortality or major cardiac events compared to OMT. Despite these findings, some continue to favor aggressive PCI interventions over conservative management in low-risk situations. Patients who undergo PCI without understanding the evidence may be inappropriately reassured that PCI will reduce the need for OMT and the risk of heart attack and death. Research shows shared decision-making can result in more conservative care, particularly when patients are assessed for health literacy and counseled on clinical evidence. Overutilization of PCI can be addressed by promoting active participation in an evidence-based decision-making process, allowing the opportunity to understand the expected value of invasive procedures over OMT alone through processes that encourage physicians to incorporate shared decision making prior to PCI in non-acute situations.

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting Janice L. Clarke, RN, Alexis Skoufalos, EdD, Alice Medalia, PhD, and A. Mark Fendrick, MD Editorial: A Call to Action : David B. Nash, MD, MBA   S-2 OVERVIEW: Depression and the Population Health Imperative    S-3 Promoting Awareness of the Issues and Opportunities for Improvement    S-5 Cognitive Dysfunction in Affective Disorders    S-5 Critical Role of Employers in Improving Health Outcomes for Employees with Depression    S-6 Closing the Behavioral Health Professional and Process Gaps    S-6 Achieving the Triple Aim for Patients with Depressive Disorders    S-6 Improving the Experience of Care for Patients with Depression    S-6 Improving Quality of Care and Health Outcomes for Patients with Depression    S-7 Changing the Cost of Care Discussion from How Much to How Well    S-8 Panel Insights and Recommendations    S-9 Conclusion    S-10.

The Journey to Creating Safety Net Accountable Care in New Jersey

New Jerseys 3-year Medicaid Accountable Care Organization (ACO) Demonstration Project was the result of a bipartisan effort to address the quality and cost issues regarding the States safety net population. The legislation sets forth a framework that allows communities to customize ACOs to meet the unique needs of their population. Camden, Trenton, and Newark are currently experimenting with implementation at various levels. This article documents the context, journey, challenges, and future direction of the legislation through the accounts of 7 stakeholders whose roles were integral in the process of its creation, marketing, and eventual implementation. Their individual perspectives serve not only as an historical record of events but also as a guide for states seeking reference for implementing their own ACO framework.