t to need mitigates incentives for population skimming and promotes the sustainability of mission-oriented organizations.
  To assess adherence to specialty medications for rheumatoid arthritis (RA) at an integrated health system specialty pharmacy (HSSP) and identify characteristics associated with adherence.
 
  Single-center, retrospective cohort study.
 
  Study patients were adults with RA who filled at least 3 prescriptions for biologic disease-modifying antirheumatic drugs (bDMARDs) between July 1, 2016, and June 30, 2017, at an integrated HSSP. Data were collected from pharmacy claims and electronic health records. The primary outcome, adherence, was measured using proportion of days covered (PDC). Proportional odds logistic regression was used to test association between PDC and age, gender, race, insurance type, and out-of-pocket costs.
 
  We included 675 patients 77% were female, 90% were White, 29% were naive to treatment at initial dispensing, 60% held commercial insurance, and the median age was 56 years. Median (interquartile range [IQR]) patient out-of-pocket cost per fill was $1.50 ($0-$5). Median (IQR) PDC was 0.95 (0.84-1.00); 80% of patients achieved PDC of 0.80 or higher. Higher adherence was more likely in patients who were male (odds ratio [OR], 1.58; 95% CI, 1.15-2.18; P = .005], naive to specialty medication treatment (OR, 3.04; 95% CI, 2.21-4.18; P < .001), and older in age (per 10 years OR, 1.17; 95% CI, 1.04-1.32; P = .008), and adherence had a significant nonlinear association with average cost per fill (P = .006); associations with race and insurance type were not significant.
 
  At an integrated HSSP, patients with RA paid low out-of-pocket costs for bDMARD therapy and achieved high treatment adherence. Data suggest that integrated HSSPs assist patients in removing financial barriers to treatment.
 At an integrated HSSP, patients with RA paid low out-of-pocket costs for bDMARD therapy and achieved high treatment adherence. Data suggest that integrated HSSPs assist patients in removing financial barriers to treatment.Violence against health care workers is an ever-present threat that has been increasing over the past several years. The majority of physicians and nurses report that they have been victims of workplace violence at least once throughout their careers. Such violent attacks negatively affect the delivery, quality, and accessibility of health care. Certain factors such as substance abuse and intense emotions increase an individual's risk of committing an act of workplace violence against a health care worker.  https://www.selleckchem.com/ALK.html  Encountering violent individuals has legal implications and can compromise the moral framework of physicians. With action from institution administrations, advocates, leaders, and government, this issue that detrimentally affects health care can be combatted and reduced. By implementing required staff training, increasing security, strengthening the doctor-patient relationship, using medical chaperones, and reforming policy, positive changes can be made to protect health care workers and the health care system.The economic burden of osteoporotic fractures may be much higher than estimated just the tip of the iceberg. In this letter, we suggest that the cost of these fractures might be underestimated by considering only direct medical cost.
  Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) to choose either retrospectively or prospectively attributed ACO populations. To understand how ACOs' choice of attribution method affects incentives for care among seriously ill Medicare beneficiaries, this study compares beneficiary characteristics and Medicare per capita expenditures between prospective and retrospective ACO populations.
 
  This retrospective, cross-sectional analysis describes survival, patient characteristics, and Medicare spending for Medicare fee-for-service beneficiaries identified with serious illness (n = 1,600,629) using 100% Medicare Master Beneficiary Summary and MSSP beneficiary files (2014-2016).
 
  We used generalized linear models with ACO and year fixed effects to estimate the average within-ACO difference between potential retrospective and prospective ACO populations.
 
  Dying in the first 90 days of the performance year was associated with reduced odds of retrospective attribution method.
  To compare relative readmission rates for beneficiaries enrolled in Medicare Advantage (MA) and traditional Medicare (TM) as suggestive evidence of changes in postdischarge care coordination and the quality of care delivered to Medicare beneficiaries.
 
  We used the Agency for Healthcare Research and Quality's 2009 and 2014 Healthcare Cost and Utilization Project State Inpatient Databases for 4 states with reliable sources of payment identifiers, linking these data to local area characteristics. Our outcome was the probability of a hospital readmission within 30 days of an index admission. We computed readmission rates overall and by subgroups, including for patients with multiple chronic conditions, by patients' state of residence, and by type of index admission.
 
  We estimated linear probability models with hospital fixed effects including a wide array of patient-level characteristics relating to health status and sociodemographic characteristics. Standard errors were adjusted for clustering at the area level.
 
  Significantly lower all-cause readmission rates were found among MA enrollees relative to those in TM in both 2009 and 2014, suggesting an association between MA enrollment and higher quality of care. However, over the 2009-2014 period, MA enrollment was not associated with an increased reduction in readmission rates relative to TM.
 
  Although our focus was on a single measure of performance, the claims that managed care plans are spearheading changes in the delivery system are not supported by our finding that relative readmission rates were stable over the 2009-2014 period.
 Although our focus was on a single measure of performance, the claims that managed care plans are spearheading changes in the delivery system are not supported by our finding that relative readmission rates were stable over the 2009-2014 period.