between .68 and .91. Emergency Medicine physicians as a group had the highest average degree centrality in 11 out of 28 communities among other specialties. Conclusions: Medicare patients with MCC are treated in a provider network composed of communities with diverse characteristics. Further research is required to understand the impact of network and community characteristics on healthrelated outcomes.
impact of risk of bias of included studies on summary estimates (26.7%) which led to limited summary evidence with serious limitation. Conclusions: As per AMSTAR 2 criteria, the overall methodological quality of representative sample of MAs on interventions for Bell's palsy is critically low and the findings of these MAs must be interpreted with caution.
Objectives: Patients with asthma exacerbations requiring inpatient care comprise a subgroup at high risk of adverse asthma-related outcomes. The quality of care in these individuals can thus have substantial impact on the burden of asthma. The purpose of this study was to provide a broad picture on the outcomes associated with different treatment strategies after discharge from an asthma-related admission. MethOds: Using administrative health data of British Columbia, Canada (1997-2012), we created a cohort of individuals discharged from an episode of asthma-related hospitalization. Exposure was assessed in the 60 days after discharge, and was categorized as no controller treatment, monotherapy with inhaled corticosteroids (ICS), or combination therapy with ICS plus long-acting beta agonists (LABA). Safety (re-admission), adherence (proportion of days covered [PDC] with controller medications, and health resource use (asthma-related costs) outcomes were ascertained in the next 365 days. Generalized propensity scores were calculated to achieve balance in the distribution of potential confounders across exposure groups. Results: The final cohort included 1,864; 848; and 954 post-discharge periods, respectively, for no treatment, ICS-only, and ICS+LABA groups. Asthma-related admissions were significantly lower in the ICS-only groups compared with no treatment group (RR= 0.69 [95%CI 0.55-0.87], P= 0.001), but were similar between the ICS+LABA and ICS-only groups (RR= 0.96 [95% CI 0.73-1.27], P= 0.787). The PDC by a controller medication was significantly higher in the ICS group compared with no treatment (difference of 8.7% [95% CI 6.8%-10.5%], P< 0.001), as well as PDC by ICS+LABA compared with PDC by ICS (difference of 7.2% [95%CI 4.7%-9.6%], P< 0.001). There were no differences in costs across the three groups. cOnclusiOns: Initiation of controller medications in the post-discharge period was associated with significant benefits. The higher adherence to controller medication between the ICS+LABA compared with ICS-only group can translate to better outcomes in the long term.
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