To test this hypothesis, we generated an experimental system where FFAs were exogenously supplied, and the effect of suboptimal concentrations of norepinephrine (NE) on energy expenditure was tested.
Patients with the most complex health profiles consume a disproportionate percentage of health care expenditures, yet often receive fragmented, suboptimal care.
To determine suboptimal concentrations of NE, we titrated NE concentrations by measuring energy expenditure as total oxygen consumption rates (OCR).
Based on this titration we chose 1 μM NE as a suboptimal concentration given that it elicited < 50% of the energy expenditure induced by 10 μM NE.
The initial finding of our study was that hormonal stimulation of brown adipocytes with suboptimal concentrations of NE allowed exogenous FFA to further stimulate energy expenditure and mitochondrial uncoupling.
Despite the enormous expenditure consumed by the current healthcare systems, clinical outcomes remain suboptimal, particularly in the USA, where 96 people per 100,000 die annually from conditions considered treatable [ 26].
Such suboptimal therapy places patients at risk for complications and further management expenditures.
For example, Medicare spending for postacute care has more than doubled over the past 10 years, with expenditures increasing from $26.6 billion to $63.6 billion, yet patient outcomes are suboptimal, resulting in Medicare's growing scrutiny of rehabilitation quality in postacute care (Medicare Payment Advisory Commission, 2010, 2012).
12, 13 Poor adherence to AHT causes suboptimal blood pressure control and, ultimately, preventable CV morbidity, hospitalizations, mortality, and health care expenditure, 10, 14– 16 all consequences that have been documented, but still remain overlooked.
Restriction of availability of OADs due to economic constraints may not be the best way of controlling health care expenditures, since treatment non-adherence may induce unexpected additional costs related to complications and suboptimal treatment effectiveness.
Geographic variations in practices and expenditures have been widely documented, leading to concerns that care in some regions is clinically suboptimal and/or economically inefficient.
