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Health Services Research

Megan Skillman, Caitlin Cross-Barnet, Rachel Friedman Singer, Sarah Ruiz, Christina Rotondo, Roy Ahn, Lynne Page Snyder, Erin M Colligan, Katherine Giuriceo, Adil Moiduddin
OBJECTIVE: To identify roles physicians assumed as part of new health care delivery models and related strategies that facilitated physician engagement across 21 Health Care Innovation Award (HCIA) programs. DATA SOURCES: Site-level in-depth interviews, conducted from 2014 to 2015 (N = 672) with program staff, leadership, and partners (including 95 physicians) and direct observations. STUDY DESIGN: NORC conducted a mixed-method evaluation, including two rounds of qualitative data collected via site visits and telephone interviews...
December 2, 2016: Health Services Research
James Bailey
OBJECTIVE: To test how Certificate of Need laws affect all-cause mortality in the United States. DATA SOURCES: The data of 1992-2011 all-cause mortality are from the Center for Disease Control's Compressed Mortality File; control variables are from the Current Population Survey, Behavioral Risk Factor Surveillance System, and Area Health Resources File; and data on Certificate of Need laws are from Stratmann and Russ (). STUDY DESIGN: Using fixed- and random-effects regressions, I test how the scope of state Certificate of Need laws affects all-cause mortality within US counties...
December 1, 2016: Health Services Research
Pascal Geldsetzer, Günther Fink, Maria Vaikath, Till Bärnighausen
OBJECTIVE: (1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method. STUDY DESIGN: Literature review, mathematical derivation, and Monte Carlo simulations. PRINCIPAL FINDINGS: Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation...
November 24, 2016: Health Services Research
Abe Dunn, Scott D Grosse, Samuel H Zuvekas
OBJECTIVE: To provide guidance on selecting the most appropriate price index for adjusting health expenditures or costs for inflation. DATA SOURCES: Major price index series produced by federal statistical agencies. STUDY DESIGN: We compare the key characteristics of each index and develop suggestions on specific indexes to use in many common situations and general guidance in others. DATA COLLECTION/EXTRACTION METHODS: Price series and methodological documentation were downloaded from federal websites and supplemented with literature scans...
November 21, 2016: Health Services Research
Alison A Galbraith, Vicki Fung, Lingling Li, Melissa G Butler, James D Nordin, John Hsu, David Smith, William M Vollmer, Tracy A Lieu, Stephen B Soumerai, Ann Chen Wu
OBJECTIVE: To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants. SETTING: Four health maintenance organizations (HMOs), two that increased copayments for albuterol inhalers that went from generic CFC-containing to branded CFC-free versions, and two that retained generic copayments for CFC-free inhalers (controls)...
November 20, 2016: Health Services Research
Jamie Fishman, Sara McLafferty, William Galanter
OBJECTIVE: To examine the contributions of individual- and neighborhood-level spatial access to care to the utilization of emergency departments (EDs) for preventable conditions through implementation of novel local spatial access measures. DATA SOURCES/STUDY SETTING: Emergency department admissions data are from four HealthLNK member hospitals in Chicago from 2007 to 2011. Primary care physician office and clinic locations were obtained from the American Medical Association and the City of Chicago...
November 17, 2016: Health Services Research
Tianyan Hu, Karoline Mortensen
OBJECTIVE: To investigate the impact of implementation of the Statewide Medicaid Managed Care (SMMC) program in Florida on access to and quality of primary care for Medicaid enrollees, measured by hospitalizations for ambulatory care sensitive conditions (ACSCs). DATA SOURCES: We examine inpatient data obtained from the Agency for Health Care Administration for 285 hospitals in Florida from January 2010 to June 2015. The analysis includes 3,645,515 discharges for Florida residents between the ages 18 and 64 with a primary payer of Medicaid or private insurance...
November 17, 2016: Health Services Research
Yujie Hu, Fahui Wang, Imam M Xierali
OBJECTIVE: To develop an automated, data-driven, and scale-flexible method to delineate hospital service areas (HSAs) and hospital referral regions (HRRs) that are up-to-date, representative of all patients, and have the optimal localization of hospital visits. DATA SOURCES: The 2011 state inpatient database in Florida from the Healthcare Cost and Utilization Project. STUDY DESIGN: A network optimization method was used to redefine HSAs and HRRs by maximizing patient-to-hospital flows within each HSA/HRR while minimizing flows between them...
November 16, 2016: Health Services Research
Kamyar Nasseh, Marko Vujicic
OBJECTIVE: To examine the impact of the Affordable Care Act on dental care use among poor adults ages 21-64 in 2014. DATA: 2010-2014 Gallup-Healthways Wellbeing Index Survey. STUDY DESIGN: Among poor adults with income at or below 138% of the Federal Poverty Level, a differences-in-differences analysis was used to compare the changes in dental care use in states with different Medicaid expansion and adult dental policies. PRINCIPAL FINDINGS: Relative to the pre-reform period and other states, in Medicaid expansion states with adult dental benefits, dental care use increased between 2 and 6 percent points in the second half of 2014, but most of these changes were not statistically significant...
November 16, 2016: Health Services Research
Nina A Bickell, Alexandra DeNardis Moss, Maria Castaldi, Ajay Shah, Alan Sickles, Peter Pappas, Theophilus Lewis, Margaret Kemeny, Shalini Arora, Lori Schleicher, Kezhen Fei, Rebeca Franco, Ann Scheck McAlearney
OBJECTIVE: To identify key organizational approaches associated with underuse of breast cancer care. SETTING: Nine New York City area safety-net hospitals. STUDY DESIGN: Mixed qualitative-quantitative, cross-sectional cohort. METHODS: We used qualitative comparative analysis (QCA) of key stakeholder interviews, defined organizational "conditions," calibrated conditions, and identified solution pathways. We defined underuse as no radiation after lumpectomy in women <75 years or mastectomy in women with ≥4 positive nodes, or no systemic therapy in women with tumors ≥1 cm...
November 14, 2016: Health Services Research
Elizabeth M Magnan, Daniel M Bolt, Robert T Greenlee, Jennifer Fink, Maureen A Smith
OBJECTIVE: To find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics. DATA SOURCES/STUDY SETTING: Twenty-nine thousand five hundred and sixty-two adult patients with diabetes seen at eight Midwestern U.S. health systems during 2010-2011. STUDY DESIGN: We retrospectively evaluated the relationship between six diabetes quality metrics and patients' combinations of chronic conditions...
November 13, 2016: Health Services Research
Maria C Raven, David Guzman, Alice H Chen, John Kornak, Margot Kushel
OBJECTIVE: Out-of-network emergency department (ED) use, or use that occurs outside the contracted network, may lead to increased care fragmentation and cost. We examined factors associated with out-of-network ED use among Medicaid beneficiaries. DATA SOURCES AND STUDY SETTING: Enrollment, claims, and encounter data for adult Medi-Cal health plan members with 1+ ED visits and complete Medicaid eligibility during the study period from 2013 to 2014. STUDY DESIGN: We analyzed the data to identify factors associated with out-of-network ED use classified by mode of arrival (ambulance vs...
November 11, 2016: Health Services Research
Aaron L Schwartz, Alan M Zaslavsky, Bruce E Landon, Michael E Chernew, J Michael McWilliams
OBJECTIVE: To assess whether provider organizations exhibit distinct profiles of low-value service provision. DATA SOURCES: 2007-2011 Medicare fee-for-service claims and enrollment data. STUDY DESIGN: Use of 31 services that provide minimal clinical benefit was measured for 4,039,733 beneficiaries served by 3,137 provider organizations. Variation across organizations, persistence within organizations over time, and correlations in use of different types of low-value services within organizations were estimated via multilevel modeling, with adjustment for beneficiary sociodemographic and clinical characteristics...
November 10, 2016: Health Services Research
Kandice A Kapinos, Lindsey Bullinger, Tami Gurley-Calvez
OBJECTIVE: Despite substantial evidence of the benefits of breastfeeding for both mothers and children, rates of sustained breastfeeding in the United States are quite low. This study examined whether mandated coverage of lactation support services under the Affordable Care Act (ACA) affects breastfeeding behavior. DATA SOURCE: We studied the census of U.S. births included in the National Vital Statistics System from 2009 to 2014. STUDY DESIGN: We used regression-adjusted difference-in-differences (DD) to examine changes in breastfeeding rates for privately insured mothers relative to those covered by Medicaid...
November 10, 2016: Health Services Research
Susan A Chapman, Lisel K Blash
OBJECTIVE: To identify and describe new roles for medical assistants (MAs) in innovative care models that improve care while providing training and career advancement opportunities for MAs. DATA SOURCES/STUDY SETTING: Primary data collected at 15 case study sites; 173 key informant interviews and de-identified secondary data on staffing, wages, patient satisfaction, and health outcomes. STUDY DESIGN: Researchers used snowball sampling and screening calls to identify 15 organizations using MAs in new roles...
November 10, 2016: Health Services Research
Christopher S Brunt
OBJECTIVE: To assess the impact of preferences, socioeconomic status (SES), and supplemental insurance (SI) on racial/ethnic disparities in the probability and use of services at physicians' offices, hospitals, and emergency departments among Medicare beneficiaries enrolled in Part B. RESEARCH DESIGN AND SUBJECTS: This study includes black and white beneficiaries from the 2009-2011 panel of the Medicare Current Beneficiary Survey who were enrolled in Medicare Part B...
November 10, 2016: Health Services Research
William M Sage, Molly Colvard Harding, Eric J Thomas
OBJECTIVE: To describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors. DATA SOURCES/STUDY SETTING: Secondary data collected from The University of Texas System, which self-insures approximately 6,000 physicians at six health campuses across the state. We obtained internal case management data for all medical malpractice claims closed during 1 year before and 6 recent years following the enactment of state tort reform legislation...
November 4, 2016: Health Services Research
William Riley, James W Begun, Les Meredith, Kristi K Miller, Kathy Connolly, Rebecca Price, Janet H Muri, Mac McCullough, Stanley Davis
OBJECTIVE: To improve safety practices and reduce adverse events in perinatal units of acute care hospitals. DATA SOURCES: Primary data collected from perinatal units of 14 hospitals participating in the intervention between 2008 and 2012. Baseline secondary data collected from the same hospitals between 2006 and 2007. STUDY DESIGN: A prospective study involving 342,754 deliveries was conducted using a quality improvement collaborative that supported three primary interventions...
November 3, 2016: Health Services Research
Michelle M Mello, Sarah J Armstrong, Yelena Greenberg, Patricia I McCotter, Thomas H Gallagher
OBJECTIVE: To implement a communication-and-resolution program (CRP) in a setting in which liability insurers and health care facilities must collaborate to resolve incidents involving a facility and separately insured clinicians. STUDY SETTING: Six hospitals and clinics and a liability insurer in Washington State. STUDY DESIGN: Sites designed and implemented CRPs and contributed information about cases and operational challenges over 20 months...
November 3, 2016: Health Services Research
Thomas H Gallagher, Jason M Etchegaray, Brandelyn Bergstedt, Amelia M Chappelle, Madelene J Ottosen, Emily W Sedlock, Eric J Thomas
OBJECTIVE: The response to adverse events can lack patient-centeredness, perhaps because the involved institutions and other stakeholders misunderstand what patients and families go through after care breakdowns. STUDY SETTING: Washington and Texas. STUDY DESIGN: The HealthPact Patient and Family Advisory Council (PFAC) created and led a five-stage simulation exercise to help stakeholders understand what patients experience following an adverse event...
October 28, 2016: Health Services Research
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