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Health Services Research

Thomas Byrne, Ann Elizabeth Montgomery, Jamison D Fargo
OBJECTIVE: To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (VHA). DATA SOURCES/STUDY SETTING: Electronic medical record data from 5.8 million Veterans who responded to the VHA's Homelessness Screening Clinical Reminder (HSCR) between October 2012 and September 2015. STUDY DESIGN: We randomly selected 80% of Veterans in our sample to develop predictive models...
September 21, 2018: Health Services Research
Lauren S Miller, Meng Wu, Anne M Schettine, Lindsay W Cogan
OBJECTIVE: The ability to identify children with special health care needs (CSHCN) is crucial to evaluate disparities in the quality of health care for children in Medicaid Managed Care. We developed and assessed the accuracy of a new method to classify CSHCN. DATA SOURCES: Secondary data analysis was conducted using NYS Medicaid administrative data and the Children with Chronic Conditions Screener (CCC Screener). STUDY DESIGN: This study included 5,907 NYS Medicaid beneficiaries (17 years old or younger) whose parents completed the CCC Screener in 2014...
September 21, 2018: Health Services Research
Ashok Reddy, Edwin Wong, Anne Canamucio, Karin Nelson, Stephan D Fihn, Jean Yoon, Rachel M Werner
OBJECTIVE: It remains unknown whether high-functioning teams can compensate for poor continuity of care to support important patient outcomes. DATA SOURCE: Linked VA administrative and Medicare claims data to measure the relationship of team-based care and continuity of care with high-cost utilization. STUDY DESIGN: Retrospective cohort study of 1.2 million VA-Medicare dual eligible Veterans assigned to a VA primary care provider (PCP) in 2012...
September 11, 2018: Health Services Research
David Neumark, Bogdan Savych
OBJECTIVE: To examine the effects of provider choice policies on workers' compensation medical and indemnity costs. DATA SOURCES/STUDY SETTING: Pooled cross-sectional analysis of administrative claims records for workers with work-related injuries primarily in 2007-2010 across 25 states (n = 4,489,729). STUDY DESIGN: We used linear and quantile regression analyses to evaluate differences in claim costs (medical and indemnity) based on whether policies give employers or injured workers control over the choice of provider...
September 11, 2018: Health Services Research
Nancy G Hedlund, Zeynep Isgor, Jack Zwanziger, Damiano Rondelli, Stephanie Y Crawford, Denise M Hynes, Lisa M Powell
OBJECTIVE: Examine the impact of the 2011 shortage of the drug cytarabine on patient receipt and timeliness of induction treatment for Acute Myeloid Leukemia (AML). STUDY DESIGN: A retrospective cohort was utilized to examine odds of receipt of inpatient induction chemotherapy and time to first dose across major (N = 105) and moderate (N = 316) shortage time periods as compared to a nonshortage baseline (N = 1,147). DATA COLLECTION/EXTRACTION METHODS: De-identified patient data from 2008 to 2011 Surveillance, Epidemiology, and End Results (SEER) were linked to 2007-2013 Medicare claims and 2007-2013 Hospital Characteristics...
September 10, 2018: Health Services Research
Jonathan G Shaw, Vilija R Joyce, Susan K Schmitt, Susan M Frayne, Kate A Shaw, Beate Danielsen, Rachel Kimerling, Steven M Asch, Ciaran S Phibbs
OBJECTIVE: To describe variation in payer and outcomes in Veterans' births. DATA/SETTING: Secondary data analyses of deliveries in California, 2000-2012. STUDY DESIGN: We performed a retrospective, population-based study of all live births to Veterans (confirmed via U.S. Department of Veterans Affairs (VA) enrollment records), to identify payer and variations in outcomes among: (1) Veterans using VA coverage and (2) Veteran vs. all other births...
September 10, 2018: Health Services Research
Benjamin C Silver, Momotazur Rahman, Brad Wright, Richard Besdine, Pedro Gozalo, Vincent Mor
OBJECTIVE: To examine the effects of Medicare's Medical Review (MR) program on short-stay inpatient hospitalization. DATA SOURCES/STUDY SETTING: One Hundred percent of Medicare Part A and Part B claims and the Master Beneficiary Summary File (2007-2010). STUDY DESIGN: Retrospective observational study using a difference-in-differences approach. We examined six primary intake diagnoses, we believed likely to be targeted by MR. We stratified by hospital profit structure, bed size, system membership, and inpatient admission rate to test for differential effects...
September 4, 2018: Health Services Research
Paul L Hebert, Adam S Batten, Eric Gunnink, Ashok Reddy, Edwin S Wong, Stephan D Fihn, Chuan-Fen Liu
OBJECTIVE: To estimate the effect of Medicare use on the receipt of outpatient services from 2001 through 2015 for a cohort of Veterans Administration (VA) users who became age-eligible for Medicare in 1998-2000. DATA SOURCES/STUDY SETTING: VA administrative data linked with Medicare claims for veterans who participated in the 1999 Large Health Survey of Enrolled Veterans. STUDY DESIGN: We coded each veteran as VA-reliant or Medicare-reliant based on the number of visits in each system and compared the health and social risk factors between VA-reliant and Medicare-reliant veterans...
September 3, 2018: Health Services Research
Amal N Trivedi, Lan Jiang, Erin E Johnson, Julie C Lima, Michael Flores, Thomas P O'Toole
OBJECTIVE: To examine the association between reliance on VA outpatient care and hospital admissions among Medicare-eligible Veterans enrolled in the Homeless Patient Aligned Care Team (H-PACT). DATA SOURCES/STUDY SETTING: Registry of H-PACT enrollees linked to VA and Medicare utilization data for 2013. STUDY DESIGN: After assigning Veterans to two groups according to whether they received >90 percent of outpatient care in VA (higher reliance) or <90 percent of outpatient care in VA (lower reliance), generalized linear models with inverse probability of treatment weights were used to estimate the association of reliance with Medicare and VA-financed hospital admissions...
August 27, 2018: Health Services Research
Monica S Aswani, Meredith L Kilgore, David J Becker, David T Redden, Bisakha Sen, Justin Blackburn
OBJECTIVE: To identify hospital/county characteristics and sources of regional heterogeneity associated with readmission penalties. DATA SOURCES/STUDY SETTING: Acute care hospitals under the Hospital Readmissions Reduction Program from fiscal years 2013 to 2018 were linked to data from the Annual Hospital Association, Centers for Medicare and Medicaid Services, Medicare claims, Hospital Compare, Nursing Home Compare, Area Resource File, Health Inequity Project, and Long-term Care Focus...
August 27, 2018: Health Services Research
Chuan-Fen Liu, Adam Batten, Edwin S Wong, Stephan D Fihn, Paul L Hebert
OBJECTIVE: To examine the long-term reliance on outpatient care at the population (i.e., system) level among fee-for-service Medicare-enrolled elderly veterans in the Department of Veterans Affairs (VA) health care system and Medicare from 2003 to 2014. DATA SOURCES/STUDY SETTING: We analyzed a 5 percent random sample, stratified by facility, age, gender, and race, of Medicare-enrolled veterans enrolled in a VA primary care panel using VA administrative data and Medicare claims...
August 27, 2018: Health Services Research
Hillary J Mull, Kamal M F Itani, Steven D Pizer, Martin P Charns, Peter E Rivard, Nathalie McIntosh, Mary T Hawn, Amy K Rosen
OBJECTIVE: Develop and validate a surveillance model to identify outpatient surgical adverse events (AEs) based on previously developed electronic triggers. DATA SOURCES: Veterans Health Administration's Corporate Data Warehouse. STUDY DESIGN: Six surgical AE triggers, including postoperative emergency room visits and hospitalizations, were applied to FY2012-2014 outpatient surgeries (n = 744,355). We randomly sampled trigger-flagged and unflagged cases for nurse chart review to document AEs and measured positive predictive value (PPV) for triggers...
August 27, 2018: Health Services Research
Alex McDowell, Christina A Nguyen, Michael E Chernew, Kevin N Tran, J Michael McWilliams, Bruce E Landon, Mary Beth Landrum
OBJECTIVE: To assess the impact of alternative methods of aggregating individual quality measures on Accountable Care Organization (ACO) overall scores. DATA SOURCE: 2014 quality scores for Medicare ACOs. STUDY DESIGN: We compare ACO overall scores derived using CMS' aggregation approach to those derived using alternative approaches to grouping and weighting measures. PRINCIPAL FINDINGS: Alternative grouping and weighting methods based on statistical criteria produced overall quality scores similar to those produced using CMS' approach (κ = 0...
August 22, 2018: Health Services Research
Peter J Huckfeldt, Lianna Weissblum, José J Escarce, Pinar Karaca-Mandic, Neeraj Sood
OBJECTIVE: To determine whether skilled nursing facilities (SNFs) chosen by health systems to participate in preferred provider networks exhibited differences in quality, costs, and patient outcomes relative to other SNFs after accounting for differences in case mix. DATA SOURCES: Medicare provider and claims data, 2012 and 2013. STUDY DESIGN: We compared SNFs included in preferred networks relative to other SNFs in the same market, prior to the establishment of preferred provider networks...
August 15, 2018: Health Services Research
Virginia Wang, Cynthia J Coffman, Karen M Stechuchak, Theodore S Z Berkowitz, Paul L Hebert, David Edelman, Ann M O'Hare, Hollis J Weidenbacher, Matthew L Maciejewski
OBJECTIVE: Growing demand for VA dialysis exceeds its supply and travel distances prohibit many Veterans from receiving dialysis in a VA facility, leading to increased use of dialysis from non-VA providers. This study compared utilization and hospitalization outcomes among Veterans receiving chronic dialysis in VA and non-VA settings in 2008-2013. DATA SOURCES: VA, Medicare, and national disease registry data. STUDY DESIGN: National cohort of 27,301 Veterans initiating dialysis, observed for a period of 2 years after treatment initiation...
August 9, 2018: Health Services Research
Caitlin McArthur, John Hirdes, Ashok Chaurasia, Katherine Berg, Lora Giangregorio
OBJECTIVES: To describe the proportion of residents receiving rehabilitation in long-term care (LTC) homes, and scores on activities of daily living (ADL) and falls quality indicators (QIs) before and after change from fee-for-service to an episode of care model; and to evaluate the effect of the change on the QIs. DATA SOURCES: Secondary data were collected from all LTC homes in Ontario, Canada, between January 1, 2011 and March 31, 2015. Variables of interest were the proportion of residents per home receiving physical therapy (PT), and the scores on seven ADL and one falls QI...
August 9, 2018: Health Services Research
Karen E Swietek, Marisa Elena Domino, Christopher Beadles, Alan R Ellis, Joel F Farley, Lexie R Grove, Carlos Jackson, C Annette DuBard
OBJECTIVE: To examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC). DATA SOURCES/STUDY SETTING: Secondary claims data from fiscal years 2008-2010. The sample included nonelderly Medicaid beneficiaries with at least two of eight target conditions (asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, seizure disorder, major depressive disorder, and schizophrenia)...
August 7, 2018: Health Services Research
Kathleen F Carlson, Tess A Gilbert, Benjamin J Morasco, Dagan Wright, Joshua Van Otterloo, Aldona Herrndorf, Lawrence J Cook
OBJECTIVE: To examine the prevalence of concurrent Veterans Health Administration (VA) and non-VA prescriptions for opioids and sedative-hypnotic medications among post-9/11 veterans in Oregon. DATA SOURCES: VA health care and prescription data were probabilistically linked with Oregon Prescription Drug Monitoring Program (PDMP) data. STUDY DESIGN: This retrospective cohort study examined concurrent prescriptions among n = 19,959 post-9/11 veterans, by year (2014-2016) and by patient demographic and clinical characteristics...
August 7, 2018: Health Services Research
Victoria Perez, Seth Freedman
OBJECTIVE: To determine the consistency with which government-issued hospital quality ratings and crowdsourced ratings on social media sites identify hospital quality. DATA SOURCES: Hospital ratings from Facebook, Google, and Yelp were linked with Hospital Compare (HC) measures. STUDY DESIGN: Fixed-effects linear regression model. PRINCIPAL FINDINGS: Among crowdsourcing sites' best-ranked hospitals, 50-60% were also the best ranked on HC's overall and patient experience ratings; 20% ranked as the worst...
August 6, 2018: Health Services Research
Momotazur Rahman, Emily A Gadbois, Denise A Tyler, Vincent Mor
OBJECTIVE: To characterize the nature and degree of hospitals' efforts to collaborate with skilled nursing facilities (SNFs) and associated patient outcomes. DATA SOURCES/STUDY SETTING: Qualitative data were collected through 138 interviews with staff in 16 hospitals and 25 SNFs in eight markets across the United States in 2015. Quantitative data include Medicare claims data for the 290,603 patients discharged from those 16 hospitals between 2008 and 2015. STUDY DESIGN/DATA COLLECTION: Semi-structured interviews with hospital and SNF staff were coded and used to classify hospitals' collaboration efforts with SNFs into high versus low collaboration hospitals, and risk-adjusted, claims-based hospital readmission rates from SNF were compared...
August 5, 2018: Health Services Research
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