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Health Services Research

Nicolae Done, Amanda M Roy, Yingzhe Yuan, Steven D Pizer, Adam J Rose, Julia C Prentice
OBJECTIVE: To characterize the rate of guideline-concordant initiation of oral anticoagulation (OAC) among elderly Veterans with atrial fibrillation (AF) and high stroke risk. DATA SOURCES/STUDY SETTING: Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) linked with Medicare claims 2011-2015. STUDY DESIGN: We identified 6619 elderly, high stroke-risk patients with a new episode of AF initially diagnosed in the VHA during fiscal years 2012-2015...
November 11, 2018: Health Services Research
Allison Witman, Christopher Beadles, Yiyan Liu, Ann Larsen, Nilay Kafali, Sabina Gandhi, Peter Amico, Thomas Hoerger
OBJECTIVE: To demonstrate rolling entry matching (REM), a new statistical method, for comparison group selection in the context of staggered nonuniform participant entry in nonrandomized interventions. STUDY SETTING: Four Health Care Innovation Award (HCIA) interventions between 2012 and 2016. STUDY DESIGN: Center for Medicare and Medicaid Innovation HCIA participants entering these interventions over time were matched with nonparticipants who exhibited a similar pattern of health care use and expenditures during each participant's baseline period...
November 9, 2018: Health Services Research
Brendan Saloner, Adam S Wilk, Douglas Wissoker, Molly Candon, Katherine Hempstead, Karin V Rhodes, Daniel E Polsky, Genevieve M Kenney
OBJECTIVE: To compare access at community health centers (CHCs) vs private offices (non-CHCs) under the Affordable Care Act. DATA SOURCE: Ten state primary care audit conducted in 2012/2013 and 2016. STUDY DESIGN: CHCs and non-CHCs were called. We calculated difference in differences comparing CHCs vs non-CHCs by caller insurance type. PRINCIPAL FINDINGS: In both rounds, Medicaid and uninsured callers had higher appointment rates at CHC than non-CHCs...
November 5, 2018: Health Services Research
Lindsey M Philpot, Kristi M Swanson, Jonathan Inselman, William J Schoellkopf, James M Naessens, Bijan J Borah, Stephanie Peterson, Barbara Gladders, Nilay D Shah, Jon O Ebbert
OBJECTIVES: To evaluate the ability of claims-based risk adjustment and incremental components of clinical data to identify 90-day episode costs among lower extremity joint replacement (LEJR) patients according to the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) program provisions. DATA SOURCES: Medicare fee-for-service (FFS) data for qualifying CJR episodes in the United States, and FFS data linked with clinical data from CJR-qualifying LEJR episodes performed at High Value Healthcare Collaborative (HVHC) and Mayo Clinic in 2013...
November 5, 2018: Health Services Research
Leah S Karliner, Celia Kaplan, Jennifer Livaudais-Toman, Karla Kerlikowske
OBJECTIVE: To investigate mammography facilities' follow-up times, population vulnerability, system-based processes, and association with cancer stage at diagnosis. DATA SOURCES: Prospectively collected from San Francisco Mammography Registry (SFMR) 2005-2011, California Cancer Registry 2005-2012, SFMR facility survey 2012. STUDY DESIGN: We examined time to biopsy for 17 750 abnormal mammogram results (BI-RADS 4/5), categorizing eight facilities as short or long follow-up based on proportion of mammograms with biopsy at 30 days...
November 5, 2018: Health Services Research
Tyler N A Winkelman, Joel E Segel, Matthew M Davis
OBJECTIVES: To examine the person-level impact of Medicaid enrollment on costs, utilization, access, and health across previously uninsured racial/ethnic groups. DATA SOURCE: Medical Expenditure Panel Survey, 2008-2014. STUDY DESIGN: We pooled multiple 2-year waves of data to examine the direct impact of Medicaid enrollment among uninsured Americans. We compared changes in outcomes among nonpregnant, uninsured individuals who gained Medicaid (N = 963) to those who remained uninsured (N = 9784) using a difference-in-differences analysis...
November 5, 2018: Health Services Research
Charles Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, Ishtiaque Fazlul
OBJECTIVE: To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years. DATA SOURCE: The 2011-2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults. DESIGN: We estimate a difference-in-difference-in-differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature...
October 30, 2018: Health Services Research
Monica Escher, Stéphane Cullati, Patricia Hudelson, Mathieu Nendaz, Bara Ricou, Thomas Perneger, Pierre Dayer
OBJECTIVE: To examine physicians' decision making and its determinants about admission to intensive care. DATA SOURCES/STUDY SETTING: ICU physicians (n = 12) and internists (n = 12) working in a Swiss tertiary care hospital. STUDY DESIGN: We conducted in-depth interviews. DATA COLLECTION/EXTRACTION METHODS: Interviews were analyzed using an inductive thematic approach. PRINCIPAL FINDINGS: Admission decisions regarding seriously ill or elderly patients with comorbidities are complex...
October 25, 2018: Health Services Research
Andrew B Bindman, Patrick S Romano
No abstract text is available yet for this article.
October 23, 2018: Health Services Research
Wei Song, Orna Intrator, Sei Lee, Kenneth Boockvar
OBJECTIVE: To examine the relationship between antihypertensive drug deintensification and recurrent falls in long-term care. DATA SOURCES/SETTINGS: Department of Veterans Affairs (VA) inpatient, outpatient, and purchased care data, Minimum Data Set assessments from VA nursing homes (NHs), and Medicare claims from fiscal years 2010 - 2015. STUDY DESIGN: We identified NH residents with evidence of overaggressive antihypertensive treatment, defined as systolic blood pressure (SBP) 80-120 and an index fall...
October 23, 2018: Health Services Research
Momotazur Rahman, David J Meyers, Vincent Mor
OBJECTIVE: The Medicare Modernization Act of 2004 allowed Medicare Advantage (MA) contracts to form provider networks in order to concentrate their patients among preferred providers. We focus on the skilled nursing facility (SNF) industry to assess patients' health when treating SNFs concentrate more patients from the same MA contract. DATA SOURCES/STUDY SETTING: We use Medicare Beneficiary Summary File and Health, HEDIS, and the Minimum Data Set for patient attributes and OSCAR, LTCfocus...
October 23, 2018: Health Services Research
Taeho Greg Rhee, Robert A Rosenheck
OBJECTIVES: To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings. DATA SOURCE: Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted)...
October 17, 2018: Health Services Research
Carolyn T Thorpe, Walid F Gellad, Maria K Mor, John P Cashy, John R Pleis, Courtney H Van Houtven, Loren J Schleiden, Joseph T Hanlon, Joshua D Niznik, Ronald L Carico, Chester B Good, Joshua M Thorpe
OBJECTIVE: To evaluate the effect of dual use of VA/Medicare Part D drug benefits on antihypertensive medication supply in older Veterans with dementia. DATA SOURCES/STUDY SETTING: National, linked 2007-2010 Veterans Affairs (VA) and Medicare utilization and prescription records for 50,763 dementia patients with hypertension. STUDY DESIGN: We used inverse probability of treatment (IPT)-weighted multinomial logistic regression to examine the association of dual prescription use with undersupply and oversupply of antihypertensives...
October 16, 2018: Health Services Research
Frank Eijkenaar, René C J A van Vliet, Richard C van Kleef
OBJECTIVE: To study the extent to which risk equalization (RE) in competitive health insurance markets can be improved by including an indicator for being healthy. STUDY SETTING/DATA SOURCES: This study is conducted in the context of the Dutch individual health insurance market. Administrative data on spending and risk characteristics (2011-2014) for the entire population (N = 16.6 m) as well as health survey data from a large sample (N = 387 k) are used. STUDY DESIGN: The indicator for being healthy is low spending in three consecutive prior years...
October 16, 2018: Health Services Research
Anna D Sinaiko, Alyna T Chien, Michael J Hassett, Pragya Kakani, Danielle Rodin, David J Meyers, Belen Fraile, Meredith B Rosenthal, Mary Beth Landrum
OBJECTIVE: To estimate and describe factors driving variation in spending for breast cancer patients within geographic region. DATA SOURCE: Surveillance, Epidemiology, and End Results (SEER)-Medicare database from 2009-2013. STUDY DESIGN: The proportion of variation in monthly medical spending within geographic region attributed to patient and physician factors was estimated using multilevel regression models with individual patient and physician random effects...
October 14, 2018: Health Services Research
Priyanka Anand, Keith Kranker, Arnold Y Chen
OBJECTIVE: To estimate the additional hospital costs associated with inpatient medical harms occurring during an index inpatient admission and costs from subsequent readmissions within 90 days. DATA SOURCE: 2009 to 2011 Healthcare Cost and Utilization Project's State Inpatient Databases from 12 states. STUDY DESIGN: We compare hospital costs incurred by patients experiencing a specific harm during their hospital stay to the costs incurred by similar patients who did not experience that harm...
October 11, 2018: Health Services Research
Peter Damiano, Julie Reynolds, Jill Boylston Herndon, Susan McKernan, Raymond Kuthy
OBJECTIVE: To develop the first standardized definition of the patient-centered dental home (PCDH). DATA SOURCES/STUDY SETTING: Primary data from a 55-member national expert panel and public comments. STUDY DESIGN: We used a modified Delphi process with three rounds of surveys to collect panelists' ratings of PCDH characteristics and open-ended comments. The process was supplemented with a 1-month public comment period. DATA COLLECTION/EXTRACTION METHODS: We calculated median ratings, analyzed consensus using the interpercentile range adjusted for symmetry, and qualitatively evaluated comments...
October 10, 2018: Health Services Research
Richard E Nelson, Makoto Jones, Chuan-Fen Liu, Matthew H Samore, Martin E Evans, Vanessa W Stevens, Thomas Reese, Michael A Rubin
OBJECTIVE: To measure how much of the postdischarge cost and utilization attributable to methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) occur within the US Department of Veterans Affairs (VA) system and how much occurs outside. DATA SOURCES/STUDY SETTING: Health care encounters from 3 different settings and payment models: (1) within the VA; (2) outside the VA but paid for by the VA (purchased care); and (3) outside the VA and paid for by Medicare...
October 9, 2018: Health Services Research
Philip W Chui, Lori A Bastian, Eric DeRycke, Cynthia A Brandt, William C Becker, Joseph L Goulet
OBJECTIVE: To examine the association of dual use of both Veterans Health Administration (VHA) and Medicare benefits with high-risk opioid prescriptions among Veterans aged 65 years and older with a musculoskeletal disorder diagnosis. DATA SOURCES/STUDY SETTING: Data were obtained from the VA Musculoskeletal Disorder (MSD) cohort and national Medicare claims data from 2008 to 2010. STUDY DESIGN: We conducted a retrospective analysis of Veterans enrolled in Medicare to examine the association of dual use with long-term opioid use (>90 days of prescription opioids/year) and overlapping opioid prescriptions...
October 8, 2018: Health Services Research
Megan E Vanneman, Ciaran S Phibbs, Sharon K Dally, Amal N Trivedi, Jean Yoon
OBJECTIVE: To examine Veterans Health Administration (VA) enrollees' use of VA services for treatment of behavioral health conditions (BHCs) after gaining Medicaid, and if VA reliance varies by complexity of BHCs. DATA SOURCES/STUDY SETTING: VA and Medicaid Analytic eXtract utilization data from 31 states, 2006-2010. STUDY DESIGN: A retrospective, longitudinal study of Veterans enrolled in VA care in the year before and year after enrollment in Medicaid among 7,249 nonelderly Veterans with serious mental illness (SMI), substance use disorder (SUD), posttraumatic stress disorder (PTSD), depression, or other BHCs...
October 8, 2018: Health Services Research
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