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Health Services Research

Caroline P Thirukumaran, Laurent G Glance, Meredith B Rosenthal, Helena Temkin-Greener, Rishi Balkissoon, Addisu Mesfin, Yue Li
OBJECTIVE: To determine whether Medicare's Nonpayment Program was associated with decline in venous thromboembolism (VTE) following hip and knee replacements; and whether the decline was greater among hospitals at risk of larger financial losses from the Program. DATA SOURCES: State Inpatient Database for New York (NY) from 2005 to 2013. STUDY DESIGN: The primary outcome was an occurrence of VTE. Medicare Utilization Ratio (MUR), which is the proportion of inpatient days in a hospital that is financed by Medicare, represented a hospital's financial sensitivity...
July 18, 2018: Health Services Research
Lawrence P Casalino, Patricia Ramsay, Laurence C Baker, Michael F Pesko, Stephen M Shortell
OBJECTIVE: To estimate the relationship between outcomes of care and medical practices' structure and use of organized care improvement processes. DATA SOURCES/STUDY SETTING: We linked Medicare claims data to our national survey of physician practices (2012-2013). Fifty percent response rate; 1,040 responding practices; 31,888 physicians; 868,213 attributed Medicare beneficiaries. STUDY DESIGN: Cross-sectional observational analysis of the relationship between practice characteristics and total spending, readmissions, and ambulatory care-sensitive admissions (ACSAs), for all beneficiaries and five categories of beneficiary defined by predicted need for care...
July 5, 2018: Health Services Research
Sara Jansen Perry, Jason P Richter, Brad Beauvais
OBJECTIVE: To explore antecedents and outcomes of nurse self-reported job satisfaction and dissatisfaction-based turnover cognitions, theorizing (using Self-Determination Theory) that leaders can foster work conditions that help fulfill innate needs, thereby fostering satisfaction of nurses and patients, and reducing adverse events. DATA SOURCES/STUDY SETTING: Primary and secondary data were collected within a 4-month period in 2015, from 2,596 nurses in 110 Army treatment facilities (hospitals and clinics) across 35 health care systems...
June 29, 2018: Health Services Research
Jamie R Daw, Laura A Hatfield
OBJECTIVE: To demonstrate regression to the mean bias introduced by matching on preperiod variables in difference-in-differences studies. DATA SOURCES: Simulated data. STUDY DESIGN: We performed a Monte Carlo simulation to estimate the effect of a placebo intervention on simulated longitudinal data for units in treatment and control groups using unmatched and matched difference-in-differences analyses. We varied the preperiod level and trend differences between the treatment and control groups, and the serial correlation of the matching variables...
June 29, 2018: Health Services Research
Lena Dahlberg, Neda Agahi, Pär Schön, Carin Lennartsson
OBJECTIVE: To examine the relationship between social factors and planned and unplanned hospital admissions among older people. DATA SOURCES/STUDY SETTING: 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012. STUDY DESIGN: The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociodemographic and ability factors, health factors)...
June 27, 2018: Health Services Research
Sarah H Gordon, Yoojin Lee, Chima D Ndumele, Patrick M Vivier, Roee Gutman, Shailender Swaminathan, Emily A Gadbois, Renee R Shield, Amy Jo Haavisto Kind, Amal N Trivedi
OBJECTIVE: To assess the impact of assignment to a Medicaid-focused versus mixed managed care plan on continuity of Medicaid coverage. DATA SOURCES: 2011-2016 Medicaid claims from a Northeastern state. STUDY DESIGN: Following the exit of a Medicaid managed care insurer, Medicaid administrators prioritized provider networks in reassigning enrollees, but randomly assigned beneficiaries whose providers were equally represented in the two plans...
June 27, 2018: Health Services Research
Shi-Yi Wang, Sylvia H Hsu, Siwan Huang, Kathy C Doan, Cary P Gross, Xiaomei Ma
OBJECTIVE: To examine whether regional practice patterns impact racial/ethnic differences in intensity of end-of-life care for cancer decedents. DATA SOURCES: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. STUDY DESIGN: We classified hospital referral regions (HRRs) based on mean 6-month end-of-life care expenditures, which represented regional practice patterns. Using hierarchical generalized linear models, we examined racial/ethnic differences in the intensity of end-of-life care across levels of HRR expenditures...
June 27, 2018: Health Services Research
Xi Zhu, Douglas R Wholey
OBJECTIVE: To examine how expertise redundancy and transactive memory (TM) in interdisciplinary care teams (ICTs) are related to team performance. DATA SOURCES/STUDY SETTING: Survey and administrative data were collected from 26 interdisciplinary mental health teams. STUDY DESIGN: The study used a longitudinal, observational design. Independent variables were measured at baseline, 6, and 12 months: expertise redundancy (the extent to which team members possess highly overlapping knowledge), TM accuracy (the extent to which team members accurately recognize experts in relevant knowledge domains), and TM consensus (the extent to which team members agree on who is expert in which knowledge domain)...
June 12, 2018: Health Services Research
Allison Witman, Joseph Acquah, Maria Alva, Thomas Hoerger, Melissa Romaire
OBJECTIVE: To test the effectiveness of financial incentives for smoking cessation in the Medicaid population. DATA SOURCES: Secondary data from the Medicaid Incentives for Prevention of Chronic Disease (MIPCD) program and Medicaid claims/encounter data from 2010 to 2015 for five states. STUDY DESIGN: Beneficiaries were randomized into receipt or no receipt of financial incentives. We ran multivariate regression models testing the impact of financial incentives on the use of counseling services, smoking behavior, and Medicaid expenditures and utilization...
June 12, 2018: Health Services Research
Lauren B Currie, Michelle L Patterson, Akm Moniruzzaman, Lawrence C McCandless, Julian M Somers
OBJECTIVE: To examine whether timely outpatient follow-up after hospital discharge reduces the risk of subsequent rehospitalization among people experiencing homelessness and mental illness. DATA SOURCES: Comprehensive linked administrative data including hospital admissions, laboratory services, and community medical services. STUDY DESIGN: Participants were recruited to the Vancouver At Home study based on a-priori criteria for homelessness and mental illness (n = 497)...
June 12, 2018: Health Services Research
Mary Vaughan Sarrazin, Gary E Rosenthal, Carolyn L Turvey
OBJECTIVE: Up to 70 percent of patients who receive care through Veterans Health Administration (VHA) facilities also receive care from non-VA providers. Using applied classification techniques, this study sought to improve understanding of how elderly VA patients use VA services and complementary use of non-VA care. METHODS: The study included 1,721,900 veterans age 65 and older who were enrolled in VA and Medicare during 2013 with at least one VA encounter during 2013...
June 12, 2018: Health Services Research
Eugene Rich, Anna Collins
OBJECTIVE: The Affordable Care Act and Medicare Access and CHIP Reauthorization Act are changing access to, and delivery of, health care in the United States, with potential implications for the field of health services research (HSR). We therefore investigated employers' perceptions of demand for individuals to conduct HSR, the competencies required for success, and implications for HSR training programs. DATA SOURCE: Interviews conducted in August 2016 with 21 key informants at a range of U...
June 12, 2018: Health Services Research
Denise A Tyler, John P McHugh, Renée R Shield, Ulrika Winblad, Emily A Gadbois, Vincent Mor
OBJECTIVE: To identify the challenges that reductions in length of stay (LOS) pose for skilled nursing facilities (SNFs) and their postacute care (PAC) patients. DATA SOURCES/SETTING: Seventy interviews with staff in 25 SNFs in eight U.S. cities, LOS data for patients in those SNFs. STUDY DESIGN: Data were qualitatively analyzed, and key themes were identified. Interview data from SNFs with and without reductions in median risk-adjusted LOS were compared and contrasted...
June 5, 2018: Health Services Research
Bianca K Frogner
OBJECTIVE: This study examines the stock and supply including educational pipeline of health services researchers (HSRers) in the United States. DATA SOURCES: National Institutes of Health Research Portfolio Online Reporting Tools, Agency for Healthcare Research and Quality Grants On-Line Database, Health Services Research Projects in Progress, PubMed, Integrated Postsecondary Education Data System, AcademyHealth membership database, and social networks. STUDY DESIGN: Exploratory descriptive analysis of individuals involved in health services research (HSR) in the United States as of 2015/16...
June 4, 2018: Health Services Research
Jean Yoon, Christine Pal Chee, Pon Su, Peter Almenoff, Donna M Zulman, Todd H Wagner
OBJECTIVES: To examine high-cost patients in VA and factors associated with persistence in high costs over time. DATA SOURCES: Secondary data for FY2008-2012. DATA EXTRACTION: We obtained VA and Medicare utilization and cost records for VA enrollees and drew a 20 percent random sample (N = 1,028,568). STUDY DESIGN: We identified high-cost patients, defined as those in the top 10 percent of combined VA and Medicare costs, and determined the number of years they remained high cost over 4 years...
June 3, 2018: Health Services Research
Eric R Pedersen, Joan S Tucker, David J Klein, Layla Parast
OBJECTIVE: Homeless youth are a population in need of housing assistance and case management, as well as services to address behavioral health problems. This study examines youth's perceived need for and receipt of services through drop-in centers. DATA SOURCE: Surveys of 273 homeless youth. STUDY DESIGN: Cross-sectional. EXTRACTION METHODS: Descriptive analyses with bivariate and multivariable regression models. PRINCIPAL FINDINGS: About one-third to half of the sample met criteria for behavioral health problems, yet half or less of those meeting criteria reported a need for services targeting the problems...
June 3, 2018: Health Services Research
Mel Hudson Smith, David Smith
OBJECTIVE: To examine the influence of dimensions of service quality on patient experience of primary care. DATA SOURCES/STUDY SETTING: Data from the national GP Patient Survey in England 2014/15, with responses from 858,351 patients registered at 7,918 practices. STUDY DESIGN: Expert panel and principal component analysis helped identify relevant dimensions of service quality. Regression was then used to examine the relationships between these dimensions and reported patient experience...
June 3, 2018: Health Services Research
Qian Gu, Andrea Hassol, Alisha Creel, Nancy L Keating
OBJECTIVE: To enhance proxy survey responses for deceased cancer patients. DATA SOURCES: Two waves of surveys about care experiences of cancer chemotherapy patients (used for a value-based purchasing initiative), collected November 2016 through March 2017. STUDY DESIGN: Surveys were mailed to deceased patients (for proxy response) in the untailored first survey wave, and using a tailored strategy in the second wave. We compared proxy responses for deceased patients with and without the tailored approach...
June 3, 2018: Health Services Research
Austin B Frakt, Julia C Prentice, Steven D Pizer, A Rani Elwy, Melissa M Garrido, Amy M Kilbourne, David Atkins
OBJECTIVE: To describe a new Veterans Health Administration (VHA) program to foster the learning health system paradigm by rigorously evaluating health care initiatives and to report key lessons learned in designing those evaluations. PRINCIPAL FINDINGS: The VHA's Quality Enhancement Research Initiative and its Health Services Research and Development Service are cooperating on several large, randomized program evaluations aimed at improving the care veterans receive and the efficiency with which it is delivered...
June 3, 2018: Health Services Research
Garth H Utter, Ginger L Cox, Oluseun O Atolagbe, Pamela L Owens, Patrick S Romano
OBJECTIVE: To convert the Agency for Healthcare Research and Quality's (AHRQ) Quality Indicators (QIs) from International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) specifications to ICD, 10th Revision, Clinical Modification and Procedure Classification System (ICD-10-CM/PCS) specifications. DATA SOURCES: ICD-9-CM and ICD-10-CM/PCS classifications, General Equivalence Maps (GEMs). STUDY DESIGN: We convened 77 clinicians and coders to evaluate ICD-10-CM/PCS codes mapped from ICD-9-CM using automated GEMs...
May 30, 2018: Health Services Research
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