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Medical Care

Amber R Comer, James E Slaven, Annie Montz, Emily Burke, Lev Inger, Alexia Torke
BACKGROUND: Without advanced preparation of legal documents, state law determines who may serve as a surrogate decision maker for patients in hospitals. OBJECTIVES: To examine the relationship characteristics associated with traditional versus nontraditional health care surrogates who are making medical decisions for patients in hospitals. RESEARCH DESIGN: Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study...
February 26, 2018: Medical Care
Wenqi Hu, Carri W Chan, José R Zubizarreta, Gabriel J Escobar
OBJECTIVE: We sought to build on the template-matching methodology by incorporating longitudinal comorbidities and acute physiology to audit hospital quality. STUDY SETTING: Patients admitted for sepsis and pneumonia, congestive heart failure, hip fracture, and cancer between January 2010 and November 2011 at 18 Kaiser Permanente Northern California hospitals. STUDY DESIGN: We generated a representative template of 250 patients in 4 diagnosis groups...
February 26, 2018: Medical Care
Jeroan J Allison, Ronnie D Horner, Catarina Kiefe
No abstract text is available yet for this article.
February 20, 2018: Medical Care
Grant R Martsolf, Marc N Elliott, Amelia M Haviland, Q Burkhart, Nate Orr, Sarah Gaillot, Debra Saliba
BACKGROUND: Having a "personal" physician is a critical element to care continuity. Little is known about which older adults are more likely to lack personal physicians and if their care experiences differ from those with a personal physician. OBJECTIVE: The objective of this study was to describe care experiences and characteristics associated with not having a personal physician. RESEARCH DESIGN: We compare rates of lacking a personal physician across subgroups...
February 16, 2018: Medical Care
Sean Orzol, Rosalind Keith, Mynti Hossain, Michael Barna, G Greg Peterson, Timothy Day, Boyd Gilman, Laura Blue, Keith Kranker, Kate A Stewart, Sheila Hoag, Lorenzo Moreno
BACKGROUND: The Center for Medicare & Medicaid Innovation (CMMI) tests new models of paying for or delivering health care services and expands models that improve health outcomes while lowering medical spending. CMMI gave TransforMED, a national learning and dissemination contractor, a 3-year Health Care Innovation Award (HCIA) to integrate health information technology systems into physician practices. This paper estimates impacts of TransforMED's HCIA-funded program on patient outcomes and Medicare parts A and B spending...
February 16, 2018: Medical Care
Jill A Marsteller, Yea-Jen Hsu, Christine Gill, Zippora Kiptanui, Oludolapo A Fakeye, Lilly D Engineer, Donna Perlmutter, Niharika Khanna, Gail B Rattinger, Donald Nichols, Ilene Harris
OBJECTIVE: To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries' experiences and satisfaction with care; and (3) perceptions of providers. DESIGN: 4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries...
February 16, 2018: Medical Care
Rachel Mosher Henke, Zeynal Karaca, Teresa B Gibson, Eli Cutler, Chapin White, Herbert S Wong
BACKGROUND: Research has suggested that growth in the Medicare Advantage (MA) program indirectly benefits the entire 65+-year-old population by reducing overall expenditures and creating spillover effects of patient care practices. Medicare programs and innovations initiated by the Affordable Care Act (ACA) have encouraged practices to adopt models applying to all patient populations, which may influence the continued benefits of MA program growth. OBJECTIVE: This study investigated the relationship between MA program growth and inpatient hospital costs and utilization before and after the ACA...
February 16, 2018: Medical Care
Leora I Horwitz, Yongfei Wang, Faseeha K Altaf, Changqin Wang, Zhenqiu Lin, Shuling Liu, Jacqueline Grady, Susannah M Bernheim, Nihar R Desai, Arjun K Venkatesh, Jeph Herrin
BACKGROUND: Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. DESIGN: Cross-sectional analysis. SUBJECTS: Nonfederal United States acute care hospitals. MEASURES: Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's "excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges...
February 16, 2018: Medical Care
Pearl A McElfish, Christopher R Long, Nalin Payakachat, Holly Felix, Zoran Bursac, Brett Rowland, Jonell S Hudson, Marie-Rachelle Narcisse
BACKGROUND: Adherence to medication treatment plans is important for chronic disease (CD) management. Cost-related nonadherence (CRN) puts patients at risk for complications. Native Hawaiians and Pacific Islanders (NHPI) suffer from high rates of CD and socioeconomic disparities that could increase CRN behaviors. OBJECTIVE: Examine factors related to CRN to medication treatment plans within an understudied population. RESEARCH DESIGN: Using 2014 NHPI-National Health Interview Survey data, we examined CRN among a nationally representative sample of NHPI adults...
February 9, 2018: Medical Care
Lisa I Iezzoni
No abstract text is available yet for this article.
February 9, 2018: Medical Care
Erika L Moen, Julie P Bynum, Andrea M Austin, Jonathan S Skinner, Gouri Chakraborti, Alistair James O'Malley
BACKGROUND: Implantable cardioverter defibrillator (ICD) therapy is used for primary prevention of death among people with heart failure, and new evidence in 2005 on its effectiveness changed practice guidelines in the United States. OBJECTIVES: The objective of this study is to examine how the connectedness of physicians and hospitals, measured using network analysis, relates to guideline-consistent ICD implantation. RESEARCH DESIGN: We constructed physician and hospital networks for cardiovascular disease...
February 6, 2018: Medical Care
Ku-Chou Chang, Jen-Wen Hung, Hsuei-Chen Lee, Chu-Ling Yen, Ching-Yi Wu, Chung-Lin Yang, Yu-Ching Huang, Pei-Li Lin, Hui-Hsuan Wang
BACKGROUND: It remains unclear whether rehabilitation has an impact on reducing the long-term risk of mortality or readmission following stroke or transient ischemic attack (TIA). OBJECTIVES: To investigate the association between the dosage and continuation of rehabilitation and the risk of outcome events (OEs) after stroke or TIA. RESEARCH DESIGN: A retrospective cohort study using Taiwan's National Health Insurance database. SUBJECTS: In total, 4594 patients admitted with first-ever acute stroke or TIA were followed-up for 32 months...
February 6, 2018: Medical Care
Kali S Thomas, Eric Boyd, Angela B Mariotto, Dolly C Penn, Michael J Barrett, Joan L Warren
BACKGROUND: The Surveillance, Epidemiology and End Results (SEER)-Medicare data combine clinical information from population-based cancer registries with Medicare claims. These data have been used in many studies to understand cancer screening, treatment, outcomes, and costs. However, until recently, these data included limited information related to the characteristics and outcomes of cancer patients residing in or admitted to nursing homes. OBJECTIVES: To provide an overview of the new linkage between SEER-Medicare data and the Minimum Data Set (MDS), a nursing home resident assessment instrument detailing residents' physical, psychological, and psychosocial functioning as well as any therapies or treatments received...
February 2, 2018: Medical Care
Kathleen B Cartmell, Mary Dooley, Martina Mueller, Georges J Nahhas, Clara E Dismuke, Graham W Warren, Vince Talbot, K Michael Cummings
INTRODUCTION: Smoking is a risk factor for hospitalization and interferes with patient care due to its effects on pulmonary function, wound healing, and interference with treatments and medications. Although benefits of stopping smoking are well-established, few hospitals provide tobacco dependence treatment services (TDTS) due to cost, lack of mandatory tobacco cessation standards and lack of evidence demonstrating clinical and financial benefits to hospitals and insurers for providing services...
February 2, 2018: Medical Care
Andrew S Huhn
No abstract text is available yet for this article.
February 2, 2018: Medical Care
David Seidenwurm
No abstract text is available yet for this article.
January 24, 2018: Medical Care
Resmi A Charalel, Jeremy C Durack, Jialin Mao, Joseph S Ross, Andrew J Meltzer, Art Sedrakyan
BACKGROUND: Public awareness of inferior vena cava (IVC) filter-related controversies has been elevated by the Food and Drug Administration (FDA) safety communication in 2010. OBJECTIVES: To examine population level trends in IVC filter utilization, complications, retrieval rates, and subsequent pulmonary embolism (PE) risk. DESIGN: A retrospective cohort study. SUBJECTS: Patients receiving IVC filters during 2005-2014 in New York State...
January 19, 2018: Medical Care
Mackenzie R Bronson, Nirav S Kapadia, Andrea M Austin, Qianfei Wang, Diane Feskanich, Julie P W Bynum, Francine Grodstein, Anna N A Tosteson
BACKGROUND: In an effort to overcome quality and cost constraints inherent in population-based research, diverse data sources are increasingly being combined. In this paper, we describe the performance of a Medicare claims-based incident cancer identification algorithm in comparison with observational cohort data from the Nurses' Health Study (NHS). METHODS: NHS-Medicare linked participants' claims data were analyzed using 4 versions of a cancer identification algorithm across 3 cancer sites (breast, colorectal, and lung)...
January 12, 2018: Medical Care
Karoline Mortensen, Manuel G Alcalá, Michael T French, Tianyan Hu
BACKGROUND: Amazon's Mechanical Turk (MTurk) platform has become a data source for peer-reviewed academic research publications, with over 24,000 Google Scholar search results. Although well-developed and supportive in other disciplines, the literature in health and medicine comparing results from samples generated on MTurk to gold standard, nationally representative health and medical surveys is beginning to emerge. OBJECTIVE: To compare the demographic, socioeconomic, and self-reported health status variables in an MTurk sample to those from 2 prominent national probability surveys, including the Medical Expenditure Panel Survey (MEPS) and the Behavioral Risk Factor Surveillance System (BRFSS)...
January 11, 2018: Medical Care
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