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Medical Care

Nancy L Keating, Haiden A Huskamp, Deborah Schrag, John M McWilliams, Barbara J McNeil, Bruce E Landon, Michael E Chernew, Sharon-Lise T Normand
BACKGROUND: Technological advances can improve care and outcomes but are a primary driver of health care spending growth. Understanding diffusion and use of new oncology therapies is important, given substantial increases in prices and spending on such treatments. OBJECTIVES: Examine diffusion of bevacizumab, a novel (in 2004) and high-priced biologic cancer therapy, among US oncology practices during 2005-2012 and assess variation in use across practices. RESEARCH DESIGN: Population-based observational study...
November 10, 2017: Medical Care
Jeffrey M Adams, Deborah Zimmermann, Pamela F Cipriano, Sharon Pappas, Joyce Batcheller
No abstract text is available yet for this article.
November 10, 2017: Medical Care
Slawa Rokicki, Jessica Cohen, Günther Fink, Joshua A Salomon, Mary Beth Landrum
BACKGROUND: Difference-in-differences (DID) estimation has become increasingly popular as an approach to evaluate the effect of a group-level policy on individual-level outcomes. Several statistical methodologies have been proposed to correct for the within-group correlation of model errors resulting from the clustering of data. Little is known about how well these corrections perform with the often small number of groups observed in health research using longitudinal data. METHODS: First, we review the most commonly used modeling solutions in DID estimation for panel data, including generalized estimating equations (GEE), permutation tests, clustered standard errors (CSE), wild cluster bootstrapping, and aggregation...
November 3, 2017: Medical Care
Laura E McClelland, Allison S Gabriel, Matthew J DePuccio
BACKGROUND: Compassion practices both recognize and reward compassion in the workplace as well as provide compassionate support to health care employees. However, these practices represent an underexplored organizational tool that may aid clinician well-being and positively impact patient ambulatory care experiences. OBJECTIVE: To examine the relationship between compassion practices and nursing staff well-being and clinic-level patients' experience ratings in the ambulatory clinic setting...
November 3, 2017: Medical Care
Raymund B Dantes, Shuai Zheng, James J Lu, Michele G Beckman, Asha Krishnaswamy, Lisa C Richardson, Sheri Chernetsky-Tejedor, Fusheng Wang
INTRODUCTION: The United States federally mandated reporting of venous thromboembolism (VTE), defined by Agency for Healthcare Research & Quality Patient Safety Indicator 12 (AHRQ PSI-12), is based on administrative data, the accuracy of which has not been consistently demonstrated. We used IDEAL-X, a novel information extraction software system, to identify VTE from electronic medical records and evaluated its accuracy. METHODS: Medical records for 13,248 patients admitted to an orthopedic specialty hospital from 2009 to 2014 were reviewed...
October 30, 2017: Medical Care
Tina W F Yen, Purushottam W Laud, Liliana E Pezzin, Emily L McGinley, Erica Wozniak, Rodney Sparapani, Ann B Nattinger
BACKGROUND: Despite clear guidelines for its use and wide adoption, no population-based study has examined the extent to which patients with early stage breast cancer are benefiting from sentinel lymph node biopsy (SLNB) by being spared a potentially avoidable axillary lymph node dissection (ALND) and its associated morbidity. OBJECTIVE: Examine variation in type of axillary surgery performed by surgeon volume; investigate the extent and consequences of potentially avoidable ALND...
October 30, 2017: Medical Care
Robert E Burke, Christine D Jones, Patrick Hosokawa, Thomas J Glorioso, Eric A Coleman, Adit A Ginde
IMPORTANCE: Hospitals and health care systems face increasing accountability for postdischarge outcomes of patients, but it is unclear how frequently hospital readmissions in particular occur at a different hospital than the index hospitalization and whether this is associated with worse outcomes. OBJECTIVE: Describe the prevalence of nonindex 30-day readmissions in a nationally representative sample of all payers and associations with outcomes. DESIGN: Secondary retrospective analysis of the 2013 Nationwide Readmissions Database...
October 30, 2017: Medical Care
Frances M Wu, Cindie A Slightam, Ava C Wong, Steven M Asch, Donna M Zulman
OBJECTIVE: The intensive and varied services required by high-need patients have inspired a number of new care delivery models; however, evidence of their effectiveness is mixed. This study evaluated whether augmenting a patient-centered medical home (PCMH) with intensive outpatient management enhances high-need patients' care processes. RESEARCH DESIGN: Retrospective analysis using differences-in-differences and χ tests. SUBJECTS: Of 545 high-need patients receiving PCMH care, 140 were previously randomly selected for the intensive outpatient management program; the remaining received usual care...
October 30, 2017: Medical Care
Frank Eijkenaar, René C J A van Vliet, Richard C van Kleef
BACKGROUND: The risk-equalization (RE) model in the Dutch health insurance market has evolved to a sophisticated model containing direct proxies for health. However, it still has important imperfections, leaving incentives for risk selection. This paper focuses on refining an important health-based risk-adjuster in this model: the diagnosis-based costs groups (DCGs). The current (2017) DCGs are calibrated on "old" data of 2011/2012, are mutually exclusive, and are essentially clusters of about 200 diagnosis-groups ("dxgroups")...
October 24, 2017: Medical Care
Helena Temkin-Greener, Dana B Mukamel, Heather Ladd, Susan Ladwig, Thomas V Caprio, Sally A Norton, Timothy E Quill, Tobie H Olsan, Xueya Cai
BACKGROUND: Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested. OBJECTIVE: Test the impact of PCTeams on end-of-life outcomes. RESEARCH DESIGN: Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention's placebo effect...
October 24, 2017: Medical Care
A Simon Pickard, Yu-Ting Hung, Fang-Ju Lin, Todd A Lee
BACKGROUND: Although societal preference weights are desirable to inform resource-allocation decision-making, patient experienced health state-based value sets can be useful for clinical decision-making, but context may matter. OBJECTIVE: To estimate EQ-5D value sets using visual analog scale (VAS) ratings for patients undergoing knee replacement surgery and compare the estimates before and after surgery. METHODS: We used the Patient Reported Outcome Measures data collected by the UK National Health Service on patients undergoing knee replacement from 2009 to 2012...
October 13, 2017: Medical Care
Arif H Kamal
No abstract text is available yet for this article.
September 15, 2017: Medical Care
Mollie E Wood, Stavroula Chrysanthopoulou, Hedvig M E Nordeng, Kate L Lapane
PURPOSE: To investigate the ability of the propensity score (PS) to reduce confounding bias in the presence of nondifferential misclassification of treatment, using simulations. METHODS: Using an example from the pregnancy medication safety literature, we carried out simulations to quantify the effect of nondifferential misclassification of treatment under varying scenarios of sensitivity and specificity, exposure prevalence (10%, 50%), outcome type (continuous and binary), true outcome (null and increased risk), confounding direction, and different PS applications (matching, stratification, weighting, regression), and obtained measures of bias and 95% confidence interval coverage...
September 15, 2017: Medical Care
Sudhakar V Nuti, Yun Wang, Frederick A Masoudi, Marcella Nunez-Smith, Sharon-Lise T Normand, Karthik Murugiah, Orlando Rodríguez-Vilá, Joseph S Ross, Harlan M Krumholz
BACKGROUND: Millions of Americans live in the US territories, but health outcomes and payments among Medicare beneficiaries in these territories are not well characterized. METHODS: Among Fee-for-Service Medicare beneficiaries aged 65 years and older hospitalized between 1999 and 2012 for acute myocardial infarction (AMI), heart failure (HF), and pneumonia, we compared hospitalization rates, patient outcomes, and inpatient payments in the territories and states...
September 15, 2017: Medical Care
Brian J Moore, Anne Elixhauser
No abstract text is available yet for this article.
August 28, 2017: Medical Care
Alfredo De Giorgi, Fabio Fabbian
No abstract text is available yet for this article.
August 28, 2017: Medical Care
John P Browne, Stefan J Cano, Sarah Smith
No abstract text is available yet for this article.
August 28, 2017: Medical Care
(no author information available yet)
No abstract text is available yet for this article.
December 2017: Medical Care
Clara E Filice, Karen E Joynt
Racial and ethnic disparities are observed in the health status and health outcomes of Medicare beneficiaries. Reducing these disparities is a national priority, and having high-quality data on individuals' race and ethnicity is critical for researchers working to do so. However, using Medicare data to identify race and ethnicity is not straightforward. Currently, Medicare largely relies on Social Security Administration data for information about Medicare beneficiary race and ethnicity. Directly self-reported race and ethnicity information is collected for subsets of Medicare beneficiaries but is not explicitly collected for the purpose of populating race/ethnicity information in the Medicare administrative record...
December 2017: Medical Care
John E Snyder, Matthew Jensen, Nguyen X Nguyen, Clara E Filice, Karen E Joynt
Rural beneficiaries make up nearly one quarter of the Medicare population, yet rural providers and patients face specific challenges with health and health care delivery that remain inadequately understood. Health disparities between rural and urban residents are widespread, barriers to health care in rural communities persist, and the rural health care workforce is limited. To better understand and track the relationship between rurality and performance under Medicare's payment programs, researchers must be able to identify rural beneficiaries, providers, and hospitals...
December 2017: Medical Care
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