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Medical Care

Kimberly E Lind, Kerry Hildreth, Richard Lindrooth, Lori A Crane, Elaine Morrato, Marcelo Coca Perraillon
INTRODUCTION: In 2011, Medicare began offering annual preventive care visits (annual wellness visit; AWV) to beneficiaries at no charge. Providing free preventive care supports primary and secondary prevention of chronic disease and may reduce ethnoracial disparities in health outcomes. OBJECTIVES: To estimate AWV utilization trends by ethnoracial group in a nationally representative sample of the Medicare population. RESEARCH DESIGN: We estimated the probability of AWV utilization using probit regression models with beneficiary-reported ethnoracial group as the primary predictor and demographics, socioeconomic indicators, and factors related to access and utilization of health care as covariates...
July 13, 2018: Medical Care
Consuelo H Wilkins
Engaging patients and community stakeholders as partners in research requires effective communication, inclusion in decision making, and mutually respectful relationships. Developing and maintaining trust among stakeholders and researchers is critical for successful engagement, especially in partnerships involving patients or community stakeholders in which there is often an imbalance of power. Although patients and community members are assuming new roles and greater responsibility in research partnerships, they often rely on researchers to help navigate unfamiliar research settings and share resources...
July 13, 2018: Medical Care
Lusine Poghosyan, Allison A Norful, Jianfang Liu, Mark W Friedberg
BACKGROUND: The chronic disease burden in the United States represents a significant challenge for the primary care system. The nurse practitioner (NP) workforce can help meet the demand for care; however, organizational barriers such as poor practice environments prevent NPs from delivering high quality care. OBJECTIVES: We investigated the relationship between NP practice environments and quality of care for chronic diseases. RESEARCH DESIGN: We fit regression models to assess cross-sectional associations between claims-based quality measure performance and survey data on NP practice environments in Massachusetts...
July 13, 2018: Medical Care
Stephen F Derose, Hui Zhou, Brian Z Huang, Prasanth Manthena, Dennis Hwang, Jiaxiao M Shi
BACKGROUND: Sleep apnea is underdiagnosed and thus undertreated. If therapy for sleep apnea results in reduced health care utilization in an entire treated population, then decision-makers will have key information for allocating limited health care resources. OBJECTIVES: To determine whether positive airway pressure (PAP) for sleep apnea was associated with reduced health care utilization in an entire treated population. RESEARCH DESIGN: This was a retrospective cohort; propensity score-matched cases and noncases; pre-post analyses of individual subject utilization...
July 13, 2018: Medical Care
Jeongyoung Park, Xiaoli Wu, Bianca K Frogner, Patricia Pittman
BACKGROUND: Few studies have looked under the hood of practice redesign to understand whether and, if so, how staffing changed with the adoption of patient-centered medical home (PCMH), and whether these staffing changes impacted utilization. OBJECTIVES: To examine the workforce transformation occurring in community health centers that have achieved PCMH status, and to assess the relationship of those changes to utilization, as measured by the number of visits. RESEARCH DESIGN, SUBJECTS, MEASURES: Using a difference-in-differences approach, we compared staffing and utilization outcomes in 450 community health centers that had adopted a PCMH model between 2007 and 2013 to a matched sample of 243 nonadopters located in the 50 states and the District of Columbia...
July 13, 2018: Medical Care
Rebecca Wells, Trey W Armstrong, Daniel F Brossart
BACKGROUND: The Relational Coordination (RC) instrument has been used extensively in the context of health care interprofessional coordination. However, the instrument's applicability to patient experiences of their interactions with professionals is largely untested. OBJECTIVES: This study's objectives were to determine: (1) whether the RC instrument could be modified for phone administration to yield internally consistent results when used with a diverse group of patients with complex health needs; and (2) whether the RC factor was invariant across patients of differing education, levels of emotional problems, race, and ethnicity, thereby showing similar interpretation of items across these groups...
July 13, 2018: Medical Care
Jean-Marie Januel, Patrick S Romano, Chantal M Couris, Phil Hider, Hude Quan, Cyrille Colin, Bernard Burnand, William A Ghali
BACKGROUND: Routinely collected hospital data provide increasing opportunities to assess the performance of health care systems. Several factors may, however, influence performance measures and their interpretation between countries. OBJECTIVE: We compared the occurrence of in-hospital venous thromboembolism (VTE) in patients undergoing hip replacement across 5 countries and explored factors that could explain differences across these countries. METHODS: We performed cross-sectional studies independently in 5 countries: Canada; France; New Zealand; the state of California; and Switzerland...
July 11, 2018: Medical Care
Olivia Burrus, Catherine Gupta, Alexa Ortiz, Brittany Zulkiewicz, Robert Furberg, Jennifer Uhrig, Camilla Harshbarger, Megan A Lewis
No abstract text is available yet for this article.
July 11, 2018: Medical Care
Jenny W Sun, James R Rogers, Qoua Her, Emily C Welch, Catherine A Panozzo, Sengwee Toh, Joshua J Gagne
No abstract text is available yet for this article.
July 11, 2018: Medical Care
Mingyang Shan, Roee Gutman, David Dosa, Pedro L Gozalo, Jessica A Ogarek, Sarah Kler, Kali S Thomas
BACKGROUND: Access to social services (eg, nutrition) can impact older adults' health care utilization and health outcomes. However, data documenting the relationship between receiving services and objective measures of health care utilization remain limited. OBJECTIVES: To link Meals on Wheels (MOW) program data to Medicare claims to enable examination of clients' health and health care utilization and to highlight the utility of this linked dataset. RESEARCH DESIGN: Using probabilistic linking techniques, we matched MOW client data to Medicare enrollment and claims data...
July 11, 2018: Medical Care
Lisa M Lines, Jessica A Williams
No abstract text is available yet for this article.
July 9, 2018: Medical Care
Rachel Kimerling
No abstract text is available yet for this article.
June 22, 2018: Medical Care
Rozalina G McCoy, Stephanie M Peterson, Lynn S Borkenhagen, Paul Y Takahashi, Bjorg Thorsteinsdottir, Anupam Chandra, James M Naessens
BACKGROUND: Care transitions programs have been shown to reduce hospital readmissions. OBJECTIVES: The main objective of this study was to evaluate effects of the Mayo Clinic Care Transitions (MCCTs) Program on potentially preventable and nonpreventable 30-day unplanned readmissions among high-risk elders. RESEARCH DESIGN: This was a retrospective cohort study of patients enrolled in MCCT following hospitalization and propensity score-matched controls receiving usual primary care...
June 22, 2018: Medical Care
Merritt Edlind, Nandita Mitra, David Grande, Frances K Barg, Tamala Carter, Lindsey Turr, Karen Glanz, Judith A Long, Shreya Kangovi
BACKGROUND: Half of all Americans have a chronic disease. Promoting healthy behaviors to decrease this burden is a national priority. A number of behavioral interventions have proven efficacy; yet even the most effective of these has high levels of nonresponse. OBJECTIVES: In this study, we explore variation in response to an evidence-based community health worker (CHW) intervention for chronic disease management. RESEARCH DESIGN: We used a convergent parallel design that combined a randomized controlled trial with a qualitative process evaluation that triangulated chart abstraction, in-depth interviews and participant observation...
June 22, 2018: Medical Care
Ron D Hays, Joshua S Mallett, Ann Haas, Katherine L Kahn, Steven C Martino, Sarah Gaillot, Marc N Elliott
RESEARCH OBJECTIVE: Care coordination among health care providers is essential for high-quality care and it is strongly associated with overall ratings of doctors. Care coordination may be especially important for sicker and chronically ill patients because of the multiple providers involved in their care. This study examines whether the association of care coordination with global ratings of one's personal doctor varies by number of chronic conditions and self-rated health. STUDY DESIGN: We used nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data to evaluate care coordination, doctor communication, getting needed care, getting care quickly, count of 6 chronic conditions (angina, cancer, chronic obstructive pulmonary disease, diabetes, heart attack, stroke), self-rated general health (5-point scale, poor to excellent, scored linearly), and interactions among them as predictors of the CAHPS global rating of personal doctor (scored 0-100 with 100 being best possible personal doctor) using linear regression models...
June 22, 2018: Medical Care
Haomiao Jia, Erica I Lubetkin, John P Barile, Willi Horner-Johnson, Kimberly DeMichele, Debra S Stark, Matthew M Zack, William W Thompson
BACKGROUND: Although the life expectancy for the US population has increased, a high proportion of this population has lived with ≥1 chronic conditions. We have quantified the burden of disease associated with 15 chronic conditions and combinations of conditions by estimating quality-adjusted life years (QALYs) for older US adults. RESEARCH DESIGN: Data were from the Medicare Health Outcomes Survey Cohort 15 (baseline survey in 2012, follow-up survey 2014, with mortality follow-up through January 31, 2015)...
June 22, 2018: Medical Care
Tadahiro Goto, Mohammad K Faridi, Carlos A Camargo, Kohei Hasegawa
OBJECTIVE: To investigate the longitudinal changes in principal readmission diagnoses within 30 days after hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). STUDY SETTING: Medicare claims data, 2010-2012. STUDY DESIGN: Retrospective cohort study. DATA COLLECTION METHODS: We identified AECOPD hospitalizations aged 65 years and above, and examined the principal 30-day readmission diagnoses (respiratory related, cardiac related, and other conditions)...
June 15, 2018: Medical Care
Katy B Kozhimannil, Amy J Graves, Alexandra M Ecklund, Neel Shah, Reena Aggarwal, Jonathan M Snowden
BACKGROUND: Nearly half of US births are financed by Medicaid, and one-third of births occur by cesarean delivery, at double the cost of vaginal delivery. With the goal of reducing unnecessary cesarean use and improving value, in 2009 Minnesota's Medicaid program introduced a blended payment rate for uncomplicated births (ie, a single facility or professional services payment regardless of delivery mode). OBJECTIVE: We evaluated the effect of the blended payment policy on cesarean use and costs for Medicaid fee-for-service births...
June 15, 2018: Medical Care
Yeunkyung Kim, Caroline P Thirukumaran, Yue Li
BACKGROUND: Accountable Care Organizations in the Medicare Shared Savings Program (MSSP) have financial incentives to reduce the cost and improve the quality of care delivered to Medicare beneficiaries that they serve. However, previous research about the impact of the MSSP on readmissions is limited and mixed. OBJECTIVE: To examine the association between hospital participation in the MSSP during the 2012-2013 period and reductions in 30-day risk-standardized readmission rates for Medicare patients initially admitted for acute myocardial infarction, heart failure (HF), pneumonia, or any cause...
June 15, 2018: Medical Care
Steven C Martino, Marc N Elliott, Joshua S Mallett, Nate Orr, Sarah Gaillot, Amelia M Haviland
BACKGROUND: Disparities in clinical process-of-care and patient experiences are well documented for Medicare beneficiaries with ≥1 social risk factors. If such patients are less willing to express disagreement with their doctors or change doctors when dissatisfied, these behaviors may play a role in observed disparities. OBJECTIVE: To investigate the association between social risk factors and self-reported likelihood of disagreeing with or changing doctors if dissatisfied among the Medicare fee-for-service population...
June 12, 2018: Medical Care
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