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https://www.readbyqxmd.com/read/28787347/improved-correction-of-misclassification-bias-with-bootstrap-imputation
#1
Carl van Walraven
OBJECTIVE: Diagnostic codes used in administrative database research can create bias due to misclassification. Quantitative bias analysis (QBA) can correct for this bias, requires only code sensitivity and specificity, but may return invalid results. Bootstrap imputation (BI) can also address misclassification bias but traditionally requires multivariate models to accurately estimate disease probability. This study compared misclassification bias correction using QBA and BI. STUDY DESIGN: Serum creatinine measures were used to determine severe renal failure status in 100,000 hospitalized patients...
August 4, 2017: Medical Care
https://www.readbyqxmd.com/read/28763374/the-veterans-affairs-cardiac-risk-score-recalibrating-the-atherosclerotic-cardiovascular-disease-score-for-applied-use
#2
Jeremy B Sussman, Wyndy L Wiitala, Matthew Zawistowski, Timothy P Hofer, Douglas Bentley, Rodney A Hayward
BACKGROUND: Accurately estimating cardiovascular risk is fundamental to good decision-making in cardiovascular disease (CVD) prevention, but risk scores developed in one population often perform poorly in dissimilar populations. We sought to examine whether a large integrated health system can use their electronic health data to better predict individual patients' risk of developing CVD. METHODS: We created a cohort using all patients ages 45-80 who used Department of Veterans Affairs (VA) ambulatory care services in 2006 with no history of CVD, heart failure, or loop diuretics...
July 31, 2017: Medical Care
https://www.readbyqxmd.com/read/28742545/reductions-in-readmission-rates-are-associated-with-modest-improvements-in-patient-reported-health-gains-following-hip-and-knee-replacement-in-england
#3
Rocco Friebel, Kumar Dharmarajan, Harlan M Krumholz, Adam Steventon
BACKGROUND: Although many hospital readmission reduction initiatives have been introduced globally, health care systems ultimately aim to improve patients' health and well-being. We examined whether the hospitals that report greater success in reducing readmissions also see greater improvements in patient-reported outcomes. RESEARCH DESIGN: We examined hospital groups (Trusts) that provided hip replacement or knee replacement surgery in England between April 2010 and February 2013...
July 24, 2017: Medical Care
https://www.readbyqxmd.com/read/28742544/the-marginal-costs-of-adverse-drug-events-associated-with-exposures-to-anticoagulants-and-hypoglycemic-agents-during-hospitalization
#4
William D Spector, Rhona Limcangco, Michael F Furukawa, William E Encinosa
BACKGROUND: Anticoagulants and hypoglycemic agents are 2 of the most challenging drug classes for medical management in the hospital resulting in many adverse drug events (ADE). OBJECTIVE: Estimating the marginal cost (MC) of ADEs associated with anticoagulants and hypoglycemic agents for adults in 5 patient groups during their hospital stay and the total annual ADE costs for all patients exposed to these drugs during their stay. RESEARCH DESIGN AND SUBJECT: Data are from 2010 to 2013 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and Medicare Patient Safety Monitoring System (MPSMS)...
July 24, 2017: Medical Care
https://www.readbyqxmd.com/read/28731893/validity-of-administrative-data-in-identifying-cancer-related-events-in-adolescents-and-young-adults-a-population-based-study-using-the-impact-cohort
#5
Sumit Gupta, Paul C Nathan, Nancy N Baxter, Cindy Lau, Corinne Daly, Jason D Pole
BACKGROUND: Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults with cancer. METHODS: We identified all Ontario adolescents and young adults 15-21 years old diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992-2012...
July 20, 2017: Medical Care
https://www.readbyqxmd.com/read/28719488/the-impact-of-the-affordable-care-act-s-dependent-coverage-mandate-on-use-of-dental-treatments-and-preventive-services
#6
Dan M Shane, George L Wehby
BACKGROUND: Oral health problems are the leading chronic conditions among children and younger adults. Lack of dental coverage is thought to be an important barrier to care but little empirical evidence exists on the causal effect of private dental coverage on use of dental services. We explore the relationship between dental coverage and dental services utilization with an analysis of a natural experiment of increasing private dental coverage stemming from the Affordable Care Act's (ACA)-dependent coverage mandate...
July 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28692572/health-care-engagement-and-follow-up-after-perceived-discrimination-in-maternity-care
#7
Laura Attanasio, Katy B Kozhimannil
BACKGROUND: Negative experiences in the health care system, including perceived discrimination, can result in patient disengagement from health care. Four million US women give birth each year, and the perinatal period is a time of sustained interaction with the health care system, but potential consequences of negative experiences have not been examined in this context. We assessed whether perceived discrimination during the birth hospitalization were associated with postpartum follow-up care...
July 7, 2017: Medical Care
https://www.readbyqxmd.com/read/28671930/icd-social-codes-an-underutilized-resource-for-tracking-social-needs
#8
Jacqueline M Torres, John Lawlor, Jeffrey D Colvin, Marion R Sills, Jessica L Bettenhausen, Amber Davidson, Gretchen J Cutler, Matt Hall, Laura M Gottlieb
BACKGROUND: Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classification of Diseases and Related Health Problems (ICD). OBJECTIVE: To explore how SDH are captured with ICD Ninth revision SDH V codes in a national inpatient discharge database...
June 30, 2017: Medical Care
https://www.readbyqxmd.com/read/28650924/comparison-of-approaches-for-notification-and-authorization-in-pragmatic-clinical-research-evaluating-commonly-used-medical-practices
#9
Kevin P Weinfurt, Juli M Bollinger, Kathleen M Brelsford, Martina Bresciani, Zachary Lampron, Li Lin, Rachel J Topazian, Jeremy Sugarman
BACKGROUND: For pragmatic clinical research comparing commonly used treatments, questions exist about if and how to notify participants about it and secure their authorization for participation. OBJECTIVE: To determine how patients react when they seek clinical care and encounter one of several different pragmatic clinical research studies. RESEARCH DESIGN: In an online survey using a between-subjects experimental design, respondents read and responded to 1 of 24 hypothetical research scenarios reflecting different types of studies and approaches to notification and authorization (eg, general notification, oral consent, written consent)...
June 23, 2017: Medical Care
https://www.readbyqxmd.com/read/28590958/constructing-a-measure-of-private-pay-nursing-home-days
#10
Kali S Thomas, Benjamin Silver, Pedro L Gozalo, David Dosa, David C Grabowski, Rajesh Makineni, Vincent Mor
BACKGROUND: Nursing home (NH) care is financed through multiple sources. Although Medicaid is the predominant payer for NH care, over 20% of residents pay out-of-pocket for their care. Despite this large percentage, an accepted measure of private-pay NH occupancy has not been established and little is known about the types of facilities and the long-term care markets that cater to this population. OBJECTIVES: To describe 2 novel measures of private-pay utilization in the NH setting, including the proportion of privately financed residents and resident days, and examine their construct validity...
June 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28806374/long-acting-reversible-contraception-among-homeless-women-veterans-with-chronic-health-conditions-a-retrospective-cohort-study
#11
Lori M Gawron, Andrew Redd, Ying Suo, Warren Pettey, David K Turok, Adi V Gundlapalli
BACKGROUND: US women Veterans are at increased risk of homelessness and chronic health conditions associated with unintended pregnancy. Veterans Health Administration (VHA) provision of long-acting reversible contraception (LARC) can assist in healthy pregnancy planning. OBJECTIVES: To evaluate perinatal risk factors and LARC exposure in ever-homeless women Veterans. RESEARCH DESIGN: A retrospective cohort study of women Veterans using VHA administrative data from fiscal years 2002-2015...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806373/patient-aligned-care-team-engagement-to-connect-veterans-experiencing-homelessness-with-appropriate-health-care
#12
Adi V Gundlapalli, Andrew Redd, Daniel Bolton, Megan E Vanneman, Marjorie E Carter, Erin Johnson, Matthew H Samore, Jamison D Fargo, Thomas P O'Toole
BACKGROUND: Veterans experiencing homelessness frequently use emergency and urgent care (ED). OBJECTIVE: To examine the effect of a Patient-aligned Care Team (PACT) model tailored to the unique needs of Veterans experiencing homelessness (H-PACT) on frequency and type of ED visits in Veterans Health Administration (VHA) medical facilities. RESEARCH DESIGN: During a 12-month period, ED visits for 3981 homeless Veterans enrolled in (1) H-PACT at 20 VHA medical centers (enrolled) were compared with those of (2) 24,363 homeless Veterans not enrolled in H-PACT at the same sites (nonenrolled), and (3) 23,542 homeless Veterans at 12 non-H-PACT sites (usual care) using a difference-in-differences approach...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806372/exploring-rural-disparities-in-medical-diagnoses-among-veterans-with-transgender-related-diagnoses-utilizing-veterans-health-administration-care
#13
Leigh A Bukowski, John Blosnich, Jillian C Shipherd, Michael R Kauth, George R Brown, Adam J Gordon
OBJECTIVES: Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806371/transgender-veterans-satisfaction-with-care-and-unmet-health-needs
#14
Keren Lehavot, Jodie G Katon, Tracy L Simpson, Jillian C Shipherd
BACKGROUND: Transgender individuals are overrepresented among Veterans. However, little is known regarding their satisfaction with Veterans Administration (VA) care and unmet health needs. OBJECTIVES: This study examined transgender Veterans' satisfaction with VA medical and mental health care, prevalence of delaying care, and correlates of these outcomes. RESEARCH DESIGN: We used data from transgender Veterans collected in 2014 through an online, national survey...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806370/will-veterans-answer-sexual-orientation-and-gender-identity-questions
#15
Mollie A Ruben, John R Blosnich, Melissa E Dichter, Lorry Luscri, Jillian C Shipherd
BACKGROUND: The Veterans Health Administration does not routinely collect and document sexual orientation and gender identity (SOGI) data, despite existing health disparities among sexual and gender minority Veterans. Because of the legacy of previous Department of Defense (DoD) policies that prohibited disclosure of sexual or gender minority identities among active duty personnel, Veterans may be reluctant to respond to SOGI questions. OBJECTIVES: This population-based study assesses item nonresponse to SOGI questions by Veteran status...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806369/intimate-partner-violence-victimization-and-associated-implications-for-health-and-functioning-among-male-and-female-post-9-11-veterans
#16
Katherine M Iverson, Dawne Vogt, Rachel M Maskin, Brian N Smith
BACKGROUND: There is increased emphasis on identifying patients who experience intimate partner violence (IPV) in Department of Veterans Affairs and other health care settings. A better understanding of IPV's implications for health and functioning is needed among post-911 Veterans, and especially male Veterans, to inform IPV screening and response. OBJECTIVES: To identify past 6-month IPV experienced among partnered post-9/11 Veterans and examine sex-based associations between IPV and health...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806368/increased-health-care-utilization-and-costs-among-veterans-with-a-positive-screen-for-military-sexual-trauma
#17
Emily Brignone, Adi V Gundlapalli, Rebecca K Blais, Rachel Kimerling, Tyson S Barrett, Richard E Nelson, Marjorie E Carter, Matthew H Samore, Jamison D Fargo
BACKGROUND: The effects of sexual trauma on long-term health care utilization and costs are not well understood due to infrequent documentation of sexual trauma history in health care systems. The Veteran's Health Administration provides a unique opportunity to address this constraint as sexual trauma is actively screened for as part of routine care. METHODS: We used a retrospective cohort design to analyze Veteran's Health Administration mental health and medical service utilization and costs as a function of a positive screen for exposure to military sexual trauma (MST) among Veterans of recent conflicts in Iraq and Afghanistan...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806367/creating-a-toolkit-to-reduce-disparities-in-patient-engagement
#18
Shimrit Keddem, Aneeza Z Agha, Judith A Long, Rachel M Werner, Judy A Shea
BACKGROUND: Patient engagement has become a major focus of health care improvement efforts nationally. Although evidence suggests patient engagement can be beneficial to patients, it has not been consistently defined, operationalized, or translated into practice. OBJECTIVES: Our objective was to develop a toolkit to help providers increase patient engagement and reduce disparities in patient engagement. RESEARCH DESIGN: We used qualitative interviews and observations with staff at primary care sites nationally to identify patient engagement practices and resources used to engage patients...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806366/african-american-veterans-storytelling-a-multisite-randomized-trial-to-improve-hypertension
#19
Thomas K Houston, Gemmae M Fix, Stephanie L Shimada, Judith A Long, Howard S Gordon, Charlene Pope, Julie Volkman, Jeroan J Allison, Kathryn DeLaughter, Michelle Orner, Barbara G Bokhour
BACKGROUND: Disparities in hypertension control persist for African American Veterans. OBJECTIVE: To enhance cultural relevance of hypertension control self-management education, in a multisite, stratified randomized trial, we tested an interactive Veteran-to-Veteran storytelling digital video disk (DVD) intervention created with Veteran partners, versus an education-only DVD comparison. METHODS: At 3 VA facilities, African American Veterans with uncontrolled hypertension were randomized to storytelling DVD intervention or didactic comparison DVD and followed for 6 months...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28806365/associations-between-perceived-race-based-discrimination-and-contraceptive-use-among-women-veterans-in-the-ecuun-study
#20
Serena MacDonald, Leslie R M Hausmann, Florentina E Sileanu, Xinhua Zhao, Maria K Mor, Sonya Borrero
OBJECTIVE: To describe perceived race-based discrimination in Veterans Affairs (VA) health care settings and assess its associations with contraceptive use among a sample of women Veterans. METHODOLOGY: This study used data from a national telephone survey of women Veterans aged 18-44 receiving health care in VA who were at risk of unintended pregnancy. Participants were asked about their perceptions of race-based discrimination while seeking VA health care and about their contraceptive use at last heterosexual intercourse...
September 2017: Medical Care
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