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Medical Care

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https://www.readbyqxmd.com/read/28221277/introduction-to-medical-care-statistical-workshops-for-health-services-research-practical-state-of-the-art-reviews
#1
Claude M Setodji, Jeroan J Allison
No abstract text is available yet for this article.
February 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28221276/a-comparison-of-self-reported-medication-adherence-to-concordance-between-part-d-claims-and-medication-possession
#2
Samuel T Savitz, Sally C Stearns, Lei Zhou, Emily Thudium, Khalid A Alburikan, Richard Tran, Jo E Rodgers
OBJECTIVE: Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence. MATERIALS AND METHODS: We matched Part D claims for 6 common medications to medications brought to a study visit in 2011-2013 for the Atherosclerosis Risk in Communities study...
February 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28221275/changes-in-emergency-department-utilization-after-early-medicaid-expansion-in-california
#3
Lindsay M Sabik, Peter J Cunningham, Ali Bonakdar Tehrani
BACKGROUND: Medicaid expansions aim to improve access to primary care, which could reduce nonemergent (NE) use of the emergency department (ED). In contrast, Medicaid enrollees use the ED more than other groups, including the uninsured. Thus, the expected impact of Medicaid expansion on ED use is unclear. OBJECTIVES: To estimate changes in total and NE ED visits as a result of California's early Medicaid expansion under the Affordable Care Act. In addition to overall changes in the number of visits, changes by payer and safety net hospital status are examined...
February 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28221274/pharmacy-use-in-the-first-year-of-the-veterans-choice-program-a-mixed-methods-evaluation
#4
Walid F Gellad, Francesca E Cunningham, Chester B Good, Joshua M Thorpe, Carolyn T Thorpe, Brandi Bair, KatieLynn Roman, Susan L Zickmund
BACKGROUND: The Veterans Choice Program (VCP) was created to ensure timely access to health care in the Department of Veterans Affairs (VA). Under this program, medications may be ordered by select non-VA clinicians to be dispensed by VA pharmacies, creating new challenges in ensuring medication safety. OBJECTIVES: To examine pharmaceutical use during the first year of the VCP and to understand barriers and facilitators for VA pharmacists to dispensing medications under the VCP...
February 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28221273/the-association-between-immigration-status-and-office-based-medical-provider-visits-for-cancer-patients-in-the-united-states
#5
Yang Wang, Fernando A Wilson, Li-Wu Chen
OBJECTIVES: We examined differences in cancer-related office-based provider visits associated with immigration status in the United States. METHODS: Data from the 2007-2012 Medical Expenditure Panel Survey and National Health Interview Survey included adult patients diagnosed with cancer. Univariate analyses described distributions of cancer-related office-based provider visits received, expenditures, visit characteristics, as well as demographic, socioeconomic, and health covariates, across immigration groups...
February 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28169977/meta-analysis-of-odds-ratios-current-good-practices
#6
Bei-Hung Chang, David C Hoaglin
BACKGROUND: Many systematic reviews of randomized clinical trials lead to meta-analyses of odds ratios (ORs). The customary methods of estimating an overall OR involve weighted averages of the individual trials' estimates of the logarithm of the OR. That approach, however, has several shortcomings, arising from assumptions and approximations, that render the results unreliable. Although the problems have been documented in the literature for many years, the conventional methods persist in software and applications...
February 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28169976/the-impact-of-alternative-payment-in-chronically-ill-and-older-patients-in-the-patient-centered-medical-home
#7
Claudia A Salzberg, Asaf Bitton, Stuart R Lipsitz, Cal Franz, Shimon Shaykevich, Lisa P Newmark, Japneet Kwatra, David W Bates
BACKGROUND: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change...
February 6, 2017: Medical Care
https://www.readbyqxmd.com/read/28146037/the-veterans-choice-act-a-qualitative-examination-of-rapid-policy-implementation-in-the-department-of-veterans-affairs
#8
Kristin M Mattocks, Michelle Mengeling, Anne Sadler, Rebecca Baldor, Lori Bastian
BACKGROUND: Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 [Veterans Choice Act (VCA)] to improve access to timely, high-quality health care for Veterans. Although Congress mandated that VCA must begin within 90 days of passage of the legislation, no guidelines were provided in the legislation to ensure that Veterans had access to an adequate number of community providers across different specialties of care or distinct geographic areas, including rural areas of the country...
January 31, 2017: Medical Care
https://www.readbyqxmd.com/read/28146036/iraq-and-afghanistan-veterans-use-of-veterans-health-administration-and-purchased-care-before-and-after-veterans-choice-program-implementation
#9
Megan E Vanneman, Alex H S Harris, Steven M Asch, Winifred J Scott, Samantha S Murrell, Todd H Wagner
BACKGROUND: The veterans choice program (VCP), enacted by Congress after concerns surfaced about access, enables veterans to receive care outside Veterans Health Administration (VHA) facilities. Veterans who face long wait times, large driving distances, or particular hardships are eligible for VCP. Prior purchased care programs were comparatively limited in scope. OBJECTIVES: We sought to describe utilization of VHA-provided and purchased outpatient care by veterans eligible for VCP before and after VCP implementation...
January 31, 2017: Medical Care
https://www.readbyqxmd.com/read/28146035/community-clinicians-and-the-veterans-choice-program-for-ptsd-care-understanding-provider-interest-during-early-implementation
#10
Erin P Finley, Polly H Noël, Michael Mader, Elizabeth Haro, Nancy Bernardy, Craig S Rosen, Mary Bollinger, Hector Garcia, Kathleen Sherrieb, Mary Jo V Pugh
BACKGROUND: In 2014, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program (VCP) to provide reimbursement for community-based care to eligible veterans. Inadequate networks of participating providers may impact the utility of VCP for veterans with posttraumatic stress disorder (PTSD), a complex condition occurring at lower frequency among civilians. OBJECTIVES: To compare characteristics and attitudes of community-based primary care and mental health providers reporting interest or no interest in VCP participation during early implementation; and to examine perceptions and experiences of VCP among "early adopters...
January 31, 2017: Medical Care
https://www.readbyqxmd.com/read/28079710/electronic-health-record-data-versus-the-national-health-and-nutrition-examination-survey-nhanes-a-comparison-of-overweight-and-obesity-rates
#11
Luke M Funk, Ying Shan, Corrine I Voils, John Kloke, Lawrence P Hanrahan
BACKGROUND: Estimating population-level obesity rates is important for informing policy and targeting treatment. The current gold standard for obesity measurement in the United States-the National Health and Nutrition Examination Survey (NHANES)-samples <0.1% of the population and does not target state-level or health system-level measurement. OBJECTIVE: To assess the feasibility of using body mass index (BMI) data from the electronic health record (EHR) to assess rates of overweight and obesity and compare these rates to national NHANES estimates...
January 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28079709/meaningful-use-of-electronic-health-records-by-outpatient-physicians-and-readmissions-of-medicare-fee-for-service-beneficiaries
#12
Mark A Unruh, Hye-Young Jung, Joshua R Vest, Lawrence P Casalino, Rainu Kaushal
BACKGROUND: Nearly one-fifth of hospitalized Medicare fee-for-service beneficiaries are readmitted within 30 days. Participation in the Meaningful Use initiative among outpatient physicians may reduce readmissions. OBJECTIVE: To evaluate the impact of outpatient physicians' participation in Meaningful Use on readmissions. SUBJECTS AND RESEARCH DESIGN: The study population included 90,774 Medicare fee-for-service beneficiaries from New York State (2010-2012)...
January 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28060052/evaluating-the-effects-of-pioneer-accountable-care-organizations-on-medicare-part-d-drug-spending-and-utilization
#13
Yuting Zhang, Kadin J Caines, Christopher A Powers
BACKGROUND: The improvement of medication use is a critical mechanism that accountable care organization (ACO) could use to save overall costs. Currently pharmaceutical spending is not part of the calculation for ACO-shared savings and risks. Thus, ACO providers may have strong incentives to prescribe more medications hoping to avoid expensive downstream medical costs. METHODS: We designed a quasinatural experiment study to evaluate the effects of Pioneer ACOs on Medicare Part D spending and utilization...
January 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28060051/e-prescribing-and-adverse-drug-events-an-observational-study-of-the-medicare-part-d-population-with-diabetes
#14
Meghan Hufstader Gabriel, Christopher Powers, William Encinosa, Julie P W Bynum
BACKGROUND: Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes. OBJECTIVE: To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia. DESIGN: This is a prospective, observational cohort study with patient fixed effects...
January 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28030476/socioeconomic-disparities-in-mortality-among-women-with-incident-breast-cancer-before-and-after-implementation-of-medicare-part-d
#15
Ann B Nattinger, Erica M Wozniak, Emily L McGinley, Jianing Li, Purushottam Laud, Liliana E Pezzin
BACKGROUND: Breast cancer patients exhibit survival disparities based on socioeconomic status (SES). Disparities may be attributable to access to expensive oral endocrine agents. OBJECTIVES: Define recent socioeconomic disparities in breast cancer survival and determine whether these improved after implementation of the Medicare Part D program. DESIGN: Difference-in-difference natural experiment of women diagnosed and treated before or after implementation of Medicare Part D...
December 27, 2016: Medical Care
https://www.readbyqxmd.com/read/28002204/anesthesia-service-use-and-the-uptake-of-screening-colonoscopies
#16
Samuel Hirshman, Soeren Mattke, Hangsheng Liu
BACKGROUND: The Center for Medicare & Medicaid Services recently defined "screening colonoscopy" to include separately furnished anesthesia services. OBJECTIVE: To examine the relationship between anesthesia service use and the uptake of screening colonoscopies. STUDY DESIGN: We correlated metropolitan statistical area (MSA) level anesthesia service use rates, derived from the 2008, 2010, and 2012 Medicare and MarketScan claims data, with the presence of individual level guideline concordant screening colonoscopy using the Behavioral Risk Factor Surveillance System data for the same years...
December 20, 2016: Medical Care
https://www.readbyqxmd.com/read/28002203/differences-in-hospital-risk-standardized-mortality-rates-for-acute-myocardial-infarction-when-assessed-using-transferred-and-nontransferred-patients
#17
Ian J Barbash, Hongwei Zhang, Derek C Angus, Steven E Reis, Chung-Chou H Chang, Francis R Pike, Jeremy M Kahn
BACKGROUND: One in 5 patients with acute myocardial infarction (AMI) are transferred between hospitals. However, current hospital performance measures based on AMI mortality exclude these patients from the evaluation of referral hospitals. OBJECTIVE: To determine the relationship between risk-standardized mortality for transferred and nontransferred patients at referral hospitals. RESEARCH DESIGN: This is a retrospective cohort study. SUBJECTS: Fee-for-service Medicare claims from 2011 for patients hospitalized with a primary diagnosis of AMI, at hospitals admitting at least 15 patients in transfer...
December 20, 2016: Medical Care
https://www.readbyqxmd.com/read/27997456/accelerating-research-impact-in-a-learning-health-care-system-va-s-quality-enhancement-research-initiative-in-the-choice-act-era
#18
Amy M Kilbourne, A Rani Elwy, Anne E Sales, David Atkins
BACKGROUND: Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice. OBJECTIVES: With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA's transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act...
December 16, 2016: Medical Care
https://www.readbyqxmd.com/read/27922910/impact-of-medicare-s-nonpayment-program-on-hospital-acquired-conditions
#19
Caroline P Thirukumaran, Laurent G Glance, Helena Temkin-Greener, Meredith B Rosenthal, Yue Li
BACKGROUND: Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. OBJECTIVE: To determine whether the Program was associated with changes in HAC incidence, and whether this association varies across hospitals with differential Medicare patient load...
December 5, 2016: Medical Care
https://www.readbyqxmd.com/read/27906769/measuring-harm-in-health-care-optimizing-adverse-event-review
#20
Kathleen E Walsh, Polina Harik, Kathleen M Mazor, Deborah Perfetto, Milena Anatchkova, Colleen Biggins, Joann Wagner, Pamela J Schoettker, Cassandra Firneno, Robert Klugman, Jennifer Tjia
OBJECTIVE: The objective of this study was to identify modifiable factors that improve the reliability of ratings of severity of health care-associated harm in clinical practice improvement and research. METHODS: A diverse group of clinicians rated 8 types of adverse events: blood product, device or medical/surgical supply, fall, health care-associated infection, medication, perinatal, pressure ulcer, surgery. We used a generalizability theory framework to estimate the impact of number of raters, rater experience, and rater provider type on reliability...
November 30, 2016: Medical Care
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