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Medical Care

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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
#1
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/28692573/associations-of-hospice-disenrollment-and-hospitalization-with-continuous-home-care-provision
#2
Shi-Yi Wang, Weixiong Dang, Melissa D Aldridge, Maureen Canavan, Emily Cherlin, Elizabeth Bradley
OBJECTIVES: To examine rates of hospice disenrollment and posthospice hospitalization among patients who are enrolled in hospices that provide continuous home care (CHC) (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices). METHODS: We performed a retrospective cohort study among Medicare fee-for-service decedents between July and December 2011, who were 66 years and older and had used hospice in their last 6 months of life...
July 7, 2017: Medical Care
https://www.readbyqxmd.com/read/28692572/health-care-engagement-and-follow-up-after-perceived-discrimination-in-maternity-care
#3
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
#4
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
#5
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
#6
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/28700457/discontinuity-of-medicaid-coverage-impact-on-cost-and-utilization-among-adult-medicaid-beneficiaries-with-major-depression
#7
Xu Ji, Adam S Wilk, Benjamin G Druss, Cathy Lally, Janet R Cummings
BACKGROUND: Gaps in Medicaid coverage may disrupt access to and continuity of care. This can be detrimental for beneficiaries with chronic conditions, such as major depression, for whom disruptions in access to outpatient care may lead to increased use of acute care. However, little is known about how Medicaid coverage discontinuities impact acute care utilization among adults with depression. OBJECTIVE: Examine the relationship between Medicaid discontinuities and service utilization among adults with major depression...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28671931/designing-an-effective-small-scope-practice-based-study
#8
R David Parker, Michael D Regier
OBJECTIVE: Present a methodology to promote good practices in designing small-scale, practice-based studies. STUDY DESIGN: We propose the following methods to assist clinicians and other practice-based researchers in designing and conducting good quality, small-scale studies in a clinical setting. METHODS: Research projects applied to a limited, practice-based study may require modification to increase the consistency of patient research. RESULTS: Although common requests to collaborative methodologists mirror methods for experimental design, clinic-based studies may face different limitations...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28671929/up-to-date-on-preventive-care-services-under-affordable-care-act-a-trend-analysis-from-meps-2007-2014
#9
Young-Rock Hong, Ara Jo, Arch G Mainous
BACKGROUND: The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans cover evidence-based preventive services. OBJECTIVES: To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18-64. RESEARCH DESIGN: Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007-2010) and post-ACA (2011-2014)...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28650923/the-effect-of-false-positive-mammograms-on-antidepressant-and-anxiolytic-initiation
#10
Joel E Segel, Rajesh Balkrishnan, Richard A Hirth
BACKGROUND: Despite reported increases in anxiety following a false-positive mammogram, there is little evidence the effect rises to the clinical level of initiating medication. OBJECTIVE: To analyze the effect of a false-positive mammogram on antidepressant or anxiolytic initiation and identify subpopulations most at risk. SUBJECTS: MarketScan commercial and Medicaid claims databases used to identify women ages 40-64 undergoing screening mammography with no prior antidepressant or anxiolytic claims...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28650922/randomized-trial-of-reducing-ambulatory-malpractice-and-safety-risk-results-of-the-massachusetts-promises-project
#11
Gordon D Schiff, Harry Reyes Nieva, Paula Griswold, Nicholas Leydon, Judy Ling, Frank Federico, Carol Keohane, Bonnie R Ellis, Cathy Foskett, E John Orav, Catherine Yoon, Don Goldmann, Joel S Weissman, David W Bates, Madeleine Biondolillo, Sara J Singer
OBJECTIVE: Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. STUDY SETTING: In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. STUDY DESIGN: Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28650921/effect-of-continuity-of-care-on-drug-drug-interactions
#12
Jiun-Yu Guo, Yiing-Jenq Chou, Christy Pu
BACKGROUND: Drug-drug interaction (DDI) is a critical concern in health care systems because it is directly associated with patient outcomes and is generally preventable. However, few studies have been conducted on whether poor continuity of care (COC) is a determinant of DDIs and whether this effect varies by level of comorbidity. Patients with higher comorbidity normally require more complex treatment regimens than other patients, and hence their COC is more critical for ensuring the accuracy of their medication information...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28617703/using-self-reports-or-claims-to-assess-disease-prevalence-it-s-complicated
#13
Patricia St Clair, Étienne Gaudette, Henu Zhao, Bryan Tysinger, Roxanna Seyedin, Dana P Goldman
BACKGROUND: Two common ways of measuring disease prevalence include: (1) using self-reported disease diagnosis from survey responses; and (2) using disease-specific diagnosis codes found in administrative data. Because they do not suffer from self-report biases, claims are often assumed to be more objective. However, it is not clear that claims always produce better prevalence estimates. OBJECTIVE: Conduct an assessment of discrepancies between self-report and claims-based measures for 2 diseases in the US elderly to investigate definition, selection, and measurement error issues which may help explain divergence between claims and self-report estimates of prevalence...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28598891/effect-of-direct-to-consumer-advertising-on-statin-use-in-the-united-states
#14
Hsien-Yen Chang, Irene Murimi, Matthew Daubresse, Dima M Qato, Sherry L Emery, G Caleb Alexander
IMPORTANCE: The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. OBJECTIVE: We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. DESIGN, SETTING, AND PARTICIPANTS: We conducted an ecological study for 75 designated market areas from 2005 to 2009 in the United States using linked data regarding televised DTCA volume, non-DTCA marketing and promotion, retail, mail order and long-term care prescription drug sales, prescription drug and ambulatory care health care utilization, and contextual factors such as health care density and socioeconomic status...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28598890/comparing-population-based-risk-stratification-model-performance-using-demographic-diagnosis-and-medication-data-extracted-from-outpatient-electronic-health-records-versus-administrative-claims
#15
Hadi Kharrazi, Winnie Chi, Hsien-Yen Chang, Thomas M Richards, Jason M Gallagher, Susan M Knudson, Jonathan P Weiner
BACKGROUND: There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, however, have been traditionally derived from claims or encounter systems. This study evaluates the challenges and opportunities of using EHR data instead of or in addition to administrative claims for risk stratification...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28549001/contribution-of-natural-language-processing-in-predicting-rehospitalization-risk
#16
Christopher Norman, Thu Van Nguyen, Aurélie Névéol
No abstract text is available yet for this article.
August 2017: Medical Care
https://www.readbyqxmd.com/read/25821898/validation-of-diagnostic-groups-based-on-health-care-utilization-data-should-adjust-for-sampling-strategy
#17
Geneviève Cadieux, Robyn Tamblyn, David L Buckeridge, Nandini Dendukuri
OBJECTIVE: Valid measurement of outcomes such as disease prevalence using health care utilization data is fundamental to the implementation of a "learning health system." Definitions of such outcomes can be complex, based on multiple diagnostic codes. The literature on validating such data demonstrates a lack of awareness of the need for a stratified sampling design and corresponding statistical methods. We propose a method for validating the measurement of diagnostic groups that have: (1) different prevalences of diagnostic codes within the group; and (2) low prevalence...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28614185/survey-instruments-to-assess-patient-experiences-with-access-and-coordination-across-health-care-settings-available-and-needed-measures
#18
Martha Quinn, Claire Robinson, Jane Forman, Sarah L Krein, Ann-Marie Rosland
BACKGROUND: Improving access can increase the providers a patient sees, and cause coordination challenges. For initiatives that increase care across health care settings, measuring patient experiences with access and care coordination will be crucial. OBJECTIVES: Map existing survey measures of patient experiences with access and care coordination expected to be relevant to patients accessing care across settings. Preliminarily examine whether aspects of access and care coordination important to patients are represented by existing measures...
July 2017: Medical Care
https://www.readbyqxmd.com/read/28614184/coordinating-care-across-health-care-systems-for-veterans-with-gynecologic-malignancies-a-qualitative-analysis
#19
Jessica L Zuchowski, Joya G Chrystal, Alison B Hamilton, Elizabeth W Patton, Laurie C Zephyrin, Elizabeth M Yano, Kristina M Cordasco
BACKGROUND: Veterans concurrently using both Veterans Affairs (VA) and community providers and facilities have increased coordination needs related to bridging their care across health care settings. Women Veterans commonly require a combination of VA and community care if they have women-specific specialty care needs, such as gynecologic malignancies. OBJECTIVES: We assessed VA women's health providers' and administrators' perceptions of coordination challenges for Veterans' gynecologic cancer care, and potential approaches for addressing these challenges...
July 2017: Medical Care
https://www.readbyqxmd.com/read/28614178/patterns-of-opioid-use-and-risk-of-opioid-overdose-death-among-medicaid-patients
#20
Renu K Garg, Deborah Fulton-Kehoe, Gary M Franklin
BACKGROUND: The Centers for Disease Control and Prevention recognizes Medicaid as a high-risk population for fatal opioid overdose. Further research is needed to identify factors that put Medicaid patients at increased risk. OBJECTIVE: To determine whether patterns of opioid use are associated with risk of opioid-related mortality among opioid users. DESIGN: This is a retrospective cohort study. PATIENTS: In total, 150,821 noncancer pain patients aged 18-64 years with ≥1 opioid prescription, April 2006 to December 2010, Washington Medicaid...
July 2017: Medical Care
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