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Medical Care

David Dunt, Khic-Houy Prang, Hana Sabanovic, Margaret Kelaher
OBJECTIVE: Public performance reporting (PPR) of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) outcomes aim to improve the quality of care in hospitals, surgeons and to inform consumer choice. Past CABG and PCI studies have showed mixed effects of PPR on quality and selection. The aim of this study was to undertake a systematic review and meta-analysis of the impact of PPR on market share, mortality, and patient mix outcomes associated with CABG and PCI...
September 18, 2018: Medical Care
Kelly C Young-Wolff, Sara R Adams, Daniella Klebaner, Alyce S Adams, Cynthia I Campbell, Derek D Satre, Judith J Prochaska
OBJECTIVES: We examined the impact of the Affordable Care Act-mandated elimination of tobacco cessation pharmacotherapy (TCP) copayments on patient use of TCP, overall and by income. METHODS: Electronic health record data captured any and combination (eg, nicotine gum plus patch) TCP use among adult smokers newly enrolled in Kaiser Permanente Northern California (KPNC). KPNC eliminated TCP copayments in 2015. We included current smokers newly enrolled in the first 6 months of 2014 (before copayment elimination, N=16,199) or 2015 (after elimination, N=16,469)...
September 18, 2018: Medical Care
Jessie Kemmick Pintor, Jie Chen, Héctor E Alcalá, Brent A Langellier, Ryan M McKenna, Dylan H Roby, Alexander N Ortega
OBJECTIVE: Latino youth experience worse access to and utilization of health care compared with non-Latino "white" youth, with inequities persisting following the implementation of the Affordable Care Act (ACA). To better understand these disparities, we examine changes in youth's access and utilization associated with the ACA for different Latino heritage groups relative to whites. STUDY DESIGN: We use 6 years (2011-2016) of National Health Interview Survey data to examine Latino youth's insurance coverage and health care utilization by heritage group, nativity, and parental language...
September 18, 2018: Medical Care
Ronald E Weir, Christopher S Lyttle, David O Meltzer, Tien S Dong, Gregory W Ruhnke
BACKGROUND: Despite widespread use of comorbidities for population health descriptions and risk adjustment, the ideal method for ascertaining comorbidities is not known. We sought to compare the relative value of several methodologies by which comorbidities may be ascertained. METHODS: This is an observational study of 1596 patients admitted to the University of Chicago for community-acquired pneumonia from 1998 to 2012. We collected data via chart abstraction, administrative data, and patient report, then performed logistic regression analyses, specifying comorbidities as independent variables and in-hospital mortality as the dependent variable...
September 18, 2018: Medical Care
Audrey Renson, Finn D Schubert, Marc A Bjurlin
BACKGROUND: Uninsured traumatic brain injury (TBI) patients have higher mortality than their insured counterparts. One possible reason is disparities in receipt of appropriate diagnostic imaging. OBJECTIVE: Examine the association between lack of insurance and use of diagnostic imaging. RESEARCH DESIGN: This is a retrospective cohort study. SUBJECTS: All adult patients admitted with severe (AIS>4 and GCS<15) TBI, in the National Trauma Data Bank 2010-2015...
September 18, 2018: Medical Care
Susan C Miller, Margot L Schwartz, Julie C Lima, Renée R Shield, Denise A Tyler, Clara W Berridge, Pedro L Gozalo, Michael J Lepore, Melissa A Clark
BACKGROUND AND OBJECTIVES: Given the dynamic nursing home (NH) industry and evolving regulatory environment, depiction of contemporary NH culture-change (person/resident-centered) care practice is of interest. Thus, we aimed to portray the 2016/2017 prevalence of NH culture change-related processes and structures and to identify factors associated with greater practice prevalence. RESEARCH DESIGN AND METHODS: We administered a nationwide survey to 2142 NH Administrators at NHs previously responding to a 2009/2010 survey...
September 18, 2018: Medical Care
Thomas M Wickizer, Gary M Franklin, Deborah Fulton-Kehoe
BACKGROUND: Long-term work disability is known to have an adverse effect on the nation's labor force participation rate. To reduce long-term work disability, the Washington State Department of Labor and Industries established a quality improvement initiative that created 2 pilot Centers of Occupational Health and Education (COHE). OBJECTIVES: To document the level of work disability in a sample of injured workers with musculoskeletal injuries and to examine (8-y) work disability outcomes associated with the COHE health care model...
September 18, 2018: Medical Care
Alexander N Ortega, Ryan M McKenna, Jessie Kemmick Pintor, Brent A Langellier, Dylan H Roby, Nadereh Pourat, Arturo Vargas Bustamante, Steven P Wallace
BACKGROUND: This paper provides statewide estimates on health care access and utilization patterns and physical and behavioral health by citizenship and documentation status among Latinos in California. METHODS: This study used data from the 2011-2015 California Health Interview Survey to examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and US-born non-Latino white adults (N=51,386)...
September 12, 2018: Medical Care
Michael Hendryx, Juhua Luo
BACKGROUND: We tested whether Medicaid expansion under the Affordable care Act was associated with increased screening for cervical, breast, and colorectal cancer among low-income adults. METHODS: We analyzed Behavioral Risk Factor Surveillance System data, identifying 2012 as preexpansion and 2016 as postexpansion (2014 was treated as a wash-out, and 2013 and 2015 had missing screening data from most states). States (including District of Columbia) either expanded Medicaid in 2014 (n=28) or not (n=18); five states that expanded after 2014 were excluded...
September 7, 2018: Medical Care
Shivan J Mehta, David A Asch, Andrea B Troxel, Raymond Lim, Jennifer Lewey, Wenli Wang, Jingsan Zhu, Laurie Norton, Noora Marcus, Kevin G Volpp
BACKGROUND: Medication adherence after myocardial infarction remains low. Pharmacy claims have typically been used to measure medication adherence, but electronic pill bottles may offer additional information. OBJECTIVE: The main objectives of this study were to compare the association of adherence measured by prescription claims and remote monitoring technologies with cardiovascular events. RESEARCH DESIGN: This study was a secondary analysis of a remote monitoring intervention to increase medication adherence in myocardial infarction patients...
July 24, 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
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
Mona Kilany, Joseph P Morrissey, Marisa E Domino, Kathleen C Thomas, Pam Silberman
BACKGROUND: The complex nature of managing care for people with severe mental illness (SMI), including major depression, bipolar disorder, and schizophrenia, is a challenge for primary care practices, especially in rural areas. The team-based emphasis of medical homes may act as an important facilitator to help reduce observed rural-urban differences in care. OBJECTIVE: The objective of this study was to examine whether enrollment in medical homes improved care in rural versus urban settings for people with SMI...
October 2018: Medical Care
Mónica Pérez Jolles, Kathleen C Thomas
BACKGROUND: Efforts to transform primary care have been underway for over a decade. Yet, we lack understanding of the progress made in scaling up this care model nationwide and on whether patient-centered medical home (PCMH) has benefited every group of children with special health care needs (CSHCNs). OBJECTIVE: The main objective of this study was to examine variation in caregiver service experience concordant with PCMH care over time and by child characteristics...
October 2018: Medical Care
Eduard E Vasilevskis, Rameela Chandrasekhar, Colin H Holtze, John Graves, Theodore Speroff, Timothy D Girard, Mayur B Patel, Christopher G Hughes, Aize Cao, Pratik P Pandharipande, E Wesley Ely
RATIONALE: Intensive care unit (ICU) delirium is highly prevalent and a potentially avoidable hospital complication. The current cost of ICU delirium is unknown. OBJECTIVES: To specify the association between the daily occurrence of delirium in the ICU with costs of ICU care accounting for time-varying illness severity and death. RESEARCH DESIGN: We performed a prospective cohort study within medical and surgical ICUs in a large academic medical center...
October 2018: Medical Care
Megan E Vanneman, Mary Jo Larson, Cheng Chen, Rachel Sayko Adams, Thomas V Williams, Esther Meerwijk, Alex H S Harris
BACKGROUND: In the Veterans Health Administration (VHA) there is growing interest in the use of nonpharmacologic treatment (NPT) for low back pain (LBP) as pain intensity and interference do not decrease with opioid use. OBJECTIVES: To describe overall and facility-level variation in the extent to which specific NPT modalities are used in VHA for LBP, either alone or as adjuncts to opioid medications, and to understand associations between veterans' clinical and demographic characteristics and type of treatment...
October 2018: Medical Care
Kathleen B Cartmell, Clara E Dismuke, Mary Dooley, Martina Mueller, Georges J Nahhas, Graham W Warren, Peter Fallis, K Michael Cummings
BACKGROUND: In 2014, the Medical University of South Carolina (MUSC) implemented a Tobacco Dependence Treatment Service (TDTS) consistent with the Joint Commission (JC) standards recommending that hospitals screen patients for smoking, provide cessation support, and follow-up contact for relapse prevention within 1 month of discharge. We previously demonstrated that patients exposed to the MUSC TDTS were approximately half as likely to be smoking one month after discharge and 23% less likely to have a 30-day hospital readmission...
October 2018: Medical Care
Kathryn M McDonald, Hector P Rodriguez, Stephen M Shortell
BACKGROUND: Primary care teams face daily time pressures both during patient encounters and outside of appointments. OBJECTIVES: We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure. RESEARCH DESIGN: Cross-sectional, observational analysis of data from concurrent surveys of care team members and their patients. SUBJECTS: Patients (n=1291 respondents, 73...
October 2018: Medical Care
Thomas Bodenheimer
No abstract text is available yet for this article.
October 2018: Medical Care
Jacob N Hunnicutt, Jonggyu Baek, Matthew Alcusky, Anne L Hume, Shao-Hsien Liu, Christine M Ulbricht, Jennifer Tjia, Kate L Lapane
OBJECTIVES: To examine and quantify geographic variation in the initiation of commonly used opioids and prescribed dosage strength among older US nursing home residents. METHODS: We merged 2011 Minimum Data Set 3.0 to Medicare claims and facility characteristics data to conduct a cross-sectional study among long-stay nursing home residents who initiated short-acting opioids commonly used in nursing homes (oxycodone, hydrocodone, or tramadol). We examined geographic variation in specific opioids initiated and potentially inappropriate doses (≥50 mg oral morphine equivalent/d) across hospital referral regions (HRRs)...
October 2018: Medical Care
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