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Medical Care

Matthew L Maciejewski, Bradley G Hammill, Elizabeth A Bayliss, Laura Ding, Corrine I Voils, Lesley H Curtis, Virginia Wang
BACKGROUND: Medicare beneficiaries with multiple chronic conditions are typically seen by multiple providers, particularly specialists. Clinically appropriate referrals to multiple specialists may compromise the continuity of care for multiple chronic condition beneficiaries and create care plans that patients may find challenging to reconcile, which may impact patient outcomes. OBJECTIVE: The objective was to examine whether glycemic control or lipid control was associated with the number of prescribers of cardiometabolic medications...
October 14, 2016: Medical Care
Robert E Burke, Jeffrey L Schnipper, Mark V Williams, Edmondo J Robinson, Eduard E Vasilevskis, Sunil Kripalani, Joshua P Metlay, Grant S Fletcher, Andrew D Auerbach, Jacques D Donzé
BACKGROUND/OBJECTIVES: New tools to accurately identify potentially preventable 30-day readmissions are needed. The HOSPITAL score has been internationally validated for medical inpatients, but its performance in select conditions targeted by the Hospital Readmission Reduction Program (HRRP) is unknown. DESIGN: Retrospective cohort study. SETTING: Six geographically diverse medical centers. PARTICIPANTS/EXPOSURES: All consecutive adult medical patients discharged alive in 2011 with 1 of the 4 medical conditions targeted by the HRRP (acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and heart failure) were included...
October 14, 2016: Medical Care
Ying P Tabak, Xiaowu Sun, Carlos M Nunez, Vikas Gupta, Richard S Johannes
BACKGROUND: Identifying patients at high risk for readmission early during hospitalization may aid efforts in reducing readmissions. We sought to develop an early readmission risk predictive model using automated clinical data available at hospital admission. METHODS: We developed an early readmission risk model using a derivation cohort and validated the model with a validation cohort. We used a published Acute Laboratory Risk of Mortality Score as an aggregated measure of clinical severity at admission and the number of hospital discharges in the previous 90 days as a measure of disease progression...
October 14, 2016: Medical Care
Larisa M Strawbridge, Jennifer T Lloyd, Ann Meadow, Gerald F Riley, Benjamin L Howell
BACKGROUND: Diabetes is highly prevalent among Medicare beneficiaries, resulting in costly health care utilization. Strategies to improve health outcomes, such as disease self-management, could help reduce the increasing burden of diabetes. OBJECTIVES: Short-term benefits of diabetes self-management training (DSMT) are established; however, longer-term impacts among Medicare beneficiaries are unknown. RESEARCH DESIGN: Claims-based observational study with 1-year follow-up beginning 6 months after diabetes diagnosis...
October 6, 2016: Medical Care
Nicholas K Schiltz, David F Warner, Jiayang Sun, Paul M Bakaki, Avi Dor, Charles W Given, Kurt C Stange, Siran M Koroukian
BACKGROUND: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood. OBJECTIVE: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. DESIGN: Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims...
October 6, 2016: Medical Care
Katharina D Hauck, Shaolin Wang, Charles Vincent, Peter C Smith
BACKGROUND: There is little satisfactory evidence on the harm of safety incidents to patients, in terms of lost potential health and life-years. OBJECTIVE: To estimate the healthy life-years (HLYs) lost due to 6 incidents in English hospitals between the years 2005/2006 and 2009/2010, to compare burden across incidents, and estimate excess bed-days. RESEARCH DESIGN: The study used cross-sectional analysis of the medical records of all inpatients treated in 273 English hospitals...
October 6, 2016: Medical Care
Vickie M Mays, Audrey L Jones, Ayesha Delany-Brumsey, Courtney Coles, Susan D Cochran
BACKGROUND: Experiences of discrimination in health care settings may contribute to disparities in mental health outcomes for blacks and Latinos. We investigate whether perceived discrimination in mental health/substance abuse visits contributes to participants' ratings of treatment helpfulness and stopped treatment. RESEARCH METHODS: We used data from 3 waves of the California Quality of Life Survey, a statewide population-based telephone survey assessing mental health/substance disorders and their treatment...
October 6, 2016: Medical Care
Anirban Basu, Kirsten Axelsen, David C Grabowski, David O Meltzer, Daniel Polsky, David B Ridley, Daniel Wiederkehr, Tomas J Philipson
No abstract text is available yet for this article.
September 26, 2016: Medical Care
Kayo Fujimoto, Peng Wang, Lisa M Kuhns, Michael W Ross, Mark L Williams, Robert Garofalo, Alden S Klovdahl, Edward O Laumann, John A Schneider
BACKGROUND: Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth. OBJECTIVES: The aim of this study was to examine the competition, collaboration, and funding source structures of multiplex organization networks and the mechanisms that promote fruitful relationships among these organizations...
September 26, 2016: Medical Care
Derek DeLia
BACKGROUND: Research on spending persistence has not focused on Medicaid and the Children's Health Insurance Program (Medicaid/CHIP), which includes a complex and growing population. OBJECTIVE OF THE STUDY: The objective of the study was to describe patterns of expenditure persistence, mortality, and disenrollment among nondually eligible Medicaid/CHIP enrollees and identify factors predicting these outcomes. RESEARCH DESIGN: The study is based on New Jersey Medicaid/CHIP claims data from 2011 to 2014...
September 21, 2016: Medical Care
Thomas D'Aunno, Harold Pollack, Qixuan Chen, Peter D Friedmann
BACKGROUND: To meet their aims of providing comprehensive and coordinated care, patient-centered medical homes (PCMHs) need to coordinate services for individuals with substance use disorders. Yet, the 14,000 addiction treatment (AT) organizations across the United States that provide services for more than 1 million individuals daily are generally ill-prepared to work with PCMHs (eg, AT organizations often lack electronic health records). OBJECTIVES: To examine the extent to which AT organizations have formal linkages through contracts with PCMHs; to identify key dimensions of linkages between PCMHs and AT organizations (eg, shared use of electronic health records); to identify characteristics of AT organizations and their environments associated with these linkages...
September 15, 2016: Medical Care
Julie C Lauffenburger, Jessica M Franklin, Alexis A Krumme, William H Shrank, Troyen A Brennan, Olga S Matlin, Claire M Spettell, Gregory Brill, Niteesh K Choudhry
BACKGROUND: With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be used to classify patients into dynamic long-term spending patterns. OBJECTIVES: To classify patients by their spending patterns over a 1-year period and to assess the ability of models to predict patients in the highest spending trajectory and the top 5% of annual spending using prior-year predictors...
September 15, 2016: Medical Care
Danielle A Southern, Bernard Burnand, Saskia E Droesler, Ward Flemons, Alan J Forster, Yana Gurevich, James Harrison, Hude Quan, Harold A Pincus, Patrick S Romano, Vijaya Sundararajan, Nenad Kostanjsek, William A Ghali
BACKGROUND: Existing administrative data patient safety indicators (PSIs) have been limited by uncertainty around the timing of onset of included diagnoses. OBJECTIVE: We undertook de novo PSI development through a data-driven approach that drew upon "diagnosis timing" information available in some countries' administrative hospital data. RESEARCH DESIGN: Administrative database analysis and modified Delphi rating process. SUBJECTS: All hospitalized adults in Canada in 2009...
September 15, 2016: Medical Care
Michael R Richards, Karen Lasater, Matthew McHugh
BACKGROUND: Care quality continues to be a focal point within US health care. One quality innovation is the Magnet recognition program for hospitals, which is a nurse-driven initiative emphasizing care and patient-safety improvements. To date, Magnet hospitals have been associated with better outcomes, but their distribution is highly uneven. Relatedly, little research has characterized what factors drive Magnet adoption (eg, competitive pressure from other hospitals). OBJECTIVE: To examine if hospitals respond to more competing hospitals becoming Magnets by also becoming Magnet institutions...
September 15, 2016: Medical Care
Joseph A Benitez, Liza M Creel, J'Aime C Jennings
BACKGROUND: While most research has focused on insurance uptake and describing the makeup of the newly insured, less is known about the characteristics among the remaining uninsured in expansion states. OBJECTIVES: Using Kentucky as a case study, we evaluate individual and contextual characteristics to learn more about groups who-despite expanded access to coverage options through US health care reform-reported being uninsured at the end of 2014. RESEARCH DESIGN: Cross-sectional data from Kentucky's Behavioral Risk Factor Surveillance System was linked to county data from the Area Health Resource File, and we used logistic regression models to assess relationships between both person-level and county-level characteristics with uninsured status...
September 15, 2016: Medical Care
Jessica M Harwood, Francisca Azocar, Amber Thalmayer, Haiyong Xu, Michael K Ong, Chi-Hong Tseng, Kenneth B Wells, Sarah Friedman, Susan L Ettner
OBJECTIVE: The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. METHODS: We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers...
September 14, 2016: Medical Care
Deborah J Rinehart, Carlos Oronce, Michael J Durfee, Krista W Ranby, Holly A Batal, Rebecca Hanratty, Jody Vogel, Tracy L Johnson
BACKGROUND: Patients with repeated hospitalizations represent a group with potentially avoidable utilization. Recent publications have begun to highlight the heterogeneity of this group. Latent class analysis provides a novel methodological approach to utilizing administrative data to identify clinically meaningful subgroups of patients to inform tailored intervention efforts. OBJECTIVE: The objective of the study was to identify clinically distinct subgroups of adult superutilizers...
September 14, 2016: Medical Care
Jeffrey L Greenwald, Patrick R Cronin, Victoria Carballo, Goodarz Danaei, Garry Choy
BACKGROUND: With the increasing focus on reducing hospital readmissions in the United States, numerous readmissions risk prediction models have been proposed, mostly developed through analyses of structured data fields in electronic medical records and administrative databases. Three areas that may have an impact on readmission but are poorly captured using structured data sources are patients' physical function, cognitive status, and psychosocial environment and support. OBJECTIVE OF THE STUDY: The objective of the study was to build a discriminative model using information germane to these 3 areas to identify hospitalized patients' risk for 30-day all cause readmissions...
September 14, 2016: Medical Care
Joseph H Puyat, Arminee Kazanjian, Hubert Wong, Elliot M Goldner
OBJECTIVES: The use of physician incentives to improve health care, in general, has been extensively studied but its value in mental health care has rarely been demonstrated. In this study the population-level impact of physician incentives on mental health care was estimated using indicators for receipt of counseling/psychotherapy (CP); antidepressant therapy (AT); minimally adequate counseling/psychotherapy; and minimally adequate antidepressant therapy. The incentives' impacts on overall continuity of care and of mental health care were also examined...
September 14, 2016: Medical Care
Amy Linsky, Steven R Simon, Kelly Stolzmann, Mark Meterko
BACKGROUND: Although clinicians ultimately decide when to discontinue (deprescribe) medications, patients' perspectives may guide the process. OBJECTIVES: To develop a survey instrument that assesses patients' experience with and attitudes toward deprescribing. RESEARCH DESIGN: We developed a questionnaire with established and newly created items. We used exploratory factor analysis and confirmatory factor analysis (EFA and CFA) to assess the psychometric properties...
August 30, 2016: Medical Care
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