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Medical Care

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https://www.readbyqxmd.com/read/28319584/episode-of-care-characteristics-and-costs-for-hip-and-knee-replacement-surgery-in-hospitals-belonging-to-the-high-value-health-care-collaborative-compared-with-similar-hospitals-in-the-same-health-care-markets
#1
William B Weeks, William J Schoellkopf, David J Ballard, Gary S Kaplan, Brent James, James N Weinstein
BACKGROUND: To inform consumers and restrain health care cost growth, efforts to promote transparency and to reimburse for care episodes are accelerating in the United States. OBJECTIVE: To compare characteristics and costs of 30-day episode of care for hip and knee replacement occurring in High Value Healthcare Collaborative (HVHC)-member hospitals to those occurring in like non-HVHC-member hospitals in the same 15 health care markets before interventions by HVHC members to improve health care value for those interventions...
March 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28319583/factor-structure-of-the-cultural-competence-items-in-the-national-home-and-hospice-care-survey
#2
Azza AbuDagga, Constance A Mara, Adam C Carle, Robert Weech-Maldonado
BACKGROUND: There is a need for validated measures of cultural competency practices in home health and hospice care (HHHC). OBJECTIVE: To establish the factor structure of the cultural competency items included in the agency-component of the 2007 public-use National Home and Hospice Care Survey file. DATA SOURCE: We used weighted survey data from 1036 HHHC agencies. RESEARCH DESIGN AND PARTICIPANTS: We used exploratory factor analyses to identify a preliminary factor structure, and then performed confirmatory factor analysis to provide further support for identified factor structure...
March 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28319582/trends-in-the-purchase-of-surgical-care-in-the-community-by-the-veterans-health-administration-va
#3
Amy K Rosen, William O'Brien, Qi Chen, Michael Shwartz, Kamal F M Itani, William Gunnar
BACKGROUND: The 2014 implementation of the Veterans Choice Program increased opportunities for Veterans to receive care in the community. Although surgical care is a Veterans Health Administration (VA) priority, little is known about the types of surgeries provided in the VA versus those referred to community care (CC), and whether Veterans are increasing their use of surgical care through CC with these additional opportunities. OBJECTIVES: To examine national trends across VA facilities in the frequencies and types of surgeries provided in the VA and through CC, and explore the association between facilities' purchase of care with rurality and surgical complexity designation...
March 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28319581/can-claims-data-algorithms-identify-the-physician-of-record
#4
Eva H DuGoff, Emily Walden, Katie Ronk, Mari Palta, Maureen Smith
BACKGROUND: Claims-based algorithms based on administrative claims data are frequently used to identify an individual's primary care physician (PCP). The validity of these algorithms in the US Medicare population has not been assessed. OBJECTIVE: To determine the agreement of the PCP identified by claims algorithms with the PCP of record in electronic health record data. DATA: Electronic health record and Medicare claims data from older adults with diabetes...
March 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28319580/hospital-characteristics-associated-with-risk-standardized-readmission-rates
#5
Leora I Horwitz, Susannah M Bernheim, Joseph S Ross, Jeph Herrin, Jacqueline N Grady, Harlan M Krumholz, Elizabeth E Drye, Zhenqiu Lin
BACKGROUND: Safety-net and teaching hospitals are somewhat more likely to be penalized for excess readmissions, but the association of other hospital characteristics with readmission rates is uncertain and may have relevance for hospital-centered interventions. OBJECTIVE: To examine the independent association of 8 hospital characteristics with hospital-wide 30-day risk-standardized readmission rate (RSRR). DESIGN: This is a retrospective cross-sectional multivariable analysis...
March 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28288076/impact-of-multisystem-health-care-on-readmission-and-follow-up-among-veterans-hospitalized-for-chronic-obstructive-pulmonary-disease
#6
Seppo T Rinne, Anashua R Elwy, Lori A Bastian, Edwin S Wong, Renda S Wiener, Chuan-Fen Liu
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though the impact of non-VA care on COPD readmissions is unknown. OBJECTIVE: To examine the association of use of non-VA outpatient care with 30-day readmission and 30-day follow-up among veterans admitted to the VA for COPD. DESIGN: This is a retrospective cohort study using VA administrative data and Medicare claims...
March 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28288075/an-electronic-health-record-based-intervention-to-promote-hepatitis-c-virus-testing-among-adults-born-between-1945-and-1965-a-cluster-randomized-trial
#7
Alex D Federman, Natalie Kil, Joseph Kannry, Evie Andreopolous, Wilma Toribio, Joanne Lyons, Mark Singer, Anthony Yartel, Bryce D Smith, David B Rein, Katherine Krauskopf
BACKGROUND: The Centers for Disease Control and Prevention (CDC) recommends one-time hepatitis C virus (HCV) antibody testing for "Birth Cohort" adults born during 1945-1965. OBJECTIVE: To examine the impact of an electronic health record (EHR)-embedded best practice alert (BPA) for HCV testing among Birth Cohort adults. DESIGN: Cluster-randomized trial was conducted from April 29, 2013 to March 29, 2014. SUBJECTS AND SETTING: Ten community and hospital-based primary care practices...
March 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28288074/racial-differences-and-disparities-in-osteoporosis-related-bone-health-results-from-the-paadrn-randomized-controlled-trial
#8
Peter Cram, Kenneth G Saag, Yiyue Lou, Stephanie W Edmonds, Sylvie F Hall, Douglas W Roblin, Nicole C Wright, Michael P Jones, Fredric D Wolinsky
BACKGROUND: Determining whether observed differences in health care can be called disparities requires persistence of differences after adjustment for relevant patient, provider, and health system factors. We examined whether providing dual-energy x-ray absorptiometry (DXA) test results directly to patients might reduce or eliminate racial differences in osteoporosis-related health care. DESIGN, SUBJECTS, AND MEASURES: We analyzed data from 3484 white and 1041 black women who underwent DXA testing at 2 health systems participating in the Patient Activation after DXA Result Notification (PAADRN) pragmatic clinical trial (ClinicalTrials...
March 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28288073/association-of-the-affordable-care-act-with-smoking-and-tobacco-treatment-utilization-among-adults-newly-enrolled-in-health-care
#9
Kelly C Young-Wolff, Daniella Klebaner, Cynthia I Campbell, Constance Weisner, Derek D Satre, Alyce S Adams
OBJECTIVES: To examine rates of smoking and tobacco treatment utilization by insurance coverage status (Medicaid, commercial, exchange) among newly enrolled patients in the post Affordable Care Act (ACA) era. METHODS: We examined new members who enrolled in Kaiser Permanente Northern California through Medicaid, the California exchange, or nonexchange commercial plans (N=122,298) in the first 6 months of 2014 following ACA implementation. We compared these groups on smoking prevalence and tested whether smokers in each group differed on sociodemographic characteristics and in their utilization of tobacco treatment (pharmacotherapy and counseling) in 2014...
March 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28288072/dissecting-leapfrog-how-well-do-leapfrog-safe-practices-scores-correlate-with-hospital-compare-ratings-and-penalties-and-how-much-do-they-matter
#10
Shawna N Smith, Heidi A Reichert, Jessica M Ameling, Jennifer Meddings
BACKGROUND: Voluntary Leapfrog Safe Practices Score (SPS) measures were among the first public reports of hospital performance. Recently, Medicare's Hospital Compare website has reported compulsory measures. Leapfrog's Hospital Safety Score (HSS) grades incorporate SPS and Medicare measures. We evaluate associations between Leapfrog SPS and Medicare measures, and the impact of SPS on HSS grades. METHODS: Using 2013 hospital data, we linked Leapfrog HSS data with central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) standardized infection ratios (SIRs), and Hospital Readmission and Hospital-Acquired Condition (HAC) Reduction Program penalties incorporating 2013 performance...
March 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28263282/the-affordable-care-act-s-dependent-care-coverage-and-mortality
#11
Chandler McClellan
BACKGROUND: In September 2010, the Affordable Care Act (ACA) enabled young adults to gain insurance coverage under their parents' policies. OBJECTIVE: Assess the impact of the ACA's dependent care coverage expansion on young adult mortality rates. RESEARCH DESIGN: Using the Multiple Cause Mortality public use database for 2008-2013, the impact of the ACA is examined with a difference-in-differences analysis of monthly mortality rates using individuals aged 26-30 as a natural control group for young adults aged 19-25...
March 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28263281/-where-s-my-choice-an-examination-of-veteran-and-provider-experiences-with-hepatitis-c-treatment-through-the-veteran-affairs-choice-program
#12
Jack Tsai, Vera Yakovchenko, Natalie Jones, Avy Skolnik, Amanda Noska, Allen L Gifford, D Keith McInnes
BACKGROUND: The Department of Veterans Affairs (VA) is the country's largest provider for chronic hepatitis C virus (HCV) infection. The VA created the Choice Program, which allows eligible veterans to seek care from community providers, who are reimbursed by the VA. OBJECTIVES: This study aimed to examine perspectives and experiences with the VA Choice Program among veteran patients and their HCV providers. RESEARCH DESIGN: Qualitative study based on semistructured interviews with veteran patients and VA providers...
March 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28263280/disparities-in-potentially-preventable-hospitalizations-between-american-indian-and-alaska-native-and-non-hispanic-white-medicare-enrollees
#13
Joan O'Connell, Jennifer Rockell, Judith C Ouellet, Mark LeBeau
OBJECTIVE: A number of health care initiatives seek to improve health outcomes by increasing access to outpatient services while reducing preventable acute events. We evaluated disparities between American Indian and Alaska Native (AI/AN) and non-Hispanic white (white) Medicare enrollees in access to outpatient preventive, primary, and specialty services by comparing their potentially preventable hospitalizations (PPHs). RESEARCH DESIGN: The study population included 121,311 adult AI/AN Medicare enrollees registered to use services funded by the Indian Health Service and 5,915,011 adult white enrollees living in the same counties...
March 3, 2017: Medical Care
https://www.readbyqxmd.com/read/28234756/a-comparison-of-nurse-practitioners-physician-assistants-and-primary-care-physicians-patterns-of-practice-and-quality-of-care-in-health-centers
#14
Ellen T Kurtzman, Burt S Barnow
BACKGROUND: Under the Affordable Care Act, the number and capacity of community health centers (HCs) is growing. Although the majority of HC care is provided by primary care physicians (PCMDs), a growing proportion is delivered by nurse practitioners (NPs) and physician assistants (PAs); yet, little is known about how these clinicians' care compares in this setting. OBJECTIVES: To compare the quality of care and practice patterns of NPs, PAs, and PCMDs in HCs. RESEARCH DESIGN: Using 5 years of data (2006-2010) from the HC subsample of the National Ambulatory Medical Care Survey and multivariate regression analysis, we estimated the impact of receiving NP-delivered or PA-delivered care versus PCMD-delivered care...
February 23, 2017: Medical Care
https://www.readbyqxmd.com/read/28234755/chronic-health-outcomes-and-prescription-drug-copayments-in-medicaid
#15
Deliana Kostova, Jared Fox
BACKGROUND: Prescription drug copayments and cost-sharing have been linked to reductions in prescription drug use and expenditures. However, little is known about their effect on specific health outcomes. OBJECTIVE: To evaluate the association between prescription drug copayments and uncontrolled hypertension, uncontrolled hypercholesterolemia, and prescription drug utilization among Medicaid beneficiaries with these conditions. SUBJECTS: Select adults aged 20-64 from NHANES 1999-2012 in 18 states...
February 23, 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
#16
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
#17
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
#18
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
#19
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/28169976/the-impact-of-alternative-payment-in-chronically-ill-and-older-patients-in-the-patient-centered-medical-home
#20
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
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