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https://www.readbyqxmd.com/read/28410339/patterns-of-buprenorphine-naloxone-treatment-for-opioid-use-disorder-in-a-multistate-population
#1
Brendan Saloner, Matthew Daubresse, G Caleb Alexander
BACKGROUND: Buprenorphine-naloxone treatment for opioid use disorder has rapidly expanded, yet little is known about treatment outcomes among patients in the general population. OBJECTIVE: To examine predictors of treatment duration, dosage, and continuity in a diverse community setting. RESEARCH DESIGN: We examined QuintilesIMS Real World Data, an all-payer, pharmacy claims database, to conduct an analysis of individuals age 18 years and above initiating buprenorphine-naloxone treatment between January 2010 and July 2012 in 11 states...
April 13, 2017: Medical Care
https://www.readbyqxmd.com/read/28410338/multiple-sources-of-prescription-payment-and-risky-opioid-therapy-among-veterans
#2
William C Becker, Brenda T Fenton, Cynthia A Brandt, Erin L Doyle, Joseph Francis, Joseph L Goulet, Brent A Moore, Virginia Torrise, Robert D Kerns, Peter W Kreiner
BACKGROUND: Opioid overdose and other related harms are a major source of morbidity and mortality among US Veterans, in part due to high-risk opioid prescribing. OBJECTIVES: We sought to determine whether having multiple sources of payment for opioids-as a marker for out-of-system access-is associated with risky opioid therapy among veterans. RESEARCH DESIGN: Cross-sectional study examining the association between multiple sources of payment and risky opioid therapy among all individuals with Veterans Health Administration (VHA) payment for opioid analgesic prescriptions in Kentucky during fiscal year 2014-2015...
April 13, 2017: Medical Care
https://www.readbyqxmd.com/read/28410337/adaptation-of-lean-six-sigma-methodologies-for-the-evaluation-of-veterans-choice-program-at-3-urban-veterans-affairs-medical-centers
#3
Sherry L Ball, Lauren D Stevenson, Amy C Ladebue, Marina S McCreight, Emily C Lawrence, Taryn Oestreich, Anne C Lambert-Kerzner
OBJECTIVE: The Veterans Healthcare Administration (VHA) is adapting to meet the changing needs of our Veterans. VHA leaders are promoting quality improvement strategies including Lean Six Sigma (LSS). This study used LSS tools to evaluate the Veterans Choice Program (VCP), a program that aims to improve access to health care services for eligible Veterans by expanding health care options to non-VHA providers. RESEARCH DESIGN: LSS was utilized to assess the current process and efficiency patterns of the VCP at 3 VHA Medical Centers...
April 13, 2017: Medical Care
https://www.readbyqxmd.com/read/28333708/cost-effectiveness-of-antihypertensive-medication-exploring-race-and-sex-differences-using-data-from-the-reasons-for-geographic-and-racial-differences-in-stroke-study
#4
Gabriel S Tajeu, Stephen Mennemeyer, Nir Menachemi, Robert Weech-Maldonado, Meredith Kilgore
BACKGROUND: Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks. OBJECTIVE: To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults. RESEARCH DESIGN: We constructed a State Transition Model to assess the costs and quality-adjusted life-years (QALYs) associated with either antihypertensive medication treatment or no-treatment using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and published literature...
March 22, 2017: Medical Care
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
#5
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
#6
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
#7
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
#8
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/28288076/impact-of-multisystem-health-care-on-readmission-and-follow-up-among-veterans-hospitalized-for-chronic-obstructive-pulmonary-disease
#9
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
#10
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
#11
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/28288072/dissecting-leapfrog-how-well-do-leapfrog-safe-practices-scores-correlate-with-hospital-compare-ratings-and-penalties-and-how-much-do-they-matter
#12
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/28263281/-where-s-my-choice-an-examination-of-veteran-and-provider-experiences-with-hepatitis-c-treatment-through-the-veteran-affairs-choice-program
#13
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
#14
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
#15
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/28221275/changes-in-emergency-department-utilization-after-early-medicaid-expansion-in-california
#16
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
#17
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
#18
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/28146037/the-veterans-choice-act-a-qualitative-examination-of-rapid-policy-implementation-in-the-department-of-veterans-affairs
#19
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
#20
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
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