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Medical Care Research and Review: MCRR

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https://www.readbyqxmd.com/read/29676190/the-role-of-organizational-affiliations-in-physician-patient-sharing-relationships
#1
Kimberley H Geissler, Benjamin Lubin, Keith M Marzilli Ericson
Provider consolidation may enable improved care coordination, but raises concerns about lack of competition. Physician patient-sharing relationships play a key role in constructing patient care teams, but it is unknown how organization affiliations affect these. We use the Massachusetts All Payer Claims Database to examine whether patient-sharing relationships are associated with sharing a practice site, medical group, and/or physician contracting network. Physicians were 17 percentage points more likely to have a patient-sharing relationship if they shared a practice site and 4 percentage points more likely if they shared a medical group, as compared with sharing no affiliation...
April 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29611457/medicare-bundled-payments-for-post-acute-care-characteristics-and-baseline-performance-of-participating-skilled-nursing-facilities
#2
Xi Cen, Helena Temkin-Greener, Yue Li
Medicare bundled payment models have focused on post-acute care as a key component of improving the efficiency and quality of health care. This study investigated the characteristics and baseline performance of skilled nursing facilities (SNFs) that participated in Medicare Bundled Payments for Care Improvement Initiative Model 3. As of July 2016, 657 SNFs participated in 7,932 episodes in risk-bearing phase. Our retrospective analyses found that larger facilities, higher occupancy rate, chain affiliation, better five-star overall rating, and higher market competition for SNF care were associated with increased likelihood of enrolling in clinical episodes in Model 3, whereas not-for-profit ownership, higher adjusted staffing levels, higher percentage of Medicaid residents, and rural location were associated with reduced likelihood of participation in Bundled Payments for Care Improvement...
April 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29606036/a-comprehensive-theory-of-integration
#3
Sara J Singer, Michaela Kerrissey, Mark Friedberg, Russell Phillips
Efforts to transform health care delivery to improve care have increasingly focused on care integration. However, variation in how integration is defined has complicated efforts to design, synthesize, and compare studies of integration in health care. Evaluations of integration initiatives would be enhanced by describing them according to clear definitions of integration and specifying which empirical relationships they seek to test-whether among types of integration or between integration and outcomes of care...
March 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29482454/np-and-pa-privileging-in-acute-care-settings-do-scope-of-practice-laws-matter
#4
Patricia Pittman, Brandi Leach, Chris Everett, Xinxin Han, Debra McElroy
As hospitals' interest in nurse practitioners (NPs) and physician assistants (PAs) grows, their leadership is eager to know how their medical staffing privileging policies for these professionals compare to peer hospitals. This study assesses the extent of variation of these policies in four clinical areas and examines whether the differences are associated with state scope of practice laws for NPs and PAs. We also examine the relationship of NP and PA privileging policies to each other. Our analysis finds no evidence that hospital privileging is associated with state scope of practice, and indeed within-state variation is more significant than cross-state variation...
February 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148321/impact-of-the-affordable-care-act-s-dependent-coverage-expansion-on-the-health-care-and-health-status-of-young-adults-what-do-we-know-so-far
#5
Joshua Breslau, Bradley D Stein, Bing Han, Shoshanna Shelton, Hao Yu
The dependent coverage expansion (DCE), a component of the Affordable Care Act, required private health insurance policies that cover dependents to offer coverage for policyholders' children through age 25. This review summarizes peer-reviewed research on the impact of the DCE on the chain of consequences through which it could affect public health. Specifically, we examine the impact of the DCE on insurance coverage, access to care, utilization of care, and health status. All studies find that the DCE increased insurance coverage, but evidence regarding downstream impacts is inconsistent...
April 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27698072/rating-communication-in-gp-consultations-the-association-between-ratings-made-by-patients-and-trained-clinical-raters
#6
Jenni Burt, Gary Abel, Natasha Elmore, Jenny Newbould, Antoinette Davey, Nadia Llanwarne, Inocencio Maramba, Charlotte Paddison, John Benson, Jonathan Silverman, Marc N Elliott, John Campbell, Martin Roland
Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician's communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview...
April 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148318/to-what-extent-are-state-scope-of-practice-laws-related-to-nurse-practitioners-day-to-day-practice-autonomy
#7
Jeongyoung Park, Erin Athey, Arlene Pericak, Joyce Pulcini, Jessica Greene
We explore the extent to which state scope of practice laws are related to nurse practitioners (NPs)' day-to-day practice autonomy. We found that NPs experienced greater day-to-day practice autonomy when they had prescriptive independence. Surprisingly, there were only small and largely insignificant differences in day-to-day practice autonomy between NPs in fully restricted states and those in states with independent practice but restricted prescription authority. The scope of practice effects were strong for primary care NPs...
February 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/28885123/thirty-day-inpatient-readmissions-for-asian-american-and-pacific-islander-subgroups-compared-with-whites
#8
Tetine Sentell, Hyeong Jun Ahn, Jill Miyamura, Deborah A Taira
Asian and Pacific Islander (API) 30-day potentially preventable readmissions (PPRs) are understudied. Hawaii Health Information Corporation data from 2007-2012 statewide adult hospitalizations ( N = 495,910) were used to compare API subgroup and White PPRs. Eight percent of hospitalizations were PPRs. Seventy-two percent of other Pacific Islanders, 60% of Native Hawaiians, and 52% of Whites with a PPR were 18 to 64 years, compared with 22% of Chinese and 21% of Japanese. In multivariable models including payer, hospital, discharge year, residence location, and comorbidity, PPR disparities existed for some API subpopulations 65+ years, including Native Hawaiian men (odds ratio [OR] = 1...
February 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27815451/financial-incentives-to-encourage-value-based-health-care
#9
Anthony Scott, Miao Liu, Jongsay Yong
This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone...
February 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27811140/hospital-ownership-of-physicians-hospital-versus-physician-perspectives
#10
Laurence C Baker, M Kate Bundorf, Aileen M Devlin, Daniel P Kessler
Although there has been significant interest from health services researchers and policy makers about recent trends in hospitals' ownership of physician practices, few studies have investigated the strengths and weaknesses of available data sources. In this article, we compare results from two national surveys that have been used to assess ownership patterns, one of hospitals (the American Hospital Association survey) and one of physicians (the SK&A survey). We find some areas of agreement, but also some disagreement, between the two surveys...
February 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27789628/implementation-of-care-management-an-analysis-of-recent-ahrq-research
#11
Andrada Tomoaia-Cotisel, Timothy W Farrell, Leif I Solberg, Carolyn A Berry, Neil S Calman, Peter F Cronholm, Katrina E Donahue, David L Driscoll, Diane Hauser, Jeanne W McAllister, Sanjeev N Mehta, Robert J Reid, Ming Tai-Seale, Christopher G Wise, Michael D Fetters, Jodi Summers Holtrop, Hector P Rodriguez, Cherie P Brunker, Erin L McGinley, Rachel L Day, Debra L Scammon, Michael I Harrison, Janice L Genevro, Robert A Gabbay, Michael K Magill
Care management (CM) is a promising team-based, patient-centered approach "designed to assist patients and their support systems in managing medical conditions more effectively." As little is known about its implementation, this article describes CM implementation and associated lessons from 12 Agency for Healthcare Research and Quality-sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis...
February 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27650421/did-massachusetts-health-reform-affect-veterans-affairs-primary-care-use
#12
Edwin S Wong, Matthew L Maciejewski, Paul L Hebert, Adam Batten, Karin M Nelson, Stephan D Fihn, Chuan-Fen Liu
Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre-post changes in PC use among Massachusetts and other NE veterans...
February 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29385881/effective-governance-and-hospital-boards-revisited-reflections-on-25-years-of-research
#13
Cathleen O Erwin, Amy Yarbrough Landry, Avery C Livingston, Ashley Dias
This study reviews and synthesizes empirical research literature focusing on the relationship between boards of directors and organizational effectiveness of U.S. hospitals. The study examines literature published in scholarly journals during the period of 1991-2017. Fifty-one empirical articles were identified that met the study's inclusion criteria. A framework from the corporate governance and nonprofit governance literature is used to classify the articles according to level of analysis (individual actors, governing bodies, organizations, and networks, alliances and multiorganizational initiatives) and focus of research (formal structure and behavioral dynamics-including informal structures and processes)...
January 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29363388/gender-differences-in-hospital-ceo-compensation-a-national-investigation-of-not-for-profit-hospitals
#14
Paula H Song, Shoou-Yih Daniel Lee, Matthew Toth, Simone R Singh, Gary J Young
Gender pay equity is a desirable social value and an important strategy to fill every organizational stratum with gender-diverse talent to fulfill an organization's goals and mission. This study used national, large-sample data to examine gender difference in CEO compensation among not-for-profit hospitals. Results showed the average unadjusted annual compensation for female CEOs in 2009 was $425,085 compared with $581,121 for male CEOs. With few exceptions, the difference existed across all types of not-for-profit hospitals...
January 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29347864/dense-breast-notification-laws-impact-on-downstream-imaging-after-screening-mammography
#15
Michal HornĂ½, Alan B Cohen, Richard Duszak, Cindy L Christiansen, Michael Shwartz, James F Burgess
Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Many states have recently enacted dense breast notification (DBN) laws to provide patients with information to help them make better-informed decisions about their health. To test whether DBN legislation affected the probability of screening mammography follow-up by ultrasound and magnetic resonance imaging (MRI), we examined the proportion of times screening mammography was followed by ultrasound or MRI for a series of months pre- and post-legislation...
January 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29307262/relational-climate-and-health-care-costs-evidence-from-diabetes-care
#16
Marina Soley-Bori, Theodore Stefos, James F Burgess, Justin K Benzer
Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored...
January 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29298545/treatments-and-health-outcomes-of-medicare-patients-with-back-pain
#17
Jean M Mitchell, Jack Hadley
Back pain treatments are costly and frequently involve use of procedures that may have minimal benefit on improving patients' functional status. Two recent studies evaluated adverse outcomes (mortality and major medical complications) following receipt of spinal surgery but neither examined whether such treatments affected functional ability. Using a sample composed of Medicare patients with persistent back pain, we examined whether functional ability improved after treatment, comparing patients treated with back surgery or spinal injections to nonrecipients...
January 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29262757/development-and-initial-validation-of-the-caregiver-perceptions-about-communication-with-clinical-team-members-capacity-measure
#18
Courtney Harold Van Houtven, Katherine E M Miller, Emily C O'Brien, Jennifer L Wolff, Jennifer Lindquist, Margaret Kabat, Margaret Campbell-Kotler, Jennifer Henius, Corrine I Voils
Despite the important role that family caregivers play managing the care of persons with complex health needs, little is known about how caregivers perceive themselves to be recognized and valued by health care professionals. Our objective was to develop and validate a novel measure, the CAregiver Perceptions About Commun Ication with Clinical Team members (CAPACITY) instrument. Questions focus on perceived quality of communication with the health care team and the extent to which caregivers believe that the health care team considers their capacity and preferences in decision making...
December 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29233051/analyses-of-complaints-investigations-of-allegations-and-deficiency-citations-in-united-states-nursing-homes
#19
Kevin E Hansen, Kathryn Hyer, Amanda A Holup, Kelly M Smith, Brent J Small
Quality of care in nursing homes has been evaluated from varying perspectives, but few studies analyze complaints made to surveyors. This study analyzed complaints, investigations, and citations for nursing homes nationwide. Using the complaint and survey data sets, analyses match nursing home complaints with findings of investigations conducted. Results showed the average complaint rate was 13.3 complaints per 100 residents and that 43.2% of complaint allegations were substantiated, with complaints about care and services provided being the most prevalent...
December 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29231131/impact-of-accountable-care-organizations-on-utilization-care-and-outcomes-a-systematic-review
#20
Brystana G Kaufman, B Steven Spivack, Sally C Stearns, Paula H Song, Emily C O'Brien
Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2)...
December 1, 2017: Medical Care Research and Review: MCRR
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