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Medical Care Research and Review: MCRR

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https://www.readbyqxmd.com/read/29233051/analyses-of-complaints-investigations-of-allegations-and-deficiency-citations-in-united-states-nursing-homes
#1
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
#2
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
https://www.readbyqxmd.com/read/29231130/development-and-testing-of-the-provider-and-staff-perceptions-of-integrated-care-pspic-survey
#3
Sarah Derrett, Kathryn E Gunter, Ari Samaranayaka, Sara J Singer, Robert S Nocon, Michael T Quinn, Mary Breheny, Amanda Campbell, Cynthia T Schaefer, Loretta J Heuer, Marshall H Chin
This article discusses development and testing of the Provider and Staff Perceptions of Integrated Care Survey, a 21-item questionnaire, informed by Singer and colleagues' seven-construct framework. Questionnaires were sent to 2,936 providers and staff at 100 federally qualified health centers and other safety net clinics in 10 Midwestern U.S. states; 332 were ineligible, leaving 2,604 potential participants. Following 4 mailings, 781 (30%) responded from 97 health centers. Item analyses, exploratory factor analysis, and confirmatory factor analysis were undertaken...
December 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29199504/hospital-readmissions-reduction-program-intended-and-unintended-effects
#4
Min Chen, David C Grabowski
This study examines whether the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excess readmissions for certain conditions, has reduced hospital readmissions and led to unintended consequences. Our analyses of Florida hospital administrative data between 2008 and 2014 find that the HRRP resulted in a reduction in the likelihood of readmissions by 1% to 2% for traditional Medicare (TM) beneficiaries with heart failure, pneumonia, or chronic obstructive pulmonary disease. Readmission rates for Medicare Advantage (MA) beneficiaries and privately insured patients with heart attack and heart failure decreased even more than TM patients with the same target condition (e...
December 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29172972/choosing-doctors-wisely-can-assisted-choice-enhance-patients-selection-of-clinicians
#5
Steven C Martino, Rachel Grob, Sarah Davis, Andrew M Parker, Melissa L Finucane, Jennifer L Cerully, Lise Rybowski, Dale Shaller, Mark Schlesinger
We conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants ( N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator. Introducing patient comments enhanced engagement with the quality information but led to a decline in decision quality, particularly the consistency of choices with consumers' stated preferences...
November 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29166825/lifetime-consequences-of-early-life-and-midlife-access-to-health-insurance-a-review
#6
√Čtienne Gaudette, Gwyn C Pauley, Julie M Zissimopoulos
Over the past decade, the number of studies examining the effects of health insurance has grown rapidly, along with the breadth of outcomes considered. In light of growing research in this area and the intense policy focus on coverage expansions in the United States, there is need for an up-to-date and comprehensive literature review and synthesis of lessons learned. We reviewed 112 experimental or quasi-experimental studies on the effects of health insurance prior to people becoming eligible for Medicare on a broad set of outcomes...
November 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29161977/coordinated-care-organizations-neonatal-and-infant-outcomes-in-oregon
#7
S Marie Harvey, Lisa P Oakley, Jangho Yoon, Jeff Luck
In 2012, Oregon's Medicaid program implemented a comprehensive accountable care model delivered through coordinated care organizations (CCOs). Because CCOs are expected to improve utilization of services and health outcomes, neonatal and infant outcomes may be important indicators of their impact. Estimating difference-in-differences models, we compared prepost CCO changes in outcomes (e.g., low birth weight, abnormal conditions, 5-minute Apgar score, congenital anomalies, and infant mortality) between Medicaid and non-Medicaid births among 99,924 infants born in Oregon during 2011 and 2013...
November 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29139330/comparing-care-for-dual-eligibles-across-coverage-models-empirical-evidence-from-oregon
#8
Hyunjee Kim, Christina J Charlesworth, K John McConnell, Jennifer B Valentine, David C Grabowski
Dual-eligible beneficiaries or "duals" are individuals enrolled in both the Medicare and Medicaid programs. For both Medicare and Medicaid, they may be enrolled in fee-for-service or managed care, creating a mix of possible coverage models. Understanding these different models is essential to improving care for duals. Using All-Payer All-Claims data, we empirically described health service use and quality of care for Oregon duals across five coverage models with different combinations of fee-for-service, managed care, and plan alignment status across Medicare and Medicaid...
November 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29094651/the-relationship-between-reported-staffing-and-expenditures-in-nursing-homes
#9
Hari Sharma, R Tamara Konetzka, Fabrice Smieliauskas
Dramatic improvements in reported nursing home quality, including staffing ratios, have come under increased scrutiny in recent years because they are based on data self-reported by nursing homes. In contrast to other domains, the key mechanism for real improvement in the staffing ratios domain is clearer: to improve scores, nursing homes should increase staffing expenditures. We analyze the relationship between changes in expenditures and reported staffing quality pre- versus post the 5-star rating system...
November 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29090623/care-transformation-strategies-and-approaches-of-accountable-care-organizations
#10
Valerie A Lewis, Katherine I Tierney, Taressa Fraze, Genevra F Murray
Although accountable care organizations (ACOs) proliferate, little is known about the activities and strategies ACOs are pursuing to meet goals of reducing costs and improving quality. We use semistructured interviews with executives at 16 ACOs to understand ACO approaches. We identified two overarching ACO approaches to changing clinical care: a practice-based transformation approach, working to overhaul care processes and teams from the inside out; and an overlay approach, where ACO activities were centralized and delivered external to physician practices...
October 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29073847/states-with-medically-needy-pathways-differences-in-long-term-and-temporary-medicaid-entry-for-low-income-medicare-beneficiaries
#11
Laura M Keohane, Amal Trivedi, Vincent Mor
Medically needy pathways may provide temporary catastrophic coverage for low-income Medicare beneficiaries who do not otherwise qualify for full Medicaid benefits. Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs (7.5% vs. 4.1%, p < .01). However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with a 3.8 percentage point (adjusted 95% confidence interval [1...
October 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27624634/a-nationwide-assessment-of-the-association-of-smoking-bans-and-cigarette-taxes-with-hospitalizations-for-acute-myocardial-infarction-heart-failure-and-pneumonia
#12
Vivian Ho, Joseph S Ross, Claudia A Steiner, Aditya Mandawat, Marah Short, Meei-Hsiang Ku-Goto, Harlan M Krumholz
Multiple studies claim that public place smoking bans are associated with reductions in smoking-related hospitalization rates. No national study using complete hospitalization counts by area that accounts for contemporaneous controls including state cigarette taxes has been conducted. We examine the association between county-level smoking-related hospitalization rates and comprehensive smoking bans in 28 states from 2001 to 2008. Differences-in-differences analysis measures changes in hospitalization rates before versus after introducing bans in bars, restaurants, and workplaces, controlling for cigarette taxes, adjusting for local health and provider characteristics...
December 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27516452/favorable-risk-selection-in-medicare-advantage-trends-in-mortality-and-plan-exits-among-nursing-home-beneficiaries
#13
Elizabeth M Goldberg, Amal N Trivedi, Vincent Mor, Hye-Young Jung, Momotazur Rahman
The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans' incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA...
December 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/28918678/the-affordable-care-act-medicaid-expansions-and-personal-finance
#14
Kyle J Caswell, Timothy A Waidmann
Using a novel data set from a major credit bureau, we examine the early effects of the Affordable Care Act Medicaid expansions on personal finance. We analyze less common events such as personal bankruptcy, and more common occurrences such as medical collection balances, and change in credit scores. We estimate triple-difference models that compare individual outcomes across counties that expanded Medicaid versus counties that did not, and across expansion counties that had more uninsured residents versus those with fewer...
September 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/28906171/association-of-state-level-restrictions-in-nurse-practitioner-scope-of-practice-with-the-quality-of-primary-care-provided-to-medicare-beneficiaries
#15
Jennifer Perloff, Sean Clarke, Catherine M DesRoches, Monica O'Reilly-Jacob, Peter Buerhaus
CONTEXT: State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. METHOD: This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care...
September 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/28901205/satisfaction-burnout-and-turnover-among-nurse-practitioners-and-physician-assistants-a-review-of-the-empirical-literature
#16
Timothy Hoff, Shannon Carabetta, Grace E Collinson
Examining the work-related psychological states of nurse practitioners and physician assistants is important, given their increased role expansion. The current PRISMA-guided review examined studies published between 2000 and 2016 for both these groups. The review also examined features of the research to draw conclusions about overall quality. Applying theories in job enrichment and job demands, 32 articles were identified that contained analyses of satisfaction, burnout, stress, and turnover. Key findings include the lack of robust research designs, overemphasis on job satisfaction, lower levels of satisfaction across both groups, and higher intrinsic versus extrinsic satisfaction levels generally...
September 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/28891386/testing-a-personal-narrative-for-persuading-people-to-value-and-use-comparative-physician-quality-of-care-information-an-experimental-study
#17
Jessica Greene, Judith H Hibbard, Rebecca M Sacks
OBJECTIVE: This study tests whether a personal narrative can persuade people to value comparative data on physician quality. METHOD: We conducted an online experiment with 850 adults. One group viewed a cartoon narrative on physician quality variation, another saw text on physician quality variation, and there was a control group. Study participants hypothetically selected a physician from a display of four physicians. The top-quality physician was furthest away and most expensive...
September 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/28882087/racial-ethnic-disparities-in-quality-of-care-for-cardiovascular-disease-in-ambulatory-settings-a-review
#18
Liming Dong, Oludolapo A Fakeye, Garth Graham, Darrell J Gaskin
Racial and ethnic disparities in cardiovascular disease (CVD) outcomes are widely reported, but research has largely focused on differences in quality of inpatient and urgent care to explain these disparate outcomes. The objective of this review is to synthesize recent evidence on racial and ethnic disparities in management of CVD in the ambulatory setting. Database searches yielded 550 articles of which 25 studies met the inclusion criteria. Reviewed studies were categorized into non-interventional studies examining the association between race and receipt of ambulatory CVD services with observational designs, and interventional studies evaluating specific clinical courses of action intended to ameliorate disparities...
September 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148356/specialization-as-an-organizing-principle-the-case-of-ambulatory-surgery-centers
#19
Kathleen Carey, Jean M Mitchell
Ambulatory surgery centers (ASCs) recently have grown to become the dominant provider of specific surgical procedures in the United States. While the majority of ASCs focus primarily on a single specialty, many have diversified to offer a wide range of surgical specialties. We exploited a unique data set from Pennsylvania for the years 2004 to 2014 to conduct an empirical investigation of the relative cost of production in ASCs over varying degrees of specialization. We found that for the majority of ASCs, focus on a specialty was associated with lower facility costs...
August 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148355/vertical-integration-of-hospitals-and-physicians-economic-theory-and-empirical-evidence-on-spending-and-quality
#20
Brady Post, Tom Buchmueller, Andrew M Ryan
Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support...
August 1, 2017: Medical Care Research and Review: MCRR
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