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Medical Care Research and Review: MCRR

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https://www.readbyqxmd.com/read/29884092/cost-effective-adjustments-to-nursing-home-staffing-to-improve-quality
#1
John R Bowblis, Amy Restorick Roberts
Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing...
June 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29877136/a-review-of-mental-health-and-mental-health-care-disparities-research-2011-2014
#2
Benjamin LĂȘ Cook, Sherry Shu-Yeu Hou, Su Yeon Lee-Tauler, Ana Maria Progovac, Frank Samson, Maria Jose Sanchez
Racial/ethnic minorities in the United States are more likely than Whites to have severe and persistent mental disorders and less likely to access mental health care. This comprehensive review evaluates studies of mental health and mental health care disparities funded by the National Institute of Mental Health (NIMH) to provide a benchmark for the 2015 NIMH revised strategic plan. A total of 615 articles were categorized into five pathways underlying mental health care and three pathways underlying mental health disparities...
June 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29779426/community-efforts-to-reduce-racial-and-ethnic-health-disparities-challenges-and-facilitators-identified-by-16-multistakeholder-alliances
#3
Jaime Hamil, Juliet Yonek, Yasmin Mahmud, Raymond Kang, Ariane Garrett, Philethea Duckett, Muriel Jean-Jacques
The Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) program aimed to improve health care quality and reduce racial and ethnic disparities in 16 diverse communities in the United States from 2006 to 2015; yet most communities failed to make substantive progress toward advancing health care equity by the program's end. This qualitative analysis of key stakeholder interviews aims to identify the major contributors to success versus failure in addressing local health disparities during AF4Q and identified five major themes...
May 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29749302/integrated-accountable-care-for-medicaid-expansion-enrollees-a-comparative-evaluation-of-hennepin-health
#4
Katherine D Vickery, Nathan D Shippee, Jeremiah Menk, Ross Owen, David M Vock, Peter Bodurtha, Dana Soderlund, Rodney A Hayward, Matthew M Davis, John Connett, Mark Linzer
Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators...
May 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29749288/changes-in-quality-of-life-among-enrollees-in-hennepin-health-a-medicaid-expansion-aco
#5
Katherine D Vickery, Nathan D Shippee, Laura M Guzman-Corrales, Cindy Cain, Sarah Turcotte Manser, Tom Walton, Jessica Richards, Mark Linzer
Despite limited program evaluations of Medicaid accountable care organizations (ACOs), no studies have examined if cost-saving goals negatively affect quality of life and health care experiences of low-income enrollees. The Hennepin Health ACO uses an integrated care model to address the physical, behavioral, and social needs of Medicaid expansion enrollees. As part of a larger evaluation, we conducted semistructured interviews with 35 primary care using Hennepin Health members enrolled for 2 or more years...
May 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29745305/why-do-so-few-consumers-use-health-care-quality-report-cards-a-framework-for-understanding-the-limited-consumer-impact-of-comparative-quality-information
#6
Neeraj Bhandari, Dennis P Scanlon, Yunfeng Shi, Rachel A Smith
Despite growing investment in producing and releasing comparative provider quality information (CQI), consumer use of CQI has remained poor. We offer a framework to interpret and synthesize the existing literature's diverse approaches to explaining the CQI's low appeal for consumers. Our framework cautions CQI stakeholders against forming unrealistic expectations of pervasive consumer use and suggests that they focus their efforts more narrowly on consumers who may find CQI more salient for choosing providers...
May 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29745304/paradoxes-of-practice-guidelines-professional-expertise-and-patient-centeredness-the-medical-care-triangle
#7
L Michele Issel
The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. METHOD: Following Poole and van de Ven's (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed...
May 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29745303/the-effect-of-aca-state-medicaid-expansions-on-medical-out-of-pocket-expenditures
#8
Joelle Abramowitz
This article considers the extent to which Affordable Care Act state Medicaid expansions alleviated the burden of out-of-pocket costs associated with obtaining health insurance and medical care using data from the 2011 to 2016 Current Population Survey Annual Social and Economic Supplement. Using a difference-in-differences framework, the analysis examines effects of the Medicaid expansions on out-of-pocket expenditures for health insurance premiums and medical care, comparing expenditures across expansion and nonexpansion states before and after the expansions were implemented, performing separate analyses for individuals with family income at various eligibility cutoff levels in the first and second years of expansion implementation...
May 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29726303/breast-and-cervical-cancer-screening-among-medicaid-beneficiaries-the-role-of-physician-payment-and-managed-care
#9
Lindsay M Sabik, Bassam Dahman, Anushree Vichare, Cathy J Bradley
Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states' Medicaid-to-Medicare fee ratios and estimate their impact on screening services...
May 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29708053/racial-and-ethnic-differences-in-medicaid-acceptance-by-primary-care-physicians-a-geospatial-analysis
#10
Michael R Daly, Jennifer M Mellor
Physician acceptance is an important dimension of access to care, especially for Medicaid patients. We constructed two new measures to quantify primary care physician (PCP) acceptance of Medicaid patients using geocoded Virginia physician addresses and population data and geospatial methods. For each Census block group, we measured the shares of "accessible PCPs" accepting any Medicaid patients or new Medicaid patients. Accessible PCPs were defined as those located within 30-minute travel from patient locations and patient locations were proxied by Census block group geographic centroids...
April 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29676190/the-role-of-organizational-affiliations-in-physician-patient-sharing-relationships
#11
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
#12
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/29148327/are-integrated-plan-providers-associated-with-lower-premiums-on-the-health-insurance-marketplaces
#13
Ambar La Forgia, Jared Lane K Maeda, Jessica S Banthin
As the health insurance industry becomes more consolidated, hospitals and health systems have started to enter the insurance business. Insurers are also rapidly acquiring providers. Although these "vertically" integrated plan providers are small players in the insurance market, they are becoming more numerous. The health insurance marketplaces (HIMs) offer a unique setting to study integrated plan providers relative to other insurer types because the HIMs were designed to promote competition. In this descriptive study, the authors compared the premiums of the lowest priced silver plans of integrated plan providers with other insurer types on the 2015 and 2016 HIMs...
April 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29148322/the-health-care-job-engine-where-do-they-come-from-and-what-do-they-say-about-our-future
#14
Bianca K Frogner
Health care has been cited as a job engine for the U.S. economy. This study used the Current Population Survey to examine the sector and occupation shifts that underlie this growth trend. Health care has had a cyclical relationship with retail trade, leisure and hospitality, education, and professional services. The entering workforce has been increasingly taking on low-skilled occupations. The exiting workforce has not been necessarily retiring or going back to school, but appeared to be leaving without a job, with potentially more child care duties, and with high rates of disability and poverty levels...
April 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
#15
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/29148319/association-between-prescription-drug-insurance-and-health-care-utilization-among-medicare-beneficiaries
#16
G Caleb Alexander, Cuiping Schiman, Robert Kaestner
Medicare Part D was associated with reduced hospitalizations, yet little is known whether these effects varied across patients and how Part D was associated with length of stay and inpatient expenditures. We used Medicare claims and the Medicare Current Beneficiary Survey from 2002 to 2010 and an instrumental variables approach. Gaining drug insurance through Part D was associated with a statistically significant 8.0% reduction in likelihood of admission across conditions examined. Reductions were generally greater for younger, healthier, and male individuals...
April 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27927839/does-medicare-advantage-reduce-racial-disparity-in-30-day-rehospitalization-for-medicare-beneficiaries
#17
Yue Li, Xi Cen, Xueya Cai, Dongliang Wang, Caroline Pinto Thirukumaran, Laurent G Glance
This study determined potential racial and ethnic disparities in risk for all-cause 30-day readmission among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries initially hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia. Our analyses of New York State hospital administrative data between 2009 and 2012 found that overall 30-day readmission rate declined from 22.0% in 2009 to 20.7% in 2012 for TM beneficiaries, and from 20.2% in 2009 to 17.9% in 2012 for MA beneficiaries...
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
#18
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/29606036/a-comprehensive-theory-of-integration
#19
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
#20
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
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