7,154 results match your criteria Medical Care[Journal]


Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams.

Med Care 2019 Feb 14. Epub 2019 Feb 14.

Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Health Care System.

Background: In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans.

Objective: The main aim of this study was to determine whether H-PACT offers a better patient experience than standard VHA primary care.

Research Design: We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001070DOI Listing
February 2019

Comparison of Medicare Claims-based Proxy Measures of Poor Function and Associations With Treatment Receipt and Mortality in Older Colon Cancer Patients.

Med Care 2019 Feb 14. Epub 2019 Feb 14.

Department of Epidemiology, Gillings School of Global Public Health.

Background: Multiple claims-based proxy measures of poor function have been developed to address confounding in observational studies of drug effects in older adults. We evaluated agreement between these measures and their associations with treatment receipt and mortality in a cohort of older colon cancer patients.

Methods: Medicare beneficiaries age 66+ diagnosed with stage II-III colon cancer were identified in the Surveillance, Epidemiology, and End Results-Medicare database (2004-2011). Read More

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http://dx.doi.org/10.1097/MLR.0000000000001073DOI Listing
February 2019

Physician Participation in Medicare Accountable Care Organizations and Spillovers in Commercial Spending.

Med Care 2019 Feb 14. Epub 2019 Feb 14.

Department of Urology, Michigan Medicine, Ann Arbor, MI.

Importance: The benefits of public payment policy may extend to private populations through "spillover" effects. If cost-saving efforts in Medicare also reduce costs among commercially insured patients, Medicare payment systems could be a versatile policy tool in future reform efforts.

Objectives: To determine whether physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercial patients. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001081DOI Listing
February 2019

Effect of Home Medication Titration on Blood Pressure Control in Patients With Hypertension: A Meta-Analysis of Randomized Controlled Trials.

Med Care 2019 Mar;57(3):230-236

Department of Mathematics, Tamkang University, Taipei, Taiwan.

Background: Medication titration has been used in home blood pressure (BP) control, with the expectation of enabling patients with hypertension to better manage their BP.

Objective: The study goal was to estimate the effects of medication titration intervention in lowering the systolic blood pressure and diastolic blood pressure of patients with hypertension.

Methods: The meta-analysis included randomized controlled trials on adults diagnosed with hypertension and BP≧130/80 mm Hg, having a medication-titration intervention, and using a home BP measurement. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001064DOI Listing

Epilepsy Among Elderly Medicare Beneficiaries: A Validated Approach to Identify Prevalent and Incident Epilepsy.

Med Care 2019 Feb 12. Epub 2019 Feb 12.

Department of Medicine, Mongan Institute, Massachusetts General Hospital.

Background: Uncertain validity of epilepsy diagnoses within health insurance claims and other large datasets have hindered efforts to study and monitor care at the population level.

Objectives: To develop and validate prediction models using longitudinal Medicare administrative data to identify patients with actual epilepsy among those with the diagnosis.

Research Design, Subjects, Measures: We used linked electronic health records and Medicare administrative data including claims to predict epilepsy status. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001072DOI Listing
February 2019

Brief Report: Trends in Hospital Utilization After Medicaid Expansion.

Med Care 2019 Feb 12. Epub 2019 Feb 12.

Institute for Healthcare Policy and Innovation.

Background: Medicaid expansion was associated with an increase in hospitalizations funded by Medicaid. Whether this increase reflects an isolated payer shift or broader changes in case-mix among hospitalized adults remains uncertain.

Reseearch Design: Difference-in-differences analysis of discharge data from 4 states that expanded Medicaid in 2014 (Arizona, Iowa, New Jersey, and Washington) and 3 comparison states that did not (North Carolina, Nebraska, and Wisconsin). Read More

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http://dx.doi.org/10.1097/MLR.0000000000001082DOI Listing
February 2019

How Much Does Medication Nonadherence Cost the Medicare Fee-for-Service Program?

Med Care 2019 Mar;57(3):218-224

Center for Medicare and Medicaid Innovation.

Background: Medication adherence is associated with lower health care utilization and savings in specific patient populations; however, few empirical estimates exist at the population level.

Objective: The main objective of this study was to apply a data-driven approach to obtain population-level estimates of the impact of medication nonadherence among Medicare beneficiaries with chronic conditions.

Research Design: Medicare fee-for-service (FFS) claims data were used to calculate the prevalence of medication nonadherence among individuals with diabetes, heart failure, hypertension, and hyperlipidemia. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001067DOI Listing
March 2019
1 Read

Veterans' Reliance on VA Care by Type of Service and Distance to VA for Nonelderly VA-Medicaid Dual Enrollees.

Med Care 2019 Mar;57(3):225-229

Health Economics Resource Center.

Background: Not much is known about nonelderly veterans and their reliance on care from the Veterans Affairs (VA) health care system when they have access to non-VA care.

Objectives: To estimate VA reliance for nonelderly veterans enrolled in VA and Medicaid.

Research Design: Retrospective, longitudinal analysis of Medicaid claims data and VA administrative data to compare patients' utilization of VA and Medicaid services 12 months before and for up to 12 months after Medicaid enrollment began. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001066DOI Listing
March 2019
2 Reads

Measuring and Analyzing Length of Stay in Critical Care Trials.

Med Care 2019 Jan 16. Epub 2019 Jan 16.

Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine.

Background: In randomized clinical trials among critically ill patients, it is uncertain how choices regarding the measurement and analysis of nonmortal outcomes measured in terms of duration, such as intensive care unit (ICU) length of stay (LOS), affect studies' conclusions.

Objectives: Assess the definitions and analytic methods used for ICU LOS analyses in published randomized clinical trials.

Research Design: This is a systematic review and statistical simulation study. Read More

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http://Insights.ovid.com/crossref?an=00005650-900000000-9849
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http://dx.doi.org/10.1097/MLR.0000000000001059DOI Listing
January 2019
4 Reads

Feasibility and Value of Patient-reported Outcome Measures for Value-based Payment.

Authors:
Dana Gelb Safran

Med Care 2019 Mar;57(3):177-179

Tufts University School of Medicine.

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http://dx.doi.org/10.1097/MLR.0000000000001069DOI Listing

Missing Data in Marginal Structural Models: A Plasmode Simulation Study Comparing Multiple Imputation and Inverse Probability Weighting.

Med Care 2019 Mar;57(3):237-243

Department of Quantitative Health Sciences, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, University of Massachusetts Medical School, Worcester, MA.

Background: The use of marginal structural models (MSMs) to adjust for time-varying confounding has increased in epidemiologic studies. However, in the setting of MSMs, recommendations for how best to handle missing data are contradictory. We present a plasmode simulation study to compare the validity and precision of MSMs estimates using complete case analysis (CC), multiple imputation (MI), and inverse probability weighting (IPW) in the presence of missing data on time-independent and time-varying confounders. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001063DOI Listing
March 2019
4 Reads

Attitudes About Consumer Strategies Among Americans in High-deductible Health Plans.

Med Care 2019 Mar;57(3):187-193

Department of Internal Medicine, University of Michigan Medicine, Ann Arbor, MI.

Background: More than 70 million Americans are enrolled in a high-deductible health plan (HDHP), with high upfront cost-sharing to encourage strategies such as price shopping to mitigate out-of-pocket spending. Recent research suggests HDHP enrollees are reluctant to engage in these consumer strategies, but there is little information on why.

Objectives: To describe associations between HDHP enrollees' attitudes about and intent to engage in consumer strategies. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001056DOI Listing
March 2019
2 Reads

Medicaid Expansion and Prescription Trends: Opioids, Addiction Therapies, and Other Drugs.

Med Care 2019 Mar;57(3):208-212

The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.

Background: Opioid overdose deaths in the United States have climbed since 1999. In 2014, the Affordable Care Act prompted some states to expand Medicaid programs, providing low-cost prescription access to millions of Americans. Some have questioned whether Medicaid expansion might worsen the opioid crisis. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375792PMC
March 2019
2 Reads

Informal Clinical Integration in Medicare Accountable Care Organizations and Mortality Following Coronary Artery Bypass Graft Surgery.

Med Care 2019 Mar;57(3):194-201

Department of Urology, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI.

Background: Accountable care organizations' (ACOs') focus on formal clinical integration to improve outcomes overlooks actual patterns of provider interactions around shared patients.

Objective: To determine whether such informal clinical integration relates to a health system's performance in an ACO.

Research Design: We analyzed national Medicare data (2008-2014), identifying beneficiaries who underwent coronary artery bypass grafting (CABG). Read More

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http://dx.doi.org/10.1097/MLR.0000000000001052DOI Listing

Evaluation of a Medicaid Lock-in Program: Increased Use of Opioid Use Disorder Treatment but No Impact on Opioid Overdose Risk.

Med Care 2019 Mar;57(3):213-217

Duke Clinical Research Institute, Durham, NC.

Background: "Lock-in" programs (LIPs) identify beneficiaries demonstrating potential overutilization of opioids, and other controlled substances, and restrict their access to these medications. LIPs are expanding to address the opioid crisis and could be an effective tool for connecting people to opioid use disorder treatment. We examined the immediate and sustained effects of a Medicaid LIP on overdose risk and use of medication-assisted treatment (MAT) for opioid use disorder. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001058DOI Listing
March 2019
9 Reads

The Impacts of the ACA Medicaid Expansions on Cancer Screening Use by Primary Care Provider Supply.

Med Care 2019 Mar;57(3):202-207

College of Public Health.

Background: Recent studies of the impacts of the Affordable Care Act (ACA) Medicaid expansions on cancer screening use have mostly found insignificant effects. We posit that these findings mask meaningful heterogeneity in impacts depending on availability of primary care providers.

Objective: This study examined the impacts of the ACA Medicaid expansions on cancer screening use separately by state-level supply of primary care providers. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001053DOI Listing

External Validation of ASPECT (Algorithm for Suspected Pulmonary Embolism Confirmation and Treatment).

Med Care 2019 Jan 2. Epub 2019 Jan 2.

Center for Clinical Epidemiology, Jewish General Hospital.

Background: Administrative health care databases are increasingly being used to study pulmonary embolism (PE), but the validity of single PE codes is variable. Using data from Quebec, Canada, we developed ASPECT (Algorithm for Suspected Pulmonary Embolism Confirmation and Treatment), combining 3 components to ascertain confirmed PE: emergency department (ED) diagnoses, imaging codes, and dispensed prescriptions or hospital diagnoses. Herein, we used unrelated administrative health care databases to externally validate ASPECT. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001055DOI Listing
January 2019
4 Reads

Patient-directed Digital Health Technologies: Is Implementation Outpacing Evidence?

Med Care 2019 Feb;57(2):95-97

College of Communication Arts and Sciences, Michigan State University, East Lansing, MI.

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http://dx.doi.org/10.1097/MLR.0000000000001068DOI Listing
February 2019

Dissemination and Implementation of Patient-centered Indicators of Pain Care Quality and Outcomes.

Med Care 2019 Feb;57(2):159-166

College of Nursing, University of Utah, Salt Lake City, UT.

Background: Previous approaches to measuring and improving nursing-sensitive, patient-centered metrics of pain quality and outcomes in hospitalized patients have been limited.

Methods: In this translational research study, we disseminated and implemented pain quality indicators in 1611 medical and/or surgical, step-down, rehabilitation, critical access, and obstetrical (postpartum) units from 326 US hospitals participating in the National Database of Nursing Quality Indicators. Eligible patients were English-speaking adults in pain. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001042DOI Listing
February 2019

Affordable Care Act-dependent Insurance Coverage and Access to Care Among Young Adult Women With a Recent Live Birth.

Med Care 2019 Feb;57(2):109-114

Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA.

Background: The Affordable Care Act (ACA)-dependent coverage Provision (the Provision), implemented in 2010, extended family insurance coverage to adult children until age 26.

Objectives: To examine the impact of the ACA Provision on insurance coverage and care among women with a recent live birth.

Research Design, Subjects, And Outcome Measures: We conducted a difference-in-difference analysis to assess the effect of the Provision using data from the Pregnancy Risk Assessment Monitoring System among 22,599 women aged 19-25 (treatment group) and 22,361 women aged 27-31 years (control group). Read More

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http://dx.doi.org/10.1097/MLR.0000000000001044DOI Listing
February 2019
5 Reads

Psychometric Evaluation of an Instrument to Measure Prospective Pregnancy Preferences: The Desire to Avoid Pregnancy Scale.

Med Care 2019 Feb;57(2):152-158

Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, School of Medicine, San Francisco.

Background: Existing approaches to measuring women's pregnancy intentions suffer important limitations, including retrospective assessment, overly simple categories, and a presumption that all women plan pregnancies. No psychometrically valid scales exist to prospectively measure the ranges of women's pregnancy preferences.

Materials And Methods: Using a rigorous construct modeling approach, we developed a scale to measure desire to avoid pregnancy. Read More

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http://Insights.ovid.com/crossref?an=00005650-900000000-9850
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http://dx.doi.org/10.1097/MLR.0000000000001048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331264PMC
February 2019
4 Reads

Risk Factors for Early Disenrollment From Colorado's Affordable Care Act Marketplace.

Med Care 2019 Jan;57(1):49-53

Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.

Background: Midyear disenrollment from Marketplace coverage may have detrimental effects on continuity of care and risk pool stability of individual health insurance markets.

Objective: The main objective of this study was to assess associations between insurance plan characteristics, individual and area-level demographics, and disenrollment from Marketplace coverage.

Data: All payer claims data from individual market enrollees, 2014-2016. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001020DOI Listing
January 2019
2 Reads
3.232 Impact Factor

Symptom Care at Home: A Comprehensive and Pragmatic Pro System Approach to Improve Cancer Symptom Care.

Med Care 2018 Dec 10. Epub 2018 Dec 10.

University of Utah (emeritus), Salt Lake City, UT.

Introduction: There is growing recognition that systematically obtaining the patient's perspective on their health experience, using patient-reported outcomes (PRO), can be used to improve patient care in real time. Few PRO systems are designed to monitor and provide symptom management support between visits. Patients are instructed to contact providers between visits with their concerns, but they rarely do, leaving patients to cope with symptoms alone at home. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001037DOI Listing
December 2018
1 Read

Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Home Health Care.

Med Care 2019 Feb;57(2):145-151

Division of Rehabilitation Sciences.

Background: Beginning in 2019, home health agencies' rates of potentially preventable hospital readmissions over the 30 days following discharge will be publicly reported.

Objectives: Our primary objective was to determine the association between patients' functional status at discharge from home health care and 30-day potentially preventable readmissions. A secondary objective was to identify the most common conditions resulting in potentially preventable readmissions. Read More

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http://Insights.ovid.com/crossref?an=00005650-900000000-9850
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http://dx.doi.org/10.1097/MLR.0000000000001047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358180PMC
February 2019
2 Reads

Indirect Estimation of Race/Ethnicity for Survey Respondents Who Do Not Report Race/Ethnicity.

Med Care 2018 Dec 4. Epub 2018 Dec 4.

RAND Corporation, Santa Monica, CA.

Background: Researchers are increasingly interested in measuring race/ethnicity, but some survey respondents skip race/ethnicity items.

Objectives: The main objectives of this study were to investigate the extent to which racial/ethnic groups differ in skipping race/ethnicity survey items, the degree to which this reflects reluctance to disclose race/ethnicity, and the utility of imputing missing race/ethnicity.

Research Design: We applied a previously developed method for imputing race/ethnicity from administrative data (Medicare Bayesian Improved Surname and Geocoding 2. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001011DOI Listing
December 2018
19 Reads

The Methodological Challenges of Using Veterans Benefits Administration Disability Codes to Ascertain Agent Orange Exposure Among Vietnam Theater Veterans With Service-connected Disabilities.

Med Care 2019 Feb;57(2):172-173

Department of Veterans Affairs, Office of Research & Development, Veterans Health Administration, NW, Washington, DC.

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http://dx.doi.org/10.1097/MLR.0000000000001045DOI Listing
February 2019
9 Reads

Role of Prices, Utilization, and Health in Explaining Texas Medicaid Newborn Care Spending Variation.

Med Care 2019 Feb;57(2):131-137

Department of Health Services Administration, University of Maryland School of Public Health, College Park, MD.

Background: Newborn care is one of the most frequent types of hospitalization and Medicaid covers over 50% of all births nationwide. However, little is known about regional variation in Medicaid newborn care spending and its drivers.

Objectives: To measure the contribution of market-level prices, utilization, and health risk on regional variation in spending among newborn Medicaid population in Texas. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001041DOI Listing
February 2019
4 Reads

Falsification Tests for Instrumental Variable Designs With an Application to Tendency to Operate.

Med Care 2019 Feb;57(2):167-171

Statistics, University of Pennsylvania.

Background: Instrumental variable (IV) methods are becoming an increasingly important tool in health services research as they can provide consistent estimates of causal effects in the presence of unobserved confounding. However, investigators must provide justifications that the IV is independent with any unmeasured confounder and its effect on the outcome occurs only through receipt of the exposure. These assumptions, while plausible in some contexts, cannot be verified from the data. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368955PMC
February 2019

Inpatients Sign On: An Opportunity to Engage Hospitalized Patients and Caregivers Using Inpatient Portals.

Med Care 2019 Feb;57(2):98-100

Department of Pediatrics, University of Wisconsin School of Medicine and Public Health.

Background: Inpatient portals are online patient portals linked to electronic health records that provide hospitalized patients and caregivers secure access to real-time clinical information and tools to enhance their communication with providers and hospital experience.

Objective: The main objective of this commentary was to provide a perspective that inpatient portals are innovative tools poised to engage patients and caregivers during hospitalization and, thus, enhance patient-centered care.

Results: Inpatient portals are desired by patients and caregivers and may contribute to improved recognition of their inpatient care team, knowledge of their treatment plan and overall inpatient experience. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331235PMC
February 2019
2 Reads

Response to Letter Regarding Characteristics of State Policies Impact Health Care Delivery.

Med Care 2019 Feb;57(2):175-176

Department of Radiology and Imaging Sciences, Emory University School of Medicine.

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http://dx.doi.org/10.1097/MLR.0000000000001039DOI Listing
February 2019

Competition in Outpatient Procedure Markets.

Med Care 2019 Jan;57(1):36-41

Stanford University and the National Bureau of Economic Research, Stanford, CA.

Background: More than half of all medical procedures performed in the United States occur in an outpatient setting, yet few studies have explored how competition among ambulatory surgery centers (ASCs) and hospitals affects prices for commercially insured outpatient services.

Objectives: We examined the association between prices for commercially insured outpatient procedures and competition among ASCs and hospitals.

Research Design: Using claims from the Health Care Cost Institute for 2008-2012, we constructed county-level price indices for outpatient procedures in hospital outpatient departments and ASCs. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001003DOI Listing
January 2019

Letter Regarding Characteristics of State Policies Impact Health Care Delivery.

Authors:
JoAnn Pushkin

Med Care 2019 Feb;57(2):174-175

DenseBreast-info.org, Deer Park, NY.

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http://dx.doi.org/10.1097/MLR.0000000000001038DOI Listing
February 2019

Using Group-based Trajectory Models and Propensity Score Weighting to Detect Heterogeneous Treatment Effects: The Case Study of Generic Hormonal Therapy for Women With Breast Cancer.

Med Care 2019 Jan;57(1):85-93

Medical College of Wisconsin, Milwaukee, WI.

Background: We extend an interrupted time series study design to identify heterogenous treatment effects using group-based trajectory models (GBTMs) to identify groups before a new policy and then examine if the effects of the policy has consistent impacts across groups using propensity score weighting to balance individuals within trajectory groups who are and are not exposed to the policy change. We explore this by examining how adherence to endocrine therapy (ET) for women with breast cancer was impacted by reducing copayments for medications by the introduction of generic ETs among women who do not receive a subsidy (the "treatment" group) to those that do receive a subsidy and are not exposed to any changes in copayments (the "control" group).

Methods: We examined monthly adherence to ET using the proportion of days covered for women diagnosed with breast cancer between 2008 and 2009 using SEER-Medicare data. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291347PMC
January 2019
11 Reads

Factors Associated With Hospices' Nonparticipation in Medicare's Hospice Compare Public Reporting Program.

Med Care 2019 Jan;57(1):28-35

Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT.

Background: To enhance the quality of hospice care and to facilitate consumers' choices, the Centers for Medicare and Medicaid Services (CMS) began the Hospice Quality Reporting Program, in which CMS posted the quality measures of participating hospices on its reporting website, Hospice Compare. Little is known about the participation rate and the types of nonparticipating hospices.

Objective: To examine the factors associated with hospices' nonparticipation in Hospice Compare. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001016DOI Listing
January 2019
1 Read

ICD-10 Coding Will Challenge Researchers: Caution and Collaboration may Reduce Measurement Error and Improve Comparability Over Time.

Med Care 2018 Nov 26. Epub 2018 Nov 26.

The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH.

Background: The October 1, 2015 US health care diagnosis and procedure codes update, from the 9th to 10th version of the International Classification of Disease (ICD), abruptly changed the structure, number, and diversity of codes in health care administrative data. Translation from ICD-9 to ICD-10 risks introducing artificial changes in claims-based measures of health and health services.

Objective: Using published ICD-9 and ICD-10 definitions and translation software, we explored discontinuity in common diagnoses to quantify measurement changes introduced by the upgrade. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001010DOI Listing
November 2018

Trends, Causes, and Outcomes of Hospitalizations for Homeless Individuals: A Retrospective Cohort Study.

Med Care 2019 Jan;57(1):21-27

Department of Medicine, Washington University School of Medicine, St. Louis, MO.

Objectives: In the United States, an estimated 553,000 people are homeless on any given night. Few data provide large-scale, contemporary insight with regard to recent patterns of acute illness in this vulnerable population. We evaluated patterns, causes, and outcomes of acute hospitalization among homeless persons compared with a demographics-standardized and risk-standardized nonhomeless cohort. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001015DOI Listing
January 2019
5 Reads

Sexual Orientation Disparities in Physical Activity: Results From Insured Adults in California.

Med Care 2019 Feb;57(2):138-144

Health Services Policy and Management, University of South Carolina, CO.

Background: The majority of adults in the United States fail to meet the Centers for Disease Control and Prevention (CDC) physical activity (PA) guideline recommendations for health promotion. Despite evidence of disparities by sexual orientation in adverse health outcomes related to PA, little is known about whether PA patterns and the likelihood of meeting these guidelines differ between heterosexual and sexual minority (SM) men and women.

Methods: In 2018, we pooled unweighted respondent data from Kaiser Permanente Northern California Member Health Surveys conducted in 2008, 2011, and 2014/15 (N=42,534) to compare PA patterns among heterosexual and SM men and women. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001017DOI Listing
February 2019

Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees.

Med Care 2019 Feb;57(2):123-130

University of Minnesota, Division of Health Policy and Management School of Public Health, Minneapolis, MN.

Background: The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors.

Objective: The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees.

Research Design: We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001024DOI Listing
February 2019
9 Reads

Emergency Department and Primary Care Use in Massachusetts 5 Years After Health Reform.

Med Care 2019 Feb;57(2):101-108

University of Massachusetts Medical School, Worcester.

Objective: Conceptually, access to primary care (through insurance) should reduce emergency department (ED) visits for primary care sensitive (PCS) conditions. We sought to identify characteristics of insured Massachusetts residents associated with PCS ED use, and compare such use for public versus private insurees.

Population And Setting: People under age 65 in the Massachusetts All-Payer Claims Data, 2011-2012. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001025DOI Listing
February 2019
10 Reads

Do Hospital and Physician Volume Thresholds for the Volume-Outcome Relationship in Heart Failure Exist?

Med Care 2019 Jan;57(1):54-62

Institute of Health Policy and Management, National Taiwan University.

Background: Although volume-outcome relationships have been explored for various procedures and interventions, limited information is available concerning the effect of hospital and physician volume on heart failure mortality. Most importantly, little is known about whether there are optimal hospital and physician volume thresholds to reduce heart failure mortality.

Objectives: We used nationwide population-based data to identify the optimal hospital and physician volume thresholds to achieve optimum mortality and to examine the relative and combined effects of the volume thresholds on heart failure mortality. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001022DOI Listing
January 2019
5 Reads

A Comparison of Methods for Classifying and Modeling Respondents Who Endorse Multiple Racial/Ethnic Categories: A Health Care Experience Application.

Med Care 2018 Nov 14. Epub 2018 Nov 14.

University of Alabama at Birmingham, Birmingham, AL.

Background: Race/ethnicity information is vital for measuring disparities across groups, and self-report is the gold standard. Many surveys assign simplified race/ethnicity based on responses to separate questions about Hispanic ethnicity and race and instruct respondents to "check all that apply." When multiple races are endorsed, standard classification methods either create a single heterogenous multiracial group, or attempt to impute the single choice that would have been selected had only one choice been allowed. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001012DOI Listing
November 2018
10 Reads

Lasso Regression for the Prediction of Intermediate Outcomes Related to Cardiovascular Disease Prevention Using the TRANSIT Quality Indicators.

Med Care 2019 Jan;57(1):63-72

Faculty of Pharmacy, University of Montreal.

Background: Cardiovascular disease morbidity and mortality are largely influenced by poor control of hypertension, dyslipidemia, and diabetes. Process indicators are essential to monitor the effectiveness of quality improvement strategies. However, process indicators should be validated by demonstrating their ability to predict desirable outcomes. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001014DOI Listing
January 2019
5 Reads

The Effects of the Patient Protection and Affordable Care Act on Children's Health Coverage.

Med Care 2019 Feb;57(2):115-122

College of Public Health, University of Iowa.

Background: Prior research of the impacts of the Patient Protection and Affordable Care Act (PPACA) on children's health coverage has been largely descriptive and focused on the Medicaid expansions.

Objective: This study examined the causal impacts of the PPACA Medicaid expansions and of the PPACA as a whole on children's health coverage through 2016.

Research Design: We utilized quasiexperimental difference in differences designs to estimate the Medicaid expansion and overall PPACA effects. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001021DOI Listing
February 2019
11 Reads

Care Coordination and Population Health Management Strategies and Challenges in a Behavioral Health Home Model.

Med Care 2019 Jan;57(1):79-84

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Objectives: Behavioral health home (BHH) models have been developed to integrate physical and mental health care and address medical comorbidities for individuals with serious mental illnesses. Previous studies identified population health management capacity and coordination with primary care providers as key barriers to BHH implementation. This study examines the BHH leaders' perceptions of and organizational capacity to conduct these functions within the community mental health programs implementing BHHs in Maryland. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289741PMC
January 2019
8 Reads

Assessing Residual Bias in Estimating Influenza Vaccine Effectiveness: Comparison of High-dose Versus Standard-dose Vaccines.

Med Care 2019 Jan;57(1):73-78

NoviSci Durham, NC.

Background: Estimating influenza vaccine effectiveness using an unvaccinated comparison group may result in biased effect estimates.

Objectives: To explore the reduction of confounding bias in an active comparison of high-dose versus standard-dose influenza vaccines, as compared with vaccinated versus unvaccinated comparisons.

Methods: Using Medicare data from the United States end-stage renal disease program (2009-2013), we compared the risk of all-cause mortality among recipients of high-dose vaccine (HDV) versus standard-dose vaccine (SDV), HDV versus no vaccine, and SDV versus no vaccine. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001018DOI Listing
January 2019
7 Reads

Feasibility of Distinguishing Performance Among Provider Groups Using Patient-reported Outcome Measures in Older Adults With Multiple Chronic Conditions.

Med Care 2019 Mar;57(3):180-186

RAND Corporation.

Objective: To examine minimum sample sizes and follow-up times required for patient-reported outcome-based performance measures (PMs) to achieve acceptable reliability as PMs.

Participants: We used 2 groups of patients age 65+ with at least 2 of 13 chronic conditions. The first was a sample of Medicare Advantage beneficiaries, who reported health-related quality of life (HRQoL) at baseline and 2 years. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375799PMC
March 2019
8 Reads

Safety of Obese Persons in Nursing Homes.

Med Care 2018 Dec;56(12):1032-1034

School of Health Professions, University of Alabama at Birmingham, Birmingham, AL.

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http://dx.doi.org/10.1097/MLR.0000000000000997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234852PMC
December 2018

The Impact of Chain Standardization on Nursing Home Staffing.

Med Care 2018 Dec;56(12):994-1000

Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI.

Background: Standardization in production is common in multientity chain organizations. Although chains are prominent in the nursing home sector, standardization in care has not been studied. One way nursing home chains may standardize is by controlling the level and mix of staffing in member homes. Read More

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http://Insights.ovid.com/crossref?an=00005650-201812000-0000
Publisher Site
http://dx.doi.org/10.1097/MLR.0000000000000998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263153PMC
December 2018
9 Reads